Stability of the irritable bowel syndrome and subgroups as measured by three diagnostic criteria - a 10-year follow-up study.

BACKGROUND: The irritable bowel syndrome (IBS) is a common disorder, but information on its natural history is limited. AIM: To study the performance of four IBS criteria in detecting incidence and stability of categories over a 10-year period. METHOD: This study was a population-based postal study. Questionnaire was mailed to the same age- and gender-stratified random sample of the Icelandic population aged 18-75 years in 1996 and again in 2006. IBS was estimated by the Manning criteria, Rome II, Rome III, subgroups and self-report. RESULTS: Prevalence of IBS varied according to criteria: Manning showed the highest (32%) and Rome II the lowest (5%). Younger subjects and females were more likely to have IBS. Prevalence was stable over 10 years for all criteria except Rome III. There was a turnover in all IBS subgroups and a strong correlation among IBS, functional dyspepsia and heartburn. CONCLUSIONS: The prevalence of the IBS remained stable over a 10-year period with a turnover in symptoms. The study suggests that IBS is a cluster of symptoms that float in time between different IBS categories, functional dyspepsia and heartburn. The irritable bowel syndrome in Iceland is very common and indicates a chronic condition, which poses a heavy burden on the health care system.

C reactive protein levels are increased in non-allergic but not allergic asthma: a multicentre epidemiological study.

BACKGROUND: High sensitivity C reactive protein (HsCRP) is an inflammatory marker known to be related to smoking, obesity, and cardiovascular disease. A study was undertaken to determine whether HsCRP is related to respiratory symptoms, asthma, atopy, and bronchial hyperresponsiveness in population samples from three countries. METHODS: HsCRP was measured in 1289 subjects from three centres in ECRHS II: Reykjavik, Uppsala and Tartu. The HsCRP values ranged from <0.01 mg/l to 70.0 mg/l and were divided into four equal groups (< or = 0.45, 0.46-0.96, 0.97-2.21, and >2.21 mg/l). RESULTS: HsCRP increased with increasing body mass index (r = 0.41; p<0.0001) and was higher in smokers than in never smokers (p = 0.02). A significant relationship was found between increased HsCRP levels and respiratory symptoms such as wheeze, attacks of breathlessness after effort, and nocturnal cough (p<0.0001). The crude odds ratio (95% CI) for the probability of non-allergic asthma was 3.57 (1.83 to 6.96) for subjects in the 4th quartile compared with the 1st quartile of HsCRP. This association remained significant after adjusting for study centre, age, sex, body weight, and smoking history (OR 2.19 (95% CI 1.04 to 4.63)). No significant relationship was observed between HsCRP and allergic asthma or bronchial responsiveness. CONCLUSIONS: Raised levels of HsCRP are significantly associated with respiratory symptoms and non-allergic asthma but not with allergic asthma.

Safety and efficacy of 7-day rabeprazole- and omeprazole-based triple therapy regimens for the eradication of Helicobacter pylori in patients with documented peptic ulcer disease.

AIM: A double-blind, randomized study was designed to determine whether rabeprazole- and omeprazole-based triple therapy regimens are therapeutically equivalent in the eradication of Helicobacter pylori. METHODS: Three hundred and forty-five patients with current or previously active peptic ulcer and a positive H. pylori urease test were randomly assigned to receive RCA, OCA, RCM or OCM twice daily for 7 days (R, rabeprazole 20 mg; O, omeprazole 20 mg; C, clarithromycin 500 mg; A, amoxicillin 1000 mg; M, metronidazole 400 mg). H. pylori eradication was documented by negative 13C-urea breath tests at 4 and 12 weeks, and was evaluated using a 2 x 2 factorial design with proton pump inhibitor and antibiotic as factors. RESULTS: Overall eradication rates (per protocol/intention-to-treat) were 87%/77% and 85%/75% with rabeprazole and omeprazole, respectively (not significant). However, a statistical interaction between proton pump inhibitor and antibiotic was identified. RCA produced a somewhat higher eradication rate than OCA (94% vs. 84%; difference, 9.8%; 95% confidence interval, - 0.7% to + 20.4%), whereas RCM produced a lower eradication rate than OCM (79% vs. 86%; difference, 8.1%; 95% confidence interval, - 21.4% to + 5.1%). Ulcer healing rates were > 90% with H. pylori eradication. Each regimen was well tolerated. CONCLUSIONS: Rabeprazole- and omeprazole-based triple therapy regimens are therapeutically equivalent in the eradication of H. pylori and well tolerated. The statistical interaction observed between the proton pump inhibitor and supplementary antibiotic may be due to chance.

