One week of treatment with esomeprazole-based triple therapy eradicates Helicobacter pylori and heals patients with duodenal ulcer disease.

BACKGROUND: Proton pump inhibitor (PPI) monotherapy is commonly continued for 3 weeks after Helicobacter pylori eradication with PPI-based triple therapy regimens to ensure duodenal ulcer (DU) healing. This randomized, double-blind, multicentre study evaluated whether only 1 week of triple therapy with the new PPI esomeprazole was sufficient to ensure high rates of ulcer healing and H. pylori eradication. METHODS: A total of 446 H. pylori-positive patients with active DU received twice daily treatment with esomeprazole 20 mg (n = 222) or omeprazole 20 mg (n = 224) in combination with amoxicillin 1 g and clarithromycin 500 mg for 1 week (EAC and OAC, respectively). Patients in the OAC group then received 3 weeks' monotherapy with omeprazole 20 mg once daily; those treated with EAC received placebo. Ulcer healing was assessed by endoscopy on completion of therapy and H. pylori status was assessed by (13)C-urea breath testing and histology 4-6 weeks later. RESULTS: Ulcer healing rates (95% CI) for intention-to-treat and per-protocol populations were: EAC + placebo 91% (87-95%) and 94% (90-97%); OAC + omeprazole 92% (88-95%) and 96% (92-98%). Corresponding H. pylori eradication rates were: EAC + placebo 86% (81-90%) and 89% (84-93%); OAC + omeprazole 88% (83-92%) and 90% (85-93%). Both eradication regimens were well tolerated, and patient compliance was high. CONCLUSIONS: A 1-week regimen of esomeprazole-based triple therapy is sufficient for DU healing and H. pylori eradication in patients with DU disease.

Topical nitrates and the higher doses of botulinum toxin for chronic anal fissure.

BACKGROUND/AIMS: Combined BT-A (botulinum toxin A) therapy and local application of nitrates can be more effective than BT-A alone for chronic anal fissure treatment, but so far the optimal dose of BT-A is not known. The aim of our study was to learn if BT-A doses higher than those used so far could change the outcome of fissure treatment. METHODOLOGY: We enrolled 14 consecutive patients suffering from idiopathic chronic anal fissure who did not respond to previous local treatment of nitric oxide donor and subsequent BT-A therapy (25 U of Botox). They were offered a local nitroglycerin treatment. In failure cases patients received the greater doses of BT-A (50 U of Botox). RESULTS: In all 11 patients with chronic anal fissure who applied nitroglycerin after BT-A injection, an effect on the internal anal sphincter relaxation was observed but fissure healing after topical nitroglycerin occurred only in 1 case. Of 13 patients with chronic anal fissure who received 50 U of BT-A no healing was reported in 6 cases. One male from this group received a greater dose (100 U of Botox) and then the fissure healed. CONCLUSIONS: The effect of topical nitrates on internal anal sphincter relaxation after botulinum toxin injection is not the last line for nonsurgical treatment of chronic anal fissure. Always we ought to consider using the next greater dose of BT-A before surgical treatment.

[Pancreatic ascites]. / Wodobrzusze trzustkowe.

Two cases of pancreatic ascites have been presented. 1. A 29 year old man, heavy alcoholic, with fast growing ascites presented since long biochemic features of pancreatitis. The diagnosis of the pancreatic origin of ascites was made on the ground of the high level of amylase in the ascitic fluid. Conservative treatment was effectless. The patients refused surgical therapy. Then he died in septic shock. Autopsy confirmed the pancreatic origin of ascites. 2. A 43 year old man heavy alcoholic as well admitted because of fast growing ascites. As in the first case examination of the fluid confirmed the diagnosis of pancreatic origin of ascites. Again a high level of amylase and protein was found. After clinical treatment and parenteral nutrition the condition of the patient improved and he was dismissed 4 weeks later.

[Attempt at evaluation of certain parameters of gastric secretion in patients with duodenogastric reflux]. / Próba oceny niektórych parametrów wydzielania zoladkowego u chorych z zarzucaniem dwunastniczo-zoladkowym.

There were four groups of patients: duodenal ulcer patients (32), duodeno-gastric reflux patients (31), patients with duodenal ulcer and reflux (33) and 12 healthy men. All of them aged 20-40. In all patients we performed gastroscopy, cholecystography, Kay's test for secretion and isotope proteolytic secretion test. High activity of proteolytic secretion in both groups of reflux patients was found. There were also the high percentage of false positive scores in endoscopy estimation of reflux, in comparison to the non-invasive isotope method. We suggest: reflux may be the important factor in duodenal ulcer pathogenesis; endoscopy cannot be used in duodeno-gastric reflux estimation.

Disturbances of the pulmonary perfusion after endoscopic sclerotherapy of oesophageal varices.

Haemorrhage from oesophageal varices is one of the most common reason of death of patients with liver cirrhosis. The possibility of treatment and prevention of the haemorrhage by endoscopic sclerotherapy (ES) has become one of the achievements of contemporary medicine. Nevertheless there are some complications described after this procedure, the most severe being the pulmonary embolia. In our study we analyzed the pulmonary circulation by perfusion scintigraphy after ES. Among twelve patients treated by ES we found two cases of disturbed pulmonary perfusion. We did not find clinical or gasometric changes in these patients. We suggest there should be done pulmonary perfusion monitoring after ES.

[Difficulties of diagnosing gluten enteropathies in adults]. / Trudnosci w rozpoznawaniu enteropatii glutenowej u doroslych.

Seven cases of adult patients with gluten enteropathy (1 male and 6 female patients, including 1 patient with Duhring's disease) are presented. These patients suffered from diarrhoea lasting for 1-10 years prior to the diagnosis of gluten enteropathy. Transient diarrhoea was noted in one female patient in her childhood. Blood calcium levels were lowered in all patients and were accompanied by tetany in five and osteomalacia in two patients. One patient's sister is suffering from mucoviscidosis. Earlier, coeliac disease was not diagnosed in any patient. Previous diagnoses included enteritis, hypoparathyroidism or neuro- and myopathies of unknown etiology. The authors suggest that the difficulties in diagnosing gluten enteropathies in adults are due to the lack of biopsy capsules, low acquaintance of physicians with this disease, and indications to small intestine biopsy.