oxytetracycline--anhydrous and Helicobacter-Infections

Helicobacter pylori has now been propelled into the forefront of gastroenterology, particularly the treatment of gastroduodenal ulcer, whereas its role in gastritis is still widely ignored, although this disease sparked much of the original observations. Forty years ago, it was shown for the first time that antibiotics can eliminate gastric ammonia production in man which suggested that this was due to eradication of bacterial urease activity. It was also found that the gastric juice ammonia concentration correlates with hypo- or anacidity in uremics and with mucosal inflammation in subjects with gastritis. In patients with nonalcoholic and alcoholic gastritis, the histology as well as the symptoms of gastritis were strikingly improved by antibiotic treatment. Beneficial effects of eradication of gastric urease activity and the resulting decreased ammonia production were also shown in patients with hepatic encephalopathy. Broader studies and clinical applications of these earlier findings are now warranted.

Topics: Ammonia; Animals; Anti-Bacterial Agents; Gastric Juice; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Hepatic Encephalopathy; Humans; Hydrogen-Ion Concentration; Male; Oxytetracycline; Urease

Eradication of H. pylori cures peptic ulcer disease. Bismuth and antibiotics in various combinations were tested at a single university hospital.. The standard treatment was bismuth subnitrate, metronidazole and oxytetracycline. A positive biopsy urease test was the main inclusion criterium, whereas a negative 14C-urea breath test performed at least four weeks after cessation of therapy was the main indicator of cured infection, and performed later for reinfection. In separate studies we tested the absorption of bismuth subnitrate compared to other bismuth preparations, what aspects of bismuth-based triple therapy are most important to obtain maximum eradication, what can be done to decrease side effects, and the reliability of diagnostic methods.. The absorption of bismuth from bismuth subnitrate was very low. More than 90% cure rates were usually obtained. Including metronidazole in the regimen increased side effects but was crucial for effectiveness. Spiramycine could replaced oxytetracycline without substantial loss of effectiveness. Effectiveness was decreased if the patients had recently used metronidazole. Aluminium containing antacids and chlorhexidine were not very useful. Side effects were frequent, up to 60%, but usually mild and very few patients withdrew from treatment. Adding ranitidine to the regimen reduced abdominal pain. 14C-urea breath test was the "gold standard" and the specificity of the biopsy urease test in diagnosing H. pylori infection was high.. Bismuth combination therapy combines high effectiveness with acceptable side effects and low cost. Biopsy urease test and urea breath test are reliable indicators of H. pylori infection.

Topics: Antacids; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Drug Therapy, Combination; Follow-Up Studies; Helicobacter Infections; Helicobacter pylori; Hospitals, University; Humans; Metronidazole; Norway; Oxytetracycline; Peptic Ulcer; Stomach Diseases; Urea; Urease

The last three years of research on treatment of Helicobacter pylori infection support the recommendations made by the Working Party, World Congress of Gastroenterology 1990. Meta-analysis shows a noteworthy difference between the recommended regimens favouring the combination of bismuth, metronidazole and tetracycline. No regimen without bismuth has been shown to have a sustained Helicobacter pylori eradication rate exceeding 90%, nor has any alternative regimen been shown convincingly to stem the adverse effects without loss of efficacy. No serious adverse effects have been reported after following the current recommendation of bismuth medication. The highest reported Helicobacter pylori eradication rate according to "intention to treat" approximates 90%, which was obtained using bismuth subnitrate, metronidazole, and oxytetracycline.

Topics: Bismuth; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Oxytetracycline

