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1.
J Crohns Colitis ; 5(2): 152-6, 2011 Apr.
Article in English | MEDLINE | ID: mdl-21453885

ABSTRACT

We describe three patients diagnosed and treated for presumed (relapsing) Crohn's disease, but who were subsequently diagnosed with a small bowel carcinoma. This case series underlines the necessity of performing a full work up in the diagnosis of CD and to consider small bowel carcinoma in patients with small bowel CD failing medical therapy.


Subject(s)
Adenocarcinoma, Mucinous/diagnosis , Ileal Neoplasms/diagnosis , Ileal Neoplasms/pathology , Ileocecal Valve/pathology , Adenocarcinoma, Mucinous/pathology , Adenocarcinoma, Mucinous/surgery , Crohn Disease/diagnosis , Diagnosis, Differential , Female , Humans , Ileal Neoplasms/surgery , Male , Middle Aged , Recurrence
2.
Clin Res Hepatol Gastroenterol ; 35(1): 29-33, 2011 Jan.
Article in English | MEDLINE | ID: mdl-20810227

ABSTRACT

BACKGROUND AND AIMS: Ursodeoxycholic acid (UDCA) has an established effect on liver bio-chemistries in primary biliary cirrhosis (PBC). Few studies have evaluated long-term laboratory treatment effects and data beyond 6 years are not available. The aim of this study was to assess the long-term evolution of liver bio-chemistries during prolonged treatment with UDCA in biochemically non-advanced PBC. PATIENTS AND METHODS: Prospective multicenter cohort study of patients with PBC with pretreatment normal bilirubin and albumin, treated with UDCA 13-15 mg/kg/day. At yearly intervals, follow-up data including serum bilirubin, alkaline phosphatase (ALP), transaminases, albumin and IgM were collected. Data were analyzed with a repeated measurement model. RESULTS: Two hundred and twenty-five patients were included and followed during a median period of 10.3 years. Following 1-year treatment with UDCA 36-100% of the total biochemical improvement was achieved, the maximum response was observed after 3 years. After initial improvements, bilirubin and AST levels increased and albumin levels significantly decreased after 6-10 years. However, these changes were of limited magnitude. The beneficial effects on ALT and ALP were maintained while IgM continued to decrease. CONCLUSION: In non-advanced PBC the biochemical response to UDCA is maintained up to 15 years. The long-term evolution of bilirubin, albumin and ALT differs from that of ALP and AST. The mean IgM level normalised and levels continued to decrease during the period of follow-up.


Subject(s)
Cholagogues and Choleretics/therapeutic use , Liver Cirrhosis, Biliary/drug therapy , Liver/drug effects , Ursodeoxycholic Acid/therapeutic use , Cholagogues and Choleretics/pharmacology , Female , Humans , Liver/physiopathology , Liver Cirrhosis, Biliary/metabolism , Liver Function Tests , Male , Middle Aged , Prospective Studies , Time Factors , Ursodeoxycholic Acid/pharmacology
3.
Minerva Gastroenterol Dietol ; 51(3): 213-24, 2005 Sep.
Article in English | MEDLINE | ID: mdl-16280963

ABSTRACT

Dyspepsia is very common in western countries, where 10-40% of the population experience upper abdominal pain or discomfort over the course of one year. Mostly it is a chronic relapsing problem. Prompt endoscopy is imperative in all patients with sinister symptoms (including the first appearance of symptoms after the age of 50-55). In other patients endoscopy is unlikely to contribute to medical management. In those a ''test and treat'' strategy implying non invasive testing for Helicobacter pylori (H. pylori) and treatment of the infection if present seems to be the best approach under current conditions (H. pylori prevalence among dyspeptics 28-61% in recent studies). If the patient is H. pylori-negative and in case of persisting symptoms after successful H. pylori eradication, empirical treatment with an antisecretory drug is justified. Endoscopy is reserved for those patients in whom this approach fails. With a continuing decrease in H. pylori prevalence the accuracy of the used non-invasive H. pylori test needs to be high and urea breath tests are to be preferred, the faecal antigen test being a reasonable alternative. At a very low prevalence of H. pylori in the dyspeptic population (below 10%) non invasive testing for H. pylori loses its significance and empirical treatment with an antisecretory drug becomes a rational first step. The physician involved in the care for dyspeptic patients needs to be aware of the current H. pylori prevalence.


