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Objective:To study the clinical effect of combined capsules of live Bifidobacterium, Lactobacillus and Enterococcus assisted triple therapy in chronic gastritis children with Helicobacter pylori ( Hp) positive. Methods:The clinical data of 80 chronic gastritis children with Hp positive from January 2019 to March 2022 in Wuxi Children′s Hospital were retrospectively analyzed. Among them, 40 children (combination group) were treated with combined capsules of live Bifidobacterium, Lactobacillus and Enterococcus combined with triple therapy (omeprazole, amoxicillin and clarithromycin), 40 children (control group) were treated with triple therapy, and all children were treated for 4 weeks. The efficacy, Hp clearance rate (performed 13C breath test after 4 weeks of discontinuation) and symptom improvement (the scores of upper abdomen pain, anorexia and sour regurgitation) were compared between two groups. The feces before treatment and after treatment were collected, and the intestinal flora was detected, including Bifidobacterium, Lactobacillus, Bifidobacterium/ Enterobacteria; the levels of C-reactive protein (CRP), tumor necrosis factor α (TNF-α), interleukin 10 (IL-10) and nuclear transcription factor κB (NF-κB) before treatment and 14 d after treatment were detected; the adverse reactions (vomiting, diarrhea, dizziness and erythra) were detected. Results:The total effective rate and Hp clearance rate in combination group were significantly higher than those in control group: 95.00% (38/40) vs. 80.00% (32/40) and 92.50% (37/40) vs. 75.00% (30/40), and there were statistical differences ( P<0.05). The scores of upper abdomen pain, anorexia and sour regurgitation after treatment in combination group were significantly lower than those in control group: (0.56 ± 0.14) scores vs. (1.12 ± 0.35) scores, (1.20 ± 0.37) scores vs. (1.50 ± 0.42) scores and (1.02 ± 0.28) scores vs. (1.39 ± 0.43) scores, and there were statistical differences ( P<0.01). The Bifidobacterium, Lactobacillus, Bifidobacterium/ Enterobacteria after treatment in combination group were significantly higher than those in control group: (8.56 ± 1.35) lgcfu/g vs. (7.94 ± 1.32) lgcfu/g, (9.27 ± 1.63) lgcfu/g vs. (8.35 ± 1.58) lgcfu/g and 1.85 ± 0.40 vs. 1.25 ± 0.34, and there were statistical differences ( P<0.01). The CRP, TNF-α and NF-κB after treatment in combination group were significantly lower than those in control group: (12.06 ± 3.14) ng/L vs. (17.36 ± 3.08) ng/L, (10.74 ± 3.25) μg/L vs. (15.30 ± 4.18) μg/L and (1.17 ± 0.34) μg/L vs. (2.21 ± 0.82) μg/L, the IL-10 after treatment was significantly higher than that in control group: (43.14 ± 6.38) μg/L vs. (35.29 ± 5.03) μg/L, and there were statistical differences ( P<0.01). There was no statistical difference in the incidence of adverse reactions between two group ( P>0.05). Conclusions:The combined capsules of live Bifidobacterium, Lactobacillus and Enterococcus assisted triple therapy has clear efficacy in chronic gastritis children with Hp positive, with few adverse reactions. It can significantly improve clinical symptoms, and its mechanism may be related to the regulation of intestinal microbiota and serum inflammation.
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Recent clinical studies have shown that mutation of phosphatase and tensin homolog deleted on chromosome 10 (PTEN) gene in cancer cells may be associated with immunosuppressive tumor microenvironment (TME) and poor response to immune checkpoint blockade (ICB) therapy. Therefore, efficiently restoring PTEN gene expression in cancer cells is critical to improving the responding rate to ICB therapy. Here, we screened an adeno-associated virus (AAV) capsid for efficient PTEN gene delivery into B16F10 tumor cells. We demonstrated that intratumorally injected AAV6-PTEN successfully restored the tumor cell PTEN gene expression and effectively inhibited tumor progression by inducing tumor cell immunogenic cell death (ICD) and increasing immune cell infiltration. Moreover, we developed an anti-PD-1 loaded phospholipid-based phase separation gel (PPSG), which formed an in situ depot and sustainably release anti-PD-1 drugs within 42 days in vivo. In order to effectively inhibit the recurrence of melanoma, we further applied a triple therapy based on AAV6-PTEN, PPSG@anti-PD-1 and CpG, and showed that this triple therapy strategy enhanced the synergistic antitumor immune effect and also induced robust immune memory, which completely rejected tumor recurrence. We anticipate that this triple therapy could be used as a new tumor combination therapy with stronger immune activation capacity and tumor inhibition efficacy.
