bismuth-tripotassium-dicitrate and Gastritis

Marginal zone lymphomas of the MALT type are a type of B-cell neoplasms that involve extranodal tissues and have an indolent clinical behaviour. The stomach is the most common site and most patients are infected by Helicobacter pylori. An increase in the resistance of this bacterium to several antibiotics has been observed in the last years and this fact has determined the review of treatment guidelines. In areas with resistance to clarithromycin greater than 15%, classical triple therapy should be abandoned and quadruple regimens with or without bismuth are currently recommended. Thus, these new guidelines for eradication treatment should be applied to patients with gastric MALT lymphoma associated with H. pylori infection.

Topics: Anti-Bacterial Agents; Breath Tests; Clarithromycin; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Gastritis; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Lymphoma, B-Cell, Marginal Zone; Omeprazole; Organometallic Compounds; Practice Guidelines as Topic; Proton Pump Inhibitors; Salvage Therapy; Stomach Neoplasms

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Amoxicillin; Animals; Clarithromycin; Drug Therapy, Combination; Gastritis; Helicobacter heilmannii; Helicobacter Infections; Humans; Lansoprazole; Metronidazole; Omeprazole; Organometallic Compounds; Tetracycline

Topics: Animals; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Duodenal Ulcer; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Organometallic Compounds; Stomach Ulcer

Within the last ten years an increasing number of Helicobacter pylori-related inflammatory gastroduodenal diseases in children has been reported. The aim of this paper is to describe the range of Helicobacter pylori infections in children including diagnosis and treatment by application of colloidal bismuth salts.

Topics: Ampicillin; Anti-Ulcer Agents; Child; Drug Therapy, Combination; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Organometallic Compounds

The relationship between Helicobacter pylori (HP) and gastric ulcer therapy is examined by analyzing both the data that suggest that eradication of HP renders the gastric mucosa less susceptible to development of gastric ulcer as well as the substantial body of evidence that does not support this contention. The results reported in clinical trials with colloidal bismuth citrate, antimicrobial agents (furazolidone), and combinations of anti-ulcer and antimicrobial agents (H2-antagonist+cefixime, H2-antagonist+metronidazole) are reviewed. Also analyzed is the relationship between HP eradication and ulcer recurrence. Only one study is available on this aspect, and the limited evidence it provides in favour of a prophylactic effect of eradication therapy is not entirely convincing. The authors conclude that there is no reasonable case for the dogmatic assumption that eradication of HP facilitates either acute healing or long-term prophylaxis of gastric ulcer, though certain subgroups of gastric ulcer patients may benefit from eradication therapy.

Topics: Anti-Bacterial Agents; Anti-Ulcer Agents; Cefixime; Cefotaxime; Cimetidine; Drug Therapy, Combination; Furazolidone; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Organometallic Compounds; Stomach Ulcer

The discovery of Helicobacter pylori has stimulated great interest in its role in gastritis, non-ulcer dyspepsia and peptic ulceration. Treatment regimens to eradicate this organism from gastric mucosa have also received considerable attention. Current recommendations limit the use of triple drug combinations only to specific patient groups.

Topics: Amoxicillin; Anti-Ulcer Agents; Drug Therapy, Combination; Duodenal Ulcer; Dyspepsia; Gastritis; Helicobacter Infections; Helicobacter pylori; Metronidazole; Organometallic Compounds

The recent isolation and classification of the spiral gastric bacteria Helicobacter pylori has led to an explosion of worldwide research. The data strongly suggest that H. pylori is the causative agent for type-B active chronic gastritis. The role of H. pylori in duodenal ulcer awaits clarification, and, more importantly, potential treatment regimens need clear documentation and further detailed research. The past decade has revealed many intriguing facts about H. pylori infection. If, during the 1990s, eradication of H. pylori by means of appropriate and safe medication can lead to the control and prevention of gastroduodenal disease, then major clinical and economic benefits can be anticipated.

Topics: Anti-Ulcer Agents; Bismuth; Duodenal Ulcer; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Organometallic Compounds; Prevalence

There is now much worldwide evidence that Campylobacter pylori plays a pathogenic role in the aetiology of gastritis rather than colonizing an already inflamed gastric mucosa. 1) There is a very close association between the presence of C. pylori on the gastric mucosa and histologically confirmed Type B chronic active gastritis. Ninety percent of patients with C. pylori infection have gastritis whereas less than 5% of patients with normal mucosa are colonized. 2) C. pylori only colonizes gastric type mucosa; it is not found colonizing intestinal type mucosa in the stomach. 3) Two volunteer studies have confirmed Koch's third and fourth postulates. Ingestion of C. pylori led to the development of histologically proven gastritis. 4) Outbreaks of hypochlorhydric C. pylori gastritis have occurred. In one such epidemic 17 of 37 volunteers developed C. pylori hypochlorhydric gastritis after acid secretion studies were undertaken with an unsterilized pH electrode. 5) Susceptible animal models (gnotobiotic piglets and the macacus monkey) inoculated with a suspension of C. pylori have developed histologically proven gastritis. 6) Clearance of C. pylori with antimicrobial agents (amoxicillin or nitrofurantoin) or bismuth salts (colloidal bismuth subcitrate or bismuth salicylate), alone or in combination, leads to rapid resolution of the histologically confirmed gastritis. If relapse occurs the gastritis returns.

Topics: Animals; Antacids; Anti-Bacterial Agents; Bismuth; Campylobacter Infections; Gastritis; Humans; Organometallic Compounds; Salicylates; Salicylic Acid

The healing properties of colloidal bismuth subcitrate (CBS) on peptic ulcer are well established and several studies have shown that healing with CBS is associated with a lower relapse rate than that produced by H2-receptor antagonists. The recent observation that CBS is effective against Campylobacter pylori has shed light on this because recent studies have shown that eradication of C. pylori by CBS leads to resolution of the associated gastritis and this may explain the low relapse rates. CBS is also effective in C. pylori positive patients with non ulcer dyspepsia (NUD) in whom clearance of these organisms from the stomach is associated with significant improvement of the associated gastritis and symptoms.

Topics: Cimetidine; Duodenal Ulcer; Dyspepsia; Gastritis; Humans; Organometallic Compounds; Peptic Ulcer; Recurrence; Stomach Ulcer

Topics: Bismuth; Campylobacter Infections; Chronic Disease; Dose-Response Relationship, Drug; Gastritis; Humans; Organometallic Compounds; Salicylates

Campylobacter pyloridis is a spiral bacterium which was seen by histopathologists several years before it was cultured in 1982 in Perth, Western Australia. It has unique cellular fatty acids, predominantly tetradecanoic acid and cis-11, 12 methylene octadecanoic acid. It also has a unique ultrastructure which is different from that of other campylobacters. C pyloridis possesses a powerful urease enzyme and produces large amounts of extracellular catalase. Both these features may be important virulence factors, allowing it to occupy a protected niche in the stomach below the mucus layer but above the gastric mucosa. Specific lesions are found in the gastric mucosa, and ultrastructural studies show the presence of adherence pedestals identical with those found with enteropathogenic Escherichia coli of the intestine. Histological examination of gastric biopsy tissue has shown that C pyloridis is strongly associated with active chronic gastritis, when polymorphonuclear leucocytes are present, and is not found on normal mucosa except when a biopsy specimen from elsewhere in the stomach shows active chronic gastritis. When patients with symptoms caused by gastritis are identified dual antibacterial treatment, combining the action of bismuth in the stomach with a systemic antibiotic, can eradicate C pyloridis, with remission of symptoms and restoration of normal epithelial morphology. Most peptic ulcers relapse after modern acid reducing treatment, and antibacterial treatment may be beneficial in preventing relapse.

Topics: Amoxicillin; Animals; Anti-Ulcer Agents; Antibodies, Bacterial; Bismuth; Campylobacter; Campylobacter Infections; Duodenal Ulcer; Escherichia coli Infections; Female; Gastric Mucosa; Gastritis; Humans; Male; Microscopy, Electron; Middle Aged; Organometallic Compounds; Rabbits; Stomach Ulcer

Recent experimental and clinical pharmacological studies on colloidal bismuth subcitrate (CBS) are reviewed. CBS combines with mucus to produce a marked retardation of the movement of hydrogen ions. CBS has potent anti-ulcer and anti-erosive action in various experimental models in animals, and is able to stimulate the generation of gastric mucosal prostaglandins. CBS is thought to be a cytoprotective agent. The type of mucosal cell repair in the vicinity of the ulcer is favourably affected in man. CBS also exhibits anti-pepsin and bile acid-binding properties. Pyloric campylobacter are inhibited in vitro and in vivo. The recent pharmacological findings are discussed in the light of the clinical efficacy of CBS and new indications.

Topics: Animals; Bismuth; Campylobacter; Dinoprostone; Duodenal Ulcer; Gastric Mucosa; Gastritis; Humans; Organometallic Compounds; Prostaglandins E

To investigate the effectiveness of 10-day bismuth-containing quadruple (B-quadruple) treatment as first-line therapy in patients with Helicobacter pylori-related chronic gastritis.. A randomized controlled trial was conducted from October 2011 to December 2013 in Zhejiang, China, including patients with H. pylori-related chronic gastritis who were randomly provided either 10-day omeprazole-based triple therapy (OM-triple; omeprazole 20 mg twice daily, clarithromycin 500 mg twice daily and amoxicillin 1 g twice daily) or 10-day B-quadruple therapy (OM-triple + bismuth subcitrate 120 mg four times daily). H. pylori status, pathologic findings and dyspeptic symptoms were assessed at baseline and after 3 months. The primary outcome was H. pylori eradication rates by intention-to-treat (ITT) and per-protocol (PP) analyses. The secondary outcomes were the histologic and symptomatic benefits from H. pylori eradication.. A total of 351 patients with H. pylori-related chronic gastritis were recruited. The eradication rates of the OM-triple and B-quadruple groups were 58.4% (108/185) and 86.1% (143/166) respectively according to ITT analysis (p <0.01). PP rates of H. pylori eradication were 63.2% (108/171) and 92.3% (143/155) respectively (p <0.01). According to the PP analysis, active and chronic inflammation in gastric mucosa was substantially improved in all treated patients (n=326). However, pathologic atrophic gastritis and intestinal metaplasia did not regress in both groups (n=326). The reduction of dyspeptic symptoms score was significantly higher in the B-quadruple group than in the OM-triple group (0.59±0.057 vs. 0.39±0.046) (p <0.01).. Ten-day B-quadruple therapy is more effective than OM-triple therapy as first-line therapy for patients with H. pylori-induced chronic gastritis in China.

Topics: Adult; China; Drug Administration Schedule; Drug Therapy, Combination; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Intention to Treat Analysis; Male; Middle Aged; Omeprazole; Organometallic Compounds; Prospective Studies; Treatment Outcome

To observe the effects and safety of quadruple regimens including domestically manufactured rabeprazole used as first line/initial therapy for Helicobacter pylori(H.pylori) eradication in gastritis and duodenal ulcer patients, and to investigate the effects of extended use of bismuth after the quadruple therapy on eradication of H. pylori.. From January to August 2013, 430 patients with chronic gastritis or duodenal ulcer who were confirmed as H. pylori positive in gastroscopy for upper gastrointestinal symptoms were enrolled from 12 centers in China for initial treatment using quadruple regimens for H. pylori eradication. The study was a prospective, multicenter, randomized double-blinded double-dummy parallel-controlled clinical trial. The 310 chronic gastritis patients were divided into 2 groups: group A1 was given quadruple regime (rabeprazole+ amoxicillin+ clarithromycin+ bismuth potassium citrate) for 10 days followed by bismuth-placebo for 21 days; group A2 was given the quadruple regimen for 10 days and then bismuth potassium citrate for 21 days. The duodenal ulcer patients were given the quadruple for 10 days, then rabeprazole for 14 days. All the patients took (13)C urea breath test to detect H. pylori 28 days after medicine withdrawal.. Altogether 428 cases were enrolled and 404 completed the trial. The total eradication rate in the chronic gastritis patients was 85.1% (262/308, intention-to-treat (ITT)analysis), which was 81.7% (125/153, ITT) in the A1 group and 88.4% (137/155, ITT) in the A2 group; the eradication rate in the duodenal ulcer patients was 85.8% (103/120, ITT). No severe adverse effects were reported. The symptoms (pain, burning sensation, reflux, belching, nausea, and vomiting) improvement status was similar among A1 and A2 groups.. The quadruple regimen using rabeprazole manufactured in China and administered for 10 days as first line/initial therapy in chronic gastritis and duodenal ulcer patients could achieve good H. pylori eradication rate. The extended use of bismuth after 10-day quadruple regimen might further improve the eradication rate. The regimens containing proton-pump inhibitor and bismuth may be well tolerated and safe in clinical application.

Topics: Amoxicillin; Antacids; Bismuth; Breath Tests; Drug Therapy, Combination; Duodenal Ulcer; Gastritis; Gastroesophageal Reflux; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Organometallic Compounds; Prospective Studies; Proton Pump Inhibitors; Urea

Chronic gastritis associated with H. pylori infection causes oxidative stress in the stomach. This study aimed to evaluate the therapeutic effects of coenzyme q10 among gastric patients infected by H. pylori. By a clinical trial, chronic gastric patients infected by H. pylori were randomly divided into 2 groups: intervention and placebo. The placebo group received a standard triple therapy regimen, and the intervention group received the triple regimen + coenzyme Q10 (CoQ10). Mean inflammation score; serum levels of 3 serum markers were then compared. A total of 100 participants of whom 67% were female were evaluated. The mean age of participants was 59.4 ± 11.4 years. The mean inflammation score was considerably decreased at the end of the study, in the intervention group. The mean levels of total antioxidant capacity (TAC) and glutathione peroxidase (GPx) at the end of the study were reduced among the triple therapy group (P < .05, P =.03 respectively). The mean levels of TAC and GPx were significantly higher among the intervention group at the end of the study compared with those at the start of the study. The combination of triple therapy with CoQ10 demonstrated an effective outcome on the mucosal inflammation, and stress oxidative in patients with chronic gastritis.

Topics: Aged; Anti-Bacterial Agents; Anti-Ulcer Agents; Antioxidants; Double-Blind Method; Drug Therapy, Combination; Female; Gastritis; Glutathione Peroxidase; Helicobacter Infections; Helicobacter pylori; Humans; Lipid Peroxidation; Male; Malondialdehyde; Metronidazole; Middle Aged; Organometallic Compounds; Oxidative Stress; Tetracycline; Ubiquinone

To evaluate the efficacy and safety of modified sequential therapy and to compare modified sequential therapy with standard quadruple therapy for Helicobacter pylori (H. pylori) eradication.. In total, 200 consecutive patients who were diagnosed with H. pylori-infected chronic gastritis by electronic endoscopy and rapid urease testing from December 2012 to October 2013 were enrolled in this study. The patients had not previously received H. pylori eradication treatment, and were randomized into two groups. The patients in Group A (n = 101) were treated with ilaprazole + bismuth potassium citrate + amoxicillin and clavulanate potassium + levofloxacin, and the patients in Group B (n = 99) were administered a modified sequential therapy composed of ilaprazole at 5 mg bid and amoxicillin and clavulanate potassium at 914 mg for the first five days followed by ilaprazole at 5 mg bid, furazolidone at 100 mg bid and levofloxacin at 500 mg qid for the next five days. Four to six weeks after the end of treatment, a 14C-urea breath test was performed for all the subjects to confirm the eradication of H. pylori. The intention-to-treat and per-protocol eradication rates were determined.. A total of 190 of the 200 patients completed the study. All 200 patients were included in the intention-to-treat analysis, whereas 190 patients were included in the per-protocol analysis. In the intention-to-treat analysis, the rates of H. pylori eradication in Groups A and B were 85.15% (86/101) and 81.82% (81/99), respectively. In the per-protocol analysis, the H. pylori eradication rates in Groups A and B were 88.66% (86/97) and 87.09% (81/93), respectively. No significant difference was observed (χ(2) = 0.109, P = 0.741) in the eradication rate between Groups A and B. The rates of adverse effects observed in the groups were similar at 6.19% (6/97) for Group A and 7.53% (7/93) for Group B (P > 0.05). No mortality or major morbidities were observed in any of the patients. Symptomatic improvements in the presentation of stomachache, acid regurgitation, and burning sensation were not significantly different between the two groups.. Ilaprazole-based 10-d standard quadruple therapy does not offer an incremental benefit over modified sequential therapy for the treatment of H. pylori infection, as both treatment regimens appear to be effective, safe, and well-tolerated as initial treatment options.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Adult; Amoxicillin; Anti-Bacterial Agents; Breath Tests; China; Chronic Disease; Clavulanic Acid; Drug Administration Schedule; Drug Therapy, Combination; Female; Gastritis; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Intention to Treat Analysis; Male; Middle Aged; Organometallic Compounds; Prospective Studies; Proton Pump Inhibitors; Time Factors; Treatment Outcome

Bismuth-containing quadruple therapy given four times a day is effective in the first-line treatment of Helicobacter pylori. We aimed to investigate whether twice daily posology could eradicate H. pylori at a comparable rate in an area with a high prevalence of antibiotic resistance.. The study group consisted of 90 patients with treatment naïve H. pylori. Patients were randomized to BOMT1 group (Bismuth citrate 2 x 600 mg, omeprazole 2 x 20 mg, metronidazole 2 x 500 mg, tetracycline 2 x 500 mg; for 14 days) and BOMT2 group (Bismuth citrate 2 x 600 mg, omeprazole 2 x 20 mg, metronidazole 3 x 500 mg, tetracycline 4 x 500 mg; for 14 days). H. pylori eradication was assessed by both C14-urea breath test and stool antigen test at least 8 weeks after treatment.. Demographic characteristics and endoscopy findings of the groups were similar. Eighty-two patients completed the study (BOMT1= 38 and BOMT2 = 44) including H. pylori eradication assessment. The eradication rates determined by PP and ITT analyses were 86.8% and 733% for BOMT1 group, 90.1% and 88.9% for BOMT2 group, respectively. BOMT1 was found to be non-inferior to BOMT2 treatment. Patients in BOMT2 group had a significantly higher rate of drug associated adverse events than BOMT1 (34.1% vs 9.3%; p = 0.008).. Twice a day quadruple therapy is as effective as four times a day quadruple therapy in the first line treatment of H. pylori in a country with high resistance to metronidazole and clarithromycin and is more tolerable.

