[Evaluation of triple therapy regimens with metronidazole or clarithromycin for helicobacter pylori eradication in children]

Half of the world's population is infected with helicobacter pylori. This organism is one of the main causes of peptic ulcer disease, gastritis and gastric cancer. This infection is most frequently acquired in childhood. There is strong evidence that eradication of infection improves healing and reduces the risk of recurrence and rebleeding in patients with duodenal or gastric ulcer. There is no consensus as to treat infected children without ulcer. The aim of this study was to compare the efficacy of two therapeutic regimens in eradication of infection in children. This study was a double-blind randomized clinical trial conducted in Tabriz Children Hospital. A total of seventy children aged 4 to 15 years were studied. These patients were referred to Endoscopy Unit and upper endoscopy and biopsy were performed. They were positive for helicobacter pylori by histological confirmation. The patients were randomly enrolled in two therapeutic groups: group-A[n=41] received omeprazole as a proton pump inhibitor, amoxicillin and metronidazole [PAM] and group-B [n=36] received omeprazole, amoxicillin and clarithromycin [PAC]. The duration of treatment was two weeks in both groups. To confirm eradication, UBT was performed after 8 weeks of treatment. Data were analyzed using SPSS package version 15. P-value <0.05 was considered significant. Mean age in PAM and PAC groups were 8.8 +/- 2.5 and 9.6 +/- 2.9 years, respectively. The age difference was not statistically significant [P=0.24]. The most common initial symptom was chronic abdominal pain in both PAM and PAC groups [81.3% and 76.3%, respectively]. There was no statistical difference in frequency of initial symptom between the two groups [P=0.41]. Side effects during treatment were seen in both PAM and PAC groups [23.7% and 19.7%, respectively]. Most patients in both groups experienced symptoms improvement after treatment whether complete or partial. In PAM and PAC groups, symptoms improvement was seen in 92.1% and 91.2%, respectively. There was no significant statistical difference between the two groups [P=0.64]. The intention to treat analysis in PAC and PAM groups were 75%and 73%, respectively and per-protocol analyses were 87% and 78.9%, respectively. There was no statistical difference in helicobacter pylori eradication rates between the two groups [P=0.39]. Our study suggested that both PAM and PAC regimens are effective in eradication of infection. Eradication of infection also can cause significant improvement of initial symptoms

Helicobacter pylori infection and hyperemesis gravidarum is there a relationship?

To investigate any possible association between Helicobacter pylori infection [H. pylori] and hyperemesis gravidarum [HG] by using both H. pylori Stool Antigen [HpSA] test and H. pylori IgG Antibody [HpIgG Ab] serologic test. Prospective randomized study. One hundred thirty pregnant women in the first 16 weeks of pregnancy divided into two groups: 65 patients with HG [HG group] and 65 randomly selected asymptomatic pregnant women matched for age, parity, gravidity and gestational age with patients in HG group and formed the control group. Serum samples collected from cases were examined for HpIgG Ab by Chemiilluminescence on Immulite and feces samples were examined for HpSA by Helicobacter Antigen Quick test. Chi square [x[2]] test was used accordingly for statistical analysis. Positive HpSA test was detected in 47.7% of patients with HG and in 13.9% of asymptomatic cases, the difference was statistically significant [x[2] = 7.25, P=0.001]. Positive HpIgG Ab was found in 81.5% of patients with HG and in 69.2% of control women. The difference was not statistically significant [x[2]= 3.23, P= 0.07]. This study suggests an association between H. pylori infection and HG. HpSA test provides a more accurate tool for detection of active H. pylori infection than IgG Ab serologic test that recommends its routine use in patients with HG as well as in women who desire to become pregnant in the near future

[Laparoscopic treatment of duodenal ulcer feasibility and results: about 160 cases]

