Seven versus ten days of rabeprazole triple therapy for Helicobacter pylori eradication: a multicenter randomized trial.

BACKGROUND: Ten-day triple therapy is somewhat more effective than 7-day treatment for curing Helicobacter pylori infection. Recent studies have suggested that rabeprazole-a proton pump inhibitor with fast onset of acid inhibition-could raise the efficacy of 7-day therapies to the levels obtained with 10-day treatment. OBJECTIVE: To compare the efficacy of 7- and 10-day rabeprazole-based triple therapy for H. pylori eradication. PATIENTS AND METHODS: Four hundred and fifty-eight patients were randomized to 7 or 10 days of triple therapy, including rabeprazole 20 mg, clarithromycin 500 mg, and amoxicillin 1 g, all twice a day. Cure rates were evaluated by urea breath test. RESULTS: Two hundred and thirty-seven patients received 7-day and 221 received 10-day therapy. Groups were comparable in terms of demographic variables. Intention to treat cure rates were 73.8% (95% CI: 67-79%) for 7-day and 79.6% (95%: CI:74-85%) for 10-day therapy (p= 0.09). Per-protocol cure rates were 81.8% (95% CI:76-86%) and 89.3% (95% CI: 84-93%), p= 0.02, respectively. Cure rates were similar in peptic ulcer patients but in subjects without ulcer they were clearly lower for 7-day therapy: 66%versus 77% by intention to treat (p= 0.08) and 73%versus 91% in the per-protocol analysis (p= 0.004). Side effects and compliance in the two groups were comparable. CONCLUSIONS: Seven- and 10-day triple therapies seem equally efficient in peptic ulcer patients. In contrast, 7-day therapy is significantly less effective in nonulcer dyspepsia patients. Ten-day therapy, therefore, seems preferable when treating nonulcer patients.

Breath test is very reliable for diagnosis of Helicobacter pylori infection in real clinical practice.

AIMS: To determine the accuracy of the most common available tests for the diagnosis of Helicobacter pylori infection in an unselected and untreated population of patients. PATIENTS AND METHODS: Prospective study including 314 unselected patients from a population of 814 patients referred for upper endoscopy at one hospital. H. pylori infection was diagnosed by rapid urease test (RUT), histology, culture and 13C-urea-breath test (UBT) and serum IgG (EIA). H. pylori infection was defined as positive if culture or at least two of the other tests were positive. RESULTS: The prevalence of H. pylori infection in this population was 72%. The diagnostic test with the greatest combination of sensitivity (97%) and specificity (100%) was the UBT. EIA had a good sensitivity (96%), but it was the test with the least specificity (71%). RUT, histology and culture showed a high specificity (>98%) but a sensitivity lower than 90%. In elderly patients (>65 years old, n=120), UBT was also the test with the greatest combination of sensitivity (94%) and specificity (100%). CONCLUSIONS: In conditions of real clinical practice the 13C-urea-breath test is a reliable test for H. pylori diagnosis, both in young and elderly patients.

Validation of the 13c-urea breath test for the initial diagnosis of helicobacter pylori infection and to confirm eradication after treatment.

OBJECTIVES: the breath test with 13C-urea (UBT) is a method widely used in Spain, but its diagnostic accuracy has not been evaluated in a clinical trial until now. Our objective was to validate the UBT (TAU-KIT) both as an initial diagnostic method for the detection of H. pylori infection and as a method to confirm eradication. METHODS: a multi-centre study in 7 Spanish hospitals was performed. A group of dyspeptic patients who had not previously received eradication treatment was included, and a second group of patients with gastric ulcer or upper gastrointestinal bleeding due to peptic ulcer was also included (eradication of H. pylori was confirmed 6 to 8 weeks after treatment completion with omeprazole, clarithromycin and amoxycillin). In both groups an endoscopy was performed with biopsies for histology and rapid urease test. Patients were considered infected if both tests yielded positive results, and not infected when both tests were negative. The UBT 13C-urea (TAU-KIT, Isomed S.L., Madrid, Spain) was performed with citric acid and 100 mg of 13C-urea. The pathologist and persons responsible for endoscopy, urease test and UBT were all unaware of the results from the other diagnostic methods. RESULTS: in the pre-treatment group (36 patients) the prevalence of H. pylori was 72%, the area under the ROC curve for the diagnosis of infection with the UBT was 0.99, and the best cut-off point was 5 units, with the following results: sensitivity= 96% (95% CI = 81-99%), specificity= 100% (69-100%), positive predictive value (PPV) = 100% (87-100%), negative predictive value (NPV) = 92% (59-100%), likelihood ratio (LR) + = infinity, and LR- = 0.04. In the post-treatment group (85 patients) the prevalence of H. pylori was 16%, the area under the ROC curve was 0.99, and the best cut point was 4.6, with the following results: sensitivity= 100% (77-100%), specificity = 97% (90-99%), PPV = 88% (62-98%), NPV = 100% (95-100%), LR+ = 35, and LR- = 0. CONCLUSION: UBT provides excellent accuracy both for the initial diagnosis of H. pylori infection and to confirm eradication after treatment.

