RESUMO
BACKGROUND: The Maastricht V Consensus recommends quadruple therapies as first-line Helicobacter pylori treatment in high clarithromycin (CLA) resistance areas. AIMS: To compare efficacy, side effects and compliance between quadruple concomitant non-bismuth vs bismuth quadruple therapy. METHOD: Prospective study enrolling H. pylori-positive patients. Omeprazol and a three-in-one formulation of bismuth-metronidazol-tetracycline (OBMT-3/1) for 10 days, or combination of omeprazol-clarithromycin-amoxicillin-metronidazol (OCAM) for 14 days, were prescribed. Eradication outcome was assessed by urea breath test or histology. Side effects and compliance were recorded during the treatment period with specific questionnaires. RESULTS: 404 patients were recruited (median age 53 years; 62.87% women). In 382 (183 with OCAM, 199 with OBMT-3/1) the post-treatment test result was available. The eradication rates were 85.94% (CI95%: 80.20-90.52) with OCAM and 88.21% (CI95%: 83.09-92.22) with OBMT-3/1 (p = 0.595) in intention-to-treat analysis, whilst in per protocol analysis they were 91.12% (CI95%: 85.78-94.95) and 96.17% (CI95%: 92.28-98.45) respectively (p = 0.083). Compliance over 90% was 91.35% with OCAM and 92.04% with OBMT-3/1 (p = 0.951). Some side effect was present in 94.02% with OCAM and in 88.89% with OBMT-3/1 (p = 0.109), being longer (12 vs 7 days, p < 0.0001) and more severe (p < 0.0001) with OCAM. CONCLUSIONS: In a high CLA-resistance area, there are no differences between OBMT-3/1 and OCAM in H. pylori eradication and compliance rates, but OBMT-3/1 achieves a higher safety profile
ANTECEDENTES: El Consenso de Maastricht V recomienda tetraterapias como tratamiento de primera línea de Helicobacter pylori en áreas con elevada resistencia a claritromicina (CLA). OBJETIVOS: Comparar la eficacia, los efectos secundarios y el cumplimiento terapéutico entre la tetraterapia sin bismuto y la tetraterapia con bismuto. MÉTODO: Estudio prospectivo que incluyó a pacientes con H. pylori. Se prescribió omeprazol y una formulación 3 en uno de bismuto-metronidazol-tetraciclina (OBMT-3/1) durante 10 días, o una combinación de omeprazol-claritromicina-amoxicilina-metronidazol (OCAM) durante 14 días. El resultado de la erradicación se evaluó mediante una prueba de aliento con urea o histología. Los efectos secundarios y el cumplimiento terapéutico se registraron durante el período de tratamiento empleando cuestionarios específicos. RESULTADOS: Se incluyeron 404 pacientes (mediana de edad de 53 años; un 62,87% de mujeres). El resultado de la prueba posterior al tratamiento estuvo disponible en 382 pacientes (183 con OCAM, 199 con OBMT-3/1). Las tasas de erradicación fueron del 85,94% (IC 95%: 80,20-90,52) con OCAM y del 88,21% (IC 95%: 83,09-92,22) con OBMT-3/1 (p = 0,595) en el análisis por intención de tratar, mientras que en el análisis por protocolo fueron del 91,12% (IC 95%: 85,78-94,95) y del 96,17% (IC 95%: 92,28-98,45), respectivamente (p = 0,083). El cumplimiento terapéutico superior al 90% fue del 91,35% con OCAM y del 92,04% con OBMT-3/1 (p = 0,951). Se observaron efectos secundarios en el 94,02% de los pacientes tratados con OCAM y en el 88,89% de los tratados con OBMT-3/1 (p = 0,109), y fueron más prolongados (12 frente a 7 días, p < 0,0001) y más graves (p < 0,0001) con OCAM. CONCLUSIONES: En un área con elevada resistencia a la CLA no se observan diferencias entre OBMT-3/1 y OCAM en la erradicación de H. pylori ni en las tasas de cumplimiento, pero OBMT-3/1 presenta un perfil de seguridad superior
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Helicobacter pylori/efeitos dos fármacos , Infecções por Helicobacter/tratamento farmacológico , Bismuto/uso terapêutico , Infecções por Helicobacter/prevenção & controle , Resultado do Tratamento , Erradicação de Doenças/métodos , Estudos Prospectivos , Omeprazol/uso terapêutico , Claritromicina/uso terapêutico , Amoxicilina/uso terapêutico , Metronidazol/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a MedicamentosRESUMO
