Subject(s)
Anti-Infective Agents/administration & dosage , Anti-Ulcer Agents/administration & dosage , Esomeprazole/administration & dosage , Gastrointestinal Diseases/microbiology , Helicobacter Infections/drug therapy , Helicobacter pylori , Adult , Age Factors , Aged , Amoxicillin/administration & dosage , Clarithromycin/administration & dosage , Cohort Studies , Drug Therapy, Combination , Gastrointestinal Diseases/drug therapy , Helicobacter Infections/complications , Humans , Japan , Metronidazole/administration & dosage , Middle AgedABSTRACT
AIM: To determine the general risk factors affecting the failure rate of first-line eradication therapy in Japanese patients with Helicobacter pylori (H. pylori) infection. METHODS: The present study enrolled 253 patients who had an H. pylori infection, underwent gastro-endoscopy, and were treated with H. pylori eradication therapy. Eradication therapy consisted of 30 mg lansoprazole plus 750 mg amoxicillin and 400 mg clarithromycin twice daily for 7 d. All of the patients underwent a 13C urea breath test at least 1 mo after the completion of eradication therapy. The current study investigated the independent factors associated with successful H. pylori eradication using a multiple logistic regression analysis. RESULTS: The overall success rate in the patients was 85.8%. Among the general factors examined in the multivariate analyses, only having an age less than 50 years was found to be significantly associated with a poor response to H. pylori eradication. Moreover, side effects were the only clinical factors in the patients who were under 50 years of age that significantly influenced the poor response to H. pylori eradication. CONCLUSION: H. pylori-positive elderly patients should undergo eradication therapy. In addition, it is necessary to improve H. pylori eradication therapy in younger patients.
Subject(s)
Aging/physiology , Anti-Bacterial Agents/therapeutic use , Helicobacter Infections/drug therapy , Helicobacter Infections/physiopathology , Helicobacter pylori , 2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use , Adult , Age Factors , Aged , Aged, 80 and over , Amoxicillin/therapeutic use , Clarithromycin/therapeutic use , Drug Therapy, Combination , Female , Helicobacter Infections/ethnology , Humans , Japan , Lansoprazole , Logistic Models , Male , Middle Aged , Retrospective Studies , Treatment FailureSubject(s)
Esophageal Neoplasms/drug therapy , Melanoma/drug therapy , Microtubule-Associated Proteins/genetics , Antineoplastic Agents/therapeutic use , Biomarkers, Tumor/genetics , Biopsy , Cysteine Proteinase Inhibitors/genetics , Esophageal Neoplasms/metabolism , Esophageal Neoplasms/pathology , Esophageal Neoplasms/surgery , Humans , Imidazoles/therapeutic use , Inhibitor of Apoptosis Proteins , Male , Melanoma/metabolism , Melanoma/pathology , Melanoma/surgery , Middle Aged , Naphthoquinones/therapeutic use , Survivin , Treatment OutcomeABSTRACT
BACKGROUND: Carcinoid tumors are usually considered to have a low degree of malignancy and show slow progression. One of the factors indicating the malignancy of these tumors is their size, and small ampullary carcinoid tumors have been sometimes treated by endoscopic resection. CASE PRESENTATION: We report a case of a 63-year-old woman with a minute ampullary carcinoid tumor that was 7 mm in diameter, but was associated with 2 peripancreatic lymph node metastases. Mild elevation of liver enzymes was found at her regular medical check-up. Computed tomography (CT) revealed a markedly dilated common bile duct (CBD) and two enlarged peripancreatic lymph nodes. Endoscopy showed that the ampulla was slightly enlarged by a submucosal tumor. The biopsy specimen revealed tumor cells that showed monotonous proliferation suggestive of a carcinoid tumor. She underwent a pylorus-preserving whipple resection with lymph node dissection. The resected lesion was a small submucosal tumor (7 mm in diameter) at the ampulla, with metastasis to 2 peripancreatic lymph nodes, and it was diagnosed as a malignant carcinoid tumor. CONCLUSION: Recently there have been some reports of endoscopic ampullectomy for small carcinoid tumors. However, this case suggests that attention should be paid to the possibility of lymph node metastases as well as that of regional infiltration of the tumor even for minute ampullary carcinoid tumors to provide the best chance for cure.
