salicylates and Gastritis

Topics: Anti-Ulcer Agents; Bismuth; Drug Therapy, Combination; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Organometallic Compounds; Peptic Ulcer; Salicylates; Tetracycline; United States

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

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

In reviewing the literature we discussed the problem, whether there is a correspondence between the morphological picture of acute gastritis and the clinical expression including a complex of symptoms "acute gastritis", which should better be called acute dyspepsia. There is no good accord.--The histological main features of acute gastritis are infiltration of mucosa by neutrophils and the leucodiapedesis. this acute gastritis is very seldom the cause of clinical symptoms of acute dyspepsia. Alcohol, spices or drugs may produce a "toxic damage" of the mucosa, but they do not cause an acute gastritis, just as little as some viral diseases or staphylococcal toxins.

Topics: Acute Disease; Adult; Condiments; Dyspepsia; Ethanol; Gastric Juice; Gastric Mucosa; Gastritis; Hepatitis, Viral, Human; Humans; Influenza, Human; Male; Neutrophils; Salicylates

Topics: Anti-Inflammatory Agents; Arthritis; Aspirin; Child; Drug Tolerance; Female; Gastric Mucosa; Gastritis; Humans; Indomethacin; Infant, Newborn; Inflammation; Kidney; Kinetics; Liver; Maternal-Fetal Exchange; Pregnancy; Prostaglandins; Salicylates; Stomach Ulcer

Helicobacter pylori (H. pylori) remains an important cause of gastric cancer and peptic ulcer disease worldwide. Treatment of H. pylori infection is one of the effective ways to prevent gastric cancer. However, standard triple therapy for H. pylori eradication is no longer effective in many countries, including Thailand. This study was designed to evaluate the efficacy of adding bismuth and probiotic to standard triple therapy for H. pylori eradication.. In this prospective single center study, H. pylori infected gastritis patients were randomized to receive 7- or 14-day standard triple therapy plus bismuth with probiotic or placebo. Treatment regimen consisted of 30 mg lansoprazole twice daily, 1 g amoxicillin twice daily, 1 g clarithromycin MR once daily and 1,048 mg bismuth subsalicylate twice daily. Probiotic bacteria composed of Bifidobacterium lactis, Lactobacillus acidophilus and Lactobacillus paracasei. Placebo was conventional drinking yogurt without probiotic. CYP2C19 genotyping and antibiotic susceptibility tests were also done. H pylori eradication was defined as a negative 13C-urea breath test at least 2 weeks after completion of treatment.. One hundred subjects were enrolled (25 each to 7- and 14-day regimens with probiotic or placebo). Antibiotic susceptibility tests showed 36.7% metronidazole and 1.1% clarithromycin resistance. CYP2C19 genotyping revealed 40.8%, 49% and 10.2% were rapid, intermediate and poor metabolizers, respectively. The eradication rates of 7- or 14 regimens with probiotics were 100%. Regarding adverse events, the incidence of bitter taste was significantly lower in the 7- day regimen with the probiotic group compared with 7- day regimen with placebo (40% vs. 64%; p=0.04).. The 7-day standard triple therapy plus bismuth and probiotic can provide an excellent cure rate of H. pylori (100%) in areas with low clarithromycin resistance such as Thailand, regardless of CYP2C19 genotype. Adding a probiotic also reduced treatment-related adverse events.

Topics: Amoxicillin; Anti-Bacterial Agents; Bismuth; Clarithromycin; Drug Therapy, Combination; Female; Follow-Up Studies; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Lansoprazole; Male; Middle Aged; Organometallic Compounds; Probiotics; Prognosis; Prospective Studies; Salicylates; Thailand

In order to investigate the potential of Helicobacter pylori (HP) to induce dyspepsia, we performed a randomized prospective study on the long-term effect of HP-eradication on symptoms of HP-positive dyspeptic patients in whom other organic causes for dyspepsia were carefully ruled out.. 201 patients referred to our endoscopy unit with dyspeptic symptoms for at least six months entered the study. Patients with previous peptic ulcer were excluded.. After endoscopy of the upper alimentary tract and 13C-urea breath test, patients with active peptic ulcer, hiatal hernia, macroscopic evidence for esophagitis and negative HP-status were excluded. The remaining patients underwent abdominal sonography, H2-exhalation test with lactose, and 24-h pH monitoring in order to exclude other organic causes for dyspepsia. In 20 patients, dyspepsia was assumed to be due to HP-gastritis. Patients received eradication therapy and were controlled as assessed by the 13C-urea breath test six weeks and six months after completion of the therapy. Dyspeptic symptoms were monitored by means of a validated symptom score.. Out of 20 patients with HP-gastritis the first eradication treatment was successful in 13, while seven patients remained HP-positive after antibiotic treatment. Six months after completion of therapy the symptoms of HP-eradicated patients improved considerably (score values 17.4 +/- 1.5 and 10.2 +/- 0.8, respectively, p < 0.01) whereas symptoms of patients with persistent infection remained unchanged (21.1 +/- 1.7 and 20.4 +/- 1.5, n.s.) and only improved after successful retherapy (20.4 +/- 1.5 and 11.7 +/- 2.1, p < 0.05). In total, 17 of 20 patients (85%) improved after successful eradication. Also, neutrophil infiltration in the gastric mucosa correlated to both dyspeptic symptoms before therapy (r = 0.85) and the decrease in symptom score after HP-eradication (r = 0.61). In contrast, the symptoms of eight patients with gastroesophageal reflux disease were not improved after eradication (20.0 +/- 1.1 and 18.2 +/- 1.0, n.s.). HP-infection per se contributes to dyspepsia. 17 of 20 (85%) HP-positive dyspeptic patients improved after HP-eradication, when other potential organic causes for dyspepsia had been ruled out. However, many patients did not completely recover but the symptoms only partly decreased which parallels the persistence of part of the inflammatory infiltration in the gastric mucosa. This emphasizes the importance of HP-gastritis as an organic disease causing dyspeptic symptoms.

Topics: Adult; Aged; Amoxicillin; Anti-Ulcer Agents; Bismuth; Clarithromycin; Diagnosis, Differential; Dose-Response Relationship, Drug; Drug Administration Schedule; Dyspepsia; Female; Follow-Up Studies; Gastritis; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Omeprazole; Organometallic Compounds; Salicylates; Tetracycline; Treatment Outcome

To study the effects of treatment of Helicobacter pylori infection in a hyperendemic population, 143 infected patients from the region of Nariño, Colombia, were treated for 2 weeks with clarithromycin (500 mg twice a day), amoxicillin (1 g twice a day), and either lansoprazole (30 mg twice a day) or omeprazole (30 mg twice a day). All patients belong to a low socioeconomic strata, had multifocal atrophic gastritis documented by gastric biopsies, and had been treated previously and unsuccessfully for 2 weeks with bismuth subsalicylate (262 mg four times a day), amoxicillin (500 mg three times a day), and metronidazole (400 mg three times a day). 13C-urea breath tests were performed 6, 12, 24, and 60 weeks after completing therapy. The 13C-urea breath test was negative in 79.7% of patients 1 month after finishing therapy, and in 69.2% of patients 1 year after finishing treatment. There were no differences in eradication rates between patients treated with omeprazole versus lansoprazole. Dyspepsia symptoms decreased from 74% in patients at baseline to 19% at the time of finishing treatment. In low-socioeconomic status populations with hyperendemic infection, triple therapy using omeprazole or lansoprazole plus clarithromycin and amoxicillin is an effective alternative when previous standard bismuth-based triple therapy has failed.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Adult; Aged; Amoxicillin; Anti-Bacterial Agents; Bismuth; Clarithromycin; Drug Therapy, Combination; Enzyme Inhibitors; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Lansoprazole; Male; Metronidazole; Middle Aged; Omeprazole; Organometallic Compounds; Penicillins; Proton Pump Inhibitors; Salicylates; Treatment Outcome

