Gastric atrophy: use of OLGA staging system in practice

Aim: This study used the OLGA system to characterize the histology pattern of gastritis in dyspeptic outpatients with a mean age of 45 years from regions with different gastric cancer risks

Background: Several classification systems have been purposed for understanding the status of the gastric mucosa. Currently, the Sydney system is the most widely employed. Nevertheless, the applicability of the Sydney system in therapeutic and prognostic areas is a matter of debate. Given this shortcoming an international group of gastroenterologists and pathologists developed a new system named Operative Link on Gastritis Assessment [OLGA]

Patients and methods: In this cross-sectional comparative study the OLGA system was used to characterize the histology pattern of gastritis in 685 dyspeptic patients referring to the department of gastroenterology of a training hospital

Results: No significant correlation was found between active inflammation and total OLGA score [P > 0.05]. Also, no statistically significant correlation was found between activity and intestinal metaplasia, dysplasia, atrophy, and cancer [P > 0.05]. Even though, there is a positive correlation between mild chronic inflammation and total OLGA score, no correlation has been identified between chronicity and dysplasia or cancer [P > 0.05]. Nearly, In all cases with no dysplasia OLGA score was zero but all patients with gastric cancer OLGA score was more than two

Conclusion: Generally, the activity is not a useful factor in predicting prognosis and its loss of relation with total OLGA score does not make OLGA score any less predictable

Penbactam for Helicobacter pylori eradication: a randomised comparison of quadruple and triple treatment schedules in an Iranian population

Selection of the best drug regimens for eradication of Helicobacter pylori infection especially in patients at risk of peptic ulcer relapses and the development of complications is challenging. This study assessed and compared the efficacy of the two common PPI based triple therapies to a quadruple therapy including PPI, metronidazole, amoxicillin and a bismuth compound in Iranian population. Three hundred and thirty patients with peptic ulcer and H. pylori infection were included in the study. Patients were randomly assigned to one of the three treatment protocols all given twice daily: [a] A 14-day quadruple therapy [OMAB group] comprising omeprazole 20 mg, metronicazole 500 mg, amoxicillin 1 g, and bismuth subcitrate 240 mg; [b] A 14-day triple regimen [OCP group] comprising omeprazole 20 mg plus clarithromycine 500 mg and penbactam 750 mg and [c] A 14-day triple regimen [OCA group] comprising omeprazole 20 mg plus clarithromycine 500 mg and amoxicillin 1 g. Cure was defined as a negative urea breath test at least six weeks after treatment. The per-protocol eradication rates achieved with both OCP regimen [87.0%] and OCA treatment [90.8%] were significantly higher than the OMAB treatment protocol [56.0%]; however, no significant difference emerged in eradication rates between the two triple treatment schedules. No significant differences between the groups were found in most side-effects. Two-week quadruple therapy showed a lower eradication rate compared to common triple treatment schedules when used as first-line eradication treatment for H. pylori infection in Iranian population

Evaluation of the benefit of addition of clidinium C to a Helicobacter pylori eradication regimen

This study aimed to evaluate the success of H.pylori eradication therapy in patients with dyspepsia by therapeutics regimes with and without clidinium C. Helicobacter pylori infections are reported in all parts of the world. Appropriate antibiotic therapy can treat infection. The ideal treatment regimen has not been specified. In a randomized, double blind clinical trials study, 250 patients with dyspepsia were enrolled. All patients were treated by Omeprazole, Metronidazole, Amoxicillin and Bismuth [OMAB] for two weeks. One tablet clidinium C before each meal was added to this regimen in the intervention group [A]. Urea Breath Test [UBT] was carried out after 8-12 weeks after treatment for evaluation of H.pylori eradication. 132 patients in the intervention group [A] and 118 patients in the control group [B] were enrolled to the study. The rate of eradication in group A was significantly higher than group B [62.1% vs. 50%, p=0.04]. The results supported the effect of clidinium C for increasing of helicobacter pylori eradication, but further studies need to be performed

New sequential versus triple treatment schedules for Helicobacter pylori eradication in Iran

