Completion Of Eradication Therapy Research Articles

Efficacy and Safety of Postbiotic Contained Inactivated Lactobacillus reuteri ( Limosilactobacillus reuteri ) DSM 17648 as Adjuvant Therapy in the Eradication of Helicobacter pylori in Adults With Functional Dyspepsia: A Randomized Double-Blind Placebo-Controlled Trial.

Increasing the effectiveness of eradication therapy is an important task in gastroenterology. The aim of this study was to evaluate the efficacy and safety of postbiotic containing inactivated (nonviable) Limosilactobacillus (Lactobacillus)reuteri DSM 17648 (Pylopass) as adjuvant treatment of Helicobacter pylori eradication in patients with functional dyspepsia (FD). This randomized, double-blind, placebo-controlled, multicenter, parallel study included H. pylori -positive patients with FD. The postbiotic group received Pylopass 200 mg bid for 14 days in combination with eradication therapy (esomeprazole 20 mg bid + amoxicillin 1,000 mg bid + clarithromycin 500 mg bid for 14 days) and another 14 days after the completion of eradication therapy. The study was registered in the ISRCTN registry (ISRCTN20716052). Eradication efficiency was 96.7% for the postbiotic group vs 86.0% for the placebo group ( P = 0.039). Both groups showed significant improvements in quality of life and reduction of most gastrointestinal symptoms with no significant differences between groups. The overall number of digestive adverse effects in the postbiotic group was lower than in the placebo group. Serious adverse effects were not registered. The postbiotic containing inactivated L. reuteri DSM 17648 significantly improves the effectiveness of H. pylori eradication therapy in FD and decreases overall number of digestive adverse effects of this therapy.

A Young Female with a Hepatic Epithelioid Hemangioendothelioma.

Primary hepatic epithelioid hemangioendothelioma (HEHE) is an extremely rare tumour of vascular origin with an incidence of <0.1 cases per 100,000 people worldwide. A 29-year-old female with the history of epigastric pain and unintentional weight loss (3 kg over six months) was referred for upper endoscopy. The examination was without visual pathological findings, but a rapid urease test was positive. First-line treatment with clarithromycin-containing triple therapy for Helicobacter pylori infection was given. After completion of eradication therapy, diffuse abdominal pain developed. An abdominal computed tomography (CT) showed multiple liver nodules. Three consecutive core liver biopsies were performed and were inconclusive. A subsequent surgical liver nodule resection was performed. Histopathology of the specimen revealed grade 2 hepatocellular carcinoma; bone scintigraphy was negative for metastasis. A multidisciplinary team (MDT) recommended giving the patient sorafenib, which was poorly tolerated. The histology was reviewed using immunohistochemistry staining at the request of the oncologist, which showed expression of CD31 and CD34. Based on clinical, morphological and immunohistochemistry findings, a diagnosis of hepatic epithelioid hemangioendothelioma was made. Based on the multidisciplinary team's findings, liver transplantation was indicated as the only curative treatment. Because of the rarity of this disease, combining clinical, radiological and histopathological methods as well as an MDT approach can help to reach the correct final diagnosis. As demonstrated in this clinical case, it is crucial to perform immunohistochemistry of a liver biopsy to confirm a HEHE diagnosis. Hepatic epithelioid hemangioendothelioma is a rare vascular tumour that is often misdiagnosed and mismanaged.This case emphasises the critical importance of interdisciplinary teamwork and the use of non-invasive and invasive techniques to achieve a definitive diagnosis.

Vitamin C does not improve the efficacy of Helicobacter pylori eradication in smokers

Purpose: To evaluate the hypothesis that vitamin C improves the efficacy of Helicobacter pylori eradication in smokers when combined with pantoprazole, amoxicillin, and clarithromycin. Materials and methods: The study completed 90 subjects of 98 enrolled, 58 smokers 32 nonsmokers. Helicobacter pylori status was determined by two methods, CLO test, and histology. Vitamin C (500 mg) was administered three times daily. The patients were considered as cured of H. pylori if the CLO test result and histology were negative 4 weeks after completion of eradication therapy. Results: Smokers had lower effectiveness of eradication therapy than non-smokers and the administration of vitamin C had not affected the outcome of eradication therapy. Conclusions: Vitamin C (500 mg tid) does not improve the eradication therapy when pantoprazole, amoxicillin, and clarithromycin were used.

