Pilot studies to identify the optimum duration of concomitant Helicobacter pylori eradication therapy in Thailand

Background and Aim: Eradication rate for Helicobacter pylori infection with standard triple therapy has globally declined including in Thailand, and new regimens are required that provide reliable high eradication rates. The study was designed to determine whether concomitant therapy administered for either 5 or 10 days would produce a ≥ 95% (grade A) treatment success in H. pylori infected Thai subjects with nonulcer dyspepsia. Methods: Two prospective, but separate, pilot single‐center studies were carried out during September 2009–December 2010 at Thammasat University Hospital, Thailand. H. pylori infected subjects were randomized into the two pilot studies; either 5‐day or 10‐day concomitant therapy. Thai concomitant therapy consisted of rabeprazole (20 mg) twice daily, amoxicillin 1 g twice daily, metronidazole 400 mg three times a day, and clarithromycin MR 1 g once daily. H. pylori status was assessed by ¹³C‐urea breath test 4 weeks after completion of the treatment. Successful treatment was defined as achieving a grade A result (≥95%) and failure by <90% cured. Results: A total of 110 subjects were randomized (55 to the 5‐day treatment trial and 55 to the 10‐day regimen). Baseline subject demographic and clinical characteristics were similar in both studies. All subjects completed their assigned therapies. The 10‐day concomitant treatment trial was successful in 53 of the 55 subjects (96.4%; 95% CI 87.4–99.5%). The 5‐day concomitant pilot was judged to be a failure as only 49 of 55 subjects (89.1%; 95% CI = 77.7–95.8%) were cured. The frequency of adverse events was low and similar in the two studies. Conclusion: The 10‐day concomitant regimen provided excellent treatment success (eradication rate >95%) and was well tolerated. Ten‐day concomitant therapy is likely to become useful first‐line H. pylori eradication in Thailand.     

A population-based survey on gastrointestinal tract symptoms and Helicobacter pylori infection in children and adolescents

Background. Helicobacter pylori infection is a frequent infection mainly acquired in childhood. Even if the infection is almost invariably associated with mild to severe gastro‐duodenal lesions, no specific clinical picture has been identified. The aim of this study was to evaluate the presence of dyspeptic symptoms and their relationship with the presence of H. pylori infection in the first two decades of life. Materials and Methods. A school‐population sample size of 808 subjects from 6‐ to 19‐year‐olds was investigated for the presence of gastrointestinal tract symptoms and evaluated by a ¹³C‐urea breath test for H. pylori infection. The relationship between clinical findings and H. pylori infection was evaluated by χ² statistic or Fisher's exact test, as appropriate. Results. Symptoms of dyspepsia were identified in 45% of subjects, while the picture of ulcer‐like and dysmotility‐like forms were present in 3–4%. H. pylori infection was demonstrated in 95 (11.8%) subjects, 49.5% of them without symptoms. Severe epigastric pain and ulcer‐like dyspepsia were significantly associated with H. pylori infection, while recurrent abdominal pain or dysmotility‐like dyspepsia were not. Conclusions. Dyspeptic symptoms are frequent in children, and its association with H. pylori infection is more evident than with recurrent abdominal pain. The age at which the infection is acquired seems to be under 6 years of age.     

Efficacy and safety of faropenem in eradication therapy of Helicobacter pylori

Aims: While triple therapy with a proton pump inhibitor, amoxicillin, and clarithromycin is the standard therapy for Helicobacter pylori eradication, it is ineffective against clarithromycin‐resistant strains. To seek a better regimen for eradication therapy, we assessed the sensitivity of clinical strains seen in Japan to faropenem and then evaluated the efficacy and safety of eradication therapy containing this antibiotic. Methods: Minimum inhibitory concentrations (MICs) of faropenem were determined in 78 Japanese clinical H. pylori isolates using the agar dilution method. H. pylori‐positive patients were consecutively assigned to a 7‐day eradication therapy protocol with LAF (lansoprazole 60 mg/day, amoxicillin 2000 mg/day, and faropenem 600 mg/day), and then to a 14‐day protocol. The outcomes of the therapies were assessed by ¹³C‐urea breath tests. Results: All 78 strains showed MICs of faropenem that were equal to or less than 0.2 µg/mL. The eradication rates according to intention‐to‐treat analyses were 46.5% with the 7‐day therapy (n = 43) and 62.5% with the 14‐day therapy (n = 32). No special measures were required to treat the adverse events observed in approximately one‐third of the patients. Conclusions: Faropenem was found to have good antimicrobial action against H. pylori in vitro. The 14‐day LAF therapy successfully eradicated H. pylori in about two‐thirds of the patients although the incidence of adverse events was high.     

