Therapeutic efficacy of amoxicillin and rifaximin in patients with small intestinal bacterial overgrowth and Helicobacter pylori infection.

INTRODUCTION: Small intestinal bacterial overgrowth (SIBO) may coexist with Helicobacter pylori infection, which can be the cause of chronic gastrointestinal complaints. AIM: Evaluation of the therapeutic efficacy of amoxicillin and rifaximin in the treatment of these diseases. MATERIAL AND METHODS: The lactulose hydrogen breath test (LHBT) and the urea breath test (13C-UBT) were performed in 116 patients. In 62 patients the coexistence of small intestinal bacterial overgrowth and H. pylori infection was observed. Then, in group I (n = 30) pantoprazole (2 × 40 mg), amoxicillin (2 × 1000 mg) and metronidazole (2 × 500 mg) and in group II (n = 32) pantoprazole and amoxicillin at the above doses and rifaximin (3 × 400 mg) were administered for 10 days. After 6 weeks, both breath tests were repeated and the degree of remission of symptoms was measured using a 10-point visual analog scale (VAS). RESULTS: After the treatment the LHBT index decreased in group I from 61.2 ±19.4 ppm to 22.0 ±8.2 ppm (p < 0.001) and in group II from 59.6 ±15.5 ppm to 15.2 ±8.6 ppm (p < 0.001). Eradication of H. pylori (13C-UBT below 4.0‰) was achieved in 63.3% of patients in group I and 59.4% in group II (p > 0.05). The decrease of pain below 3.0 points in the VAS was obtained in 64.8% of patients in group I and in 56.2% in group II. CONCLUSIONS: Combination of amoxicillin and rifaximin may be effective in the treatment of patients with small intestinal bacterial overgrowth syndrome and concomitant H. pylori infection.

[Thyroid dysfunction in patients with small intestinal bacterial overgrowth]. / Ocena czynnosci tarczycy u osób z zespolem przerostu bakteryjnego jelita cienkiego.

Small intestinal bacterial overgrowth (SIBO), similarly as thyroid diseases, is characterized by chronic diarrhea or constipation, but it is not known whether there is a causal relationship between these disorders. AIM: The aim of the study was to assess thyroid function indices in different clinical forms of SIBO. MATERIALS AND METHODS: The study was performed in 34 patients with diarrhea predominant SIBO (group I), 30 with constipation predominant SIBO (group II) and 30 clinically healthy subjects (control group - K). Small intestinal bacterial overgrowth was assessed with lactulose hydrogen breath test (LHBT) using the breath-hydrogen analyzer (Gastrolyser, Bedfont). Serum thyrotropin (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) levels were determined by immunochemical method (ELFA) and anti-thyroid peroxidase (ATPO) protein level by immunoenzymatic method (ELISA). RESULTS: LHBT value was respectively in groups: K - 8,5 ± 2,9 ppm, I - 66,9 ± 16,9 ppm, II- 62,0 ± 15,5 ppm (p <0,001). The levels of hormones were similar in group K and I, whereas in group II differentiated: FSH 2,5 ± 0,7 vs. 3,8 ± 1,8 mU/L (p <0,05), FT3- 5,1 ± 1,2 vs. 3,7 ± 1,0 mU/L (p <0,05), FT4 - 14,1 ± 2,5 vs. 9,4 mU/L (p <0,01). In both groups of patients the levels of ATPO were statistically significantly higher than in the control group - respectively: K - 6,3 ± 3,1 IU/ml , I - 39,9 ± 23,4 IU/ml (p < 0,001), II - 94,1 ± 56,3 IU/ml (p <0,001). CONCLUSIONS: Thyroid function may be impaired in patients with small intestinal bacterial overgrowth which should be taken into account in the diagnostic and therapeutic management of the diseases of these organs.

The Diagnosis of Sigmoid Liposarcoma in a Young Male with Metabolic Syndrome.

The clinical picture and risk factors are decisive in differential diagnosis. It was proved that patients with metabolic syndrome have increased incidence of malignant tumours. The visceral adipose tissue releases active proteins that promote oncogenesis. We are presenting a case of 34-year-old male with metabolic syndrome suffering from pain in left iliac fossa with accompanying variable stool pattern. At first, the sigmoid diverticulosis was suspected. Patient's condition after the treatment has improved. The ambulatory, partial colonoscopy revealed a cauliflower-like, balloting, wide-base growth in the sigmoid that narrowed its lumen. The biopsy did not reveal atypical growth characteristics. Because of tumour type and enlarged regional lymph nodes seen in abdomen CT scan, the segmental colon resection and end-to-end anastomosis was performed in the area of sigmoid-rectal junction. Macroscopically, there were no visible metastases in the operation field. The surgery and postoperative period ran without any complications. On histopathological examination, the removed tumour was a well differentiated liposarcoma (WDL) stemming unusually from adipose tissue of colonic submucosa in an obese male. WDL is a hard to diagnose tumour, especially in early stages of its growth. In the presented case, the tumour was completely resected.

[The clinical significance of GastroPanel in diagnostics of Helicobacter pylori eradication efficiency in patients with dyspepsia with correlation of family history of gastric cancer]. / Kliniczne znaczenie GastroPanelu w diagnostyce skutecznej eradykacji Helicobacter pylori u chorych z dyspepsja w zaleznosci od rodzinnego wystepowania raka zoladka.

