ABSTRACT
Gastrointestinal tract is the most common site for the development ofextra nodal lymphoma. This study was done to analyze clinical and pathological features as well as the treatment outcome of this disease. We carried out analysis of25 cases of primary gastrointestinal (GI) lymphomas during period from March 2001 to February 2003 at Gujarat Cancer & Research Institute. Out of 25 cases of primary GI lymphoma, nine cases of gastric lymphoma, nine cases of small intestinal lymphoma and seven cases of large intestinal lymphoma were identified. A male to female ratio of 2.6:1 was observed. Peak incidence was observed infirst and second decades of life (range 4-63 years). Abdominal pain and abdominal lump were the two most common presenting symptoms. Diffuse large B-cell type and Burkitt's lymphoma were the most common histologic variants, accounting for equal proportions (36% each). All the patients were treated with either surgery alone or in combination of surgery, chemotherapy and radiotherapy depending on the site, stage and histology. Anti H-pylori kit was used in early stage GI maltomas. 18 cases of GI lymphoma were evaluable, and out of these, 66.6% (11 cases) attained complete remission with a median follow up time of 12 months. The disease free survival was 50% (9 cases), and the overall survival was 72.2% (13 cases). In conclusion, although there are considerable therapeutic controversies, surgery with adjuvant chemotherapy and radiotherapy yield good survival. Clinical and histopathologic characteristics and prognosis of our cases with primary gastrointestinal lymphoma were usually similar to the cases in western countries with some differences in the incidence and histologic subtypes.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Combined Modality Therapy , Female , Gastrointestinal Neoplasms/microbiology , Helicobacter Infections/diagnosis , Helicobacter pylori/isolation & purification , Humans , Lymphoma/microbiology , Lymphoma, B-Cell, Marginal Zone/pathology , Male , Middle Aged , Neoplasm Staging , Prognosis , Retrospective StudiesABSTRACT
Background: Epidemiological differences suggest that treatments for H. pylori eradication should be locally validated. Aim: To perform a cost benefit study of different treatment options for H. pylori infection. Patients and methods: One hundred and sixty-seven patients with active duodenal ulcer and H. pylori infection who completed a 2-week treatment with one of the following regimens were included: famotidine plus amoxycillin plus metronidazole (FAM), omeprazole plus amoxycillin plus tinidazole (OAT) or lansoprazole plus clarithromycin plus amoxycillin in 3 (LAC1) or 2 (LAC2) daily doses. We compared efficacy, adverse effects and cost. Results: Eradication rate was 74.6, 72.9, 96.4 y 91.7 percent for FAM, OAT, LAC1 and LAC2 respectively (p<0.05). Direct cost ranged from US$ 50 for FAM to US$ 220 for LAC1. A decision analysis was carried out in a model including direct and indirect costs and considering retreatment with antibiotics after the first treatment failure and one-year treatment with H2-blockers in case of a second failure. FAM was selected as the most cost-effective option, with an estimated cost of about US$ 300 ñ 148 per patient. However, cost associated to LAC2 was very similar (US$ 320 ñ 58) and the lower standard deviation suggests less variation. Sensitivity analyses, considering reasonable fluctuation in parameters such as eradication rate, cost and follow-up period suggest that a regimen containing a proton pump inhibitor, clarithromycin and amoxycillin may be the most cost-effective treatment. Conclusions: These results should be confirmed in other settings, specially in ordinary clinical practice, far from clinical research
Subject(s)
Humans , Male , Female , Helicobacter pylori/drug effects , Helicobacter Infections/drug therapy , Urease , Famotidine/administration & dosage , Follow-Up Studies , Helicobacter Infections/diagnosis , Cost-Benefit Analysis , Proton Pumps/administration & dosage , Clarithromycin/administration & dosage , Drug Therapy, Combination/administration & dosage , Amoxicillin/administration & dosage , Lymphoma/microbiology , Drug Administration Schedule , Peptic Ulcer/microbiologyABSTRACT
Helicobacter pylori es quizá la infección bacteriana crónica más frecuente en el mundo. Se calcula que hasta un 50 por ciento de la población puede esta infectada, cifra que alcanza 100 por ciento en poblaciones con escasas condiciones sanitarias. El espectro clínico de la enfermedad es amplio, abarca desde la gastritis y úlcera péptica hasta el cáncer gástrico, pasando por asociaciones menos claras, como enfermedad coronaria, rosácea y retraso del crecimiento en niños. Los mecanismos fisiopatológicos responsables apenas se comienzan a comprender, modificando el antiguo concepto de ®no ácido, no úlcera¼, que aunque aún es válido, no es suficiente. Por lo anterior, tiene suma importancia establecer la presencia del germen y proporcionar el tratamiento correcto