Topics: Adult; Anti-Bacterial Agents; Anti-Ulcer Agents; Drug Resistance, Bacterial; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Omeprazole; Organometallic Compounds; Prevalence; Prospective Studies

The increasing trend of antibiotic resistance requires effective second-line Helicobacter pylori (H. pylori) treatment in high prevalence area of H. pylori. The aim of our study was to evaluate the reinfection rate of H. pylori after second-line treatment that would determine the long-term follow up effect of the rescue therapy.. A total of 648 patients who had failed previous H. pylori eradication on standard triple therapy were randomized into two regimens: 1, esomeprazole (20 mg b.i.d), tripotassium dicitrate bismuthate (300 mg q.i.d), metronidazole (500 mg t.i.d), and tetracycline (500 mg q.i.d) (EBMT) or 2, moxifloxacin (400 mg q.d.), esomeprazole (20 mg b.i.d), and amoxicillin (1000 mg b.i.d.) (MEA). At four weeks after completion of eradication therapy, H. pylori tests were performed with 13C urea breath test or invasive tests. In patients who maintained continuous H. pylori negativity for the first year after eradication therapy, H. pylori status was assessed every year. For the evaluation of risk factors of reinfection, gender, age, clinical diagnosis, histological atrophic gastritis or intestinal metaplasia were analyzed.. The recrudescence rate of the EBMT was 1.7% and of the MEA group 3.3% (p = 0.67). The annual reinfection rate of H. pylori of EBMT was found to be 4.45% and the MEA group 6.46%. Univariate analysis (Log-rank test) showed no association with any clinical risk factor for reinfection.. The long-term reinfection rate of H. pylori stayed low in both of bismuth-containing quadruple therapy and moxifloxacin-based triple therapy; thus reinfection cannot affect the choice of second-line treatment.. Clinical Trial Registration Number NCT01792700.

Topics: Aged; Amoxicillin; Anti-Bacterial Agents; Anti-Ulcer Agents; Aza Compounds; Breath Tests; Disease-Free Survival; Drug Therapy, Combination; Esomeprazole; Female; Fluoroquinolones; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Kaplan-Meier Estimate; Longitudinal Studies; Male; Metronidazole; Middle Aged; Moxifloxacin; Organometallic Compounds; Peptic Ulcer; Quinolines; Recurrence; Stomach Neoplasms; Tetracycline; Treatment Outcome

The influence of gastritis patterns in Helicobacter pylori eradication rates has been poorly investigated.. To compare the efficacy of bismuth or proton pump inhibitors triple therapy for H. pylori eradication in pangastritis.. One hundred and eight patients with pangastritis were assigned to either lansoprazole 30 mg once a day (n=54) or bismuth 240 mg bis in die (n=54) for 14 days combined, for the first week, with amoxicillin 1g plus metronidazole 250 mg tris in die. Eradication was confirmed by (13)C-urea breath test.. With bismuth, successful eradication was observed in 75.9% (41/54) in the intention-to-treat analysis and 78.8% (41/52) in the per-protocol analysis. With lansoprazole, the eradication rates were respectively 46.3% (25/54) and 51.0% (25/49). Bismuth had a significant higher efficacy according to both intention-to-treat analysis (p=0.0029) and per-protocol analysis (p=0.0038) with OR of 3.66 (95% CI: 1.61-8.32) and 3.58 (95% CI: 1.50-8.54) respectively. At regression analysis, the only independent variable affecting eradication was the type of regimen (p=0.026) with an OR of 3.31 (95% CI: 1.16-9.44).. In pangastritis patients, bismuth is more effective than PPI in first-line eradication. For improving the overall eradication rates, an evaluation of gastritis extent might need to be considered.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Adolescent; Adult; Aged; Amoxicillin; Anti-Infective Agents; Anti-Ulcer Agents; Drug Therapy, Combination; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Lansoprazole; Male; Metronidazole; Middle Aged; Organometallic Compounds; Proton Pump Inhibitors; Young Adult

In eradication of Helicobacter pylori infection, standard quadruple second-line therapy consisting of proton pump inhibitor (PPI), bismuth, metronidazole and tetracycline often fails and shows poor patient compliance. The aim of our study was to evaluate the efficacy and tolerability of moxifloxacin-based triple therapy as an alternative second-line protocol.. A total of 160 patients, in whom the initial standard PPI triple therapy had failed to eradicate H. pylori infection, were included in the study. The initial H. pylori status was assessed using the (13)C-urea breath test. Patients were randomized to one of the following 7-day treatment regimens: (1) OMM: omeprazole 20 mg twice a day, moxifloxacin 400 mg/day, metronidazole 500 mg three times a day; and (2) OBMT: omeprazole 20 mg twice a day, colloidal bismuth subcitrate 120 mg four times a day, metronidazole 500 mg three times a day, tetracycline 500 mg four times a day. Patient compliance and adverse events were evaluated one week after completion of therapy. H. pylori status was re-assessed with the (13)C-urea breath test six weeks after the end of therapy.. The eradication rates were 73.2% (60/82) and 78.9% (60/76) with moxifloxacin-based triple therapy, and 53.8% (42/78) and 64.6% (42/65) with bismuth-based quadruple therapy, by intention-to-treat (p = 0.018) and per-protocol (p = 0.088) analyses, respectively. Adverse events/intolerability were described in 12/82 patients in the OMM group and 18/78 patients in the OBMT group. Compliance with treatment was 92.7% in the OMM group and 83.3% in the OBMT group.. Moxifloxacin-based triple therapy is a highly effective second-line eradication treatment in H. pylori infection. Because of its high levels of safety and tolerability, this protocol represents an adequate alternative to the standard bismuth-based quadruple therapy.

Topics: Adult; Anti-Infective Agents; Anti-Ulcer Agents; Aza Compounds; Breath Tests; Drug Administration Schedule; Drug Therapy, Combination; Female; Fluoroquinolones; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Moxifloxacin; Omeprazole; Organometallic Compounds; Proton Pump Inhibitors; Quinolines; Recurrence; Retreatment; Single-Blind Method; Tetracycline; Young Adult

Proton pump inhibitor-containing triple therapy with amoxicillin and metronidazole is recommended as initial treatment of Helicobacter pylori in childhood. However, eradication rate with this "classic" regimen is relatively low in Russia.. To evaluate empiric nifuratel, amoxicillin, and bismuth triple therapy for H. pylori gastritis in childhood.. Pediatric outpatients with H. pylori-associated chronic gastritis who underwent endoscopy for dyspeptic symptoms received the combination of bismuth subcitrate (8 mg/kg/day, q.d.s.), nifuratel (30 mg/kg/day, q.d.s.), and amoxicillin (50 mg/kg/day, q.d.s.) for 10 days. H. pylori status was determined before and after the treatment (in 4-6 weeks) by modified Giemsa staining.. Seventy-three children (48 boys, 25 girls, age range 9-14) were entered. H. pylori was eradicated in 63 patients (86%; 95% confidence interval: 76.6-93.2; intention-to-treat and per protocol). There were no serious adverse reactions and were no withdrawals due to any side-effects. All of side-effects were self-limiting (dark stools, urine discoloration, blackening of the tongue, and others).. The combination of nifuratel, bismuth subcitrate, and amoxicillin was an effective and tolerable regimen for H. pylori eradication.

Topics: Adolescent; Amoxicillin; Child; Drug Therapy, Combination; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Nifuratel; Organometallic Compounds; Peptic Ulcer; Prospective Studies; Treatment Outcome

To elucidate the influences of H pylori infection on oral iron treatment for iron deficiency anemia (IDA).. A total of 86 patients were divided into two groups: group A, receiving ferrous succinate combined with triple therapy for H pylori eradication, and group B (control), treated with ferrous succinate only. During treatment of IDA, dynamic changes in hemoglobin (Hb) level, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), serum iron (SI), and serum ferritin (SF) were compared between the groups.. Hb was slightly higher in group A at d 14 after the start of triple therapy for H pylori eradication (P > 0.05). After the therapy, the increase of Hb in group A became significantly faster than that in group B (P < 0.05). At d 56, the mean Hb in group A returned to the normal level, however, in group B, it was lower than that in group A (P < 0.05) although it had also increased compared with that before oral iron treatment. The MCV and MCH in group A recovered to the normal level, and were much higher than those in group B (P < 0.05) at d 21. In Group B, the MCV and MCH remained at lower than normal levels until d 42 after the start of therapy. And then, they reached a plateau in both groups and the differences disappeared (P > 0.05). The SF in group A was higher than that in group B (P < 0.05) 28 d after the treatment and its improvement was quicker in group A (P < 0.05) , and the difference between the two groups was even more significant (P < 0.01) at d 56. The SI in group A was higher than that in group B (P < 0.05) at d 14 and this persisted until d 56 when the follow-up of this research was finished.. Treatment of H pylori can enhance the efficacy of ferrous succinate therapy in IDA patients with H pylori-positive chronic gastritis.

Topics: Adolescent; Adult; Aged; Amoxicillin; Anemia, Iron-Deficiency; Anti-Infective Agents; Chronic Disease; Drug Therapy, Combination; Erythrocyte Indices; Female; Ferritins; Ferrous Compounds; Gastritis; Helicobacter Infections; Helicobacter pylori; Hemoglobins; Humans; Iron; Male; Metronidazole; Middle Aged; Organometallic Compounds; Risk Factors

Clinical and instrumental-laboratory investigations have been conducted in 372 patients with chronic antral gastritis (CAG, n = 131), diffuse gastritis (DG, n = 108) and ulcer disease (UD, n = 135). Immunomodulators tactivin and levamisol were added to standard treatment of 75 CAG, 63 DG and 85 UD patients. Healing of the lesions was observed, on the average, on the treatment day 24.3 +/- 0.5 and 18.4 +/- 0.6 in the standard treatment and with the added immunomodulator, respectively. Adjuvant levamisol diminished the number of recurrences of chronic gastritis and UD.

Topics: Adjuvants, Immunologic; Anti-Infective Agents; Chronic Disease; Drug Administration Schedule; Drug Therapy, Combination; Duodenoscopy; Gastritis; Gastroscopy; Humans; Levamisole; Organometallic Compounds; Peptides; Stomach Ulcer; Thymus Extracts

A novel rifabutin-based therapy is able to cure Helicobacter pylori infection in most patients who have failed eradication after standard proton pump inhibitor (PPI)-based triple therapy. We compared this regimen with the quadruple therapy.. A total of 135 patients were randomized into three groups who were treated for 10 days with pantoprazole 40 mg b.i.d., amoxycillin 1 g b.i.d., and rifabutin 150 mg o.d. (RAP50150 group), or 300 mg o.d. (RAP300 group), and pantoprazole 40 mg b.i.d., metronidazole 250 mg t.i.d., bismuth citrate 240 mg b.i.d., and tetracycline 500 mg q.i.d. (QT group). Before therapy, patients underwent endoscopy with biopsies for histology, culture and antibiotic susceptibility tests. H. pylori eradication was assessed by the 13C-urea breath test.. On intention-to-treat analysis, eradication rates (with 95% confidence intervals [CI]) were 66.6% (53-80%) in the RAP150 and QT groups, respectively, and 86.6% (76-96%) in RAP300 group (p < 0.025). Most patients harboring metronidazole- and clarithromycin-resistant strains were eradicated at an equal rate by each of the three regimens. Side effects were observed in 9% and 11% of rifabutin-treated patients, and in 47% of those on quadruple therapy (p < 0.0001).. In patients who failed standard eradicating treatments, a 10-day course of rifabutin with pantoprazole and amoxycillin is more effective and well tolerated than the quadruple therapy.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Adult; Aged; Amoxicillin; Anti-Bacterial Agents; Benzimidazoles; Biopsy, Needle; Confidence Intervals; Drug Administration Schedule; Drug Therapy, Combination; Enzyme Inhibitors; Female; Follow-Up Studies; Gastritis; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Omeprazole; Organometallic Compounds; Pantoprazole; Probability; Prospective Studies; Rifabutin; Sulfoxides; Tetracycline; Treatment Failure

Both iron deficiency anaemia and Helicobacter pylori infection are rare in developed countries. A possible connection has been suggested between these two diseases and our aim was to define the clinical picture and to study the effect of bacterial eradication in H. pylori colonized children with severe anaemia.. Eight children with iron deficiency anaemia refractory to iron supplementation were examined with gastroscopy because of suspicion of H. pylori infection. Anaemia was treated with oral ferrous sulphate. Two patients needed blood transfusions. Eradication therapy was given either with combination of colloidal bismuth subcitrate and metronidazole or with omeprazole, clarithromycin and amoxycillin. Eradication was confirmed by urea breath test 4 weeks post-treatment.. H. pylori infection was confirmed histologically and microbiologically in all children, who also presented with chronic, active gastritis. Bacteria were successfully eradicated in 7/8 patients. Correction of haemoglobin values was observed post-treatment, iron stores still being deficient at control in 4/8 children.. Our results suggest that H. pylori might have a role in causing iron deficiency anaemia in school-age children. Screening for H. pylori should be extended to cover those patients with other clinical manifestations than symptoms from gastrointestinal tract.

Topics: Adolescent; Amoxicillin; Anemia, Iron-Deficiency; Anti-Bacterial Agents; Anti-Ulcer Agents; Breath Tests; Child; Chronic Disease; Clarithromycin; Drug Therapy, Combination; Gastritis; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Hemoglobins; Humans; Metronidazole; Omeprazole; Organometallic Compounds; Proton Pump Inhibitors; Urea

To evaluate the effect of a therapeutic regimen of 7 days versus 14 days on the clinical manifestations of Helicobacter pylori gastritis in children.. Ninety children (age 2-19 years) who had abdominal pain and/or recurrent vomiting were determined to have H. pylori gastritis by endoscopy, histology, and a Giemsa stain positive for H. pylori. The patients were randomized to receive amoxicillin, metronidazole, and bismuth subcitrate for 7 days (group A; 45 children) or 14 days (group B; 45 children) and were observed clinically for 19 +/- 11.5 months. Resolution of all abdominal and gastrointestinal symptoms was considered a good response.. A good response was obtained in 36 (80%) children from group A, and in 37 (82%) from group B. A recurrence of symptoms occurred in four (11%) of the responders from group A, and in six (15.2%) from group B.. A 7-day course of bismuth-based triple therapy for H. pylori gastritis in children appears to be clinically as effective as a 14-day regimen. The feasibility of a shorter therapeutic regimen may enhance patient compliance and provide a better chance of clinical benefit.

Topics: Abdominal Pain; Adolescent; Adult; Anti-Bacterial Agents; Anti-Ulcer Agents; Child; Child, Preschool; Clarithromycin; Drug Therapy, Combination; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Omeprazole; Organometallic Compounds; Recurrence; Treatment Failure; Vomiting

The efficacy of anti-Helicobacter pylori treatment and cytoprotective drugs in H. pylori-positive and -negative non-ulcer dyspepsia (NUD), respectively, is debatable.. In a randomized study, the efficacy of anti-H. pylori treatment versus sucralphate was tested in patients with NUD. One hundred and twelve patients with NUD, 62 positive and 50 negative for H. pylori were studied. Of 62 patients positive for H. pylori, 32 were treated with triple therapy (colloidal bismuth subcitrate, tetracycline and metronidazole) for 2 weeks and the remaining 30 were treated with sucralphate (1 g, q.i.d.) for 4 weeks. Of 50 patients negative for H. pylori, 25 each were treated with either sucralphate (1 g, q.i.d.) or ranitidine (150 mg, b.d.) for 4 weeks.. In patients with NUD and H. pylori infection, triple therapy eradicated H. pylori in 88% and was superior to sucralphate in producing symptom relief (81 vs 33%, P = 0.0003) and histological improvement in gastritis (73 vs 30%, P = 0.003). In the H. pylori-negative group, sucralphate was superior to ranitidine with regard to symptom relief (68 vs 36%, P = 0.04) and improvement in gastritis (44 vs 12%, P = 0.09). The symptomatic improvement persisted until 12 weeks after the start of treatment in triple therapy group only.. In patients with NUD associated with H. pylori, triple therapy was better than sucralphate in terms of symptomatic and histological improvement. However, sucralphate was superior to ranitidine in providing symptom relief in patients with H. pylori-negative NUD.

