scholarly journals Eradication Therapy Should Be Different for Dyspeptic Patients than for Ulcer Patients

2003 ◽  
Vol 17 (suppl b) ◽  
pp. 41B-45B ◽  
Author(s):  
Wink A de Boer
Keyword(s):  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Eradication Therapy ◽  
Cure Rate ◽  
Ulcer Disease ◽  
Biological Explanation ◽  
Choice Of Treatment ◽  
H Pylori ◽  
Different Strains ◽  
Cure Rates

Physicians should try to achieve an optimal cure rate with their initialHelicobacter pylorieradication therapy. Most physicians use the same treatment in all their patients.H pyloriinfection 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+,vacAtype s1] compared with nonvirulent strains [cagA–,vacAtype 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 initialHelicobactereradication therapy from seven to 10 to 14 days in patients without ulcers.

scholarly journals Role of Probiotics in Helicobacter pylori Eradication: Lessons from a Study of Lactobacillus reuteri Strains DSM 17938 and ATCC PTA 6475 (Gastrus®) and a Proton-Pump Inhibitor

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Maria Pina Dore ◽  
Stefano Bibbò ◽  
Giovanni Mario Pes ◽  
Ruggero Francavilla ◽  
David Y. Graham
Keyword(s):  
Helicobacter Pylori ◽  
Lactobacillus Reuteri ◽  
Eradication Therapy ◽  
Cure Rate ◽  
Double Blind ◽  
Antibiotics Use ◽  
Incremental Improvement ◽  
H Pylori ◽  
Meta Analyses ◽  
Cure Rates

Background. Meta-analyses involving >4000 subjects with probiotics added to antimicrobial Helicobacter pylori eradication therapy have reported a mean increase in the eradication rate of 12 to 14%. It is unclear how to translate that result into clinical practice. Aim. To evaluate whether administration of Lactobacillus reuteri plus a PPI without antibiotics would eradicate H. pylori infections. Methods. This was a double-blind placebo-controlled randomized 2-site study of L. reuteri (Gastrus®) at a dose of 2 × 108 CFU, 7 times per day, or matching placebo plus 20 mg pantoprazole b.i.d. for 4 weeks. Cure was defined by negative 13C-UBT, 4 weeks after therapy. Sample size required ≥50% cure rates for using probiotics as a clinically useful monotherapy. Results. Recruitment was halted after 56 subjects because of the low cure rate; there were 8 dropouts; 48 subjects completed therapy (71% women, average age 49 years). The cure rates per protocol were 3/24 (12.5%; 95% CI 2.6–32%) with L. reuteri vs. 1/24 (4.1%) with placebo. Side effects (most often diarrhea) occurred infrequently (in 5/28 vs. 3/28; active vs. placebo therapy) (P=0.53). Conclusion. L. reuteri plus a PPI therapy was unable to provide a clinically important rate of H. pylori eradication. The cure rate albeit low (12.5%) was essentially identical to that achieved when probiotics were added to antibiotic therapy. The incremental improvement was additive and independent of antimicrobial resistance or antibiotics use. Probiotics can reliably increase the cure rate to ≥90% only in regimens achieving cure rates of ∼80%. This trial is registered with NCT03404440.

scholarly journals Helicobacter pylori: Basic Mechanisms to Clinical Cure

1995 ◽  
Vol 9 (2) ◽  
pp. 91-95 ◽  
Author(s):  
ABR Thomson ◽  
CN Williams
Keyword(s):  
Gastric Cancer ◽  
Duodenal Ulcer ◽  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Clinical Cure ◽  
Eradication Therapy ◽  
Dual Therapy ◽  
Quadruple Therapy ◽  
Ulcer Disease ◽  
H Pylori

Since its rediscovery 10 years ago,Helicobacter pylorihas reshaped our thinking about the course of peptic ulcer disease. Our approach to the patient with a duodenal ulcer has become one of attempting eradication therapy at the time of first diagnosis, in the hope of curing the ulcer disease. Gastric and duodenal ulceration are only two of the manifestations of this chronic antral infection; other complications ofH pyloriinclude gastritis, gastric cancer and possible maltomas. Therapy ofH pyloriinfection is complicated and involves dual therapy with an antibiotic plus a protein pump inhibitor, such as omeprazole 20 mg bid plus amoxicillin 1 g bid for two weeks, triple or quadruple therapy with bismuth, two antibiotics and an H2-receptor antagonist. Vaccination againstH pyloriis on the far horizon.

