bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do mucosal defensive agents improve the cure rate when used with dual or triple therapy regimens for eradicating Helicobacter pylori infection?
Authors: Hojo  , Miwa  , Kikuchi  , Sato  
Published: March 2003

Background:Some of mucosal defensive agents have anti‐Helicobacter pylori activities. However, their effectiveness in eradicating H. pylori infection has not been evaluated.Aim:To assess the additive effect of mucosal defensive agents in eradication regimens using statistical analysis.Methods:Pertinent studies were retrieved using the Medline and the Igaku–chuo–zasshi databases in Japan, reference and congress abstract lists. Studies in which regimens consisted of dual or triple therapy with mucosal defensive agents and without them, were selected from the retrieved studies. Eradication rates were extracted from studies according to intention‐to‐treat analysis. We evaluated the efficacies of mucosal defensive agents by pooled relative risk of eradication rates and its 95% confidence intervals (95% CI), which were calculated by Mantel–Haenszel method. Heterogeneity among the studies in treatment effect was evaluated by a χ2‐test.Results:In dual therapy regimens, mucosal defensive agents demonstrated significant additive effects (pooled relative risk 1.41; 95% CI: 1.24–1.61). In triple therapy regimens, these agents did not provide significant additive effect. The clinical usefulness of specific agents could not be established, when each agent was analysed independently.Conclusions:Mucosal defensive agents improve the cure rate when used with existing dual therapy regimens for eradicating H. pylori infection.
Furazolidone versus metronidazole in quadruple therapy for eradication of Helicobacter pylori in duodenal ulcer disease
Authors: Malekzadeh  , Ansari  , Vahedi  , Siavoshi  , Alizadeh  , Eshraghian  , Vakili  , Saghari  , Massarrat  
Published: March 2003

Objective:Furazolidone, an old but cheap antibiotic, was shown to be a good alternative to metronidazole in triple therapy for Helicobacter pylori eradication in areas where metronidazole resistant bacteria are common, but randomized studies are lacking.Aim:A randomized controlled trial to determine the efficacy and safety of furazolidone compared to metronidazole in classic quadruple therapy for eradication of H. pylori infection in duodenal ulcer patients.Methods:Patients with endoscopically proven duodenal ulcer and positive urease test were randomized to receive ranitidine 300 mg, amoxycillin 1000 mg and bismuth subcitrate 240 mg b.d, with either furazolidone 200 mg b.d (RABF), or metronidazole 500 mg b.d. (RABM) for 2 weeks. Compliance and side‐effects were monitored and recorded by table diary. H. pylori eradication was assessed at least 4 weeks after the completion of therapy with 14C‐urea breath test.Results:A total of 106 patients were enrolled and 101 (59 male, 42 female, mean age=40 ± 11 years) completed the study. Endoscopic findings and demographic data were comparable in both groups. Intention‐to‐treat eradication rates were 75% and 55% (P=0.03) and per protocol eradication rates were 82 and 56% (P=0.006) in the RABF and RABM groups, respectively. Side‐effects were reported by 13 patients (27%) in the RABF group (one stopped treatment) compared to five patients (10%) in the RABM group (P=0.04).Conclusion:Quadruple therapy containing furazolidone, instead of metronidazole, results in a significantly higher H. pylori eradication rate in Iranian duodenal ulcer patients.
Rifabutin‐based ‘rescue therapy’ for Helicobacter pylori infected patients after failure of standard regimens
Authors: Perri  , Festa  , Clemente  , Quitadamo  , Andriulli  
Published: March 2003

Background:The ideal treatment for patients who have failed eradication of Helicobacter pylori infection after standard proton pump inhibitor‐based triple therapies has still to be determined. Although either a second course of triple therapy or a quadruple therapy (proton pump inhibitor plus bismuth‐based triple therapy) has been proposed, the efficacy of these second‐line therapies is relatively unknown. Therefore, alternative strategies are needed.Aim:To assess the efficacy and tolerability of rifabutin, a derivative of rifamycin‐S, in patients who were still H. pylori infected after two or more courses of 1‐week triple therapies.Methods:Patients were given a 1‐week regimen of pantoprazole 40 mg b.d. + amoxycillin 1 g b.d. + rifabutin 300 mg daily. Side‐effects and compliance were determined at the end of therapy. Eradication rate was assessed with a 13C‐urea breath test performed at 4 and 12 weeks after treatment.Results:Forty‐one patients (mean age 47 ± 15 years) were studied. All patients took medications according to the proposed schedule. Side‐effects were infrequent and mild. The eradication rates were 71% (95% CI: 57–85%) on intention‐to‐treat analysis and 74% (95% CI: 61–88%) on per protocol analysis.Conclusions:Rifabutin, in combination with pantoprazole and amoxycillin, is an effective and well tolerated regimen in patients who failed standard eradication treatments.
Diagnosis of Helicobacter pylori after triple therapy in uncomplicated duodenal ulcers—a cost‐effectiveness analysis
Authors: Gené  , Calvet  , Azagra  
Published: March 2003