A randomized, double-blind trial of the efficacy and safety of 10 or 20 mg rabeprazole compared with 20 mg omeprazole in the maintenance of gastro-oesophageal reflux disease over 5 years.

BACKGROUND: Gastro-oesophageal reflux disease has a chronic course, and often requires long-term treatment. Proton pump inhibitors are the treatment of choice for both acute and maintenance treatment, but little is known from randomized controlled trials of their effects beyond 1 year. AIM: To compare the efficacy and safety of two doses of rabeprazole with 20 mg omeprazole in the maintenance treatment of erosive gastro-oesophageal reflux disease over 5 years. METHODS: Two hundred and forty-three patients who had previously responded to acute treatment for erosive gastro-oesophageal reflux disease were prospectively randomized to receive 5 years of treatment with rabeprazole (10 or 20 mg daily) or omeprazole (20 mg daily). The primary outcome measure was endoscopically confirmed relapse of erosive gastro-oesophageal reflux disease. RESULTS: One hundred and twenty-three patients (51%) completed all 5 years of the study, with similar completion rates in the three groups. Relapses occurred in nine of 78 (11.5%), eight of 82 (9.8%) and 11 of 83 (13.3%) patients in the rabeprazole 20 mg, rabeprazole 10 mg and omeprazole 20 mg groups, respectively. Gastric biopsy showed no evidence of any harmful effects. All treatments were well tolerated. CONCLUSIONS: Rabeprazole 10 mg, rabeprazole 20 mg and omeprazole 20 mg all had similar efficacy in the maintenance treatment of gastro-oesophageal reflux disease. All three were safe and well tolerated during 5 years of treatment.

Effect of Pentavac and measles-mumps-rubella (MMR) vaccination on the intestine.

BACKGROUND: The safety of infant vaccination has been questioned in recent years. In particular it has been suggested that the measles, mumps, and rubella (MMR) vaccination leads to brain damage manifesting as autism consequent to the development of an "enterocolitis" in the immediate post-vaccination period. AIM: To assess if MMR vaccination is associated with subclinical intestinal inflammation, which is central to the autistic "enterocolitis" theory. METHODS: We studied 109/58 infants, before and two and four weeks after immunisation with Pentavac and MMR vaccines, for the presence of intestinal inflammation (faecal calprotectin). RESULTS: Neither vaccination was associated with any significant increase in faecal calprotectin concentrations. CONCLUSIONS: The failure of the MMR vaccination to cause an intestinal inflammatory response provides evidence against the proposed gut-brain interaction that is central to the autistic "enterocolitis" hypothesis.

Selective inhibition of COX-2 in humans is associated with less gastrointestinal injury: a comparison of nimesulide and naproxen.

BACKGROUND: Selective inhibitors of cyclooxygenase (COX)-2 may provoke less gastric damage and platelet inhibition than conventional non-steroidal anti-inflammatory drugs. AIMS: We compared the biochemical and gastrointestinal effects of nimesulide, a potent and selective COX-2 inhibitor, with naproxen which exhibits no selectivity. SUBJECTS: Thirty six healthy volunteers were randomised to nimesulide 100 mg or naproxen 500 mg twice daily for two weeks in a double blind, crossover study with a washout between treatments. METHODS: Gastrointestinal side effects were assessed by endoscopy, and by estimation of small intestinal absorption-permeability and inflammation. Comparisons were made between variables at the end of each treatment phase. RESULTS: Nimesulide caused significantly less gastric injury using the modified Lanza score (p<0.001) as well as reduced duodenum injury (p=0.039). Nimesulide had lower visual analogue scores (VAS) for haemorrhage and erosive lesions in the stomach (p<0.001) and for mucosal injection in the duodenum (p=0.039). Naproxen increased excretion of calprotectin, a marker of intestinal inflammation (5.5 (1.2) to 12.1 (2.1) mg/l) while nimesulide had no effect (treatment difference p=0.03). Naproxen abolished platelet aggregation to arachidonic acid and suppressed serum thromboxane B(2) (TXB(2)) by 98%, indices of COX-1 activity. In contrast, nimesulide had no significant effect on platelet aggregation, although it reduced serum TXB(2) by 29%. Production of prostaglandin E(2) and prostacyclin by gastric biopsies, also COX-1 dependent, was inhibited by naproxen, but not by nimesulide. COX-2 activity, determined as endotoxin induced prostaglandin E(2) formation in plasma, was markedly suppressed by both treatments. INTERPRETATION: Nimesulide has preferential selectivity for COX-2 over COX-1 in vivo at full therapeutic doses and induces less gastrointestinal damage than that seen with naproxen in the short term.

