Helicobacter Pylori Therapy Research Articles

Helicobacter pylori and Gastro-oesophageal Reflux Disease: Association and Clinical Implications: To Treat or Not to Treat with anti- H. pylori Therapy?

Background : It has been reported that patients are at risk of developing reflux oesophagitis after successful anti- Helicobacter pylori therapy, and the presence of the bacterium might be protective against the development of reflux oesophagitis. Methods : Review of the literature. Results : H. pylori is relevant to the management of oesophagitis because it increases the pH-elevating effect of proton-pump inhibitors, which increase the tendency of H. pylori gastritis to progress to atrophic gastritis, and because eradication of H. pylori increases the likelihood of oesophagitis. H. pylori increases basal gastrin levels, basal acid output, meal-stimulated maximal acid output and 24-h intragastric acidity. The effects on gastric acid production depend on the distribution of gastritis in the stomach. Conclusion : H. pylori eradication may induce or exacerbate gastro-oesophageal reflux by its influence on gastric acidity and the antisecretory action of proton-pump inhibitors.

Current Features of Peptic Ulcer Disease in Finland: Incidence of Surgery, Hospital Admissions and Mortality for the Disease During the Past Twenty-five Years

Background: Medical therapy of peptic ulcer disease (PUD) has improved dramatically during the past 20 years with the introduction of modern antisecretory drugs as well as eradication therapy of Helicobacter pylori. During the 1990s, there has been a 3-fold increase in the consumption of histamine2-receptor antagonists and proton-pump inhibitors, but also an 8-fold increase in the consumption of nonsteroidal anti-inflammatory drugs (NSAIDs) in Finland. Methods: The incidence of surgery, hospital admissions and mortality for PUD was analysed between 1972 and 1999; the data were collected from the National Research and Development Centre for Welfare and Health and from the National Centre for Statistics. In the analysis, the codes of the International Statistical Classification of Diseases 8-10 were used. Results: In 1987, 11.9 elective operations (per 10 5 inhabitants) were performed (mean of 2 consecutive years), but only 1.3 in 1997, a reduction of 89%. In 1987, 5.2 emergency operations for ulcer perforation or bleeding were performed, whereas there were 7.5 in 1997, an increase of 44%. The annual hospital admission rate increased from 38.3 admissions (per 10 5 inhabitants) in 1972 (mean ± s (standard deviation) of 5 consecutive years) to 68.7 in 1992. This 79% increase was mainly due to bleeding from gastric ulcer in elderly women. The overall annual mortality rate increased between 1972 and 1992 from 6.4 to 8.4 deaths (per 10 5 inhabitants), i.e. by 31%. The mortality rate from ulcer perforation and haemorrhage increased from 4.2 deaths in 1972 to 7.3 deaths in 1992, i.e. by 74%. Conclusions: The increasing incidence rates of emergency surgery, hospital admissions and mortality for PUD in the 1980s and 1990s have started to decrease in the most recent years in Finland. This epidemiologic change probably reflects both the demographic change and an increased consumption of NSAIDs, among the elderly people, in particular. The most recent epidemiologic change may reflect an increased consciousness about the harmful effects of conventional NSAIDs. Regardless of the constantly occurring emergency surgery, elective surgery for PUD is hardly ever required today.

Review: Helicobacter pylori therapy does not reduce symptoms in nonulcer dyspepsia

Source Citation Laine L, Schoenfeld P, Fennerty MB. Therapy for Helicobacter pylori in patients with nonulcer dyspepsia. A meta-analysis of randomized, controlled trials. Ann Intern Med. 2001 Mar 6;134:361-9. 11242496

Comparison of standard dose rabeprazole and double dose omepazole in PPI-bassed triple therapy for Helicobacter pylori infection-a randomized clinical trial

Comparison of standard dose rabeprazole and double dose omepazole in PPI-bassed triple therapy for Helicobacter pylori infection-a randomized clinical trial

Treatment failures and secondary resistance to antibiotics. A growing concern in Helicobacter pylori therapy

Treatment failures and secondary resistance to antibiotics. A growing concern in Helicobacter pylori therapy

Therapy of Helicobacter pylori: current status and issues

Therapy of Helicobacter pylori: current status and issues

Effect of pretreatment antibiotic resistance to metronidazole and clarithromycin on outcome of Helicobacter pylori therapy: a meta-analytical approach.

Our purpose was to define the effect of pretreatment Helicobacter pylori resistance to metronidazole or to clarithromycin on the success of antimicrobial therapy. We used 75 key words to perform a literature search in MEDLINE as well as manual searches to identify clinical treatment trials that provided results in relation to H. pylori susceptibility to metronidazole and clarithromycin or both during the period 1984-1997 (abstracts were not included). Meta-analysis was done with both fixed- and random-effect models; results were shown using Galbraith's radial plots. We identified 49 papers with 65 arms for metronidazole (3594 patients, 2434 harboring H. pylori strains sensitive to metronidazole and 1160 harboring resistant strains). Metronidazole resistance reduced effectiveness by an average of 37.7% (95% CI = 29.6-45.7%). The variability in the risk difference for metronidazole was 122.0 to -90.6 and the chi-square value for heterogeneity was significant (P<0.001). Susceptibility tests for clarithromycin were performed in 12 studies (501 patients, 468 harboring H. pylori strains sensitive to clarithromycin and 33 harboring resistant strains). Clarithromycin resistance reduced effectiveness by an average of 55% (95% CI = 33-78%). We found no common factors that allowed patients to be divided into subgroups with additional factors significantly associated with resistance. In conclusion, metronidazole or clarithromycin pretreatment resistant H. pylori are the main factors responsible for treatment failure with regimens using these compounds. If H. pylori antibiotic resistance continues to increase, pretherapy antibiotic sensitivity testing might become necessary in many regions.