BACKGROUND: The Maastricht V Consensus recommends quadruple therapies as first-line Helicobacter pylori treatment in high clarithromycin (CLA) resistance areas. AIMS: To compare efficacy, side effects and compliance between quadruple concomitant non-bismuth vs bismuth quadruple therapy. METHOD: Prospective study enrolling H. pylori-positive patients. Omeprazol and a three-in-one formulation of bismuth-metronidazol-tetracycline (OBMT-3/1) for 10 days, or combination of omeprazol-clarithromycin-amoxicillin-metronidazol (OCAM) for 14 days, were prescribed. Eradication outcome was assessed by urea breath test or histology. Side effects and compliance were recorded during the treatment period with specific questionnaires. RESULTS: 404 patients were recruited (median age 53 years; 62.87% women). In 382 (183 with OCAM, 199 with OBMT-3/1) the post-treatment test result was available. The eradication rates were 85.94% (CI95%: 80.20-90.52) with OCAM and 88.21% (CI95%: 83.09-92.22) with OBMT-3/1 (p=0.595) in intention-to-treat analysis, whilst in per protocol analysis they were 91.12% (CI95%: 85.78-94.95) and 96.17% (CI95%: 92.28-98.45) respectively (p=0.083). Compliance over 90% was 91.35% with OCAM and 92.04% with OBMT-3/1 (p=0.951). Some side effect was present in 94.02% with OCAM and in 88.89% with OBMT-3/1 (p=0.109), being longer (12 vs 7 days, p<0.0001) and more severe (p<0.0001) with OCAM. CONCLUSIONS: In a high CLA-resistance area, there are no differences between OBMT-3/1 and OCAM in H. pylori eradication and compliance rates, but OBMT-3/1 achieves a higher safety profile.
Assuntos
Bismuto/administração & dosagem , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto JovemRESUMO
No disponible
Assuntos
Humanos , Feminino , Idoso , Colestase/complicações , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Coledocolitíase/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica/métodos , Síncope/complicações , Dor Abdominal/etiologia , Biópsia , Células Ciliadas da Ampola/patologia , Pancreatite Crônica/complicaçõesAssuntos
Falso Aneurisma/complicações , Colestase/etiologia , Artéria Hepática/patologia , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Colangiografia , Colangiopancreatografia Retrógrada Endoscópica , Coledocolitíase/diagnóstico , Colestase/diagnóstico , Colestase/diagnóstico por imagem , Terapia Combinada , Neoplasias do Ducto Colédoco/diagnóstico , Diagnóstico Diferencial , Drenagem , Embolização Terapêutica , Feminino , Artéria Hepática/diagnóstico por imagem , Humanos , Radiografia Intervencionista , Úlcera Gástrica/complicações , Tomografia Computadorizada por Raios XRESUMO
Objetivo: analizar las posibles diferencias en el diagnóstico final de pancreatitis crónica empleando los criterios estándar descritos por Wiersema y cols. y la nueva clasificación propuesta recientemente en Rosemont. Material y métodos: se incluyen 47 pacientes con diagnóstico de pancreatitis crónica. Se estudian los criterios parenquimatosos y ductales, dividiendo a los pacientes en 2 grupos según los criterios de Wiersema: < 4 criterios, no diagnóstico de pancreatitis crónica, >= 4 criterios, diagnóstico de pancreatitis crónica. Se estudiaron nuevamente dichos pacientes aplicando la clasificación de Rosemont: páncreas normal, indeterminado, sugestivo y diagnóstico de pancreatitis crónica. Se analizaron estos datos con la prueba estadística Chi-cuadrado con un intervalo de confianza de 95%. Resultados: en los pacientes con pancreatitis crónica el criterio presente con mayor frecuencia es la lobularidad en 66% de los casos seguido de la dilatación del Wirsung y la presencia de calcificaciones en 57,4% respectivamente. Se observó una asociación estadísticamente significativa entre los resultados de ambas clasificaciones (p < 0,05). La mayor asociación se encontró para pacientes que presentaban más de 4 criterios estándar y diagnóstico definitivo de pancreatitis crónica según la clasificación de Rosemont. Sin embargo, los pacientes que presentaron menos de 4 criterios estándar fueron sugestivos de pancreatitis crónica mediante el empleo de la clasificación de Rosemont en un 27,66% de los casos (p < 0,05). Conclusión: estos resultados muestran que no existen diferencias estadísticamente significativas para los pacientes que presentan >= 4 criterios diagnósticos según los criterios estándar. No obstante, 27,66% pacientes con menos de 4 criterios estándar serían sugestivos de pancreatitis crónica según la clasificación de Rosemont (p < 0,05). Por tanto, esta nueva clasificación sería útil para pacientes con elevada sospecha de pancreatitis crónica que presenten < 4 criterios estándar pero con presencia de criterios de mayor importancia como las calcificaciones intraparenquimatosas, la lobularidad o las litiasis intraductales(AU)