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Background@#Helicobacter pylori is acknowledged to cause chronic gastritis and peptic ulcer disease and is also implicated in gastric carcinoma and B cell mucosa-associated lymphoid tissue (MALT) lymphoma development. It has infected at least half of the world’s population. Proton Pump Inhibitors (PPIs) have been the conventional antacid of choice for H. pylori eradication triple therapy, while vonoprazan is a novel drug of its class that was recently studied but is limited to an oral form which makes it less feasible in cases of acute gastrointestinal bleeding. According to several systematic reviews and meta-analyses, the vonoprazan-based triple therapy regimen for H. pylori eradication is a non-inferior treatment to traditional PPI-based treatment when given in 1 week for patients having no active gastrointestinal bleeding. Likewise, a safety profile has been established with its use, offering an alternative treatment option.@*Objectives@#The research aims to identify the H. pylori eradication rate among H. pylori-positive patients who received a vonoprazan-based triple therapy regimen as outpatients, describe their clinicodemographic profile, and identify potential side effects associated with the treatment.@*Methods@#This study utilized a cross-sectional study design in a single tertiary institution from January 2018 to December 2020. Descriptive and inferential statistics were used in data analysis. Frequency and percentage were utilized to determine the success and failure rates of H. pylori eradication, describe the clinicodemographic profile of patients who underwent vonoprazan-based triple therapy, and the potential side effects with treatment. The chi-square test of independence was applied to assess the significant difference in the successful and failed eradication rates across the clinicodemographic profile. A P-value of <0.05 was considered statistically significant, and statistical analyses were conducted using SPSS version 20.0.@*Results@#32 (91%) had successful H. pylori eradication, with the majority of them determined by a negative 13C-UBT result (62.8%) and the rest with a negative H. pylori stool antigen test (28.6%). The majority of patients undergoing H. pylori eradication using a vonoprazan-based regimen with documented successful eradication belonged to the 19 to 39 years old group (50%), clerical support workers (40.63%), with a chief complaint of abdominal pain (46.88%), with no known co- morbid illness (75%), and with endoscopic finding limited to antral gastritis alone (46.88%). This study described only two documented side effects of treatment: diarrhea and abdominal pain (2.9%).@*Conclusion@#Vonoprazan-based triple therapy, given at 20 mg twice daily for 7 days, has shown a high H. pylori eradication rate among hemodynamically stable patients, without active bleeding, and treated on an outpatient basis. There was a significant difference in eradication success and failure across co-morbidities, with a higher success rate in those without co-morbid illness. A high success rate was also seen in patients <40 years of age, with a single chief complaint, and with antral gastritis as the sole endoscopic finding.
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Helicobacter pyloriABSTRACT
El asma es una enfermedad crónica de la vía aérea prevalente en nuestro país, con frecuente mal control. Algunos especialistas de la Asociación de Alergia e Inmunología Clínica y la Asociación Argentina de Medicina Respiratoria han realizado recomendaciones sobre el manejo y tratamiento del asma mediante la metodología de consenso RAND/UCLA Delphi modificada sobre la base de la evidencia científica (GRADE). Este documento provee recomendaciones basadas en la opinión de especialistas y fundamentada en evidencia científica seleccionada en cuanto a la importancia de mejorar la adherencia al tratamiento y seguimiento a través de diferentes estrategias. Así mismo, provee recomendaciones actualizadas en aspectos críticos del tratamiento del asma leve al grave. Se recomienda, para mejorar la adherencia, el uso de planes personalizados de manejo (1 °C), uso de herramientas a través de teléfonos móviles (1B) y educación (1 °C). Con respecto a la inmunoterapia sublingual solo debe ser indicada a pacientes con asociación con rinitis alérgica, asociada a ácaros y síntomas de asma a pesar del tratamiento adecuado con FEV1 > 70 % (1B). Se recomienda fuertemente en el asma leve (escalón 2 GINA) el uso de broncodilatadores de acción rápida asociados a corticoides inhalados a demanda (1A). En asma grave, se recomienda el uso de la triple terapia inhalada con anticolinérgicos de acción prolongada, beta 2 de acción prolongada y corticoides inhaladas (1B). El uso de biológicos en asma grave está fuertemente indicado en fenotipo T2 con dupilumab (1A), T2 alérgico con omalizumab (1A) y en el T2 eosinofílico con benralizumab, o mepolizumab, con sus características distintivas (1A).
