High prevalence of clarithromycin resistance and effect on Helicobacter pylori eradication in a population from Santiago, Chile: cohort study and meta-analysis.

Helicobacter pylori (H. pylori) eradication using standard triple therapy (STT) with proton pump inhibitors (PPI), amoxicillin and clarithromycin (CLA) has been the standard in Latin America. However, CLA resistance is a rising problem affecting eradication rates. Genetic polymorphisms of CYP2C19, a PPI metabolizer may also affect eradication. The primary aims of this study were to evaluate the effect of clarithromycin resistance on H. pylori eradication in a population from Santiago, and to establish the pooled clarithromycin resistance in Santiago, Chile. Symptomatic adult patients attending a tertiary hospital in Santiago were recruited for this study. CLA resistance and the polymorphisms of CYP2C19 were determined on DNA extracted from gastric biopsies, using PCR. The STT was indicated for 14 days and eradication was determined by a urea breath test 4-6 weeks after therapy. A meta-analysis of CLA resistance studies among adult residents in Santiago was performed. Seventy-three out of 121 consecutive patients had positive rapid urease test (RUT) and received STT. Sixty-nine patients (95%) completed the study. The H. pylori eradication rate was 63% and the prevalence of CLA resistance was 26%. According to the CYP2C19 polymorphisms, 79.5% of the RUT-positive patients were extensive metabolizers. Multivariable analyses showed that only CLA resistance was significantly and inversely associated with failure of eradication (OR: 0.13; 95% confidence interval [95% CI], 0.04-0.49). A meta-analysis of two previous studies and our sample set (combined n = 194) yielded to a pooled prevalence of CLA resistance of 31.3% (95% CI 23.9-38.7). Our study shows that CLA resistance is associated with failure of H. pylori eradication. Given the high pooled prevalence of CLA resistance, consideration of CLA free therapies in Santiago is warranted. We could recommend bismuth quadruple therapy or high-dose dual therapy, according to bismuth availability. Further studies need to evaluate the best therapy.

Estudio de los enfermos colecistectomizados por patologia biliar benigna en el Hospital de San Carlos entre 1972 Y 1981. / Choledochostomized patients for benign biliary disease at the Hospital of San Carlos 1972-1981

Se analizan las caracteristicas de una muestra representativa de 1.557 pacientes colecistectomizados por patologia benigna en el Hospital de San Carlos en el decenio comprendido entre 1972 y 1981. Se destaca el predominio de las mujeres sobre los hombres en proporcion de 5 a 1. Se describen algunos detalles de tecnica quirurgica Se hace hincapie en el hecho que la patologia vesicular aguda represento el 35,4% de los casos; que se hizo coledocostomia en el 15,8% de ellos; que la litiasis coledociana se comprobo en el 10,4% del grupo total y en el 65,6% de los coledocostomizados. Se enumeran las principales complicaciones postoperatorias inmediatas y alejadas. La mortalidad global fue de 0,9% y la de los casos de colecistitis aguda de 3%