Helicobacter Pylori-associated Peptic Ulcer Research Articles

Уровни оксида азота и эндотелина-1 в крови при Helicobacter pylori-ассоциированной язвенной болезни у детей

Актуальность. В последние годы многие ученые подчеркивают определяющую роль сосудистой стенки в регуляции агрегатного состояния крови, а также значение ее нарушений в развитии заболеваний пищеварительной системы. Однако до настоящего времени отсутствуют данные о роли Helicobacter pylori в развитии эндотелиальной дисфункции. Цель: оценить характер изменений уровня оксида азота (NO) и эндотелина-1 в крови детей при эрозивно-язвенных поражениях верхних отделов желудочно-кишечного тракта. Материалы и методы. Проведено комплексное клиническое и инструментально-лабораторное обследование 120 детей с хроническим эрозивным гастродуоденитом (79 человек) и язвенной болезнью двенадцатиперстной кишки (41 человек) в возрасте 7–18 лет (основная группа) и 50 детей соответствующего возраста без патологии пищеварительной системы (группа сравнения). Всем детям проводилось тщательное клинико-параклиническое исследование по общепринятым в клинике методикам. Концентрацию нитритов в плазме крови определяли по методике П.П. Голикова (2004). Исследование уровня эндотелина-1 в сыворотке крови проводилось с помощью метода иммуноферментного анализа с использованием наборов фирмы Biomedicagruppe (Германия). Результаты исследования представлены количеством наблюдений в группе, процентами или средним и среднеквадратичным отклонением, точным значением р. Результаты. Дети были распределены по возрасту, полу, месту жительства и нозологической форме патологии. Уровень NО в плазме крови детей основной группы был достоверно ниже и составлял 11,78 ± 1,10 мкмоль/л, р < 0,05. При внутригрупповом анализе в обеих группах обследованных детей достоверной разницы между содержанием NО в крови в зависимости от пола и возраста не выявлено (р > 0,05). При отсутствии Helicobacter pylori уровень NО в крови достоверно выше по сравнению с группой больных, в которой диагностирована Helicobacter pylori-ассоциированная патология (р < 0,05). Выявлена разница в уровнях NO в крови детей в зависимости от периода болезни: его уровень выше в период обострения как хронического эрозивного гастродуоденита, так и язвенной болезни двенадцатиперстной кишки. В среднем у детей основной группы уровень эндотелина-1 в крови был достоверно ниже такового у детей группы сравнения — 0,36 ± 0,02 фмоль/мл и 0,48 ± 0,02 фмоль/мл соответственно, p < 0,01. Уровень эндотелина-1 в крови детей также зависел от наличия Helicobacter pylori. Выводы. Уровни метаболитов NО и эндотелина-1 достоверно снижены в крови детей с эрозивно-язвенной патологией верхних отделов желудочно-кишечного тракта, зависят от периода заболевания и наличия Helicobacter pylori и не зависят от возраста и пола.

Helicobacter pylori infection and nonmalignant diseases.

A substantial decrease in Helicobacter pylori-associated peptic ulcer disease has been observed during the last decades. Drug-related ulcers as well as idiopathic ulcers are becoming predominant and are more refractory to treatment; however, H. pylori infection still plays an important role in ulcer bleeding and recurrence after therapy. The effect of H. pylori eradication upon functional dyspepsia symptoms has been reviewed in this article and generally confirms the results of previous meta-analyses. Additional evidence suggests a lack of impact upon the quality of life, in spite of improvement in symptoms. The association of H. pylori with gastroesophageal reflux disease and Barrett's esophagus remains controversial with a majority of published studies showing a negative association. Furthermore, a strong inverse relationship between the presence of H. pylori and the esophageal eosinophilia was also reported. Several studies and a review addressed the role of H. pylori in autoimmune gastritis and pernicious anemia. The association of the above still remains controversial. Finally, the necessity of routine endoscopy and H. pylori eradication before bariatric surgery is discussed. Several studies suggest the rationale of preoperative upper endoscopy and H. pylori eradication prior to surgery. However, the prevalence of H. pylori infection prior to surgery in these studies generally reflects the overall prevalence of the infection in the particular geographic area. In addition, results on the role of H. pylori in developing postoperative complications remain controversial.

Interval hypoxic training in complex treatment of Helicobacter pylori-associated peptic ulcer disease.