Selection of the best approach for the treatment of Helicobacter pylori [H. pylori] infection that encompasses higher eradication and lower failure rates leads to a decline in its related complications and disorders. To understand the relative efficacy of new sequential therapy compared with standard triple therapy as two common regimens, we have performed a randomized, controlled trial to compare these two treatment protocols in an Iranian population. This study enrolled 220 patients aged 18-81 years old with dyspepsia or peptic ulcers who were candidates for endoscopy and referred to Taleghani Hospital, Tehran, Iran. Patients were randomized to receive one of two treatment regimens, a 14-day new sequential therapy that consisted of omeprazole [20 mg], amoxicillin [1.0 g], and ciprofloxacin [500 mg] administered twice daily for the first seven days, followed by omeprazole [20 mg], amoxicillin [1.0 g], and furazolidon [200 mg] administered twice daily for the remaining seven days. The second regimen comprised a proton pump inhibitor [PPI]-based triple therapy of omeprazole [20 mg], amoxicillin [1.0 g], and clarithromycin[500 mg] administered twice daily for 14 days. Overall, 10 patients in PPI-based triple therapy group and 16 patients in the 14-day new sequential group stopped treatment and did not undergo 13C-urea breath testing [UBT]. Among the remaining patients, the eradication rate with the PPI-based triple therapy was 89.0%, whereas it was 91.5% with the 14-day new sequential therapy which was not significantly different. No significant differences were found in eradication rates between genders in each treatment group. Adverse effects were mainly mild and comparable between the two treatment regimens. It seems that sequential regimen is at least as effective as standard therapy and can be used as an alternative treatment for H pylori eradication.

Evaluation of antibody frequency against HBV, HCV and HTLV-1

This study was designed to evaluate the frequency of antibody against these viruses in individuals attending the endoscopy ward of Taleghani hospital Tehran, Iran. Blood-borne viruses such as hepatitis B and hepatitis C virus and HTLV-1 virus are among the world's public health problems. Hepatitis viruses cause liver problems and HTLV-1 infection can lead to adult T-Cell lymphoma [ATL]. Blood samples of 219 individuals attending the endoscopy ward of Taleghani hospital between years 2009-2011 were collected. A questionnaire containing demographic data was completed for each subject. Blood samples were tested for antibody against HTLV-1, HCV and HBc by ELISA [Dia.pro Italy]. In case of positive results for anti-HBc, samples were also tested for HBs Ag antigen. Ninety two subjects were male and 127 were female. Mean age of the population was 39.87 +/- 16.47. None of the subjects had anti-HCV antibody, while 4 of them had anti-HTLV-1 antibody and 26 anti-HBc antibody; which only two of these individuals had HBs Antibody. The results of this study show that frequency of anti-HCV and anti-HTLV-1 antibodies are very low, while the frequency of anti-HBc was higher in the population. Since HTLV-1 is the causative agent of a type of blood cancer, it seems that screening of donated bloods in this region should be considered

relation between the level of interleukin-23 with duration and severity of ulcerative colitis

In this study, we determined the relationship between the serum level of IL-23 and the severity of ulcerative colitis [UC] among our population. A recent major breakthrough for describing the pathogenesis of intestinal tissue injury in inflammatory bowel disease [IBD] is the pathway related to interleukin-23 [IL-23]. We performed a prospective case-control study on a total of 85 new patients with ulcerative colitis, recruited from a general referral hospital. Forty ethnically matched healthy controls were also enrolled among hospital staffs and analyzed. Serum IL-23 level was quantified using an electrochemiluminescence immunoassay [ECLIA] method with an immunoassay analyzer. The mean serum IL-23 level in the group with ulcerative colitis was significantly higher than the healthy individuals [347.5 +/- 130.9 pg/ml versus 233.5 +/- 86.3 pg/ml; p<0.001]. There was a positive correlation between the serum level of IL-23 and disease duration [r = 0.27, p = 0.04]. Also, a direct relationship was found between the serum level of IL-23 and the severity of disease [mean IL-23 in mild UC = 296.2 +/- 51.2 pg/ml; in moderate UC = 356.1 +/- 142.9 pg/ml; and in severe UC=399.3 +/- 163.8 pg/ml, p=0.04]. Serum level of IL-23 is directly correlated with the duration and severity of ulcerative colitis

Clinical and histological presentation of helicobacter pylori and gluten related gastroenteropathy