38 Single centre experience with h.pylori eradication therapy

Background Helicobacter pylori, is a gram-negative, microaerophilic bacterium usually found in the stomach and has been linked with chronic gastritis, gastric and duodenal ulcers, gastric cancer and MALT. An increasing resistance to antibiotics has resulted in changes in the recommended eradication therapy. The H.Pylori study group has recently updated the recommended eradication therapy. Aim To study the compliance with the updated therapy for H.Pylori infection. Method The prescriptions for triple therapy were collected and reviewed in compliance with the guidelines. The results of the follow-up Urea Breath Test following completion of eradication therapy were recorded and the rate of successful eradication was compared in the group of patients who were treated according to the new recommendations versus old recommendations. Results The initial compliance with the new guidelines was 82%. Staff and junior doctor education have resulted in improvement in compliance rate. Conclusions 1. Longer duration of therapy and more compliance with new guidelines has been associated with improved eradication therapy. 2. Confirming eradication of H.Pylori is an essential step in reducing and eliminating long term complications.

Su1182 Usefulness of the Non-Invasive Rapid Urease Test Using Gastric Mucus for the Diagnosis of Helicobacter pylori Infection

Background: Eradication therapy for Helicobacter pylori-related chronic gastritis was approved for coverage by the Japanese national insurance in February 2013. Therefore, the use of eradication therapy has rapidly increased in Japan. The primary eradication rate of H. pylori using the 7-day triple therapy has gradually decreased in recent years. Drug resistance to clarithromycin (CAM), poor treatment compliance, and smoking are factors associated with eradication failure. A recent study showed that combination of eradication agents is useful for increasing eradication success, because combination treatments are prepared using daily dosages on one sheet. In our study, we prospectively compared the eradication rate in patients receiving conventional therapy with three drugs to that in patients receiving combination therapy. Patients and methods: Between July 2012 and September 2013, we included 276 patients (147 men and 129 women; mean age, 62.2 years) with H. pylori-positive peptic ulcers and gastritis. Combination therapy (Lansap®; lansoprazole 30 mg plus amoxicillin 750 mg plus CAM 200 mg) was administered to 54 patients twice a day for 7 days, and conventional therapy (omeprazole 20 mg or esomeprazole 20 mg or rabeprazole 20 mg plus amoxicillin 750 mg plus CAM 200 mg) was administered to 221 patients as individual drugs twice a day for 7 days. The 13C-urea breath test was used to confirm the eradication of H. pylori at least 6 weeks after the completion of eradication therapy. Patients who had undergone H. pylori eradication therapy in the past and patients who used proton pump inhibitors and antibiotics within 4 weeks were excluded. Results: No significant difference was observed in the background criteria of patients between the combination group and conventional group. The eradication rate (per protocol analysis) in the combination group was 90.3% (47/52), which was significantly different from that in the conventional group (74.9%; 161/215; p< 0.01). In addition, the eradication rate in intention-to-treat (ITT) analysis was significantly higher in the combination group (85.4%, 47/55) than in the conventional group (72.8%, 161/221; p< 0.01). No significant difference was observed in the incidence of adverse drug reactions (such as diarrhea, dysgeusia, and eruption) between the two groups (combination group 4.1%; conventional group 4.7%). Conclusions: Our study suggested that combination therapy with eradication agents is more useful for successful eradication of H. pylori than conventional therapy, although the primary eradication rate has decreased in Japan in the recent years. The underlying reason for the decrease in the primary eradication rate might be greater compliance to combination therapy.