Asthma is a common chronic airway disease in our country, although with high poor control. Some specialists of the Asociación de Alergia e Inmunología Clínica and Asociación Argentina de Medicina Respiratoria have made recommendations for management and treatment of asthma, using a RAND/UCLA modified Delphi consensus methodology, based on GRADE evidence. This document provides recommendations based on specialist opinions about different strategies to improve adherence. Besides, it provides recommendations about critical issues of mild to severe asthma treatment. It´s recommended to improve adherence, personalized control-based management plan (1 °C), mobile devices (1B) and education (1 °C). Sublingual immunotherapy must be prescribed only in patients with allergic rhinitis, mite associated, and persistent symptoms although appropriate treatment with FEV1 > 70 % (1B). Use of fast action bronchodilators associated with inhaled corticosteroids prn in mild asthma (GINA stage 2) has strong recommendation (1A). Use of triple inhaled therapy (long acting anticholinergics, long acting beta 2 agonists and inhaled corticosteroids) is recommended in severe asthma (1B). Biologics has strong recommendations severe asthma: in phenotype T2 with dupilumab (1A), in phenotype allergic T2 with omalizumab (1A) and phenotype eosinophilic T2 with benralizumab or mepolizumab with distinctive characteristic (1A).
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Objective:To investigate the distribution of CYP2C19 genotypes in Helicobacter pylori (Hp) infected children in Chongqing and the correlation of genotypes with gender, age and efficacy, and to provide a reasonable plan for Hp eradication in children in Chongqing. Methods:A prospective clinical cohort study was carried out on 156 children who were suspected of Hp infection and underwent gastroscopy in Children′s Hospital of Chongqing Medical University from March to July 2020. 13C-urea breath test ( 13C-UBT), rapid urease test (RUT) and histological examination were made for all the children included.Meanwhile, for Hp-positive children, the CYP2C19 genotypes were detected by using the polymerase chain reaction(PCR)-sequence-specific primer method, and their sensitivity to Clarithromycin and Amoxicillin was assessed.According to the genetic testing results, the CYP2C19 genotypes were divided into homozygous extensive metabolizer (HomEM), heterozygous extensive metabolizer (HetEM) and poor metabolizer (PM). The eradication outcomes of proton pump inhibitor combined with Amoxicillin and Clarithromycin (PAC) in different genotypes were observed.The measurement data that did not conform to the normal distribution were expressed with the median ( M), and the enumeration data were represented by the rate or the constituent ratio.The Chi- square test was used for comparison between groups, and P<0.05 indicated statistically significant difference. Results:(1)A total of 102 children were Hp positive.Positive rates of 13C-UBT, RUT and histologic results were 97.1% (99/102), 99.0% (101/102), and 90.2% (92/102), respectively.(2)Among the 102 Hp-infected children HomEM accounted for 45.1% (46/102), HetEM for 41.2% (42/102), and PM for 13.7% (14/102). (3)There were 50 males and 52 females in 102 Hp-infected children.The age range was 3 years to 17 years and 9 months (median: 9 years and 7 months). There was no significant difference in the distribution of CYP2C19 genotypes between females and males and among children of different ages (all P>0.05). (4)In 87 cases treated with PAC regimen, 36 cases failed to eradicated Hp in the initial treatment, including 18 cases of HomEM, 15 cases of HetEM, and 3 cases of PM.Hp was eradicated successfully in 51 cases, including 21 cases of HomEM, 21 cases of HetEM and 9 cases of PM.There was no statistically significant difference in the Hp eradication efficacy among children with different CYP2C19 genotypes treated by the PAC regimen ( P>0.05). (5) Among the 87 children, 45 children were sensitive to Clarithromycin, and 37 of them achieved successful Hp eradication.About 42 children were resistant to Clarithromycin, and Hp eradication was fulfilled in 14 of them.There was a statistically significant difference in the Hp eradication efficacy among Clarithromycin-resistant children treated by PAC regimen ( P<0.05). Conclusions:The CYP2C19 genotypes have no correlation with gender, age and Hp eradication efficacy of PAC in children with Hp infection in Chongqing.
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Absence of adequate treatment for Helicobacter pylori (H. pylori) infection leads to prolonged life time colonization which is responsible for complications. Antibiotics resistance is the main cause of eradication failure in H. pylori infection, thus our study aimed to evaluate the efficiency and tolerability of standard triple therapy vs. quadruple regimen therapy in H. pylori eradication in Egypt.