Aim: to study the possible differences in the final diagnosis of chronic pancreatitis by using standard classification described by Wiersema et al. and the new classification proposed recently by Ro - semont. Material and methods: forty-seven patients with the diagnosis of chronic pancreatitis were included in this study. The parenchymal and ductal criteria were studied, the patients were divided in two groups for Wiersema criteria: < 4 criteria, non-diagnostic for chronic pancreatitis and >= 4 criteria, diagnosis of chronic pancreatitis. The same patients were divided in four groups according to Rosemont classification: normal pancreas, indeterminate, suggestive and consistent with chronic pancreatitis. We analyzed these data with Chisquare test reported with 95% confidence intervals (CI). Results: in patients with chronic pancreatitis the most frequent criteria observed were lobularity in 66% of cases and pancreatic duct dilatation and calcifications in 57.4% of cases each. We found a significant statistical association between the results of both classifications (p < 0.05). The highest association is found in patients with more than 4 standard criteria and definitive diagnostic of chronic pancreatitis according to Rosemont classification. In patients who have less than 4 standard criteria the diagnosis is suggestive of chronic pancreatitis by using the Rosemont classification in 27.66% (p < 0.05). Conclusion: these results show that no significant statistical differences are found for patients with > 4 criteria diagnosis by standard criteria. But 27.66% patients with less than 4 standard criteria would be suggestive according to Rosemont classification (p < 0.05). Hence, the new classification would be useful in patients with high suspicion of chronic pancreatitis with < 4 standard criteria but with more significance such as parenchymal lithiasis, lobularity or ductal calcifications(AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Pancreatite Crônica/classificação , Pancreatite Crônica/diagnóstico , Endoscopia/métodos , Endoscopia , Endossonografia/métodos , Pancreatite Crônica/fisiopatologia , Pancreatite Crônica , Intervalos de Confiança , Estudos de Coortes , Estudos Retrospectivos , Endossonografia/tendências , EndossonografiaAssuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Perfuração Esofágica/cirurgia , Perfuração Esofágica , Próteses e Implantes , Gastroscopia/métodos , Gastroscopia , Doença Iatrogênica/epidemiologia , Doenças do Esôfago/patologia , Doenças do Esôfago , Perfuração Esofágica , Esôfago/lesões , Esôfago/patologia , EsôfagoAssuntos
Humanos , Masculino , Idoso , Abscesso Hepático/complicações , Abscesso Hepático/diagnóstico , Neoplasias do Colo/complicações , Neoplasias do Colo/diagnóstico , Biópsia , Citrobacter freundii/isolamento & purificação , Infecções Pneumocócicas/complicações , Estreptococos Viridans/isolamento & purificação , Bacteroides/isolamento & purificação , Abscesso Hepático , Neoplasias do Colo/fisiopatologia , Neoplasias do ColoRESUMO
BACKGROUND: Increased visceral adiposity is a key feature of obesity and metabolic syndrome. Previous studies have generated controversial results regarding visceral fat (VF) removal as a therapy for obesity and metabolic syndrome. OBJECTIVE: To study the effect of surgical VF removal on metabolic profiles in a mouse model of diet-induced obesity and metabolic syndrome and to evaluate for the first time the feasibility of endoscopic omentectomy using natural orifice transluminal endoscopic surgery (NOTES) technique as treatment for obesity and metabolic syndrome in a feline model. SETTING: The Johns Hopkins Hospital. DESIGN: Sham-controlled study in a mouse model of metabolic syndrome and then pilot endoscopic sham-controlled study in cats. INTERVENTIONS: Partial or total surgical VF removal was performed in a high-fat diet-induced mouse model of obesity and metabolic syndrome, followed by measurements of metabolic profiles, and endoscopic omentectomy was performed in a feline model using the NOTES approach. MAIN OUTCOME MEASUREMENTS: Weight loss and metabolic profiles. RESULTS: In a mouse model of obesity, total but not partial VF removal significantly improved obesity and metabolic syndrome, including insulin resistance and hepatic steatosis (all P < .05 vs sham surgery). The improved metabolic syndrome was associated with significantly decreased inflammatory cytokines. In a feline model, endoscopic omentectomy was feasible and safe and resulted in a net weight loss compared with sham surgery (-387 ± 437 g vs 233 ± 351 g, P = .1, respectively). LIMITATIONS: Animal experiments. CONCLUSIONS: Endoscopic omentectomy is safe and feasible and has the potential to treat obesity and metabolic syndrome. Near-total VF removal is required to achieve net weight loss and improvement of metabolic syndrome.