Has the impact of helicobacter pylori therapy on ulcer recurrence in the united states been overstated? A meta-analysis of rigorously designed trials

Has the impact of helicobacter pylori therapy on ulcer recurrence in the united states been overstated? A meta-analysis of rigorously designed trials

One week triple therapy for Helicobacter pylori

One week triple therapy for <i>Helicobacter pylori</i>

A quadruple therapy for Helicobacter pylori in a region with high metronidazole resistance

A quadruple therapy for Helicobacter pylori in a region with high metronidazole resistance

Do incurable gastric and duodenal ulcers really exist since the appearance of proton pump inhibitors and eradication therapy of Helicobacter pylori?

Do incurable gastric and duodenal ulcers really exist since the appearance of proton pump inhibitors and eradication therapy of Helicobacter pylori?

Study of the usefulness of measurement of serum pepsinogen in eradication therapy of Helicobacter pylori

Study of the usefulness of measurement of serum pepsinogen in eradication therapy of Helicobacter pylori

Accuracy of CLOtest after Helicobacter pylori therapy

Background: The accuracy of rapid urease testing after Helicobacter pylori therapy has not been widely studied and might be diminished because of decreased numbers of organisms. We assessed CLOtest results after therapy in two randomized, double-blind trials. Methods: A total of 233 patients (in two separate studies) with true-positive baseline CLOtests (by histology or culture) received 2 weeks of omeprazole/amoxicillin, omeprazole, or amoxicillin. In study 1, patients received an additional 2 weeks of omeprazole therapy (20 mg/day) or placebo; no additional therapy was given in study 2. Endoscopy was repeated 4 weeks after completion of therapy in both studies. A diagnosis of cure required at least two negative endoscopic biopsy tests (histology, culture, CLOtest) and no positive tests. Results: After therapy, 178 patients (76%) remained positive for H. pylori by histology and/or culture for both studies combined. Post-therapy CLOtest sensitivity was 86% and specificity was 95%. Sensitivity was poorer in patients after dual therapy than after monotherapy in both study 1 (68% vs. 89%; p = 0.03) and study 2 (75% vs. 94%; p = 0.03). Conclusions: CLOtest sensitivity after therapy was lower than expected in our large group of patients with baseline true-positive CLOtests. In addition, sensitivity was lower after the use of more effective therapy (i.e., dual therapy as compared with monotherapy). Although most patients with unsuccessful treatment will be identified with the CLOtest alone, a negative result should not be taken as diagnostic of eradication. (Gastrointest Endosc 1998;47:250-3.)

Comparison of Colloidal Bismuth Subcitrate and Metronidazole, Both in Combination with an H2-Antagonist as Therapy for Helicobacter pylori

In this random study, the efficacy of either colloidal bismuth subcitrate (CBS) or metronidazole in combination with an H2-antagonist in the treatment of various gastric pathologies was evaluated, along with the trends in antibody levels. Among the 40 Helicobacter pylori-positive patients with various gastroduodenal pathologies who underwent chemotherapy, 27 were treated with CBS and 13 with metronidazole. H. pylori was eradicated in 48.14% of the patients treated with CBS and 53.8% of those treated with metronidazole. After therapy, no statistically significant or slight decrease in the serum levels of antibodies was found.

Effect of anti- Helicobacter pylori therapy on inflammatory cell infiltration and acquired malt in gastric mucosa: A morphometric study by means of computer-assisted image analysis

Effect of anti- Helicobacter pylori therapy on inflammatory cell infiltration and acquired malt in gastric mucosa: A morphometric study by means of computer-assisted image analysis

Closing Remarks H2-Receptor Antagonists andHelicobacter pyloriEradication

Background: To discuss the place of histamine H2-receptor antagonists in eradication therapy of Helicobacter pylori. Methods: Analysis of two papers in this supplement and the relevant literature. Results: Triple therapy comprising ranitidine and two antibiotics is effective in speeding up healing of duodenal ulcer and eradicating H. pylori from the stomach. Conclusion: Ranitidine is to be considered as a valuable and safe component of triple therapy against H. pylori in duodenal ulcer patients.

Dual therapy in GI disease

Eradication therapies for Helicobacter pylori using a proton pump inhibitor and an antibacterial are beginning to challenge the notoriously unpleasant and complicated triple therapy regimens (bismuth chelate, metronidazole, and either tetracycline or amoxicillin). Dual therapy appears to be more convenient to use, with fewer adverse effects. Accordingly, clinicians are likely to be more receptive to its use in their patients. This situation brings with it an urgent need for clarification of the appropriate role of eradication treatments.