This study was aimed to demonstrate the efficacy of interval hypoxic training (IHT) in complex treatment of Helicobacter pylori-associated duodenal peptic ulcer disease (DPUD) by parameters of aerobic metabolism and indexes of heart rate variability (HRV). Eighty patients with H. pylori-associated DPUD were included into the study, mean age 32+/-1.8 yrs, duration of the disease up to 10 years (66.3 %). IHT was modulated using Frolov's hypoxicator (TDI-01) for 30 days after standard eradication therapy. Daily hypoxic sessions consisted of three one-minute sessions, one two-minute, and one three-minute sessions separated by one-minute intervals of room-air breathing. Use of IHT resulted in more efficient elimination of clinical symptoms, histological hallmarks of inflammation and signs of oxidative stress in glandulocytes of the gastric mucosa as determined by 4-hydroxynonenal accumulation. Moderate prooxidant activity of IHT was demonstrated by the increased level of TBARS and oxidatively modified products, normalization of hydroperoxides, middle mass molecules and atherogenic beta-lipoproteins with simultaneous increase in catalase activity and mild decline of SOD activity. Therefore, IHT appeared to be accompanied by higher intensity of redox reactions and enhanced regeneratory processes in cells and tissues. Significant increase in HRV was also noted. Such changes were associated with reduction of inflammation signs and modulation of the autonomic homeostasis in DPUD patients. In general, use of IHT in complex treatment of H. pylori in DPUD patients can be recommended to increase resistance to oxidative stress and to modulate autonomic balance and oxidative homeostasis.

Carbamazépine et clarithromycine : une interaction médicamenteuse cliniquement significative

Carbamazepine is associated with clinically relevant drug interactions especially with macrolide antibiotics such as troleandomycin and erythromycin. These drugs inhibit the metabolism of carbamazepine. Clarithromycin, a macrolide antibiotic similar to erythromycin, is widely used to treat respiratory tract infections and is used for the treatment of atypical mycobacterial infections and Helicobacter pylori-associated peptic ulcer disease. To report an interaction between carbamazepine and clarithromycin, we present a study that includes three regular attenders at the epilepsy department of Montpellier and seven cases reported by the French national drug safety center. In patients receiving carbamazepine alone or in combination with other drugs, administration of clarithromycin led to a transitory overdosage (ataxia, dizziness, diplopia, nausea, vomiting, drowsiness). Blood level was available in 8 patients with a concentration of carbamazepine ranging from 13.3 to 28.5 mg/l. Carbamazepine is extensively metabolized by cytochrome P450 enzymes, especially CYP34A. As clarithromycin is also metabolized by CYP3A4, this drug has the propensity to inhibit the metabolism of carbamazepine. Clarithromycin should be thus avoided in patients taking carbamazepine.

Stability of metronidazole, tetracycline HCl and famotidine alone and in combination

Metronidazole, tetracycline HCl and famotidine are commonly used for the treatment of Helicobacter pylori-associated peptic ulcer. In this paper, stabilities of these drugs and their combinations in solid and liquid states were studied as part of preformulation in the development of a combination drug delivery system. Solubility studies of metronidazole and tetracycline HCl were investigated, which indicated that both metronidazole and tetracycline HCl have high solubilities at and around pH 2.0. Metronidazole is relatively stable with little degradation in liquid phase. Tetracycline HCl in the dry state is stable when stored at room temperature regardless of exposure to light or humidity in the range of 20–65%. Enhanced temperature associated humidity effect was responsible for the instabilities of tetracycline HCl and famotidine to different extents. Elevated temperature accelerated the degradation of all the drugs in liquid phase but light exposure was not a factor for the degradation. The degradation processes of tetracycline HCl and famotidine were highly dependent on the pH of the solution, and relatively stable profiles were achieved at pH 4.0. No potential incompatibility between the drugs under storage conditions was observed in the development of a new multi-drug delivery tablet.

Antigen stool test for assessment of Helicobacter pylori infection in patients with upper gastrointestinal bleeding.

Re-bleeding of Helicobacter pylori-associated peptic ulcer disease is reduced by H. pylori eradication. To validate a non-invasive test, the Premium Platinum HpSA stool test, in patients with upper gastrointestinal bleeding. Stool samples of consecutive patients with relevant bleeding from gastric or duodenal ulcers or erosions were collected at initial endoscopy and during the following week. Samples were assessed using the HpSA test. H. pylori status was defined by three biopsy-based reference methods: culture, rapid urease test and histology. It was positive if culture was positive or if rapid urease test and histology were positive. One hundred and fourteen patients (mean age, 66 years) were included. In accordance with the definition, 56 (49%) were H. pylori positive. The sensitivity and specificity of the first stool sample were 84% and 90%, respectively. The respective values for two samples from consecutive days were 91% and 86%. In comparison with a serum immunoglobulin G antibody enzyme-linked immunoabsorbent assay, the HpSA test showed superior specificity. The diagnostic accuracy, in particular the sensitivity, of the HpSA stool test is reduced by upper gastrointestinal bleeding. The positive predictive value of 89%, however, justifies the initiation of eradication therapy on the basis of a positive stool test. A negative test result should be confirmed by a further diagnostic method.