Assuntos
Tecido Adiposo/cirurgia , Síndrome Metabólica/cirurgia , Cirurgia Endoscópica por Orifício Natural , Obesidade/cirurgia , Omento/cirurgia , Vísceras/cirurgia , Animais , Gatos , Fígado Gorduroso/fisiopatologia , Masculino , Síndrome Metabólica/fisiopatologia , Camundongos , Camundongos Endogâmicos C57BL , Obesidade/fisiopatologia , Projetos Piloto , Redução de PesoAssuntos
Aneurisma da Aorta Abdominal/cirurgia , Doenças da Aorta/complicações , Implante de Prótese Vascular , Hemorragia Gastrointestinal/etiologia , Fístula Intestinal/complicações , Complicações Pós-Operatórias/etiologia , Fístula Vascular/complicações , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/complicações , Doenças da Aorta/diagnóstico , Doenças da Aorta/diagnóstico por imagem , Ruptura Aórtica/etiologia , Aortite/complicações , Aortite/tratamento farmacológico , Comorbidade , Meios de Contraste , Quimioterapia Combinada , Evolução Fatal , Gastroenterostomia , Hematemese/etiologia , Humanos , Imipenem/administração & dosagem , Imipenem/uso terapêutico , Fístula Intestinal/diagnóstico , Fístula Intestinal/diagnóstico por imagem , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/tratamento farmacológico , Infecções Relacionadas à Prótese/complicações , Tomografia Computadorizada por Raios X , Vancomicina/administração & dosagem , Vancomicina/uso terapêutico , Fístula Vascular/diagnóstico , Fístula Vascular/diagnóstico por imagemRESUMO
AIM: to study the possible differences in the final diagnosis of chronic pancreatitis by using standard classification described by Wiersema et al. and the new classification proposed recently by Rosemont. MATERIAL AND METHODS: forty-seven patients with the diagnosis of chronic pancreatitis were included in this study. The parenchymal and ductal criteria were studied, the patients were divided in two groups for Wiersema criteria: < 4 criteria, non-diagnostic for chronic pancreatitis and ≥ 4 criteria, diagnosis of chronic pancreatitis. The same patients were divided in four groups according to Rosemont classification: normal pancreas, indeterminate, suggestive and consistent with chronic pancreatitis. We analyzed these data with Chisquare test reported with 95% confidence intervals (CI). RESULTS: in patients with chronic pancreatitis the most frequent criteria observed were lobularity in 66% of cases and pancreatic duct dilatation and calcifications in 57.4% of cases each. We found a significant statistical association between the results of both classifications (p < 0.05). The highest association is found in patients with more than 4 standard criteria and definitive diagnostic of chronic pancreatitis according to Rosemont classification. In patients who have less than 4 standard criteria the diagnosis is suggestive of chronic pancreatitis by using the Rosemont classification in 27.66% (p < 0.05). CONCLUSION: these results show that no significant statistical differences are found for patients with > 4 criteria diagnosis by standard criteria. But 27.66% patients with less than 4 standard criteria would be suggestive according to Rosemont classification (p < 0.05). Hence, the new classification would be useful in patients with high suspicion of chronic pancreatitis with < 4 standard criteria but with more significance such as parenchymal lithiasis, lobularity or ductal calcifications.