scholarly journals The Effect of Probiotic Supplement as Adjuvant Therapy on Dyspeptic Symptoms and Quality of Life during Helicobacter pylori Eradication Therapy in a Sample of Iraqi Patients with Peptic Ulcer Disease

2018 ◽  
pp. 151-162
Keyword(s):  
Quality Of Life ◽  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Side Effects ◽  
Adverse Effects ◽  
Eradication Therapy ◽  
Study Group ◽  
Ulcer Disease ◽  
H Pylori

Infection with Helicobacter pylori (H. pylori) had been associated with development of certain symptoms in addition to the use of standard eradication triple therapy has resulted in the increased incidence of undesirable side effects, which can lead to reduced compliance. Probiotics have been proposed to contribute to their efficacy in increasing H. pylori eradication and decreasing side effects when used together with eradication therapy. This study was intended to minimize the side effects of antibiotics therapy and the symptoms associated with peptic ulcer disease (PUD) and improving patient's quality of life (QOL). This interventional prospective randomized- controlled, open-label study was carried out on 77 patients diagnosed with positive H. pylori infection during the period from September 2017 to April 2018. The incidence and intensity of symptom score that caused by adverse effects of both infection and therapy were highly significantly decrease in terms of epigastric pain, bloating, flatulence, taste disturbance, loss of appetite, nausea, vomiting, and heartburn after 2 months of treatment within each study group correspondingly all domains of the quality of life were significantly improved in all patients after H. pylori eradication within each study group. From the present study concluded that the administra¬tion of probiotics as adjuvant to standard triple therapy may suggest a role in improving the symptoms and reduce the adverse effects accompanying with the eradication therapy for H. pylori thus improving patient's quality of life.

scholarly journals Prevalence of Helicobacter pylori in peptic ulcer perforation

2017 ◽  
Vol 4 (10) ◽  
pp. 3350 ◽  
Author(s):  
Binni John ◽  
Bipin P. Mathew ◽  
Vipin Chandran C.
Keyword(s):  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Eradication Therapy ◽  
Perforated Peptic Ulcer ◽  
Peptic Ulcer Perforation ◽  
Female Ratio ◽  
Ulcer Disease ◽  
Ulcer Perforation ◽  
H Pylori

Background: Helicobacter pylori have an important role in the pathogenesis of peptic ulcer disease. The aim of the present study was to observe the prevalence of H. pylori in peptic ulcer perforation cases and the rationale of H. pylori eradication therapy post operatively and to investigate factors associated with peptic ulcer.Methods: This cross-sectional study was conducted at the Department of general surgery, Government Medical College, Kottayam for a period 20 months from March 2012 to October 2013 after getting approval from institutional ethics committee. A total of 113 patients were participated in the study after meeting inclusion criteria. After getting written consent from the patients with perforated peptic ulcer, resuscitation and laparotomy was performed in the emergency department. H. pyloriinfection was confirmed by histopathological examination by Giemsa staining. Based on the histopathological report, the prevalence of H. pylori infection in the patients was assessed and was given appropriate H. pylori eradication regimen.Results: The mean age of presentation of the patients was 52.81±14.5 years. Male to female ratio was 4.14:1. Out of 113 cases, 67 cases (59.3%) had duodenal ulcer perforation while 46 cases (40.7%) had gastric ulcer perforation. Of them 53(46.9%) cases were positive H. pylori positive. No significant association was found between the incidence of H. pylori infection in peptic ulcers with smoking, hypertension, diet intake, NSAIDS intake. In our study association between H. pylori and diabetes mellitus (p=0.02) found to be significant which can be further investigated.Conclusion: According to our study the prevalence of H. pylori infection in perforated peptic ulcer disease is 47% which must be considered as significant. Hence all the patients undergoing laparotomy for peptic ulcer perforation should be investigated for H. pylori infection and if positive we must start the anti H. pylori regimen for them, which is more cost effective.