Subject(s)
Dyspepsia , Dyspepsia/diagnosis , Dyspepsia/drug therapy , Dyspepsia/etiology , Helicobacter Infections/complications , Helicobacter pylori , Humans , Primary Health Care
4.
Ned Tijdschr Geneeskd ; 149(53): 2955-7, 2005 Dec 31.
Article in Dutch | MEDLINE | ID: mdl-16425846

ABSTRACT

This year, the Nobel Prize in Physiology or Medicine was awarded to the Australian doctors Marshall and Warren for their discovery and further identification of the stomach bacterium Helicobacter pylori. Thanks to their confidence in their own observations, we are now able to cure people with peptic-ulcer disease and low-grade gastric lymphoma and are potentially able to prevent gastric cancer.


Subject(s)
Helicobacter pylori/isolation & purification , Nobel Prize , Peptic Ulcer/history , Gastritis/history , Gastritis/microbiology , History, 20th Century , Humans , Peptic Ulcer/microbiology , United States , Western Australia
5.
Scand J Gastroenterol Suppl ; (239): 44-50, 2003.
Article in English | MEDLINE | ID: mdl-14743883

ABSTRACT

BACKGROUND: Dyspepsia is common in western society. Prompt endoscopy is imperative in all patients with sinister symptoms or if symptoms first appear after the age of 50-55 years, but the optimal management of younger patients with uncomplicated dyspepsia is still open to debate. METHODS: The literature on the management of uncomplicated dyspepsia is reviewed and a personal view is presented. RESULTS: Strategies based on non-invasive detection of Helicobacter pylori are probably the most cost-effective. Currently (H. pylori prevalence 30%-40%), a 'test and treat' approach using a non-invasive test to detect H. pylori is likely to be the most efficient first step. If the patient is H. pylori-negative or if symptoms persist after successful H. pylori eradication, empirical treatment with an anti-secretory drug is justified. Endoscopy is reserved for those patients in whom this approach fails. If the prevalence of H. pylori decreases, the positive predictive value of any non-invasive H. pylori test will become too low. A 'test and scope' approach in which a positive test can be confirmed by two or more biopsy-based tests is then more appropriate. At a very low prevalence of H. pylori in the dyspeptic population, non-invasive testing for H. pylori loses its significance and empirical treatment with an antisecretory drug becomes a rational first step. CONCLUSIONS: The optimal approach to management of uncomplicated dyspepsia is dependent on the prevalence of H. pylori among the dyspeptic population. At the current prevalence rate, 'test and treat', followed by acid suppressive treatment in the case of persisting symptoms, is the most appropriate strategy.


Subject(s)
Dyspepsia/therapy , Anti-Ulcer Agents/therapeutic use , Breath Tests/methods , Dyspepsia/etiology , Endoscopy, Digestive System/methods , Enzyme Inhibitors/therapeutic use , Helicobacter Infections/complications , Helicobacter Infections/diagnosis , Helicobacter Infections/drug therapy , Humans , Primary Health Care , Urea
6.
Postgrad Med J ; 78(926): 707-16, 2002 Dec.
Article in English | MEDLINE | ID: mdl-12509687

ABSTRACT

In this paper the rationale and limitations of the four most important approach strategies to dyspepsia in primary care (empiric treatment, prompt endoscopy, "test-and-scope", and "test-and-treat") are analysed. It is concluded that in the absence of alarm symptoms, a "test-and-treat" approach is currently the most rational approach provided that three conditions are met: (1) a highly accurate test should be used, (2) the prevalence of Helicobacter pylori in the population should not be too low, and (3) an effective anti-H pylori regimen should be prescribed taking sufficient time to instruct and motivate the patient.