Validación de la prueba del aliento con 13C-urea para el diagnóstico inicial de la infección por Helicobacter pylori y la confirmación de su erradicación tras el tratamiento / Validation of 13 C-urea breath test for the initial diagnosis of Helicobacter pylori infection and for the confirmation of its eradication after treatment

Objetivos: el test del aliento con l3C-urea (TAU) es un método ampliamente utilizado en España, pero su validez diagnóstica no ha sido evaluada hasta hoy en un ensayo clínico. Nuestro objetivo fue validar el TAU-KIT® tanto para el diagnóstico inicial de H. pylori como para la confirmación de su erradicación. Métodos: estudio multicéntrico realizado en 7 hospitales españoles. Se incluyó un grupo de pacientes dispépticos en los que no se había administrado tratamiento erradicador previo y otro grupo con úlcera gástrica o hemorragia digestiva por úlcera gastroduodenal en el que se confirmaba la erradicación de H. pylori 6 a 8 semanas después de finalizar el tratamiento con omeprazol, claritromicina y amoxicilina. En ambos grupos se realizó gastroscopia con biopsias para histología y test rápido de la ureasa. Se consideró infectado a un paciente cuando ambas pruebas eran positivas, y no infectado cuando ambas eran negativas. Se realizó el TAU (TAU-KIT®, Isomed S.L., Madrid) con ácido cítrico y 100 mg de 13C-urea. El endoscopista, el patólogo y la persona responsable de la lectura del test de la ureasa y del TAU desconocían el estado de infección por los demás métodos diagnósticos. Resultados: en el grupo pretratamiento (36 pacientes) la prevalencia de H. pylori fue del 72 por ciento, el área bajo la curva ROC para el diagnóstico de la infección con el TAU fue de 0,99 y el mejor punto de corte se situó en 5 unidades , con los siguientes resultados: sensibilidad (S)=96 por ciento (IC 95 por ciento=81-99), especificidad (E)=100 por ciento (69-100), valor predictivo positivo (VPP)=100 por ciento (87100), valor predictivo negativo (VPN)=92 por ciento (59-100), cociente de probabilidades (CP) += y CP-=0,04. En el grupo postratamiento (85 pacientes) la prevalencia de H. pylori fue del 16 por ciento, el área bajo la curva ROC de 0,99 y el punto de corte óptimo de 4,6, con los siguientes resultados: S=100 por ciento (77-100), E=97 por ciento (90-99), VPP=88 por ciento (62-98), VPN=100 por ciento (95-100), CP+=35 y CP-=0.Conclusión: el TAU posee una excelente exactitud tanto para el diagnóstico inicial de la infección por H. pylori como para la confirmación de su erradicación después del tratamiento (AU)

[Helicobacter pylori eradication in patients with peptic ulcer after two treatment failures: a prospective culture-guided study]. / Erradicación de Helicobacter pylori en pacientes con úlcera péptica tras fracaso de dos tratamientos previos: estudio prospectivo guiado por cultivo.

