[ comparative study of eradication of H. pylori infection in dyspepsy patients using a low dose and a high dose triple therapy with clarithromycin, amoxicillin and Omeprazole]

Helicobacter Pylori is a major cause of diseases of the upper gastrointestinal tract. Having considered the high prevalence of the infection, an ideal regimen has been a matter of debate by the scientists for many years. This study evaluates the efficacy of the more tolerable regimens in the eradication of the bacteria and the effect of the treatment on the gastric symptoms. This parallel randomized control trial study included 560 patients with dyspepsia admitted to Imam Reza Hospital, Kermanshah University of Medical Sciences between 2006-2007. Patients who were identified with dyspepsia based on Rome II and were candidate for endoscopy were examined for H. pylori infection through rapid urease test and histology. Those proven positive were assigned at random to one of the two groups of high dose [Omeprazole 20mg, Clarithromycin 500 mg, and Amoxicillin 1000 mg] and low dose [Omeprazole 20 mg, Clarithoromycin 250 mg, Amoxicillin 500 mg] treatment regimens. They all went under treatment every 12 hours for a period of seven days. 4 weeks after the therapy, eradication success rate and gastric symptoms were evaluated using the same protocol. Side effects were recorded through a questionnaire. From the total of 560, 480 were proven positive for H. pylori [85.7%]. Eradication success rate was the same for the two groups [87.5%]. History of pyrosis before the treatment was statistically associated with eradication failure at the end of the treatment. Symptoms such as pyroisis were significantly reduced. General well being was also improved but the improvement was not statistically significant. Mild side effects were observed in 11% of high and 8% of low dose treatment regimens. However they were well tolerated and did not result in drug withdrawal. Eradiation success rate of one-week low dose treatment regimen was within the acceptable level. Eradication also reduced pyrosis episodes. Symptoms were improved even when the therapy did not result in eradication

[ efficacy of Fluoxetin and Doxepin in treatment of irritable bowel syndrome]

This study compares the efficacy of Fluoxetine [serotonin-selective reuptake inhibitors-SSRI] with Doxepin [tricyclic antidepressants -TCAs-antihistaminic] in treatment of irritable bowel syndrome [IBS]. This randomized clinical trial recruited 200 patients who had referred to Kermanshah Imam Reza hospital during the period 2006-7. All the patients had been diagnosed with IBS bases on Rome II criteria of IBS and were randomized into two groups. The patients were then received treatment with anti-depresants Fluoxetine [20mg/day] in one group and Doxepin [20mg/day] in the other group for 12 weeks. In order to compare the quantitative variables, we used Leven and t-test. Chi-2 test was used for qualitative variables. There was no statistically significant difference between mean age in Fluoxetine [37 +/- 98 years] and Doxipin group [37 +/- 02 years]. The number of males in Fluoxitine and Doxipin groups was 40 and 42 respectively, which indicated no difference. Doxipin proved more effective on bloating, decreasing stool consistency, need for urgency and incomplete evaluation than Fluoxetine. On the other hand, the effect of Fluoxetin on abdominal pain and increasing of defecation was greater than Doxipin [p<0.05]. The figure for positive response to improvement of 50% was 67% and 52% for Doxipin and Fluoxetine groups respectively [p<0.022]. Our results indicated higher efficacy of Doxipin, the new TCA generation, in reducing most symptoms in patients with IBS, making it the recommended anti-depressant in treating IBS with no constipation