UNLABELLED: Gastric cancer remains a significant medical and social problem. Familial, hereditary, social, and demographic factors increase the susceptibility of subjects to cancer development, especially those infected with Helicobacter pylori (H. pylori). Apart from genetic studies, there are ongoing biochemical studies of possible practical value in assessment of the risk of gastric cancer development. The GastroPanelBiohit test, that include determination of the levels of gastrin (G-17), pepsinogen I (PGI), pepsinogen II (PGII) and antibodies IgG/IgA against H. pylori in serum, allowed us to determine whether there are any abnormal changes in the gastric mucosa. The aim of the study was to determine whether GastroPanel parameters, identified in patients with dyspeptic symptoms (with or without history of gastric cancer in first degree relatives) before and after successful eradication of H. pylori, have any clinical value, especially in gastric cancer development. MATERIAL AND METHODS: The study comprised 61 patients aged 18-56 years with symptoms of dyspepsia. In all patients, the preliminary urea breath test (UBT) for the presence of H. pylori was performed and the positive result qualified for further study. For final analysis, 42 patients were approved, who were divided into two groups: group I (a control group) - 22 patients with negative family history of gastric cancer among the relatives of first degree, group II - 20 patients with positive history of gastric cancer among the relatives of first degree. All the patients had the gastroscopy with the biopsy of gastric mucosa for the histopathological evaluation. Additionally, the GastroPanel test was performed. RESULTS: In the blood serum of the patients with H. pylori infection, the concentrations of gastrin (G-17), pepsinogen I (PGI) and pepsinogen II (PGII) did not depend on family history of gastric cancer (p > 0.05). Successful eradication of H. pylori decreases the levels of G-17, PGI and PGII (statistical significance p < 0.05), and this correlates with the histopathological changes of gastric mucosa. The patients with positive family history of gastric cancer had more intense H. pylori colonization of gastric mucosa (IV degree of insensitivity of infection in UBT; group I - 22% vs group II - 69%) as compared to the control group. After effective eradication of H. pylori, statistically significant decreases of IgG H. pylori antibodies and of the level of gastrin (p < 0.05) in blood serum were seen (in a 3 months follow up) only in the control group. CONCLUSIONS: Independently of the history of familial gastric cancer, the GastroPanelBiohit test provides important clinical data useful for diagnosis, for assessment of effectiveness of H. pylori eradication therapy and in evaluation of the degree of the inflammatory changes in gastric mucosa.

[Electrogastrography in various clinical forms of functional dyspepsia]. / Elektrogastrografia w róznych postaciach klinicznych dyspepsji czynnosciowej.

Electrogastrography (EGG) is simple, noninvasive, painless and repeatable method of assessment of gastric myoelectrical activity. By means of cutaneous electrodes placed on the abdomen skin we can record and then using computer evaluate the slow waves of the stomach and this is one of the methods for the assessment of gastric myoelectrical activity that makes its possible to draw inferences about gastric motility. The pathogenesis of functional dyspepsia is still not clear, but the disorders of the motility and myoelectrical activity of the stomach probably play here very important role. AIM OF OUR STUDY: To evaluate gastric myoelectrical activity in patients suffering from functional dyspepsia (FD) and to answer the question if there are some differences between two clinical forms of the functional dyspepsia. MATERIAL AND METHODS: A group of 60 patients diagnosed with functional dyspepsia, aged 18-65 years (x = 34.8, SD = +/-12.1), and a reference group of 30 healthy volunteers aged 18-65 years (x = 38.2, SD = +/- 18.4) were tested. Dyspepsia was diagnosed on the basis of a detailed medical history taken according to the Roman Criteria III. A half of the patients with functional dyspepsia,. i.e., 30 persons tested, was composed of the patients with postprandial distress syndrome (PDS), whereas the other half (30 patients) included the patients with epigastric pain syndrome (EPS). The occurrence of Helicobacter pylori was excluded by a 13C-urea breath test and a urease test performed during gastroscopy. Cutaneous electrogastrography was recorded by electrodes placed on the abdomen skin for six hours. After an hour of recording of the gastric myoelectrical activity in patients on an empty stomach a solid or liquid test meal was served. Test meals, both solid and liquid, were of approximately the same energy value of about 300 kcal. RESULTS: In the patients with functional dyspepsia gastric myoelectrical disorders occur with dominating dysrhythmia (p < 0.001), especially bradygastria, both in the record on an empty stomach and after a meal. The EGG records were different in the two forms of dyspepsia: in the group of patients with postprandial distress syndrome (PDS) there was statistically significant larger number of tachygastria both in the total record period (t = 2.719; p < 0.01) and after a meal (t = 2.164; p < 0.05) than in the group of patients with epigastric pain syndrome (EPS). CONCLUSIONS. (1) In the patients with functional dyspepsia gastric myoelectrical disorders occur with dominating dysrhythmia, especially bradygastria. (2) The EGG records are different in the two clinical forms of dyspepsia and this may be used for differential diagnostics of this disease: in epigastric pain syndrome bradygastria prevails whereas in postprandial distress syndrome bradygastria is dominant and an essential proportion of tachygastria is observed.