Subject(s)
Dyspepsia/microbiology , Endoscopy, Gastrointestinal/methods , Helicobacter Infections/complications , Helicobacter pylori , Diagnosis, Differential , Dyspepsia/diagnosis , Dyspepsia/therapy , Helicobacter Infections/diagnosis , Helicobacter Infections/therapy , Humans , Primary Health Care/methods
7.
Eur J Gastroenterol Hepatol ; 13(10): 1235-9, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11711782

ABSTRACT

OBJECTIVE & DESIGN: We question whether Helicobacter pylori eradication in peptic ulcer disease patients leads to a decrease in symptoms and reduced use of anti-dyspeptic drugs. Therefore, the recurrence rate of H. pylori, upper abdominal symptoms and the use of acid-suppressive drugs were determined 6 years after successful triple therapy. METHODS: Peptic ulcer disease patients successfully treated in 1990-1993 with 'classic' triple therapy were eligible. Patients were asked about symptoms and invited for a 13C-urea breath test or endoscopy in 1997-1998. Data on the use of anti-dyspeptic drugs were obtained from the pharmacy or general practitioner. RESULTS: Of the 113 eligible patients, 90 could be included in the study. The mean follow-up time was 6 years (range 4.6-7.6 years). H. pylori infection recurred in one patient (recurrence rate: 0.19% per patient-year; 95% confidence interval: 0.01-1.1%). Moderate or severe symptoms were experienced before therapy by 79% of the patients and after therapy by 18% of the patients (P< 10(-7)). Before triple therapy, 98% of the patients used H2-receptor antagonists and 54% were on maintenance treatment. After treatment, 30% used anti-dyspeptic medication and only 13% were on maintenance treatment (P < 10(-7)). CONCLUSIONS: Six years after successful triple therapy in peptic ulcer disease patients, the recurrence rate of H. pylori infection is low and both symptoms and the use of anti-dyspeptic drugs have decreased significantly.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Anti-Ulcer Agents/therapeutic use , Helicobacter Infections/drug therapy , Peptic Ulcer/drug therapy , Aged , Antacids/administration & dosage , Drug Therapy, Combination , Female , Follow-Up Studies , Helicobacter Infections/complications , Helicobacter pylori/isolation & purification , Humans , Male , Metronidazole/therapeutic use , Middle Aged , Organometallic Compounds/therapeutic use , Peptic Ulcer/microbiology , Quality of Life , Recurrence , Retrospective Studies , Tetracycline/therapeutic use , Treatment Outcome
8.
Am J Gastroenterol ; 96(9): 2603-8, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11569682

ABSTRACT

OBJECTIVE: To study the relationship between the presence of H. pylori virulence factors and clinical outcome in H. pylori infected patients. METHODS: DNA was isolated from an antral biopsy sample and vacA, cagA, and iceA genotype were determined by PCR and a reverse hybridization technique in 183 patients with culture-proven H. pylori infection: 51 with peptic ulcer disease (PUD), 62 with gastroesophageal reflux disease (GERD), and 70 with a normal endoscopy (gastritis only; GO). RESULTS: Forty-four samples (24%) showed more than one allelic variant in the vacA s- or in-region and/or both iceA1 and iceA2 genotypes, indicating multiple strain infection. These were excluded from statistical analysis. vacA s1 and cagA were significantly more common in PUD than in GERD and GO. Logistic regression analysis showed that GERD patients were more often infected with strains lacking both cagA and iceA than GO patients (OR = 0.36; CI = 0.15-0.89). Trend analysis showed that GERD patients were most often infected with less virulent strains (p < 0.002). CONCLUSION: Multiple strain infection is common. H. pylori strains possessing the vacA s1 genotype and/or cagA are associated with PUD. GERD patients, infected with H. pylori, mostly carry less virulent strains possessing neither cagA nor iceA1. Our findings support the hypothesis that virulent strains protect against the development of GERD.


Subject(s)
Antigens, Bacterial , Bacterial Outer Membrane Proteins/genetics , Bacterial Proteins/genetics , Gastritis/microbiology , Gastroesophageal Reflux/microbiology , Helicobacter Infections/microbiology , Helicobacter pylori/genetics , Peptic Ulcer/microbiology , Bacterial Outer Membrane Proteins/analysis , Bacterial Proteins/analysis , Female , Genotype , Humans , Male
9.
Eur J Clin Microbiol Infect Dis ; 20(6): 418-20, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11476444

ABSTRACT

This study examined whether the simultaneous presence of metronidazole-susceptible and -resistant Helicobacter pylori colonies in a single biopsy specimen is caused by a multiple strain infection with a susceptible and a resistant strain or by two subpopulations within a single strain. Single colonies obtained from seven biopsy specimens known to harbour both susceptible and resistant Helicobacter pylori were fingerprinted by restricted fragment length polymorphism typing of the ureC gene and by the random amplified polymorphic DNA procedure. Metronidazole susceptibility was determined by the E test. The results indicated that the occurrence of metronidazole-resistant and metronidazole-susceptible bacteria within a single biopsy does not imply the presence of a multiple strain infection with one resistant and one sensitive strain.