The objective of this study is to evaluate the feasibility, efficacy and safety of laparoscopic repair for perforated duodenal ulcer. One hundred and sixty patients were treated by coelioscopic procedure for a perforated duodenal ulcer. The procedure consists of a suture of perforated ulcer associated with a peritoneal lavage. A medical treatment of Helicobacter pylori associated with an inhibitor of the protons pump was conducted. The coelioscopic procedure permitted to confirm the diagnostic of perforated duodenal ulcer in all cases. A simple suture of the ulcer was done in 155 cases. The conversion was compulsory in 5 cases, because of difficulties of the peritoneal lavage in 2 cases, a bleeding associated with perforation of the ulcer in one case and associated stenosis in 2 cases. Mean duration was 90 min [extremes 50 - 120 min]. Complications occur in 3.1%. There were post - operative peritonitis in 3 cases and duodenal fistulae in 2 cases. All patients were reviewed at 16 months. A recurrence, either clinical or endoscopic occured in 4 cases because of no adhesion to medical treatment. Coelioscopic treatment of perforated duodenal ulcer is a safe and efficacy method. It permits to avoid potential septic and parietal complications of laparotomy. The actual efficacy of medical treatment mustn't allow place to the radical treatment of ulcerous illness

Helicobacter pylori infection in children with refractory iron deficiency anemia [RIDA]

The prevalence of iron deficiency anemia [IDA] varies widely between developed and developing countries and is related to many factors. If iron therapy does not produce the expected results, patient compliance with the prescribed medication should be insured, and if confirmed, the diagnosis of IDA should be reevaluated. Continued iron therapy in the absence of iron deficiency can produce iron overload. Refractory Iron Deficiency Anemia accounts for about 15% of all IDA. Previous reports by many authors suggested that there was a relation between Helicobacter pylori [H. pylori] infection and IDA. The aim of the present work is to determine the prevalence of H. pylori infection among patients with RIDA, to describe the clinical presentation of H. pylori infection among these patients and to determine the value of serum immunoglobulin G, and immunohistochemistery in diagnosing H. pylori infection and finally to describe the histopathological changes in gasrtic biopsy of these patients. The study included 40 cases with RIDA [Hb < 10gm/dl, not responding to oral iron therapy for three months]. They were attending the Hematology unit and children hospital, Assuit University during the period June 2003 to May 2004. They were 31 males and 9 females and their ages ranged from 4 to 13 years. The study also included 10 apparently healthy children of matched age and sex as a control group. Children with positive Tuberculin test, PEM, malabsorption particularly Celiac disease, myeloproliferative, connective tissue disease and those with repeated overt blood loss were excluded from the study. In addition to careful history taking and thorough clinical examination, the following investigations were done: complete blood picture, urine analysis, stool analysis for three consecutive days, stool analysis for occult blood, serum iron, TIBC, serum ferritin, Hb electrophoresis and serum IgG for H. pylori. Patients were subjected to upper gastrointestinal endoscopy and gastric biopsies were taken for Monoclonal antibody against H. pylori [1HC], and for pathological changes by H and E stain. Identification of H. pylori using other stains namely Giemsa and Leung was also done. Triple therapy was given to eradicate H pylori infection and follow up by hem atological profile and iron status was done. Out of the cases with RIDA, 40% were 4 times during the study period. Serum IgG for H. pylori was positive in 32.5% of cases and in 20% of the control. IHC staining for H. pylori was positive in 50%. Sensitivity of IgG for H. pylori was 60%, specificity was 95%, positive predictive value was 92%, negative predictive value was 70% and accuracy was 76%. There was significantly higher frequency of RAP among cases positive for H. pylori IgG than among negative ones. There was also a significantly higher frequency of anemic heart failure and repeated blood transfusion among positive cases for IgG than the negative ones. H. pylori organisms were detected in 50% of the cases by IHC staining. There was significantly higher frequency of positive IHC for H. pylori among cases > 6 years and among males. There was significantly higher frequency of RAP in the positive cases for H. pylori by IHC than in the negative cases. In addition, the frequency of cases with Hb