The present study was designed to compare the efficacy and tolerability of triple therapy and dual therapy for Helicobacter pylori in duodenal ulcer patients and to evaluate the long-term clinical course of ulcer disease. Forty duodenal ulcer patients with proven H. pylori infection were enrolled into the study and randomly treated with either triple therapy consisting of bismuth subsalicylate, metronidazole and tetracycline plus ranitidine or with dual therapy comprising omeprazole and amoxicillin. Patients were investigated clinically and endoscopically including assessment of H. pylori infection by means or rapid urease test, culture, histology and urea breath testing 4 weeks after cessation of eradication therapy, in 1-year intervals and when dyspeptic symptoms recurred. One patient of each group was lost during follow-up. H. pylori infection was cured by triple therapy in 84.2% and by dual therapy in 78.9% (p = 1.00). During follow-up, all patients with cure of H. pylori infection (n = 31) remained in stable remission with respect to duodenal ulcer disease, while 6 out of 7 patients persistently infected with H. pylori developed an ulcer relapse (p < 0.001). One patient with cured infection had had an episode of dyspeptic symptoms requiring pharmacotherapy and in another 3 patients mild refluxesophagitis without necessity of medical treatment had been detected on the occasion of a scheduled endoscopy. In the short-term, cure of the infection resulted in a marked reduction of the degree of antral gastritis and in a loss of activity in all but one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Amoxicillin; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Duodenal Ulcer; Female; Follow-Up Studies; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Omeprazole; Organometallic Compounds; Penicillins; Prospective Studies; Ranitidine; Recurrence; Salicylates; Tetracycline; Treatment Outcome

Chronic Helicobacter pylori-associated gastritis is now widely accepted as one of the most important pathogenic factors in duodenal ulcer disease. However, little is known about for how long patients remain free of duodenal ulcer relapses after H. pylori infection has been cured. In the present study, we investigated remission time during a 5-year follow-up period after anti-H. pylori treatment.. The patients were randomly allocated to treatment with either a combination of 3 x 600 mg bismuth subsalicylate and 2 x 1000 mg amoxycillin or 3 x 600 mg bismuth subsalicylate monotherapy. Endoscopy, including histological and microbiological examination of biopsies, was performed 4 weeks after termination of treatment and after 1 and 2 years. During the third, fourth and fifth years of the follow-up period, patients were monitored twice a year for symptoms compatible with ulcer relapse and for their use of anti-ulcer medication. Endoscopic and histological examinations were carried out whenever symptoms occurred.. Of 56 evaluated patients, 47 showed healing of ulcers after bismuth subsalicylate plus amoxycillin compared with 44 of 57 after bismuth subsalicylate monotherapy. H. pylori infection was cured in 52% (29 of 56) of the patients after combined therapy and in 4% (2 of 57) after the monotherapy. The cumulative duodenal ulcer relapse rates after 5 years were 38% (18 of 47) after the combined therapy and 75% (33 of 44) after the monotherapy. In patients who were cured of H. pylori infection, the cumulative duodenal ulcer relapse rate after 5 years was 9.7% (3 of 31), compared with 81.7% (49 of 60) in those patients who remained H. pylori-positive after treatment (P < 0.001). In two of the three patients who suffered duodenal ulcer relapse after being cured of H. pylori infection, H. pylori was present again at the time of relapse.. The data suggest that curing H. pylori infection results in long-term cure of duodenal ulcer disease and that duodenal ulcer relapses in successfully treated patients are most often associated with H. pylori reinfection.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin; Bismuth; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Duodenal Ulcer; Female; Follow-Up Studies; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Organometallic Compounds; Penicillins; Recurrence; Salicylates

Gastritis caused by Helicobacter pylori (HP) is common in patients with nonulcer dyspepsia (NUD), but an etiologic relationship between the histologic lesion and clinical symptoms is unproven. HP is inhibited by bismuth subsalicylate (BSS), a traditional remedy for dyspeptic complaints. The aim of this study was to assess the short- and long-term effects of BSS on HP, gastritis, and symptoms in patients with NUD. One hundred twenty-six patients with NUD who were shown to be infected with H. pylori (HP+) were enrolled. There was a two-week placebo run-in period to eliminate placebo responders. Fifty patients remained symptomatic and were randomly assigned to therapy with either BSS liquid or a matching placebo. EGD, biopsy, and clinical evaluations were performed at entry, at week 5 (end of therapy), at week 9 (four weeks after therapy), or at time of symptomatic relapse. Twenty-seven patients received placebo and 23 patients received BSS. BSS suppressed H. pylori in 15/23 patients (65%) and eradicated it in one patient, whereas the placebo had no effect on H. pylori. Gastritis improved during therapy with BSS but relapsed by week 9. There was no significant change in level of dyspeptic symptoms during or after treatment, although one month after the end of treatment, the patients in the BSS group consistently had lower symptom scores and fewer symptomatic days for all symptoms measured. The study confirms that BSS given for three weeks suppresses but does not usually eradicate H. pylori. Such short-term suppression of H. pylori heals gastritis but does not result in clinical improvement.

Topics: Adult; Bismuth; Chronic Disease; Double-Blind Method; Dyspepsia; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Leukocyte Count; Organometallic Compounds; Salicylates; Treatment Outcome

The efficacy of omeprazole in the elimination of Helicobacter pylori was investigated in a prospective randomized-controlled trial. 50 patients with upper gastrointestinal symptoms and chronic active H. pylori-associated gastritis were allocated to one of the following four therapeutic schedules: 1) omeprazole 40 mg/d for 4 weeks (n = 13); 2) bismuth subsalicylate (BSS) 3 x 600 mg for 4 weeks (n = 12); 3) omeprazole plus BSS for 4 weeks (n = 13); 4) triple therapy (BSS for 4 weeks, amoxicillin 3 x 750 mg and metronidazole 3 x 400 mg for 10 days) (n = 12). Clinical symptoms, endoscopic and histologic findings, and H. pylori status were reassessed immediately after therapy, and 1 and 6 months later. After cessation of therapy bacterial clearance rates were: 1) omeprazole 2/13 (15%); 2) BSS 6/12 (50%); 3) omeprazole plus BSS 5/13 (38%); 4) triple therapy 10/12 (83%). The degree of density of gastric mucosal infestation with H. pylori and the degree of activity of gastritis was reduced in all treatment groups but was most prominent after triple therapy. Clinical symptoms improved in all treatment groups. One and six months after completion of therapy H. pylori eradication rates were: 1) omeprazole 0/13 (0%); 2) BSS 1/12 (8%); 3) omeprazole plus BSS 1/13 (8%); 4) triple therapy 10/12 (83%). Our study shows that 40 mg/d omeprazole is ineffective in eradicating H. pylori. Dual therapy with omeprazole and bismuth subsalicylate does not improve bacterial elimination. Only triple therapy effectively eradicates H. pylori.

Topics: Adult; Aged; Amoxicillin; Bismuth; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Omeprazole; Organometallic Compounds; Prospective Studies; Salicylates

We assessed the relative roles of alcohol and infection with Helicobacter pylori in the pathogenesis of chronic gastritis in alcoholic patients. Helicobacter pylori was found in 14 of 18 alcoholics with dyspepsia and was associated with chronic antral gastritis. Gastric biopsy specimens were normal in four H pylori-negative alcoholics. Studies were repeated 3 to 4 weeks after controlled abstinence. There was no change in histologic findings during this period, indicating that alcohol itself was not the major causative agent. We then eliminated H pylori in 10 subjects by giving triple therapy (bismuth subsalicylate, amoxicillin, and metronidazole). Treatment for H pylori was associated with almost complete normalization of histologic findings. Four control subjects who received antacids alone showed no improvement. Dyspeptic symptoms in H pylori-positive patients significantly improved after elimination of this organism, whereas there was no change with antacid treatment.

Topics: Adult; Alcoholism; Aluminum Hydroxide; Amoxicillin; Bismuth; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Organometallic Compounds; Salicylates; Temperance

In a placebo controlled prospective clinical trial of bismuth salicylate in helicobacter pylori associated gastritis, 52 adult patients were randomly allocated to treatment with bismuth salicylate or placebo. Helicobacter pylori were totally cleared in 77% patients in bismuth group but none in placebo group (P less than 0.001). Resolution of gastritis (P less than 0.001) and improvement of symptoms (P less than 0.01) were significantly better in patients where H. pylori infection cleared as compared to patients where the infection persisted.

Topics: Adolescent; Adult; Bismuth; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Placebos; Prospective Studies; Salicylates; Salicylic Acid

In order to assess whether bismuth subsalicylate (BSS) clears Campylobacter pylori and whether this clearance is associated with improvement in histologic gastritis, 20 patients with antral biopsies colonized by C. pylori were randomized to treatment with 30 ml of BSS (525 mg) or placebo q.i.d. for 21 days. After both 2 and 3 wk of treatment, C. pylori was cleared in 70% (7/10) of BSS-treated patients, compared with 10% (1/10) of patients on placebo (p less than 0.05) at 2 wk and 0% (0/10) of patients on placebo at 3 wk (p less than 0.01). A significant improvement in histologic gastritis (p less than 0.05) was noted after 2 and 3 wk of treatment in the group receiving BSS. Gastritis improvement was a result of both reduced polymorphonuclear and mononuclear cell infiltration. Clearance of C. pylori was highly correlated with improvement of histologic gastritis (p less than 0.001). In addition, mucus depletion scores were significantly improved in the BSS-treated group. These data indicate that treatment with BSS provides short-term clearance of C. pylori in antral mucosa, and this clearance is associated with an improvement in histologic gastritis. These findings support the pathogenic role of C. pylori in histologic antral gastritis.