Subject(s)
Anti-Bacterial Agents/pharmacology , Digestive System/microbiology , Helicobacter Infections/drug therapy , Helicobacter pylori/drug effects , Metronidazole/pharmacology , Anti-Bacterial Agents/therapeutic use , Biopsy , DNA Fingerprinting , DNA, Bacterial/analysis , Digestive System/pathology , Drug Resistance, Bacterial , Helicobacter Infections/microbiology , Helicobacter pylori/genetics , Helicobacter pylori/growth & development , Humans , Metronidazole/therapeutic use , Microbial Sensitivity Tests , Polymorphism, Restriction Fragment Length
10.
Eur J Gastroenterol Hepatol ; 13(4): 383-6, 2001 Apr.
Article in English | MEDLINE | ID: mdl-11338066

ABSTRACT

OBJECTIVE AND DESIGN: To evaluate the performance of the Helicobacter pylori stool antigen test (HpSA test) in detecting H. pylori infection and monitoring the effect of treatment. This was done in two separate studies using either a biopsy or the 13C-urea breath test based 'gold standard' (in untreated and treated patients, respectively). SETTING: Endoscopy units of two general hospitals. PATIENTS: One hundred and twenty-eight dyspeptic patients undergoing endoscopy in the first study. Sixty-five patients receiving anti-H. pylori treatment in the second study. RESULTS: Sensitivity and specificity in untreated patients were 96.3% and 81.8%, respectively. Seven days after treatment, these figures were 20% and 95%, and 4 weeks after treatment they were 40% and 95%. CONCLUSION: The HpSA test is accurate in untreated patients but fails in monitoring treatment success.


Subject(s)
Antigens, Bacterial/isolation & purification , Helicobacter Infections/diagnosis , Helicobacter pylori/immunology , Immunoassay , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , ROC Curve , Sensitivity and Specificity
11.
Scand J Gastroenterol Suppl ; (234): 10-4, 2001.
Article in English | MEDLINE | ID: mdl-11768554

ABSTRACT

Metronidazole was introduced in 1959 for the treatment of Trichomonas vaginalis, but was subsequently shown to be active against anaerobic and some micro-aerophilic bacteria as well. In anaerobic microorganisms with their low redox potential, metronidazole is reduced to its active metabolite by a one-electron transfer step. Metronidazole is often used in treatment regimens for Helicobacter pylori, a microaerophilic bacterium, but resistance to this drug is frequently encountered. The metabolism of metronidazole in H. pylori must differ from that in anaerobic bacteria as metabolites formed by a one-electron transfer are readily re-oxidized in the micro-aerophilic environment of H. pylori. This process is called 'futile cycling' and is accompanied by the formation of toxic oxygen radicals that are neutralized by an active scavenger system. Recently, it has been shown that in H. pylori, in contrast to the situation in anaerobes, an oxygen-insensitive nitroreductase. encoded by the rdxA gene, is responsible for the activation of metronidazole. Activation by this enzyme is by a two-electron transfer step, preventing futile cycling' and thereby enabling the activation of metronidazole in a micro-aerophilic environment. Metronidazole resistance has been shown to be associated with null mutations in the rdxA gene in most clinical isolates. However, there may be some 'background metronidazole susceptibility' in metronidazole-resistant strains caused by other (oxygen-sensitive) nitroreductases. Recently, three meta-analyses of the impact of metronidazole resistance on treatment efficacy have all shown a significant reduction in efficacy of metronidazole containing regimens in patients infected with a resistant strain. The impact of resistance proved to be dependent on the other components of the regimen and on treatment duration.


