Empirical rescue therapy after Helicobacter pylori treatment failure: a 10-year single-centre study of 500 patients.

BACKGROUND: Several 'rescue' therapies have been recommended to eradicate Helicobacter pylori, but they still fail in >20% of the cases, and these patients constitute a therapeutic dilemma. AIM: To evaluate the efficacy of different 'rescue' therapies empirically prescribed during 10 years to 500 patients in whom at least one eradication regimen had failed to cure H. pylori infection. DESIGN: Prospective single-centre study. PATIENTS: Consecutive patients in whom at least one eradication regimen had failed. INTERVENTION: Rescue regimens included: (i) quadruple therapy with omeprazole-bismuth-tetracycline-metronidazole; (ii) ranitidine bismuth citrate-tetracycline-metronidazole; (iii) omeprazole-amoxicillin-levofloxacin; and (iv) omeprazole-amoxicillin-rifabutin. Antibiotic susceptibility was unknown (rescue regimens were chosen empirically). OUTCOME: Eradication was defined as a negative (13)C-urea breath test 4-8 weeks after completing therapy. RESULTS: Five hundred patients were included (76% functional dyspepsia, 24% peptic ulcer). Compliance rates with first-, second- and third-line regimens were 92%, 92%, and 95%, respectively. Adverse effects were reported by 30%, 37%, and 55% of the patients receiving second-, third-, and fourth-line regimens. Overall, H. pylori cure rates with the second-, third-, and fourth-line rescue regimens were 70%, 74%, and 76%, respectively. Cumulative H. pylori eradication rate with four successive treatments was 99.5%. CONCLUSION: It is possible to construct an overall treatment strategy to maximize H. pylori eradication, on the basis of administration of four consecutive empirical regimens; thus, performing bacterial culture even after a second or third eradication failure may not be necessary.

Helicobacter pylori and idiopathic chronic urticaria.

BACKGROUND: Different studies have shown a high prevalence of Helicobacter pylori (HP) infection in patients with chronic urticaria (CU), and occasional remission of the skin lesions after eradication therapy. Recent investigations, however, have failed to find a significant relationship between the two conditions. We designed a case-control study to assess the prevalence of HP infection and the effect of bacterium eradication on the outcome of the skin disease in patients affected by CU. The literature is reviewed. METHODS: Twenty-five patients diagnosed with CU were included. Information about their medical history and a complete laboratory investigation ruled out other diseases or situations suspected to cause CU. Twenty-five healthy volunteers from a census-based, randomized sample were used as controls. HP infection was assessed by the (13)C-urea breath test (UBT). Eradication therapy included oral amoxicillin, omeprazole, and clarithromycin for 1 week. RESULTS: The high prevalence of HP infection (68%) and mean titer of UBT (24.13) in our patients with idiopathic CU do not differ from the general population. Marked differences were observed in the mean age of the CU patients with positive UBT (45.52years) vs. those without HP infection (35.25 years). After eradication therapy, only one patient showed a complete remission of urticaria and two showed a partial remission. CONCLUSIONS: Our results support a lack of relationship between HP infection and the course of idiopathic CU.

[A comparative analysis of diagnostic methods for Helicobacter pylori infection in children]. / Análisis comparativo de los métodos diagnósticos de la infección por Helicobacter pylori en el niño.

OBJECTIVE: The aim of this study was to investigate the usefulness of five diagnostic tests for Helicobacter pylori (Hp) infection in children. PATIENTS AND METHODS: Sixty-five children with epigastric pain, recurrent abdominal pain, regurgitation, diarrhoea, anemia and insulin-dependent diabetes mellitus were investigated. Endoscopic biopsies from gastric antrum were performed and examined by the urease rapid test, histological examination and microbiological culture. An ELISA was used to detect specific IgG and anti-Hp. A carbon urea breath test was performed in 58 patients. RESULTS: Fifty-three patients were infected with Hp. The endoscopy appearance revealed nodularity in antral mucosa in 42 (79%) and erosions in 1 patient. The histology showed gastritis in all patients infected and Hp was identified in 46. The urease rapid test was positive in 96% and the culture positive in 89% of the patients infected. IgG antibodies to Hp were detected in 67% of the patients infected and the carbon urea breath test was positive in 96%. Twelve children were Hp negative, two of them having gastritis without Hp by histology. In the urease rapid test 3 false-positive results were detected and 1 false positive was found in the cultures. All Hp negative patients had negative results in the carbon urea breath test and were negative for IgG antibodies to Hp. CONCLUSIONS: The carbon urea breath test has a high sensitivity and specificity for the diagnosis of Hp infection and allows the selection of candidates for endoscopy.

[C13 urea breath test in the diagnosis of Helicobacter pylori infection in the gastric mucosa. Validation of the method]. / Prueba del aliento con urea marcada con carbono 13 para el diagnóstico de la infección por Helicobacter pylori en la mucosa gástrica. Validación del método.

Helicobacter pylori has been implicated as an agent in the pathogenesis of antral gastritis, gastric and duodenal ulcer and probably in gastric cancer. The C13 urea breath test is a diagnostic method quick to perform, sensitive, reliable and non invasive. It is based on the presence of Helicobacter pylori urease activity, which permits to detect it in the infected mucosa. A substrate (urea) labelled with Carbon 13 is administered to the patient and exhaled breath is collected to detect the possible catabolism product (CO2 labelled with C13). In the European protocol, patients in fasting condition are given a test meal to delay gastric emptying and five minutes later a solution which contents 100 mg of C13 labelled urea. Breath samples are collected before and 30 minutes after urea was given. In our first year of experience, 363 patients with Helicobacter pylori infection detected by histology or urease were studied by C13 urea breath test, with a sensitivity and specificity of 95 and 96%. False negatives may occur if the test is used after antibiotics and other antiulcer drugs. Its main indication is to monitor eradication therapy after treatment. Its possible use as a quantitative test still remains unclear.

[The usefulness of determining antigliadin IgA antibodies for the detection and follow-up of adult celiac disease]. / Utilidad de la determinación de los anticuerpos antigliadina IgA séricos para la detección y seguimiento de la enfermedad celiaca del adulto.

Antibodies to gliadin IgA (IgA-AGA) were detected by enzyme-linked-immunosorbent-technique (ELISA) in 30 healthy controls, 20 coeliac patients and 25 patients with non coeliac malabsorption. All the controls had levels of IgA-AGA in the normal range (25AV). Three of the 25 patients with non coeliac malabsorption presented high titres of IgA-AGA. Thirty six determinations of IgA-AGA were made on the coeliac patients. All but one of the determinations made during the symptomatic phase of the disease were 25AV. The highest titres corresponded either to untreated patients or patients with complications (cirrhosis, lymphoma). In our study the sensitivity and the specificity of the test for symptomatic patients were 94.4% and 94.5% respectively.