Topics: Adult; Anti-Bacterial Agents; Anti-Ulcer Agents; Biopsy; Double-Blind Method; Drug Therapy, Combination; Dyspepsia; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; India; Male; Metronidazole; Organometallic Compounds; Prospective Studies; Ranitidine; Sucralfate; Tetracycline; Treatment Outcome

Two groups of 12 human volunteers, who had been treated with colloidal bismuth subcitrate, because of Helicobacter pylori-associated gastritis, participated in the study. The patients received a single dose of meso-2,3-dimercaptosuccinic acid (DMSA) or D,L-2,3-dimercaptopropane-1-sulfonic acid (DMPS) at a dose of 30 mg kg-1 in a randomized single blind study. In contrast to DMPS, increasing concentrations of bismuth in blood were observed during the first 4 h after intake of DMSA. In urine, both chelators induced a 50-fold increase in urinary bismuth excretion compared with the control urines. The treatment was well tolerated. The results indicate that both DMSA and DMPS effectively increase the elimination of bismuth in human urine. Consequently, both chelators may be of benefit in the treatment of patients with bismuth intoxication.

Topics: Adult; Aged; Analysis of Variance; Antacids; Bismuth; Chelating Agents; Gastritis; Helicobacter Infections; Humans; Middle Aged; Organometallic Compounds; Single-Blind Method; Succimer; Unithiol

We sought to evaluate the effect of Helicobacter pylori eradication in patients with fundic atrophic gastritis.. Acid secretion, gastric emptying, and histology were evaluated in 20 patients with fundic atrophic gastritis and H. pylori infection. After investigation, 10 patients (Group 1) received an eradicating treatment and 10 (Group 2) did not receive any treatment. One year later, the baseline investigations were repeated. Subsequently, patients in Group 2 received the same treatment given to patients in Group 1 and were reevaluated 12 months later. A further follow-up was performed in both groups 36 months after the treatment.. At 1-yr follow-up, all the patients in Group 1 were H. pylori negative whereas all the patients in Group 2 were still infected. In Group 1, there was a significant improvement of both fundic atrophy and acid secretion, compared with baseline (p < 0.01). In Group 2, no substantial modification of either histological or functional parameters was observed at the first follow-up; conversely, a significant (p < 0.01) improvement of fundic atrophy and acid secretion was detected in these patients 12 months after eradication of the bacterium. Histological pattern remained unchanged at 36 months of follow-up in both groups. Gastric emptying remained, on the average, unaffected by the treatment; however, three patients with delayed gastric emptying at entry had normal gastric emptying after eradication of H. pylori.. Our data suggest that mucosal atrophy can be reduced or even reversed by the eradication of H. pylori, and this is associated with a recovery of gastric function.

Topics: Amoxicillin; Anti-Bacterial Agents; Anti-Ulcer Agents; Atrophy; Female; Follow-Up Studies; Gastric Acid; Gastric Emptying; Gastric Fundus; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Organometallic Compounds

Helicobacter pylori is associated with primary antral gastritis, duodenal ulceration, and gastric cancer. Current regimens for treating infection in children using bismuth and antibiotics for two to six weeks are cumbersome. The aim of this study was to evaluate a one week course of treatment. All children undergoing endoscopy were assessed for the presence of H pylori by culture, histology, rapid urease test, and 13C urea breath test. Infected children received a one week course of colloidal bismuth subcitrate 480 mg/1.73 m2/day (maximum 120 mg four times a day), combined with metronidazole 20 mg/kg/day (maximum 200 mg three times a day), and clarithromycin 15 mg/kg/day (maximum 250 mg twice a day). To optimise compliance, drugs were dispensed in a 'Redidose' box containing a compartment for each day, and subcompartments marked 'breakfast', 'lunch', 'dinner', and 'bedtime'. Compliance and side effects were assessed immediately after treatment. A urea breath test was performed at least one month after treatment. Twenty two children infected with H pylori were entered into the study; 20 of these took all doses; two children suffered significant side effects (diarrhoea and vomiting). H pylori was eradicated in 21 of the 22 children (95.45%; 95% confidence interval 77% to 100%). This study shows that H pylori infection in children can be cleared by a one week course of treatment.

Topics: Adolescent; Anti-Bacterial Agents; Antitrichomonal Agents; Bismuth; Breath Tests; Child; Child, Preschool; Clarithromycin; Drug Administration Schedule; Drug Therapy, Combination; Gastritis; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Infant; Metronidazole; Organometallic Compounds

Helicobacter pylori (Hp) eradication in peptic ulcer disease is associated with a greatly reduced recurrence rate. The optimal drug regimen for HP eradication remains uncertain. It is also unclear if eradication of Hp in duodenitis and antral gastritis improves symptoms. The aims of this study were to compare the efficacy of three drug regimens in the eradication of Hp and to assess if Hp eradication improved symptoms in patients with duodenitis and antral gastritis. Patients (n = 79) found to have duodenal ulcer, duodenitis and/or antral gastritis with a positive urease test (CLO) at endoscopy were allocated to one of the three regimens: A. omeprazole 20 mg b.d. and clarithromycin 500 mg t.d.s. for two weeks (n = 27), B. De-Nol 240 mg b.d. for four weeks, metronidazole 400 mg t.d.s. and amoxicillin 500 mg t.d.s. for one week (n = 26), and C. omeprazole 20 mg b.d. and amoxicillin 500 mg t.d.s. for two weeks (n = 26). In conclusion, traditional 'triple' therapy with bismuth and two antibiotics achieved the highest Hp eradication rate and was best tolerated. Recolonisation with Hp was uncommon after eradication. Dyspeptic symptoms improved with Hp eradication in duodenitis and antral gastritis.

Topics: Adult; Aged; Amoxicillin; Anti-Bacterial Agents; Bismuth; Clarithromycin; Drug Therapy, Combination; Duodenal Ulcer; Duodenitis; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Omeprazole; Organometallic Compounds; Penicillins; Treatment Outcome

Helicobacter pylori infection is mainly acquired in childhood, and studies on the epidemiology of this infection depend on the availability of a noninvasive diagnostic test for use in children. The aim of this study was to determine whether the carbon 13-labeled urea breath test (UBT) can be used in children by evaluating: (1) its sensitivity and specificity compared with either culture or both rapid urease test and histologic examination, (2) whether a test meal or a prolonged fast is required, (3) the usefulness after treatment for H. pylori. Eighty-eight children (mean age, 10.6 +/- 4.19 years) who were undergoing upper endoscopy were studied while fasting, not fasting, and after treatment. Children were given 50 mg of 13C-urea if they weighed less than 50 kg or 75 mg of 13C-urea if they weighed more than 50 kg with 50 mg of a glucose polymer solution in 7.5 ml of water. Breath samples were collected at baseline and at 15, 30, 45, and 60 minutes. In 63 fasting children the UBT was 100% sensitive and 97.6% specific at 30 minutes with a cutoff value of 3.5 delta 13CO2 per mil. Nonfasting tests in 23 children, performed between 1 and 2 hours after their usual meal, were 100% sensitive and 91.6% specific. In 13 children fed directly before the UBT, the sensitivity of the test was reduced to 50%. Thirty minutes was the optimal sampling time. There was a significant decrease in specificity when samples were obtained at 15 minutes, possibly caused by the interference of oral urease-producing organisms. The test was 100% sensitive and specific in 20 children after treatment for H. pylori infection. The UBT is a highly sensitive and specific test for the diagnosis of H. pylori infection in children. Neither a prolonged fast nor a test meal is required.

Topics: Adolescent; Amoxicillin; Anti-Bacterial Agents; Biopsy; Breath Tests; Carbon Radioisotopes; Child; Child, Preschool; Fasting; Female; Gastric Mucosa; Gastritis; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Infant; Male; Metronidazole; Organometallic Compounds; Predictive Value of Tests; Sensitivity and Specificity; Urea

The pathogenesis of gastric metaplasia (GM) in the duodenum is unclear. The aim of this investigation was to study the effect on the extent of GM of ulcer healing, Helicobacter pylori eradication, and acid suppression singly and in combination. The relationship between GM and gastroduodenal inflammation and H. pylori infection density was also studied.. Duodenal and gastric antral biopsy specimens were obtained from H. pylori-positive patients with duodenal ulcer and from H. pylori-positive nonulcer subjects. Biopsy procedures from patients with duodenal ulcer were repeated after 6 months of treatment. Nonulcer subjects were treated symptomatically and did not undergo re-endoscopy.. Ulcer healing alone produced no change in GM or in gastroduodenal inflammation. H. pylori eradication produced a 42% reduction in GM and improvement in inflammation. Acid suppression produced a 43% reduction in GM but without a significant change in inflammation. A combination of H. pylori eradication and acid suppression produced an additive effect with a 66% reduction in GM. A positive relationship was detected between the extent of GM and antral H. pylori density, duodenitis score, and antral gastritis score.. This study shows that the extent of duodenal GM is unrelated to the presence or absence of ulceration but is partly due to H. pylori and partly due to acid.

Topics: Adult; Aged; Amoxicillin; Antacids; Anti-Ulcer Agents; Drug Therapy, Combination; Duodenal Ulcer; Duodenitis; Duodenum; Female; Gastric Acid; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metaplasia; Metronidazole; Middle Aged; Omeprazole; Organometallic Compounds; Penicillins

The aim of this study was to assess the effect of colloidal bismuth subcitrate (CBS) and metronidazole on Helicobacter pylori eradication and on the course of symptoms due to functional dyspepsia. Forty-one patients with functional dyspepsia were entered into the study and randomized to treatment with CBS (120 mg four times a day) for four weeks combined with metronidazole (250 mg four times a day) for one week (group A, N = 21) or matching placebo (group B, N = 20). The severity of gastritis and of bacterial colonization and the symptom score was assessed by endoscopy and clinical evaluation at baseline and after four, eight, and 24 weeks from the start of the treatment. With intent-to-treat analysis eradication was achieved in 16/25 (64%) patients in group A and in 6/24 (25%) in group B. At eight and 24 weeks the gastritis score was significantly lower only in those patients with eradication. No change was seen in patients in whom the bacteria was not eradicated. The symptom score at eight weeks was considerably lower both in patients with eradication and in those with infection. However, at 24 weeks a gradual decrease in the symptom score in patients with eradication and a worsening of symptoms in controls was observed. No differences were observed between patients with ulcerlike and those with dysmotility-like dyspepsia. The study confirms the need for a long observation period after antibacterial treatment in patients with functional dyspepsia and suggests that Helicobacter pylori-eradicating treatment improves the course of this functional syndrome.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Double-Blind Method; Drug Therapy, Combination; Dyspepsia; Female; Follow-Up Studies; Gastritis; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Organometallic Compounds

There is a need to develop alternative regimen(s) for treating Helicobacter pylori infection because of problems of drug compliance, side-effects and resistance with the conventional regimen consisting of bismuth, metronidazole and an antibiotic.. To compare prospectively the efficacy of conventional triple therapy (bismuth subcitrate 120 mg QID, amoxycillin 500 mg QID and metronidazole 400 mg TID for 2 weeks with one containing omeprazole (20 mg OD), bismuth subcitrate and amoxycillin (regimen B).. Sixty two consecutive patients with H pylori infection associated with antral gastritis and/or duodenal ulcer were randomized to two treatment groups and re- evaluated after completion of 2 weeks of therapy and then after a further 4 weeks for eradication of H pylori, ulcer healing and drug side-effects.. Regimen B resulted in higher H pylori eradication rate as compared to regimen A (76.7% vs 63.3%, better ulcer healing rate (90.9%, vs 70.6%), lesser side-effects (10.0% vs 36.7%) and better drug compliance (100% vs 93.3%). The difference between the two regimens was significant (p < 0.05) only in respect to side-effects.. For H pylori eradication, omeprazole, bismuth and amoxycillin combination for 2 weeks is as effective as the conventional therapy and is better tolerated.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Anti-Ulcer Agents; Drug Therapy, Combination; Duodenal Ulcer; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Omeprazole; Organometallic Compounds; Prospective Studies; Time Factors

Colloidal bismuth subcitrate (CBS) causes endoscopic and histological improvement in gastritis and eradication of Helicobacter pylori in patients with non-ulcer dyspepsia (NUD). The effect of sucralfate, a cytoprotective drug, on endoscopic and histologic gastritis and H pylori clearance is not clear. We studied the effect of CBS and sucralfate on these features in patients with NUD.. Sixty three patients with NUD and H pylori infection were randomized to receive one of the following for four weeks: (i) CBS (240 mg twice daily) (Group 1); (ii) placebo I, similar in size, color and shape to CBS (Group 2); (iii) sucralfate (2.0 g twice daily) (Group 3) and (iv) placebo II, similar to sucralfate (Group 4). Symptoms, endoscopic and histological findings and H pylori status were assessed before and after treatment.. Similar symptomatic improvement was observed with each treatment, indicating a placebo effect. Significant endoscopic and histological improvement was observed with CBS only. CBS was better than sucralfate in inducing endoscopic and histological improvement. Clearance rate of H pylori was 46.6% with CBS, 16.6% with its placebo, 33.3% with sucralfate and 13.3% with its placebo.. CBS is more effective than sucralfate in inducing endoscopic and histologic healing of H pylori-related gastritis among NUD patients.

Topics: Adult; Anti-Bacterial Agents; Anti-Ulcer Agents; Dyspepsia; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Organometallic Compounds; Sucralfate

The efficacy of a new combination preparation containing bismuth citrate and amoxicillin in one tablet was compared with the efficacy of bismuth citrate monotherapy in a randomised double-blind study on the eradication of Helicobacter pylori. The study involved 70 H. pylori positive (antrum biopsies showing a positive urease test) patients with non-ulcer dyspepsia and chronic gastritis. The treatment period was 14 days; 35 patients in group 1 received 2 tablets tid containing the bismuth citrate amoxicillin combination (BIAM tablet; 250 mg amoxicillin base and 120 mg bismuth); 35 patients in group 2 were treated with 2 tablets tid containing bismuth citrate (BI tablet; 120 mg bismuth). Total daily dose was therefore 1500 mg amoxicillin + 720 mg bismuth in group 1 patients resp. 720 mg bismuth in group 2 patients. 4 weeks after therapy H. pylori could not be histologically detected in the antrum of 22 patients (63%) in group 1 and 8 patients (24%) in group 2. Thus in group 1 (BIAM) a significantly higher eradication rate (p < 0.001) was shown than in group 2 (BI). Inflammation characterized by the infiltration of polymorphonuclear cells was significantly (p < 0.01) less pronounced in group 1 (BIAM) than in group 2 (BI) 4 weeks after the end of treatment. Gastrointestinal distress was quantified by evaluation of 13 different symptoms using a fourpoints scale at the beginning of the study and after 2 and 6 weeks. The sum of scores decreased by 81% in group 1 (BIAM) and 71% in group 2 (BI) after 6 weeks.

Topics: Adult; Aged; Amoxicillin; Anti-Ulcer Agents; Double-Blind Method; Drug Combinations; Dyspepsia; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Organometallic Compounds

The NIH Consensus Conference in 1994 (1) concluded that all patients with peptic ulcer disease should be tested and treated for Helicobacter pylori and that further evaluation was needed for patients in remission.. We evaluated in a double blind randomization 30 patients whose duodenal ulcers had been healed with H2-receptor antagonists and who remained in remission on maintenance therapy. After ulcer healing and the presence of H. pylori had been confirmed, these patients were randomized to receive eradication therapy or placebo and were followed for a mean period of 23 months.. Almost all patients receiving placebo had ulcer recurrence, whereas the patients treated with antibiotics demonstrate a low recurrence rate.. These data suggest, for the first time to our knowledge, the importance of treating with antibiotics duodenal ulcer patients whose disease is in remission.