AIM: To determine the effectiveness of a third, culture-guided, treatment of H. pylori infection after two unsuccessful attempts. PATIENTS AND METHODS: Forty-two consecutive patients with a diagnosis of peptic ulcer were included in an open prospective and multicenter study. After two unsuccessful attempts at eradication (demonstrated by positive urea breath test), all patients underwent endoscopy and H. pylori infection was confirmed by urease test, histology and culture (Pylori-Agar, Bio Merieux, France). Antibiotic susceptibility to metronidazole, amoxicillin, tetracycline and clarithromycin was defined by E-test. Thirty-nine patients received a two-week quadruple culture-guided therapy defined by the protocol, which considered sensitivity data and previous allergies to antibiotics (one culture was contaminated, one patient refused treatment and one was allergic to tetracycline and amoxicillin and was resistant to metronidazole and clarithromycin). Compliance was monitored by pill counting and eradication was defined as a negative urea breath test six weeks after the end of treatment. RESULTS: Sensitivity data were obtained in 41 patients. Intention-to-treat analysis revealed that overall eradication was achieved in 60% (24/40). Eighteen strains (43.9%) were resistant to metronidazole, 21 (51.2%) were resistant to clarithromycin and 8 (19.5%) were resistant to both drugs. None of the strains were resistant to amoxicillin or tetracycline. We used mainly two kinds of quadruple therapy in the 39 patients. Despite good compliance with treatment based on omeprazole (20 mg/12 h), bismuth subcitrate (120 mg/6 h), tetracycline (500 mg/4 h) and clarithromycin (500 mg/ 12 h) (OBTC) eradication was achieved in only 9 of 19 patients (47.4%; CI: 24.4-71.1) (one patient failed to attend the urea breath test). Nineteen clarithromycin-resistant patients received amoxicillin (1,000 mg/12 h) instead of clarithromycin (OBTA) and this treatment was effective in 14 (73.7%; CI: 48.8-90.9). Eradication was achieved in one patient who was allergic to amoxicillin and resistant to clarithromycin and metronidazole and who received ciprofloxacin (500 mg/8 h) instead of clarithromycin (OBTCipro). No clinical factors associated with eradication failure were found. CONCLUSIONS: Despite the use of two-week, high-dose, quadruple and culture-guided combinations of drugs, a third treatment was frequently unsuccessful. The lowest eradication rate was obtained in patients with H. pylori strains sensitive to all antibiotics; therefore, we believe that other factors could influence eradication rates. New prospective and randomized studies are needed in this subgroup of patients to find effective treatments.

One-week triple vs. quadruple therapy for Helicobacter pylori infection - a randomized trial.

BACKGROUND: Seven-day triple therapy including omeprazole, clarithromycin and amoxicillin has become the treatment of choice for Helicobacter pylori infection. However, 7 days of classical quadruple therapy combining omeprazole, tetracycline, metronidazole and bismuth may be an alternative to triple therapy. AIM: To compare triple vs. quadruple therapy for H.pylori eradication. METHODS: Three hundred and thirty-nine patients with peptic ulcer and H. pylori infection were included in the study. Patients were randomized to receive omeprazole, 20 mg, amoxicillin, 1 g, and clarithromycin, 500 mg, all b.d., or omeprazole, 20 mg b.d., tetracycline chloride, 500 mg, metronidazole, 500 mg, and bismuth subcitrate, 120 mg, all t.d.s. Cure was defined as a negative urea breath test at least 2 months after treatment. RESULTS: Per protocol and intention-to-treat cure rates were 86%[95% confidence interval (CI), 80-91%] and 77% (95% CI, 70-83%) for triple therapy, and 89% (95% CI, 82-93%) and 83% (95% CI, 76-88%) for quadruple therapy. No significant differences between the groups were found in the cure rates, compliance or side-effects. CONCLUSION: One-week triple and quadruple therapy show similar results when used as first-line eradication treatment.

Factors affecting the variation in antibiotic resistance of Helicobacter pylori over a 3-year period.

Strains of Helicobacter pylori, isolated from 300 patients between 1996 and 2000 were tested for their sensitivity to clarithromycin, metronidazole and amoxycillin. Primary resistances (95% CI) were 9. 7% for clarithromycin and 21.7% for metronidazole. No strains were resistant to amoxycillin. There was no significant difference between the number of resistant strains in the male and female groups. Clarithromycin resistance was more common in older patients (P<0.01) and metronidazole resistance was more common in patients with peptic ulcer compared with patients with chronic gastritis (P<0. 05). Logistic regression analysis confirmed these results.

Third line treatment for Helicobacter pylori: a prospective, culture-guided study in peptic ulcer patients.

BACKGROUND: A third line treatment is needed in roughly 5% of patients infected with Helicobacter pylori. Few data have been reported on efficacy of treatment regimens in these patients. METHODS: A prospective trial was designed to study the effectiveness of third line treatment of H. pylori infection in ulcer patients. Two-week quadruple, culture-guided, combinations were used in 31 consecutive patients. Susceptibility to metronidazole and clarithromycin were studied by E-test, and thereafter a predetermined treatment regimen was used. Compliance was evaluated by pill count, and eradication defined by negative urea breath test at 6 weeks. RESULTS: Two main quadruple regimens were used in 29 patients. In spite of good compliance, the combination of omeprazole, tetracycline, bismuth and clarithromycin (OTBC) showed an eradication rate (per protocol analysis) of 36% (five out of 14; CI: 12.8-64.9), and if amoxycillin was used (OTBA) the rate was 67% (eight out of 12; CI: 34.9-90.1). The difference was not significant. No clinical factor was found to be associated with failure to eradicate. CONCLUSIONS: Third line treatment often fails to eradicate H. pylori infection. New strategies need to be developed and tested for this common clinical situation.