Topics: Bismuth; Campylobacter; Campylobacter Infections; Gastritis; Humans; Organometallic Compounds; Prospective Studies; Random Allocation; Salicylates

An investigator blind trial was performed comparing bismuth salicylate, erythromycin ethylsuccinate, and placebo in the treatment of Campylobacter pyloridis associated gastritis in patients without peptic ulceration. Fifty patients fulfilled the study criteria. There was a strong correlation between the presence of C pyloridis and histologically confirmed gastritis. Clearance of organisms led to improvement of the gastritis. C pyloridis was cleared from 15 patients; of these, 13 had gastritis initially, which resolved in 12. Conversely, gastritis resolved in only four of 32 patients not cleared of organisms (p less than 0.0001). There was significantly greater improvement in endoscopic appearances in the patients cleared of C pyloridis compared with those whose infection persisted (p less than 0.001). In the three treatment groups organisms were cleared from 14 of 18 patients receiving the locally active bismuth salicylate, only one of 15 patients receiving erythromycin ethylsuccinate, and none of 17 patients taking placebo. These findings suggest that the ideal antimicrobial for the successful eradication of C pyloridis associated gastritis should be locally active, stable at low pH, and should penetrate gastric mucus. The resolution of gastritis and improvement in endoscopic appearances associated with clearance of C pyloridis support the view that these organisms may play a part in this condition.

Topics: Adult; Aged; Bismuth; Campylobacter; Campylobacter Infections; Clinical Trials as Topic; Erythromycin; Erythromycin Ethylsuccinate; Female; Gastric Mucosa; Gastritis; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Salicylates; Salicylic Acid

A 4-week, double-blind, controlled multi-centre study was carried out in 235 patients with active rheumatoid arthritis to compare the efficacy and tolerance of 500 mg or 1000 mg diflunisal per day administered once daily, in the evening, or in divided, twice daily dosage. The results showed that diflunisal given once daily was at least as effective as diflunisal given twice daily. Day pain, morning stiffness, average grip strength and erythrocyte sedimentation rate improved similarly in both groups. Significant differences favouring the once-daily regimen were observed for improvement in night pain, Ritchie index and overall assessments by patient and investigator. Adverse experiences were slightly more common in patients taking diflunisal once daily (24% vs 19%) but this difference was not significant. It is concluded, therefore, that diflunisal once-a-day is an alternative regimen for the treatment of rheumatoid arthritis. It is at least as effective as the twice-daily regimen and may provide additional convenience to the patient and potential enhancement of compliance.

Topics: Adolescent; Adult; Aged; Arthritis, Rheumatoid; Clinical Trials as Topic; Diflunisal; Double-Blind Method; Drug Administration Schedule; Drug Eruptions; Drug Tolerance; Female; Gastritis; Humans; Male; Melena; Middle Aged; Patient Compliance; Salicylates; Thrombocytopenia

Topics: Aspirin; Clinical Trials as Topic; Diflunisal; Double-Blind Method; Gastric Mucosa; Gastritis; Humans; Peptic Ulcer Hemorrhage; Salicylates

In a randomized double-blind study efficacy and tolerance of diflunisal, 375 mg twice daily, and oxyphenbutazone, 200 mg twice daily, were compared in 40 patients (aged 21 to 70 years, average 38 years), with moderate or severe complaints after spraining or dislocating ankle or wrist. The drugs were given for five days. Both proved to be highly efficacious, diflunisal slightly more so. Among the 20 patients in the diflunisal group one developed diarrhoea, another gastritis; in the oxyphenbutazone group one developed gastritis, another herpetiform pustules. There were no clinically significant abnormalities in routine biochemical tests.

Topics: Adult; Aged; Ankle Joint; Anti-Inflammatory Agents, Non-Steroidal; Clinical Trials as Topic; Diarrhea; Double-Blind Method; Drug Tolerance; Female; Gastritis; Humans; Joint Dislocations; Male; Middle Aged; Oxyphenbutazone; Salicylates; Skin Diseases; Sprains and Strains; Wrist Injuries

Topics: Absorption; Achlorhydria; Adult; Chlorides; Clinical Trials as Topic; Diffusion; Female; Gastric Mucosa; Gastritis; Gastrointestinal Hemorrhage; Humans; Hydrochloric Acid; Hydrogen-Ion Concentration; Male; Potassium; Salicylates; Sodium

Topics: Aminobenzoates; Arthritis, Rheumatoid; Aspirin; Blood Coagulation; Buffers; Dyspepsia; Gastritis; Gastrointestinal Hemorrhage; Humans; Intestinal Absorption; Kidney Diseases; Placebos; Salicylates; Sodium Salicylate; Tablets, Enteric-Coated

Topics: Anniversaries and Special Events; Antacids; Anti-Bacterial Agents; Asthma; Bacterial Vaccines; Bismuth; Drug Resistance, Bacterial; Drug Therapy, Combination; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Nobel Prize; Organometallic Compounds; Peptic Ulcer; Probiotics; Salicylates; Stress, Psychological

We determined the in vitro susceptibility of clinical isolates of Helicobacter pylori to ZnCl, compared its sensitivity to bismuth subsalicylate (BSS) and clarithromycin (CLR) that are used for the treatment of H. pylori infection and its activity at different gastric pH. One hundred sixteen clinical isolates of H. pylori strains were chosen. Agar gel dilution method was used to determine the susceptibility of H. pylori isolates to ZnCl 40 μg/ml, BSS 20 μg/ml, and CLR 2 μg/ml. Suspension of 10(9) bacteria/μl was streaked on the blood agar plate. The control consisted of H. pylori incubated without ZnCl, BSS, and CLR. One hundred ten H. pylori strains (95%) were susceptible to ZnCl 40 μg/ml compared to 114 (98%) to BSS 20 μg/ml (p=0.002) and 92 (79%) to CLR 2 μg/ml (p=0.602). H. pylori isolates from patients with nonulcer dyspepsia and from peptic ulcer were equally susceptible to ZnCl 40 μg/ml (90/96 vs. 26/26, p=0.208). H. pylori associated with chronic gastritis and chronic active gastritis were equally susceptible to ZnCl. H. pylori demonstrated susceptibility to ZnCl in vitro. H. pylori susceptibility to ZnCl 40 μg/ml was greater than BSS and comparable to CLR. ZnCl may be used in the treatment of H. pylori infection.

Topics: Adult; Aged; Anti-Bacterial Agents; Bismuth; Chlorides; Chronic Disease; Clarithromycin; Drug Resistance, Bacterial; Dyspepsia; Female; Gastric Juice; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Hydrogen-Ion Concentration; Male; Microbial Sensitivity Tests; Middle Aged; Organometallic Compounds; Peptic Ulcer; Salicylates; Zinc Compounds

Topics: Anti-Ulcer Agents; Bismuth; Crystallography, X-Ray; Gastritis; Models, Molecular; Molecular Structure; Organometallic Compounds; Salicylates

Helicobacter pylori (H. pylori) infection has been linked to gastric cancer. The factors that promote carcinogenesis remain unknown. Epidermal growth factor (EGF) has been shown to be a potent epithelial mitogen and oncoprotein when sustained over expression occurs. Our aim was to compare gastric mucosal levels of EGF and its receptor (EGFR) among controls, H. pylori infected subjects, and subjects following H. pylori eradication using quantitative flow cytometric analysis.. Patients referred for evaluation of dyspepsia underwent EGD and six antral biopsies were performed (two each for rapid urease testing (RUT), histopathology, and flow cytometry). Controls were those found to be H. pylori negative while subjects had confirmed infection. The study patients were treated, then had repeat EGD with biopsies.. There were 17 controls and 28 cases. Mean EGF and EGFR values were 2.69 and 2.46 for controls and 4.67 and 4.64 for subjects. Subjects' mean EGF was 73% higher (p = .035) and EGFR was 88% higher (p = 0.029) than controls. After treatment, the subjects' mean values declined 55% (p = 0.0001) for EGF and 40% (p = 0.002) for EGFR. Three subjects had persistent infection and showed no change in their EGF/EGFR levels. No difference was found among factor levels with respect to endoscopic findings.. Both EGF and EGFR from gastric antral biopsies are increased nearly 2-fold in infection with H. pylori. Infection eradication reduces levels of both factors to those of controls. One major pathogenic mechanism for gastric mucosal hyperproliferation and possibly carcinogenesis related to H. pylori may be the over expression of EGF and increased receptor density of EGFR on gastric mucosal cells.

