Antibiotic sensitivity of Helicobacter pylori in Jamaica

Helicobacter pylori infection is one of the commonest chronic infections worldwide. Eradication regimes usually contain two antibiotics, however resistance is increasing and this decreases treatment success. This study reports on the sensitivity and resistance of H pylori to several antibiotics in patients undergoing upper gastrointestinal endoscopy in Jamaica. The rapid urease test (CLO) was positive in 128 (38) of 336 patients. Fifty patients (39; 50/128) with positive CLO tests had positive cultures for H pylori. Two-thirds (32/48) of islolates were sensitive to metronidazole and one-third (16/48) were resistant. Ninety-seven per cent of isolates (31/32) were sensitive to erythromycin. The sensitivity for clarithromycin was 92 (11/12) with one isolate (8) resistant. All strains of H pylori (48/48) were sensitive to ampicillin and amoxicillin - clavulanate. Metronidazole resistance is present in one-third of H pylori isolates and resistance to macrolides is relatively low in Jamaican patients. It is important to monitor antibiotic resistance in order to provide clinicians with data on the most appropriate and cost effective eradication regimes for H pylori

Dyspepsia: review of management options

Dyspepsia is a common clinical problem which is associated with significant healthcare cost. The management of patients presenting with dyspepsia remains controversial. It has been shown to be cost effective and associated with long-term improvement to test and treat young patients positive for H. pylori, who present to the primary care setting. Patients negative for H. pylori may be treated with an antisecretory medication. Prompt endoscopy is recommended in patients over age 50 years, those with alarm symptoms and those who have failed previous therapy. In the Caribbean, the management of patients should be individualized in view of the relatively high prevalence of H pylori infection and gastric carcinoma

Helicobacter pylori infection in the Caribbean: update in management

Helicobacter pylori infection of the stomach is one of the commonest chronic infections worldwide and in the Caribbean, over 50 of the population are affected. H pylori is probably transmitted from person to person by oro-faecal and oro-oral means. H pylori is directly associated with peptic ulcer disease, chronic antral gastritis, gastric carcinoma and B-cell lymphoma of the stomach. In patients with peptic ulcers and H pylori infection, eradication of infection with antibiotics significantly decreases recurrence of ulcers. All patients with H pylori related disease should be tested and treated if positive. The treatment of H pylori infection has evolved over the years but at present triple therapy which includes two antibiotics is recommended.

Use of alcohol, tobacco and non-prescription drugs among Jamaican high school students

The prevalence of alcohol, tobacco and non-prescription drug use was investigated among 2,417 Jamaican high school students (1,063 boys, 1,354 girls). 1,317 were grade 10 (form four or 16 years old) and 1,100 were grade 11 (form five or 17 years old); 1,072 and 1,345 were from rural and urban schools, respectively; and 1,126 and 1,291 were children of professionals and non-professionals, respectively. The prevalence of alcohol and tobacco use was 50.2and 16.6, respectively; and there was a high level of non-prescription drug use: paracetamol (85.7), aspirin (76.7), multivitamins (41.9) and bismuth (29.9). Drug use among males, urban students, and children of professionals was higher than among females, rural students and children of non-professionals.

Management of colonic polyps by colonoscopic polypectomy

Colonoscopic polypectomy is an important therapeutic advance as it enables most colonic polyps to be removed entirely and studied pathologically and has virtually replaced surgical treatment. The clinical and pathological features of patients with colonic polyps treated by colonoscopic polypectomy over a five-year period are reported. Seventy-four patients (37 men, 37 women) with a mean age of 57 years had 109 polyps removed by snare polypectomy. Rectal bleeding was the predominant symptom and was present in 63.5%. Lower abdominal pain was present in 12%. The majority of polyps were located in the sigmoid (38.5%) and descending (40.3%) colon. Ninety-five polyps were pedunculated and 14 were sessile. Of the neoplastic polyps, 61.6% were pure tubular adenomas, 25.2% were mixed tubulo-villous adenomas and 1% were pure villous adenomas. There were no complications arising from colonoscopy or snare polypectomy. Colonoscopic polypectomy is a safe, reliable and cost-effective therapeutic procedure that has revolutionized the management of pre-cancerous neoplastic colonic polyps.

