P0094 SUPPURATIVE GASTRITIS CAUSED BY KLEBSIELLA PNEUMONIA INAPATIENTWITHSLE (original) (raw)
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Two Years Follow Up After Eradication Therapy of Peptic Ulcer
International Journal of Current Pharmaceutical Research, 2020
Objective: This study was performed to detect the recurrence rate for two years after eradication therapy of peptic ulcer. Methods: Sixty-nine patients included in this study in Kirkuk city from January 2004 to January 2005 as 1st year follow up, and 49 patients from January 2005 to January 2006 as second year follow up study. A urea breath test and re-endoscopic examination were carried out to confirm peptic ulcer recurrence. A questionnaire was prepared to take the history of the disease and other relevant data of each patient. Results: The recurrence was occurred in 6 (8.7%) and 8 patients (16.33%) in the 1st and 2nd years after eradication therapy. Highly risk of recurrence was smoking, age below 50 y and stress in 1st year follow up, and stress was the highly risk in the 2nd year follow up. Conclusion: After triple and quadruple therapy of peptic ulcer, the recurrence is low, However, the possibility of H. pylori resistance should be considered.
Revista Española de Enfermedades Digestivas, 2005
The results of the 2 nd Spanish Consensus Conference for appropriate practice regarding indications for eradication, diagnostic tests, and therapy regimens for Helicobacter pylori infection are summarized. The Conference was based on literature searches in Medline, abstracts from three international meetings, and abstracts from national meetings. Results were agreed upon and approved by the whole group. Results are supplemented by evidence grades and recommendation levels according to the classification used in the Clinical Practice Guidelines issued by Cochrane Collaboration. Convincing indications (peptic ulcer, duodenal erosions with no history of ASA or NSAIDs, MALT lymphoma), and not so convincing indications (functional dyspepsia, patients receiving lowdose ASA for platelet aggregation, gastrectomy stump in patients operated on for gastric cancer, first-degree relatives of patients with gastric cancer, lymphocytic gastritis, and Ménétrier's disease) for H. pylori eradication are discussed. Diagnostic recommendations for various clinical conditions (peptic ulcer, digestive hemorrhage secondary to ulcer, eradication control, patients currently or recently receiving antibiotic or antisecretory therapy), as well as diagnostic tests requiring biopsy collection (histology, urease fast test, and culture) when endoscopy is needed for clinical diagnosis, and non-invasive tests requiring no biopsy collection (13 C-urea breath test, serologic tests, and fecal antigen tests) when endoscopy is not needed are also discussed. As regards treatment, first-choice therapies (triple therapy using a PPI and two antibiotics), therapy length, quadruple therapy, and a number of novel antibiotic options as "rescue" therapy are prioritized, the fact that prolonging PPI therapy following effective eradication is unnecessary for patients with duodenal ulcer but not for all gastric ulcers is documented, the fact that cultures and antibiograms are not needed for all eradicating therapies is indicated, and finally the test and treat strategy is considered adequate, however only under certain circumstances.
Current Therapeutic Research, 2004
Background: Following standard first-line triple therapies for Helicobacter pylori infection, up to 20% of patients require further eradication. Objective: The aim of this study was to assess the effects of second-line triple therapies and third-line quadruple therapies for the eradication of H pylori. Methods: This 7-week, prospective, crossover, controlled, second-and third-line trial was conducted at the Department of Gastroenterology, Ferenc-v~os Health Center (Budapest, Hungary). Patients aged 18 to 80 years with duodenal ulcers and an H pylori infection resistant to first-line triple therapy (pantoprazole 40 mg BID + amoxicillin 1000 mg BID + clarithromycin 500 mg BID [PAC] given as tablets) received a different triple therapy regimen (ranitidine bismuth citrate 400 mg BID + metronidazole 500 mg BID + clarithromycin 500 mg BID [RBC-MC]) for 7 days (group 1A), and nonresponders after RBC + 2 antimicrobials received the pantoprazole-based regimen (group 1B). After secondary failure, patients were randomized to receive quadruple therapies: pantoprazole, amoxicillin, tetracycline, and either nitrofurantoin or bismuth subsalicylate (groups 2A and 2B). Results: One hundred thirty-four patients were enrolled in the second-line study (56 men, 78 women; mean [SD] age, 51.1 [12.4] years; group 1A, 68 patients; group 1B, 66 patients). Subsequently, 41 (30.6%) of these patients were randomized to receive quadruple therapies. Using intent-to-treat (ITT) analysis, the eradication rates did not differ significantly (60.3% and 65.2% in groups 1A and 1B, respectively; 61.9% and 55.0% in groups 2A and 2B, respectively). Perprotocol eradication rates did not differ significantly (66.1% and 68.3% in groups 1A and 1B, respectively); however, the rates were significantly different in group 2A (66.7%) versus group 2B (55.5%) (P = 0.03).
Journal of International Medical Research, 2003
We aimed to determine if successful or failed eradication of Helicobacter pylori with triple therapy causes any difference in gastric mucosal histology. Japanese H. pyloripositive patients with a healed peptic ulcer received high (n = 112) or low (n = 113) doses of triple therapy (omeprazole, amoxicillin and clarithromycin) for 1 week. Biopsies from the greater curvature of the central antrum and upper corpus were taken 6 weeks and 30 weeks after treatment completion, and gastric mucosal histology compared between successful (n = 171) and failed (n = 34) eradication groups. Morphological variables of gastritis were graded according to the updated Sydney System. Successful eradication therapy was defined as improvement in inflammation, neutrophil activity and atrophy; failed eradication therapy as improvement in inflammation and neutrophil activity only. Gastric mucosal atrophy gradually improved (in addition to improvements in inflammation and neutrophil activity) with successful eradication of H. pylori infection.