In-vitro metronidazole resistance rates of Helicobacter pylori determined by Etest are high, and the predictive value of metronidazole resistance is low. It was hypothesised that altered laboratory methods could reduce the overestimation of resistance and improve the predictive value of the Etest. Pre-treatment isolates (n = 150) of H. pylori from 150 patients were investigated by Etest with incubation for 72 h. Treatment with metronidazole, tetracycline and bismuth for 10 days failed to eradicate H. pylori in 23 patients. After isolate storage for 3 years, resistance determination results by agar dilution and Etest, with incubation for 72 and 31 h, were compared. The rate of metronidazole resistance was reduced significantly during storage, and instability of resistance was associated significantly with treatment outcome. Isolates that retained in-vitro resistance had significantly (p 0.008) higher treatment failure rates (n = 13; 42%) than isolates that lost resistance (n = 3; 9%). The reproducibility achieved by dual testing with agar dilution and Etest was 41% and 70% for +/- 1 and +/- 2 log2 dilutions, respectively, after incubation for 72 h, and 85% and 92%, respectively, after incubation for 31 h. Thus, the predictive value was improved from 25% to 50% by the altered laboratory conditions (p 0.04). MIC values of 2-8 mg/L signified an intermediate risk of treatment failure.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Bismuth; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Oxytetracycline; Specimen Handling; Treatment Outcome

It is well documented that dyspepsia in patients with peptic ulcer disease (PUD) improves markedly after eradication of Helicobacter pylori, while rarely does it improve in patients with functional dyspepsia. There is a large group of H. pylori-infected patients who do not qualify for either diagnosis, but in whom eradication may be considered. The aim of this study was to compare symptom severity, change in gastrointestinal symptoms 1 year after eradication and satisfaction with therapy between PUD patients and patients with endoscopic diagnoses of gastritis and/or duodenitis (G/D patients).. The patients were randomized to one of four triple regimens containing ranitidine bismuth and metronidazole, and either oxytetracycline or spiramycine. Eradication was assessed with the 14C-urea breath test. GI symptoms were evaluated using the Gastrointestinal Symptom Rating Scale (GSRS) and the Ulcer Esophagitis Subjective Symptoms Scale (UESS) questionnaires.. One-hundred-and-eighty-three patients were recruited from GI outpatient clinics. Patients with PUD and G/D had similar severity of symptoms before eradication therapy. One year after H. pylori eradication, 99% of the PUD patients and 75% of the G/D patients felt better regarding their main upper GI complaint. Abdominal pain score decreased by 48% as measured by GSRS and by 78% as measured by UESS in the PUD group and by 25% and 47%, respectively, in the G/D group. Reflux symptoms decreased by 41% and 63% in PUD patients and by 28% and 45% in G/D patients; indigestion by 30% and 47% in PUD and by 20% and 34% in G/D; eating discomfort by 60% in PUD and by 35% in G/D. Sleep quality score improved by 68% in PUD and by 41% in NU patients. Constipation decreased by 22% in the PUD group. All these differences in symptoms were highly significant compared to baseline. Diarrhoea was unchanged.. Abdominal pain, reflux symptoms, indigestion and the ability to eat and sleep improved in both PUD and G/D patients 1 year after H. pylori eradication. Chronic diarrhoea was not induced. Abdominal pain improved significantly more in PUD than in G/D patients. Further study of the effect of H.pylori eradication in G/D patients is warranted.

Topics: Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Drug Therapy, Combination; Duodenitis; Female; Follow-Up Studies; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Oxytetracycline; Peptic Ulcer; Ranitidine; Spiramycin; Time Factors

To compare the efficacy and side effects of standard bismuth triple therapy with those of omeprazole-based triple therapy in patients with Helicobacter pylori infection and duodenal ulcer disease.. One hundred patients were prospectively recruited and randomized to receive either bismuth subnitrate 75 mg q.i.d., oxytetracycline 500 mg q.i.d., and metronidazole 400 mg b.i.d. (regimen BTM), or omeprazole 20 mg b.i.d., amoxicillin 750 mg b.i.d., and metronidazole 400 mg b.i.d. (regimen OAM), both for 14 days. Upper endoscopy (with antral biopsy specimens for microbiology and antral and corpus biopsy specimens for histology) was performed before treatment, after 2 months, and again 1 yr after treatment. Serum samples for serology (IgG) were taken. Patients with in vitro metronidazole-resistant (M-R) H. pylori strains were excluded. In a nonrandomized study, 41 patients with M-R strains were given either BTM or OAM.. According to intention-to-treat analysis, H. pylori cure rates were 91% and 96% with BTM and OAM, respectively (p = 0.45). In the BTM group, the mean total side effect score was higher (p < 0.001), and more severe side effects were reported (32% vs. 4%, p < 0.001). In the nonrandomized group of patients with M-R strains, H. pylori cure rates were 88% and 67% with BTM and OAM, respectively. All of the successfully treated patients were still H. pylori-negative after 1 yr.. Both treatment regimens were highly effective in curing H. pylori infection in patients with metronidazole-sensitive strains. Omeprazole-based triple therapy was tolerated better than standard bismuth-based triple therapy.

