[European Registry on the management of Helicobacter pylori infection: features of diagnosis and treatment in Kazan].

BACKGROUND: As part of an observational multicenter prospective study European Registry on the management of Helicobacter pylori infection, conducted on the initiative of the European H. pylori and Microbiota Study Group, the compliance of clinical practice in the management of patients with Helicobacter pylori infection in Kazan with clinical guidelines was assessed. MATERIALS AND METHODS: The data of 437 patients included into the register by clinical sites in Kazan in 20132019 were analyzed. The methods used for the initial diagnosis of H. pylori infection and eradication control were evaluated. The frequency of various eradication therapy regimens prescription was analyzed in 379 cases. Data regarding the effectiveness of eradication therapy was analyzed in 173 patients. RESULTS: The rapid urease test (44.2% of cases) and cytology/histology (60% of cases) were most often used for the initial diagnosis of H. pylori infection; however non-invasive methods such as 13C-urea breath (9.2%), serology (6.2%), H. pylori stool antigen test (2.3%) were less common. In 21.7% of patients two methods of H. pylori detection were used for primary diagnosis. The control test to evaluate the effectiveness of eradication therapy at the recommended timepoint was performed in 46.2% of patients. 13C-urea breath test (31.7%), stool PCR/stool antigen test (28.7%), rapid urease test (22.3%), cytology/histology (26.2% of cases) prevailed in the assessment of eradication rate. Standard triple therapy, including proton pump inhibitor, clarithromycin and amoxicillin was most commonly prescribed as first-line therapy (64.6% of cases). The duration of eradication therapy was 14 days in the majority of cases with pantoprazole as the most common proton pump inhibitor in standard triple therapy regimens (84.8%). The efficacy of 14-day standard triple therapy (mITT) was 87.0%. CONCLUSION: The results indicate a high frequency of non-invasive methods use for assessing the effectiveness of eradication therapy; however, the overall rate of eradication efficacy assessment is low, limiting the possibility of analyzing the eradication results. The effectiveness of the most common 14-day standard triple first-line therapy in Kazan doesnt reach the recommended 90% eradication level. This could be explained by high rate of pantoprazole use, which is not an optimal proton pump inhibitor in eradication therapy regimens.

[European registry on Helicobacter pylori management (Hp-EuReg) as a tool to evaluate and improve clinical practice in Moscow].

Continuous evaluation of the actual clinical practice of diagnosis and treatment of Helicobacter pylori is crucial in order to provide the best standard of care and to compare health outcomes with expert recommendations. AIM: to evaluate the effectiveness of the standard triple therapy (amoxicillin, clarithromycin, a proton pump inhibitor) and the standard triple therapy plus bismuth tripotassium dicitrate. MATERIALS AND METHODS: Observational, prospective, multicenter study, carried out in one single Russian centre A.S. Loginov Moscow Clinical Scientific Center as part of the Hp-EuReg. Patients were included from 2013 to November 2019 by Russian gastroenterologists. RESULTS: A total of 647 patients were collected and 330 were administered either standard triple therapy ((amoxicillin, clarithromycin, a proton pump inhibitor) or standard triple therapy plus bismuth tripotassium dicitrate. Invasive methods is dominates in the initial diagnosis of H. pylori: the frequency of use of the quick urease test decreased from 50% in 2013 to 31% in 2019. Serology was used in 27.9%. There has been an increase in the use of the13C-urea breath test from 13% in 2013 to 31% in 2019. The histological method (7.5%) and the stool antigen test (3.2%) were used less frequently. For eradication control non-invasive methods are mostly used:13C-UDT (82.7%) and the stool antigen test (14.4%). The effectiveness of standard triple therapy (mITT) was 68% with a 7-day course, 79% with a 10-day course, and 70% with a 14-day course. Combination of bismuth and standard triple therapy eradicates H. pylori (mITT) in 63%, 75% and 89%, respectively. CONCLUSION: An improvement in the clinical practice of managing patients with H. pylori infections has been noted. The standard triple therapy in combination with bismuth tripotassium dicitrate, prescribed for 14 days, is more effective.

Cyclosporine in the treatment of severe attack of ulcerative colitis: a systematic review.

