[Antibiotic resistance of Helicobacter pylori: prevalence in one region in the southern Netherlands and implications for treatment]. / Antibioticaresistentie van Helicobacter pylori: prevalentie in Oost-Brabant en implicaties voor de behandeling.

OBJECTIVE: To determine the current prevalence of antimicrobial resistance of Helicobacter pylori in the Netherlands, and to draw up empirically based treatment advice. DESIGN: Cross-sectional retrospective study. METHOD: Data were collected from all H. pylori-positive isolates cultured in the Bernhoven Hospital in the southern Netherlands, between 2005 and 2012 in which susceptibility for clarithromycin and metronidazole had been determined. Susceptibility for clarithromycin and metronidazole was determined using the E-test, with cut-off minimum inhibitory concentrations of 0.5 µg/ml and 8 µg/ml, respectively. RESULTS: Susceptibility to metronidazole was determined in 417 isolates; 10.1% of these were resistant Susceptibility to clarithromycin was determined in 421 isolates; 6.2% of these were resistant. Women carried resistant strains more often than men, but the difference was statistically non-significant. Resistance of H. pylori to clarithromycin has increased in recent years, whereas the resistance to metronidazole has decreased slightly. CONCLUSION: The prevalence of resistance of H. pylori to clarithromycin and metronidazole in this region of the Netherlands is still low enough to advise standard therapy consisting of a proton pump inhibitor, amoxicillin and clarithromycin as the empirical therapy of choice. However, resistance to clarithromycin is increasing, so it is important to continue to monitor the prevalence of resistance of H. pylori in the Netherlands.

[pH or Hp first? Considerations in the revised Dutch College of General Practitioners' (NHG) practice guideline 'Gastric Symptoms']. / Eerst de pH of eerst de Hp? Overwegingen bij de herziene NHG-standaard 'Maagklachten'.

Considerations in the revised Dutch College of General Practitioners' (NHG) practice guideline 'Gastric Symptoms': The NHG practice guideline 'Gastric symptoms' differs slightly from guidelines in other countries. In other parts of Europe and in Asia the guidelines advise performing a Helicobacter pylori test immediately on all patients with gastric symptoms. In the Netherlands, patients experiencing symptoms for the first time are initially prescribed antacids in accordance with a 'step-up' policy. This commentary describes the arguments for giving priority to an H. pylori test.

Effect of the antidepressant venlafaxine in functional dyspepsia: a randomized, double-blind, placebo-controlled trial.

BACKGROUND & AIMS: Antidepressants could be effective in the treatment of functional gastrointestinal disorders through their anticholinergic and pain-modulating effects. Previous studies with these drugs lacked sufficient power and were predominantly conducted in patients with irritable bowel syndrome. This study aimed to assess the effectiveness of the serotonin and norepinephrine reuptake inhibitor venlafaxine in patients with functional dyspepsia. METHODS: This was a multi-center, randomized, double-blind, placebo-controlled trial. Participants had persistent dyspeptic symptoms and underwent upper gastrointestinal endoscopy in a secondary care hospital to exclude organic abnormalities. They were randomly assigned to receive 8 weeks of treatment with either venlafaxine XR (2 weeks 75 mg once daily, 4 weeks 150 mg once daily, and 2 weeks 75 mg once daily) or placebo. Symptoms, health-related quality of life, anxiety, and depression were assessed before and at 4, 8, 12, and 20 weeks after inclusion. RESULTS: One hundred sixty patients were randomized; 56% and 73% of participants completed treatment with venlafaxine or placebo, respectively, according to protocol. There was no difference in proportions of symptom-free patients after 8 weeks of treatment or at 20 weeks after inclusion, with venlafaxine in comparison to placebo (37% and 39%, respectively; odds ratio [OR], 0.8; 95% confidence interval [CI], 0.3-2.1; and 42% and 41%, respectively; OR, 3.1; 95% CI, 0.9-12.6). Per-protocol analysis did not reveal any differences between venlafaxine and placebo either (38% and 39% symptom-free, respectively; OR, 1.0; 95% CI, 0.4-2.4 at 8 weeks). CONCLUSIONS: Treatment with the selective serotonin and norepinephrine reuptake inhibitor venlafaxine is not more effective than placebo in patients with functional dyspepsia.