Topics: Adult; Aged; Amoxicillin; Antacids; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Drug Therapy, Combination; Female; Follow-Up Studies; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Omeprazole; Oxytetracycline; Penicillins; Prospective Studies; Recurrence; Time Factors

In this study we compared the cure rates of two clarithromycin-based regimens in patients in whom anti-Helicobacter pylori therapy had previously failed.. Thirty-three patients were randomized to receive either regimen OAC (20 mg omeprazole, 750 mg amoxicillin, and 250 mg clarithromycin) or BTC (240 mg bismuth subcitrate, 750 mg oxytetracycline, and 250 mg clarithromycin), all twice daily for 10 days. A further 28 patients were all treated with OAC. Previously failed therapy included combinations of bismuth (B), omeprazole (O), tetracycline (T), metronidazole (M), amoxicillin (A), or clarithromycin (C) in BTM (n = 48), OAM (n = 13), OA (n = 7), OCM (n = 2), or BCM (n = 1). H. pylori infection was confirmed by culture of biopsy specimens, and antimicrobial susceptibility testing was performed with the E test.. H. pylori infection was cured in all patients (n = 18) with OAC and in 8 patients (53%) with BTC (P = 0.001) in the randomized group and in 27 patients (96%) receiving OAC in the open-label group.. Ten-day OAC is highly effective and superior to BTC in patients in whom metronidazole-based treatment has previously failed.

Topics: Adult; Aged; Amoxicillin; Anti-Bacterial Agents; Anti-Ulcer Agents; Antitrichomonal Agents; Clarithromycin; Drug Evaluation; Drug Therapy, Combination; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Omeprazole; Organometallic Compounds; Oxytetracycline; Prospective Studies

180 Helicobacter pylori-positive patients with peptic ulcer disease were randomly allocated to double-blind placebo-controlled treatment with one of four anti-H. pylori regimens consisting of bismuth subnitrate suspension (B), oxytetracycline (OT), metronidazole (M)/metronidazole placebo, or ranitidine (R)/ranitidine placebo.. Regimen 1: B 150 mg q.i.d., OT 500 mg q.i.d., M 400 mg t.i.d. for 10 days and R 300 mg b.i.d. for 4 wk. Regimen 2: same as regimen 1 except ranitidine. Regimen 3: same as regimen 1 except metronidazole. Regimen 4: same as regimen 1 except metronidazole and ranitidine. Gastroscopy and 14C-urea breath test were performed 4 wk after cessation of therapy, and breath test six months after cessation.. According to intention-to-treat analysis, H. pylori eradication rates were 96%, 91%, 20%, and 9% with regimens 1, 2, 3, and 4, respectively. Comparing regimens 1+2 and 3+4, the eradication rates with and without metronidazole were 93% and 14%, respectively (p < 0.0001). Metronidazole increased the occurrence of diarrhea and abdominal pain. Comparing regimens 1+3 with 2+4 ranitidine did not influence H. pylori eradication (58% with and 50% without ranitidine; p = 0.37) or ulcer healing (93% with and 90% without ranitidine; p = 0.72) significantly, but reduced the occurrence of pain (p < 0.01). Six months after treatment, three patients who were H. pylori negative at 4 wk had become positive. These three had all received metronidazole placebo. H. pylori status remained negative in the other 85 patients.. H. pylori eradication with this triple therapy is critically dependent on metronidazole. Adding ranitidine reduces the occurrence of abdominal pain during such therapy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antacids; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Drug Therapy, Combination; Female; Helicobacter Infections; Helicobacter pylori; Histamine H2 Antagonists; Humans; Male; Metronidazole; Middle Aged; Oxytetracycline; Palliative Care; Peptic Ulcer; Ranitidine; Treatment Outcome