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Helicobacter pylori , Clarithromycin , Amoxicillin , Therapeutics , Anti-Bacterial AgentsABSTRACT
Objective:To evaluate the impact of amoxicillin and clarithromycin resistance on the eradication rate of Helicobacter pylori ( H. pylori), and to explore the optimal minimal inhibitory concentration (MIC) breakpoint of amoxicillin and clarithromycin. Methods:From March 2008 to December 2010, patients with H. pylori positive received standard triple therapy to eradicate H. pylori were retrospectively analyzed, 140 patients with H. pylori infetion were included, of which 12 patients did not receive eradication treatment. At 8 to 12 weeks after treatment, the eradication rate of H. pylori of 140 and 128 patients was calculated by intention-to-treat (ITT) and per-protocol population (PP) analysis, respectively. The correlation between amoxicillin and clarithromycin resistance and failure of H. pylori eradication was analyzed. And the relation between different MIC breakpoints of amoxicillin and clarithromycin and failure of H. pylori eradication was also analyzed. Binary logistic regression analysis and consistency test were used for statistical analysis. Results:The results of ITT and PP analysis indicated that the eradication rate of H. pylori of the standard triple therapy was 66.4%(93/140)and 72.7% (93/128), respectively, 95% confidence interval ( CI) 59.3% to 74.3%, and 65.6% to 79.7%, respectively. The results of binary logistic regression analysis showed that amoxicillin resistance (odds ratio ( OR)=6.326, 95% CI 1.090 to 36.725, P=0.040) and clarithromycin resistance ( OR=10.686, 95% CI 4.031 to 28.326, P<0.01) were both independent risk factors of H. pylori eradication failure. The results of consistency test demonstrated that when the MIC breakpoint of amoxicillin was 0.125 mg/L, the correlation between amoxicillin resistance and H. pylori eradication failure was the highest (fair consistency, P<0.05); when the MIC breakpoint of clarithromycin was 2.000 mg/L, the correlation between clarithromycin resistance and H. pylori eradication failure was the highest (moderate consistency, P<0.05). Conclusions:The eradication rate of H. pylori of standard triple therapy dropped to <80%. The decrease of H. pylori eradication rate was related to the resistance of amoxicillin and clarithromycin. The best MIC breakpoints of amoxicillin and clarithromycin were 0.125 and 2.000 mg/L, respectively.
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Alternate remedies with natural products provides unlimited opportunities for new drug development. Thesecan be either as pure compounds or as standardized set of compounds. The phytochemicals and secondarymetabolites are in great demand for screening bioactive compounds and plays an important role towards drugdevelopment. Natural products have many advantages over to synthetic chemical drugs. Helicobacter pylori(H. pylori) a Gram-negative bacteria has been classified as Class I carcinogen by World Health Organization in1994. Current treatment regimens for H. pylori is ‘triple therapy’ administrated for two weeks which includes acombination of two antibiotics like Amoxicillin and Clarithromycin and a proton pump inhibitor (PPI) likeLansoprazole, and for ‘quadruple therapy’ in addition to antibiotics and a PPI, Bismuth is used. Antibioticresistance can be named as the main factor for failure of treatment of H. pylori infection. The need of the houris to develop a herbal remedy that could combat the growth of H. pylori. Probiotics can also be used as‘feasible’ tool for H. pylori infection management. Present review is an attempt to briefly discuss about thepathogenicity, genetic predisposition, perturbation of gut microbiota due to antibiotic treatment and restorationof healthy gut microbiota with phytochemicals and probiotics.
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Background: Helicobacter pylori colonization is a risk factor for Adenocarcinomas of the distal (noncardia) stomach. The presence of Helicobacter pylori is strongly associated with primary gastric lymphoma. The urea breath test, the stool antigen test, and biopsy-based tests can all be used to assess the success of treatment. Helicobacter pylori is susceptible to a wide range of antibiotics in vitro, monotherapy is not usually successful, probably because of inadequate antibiotic delivery to the colonization niche. Current regimens consist of a PPI or H2 blocker, bismuth citrate and two or three antimicrobial agents given for 7-14 days. Research on optimizing drug combinations to increase efficacy continues. Efficacy of Sequential Therapy versus Standard Triple Therapy versus Quinolone-based Triple Therapy for eradication of Helicobacter pylori infection is done in this study.Methods: This study had been conducted on 150 patients divided into three groups randomly 50 Patients each and were treated with Sequential, Standard and Quinolone based triple therapy respectively. Patients were followed up no sooner than four weeks of completing therapy by rapid urease test to confirm eradication.Results: There was no significant difference with regards to presence of GERD, Gastric Ulcers, Duodenal Ulcers (p value>0.05) except for presence of erosive gastritis which was significantly higher in patients in quinolone group (p value<0.05). The eradication rate was 90%, 86%, 82% in Sequential therapy group, Triple therapy group and Fluroquinolone group respectively. However, there was no statistically significant difference in eradication rates in these groups (p value>0.05).Conclusions: Sequential therapy group had better eradication rates (90%) as compared to standard triple therapy group (86%) and fluroquinolone therapy group (82%) but results were not statistically significant when all three groups were compared together.
