BackgroundRifabutin has been found to be effective in multi-resistant patients after various treatment cycles for Helicobacter pylori (HP) infection, but it has not been analysed as a second-line treatment. Therefore, we seek to compare the effectiveness of a treatment regimen including rifabutin versus conventional quadruple therapy (QT).MethodsOpen clinical trial, randomised and multi-centre, of two treatment protocols: A) Conventional regime -QT- (omeprazole 20 mg bid, bismuth citrate 120 mg qid, tetracycline 500 mg qid and metronidazole 500 mg tid); B) Experimental one -OAR- (omeprazole 20 mg bid, amoxicillin 1 gr bid, and rifabutin 150 mg bid), both taken orally for 7 days, in patients with HP infection for whom first-line treatment had failed. Eradication was determined by Urea Breath Test (UBT). Safety was determined by the adverse events.Results99 patients were randomised, QT, n = 54; OAR, n = 45. The two groups were homogeneous. In 8 cases, treatment was suspended (6 in QT and 2 in OAR). The eradication achieved, analysed by ITT, was for QT, 38 cases (70.4%), and for OAR, 20 cases (44.4%); p = 0.009, OR = 1.58. Of the cases analysed PP, QT were 77.1%; OAR, 46.5%; p = 0.002. Adverse effects were described in 64% of the QT patients and in 44% of the OAR patients (p = 0.04).ConclusionA 7-day rifabutin-based triple therapy associated to amoxicillin and omeprazole at standard dose was not found to be effective as a second-line rescue therapy. The problem with quadruple therapy lies in the adverse side effects it provokes. We believe the search should continue for alternatives that are more comfortably administered and that are at least as effective, but with fewer adverse side effects.Trial RegistrationCurrent Controlled Trials ISRCTN81058036

The trial will continue through 2010. The study is proceeding as planned.

This short report discusses a case of solitary colonic polypoid ganglioneuroma associated with melanosis coli in a woman with no systemic manifestations. To our knowledge this is the first ganglioneuroma reported in the literature in association with melanosis coli. The nature and significance of this event remains unclear, although this may be coincidental due to the laxative intake. Further investigation is necessary to clarify this point. The interest of this case lies moreover in the rarity of this entity and its endoscopic and histologic resemblance to sessile polyps frequent in the clinical practice. FindingsThe hereditary syndromes of the gastrointestinal tract are classified as adenomatous or hamartomatous [1]. As a part of the hamartomatous polyposes, ganglioneuroma (GN) of the gastrointestinal tract are rare tumors composed of ganglion cells, nerve fibers, and supporting cells of the enteric nervous system [1,2]. There are few reports in the literature. We present a case of polypoid GN and melanosis coli. To our knowledge this is the first case reported in literature with this association.A 48-year old woman with arthrosis underwent colonoscopy because of a family history of colon cancer (father and cousin) and an episode of lower intestinal bleeding. The patient was an anthracene-type laxatives ("sacred rind") consumer due to usual constipation. No other symptoms were related. She and her family had no known history of multiple endrocrine neoplasia or neurofibromatosis. The laboratory tests were within the normal limits, including carcinoembryonic antigen (CEA). Physical examination revealed an anal fissure. No pigmented skin lesions were identified. The colonoscopy revealed a millimetric sessile polyp in the sigmoid colon that was removed with biopsy forceps (Figure 1).The biopsy specimen consisted of three fragments. At low magnification they looked like a hyperplastic polyp. Microscopic examination of the fragments of the polyp showed a collection of nerve ganglion and stromal cells in the lamina propia that elevated the overlying elongated glands in a nodular configuration. No significant disarray of the mucosal architecture was observed. An additional finding of diffuse melanosis coli was noticed (Figure 2). Inmunohistochemical studies were performed. The ganglion cells and the spindle stromal surrounding cells demonstrated inmunoreactivity to protein S-100, and neuronspecific enolase (NSE) marked the ganglion cells ( Figure 3).

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What is already known on this topic? Adults aged 40 years or older with impaired vision reported having more problems related to cost of health care and availability of insurance coverage according to pooled 2002-2004 data from the Medical Expenditure Panel Survey.What is added by this report? Adults aged 18 years or older with vision impairment reported lower access to and use of health care than those without, according to the 2018 Behavioral Risk Factor Surveillance System survey.What are the implications for public health practice? Further research can better identify and understand barriers to care to improve access to and use of health care among adults with vision impairment.