Su1183 Rebamipide, Mucosal-Protective and Ulcer-Healing Drug, Improves Chronic Inflammation of the Corpus After H. pylori Eradication: A Multicenter Study in Japan

Background: Eradication therapy for Helicobacter pylori-related chronic gastritis was approved for coverage by the Japanese national insurance in February 2013. Therefore, the use of eradication therapy has rapidly increased in Japan. The primary eradication rate of H. pylori using the 7-day triple therapy has gradually decreased in recent years. Drug resistance to clarithromycin (CAM), poor treatment compliance, and smoking are factors associated with eradication failure. A recent study showed that combination of eradication agents is useful for increasing eradication success, because combination treatments are prepared using daily dosages on one sheet. In our study, we prospectively compared the eradication rate in patients receiving conventional therapy with three drugs to that in patients receiving combination therapy. Patients and methods: Between July 2012 and September 2013, we included 276 patients (147 men and 129 women; mean age, 62.2 years) with H. pylori-positive peptic ulcers and gastritis. Combination therapy (Lansap®; lansoprazole 30 mg plus amoxicillin 750 mg plus CAM 200 mg) was administered to 54 patients twice a day for 7 days, and conventional therapy (omeprazole 20 mg or esomeprazole 20 mg or rabeprazole 20 mg plus amoxicillin 750 mg plus CAM 200 mg) was administered to 221 patients as individual drugs twice a day for 7 days. The 13C-urea breath test was used to confirm the eradication of H. pylori at least 6 weeks after the completion of eradication therapy. Patients who had undergone H. pylori eradication therapy in the past and patients who used proton pump inhibitors and antibiotics within 4 weeks were excluded. Results: No significant difference was observed in the background criteria of patients between the combination group and conventional group. The eradication rate (per protocol analysis) in the combination group was 90.3% (47/52), which was significantly different from that in the conventional group (74.9%; 161/215; p< 0.01). In addition, the eradication rate in intention-to-treat (ITT) analysis was significantly higher in the combination group (85.4%, 47/55) than in the conventional group (72.8%, 161/221; p< 0.01). No significant difference was observed in the incidence of adverse drug reactions (such as diarrhea, dysgeusia, and eruption) between the two groups (combination group 4.1%; conventional group 4.7%). Conclusions: Our study suggested that combination therapy with eradication agents is more useful for successful eradication of H. pylori than conventional therapy, although the primary eradication rate has decreased in Japan in the recent years. The underlying reason for the decrease in the primary eradication rate might be greater compliance to combination therapy.

Su1181 Combination Therapy With Eradication Agents Is Useful for Successful Eradication of Helicobacter pylori in Japan

Background: Eradication therapy for Helicobacter pylori-related chronic gastritis was approved for coverage by the Japanese national insurance in February 2013. Therefore, the use of eradication therapy has rapidly increased in Japan. The primary eradication rate of H. pylori using the 7-day triple therapy has gradually decreased in recent years. Drug resistance to clarithromycin (CAM), poor treatment compliance, and smoking are factors associated with eradication failure. A recent study showed that combination of eradication agents is useful for increasing eradication success, because combination treatments are prepared using daily dosages on one sheet. In our study, we prospectively compared the eradication rate in patients receiving conventional therapy with three drugs to that in patients receiving combination therapy. Patients and methods: Between July 2012 and September 2013, we included 276 patients (147 men and 129 women; mean age, 62.2 years) with H. pylori-positive peptic ulcers and gastritis. Combination therapy (Lansap®; lansoprazole 30 mg plus amoxicillin 750 mg plus CAM 200 mg) was administered to 54 patients twice a day for 7 days, and conventional therapy (omeprazole 20 mg or esomeprazole 20 mg or rabeprazole 20 mg plus amoxicillin 750 mg plus CAM 200 mg) was administered to 221 patients as individual drugs twice a day for 7 days. The 13C-urea breath test was used to confirm the eradication of H. pylori at least 6 weeks after the completion of eradication therapy. Patients who had undergone H. pylori eradication therapy in the past and patients who used proton pump inhibitors and antibiotics within 4 weeks were excluded. Results: No significant difference was observed in the background criteria of patients between the combination group and conventional group. The eradication rate (per protocol analysis) in the combination group was 90.3% (47/52), which was significantly different from that in the conventional group (74.9%; 161/215; p< 0.01). In addition, the eradication rate in intention-to-treat (ITT) analysis was significantly higher in the combination group (85.4%, 47/55) than in the conventional group (72.8%, 161/221; p< 0.01). No significant difference was observed in the incidence of adverse drug reactions (such as diarrhea, dysgeusia, and eruption) between the two groups (combination group 4.1%; conventional group 4.7%). Conclusions: Our study suggested that combination therapy with eradication agents is more useful for successful eradication of H. pylori than conventional therapy, although the primary eradication rate has decreased in Japan in the recent years. The underlying reason for the decrease in the primary eradication rate might be greater compliance to combination therapy.