H. pylori eradication: new role for the pharmacist?

The American Society of Health-System Pharmacists (ASHP) has published therapeutic position statements on a select group of disease states. The ASHP directors created an advisory body called the Commission on Therapeutics to be concerned with societal drug use and therapeutic issues. The ASHP therapeutic position statement on the identification and treatment of Helicobacter pylori-associated peptic ulcer disease in adults was developed by this organization after an extensive review of the available literature and consensus panel guidelines. The purpose of the article is to summarize testing options for identifying H. pylori infection, effective treatment regimens for eradicating H. pylori infection, and the role and impact of antimicrobial resistance, and to stress the importance of pharmacists’ involvement in identifying and treating patients with H. pylori-associated disease. The complexity of treatment regimens heightens the importance of patient education and monitoring to ensure compliance and optimal response to therapy. The article is divided into several sections, beginning with an informative background review of H. pylori infection including incidence, complications, and relationship to peptic ulcer disease. The first major topic addressed is testing for H. pylori infection. This section is followed by a review of six treatment regimens. The last two sections include a review of the impact of antimicrobial resistance and the role of the pharmacist as a resource in managing the H. pylori-infected patient.

H. pylori eradication: new role for the pharmacist?

Abstract The American Society of Health-System Pharmacists (ASHP) has published therapeutic position statements on a select group of disease states. The ASHP directors created an advisory body called the Commission on Therapeutics to be concerned with societal drug use and therapeutic issues. The ASHP therapeutic position statement on the identification and treatment of Helicobacter pylori-associated peptic ulcer disease in adults was developed by this organization after an extensive review of the available literature and consensus panel guidelines. The purpose of the article is to summarize testing options for identifying H. pylori infection, effective treatment regimens for eradicating H. pylori infection, and the role and impact of antimicrobial resistance, and to stress the importance of pharmacists’ involvement in identifying and treating patients with H. pylori-associated disease. The complexity of treatment regimens heightens the importance of patient education and monitoring to ensure compliance and optimal response to therapy. The article is divided into several sections, beginning with an informative background review of H. pylori infection including incidence, complications, and relationship to peptic ulcer disease. The first major topic addressed is testing for H. pylori infection. This section is followed by a review of six treatment regimens. The last two sections include a review of the impact of antimicrobial resistance and the role of the pharmacist as a resource in managing the H. pylori-infected patient.

Declining prevalence of Helicobacter pylori-associated peptic ulcer disease: Results of a prospective study of 160 patients

Declining prevalence of Helicobacter pylori-associated peptic ulcer disease: Results of a prospective study of 160 patients

Declining prevalence of Helicobacter pylori-associated peptic ulcer disease: Results of a prospective study of 160 patients

Declining prevalence of Helicobacter pylori-associated peptic ulcer disease: Results of a prospective study of 160 patients

ASHP therapeutic position statement on the identification and treatment of Helicobacter pylori-associated peptic ulcer disease in adults. Developed by the ASHP Commission on Therapeutics and approved by the ASHP Board of Directors on November 11, 2000.

ASHP supports the identification and treatment of H. pylori infection in appropriate patients as an effective method of reducing the morbidity and mortality associated with peptic ulcer disease. Successful and safe therapy requires extensive patient education and monitoring by qualified health care professionals to maximize patient understanding of and compliance with medication regimens and to minimize adverse events. Pharmacists are key to ensuring that patients use prescribed regimens appropriately so that H. pylori is eradicated and that clinical outcomes of associated peptic ulcer disease are optimal.

Helicobacter pylori-associated peptic ulcer disease in older patients: current management strategies.

