Eficácia e segurança do Esomeprazol e Lansoprazol comparados ao Omeprazol para o tratamento de doença do refluxo gastroesofágico em adultos: revisão rápida / Effectiveness and safety of esomeprazole and lansoprazole compared to omeprazole for the treatment of gastroesophageal reflux disease in adults: rapid review

Tecnologia: Esomeprazol e lansoprazol. Indicação: Tratamento de doença do refluxo gastroesofágico em adultos. Pergunta: Esomeprazol e lansoprazol são mais eficazes e toleráveis que o omeprazol já incorporado ao SUS para o tratamento de Doença do Refluxo Gastroesofágico (DRGE) em adultos? Métodos: Uma revisão rápida de evidências, uma revisão de revisões sistemáticas, com levantamento bibliográfico realizado na base de dados PUBMED, utilizando estratégia estruturada de busca. A qualidade metodológica das revisões sistemáticas foi avaliada com AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews). Resultados: Foram selecionadas três revisões sistemáticas com meta-análise, que atendiam aos critérios de inclusão. Conclusão: O esomeprazol era mais eficaz para cicatrização da lesão nos casos de esofagite erosiva, prevenção da mucosa do esôfago, maior controle de ácido no tratamento de curto prazo (4 e 8 semanas) de esomeprazol 40mg e tratamento de longo prazo (6 meses) de esomeprazol 20mg. A taxa de resposta no alívio dos sintomas, o esomeprazol 20mg e 40mg apresentou ser mais eficaz, especialmente, na azia e dor epigástrica. Quanto ao perfil de segurança, não houve diferença significativa entre as taxas de eventos adversos, todos medicamentos eram parecidos entre si

Technology: Esomeprazole and Lansoprazole. Indication: Treatment of gastroesophageal reflux disease in adults. Question: Are Esomeprazole and Lansoprazole more effective and tolerable than omeprazole already incorporated into SUS for the treatment of Gastroesophageal Reflux Disease (GERD) in adults? Methods: A rapid review of evidence, an overview of systematic reviews, with bibliographic survey carried out in the PUBMED database, using a structured search strategy. The methodological quality of systematic reviews was assessed using AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews). Results: Three systematic reviews with meta-analysis were selected, which met the inclusion criteria. Conclusion: Esomeprazole was more effective in achieving wound healing in cases of erosive esophagitis, prevention of esophageal mucosa, greater acid control in short-term treatment (4 and 8 weeks) of esomeprazole 40mg and long-term treatment (6 months) of esomeprazole 20mg. the response rate in symptom relief, esomeprazole 20mg and 40mg proved to be more effective, especially in heartburn and epigastric pain. As for the safety profile, there was no significant difference between the rates of adverse events, all drugs were similar to each other

Effect of sequential therapy on treatment of Helicobacter pylori infection in children / Efecto de la terapia secuencial en el tratamiento de la infección por Helicobacter pylori en niños

Background: Helicobacter pylori infection which plays a major role in the etiology of chronic gastritis and duodenal ulcers in children and adults is one of the commonest chronic infection worldwide. Cure of the infection leads to healing of gastric inflammation and prevention of peptic ulcer. Objective: The aim of this study was to evaluate the efficacy of the sequential therapy for treatment of Helicobacter pylori infection. Materials and methods: In this study, 40 children with symptoms of H. Pylori that the infection was proved by endoscopy and biopsy and rapid urease test (UBT) were enrolled, and received sequential therapy (Lansoprazol, Amoxicillin) for 5 days and (Lansoprazol, Metronidazole and Clarithromycin) for next 5 days. The eradication rate of therapy was evaluated by stool antigen test 6 weeks after completion of therapy. This study was carried out in Pediatric Gastroenterology Clinic of Shiraz University of Medical Sciences, Shiraz, Iran. This study was approved by ethic committee of Shiraz University of Medical Sciences. Results: Forty children with mean age of (10.8±4 years) were evaluated. The most common symptom on first admission was epigastric pain (82.5%), with mean duration of symptoms (16±14.5 month). The most common endoscopic findings was redness and erosion of the antrum (55%) and the most pathologic findings was chronic gastritis (77.5%). The most drug adverse effect was nausea (22.5%). The eradication rate of sequential therapy was 82.5%. Conclusion: Eradication rate of sequential therapy was 82.5% among our cases.