Subject(s)
Anti-Bacterial Agents/pharmacology , Helicobacter pylori/drug effects , Metronidazole/pharmacology , Drug Resistance, Bacterial/genetics , Helicobacter pylori/metabolism , Humans
12.
Ned Tijdschr Geneeskd ; 144(29): 1385-8, 2000 Jul 15.
Article in Dutch | MEDLINE | ID: mdl-10923145

ABSTRACT

Four patients with gastroduodenal ulcers in the absence of Helicobacter pylori illustrate the decreasing prevalence of this microorganism. One was a 19-year-old boy with nausea, diarrhoea and weight loss caused by multiple gastroduodenal ulcers due to the Zollinger-Ellison syndrome. Another was a 36-year-old man with abdominal discomfort caused by an ulcer due to Crohn's disease. The other two cases concerned a 29-year-old man and a 68-year-old woman with relapsing ulcer disease and active bleeding, in whom no causal factors could be determined. Recent studies suggest a decreasing prevalence of H. pylori leading to both a relative and an absolute decrease of gastroduodenal ulcers attributed to H. pylori. Future treatment strategies will have to take these altered prevalence rates into consideration.


Subject(s)
Crohn Disease/diagnosis , Helicobacter Infections/epidemiology , Helicobacter pylori/isolation & purification , Peptic Ulcer/diagnosis , Peptic Ulcer/epidemiology , Zollinger-Ellison Syndrome/diagnosis , Adult , Aged , Crohn Disease/complications , Diagnosis, Differential , Female , Helicobacter Infections/drug therapy , Helicobacter Infections/microbiology , Humans , Male , Melena/etiology , Netherlands/epidemiology , Peptic Ulcer/drug therapy , Peptic Ulcer/etiology , Peptic Ulcer/microbiology , Prevalence , Recurrence , Zollinger-Ellison Syndrome/complications
13.
Gut ; 46(5): 615-21, 2000 May.
Article in English | MEDLINE | ID: mdl-10764703

ABSTRACT

BACKGROUND: We have previously observed that profound acid suppressive therapy in Helicobacter pylori positive patients with gastro-oesophageal reflux disease is associated with increased corpus inflammation and accelerated development of atrophic gastritis. AIM: To investigate if H pylori eradication at the start of acid suppressive therapy prevents the development of these histological changes. PATIENTS/METHODS: In a prospective randomised case control study, patients with reflux oesophagitis were treated with omeprazole 40 mg once daily for 12 months. H pylori positive patients were randomised to additional double blind treatment with omeprazole 20 mg, amoxicillin 1000 mg and clarithromycin 500 mg twice daily or placebo for one week. Biopsy sampling for histology, scored according to the updated Sydney classification, and culture were performed at baseline, and at three and 12 months. RESULTS: In the persistently H pylori positive group (n=24), active inflammation increased in the corpus and decreased in the antrum during therapy (p=0.032 and p=0.002, respectively). In contrast, in the H pylori positive group that became H pylori negative as a result of treatment (n=33), active and chronic inflammation in both the corpus and antrum decreased (p

Subject(s)
Anti-Ulcer Agents/therapeutic use , Esophagitis, Peptic/drug therapy , Gastritis, Atrophic/prevention & control , Helicobacter Infections/drug therapy , Helicobacter pylori , Omeprazole/therapeutic use , Adult , Aged , Amoxicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Case-Control Studies , Clarithromycin/therapeutic use , Esophagitis, Peptic/microbiology , Female , Gastroesophageal Reflux/complications , Helicobacter Infections/microbiology , Humans , Male , Middle Aged , Penicillins/therapeutic use , Prospective Studies
14.
Aliment Pharmacol Ther ; 14(1): 7-14, 2000 Jan.
Article in English | MEDLINE | ID: mdl-10632640

ABSTRACT

The efficacy of a nitroimidazole-containing regimen for the treatment of Helicobacter pylori infection is decreased by nitroimidazole resistance. Nitroimidazoles are meta- bolized by H. pylori by several nitro-reductases of which an oxygen-insensitive NADPH nitroreductase encoded by the rdxA gene is the most important. Null mutations in this gene are associated with resistance. Susceptibility testing to nitroimidazoles may give variable results. This is not only related to the slow growth under specific conditions, but also to variability in the activity of the other nitroreductases and the ability to deactivate toxic metabolites of an NI and to repair DNA damage. Moreover, co-infections with resistant and susceptible bacteria are frequently found. The presence of nitroimidazole resistance is related to the previous use of this drug. The prevalence of resistance is rising and nowadays 10-50% of the isolates are resistant. Resistance reduces the efficacy of a treatment regimen to a variable degree. This is related to efficacy of the other components of the regimen and the treatment duration. Whether a nitroimidazole is still effective in resistant strains remains unresolved. When nitroimidazole resistance is present, a nitro-imidazole-containing regimen should be avoided or a regimen with other highly effective components should be used.