Background:The cost‐effectiveness of determining Helicobacter pylori status after treatment remains to be established.Aim:To determine the benefit of post‐treatment assessment of H. pylori eradication in patients with uncomplicated duodenal ulcer.Materials and methods:A decision analysis was performed in patients with uncomplicated duodenal ulcer who were H. pylori‐positive and had received eradication therapy. A decision tree was devised to compare the costs per patient of two different strategies: (a) systematic performance of post‐treatment urea breath test and new treatment if positive; and (b) clinical follow‐up, 13C‐urea breath test if dyspeptic symptoms recurred and eradication treatment if the test was positive.Results:Post‐eradication 13C‐urea breath test was notably more expensive than clinical follow‐up, both in a low‐cost per care setting (197 vs. 132 Euros) and in a high‐cost per care (614 vs. 340 US $) scenario. This conclusion remained stable for a wide range of variations of the variables included in the decision tree (e.g. cure rates of eradication treatment, cost of the urea breath test or sensitivity, and specificity of urea breath test to detect eradication).Conclusion:In patients with uncomplicated duodenal ulcer, evaluation of eradication after H. pylori treatment markedly increases costs with no clear improvement in results and therefore should not be performed routinely.
Randomized study comparing omeprazole with ranitidine as anti‐secretory agents combined in quadruple second‐line Helicobacter pylori eradication regimens
Authors: Michopoulos  , Tsibouris  , Bouzakis  , Balta  , Vougadiotis  , Broutet  , Kralios  
Published: March 2003

Background:Few data are available on the efficacy of second‐line H. pylori eradication regimens.Aim:To compare the efficacy of either omeprazole or ranitidine in a second‐line quadruple regimen in patients with duodenal ulcer or erosive duodenitis.Patients and methods:A total of 37 patients with erosive duodenitis and 119 with duodenal ulcer who have failed eradication of H. pylori with double or triple regimens, without metronidazole, were randomly assigned to receive tripotassium dicitrato bismuthate 600 mg t.d.s. + metronidazole 500 mg t.d.s. + tetracycline hydrochloride 500 mg t.d.s. combined with either omeprazole 20 mg b.d. (group O, 78 patients) or ranitidine 300 mg b.d. (group R, 78 patients) for 14 days. H. pylori eradication was verified by histology, rapid urease test and 13C‐urea breath test.Statistics: t‐test, χ2‐test.Results:A total of 143 patients had a post‐treatment endoscopy. Eradication rates were: intention‐to‐treat: group O 77% (67–87), group R 76% (66–85), P=0.85; per protocol analysis: group O 86% (77–95), group R 82 (71–93), P=0.58. Side‐effects were frequent but mild.Conclusions:Omeprazole 20 mg b.d. and ranitidine 300 mg b.d. were equally effective as antisecretory agents combined in a second‐line quadruple eradication regimen.
A new highly effective short‐term therapy schedule for Helicobacter pylori eradication
Authors: Zullo  , Rinaldi  , Winn  , Meddi  , Lionetti  , Hassan  , Ripani  , Tomaselli  , Attili  
Published: March 2003

Background:Although triple therapy regimens suggested in the Current European guidelines give fairly good results, several studies have reported an unsatisfactory Helicobacter pylori eradication rate (< 80%).Aim:To evaluate the efficacy of a new short‐term treatment sequence on H. pylori eradication.Methods:A total of 52 patients with H. pylori infection and either non‐ulcer dyspepsia (34 patients) or peptic ulcer (18 patients) were enrolled to receive a 10‐day therapy: omeprazole 20 mg b.d. plus amoxycillin 1 g b.d. for the first 5 days, followed by omeprazole 20 mg b.d., clarithromycin 500 mg b.d. and tinidazole 500 mg b.d. for the remaining 5 days. H. pylori infection at entry was assessed by rapid urease test and histology on biopsies from the antrum and the corpus. Bacterial eradication was assessed by endoscopy (peptic ulcer patients) or 13C urea breath test (non‐ulcer dyspepsia patients) 4–6 weeks after therapy had ended.Results:All patients completed the study. H. pylori eradication was achieved in all but one patient, with an eradication rate of 98% (95% CI: 94.3–100) with intention‐to‐treat analysis. Patient compliance was good (consumption of prescribed drugs > 95%) for all but one patient, who took the triple therapy regimen for 4 days instead of 5 days. No major side‐effects were reported but three (6%) patients complained of mild side‐effects.Conclusions:The use of this ‘five plus five’ therapy schedule as an initial treatment for H. pylori deserves further investigation.
Effects of fedotozine on gastric emptying and upper gastrointestinal symptoms in diabetic gastroparesis
Authors: Jones  , Wishart  , Berry  , Abitbol  , Horowitz  
Published: March 2003