Topics: Adult; Antacids; Anti-Bacterial Agents; Anti-Ulcer Agents; Biopsy; Bismuth; Chronic Disease; Drug Therapy, Combination; Epidermal Growth Factor; ErbB Receptors; Female; Flow Cytometry; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Omeprazole; Organometallic Compounds; Prospective Studies; Salicylates

Topics: Adult; Amoxicillin; Anti-Ulcer Agents; Autoimmune Diseases; Bismuth; Drug Therapy, Combination; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; L-Lactate Dehydrogenase; Metronidazole; Omeprazole; Organometallic Compounds; Purpura, Thrombocytopenic, Idiopathic; Salicylates; Tetracycline

Rhesus monkeys raised in colonies tend to become naturally infected by Helicobacter pylori early in life. Earlier attempts to cure H. pylori infection with a 10-day triple therapy (metronidazole, amoxicillin, and peptobismol) were only partially (60%) successful, probably because of preexisting metronidazole resistance. This study was carried out to determine the efficacy of an alternative clarithromycin-omeprazole-based therapy for curing H. pylori infection in Rhesus monkeys (Macaca mulatta), and to examine histologic and serologic correlates of curing. Five monkeys were endoscoped under ketamine anesthesia. Histology and culture of gastric biopsies and serologic tests demonstrated that they were H. pylori-positive. Two animals had not received prior anti-H. pylori treatment, while three other animals had failed triple therapy and carried metronidazole-resistant H. pylori strains. Quadruple therapy with omeprazole, clarithromycin, amoxicillin, and bismuth subsalicylate was given for 10 days to these five animals. All five animals were cured of the infection, and remained H. pylori-free, based on histology and culture at regular intervals for the 5 months posttherapy during which they were followed. Gastritis scores and anti-H. pylori IgG levels decreased in each animal during this period to levels characteristic of uninfected animals. These results indicate that an omeprazole-clarithromycin-based regimen can cure H. pylori infection in Rhesus monkeys, with resolution of abnormal histology and serologic responses. They suggest that this preclinical animal model is useful for testing new anti-H. pylori therapies.

Topics: Amoxicillin; Animals; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Clarithromycin; Drug Therapy, Combination; Endoscopy, Gastrointestinal; Enzyme Inhibitors; Gastritis; Helicobacter Infections; Helicobacter pylori; Macaca mulatta; Male; Omeprazole; Organometallic Compounds; Penicillins; Salicylates

Topics: Bacterial Infections; Bismuth; Child; Gastric Mucosa; Gastritis; Helicobacter heilmannii; Humans; Male; Metronidazole; Organometallic Compounds; Salicylates; Tetracycline

Helicobacter pylori has been proposed as a major determinant in multiple gastric disorders. We describe the case of a young adult with a long-standing medical history of sideropenic anaemia and of oral iron consumption dependence with a chronic superficial H. pylori-positive gastritis. All other causes of sideropenic anaemia were carefully excluded. Histology showed a peculiar pattern of non-active H. pylori-positive gastritis. The bacterium was a non-VacA-producing strain. The first attempt at eradication caused a reduction in bacterial load and led to a partial normalization of haematologic variables without improving the ferritin level. A successful second course of eradication therapy completely reversed the anaemia and restored the iron deposit, which persisted at the 29-month follow-up. H. pylori infection can be involved in unexplained cases of iron deficiency anaemia in adults, and its cure can normalize the haematologic picture.

Topics: Adult; Anemia, Iron-Deficiency; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Clarithromycin; Drug Therapy, Combination; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Omeprazole; Organometallic Compounds; Salicylates; Tetracycline

Three cheetahs (Acinonyx jubatus) had a clinical history of chronic spiral bacteria-associated gastritis and three cheetahs had no clinical history of gastritis. Gastric biopsies were obtained from all six cheetahs prior to treatment for gastritis and 3 wk and 1 yr posttreatment. The cheetahs were treated with tetracycline hydrochloride 500 mg p.o. q.i.d., metronidazole 250 mg p.o. q.i.d., and bismuth subsalicylate 300 mg p.o. q.i.d. Each drug was administered concurrently for 7 days. Following this treatment, each cheetah was maintained on 300 mg bismuth subsalicylate p.o. s.i.d. for 1 yr. The three cheetahs with a history of gastritis were culture positive for Helicobacter acinonyx and remained positive during the entire study. The three cheetahs with no clinical history of gastritis were culture negative for H. acinonyx, but gastric biopsies revealed Gastrospirillum-like bacteria (tentatively named Helicobacter heilmannii) pretreatment. Gastric biopsies were negative for H. heilmannii on subsequent examinations. Although the treatment did not eradicate H. acinonyx, it did provide symptomatic relief from the vomiting, anorexia, and weight loss associated with clinical gastritis. The use of endoscopically guided gastric mucosal biopsies for urease testing and histopathologic examination of Warthin-Starry-stained sections is a sensitive and specific method of diagnosing spiral bacteria-associated gastritis. Treatment of spiral bacteria-associated gastritis in cheetahs should include the rational use of antibiotics (tetracycline or amoxicillin and metronidazole), bismuth compounds, and omeprazole and evaluation of husbandry methods to reduce stress.

Topics: Acinonyx; Animals; Anti-Bacterial Agents; Antitrichomonal Agents; Biopsy; Bismuth; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Gastric Mucosa; Gastritis; Gram-Negative Bacterial Infections; Helicobacter; Helicobacter Infections; Lymphocytes; Male; Metronidazole; Organometallic Compounds; Prospective Studies; Salicylates; Sensitivity and Specificity; Tetracycline; Time Factors

Topics: Amoxicillin; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Clarithromycin; Duodenal Ulcer; Esophagitis, Peptic; Female; Follow-Up Studies; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Omeprazole; Organometallic Compounds; Penicillins; Prospective Studies; Risk Factors; Salicylates; Sex Factors; Weight Gain

Recrudescence or reinfection may occur after eradication of Helicobacter pylori in humans.. We used the ferret Helicobacter mustelae model to investigate the effect of prior infection and eradication on reinfection by experimental and natural routes. Two groups of ferrets with naturally acquired H. mustelae infection were treated with an eradication protocol using amoxicillin, metronidazole, and bismuth subsalicylate. The ferrets were monitored for recrudescence by repeated cultures of endoscopic gastric mucosal biopsies. The ferrets were challenged at 17 months (group I) and 6 months (group II) after eradication with a strain of H. mustelae having a distinctive restriction endonuclease analysis pattern. The eradication protocol was repeated to eliminate the infection produced by experimental challenge. The ferrets were then cohoused intermittently with naturally infected ferrets.. The original H. mustelae infection was successfully eliminated by the eradication protocol. No recrudescence was observed in group I for 12 months nor for 3 months in group II after eradication. All ferrets became persistently reinfected with the challenge strain. The infection from the challenge strain was eradicated successfully. No ferrets in group I and all ferrets in group II became infected through cohousing.. These results suggest that though prior infection with H. mustelae may confer some protection against reinfection, such protection is not universal in all circumstances; that susceptibility to reinfection by contact with infected animals varies between individuals; and that age may be a factor in this individual variability. These results are applicable to studies of reinfection after eradication of H. pylori in humans.

