Levofloxacin-amoxicillin/clavulanate-rabeprazole versus a standard seven-day triple therapy for eradication of Helicobacter pylori infection.

The resistance rates of Helicobacter pylori to amoxicillin and metronidazole therapy are higher in eastern Taiwan as compared to national and worldwide rates. The high resistance rate in this territory justified a search for a better eradication regimen. We conducted an open-labeled, prospective, randomized, and controlled study in a tertiary referral hospital in eastern Taiwan. Between December 2007 and December 2009, a total of 153 Helicobacter pylori-positive, therapy-naïve patients with a positive rapid urease test were recruited for random assignment to two seven-day treatment groups: levofloxacin (500 mg), amoxicillin/clavulanate (875 mg/125 mg), and rabeprazole (20 mg) twice per day (LAcR) or clarithyromicin (500 mg), amoxicillin (1000 mg), and rabeprazole (20 mg) twice per day (CAR). Helicobacter pylori eradication was assessed using the (13)C-urea breath test or rapid urease test performed at least 4 weeks after the end of treatment. After exclusion, 146 patients were enrolled and allocated in the study. The Helicobacter pylori eradication rates analyzed by both intention to treat (78.1% versus 57.5%, P = 0.008) and perprotocol (80.9% versus 61.8%, P = 0.014) were significantly higher for the LAcR group. In conclusion, the seven-day LAcR regimen provided improved Helicobacter pylori eradication efficacy when compared with the standard CAR triple therapy in eastern Taiwan.

Strongyloides stercoralis infection: a health issue regarding indigenous people in Taiwan.

Strongyloidiasis, caused by Strongyloides stercoralis, is endemic in tropical and subtropical regions. Whether or not the infection rate is higher among indigenous populations in Taiwan remains unclear. The aim of our study was to assess the racial demographics, diagnoses and clinical details of strongyloidiasis. A total of 41 patients (27 males and 14 females) with strongyloidiasis at a tertiary referral centre in eastern Taiwan in a 21-year period were investigated retrospectively. The majority (36/41, 88%) of these patients lived in rural townships. Common clinical symptoms were anorexia, abdominal pain, nausea, vomiting, fever, coughing and diarrhea. The laboratory abnormalities were anemia, eosinophilia, and leukocytosis. The average age of the indigenous patients was younger than that of the Hans Chinese patients. Alcoholism among the indigenous Taiwanese (all males) was significantly more frequent than in the Hans Chinese, which might be one of the reasons that the indigenous males had a higher infection rate than Hans Chinese males. The group of patients with intestinal strongyloidiasis exhibited a significant lower mortality and a higher recovery rate than those with hyperinfection syndrome. Leptospirosis should be considered as an underlying factor associated with strongyloidiasis, especially in indigenous patients. The relationship and mechanism of leptospira-induced overwhelming infection including strongyloidiasis remains to be elucidated.

Esophageal acid exposure in healthy adults in Taiwan: experience with pH step-up method by dual-channel pH-metry.

Esophageal acid exposure is common in normal subjects. The aim of this study was to investigate proximal and distal esophageal acid exposure in asymptomatic volunteers using dual-channel esophageal pH-metry with probe positioning by pH step-up. A total of 21 healthy subjects (9 male; mean age, 51 years) underwent 24-hour ambulatory esophageal pH recording with the pH step-up method using a two-channel pH probe, a portable digital data recorder, and computerized data analysis. All reflux episodes, episodes longer than 5 minutes, longest reflux episode, duration of acidity (pH <4), and percentage of time with acidity were analyzed. The 95th percentile for reflux parameters assessed in the distal/proximal esophagus were: total reflux episodes, 100/34; episodes greater than 5 minutes, 2.9/0; longest reflux episode, 16.6/2.95 minutes; duration of acidity, 87.95/15.5 minutes; and percentage of time with acidity, 7.0%/1.3%. Proximal and distal acid exposure were well correlated. Results showed that neither gender nor age influenced reflux parameters and that asymptomatic volunteers might experience some gastroesophageal reflux.