Evaluation of the 14C-urea breath test using indigenously produced 14C-urea capsules and a modified technique for trapping exhaled breath

The carbon urea breath test ((14)C-UBT) is a noninvasive technique used to detect Helicobacter pylori infection in patients presenting with dyspeptic symptoms. The present study was undertaken to determine the efficacy of indigenously produced (14)C-UBT capsules by the Board of Radiation and Isotope Technology, India. Thirty consecutive patients with dyspeptic symptoms were included in the study. After ingestion of capsules, breath samples were collected in a CO2-trapping solution to which a scintillation cocktail was added. After 24 h, the whole sample was counted in a liquid scintillation counter along with a standard of (14)C. The number of disintegrations of (14)C per minute in the breath sample was calculated. The results were compared with histopathological reports. Of 30 patients, 19 were positive and 11 were negative on (14)C-UBT. Histopathological reports confirmed 27 cases as positive and three as negative for H. pylori. Thus, the results of (14)C-UBT were concordant with histopathological results in 22/30 (73.3%) cases. Considering histopathology as the gold standard, the sensitivity, specificity, and positive predictive value of (14)C-UBT using indigenously produced capsules were found to be 70.33, 100, and 100%, respectively. On critical analysis of the discordant results, we observed that six patients had undergone H. pylori eradication therapy exactly 4 weeks before the test. When these six patients were excluded from the analysis, the sensitivity, specificity, and positive predictive value were found to be 90.05, 100, and 100%, respectively, which compared well with the values obtained using the standard procedure. The study demonstrates adequate efficacy of the indigenous methodology in newly diagnosed symptomatic patients with acid peptic disorders. The analyses of the results indicate that the test should be preferably employed after the recommended period of 1 month following completion of eradication therapy.

Sa1922 Superiority of Acid Suppression for Esomeprazole-Based Helicobacter pylori Eradication Therapy in Japanese CYP2C19 Rapid Metabolizers

Background/Aims: The increasing trend of antibiotic resistance requires effective secondline Helicobacter pylori (H. pylori) treatment in high prevalence area of H. pylori. The aim of our study was to evaluate the reinfection rate of H. pylori that would determine the effect of the eradication therapy in long-term follow up period after second-line treatment. Methods: During 2003-2011, 898 patients who had failed previous H. pylori eradication on standard triple therapy were treated with either of two regimens: 1, esomeprazole (20 mg b.i.d), tripotassum dicitrate bismuthate (300 mg q.i.d), metronidazole (500 mg t.i.d), and tetracycline (500 mg q.i.d) (EBMT) or 2, moxifloxacin (400 mg q.d.), esomeprazole (40 mg b.i.d), and amoxicillin (1000 mg b.i.d.) (MEA). At four weeks after completion of eradication therapy, follow-up H. pylori tests were performed with 13C urea breath test or invasive tests (Giemsa histology, CLO test, and culture). In patients who were maintained continuous H. pylori negativity for the first year after eradication therapy, H. pylori status was assessed every year. Results: Mean follow-up periods were 34.1 months and 35.6 months in the quadruple therapy group (n = 65) and moxifloxacin group (n = 177), respectively. H. pylori reappeared in 9 (13.8%) of EBMT and in 31 (17.5%) of MEA, resulting in the annual reinfection rate of 4.88% and 3.13% per year, respectively (P = 0.496). In addition, recrudescence rate of EBMT and MEA group was found to be 1.52% and 3.28% (MEA), respectively (P = 0.679). Multivariate analysis showed that there was no association with any clinical risk factor for H. pylori reinfection. Conclusion: This long-term reinfection rate of H. pylori stayed rather low in both of bismuth-containing quadruple therapy and moxifloxacin-based triple therapy, thus reinfection cannot affect the choice of second-line treatment.