Topics: Amoxicillin; Animals; Antacids; Bacterial Proteins; Biopsy; Bismuth; DNA, Bacterial; Drug Therapy, Combination; Ferrets; Gastric Mucosa; Gastritis; Gastroscopy; Helicobacter; Helicobacter Infections; Metronidazole; Organometallic Compounds; Recurrence; Salicylates; Time Factors; Urease

Numerous clinical trials evaluating the efficacy of various antimicrobial compounds against Helicobacter pylori infection have been performed in humans. A convenient animal model for Helicobacter infection would facilitate the evaluation of novel therapies. These experiments were performed to evaluate the use of ferrets as a model of Helicobacter infection.. Ferrets were infected experimentally with Helicobacter mustelae and subsequently treated with bismuth subsalicylate (BSS) triple therapy (BSS, metronidazole, and amoxicillin), or left untreated. The status of infection and serology was assessed during treatment and for 8 weeks posttreatment. Seven ferrets successfully treated with triple therapy were challenged with H. mustelae and monitored for infection for an additional 5 weeks.. Infection of ferrets by H. mustelae was accompanied by gastritis and a specific antibody response. Treatment of H. mustelae-infected ferrets with BSS suppressed bacterial growth in four of nine animals but did not eradicate infection. Triple therapy eradicated infection in all nine ferrets with a reduction in gastric inflammation. No relapse of infection occurred up to 8 weeks posttherapy. Challenge with H. mustelae of ferrets successfully treated with triple therapy resulted in a 100% rate of reinfection.. H. mustelae infection can be eliminated by triple therapy, but this does not result in protective immunity against reinfection by H. mustelae. This model, using a strain of Helicobacter indigenous to the host, may be useful for assessing therapeutic efficacy of novel therapies for the treatment of human infection by H. pylori.

Topics: Amoxicillin; Animals; Antacids; Antibodies, Bacterial; Bismuth; Drug Therapy, Combination; Female; Ferrets; Gastritis; Helicobacter; Helicobacter Infections; Male; Metronidazole; Organometallic Compounds; Salicylates; Specific Pathogen-Free Organisms

To determine the role of Helicobacter pylori infection in children with recurrent abdominal pain and the usefulness of serologic tests in screening H pylori infection and monitoring treatment of H pylori-associated gastritis.. During a 3 year period, we investigated the presence of serum immunoglobulin G (IgG) antibody to H pylori in 456 children using the high-molecular-weight cell-associated protein H pylori enzyme immunoassay kit. Among the 456 children studied, 218 (age range, 3 to 18 years; mean age, 9.5 years) had symptoms of recurrent abdominal pain (RAP syndrome) with or without vomiting, and the remaining 238 (age range, 3 to 18 years; mean age, 9.8 years) had no RAP (non-RAP syndrome). We performed upper gastrointestinal endoscopy on 111 consecutive children of the 218 with RAP syndrome and obtained mucosal biopsies for culture, histologic analysis, CLO test (Delta West, Perth, Australia), and H pylori detection by polymerase chain reaction.. Thirty-eight (17.4%) of 218 children in the RAP group and 25 (10.5%) of 238 children in the non-RAP group were seropositive for H pylori. Of the 111 children endoscoped, 95 were found to be negative, and 12 were positive by all five assays. Specimens from 2 children were negative by culture and the CLO test but positive by the other three assays. Specimens from 1 child were negative by histologic analysis but positive by all other tests. The remaining child was positive for anti-H pylori IgG but negative by all of the other four assays. Upper gastrointestinal endoscopy detected 14 children with peptic ulcer disease (9 duodenal ulcer and 5 gastric ulcer) and 12 with antral nodular gastritis. Only 4 of the 14 diagnosed with peptic ulcer were H pylori positive by all five assays, whereas all 12 children with antral nodular gastritis were H pylori positive. Nine of the 12 H pylori-positive children were treated with a combination of bismuth subsalicylate, amoxicillin, and metronidazole for 2 weeks. Sera obtained at 2, 4, and 6 months after treatment from all 9 children showed a decrease in anti-H pylori IgG titer. Three H pylori-infected children who did not receive any treatment served as control children, and their IgG levels remained elevated or increased over time.. The results from our study indicate that screening for the serum IgG antibody to H pylori is a practical method for diagnosing H pylori infection in children, and that serial measurements of the H pylori IgG antibody are useful for monitoring treatment of H pylori because of its high sensitivity and ease of performance. Only 4 of the 14 children diagnosed with peptic ulcer disease were confirmed to be infected with H pylori, whereas all 12 children with antral nodular gastritis were found to be infected by H pylori. These observations suggest that H pylori infection is more frequently associated with gastritis than with peptic ulcer disease in children, and that H pylori gastritis is a cause of RAP syndrome in children.

Topics: Abdominal Pain; Adolescent; Amoxicillin; Antibodies, Bacterial; Bismuth; Child; Child, Preschool; Duodenal Ulcer; Endoscopy, Gastrointestinal; Enzyme-Linked Immunosorbent Assay; Female; Follow-Up Studies; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Immunoglobulin G; Male; Metronidazole; Organometallic Compounds; Polymerase Chain Reaction; Recurrence; Salicylates; Stomach Ulcer

To study the relationship between Helicobacter pylori infection, gastric inflammatory scores, and fasting gastrin and pepsinogen A and C concentrations, and to evaluate the effect of treatment on these parameters.. Gastrin and pepsinogen A and C concentrations were measured in 36 patients with gastritis, 10 gastric ulcer patients, 12 duodenal ulcer patients, and in 15 subjects with normal gastric mucosa, by standard radioimmunoassay techniques. Fifteen patients with H. pylori infection underwent triple therapy (bismuth subsalicylate, amoxicillin, metronidazole) and were reassessed 1 month later.. Fasting gastrin and pepsinogen A and C concentrations were significantly higher in H. pylori-positive gastritis and peptic ulcer patients than in subjects with normal mucosa and in patients with H. pylori-negative gastritis. There was a significant correlation between inflammatory scores and serum gastrin (r = 0.45, p < 0.0001), and pepsinogen A (r = 0.33, p < 0.006) and pepsinogen C (r = 0.55, p < 0.0001) concentrations. Neither sex nor age affected basal gastrin and pepsinogen concentrations. Eradication of H. pylori infection was successful in 12 patients and resulted in a significant fall in serum gastrin and in pepsinogen A and C concentrations, and in a concomitant improvement of the inflammatory scores. Serum peptide levels and gastritis scores were unchanged in those patients in whom H. pylori infection persisted.. These findings suggest that hypergastrinemia and hyperpepsinogenemia are secondary to H. pylori infection and are related to mucosal inflammation.

Topics: Amoxicillin; Bismuth; Drug Therapy, Combination; Female; Gastrins; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Organometallic Compounds; Pepsinogens; Peptic Ulcer; Salicylates

Topics: Anti-Bacterial Agents; Bismuth; Drug Therapy, Combination; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Organometallic Compounds; Peptic Ulcer; Salicylates

To investigate the change of vitamin C concentration (ascorbic and dehydroascorbic acid) in gastric juice after anti-Helicobacter pylori treatment, and to relate any observed change to gastric pH, inflammatory compromise of the gastric mucosa, plasma vitamin C concentration, and smoking habits.. Plasma and gastric juice vitamin C, fasting gastric juice pH, gastric histology, and smoking status were studied in 70 patients with H. pylori-associated gastritis before and after therapy.. Gastric juice ascorbic acid increased significantly after H. pylori clearance. For the most part, this change was confined to patients who experienced reduction of gastric pH. It was also related to improvement of the compromise of the gastric epithelium, reduction of the proportion of vitamin C composed by dehydroascorbic acid, and increase of the gastric juice/plasma vitamin C concentration gradient. Smokers had lower vitamin C concentrations in plasma and gastric juice before and after H. pylori clearance than nonsmokers.. The findings are consistent with a causal association between H. pylori infection and low ascorbic acid levels in gastric juice, and support two mechanisms for this association: increased oxidation and a decreased secretion of ascorbic acid.

Topics: Amoxicillin; Ascorbic Acid; Bismuth; Female; Gastric Juice; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Nitrofurantoin; Organometallic Compounds; Salicylates; Smoking

The charts of 54 children diagnosed with antral H. pylori were reviewed, to establish the incidence of gastroduodenal inflammation and compare therapeutic efficacies of antisecretory vs. antibacterial therapy. Histology demonstrated normal mucosa in three cases (6%) and gastric/duodenal inflammation (> or = Whitehead grade 3) in 51 biopsies (94%). 23/43 children (53%) initially responded to H2-blockers; however, by 10 mo, 13 had relapsed clinically. All of these patients subsequently responded to amoxicillin plus bismuth subsalicylate. Of the 20 children who failed to enter remission after an initial course of H2-blockers, all became symptom-free after treatment with amoxicillin/bismuth. Compared to antisecretory agents, antibacterial treatment induced clinical remission in 11/11 patients (p < 0.001), who remained symptom-free for 10 +/- 0.2 mo. Clinical remissions were maintained in significantly more patients following amoxicillin/bismuth vs. H2-blockers (44/54 vs. 10/43 courses, p < 0.001); and, the cumulative probability of remaining asymptomatic was significantly greater in the antibiotic group (p < 0.001). These data suggest that gastric colonization by H. pylori is highly predictive of mucosal pathology in children. Initial therapy should be directed toward achieving bacterial eradication, as opposed to gastric acid suppression.