scholarly journals MODERN ASPECTS TO THE PROBLEM OF THE PREVALENCE OF HELICOBACTER PYLORI ASSOCIATED STOMACH DISEASES IN UZBEKISTAN

2021 ◽  
Vol 1 (2) ◽  
pp. 28-30
Author(s):  
Jadida Akhmedjanovna Ismailova ◽  
Akhrorbek A. Yusupbekov
Keyword(s):  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Eradication Therapy ◽  
Type B ◽  
Genetic Characteristics ◽  
Ulcer Disease ◽  
Stomach Diseases ◽  
H Pylori ◽  
High Degree

Introduction. We studied the regional epidemiological and genetic characteristics of the prevalence of Helicobacter pylori among the population of Uzbekistan. The work is based on the totality of the results of clinical, biochemical, immunological, genetic and instrumental research methods. Materials and Methods. It was established that Uzbekistan belongs to the regions with a high degree of H. pylori infection of the population (80%). 84% of the population of Uzbekistan have a mixed IceA1- / IceA2-genotype CagA. In peptic ulcer disease, the pathogenic strain CagA + VacA s1, VacA m2 and IceA 1,2 prevails, in chronic gastritis (type B) associated with H. pylori, the strain Cag + VacA s1, VacA m2 and IceA 1. Results and Discussion. The level of resistance of H. pylori strains to clarithromycin reaches 13.3%. Prolongation of eradication therapy up to 10 days and the addition of BTD to it makes it possible to increase the efficiency of H. pylori eradication up to 95%. Conclusion. Due to the presence of HP resistance to clarithromycin in 13.3% of cases and taking into account the low effectiveness of triadotherapy (72.5%), it is advisable to use quadritherapy with the inclusion of BTD in the standard of treatment, which contributes to an increase in the eradication efficiency up to 95%.

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

2010 ◽  
Vol 57 (2) ◽  
Author(s):  
Khrysyna O Semen ◽  
Olha P Yelisyeyeva ◽  
Danylo V Kaminskyy ◽  
Andriy P Cherkas ◽  
Kamelija Zarkovic ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Eradication Therapy ◽  
Simultaneous Increase ◽  
Complex Treatment ◽  
Ulcer Disease ◽  
Hypoxic Training ◽  
H Pylori

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.

scholarly journals Identification of Markers for Helicobacter pylori Strains Isolated from Children with Peptic Ulcer Disease by Suppressive Subtractive Hybridization

2006 ◽  
Vol 74 (7) ◽  
pp. 4064-4074 ◽  
Author(s):  
Mónica Oleastro ◽  
Lurdes Monteiro ◽  
Philippe Lehours ◽  
Francis Mégraud ◽  
Armelle Ménard
Keyword(s):  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Subtractive Hybridization ◽  
Suppressive Subtractive Hybridization ◽  
Ulcer Disease ◽  
Lipopolysaccharide Biosynthesis ◽  
The Difference ◽  
H Pylori

ABSTRACT Peptic ulcer disease (PUD) occurs after a long-term Helicobacter pylori infection. However, the disease can develop earlier, and rare cases have been observed in children, suggesting that these H. pylori strains may be more virulent. We used suppressive subtractive hybridization for comparative genomics between H. pylori strains isolated from a 5-year-old child with duodenal ulcer and from a sex- and age-matched child with gastritis only. The prevalence of the 30 tester-specific subtracted sequences was determined on a collection of H. pylori strains from children (15 ulcers and 30 gastritis) and from adults (46 ulcers and 44 gastritis). Two of these sequences, jhp0562 (80.0% versus 33.3%, P = 0.008) and jhp0870 (80.0% versus 36.7%, P = 0.015), were highly associated with PUD in children and a third sequence, jhp0828, was less associated (40.0% versus 10.0%, P = 0.048). Among adult strains, none of the 30 sequences was associated with PUD. However, both jhp0562 and jhp0870 were less prevalent in adenocarcinoma strains than in PUD strains from children and adults, the difference being statistically significant for jhp0870. In conclusion, two H. pylori genes were identified as being strongly associated with PUD in children, and their putative roles as an outer membrane protein for jhp0870 and in lipopolysaccharide biosynthesis for jhp0562, suggest that they may be novel virulence factors of H. pylori.