Subject(s)
Anti-Inflammatory Agents/pharmacology , Helicobacter pylori/drug effects , Nitroimidazoles/pharmacology , Anti-Inflammatory Agents/therapeutic use , Drug Resistance, Microbial , Helicobacter Infections/drug therapy , Helicobacter Infections/microbiology , Humans , Nitroimidazoles/therapeutic use
15.
Eur J Gastroenterol Hepatol ; 11(11): 1255-8, 1999 Nov.
Article in English | MEDLINE | ID: mdl-10563536

ABSTRACT

OBJECTIVE: Recurrence of Heliobacter pylori after apparently successful treatment mostly represents resurgence of the infection, rather than a new one. Therefore, the reliability of biopsy-based tests after treatment was investigated. METHODS: Four weeks or more after treatment, antral biopsy samples were taken for culture, histology, urease test and polymerase chain reaction (PCR), and a corpus specimen for culture. Treatment failure was defined as > or = 2 tests positive. If one test was positive, a 13C-urea breath test was performed and considered conclusive. RESULTS: One hundred and ninety-seven patients were evaluated. Endoscopy was performed 53 days (27-92 days) after treatment. Twenty-one patients with missing test results and 19 patients on acid-suppressive drugs were excluded. In 140 of 156 patients (89.7%), H. pylori was eradicated. Sensitivity and specificity of culture of antrum were, respectively, 100% and 100%; culture of corpus, 100% and 100%; rapid urease test, 87% and 99%; haematoxylin/eosin stain, 94% and 95%; Giemsa stain, 81% and 99%; and PCR, 88% and 100%. CONCLUSION: Although all biopsy-based tests are reliable after treatment, culture is the biopsy-based test of first choice as it is the most accurate and gives additional information on antibiotic resistance.


Subject(s)
Helicobacter Infections/microbiology , Helicobacter Infections/pathology , Helicobacter pylori/isolation & purification , Adult , Aged , Aged, 80 and over , Biopsy/statistics & numerical data , Breath Tests , Endoscopy, Gastrointestinal , Evaluation Studies as Topic , Female , Follow-Up Studies , Helicobacter pylori/enzymology , Humans , Male , Middle Aged , Polymerase Chain Reaction , Predictive Value of Tests , Pyloric Antrum/microbiology , Pyloric Antrum/pathology , Reproducibility of Results , Sensitivity and Specificity , Urease/metabolism
17.
Am J Gastroenterol ; 94(7): 1751-9, 1999 Jul.
Article in English | MEDLINE | ID: mdl-10406231

ABSTRACT

OBJECTIVE: The aim of this study was to determine the influence of nitroimidazole resistance (NIR) on the efficacy of treatment for Helicobacter pylori (H. pylori) infections by meta-analysis of the world literature. METHODS: A MEDLINE search, a manual search of all major gastroenterological journals from 1993 to 1997, and abstracts of gastroenterological and H. pylori meetings from 1993 to 1997 were performed. All treatment studies using a nitroimidazole and providing data about the medication used, dose frequency, total daily dose, duration of treatment, and eradication results in relation to NIR were included. Eradication had to be assessed by two biopsy-based tests or a urea breath test > or = 4 wk after treatment. Individual studies were pooled into groups according to the medication used and the duration of treatment. The pooled estimate of the odds ratio (OR) of NIR for treatment failure and its 95% confidence interval (95% CI) were calculated for each group using the logit method. To detect any possible bias, funnel plots (plots of effect estimates against sample size) were constructed. RESULTS: A total of 91 treatment arms, including a total of 4823 patients, were evaluated. The pooled ORs of NIR for treatment failure (95% CI) of proton pump inhibitors, bismuth, and quadruple regimens were 5.2 (3.8-7.1), 5.9 (4.1-8.3), and 7.0 (3.1-16.0), respectively. Eradication rates were 90% in susceptible strains but <75% in resistant strains. In susceptible strains, neither treatment duration nor the choice of the second antibiotic influenced efficacy. In resistant strains, tetracycline was more effective than amoxicillin (bismuth regimens), and the longer the duration of regimens (bismuth-amoxicillin regimens) the more effective they were. Only quadruple regimens given for > or = 1 wk were effective in resistant strains. CONCLUSIONS: NIR decreases treatment efficacy. Treatment duration and choice of other drugs influence the impact of NIR on treatment efficacy. If NIR is present, a nitroimidazole-containing regimen should be avoided or a quadruple regimen should be given for > 1 wk.


Subject(s)
Helicobacter Infections/drug therapy , Helicobacter pylori , Nitroimidazoles/administration & dosage , Drug Resistance, Microbial , Drug Therapy, Combination , Helicobacter pylori/drug effects , Humans , Nitroimidazoles/pharmacology
18.
Antimicrob Agents Chemother ; 43(6): 1484-6, 1999 Jun.
Article in English | MEDLINE | ID: mdl-10348776

ABSTRACT

Metronidazole susceptibility testing by E test was compared to that by disk diffusion for 263 Helicobacter pylori isolates and to that by breakpoint agar dilution for 90 H. pylori isolates. In 5% and 6% of the cases, respectively, results were discrepant. For each of 52 clinical isolates an E test was performed on 10 separate colonies. Subpopulations of resistant and susceptible bacteria were found in five cases. From three isolates, each colony was subcultured and tested up to 10 times. All but 1 of 292 tests showed the same result. We conclude that the E test is reliable and that subpopulations are responsible for discordant results.


Subject(s)
Anti-Bacterial Agents/pharmacology , Helicobacter pylori/drug effects , Metronidazole/pharmacology , Drug Resistance, Microbial , Humans , Microbial Sensitivity Tests
19.
Aliment Pharmacol Ther ; 13(3): 297-302, 1999 Mar.
Article in English | MEDLINE | ID: mdl-10102961

ABSTRACT

AIM: To assess the influence of metronidazole resistance on the efficacy of ranitidine bismuth citrate-based triple therapy regimens in two consecutive studies. METHODS: In the first study, patients with a culture-proven Helicobacter pylori infection were treated with ranitidine bismuth citrate 400 mg, metronidazole 500 mg, and clarithromycin 500 mg, all twice daily for 1 week (RMC). In the second study, amoxycillin 1000 mg was substituted for clarithromycin (RMA). Susceptibility testing for metronidazole was performed with the E-test. Follow-up endoscopy was performed after >/= 4 weeks. Antral biopsy samples were taken for histology and urease test, and culture and corpus samples for histology and culture. RESULTS: 112 patients, 53 males, age 55 +/- 14 years (39 duodenal ulcer, 7 gastric ulcer and 66 gastritis) were treated with RMC, and 89 patients, 52 males, age 58 +/- 15 years (23 duodenal ulcer, 7 gastric ulcer and 59 gastritis) were treated with RMA. For RMC, intention-to-treat eradication results were 98% (59/60, 95% CI: 91-100%) and 95% (20/21, 95% CI: 76-100%) for metronidazole susceptible and resistant strains, respectively (P = 0.45). For RMA these figures were 87% (53/61, 95% CI: 76-94%) for metronidazole susceptible strains and 22% (2/9, 95% CI: 3-60%) for resistant strains (P = 0.0001). CONCLUSION: Both regimens are effective in metronidazole susceptible strains. However, in contrast to the amoxycillin-containing regimen, that containing clarithromycin is also effective in resistant strains.


Subject(s)
Anti-Bacterial Agents/pharmacology , Anti-Ulcer Agents/therapeutic use , Bismuth/therapeutic use , Helicobacter Infections/drug therapy , Helicobacter pylori/drug effects , Metronidazole/pharmacology , Ranitidine/analogs & derivatives , Adult , Amoxicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Clarithromycin/therapeutic use , Drug Resistance, Microbial , Drug Therapy, Combination , Duodenal Ulcer/drug therapy , Duodenal Ulcer/microbiology , Female , Gastritis/drug therapy , Gastritis/microbiology , Gastroscopy , Helicobacter Infections/microbiology , Humans , Male , Penicillins/therapeutic use , Ranitidine/therapeutic use , Stomach Ulcer/drug therapy , Stomach Ulcer/microbiology
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