Antibiotic Susceptibility and Clarithromycin Resistance Determinants in Helicobacter pylori in the Northeast of Spain: A One-Year Prospective Study.

Helicobacter pylori is one of the most widespread infections, and it is reaching alarming resistance levels worldwide. The recommended first-line empirical treatment differs according to the local rate of clarithromycin resistance. Macrolide resistance is mainly associated with three point mutations in the 23S rRNA gene. The aim of this study was to describe the antibiotic susceptibility of H. pylori in our healthcare area and the main mechanisms involved in clarithromycin resistance. Gastric biopsies (n = 641) were collected and cultured in a one-year prospective study. Antibiotic susceptibility testing was performed by gradient diffusion. A multiplex real-time PCR test (AllplexTMH.pylori & ClariR Assay, Seegene) was used to detect the most frequent mutations associated with clarithromycin resistance. Overall, 141 isolates were available for antibiotic susceptibility testing. The highest resistance rates were detected in metronidazole and levofloxacin. The rate of clarithromycin resistance was 12.1%, and the associated mutations were A2143G and A2142G. More than half of the clarithromycin-resistant isolates presented high MIC values (>256 mg/L). Tetracycline resistance was not detected, suggesting that therapies that contain tetracycline could be a suitable option. The low clarithromycin resistance rate coupled with the high rates of metronidazole resistance may support the recovery of the classical triple therapy in our healthcare area.

Manejo de la hemorragia digestiva alta no varicosa: documento de posicionamiento de la Societat Catalana de Digestologia / Management of non variceal upper gastrointestinal bleeding: position statement of the Catalan Society of Gastroenterology

En los últimos años se han producido avances en el manejo de la hemorragia digestiva alta no varicosa que han permitido disminuir la recidiva hemorrágica y la mortalidad. El presente documento de posicionamiento de la Societat Catalana de Digestologia es una actualización de las recomendaciones basadas en la evidencia sobre el manejo de la hemorragia digestiva por úlcera péptica

In recent years there have been advances in the management of non-variceal upper gastrointestinal bleeding that have helped reduce rebleeding and mortality. This document positioning of the Catalan Society of Digestologia is an update of evidence-based recommendations on management of gastrointestinal bleeding peptic ulcer

Management of non variceal upper gastrointestinal bleeding: position statement of the Catalan Society of Gastroenterology. / Manejo de la hemorragia digestiva alta no varicosa: documento de posicionamiento de la Societat Catalana de Digestologia.

In recent years there have been advances in the management of non-variceal upper gastrointestinal bleeding that have helped reduce rebleeding and mortality. This document positioning of the Catalan Society of Digestologia is an update of evidence-based recommendations on management of gastrointestinal bleeding peptic ulcer.

Incidencia y factores predictivos de anemia ferropénica tras una hemorragia digestiva alta no asociada a hipertensión portal / Incidence and predictive factors of iron deficiency anemia after acute non-variceal upper gastrointestinal bleeding without portal hypertension

Introducción: Se desconoce la incidencia de anemia ferropénica (AF) tras un episodio de hemorragia digestiva no asociada a hipertensión portal (HDA). Objetivos: El objetivo principal fue estudiar la incidencia de AF tras una HDA, y los secundarios describir los factores predictivos de AF y elaborar modelos que permitan detectar aquellos pacientes que se beneficiarían de ferroterapia. Material y método: Desde abril de 2007 hasta mayo de 2009 se valoraron de forma prospectiva 391 pacientes con HDA. Se excluyeron todas las hemorragias secundarias a hipertensión portal y pacientes con condiciones clínicas y/o biológicas que pudieran artefactuar el patrón ferrocinético. Se practicó una analítica con parámetros férricos al ingreso, al 5.° y al 30.° día de la HDA. Se utilizó un modelo de regresión logística múltiple y un modelo de árboles de decisión. Resultados: De los 124 pacientes incluidos 76 (61,3%) presentaron AF a los 30 días de la HDA. Las variables predictoras de AF: edad > 75 años (p = 0,037; OR 3,9; IC 95%: 1,3-11,6), urea inicial > 80 mg/dl (p = 0,027; OR 2,9; IC 95%: 1,1-7,6), ferritina inicial ≤ 65 ng/dl (p = 0,002; OR 7,6; IC 95%: 2,9-18,5), Hb inicial ≤ 100 g/l (p = 0,003; OR 3,2; IC 95%: 1,3-8,0), Hb al 5.° día ≤ 100 g/l (p < 0,001; OR 14,9; IC 95%: 3,6-61,1) e índice de saturación de transferrina al 5.° día < 10% (p < 0,001; OR 7,2; IC 95%: 2,6-20,3). Conclusiones: La mayoría de pacientes con HDA presentan AF a los 30 días del episodio hemorrágico. La identificación de los factores predictivos de la misma permite establecer una indicación de ferroterapia tras la HDA (AU)