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BACKGROUND/AIMS: This nationwide, multicenter prospective randomized controlled trial aimed to compare the efficacy and safety of 10-day concomitant therapy (CT) and 10-day sequential therapy (ST) with 7-day clarithromycin-containing triple therapy (TT) as first-line treatment for Helicobacter pylori infection in the Korean population. METHODS: Patients with H. pylori infection were assigned randomly to 7d-TT (lansoprazole 30 mg, amoxicillin 1 g, and clarithromycin 500 mg twice daily for 7 days), 10d-ST (lansoprazole 30 mg and amoxicillin 1 g twice daily for the first 5 days, followed by lansoprazole 30 mg, clarithromycin 500 mg, and metronidazole 500 mg twice daily for the remaining 5 days), or 10d-CT (lansoprazole 30 mg, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg twice daily for 10 days). The primary endpoint was eradication rate by intention-to-treat (ITT) and per-protocol (PP) analyses. RESULTS: A total of 1,141 patients were included. The 10d-CT protocol achieved a markedly higher eradication rate than the 7d-TT protocol in both the ITT (81.2% vs 63.9%) and PP analyses (90.6% vs 71.4%). The eradication rate of the 10d-ST protocol was superior to that of the 7d-TT protocol (76.3% vs 63.9%, ITT analysis; 85.0% vs 71.4%, PP analysis). No significant differences in adherence or serious side effects were found among the three treatment arms. CONCLUSIONS: The 10d-CT and 10d-ST regimens were superior to the 7d-TT regimen as standard first-line treatment in Korea.
Subject(s)
Humans , Amoxicillin , Arm , Clarithromycin , Disease Eradication , Helicobacter pylori , Helicobacter , Korea , Lansoprazole , Metronidazole , Prospective StudiesABSTRACT
Objective To determine the efficacy of different first-line regimens for Helicobacter pylori(Hp) eradication,and to suggest an alternative first-line therapy particularly in children.Methods One hundred and twenty-four patients who diagnosed as peptic ulcer or chronic gastritis by gastroscope with Hp infection were included and randomly divided into four groups,each receiving different first-line eradication therapy.A group:standard triple therapy for 10 days;B group:standard triple therapy for 14 days;C group:triple therapy containing bismuth agent;D group:sequential therapy.The eradication rates of Hp and adverse event rates in four groups were compared.Results The highest eradication rate was in D group (90.9％,P ＜ 0.05),there was no significant difference between the other three groups (P ＞ 0.05).The main adverse reactions during treatment were abdominal pain,fullness,nausea and vomiting.Among them,adverse event rate was the highest in C group (41.4％,P ＜ 0.05),there was no significant difference between the other three groups (P ＞ 0.05).Conclusion The sequential therapy is significantly more effective than standard triple therapy and triple therapy containing bismuth agent.Adverse event rate is the highest in the triple therapy containing bismuth agent.
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Objective@#To explore clinical efficacy and safety of Wumeiwan combined with triple therapy for treatment of chronic atrophic gastritis (CAG).@*Methods@#According to the random indicator method, 113 patients with CAG were divided into control group (n=56) and treatment group (n=57). Patients of control group were treated with triple therapy, while treatment groupwere treated Wumeiwan combined with triple therapy. The two groups were treated for 3 months. Clinical effect was evaluated after treatment. The helicobacter pylori (Hp) conversion to negative of the two groups was compared and recorded. The Hp overcast conditions of the two groups were compared. The serum TNF-α, IL-6, IL-8 and peripheral blood CD3+, CD4+, CD8+, CD4+/CD8+ of the two groups before and after treatment were compared. The adverse reactions of the two groups during the treatment were compared.@*Results@#Total effective rate of treatment group was 94.7% (54/57), which was significantly higher than the control group 82.14% (46/56), and the difference was statistically significant (χ2=4.401, P=0.036). Hp overcast rate of treatment group was 88.2% (45/51), which was significantly higher than the control group 48.0%(24/50), and the difference was statistically significant (χ2=18.883, P=0.000). After treatment, the serum TNF-α (1.43 ± 0.17 mg/L vs. 1.97 ± 0.22 mg/L, t=14.615), IL-6 (30.79 ± 3.65 ng/L vs. 41.13 ± 4.10 ng/L, t=14.166), IL-8 (7.52 ± 1.32 ng/L vs. 9.60 ± 1.77 ng/L, t=7.090) in the treatment group were lower than those in the control group (P<0.05). After treatment, the peripheral blood CD3+ (75.12% ± 16.44% vs. 67.33% ± 14.37%, t=2.680), CD4+ (39.02% ± 11.41% vs. 33.49% ± 10.61%, t=2.667), CD4+/CD8+ (1.58 ± 0.35 vs. 1.19 ± 0.32, t=6.179) in the treatment group were higher than those in the control group (P<0.05), the peripheral blood CD8+ (24.75% ± 9.69% vs. 28.12% ± 11.29%, t=1.704) in the treatment group were higher than those in the control group (P<0.05). There was no significantly difference of the adverse reaction rates of the two groups during treatment (χ2=0.134, P=0.714).@*Conclusions@#The Wumeiwan combined with triple therapy for treatment of CAG has a good efficacy and low adverse reactions, has serious anti-inflammatory effects, can improve the body immunity, and it was worthy clinical application.