Topics: Adult; Aged; Antacids; Anti-Ulcer Agents; Disease-Free Survival; Double-Blind Method; Doxycycline; Drug Therapy, Combination; Duodenal Ulcer; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Histamine H2 Antagonists; Humans; Life Tables; Male; Metronidazole; Middle Aged; Organometallic Compounds; Ranitidine; Recurrence; Remission Induction

Two 4-week triple-therapy treatment regimens, metronidazole+tetracycline+bismuth subcitrate and omeprazole+amoxycillin+bismuth subcitrate, were compared in a randomly allocated double-blind trial for their efficacy in eradicating Helicobacter pylori from the gastric mucosa of patients with gastritis and/or peptic ulcer disease.. The presence of gastritis and/or peptic ulcers was confirmed by endoscopy in all patients included in the study. To evaluate drug effects, we used the urease test on gastric mucosa, and haematoxylin-eosin and specific Giemsa stains on biopsy tissues obtained by endoscopic procedures; we also evaluated the improvement in clinical symptoms before and after the 4-week treatments.. Among 164 patients with gastritis and/or peptic ulcers, H. pylori infection was confirmed in 93.9% (154 patients) by the urease test and in 87.8% (144 patients) by haematoxylin-eosin stain. Following 4 weeks of treatment with both combination regimens, negative conversion rates by the urease test and haematoxylin-eosin staining and rates of recovery from clinical symptoms were similar in both regimens (metronidazole+tetracycline+bismuth subcitrate: 82.3, 72.9 and 73.9%; omeprazole+amoxycillin+bismuth subcitrate: 89.6, 83.4 and 76.1%, respectively). Also, the extent of inflammatory activity and the H. pylori score by the Giemsa method indicated high rates of recovery, with improvements to grade 0 (lowest grade) from higher grades with both combination regimens (60.4 and 66.7% of patients taking metronidazole+tetracycline+bismuth subcitrate and 64.6 and 83.3 of those taking omeprazole+amoxycillin+bismuth subcitrate). However, the prevalence of side effects during the 4 weeks of treatment was doubled in the former group compared to the latter (25.5 versus 12.5% of patients).. Significant improvements in biochemical and histopathological findings and in the clinical symptoms of gastritis and/or peptic ulcer disease in patients with a high rate of H. pylori infection were observed equally with both regimens. However, there were notably fewer side effects in patients treated with omeprazole+amoxycillin+bismuth subcitrate. We therefore recommended this regimen in preference to metronidazole+tetracycline+bismuth subcitrate for the treatment of H. pylori-related gastritis and peptic ulcer disease.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Anti-Ulcer Agents; Double-Blind Method; Drug Therapy, Combination; Duodenal Ulcer; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Omeprazole; Organometallic Compounds; Peptic Ulcer; Stomach Ulcer; Tetracycline; Treatment Outcome

In the present study we evaluated the efficacy and tolerability of two different therapeutic schedules in eradicating Helicobacter pylori. Forty-six consecutive patients (suffering from either peptic ulcer or non-ulcer dyspepsia) with helicobacter pylori infection were randomly allocated to one of the following two groups: group 1 (n = 23) 2 weeks of treatment with bismuth subcitrate tablets (120 mgx4) + amoxycillin capsules (500 mgx4) + metronidazole tablets (250 mgx4); group 2 (n = 23) 2 weeks of treatment with amoxycillin capsules (500 mgx4) + metronidazole tablets (250 mgx4). Endoscopy, histology and bacterial culture were performed at entry, and 30 and 90 days after treatment. Two group 1 patients and one group 2 patient did not complete the treatment. Successful eradication was obtained in 20/21 (95%) patients treated with triple therapy (group 1) and in 17/22 (77%) patients treated with double therapy (group 2) (p = 0.2). Side-effects occurred in 9/21 (43%) patients of group 1 and in 9/22 (41%) patients of group 2 (p = 0.9). These were all self-limiting and required no specific treatment. These data suggest that combined therapy with amoxycillin and metronidazole, with or without bismuth subcitrate, represents a safe and effective therapeutic approach for the treatment of Helicobacter pylori infection. In our series, triple therapy determined a numerically higher eradication rate than double therapy.

Topics: Adult; Amoxicillin; Anti-Ulcer Agents; Bismuth; Drug Administration Schedule; Drug Therapy, Combination; Duodenal Ulcer; Dyspepsia; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Organometallic Compounds; Time Factors

We have carried out a double blind placebo controlled trial to assess the effects of treatment with colloidal bismuth subcitrate in Helicobacter pylori associated non-ulcer dyspepsia. Eighty patients with dyspepsia, normal upper gastrointestinal appearances at endoscopy and H pylori associated active chronic gastritis on histology of gastric antral biopsies were included in the trial. The patients were randomised to receive colloidal bismuth subcitrate 240mg twice daily for four weeks or matching placebo and were reassessed four weeks after completing treatment. Twenty-six patients (67%) receiving colloidal bismuth subcitrate had normal histology or improved inflammation compared with five (13%) receiving placebo (p less than 0.001), and symptoms were absent or improved in 32 (82%) and two (5%) respectively (p less than 0.001). Serum IgG level was a marker of infection, and fell with successful treatment. Colloidal bismuth subcitrate is effective treatment for H pylori associated non-ulcer dyspepsia with improved gastric antral histological appearances and has a beneficial effect on symptoms.

Topics: Adult; Anti-Ulcer Agents; Bismuth; Double-Blind Method; Dyspepsia; Female; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Organometallic Compounds; Prospective Studies

In a controlled, prospective, randomized trial, 10 patients with Helicobacter pylori positive gastritis were treated either with triple therapy (tetracycline, ornidazole, bismuth subcitrate; T, Or, CBS), or omeprazole/CBS (O/CBS) to test the eradication rate of each treatment, its effect on gastritis and meal stimulated gastrin release.. 6 patients were treated with triple therapy and 4 patients with O/CBS for 2 weeks. Initially, and 0.5, 1, 3, 6, and 12 months after therapy, patients were investigated by a highly specific, quantitative Helicobacter serology, 13C-urea breath test and measurement of meal-stimulated gastrin release. After 3 and 12 months antral biopsies were taken endoscopically for rapid urease testing and culture. Activity of histological gastritis was graded.. Eradication for at least 12 months was achieved in 5 out of 6 patients with triple therapy. Serology normalized and gastritis activity improved. In all patients treated with O/CBS, HP was suppressed only temporarily. No eradication was achieved. Urease testing and histology proved to be reliable tests for detecting HP. Culturing of HP was successful in only 66% due to technical problems. The 13C-urea breath test was correct in all cases. The initially, increased meal-stimulated gastrin release was normalized after eradication of HP.. (1) Triple therapy is also successful in short term treatment in up to 80% of patients with HP gastritis and improves gastritis activity. (2) The combination O/CBS failed to eradicate HP in all treated patients. (3) The 13C-urea breath test and HP serology are reliable non-invasive parameters during follow-up. (4) Normalization of meal stimulated gastrin release after eradication of HP supports the hypothesis that HP induces increased gastrin release and hyperacidity.

Topics: Antacids; Breath Tests; Drug Therapy, Combination; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Omeprazole; Organometallic Compounds; Ornidazole; Prospective Studies; Tetracycline; Urea

The relationship between Helicobacter pylori (HP) and gastric ulcer therapy is examined by analyzing both the data that suggest that eradication of HP renders the gastric mucosa less susceptible to development of gastric ulcer as well as the substantial body of evidence that does not support this contention. The results reported in clinical trials with colloidal bismuth citrate, antimicrobial agents (furazolidone), and combinations of anti-ulcer and antimicrobial agents (H2-antagonist+cefixime, H2-antagonist+metronidazole) are reviewed. Also analyzed is the relationship between HP eradication and ulcer recurrence. Only one study is available on this aspect, and the limited evidence it provides in favour of a prophylactic effect of eradication therapy is not entirely convincing. The authors conclude that there is no reasonable case for the dogmatic assumption that eradication of HP facilitates either acute healing or long-term prophylaxis of gastric ulcer, though certain subgroups of gastric ulcer patients may benefit from eradication therapy.

Topics: Anti-Bacterial Agents; Anti-Ulcer Agents; Cefixime; Cefotaxime; Cimetidine; Drug Therapy, Combination; Furazolidone; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Organometallic Compounds; Stomach Ulcer

Sixty patients with Helicobacter Pylori positive non ulcer dyspepsia were randomly allocated to one of the following treatment groups: Group I--norfloxacin 400 mg bid for 10 days, Group II--amoxycillin 500 mg bid plus tinidazole 500 mg bid for 15 days, Group III--colloidal bismuth subcitrate (CBS) 240 mg bid for 4 weeks. H pylori elimination was achieved in 14%, 81%, and 62% in Groups I, II and III respectively. Eradication of H pylori was not observed in Groups I and II, but was achieved in 25% of patients in Group III. Antral gastritis improved in 69% in Group II and 50% in Group III. We conclude that norfloxacin is not effective in H pylori infection. A combination of amoxycillin and tinidazole is highly effective in H pylori elimination with improvement in associated gastritis, but H pylori eradication is not observed with this therapy. CBS is also effective in H pylori elimination though H pylori eradication is achieved in only 25%.

Topics: Adult; Amoxicillin; Antacids; Anti-Bacterial Agents; Anti-Ulcer Agents; Drug Therapy, Combination; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Norfloxacin; Organometallic Compounds; Tinidazole

Sixty consecutive patients with endoscopically proven duodenal ulcers were given colloidal bismuth subcitrate tablets either as 120 mg q.d.s. or 240 mg b.d., in a randomized single-blind study. The efficacy of each regimen was determined by endoscopic examination and antral biopsy at 4 weeks; if the ulcer remained unhealed, treatment was continued and endoscopy repeated at 8 weeks. The ulcer-healing efficacy of the two regimens was identical; however, in the four times daily group only 27% remained Campylobacter pylori positive after 8 weeks of treatment compared with 58% of the twice-daily group. Similarly, only 21% of twice daily patients were free of histological gastritis compared with 42% of the four times daily patients.

Topics: Anti-Ulcer Agents; Colloids; Duodenal Ulcer; Endoscopy, Gastrointestinal; Gastritis; Helicobacter pylori; Humans; Organometallic Compounds; Single-Blind Method

The aim of this study was to determine the effect of colloidal bismuth subcitrate (De Nol) on symptoms and gastric histology in patients with non-ulcer dyspepsia. In a single centre trial, patients with food related upper abdominal pain not caused by ulcer disease were randomised to receive one tablet of colloidal bismuth subcitrate or matching placebo four times daily for eight weeks. Seventy three patients were entered and 51 completed the trial: 28 patients in the colloidal bismuth subcitrate group and 23 in the placebo group. Overall there was no difference between the two groups in terms of symptom relief. Among patients with histological gastritis (n = 23), however, those who took colloidal bismuth subcitrate used fewer antacid tablets (for three of four fortnightly periods) and were more likely to become asymptomatic (eight of 11 v three of 12, p less than 0.05); their gastritis was more likely to resolve (five of 10 v 0 of 12, p less than 0.025) and their gastric biopsies more likely to become negative for Helicobacter like organisms (eight of nine v 0 of 12, p less than 0.001) when compared with patients taking placebo. In contrast, patients who did not have gastritis in their index biopsies (n = 28) fared similarly whether they received colloidal bismuth subcitrate or placebo. Our results indicate that the administration of colloidal bismuth subcitrate benefited non-ulcer dyspepsia patients with gastritis but had no effect on those without.

Topics: Adult; Bismuth; Double-Blind Method; Dyspepsia; Female; Gastric Mucosa; Gastritis; Gastroscopy; Humans; Male; Middle Aged; Organometallic Compounds; Randomized Controlled Trials as Topic

Fifty consecutive patients with non-ulcer dyspepsia and a Campylobacter associated gastritis (CAG) were randomly assigned to treatment with colloidal bismuth subcitrate (CBS) 240 mg twice daily or placebo, according to a double blind study design. After the blind treatment an 'open' treatment with CBS was started in both groups. Twenty six patients treated with CBS showed a significant reduction in colonisation with Campylobacter pylori and a significant improvement in the Whitehead gastritis score. No significant changes were recorded in twenty four patients treated with placebo. After an additional course of CBS no further improvement in gastritis score was noted but there was a further reduction in Campylobacter colonisation. CBS did not greatly alter subjective complaints. Subjective complaints were improved in both treatment groups except for nausea and meteorism that improved more in the CBS treated patients. This finding again questions the clinical significance of gastritis and also casts doubt on the clinical relevance of therapeutical measures aimed at eradication of C pylori.

Topics: Adolescent; Adult; Aged; Antacids; Bismuth; Campylobacter Infections; Clinical Trials as Topic; Double-Blind Method; Dyspepsia; Female; Gastritis; Humans; Male; Middle Aged; Organometallic Compounds; Prospective Studies

Non-ulcer dyspepsia (NUD) is a common complaint in which no systematic illness or organic proximal alimentary tract disease can be identified. The pathophysiology of NUD is probably heterogeneous. Eighty-two subjects with NUD were studied in a prospective randomized placebo-controlled study to assess the efficacy of colloidal bismuth subcitrate (CBS) chewable tablets at a dose of four tablets daily for 1 month. The role of Campylobacter pylori and associated histological gastritis was evaluated. Sixty-one percent of NUD patients had C. pylori in the gastric antrum compared with 25% of age-matched controls. C. pylori was associated with acute and chronic inflammation (P less than 0.001) in the antrum. C. pylori was cleared in 59% of CBS-treated subjects compared with only 4% placebo (P less than 0.05). Both acute and chronic inflammation improved in subjects cleared of bacteria. Clearance of C. pylori and histological improvement was associated with a significant decrease in symptoms. In C. pylori negative subjects improvement in symptoms occurred in both the placebo and active treatment groups. This study would suggest that C. pylori and associated histological gastritis may play a role in non-ulcer dyspepsia.

Topics: Adult; Aged; Antacids; Campylobacter; Dyspepsia; Female; Gastritis; Humans; Male; Middle Aged; Organometallic Compounds; Prospective Studies; Randomized Controlled Trials as Topic

Topics: Anti-Ulcer Agents; Campylobacter Infections; Clinical Trials as Topic; Double-Blind Method; Dyspepsia; Gastritis; Humans; Organometallic Compounds

Antral biopsies were obtained to detect Campylobacter pylori infection in 382 patients referred for gastroscopy. One hundred and seventy four patients (46%) were infected. Infection was strongly associated with histological gastritis (p less than 0.001), but there was no association between histological antral gastritis and the appearance of the gastric antrum during gastroscopy. Because it has been suggested that the lower relapse rate for duodenal ulcer following colloidal bismuth subcitrate (CBS) is due to suppression of C pylori we investigated different formulations and dosing of CBS for their efficacy in clearing C pylori. Seventy four infected patients were prospectively assigned to therapy with pirenzepine (11 patients) or one of four regimens of CBS; one swallow tablet 4 times a day (11 patients); two swallow tablets twice daily (16 patients); two buffered swallow tablets twice daily (14 patients); or two chew tablets twice daily (22 patients). All patients treated with pirenzepine and one CBS swallow tablet 4 times a day were still infected after treatment. Infection was not detected in 16 patients taking twice daily doses of CBS; 8 (50%), 3 (21%) and 5 (23%) patients taking two standard, buffered or chew tabs twice daily respectively. Improvement of histological gastritis was observed only in those patients apparently cleared of C pylori (p less than 0.01) and this was due to a decrease in polymorphonuclear leukocytes. Nine patients apparently cleared of the infection were rebiopsied 44-137 days following treatment and 6 (66%) were found again to be infected. This study suggests that suppression of C pylori may vary with the formulation and dosing of CBS.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Adult; Biopsy; Bismuth; Campylobacter; Campylobacter Infections; Clinical Trials as Topic; Drug Administration Schedule; Female; Follow-Up Studies; Gastritis; Humans; Male; Middle Aged; Organometallic Compounds; Pilot Projects; Pirenzepine; Pyloric Antrum; Random Allocation; Recurrence

This double blind randomised study tested the effectiveness of colloidal bismuth subcitrate (De-Nol) in non-ulcer dyspepsia (NUD) and if any benefit is associated with clearance of Campylobacter pylori (C pylori) from the gastric mucosa. Sixty six patients with dyspepsic symptoms, normal abdominal ultrasound, and upper GI endoscopy, were randomly allocated to placebo or De-Nol for eight weeks. Antral biopsies were taken for bacteriological and histological examination, and endoscopies and clinical questionnaires were administered before and after treatment. Fifty two patients (25 on De-Nol and 27 on placebo) completed the trial. De-Nol cleared C pylori from 10 of the 12 C pylori positive patients (83.3%), whereas placebo did not clear C pylori from any of the eight C pylori positive patients (p less than 0.01). In patients receiving De-Nol gastritis improved (p less than 0.01) and symptomatic response was better (p less than 0.001) compared with placebo. In the placebo group seven of the 19 C pylori negative patients became positive: this was associated with significant deterioration of symptoms, a phenomenon not seen in the De-Nol treated group.