A simple method for assessing intestinal inflammation in Crohn's disease.

BACKGROUND AND AIMS: Assessing the presence and degree of intestinal inflammation objectively, simply, and reliably is a significant problem in gastroenterology. We assessed faecal excretion of calprotectin, a stable neutrophil specific marker, as an index of intestinal inflammation and its potential use as a screening test to discriminate between patients with Crohn's disease and those with irritable bowel syndrome. METHODS: The validity of faecal calprotectin as a marker of intestinal inflammation was assessed in 22 patients with Crohn's disease (35 studies) by comparing faecal excretions and concentrations using four day faecal excretion of (111)indium white cells. A cross sectional study assessed the sensitivity of faecal calprotectin concentration for the detection of established Crohn's disease (n=116). A prospective study assessed the value of faecal calprotectin in discriminating between patients with Crohn's disease and irritable bowel syndrome in 220 patients referred to a gastroenterology clinic. RESULTS: Four day faecal excretion of (111)indium (median 8.7%; 95% confidence interval (CI) 7-17%; normal <1.0%) correlated significantly (p<0.0001) with daily (median ranged from 39 to 47 mg; normal <3 mg; r=0.76-0.82) and four day faecal calprotectin excretion (median 101 mg; 95% CI 45-168 mg; normal <11 mg; r=0.80) and single stool calprotectin concentrations (median 118 mg/l; 95% CI 36-175 mg/l; normal <10 mg/l; r=0.70) in patients with Crohn's disease. The cross sectional study showed a sensitivity of 96% for calprotectin in discriminating between normal subjects (2 mg/l; 95% CI 2-3 mg/l) and those with Crohn's disease (91 mg/l; 95% CI 59-105 mg/l). With a cut off point of 30 mg/l faecal calprotectin has 100% sensitivity and 97% specificity in discriminating between active Crohn's disease and irritable bowel syndrome. CONCLUSION: The calprotectin method may be a useful adjuvant for discriminating between patients with Crohn's disease and irritable bowel syndrome.

Rabeprazole versus omeprazole in preventing relapse of erosive or ulcerative gastroesophageal reflux disease: a double-blind, multicenter, European trial. The European Rabeprazole Study Group.

Gastroesophageal reflux disease (GERD) is a chronic condition, with 50-80% of patients experiencing recurrence within one year of completing initial treatment. In patients with erosive GERD, proton-pump inhibitors (PPI) provide faster healing and symptom relief than do H2-receptor antagonists and have become the treatment of choice. Rabeprazole is a new PPI with demonstrated efficacy in both the acute and maintenance treatment of erosive GERD. The primary objective was to compare efficacy and tolerability of rabeprazole and omeprazole in preventing relapse of healed erosive GERD. Secondary objectives included comparison of efficacy in preventing GERD relapse symptoms and in maintaining quality of life. In this multicenter, double-blind, parallel-group study, 243 patients with healed erosive GERD were randomised to receive rabeprazole 10 mg once daily in the morning (QAM) (N = 82); rabeprazole 20 mg QAM (N = 78); or omeprazole 20 mg QAM (N = 83). Endoscopies were performed at weeks 13, 26, 39 (if clinically indicated), and 52, or when symptoms suggested recurrence. Corpus biopsies were performed at each endoscopy, and antral biopsies were performed at study entry and exit. Rabeprazole 10 mg and 20 mg QAM were equivalent to omeprazole 20 mg QAM for all efficacy parameters. At week 52, relapse rates in the intent-to-treat populations were 5%, 4%, and 5% for rabeprazole 10 mg and 20 mg and omeprazole 20 mg, respectively. All treatments were well tolerated. In conclusion, both rabeprazole 10 mg and 20 mg QAM are equivalent to omeprazole 20 mg QAM in preventing recurrence of erosive GERD.

