ABSTRACT
Background: Considering the importance of Helicobacter pylori [H. pylori] eradication, this clinical trial was designed to prospectively evaluate the efficacy of levofloxacin-based, sequential therapy in comparison with quadruple therapy for eradicating H. pylori
Methods: Overall 156 patients with dyspepsia and H. pylori infection were included in this study and were randomly allocated to either 10-day sequential therapy group [group A] to receive pantoprazole [40 mg twice daily], amoxicillin [1 gr twice daily], levofloxacin [500 mg twice daily], and tinidazole [500 mg twice daily] [PALT] or 14-day quadruple therapy group [group B] to receive pantoprazole, clarithromycin, bismuth subcitrate, and amoxicillin [PABC]. At the end of the study the eradication rate in each group was assessed by urea breath test [UBT]
Results: Age range of the participants was 18-65 years [average 36.9 years] and 50% of them [78 patients] were men. 78 patients were allocated to group A and 78 patients to groupe B. After antibiotic therapy, all the patients received acid suppression therapy with Proton Pump Inhibitor [PPI] for 4 weeks and then the eradication rate was confirmed by UBT [Heli FAN plus 13C, Germany]. Before performing UBT, all the participants were requested to halt consumption of PPI for at least 1 week. During the treatment there was not any major complication but in group A [sequential therapy], two patients complained of minor complications including musculoskeletal pain. None of the patients in group B had any complaint or side effect.The rate of H. pylori eradication in group A was 78.2% [61 patients] while this rate in group B was 83.3% [65 patients] with no significant difference between the two groups [p = 0.42]. In subgroup analysis, the rate of eradication among men in group A and B were 76.9% and 89.7%, respectively [p = 0.22] while the eradication rate among women were 79.4% and 76.9%, respectively [p = 1.00]
Conclusion: It seems that levofloxacin base sequential therapy does not have any advantage in comparison with quadruple regimen and until finding any more effective short course therapy for H. Pylori eradication; we encourage quadruple regimen to be used as the first line therapy
ABSTRACT
BACKGROUND: Celiac disease presents with a wide spectrum of symptoms
This study clarifies different aspects of celiac disease along with the most common patterns of celiac presentation in Khuzestan Province, Iran
METHODS: Patients' information was obtained by evaluation of their files from the archives of the Khuzestan Celiac Society and records at gastroenterologists' offices in this province
RESULTS: Overall, there were 103 [40 males, 63 females] patients included in this study. Patients' mean ages were 33 +/-11 years [males] and 31.6 +/- 11.7 years [females]. In terms of geographic distribution, 54.1% resided in the center of the province followed by 26.5% who were residents of the northern area. The rate of employment among men was 70.6% whereas it was 8.3% for women. In terms of education, 21.9% of men and 33.3% of women had academic educations. The rate of matrimony was 80.6% [n=29] for men, 65.4% [n=38] for women and 3.4% [n=2] who were divorced. Mean height was 164 +/- 14 cm in men and 157.5 +/- 10 cm in women. Mean BMI at the time of presentation was 22.7 in men and 22.6 in women. The most common gastrointestinal [GI] complaints in male patients were diarrhea [35%], reflux [20%], bloating [17.5%], abdominal pain [15%], vomiting [15%] and constipation [7.5%]. Female patients experienced diarrhea [49.2%], abdominal pain [31.7%], bloating [31.7%], vomiting [19%], constipation [9.5%] and reflux [7.9%]. The most common concomitant non-GI disorders among male patients were anemia [17.1%], thyroid disease [14.3%], and weight loss (14.3%); women experienced anemia [33.9%], thyroid disease [12.5%], and weight loss [7.1%]. Approximately half of the patients exhibited symptoms for more than five years prior to diagnosis and 90% were diagnosed by gastroenterologists. Of these, 43% had normal endoscopy results. The most common serologic markers were anti-TTG [69.9%], anti-EMA [27.7%]
CONCLUSION: Physicians, prior to attributing patients' symptoms to irritable bowel syndrome [IBS] should be aware that patients who present with long-term nonspecific symptoms might possibly have celiac disease. During endoscopy, the threshold for obtaining biopsies should be low
ABSTRACT
Background: upper endoscopy, as an important diagnostic and occasional therapeutic tool is invasive. Sedation of patients during the endoscopy procedure with minimal side effects could raise patient tolerability, allowing for ease and increased effectiveness of this procedure
Materials and Methods: in this study, 105 patients who were candidates for the upper endoscopy procedure were randomly divided into two groups: [A] midazolam [n=53] and [B] placebo [n=52]. Group A patients received 5 mg of midazolam dissolved in 5 cc distilled water and group B received 5 cc of distilled water, via an intra-nasal drip. After 40 to 45 minutes, the upper endoscopy was performed. During the endoscopy, patients were monitored and the endoscopy time, gag reflex stimulation, heart rate, arterial oxygen saturation [SPO2], amnesia and patient justification were recorded and compared
Results: the average age in group A was 39.3 years; for group B, it was 39.9 years. There were no statistically significant results for average endoscopy time [p=0.23], gag reflex stimulation [p=0.27], heart rate [p=0.09], SPO2 [p=0.49], amnesia [p=0.12], and patient justification [p= 0.1] between both groups
Conclusion: according to the results of this study, it seems that intra-nasal midazolam is not effective for patient sedation. This field needs additional evaluation