Antecedentes: La infección por Helicobacter pylori, que juega un rol principal en la etiología de la gastritis crónica y las úlceras duodenales en niños y adultos, es una de las infecciones crónicas más comunes en el mundo. La cura de esta infección lleva a la cura de la inflamación gástrica y a la prevención de la úlcera péptica. Objetivo: Evaluar la eficacia de la terapia secuencial en el tratamiento de la infección por Helicobacter pylori. Material y métodos: En este estudio, se enrolaron 40 niños con síntomas en los que la infección por H. pylori se demostró por endocopía con biopsia y prueba rápida de ureasa (UBT) y recibieron terapia secuencial (Lansoprazol, Amoxicilina) por 5 días y (lansoprazol, metronidazol y clarotromicina) por otros 5 días. La tasa de erradicación de la terapia se evaluó por prueba de antígeno en heces 6 semanas después de terminar la terapia. Este estudio se llevó a cabo en la Clínica de Gastroenterología Pediátrica de la Universidad de Ciencias Médicas de Shiraz, Irán. El estudio fue aprobado por el comité de ética de la Universidad de Ciencias Médicas de Shiraz. Resultados: Se evaluaron cuarenta niños con una edad media de (10,8±4 años). El síntoma más común al ingreso fue dolor epigástrico (82,5%) con una duración media de síntomas de (16±14,5 meses). El hallazgo endoscópico más común fue enrojecimiento y erosión del antro (55%) y el hallazgo patológico más común fue gastritis crónica (77,5%). El evento adverso más común fue náusea (22,5%). La tasa de erradicación de la terapia secuencial fue 82,5%. Conclusión: La tasa de erradicación de la terapia secuencial fue de 82,5% en nuestros casos.

Erradicación de Helicobacter pylori con terapia triple estándar de primera línea / Helicobacter pylori eradication with standard first-line triple therapy

La infección por Helicobacter pylori es una de las infecciones crónicas más comunes a nivel mundial y causa importante de enfermedad péptica y cáncer gástrico. Infecta al 50% de la población adulta con mayor prevalencia en América Central/Sur y Asia y al menos dos veces mayor en poblaciones con alta incidencia de cáncer gástrico. Los objetivos de esta investigación fueron identificar la tasa de erradicación de H. pylori con terapia triple estándar y las posibles características asociadas a su erradicación. Se estudió a 119 pacientes con diagnóstico de infección por H. pylori, seleccionados en forma consecutiva de la consulta externa de Gastroenterología del Hospital General San Juan de Dios. Se realizó endoscopia diagnóstica y toma de biopsia gástrica. Se dio terapia triple estándar con lansoprazol, amoxicilina y claritromicina durante 10 días, seguido de 30 días con lansoprazol. Seis semanas después de completado el tratamiento se evaluó el antígeno de H. pylori en heces para determinar si hubo erradicación. La edad promedio de los participantes fue 49.0 años, 81.5% mujeres, 85.7% de área urbana, el síntoma más común fue dispepsia en 86.6%. En el examen post tratamiento el 89.9%, IC 95% [83.0, 94.7] presentó antígeno en heces negativo. No se encontró asociación entre las características de los pacientes con la respuesta al tratamiento. En conclusión, la respuesta a la terapia triple de primera línea se encuentra dentro del rango aceptable para continuar con ese esquema, pero debe mantenerse una evaluación constante por la presencia de posible resistencia.

Infection by Helicobacter pylori is one of the most common chronic infections worldwide and an important cause of peptic disease and gastric cancer. It infects 50% of the adult population with the highest prevalence in Central / South America and Asia and at least twice as high in populations with a high incidence of gastric cancer. The objectives of this research were to identify the eradication rate of H. pylori after first line standard triple therapy and the possible characteristics associated with its eradication. It was studied 119 patients with a diagnosis of H. pylori infection, selected consecutively from the outpatient department of Gastroenterology of the San Juan de Dios General Hospital. Diagnostic endoscopy and gastric biopsy was performed. Standard triple therapy was given with lansoprazole, amoxicillin and clarithromycin for 10 days, followed by 30 days with lansoprazole. Six weeks after the treatment was completed, the H. pylori antigen in feces was evaluated to determine if there was eradication. The average age of the participants was 49.0 years, 81.5% women, 85.7% of urban area, the most common symptom was dyspepsia in 86.6%. In the post-treatment examination 89.9%, 95% CI [83.0, 94.7] presented negative antigen in feces. No association was found between the characteristics of the patients with the response to treatment. In conclusion, the response to first line triple therapy is within the acceptable range to continue with this scheme, but a constant evaluation must be maintained due to the presence of possible resistance.