Topics: Adolescent; Adult; Amoxicillin; Child; Cimetidine; Drug Therapy, Combination; Duodenitis; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Histamine H2 Antagonists; Humans; Male; Ranitidine; Retrospective Studies; Salicylates; Salicylic Acid

We have investigated the effect of therapy for Helicobacter pylori gastritis on serum concentrations of pepsinogen I and II in 43 patients. In the 22 patients in whom therapy resulted in dramatic decrease in gastritis scores and in clearance of the bacteria, there was a highly significant (P = 0.0001) fall in mean serum pepsinogen II from 13.3 +/- 0.8 to 7.9 +/- 0.7 micrograms/liter, and a less pronounced fall in pepsinogen I from 89.0 +/- 5.9 to 78.5 +/- 0.4 micrograms/liter (P = 0.01). These changes resulted in a significant (P = 0.01) increase in the pepsinogen I/II ratio. In contrast, nonsignificant declines of 3.5% and 11.6% were observed in mean pepsinogen I and II levels in the 21 patients whose gastritis failed to resolve histologically and whose infection did not clear. These findings suggest that serum pepsinogen levels, especially pepsinogen II, are a new tool that may be found to be clinically useful in evaluation of treatment outcome in patients with H. pylori-associated gastritis.

Topics: Adult; Biopsy; Bismuth; Female; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Nitrofurantoin; Organometallic Compounds; Pepsinogens; Salicylates

To establish the rate of Helicobacter pylori recurrence after a standard triple-therapy regimen (bismuth subsalicylate, tetracycline, metronidazole) and determine which clinical factors affect reinfection, we prospectively followed 118 patients after successful H. pylori eradication. Elimination of H. pylori was confirmed by repeat endoscopy and urea breath test 4 wk after completion of therapy. Serial [13C]urea breath tests were performed at 3-month intervals; antral biopsies were used to verify reinfection. Recurrence of H. pylori infection occurred in 4/118 (3.4%) patients. Three of the four relapses occurred in the 1st yr after treatment. Gender, age, ethnic group, alcohol consumption, cigarette use, and gastrointestinal diagnosis do not predict H. pylori recurrence. We conclude that the rate of recurrence after successful H. pylori eradication is low, and that when reinfection takes place, it occurs most commonly within the 1st yr after treatment.

Topics: Bismuth; Drug Therapy, Combination; Female; Follow-Up Studies; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Organometallic Compounds; Recurrence; Salicylates; Tetracycline

Helicobacter pylori infection has been associated with gastritis, duodenal ulcer, gastric ulcer, and the epidemic form of gastric carcinoma. Eradication of H. pylori infection has proven to be difficult. Recently, combinations of antimicrobial drugs have been shown to eradicate greater than 50% of infections; however, the results have proven variable, and the factors influencing effectiveness of therapy are unclear. In the present study, the effectiveness of a triple therapy for eradication of H. pylori infection was evaluated. Triple therapy consisted of 2 g tetracycline, 750 mg metronidazole, and five or eight tablets of bismuth subsalicylate daily in 93 patients (70 with duodenal ulcer, 17 with gastric ulcer, and 6 with simple H. pylori gastritis). Combinations of a sensitive urea breath test, serology, culture, and histology were used to confirm the presence of infection, eradication, or relapse. Eradication was defined as inability to show H. pylori greater than or equal to 1 month after ending therapy. The overall eradication rate was 87%. The factors evaluated for their effect on predicting eradication included age, gender, type of disease, duration of therapy, amount of bismuth subsalicylate [five or eight Pepto-Bismol tablets daily (Procter & Gamble, Cincinnati, OH)], and compliance with the prescribed medications. Stepwise regression showed that compliance was the most important factor predicting success; the success rate was 96% for patients who took greater than 60% of the prescribed medications and 69% for patients who took less. For those taking greater than 60% of the prescribed therapy, the eradication rates were similar (a) for patients receiving therapy for 14 days or when tetracycline and bismuth subsalicylate were taken for an additional 14 days; (b) for patients with duodenal ulcer, gastric ulcer, and simple H. pylori gastritis; and (c) whether five or eight bismuth subsalicylate tablets were taken. It is concluded that triple therapy is effective for eradication of H. pylori and that future studies need to take compliance into account for comparisons between regimens.

Topics: Adult; Aged; Aged, 80 and over; Bismuth; Drug Therapy, Combination; Duodenal Ulcer; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Organometallic Compounds; Patient Compliance; Regression Analysis; Salicylates; Stomach Ulcer; Tetracycline

Eradication of Helicobacter pylori infections has proved to be difficult. There is a need both for improved therapies and for ways to rapidly identify therapies that show sufficient promise to be worth pursuing. The objectives of this study were to evaluate the value of a therapeutic regimen of a bismuth salt plus nitrofurantoin for eradication of infection by H. pylori and to determine the validity/utility of the urea breath test in monitoring the progress of a clinical trial. We used an 80% eradication rule to define a promising therapeutic regimen, i.e., a regimen that eradicated the infection (no evidence of infection by H. pylori 4 wk after termination of therapy) in at least 80% of the individuals treated. Eighteen men (median age 38) with documented infection by H. pylori completed the study. At the end-of-study evaluation, H. pylori infection was eradicated (negative urea breath test, culture, and histology) in only one of 18 (5.5%) subjects; 15 were positive by the urea breath test, 16 by culture, 15 by Warthin-Starry stain, and 16 by the presence of acute-on-chronic inflammation. Using the 80% eradication rule, any one of these tests alone would have identified that the combination of antimicrobials tested was not effective in the eradication of the infection. We conclude that the urea breath test is a simple, noninvasive, cost-effective method to separate promising from unpromising candidate therapies and for the evaluation of new therapeutic concepts.

Topics: Adult; Bismuth; Breath Tests; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Nitrofurantoin; Organometallic Compounds; Salicylates; Urea

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Bismuth; Drug Therapy, Combination; Follow-Up Studies; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Organometallic Compounds; Recurrence; Salicylates

To determine whether Helicobacter pylori has an effect on gastroduodenal mucosal prostaglandin generation, mucosal biopsies were obtained from the gastric body, antrum, and duodenal bulb of 30 patients who were undergoing upper gastrointestinal endoscopy for clinical indications. One biopsy from the gastric body and one from the antrum were tested for urease activity (urea broth) and one biopsy from each area including the duodenum was processed for histology. Two other biopsies form each area were incubated and the accumulation of prostaglandin E2 and 6-keto prostaglandin F1 alpha in the incubation medium was measured by radioimmunoassay. Twelve of the 17 H. pylori-positive patients and seven of the 13 H. pylori-negative patients agreed to take bismuth subsalicylate (Pepto-Bismol) two tablets four times a day for four weeks. One week after treatment, these patients again underwent endoscopy and the above studies. This study indicates that: (1) mucosal PGE2 generation may be increased in the duodenum, gastric body, and antrum in H. pylori-positive patients compared to H. pylori-negative patients, and (2) treatment with bismuth subsalicylate for four weeks results in reduction of mucosal PGE2 in the duodenum, gastric body, and antrum of H. pylori-positive patients and fails to eradicate H. pylori or reduce gastric inflammation.

Topics: Adult; Aged; Aged, 80 and over; Bismuth; Dinoprostone; Duodenitis; Female; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Organometallic Compounds; Salicylates

Topics: Bismuth; Child; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Organometallic Compounds; Salicylates

Two-hundred and ten consecutive patients undergoing routine gastroscopy were additionally investigated for evidence of Campylobacter pylori (C.p.). 106 patients were positive in one or more tests: 99.1% using a rapid urease detecting test (CLO-test), 80.2% histology, 78.3% cytology and 60% culture. We found no difference between the CLO-test results from biopsies taken from different parts of the stomach in individual patients. C.p. was found in 100% of patients with significant chronic antral gastritis, 67.7% with gastric ulcers, 65% with duodenal ulcers and in 12.1% of normal individuals. The C.p. infection was apparently eliminated in 50% of cases treated with bismuth subsalicylate (BSS) for four weeks. The combination of BSS with amoxicillin, tinidazole or an H2-receptor antagonist offered no advantage over BSS alone. Treatment with BSS led to improvement in symptoms and histological findings including healing of ulcers in patients with or without persistent C.p. infection. The recurrence of C.p. infection after apparently successful treatment was, however, 75% in 4 weeks. In conclusion, C.p. infection correlates strongly with the presence of chronic gastritis, and significantly with gastric and duodenal ulceration. The best diagnostic approach is the combination of a rapid urease detecting test and histology. C.p. infection is of long duration and difficult to eliminate. The most effective treatment for C.p. infection remains BSS as single agent.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin; Bismuth; Diagnosis, Differential; Drug Therapy, Combination; Female; Gastritis; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Histamine H2 Antagonists; Humans; Male; Middle Aged; Organometallic Compounds; Prevalence; Salicylates; Tinidazole; Urease

We report two cases of patients with 3-yr histories of upper gastrointestinal symptoms, hyperplastic gastric polyps, and active chronic gastritis. Biopsies retrospectively stained with Giemsa revealed the persistent presence of Helicobacter pylori (HP) in gastric biopsies of both patients throughout the 3 yr. After treatment with amoxicillin and bismuth subsalicylate, both became asymptomatic, one demonstrating disappearance and recurrence of the gastric polyps in conjunction with the HP. These cases demonstrate 3 yr of hyperplastic gastric polyps associated with HP and active gastritis.