Introduction: There are few studies on iron deficiency anemia (IDA) after non-variceal acute upper gastrointestinal bleeding (UGIB) in patients without portal hypertension. Objectives: To define the incidence of IDA after UGIB, to characterize the predictive factors for IDA and to design algorithms that could help physicians identify those patients who could benefit from iron therapy. Material and method: We registered 391 patients with UGIB between April 2007 and May 2009. Patients with portal hypertension and those with clinical or/and biological conditions that could affect the ferrokinetic pattern were excluded. Blood analyses were performed, including ferric parameters upon admission, on the 5 th day, and on the 30th day after the hemorrhage episode. We used a multiple logistic regression model and a classification and regression tree model. Results: A total of 124 patients were included, of which 76 (61.3%) developed IDA 30 days after UGIB. The predictive variables were age > 75 years (P = .037; OR 3.9; 95% CI: 1.3-11.6), initial urea level > 80 mg/dL (P = .027; OR 2.9; 95% CI: 1.1-7.6), initial ferritin level ≤ 65 ng/dL (P = .002; OR 7.6; 95% CI: 2.9-18.5), initial hemoglobin level ≤ 100 g/L (P = .003; OR 3.2; 95% CI: 1.3-8.0), hemoglobin level on the 5 th day ≤ 100 g/L (P < .001; OR 14.9; 95% CI: 3.6-61.1) and the value of the transferrin saturation index on the 5 th day < 10% (p < 0.001; OR 7.2; 95% CI: 2.6-20.3). Conclusions: Most patients with UGIB developed IDA 30 days after the episode. Identification of the predictive factors for IDA may help to establish guidelines for the administration of iron therapy (AU)

[Incidence and predictive factors of iron deficiency anemia after acute non-variceal upper gastrointestinal bleeding without portal hypertension]. / Incidencia y factores predictivos de anemia ferropénica tras una hemorragia digestiva alta no asociada a hipertensión portal.

INTRODUCTION: There are few studies on iron deficiency anemia (IDA) after non-variceal acute upper gastrointestinal bleeding (UGIB) in patients without portal hypertension. OBJECTIVES: To define the incidence of IDA after UGIB, to characterize the predictive factors for IDA and to design algorithms that could help physicians identify those patients who could benefit from iron therapy. MATERIAL AND METHOD: We registered 391 patients with UGIB between April 2007 and May 2009. Patients with portal hypertension and those with clinical or/and biological conditions that could affect the ferrokinetic pattern were excluded. Blood analyses were performed, including ferric parameters upon admission, on the 5th day, and on the 30th day after the hemorrhage episode. We used a multiple logistic regression model and a classification and regression tree model. RESULTS: A total of 124 patients were included, of which 76 (61.3%) developed IDA 30 days after UGIB. The predictive variables were age >75 years (P=.037; OR 3.9; 95% CI: 1.3-11.6), initial urea level >80mg/dL (P=.027; OR 2.9; 95% CI: 1.1-7.6), initial ferritin level ≤65ng/dL (P=.002; OR 7.6; 95% CI: 2.9-18.5), initial hemoglobin level ≤100g/L (P=.003; OR 3.2; 95% CI: 1.3-8.0), hemoglobin level on the 5th day ≤100g/L (P<.001; OR 14.9; 95% CI: 3.6-61.1) and the value of the transferrin saturation index on the 5th day <10% (p<0.001; OR 7.2; 95% CI: 2.6-20.3). CONCLUSIONS: Most patients with UGIB developed IDA 30 days after the episode. Identification of the predictive factors for IDA may help to establish guidelines for the administration of iron therapy.