Journal of Gastroenterology and Hepatology, 2012
were performed and 1469 of these were for investigation of ulcer-like dyspepsia or atypical dyspepsia, excluding refl ux. Rates of dyspepsia fell from 9.5% in 2001 to 7.3% in 2010 (p < 0.05; Fisher's Exact Test). Gastric ulcer and duodenal ulcer were found in 3.56% and 3.32% of endoscopies respectively. No signifi cant difference in rates of GU or DU was found between 2001 and 2010. Gastric cancer rates were overall 0.62% and no statistically difference found between 2001 and 2010. Testing for H. pylori at endoscopy dropped from 45.4% of patients tested in 2005 to 20.7% tested in 2010 (p < 0.0001 Fischer's Exact test). H. pylori positive rates on testing were 21.2% in 2005 and 15.8% in 2010 (p > 0.05, N.S.). Aspirin and NSAID use amongst patients having endoscopy did not change signifi cantly from 2005 to 2010. Amongst patients diagnosed with ulcers, 25.3% used aspirin or an NSAID in 2005 compared to 32.4% in 2010 (p > 0.05, N.S.). Discussion and conclusions Indications for endoscopy are changing and this may refl ect terminology describing symptoms as well as true variations in symptom prevalence. Rates of DU, GU and cancer are low and collectively account for only 7.5% of endoscopic diagnoses. H. pylori rates in patients referred for endoscopy are low and testing for H. pylori is being performed less often.
Family Practice, 1999
Background. Few patients with a history of peptic ulcer are treated by their GP for H. pylori infection, even though theoretical evidence supports such an approach. Objectives. We aimed to determine the validity of this recommendation and to test the feasibility of quadruple therapy in primary health care. Methods. In this prospective, non-randomized intervention study, 51 unselected patients with a history of proven ulcer disease received a 7-day quadruple therapy (lansoprazole, colloidal bismuth subcitrate, tetracycline and metronidazole) from their GP. Main outcome measures were: (i) endoscopically confirmed cure of the infection; (ii) results of serology at entry and at 6 months follow-up; (iii) quality of life at entry, at 6 weeks and at 6 months follow-up; (iv) gastric symptoms at entry, at 6 weeks and at 6 months follow-up; and (v) medication at entry and at 6 months follow-up. Results. Quadruple therapy was well tolerated and there were no drop-outs with this regimen. Intention to treat cure rate was 48/51 (94%, 95% CI 87-100%), per protocol cure rate was 48/49 (98%, 95% CI 94-100%). 45/50 (90%) had positive serology at entry. IgG antibody titres decreased Ͼ40% in 95.2% of patients. Quality of life improved significantly after treatment, gastric symptoms decreased and medication use decreased. Conclusions. GPs should be encouraged to identify patients with a history of ulcer disease and chronic use of acid suppressants and offer them treatment for H. pylori infection. This approach will cure the infection in almost all patients, it will improve the quality of life and decrease costs. Quadruple therapy does not lose efficacy when employed in primary care. Pretreatment serological testing is potentially useful for narrowing down the treatment group to those with actual infection, and serology is promising as an easy and cheap follow-up instrument in primary health care.
Open Journal of Gastroenterology, 2021
Introduction: The treatment of Helicobacter pylori (H. pylori) requires the combination of antibiotic therapy with an antisecretory agent. Due to increasing antibiotic resistance, which varies from one geographical region to another, several eradication protocols exist. Objective: The objective is evaluate and compare the efficacy of three treatment regimens for H. pylori infection: 1) Arm A: Omeprazole + Amoxicillin + Clarithromycin for 10 days; 2) Arm B: Omeprazole + Amoxicillin + Metronidazole for 10 days; 3) Arm C: Sequential treatment = Omeprazole + Amoxicillin for 5 days then Omeprazole + Clarithromycin + Metronidazole for 5 days. Patients and Method: This was a prospective randomised study conducted from February 2016 to July 2016 and from April 2017 to September 2017 in the digestive endoscopy center of the gastroenterology and hepatology department of the University Hospital Center Aristide Le Dantec. Our study population consisted of all patients aged 18 years or older referred for upper GI endoscopy. We included all patients whose indication for the examination was epigastralgia and/or dyspepsia and whose rapid urease test was positive. Patients were randomized to the different treatment arms. A 13C-urea breath test was performed at least 4 weeks after stopping antibiotics and 2 weeks after stopping proton pump inhibitor (PPI). Results: We included 120 patients. There were 95 women and 25 men. The mean age was 40 years. Epigastralgia and dyspepsia were present in 90% and 59% of cases, respectively. Upper GI endoscopy showed peptic ulcer in 19.2% and gastroduodenal erosions in 42.5%. The distribution of patients in the different treatment arms was as follows: 40 patients in arm A, 39 patients in arm B and 41 patients in arm C. Treatment was effective in 71.7% of cases in all arms mixed up. Arms A, B and C were effective in 92.5%, 28.