Eradication of Helicobacter pylori infection in patients with duodenal ulcer and non-ulcer dyspepsia and analysis of one-year reinfection rates

Helicobacter pylori (HP) infection is endemic worldwide. The proposed treatment is expensive and there are few reports regarding reinfection rates in Brazil. The aim of this study was to compare the eradication rates obtained with two therapeutic options and to evaluate reinfection one year after treatment. This was a prospective randomized trial with 55 patients. Thirty-nine patients had active duodenal ulcer (DU) and 16 non-ulcer dyspepsia (NUD), and all tested positive for HP. Diagnosis was based on at least two positive tests: ultrarapid urease test, histology and/or culture. Patients were randomized to two groups: group OMC treated with 40 mg omeprazole (once a day), 500 mg metronidazole and 250 mg clarithromycin (twice daily) for 7 days, or group NA treated with 300 mg nizatidine (once a day) and 1000 mg amoxicillin (twice daily) for 14 days. Those patients in whom HP was eradicated were followed up for one year to evaluate reinfection. Twenty-five patients were randomized for OMC and 30 for NA. HP eradication occurred in 20/25 patients (80 per cent) treated with OMC and 13/30 (43 per cent) treated with NA (P = 0.01). After reallocation because of initial treatment failure, the overall eradication rate was 44/51 patients (86 per cent). After an average follow-up of one year, we evaluated 34 patients (23 with DU and 11 with NUD). Reinfection occurred in 3/34 patients (7.6 per cent). We conclude that OMC is effective for HP eradication, and that NA should not be used. Reinfection occurs in 7.6 per cent of the patients in the first year after eradication.

Eradication of Helicobacter pylori infection in patients with duodenal ulcer and non-ulcer dyspepsia and analysis of one-year reinfection rates.

Helicobacter pylori (HP) infection is endemic worldwide. The proposed treatment is expensive and there are few reports regarding reinfection rates in Brazil. The aim of this study was to compare the eradication rates obtained with two therapeutic options and to evaluate reinfection one year after treatment. This was a prospective randomized trial with 55 patients. Thirty-nine patients had active duodenal ulcer (DU) and 16 non-ulcer dyspepsia (NUD), and all tested positive for HP. Diagnosis was based on at least two positive tests: ultrarapid urease test, histology and/or culture. Patients were randomized to two groups: group OMC treated with 40 mg omeprazole (once a day), 500 mg metronidazole and 250 mg clarithromycin (twice daily) for 7 days, or group NA treated with 300 mg nizatidine (once a day) and 1000 mg amoxicillin (twice daily) for 14 days. Those patients in whom HP was eradicated were followed up for one year to evaluate reinfection. Twenty-five patients were randomized for OMC and 30 for NA. HP eradication occurred in 20/25 patients (80%) treated with OMC and 13/30 (43%) treated with NA (P = 0.01). After reallocation because of initial treatment failure, the overall eradication rate was 44/51 patients (86%). After an average follow-up of one year, we evaluated 34 patients (23 with DU and 11 with NUD). Reinfection occurred in 3/34 patients (7.6%). We conclude that OMC is effective for HP eradication, and that NA should not be used. Reinfection occurs in 7.6% of the patients in the first year after eradication.

[Comparison between invasive tests for the diagnosis of Helicobacter pylori infections]. / Comparação entre testes invasivos para o diagnóstico da infecção pelo Helicobacter pylori.

Helicobacter pylori is a Gram negative bacteria that colonizes gastric epithelial cells. It has been associated with several gastric disease including chronic gastritis and peptic ulcer. Helicobacter pylori infection diagnosis can be done with invasive and non-invasive methods. In invasive methods an endoscopic gastric mucosa biopsy specimen is used. In our study we compare the sensitivity, specificity, costs and applicability of four invasive diagnostic tests: culture, urease ultra-rapid test, histology (Giemsa and Hematoxilineosin stain) and fuchsin stained mucosal slides. Urease test was the easiest, fastest diagnostic test, with sensitivity of 86% and specificity of 100%, being also the cheapest test. We concluded that it should be the test of choice for Helicobacter pylori infection diagnosis.

[Endoscopic therapy of pancreatic pseudocyst]. / Terapêutica endoscópica do pseudocisto de pâncreas.

Endoscopy therapy of pancreatic pseudocyst has been described as an efficient method. We report six cases of pancreatic pseudocyst treated by pancreatic stenting (three cases), cystogastrostomy (three cases) and cystoduodenostomy (one case). Rapid symptomatic improvement and pseudocyst regression were noted in all cases, except one. Such patient needed pancreatic stenting even after cystogastrostomy due to main pancreatic duct stenosis. There were three complications: hemorrhage (one case) and pseudocyst infection (two cases), and all were treated clinically. Two patients had pseudocyst infection previous to endoscopic manipulation, and they were treated only with antibiotics and endoscopic drainage, without surgery (treatment suggested by most of the authors). We concluded that endoscopic therapy of pancreatic pseudocyst is efficient and safe, being responsible for rapid relief of symptoms in most of patients.