Bovine lactoferrin for Helicobacter pylori eradication: an open, randomized, multicentre study.

BACKGROUND: Cure rates for eradication of Helicobacter pylori appear to be decreasing, thus more effective therapies must be identified. AIM: To evaluate the efficacy of bovine lactoferrin in the treatment of H. pylori infection. METHODS: In a multicentered prospective study, 402 (mean age 52.4, range 19-84 years) H. pylori-positive patients were assigned to one of three regimens: group A - esomeprazole 20 mg b.d., clarithromycin 500 mg b.d. and tinidazole 500 mg b.d. for 7 days; group B - lactoferrin 200 mg b.d. for 7 days followed by the same schedule of group A; group C - esomeprazole 20 mg b.d., clarithromycin 500 mg b.d. and tinidazole 500 mg b.d. plus lactoferrin 200 mg b.d. for 7 days. RESULTS: Of the 402 patients, 389 completed the study. Six patients were discontinued due to side effects, one patient in group B died and six patients were lost to follow up. The eradication rate (intention-to-treat analysis) was 77% in group A (105/136), 73% in group B (97/132) and 90% in group C (120/134) (chi(2)-test P < 0.01). The incidence of side effects was 9.5% in group A, 9% in group B and 8.2% in group C (chi(2)-test P = 0.1). CONCLUSION: This study demonstrates that bovine lactoferrin is an effective adjuvant to 7-day triple therapy for eradication of H. pylori infection.

[Is there a role for double-contrast radiology in the characterization of patients with non-ulcer dyspepsia?]. / Esiste un ruolo per l'esame radiologico a doppio contrasto nella caratterizzazione di pazienti con dispepsia non ulcerosa?

Nun-ulcer dyspepsia (NUD) is a very common disorder: about 30% of subjects may suffer from this syndrome, with a subsequent increase in sanitary cost. NUD is diagnosed by means of both an accurate anamnesis and instrumental investigations like double-contrast upper gastrointestinal X-rays, endoscopy, and US of the biliary tract. Our study was aimed at evaluating the actual capabilities of double-contrast radiology in the characterization of NUD patients. One-hundred consecutive outpatients (53 males and 47 females, age range 15-84 years) with clinical symptoms of NUD were submitted to double-contrast gastric radiological examination. X-rays were performed without pharmacological hypotonicity to better depict functional disorders (i.e., impaired esophageal motility, gastroesophageal and duodenogastric reflux, gastric hypotonicity, and delayed gastric emptying) even though this prevented the though evaluation of morphological features, which are better identified by gastrointestinal endoscopy. 42% of patients, especially middle-aged ones, exhibited only functional disorders. Double-contrast X-rays might therefore be suggested as a useful investigation technique in young patients with clinical symptoms of NUD: it is capable of showing functional disorders and therefore can support upper gastrointestinal tract endoscopy in the pathophysiological characterization of NUD patients.

Risk of hepatitis B virus infection following upper gastrointestinal endoscopy: a prospective study in an endemic area.

A prospective survey, comprising 623 consecutive upper gastrointestinal endoscopies (in 588 patients) was carried out simultaneously at two endoscopy centres of a Mediterranean country, without altering the routine procedures. Each patient was tested for HBsAg, and sera found to be HBsAg-positive were tested for HBeAg/antiHBe: 40/588 (7.1%) subjects were found to be HBsAg-positive and 6 of them were HBeAg-positive. Sera of the first 5 HBsAg-negative patients in whom the same endoscope and/or biopsy forceps were used after a HBsAg-positive subject, were tested for antiHBc to ascertain antecedent HBV immunity: 77/136 (56.6%) were found to be antiHBc-positive. Forty-eight out of the 59 individuals "at risk" lacking evidence of previous HBV infection were contacted 6 months after endoscopy: none reported symptoms of hepatitis; 40 of them had blood tests for HBsAg and antiHBc: none showed serum markers of HBV infection. It is therefore concluded that, in spite of the high number of HBsAg carriers among endoscopy candidates, the risk of HBV spread during upper G.I. endoscopy is very low, even in high prevalence areas.