Topics: Adolescent; Adult; Antacids; Campylobacter; Clinical Trials as Topic; Double-Blind Method; Dyspepsia; Female; Gastritis; Humans; Male; Middle Aged; Organometallic Compounds; Stomach

To determine the clinical importance of Campylobacter pyloridis infection, its association with gastric inflammation, and the response to drug therapy, patients with a duodenal or gastric ulcer (n = 63), patients with nonulcer dyspepsia (n = 240), and asymptomatic volunteers (n = 34) were studied. In a prospective longitudinal study, the type, intensity, and distribution of inflammation in antral biopsy specimens were correlated with the presence of C. pyloridis. Campylobacter pyloridis was cultured from antral biopsy specimens in 98% of the ulcer patients, 70% of the nonulcer dyspepsia patients, and 20% of the asymptomatic volunteers. The dependency of chronic active gastritis on the presence of C. pyloridis was shown by an association of gastritis with positive culture and healing of gastritis with negative culture after various therapeutic regimens. Spontaneous disappearance of C. pyloridis never occurred. Colloidal bismuth subcitrate, amoxicillin, and the combination of colloidal bismuth subcitrate and amoxicillin were effective therapies in eradicating C. pyloridis. Recolonization with the same bacterial subtype and recurrence of gastritis frequently occurred within 1 mo after initial eradication. In this study we demonstrate ultimate normalization of gastric mucosa after successful eradication of C. pyloridis. Especially complete normalization of gastric mucosa after amoxicillin monotherapy provides additional strong evidence for a true cause-effect relationship between C. pyloridis colonization and gastritis.

Topics: Adult; Amoxicillin; Anti-Ulcer Agents; Campylobacter; Campylobacter Infections; Duodenal Ulcer; Dyspepsia; Female; Gastritis; Humans; Longitudinal Studies; Male; Middle Aged; Organometallic Compounds; Prospective Studies; Stomach Ulcer

Antral gastritis has been described in up to 100% of patients with duodenal ulcer disease, and recently has been associated with Campylobacter pylori infection. The present study examines the effect of two ulcer therapies (cimetidine and colloidal bismuth subcitrate) on this lesion. Sixty-four consecutive patients with endoscopically diagnosed duodenal ulcer were randomized to treatment with either agent upon entry into the study. Antral biopsies were taken at both initial and final endoscopies for culture of C. pylori and assessment of degree of gastritis (as based on inflammatory cell infiltrate: grades 0 to 3). The organism was detected in 90% of the patients at initial biopsy, and grades 2 and 3 gastritis were documented in 76%. The presence of the organism and the gastritis were significantly correlated (p less than 0.001), and the bacterium was not cultured from histologically normal antral mucosa. Active chronic gastritis (grade 3) was seen in 65% of those with C. pylori, and was not found in any patient without the bacterium. Cimetidine had no effect on either the organism or the gastritis, whereas the bismuth preparation significantly (p less than 0.002) reduced the prevalence of both. The present study documents that therapy directed against C. pylori has a significant effect on the gastritis of duodenal ulcer disease and possible mechanisms for the observed effects are discussed.

Topics: Adult; Anti-Ulcer Agents; Campylobacter Infections; Cimetidine; Drug Evaluation; Duodenal Ulcer; Female; Gastritis; Humans; Male; Organometallic Compounds; Random Allocation; Smoking

This study investigated the effect of colloidal bismuth subcitrate and cimetidine on Campylobacter pylori in peptic disease. In 74% of 135 patients with peptic disease diagnosed at endoscopy C pylori was detected before treatment. Compared with cimetidine, colloidal bismuth subcitrate significantly decreased the incidence of C pylori after six weeks of treatment (p less than 0.001). In the colloidal bismuth subcitrate group, subsequent healing of the lesion was correlated with the clearance of C pylori, unlike in the cimetidine group. C pylori was strongly associated with the presence of histological gastritis, which was decreased by colloidal bismuth subcitrate (p less than 0.001).

Topics: Adult; Campylobacter Infections; Cimetidine; Drug Therapy, Combination; Esophagitis; Female; Gastritis; Humans; Male; Organometallic Compounds; Peptic Ulcer; Prospective Studies; Random Allocation

Campylobacter pyloridis colonization of the stomach may be an etiological factor in gastritis and peptic ulceration. Campylobacter pyloridis produces large amounts of urease, and the presence of this enzyme in gastric mucosa usually indicates infection with the organism. In this paper we describe the use of a rapid urease test (CLOtest) to detect C. pyloridis infection in gastric mucosal biopsies. In 141 consecutive endoscopy cases, antral biopsies were taken for culture and histology, and an extra biopsy was inserted into the CLOtest gel. There were 79 patients infected with C. pyloridis, 78 of whom were detected by CLOtest: 75% were positive at 20 min, 92% at 3 h, and 98% at 24 h. There were no false positive results. Eighteen infected patients were rebiopsied after a course of amoxycillin and bismuth subcitrate. Active chronic gastritis resolved in eight of nine who were cleared of the organism, but histological gastritis was unchanged in nine patients who were still infected. CLOtest is a simple, sensitive, and highly specific test that enables the endoscopist to diagnose C. pyloridis infection in the endoscopy room. A negative test after antibiotic therapy correlates with clearance of the bacteria and healing of active gastritis.

Topics: Amoxicillin; Antacids; Campylobacter; Campylobacter Infections; Clinical Trials as Topic; Double-Blind Method; Evaluation Studies as Topic; Gastritis; Gastroscopy; Humans; Organometallic Compounds; Pilot Projects; Urease

The pathophysiology of gastric ulcer and gastritis has been related to an increase in damaging factors such as duodeno-gastric reflux and anti-inflammatory drugs. A decreased capacity for mucosal prostaglandin generation is highly likely. Acid secretion is usually normal or even reduced. Colloidal bismuth subcitrate (CBS) has been shown to increase gastric mucosal defence. In controlled trials a clear superiority over placebo has been demonstrated. Amalgamation of the data shows an average healing rate of about 70% in gastric ulcer, which is statistically significantly higher than that for cimetidine in comparative trials. The therapeutic gain (the difference between the healing rate of drug and placebo in a direct comparison) of CBS is high compared with other anti-ulcer agents. In campylobacter gastritis we have shown that the microorganism is very sensitive to CBS, and its eradication results in histological improvement.

Topics: Bismuth; Campylobacter; Clinical Trials as Topic; Gastritis; Humans; Organometallic Compounds; Stomach Ulcer

The resistance of Helicobacter pylori to antibiotics is a growing problem in Spain and eradication rates must be improved. The new Spanish consensus considers quadruple therapy with bismuth as first- or second-line therapy. This study evaluated the use of Pylera. A cross-sectional descriptive study was conducted to evaluate the eradication rate of Helicobacter pylori in patients treated with Pylera. A total of 185 patients were included (51.6±16.19 years); 63.8% were women and 9.2% had a family history of gastric cancer. The most frequent indication was dyspepsia (55.1%). Approximately 57.8% received Pylera. Pylera

Topics: Adult; Aged; Breath Tests; Cross-Sectional Studies; Drug Evaluation; Drug Therapy, Combination; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Omeprazole; Organometallic Compounds; Recurrence; Retrospective Studies; Tetracycline; Treatment Outcome; Young Adult

The European Helicobacter Study Group has recently issued the current concepts in the management of Helicobacter pylori infection (Maastricht III Consensus Report, 2005). The aim of the study was to examine the cumulative H. pylori eradication rates that can be achieved in clinical practice by adopting first and second regimens as proposed by the Maastricht III consensus and a third-line empirical levofloxacin-based regimen.. H. pylori-positive patients were treated initially with a first-line eradication triple regimen consisting of omeprazole, amoxicillin, and clarithromycin and subsequently with a second-line quadruple regimen consisting of omeprazole, bismuth, metronidazole, and tetracycline. Finally, after two previous H. pylori eradication failures, patients received omeprazole, amoxicillin, and levofloxacin, as a third-line empirical strategy. The success rate was calculated by both intention-to-treat (ITT) and per protocol (PP) analyses.. In total, 540 consecutive H. pylori-positive patients received first-line treatment (omeprazole, amoxicillin, and clarithromycin). H. pylori were eradicated in 380 patients and 40 patients were withdrawn (ITT, 70.3%; PP, 76%). The remaining 120 H. pylori-positive patients received second-line treatment (omeprazole, bismuth, metronidazole, and tetracycline). H. pylori were eradicated in 83 patients and 7 patients were withdrawn (ITT, 69.1%; PP, 73.45%). Finally, the remaining 30 H. pylori-positive patients received third-line treatment (omeprazole, amoxicillin, and levofloxacin). H. pylori were eradicated in 21 patients and 0 patients were withdrawn (ITT, 70%; PP, 70%). Thus, out of 540 patients initially included in the study, H. pylori were eradicated in 484 patients, 47 were withdrawn, and only 9 remained positive. These results give 89.6% ITT and 98.1% PP cumulative H. pylori eradication rates.. By adopting first- and second-line regimens, as proposed by the Maastricht III consensus and a third-line levofloxacin-based empirical regimen, high cumulative H. pylori eradication rates can be achieved. Thus, a substantial number of cultures to determine sensitivity to antibiotics can be avoided with beneficial consequences concerning cost.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Anti-Ulcer Agents; Drug Therapy, Combination; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Organometallic Compounds; Practice Guidelines as Topic; Proton Pump Inhibitors; Young Adult

Helicobacter pylori infection, is seen in more than 80% of adult population in Turkey. The aims of this study were 1) to evaluate the importance of the diagnostic tests 2) to investigate the relationship between Hp infection and functional dyspepsia.. A total 75 patients with functional-dyspepsia were involved into the study. Hp infection was diagnosed by histopathological examination. CLO, cytology, culture, stool antigen and breath test. Symptom score using ROME II criteria was also evaluated to all patients. All patients were taken ranitidine-bismuth-citrate (400mg bid/day), clarithromycin (500 mg bid/day) and amoxicillin (1000 mg bid/day) for 14 days. All tests and symptom score analyses were re-applied at month 1 and 6.. The eradication rate was 95.9%. The baseline specifity of breath test, CLO, cytology, culture and stool antigen were 87.3%, 95.4%, 95.4% 94.5% and 86.4%, respectively. The sensitivity of such tests at first month after stopping the treatment were 86.1%, 100%, 100%, 100%, 84.7%, respectively, and were 91.6%, 100%, 100%, 100%, 87.5%, respectively at six months after treatment. Symptom scores were 29.6+/-5.4, 15.8+/-4.7 and 17.9+/-5.3 at baseline, first month and six months after treatment, respectively (p<0.001).. The success of eradication may be related to use of bismuth which prevents antibiotic resistance development. Stool antigen and breath tests are less effective than invasive diagnostic-tests. The finding of improved symptomscores after eradication suggests that Hp may play a role in functional dyspepsia.

Topics: Adolescent; Adult; Aged; Amoxicillin; Antacids; Anti-Bacterial Agents; Anti-Ulcer Agents; Antigens; Biopsy; Breath Tests; Clarithromycin; Colony Count, Microbial; Cytological Techniques; Dyspepsia; Endoscopy, Gastrointestinal; Feces; Female; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Organometallic Compounds; Prospective Studies; Ranitidine; Sensitivity and Specificity; Treatment Outcome; Young Adult

Current combination therapies cure Helicobacter pylori infection in 75 to 85% of cases. However, many treatment failures are not explained by antibiotic resistance. Our goal was to explore treatment failures under in vivo conditions by using the H. pylori Sydney strain (SS1) mouse model. Mice infected with H. pylori (SS1) were treated with monotherapies or combination therapies used in human trials. Bacterial levels and distribution of organisms within the stomach were assessed 24 h after treatment to determine clearance and location of treatment failures and 29 days after treatment to determine cure rates. Except for treatment with metronidazole, mono- and dual therapies did not cure infection but resulted in decreases in bacterial levels and differences in distribution within the stomach. In cases of treatment failure when clarithromycin was used, omeprazole and dual therapy with omeprazole and amoxicillin resulted in organisms being cleared from the antrum, but organisms remained in the antrum-body transitional zone. The triple therapies of OMC and bismuth subcitrate, metronidazole, and tetracycline were successful in eradicating infection. Except for metronidazole monotherapy and triple therapy with OAC, there was good correlation between the Sydney strain mouse model and humans with respect to the success of antimicrobial therapy. The antrum-body transitional zone was identified as a sanctuary site in treatment failure. This could result from antimicrobial agents not functioning effectively at this site or bacteria in this location expressing products that protect them against antimicrobial agents. This is the first demonstration of a possible sanctuary site as a reason for failure of therapy.

Topics: Amoxicillin; Animals; Anti-Bacterial Agents; Anti-Ulcer Agents; Clarithromycin; Disease Models, Animal; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Metronidazole; Mice; Mice, Inbred C57BL; Microbial Sensitivity Tests; Omeprazole; Organometallic Compounds; Penicillins; Pyloric Antrum

In this pilot study we investigated the efficacy and tolerability of a new monocapsule that contains a bismuth compound, tetracycline, and metronidazole. If proven to be effective, this monotherapy would turn the well-accepted multidrug regimen of standard bismuth-based triple therapy into an easy and more patient-friendly regimen. It can be used in patients allergic to penicillin.. A total of 53 consecutive H. pylori-infected patients (30 with proven ulcer disease, 23 with gastritis only) from a single center were prescribed two monocapsules q.i.d. after the three meals and after an evening snack during 10 days. Each capsule contained 60 mg colloidal bismuth subcitrate (as Bi2O3 equivalent), 125 mg tetracycline, and 125 mg metronidazole. Repeat endoscopy with biopsies for urease test, Giemsa stain, and culture was carried out > or =5 wk later. Side effect data were collected.. One patient was lost to follow-up, two failed to respond, and 50 were cured. The intention-to-treat cure rate was 50 of 53 (94.4%, 95% CI 88.1-100%). Antibiotic sensitivity was available from 51 isolates. The cure rate in the metronidazole sensitive strains was 44 of 45 (97.8%, 95% CI: 93.5-100%), whereas it was four of five in the resistant strains. The regimen was well tolerated, with only two drop-outs (4%) because of side effects.. The new monocapsule is an inexpensive, well tolerated, and patient-friendly formulation of a bismuth based triple therapy. A 10-day course with this multidrug capsule reached a very high cure rate in metronidazole-sensitive strains. The number of cases with resistant strains was insufficient to allow firm conclusions about its efficacy in case of resistance. The results are in agreement with previous data with bismuth triple therapy using separate drugs. From the high cure rate, we can conclude that the new capsule dissolves adequately, with proper delivery of its ingredients at the site of action.

Topics: Adult; Aged; Anti-Ulcer Agents; Capsules; Female; Gastritis; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Organometallic Compounds; Peptic Ulcer; Pilot Projects; Tetracycline; Treatment Outcome

In a 2- to 4-year prospective study, the reversibility of gastritis after Helicobacter pylori eradication was analysed. Sixty-three H. pylori-positive, chronic duodenal ulcer patients were studied after the successful eradication of bacteria in the period from 1990 to 1993. H. pylori eradication was obtained by triple antimicrobial regimens (colloidal bismuth subcitrate, amoxycillin, and metronidazole) applied for at least 14 days. The criteria for eradication were the absence of bacteria from two antral and two body of stomach biopsies stained with haematoxylin, eosin, and Warthin Starry, and a negative antral biopsy culture. The same diagnostic procedures were repeated, at regular follow-up endoscopies, each year for up to 4 years. Neutrophil-granulocyte infiltration of gastric mucosa disappeared in 2 months after bacterial eradication. Mononuclear cellular infiltration was disappearing with statistical significance up to the second year and normal mucosa was observed in the majority of patients in the fourth year of follow-up. Degeneratively changed lymphoid aggregates were also present in the fourth year in the antrum (12.5 per cent of patients) and in the body of stomach (14 per cent of patients). There was no significant change in antral intestinal metaplasia during the 4 years of follow-up. Antral atrophy declined significantly in the period from 1 to 3 years of follow-up. In conclusion, 3-4 years are needed for gastric mucosa to become normal after H. pylori eradication, although some residual lymphoid aggregates persist even after that period.

