RESUMEN
Background : Chronic diarrhoea remains a major gastroenterological problem in Thailand Data regarding investigation, diagnosis and treatment of chronic diarrhoea varies from one country to another. Socio-economic status including sanitation and hygiene may also affect etiology and the clinical course of disease. There data may be misleading for practitioners facing the problem in Thailand. To date, few studies on chronic diarrhoea in Thailand are available. Objectives : To find the causes and clinical courses of chronic diarrhoea. To determine the frequency of various causes. Finally, to see if simple guidelines can be developed to help investigators in Thailand reach a final diagnosis. Methods : Thirty-four in-patients with chronic diarrhoea at Siriraj Hospital were worked up using a systematic scheme for evaluation of chronic diarrhoea by prospective study. Close follow-ups were monitored for an average period of six months. Results : Among the 34 cases, a definite diagnosis was reached in 21 cases (62%) : parasitic infestation seven cases (33%), carcinoma of colon four cases (19%), lymphoma there cases (14%), radiation proctitis two cases (9%), malabsorption and/or maldigestion two cases (9%), tuberculous peritonitis one cases (5%) hyperthyroidism one case (5%) and villous adenoma one case (5%). Conclusion : Our study suggests that a simple investigation using complete blood count, stool examination, and especially concentration methods and sigmoidoscopy in all patients can usually find in up to 38 per cent, while further investigations can detect causes in up to 62 per cent. Of the 13 patients for whom no definite diagnosis was reached, spontaneous remission of chronic diarrhoea was found in four cases (31%).
RESUMEN
Although dyspepsia frequently occurs in general population, its causes are poorly understood. This study is aimed at determining the role of Helicobacter pylori in non-ulcer dyspepsia (NUD) and evaluating the efficacy of dual therapies for H.pylori. Two groups totaling of 39 patients with endoscopically-proven NUD participated in the study. One group, comprising of 23 patients, received 300 mg of ranitidine daily for 4 weeks together with 500 mg of amoxicillin four time a day for two weeks. The second group, comprising of 16 patients, received GacidaTM 1 tablet for 4 weeks together with 500 mg of amoxicillin four time a day for 2 weeks respectively. H.pylori status was determined by histology and CLO testTM before and in the fourth and eighth week after treatment. Thirty-six patients completed the study, 21 in the ranitidine treatment group and 15 in the GacidaTM group H.pylori was successfully eradication in 47.3 percent (9/21) of ranitidine treatment group. Symptom relief at the second and sixth weeks was significantly higher under ranitidine regimen at 90.47 percent (19/21) and 100 percent (21/21) respectively, compared with the gacida regimen at 46.66 percent (7/15) and 53.33 percent (8/15) respectively. The number of patients who were symptom-free at the sixth week of treatment was significantly higher in the ranitidine group at 71.4 percent (15/21), compared with the gacida group at 20 percent (3/15). We concluded that the ranitidine regimen can relief the symptoms of NUD patients with H.pylori infection. However, the role of H.pylori needs further studies.
RESUMEN
We report an open trial study to determine the role of Helicobacter pylori (HP) in patients with non-ulcer dyspepsia (NUD) and to determine the effect of two drugs (colloidal bismuth subcitrate, CBS and cimetidine) on HP. Our study consisted of 48 patients, 30 received CBS two tablets twice daily and 18 received cimetidine 400 mg twice daily. The result of HP suppression detected by rapid urease test was 66.7% and 86.7% for CBS group after receiving the drug for 4 and 8 weeks respectively, for cimetidine only 11.1% urease test negative during the same period. Follow up urease test 19.2% of patients treated by CBS remained negative but none in the cimetidine group. AII patients felt better during treatment irrespective to status of HP. Our conclusion is that there is no correlation between HP status and NUD symptoms. To evaluate this relationship, further study must be done. To date there is no strong evidence to recommend HP eradication in HP associated NUP patients.