Azithromycin effect on helicobacter pylori eradication: double blind randomized clinical trial.

BACKGROUND/AIMS: To evaluate the efficacy of one- and two-week regimen of quadruple therapy containing azithromycin for Helicobacter pylori infection eradication. METHODOLOGY: A total of 84 H. pylori-infected patients, were randomized into three groups: First group (n=31): 6 g AzOAB: Azithramycin 500 mg twice daily for 6 days and Omeprazole 20 mg, Amoxicillin 1 g, Bismuth 240 mg all twice daily for 2 weeks. Second group (n=28): 3 g AzOAB: Azithramycin 500 mg twice daily for 3 days and Omeprazole 20 mg, Amoxicillin 1 g, Bismuth 240 mg all twice daily for 1 week. Third group (n=25): 1.5 g AzOAB: Azithromycin 250 mg twice daily for 3 days and Omeprazole 20 mg, Amoxicillin 1 g, Bismuth 240 mg all twice daily for 1 week. Eradication was defined as a negative urea breath test, four weeks after the end of treatment. RESULTS: The eradication rate in the first, second and third group was 92% (95% CI: 84-99.8%), 88.46% (95% CI: 84.47-84.74%), 80% (95% CI: 79.88-80.11%) respectively, based on per-protocol analysis. There was no significant difference between eradication rates (P=0.44). The frequency of drug side effects in the study groups was respectively 19.23%, 7.6% and 0%. There was no statistically significant difference between the three regimens (P=0.06). However, frequency of drug side effects between 6 g AzOAB and 1.5 g AzOAB was statistically significant (P=0.02). CONCLUSIONS: According to the results of these 3 regimens, it seems that one week quadruple regimens of 3 g Azithromycin may be more favorable for H. pylori eradication.

The efficacy of a synbiotic containing Bacillus Coagulans in treatment of irritable bowel syndrome: a randomized placebo-controlled trial.

AIM: We aimed to evaluate the efficacy of a synbiotic containing Bacillus Coagulans in treatment of IBS. BACKGROUND: Some studies have shown the efficacy of probiotics in the treatment of irritable bowel syndrome (IBS). PATIENTS AND METHODS: Adult IBS patients (n=85) were randomized to receive a synbiotic containing Bacillus Coagulans or placebo for 12 weeks. Frequency of IBS symptoms including abdominal pain (scored 1 to 7), and diarrhea and constipation (scored 1 to 5) was evaluated before and after the intervention and then after nine months follow-up. RESULTS: Twenty-three patients in the synbiotic group and 33 patients in the placebo group completed the study (age = 39.8±12.7 years, 78.6% female). After treatment, more reduction in abdominal pain frequency was observed with synbiotic compared with placebo (score reduction 4.2±1.8 vs. 1.9±1.5, P<0.001). Diarrhea frequency was decreased in the synbiotic group, but not in the placebo group (score reduction 1.9±1.2 vs. 0.0±0.5, P<0.001). Decrease in constipation frequency was the same between the two groups (score reduction 0.9±1.2 vs. 0.8±1.1, P=0.561). After nine months follow-up, abdominal pain frequency was decreased (P=0.016), constipation frequency was increased (P<0.001), and diarrhea frequency remained unchanged in the synbiotic group (P=1.000). In the placebo group, abdominal pain frequency was increased (P<0.001), constipation frequency remained unchanged (P=0.553), and diarrhea frequency was increased (P<0.001). CONCLUSION: Bacillus Coagulans improves abdominal pain and diarrhea in IBS patients. Further studies on a larger sample of patients are warranted.

Is helicobacter pylori infection a risk factor for coronary heart disease?

BACKGROUND: There is still controversy about association of Helicobacter pylori (H. pylori) infection with coronary heart disease (CHD). This study designed to evaluate this association in a sample of Iranians Population. METHODS: Medical and drug history as well as fasting blood samples of 112 consecutive patients who were candidate for coronary angiography were taken on catheterization day. Fasting blood samples were used to measure C-reactive protein (CRP), anti H. pylori immunoglobulin G (anti H. pylori IgG) and interlukine-6 (IL6). According to angiography reports, participants were divided into patients with (n = 62) or without CHD (n = 43). To compare the association between H. pylori infection with CHD, multivariate logistic regression tests were used by adjusting sex and age, age and sex plus history of diabetes mellitus (DM), Dyslipidemia (DLP), and/or hypertension (HTN), CRP status and IL-6 level. RESULTS: Sixty two patients with CHD and 43 participants without CHD were enrolled in the present study. The mean ages of patients with and without CHD were 62.4 261 9.5 and 59.0 261 10.5 years respectively. Multivariate logistic regression analysis after adjusting for history of DM and/or DLP and/or HTN plus CRP status and IL-6 level showed significant association of H. pylori infection with CHD (OR 3.18, 95%CI 1.08-9.40). CONCLUSION: H. pylori infection is one of the probable risk factors for CHD independent of history of DM, DLP, HTN, CRP status and IL-6 level.