Is 1-week treatment for peptic ulcer healing sufficient and safe?

OBJECTIVE: To confirm whether 1-week anti-Helicobacter therapy to achieve ulcer healing is sufficient and safe. METHODS: We retrospectively analyzed patients with peptic ulcer who were infected with Helicobacter pylori and treated with 3 different 7-day regimens, according to predefined protocols in 3 different centers in the same geographical area (Aragón, Spain). Three combinations commonly described in the literature were used: a) omeprazole (40 mg/24 h), tetracycline hydrochloride (2 g/24 h), colloidal bismuth subcitrate (480 mg/24 h) and metronidazole (750 mg/24 h) (OBTM, n = 105); b) omeprazole (40 mg/24 h), clarithromycin (1.5 g/24 h) and amoxicillin (3 g/24 h) (O40C1.5A3, n = 13); and c) omeprazole (40 mg/24 h), clarithromycin (1 g/24 h) and amoxicillin (2 g/24 h) (O40C1A2, n = 4). In all patients the diagnosis of peptic ulcer disease was confirmed endoscopically, and H. pylori infection was verified with urease testing and histological analysis. After treatment ended, no other antacids were allowed until after endoscopic examination to check eradication and ulcer healing. RESULTS: 122 patients were included (107 with duodenal ulcer, 12 with gastric ulcer and 3 with both). Compliance was good and side effects infrequent and mild. Eradication rates were 88.5% (93/105) in the OBTM group, 100% (13/13) with O40C1.5A3, and 75% (3/4) with O40C1A2. Healing was achieved in 98.16% (107/109) of the patients in whom the bacterial infection was eradicated, and in 23.07% (3/13) of those in whom it was not (p < 0.0001). No patient had any complications during the period without treatment. CONCLUSIONS: 1-week eradication therapy with previously described combinations commonly used in clinical practice achieves high ulcer healing rates with no complications in the period without antacid treatment. We consider that it is not necessary, at least in most patients, to prolong antacid therapy.

[Does eliminating Helicobacter pylori mean the healing of the duodenal ulcer? The results of a prospective study in Spain]. / Erradicar Helicobacter pylori significa cicatrizar la úlcera duodenal? Resultados de un estudio prospectivo en nuestro medio.

AIM: To evaluate the predictive value of Helicobacter pylori eradication in the healing of duodenal ulcer. METHODS: A prospective study of 92 duodenal ulcer patients (diagnosed by endoscopy) with H. pylori infection demonstrated by rapid urease test, positive histology and culture. They were treated with a 7-day regimen of lansoprazole, clarithromycin and amoxicillin. Healing was evaluated in a follow-up gastroscopy performed one month after treatment had finished. Eradication was defined as negative urease test, histology and culture at 30 days and negative urea breath test at 60 days. RESULTS: Duodenal ulcer healing was observed in 85 patients (92.4%, CI 85-96.9). Eradication of H. pylori infection was the only variable independently associated with ulcer healing. Healing was observed in 97.2% of patients with H. pylori eradication versus 75% of those with persistent infection (p < 0.01; OR = 11.6; CI 95% = 2.06-65.9). CONCLUSION: Eliminating H. pylori infection favors duodenal ulcer healing and, from a clinical point of view, confirmation of H. pylori eradication almost always means healing of duodenal ulcer.

¿Es suficiente y seguro un tratamiento de una semana para cicatrizar la úlcera péptica? / Is 1-week treatment for peptic ulcer healing sufficient and safe?