Review article: rabeprazole's tolerability profile in clinical trials.

Rabeprazole is a new member of a class of substituted benzimidazole drugs known as proton pump inhibitors. Comparative trials have demonstrated that it is at least as effective as omeprazole for the treatment of gastrooesophageal reflux disease (GERD), duodenal ulcers, or gastric ulcers. It is significantly more effective than histamine2-receptor antagonists for acid suppression, GERD healing and pain relief, and duodenal ulcer healing and pain relief. Adverse events reported during clinical trials provide an important indication of a medication's tolerability. We demonstrate that rabeprazole has a favourable adverse events profile. It is well tolerated in placebo-controlled studies and comparative trials with omeprazole and H2-receptor antagonists. Moreover, no dose adjustments are required for special populations, such as the elderly or patients with renal or mild-to-moderate hepatic disease. Adverse events data from clinical trials support the use of rabeprazole as a treatment for acid-related diseases.

Gastrointestinal toxicity of non-steroidal anti-inflammatory drugs: the effect of nimesulide compared with naproxen on the human gastrointestinal tract.

This overview includes theories and evaluation of non-steroidal anti-inflammatory drug (NSAID)-induced gastrointestinal toxicity. Factors in damage include microvascular aspects, neutrophil recruitment, mucosal prostaglandins, gastrointestinal secretions and bacteria. We have proposed an extensive simplified framework that includes an important local initiating effect which may involve NSAID accumulation, interaction with surface phospholipids, events that alter cellular ATP, and local/systemic effects of cyclooxygenase (COX) inhibition. COX-2-selective drugs are desirable not only because they spare COX-1 and so avoid gastrointestinal toxicity, but also because COX-2-selective agents are only weakly acidic and therefore avoid substantial accumulation in the gastric mucosa. Short-term endoscopy studies of NSAIDs are important initially to evaluate human gastroduodenal tolerability. They show that injury increases with the amount of NSAIDs even though the lowest therapeutic doses inhibit gastric COX almost completely, and that the more-acidic NSAIDs tend to cause greater gastric damage. Long-term endoscopy studies involve NSAID ingestion for at least 3 months. A main question is the extent to which the ulcers seen cause symptoms, substantial bleeding and/or perforation. Measurement of serious outcomes is thought by many to be the best assessment of gastrointestinal safety, but studies find marked variations even with the same drug. Damage to the small intestine by NSAIDs is even more frequent than to the upper gastrointestinal tract, but is difficult to evaluate. Conventional acidic NSAIDs increase the permeability of human small intestine, probably by a non-prostaglandin mechanism, but nimesulide does not do so, possibly because of its very weak acidity.

Comparison of rabeprazole 20 mg versus omeprazole 20 mg in the treatment of active duodenal ulcer: a European multicentre study.

BACKGROUND: Rabeprazole sodium is the newest member of a class of substituted benzimidazole molecules known as proton pump inhibitors. Other proton pump inhibitors have been shown to be effective in healing active duodenal ulcer. METHOD: This randomized, double-blind, multicentre study, conducted at 25 European sites, compared the efficacy and tolerability of rabeprazole and omeprazole in patients with active duodenal ulcers. One hundred and two patients with active duodenal ulcer received rabeprazole 20 mg and 103 patients omeprazole 20 mg once daily for 2 or 4 weeks, with ulcer healing monitored by endoscopy. RESULTS: After 2 weeks, complete ulcer healing was documented in 69% of patients given rabeprazole 20 mg and in 62% of patients given omeprazole 20 mg (N.S.). After 4 weeks, healing rates were 98% in the rabeprazole group and 93% in the omeprazole group (P = 0.083). Rabeprazole-treated patients had significantly greater improvement in daytime pain symptom relief than those treated with omeprazole at the conclusion of the study (P = 0.038). Both drugs were well tolerated over the 4-week treatment period. Mean changes from baseline to end-point in fasting serum gastrin were significantly greater in the rabeprazole group, but at end-point mean values were well within normal limits for both groups. No clinically meaningful changes or other between-group differences were observed in laboratory parameters. CONCLUSION: In this study, rabeprazole produced healing rates equivalent to omeprazole at weeks 2 and 4, and provided significantly greater improvement in daytime pain. Both treatments were well tolerated.