Topics: Aged; Amoxicillin; Bismuth; Campylobacter Infections; Chronic Disease; Female; Gastritis; Helicobacter pylori; Humans; Hyperplasia; Middle Aged; Neoplasm Recurrence, Local; Organometallic Compounds; Polyps; Salicylates; Stomach; Stomach Neoplasms

Topics: Administration, Oral; Bismuth; Duodenal Ulcer; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Organometallic Compounds; Salicylates

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

Numerous reports have established the association of Helicobacter pylori and peptic ulcer disease in adults. Recently, this association has also been demonstrated in children. We investigated 14 children and adolescents with recurrent abdominal pain. In six patients, endoscopy revealed gastritis and Helicobacter pylori was identified. Giemsa stain was more sensitive than culture or urease testing in identifying the bacteria. In four of the six, a nodular appearance of the antral mucosa was observed. The histological examination suggests lymphoid hyperplasia as the cause of the nodularity. All of the patients became symptomless after combined treatment with amoxicillin and bismuth subsalicylate. We conclude that nodular gastritis is a peculiar type of gastritis in children. It is frequently found in association with Helicobacter pylori infection.

Topics: Adolescent; Amoxicillin; Biopsy; Campylobacter; Campylobacter Infections; Child; Female; Gastric Mucosa; Gastritis; Gastroscopy; Humans; Male; Peptic Ulcer; Salicylates; Salicylic Acid

Salicylic acid is a major hydrolytic degradation product of aspirin, responsible especially for gastric irritation during oral aspirin administration. This impurity was investigated in 12 different brands of aspirin formulation readily available in our locality. A simple, rapid and sensitive high performance liquid chromatographic method was adopted for this investigation. The mobile phase was methanol/water (20/80, v/v) adjusted to pH 2.5 with phosphoric acid and was run on a 50 mm reversed-phase column monitored at 240 nm. The limit of detection for salicylic acid was 5 ng. Only three of these formulations showed the presence of salicylic acid impurity and all these contained salicylic acid in excess of the USP 1980 limit of 0.3% salicylic acid per tablet.

Topics: Aspirin; Chromatography, High Pressure Liquid; Drug Compounding; Gastritis; Humans; Nigeria; Salicylates

The effect of treatment of Campylobacter pylori-associated gastritis on acid secretion was studied to examine further the strong association between C. pylori and peptic diseases. Twelve symptomatic patients with non-ulcer dyspepsia and C. pylori-associated histologic gastritis had basal and pentagastrin-stimulated gastric acid analysis before and after a 14-day course of amoxicillin 250 mg qid and bismuth subsalicylate 524 mg qid. Endoscopy, antral biopsies, and symptom questionnaires were obtained at entry and at the conclusion of the study. C. pylori was identified by Warthin-Starry stain. Biopsy specimens were also graded for the severity of chronic inflammation and the presence of neutrophils in the epithelium. The treatment regimen cleared C. pylori in 10 of 12 patients. Dyspeptic symptoms improved in 10 of 12 patients, two of whom did not clear the organism, and were unchanged in the remaining two patients, both of whom cleared the bacteria. Neutrophil infiltration in the antral biopsies resolved in 10 patients, including nine with C. pylori clearance and one with persistence of the organism. The severity of the underlying chronic inflammation improved in only one of the 10 organism-free patients and one of the two persistently infected individuals. Pretreatment gastric acid analysis demonstrated hypochlorhydria in three of 12 patients, mild hyperchlorhydria in three of 12 patients, mild hyperchlorhydria in two of 12, and normal acid secretion in the remaining seven patients. Posttreatment acid studies revealed that four of 12 patients were hypochlorhydric, one of 12 had hyperchlorhydria, and seven of 12 were normochlorhydric. After treatment, there was no significant change in basal or maximal acid secretion in the 10 patients who cleared the organism. The two patients who failed to clear C. pylori had insignificant increases in acid secretion after treatment. Our data show no consistent pretreatment pattern of acid secretion in patients with C. pylori-associated gastritis. In addition, gastric acid output did not show a consistent change after treatment for C. pylori. This suggests that the association between C. pylori infection and peptic diseases does not occur via altered acid secretion.

Topics: Amoxicillin; Bismuth; Campylobacter Infections; Drug Therapy, Combination; Gastric Acid; Gastritis; Humans; Organometallic Compounds; Salicylates

Topics: Adolescent; Amoxicillin; Bismuth; Campylobacter Infections; Child; Child, Preschool; Chronic Disease; Gastritis; Humans; Infant; Organometallic Compounds; Salicylates

The relationship between Campylobacter pylori (CP), histologic gastritis, and dyspeptic symptoms is becoming gradually clearer, but there is still a lack of knowledge of the natural history of treated or untreated gastritis. We examined serial biopsies from the gastric fundus, body, and antrum, and from the duodenum in 16 dyspeptic patients. Patients with concomitant peptic ulcers, alcoholism, or nonsteroidal anti-inflammatory drug use were excluded. CP was present in the biopsies of 50% of patients at presentation. When CP was present, the antrum was always infected, and often had the highest density of organisms. In the duodenum, CP was found only in areas of gastric metaplasia. The presence of CP was highly correlated with gastritis activity (neutrophilic infiltrate). A 4-yr follow-up study of symptoms, endoscopic appearance, and histologic findings including the presence of CP was performed in 10 of the original 16 patients. After 4 yr, both the severity and frequency of epigastric pain remained the same in seven patients, worsened in one, and improved in two. All patients who had CP at initial presentation retained the organism (5/10), whereas none of the previously noninfected patients acquired the infection (5/10). Both CP-positive and -negative patients were treated for 3 wk with 524 mg bismuth subsalicylate qid, and for the first 2 of 3 wk with 250 mg metronidazole qid. One patient who was CP positive was lost to follow-up. In three of the remaining four patients on this regimen, the organism was eradicated. Of the nine patients who completed the treatment program, two had no change in symptoms and seven improved. CP was present in three of seven with improved symptoms and in one of two with no change in symptoms. After treatment, the only change in histology was the disappearance of activity in the CP-positive patients who lost the organism. In conclusion, CP was present in 50% of dyspeptic patients with endoscopic evidence of at least one erosion. Both the symptoms and CP persisted for 4 yr. Dyspeptic symptoms improved after bismuth subsalicylate/metronidazole therapy, regardless of the presence or absence of CP, although the regimen did succeed in eradicating the organism in three of the four CP-positive patients who completed the study.

Topics: Adolescent; Adult; Aged; Bismuth; Campylobacter; Duodenitis; Dyspepsia; Endoscopy; Gastric Mucosa; Gastritis; Humans; Metronidazole; Middle Aged; Organometallic Compounds; Pyloric Antrum; Salicylates

Topics: Amoxicillin; Bismuth; Campylobacter Infections; Drug Therapy, Combination; Gastric Mucosa; Gastritis; Humans; Metronidazole; Organometallic Compounds; Peptic Ulcer; Salicylates

37 patients with epigastric pain and chronic erosive gastritis underwent an open controlled therapeutic trial with bismuthsubsalicylate (BS). Group A (21 patients) was treated with BS, liquid, 4 X 314 mg for three weeks, group B (16 patients) with BS tablets, 3 X 300 mg for two weeks. A significant reduction of symptoms (p less than 0.001) and endoscopically assessed chronic erosions (p less than 0.001) was achieved in both groups. Campylobacter pylori was detected in 89% of the patients before treatment, but was absent in 78% of the patients after treatment. The histological grading of antral mucosa showed a significant reduction (p less than 0.001) of polymorphonuclear cell (PML) infiltration after two and three weeks treatment respectively. While in group A PML cells had disappeared from gastric mucosa in all but two patients, in group B 50% of the patients had some degree of PML cell infiltration left in the antral mucosa. This study confirms the beneficial effect of BS in the treatment of C. pylori associated active chronic gastritis and reemphasizes the pathogenetic role of C. pylori in this disease.

