Therapeutic success with bismuth-containing sequential and quadruple regimens in Helicobacter pylori eradication

Background and study aims: The success rate of Helicobacter pylori [H. pylori] eradication with the classical triple therapy is gradually declining. In this study, we aimed to compare and assess the efficacies of six different eradication regimens including sequential protocols

Patients and methods: Endoscopically confirmed nonulcer dyspepsia patients were enrolled. H. pylori presence was determined either histologically or by a rapid urease test. Treatment-naive patients were randomly assigned to an either one of three 10-day [OAC, OTMB, and OACB] or one of three sequential protocols [OA + OCM, OA + OCMB, and OA + OMDB] [O = omeprazole, A = amoxicillin, C = clarithromycin, T = tetracycline, M = metronidazole, B = bismuth, D = doxycycline]. The eradication was assessed 6-8 weeks after the completion of the treatment by a 14C-urea breath test

Results: In total, 301 patients were included. Fifty-two percent of the participants [n = 157] were female, and the mean age was 44.9 years [range = 18-70]. The intention to treat [ITT] and per protocol [PP] eradication rate for each regimen is as follows: OAC [ITT = 61.2%, PP = 75%], OTMB [83.3%, 87%], OACB [76.5%, 79.6%], OA + OCM [72.3%, 73.9%], OA + OCMB [82.7%, 89.6%], and OA + OMDB [59.3%, 65.3%]. Smoking significantly affected the eradication rate [P = 0.04]

Conclusion: In this study, OTMB and OA + OCMB were significantly superior to the triple therapy and succeeded to reach the eradication rate proposed by the Maastricht consensus [over 80%]. These two bismuth-containing regimens could be considered for first-line therapy in the regions with high clarithromycin resistance

Gallstone Disease Does Not Predict Liver Histology in Nonalcoholic Fatty Liver Disease

BACKGROUND/AIMS: We sought to examine whether the presence of gallstone disease (GD) in patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD) is associated with liver fibrosis and histological nonalcoholic steatohepatitis (NASH) score. METHODS: We included 441 Turkish patients with biopsy-proven NAFLD. GD was diagnosed in the presence of sonographic evidence of gallstones, echogenic material within the gallbladder with constant shadowing and little or no visualization of the gallbladder or absence of gallbladder at ultrasonography, coupled with a history of cholecystectomy. RESULTS: Fifty-four patients (12.2%) had GD (GD+ subjects). Compared with the GD- subjects, GD+ patients were older, had a higher body mass index and were more likely to be female and have metabolic syndrome. However, GD+ patients did not have a higher risk of advanced fibrosis or definite NASH on histology. After adjustment for potential confounding variables, the prevalence of GD in NAFLD patients was not associated with significant fibrosis (> or =2) (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.53 to 2.21; p=0.68) or definite NASH (OR, 1.03; 95% CI, 0.495 to 2.12; p=0.84). CONCLUSIONS: The presence of GD is not independently associated with advanced fibrosis and definite NASH in adult Turkish patients with biopsy-proven NAFLD.