Double-blind comparison [correction of Double-blind, placebo-controlled comparison] of rabeprazole 20 mg vs. omeprazole 20 mg in the treatment of erosive or ulcerative gastro-oesophageal reflux disease. The European Rabeprazole Study Group.

BACKGROUND: Rabeprazole sodium is the most recent member of a class of substituted benzimidazole molecules known as proton pump inhibitors. Other proton pump inhibitors have been shown to be effective in healing oesophagitis. METHODS: In this randomised, double-blind, multicentre study, conducted at 27 European sites, the efficacy and safety of rabeprazole and omeprazole were compared in patients with erosive or ulcerative gastro-oesophageal reflux disease (GERD).100 patients received rabeprazole 20 mg, and 102 patients omeprazole 20 mg once daily for 4 or 8 weeks, with healing monitored by endoscopy. RESULTS: Overall GERD healing rates observed and evaluated at weeks 4 and 8 were equivalent. Four-week healing rates for rabeprazole and omeprazole were 81%-81% and 92%-94% for 8-week healing. Rabeprazole-treated patients had similar relief of the frequency and intensity of heartburn to those treated with omeprazole. Both drugs were well tolerated over the 8-week treatment period. Mean changes in fasting serum gastrin were comparable. No significant differences in laboratory parameters were seen. Biopsies for argyrophil ECL cell histology at the end-point revealed a similar distributions of hyperplasia grades to those at baseline in both groups. Biopsies of body and antral mucosa for other parameters were similar between treatments for Helicobacter pylori colonization, presence or degree of inflammation, atrophy or intestinal metaplasia at the end-point. CONCLUSION: In this study, GERD healing rates following rabeprazole 20 mg once daily were equivalent to those obtained with omeprazole 20 mg once daily. Both treatments resulted in a comparable relief of the frequency and intensity of heartburn associated with this disease, and both were well tolerated.

[Trends in peptic ulcer morbidity and mortality in Iceland. Crowding, poor hygiene and the birth of high risk generations.].

INTRODUCTION: A cohort pattern has been demonstrated for ulcer mortality and perforation, pointing to a role of early life factors, while only a period-related decrease has been observed in elective ulcer surgery which reflects uncomplicated ulcer. OBJECTIVE: To study whether the susceptibility to peptic ulcer disease is determined early in life, as reflected in a cohort pattern consistent for all ulcer manifestations. MATERIAL AND METHODS: All patients treated surgi-cally for peptic ulcer (perforations 1962-1990; bleedings 1971-1990; elective surgery 1971-1990) and all deaths from peptic ulcer (perforations and other ulcer deaths 1951-1989) in Iceland. Age-specific incidence and mortality were presented graphically by year of birth (cohort) and by year of event (period). The effects of cohort and period on incidence and mortality were analysed by Poisson regression. RESULTS: Ulcer perforation and bleeding, incidence and mortality, showed a rise and subsequent fall in successive generations, with the highest risks observed in the subjects born after the turn of this century. This was confirmed by statistical analyses showing highly significant cohort effects (p<0.001) and no period effects. A cohort pattefn was similarly found for elective ulcer surgery (p<0.001), also showing a period-related decrease across age groups (p<0.001). CONCLUSIONS: Ulcer complications, ulcer deaths and uncomplicated ulcer were particularly common in specific generations carrying a high risk of peptic ulcer throughout their lives. These were the generations with the highest prevalence of H. pylori antibodies, the subjects born after the turn of the century at a time of maximum crowding and poor hygiene in Iceland due to migration from rural to urban regions.

Comparison of rabeprazole 20 mg vs. omeprazole 20 mg in the treatment of active gastric ulcer--a European multicentre study. The European Rabeprazole Study Group.