Low concentrations of zinc in gastric mucosa are associated with increased severity of Helicobacter pylori-induced inflammation

BACKGROUND: Chronic Helicobacter pylori infection is the most common cause of gastric cancer. H. pylori induces oxidative stress while zinc deficiency results in increased sensitivity to it. In Ecuador, the prevalence of gastric cancer and zinc deficiency are high. We hypothesized that zinc deficiency in Ecuadorian people would cause increased H. pylori-induced inflammation in the gastric mucosa associated with lower tissue zinc concentrations. METHODS: Three hundred and fifty-two patients with dyspepsia underwent endoscopy to obtain gastric mucosa biopsies. Diagnosis of H. pylori infection and its severity, histopathology, mucosal zinc concentration, and inflammation intensity were determined. RESULTS: H. pylori-infected patients with non-atrophic chronic gastritis had lower concentrations of zinc in gastric mucosa than uninfected patients with the same type of gastritis (251.3 +/- 225.3 vs. 426.2 +/- 279.9 ng/mg of protein; p = .016). Considering all patients, the more severe the H. pylori infection, the higher the percentage of subjects with infiltration by polymorphonuclear (PMN) cells (p = .0001). Patients with high PMN infiltration had lower mucosal zinc concentrations than patients with low PMN infiltration (35.2 +/- 20.7 vs. 242.9 +/- 191.8 ng/mg of protein; p = .021). CONCLUSIONS: The degree of inflammation in H. pylori-induced gastritis appears to be modulated by gastric tissue zinc concentrations.     

Does Helicobacter pylori eradication affect symptoms in nonulcer dyspepsia: a 5-year follow-up study

The role of Helicobacter pylori infection in nonulcer dyspepsia remains controversial. To date studies exploring the effect of H. pylori eradication on symptoms have reported conflicting results. Randomised control trials employing validated outcome measures have also been difficult to interpret because of several important issues such as the large placebo response seen in patients with nonulcer dyspepsia and both the natural variability in symptoms and symptom severity with time. The association of symptom improvement with resolution of gastritis has meant that the length of follow up employed in most studies has been insufficient. We report the findings of a randomised placebo controlled trial (n = 100), using a validated symptom questionnaire and 5 year follow up to determine the effect of H. pylori eradication on symptoms in nonulcer dyspepsia. In all 64 that were reviewed at 5 years there was a significant difference between patients who were H. pylori negative and those who remained positive with regard to complete symptom resolution, consumption of relevant medications and peptic ulcer disease development, in favour of active treatment. There was a trend for gradual symptom improvement over time irrespective of H. pylori status, which may reflect the natural history of this condition. For those who remained symptomatic at 5 years, there was no difference in symptom severity based on H. pylori status. The findings of this study support the use of H. pylori eradication in symptomatic patients with nonulcer dyspepsia both to induce symptom resolution and to prevent disease progression.     

瑞倍三联1周疗法根除幽门螺杆菌的临床研究

目的 :观察枸橼酸铋雷尼替丁 (RanitidineBismuthCitrate ,RBC瑞倍 )为主的 1周三联疗法的幽门螺杆菌 (Helicobaterpylori,Hp)根除疗效及安全性。方法 :随机将 10 0例Hp阳性患者分为瑞倍治疗组 (A组 )与奥美拉唑三联疗法组 (B组 ) ,疗程 1周 ,14 C 尿素呼气试验及粪抗原检测判断Hp根除效果。结果 :根据意图治疗 (ITT)分析Hp根除率分别为A组 84 0 %及B组 78 0 %。根据试验方案分析 (PP)Hp根除率分别为A组 87 5 %及B组 83 0 %。A组副反应发生率 12 5 % ,B组为 6 4 %。两组变化均无统计学意义 (P >0 0 5 )。结论 ;瑞倍为主短程三联方案的Hp根除疗效与奥美拉唑为主的短程疗效相当 ,副反应发生相似     

猪胃螺杆样细菌与幽门螺杆菌的比较研究

我们检测１０例普通猪的胄组织,有８例分离到螺杆菌样细菌（ＨＬＯ）。其菌落、菌体形态和某些生化反应与幽门螺杆菌（ＨＰ）相似,但其尿素酶活性较低,ＨＬＯ全菌蛋白的ＳＤＳ一ｐＡＧＥ图谱也与ＨＰ的不同。本文就ＨＰ和ＨＬＯ及其伴发的人、猪慢性胃炎的特点,作了比较和讨论。     

公英益胃汤联合四联疗法对慢性胃炎的治疗效果及对幽门螺旋杆菌感染的影响

摘要 目的：分析感染幽门螺旋杆菌（Hp）的慢性胃炎患者在接受治疗时应用公英益胃汤+四联疗法后对疗效的影响。方法：随机将80例我院诊治的Hp阳性的慢性胃炎患者分为对照组与实验组,每组40例,对比两组患者的治疗效果、两组患者治疗前后症状评分、两组患者症状缓解时间、Hp清除率及复发率、两组患者不良反应发生率。结果：实验组患者的治疗总有效率为97.50 %,对照组患者的治疗总有效率为77.50%,实验组治疗有效率较对照组高（P＜0.05）;治疗前两组患者的上腹疼痛、反酸、嗳气、食后胀满各项症状积分差异无统计学意义（P＞0.05）,治疗后两组患者的上腹疼痛、反酸、嗳气、食后胀满各项症状积分均降低,并且治疗后实验组患者以上症状评分均低于对照组治疗后（P＜0.05）;实验组患者腹部隐痛、食欲不佳、反酸缓解时间均较对照组短（P＜0.05）;两组不良反应发生率无差异（P＞0.05）;实验组患者的HP根除率高于对照组,复发率低于对照组（P＜0.05）。结论：公英益胃汤+四联疗法对于减轻Hp感染的慢性胃炎患者临床症状,促进其病情在短时间内得到缓解有着显著的疗效,同时这一治疗方案也能够有效清除患者体内的幽门螺旋杆菌,避免疾病的反复发作,降低疾病复发率,且不良反应较少,能够保证患者的用药安全。