Therapeutic endoscopy in combination with quadruple therapy in treating bleeding caused by gastric ulcer

Objective: To analyze the efficacy of therapeutic endoscopy in combination with quadruple therapy in treating bleeding caused by gastric ulcer and investigate the factors inducing rebleeding

Methods: Two hundred and twelve patients with bleeding caused by gastric ulcer who were admitted to Binzhou People's Hospital, Shandong, China between April 2015 and April 2016 were selected as research subjects. The patients were randomly divided into a control group and an experimental group. Patients in the control group were treated by quadruple therapy, while patients in the observation group received therapeutic endoscopy treatment in addition to the same treatment as the control group. The treatment efficacy, adverse reaction, H pylori [Hp] clearance rate and rebleeding were compared between the two groups

Results: The effective rate of the observation group was 98.1%, which was significantly higher than that of the control group [80.2%], and the difference had statistical significance [P<0.05]. The incidence of adverse reactions in the observation group was lower than that in the control group. The Hp clearance rate of the observation group was higher than that of the control group, and the difference had statistical significance [P<0.05]. The multi-factor analysis on rebleeding suggested that whether therapeutic endoscopy was performed or not, hemoglobin level and presence of peptic ulcer stage A1 were independent risk factors

Conclusion: Endoscopic treatment in combination with quadruple therapy is better in the treatment of bleeding caused by gastric ulcer as compared to medical treatment alone. Patients with high-risk factors such as low content of hemoglobin and ulcer at stage A1 should be monitored more carefully to prevent the occurrence of rebleeding

Informe de evaluación científica basada en la evidencia disponible: colitis ulcerosa / Scientific evaluation report based on available evidence: ulcerative colitis

INTRODUCCIÓN: La colitis ulcerosa es una enfermedad inflamatoria crónica que afecta la mucosa del colon en forma continua, comprometiendo el recto y una porción variable de la extensión del resto del colon, sin la presencia de granulomas en la biopsia. En esta enfermedad, el sistema inmune reconoce esta porción del colon como ajena al cuerpo y lo ataca generando úlceras que caracterizan a esta enfermedad. TECNOLOGÍAS SANITARIAS ANALIZADAS: Adalimumab, azatioprina, golimumab, infliximab, mesalazina, lansoprazol, omeprazol, sulfasalazina y colestiramina. EFICACIA DE LOS TRATAMIENTOS: Se extrajeron 31 revisiones sistemáticas que incluyen 11 ensayos controlados aleatorizados que evaluaban la eficacia de adalimumab, golimumab e infliximab en pacientes con colitis ulcerosa moderada a grave. El tratamiento con adalimumab aumenta ligeramente el número de pacientes que cicatrizan su mucosa e incrementan su score IBDQ (calidad de vida) en más de 12 puntos, a las 8 semanas. El tratamiento con golimumab probablemente aumenta el número de pacientes que responden clínicamente a las 6 semanas, mientras que probablemente aumenta ligeramente el número de pacientes que remite y cicatrizan su mucosa a las 6 semanas. Además, golimumab probablemente no genera diferencias en cuanto a la calidad de vida (cuestionario IBDQ) de pacientes con colitis ulcerosa. El tratamiento con infliximab aumenta el número de pacientes que presentan respuesta clínica a las 8 semanas, mientras que reduce ligeramente el número de pacientes que reciben colectomía a las 54 semanas. No se encontró evidencia de eficacia de los tratamientos sobre una menor hospitalización o una menor estadía hospitalaria, ni estudios que evaluaran la eficacia en niños con colitis ulcerosa. ANÁLISIS ECONÓMICO: Infliximab resultó ser la alternativa que presentó mayor efectividad. Sin embargo, la efectividad incremental en relación a adalimumab es sólo de 0,66 QALYs, superándolo en costes en aproximadamente un 45%. Infliximab y golimumab fueron los tratamientos que presentaron mayor costo en relación a adalimumab. En esto se incluyen los costos de efectos adversos serios, porcentaje de pacientes que se sometían a colectomía mientras estaban en terapia con algún biológico y los costos de administración de infliximab. Para este último se consideró un costo mayor, ya que como su administración es intravenosa se deben considerar las horas en que el paciente debe estar en una sala de observaciones para que se le administre el biológico. En cuanto a las agencias internacionales, Inglaterra recomienda el uso de adalimumab, infliximab o golimumab en pacientes con colitis ulcerosa moderada a grave, siempre y cuando la terapia convencional no funcione o no sea la adecuada. El impacto presupuestario calculado para el primer año de tratamiento fue de MM$1.810 para adalimumab, $MM2.424 para infliximab, y MM$353.378 para golimumab. CONCLUSIÓN: Para dar cumplimiento al artículo 28° del Reglamento que establece el proceso destinado a determinar los diagnósticos y tratamientos de alto costo con Sistema de Protección Financiera, según lo establecido en los artículos 7°y 8° de la ley N°20.850, aprobado por el decreto N°13 del Ministerio de Salud, se concluye que el presente informe de evaluación se considera favorable, de acuerdo a lo establecido en el Título III. de las Evaluaciones Favorables de la Norma Técnica N° 0192 de este mismo ministerio.