Background:Delayed gastric emptying and upper gastrointestinal symptoms occur frequently in patients with diabetes mellitus.Aim:To evaluate the effects of fedotozine on gastric emptying and gastrointestinal symptoms in diabetic gastroparesis.Methods:Thirty‐one diabetic patients (20 type 1, 11 type 2) with gastroparesis were randomized to receive fedotozine (30 mg as the tartrate) or placebo t.d.s. Measurements of gastric emptying (100 g ground beef labelled with 20 MBq 99mTc‐sulphur colloid chicken liver and 150 mL 10% dextrose labelled with 10 MBq 113mIn‐DTPA) and gastrointestinal symptoms were performed before and after 12–16 days of treatment. Data are the mean ± s.d.Results:Of the 31 patients enrolled, two were excluded from analysis. Data from the remaining 29 patients (18 type 1, 11 type 2; 22 female, seven male), aged 42.7 ± 11.1 years (of whom 14 were randomized to fedotozine and 15 to placebo), were analysed. Fedotozine had no effect on either gastric emptying (solid retention at 100 min; fedotozine: baseline, 84 ± 15%; treatment, 73 ± 23% vs. placebo: baseline, 83 ± 10%; treatment, 70 ± 20%) or liquid 50% emptying time (fedotozine: baseline, 59 ± 32 min; treatment, 58 ± 38 min vs. placebo: baseline, 44 ± 9 min; treatment, 43 ± 21 min) or gastrointestinal symptoms (fedotozine: baseline, 4.4 ± 2.9; treatment, 4.1 ± 3.9 vs. placebo: baseline, 4.9 ± 4.2; treatment, 4.8 ± 3.9).Conclusions:Fedotozine has no effect on gastric emptying in patients with diabetic gastroparesis.
Motilides accelerate regional gastrointestinal transit in the dog
Authors: Chiba  , Thomforde  , Kost  , Allen  , Phillips  
Published: March 2003

Background:Motilides have prokinetic effects on the upper gut during fasting, increasing the strength of antral contractions and stimulating gastroduodenal phase 3 sequences. Effects on the distal gut, and postprandially, are less well documented.Aim:To evaluate dose–response effects of motilin and erythromycin on gastric emptying, small bowel and colonic transit in the dog using a validated scintigraphic technique.Methods:For gastric emptying and small bowel transit, 99mTc labelled beads were added to a meal of dog chow (450 kcal). Regional colonic transit was measured by 111In labelled beads placed in a capsule which dissolved and released radiation into the proximal colon. Scintiscans were taken at regular intervals and indices of whole‐gut transit were calculated. Drugs were given by slow intravenous administration.Results:In the doses used, motilin accelerated regional colonic transit but did not hasten gastric emptying or small bowel transit. Single or repeated doses of motilin had similar effects on colonic transit. Erythromycin accelerated gastric emptying, small bowel transit and regional colonic transit.Conclusions:Motilin receptors are apparently present in the canine small bowel and colon. Postprandially, motilides accelerate transit in the distal gut.
Oral pharmacokinetics of omeprazole and lansoprazole after single and repeated doses as intact capsules or as suspensions in sodium bicarbonate
Authors: Sharma  , Peyton  , Spears  , Raufman  , Howden  
Published: March 2003