Caustic strictures of the oesophagus

Ingestion of caustic material is a major management problem which occurs most commonly in children. Twenty-five patients with caustic ingestion seen over a ten-year period are reported. Twelve patients had severe burns, resulting in oesophageal strictures. Of these, ten were children below six years of age (median age, 3 years). Dysphagia and vomitting were the main presenting features. Oropharyngeal burn was present in 83%of patients with oesophageal burns. The strictures involved the entire oesophagus in two patients, the upper third in four, the mid oesophagus in two and the lower third in four. Periodic dilatations were successful in restoring an adequate lumen in 7 patients with short strictures. Five patients required surgery. There was one death. Caustic damage to the oesophagus is preventable. Education of the public and simple measures by manufacturers of caustics are urgently needed,

Tetracycline-induced proximal oesophagitis

Medication-induced oesophagitis is an unusual cause of oesophageal damage. A patient is presented who developed sudden onset of odynophagia while taking tetracycline. Endoscopy revealed proximal oesophagitis which was confirmed histologically. Symptoms resolved rapidly after stopping the offending drug. Drug-induced oesophagitis should be considered in patients with unexplained oesphageal symptoms. This condition is often unrecognized as symtoms usually resolve on cessation of the drug. Prevention is the best approach

Colonoscopy in Jamaica: a 12 year experience

Four hundred and nine colonoscopic examinations were performed in 335 patients over a 12-year period in Jamaica. The indications were suspected polyps (34%), rectal bleeding (22%), and suspected carcinoma (11%). Total colonoscopy was performed in 33% of cases. The ascending colon and hepatic flexure were examined in a further 25%, and the transverse colon in another 21%. Endoscopic examination of the suspected abnormal area was possible in all cases. In 142 examinations, no abnormality was detected, reflecting a false positive Barium enema in som. Polyps were found in 135 examinations, diverticula in 69 and carcinoma in 13. There were complications. Colonoscopy was more sensitive and specific than Barium enema. The Barium enema findings were incorrect in 91 of 224 examinations (41%). Colonoscopy is a safe and accurate procedure which enables improved patient management

Success of didactic gastroenterology teaching for postgraduate medical residents

Although the Doctor of Medicine programme in Internal Medicine at the U. W. I. is a structured course with several teaching formats, the optimally effective form of reaching remains unknown. An experimental didactic teaching course in Gastroenterology was preceded and followed by an examination. This was conducted to determine the effectiveness of this form of teaching. The maajority of residents ranked the course favourably. the mean examination score increased by 6.4%, form 25.4% before the course to 31.8% at the end. Although the more senior residents scored higher than their juniors in the pre-test, this difference disappeared in the post-test. Structured didactic teaching requirs close supervision, active participation by trainee and reinforcement for the full benefit to be attained

Endoscopic sclerotherapy of bleeding oesophageal varices in Jamaica

The results of oesophageal sclerotherapy (OS) in 18 patients with recurrent bleeding varices are compared with 15 patients treated medically. The total transfusion requirement pre sclerotherapy was 112 units of blood (mean 6/patient) which decreased to 46 units ( mean 2.5) after sclerotherapy treatment was started (p=0.005). In the medically treated group, total transfusion was 74 units (mean 5 units/patient). One hundred and forty-three infection sclerotherapy session were given, and all but one patient had significant reduction or eradication of varices. Three patients died of recurrent bleeding (17%) and one other required surgery. In the medically treated group, 3 patients died of bleeding (20%). Complications of sclerotherapy included mild bleeding (39%), chest pain (28%) and oesophageal ulcer (5.5%). OS reduces transfusion requirements in patients with recurrent variceal bleeding

Drug availability in Jamaica

The availability of drugs and the supply systen in Jamaica were examined. The Jamaica Commodity Trading Company imports all drugs through an international tendering system for the public health sector, and vital drugs for private distributors. For the 18-month period from January 1988, 652 awards were made, consisting of 426 (65%) brand and 226 (35%) generic drugs. There were several strengths and formulations for many drugs, including 19 preparations of 2 antibiotics. The University Hospital of the West Indies (UHWI) has been experiencing recurrent delays in the supply of several important drugs. In contrast, the private hospitals and pharmacies surveyed were adequately supplied. Many brands of several classes of drugs were available, including 51 antibiotics 18 different anti-inflammatory analgesic and anti-hypertensive agents. However, several drugs used in special situations were only available at the UHWI. There is a need for the supply of drugs to be a priority in the public health sector and for the use of several drugs to be rationalized

Crohn's disease in Jamaica

Twenty patients with Crohn's disease seen in Jamaica over the past 20 years are reviewed. There were 14 women and 6 men. The mean age at presentation was 37m years, and symptoms were present for a mean of 12 months. Fourteen patients presented with lower abdominal pain, and diarrhoea was present in 11. Lower gastrointestinal bleeding was the presenting feature in 2. The distribution of disease was ileal in 6, and 8 had primary colonic involvement. Three patients had ileocolitis and one perianal disease. One had involvement of the entire small intestine and ascending colon and another had skip lesions involving several areas of the small intestine. Surgical resection was performed in 5 patients. Of the 15 patients treated medically, 6 have remained well while 8 had recurrent episodes of relapse. Crohn's disease in an uncommon disorder in Jamaica but should be considered in patients presenting with inflammatory bowel disease