Azithromycin, furazolidone and omeprazole: a promising low-dose, short-term, anti-H. pylori triple therapy

Aim: Tocompare four anti-H. pylori regimes using omeprazole and azithromycin associated to different antimicrobials in peptic ulcer H. pylori positive patients. Patients and methodos: afterinformed consent, 136 endoscopically proven peptic ulcer patients(74 male, 62 female) were randomly assigned to one of thefollowing therapy groups: Group 1: Om 20mg mane for 7 ays + Az 500mgmane for 3 days + tinidazole (Ti) 500mg bid for 7 ays. Group 2: Om 20 mg mane for 7 days + Az 500mane for 3 days + amoxycilin (Am) 500mg tid for 7 days. Group 3 Om 20 mg mane for 7 days + Az 500mg mane for 3 days + furazolidone (F) 200 mg tid for 7 days. Group 4: Om 20 mg mane for 7 days +Az 500mg mane for 3 days + colloidal bismuth subcitrate (CBS) 120 mg tid ( double dose at bedtime) for7 days. The H. Pylori status was assessed before treatment and 94 (63-214) days post treatment using urease test, and 14C-urea breath test. Statistical analysis was performed by Kruskal-Wallis test, chi-square test, Fisher's exact test, and Lancaster & Irvin method. Results: The four groups had similar demographic and clinical characteristics. 120/136 patients completed the study. One patient discontinued treatment due to side effects and 15 were lost to follow-up.32/136 (23.5por cento) hed side effect during treatment, mainly nause. H.pylori eradication in group 3 was statistically different from the other groups ( p=0.000). Group 3 & 4 (statistically non-different) presented significantly more side effects than group 1 and 2 (p=0.002). Conclusion: 1)Om + Associated to F (the cheapest ant- H.Pylori drug) for one week represents an efficient reasonaaable well-tolerates alternatiaaaaaave to H.pylori eradication. 2) Future studies testing F with other macrolides or Az during 7 days can enhance H. Pylori eradication rates

Measurement of gastric emptying of solid meal using scitigraphy with 99mTccoloidal sulfur and breath test with 14C-acid octanoic

The gastric emptying rate of solids was measures in 33 volunteers (19 female 14 male, mean age 38.2 (24-74) years) by scintigraphy and 14-C-octanoic acid breattest. Eleven participants were normal controls, 11 had functional dyspepsia, 5 patients were diabetic and 6 patients had pyloric stenosis due to peptic ulcer. Methods: The test meal consisted of an omelet labeled with 99mTc-sulfur colloid and 14C-octanoic acid for scitigraphy and breath tes, respectively. Radioscintigraphic scans were obtained every 15 min for a period of 150 min and breath samples were taken every 15 min for a period of 4 hours. Reults: the half gastric emptying time (t1/2) and lag phase (tlag) in diabetica and dyspeptic volunteers measured by scintigraphy and breath tes showed higher values than in controls. Two out 6 patients with pyloric stenosis showed gastric emptying rate delayed when compared with controls. There was a positive and significant (p<0.0001) correlation between the t1/2 determined by scintigraphy and breath test. Conclusions: 14C-octanoic acid breath test is a reliable and sensitive method that can be used as an alternative procedure to measure gastric emptying rat of solids

"Helicobacter pylori": erradicaçäo em curto prazo com o esquema Belo Horizonte modificado / Helicobacter pylori: short-term eradication with modified Belo Horizonte scheme

Após a constataçao de que a erradicaçao do H. pylori está correlacionada com a cura da doença ulcerosa, numerosos esquemas terapêuticos têm sido testados na procura de um tratamento ideal.Como os estudos in vitro mostram número elevado de cepas de H. pylori resistentes ao metronidazol, no Brasil, foram comparados dois grupos com diferentes esquemas. Sessenta pacientes (34 homens, idade média de 42 anos), positivos para o H. pylori, foram divididos em dois grupos: A) associaçao de furazolidona 600mg/dia, amoxicilina 1.500 mg/dia e subcitrato de bismuto 480mg/dia (esquema Belo Horizonte modificado); B) amoxicilina 2.000mg/dia, metronidazol 1.250mg/dia e subcitrato de bismuto 480mg/dia (esquema Sydney).A presença do H. pylori foi avaliada pelo teste da urease e pelo teste respiratório. Dos 60 pacientes, 49 (81 por cento) completaram o estudo (26 do grupo A e 23 do grupo B). Quatro pacientes (três no grupo A e um no grupo B) nao retornaram para controle. Sete pacientes (um no grupo A e seis no grupo B) interromperam o tratamento por causa de efeitos colaterais. No grupo A, o H. pylori foi erradicado em 17 (65,4 por cento) dos pacientes e, no grupo B, em 17 (73,9 por cento), nao havendo diferença estatisticamente significativa, permitindo a conclusao de que o esquema Belo Horizonte modificado é uma alternativa satisfatória na terapêutica anti-H.pylori.

Maytenus elicifolia ("Espinheira santa"), peptic ulcer and Helicobacter pylory

The plant Maytenus ilicifolia (populary called "Espinheira Santa") is used in Brazilian folk medicine to combat gastroduodenal affections. Experimental evidence has sugested that the plant has anti-ulcer activity although its mechanism of action is still unknown. To determine a possible effect of the plant on Helicobacter pulori (HP0, the major agent involved in gastroduodenal ulcer, 10 patients with duodenal ulcer and infected with HP were studied. The diagnosis of the presence of HP and the quatitative evaluation of a possible anti-urease activity or the supressor and/or eradicating action of a dry extract of the plant on HP were performed by the (14)C-urea breath test (UBT). All patients were submitted to four UBT: the first upon admission to the study the second 20 min after the ingestion of a capsule containing 300 mg of a dry extract at 8-h intervals for one week, and the fourth one month after discontinuation of the preparation. One patient presented suppression of urease activity at the third UBT, but the activity had returned to basal values on the occasion of the fourth examination. We conclude that at the doses and formulation employed, Maytemus ilicifolia has no significant action against HP.