Spiramycin (Rovamycin) is a well-established macrolide antibiotic with good anti-Helicobacter pylori activity in vitro. It is acid-stable and found in high concentration in various body fluids and cells after oral administration. Its anti-H. pylori activity in vivo has not yet been tested.. Twenty-five consecutive patients with endoscopically verified peptic ulcer and a positive biopsy urease test were given spiramycin tables 1.5 MIU instead of oxytetracycline 500 mg q.d.s. in our triple therapy regimen with bismuth subnitrate suspension 10 mL (150 mg bismuth subnitrate) q.d.s. and metronidazole 400 mg t.d.s. for 10 days. Bismuth was taken between meals and spiramycin and metronidazole with meals. Re-endoscopy and 14C-urea breath test were performed 4 weeks after completion of therapy. Those who were H. pylori negative according to the breath test returned for 1-year follow-up.. Per protocol analysis at 4 weeks showed that 21 out of 23 patients were H. pylori negative and had healed ulcers. These 21 patients were persistingly H. pylori negative and had no ulcers at 1-year follow-up. H. pylori eradication and ulcer healing rates were thus 91.3%; 95% confidence interval from 72.0% to 98.9%. Side-effects limiting daily activity were significantly less frequent than we have experienced previously using oxytetracycline in triple therapy.. Spiramycin appears to be an alternative to tetracycline in the triple therapy of H. pylori infection. Further studies to position spiramycin as an anti-H. pylori drug are warranted.

Topics: Adult; Aged; Bismuth; Breath Tests; Drug Therapy, Combination; Female; Follow-Up Studies; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Oxytetracycline; Peptic Ulcer; Spiramycin; Treatment Outcome

The aim of the study was to compare relapse rates and quality of life before and after eradication of Helicobacter pylori in a group of patients with documented recurrent duodenal ulcer disease.. Seventy-four patients with three endoscopically verified duodenal ulcers during the past 2 years received triple treatment consisting of bismuth subnitrate, oxytetracycline, and metronidazole for 14 days. Quality of life was measured with the Psychosocial Adjustment to Illness Scale (PAIS-SR) and H. pylori status with the 14C-urea breath test.. After triple treatment H. pylori was eradicated in 96%, and the ulcer was healed in all. Ulcer relapse was reduced from 100% before to 1.4% during a mean observation time of 111 weeks. The H. pylori reinfection rate was 2.4% during the 1st year. The patients were more satisfied with the health care system and had better sexual relationship and less psychologic distress 1 year after eradication of H. pylori than before.. For patients with recurrent duodenal ulcer, eradication of H. pylori with triple treatment leads to a significantly reduced ulcer relapse rate and improved quality of life.

Topics: Adolescent; Adult; Antacids; Bismuth; Cognitive Behavioral Therapy; Combined Modality Therapy; Drug Therapy, Combination; Duodenal Ulcer; Female; Follow-Up Studies; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Oxytetracycline; Prospective Studies; Quality of Life; Recurrence; Severity of Illness Index; Time Factors

Duodenal and gastric content of mucosal enzymes in duodenal ulcer (DU) patients differs from that of controls. The purpose of this study has been to examine the effect of omeprazole and eradication of Helicobacter pylori on mucosal enzymes in DU patients.. The enzyme activities of seven gastric and duodenal mucosal marker enzymes from the brush border, lysosomes, and mitochondria have been studied. In study I the measurements were made in 29 patients with an active DU before and after 14 days of omeprazole treatment. In study II 22 duodenal ulcer patients were given bismuth subnitrate, oxytetracycline, and metronidazole (triple therapy) for 2 weeks to eradicate H. pylori. Biopsy specimens were taken from the duodenum and the stomach for enzyme measurements and histologic assessment. In study II additional specimens were obtained from the prepyloric region for urease tests and culture of H. pylori.. The ulcer healing rates were more than 90% after both omeprazole and triple therapy. H. pylori was eradicated in 86% after triple therapy. The activities of the brush-border enzymes lactase, neutral-alpha-glucosidase, alkaline phosphatase, leucyl-beta-naphthylamidase, and gamma-glutamyltransferase (gamma-GT) increased significantly in the duodenal bulb and the descending duodenum during treatment with omeprazole. No changes in duodenal enzyme activity were detected after triple therapy, whereas a significant fall in gamma-GT and acid phosphatase activities was seen in the stomach. The mucosal DNA in the gastric antrum decreased both after treatment with omeprazole and after triple therapy.. A similar decrease in mucosal DNA of the gastric antrum was demonstrated after both omeprazole and triple therapy with bismuth subnitrate, oxytetracycline, and metronidazole. Omeprazole also affects the content of duodenal mucosal enzymes, whereas triple therapy particularly affects the gastric mucosal enzyme activity.