BACKGROUND: Rabeprazole sodium is the newest member of a class of substituted benzimidazole molecules known as proton pump inhibitors. Other proton pump inhibitors have been shown to be effective in healing active, benign gastric ulcers. METHODS: In this randomized, double-blind, multicentre study, conducted at 25 European sites, rabeprazole and omeprazole were compared in patients with active gastric ulcers. Two hundred and twenty-seven patients with active benign gastric ulcer were randomized to receive either rabeprazole 20 mg (n = 113) or omeprazole 20 mg (n = 114) once daily for 3 or 6 weeks, with healing monitored by endoscopy. RESULTS: After 3 weeks, complete healing (ITT analysis) was documented in 58% of patients given rabeprazole and 61% in patients given omeprazole (N.S.). After 6 weeks the healing rates were identical in both groups at 91%. Rabeprazole-treated patients had numerically greater symptom relief at all 12 points of comparison. The differences significantly favoured rabeprazole at week 3 for daytime pain improvement (P = 0.023) and at week 6 for pain frequency (P = 0.006) and complete resolution of night pain (P = 0.022). Both drugs were well-tolerated over the 6-week treatment course. Mean changes from baseline to end-point in fasting serum gastrin were comparable. No significant differences in laboratory parameters were seen. CONCLUSION: In this study, rabeprazole produced healing rates comparable to omeprazole at weeks 3 and 6, but provided more consistent and occasionally significantly superior symptom improvement. Both treatments were well-tolerated.

Epidemiology of liver cirrhosis morbidity and mortality in Iceland.

BACKGROUND: The mortality from liver cirrhosis in Iceland is the lowest in the Western world. OBJECTIVE: To study the epidemiology of liver cirrhosis mortality and morbidity in Iceland and to obtain a reliable separation between alcoholic cirrhosis (AC) and non-alcoholic cirrhosis (NAC) by using multiple data sources. METHODS: The study included the whole population of Iceland. Mortality was studied through death certificate data for the period 1951-90 and morbidity (clinical incidence) through hospital, autopsy and biopsy records for the period 1971-90. RESULTS: The average mortality for AC in age group 20 years and older was 8.6 and for NAC 19.2 per 10(6)/year and the average clinical incidence was 22.1 per 10(6)/year for AC and 25.9 per 10(6)/year for NAC. In the morbidity study 44% of cases were due to AC. In the mortality study 24% of cases were due to AC but the data suggested an underreporting of AC for males at a rate of 30%. There was a significant decrease in AC mortality with time but no change in NAC. Average alcohol consumption of inhabitants aged over 15 years increased from 2.1 to 4.9 litres per year (130%) during the period 1951-90. CONCLUSION: The incidence of cirrhosis in Iceland is very low for both AC and NAC, accounting for only 0.2% of total deaths. The reasons are unknown. The low incidence of AC in Iceland is probably partly due to low alcohol consumption. The decreasing incidence of AC despite 130% increase in alcohol consumption is thought to be due to intensive treatment of alcoholism. A low prevalence of hepatitis B and C probably contributes to the low incidence of NAC.

[Comparison of the efficacy of Losec/Lómex and Zantac/Famex by continuous 24 hour gastric pH-metry.].

OBJECTIVE: The study proposes to investigate the pharmacological efficacy of four commonly used acid inhibitory drugs. The effect on 24 hour gastric pH of seven days treatment was assessed for two omeprazole preparations, Losec(R) 20 mg (Hassle) and Lómex(R) 20 mg, (Omega Farma) and two H2 blockers, famotidine 40 mg (Famex(R), Omega Farma) and ranitidine 300 mg (Zantac(R), Glaxo). MATERIAL AND METHODS: Sixteen healthy volunteers participated in each experiment comparing blindly Losec(R) / Lómex(R) and Famex(R) / Zantac(R). The stomach was intubated with monocrystant antimony catheter and the pH sensor was placed 10 cm below the cardia. A 24 hour control pH-metry was performed followed by a 24 hour pH-metry on the seventh day of treatment with each drug. RESULTS: All four drugs gave significant acid inhibition compared to control. Zantac treatment resulted in a pH over 3 for 8.8 hours and correspondingly Famex(R) treatment for 11.2 hours, Losec(R) treatment for 17.5 hours and Lómex(R) for 18.3 hours. Famex(R) gave significantly greater inhibition than Zantac(R) but the difference between Lómex(R) and Losec(R) was not significant. CONCLUSION: The study shows the efficacy of com notmonly used acid lowering drugs on the Icelandic market. The relative efficacy is indicated by the fact that Zantac(R) increased the median time for pH over 3 by 2.6 hours, Famex(R) by 5.0 hours, Losec(R) by 11.3 hours and Lómex(R) by 12.1 hours.

Seroprevalence of Helicobacter pylori in south Sweden and Iceland.