Topics: Adult; Aged; Amoxicillin; Drug Therapy, Combination; Duodenal Ulcer; Female; Follow-Up Studies; Gastric Mucosa; Gastritis; Helicobacter; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metaplasia; Metronidazole; Middle Aged; Organometallic Compounds; Prospective Studies; Statistics, Nonparametric

Topics: Abdominal Pain; Adolescent; Adult; Age Factors; Amoxicillin; Antacids; Anti-Bacterial Agents; Anti-Ulcer Agents; Antibodies, Bacterial; Child; Chronic Disease; Clarithromycin; Clinical Trials as Topic; Drug Therapy, Combination; Duodenal Ulcer; Endoscopy; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Omeprazole; Organometallic Compounds; Penicillins; Recurrence; Risk Factors; Stomach Ulcer

Thirty-eight clinical strains of Helicobacter pylori were isolated from patients with chronic gastritis and gastroduodenal ulceration, and their susceptibility to macrolide antibiotics (roxithromycin, flurithromycin, azithromycin, erythromycin) in combination with proton-pump inhibitors (lansoprazole and omeprazole) and bismuth subcitrate was assayed. Chequerboard titration was used to analyse the results of antimicrobial interactions and showed that the activity of macrolides was enhanced by combining them with lansoprazole, omeprazole or, to a lesser extent, bismuth subcitrate. While the interactions between erythromycin and the proton-pump inhibitors or bismuth subcitrate were always additive, the combinations of roxithromycin-lansoprazole, flurithromycin-omeprazole and azithromycin-lansoprazole acted synergically on 82%, 60% and 60% of H. pylori strains, respectively. These results may, in part, account for the enhanced clinical efficacy of macrolides administered with proton-pump inhibitors in the treatment of H. pylori-associated diseases.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Anti-Bacterial Agents; Anti-Ulcer Agents; Azithromycin; Drug Synergism; Erythromycin; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Lansoprazole; Microbial Sensitivity Tests; Omeprazole; Organometallic Compounds; Peptic Ulcer; Proton Pump Inhibitors; Roxithromycin

The aim of the present study was to evaluate the efficacy and the safety of a short-term regimen (weekend therapy) in the cure of Helicobacter pylori infection and to analyze the factors that may influence the success of the treatment.. Seventy-one patients with gastric colonization by a tinidazole sensitive H. pylori strain (34 duodenal ulcer and 37 nonulcer dyspepsia) received omeprazole 40 mg o.m. for 7 days (from Monday to Sunday) and bismuth 240 mg q.i.d. + amoxicillin 1000 mg/q.i.d. + tinidazole 500 mg q.i.d. for only 2 days (Saturday and Sunday). Endoscopy, histology, culture, urease test, and susceptibility studies were done at entry and 30 days after treatment.. Successful eradication was obtained in 84% of patients. The percentage of eradication was higher in duodenal ulcer patients (94%) than in those with nonulcer dyspepsia (74%; p < 0.05), and in patients who received the treatment during hot weather (94%) than in those who received the treatment during cold weather (74%; p < 0.05). Side-effects were induced by the treatment in 17% of patients, and these were all not severe, self-limiting, short-lasting, and did not require specific treatment.. These data suggested that weekend therapy with high doses of drugs represents an effective, safe, and inexpensive therapeutic approach for the treatment of H. pylori infection, particularly in patients with duodenal ulcer. Furthermore, they also confirm the relevant role that short-term treatments may play in the therapeutic approach to H. pylori infection, and highlight some important aspects influencing short-term schedules.

Topics: Adult; Aged; Amoxicillin; Antacids; Anti-Bacterial Agents; Anti-Ulcer Agents; Drug Administration Schedule; Drug Therapy, Combination; Duodenal Ulcer; Dyspepsia; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Omeprazole; Organometallic Compounds; Penicillins; Tinidazole

The current standard of Helicobacter pylori treatment has been confirmed by the studies presented at the Lisbon workshop--that is, one of three one week proton pump inhibitor (PPI) based triple therapies comprising a twice daily standard dose of a PPI in combination with two of the following antimicrobial agents: clarithromycin, amoxycillin, or a nitromidazole. This standard of treatment is also highly efficacious and cost-effective in routine community practice. The current data confirm the equivalence of ranitidine bismuth citrate to PPI, and of azithromycin to clarithromycin. The optimum dose for azithromycin has not yet been defined. There is some evidence that in certain regions treatment for more than one week may be advantageous. The reasons are still not clear. However, microbial resistance may be one important factor, as it has a substantial effect on treatment outcome and the prevalence of resistance varies considerably in different areas. The negative impact of resistance is increased by shortening the treatment time. At present, there is no general necessity to test for resistance before treatment. However, before selection of a second line treatment, testing for resistance is recommended.

Topics: Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Clinical Trials as Topic; Drug Therapy, Combination; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Organometallic Compounds; Portugal; Proton Pump Inhibitors; Ranitidine

Azithromycin, a new antibiotic chemically related to erythromycin, has been proposed for the cure of Helicobacter pylori, achieving high gastric tissue levels (above the MIC for H. pylori) after oral administration. The aim of the study was to establish whether azithromycin plus metronidazole in association with either omeprazole or bismuth subcitrate is useful in curing H. pylori infection of the stomach.. The study involved 132 dispeptic patients who proved to be H. pylori infected by antral and corpus histology (Giemsa, modified) and rapid urease test (CLOtest); the Sydney system was used to classify the gastritis. Sixty-three patients received bismuth subcitrate 120 mg q.i.d. for 14 days plus azithromycin 500 mg o.d. for the first 3 days plus metronidazole 250 mg q.i.d. for the first 7 days; 69 patients received omeprazole 40 mg for 14 days plus azithromycin 500 mg o.d. for the first 3 days plus metronidazole 250 mg q.i.d. for the first 7 days. Patients were well matched for common clinical variables. Cure of H. pylori infection was assessed by the same methods 2 months after completion of treatment.. Eleven patients dropped out of the study, only one reporting side effects (nausea, vomiting, and epigastric pain). Cumulative "per protocol" cure rate was 66.1% (CI 95%, 58.5-75.3%). There was no statistically significant difference between the two treatment groups: 58.9% (CI 95% 48.4-74.6%) versus 72.3% (CI 95%, 60.7-82.5%). Intention to treat does not substantially modify results. Few side effects were recorded. Cured patients showed a significant reduction in the activity of gastritis.. Azithromycin, combined with omeprazole and metronidazole, the cure rate of H. pylori was about 70%. The cure of H. pylori infection improves the activity of gastritis.

Topics: Adult; Aged; Antacids; Anti-Bacterial Agents; Anti-Ulcer Agents; Azithromycin; Drug Therapy, Combination; Dyspepsia; Female; Follow-Up Studies; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Omeprazole; Organometallic Compounds; Time Factors

Topics: Adolescent; Amoxicillin; Anti-Ulcer Agents; Child; Child, Preschool; Drug Administration Schedule; Drug Therapy, Combination; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Omeprazole; Organometallic Compounds; Penicillins

Hepatocyte growth factor (HGF) is increasingly recognized for its role in a variety of hepatic and systemic diseases. Its relationship to gastritis has not been studied. We aimed at measuring gastric mucosal HGF levels in the presence or absence of Helicobacter pylori gastritis, in peptic ulcers, and in response to H. pylori eradication.. Fifty one patients were studied. Patients were not entered if they had liver disease, malignancy, or any systemic illness. HGF was measured in gastric antral incubates using an enzyme-linked immunosorbent assay. Assessments were repeated 6 wk after a 2-wk course of anti-H. pylori triple therapy in 12 patients. Code numbers were used for blinding.. The median gastric mucosal HGF level was 36 ng/gm/tissue in patients with H. pylori gastritis (n = 33) compared with 19 ng/gm in 18 negative controls (p = 0.0024), 18 ng/gm after the eradication of H. pylori (p = 0.021), 23 ng/gm in all patients with ulcers (n = 10), and 26 ng/gm/tissue in H. pylori-positive ulcers (n = 7).. Gastric mucosal HGF levels were elevated in H. pylori gastritis and reduced by its eradication. These results are relevant to our understanding of the increased gastric cell proliferation in patients with H. pylori-related gastritis.

Topics: Adult; Amoxicillin; Anti-Ulcer Agents; Biopsy; Drug Therapy, Combination; Female; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Hepatocyte Growth Factor; Humans; Male; Metronidazole; Middle Aged; Organometallic Compounds; Penicillins; Peptic Ulcer; Statistics, Nonparametric; Time Factors

Standard triple therapy remains the recommended first line treatment for Helicobacter pylori in New Zealand. The real eradication rate achieved in busy hospital clinics may be different from data obtained from clinical trials outside of New Zealand.. One hundred and thirty patients with proven H pylori infection (by at least two tests) were treated with low dose triple therapy (DeNol 1 qid, tetracycline 250 mg qid and metronidazole 200 mg qid for 2 weeks; dosing with meals and at night); 83 were given a standard prescription for triple therapy (dispensed in bottles) and 47 were given a medication pack with times of dosing clearly marked. Eradication was proven by a negative 13C urea breath test at least 4 weeks after finishing treatment.. Follow up urea breath test was obtained in 120 patients (92%). The eradication rate for separate bottles was 79% and for the medication pack 76%. Compliance was estimated to be greater than 90% in 92% of patients who attended for followup. H pylori culture and sensitivity results were available for 41 patients. Overall rate of metronidazole resistance was 32%. The eradication rate for metronidazole sensitive strains was 89% and for resistant strains 46%. Mild side effects were reported in 10% and moderate side effects in 10%. No patient stopped treatment because of side effects. There was no effect of age, ethnicity, smoking, alcohol intake, pretreatment with H2-antagonists or endoscopic diagnoses on eradication rates.. The low dose triple therapy has an acceptable real eradication rate. The most important determinant of success was metronidazole resistance. The eradication rate was not improved by using medication packs.

Topics: Adult; Aged; Anti-Bacterial Agents; Antitrichomonal Agents; Drug Therapy, Combination; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Medical Audit; Metronidazole; Middle Aged; Organometallic Compounds; Patient Compliance; Peptic Ulcer; Tetracycline; Treatment Outcome

The aim of this study was to assess the clinical outcome of two different durations of triple therapy in children with Helicobacter pylori infection. We established two treatment groups: 1) Short treatment, including 2 week of bismuth subcitrate, amoxycillin and metronidazole treatment (n = 21) and 2) Long treatment, which included the same therapy for two weeks plus bismuth subcitrate alone for two weeks more (n = 26). We found no difference between the short and long treatments. The infection remained in 14% and 19%, respectively. In both groups, we observed children (19%) with persistent abdominal pain in spite of Helicobacter pylori eradication and gastritis healing. We conclude that it is not necessary to prolong triple therapy more than 2 weeks in order to have therapeutic success.

Topics: Adolescent; Amoxicillin; Anti-Bacterial Agents; Bismuth; Child; Child, Preschool; Drug Evaluation; Drug Therapy, Combination; Duodenitis; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Organometallic Compounds; Penicillins; Time Factors

To study the concordance between 13C-urea breath test and histology in the diagnosis of Helicobacter pylori infection, and to evaluate whether there is a correlation between breath test values and histologic lesions of the gastric mucosa.. Sixty-nine patients with duodenal ulcer were prospectively studied. An endoscopy with biopsy samples (H&E stain) taken from the antrum and body was performed, and a 13C-urea breath test (measuring 13C difference: delta 13CO2) was also done. Both procedures were repeated one month after completing therapy ["classic" triple therapy (n = 28), and omeprazole+amoxycillin (n = 41)]. Eradication was defined as the absence of H. pylori both by histological and breath test methods.. At the beginning of the study, 94.2% of patients (n = 65) were H. pylori positive by histological methods, and 98.6% (n = 68) were positive by the breath test (ratio of positive agreement = 0.96). Kappa for H. pylori diagnosis after therapy was 0.83 (95% CI: 0.69-0.96). A correlation between delta 13CO2 and histologic lesions was observed, both in the antrum at before treatment (Spearman coef = 0.34; p = 0.007) and after therapy in both the gastric antrum (0.63; p < 0.001) and body (0.35; p = 0.005). A significant difference was observed when comparing mean delta 13CO2 in patients with different degrees of histologic gastritis, both before treatment (antrum: W Kruskal-Wallis = 6; p < 0.05) and after therapy (antrum: W = 17; p < 0.001; body: W = 10; p < 0.05).. A high concordance was observed between the 13C-urea breath test and histology in the diagnosis of H. pylori infection. A correlation exists between breath test values and histologic lesions of the gastric mucosa.

Topics: Adult; Amoxicillin; Antacids; Anti-Bacterial Agents; Anti-Ulcer Agents; Biopsy; Breath Tests; Drug Therapy, Combination; Duodenal Ulcer; Endoscopy; Female; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Omeprazole; Organometallic Compounds; Penicillins; Prospective Studies; Tetracycline

In the present study, the effectiveness of a triple therapy for eradication of Helicobacter pylori was evaluated. Therapy consisted of 120 mg tripotassium dicitrato bismuthate q.d.s. for four weeks, 500 mg amoxycillin q.d.s. and 500 mg metronidazole t.d.s. for two weeks. In 77 Helicobacter pylori-positive patients with duodenal ulcers (n = 32), gastritis (n = 18) and after gastric resection (n = 7), rapid urease-based test, culture, histology and serology were used to confirm the eradication, or relapse. The overall eradication rate was 75.3%, ulcers were healed in 82.1% and an improvement of the endoscopic gastritis was observed in 75.3% of the patients. The eradication rates were not statistically different among the subgroups. 1-3 months after the treatment IgG titres had fallen by 25% and over in 67.5% of the patients irrespective of the success of bacterial eradication. Side effects, particularly diarrhoea and nausea, were common (53.2%) but mild. Only 6.5% of the patients' had to discontinue the treatment because side effects became intolerable.

Topics: Adult; Aged; Aged, 80 and over; Amoxicillin; Anti-Bacterial Agents; Drug Administration Schedule; Drug Therapy, Combination; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Organometallic Compounds; Stomach Ulcer; Treatment Outcome

Topics: Antacids; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Duodenal Ulcer; Duodenitis; Evaluation Studies as Topic; Gastritis; Gastroesophageal Reflux; Helicobacter Infections; Helicobacter pylori; Humans; Organometallic Compounds; Peptic Ulcer; Stomach Ulcer; Time Factors

This study tested the influence of pretreatment bacterial density on the eradication rate of Helicobacter pylori with triple therapy. One hundred and thirty two patients with endoscopically confirmed H pylori positive, duodenal ulcer or antral gastritis were treated with triple therapy (colloidal bismuth/metronidazole/amoxicillin) for two weeks. Pretreatment urease activity was assessed by the 14C-urea breath test (UBT) in all patients. The mean (SD) pretreatment UBT concentration was similar in patients with duodenal ulcers (318.4 (175.0)) and patients with antral gastritis (288.9 (165.5)). Overall eradication of H pylori was achieved in 85 of 132 patients (64.4%), but was significantly different between patients with high, intermediate, or low pretreatment urease activity (37.5%, 69.5%, and 87.8% respectively). The mean post-treatment UBT value of patients in whom eradication failed was in direct correlation with the pretreatment UBT values. In conclusion, bacterial density, as assessed by urease activity, is an important factor in predicting H pylori eradication. It is suggested that the pretreatment UBT has the potential to identify patients who require modification of the standard therapeutic regimen.

Topics: Amoxicillin; Anti-Bacterial Agents; Anti-Ulcer Agents; Breath Tests; Chronic Disease; Colony Count, Microbial; Drug Therapy, Combination; Duodenal Ulcer; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Organometallic Compounds; Urea; Urease

Helicobacter pylori causes chronic (type B) gastritis. The 'intestinal' form of gastric cancer arises against a background of chronic gastritis, and prospective epidemiological studies have shown that H pylori is a major risk factor for this. An increase in mucosal cell proliferation increases the likelihood of a neoplastic clone of epithelial cells emerging where there is chronic epithelial cell injury associated with H pylori gastritis. In vitro bromodeoxyuridine labelling of endoscopic antral biopsy specimens was used to measure mucosal cell proliferation in H pylori associated gastritis before and after therapy for H pylori triple infection. Cell proliferation was increased in H pylori associated gastritis patients compared with normal controls and patients with H pylori negative chronic gastritis (p = 0.0001; Tukey's Studentised range). There was no difference in antral epithelial cell proliferation between duodenal ulcer and non-ulcer subjects infected with H pylori (p = 0.62; Student's t test). Antral mucosal cell proliferation fell four weeks after completing triple therapy, irrespective of whether or not H pylori had been eradicated (p = 0.0001). At retesting six to 18 months later (mean = 12 months), however, those in whom H pylori had not been successfully eradicated showed increased mucosal proliferation compared with both H pylori negative subjects at a similar follow up interval and all cases (whether H pylori positive or negative) four weeks after completion of triple therapy (p = 0.024). These findings suggest that H pylori infection causes increased gastric cell proliferation and in this way may play a part in gastric carcinogenesis.