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BACKGROUND/AIMS: Recent Korean studies performed over the past few decades have shown diminishing efficacy and unacceptability of clarithromycin-based triple therapy as first-line eradication therapy for Helicobacter pylori infection, based on evidence of a declining eradication rate. Triple therapy continues to be used as first-line eradication therapy despite concerns regarding high clarithromycin resistance among Koreans. Patient compliance and acid suppression are important factors associated with the H. pylori eradication rate. We investigated whether regular administration of a proton pump inhibitor (PPI) 30 minutes before a meal can improve the eradication rate. MATERIALS AND METHODS: We retrospectively analyzed the data of 316 patients who were treated with first-line triple therapy (PPI, amoxicillin, and clarithromycin) for H. pylori infection between January 2012 and September 2017. Patients were divided into 2 groups based on the time of administration of the PPI (group A: before a meal, group B: after a meal). The urea breath test was performed 4~6 weeks after eradication of infection. RESULTS: Notably, 249 patients (78.8%, 249/316) showed successful eradication. The eradication rates in groups A and B were 87.5% (49/56 patients) and 76.9% (200/260 patients), respectively. We observed that regular administration of PPI before meals improved the eradication rate (P=0.079). CONCLUSIONS: We observed that although clarithromycin-based triple therapy was associated with an overall eradication rate <80%, regular PPI administration before meals improved the eradication rate. Regular PPI administration before meals and effective education to improve patient compliance could improve the eradication rate through maximal acid suppression.
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Humans , Amoxicillin , Breath Tests , Clarithromycin , Education , Helicobacter pylori , Helicobacter , Meals , Patient Compliance , Proton Pump Inhibitors , Proton Pumps , Protons , Retrospective Studies , UreaABSTRACT
BACKGROUND AND PURPOSE: Parkinson's disease (PD) is a major neurological disorder that requires lifelong treatment, and the combined presence of Helicobacter pylori (H. pylori) infection can increase the required anti-PD medications. We aim to investigate the effect of H. pylori infection in Indian PD patients. METHODS: We prospectively recruited 36 PD patients from December 2007 to January 2011. All patients underwent a detailed neurological evaluation and serological examination for H. pylori infection. Seropositive and seronegative patients were considered to be the cases and controls, respectively. All patients who were seropositive received triple therapy for 2 weeks. Outcome measures of the mean ‘off’ Unified Parkinson's Disease Rating Scale (UPDRS)-III score, mean ‘on’ UPDRS-III score, mean onset time, mean ‘on’ duration, and mean daily ‘on’ time were measured at baseline and at a 3-week follow-up. RESULTS: H. pylori-IgG positivity was present in 18 (50%) PD patients. The prevalence of men (72.2% vs. 33.3%), mean duration of disease (13.8 vs. 12.5) and mean levodopa equivalent daily dose (824 mg vs. 707 mg) were significantly higher among H. pylori positive patients than in controls (p<0.0001). Controls had a significantly longer ‘on’ duration and daily ‘on’ time, and better ‘on’ UPDRS-III scores. Seropositive patients took a significantly longer time to turn ‘on’ after a levodopa challenge. At the 3-week follow-up, H. pylori eradication significantly improved the mean ‘on’ UPDRS-III score, onset time, ‘on’ duration, and daily ‘on’ time. CONCLUSIONS: H. pylori infection was present in 50% of Indian PD patients. H. pylori seropositivity was associated with a poor response to levodopa and increased medication usage, while eradication therapy was associated with better patient outcomes.