Association of helicobacter pylori infection with severity of coronary heart disease.

BACKGROUND: There are few literatures evaluating the association between cytotoxin-associated gene A (CagA) positive strains of Helicobacter pylori (HP) and the severity of coronary heart disease (CHD). This study was designed to investigate this association. METHODS: Medical and drug history of 112 consecutive patients who were candidate for coronary angiography were taken. Fasting blood samples were obtained to measure C-reactive protein (CRP), anti Helicobacter pylori immunoglobulin G (anti-HP IgG), anti-CagA antibody (Ab) and interlukine-6 (IL6). According to angiography reports, participants were divided into patients with mild (n = 69) and with sever CHD (n = 36). To measure the association between CagA positive strains of HP with the severity of CHD, multivariate logistic regression tests were used by adjusting age, sex, history of diabetes mellitus (DM), dyslipidemia (DLP), and/or hypertension (HTN), CRP status and IL-6 level. RESULTS: The analysis was concluded on 105 subjects. HP infection and CagA Ab were not significantly higher compared to the patients with severe and mild CHD (P = 0.28 and P = 0.68, respectively). Colonization of CagA positive HP did not significantly associate with severity of CHD (OR 1.05, 95% CI 0.33-3. 39). CONCLUSION: Colonization of CagA positive HP was not an independent risk factor for severe coronary heart disease.

Non-alcoholic Steatohepatitis in a Sample of Iranian Adult Population: Age is a Risk Factor.

OBJECTIVES: Non-alcoholic Steatohepatitis (NASH) is a cause of cirrhosis. Detecting its preventable causes could be useful in decreasing the disease and its complications. This study aimed to assess the prevalence of NASH in adult population living in Isfahan city as a sample of Iranian population. METHODS: Blood samples of 2030 individuals referring to Dr. Shariati Hospital for routine health checkup were collected. All individuals with high liver enzymes [aspartate aminotransferase (AST) and/or Alanine aminotransferease (ALT)] were included in the study. Known causes of altered liver enzymes were excluded. Second blood samples were obtained 6 months later and those cases with persistent enzyme elevation were surveyed with ultrasonography. RESULTS: In the first survey, 234 individuals (11.5 %) had ALT levels of more than 40 U/L. By rechecking samples after 6 months, 50% of all high serum ALT individuals remained at high level. After conducting complementary biochemical tests, 3.3% of the population was considered to have NASH; 20% of NASH cases did not have any abnormal findings in ultrasonography. Hypercholesterolemia was the most coexisting risk factor in NASH cases. We found a reverse correlation between ALT level and age (P = 0.02). CONCLUSIONS: The prevalence of NASH was comparable with other countries. According to the significantl correlation between ALT level and age, preventive interactions in younger individuals would decrease the incidence of NASH.

Association of gastroesophageal reflux disease symptoms with exacerbations of chronic obstructive pulmonary disease.

BACKGROUND: Symptoms of gastroesophageal reflux disease (GERD) are common in various chronic respiratory diseases, but little is known about GERD in the setting of chronic obstructive pulmonary disease (COPD). The aim of this study was to determine the effect of GERD symptoms on COPD exacerbations and subsequent hospitalization and drug usage. METHODS: This retrospective study was conducted from December 2008 to February 2009 in the Pulmonary Clinic of Dr. Shariati University Hospital, Isfahan, Iran. Consecutive patients who were diagnosed with COPD based on clinical features and pulmonary function tests were included. Patients were categorized in GERD positive and GERD negative groups based on the Mayo GERD questionnaire. Exacerbation of COPD, hospitalization, and drug usage were compared between the two groups. RESULTS: During the study period, 110 patients with COPD (mean age = 68.0 +/- 8.4 years, 87.3% male) were included; 59 (53.6%) patients were GERD positive. There was no significant difference between the GERD positive and GERD negative patients in age, gender, tobacco use, or body mass index. GERD positive patients experienced significantly more acute exacerbations of COPD than patients who were GERD negative (p < 0.001). The rate of hospitalization due to COPD exacerbations was significantly higher in GERD positive patients and they had a more severe COPD (p < 0.05) and more concurrent use of multiple therapies as compared with GERD negative patients (p < 0.05). CONCLUSION: Patients with GERD symptoms have more COPD exacerbations and subsequent hospitalizations and drug usage. Clinical trials and preventive strategies for GERD in patients with COPD are warranted.