Background:Omeprazole and lansoprazole can be given in sodium bicarbonate as, respectively, simplified omeprazole suspension and simplified lansoprazole suspension. We previously found the antisecretory effect of omeprazole 20 mg given as simplified omeprazole suspension to be lower than with intact capsules. However, lansoprazole 30 mg as simplified lansoprazole suspension produced an effect similar to that seen with intact capsules.Aim:To evaluate the absorption of both drugs when given orally as capsules or as suspensions in sodium bicarbonate.Methods:In random order, we gave 5‐day courses of omeprazole 20 mg and lansoprazole 30 mg as capsules and as suspensions in sodium bicarbonate to 12 healthy women. Serial blood samples were taken on days 1 and 5 of each course for pharmacokinetic measurements.Results:There was impairment of omeprazole absorption when given as simplified omeprazole suspension. Maximum plasma concentration and area under the concentration/time curve were lower with simplified omeprazole suspension than with omeprazole capsules (P=0.034 and 0.013, respectively, on day 5). No differences were found in lansoprazole absorption when simplified lansoprazole suspension was compared with its standard capsule formulation. Relative bioavailability of omeprazole from simplified omeprazole suspension compared to the capsule was 58.4% on day 5. The corresponding value for lansoprazole was 84.7%.Conclusions:Simplified omeprazole suspension 20 mg does not supply adequate omeprazole for systemic absorption. Lansoprazole absorption from simplified lansoprazole suspension is maintained.
Review article: treatment of Helicobacter pylori infection with ranitidine bismuth citrate‐ or proton pump inhibitor‐based triple therapies
Authors: Van Oijen A. H. A. M. , Verbeek A. L. , Jansen J. B. M. J. , De Boer W. A. 
Published: March 2003

Triple therapy, combining a proton pump inhibitor with clarithromycin (C) and either amoxycillin (A) or a nitro‐imidazole (I) is the standard in Helicobacter pylori eradication therapy. Recently, triple therapies based on ranitidine bismuth citrate (RBC) have emerged as an alternative. This review examines the current literature for studies directly comparing proton pump inhibitor‐ with RBC‐based triple therapies. Seventeen studies were identified, of which three have been published as a full paper.Eradication rates in an intention‐to‐treat analysis ranged from 51 to 98%. No large difference in cure rates between the different regimens was demonstrated, although the RBC‐I‐C combination was somewhat superior. No definite conclusions could be made about the impact of metronidazole or clarithromycin resistance since only three studies performed a formal resistance analysis. No serious side‐effects were reported, and dropout rates were equal for the two regimens.Both RBC‐ and proton pump inhibitor‐based triple therapies are highly effective. If one prefers a imidazole/clarithromycin combination the evidence presented here suggests that RBC should be used instead of a proton pump inhibitor. Larger studies comparing both forms of triple therapy, using proper resistance analysis, are needed before final conclusions can be reached regarding efficacy in the setting of bacterial resistance.
Esomeprazole provides improved acid control vs. omeprazole in patients with symptoms of gastro‐oesophageal reflux disease
Authors: Lind  , Rydberg  , Kylebäck  , Jonsson  , Andersson  , Hasselgren  , Holmberg  , Röhss  
Published: March 2003

Background:Esomeprazole (Nexium) is a new proton pump inhibitor for the treatment of acid‐related diseases.Methods:In this double‐blind crossover study, 38 patients with gastro‐oesophageal reflux disease (GERD) symptoms were randomized to esomeprazole 40 and 20 mg and omeprazole 20 mg once daily for 5 days. On day 5 of each dosing period, 24‐h intragastric pH and pharmacokinetic variables were measured.Results:Thirty‐six patients aged 29–58 (mean 45) years completed the study. Esomeprazole 40 and 20 mg maintained intragastric pH > 4 for (mean) 16.8 and 12.7 h, respectively, vs. 10.5 h for omeprazole 20 mg (P < 0.001 and P < 0.01). Twenty‐four‐hour median intragastric pH was significantly higher with esomeprazole 40 mg (4.9) and 20 mg (4.1) than with omeprazole 20 mg (3.6) (P < 0.001 and P < 0.01). Area under the plasma concentration–time curve (AUC) was 80% higher for esomeprazole 20 mg vs. omeprazole, while that for esomeprazole 40 mg was more than five times higher (each P < 0.0001). Interpatient variability in intragastric pH and AUC was less with esomeprazole than with omeprazole. Esomeprazole was well tolerated and there were no safety concerns.Conclusions:Esomeprazole provides more effective acid control than omeprazole, with reduced interpatient variability, thereby offering the potential for improved efficacy in acid‐related diseases.
Effects of iron and iron chelation in vitro on mucosal oxidant activity in ulcerative colitis
Authors: Millar  , Rampton  , Blake  
Published: March 2003