Topics: Antacids; Biopsy; Bismuth; DNA; Drug Therapy, Combination; Duodenal Ulcer; Duodenum; Female; Gastric Mucosa; Gastrins; Helicobacter Infections; Helicobacter pylori; Humans; Intestinal Mucosa; Male; Metronidazole; Middle Aged; Omeprazole; Oxytetracycline; Stomach

Topics: Anti-Ulcer Agents; Drug Resistance, Microbial; Drug Therapy, Combination; Duodenal Ulcer; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Organometallic Compounds; Oxytetracycline; Ranitidine

A total of 152 patients with recurrent peptic ulcer disease were treated with bismuth subnitrate, oxytetracycline and metronidazole. The 51 patients in Group 1 were included following a study of the effect of cognitive psychotherapy on the recurrence rate after curative treatment for duodenal ulcer (DU). Group 2 comprised 101 consecutive patients referred to us with recurrent peptic ulcer. Their Helicobacter pylori (Hp) status was assessed before, and 4 weeks after, discontinuation of treatment, using the 14C-urea breath test. The primary aim of the study was to determine the effect of the triple treatment regimen on Hp eradication. All but two patients were Hp-positive prior to treatment. Four weeks after termination of treatment, Hp was found to have been eradicated in 50 out of 51 patients (98%) in Group 1, and in 86 out of 97 patients (89%) in Group 2. The respective ulcer healing rates for the two groups were 100% and 95%. Fifty percent of the patients noted moderate to severe adverse effects, mainly nausea and diarrhea, but only 5 patients discontinued treatment prematurely. The results indicate that virtually all patients with recurrent peptic ulcer disease have gastric Hp infection, and that the present triple treatment is highly effective in terms of both Hp eradication and ulcer healing.

Topics: Adult; Aged; Antacids; Bismuth; Drug Therapy, Combination; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Oxytetracycline; Peptic Ulcer; Recurrence

Ascorbic acid, the reduced form of vitamin C, may protect against gastric cancer and is secreted by the normal stomach. Secretion is impaired in Helicobacter pylori (H pylori) associated chronic gastritis. This study examined if eradication of H pylori improves gastric juice ascorbate values. Fasting gastric juice and plasma samples were collected at endoscopy from patients participating in trials of H pylori eradication for duodenal ulcer disease and intestinal metaplasia before and up to 15 months after attempted eradication. Ascorbic acid and total vitamin C concentrations were determined by high performance liquid chromatography. In 12 patients in whom H pylori was successfully eradicated gastric juice ascorbate and total vitamin C concentrations and the ratio of juice to plasma vitamin C rose after treatment. Analysis after treatment suggested that the rise was greatest in patients with high final plasma vitamin C concentrations, even though these did not change with treatment. By contrast, in 22 patients in whom H pylori eradication was unsuccessful there were no significant changes in juice or plasma concentrations after treatment. It is concluded that successful eradication of H pylori improves secretion of vitamin C into gastric juice. It is speculated that this increases protection against gastric cancer.