Clinical Factors Related with Helicobacter Pylori Infection - Is there an Association with Gastric Cancer History in First-Degree Family Members?

The aim of this study was to assess clinical factors associated with Helicobacter pylori positivity and to evaluate the incidence of gastric carcinoma in first-degree family members of infected patients. A total of 580 patients (mean age:38±17) with gastrointestinal complaints underwent C-14 urea breath test (UBT). Patients were grouped as: Group-1, untreated patients (n:384); and Group-2, patients who previously treated with eradication triple therapy (n:196). C-14 UBT was performed 1-2 months after the completion of eradication therapy. Associations of H pylori positivity with age, gender, ABO and Rhesus groups, smoking, dietary habits, and history of gastric cancer in first-degree family members were evaluated. The frequency of H pylori positivity was significantly higher in group-1 (58%) compared to group-2 (20%), p=0.001. There were no correlations between H pylori positivity and age, gender, ABO groups, Rhesus subgroups, smoking and dietary habits in both patient groups. The frequency of gastric cancer in family members was significantly higher in patients with H pylori infection among group-1, compared to infected patients among group-2 (56% vs. 28.6% respectively, p=0.03). We observed a significant association between H pylori positivity and the presence of gastric cancer in first-degree relatives of group-1 patients. Our results provide some confirmation of the presence of a link between gastric cancer development and H pylori. C-14 UBT is a sensitive, reliable and a widely recommended test for the detection of H pylori infection and recurrence. We suggest that detection and eradication of H pylori may contribute to a reduced risk of gastric cancer in the family members of infected patients.

The Effect of Probiotics and Mucoprotective Agents on PPI‐Based Triple Therapy for Eradication of Helicobacter pylori

Recent studies have found that probiotics have anti-Helicobacter pylori (HP) properties. We evaluated the additive effects of (i) Saccharomyces boulardii combined with proton pump inhibitor (PPI)-based triple therapy and (ii) S. boulardii and a mucoprotective agent (DA-9601) coupled with PPI-based triple therapy for HP eradication. We recruited 991 HP infected patients and randomized them into one of three groups, (A) PPI-based 7-day triple therapy, (B) the same triple therapy plus S. boulardii for 4 weeks, and (C) the same 7-day triple therapy plus S. boulardii and mucoprotective agent for 4 weeks. All patients in the three groups were tested via (13)C-urea breath test 4 weeks after the completion of the therapy. According to the results of an intention-to-treat analysis, HP eradication rates for the groups A, B, and C were 71.6% (237/331), 80.0% (264/330), and 82.1% (271/330), respectively (p = .003). According to the results of a per protocol analysis, the eradication rates were 80.0% (237/296), 85.4% (264/309) and, 84.9% (271/319), respectively (p = .144). The frequency of side effects in group B (48/330) and C (30/330) was lower than that in group A (63/331) (p < .05). This study suggests that supplementation with S. boulardii could be effective for improving HP eradication rates by reducing side effects thus helping completion of eradication therapy. However, there were no significant effects on HP eradication rates associated with the addition of mucoprotective agents to probiotics and triple therapy.

Age-dependent eradication ofHelicobacter pyloriin Japanese patients

To determine the general risk factors affecting the failure rate of first-line eradication therapy in Japanese patients with Helicobacter pylori (H. pylori) infection. The present study enrolled 253 patients who had an H. pylori infection, underwent gastro-endoscopy, and were treated with H. pylori eradication therapy. Eradication therapy consisted of 30 mg lansoprazole plus 750 mg amoxicillin and 400 mg clarithromycin twice daily for 7 d. All of the patients underwent a 13C urea breath test at least 1 mo after the completion of eradication therapy. The current study investigated the independent factors associated with successful H. pylori eradication using a multiple logistic regression analysis. The overall success rate in the patients was 85.8%. Among the general factors examined in the multivariate analyses, only having an age less than 50 years was found to be significantly associated with a poor response to H. pylori eradication. Moreover, side effects were the only clinical factors in the patients who were under 50 years of age that significantly influenced the poor response to H. pylori eradication. H. pylori-positive elderly patients should undergo eradication therapy. In addition, it is necessary to improve H. pylori eradication therapy in younger patients.