Celiac disease has been reported to be associated with gastric abnormalities. The aim of this study was to assess the relationship between the prevalence of celiac disease and Helicobacter pylori infection in an Iranian population of 250 patients. Biopsies were taken from the gastric antrum and duodenum. Morphology and histology were evaluated using the updated Sydney system and modified Marsh criteria, respectively. To simplify the interpretation of gastric lesions we classified gastritis in macroscopic and microscopic stages. Serology for anti-tissue transglutaminase antibody was performed to determine the presence of celiac disease. Among 250 patients, 232 [93%] had histological evidence of Helicobacter pylori infection. Histological abnormalities [Marsh I to IIIc] were present in 24 [10%]. Of 24 patients, 20 [83%] with histological abnormalities were infected with Helicobacter pylori. Of 250 patients, 25 [10%] had a positive anti-tissue transglutaminase antibody. Of 25 anti-tissue transglutaminase antibody positive patients, 9 [3.6%] had microscopic and macroscopic enteritis [Marsh I to IIIc]. Clinical presentation of celiac disease was not distinguishable from cases infected with Helicobacter pylori. Histology, even in patients with positive serology, was non-specific and unhelpful. We found a high prevalence of Helicobacter pylori infection and chronic gastritis, but neither was associated with celiac disease, in agreement with studies in Western populations

Correlation between creatinine clearance and Helicobacter pylori infection eradication with sequential and triple therapeutic regimens: a randomised clinical trial

Uraemic patients show susceptibility to gastrointestinal mucosal lesions and colonisation by Helicobacter pylori [HP]. Antibiotic resistance constitutes a problem in treatment and bismuth preparations are toxic in uraemic patients. This study aimed to assess the correlation between creatinine clearance [CrCl] and eradication of HP infection with new sequential and standard triple therapeutic regimens. A total of 120 HP-positive patients with renal function impairment and 60 control patients with HP infection were enrolled in this study. Patients were divided into four groups on the basis of CrCl and were randomly assigned to one of the two different regimens: A 14-day standard triple therapy with 20 mg omeprazole bid, 1000 mg amoxicillin bid and 500 mg clarithromycin bid and a new sequential regimen with 20 mg omeprazole bid and 1000 mg amoxicillin bid both for 14 days, 500 mg ciprofloxacin bid for the first 7 days and 200 mg furazolidone bid for the last 7 days. Doses of amoxicillin, clarithromycin and ciprofloxacin were reduced to 50% in the cases of CrCl <30 mg dl[-1] One hundred and sixty two out of 180 HP-positive patients [54.3% male, 51.6 +/- 12.1 years] completed treatment in the four groups and were studied. According to renal function they were classified into group A [n = 39], haemodialysis [HD] patients; group B [n = 37], CrCl <30 mg dl[-1] without HD; group C [n = 36], CrCl between 30 and 60 mg dl[-1]; and group D [n = 50], control subjects with CrCl >90 mg dl[-1]. HP was successfully eradicated in 77.7% of patients with standard triple therapy and in 81.4% of patients with the sequential therapy. There was no significant difference among the study groups in the rate of HP-infection eradication with both regimens. HP eradication rates did not differ with both sequential and standard therapeutic regimens in uraemic and non-uraemic patients. We, therefore, prefer the standard triple therapy due to its simplicity and reported

Quadruple versus common triple-treatment regimens for Helicobacter pylori eradication in the Iranian population: a randomized study

Selection of the best drug regimens for effective eradication of Helicobacter pylori [H.pylori] infection, especially in patients at risk of peptic ulcer relapses and development of complications of peptic ulcer disease, is challenging. This study assessed and compared the efficacy of the two common proton pump inhibitor [PPI]-based triple therapies to a quadruple therapy including PPI, metronidazole, amoxicillin and a bismuth compound in Iranian population. A total of 330 patients with peptic ulcer and H. pylori infection were included in the study. Patients were randomly assigned to one of the three treatment protocols: [1] a 14-day quadruple therapy [OMAB group] comprising omeprazole 20 mg, metronidazole 500 mg, amoxicillin 1g and bismuth subcitrate 240 mg; [2] a 14-day triple regimen [OCP group] comprising omeprazole 20 mg plus clarithromycin 500 mg and penbactam 750 mg; and [3] a 14-day triple regimen [OCA group] comprising omeprazole 20 mg plus clarithromycin 500 mg and amoxicillin 1 g, all given twice daily. Cure was defined as a negative urea breath test at least 6 weeks after treatment. The intention-to-treat H.pylori eradication rates achieved with both OCP regimen [87.0%] and OCA treatment [88.8%] were significantly higher than the OMAB treatment protocol [56.0%]; however, no significant difference emerged in eradication rates between the two triple-treatment schedules. No significant differences were found in most side effects between the groups. Two-week quadruple therapy showed a lower eradication rate compared with common triple-treatment schedules when used as a first-line eradication treatment for H.pylori infection in the Iranian population