Topics: Adult; Cell Division; Chronic Disease; Drug Therapy, Combination; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Immunohistochemistry; Metronidazole; Organometallic Compounds; Tetracycline

H. pylori has recently been recognized as a novel risk factor of gastric cancer, but its precise role in gastric carcinogenesis is as yet unknown. The aim of the present study was to assess the relationship between H. pylori infection and vitamin C levels in gastric juice and also to examine whether eradication of H. pylori could have any impact on these levels. Gastric juice and plasma vitamin C levels were measured in 88 dyspeptic patients who had an upper gastrointestinal endoscopy. In the subgroup of H. pylori-positive patients, eradication was attempted with triple therapy. This subgroup was studied on two occasions, ie, before and after treatment. There were 58 H. pylori-positive and 30 -negative patients. Gastric juice vitamin C levels in H. pylori-positive patients were statistically lower (P < 0.001) than the levels in the H. pylori-negative patients. Triple therapy achieved eradication in 45 patients (77.6%) of the 58 H. pylori-positive patients. Before H. pylori was eradicated in these 45 patients gastric juice vitamin C levels were significantly (P < 0.001) lower than those after eradication, the latter being no different than the group of 30 H. pylori-negative patients. There was a significant (P < 0.001) improvement of gastritis after eradication, which paralleled the elevation of gastric juice vitamin C levels. No difference was noted in plasma vitamin C levels between H. pylori-negative and -positive patients or in the latter before and after H. pylori treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Ascorbic Acid; Bismuth; Drug Therapy, Combination; Female; Gastric Juice; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Organometallic Compounds; Stomach Neoplasms

Topics: Aged; Anti-Bacterial Agents; Anti-Ulcer Agents; Drug Therapy, Combination; Duodenal Ulcer; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Omeprazole; Organometallic Compounds; Pyloric Stenosis; Tetracycline

The bismuth concentration was measured in the blood and urine of 21 children from 8 to 17 years old (13.12 +/- 2.67) treated with Ventrisol (Polfa)-tripotassium dicitrato bismuthate (TDB). One tablet of TDB-equivalent to 120 mg Bi2O3. One tablet was given orally to the patients four times a day. Blood and urine was taken for measurement of bismuth concentration in the morning, on fasting, before the administration of Ventrisol on the 6-8 days, the 27-28 days of the therapy and in the 4-5, 8-9 weeks after TDB therapy. The reason for TDB treatment was chronic gastritis and/or duodenal ulcers, which were diagnosed by endoscopic examination. No bismuth in the blood and a very low concentration in the urine were determined in 19 children before TDB treatment. After 6-8 days of TDB treatment the bismuth concentration in the blood was 40.85 +/- 31.05 micrograms/L and 75.11 +/- 82.07 micrograms/L in the urine. In the 27-28 days of the treatment the bismuth concentration in the blood was 37.67 +/- 25.06 micrograms/L, and 163.56 +/- 181.86 micrograms/L in the urine. In the 4-5 weeks after the TDB treatment the bismuth concentration in the blood was 7.77 +/- 10.56 micrograms/L, and 15.72 +/- 9.87 micrograms/L in the urine. The bismuth concentration level in the urine rose together with the rise of the bismuth concentration level in the blood, the correlation factor was r = 0.68. No symptoms of side effects caused by the TDB treatment were observed. Before the treatment a high bismuth concentration was found in the blood of two patients. These cases are discussed later.

Topics: Adolescent; Bismuth; Child; Duodenal Ulcer; Gastritis; Humans; Organometallic Compounds; Pilot Projects

Helicobacter pylori was cultured and Helicobacter-like organisms (HLO) were seen in 6 (16%) of 37 children with recurrent abdominal pain. Five children had concomitant histological inflammation, but none had endoscopic changes. All 6 children demonstrated positive serology. Compared with the total group, they were more often from developing countries, larger families and lower social groups. Treatment with phenoxymethyl penicillin and colloidal bismuth subcitrate did not result in side effects or elevated serum levels of serum bismuth. Three children demonstrated metronidazole-resistant strains and the treatment of these children remained an unsolved problem. Among the 31 H. pylori/HLO negative children 8 (26%) demonstrated histological changes, 5 (16%) endoscopic changes and 11 (35%) had positive serology. In conclusion, pathological findings at upper gastrointestinal endoscopy are common in children with recurrent abdominal pain. Because of disconcordance between endoscopy, histology and culture, we recommend that biopsies should always be taken to clarify the diagnosis.

Topics: Abdominal Pain; Adolescent; Anti-Ulcer Agents; Biopsy; Child; Child, Preschool; Endoscopy, Gastrointestinal; Female; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Organometallic Compounds; Recurrence

A human in vitro model to study the interaction between Helicobacter pylori and gastric epithelial cells was developed using primary cultures of gastric mucosal cells (isolated from gastric biopsies or operative specimen and maintained in culture for 2 weeks) as well as the well-differentiated human gastric carcinoma cell line HM02, the undifferentiated gastric tumour cell line HM51, and the laryngeal epithelial cell line HEp-2. Primary cultures and all cell lines were exposed to seven isolates of H. pylori isolated from gastritis and duodenal ulcer patients. Microbial adherence was assessed by microscopical evaluation of Giemsa-stained preparations and by culturing the viable bacteria attached to the epithelial cells. All H. pylori isolates adhered to the gastric cells in primary culture, to HM02 cells, and to HEp-2 cells with the greatest binding affinity found in primary gastric cells. No adherence was detected in HM51 cells. H. pylori adherence was dependent on bacterial load, incubation time, and temperature. There was no difference in microbial binding between H. pylori isolates derived from gastritis and duodenal ulcer patients. The effect of antiulcer drugs on H. pylori adherence was investigated by pre-incubating isolates of H. pylori with omeprazole, cimetidine, and bismuth subcitrate. Omeprazole and cimetidine failed to significantly influence microbial adherence. In contrast, bismuth subcitrate already in concentrations below the MIC range decreased H. pylori adherence in gastric epithelial cells and in HEp-2 cells substantially. Our study shows that primary cultured human gastric mucosal cells and the human gastric carcinoma cell line HM02 provide suitable in vitro models for the study of the interactions between H. pylori and the gastric epithelium. This gastric cell model is characterized by a high affinity for H. pylori binding.

Topics: Anti-Ulcer Agents; Bacterial Adhesion; Carcinoma; Cells, Cultured; Cimetidine; Duodenal Ulcer; Epithelial Attachment; Epithelial Cells; Epithelium; Gastric Mucosa; Gastritis; Gastrointestinal Neoplasms; Helicobacter Infections; Helicobacter pylori; Humans; Laryngeal Neoplasms; Microscopy, Phase-Contrast; Omeprazole; Organometallic Compounds; Tumor Cells, Cultured

Metronidazole-susceptible pretreatment isolates and metronidazole-resistant posttreatment isolates of Helicobacter pylori from 11 patients before and after unsuccessful triple therapy consisting of metronidazole, amoxicillin, and colloidal bismuth subcitrate were studied. Ribotyping (rRNA gene restriction pattern analysis) of the isolates demonstrated that all patients except one had identical digest patterns for pre- and posttreatment isolates.

Topics: Amoxicillin; Anti-Ulcer Agents; DNA, Bacterial; DNA, Ribosomal; Drug Resistance, Microbial; Drug Therapy, Combination; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Organometallic Compounds; Peptic Ulcer

Topics: Adolescent; Amoxicillin; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Hemoptysis; Humans; Organometallic Compounds

The connection between dyspeptic symptoms and Helicobacter pylori infection was studied prospectively in 21 children treated for verified H. pylori infection with bismuth subcitrate and tinidazole. Gastroscopy with biopsy was performed before and a mean of 4 months after discontinuation of the treatment. A second post-treatment check with determination of H. pylori antibodies and serum pepsinogen 1 level was made a mean of 1.5 years after cessation of treatment. The therapy given cleared the bacteria in 67% of the patients. No significant difference in symptoms was observed between treatment successes and failures. The histopathologic diagnosis of H. pylori infection was accompanied by positive IgG serology in 15 (75%) of the 20 patients tested, and a decrease in antibody levels was observed in children with successful eradication. Serum pepsinogen 1 seemed to be even a better marker in the follow-up. The healing of acute and also to some extent of chronic gastritis took place closely after successful eradication. Our results suggest that healing of H. pylori-induced gastritis should be confirmed at reendoscopy only, independent of the symptoms.

Topics: Adolescent; Biomarkers; Child; Child, Preschool; Drug Therapy, Combination; Dyspepsia; Female; Follow-Up Studies; Gastritis; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Immunoglobulin G; Male; Organometallic Compounds; Pepsinogens; Prospective Studies; Tinidazole

Topics: Amoxicillin; Anemia, Hypochromic; Anti-Bacterial Agents; Antibodies, Bacterial; Child; Chronic Disease; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Immunoglobulin G; Male; Organometallic Compounds; Pyloric Antrum

A 14-year-old girl was transferred to our unit after 6 weeks of repeating episodes of what was thought to be 'hemoptysis'. Apart from discrete nausea, she did not have any other complaints. The episodes of 'hemoptysis' occurred once every 3 days, mostly in the late evening. The physical examination was strictly normal. A thorough investigation revealed a chronic active gastritis and Helicobacter pylori infection. No lung disease could be confirmed. Treatment consisted of a combination therapy with amoxycillin (50 mg/kg/day orally in 3 doses) and colloidal bismuth subcitrate (120 mg orally, 3 times daily) during a period of 1 week. Together with the clearance of Helicobacter pylori and healing of the chronic active gastritis, as demonstrated by histology, the symptoms disappeared. An eradication of the microorganism was obtained. Since that time, she has had no further similar complaints. This case reflects an atypical presentation of Helicobacter pylori infection.

Topics: Adolescent; Amoxicillin; Anti-Bacterial Agents; Drug Therapy, Combination; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Hemoptysis; Humans; Organometallic Compounds

The present study evaluated the effect of a one-day high-dose combined therapy on Helicobacter pylori infection. Thirty-two consecutive patients (suffering from either peptic ulcer or nonulcer dyspepsia) with Helicobacter pylori infection received omeprazole (40 mg) + bismuth subcitrate (240 mg x 4) + amoxicillin suspension (2000 mg x 4) + metronidazole (500 mg x 4), for only one day. Endoscopy, histology, culture, and susceptibility studies were done at entry and 30 and 90 days after the treatment day. Successful eradication was obtained in 23/32 (72%) patients and gastritis had resolved in 95% of these. Side effects were induced by the treatment in 6/32 (19%) patients, but these were all self-limiting, short-lasting, and did not require any specific treatment. Development of bacterial resistance to metronidazole occurred in 6/9 (67%) non-eradicated patients. These data suggest that one-day treatment with high doses of amoxicillin, metronidazole, bismuth, and omeprazole represents an effective, safe, and inexpensive therapeutic approach for the treatment of H. pylori infection.

Topics: Adult; Amoxicillin; Anti-Ulcer Agents; Chronic Disease; Drug Administration Schedule; Drug Therapy, Combination; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Omeprazole; Organometallic Compounds; Peptic Ulcer; Treatment Outcome

The significance of Helicobacter pylori (HP) infection was assessed prospectively in forty-two patients with dyspepsia using histological, bacteriological and biopsy urease techniques. Thirty-eight patients (90.5%) were positive for HP infection and were treated with bismuth subcitrate (De Nol), tinidazole and doxycycline. HP was present in the antrum, corpus, fundus, duodenum and gastric juice in 36, 26, 23, 2 and 2 patients respectively (p < 0.01, X2 test). Histological assessment yielded more positive identifications of HP than the urease test (36 vs 28 positive cases, p < 0.01, McNemar's X2 test), while histology and bacteriology were virtually identical (38 vs 37 of 41 pairs, p > 0.5, X2 test). There was a good correlation between bacterial and polymorphonuclear leucocyte (PMNL) counts per high power field (r = 0.8; p < 0.001; n = 34 pairs). There was resistance to metronidazole in 10 out of 16 isolates, but no resistance was recorded against tetracycline (p < 0.001, X2 test). Among the sixteen patients who attended follow-up endoscopy, there was clinical improvement and no evidence of HP in 5 individuals (31.25%). One patient had amelioration of his symptoms, 5 experienced no change and in 5 their symptoms became worse. Metronidazole resistance may be one of the important factors in the United Arab Emirates and elsewhere.

Topics: Adolescent; Adult; Antacids; Bacteriological Techniques; Bismuth; Doxycycline; Drug Resistance, Microbial; Dyspepsia; Female; Follow-Up Studies; Gastritis; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Organometallic Compounds; Patient Compliance; Prevalence; Prospective Studies; Stomach; Tinidazole; United Arab Emirates

Topics: Anti-Bacterial Agents; Anti-Ulcer Agents; Chronic Disease; Drug Therapy, Combination; Duodenitis; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Organometallic Compounds; Peptic Ulcer; Recurrence

Gastritis associated with Helicobacter pylori was present in gastric biopsies from 24/95 (25%) children and adolescents undergoing endoscopy for recurrent abdominal pain and upper gastrointestinal symptoms. H pylori associated gastritis occurred mainly in older children (8-16 years) and was significantly associated with low socioeconomic class and a family history of peptic ulcer disease. Antral nodularity was a common endoscopic finding in H pylori positive children. Eighteen children, all over 5 years of age, were treated with tripotassium dicitratobismuthate (De-Nol) for two months and ampicillin for two weeks. In 12 children follow up gastric biopsies were obtained six weeks after completion of treatment. In 9/12 (75%) children H pylori was eradicated, and gastritis improved.

Topics: Age Factors; Ampicillin; Antacids; Biopsy; Bismuth; Child; Drug Therapy, Combination; Gastric Mucosa; Gastritis; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Organometallic Compounds; Prevalence; Prospective Studies; Sex Factors; Socioeconomic Factors

The importance of pro-inflammatory leukotriene C4 in Helicobacter pylori (H. pylori) associated gastritis in man is unknown. Fresh gastric biopsy specimens from 28 dyspeptic patients were obtained: 10 showed normal antral histology with no evidence of H. pylori, the remaining 18 patients exhibited histological gastritis and were H. pylori positive as assessed by histology, culture and urease test. Twelve of these 18 patients received 240 mg twice daily colloidal bismuth subcitrate for four weeks before re-endoscopy. Gastric biopsies from H. pylori positive patients were incubated under basal and Ca(2+)-ionophore mediated conditions: Radioimmunoassay analysis of the supernatant showed basal release of prostaglandin E2 and leukotriene C4 was slightly but not significantly elevated in H. pylori positive mucosa. However in H. pylori positive mucosa there was an 85% increase in leukotriene C4 synthesis when biopsies were incubated with ionophore, compared to only 13% increase in H. pylori negative mucosa (p less than 0.02). After eradication of H. pylori by colloidal bismuth subcitrate, there was a clearance of inflammatory cell infiltrate as assessed by histology and a significant reduction in ionophore-mediated leukotriene C4 formation compared with before treatment (p less than 0.02). These results suggest that H. pylori gastritis is associated with increased capacity to generate leukotriene C4, which may amplify the damaging effects of the bacteria on gastric mucosa.

Topics: Adult; Aged; Calcimycin; Dinoprostone; Female; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Organometallic Compounds; SRS-A

The aim of the study was to observe the relationship between the two reservoirs of Helicobacter pylori--that is, dental plaque and the stomach. With the Campylobacter-like organism (CLO) test, H. pylori was detected in dental plaque and in gastric antral and body mucosa in 98%, 67% and 70%, respectively, of 43 consecutive patients with dyspepsia. The rapidity of the CLO test indicates that the density of H. pylori is heaviest in dental plaque, less in the antrum, and least in the body mucosa of the stomach. Triple drug therapy (bismuth, tinidazole, and amoxycillin or doxycycline) was administered for 15 days to 24 patients. By the CLO test, H. pylori was eliminated from the gastric mucosa in all 24 patients but persisted in dental plaque in all of them. Our observations indicate that dental plaque is unaffected by triple drug therapy and is perhaps a permanent reservoir of H. pylori if local therapy also fails to eradicate the organism.

Topics: Adolescent; Adult; Aged; Amoxicillin; Antacids; Dental Plaque; Doxycycline; Drug Therapy, Combination; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Organometallic Compounds; Stomach; Tinidazole

A 30-year-old man with AIDS presented with symptoms of fever, epigastric pain and weight loss, together with histological findings of Helicobacter pylori-induced gastritis. His symptoms resolved with treatment, as indicated by the clearing of his H. pylori infection on repeat gastric biopsy. Although uncommon, H. pylori infection can cause severe illness in patients with AIDS.

Topics: Acquired Immunodeficiency Syndrome; Adult; Ampicillin; Animals; Biopsy; Drug Therapy, Combination; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Organometallic Compounds; Pyloric Antrum

Nine patients with Helicobacter pylori-related antral gastritis and history of duodenal ulceration were studied before and at 1 and 7 months after eradication of the infection by a 4-week course of tripotassium dicitrato bismuthate, metronidazole, and amoxycillin. The median basal gastrin concentration before eradication was 30 ng/l (range, 20-60) and fell to 20 ng/l (5-20) at 1 month (p less than 0.02) and 15 ng/l (5-20) at 7 months (p less than 0.01) after eradication. The integrated gastrin response to a peptide meal was 3650 ng/l.min (range, 1875-6025) before treatment compared with 1800 ng/l.min (range, 1200-3075) at 1 month (p less than 0.01) and 1312 ng/l.min (875-2625) at 7 months (p less than 0.03). Daytime intragastric pH (0900-2100 h) was similar before treatment (median, 1.4; range, 1.1-2.1) and at 1 month (1.4; 1.1-2.3) and 7 months (1.4; 1-2.2) after eradication. In five of the patients nighttime acid output (2300-0900 h) was also studied and was similar before (median, 86 mmol/10 h; range, 52-114) and at 1 month (76 mmol/10 h; 50-143) and 7 months (94 mmol/10 h; 63-106) after eradication. In conclusion, eradication of H. pylori is accompanied by a sustained fall in serum gastrin concentrations but is not accompanied by an early or late reduction of daytime intragastric acidity or nighttime acid output.