Association of erosive esophagitis withHelicobacter pylorieradication: a role of salivary bicarbonate and glycoprotein secretion

In some populations, Helicobacter pylori eradication is associated with development of erosive esophagitis. The aim of this study was to evaluate the contribution of salivary bicarbonate and glycoprotein secretion to the pathogenesis of erosive esophagitis developing after H. pylori eradication. Gastroscopy and saliva collection were performed at recruitment and 12 months after completion of eradication therapy. Eighty-eight patients with duodenal ulcer were recruited to the study. Erosive esophagitis was found in 13 patients (grade A, 8 patients; grade B, 4 patients; grade C, 1 patient). Among the 74 subjects who completed the study, erosive esophagitis was detected in 21 patients (grade A, 15 patients; grade B, 6 patients); they all were successfully eradicated. Bicarbonate and glycoprotein secretion was not found to differ significantly between the subjects with and without erosive esophagitis both before and 1 year after H. pylori eradication. However, it was lower in H. pylori-infected (baseline) than in H. pylori-noninfected erosive esophagitis subjects (1 year after successful eradication) (bicarbonate 2.34 [1.29-3.40)]vs. 3.64 [2.70-4.58]micromol/min and glycoprotein 0.23 [0.15-0.31]vs. 0.35 [0.28-0.43] mg/min, P= 0.04 and P= 0.04, respectively). We conclude that changes in salivary bicarbonate and glycoprotein secretion related to H. pylori eradication do not promote the development of erosive esophagitis in duodenal ulcer patients.

Reflux Masquerader: Acute Helicobacter pylori Infection in Neonates and Infants

Reflux Masquerader: Acute <i>Helicobacter pylori</i> Infection in Neonates and Infants

Rabeprazole‐ versus Esomeprazole‐Based Eradication Regimens for H. pylori Infection

Different kinds of proton pump inhibitor-based triple therapies could result in different Helicobacter pylori eradication rates. The aims of this study were to compare the efficacy and safety of rabeprazole- and esomeprazole-based triple therapy in primary treatment of H. pylori infection in Taiwan. From June 2005 to March 2007, 420 H. pylori-infected patients were randomly assigned to receive a 7-day eradication therapy with either esomeprazole 40 mg daily (EAC group, n = 209) or rabeprazole 20 mg b.i.d. (RAC group, n = 211) in combination with amoxicillin 1 g b.i.d. and clarithromycin 500 mg b.i.d.. Follow-up endoscopy with biopsy was done 12-16 weeks after completion of eradication therapy. Those who refused endoscopic exams underwent (13)C-urea breath test to assess the treatment response. Intention-to-treat analysis revealed that the eradication rate was 89.4% in the EAC group and 90.5% in RAC groups (p-value = .72). All of the subjects returned for assessment of compliance (100% in EAC group vs. 99.5% in RAC group, p-value = .32) and adverse events (3.83% in EAC group vs. 6.16% in RAC group, p-value = .27). Sixty (28.7%) and 37 (17.6%) patients in EAC and RAC group, respectively, refused endoscopy and underwent a (13)C-urea breath test to determine the treatment effect. In conclusion, rabeprazole- and esomeprazole-based primary therapies for H. pylori infection are comparable in efficacy and safety.