Helicobacter pylori causes gastrointestinal hemorrhage in patients with congenital bleeding disorders

2003 ◽  
Vol 89 (04) ◽  
pp. 741-746 ◽  
Author(s):  
Ann-Sofie Rehnberg ◽  
Marju Hein ◽  
Olga Hegedus ◽  
Per Lindmarker ◽  
Per Hellström ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Gastrointestinal Hemorrhage ◽  
Breath Test ◽  
Eradication Therapy ◽  
Urea Breath Test ◽  
Von Willebrand Disease ◽  
Bleeding Disorders ◽  
Ulcer Disease ◽  
H Pylori ◽  
One Year

Summary Helicobacter pylori (H. pylori) infection is associated with peptic ulcer disease and gastric cancer. The eradication of H. pylori is of special interest in patients with congenital bleeding disorders, for whom treatment of gastrointestinal hemorrhage with factor concentrates is costly. The prevalence of H. pylori varies between different populations and identification of high-risk subgroups may allow for more targeted screening and eradication of the infection. We performed a 5-year retrospective study of gastrointestinal bleeding, combined with screening and treatment for H. pylori and a long-term prospective follow-up in 168 Swedish and 23 Estonian patients with hemophilia or von Willebrand disease. The prevalence of seropositivity was lower in Sweden than in Estonia (28 versus 48%, p = 0.03), lower in native Swedes than in non-Nordic immigrants to Sweden (20 versus 76%, p = 0.0001) and lower in patients less than 40 years of age than older patients (16 versus 38%, p = 0.002). The incidence of gastrointestinal hemorrhages among the 35 Swedish patients with active H. pylori infection, confirmed by a urea breath test, was 6.0 per 100 patient-years before eradication therapy versus 1.7 during the prospective followup. A negative urea breath test one month after therapy always remained negative after one year. Screening, followed by treatment of all infected patients, yielded a reduction of direct costs over a 5-year period of 130 US-$ per screened patient. We conclude that screening and eradication therapy for infection with H. pylori in patients with congenital bleeding disorders is an effective and economic strategy.

scholarly journals Helicobacter pyloriManagement: How to Improve the Therapeutic Confusion in Practice

2003 ◽  
Vol 17 (suppl b) ◽  
pp. 21B-24B ◽  
Author(s):  
Nicholas J Talley
Keyword(s):  
Peptic Ulcer ◽  
Secondary Care ◽  
Bacterial Resistance ◽  
Peer Group ◽  
Eradication Therapy ◽  
Prescribing Patterns ◽  
Therapeutic Success ◽  
Ulcer Disease ◽  
Treatment Regimens ◽  
H Pylori

There appears to be a disconnect between current guidelines forHelicobacter pyloritesting and treatment, and clinical practice, including physician beliefs and actual prescribing patterns. In particular, there are markedly different approaches in primary and secondary care, and country- specific differences in eradication therapy forH pyloriinfection. Although most physicians do not believe thatH pyloricauses nonulcer dyspepsia, the majority appear to prescribe eradication. Less information is available on the management ofH pyloriinfection and gastroesophageal reflux disease, and more marked differences in attitudes and practice occur in this condition. Even in peptic ulcer disease, where most clinicians both in primary and in secondary care believeH pylorishould be eradicated, there is often a breakdown in the translation of this belief into practice. There is also confusion in terms of treatment regimens applied forH pylorieradication. Eradication regimens are less successful in practice than in clinical trials. Furthermore, a sizable proportion of patients with peptic ulcer remain symptomatic despite cure of the ulcer diathesis, which may undermine confidence. Therapeutic confusion about what to prescribe, side effects limiting compliance, bacterial resistance, and socioeconomic factors may all impair therapeutic success with eradication therapy in practice. Unfortunately, it has been well documented that guidelines alone are likely to have little or no impact in practice. Publication in a journal is unlikely to lead to effective implementation in primary care. On the basis of available evidence, clinical behaviour is most likely changed when guidelines are developed by the peer group of clinicians for whom they were intended, are disseminated through a specific educational program, and are implemented by applying, preferably during the consultation, specific reminders.

Sign in / Sign up

Export Citation Format

Share Document