INTRODUCTION: Intravenous steroid therapy is the standard treatment in severe attacks of ulcerative colitis (UC), but 20% to 60% of patients fail to respond and require colectomy. Cyclosporine (CyA) has shown efficacy in steroid failures and could avoid surgery, but controversy remains. AIM: The objective of this study was to conduct a systematic review to evaluate the effectiveness and safety of CyA in inducing remission in patients with a severe attack of UC. METHODS: We did a systematic review using Cochrane methodology, including data from published (in English, French, Spanish or German) clinical trials done in adults using intravenous or oral CyA in UC. Data on efficacy are obtained from controlled and observational clinical trials, and for safety issues case reports are also considered. RESULTS: 31 studies were identified which met the inclusion criteria, 22 (18 uncontrolled, 4 controlled) with intravenous CyA, and 9 (all uncontrolled) using oral CyA. Only 4 controlled trials (one in abstract form) are available, and only one compares CyA to placebo. However, efficacy results are very consistent in these 4 trials, and very similar to those in observational studies. CyA achieves remission in 91,4% and 71.4% of patients in controlled and uncontrolled studies using intravenous route, and in 71,2% using oral route. Two mg/kg/day seems so efficacious and safer as previous standard 4 mg/kg/day dose. Minor side effects are rather common but do not seriously limit therapy. Severe side effects, specially infections, are uncommon but clinically relevant with several deaths reported. CONCLUSION: CyA (intravenous, 2 mg/kg/day) constitutes an efficacious and relatively safe alternative in the treatment of severe, steroid-refractory, attack of UC. To optimize treatment, the correct selection of patients, a standardized protocol and clinical surveillance are recommended.

Cyclosporine in the treatment of severe attack of ulcerative colitis: a systematic review

Introducción: La administración intravenosa de esteroides es el tratamiento habitual en los episodios graves de colitis ulcerosa (CU), aunque el 20-60% de los pacientes no responde a él y precisa intervención quirúrgica mediante colectomía. La ciclosporina (CyA) ha demostrado ser eficaz en los cuadros de falta de respuesta a los esteroides y podría evitar la intervención quirúrgica; no obstante, existe controversia a este respecto. Objetivo: El objetivo del presente estudio ha sido efectuar una revisión sistemática con objeto de evaluar la eficacia y seguridad de la CyA para conseguir la remisión en pacientes con un episodio grave de CU. Métodos: Revisión sistemática mediante la metodología Cochrane, incluyendo los datos correspondientes a los ensayos clínicos publicados en inglés, francés, español o alemán, y referidos a pacientes adultos con CU tratados mediante la administración intravenosa u oral de CyA. Los datos de eficacia se obtuvieron a partir de los ensayos clínicos efectuados con controles y de los estudios de observación; también se consideraron los casos aislados respecto a las cuestiones de seguridad. Resultados: Se identificaron 31 estudios que cumplían los criterios de inclusión en la revisión, 22 (18 sin control y 4 con control) en los que se administró CyA intravenosa y 9 (todos ellos sin grupo control) en los que se administró CyA por vía oral. Sólo se hallaron 4 ensayos clínicos realizados con controles (uno de ellos publicado en forma de resumen), y en sólo uno de ellos se comparó la CyA con placebo. No obstante, los resultados de eficacia fueron muy similares en los 4 ensayos clínicos y también en los estudios de observación. En los estudios realizados con y sin controles, la CyA intravenosa dio lugar a remisión en el 91,4 y el 71,4% de los pacientes, respectivamente, mientras que el porcentaje correspondiente a la CyA oral fue del 71,2%. La dosis de 2 mg/kg/día pareció tener una eficacia y una seguridad similares a las de la dosis habitual utilizada previamente, de 4 mg/kg/día. Los efectos adversos de carácter menor fueron bastante frecuentes, pero no limitaron gravemente el tratamiento. Los efectos adversos graves, en especial las infecciones, fueron infrecuentes pero potencialmente graves; en los estudios publicados se produjeron varios fallecimientos por esta causa. Conclusión: La CyA intravenosa en dosis de 2 mg/kg/día constituye una opción eficaz y relativamente segura en el tratamiento de los episodios graves de CU refractarios a los esteroides. Para optimizar el tratamiento, se recomiendan una selección correcta de los pacientes y la aplicación de un protocolo estandarizado de tratamiento y de seguimiento clínico