Efficacy and Safety of Saccharomyces boulardii in the 14‐day Triple Anti‐Helicobacter pylori Therapy: A Prospective Randomized Placebo‐Controlled Double‐Blind Study

Recent studies indicate a potential role of Saccharomyces boulardii in the prevention of Helicobacter pylori treatment-related side-effects and also in improvement of eradication rate. Our aim is to investigate the efficacy and safety of S. boulardii in the prevention of side-effects related to H. pylori eradication. The secondary aim of the study was to define the effect of S. boulardii on the eradication success of anti-H. pylori therapy. One hundred and twenty-four patients with H. pylori infection (male/female: 44/80, mean age: 48 +/- 14.25 year) receiving 14 days of triple therapy (clarithromycin 500 mg b.i.d., amoxicillin 1000 mg b.i.d., and lansoprazole 30 mg b.i.d.) were randomly assigned to S. boulardii or placebo. Dyspeptic symptoms were recorded by using modified Glasgow Dyspepsia Questionnaire (GDQ). Side-effect profile and tolerability were assessed using a symptom-based questionnaire. H. pylori status was rechecked after 6 weeks after completion of eradication therapy. H. pylori eradication rate, although higher in the treatment group, was statistically similar in treatment and control groups: 71% (44/62) versus 59.7% (37/62), respectively (p > .05). Nine (14.5%) patients in the treatment group and 19 (30.6%) patients in the placebo group experienced diarrhea (p < .05). Epigastric discomfort was more frequent in the control group [9 (14.5%) versus 27 (43.5%), respectively (p < .01)]. Diffuse abdominal pain, abdominal gas, taste disturbance, urticaria, nausea symptoms were similar in both groups. GDQ scores after treatment were significantly better for treatment group (mean +/- SD, range: 1.38 +/- 1.25 (0-5) vs. 2.22 +/- 1.44 (0-6), respectively; p < .01). S. boulardii improved anti-H. pylori antibiotherapy-associated diarrhea, epigastric discomfort, and treatment tolerability. In addition, S. boulardii supplement decreased post-treatment dyspepsia symptoms independent of H. pylori status. However, S. boulardii had no significant affect on the rate of H. pylori eradication.

Comparison of stool enzyme immunoassay and immunochromatographic method for detecting Helicobacter pylori antigens before and after eradication

The objective of this study is to compare the performance of enzyme immunoassay (Premier Platinum HpSA) and immunochromatographic method (ImmunoCard HpSA STAT) in detecting stool Helicobacter pylori antigen before and after eradication therapy. Two hundred forty dyspeptic patients (143 men and 97 women; mean age, 53.2 years old; range, 19–79 years old) volunteered to participate in this study. Those who delivered improper stool samples, including diarrhea, inadequate amount, or delayed delivery after collection, were excluded. All of the participants received endoscopy, biopsy-based tests, and noninvasive tests, including 13C-urea breath test ( 13C-UBT) and 2 stool antigen tests. Fifty-eight patients completed all the above tests before and after eradication therapy, and each contributed to 2 person-times. In total, there were 176 person-times in the preeradication group and 100 in the posteradication group that were analyzed for comparison. Follow-up endoscopic examinations were done 2 to 4 months after completion of eradication therapy, and stool samples were collected within 3 days after endoscopy. Positive H. pylori infection was established when either culture was positive or any 2 of the histology, rapid urease test, and UBT were positive. In the preeradication group ( n = 176), 99 (56.3%) were H. pylori positive and 77 were Hp negative. In the posteradication group ( n = 100), the treatment was successful in 67 (67.0%) of them. In the preeradication group, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were 95.2%, 87.0%, 90.4%, 93.1%, and 91.5%, respectively, for ImmunoCard HpSA STAT, and 83.8%, 90.9%, 92.2%, 81.4%, and 86.9%, respectively, for Premier Platinum HpSA. In the posteradication group, the sensitivity, specificity, PPV, NPV, and accuracy were 100%, 91.0%, 84.6%, 100%, and 94.0%, respectively, for ImmunoCard HpSA STAT, and 84.9%, 92.5%, 84.8%, 92.5%, and 90.0%, respectively, for Premier Platinum HpSA. There were no statistically significant differences between these 2 stool tests. ImmunoCard HpSA STAT is a rapid, simple, and accurate in-clinic test for preeradication diagnosis of H. pylori and posteradication follow-up.