OBJETIVO: confirmar si la terapia anti-Helicobacter pylori de una semana de duración es suficiente y segura para cicatrizar la úlcera péptica. MATERIAL Y MÉTODOS: se analizan de forma retrospectiva pacientes con úlcera péptica e infección por Helicobacter pylori sometidos a tratamiento erradicador con diversas pautas de siete días, con protocolos predefinidos, en tres centros diferentes de la misma área geográfica (Aragón, España). Se han utilizando tres combinaciones de fármacos ampliamente utilizadas en la literatura: a) OBTM (n = 105) omeprazol (40 mg/día), clorhidrato de tetraciclina (2 g/día), subcitrato de bismuto coloidal (480 mg/día) y metronidazol (750 mg/día); b) 040C1.5A3 (n = 13) omeprazol (40 mg/día), claritromicina (1,5 g/día) y amoxicilina (3 g/día), y c) 04OClA2 (n = 4) omeprazol (40 mg/día), claritromicina (1 g/día) y amoxicilina (2 g/día). Todos ellos eran diagnosticados de úlcera péptica activa por endoscopia e infección por Helicobacter pylori mediante ureasa y confirmación histológica. Tras la semana de tratamiento el enfermo no recibió fármacos antisecretores hasta la revisión endoscópica, realizada entre 28-60 días de finalizar el tratamiento, donde se comprobó cicatrización y erradicación (ureasa e histología). RESULTADOS: ciento veintidós pacientes fueron incluidos (107 con úlcera duodenal, 12 con úlcera gástrica y tres con ambas simultáneamente). El cumplimiento del tratamiento fue bueno y los efectos secundarios escasos y leves. Las tasas de erradicación obtenidas eran 88,5 por ciento (93/105) para el grupo OBTM, 100 por ciento (13/13) para 040CI.5A3 y 75 por ciento (3/4) para 04OClA2. Habían cicatrizado el 98,16 por ciento (107/109) de los pacientes erradicados frente a un 23,07 por ciento (3/13) de los no erradicados (p < 0,0001). Ningún paciente presentó complicaciones en el periodo de tiempo sin tratamiento. CONCLUSIONES: el tratamiento erradicador de sólo una semana de duración con las pautas descritas, las más utilizadas en la práctica clínica, tiene una alta eficacia en la cicatrización de las lesiones sin existir complicaciones en el periodo de tiempo sin tratamiento. Por ello consideramos que no es necesario, al menos en la mayoría de los pacientes, prolongar el tratamiento antisecretor (AU)

Quadruple therapy is effective for eradicating Helicobacter pylori after failure of triple proton-pump inhibitor-based therapy: a detailed, prospective analysis of 21 consecutive cases.

BACKGROUND: Data regarding the effectiveness of second-line treatment of Helicobacter pylori infection are limited, especially if microbiological studies are considered. METHODS AND PATIENTS: We conducted a prospective, uncontrolled study of a consecutive series of 21 peptic ulcer patients with failure of 1-week lansoprazole, amoxicillin, and clarithromycin. H. pylori status was evaluated by urease test, histology, culture, and urea breath test. Susceptibility to amoxicillin, clarithromycin, and metronidazole was studied by E-test. Cure of infection was defined as negative results from endoscopy-based tests 1 month after treatment and negative results from a urea breath test at 2 months. Treatment consisted of a 1-week combination of lansoprazole (30 mg bid), tetracycline (500 mg qid), metronidazole (500 mg tid), and bismuth subcitrate (120 mg qid). RESULTS: H. pylori was resistant to metronidazole in three cases, to clarithromycin in three cases, and to both clarithromycin and metroinidazole in an additional three patients. No resistance to amoxicillin was found. Eradication was obtained in 20 cases (95.2% confidence interval [CI], 76.2-99.9). The only patient in whom infection was not eradicated harbored a metronidazole-resistant (minimum inhibitory concentration > 32 micrograms/ml) strain. No significant side effects were reported. CONCLUSION: Quadruple therapy obtains a high eradication rate even in patients with clarithromycin- and metronidazole-resistant strains. Further randomized and controlled studies are warranted and are urgently needed.

Impact of clarithromycin resistance on the effectiveness of a regimen for Helicobacter pylori: a prospective study of 1-week lansoprazole, amoxycillin and clarithromycin in active peptic ulcer.

BACKGROUND: Clarithromycin is a key antimicrobial in the combinations used to cure Helicobacter pylori infections, so there is a need to define the impact of in vitro resistance on in vivo results. METHODS: A prospective trial was designed to study the effectiveness of the 1-week combination of lansoprazole, clarithromycin and amoxycillin in 102 consecutive patients with active peptic ulcer. The pre-treatment and post-treatment sensitivity to amoxycillin, metronidazole and clarithromycin were studied by E-test, and H. pylori status was defined by histology, culture and urease test at diagnosis and one month after treatment, and by urea-breath test 2 months after treatment. RESULTS: The eradication rate (intention-to-treat analysis) was 77% (95% CI: 69-86). No clinical factor was found to be different between eradicated and non-eradicated patients. Clarithromycin-resistant strains were found in 10 (10%; CI: 5-17) patients. The eradication rate was 20% (CI: 3-56) in these patients vs. 83% (CI: 75-91) in patients harbouring clarithromycin-sensitive strains (P < 0.001). A logistic-regression analysis confirmed clarithromycin resistance as the only factor associated with treatment failure. CONCLUSIONS: Clarithromycin resistance significatively impairs the effectiveness of the combination of lansoprazole, amoxycillin, and clarithromycin. The 80% efficacy goal will be difficult to reach in areas with high (>10%) primary clarithromyicin resistance, if currently recommended proton pump inhibitor-triple therapies are used.

