ABSTRACT
INTRODUCTION: Recent studies suggest that the initial treatment success rates for H. pylori infection are falling below 80% in many parts of the world. AIM: The aim of this study was to evaluate the efficacy of standard triple therapy in the treatment of H. pylori infection in Kuwait. METHODS: Consecutive H. pylori positive patients were enrolled in the study to receive clarithromycin, amoxicillin and omeprazole for 10 days. H. pylori status was checked with 13C urea breath test 6 weeks after the end of therapy. Endoscopic findings was recorded in all patients. RESULTS: One hundred forty-one patients (82 male and 59 females; mean age 41.8 years) were enrolled in the study. A total of seven patients were excluded from the per protocol analysis. The eradication rates in intention to treat (ITT) and per protocol (PP) were 72.3% (95% CI 64.2-79.5%) and 76.1% (95% CI 68-83%), respectively. The main endoscopic findings were normal in 47.5% and gastritis in 37.6%. CONCLUSION: The efficacy of the current standard triple therapy for H. pylori eradication in our community is suboptimal. Confirmation for H. pylori eradication with noninvasive tests is recommended, especially in high-risk patients. New antimicrobial regimens for H. pylori eradication are considered necessary.
Subject(s)
Amoxicillin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Anti-Ulcer Agents/administration & dosage , Clarithromycin/administration & dosage , Helicobacter Infections/drug therapy , Omeprazole/administration & dosage , Adult , Drug Therapy, Combination , Endoscopy, Gastrointestinal , Female , Helicobacter Infections/diagnosis , Helicobacter pylori , Humans , Kuwait , Male , Middle Aged , Treatment OutcomeABSTRACT
BACKGROUND AND GOAL: The rapid urease CLOtest is commonly used during endoscopy to diagnose the presence of Helicobacter pylori. The aim of this study was to determine whether the sensitivity of the CLOtest can be improved by increasing the number of gastric antral biopsies from 1 to 4. METHODS: The study included 100 adult patients who were referred for upper gastrointestinal endoscopy and tested positive for H. pylori infection on C urea breath test ("gold standard"). These 100 patients were then randomly divided into 4 equal groups (groups 1 to 4), and underwent an upper gastrointestinal endoscopy. Patients in group 1 had 1 gastric antral biopsy during endoscopy, whereas those in groups 2, 3, and 4 had 2, 3, and 4 biopsies, respectively. The biopsies were placed in the rapid urease CLOtests, which were incubated at room temperature for up to 24 hours, and read for positive results at 1, 6, and 24 hours. RESULTS: About half of the patients (52%) had a positive CLOtest in group 1, compared to 68% in group 2, 76% in group 3, and 96% in group 4 (group 1 vs. 4 P<0.01). After 1 hour of incubation 96% of the patients in group 4 had a positive CLOtest, compared to 40% in group 3, 12% in group 2, and 4% in group 1. CONCLUSIONS: Increasing the number of gastric antral biopsies from 1 to 4 significantly improves the sensitivity of the CLOtest, eliminates sampling error, and hastens the time needed by the test to become positive for the diagnosis of H. pylori infection.
Subject(s)
Biopsy/statistics & numerical data , Breath Tests/methods , Helicobacter Infections/diagnosis , Helicobacter pylori/isolation & purification , Pyloric Antrum/pathology , Urease/analysis , Adolescent , Adult , Aged , Biopsy/trends , Diagnosis, Differential , Endoscopy, Gastrointestinal , Female , Helicobacter Infections/microbiology , Humans , Male , Middle Aged , Pyloric Antrum/microbiology , Sensitivity and SpecificityABSTRACT
BACKGROUND AND AIMS: A substantial proportion of patients with chronic hepatitis C virus infection have persistently normal serum transaminase levels. The aim of this study was to assess the efficacy and safety of interferon plus ribavirin combination therapy in this population. METHODS: In this prospective open trial 152 patients with biopsy-proven chronic hepatitis C were enrolled, 32 of whom had persistently normal alanine aminotransferase levels (group A). The remaining 120 patients served as a comparison (group B). Patients were treated for 12 months with 4.5 million units of interferon-alpha(2a) thrice weekly in combination with ribavirin 1,000 or 1,200 mg daily. They were followed up for at least 6 months after therapy. Serum hepatitis C RNA was detected by polymerase chain reaction and quantified by a branched DNA assay. RESULTS: At the end of treatment, 12 (37.5%) and 48 patients (40%) were negative for HCV-RNA in groups A and B, respectively (p = 0.33). After 24 weeks of follow-up, 9 patients (28%) from group A and 36 patients (30%) from group B were still HCV-RNA negative (p = 0.4). Treatment was well tolerated by both groups. There were no alanine transferase elevations among group A patients during therapy. CONCLUSION: Interferon-ribavirin combination therapy was safe and induced a sustained virologic response in a significant proportion of patients with chronic hepatitis C and repeatedly normal serum transaminase levels.
