[Short-term triple therapy with pantoprazole, amoxicillin and metronidazole in Helicobacter pylori infection]. / Kurzzeit-Tripeltherapie mit Pantoprazol, Amoxicillin und Metronidazol bei Helicobacter-pylori-Infektion.

BACKGROUND: The present study was conducted to investigate the efficacy and tolerability of a 7-day treatment with pantoprazole, amoxicillin and metronidazole for the eradication of Helicobacter pylori (H. pylori) infection. PATIENTS AND METHODS: Fifty patients (26 male, 24 female, age 18 to 86, mean 54 years) with an active duodenal (n = 25) or gastric ulcer (n = 25) were recruited into the study, 48 patients being H. pylori positive at the study start. Patients were treated with pantoprazole (40 mg bid), amoxicillin (1 g bid) and metronidazole (500 mg bid) for 7 days and for another 21 days with pantoprazole (40 mg/od). Four weeks after the end of study medications the patients were re-examined endoscopically and their H. pylori status was re-assessed using urease test, histology and 13C-urea-breath test. RESULTS: In 39 of 48 intention to treat patients, H. pylori infection was cured, according to 81% (95%-CI = 67 to 91%). In the per protocol population in 35 of 41 patients H. pylori was eradicated, which results in an eradication rate of 85% (95%-CI = 71 to 94%). Ulcer healing was endoscopically confirmed in 45 of 48 patients (94%; 95%-CI = 83 to 99%) after 8 weeks. Six of 50 patients (12%) reported mild to moderate probable side-effects of the study medication. Cure of the infection was associated with a distinct reduction of the gastritis grade and activity. CONCLUSION: A 7-day triple therapy using pantoprazole, amoxicillin and metronidazole is an effective and cost-effective alternative to regimens including clarithromycin for the treatment of H. pylori infection.

[The significance of dietary fat and fiber for the aetiology of colon cancer (author's transl)]. / Zur Bedeutung des Fett- und Rohfasergehalts der Nahrung für die Entstehung des Kolonkarzinoms.

Dietary habits of 49 patients with colorectal carcinoma or precancerous adematous polyps were investigated and compared with age- and sex matched, healthy controls. The dietary fiber intake of the tumor group was not significantly lower than control. Tumour patients were found to eat more animal fat than controls, the difference not reaching statistical significance. By contrast, we found a highly significant difference in the ratio of daily dietary fat/fiber intake (p less than 0.001). The ratio was 19.1 +/- 1.1 in tumour patients and 14.5 +/- 0.6 in controls. It is concluded that in the genesis of colorectal carcinoma, the relation of dietary fat to fiber might be more important than the intake of these two dietary constituents in absolute terms.

[Importance of follow-up investigation in colonic carcinoma (author's transl)]. / Bedeutung der Nachsorgeuntersuchung beim Dickdarmkarzinom.

Extensive follow-up investigations were done in 1978 in 135 patients, most of whom had been operated for colo-rectal carcinoma of all stages in 1977. In 71% of the cases no or no sufficient postoperative control had been performed in the patients' own area. At the follow-up investigations 11 recurrences in the anastomosis, 10 of which were operable, 20 distant metastases, 1 simultaneous second carcinoma, 15 adenomas, partially with numerous atypical cells, 1 polyposis coli and 23 nonspecific granulomas of the anastomosis were detected. The Haemoccult test was positive in 3 of the 11 anastomotic recurrences. Only in cases of distant metastases were values of carcinoembryonic antigen clearly increased (greater than 5 ng/ml). These findings underline the necessity of intensifying the regular follow-up investigation in colo-rectal carcinoma.

[The role of acid in ulcer pain (author's transl)]. / Zur Bedeutung der Mqgensäure für den Ulkusschmerz.

In 33 patients (duodenal ulcer 11, gastric ulcer 10, nonulcerous bulbar lesions 7, anastomotic ulcer 4, antral erosions 1), approximately 4 ml HCL 0,1 N were instilled under endoscopic view directly onto the lesion, with the purpose of eliciting patients-specific pain. Five (5) patients were test-positive; their pain was reproduced (duodenal ulcer 1, gastric ulcer 2, other bulbar lesions 2), the rest was negative. Twenty-three of the 33 patients were studied during a period of spontaneous pain, 4 exhibiting a positive test; 9 were asymptomatic, and 2 of these had a positive test. The role of acid in ulcer pain remains unclear. The pertinent literature is discussed.

[A modified guaiac test for the early detection of tumors of the intestinal tract (author's transl)]. / Modifizierte Guajakprobe zur Früherkennung von Tumoren des Verdauungstraktes

Of 1400 patients who were submitted to the Haemoccult test, 46 showed a postive result. Among other things there were 29 polyps, of which 3 already showed a focal carcinoma, and 5 carcinomata of the large intestine and 3 gastric carcinomata were also diagnosed. Over 70% of the tumor hosts had observed bleeding per anum at some time. In order to detect the number of false nagative results, patients were investigated in the same way even when the Haemoccult test had been negative three times. In this way 55 polyps were found as well as 7 partly advanced carcinomata of the large intestine. 35% of the Haemoccult-negative patients stated bleeding per anum in their history. The number of false negative findings must be considerably higher than previously estimated.

Spontaneous expulsion of a migrating infantry missile impacted in the duodenum and the common bile duct, 32 years after wounding.

32 years after the injury, an infantry bullet was found to extrude into the duodenum, with its sharp end impacted in the common bile duct. After several previous endoscopic examinations (duodenoscopy, ERCP), endoscopic removal was planned. In the meantime, the bullet was expelled per vias naturales, leaving a biliodigestive fistula.