Introduction: Intravenous steroid therapy is the standard treatment in severe attacks of ulcerative colitis (UC), but 20% to 60% of patients fail to respond and require colectomy. Cyclosporine (CyA) has shown efficacy in steroid failures and could avoid surgery, but controversy remains. Aim: The objective of this study was to conduct a systematic review to evaluate the effectiveness and safety of CyA in inducing remission in patients with a severe attack of UC. Methods: We did a systematic review using Cochrane methodology, including data from published (in English, French, Spanish or German) clinical trials done in adults using intravenous or oral CyA in UC. Data on efficacy are obtained from controlled and observational clinical trials, and for safety issues case reports are also considered. Results: 31 studies were identified which met the inclusion criteria, 22 (18 uncontrolled, 4 controlled) with intravenous CyA, and 9 (all uncontrolled) using oral CyA. Only 4 controlled trials (one in abstract form) are available, and only one compares CyA to placebo. However, efficacy results are very consistent in these 4 trials, and very similar to those in observational studies. CyA achieves remission in 91,4% and 71.4% of patients in controlled and uncontrolled studies using intravenous route, and in 71,2% using oral route. Two mg/kg/day seems so efficacious and safer as previous standard 4 mg/kg/day dose. Minor side effects are rather common but do not seriously limit therapy. Severe side effects, specially infections, are uncommon but clinically relevant with several deaths reported. Conclusion: CyA (intravenous, 2 mg/kg/day) constitutes an efficacious and relatively safe alternative in the treatment of severe, steroid-refractory, attack of UC. To optimize treatment, the correct selection of patients, a standardized protocol and clinical surveillance are recommended

[Spanish scientific publications on hepatitis C virus. A Medline study (1980-2002)]. / Producción científica española relacionada con el virus de la hepatitis C. Un estudio a través de MedLine (1980-2002).

BACKGROUND: To analyze the scientific publications on hepatitis C virus infection from Spanish hospitals between 1980 and 2002. METHOD: Articles published from January 1980 to December 2002 and contained in the Medline database were selected using the following key words: "Hepatitis C" [MeSH] AND ((Spain [AD] OR Espana [AD] OR Spanien [AD] OR Espagne [AD] OR Espanha [AD]) OR (Spanish [LA]) OR Spain)). Geographical and institutional distribution, national or international publication, subject matter of the article, and date of publication were recorded. Bibliometric indicators of output and impact were estimated. RESULTS: A total of 1.051 articles were studied, of which 346 were excluded. The number of articles published increased from 0 in 1980 to 121 in 1998 and decreased to 36 in 2002. More articles were published in international journals than in Spanish journals (59.2% versus 40.8%). The main topic was epidemiology (28.6%) in the first decade and treatment (20.2%) in the second. Original articles were the most common type of article (80.5%). The centers with the greatest output were Hospital Clinic in Barcelona (11.6%), Vall d'Hebron Hospital (8.9%) in Barcelona and Fundación Jiménez Díaz in Madrid (8.9%). The mean impact factor increased linearly from 0 in 1980 to 3 in 2002. CONCLUSIONS: The number and impact factor of scientific publications on hepatitis C virus by Spanish authors has grown significantly during the last 2 decades.

[Detection of serum IgG (ELISA) against Helicobacter pylori: relationship with age and gastroduodenal disease]. / Detección de IgG sérica (ELISA) frente a Helicobacter pylori: relación con la edad y patología gastroduodenal.

OBJECTIVE: An attempt was made to investigate the serological response against Helicobacter pylori by using a IgG serum detection technique (ELISA Biometra) to establish a relationship with age and gastroduodenal pathology. The serological response was compared with the microbiologic and histologic studies of biopsy samples from 4 locations in each patient: duodenal bulb, gastric antrum, corpus and fundus. PATIENTS: A total of 309 patients with gastrointestinal symptoms who underwent an upper digestive endoscopy were included. RESULTS: The overall sensitivity of the serological technique (cut-off value 15 U/ml) was 89.3%, the specificity 75.7%, the positive predictive value 96.9% and the negative predictive value 45.4%. The mean titer in patients with a negative microbiology increased with age: 13.5 U/ml, 14-30 years; 10.0 U/ml, 31-50 years; 18.5 U/nl, 51-65 years and 29.2 U/ml, > 65 years. By increasing the cut-off value to 20 and 30 U/ml in the last two age groups, the specificity increased without a significant decrease in the sensitivity. Patients without abnormal findings at endoscopy had mean titers considerably lower (64.7 U/ml) than those with the stomach resected -Billroth I or II- (99.6 U/ml) and those with gastritis, duodenitis and ulcus (86.7-83.1 U/ml), Patients with gastritis but without acute inflammatory activity had mean titers (62.5 U/ml) lower than those observed in patients with active gastritis (p < 0.01) and increased in parallel with the increasing activity of gastritis. In contrast, patients with atrophic gastritis had the lowest mean titers (54 U/ml). CONCLUSIONS: Our results suggest that the cut-off value in the serological technique should be increased according to the patient's age. Moreover, there is a clear relationship between the serum levels of IgG and the activity of gastritis.