Improving the standard sequential treatment of Helicobacter pylori with either extended treatment or by adding bismuth

Background and study aims: Standard sequential treatment for Helicobacter pylori [H. pylori] eradication has less success because of increasing clarithromycin resistance. Extended treatment and bismuth containing regimens were, therefore, investigated

Patients and methods: Consecutive H. pylori-positive patients with dyspepsia were randomly allocated to one of the three sequential regimens: The first group was given lansoprazole 30 mg b.i.d. plus amoxicillin 1 g b.i.d. for the first 5 days, followed by lansoprazole 30 mg b.i.d., clarithromycin 500 mg b.i.d., and metronidazole 500 mg t.i.d. for the second 5 days [standard sequential, SS]. The second group was given the same regimen but for 7 + 7 days instead of 5 + 5 days [extended sequential, ES]. In the third group, colloidal bismuth 600 mg b.i.d. was added to the second regimen for 14 days [extended sequential + bismuth subcitrate, ES + B]. Urea breath test or histology was performed before enrolment and 6 weeks after the end of treatment to detect H. pylori

Results: A total of 280 patients were included in the study. Per-protocol eradication rates were 62% [56/90], 72% [56/78], and 75% [54/72] in patients who received SS, ES, and ES + B regimens, respectively. Moreover, intention-to-treat eradication rates were 53% [56/104], 62% [56/90] and 62% [54/86], respectively. The differences in eradication rates between the groups were not statistically significant

Conclusion: Although prolonging of the sequential treatment to 14 days may be considered, addition of bismuth to the regimen is of no avail

Comparison on Oral versus Intravenous Proton Pump Inhibitors for Prevention of Bleeding after Endoscopic Submucosal Dissection of Gastric Lesions / 대한소화기학회지

BACKGROUND/AIMS: Although intravenous proton pump inhibitor (PPI) has been used for the prevention of post endoscopic submucosal dissection (ESD) bleeding, the route of administration has not been confirmed. The aim of the present study was to compare the efficacy of intravenous and oral PPI administration for the prevention of delayed post ESD bleeding. METHODS: Total 166 consecutive patients were randomly assigned to 30 mg lansoprazol twice a day (PO group) and 120 mg pantoprazole intravenous injection (IV group) for 48 hours. Finally, 65 patients in PO group and 87 patients in IV group were analyzed. After ESD, all patients underwent follow up endoscopy after 24 hours and were observed the symptoms of bleeding up to 60 days after ESD. RESULTS: Age, sex and use of anticoagulants were not different between groups. At follow up endoscopy after 24 hours, oozing and exposed vessel was noted in 4.6% of PO group and 8.0% of IV group and there was no significant difference. Delayed bleeding occurred in 4 of 65 patients (6.2%) in the PO group and 8 of 87 patients (9.2%) in the IV group (p>0.999). By multivariate analysis, oozing or exposed vessels at follow up endoscopy were risk factors for delayed bleeding (OR=17.5, p=0.022). CONCLUSIONS: There was no significant difference in the delayed bleeding, length of hospital stay according to the administration route. Bleeding stigmata at follow up endoscopy was risk factor of delayed bleeding. Oral PPI administration can cost-effectively replace IV PPI for prevention of post ESD bleeding.

Ten Day Concomitant Therapy Is Superior to Ten Day Sequential Therapy for Helicobacter pylori Eradication / 대한소화기학회지

BACKGROUND/AIMS: Because the efficacy of standard triple therapy for Helicobacter pylori eradication has declined, new regimens such as sequential therapy (ST) and concomitant therapy (CoCTx) have been introduced. The aim of this study was to compare the efficacy of 10-day ST and 10-day CoCTx for H. pylori eradication. METHODS: We retrospectively reviewed the medical records of 316 patients with proven H. pylori infection. They were assigned to one of 2 regimens; ST (n=191) consisted of, lansoprazole 30 mg and amoxicillin 1 g for 5 days followed by lansoprazole 30 mg, metronidazole 500 mg, and clarithromycin 500 mg for 5 days, and CoCTx (n=125) consisted of lansoprazole 30 mg, amoxicillin 1 g, metronidazole 500 mg, and clarithromycin 500 mg for 10 days. All drugs were administered twice a day. Bacterial eradication was checked by using a 13C-urea breath test at least 4 weeks after completion of treatment. RESULTS: The mean age and male to female ratio was 51.74 and 1.03, respectively. Baseline characteristics were not different in both groups. Ten day CoCTx group (94.4%, 118/125) showed better eradication rate than ST group (82.2%, 157/191) (p=0.002). Drug compliances were not statistically different between the two groups (p=0.19). Side effects were more frequently reported in the CoCTx group than in the ST group (p=0.03). CONCLUSIONS: Ten-day CoCTx was superior to ST in terms of eradicating H. pylori infection. Although the CoCTx producing more side effects than ST, CoCTx can be thought to be a promising alternative to ST as a treatment regimen for H. pylori eradication.