BACKGROUND: Seroepidemiologic studies on the prevalence of Helicobacter pylori infection have been reported from several European countries but not from Sweden or Iceland. METHODS: Serum samples were collected from 443 persons in Sweden and 387 persons in Iceland. All the 830 sera were tested with the same enzyme immunoassay test with an acid glycine extract of H. pylori surface proteins as antigen. RESULTS: The antibody levels were low in the young age groups in both Sweden and Iceland, with increasing levels with age. CONCLUSIONS: The results are consistent with previous studies from other comparable countries, but with important differences. The prevalence was lower in Sweden than in other, previously studied, Western European countries, but, on the other hand, the prevalence was slightly higher in Iceland.

[Epidemiology of liver cirrhosis morbitity and mortality in Iceland.].

BACKGROUND: The mortality from liver cirrhosis in Iceland is the lowest in the Western world. OBJECTIVE: To study the epidemiology of liver cirrhosis mortality and morbitity in Iceland and to obtain a reliable separation between alcoholic cirrhosis (AC) and non alcoholic cirrhosis (NAC) by using multiple data sources. METHODS: The study included the whole population of Iceland. Mortality was studied through death certificate data for the period 1951-1990 and morbidity (clinical incidence) through hospital, autopsy and biopsy records for the period 1971-1990. RESULTS: 1) The average mortality for AC in age group 20 years and older was 8.6 and for NAC 19.2 per 106 per year and the average clinical incidence was 22.1 for AC and 25.9 for NAC. 2) In the morbitity study 44% were due to AC. In the mortality study 24% were due to AC but the data suggested an underreporting of AC for males at a rate of 30%. 3) There was a significant decrease in AC mortality with time but no change in NAC. 4) Alcohol consumption per inhabitant over 15 years increased from 2.1 to 4.9 litre (130%) during the period 1951-1990. CONCLUSION: The incidence of cirrhosis in Iceland is very low for both AC and NAC accounting for only 0.2% of total deaths. The reasons are unknown. The low incidence of AC in Iceland is probably partly due to a low population alcohol consumption. The decreasing incidence of AC despite 130% increase in alcohol consumption is thought to be due to intensive treatment of alcoholism. A low prevalence of hepatitis B and C probably contributes to the low incidence of NAC.

[The prevalence of H. pylori antibodies in Iceland.].

Helicobacter pylori causes gastritis and duodenal ulcerations, and is possibly one of the causes of gastric cancer. Diagnosis has relied on gastroscopy, but with the advent of reliable serological tests, epidemiological studies have become easier. Previous studies have indicated a higher H. pylori infection rate in Iceland than neighbouring countries. To study this further, an H. pylori (acid glycine extract) ELISA test was set up. Serum samples were obtained from 387 individuals, aged three months to 97 years, mean 41 years (161 blood donors, 83 outpatients, 64 ante natal clinic, 33 hospitalised children, 27 old people's home and 19 college students). Positive antibody titers were found in 151 (39%), of which 14 were borderline. The prevalence increased with age and was highest 75% in 60-69 years old, but lowest 9% in the youngest age group. The prevalence of H. pylori antibodies appears to be higher than in neighbouring countries, but lower than in the developing countries, and Icelanders appear to acquire the infection at a younger age than in the neighbouring countries. This high prevalence is important in view of the high prevalence of gastric cancer in Iceland.

[Helicobacter pylori infection: the efficacy of a short course of azithromycin and fleroxacin treatment.].

The aim of this open pilot study was to assess the efficacy of a short course of fleroxacin and azithromycin in the treatment of Helicobacter pylori infection. Seventeen patients were included. All had H. pylori infection confirmed by urease test and culture. Eight patients had non-ulcer dyspepsia, 8 had duodenal ulcer and 1 had gastric ulcer. The patients were given omeprazole 40 mg on days 1-14, fleroxacin 400 mg on days 7-14 and azithromycin 500 mg on days 7 and 8. Side effects were assessed on a scale 0-4. The patients were gastroscoped 3 months after the treatment finished and urease test and H. pylori culture repeated. If both were negative eradication was regarded as successful. Six patients (35%) were H. pylori negative. However, only 1 (13%) of the patients with non-ulcer dyspepsia became H. pylori negative, whereas 5 (56%) with peptic ulcer did (P=0,131). The mean side effect score for patients with non-ulcer dyspepsia was 12.3, but 2.3 for patients with peptic ulcer (p<0,01). It is concluded that a short course with fleroxacin and azithromycin is inadequate for treatment of H. pylori infection.