tetracycline and Duodenitis

Few data are available on the efficacy of second-line H. pylori eradication regimens.. To compare the efficacy of either omeprazole or ranitidine in a second-line quadruple regimen in patients with duodenal ulcer or erosive duodenitis.. A total of 37 patients with erosive duodenitis and 119 with duodenal ulcer who have failed eradication of H. pylori with double or triple regimens, without metronidazole, were randomly assigned to receive tripotassium dicitrato bismuthate 600 mg t.d.s. + metronidazole 500 mg t.d.s. + tetracycline hydrochloride 500 mg t.d. s. combined with either omeprazole 20 mg b.d. (group O, 78 patients) or ranitidine 300 mg b.d. (group R, 78 patients) for 14 days. H. pylori eradication was verified by histology, rapid urease test and 13C-urea breath test.. t-test, chi2-test.. A total of 143 patients had a post-treatment endoscopy. Eradication rates were: intention-to-treat: group O 77% (67-87), group R 76% (66-85), P=0.85; per protocol analysis: group O 86% (77-95), group R 82 (71-93), P=0.58. Side-effects were frequent but mild.. Omeprazole 20 mg b.d. and ranitidine 300 mg b.d. were equally effective as antisecretory agents combined in a second-line quadruple eradication regimen.

Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Anti-Ulcer Agents; Drug Administration Schedule; Drug Therapy, Combination; Duodenal Ulcer; Duodenitis; Female; Gastric Acid; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Omeprazole; Organometallic Compounds; Ranitidine; Tetracycline; Treatment Outcome

Microscopic changes in duodenal biopsy specimens from 16 elderly patients with small-bowel bacterial overgrowth were studied before and after cyclical courses of antibiotic treatment, using computer-aided morphometry measurements as well as visual assessment. Twenty-three subjects in the same age group with no evidence of intestinal disorder were studied as controls. Mean villus height was significantly reduced in the pre-treatment study compared to the post-treatment measurements and those in controls. Similar significant differences were found in mean crypt depth and total mucosal thickness. The mean intra-epithelial lymphocyte count was raised before treatment and fell after treatment to a level similar to that of the controls. The mean lymphocyte count in the peripheral blood rose significantly after treatment. This study provides objective evidence of microscopic structural changes in the bacterial overgrowth syndrome in old age. The return to normality after antibiotic treatment suggests that these changes are directly attributable to the presence of bacteria in the gut lumen.

Topics: Aged; Aged, 80 and over; Amoxicillin; Anti-Bacterial Agents; Biopsy; Clavulanic Acid; Clavulanic Acids; Duodenitis; Enterobacteriaceae; Enterobacteriaceae Infections; Erythromycin; Female; Humans; Image Processing, Computer-Assisted; Intestinal Mucosa; Male; Microscopy; Tetracycline

Eighty-two patients, whose duodenal ulcers were recurrent or resistant to H2-receptor antagonist therapy, were entered in a treatment protocol of ranitidine followed by a four-week "triple therapy" course to eradicate Helicobacter pylori (HP) infection. The triple therapy consisted of colloidal bismuth subcitrate, tetracycline and metronidazole. Duodenal ulcer healed in all 78 patients available for endoscopy and H. pylori infection was shown to be eliminated in 75 patients (96%) at rebiopsy four weeks after cessation of therapy. In these 75 remaining patients the relapse rates for H. pylori infection and duodenal ulcer were studied endoscopically, yearly and at any recurrence of symptoms. At Year 1, 71 of 73 patients remained free of H. pylori infection (HP-negative) and duodenal ulcer. The corresponding figures subsequently were: Year 2, 57/57; Year 3, 34/34; Year 4, 15/15. No duodenal ulcers recurred in HP-negative patients who were followed for up to four years. Two patients of the original cohort of 75 HP-negative patients were HP-positive with endoscopic duodenitis at 12 months, and one at 36 months, but all were without reulceration. Distorted duodenal caps gradually returned to near-normal appearance in 80% of patients by two years. From this four-year follow-up study we conclude that duodenal ulcer disease will not recur provided the patient remains free of H. pylori.

Topics: Adult; Aged; Anti-Ulcer Agents; Campylobacter Infections; Duodenal Ulcer; Duodenitis; Duodenum; Female; Follow-Up Studies; Gastroscopy; Histamine H2 Antagonists; Humans; Male; Metronidazole; Middle Aged; Organometallic Compounds; Recurrence; Tetracycline