Inappropriate CA 72-4 elevation in a Helicobacter pylori infected patient.

Carcinoma antigen 72-4 is a cell surface glycoprotein produced by gastric carcinoma cells. In the case presented, Helicobacter pylori infection induced an inappropriate elevation of this tumour antigen in a 66-year-old female patient, reaching values seen with gastric carcinomas. Extragastric sources of CA 72-4 elevation were ruled out. The elevation slowly returned to normal levels after two courses of triple and sequential eradication therapy, causing considerable anxiety for the patient and several costly examinations.

Six regimens for the eradication of Helicobacter pylori (Hp) in duodenal ulcer patients: three consecutive trials (1995-1999).

AIM: to present our experience in eradicating Hp in three consecutive trials performed between 1995 and 1999. METHODS: 320 duodenal ulcer outpatients have been enrolled in three open, prospective controlled trials. Hp infection was confirmed by Giemsa stain and Rut. In Trial I, 52 cases received 20 mg omeprazole + 2 x 250 mg clarithromycin + 2 x 500 mg tinidazole (OCT), 48 patients were given 20 mg omeprazole, 2 x 1000 mg amoxicillin + 2 x 500 mg metronidazole (OAM) for 7 days; in Trial II, 48 cases received 40 mg pantoprazole + 2 x 1000 mg amoxicillin + 2 x 500 mg clarithromycin (PAC) for 7 days and 5l cases 2 x 400 mg ranitidin bismuth citrate + 2 x 500 mg clarithromycin for 14 days (RBC-C); in Trial III, 60 cases were treated with 2 x 30 mg lansoprazole + 2 x 250 mg clarithromycin + 2 x 500 mg metronidazole and 6l patients received 2 x 400 mg ranitidin bismuth citrate+2 x 250 mg clarithromycin + 2 x 500 mg metronidazole (RBC-CM). The patients were controlled within 4-6 weeks by endoscopy in trials I-II and 13C-urea breath test in trial III. RESULTS: Eradication rates on ITT/PP basis were: OCT: 72.3/80.2% vs OAM 51.2/63.5% (P = 0.02/P = 0.03); PAC: 80.8/88.3% vs RBC-C 80.3/85.4% (P = 0.65/0.67) and LCM 78.3/92.1% vs RBC-CM 78.7/90.5% (P = 0.86/P = 0.93). Side effects occurred in 5.2, 8.6, 9.5, 14.5, 13.5 and 18.3% of the cases. CONCLUSION: Regimens using 2 x l PPI or RBC + 2 antibiotics for l week proved to be the most effective for Hp eradication in duodenal ulcer patients.

[Prevalence of Helicobacter pylori, correlations between alcohol consumption and gastroduodenal damage]. / A Helicobacter pylori prevalenciája, az alkoholfogyasztás és a gastroduodenum károsodása közötti összefüggések.

We studied the prevalence of Helicobacter pylori (HP) infection, and that of upper gastro-intestinal tract lesions in chronic alcoholics. 73 chronic alcoholic, 74 duodenal ulcer and 40 non-ulcer dyspepsia patients were included. The prevalence and severity of HP infection and gastritis, profile of endoscopic lesions and the correlation between severity of alcohol consumption and that of HP infection were determined. HP was found in 31.5% of alcoholics, 83.78% of duodenal ulcer (p < 0.05) an 47.50% of non-ulcer dyspepsia cases (p > 0.18). The Genta score was in the same groups 0.47 +/- 0.09, 1.91 +/- 0.22 (p < 0.05), and 0.65 +/- 0.14 (p > 0.98). Endoscopy revealed oesophagitis in 23.6%, nonerosive gastritis in 24.5%, erosive gastritis in 13.6%, gastric ulcer in 17.5% and duodenal ulcer in 28.6% of alcoholics. Multiple findings were present in 51.8% and no lesion was found in 6.4% of the cases. Severity of gastritis was also lower in alcoholics as compared to duodenal ulcer patients. There was no correlation between severity of drinking and that of HP infection. Thus, heavy alcohol intake is associated with lower prevalence and severity of HP infection. However, alcoholics have significant, often multiple endoscopic lesions suggesting the role of other aetologic factors in addition to HP infection.

[Eradication of Helicobacter pylori in peptic ulcer patients]. / A Helicobacter pylori eradikációja peptikus fekélybetegekben.

The aim of this study was to compare in an open trial the efficacy of 2 x 500 mg clarithromycin + 2 x 1000 mg amoxicillin + 40 mg pantoprazole/day given for 7 days (I. group, 48 cases), with that of 2 x 500 mg clarithromycin + 2 x 400 mg ranitidine bismuth citrate/day given for 14 days (II. group, 51 cases). The diagnosis of peptic ulcer was established endoscopically. HP infection was confirmed the modified Giemsa stain and rapid urease test. After eradication all patients were given 2 x 150 mg ranitidine for one month. Controls were performed 4-6 weeks after eradication. Peptic ulcer healing was proven in the group I in 93.0% and in the group II in 91.6% (p > 0.05). On intention-to-treat basis, HP was eradicated in 80.3% (confidence interval, CI: 73-92.7%) in the I. and 80.3% (confidence interval: 76-95%) in the II. group (p > 0.05). Per protocol analysis revealed eradication rates of 88.3% (CI: 81-97.6%) and 85.4% (CI: 80-97%) (p > 0.05). Side effects were recorded in 9.5% and 14.5% of the cases. Both regimens were equally effective in the eradication of HP and healing of peptic ulcers.