The ideal therapy must be defined in each geographical area: experience with a quadruple therapy in Spain.

BACKGROUND: Multiple therapeutic combinations have been tested to determine the optimal regimen(s) for Helicobacter pylori eradication, leading to very different results depending on the geographical area. Our goal was to evaluate the efficacy of a "quadruple" therapy with omeprazole, tetracycline, bismuth and metronidazole in our area. MATERIALS AND METHODS: We investigate 106 consecutive patients with active peptic ulcer disease (duodenal, gastric or both) and Helicobacter pylori infection. One-week therapy with omeprazole 20 mg b.i.d., tetracycline hydrochloride 500 mg q.i.d., colloidal bismuth subcitrate 120 mg q.i.d., and metronidazole 250 mg t.i.d was prescribed. Between the days 30 and 40 after treatment ended follow-up endoscopy was performed. Eradication was defined as both negative urease test and histology. Between days 90 and 360 a 13C urea breath test was performed in 100 patients. RESULTS: Of the 106 patients in the study, 91 had duodenal ulcer, 12 had gastric ulcer, and 3 had both. Side effects were observed in 25% of the cases. Eradication was achieved in 87.7% (93/106; CI 79.9-93.3). Healing was obtained in 95.2% (100/105; CI 89.2-98.4); 97.8% (CI 92.4-99.7) in those eradicated and 75% (CI 42.8-94.5) in non-eradicated (p < .01). CONCLUSIONS: Quadruple therapy with omeprazole, tetracycline, bismuth subcitrate and metronidazole achieves healing rates up to 95-100%. The 87.7% eradication rate obtained suggests that the regimen we used is a reasonable therapeutic alternative in our area.

[Gammagraphy with sucralfate labelled with technetium in esophagitis]. / Gammagrafía con sucralfato marcado con tecnecio en la esofagitis.

In previous studies it has been reported that, after being labeled with technetium, sucralfate, an useful drug in peptic diseases, can be used to detect peptic lesions of the digestive tract. In this work we report our experience with this technique in the diagnosis of esophagitis. 25 studies (11 controls and 14 patients) were undertaken. Sucralfate scintigraphy was normal in the 11 control studies, and abnormal in 10 out of 14 patients. Scintigraphy was abnormal in peptic as well as caustic lesions.

[Gammagraphy with labeled leukocytes as an activity and extension index of Crohn disease]. / Gammagrafía con leucocitos marcados como índice de actividad y extensión de la enfermedad de Crohn.

The knowledge of the location and extent of bowel involment and disease activity can be an important aspect on the evaluation of inflammatory bowel disease. Thirty five patients of Crohn's disease (CD) have been studied in this sense. We performed a total of 44 scintigraphic examinations using 99mTc-HMPAO labeled leukocytes and the results were compared with several clinical-biological indexes and with radiology and endoscopy. The Tc scan was the most sensitive (84.3%) and specific (100%) activity index and showed an excellent correlation with radiology and/or endoscopy in the assessment of extent of disease. Leukocyte scanning brought useful information for the management of stenosis in CD.

[Prevalence of peptic ulcer in smokers and non-smokers in Aragon]. / Prevalencia de úlcera péptica en fumadores y no fumadores en Aragón.

The present study has attempted to determine the prevalence of peptic ulcer (UP) in smokers and nonsmokers in the geographic region of Aragon (Spain) using a sample of 10,000 subjects, 1,897 with ulcer, 1,708 of them diagnosed by endoscopy. The prevalence of smokers is 42.4% (63% of males and 14% of females). The prevalence of peptic ulcer in smokers (26.87%) is double that of nonsmokers (13.38%) (p less than 0.05). In males, all of the locations (duodenal, duodenal + gastric and gastric) are more common among smokers than among nonsmokers. These differences do not exist in women, gastric ulcer being more common among nonsmokers. Complications were more frequent among smokers with ulcer (60%) than among nonsmokers with ulcer (40%).