Background:Reactive oxygen species may be pathogenic in ulcerative colitis. Oral iron supplements anecdotally exacerbate inflammatory bowel disease and iron levels are elevated in the inflamed mucosa. Mucosal iron may enhance hydroxyl ion production via Fenton chemistry. Conversely, the iron chelator, desferrioxamine, is reportedly beneficial in Crohn’s disease.Aims:To assess the in vitro effects of exogenous iron and of iron chelators on the production of reactive oxygen species by colonic biopsies from normal control subjects and patients with ulcerative colitis.Methods:Luminol‐amplified chemiluminescence was used to measure mucosal reactive oxygen species production both before and after addition in vitro of ferric citrate (100 μM), desferrioxamine (1 m
M) and 1,10‐phenanthroline (1 m
M).Results:Ferric citrate had no effect on the chemiluminescence produced by human colonic mucosa. However, desferrioxamine and phenanthroline reduced chemiluminescence by 47% (n=7, P=0.018) and by 26% (n=10, P=0.005), respectively, in inactive ulcerative colitis, and by 44% (n=9, P=0.008) and 42% (n=11, P=0.006) in active disease.Conclusion:The lack of effect of ferric citrate suggests that sufficient free iron is already present in inflamed biopsies to drive the Fenton reaction maximally. The effects of desferrioxamine and 1,10‐phenanthroline on the chemiluminescence of biopsies from patients with ulcerative colitis suggest that a clinical trial of topical iron chelation in active disease is indicated.
Third line treatment for Helicobacter pylori: a prospective, culture‐guided study in peptic ulcer patients
Authors: Gomollón F. , Sicilia B. , Ducóns J. A. , Sierra E. , Revillo M. J. , Ferrero M. 
Published: March 2003

Background:A third line treatment is needed in roughly 5% of patients infected with Helicobacter pylori. Few data have been reported on efficacy of treatment regimens in these patients.Methods:A prospective trial was designed to study the effectiveness of third line treatment of H. pylori infection in ulcer patients. Two‐week quadruple, culture‐guided, combinations were used in 31 consecutive patients. Susceptibility to metronidazole and clarithromycin were studied by E‐test, and thereafter a predetermined treatment regimen was used. Compliance was evaluated by pill count, and eradication defined by negative urea breath test at 6 weeks.Results:Two main quadruple regimens were used in 29 patients. In spite of good compliance, the combination of omeprazole, tetracycline, bismuth and clarithromycin (OTBC) showed an eradication rate (per protocol analysis) of 36% (five out of 14; CI: 12.8–64.9), and if amoxycillin was used (OTBA) the rate was 67% (eight out of 12; CI: 34.9–90.1). The difference was not significant. No clinical factor was found to be associated with failure to eradicate.Conclusions:Third line treatment often fails to eradicate H. pylori infection. New strategies need to be developed and tested for this common clinical situation.
Efficacy of two one‐week rabeprazole/levofloxacin‐based triple therapies for Helicobacter pylori infection
Authors: Cammarota G. , Cianci R. , Cannizzaro O. , Cuoco L. , Pirozzi G. , Gasbarrini A. , Armuzzi A. , Zocco M. A. , Santarelli L. , Arancio F. , Gasbarrini G. 
Published: March 2003

Background:One‐week low‐dose proton pump inhibitor‐based triple therapies have usually proved to be effective treatments for Helicobacter pylori infection.Aim:To investigate the eradication efficacy, safety profile and patient compliance of two triple therapies containing a standard dose of rabeprazole and a new fluoroquinolone, levofloxacin.Methods:One hundred patients referred to us for gastroscopy, who were H. pylori‐positive, were consecutively recruited in a prospective, open‐label study. The enrolled patients were randomised to receive a seven‐day course of rabeprazole 20 mg o.d. plus levofloxacin 500 mg o.d. and either amoxycillin 1 g b.d. (RLA group) or tinidazole 500 mg b.d. (RLT group). Their H. pylori status was assessed by means of histology and rapid urease test at entry, and by 13C‐urea breath test 8 weeks after the end of treatment.Results:All 100 enrolled patients completed the study. Forty‐six of 50 patients treated with RLA (both PP and ITT analysis: 92%; 95% CI: 81–98%) and 45 of 50 with RLT (both PP and ITT analysis: 90%: 95% CI: 78–97%), became H. pylori‐negative. Slight or mild side‐effects occurred in 4 (8%) patients of the RLA group and in 5 (10%) of the RLT group.Conclusions:This study demonstrates the efficacy of two 1‐week rabeprazole‐based triple therapies including levofloxacin to eradicate H. pylori. These regimens prove to be safe, well‐tolerated, and achieved good eradication rates. Levofloxacin may be an effective alternative to clarithromycin in triple therapy regimens.