The incidence of peptic ulcer and its severe complications, i.e. bleeding or perforation, is increasing in elderly patients worldwide. The prevalence of Helicobacter pylori infection in patients with peptic ulcer aged over 65 years has been reported to range from 58 to 78%. However, in elderly patients hospitalised for ulcer disease, the rate of diagnostic screening or treatment for H. pylori infection was less than 60%, and only 50 to 73% of patients who had a positive H. pylori test were treated with antibacterials. The eradication of H. pylori infection is known to be of proven benefit for elderly patients with H. pylori-associated ulcer disease. Significant improvement of the clinical outcome, and reduction of ulcer recurrences, symptoms and histological signs of ulcer-associated chronic gastritis activity, as well as decreased costs in elderly healthcare, all result from successful therapy. Proton pump inhibitor (PPI)-based triple therapy regimens including clarithromycin, amoxicillin and/or nitroimidazoles are highly effective and well tolerated in elderly patients, particularly if therapy is of a short duration and low doses of both the PPI and clarithromycin are used. Resistance of H. pylori to antibacterials and low compliance are the major reasons for treatment failure. Surveillance of H. pylori susceptibility to antibacterials at the regional level and enhanced compliance programmes give promising results that suggest new approaches to anti-H. pylori treatment, especially in elderly patients. The role of H. pylori infection in nonsteroidal anti-inflammatory drug (NSAID)-related peptic ulcer still remains controversial. At present, no clear evidence supports the testing and treatment of H. pylori infection for the prevention of drug-related peptic ulcer in elderly patients receiving an NSAID or aspirin (acetylsalicylic acid). After therapy, elderly patients with peptic ulcer may be re-evaluated by invasive methods, i.e. endoscopy and gastric biopsies. or by noninvasive methods. In elderly patients, the 13C-urea breath test demonstrated significantly higher sensitivity, specificity and diagnostic accuracy for detecting H. pylori infection than anti-H. pylori antibodies.

The Long-Term Clinical Outcome of Elderly Patients with Helicobacter pylori-Associated Peptic Ulcer Disease

The objective of this study was to evaluate the long-term efficacy of Helicobacter pylori (HP) eradication treatment in elderly patients with HP-associated peptic ulcer. A total of 56 subjects, 25 affected with gastric ulcer (GU, 9 males, 16 females, mean age 77.8 years, range 67–93) and 31 with duodenal ulcer (DU, 19 males, 12 females, mean age 76.5 years, range 65–87) were confirmed to be HP-positive by gastric histology and the rapid urease test. All patients were then consecutively treated with omeprazole for 4 weeks plus one or two antibiotics for 1 week as anti-HP treatment. Clinical checkups were then performed every 3 months for 1 year for the evaluation of symptoms and clinical recurrences. Endoscopy with gastric biopsies was repeated after 1, 3 and 12 months for the evaluation of ulcer healing, HP infection and chronic gastritis activity. Statistical analysis was performed by means of the Student t test for unpaired data, the Fisher exact test (two-tailed), and the McNemar χ² test. After 4 weeks of treatment, endoscopy confirmed healing of the ulcer in all patients, regardless of the treatment used to cure HP infection. Two months after the end of therapy, a total of 44 patients were HP-negative and 12 patients were still HP-positive. During the 1-year follow-up period 1/44 (2.2%) of the HP-eradicated patients and 5/12 (41.6%) of the still HP-positive patients suffered relapses (p = 0.001): the difference between the two groups remained statistically significant when patients were divided into the subgroups, GU (p = 0.01) and DU (p = 0.04). Two months after the end of therapy, there was still a significant reduction of symptoms both in HP-eradicated (p < 0.0000) and in HP-positive (p = 0.002) patients. After 1 year, however, there was a significantly decreased symptomatology only in HP-eradicated subjects (p < 0.0000) and not in patients still HP-positive. After both 2 months and 1 year of follow-up, chronic gastritis activity demonstrated a significant improvement only in HP-eradicated patients (p = 0.0000). In conclusion, the eradication of HP infection significantly improved the long-term clinical outcome of peptic ulcer disease in the elderly, reducing the recurrences of GU and DU, the patient’s symptomatology and the histological signs of chronic gastritis activity. The cure of HP infection is, therefore, strongly recommended in elderly patients with HP-associated peptic ulcer disease.

Clinical economics review: Helicobacter pylori-associated peptic ulcer disease.

The high prevalence and chronic nature of peptic ulcer disease have traditionally resulted in a major economic burden on health care systems. In 1991, for example, peptic ulcer disease was estimated to account for over one-third of all National Health Service expenditure on gastrointestinal diseases. It is now well established that elimination of Helicobacter pylori can lead to a dramatic reduction in gastroduodenal ulcer relapse, with obvious clinical benefits. This review considers the economic implications of the use of H. pylori eradication therapy in peptic ulcer disease.