Evaluation of two enzyme immunoassays for detecting Helicobacter pylori in stool specimens of dyspeptic patients after eradication therapy

The aim of the current study was to assess the reliability of two enzyme immunoassays in detecting the Helicobacter pylori status of stool specimens of Turkish dyspeptic patients in the post-treatment period. Forty-eight patients with non-ulcer dyspepsia who were positive for H. pylori underwent a 1 week regimen of triple therapy. Stool samples of patients were obtained 2 and 6 weeks after eradication therapy and a [13C]urea breath test was performed 6 weeks after therapy in order to assess the reliability of mAb-based (Amplified IDEIA HpStAR, DakoCytomation) and polyclonal-antiserum-based (Premier Platinum HpSA, Meridian Diagnostics) stool antigen test kits and to compare their diagnostic accuracies. Using a minimum cutoff OD450 value of 0.19 for Amplified IDEIA HpStAR and 0.16 for Premier Platinum HpSA the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the tests were determined 2 and 6 weeks after completion of eradication therapy. At both the second and the sixth week in the post-treatment period the diagnostic accuracy of Amplified IDEIA HpStAR was significantly better than the Premier Platinum's (75% versus 50%, S2=6.4; P=0.011, and 90% versus 69%, S2=6.316; P=0.012, respectively). In light of these findings the mAb-based Amplified IDEIA HpStAR has a high diagnostic accuracy for H. pylori infection in Turkish dyspeptic patients 6 weeks after completion of eradication therapy.

Helicobacter pylori infection reduces intraluminal nitric oxide in humans.

It has recently been demonstrated that nitric oxide (NO) is highly concentrated in the gastric lumen and plays an important role in defending against pathogenic microorganisms in the stomach. NO in the gastric lumen is mainly delivered by extrinsic sources from saliva. We studied whether Helicobacter pylori infection affected intraluminal NO levels in humans. H. pylori infection was diagnosed on the basis of histology and culture or (13C)-urea breath test. Air and gastric juice in the gastric lumen were collected endoscopically. The concentration of intraluminal NO was measured by a chemiluminescence system, using an NO analyzer. The concentration of nitrite in gastric juice was measured by the Griess reaction. The intraluminal concentration of NO in H. pylori-positive patients (198.2 +/- 41 parts per billion [ppb] mean +/- SE; n = 70) was significantly lower than that in H. pylori-negative patients (353.0 +/-57.9ppb; n = 43; P < 0.05). In contrast, the concentration of nitrite in gastric juice in H. pylori-positive patients (57.7 +/- 12.3 RM; n = 70) was significantly higher than that in H. pylori-negative patients (25.9 +/- 6.4 microM; n = 43, P < 0.01). The intraluminal concentration of NO in H. pylori-positive patients was markedly increased and the concentration of nitrite in H. pylori-positive patients was markedly decreased following the completion of eradication therapy. Based on these results, we propose that a decrease in NO and excess nitrite production in the gastric lumen are associated with H. pylori infection and may play an important role in the pathogenesis of H. pylori-related abnormalities.

Recurrence of peptic ulcer after successful eradication of Helicobacter pylori infection in the Japanese popultion: A prospective follow-up study

Background: Successful eradication of 11. pylori reduces the rate of duodenal ulcer (DU) relapses. Only a few studies in patients with gastric ulcer (GU) have been reported. Aim: To determine the recurrence rates of GUs or DUs after cure of H. pylori infection. Patients and Methods: A total of 236 patients who had successful eradication therapy, including 133 patients with GU, 89 patients with DU and 14 patients with gastro-duodenal ulcer (GDU), were enrolled in this study. Patients using nonsteroidal anti-inflammatory drugs (NSAIDs) at entry or taking maintenance antisecretory therapy after healing of ulcers were excluded. They were followed up endoscopically at 1, 3, 6 and every 12 months after the completion of eradication therapy and at any time when an ulcer symptom recurred, for assessment of ulcer healing and cure of 1-1. pylori infection. (mean follow-up period (range): 1.5 year (0.5 4.5 years)) Biopsy specimens were taken from both the antrum and corpus. H. pylori status was assessed by rapid urease tests, histological examination (hematoxyllin and eosin stain and Giemsa stain), culture and 13C-urea breath test. Results: