Improvement in symptoms after H2-receptor antagonist-based therapy for eradication of H pylori infection.

AIM: To investigate the therapeutic effects of triple therapy combining lafutidine with clarithromycin and amoxicillin on H pylori infection and the resolution of gastroesophageal symptoms after eradication. METHODS: We conducted a randomized, multicenter, open-label controlled trial to compare the effectiveness of a triple therapy of lafutidine, clarithromycin, and amoxicillin (lafutidine group) with that of a triple therapy of lansoprazole, clarithromycin, and amoxicillin (lansoprazole group) in patients with H pylori infection. The study group comprised 22 patients with gastric ulcers and 18 patients with duodenal ulcers who had H pylori infection. RESULTS: H pylori eradication rates were similar in the lafutidine group (14/20, 70%) and the lansoprazole group (14/20, 70%). Gastroesophageal reflux and abdominal symptoms improved after eradication therapy in both groups, whereas abdominal discomfort, diarrhea, and constipation were unchanged. H pylori status had no apparent effect on improvement of gastroesophageal reflux or abdominal symptoms after treatment. Adverse events were similar in both groups. CONCLUSION: The triple therapy including lafutidine is equivalent to triple therapy including lansoprazole in terms of H pylori eradication rates and improvement in gastroesophageal reflux and abdominal symptoms. These results are attributed to the fact that lafutidine has strong, continuous antisecretory activity, unaffected by CYP2C19 polymorphisms.

Anal canal carcinoma with Pagetoid spread: report of a case.

A 70-year-old man with a history of colon polyps was found to have a semipedunculated polyp in the anal canal. The patient was asymptomatic. The lesion was 14 mm in diameter and located 5 mm from the dentate line. Histological examination of biopsy specimens revealed well-differentiated adenocarcinoma of the anal canal. During transanal local excision of the tumor, an abnormality of the perianal skin was recognized. Although intraoperative frozen section of the perianal skin did not show malignancy, permanent sections of the perineal skin revealed Paget's cells in the epidermis. Pathological examination of the anal canal carcinoma revealed submucosally invasive well-differentiated adenocarcinoma with a positive distal surgical margin. Thus, we performed additional wide local excision of the perianal skin including the distal margin of the previous local excision. Pathological examination revealed continuance within the epidermis between the anal canal adenocarcinoma and Paget's cells in the perianal skin lesion. Scattered Paget's cells also formed some glandular structures. Thus, we concluded that the perianal skin lesion was Pagetoid spread of anal canal adenocarcinoma. This report shows that the perianal skin should be examined carefully in patients with anal canal carcinoma.