Topics: Aged; Ampicillin; Anti-Ulcer Agents; Ascorbic Acid; Drug Therapy, Combination; Duodenal Ulcer; Fasting; Follow-Up Studies; Gastric Juice; Helicobacter Infections; Helicobacter pylori; Humans; Intestines; Male; Metaplasia; Metronidazole; Organometallic Compounds; Oxytetracycline; Treatment Outcome

Increased prevalence of oesophagitis has been reported following eradication of Helicobacter pylori. We hypothesized that H. pylori eradication might increase gastro-oesophageal acid reflux in patients with reflux oesophagitis.. Twenty-five consecutive patients (13 male, 12 female) with H. pylori infection and reflux oesophagitis grade I (22 patients) or II (three patients) were enrolled; mean age 49.9 (range 33-75) years. Twenty-four hour intra-oesophageal pH recording was performed before and 12 weeks after eradication of H. pylori, which was achieved using bismuth subnitrate suspension 150 mg q.d.s., oxytetracycline 500 mg q.d.s. and metronidazole 400 mg t.d.s. for 10 days. Eradication was confirmed by 14C-urea breath test 12 weeks after completion of treatment. The patients did not receive acid-suppressive medication.. All patients had abnormal gastro-oesophageal reflux before anti-H. pylori treatment. After treatment, there was no significant change in the percentage of total time oesophageal pH < 4 (P=0.46) in the 23 patients in whom the infection had been cured. Nine of the cured patients had increased acid exposure, whereas 14 had decreased acid exposure. No significant change in reflux symptom scores was found. There was no relationship between change in acid exposure and symptom improvement.. Twelve weeks after H. pylori eradication there was no consistent change in gastro-oesophageal acid reflux in patients with mild or moderate reflux oesophagitis.

Topics: Adult; Aged; Antacids; Anti-Bacterial Agents; Bismuth; Breath Tests; Drug Therapy, Combination; Esophagitis; Female; Gastroesophageal Reflux; Helicobacter Infections; Helicobacter pylori; Humans; Hydrogen-Ion Concentration; Male; Metronidazole; Middle Aged; Oxytetracycline; Severity of Illness Index

To evaluate the cure rate of Helicobacter pylori infection, including the impact of in vitro metronidazole resistance (M-R), and the side effects of a simplified 10-day bismuth triple therapy in routine clinical practice.. From September 1995 to March 1996, 248 consecutive H. pylori-positive patients received 10 days of bismuth subnitrate 150 mg, oxytetracycline 500 mg, and metronidazole 400 mg, all t.id. Before treatment, upper endoscopy, including biopsy specimens for microbiological analysis and IgG serology were performed. M-R was found in 45% of females and 36% of males. At least 2 months after treatment, H. pylori status was assessed by the 14C urea breath test (n = 131), endoscopy (n = 37), urea breath test and endoscopy (n = 63), or solely by IgG serology (n = 7). Ten patients withdrew. IgG serology was performed again after 1 yr.. H. pylori infection was cured in 205 patients: 86% by all-patients-treated analysis and 83% by intention-to-treat analysis. When patients were classified according to pretreatment metronidazole susceptibility, cure of infection was achieved in 76% of females harboring M-R strains versus 96% of those with sensitive strains (p = 0.002) and in 81% versus 88% (p = 0.34) of males with M-R versus sensitive strains, respectively. Twelve patients (5 %) had to stop treatment prematurely because of severe side effects, but eight of them were treated successfully. One case of H. pylori infection (0.6 %) was detected at 1-yr follow-up.. Ten-day bismuth triple therapy t.i.d. was effective in curing H. pylori infection in the context of routine clinical practice. The efficacy was reduced in females harboring M-R strains.

Topics: Adult; Aged; Aged, 80 and over; Antacids; Anti-Bacterial Agents; Bismuth; Drug Administration Schedule; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Oxytetracycline; Peptic Ulcer

We treated 143 Helicobacter pylori positive ulcer patients (duodenal ulcer 81, gastric ulcer 24, pyloric ulcer nine, previous duodenal ulcer 27, others two) with a ten days regimen of bismuth subnitrate, oxytetracycline and metronidazole. Four weeks after cessation of treatment the 14C-urea breath test showed that the infection was eradicated in 133 out of 140 patients (95%). The ulcer had healed in 129 (97%) of the H. pylori negative patients. Status at one year after treatment showed that 121 (98.4%) of 123 patients who had become H. pylori negative had remained negative. None of the H. pylori negative patients experienced ulcer relapse. The results show that the treatment is effective and that the rate of recurrence of H. pylori during the first year is very low.