Clinical Efficacy of Lansoprazole in Eradication of Helicobacter pylori

A randomized, single-blind study was designed to assess the effect of lansoprazole alone and lansoprazole plus amoxicillin on the healing and eradication rates in Helicobacter pylori-associated peptic ulcer disease. Seventy-nine patients with gastric ulcers and 54 patients with duodenal ulcers were randomly assigned to two treatment groups. Group 1 received lansoprazole 30 mg daily for 8 weeks for gastric ulcers or 6 weeks for duodenal ulcers. Group 2 received the group 1 regimen plus amoxicillin 2 g daily for 2 weeks. Healing rates at 8 weeks for the gastric ulcer patients were 92 and 84% in groups 1 and 2, respectively (p = not significant). Healing rates at 6 weeks for duodenal ulcers were 96% in group 1 and 100% in group 2 (p = not significant). The eradication rates of H. pylori for gastric ulcer patients were 21 and 54% in groups 1 and 2, respectively (p < 0.05). The H. pylori eradication rates for duodenal ulcer patients were 5 and 73% in groups 1 and 2, respectively (p < 0.001). The H. pylori eradication rates in group 2 were significantly higher than in group 1. Lansoprazole was effective for eradicating H. pylori in this study.

Helicobacter pylori-Associated Peptic Ulcer in Heterotopic Gastric Mucosa Within Ileal Duplication

A 12-year-old boy, operated on for remitting abdominal pain and hematochezia, had an ileal duplication, with Helicobacter "gastritis" under a chronic peptic ulcer in the ectopic fundic gastric mucosa. We suggest the Helicobacter infection might have played a role in the pathogenesis of the inflammation and the peptic ulceration in this rare location.

Accuracy of a rapid 10-minute carbon-14 urea breath test for the diagnosis of Helicobacter pylori-associated peptic ulcer disease.

Urease in the human gastric mucosa is a marker for infection with Helicobacter pylori (HP), an organism which is associated with peptic ulcer disease. To detect gastric urease, we examined 184 patients (144 males, 40 females; mean age: 49.8 +/- 15.6 years) with suspected peptic ulcer disease. Fasting patients were given orally 5 microCi of carbon-14 labelled urea. From each patient only one breath sample was collected in hyamine at 10 min. The amount of 14C collected at 10 min was expressed as follows: [(DPM/mmol CO2 collected)/(DPM administered)] x 100 x body weight (kg). The presence of HP colonization was determined by examination of multiple endoscopic prepyloric antral biopsy specimens subjected to culture or a rapid urease test. For the purpose of this study, HP-positive patients were defined as those with characteristic bacteria as indicated by a positive result of either the culture or the rapid urease test; HP-negative patients were defined as those with negative findings on both the culture and the rapid urease test. Of the 184 cases, 99 (53.8%) were positive for HP infection, and 85 (46.2%), negative. The sensitivity and specificity of the rapid 10 min 14C-urea breath test for the diagnosis of HP-associated peptic ulcer disease were evaluated by a receiver operating characteristic (ROC) curve with a variable cut-off value from 1.5 to 4.5. When a cut-off value of 1.5 was selected, the sensitivity was 100% and the specificity, 83.5%; when a cut-off value of 4.5 was selected, the sensitivity was 54.5% and the specificity, 97.6%.

Influence of colloidal bismuth subcitrate on enzyme secretion from isolated rat pancreatic acinar cells.

Bismuth salts are currently used as monotherapy or in combination with antibiotics for the treatment of Helicobacter pylori-associated peptic ulcer disease. Besides encouraging clinical results with colloidal bismuth subcitrate (CBS), there is an ongoing fear of organ toxicity with the use of bismuth salts. To study potential toxic effects of CBS under short-term exposure, we tested the influence of CBS on amylase secretion from isolated rat pancreatic acinar cells under basal conditions and following carbachol (CCh) and ceruletide (CRT) stimulation. Basal secretion was reduced by 8.9 +/- 9.6% (n = 10) (mean +/- SEM) (P < 0.05), 5.2 +/- 9.2% (P < 0.05), 9.4 +/- 6.4% (P < 0.01), and 6.2 +/- 12.2% (P < 0.05) with 0.001, 0.01, 0.1, and 1 micrograms/ml CBS, respectively. With 10 micrograms/ml and 100 micrograms/ml CBS, basal amylase secretion was increased in a dose-dependent manner, by 13.7 +/- 11.7% (P < 0.05) and 24.5 +/- 12.8% (P < 0.01). CCh (10(-5) M)- and CRT (3 x 10(-10) M)-stimulated secretory responses were not altered significantly by any of the CBS doses used. In concentrations above 1 microgram/ml, CBS increased pancreatic amylase secretion. Amylase secretion in response to secretagogues was not affected by CBS. These findings are unlikely to be associated with a toxic effect of CBS on exocrine pancreatic acinar cell function.