Severe, recurrent mesenteric vasculitis as the initial presentation of Systemic Lupus Erythematosus

Gastrointestinal symptoms are common in systemic lupus erythematous [SLE] patients and more than half of them are caused by adverse reactions to medications and infections. Cases of mesenteric vasculitis in SLE are well described; however, we describe a condition of severe, recurrent lupus vasculitis accompanied with hypocomplementemia as the initial presentation of SLE. Lupus should be suspected in any patient with computed tomography findings of ischemic enteritis, even without lupus-related symptoms or signs. C3/C4 levels may be helpful

Effect of Helicobacter pylori eradication on glycaemia control in patients with type 2 diabetes mellitus and comparison of two therapeutic regimens

The eradication rate of Helicobacter pylori [H. pylori] has been reported as being lower in patients with type 2 diabetes mellitus [DM] than in those without DM. The aim of the study was to assess the efficacy of the two H. pylori eradication regimens in patients without and with type 2 DM and to study the effect of H. pylori treatment on glycaemia control. A total of 93 consecutive type 2 DM [non-insulin users] and 98 non-diabetic ageand sex-matched patients were enrolled. Patients were randomly assigned to one of the two treatment protocols all given twice daily: [a] a 14-day quadruple therapy comprising of omeprazole 20 mg, metronidazole 500 mg, amoxicillin 1 g and bismuth subcitrate 240 mg [OMAB] and [b] a 14-day triple regimen comprising of omeprazole 20 mg plus clarithromycin 500 mg and amoxicillin 1 g [OCA]. Cure was defined as a negative 13C-urea breath test at least 6 weeks after treatment. The H. pylori eradication rate with the OCA regimen was 63% in patients with type 2 DM [noninsulin users] and 87.7% in the control group [p = 0.017]. The H. pylori eradication rate with the OMAB regimen was 38.2% in patients with type 2 DM and 55.1% in the control group [p < 0.001]. Mean decrease of fasting plasma glucose and HbA1c level shows no statistically significant difference after H. pylori eradication. This study suggests that the eradication rate of H. pylori with OCA or OMAB treatment is lower in patients with type 2 diabetes than in non-diabetics and H. pylori treatment in patients with type 2 DM has no role in the control of the glycaemia. The triple therapy [OCA] is superior to the quadruple protocol [OMAB] in H. pylori eradication of both DM and non-DM cases

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

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

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