Topics: Adult; Aged; Bismuth; Drug Therapy, Combination; Female; Follow-Up Studies; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Oxytetracycline; Peptic Ulcer; Time Factors

Recent data on peptic ulcer and Helicobacter pylori colonization of the ventricle were discussed. Agreement was reached to re-adjust the pharmacological treatment of this condition. All patients for whom antibiotic therapy is considered should be examined by gastroscope. The bacterial agent should be proved by at least one out of several available methods. Two different established regimens are prescribed, either triple therapy with bismuth, metronidazole and tetracycline or double treatment without bismuth, for instance amoxicillin and omeprazole. Clinical control should take place after about eight weeks, with a "breath-test" in the case of duodenal ulcers, or with gastroscopy and a urease test. Many pointed out that treatment aimed at gastric acid reduction is to be preferred in cases of first occurrence of ventricular ulcers. Long-term acid reduction by drugs should not be offered to a patient until an attempt has been made to eradicate existing bacteria. No patient should be operated on before he being given antibacterial treatment. Treatment of non-ulcer dyspepsia with antibiotics has not shown to have an affect.

Topics: Amoxicillin; Bismuth; Drug Therapy, Combination; Follow-Up Studies; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Norway; Omeprazole; Oxytetracycline; Peptic Ulcer

Despite the close association between gastric Helicobacter pylori infection and duodenal ulcer, little is known about how this organism may promote mucosal damage. A possibility might be that it produces, or induces the host to release, phospholipases that metabolize the protective layer of phospholipids.. Aimed at determination of phospholipase A2 activity and the concentration of choline-containing phospholipids in gastric juice, aspirates were collected during gastroscopy in 38 consecutive referrals with either active (n = 19) or H. pylori-eradicated healed duodenal ulcer (n = 19).. Gastric juice phospholipase A2 activity was 3.1 times higher in active than in healed duodenal ulcers (P = 0.03). Concurrently, the concentration of choline-containing phospholipids in the group with active ulcers was less than half compared with the healed group (P = 0.02).. The results indicate that phospholipase A2 activity and the concentration of choline-containing phospholipids in gastric juice are related to H. pylori status and duodenal ulcer disease.

Topics: Adult; Aged; Bile Acids and Salts; Bismuth; Choline; Drug Therapy, Combination; Duodenal Ulcer; Female; Gastric Juice; Helicobacter Infections; Helicobacter pylori; Humans; Hydrogen-Ion Concentration; Male; Metronidazole; Middle Aged; Oxytetracycline; Phospholipases A; Phospholipases A2; Phospholipids

Two pilot studies were performed to determine whether aluminium-containing antacids may have a place in the treatment of Helicobacter pylori infection. The urease activity of H. pylori is cytopathic to gastric epithelium, and inhibition of this enzyme may have therapeutic potential. In the first study 24 subjects, 12 of which were infected with H. pylori, were given 1 tablet of chewable aluminium hydroxide-containing antacids 10 min before a 14C-urea breath test. Gastric urease activity was suppressed by 33.3% (p = 0.02) in the H. pylori-positive subjects (none became negative) within 40 min after administration of the tablet. Gastric H. pylori infection can be effectively eradicated by triple regimens containing bismuth salts, tetracycline, and metronidazole. Owing to adverse effects of this treatment and concern for possible neurotoxicity of bismuth, a bismuth substitute is warranted. Hence, in the second study, 20 subjects infected with H. pylori were treated with 1 antacid tablet 4 times daily between meals, plus 500 mg oxytetracycline and 200 mg metronidazole 4 times daily with meals for 2 weeks. Individual H. pylori status was assessed by the 14C-urea breath test. Four weeks after cessation of treatment, H. pylori was eradicated in 45% (9 of 20) of the subjects (95% confidence interval, 23.1-68.5%). Thirty per cent (6 of 20) observed one or more adverse effect regarded as moderate or severe, of which loose stools and headache were the most common.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aluminum Hydroxide; Antacids; Breath Tests; Carbonates; Clinical Enzyme Tests; Drug Therapy, Combination; Female; Gastrointestinal Diseases; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Oxytetracycline; Stomach; Urea; Urease