ABSTRACT
OBJECTIVE: To evaluate whether the addition of bismuth subnitrate to a dual oral therapy regimen with omeprazole plus amoxycillin could improve Helicobacter pylori eradication. METHODS: Fifty consecutive Helicobacter pylori-positive patients were randomly enrolled to receive either (A) bismuth subnitrate (300 mg q.d.s.), omeprazole (20 mg b.d.) and amoxycillin (500 mg q.d.s.), or (B) omeprazole (20 mg b.d.) and amoxycillin (500 mg q.d.s.). Both groups (n=25 each) received the medication for 14 days. H. pylori status was reassessed 30 days after completion of the therapy in order to evaluate eradication rates. RESULTS: Six patients were lost to follow-up and therefore excluded from the study (three patients from each group). One patient from Group B withdrew from the study because of side-effects. The addition of bismuth subnitrate to omeprazole and amoxycillin significantly improved its efficacy in eradicating H. pylori, with 72% (18/25) eradication in Group A and 52% (13/25) in Group B (P=0.027). The addition of bismuth subnitrate to dual oral therapy was also capable of improving the healing of peptic ulcers when compared with dual oral therapy alone (100%, 8/8 vs. 58%, 4/7; P=0.021). CONCLUSION: Our results demonstrate that the addition of bismuth subnitrate to dual oral therapy enhances H. pylori eradication, and improves healing of peptic ulcers.
Subject(s)
Amoxicillin/therapeutic use , Anti-Ulcer Agents/therapeutic use , Bismuth/therapeutic use , Helicobacter Infections/drug therapy , Helicobacter pylori , Omeprazole/therapeutic use , Penicillins/therapeutic use , Ranitidine/analogs & derivatives , Stomach Ulcer/drug therapy , Adult , Aged , Amoxicillin/administration & dosage , Amoxicillin/adverse effects , Anti-Ulcer Agents/administration & dosage , Anti-Ulcer Agents/adverse effects , Bismuth/administration & dosage , Bismuth/adverse effects , Drug Therapy, Combination , Female , Follow-Up Studies , Gastroscopy , Helicobacter Infections/microbiology , Humans , Male , Middle Aged , Omeprazole/administration & dosage , Omeprazole/adverse effects , Penicillins/administration & dosage , Penicillins/adverse effects , Ranitidine/administration & dosage , Ranitidine/adverse effects , Ranitidine/therapeutic use , Stomach Ulcer/microbiologyABSTRACT
O leiomioma duodenal, tumor benigno originado das fibras musculares lisas, representa uma forma muito infreqüente de sangramento gastrintestinal. Os autores apresentam caso clínico de mulher com 54 anos, que apresentou quadro maciço de hemorragia digestiva. Clinicamente este tumor apresenta sintomatologia inespecífica, que depende de seu tamanho e localizaçao. Nao sao infreqüentes os casos de hemorragia digestiva. A principal controvérsia ocorre quando há necessidade da sua diferenciaçao histológica com o leiomiossarcoma. O achado pré-operatório deste tumor é dificultado pela sua sintomatologia inespecífica, e pela inespecificidade dos exames complementares de diagnóstico. O tratamento que se impoe é o cirurgico.