Subject(s)
Humans , Male , Follow-Up Studies , Helicobacter pylori , Helicobacter , Levodopa , Nervous System Diseases , Outcome Assessment, Health Care , Parkinson Disease , Prevalence , Prospective StudiesABSTRACT
Objective To discuss the application of combined probiotics pretreatment and late triple therapy with helicobacter pylori infection in children.Methods 300 children with helicobacter pylori infection were randomly divided into three groups according to the way of random table.Group A was treated with standard triple therapy, omeprazole,amoxicillin and clarithromycin treatment,and 10 d was 1 treatment course.B group was given probiotic pretreatment,prior to the triple therapy using compound lactobacillus acidophilus piece 1 piece /time,cold water to take after meals,taking 2 weeks,follow -up treatment with triple therapy for 10d.In group C,triple therapy before using compound lactobacillus acidophilus piece 1 piece /time,cold water to take after meals,taking 2 weeks,follow -up treatment with triple therapy for 10d.To take one week after the completion of compound lactobacillus acidophilus piece 1 piece /time,cold water after meals.The clinical therapeutic effects were recorded.Results The helicobacter pylori clearance rate of group A was 55.00%,that of group B was 86.00%,that in group C was 89.00%,the helico-bacter pylori clearance rate of group B and group C was significantly higher than that in group A,the difference was statistically significant (χ2 =23.103 7,28.670 6,all P 0.05 ).In A group,nausea and vomiting occurred in 5 cases,2 cases of diarrhea,abdominal distension abdominal pain in 4 cases,skin rash in 5 cases.In group B,nausea and vomiting occurred in 2 cases,0 cases of diarrhea,abdominal distension abdominal pain in 1 case,skin rash in 1 case.In group C,nausea and vomiting occurred in 1 case,0 cases of diarrhea,abdominal distension abdominal pain 0 cases,skin rashes in 1 case.The incidence rate of adverse reactions in group B and group C was lower than that in group A,the difference was statistically significant (χ2 =11.965 8,8.000 0,all P 0.05). Conclusion Joint probiotics pretreatment and late triple therapy application in helicobacter pylori in children can promote helicobacter pylori clearance,reduce the triple therapy drug adverse reactions,it is worthy of popularization and application in clinic.
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The efficacy of standard triple therapy for Helicobacter pylori (Hp) eradication has been significantly decreased, or even less than 80%.Abroad studies have shown that Hp eradication rate of sequential therapy is significantly higher than that of triple therapy.At home, we lack a large sample of data analysis to clarify the efficacy of sequential therapy.Aims: To systematically review the efficacy of sequential therapy and triple therapy in Hp eradication at home and abroad.Methods: PubMed, Medline, Embase, Cochrane Library, CNKI, Wanfang, VIP and CBMdisc were retrieved to collect the randomized controlled trials (RCT) comparing sequential therapy and triple therapy in the treatment of Hp infection in last 7 years.Article selection, data extraction and quality evaluation were conducted independently by two reviewers.Meta-analysis was conducted by RevMan 5.3 software.Results: A total of 31 RCT involving 8 371 subjects were included.Meta-analysis showed that Hp eradication rate of sequential therapy was significantly higher than that of triple therapy (83.3% vs.74.7%;RR=1.13, 95% CI: 1.09-1.16).Sixteen domestic studies showed that Hp eradication rate of sequential therapy was significantly higher than that of triple therapy (88.1% vs.78.0%;RR=1.13, 95% CI: 1.10-1.16), fifteen abroad studies showed that Hp eradication rate of sequential therapy was significantly higher than that of triple therapy (79.0% vs.71.8%;RR=1.13, 95% CI: 1.06-1.20).No significant difference in incidence of adverse reactions was found between sequential therapy and triple therapy (20.7% vs.22.0%;RR=0.94, 95% CI: 0.86-1.03).Conclusions: Sequential therapy achieves higher Hp eradication rate than standard triple therapy, and no significant difference in incidence of adverse reactions is found between sequential therapy and triple therapy.Hp eradication rate of sequential therapy is significantly higher than that of triple therapy and is higher than 80% in China, which can be recommended as a Hp eradication supplement of bismuth quadruple therapy.
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Objective To discuss the effect of triple therapy plus traditional Chinese medicine in the treatment of peptic ulcer (PU) caused by Helicobacter pylori ( Hp) .Methods 148 cases with PU were randomly divided into study group and control group of 74 cases in each group.The control group were treated with triple therapy (omeprazole +clarithromycin +amoxicillin), and the study group were given liver-discharging and heat-clearing and invigorating spleen and removing blood stasis decoction, additionally.Both groups received treatment for one course of 4 weeks.The changes of clinical symptoms, negative conversion ratio of Hp and adverse reaction were compared.Results The scores of clinical symptoms were all significantly decreased in both two groups after treatment (P<0.05), but the study group changed more than control group (P<0.05).The total effective rate was 95.95%, rather higher than 79.73% in control group (P<0.05).The negative conversion ratio of Hp was 82.43%, obviously higher than 64.86% in control group (P<0.05).The incidence of adverse reaction was 12.16% in study group, similar to 9.46% in control group.Conclusion Triple therapy plus traditional Chinese medicine can significantly improve the clinical symptoms, clinical effect and negative conversion ratio of Hp, and has a good safety and tolerability.