Topics: Adult; Bismuth; Campylobacter; Chronic Disease; Female; Gastritis; Gastroscopy; Humans; Male; Middle Aged; Organometallic Compounds; Pyloric Antrum; Salicylates; Stomach

We evaluated the efficacy of medical therapy, consisting of liquid bismuth subsalicylate prescribed either in combination with oral ampicillin (n = 15) or alone (n = 1), in the clearing of bacterial colonization on the antrum in 16 children with Campylobacter pylori-associated antral gastritis. We also examined the effects of medical treatment on altering the severity of associated antral inflammation. Eight patients had upper gastrointestinal tract hemorrhage, two had acute gastric outlet obstruction, and 10 had symptoms of episodic epigastric abdominal pain. Duodenal ulcers were demonstrated in 10 of the 16 patients; in the other six, C. pylori-associated antral gastritis was documented without evidence of acute peptic ulceration. Seven days after a 6-week course of medical therapy, repeat upper endoscopy plus mucosal biopsy specimens showed that C. pylori colonization of the antrum had cleared in 12 of the 16 (75%) patients. Inflammation in the antrum improved in all patients in whom colonization by C. pylori was eradicated. In contrast, in the four with persistent colonization of the antrum, the severity of antral gastritis had not improved (p less than 0.01). Clinical symptoms improved in 9 of 12 patients in whom C. pylori colonization was no longer present, whereas subjective symptoms were unaffected in those with continued bacterial colonization of the antrum (p less than 0.05). We conclude that oral bismuth subsalicylate, in conjunction with ampicillin, can eradicate C. pylori colonization of the antrum, and that clearing of C. pylori is correlated with an improvement in the associated antral gastritis and clinical symptoms. These findings provide additional support for the hypothesis that these gastric organisms could play an etiologic role in primary antral gastritis and peptic ulcer disease.

Topics: Adolescent; Ampicillin; Bismuth; Campylobacter; Campylobacter Infections; Child; Drug Therapy, Combination; Duodenal Ulcer; Gastritis; Humans; Organometallic Compounds; Pyloric Antrum; Salicylates

In a prospective open study 21 patients with upper abdominal complaints and chronic active gastritis as well as endoscopically proven erosions were treated with bismuth subsalicylate (4 X 30 ml/day, corresponding to 4 X 314 mg Bi3+) for three weeks. In 20 patients (95%) Campylobacter pylori (CP) was found in at least two of three examinations (culture, CLO quick-test, special histology). After the treatment 17 of 21 patients (81%) were CP negative, and the clinical symptoms had gradually disappeared. The histologically demonstrated degree of activity had regressed significantly after the three-week treatment; in 90% of patients the inflammatory process had completely abated. These results demonstrate that bismuth subsalicylate is highly effective in the acute treatment of CP-associated chronic erosive gastritis.

Topics: Adult; Aged; Biopsy; Bismuth; Campylobacter; Campylobacter Infections; Chronic Disease; Drug Evaluation; Female; Gastric Mucosa; Gastritis; Gastroscopy; Humans; Male; Microscopy, Electron; Microscopy, Electron, Scanning; Middle Aged; Organometallic Compounds; Salicylates

Topics: Anti-Bacterial Agents; Bismuth; Campylobacter Infections; Erythromycin; Erythromycin Ethylsuccinate; Gastritis; Humans; Organometallic Compounds; Salicylates

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

Topics: Aspirin; Biological Availability; Chemical Phenomena; Chemistry; Diflunisal; Gastric Mucosa; Gastritis; Humans; Salicylates

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Ethanol; Gastric Mucosa; Gastritis; Humans; Salicylates

From history-taking and from analysis of plasma salicylate levels it is shown that a link exists between aspirin and gastrointestinal bleeding in 68% of cases. Salicylate levels alone indicate that aspirin has been taken in 22% of cases. Plasma salicylate measurement and endoscopy allow a better understanding of haemorrhagic lesions due to aspirin. Aspirin is responsible especially for haemorrhage from ulcers and acute gastritis or duodenitis. Aspirin is seen to be dangerous in a moderate number of susceptible individuals: those with peptic ulcer constitution or cirrhosis.

Topics: Aspirin; Duodenal Diseases; Enteritis; Gastritis; Gastrointestinal Hemorrhage; Humans; Peptic Ulcer Hemorrhage; Salicylates

Topics: Drug Interactions; Gastritis; Humans; Salicylates

Four hundred consecutive patients, in a representative Southern California population, hospitalized for upper gastrointestinal hemorrhage, had endoscopic examinations performed within 24 hours of arrival in the emergency room. Seventy-four (18.5 percent) of these were found to have the typical lesions of acute hemorrhagic erosive gastritis. The clinical spectrum of this group is examined and a comparison made with a Veterans Hospital population reported previously.

Topics: Adult; Aged; Duodenal Ulcer; Esophageal and Gastric Varices; Esophagitis; Ethanol; Female; Gastritis; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Male; Middle Aged; Peptic Ulcer Hemorrhage; Salicylates; Sex Ratio; Stomach Ulcer

Topics: Acetanilides; Adult; Aged; Anti-Inflammatory Agents; Aspirin; Blood Transfusion; Female; Gastritis; Gastrointestinal Hemorrhage; Hematemesis; Humans; Male; Melena; Methyl Ethers; Middle Aged; Naphthalenes; Propionates; Salicylates

Topics: Analgesics; Anti-Inflammatory Agents; Antimalarials; Aspirin; Digestive System; Duodenal Ulcer; Esophagoscopy; Gastritis; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Gastroscopy; Glycols; Humans; Indomethacin; ortho-Aminobenzoates; Phenylbutazone; Pyrazoles; Quinolines; Salicylates; Stomach Ulcer

Topics: Acute Disease; Adult; Anticoagulants; Cortisone; Diagnostic Errors; Drug Synergism; Emergencies; Esophageal and Gastric Varices; Esophagitis; Ethanol; Gastritis; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Peptic Ulcer Hemorrhage; Retrospective Studies; Salicylates

Topics: Aspirin; Electric Conductivity; Fatty Acids, Unsaturated; Gastric Acidity Determination; Gastric Mucosa; Gastritis; Glycyrrhiza; Humans; Hydrogen-Ion Concentration; Plants, Medicinal; Salicylates; Sesquiterpenes; Stomach Ulcer; Succinates; Triterpenes

Topics: Adult; Age Factors; Aged; California; Esophageal and Gastric Varices; Ethanol; Gastritis; Gastrointestinal Hemorrhage; Gastroscopy; Hematemesis; Hematocrit; Hospitalization; Humans; Liver Cirrhosis; Melena; Middle Aged; Peptic Ulcer; Recurrence; Salicylates; Shock, Hemorrhagic

Topics: Alcohol Drinking; Barium Sulfate; Diagnosis, Differential; Esophageal and Gastric Varices; Esophagoscopy; Ethanol; Fiber Optic Technology; Gastritis; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Mallory-Weiss Syndrome; Peptic Ulcer; Radiography; Salicylates; Time Factors

Topics: Absorption; Aspirin; Atrophy; Cobalt Isotopes; Gastric Mucosa; Gastritis; Humans; Hydrogen-Ion Concentration; Intestinal Absorption; Methods; Salicylates; Time Factors

Topics: Biliary Tract Diseases; Duodenal Ulcer; Gastric Acidity Determination; Gastric Juice; Gastritis; Glycoproteins; Humans; Hydrochloric Acid; Mucoproteins; Neuraminic Acids; Salicylates; Stomach Ulcer; Tannins

Topics: Alkalosis; Antacids; Anti-Inflammatory Agents; Antibody Formation; Arthritis, Rheumatoid; Aspirin; Drug Hypersensitivity; Gastritis; Humans; Salicylates

Topics: Aspirin; Dogs; Gastric Mucosa; Gastritis; Gastroscopy; Pharmacology; Research; Salicylates; Sodium Salicylate; Toxicology

Topics: Aspirin; Gastritis; Gastrointestinal Hemorrhage; Humans; Salicylates