Does Helicobacter pylori infection influence response rate or speed of symptom control in patients with gastroesophageal reflux disease treated with rabeprazole?

OBJECTIVE: The findings of several studies suggest that proton-pump inhibitors (PPIs) suppress gastric acid more effectively in Helicobacter pylori-infected (Hp +) than in non-infected (Hp -) patients, but there has been no evaluation of the short-term clinical response. MATERIAL AND METHODS: Results of the first week of treatment with rabeprazole in Hp+ and Hp- patients with gastroesophageal reflux disease (GERD) were compared in a large prospective open-label, multicenter, cohort study in general and specialized practices. GERD patients were recruited on the basis of either typical symptoms alone or endoscopic results, assessed for H. pylori infection and treated with rabeprazole (20 mg). Heartburn and regurgitation symptoms were assessed daily during the first 7 days. Outcome parameters were calculated for both symptoms and compared between Hp+ and Hp- patients. RESULTS: Data on 1548 patients (74.5% Hp-, 25.5% Hp + ) were available. Mean heartburn and regurgitation scores decreased during the first week. For both symptoms, more than 70% of the patients had "adequate" symptom relief at day 5, and more than 80% at day 7. "Complete" symptom relief was reached in more than 70% of patients. Mean onset of adequate symptom control was about 4 days. In Hp+ and Hp- patients there was no difference in response for any of the parameters. CONCLUSIONS: Among patients treated with rabeprazole in clinical practice, H. pylori infection or its absence has no effect on the speed or degree of GERD symptom relief. Infected patients and non-infected patients can therefore be treated with a similar dose. When treating heartburn with rabeprazole, physicians do not need to consider the patient's H. pylori status and most patients (>80%) have adequate symptom relief after just a few days of treatment.

Good bugs and bad bugs: indications and therapies for Helicobacter pylori eradication.

The discovery of Helicobacter pylori has had a major clinical impact. Clinical research is now focused on the role of H. pylori and H. pylori eradication in the treatment of several upper gastrointestinal disorders such as non-ulcer dyspepsia, ulceration during therapy with aspirin or other anti-inflammatory drugs, the treatment of precancerous conditions of the stomach, and the prevention of gastric cancer. Triple and quadruple therapies have become the standard for H. pylori eradication. The expansion of knowledge and the development of new therapeutic modalities are likely to lead to a further implementation of H. pylori-related methods in strategies for the prevention and treatment of upper gastrointestinal disorders.

Eradication therapy should be different for dyspeptic patients than for ulcer patients.

Physicians should try to achieve an optimal cure rate with their initial Helicobacter pylori eradication therapy. Most physicians use the same treatment in all their patients. H pylori infection in patients with peptic ulcer disease (PUD) is more likely to be cured than that in patients with functional dyspepsia (FD). Differences in cure rates of 5% to 15% are usually reported, which is considered to be clinically relevant. A plausible biological explanation for this finding suggests that different strains (virulent [cagA+, vacA type s1] compared with nonvirulent strains [cagA-, vacA type s2]) in PUD and FD induce different changes in the gastric mucosa, and this facilitates or impairs antimicrobial efficacy. Physicians should be aware that most published treatment studies have included only PUD patients. This means that in clinical practice cure rates obtained in patients with FD or perhaps uninvestigated dyspepsia are usually lower than those reported in the literature. This has implications for the choice of treatment. Physicians should consider prolonging the duration of initial Helicobacter eradication therapy from seven to 10 to 14 days in patients without ulcers.