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Objective To evaluate the effect and adverse drug reaction of Boulardii yeast combined with triple and quadruple therapy on eradication helicobacter pylori (H.pylori).Methods240 cases of peptic ulcer patients of H.pylori positive were selected in our hospital from January 2014 to December 2015, according to different treatment were divided into the triple threapy group(n=60), the triple therapy union group (n=60), the quadruple therapy group (n=60) and the quadruple therapy union group (n=60).The triple threapy group were given clarithromycin and amoxicillin and pantoraazole;on the basis of this, the triple therapy union group were given Boulardiiyeast.the quadruple therapy group were given clarithromycin and amoxicillin and pantoraazole and CBS capsule, on the basis of this, the quadruple therapy union group were given Boulardiiyeast.The four groups were treated continuously for 14 days.14C-UBT, H.pylori eradication rate and adverse drug reaction in the four groups were evaluated five weeks after treatment.ResultsCompared with the triple threapy group and the quadruple therapy group, H.pylori eradication rate in the triple therapy union group(91.2%) and the quadruple therapy union group(94.7%) were improved obviously, and the adverse drug reactions (31.6%、29.8%) decreased significantly, the cumulative recurrence rate of H.pylori were significantly decreased, and the differences were statistically significant (P< 0.05).ConclusionBoulardii yeast combined with triple and quadruple therapy can obviously increase the H.pylori eradication rate, reduce the incidence of adverse drug reactions and the risk of recurrence.The reasonable treatment plan should be selected according to the actual situation.
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Objective To study and analyze the effects of triple therapy (clarithromycin, amoxicillin, and lansorazole) combined with psychological intervention in the treatment of elderly peptic gastric ulcer. Methods 100 patients with aged gastrointestinal ulcer who were admitted to the hospital from February 2015 to April 2016 were selected as the study subjects, randomly divided into the control group and the experimental group, and 50 patients in each group.The control group was treated with conventional treatment, the experimental group was treated with triple therapy (clarithromycin, amoxicillin, lansorazole) combined with psychological intervention therapy, pay attention to the psychological state of the patients, strengthen the communication and exchanges with the patient, the treatment of patients with increased confidence and treatment compliance. The treatment effect of the experimental group and the control group was compared. Results After the corresponding treatment, the effective rate of treatment in the experimental group was 96.0%, significantly higher than the control group (86.0%), the difference was statistically significant (P<0.05). No obvious adverse reactions were found in the experimental group and the control group. The recurrence rate in the control group was 400%, which was significantly higher than that in the experimental group (14.0%), the difference was statistically significant (P<0.05). Conclusion Triple therapy (clarithromycin, amoxicillin, lansorazole) combined with psychological intervention in treatment of elderly peptic ulcer effect is good, can significantly improve the treatment efficiency, the recurrence rate is low.
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Objective To study and analyze the effects of triple therapy (clarithromycin, amoxicillin, and lansorazole) combined with psychological intervention in the treatment of elderly peptic gastric ulcer. Methods 100 patients with aged gastrointestinal ulcer who were admitted to the hospital from February 2015 to April 2016 were selected as the study subjects, randomly divided into the control group and the experimental group, and 50 patients in each group.The control group was treated with conventional treatment, the experimental group was treated with triple therapy (clarithromycin, amoxicillin, lansorazole) combined with psychological intervention therapy, pay attention to the psychological state of the patients, strengthen the communication and exchanges with the patient, the treatment of patients with increased confidence and treatment compliance. The treatment effect of the experimental group and the control group was compared. Results After the corresponding treatment, the effective rate of treatment in the experimental group was 96.0%, significantly higher than the control group (86.0%), the difference was statistically significant (P<0.05). No obvious adverse reactions were found in the experimental group and the control group. The recurrence rate in the control group was 400%, which was significantly higher than that in the experimental group (14.0%), the difference was statistically significant (P<0.05). Conclusion Triple therapy (clarithromycin, amoxicillin, lansorazole) combined with psychological intervention in treatment of elderly peptic ulcer effect is good, can significantly improve the treatment efficiency, the recurrence rate is low.