Topics: Adult; Aged; Amoxicillin; Anti-Ulcer Agents; Bismuth; Circadian Rhythm; Duodenal Ulcer; Female; Gastric Acid; Gastrins; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Hydrogen-Ion Concentration; Male; Metronidazole; Middle Aged; Organometallic Compounds; Stomach; Time Factors

A 15-year-old girl was admitted after 1 week of increasing fatigue and pallor. She had no gastro-intestinal complaints. The patient had suffered from four episodes of syncope during the last 3 days prior to admission. Besides pallor and a discrete cardiac murmur, the physical examination was normal. A further thorough investigation revealed an iron deficiency anaemia related to a Helicobacter pylori positive chronic active haemorrhagic gastritis. Treatment consisted of amoxycillin and colloidal bismuth subcitrate (500 mg and 120 mg orally respectively, 3 times daily) during a period of 6 weeks. Iron supplements were not administered. Together with the clearance of H. pylori and healing of the haemorrhagic gastritis, as demonstrated by histology, haemoglobin values returned to normal and the symptoms disappeared. An eradication of the micro-organism was obtained. She has since had no further similar complaints.

Topics: Adolescent; Amoxicillin; Anemia, Hypochromic; Anti-Ulcer Agents; Biopsy; Chronic Disease; Female; Gastric Mucosa; Gastritis; Gastrointestinal Hemorrhage; Helicobacter Infections; Helicobacter pylori; Humans; Organometallic Compounds; Syncope

In a study of six laboratory strains of Helicobacter pylori, two different modes of bacterial adherence to HEp-2 cells were found. Electronmicroscopy revealed that strains known to possess soluble haemagglutinin adhered intimately to the cell surfaces, with cupping of the plasma membrane and coalescence of glycocalyces at sites of attachment. Strains of H. pylori without soluble haemagglutinin also attached, but did not induce membrane cupping or show glycocalyx fusion. Light microscopy did not distinguish between these patterns of adherence. Bacterial attachment was unaffected by pre-treatment of HEp-2 cells with neuraminidase. Exposure of the bacteria to trypsin or to colloidal bismuth subcitrate (CBS) before being added to HEp-2 cells markedly impaired bacterial adherence. This effect of CBS may contribute to the known efficacy of bismuth therapy in patients with H. pylori-related gastritis.

Topics: Bacterial Adhesion; Cells, Cultured; Gastritis; Helicobacter pylori; Hemagglutinins; Humans; Neuraminidase; Organometallic Compounds; Polysaccharides, Bacterial; Solubility

The authors investigated the effect of one month bismuth treatment (Bismuthi citrici 120 mg per capsule), 4 x 120 mg/day, on morphological changes of the gastric mucosa along with the effect on Campylobacter pylori (CP) in a group of 23 probands with histologically verified active superficial CP positive antrum gastritis. The probands suffered only from functional dyspepsia, to eliminate the action of other disease of the digestive tract on chronic gastritis. Complete eradication of CP occurred in 65.2% and disappearance of granulocytic infiltration as a manifestation of activity in 73.9%. The disappearance of activity correlated with the eradication of CP in 88.2. The authors evaluated also the degree of circular nuclear cellulization (grade 1-3). After one-month treatment it was reduced by 1 grade in 56.5% in the antrum, while in the corpus it remained unaltered in the majority. Complete histological normalization of the mucosa was not recorded.

Topics: Adult; Antacids; Chronic Disease; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Middle Aged; Organometallic Compounds

Biopsy samples were taken endoscopically from the antral-mucosa of 693 patients with peptic ulcer and chronic gastritis presenting dyspepsia symptoms. Campylobacter pyloridis cultures were positive in 59 of 98 (60.2%) cases and histopathologically the organisms were found in 411 of 693 cases (59.3%). Pathologically, Campylobacter pyloridis was positive in 273 out of 300 patients with chronic superficial gastritis (91.0%), in 102 of 249 patients with chronic atrophic gastritis (40.9%), in 36 out of 144 patients with chronic atrophic gastritis with intestinalization or dysplasia (25.0%). We found that there was a significant association between the presence of Campylobacter pyloridis and chronic superficial gastritis, also the degree of lymphocyte infiltration showed a strong inverse association with the presence of Campylobacter pyloridis, suggesting that a local immune response might exert an important action in the eradication of this organism. These findings support the view that Campylobacter pyloridis, may be etiologically related to chronic gastritis and peptic ulceration, even though its role still remains to be determined.

Topics: Campylobacter; Campylobacter Infections; Gastric Mucosa; Gastritis; Humans; Organometallic Compounds; Peptic Ulcer

Twenty-three children with Helicobacter (Campylobacter) pylori-associated chronic gastritis are reported. Family history of peptic disease, previous digestive procedures, and nonspecific epigastric pain were the most frequently encountered clinical features. Antral nodularity at endoscopy and histologic evidence of follicular gastritis were characteristic morphological aspects. Rapid urease tests suggested the diagnosis in 90% of patients. Significant increases of serum IgG and IgA against Helicobacter pylori allowed the identification of infected children with 95% cumulative sensitivity. Treatment with amoxicillin and bismuth subcitrate eradicated the infection and improved gastritis in 13 of 19 children. These findings provide further evidence for the etiologic role of Helicobacter pylori in chronic antral gastritis in children.

Topics: Adolescent; Amoxicillin; Antacids; Child; Child, Preschool; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Immunoglobulins; Male; Organometallic Compounds; Stomach

Helicobacter pylori-associated gastritis was found by endoscopy in 15 (= 28%) out of 53 patients presenting gastric pain of ulcer type without macroscopically detectable lesion of the gastric mucosa. Following a treatment of four weeks with bismuth subcitrate tablets (2 x 2 tablets daily), in 73% improvement of histological findings and in 87% elimination of bacteria could be attained. Thus, this causal therapy had a favourable effect on patient complaints.

Topics: Adult; Aged; Aged, 80 and over; Antacids; Anti-Ulcer Agents; Campylobacter; Campylobacter Infections; Gastritis; Humans; Middle Aged; Organometallic Compounds

Topics: Antacids; Campylobacter Infections; Duodenal Ulcer; Gastritis; Humans; Organometallic Compounds; Ranitidine; Sucralfate

Topics: Administration, Oral; Bismuth; Campylobacter Infections; Dose-Response Relationship, Drug; Gastritis; Humans; Organometallic Compounds; Salicylates; Stomach Ulcer

Topics: Antacids; Bismuth; Campylobacter Infections; Colloids; Gastritis; Humans; Organometallic Compounds; Uremia

Topics: Antacids; Campylobacter; Campylobacter Infections; Duodenal Ulcer; Gastrins; Gastritis; Humans; Metronidazole; Organometallic Compounds; Pyloric Antrum

Topics: Anti-Bacterial Agents; Anti-Ulcer Agents; Campylobacter; Campylobacter Infections; Chronic Disease; Duodenal Ulcer; Gastritis; Humans; Organometallic Compounds; Pyloric Antrum; Recurrence; Risk Factors

Topics: Anti-Ulcer Agents; Campylobacter Infections; Drug Therapy, Combination; Follow-Up Studies; Gastritis; Humans; Metronidazole; Organometallic Compounds; Stomach Ulcer

Topics: Amoxicillin; Bismuth; Campylobacter Infections; Child; Female; Gastritis; Humans; Male; Organometallic Compounds

Topics: Adult; Anti-Ulcer Agents; Campylobacter Infections; Chronic Disease; Female; Gastritis; Humans; Male; Organometallic Compounds

Two children with antral nodular hyperplasia and active chronic gastritis associated with Campylobacter pylori are reported. The organism was observed by scanning electron microscopy and cultured from antral biopsies obtained at endoscopy from each patient. Anti-C. pylori IgG was detected in high titre in both patients together with serum IgM in one patient. Treatment with ampicillin and a bismuth preparation resulted in total resolution of symptoms. Repeated endoscopy with antral biopsy and culture, as well as the absence of acute inflammatory changes, confirmed the eradication of the organism. Correlation of positive bacteriological cultures and serological tests with the clinical improvement related to therapy supports a causative role for C. pylori in antral lymphoid hyperplasia and antral gastritis in children.

Topics: Adolescent; Ampicillin; Anti-Ulcer Agents; Antibodies, Bacterial; Biopsy; Campylobacter; Campylobacter Infections; Child; Enzyme-Linked Immunosorbent Assay; Gastric Mucosa; Gastritis; Humans; Immunoglobulin G; Immunoglobulin M; Male; Organometallic Compounds

Topics: Acute Disease; Antacids; Antibodies, Bacterial; Campylobacter; Campylobacter Infections; Chronic Disease; Gastritis; Humans; Organometallic Compounds; Prospective Studies

The gastric protective properties of the anti-ulcer drug, colloidal bismuth subcitrate (CBS; DE-NOL) were examined in comparison with the effects of prostaglandin E2 (PGE2), sucralfate and cimetidine using an ethanol induced gastric erosion model in rats. To elucidate the mechanism of action of CBS it was studied whether it could stimulate PGE2 generation in gastric mucosa. Using a quantitative visual scoring technique of mucosal damage, CBS was shown to be less potent than PGE2, though about 4 times more potent than sucralfate at reducing ethanol induced gastric lesions. Cimetidine was only weakly active. Pretreatment of rats with CBS led to complete, partial and no protection at 0.25, 8 and 16 hr respectively. Prostaglandin generation was stimulated by vortexing biopsies of washed fundus, and the released PGE2 was measured by radio-immuno assay. PGE2 generation was dose-dependently increased by oral doses of CBS. Peak synthesis occurred at 0.25 hr. Although partial protection against ethanol lesions was found 8 hr after administration, basal levels of PGE2 had already returned at 4 hr. Indomethacin blocked control and CBS stimulation of PGE2, but only partially blocked the protection against ethanol induced lesions. These findings indicated that CBS protects the rat gastric mucosa against ethanol lesions, and that both prostaglandin and non-prostaglandin mediated mechanisms are probably involved.

Topics: Animals; Anti-Ulcer Agents; Cimetidine; Dinoprostone; Ethanol; Female; Gastric Mucosa; Gastritis; Indomethacin; Male; Organometallic Compounds; Prostaglandins E; Rats; Rats, Inbred Strains; Sucralfate

We present a trial on 21 patients with gastric surgery, by different pathologies, benign and malignant, with the aim of detecting presence or absence of Pyloric Campylobacter. The clinical, endoscopic findings and presence-absence of Pyloric Campylobacter were correlated. Regarding the clinical symptomatology, it was not possible to obtain a favourable conclusion to the presence of Pyloric Campylobacter in both groups. The endoscopic findings showed changes more evident in those cases of positive Pyloric Campylobacter. The therapeutical response of positive Pyloric Campylobacter to TDB during 30 days was beneficial regarding the disappearance of the symptoms.

Topics: Adult; Aged; Aged, 80 and over; Campylobacter; Campylobacter Infections; Female; Gastritis; Gastroenterostomy; Humans; Male; Middle Aged; Organometallic Compounds; Pylorus

Topics: Adult; Aged; Amoxicillin; Campylobacter Infections; Drug Therapy, Combination; Female; Gastritis; Humans; Male; Middle Aged; Organometallic Compounds; Pain; Tinidazole

Colloidal bismuth subcitrate (CBS, De-Nol) heals duodenal ulcers but with a lower relapse rate than cimetidine, perhaps due to inhibition of Campylobacter pyloridis (CP) organisms. To test this hypothesis we studied gastric mucosal histology in three groups of ulcer patients treated with either cimetidine, CBS, or CBS in combination with an antibiotic. Cimetidine had no effect on CP or gastric mucosal histology but with CBS therapy there was a significant reduction in the number of bacteria (p less than 0.0001). However, relapse of both CP infection and gastritis usually occurred once CBS was withdrawn. When CBS was combined with amoxycillin or tinidazole, long-term disappearance of both CP bacteria and gastritis was achieved (p less than 0.0001). In ultrastructural studies 30-90 min after single oral doses of CBS or bismuth subsalicylate, CP had detached from the gastric epithelial cells and exhibited structural degradation associated with the selective deposition of a particulate bismuth complex within and upon the surface of the organisms. In vitro, CP and other campylobacters were inhibited by bismuth compounds at 25 mg/l but they were resistant to cimetidine and ranitidine. CBS has a powerful antibacterial effect against CP but relapse of infection is common after CBS alone. In combination with antibiotics however, eradication of CP and long-term healing of gastritis occurs. In such cases the gastroduodenal mucosa is intact, and less likely to ulcerate.

Topics: Anti-Bacterial Agents; Anti-Ulcer Agents; Campylobacter; Campylobacter Infections; Cimetidine; Gastric Mucosa; Gastritis; Gastroscopy; Humans; Microscopy, Electron; Organometallic Compounds

Colloidal bismuth subcitrate (CBS) precipitates in an acid environment, adheres to mucus, blocks pepsin activity, retards hydrogen-ion back diffusion and stimulates prostaglandin synthesis. The average healing rate after 4 weeks' treatment with CBS is 78% in duodenal ulcer versus 67% with cimetidine. A direct comparison with ranitidine gives healing rates of 78% (CBS) as opposed to 78% with ranitidine. The corresponding figures in gastric ulcer are 68% (CBS) and 54% (cimetidine). The percentage of relapse-free patients is substantially higher after CBS ulcer healing than after H2-blockers. Bismuth subsalicylate eliminates Campylobacter pylori in 71% after 4-weeks' therapy. Parallel to this elimination a decrease and normalization of the acute inflammatory process can be seen in antral mucosa.

Topics: Anti-Ulcer Agents; Bismuth; Campylobacter Infections; Chronic Disease; Duodenal Ulcer; Gastritis; Humans; Organometallic Compounds; Peptic Ulcer; Salicylates; Stomach Ulcer

In 1983, bacteriological examinations of gastric epithelium isolated a new species of bacteria, the so-called Campylobacter pyloridis. These bacteria were found in 50% of the gastroscopic examinations from patients with dyseptic disorders. C. pyloridis is a gram-negative curved bacterium. Up to now it has been found on the surface of the human gastric epithelium. C. pyloridis is rarely isolated from the healthy gastric epithelium. The gastric epithelium containing C. pyloridis mostly suffers from inflammatory infiltration or from pathological changes like chronic gastritis of type B. The route of infection is unknown. C. pyloridis has not yet been isolated outside of the human stomach. For laboratory diagnosis of a disease caused by C. pyloridis, the bacterium has to be isolated from gastric bioptic specimen. Another possibility is to check for high serum antibody levels against C. pyloridis. Direct microscopic examinations of gastric epithelium are also possible. The positive urease test is the main criterion to differentiate C. pyloridis from other human pathogenic campylobacter species. As therapeutic agents are recommended: bismuthates, amoxicillin, furazolidone and tinidazole. These agents are able to eliminate C. pyloridis from gastric epithelium and to fade away the gastritis.

Topics: Amoxicillin; Antibodies, Bacterial; Biopsy; Bismuth; Campylobacter; Campylobacter Infections; Chronic Disease; Furazolidone; Gastric Mucosa; Gastritis; Humans; Organometallic Compounds; Tinidazole; Urease

Topics: Aluminum; Antacids; Anti-Ulcer Agents; Benzimidazoles; Bismuth; Carbenoxolone; Critical Care; Gastritis; Histamine H2 Antagonists; Humans; Omeprazole; Organometallic Compounds; Peptic Ulcer Hemorrhage; Prostaglandins; Risk; Stomach Ulcer; Stress, Physiological; Sucralfate

The activities of 11 antimicrobial agents, including two bismuth salts, against 70 strains of Campylobacter pyloridis isolated from gastric biopsy specimens were tested. The isolates were very susceptible to penicillin (the MIC for 90% of the strains tested [MIC90] was 0.03 microgram/ml), erythromycin, cefoxitin (MIC90, 0.12 microgram/ml), gentamicin, and ciprofloxacin (MIC90, 0.25 microgram/ml). The bismuth salts and nalidixic acid had moderate activity (MIC90, 16 to 64 micrograms/ml). Twenty percent of the isolates were resistant to metronidazole (MIC, greater than 1 micrograms/ml), and all were resistant to sulfamethoxazole and trimethoprim (MIC90, greater than 256 micrograms/ml).

Topics: Anti-Bacterial Agents; Bismuth; Campylobacter; Cefoxitin; Ciprofloxacin; Erythromycin; Gastritis; Gentamicins; Humans; Metronidazole; Nalidixic Acid; Organometallic Compounds; Penicillin Resistance; Penicillins; Quinolines; Sulfamethoxazole; Tartrates; Trimethoprim

Topics: Aluminum; Anti-Ulcer Agents; Bismuth; Carbenoxolone; Drug Evaluation; Gastric Acid; Gastric Mucosa; Gastritis; Humans; Organometallic Compounds; Prostaglandins; Stomach Ulcer; Sucralfate

A patient with chronic erosive gastritis and protein-losing gastropathy is reported. Presentation was with weight loss and abdominal discomfort. There were endoscopic and radiological features of erosive gastritis. Radioactive chromium studies confirmed that the low serum albumin was associated with fecal protein loss. No improvement occurred with bed rest or Caved S but coincided with DeNol therapy.

Topics: Aged; Bismuth; Chronic Disease; Female; Gastritis; Glycyrrhiza; Humans; Organometallic Compounds; Plants, Medicinal; Protein-Losing Enteropathies; Smallpox