Non-ulcer dyspepsia and short term De-Nol therapy: a placebo controlled trial with particular reference to the role of Campylobacter pylori.

Rokkas, Theodoros; Pursey, C; Uzoechina, E; Dorrington, L.; Simmons, N.A.; Filipe, M. I.; Sladen, G E

doi:10.1136/gut.29.10.1386

Cited by 129 publications

(36 citation statements)

References 21 publications

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“…Superior results were reported after treatment with a combination of two or more antibiotic drugs, especially after triple therapy including, e.g., metronidazole, amoxicillin, and bismuth subcitrate (3). Except for treatment of duodenal ulcer disease that had been resistant to conventional therapy, the risks of possible toxicity, side effects, and development of bacterial drug resistance do not justify the widespread use of antibiotic combinations for relatively harmless conditions such as antral gastritis, especially since there controversy about the clinical relevance of gastritis in nonulcer dyspepsia remains (10,14,17,26).…”

Section: Resultsmentioning

confidence: 99%

“…After intake of both the tablets and the Tabs, most amoxicillin levels in the corpus and fundus were far below the MBC.). The benefit from elimination of the bacterium from the gastric mucosa, but early recolonization is a major problem of current therapeutic regimens (21,25,26). The recolonization rate after monotherapy with bismuth salts or amoxicillin is about 60 to 70% within 4 weeks (25).…”

Section: Resultsmentioning

confidence: 99%

“…There is also convincing evidence that H. pylon plays an important role in duodenal ulcer disease (2,5,12), especially since eradication of the bacterium is associated with a significantly lower recurrence rate compared with H2 receptor blocker therapy (6,13,19). Moreover, in up to 70% of patients with nonulcer dyspepsia, H. pylon-positive active antral gastritis can be diagnosed (18,25), and although controversy about the clinical relevance of chronic gastritis remains, several investigators have found that these patients profit from elimination of H. pylon in terms of symptomatic improvement (14,26). Bismuth salts, like colloidal bismuth subcitrate, and a variety of antibiotic drugs are able to eliminate the bacterium from the antral mucosa (15,23), but recolonization within 1 month after therapy is the rule (24,25).…”

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confidence: 99%

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Local gastric and serum amoxicillin concentrations after different oral application forms

Cooreman

Krausgrill

Hengels

1993

Antimicrob Agents Chemother

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The high recolonization rate after monotherapy of Helicobacter pylori-positive gastritis may be due to insufficient local drug concentrations. To investigate the role of local diffusion, we measured levels of amoxicillin, a drug with good in vitro activity against H. pylori, in the mucosa and serum. One gram of amoxicillin was given to healthy volunteers as a tablet (n = 6) or as water-dissolved, fizzing "Tab" (n = 6). Gastroscopy with biopsies from the antrum, corpus, and fundus was performed at 30, 60, and 90 min. Concentrations in the mucosa were measured after homogenization with the agar diffusion method using BaciUlus subtilis as the biological indicator. Serum samples, taken basally and every 15 min, were analyzed by high-pressure liquid chromatography. Drug levels in the fundus and corpus remained far below those in the antrum for both application forms. The highest concentrations were reached after 30 min, with bactericidal levels in the antrum in two of six subjects who took the tablet form and five of six subjects who used Tabs. At 60 and 90 min, almost all values were below the MBC for 90% of the strains tested. The concentrations in serum, however, rose continuously, to reach a maximum after 75 or 90 min. These results show that incomplete elimination may be due to subbactericidal concentrations of antibiotics with high in vitro efficiency at the desired site of action in vivo and that local diffusion in the mucosa is essential for therapeutic effectiveness against H. pylor.Worldwide and in all age groups, Helicobacterpylori is the major etiologic factor in chronic active antral gastritis (8,9,20,28). There is also convincing evidence that H. pylon plays an important role in duodenal ulcer disease (2, 5, 12), especially since eradication of the bacterium is associated with a significantly lower recurrence rate compared with H2 receptor blocker therapy (6,13,19). Moreover, in up to 70% of patients with nonulcer dyspepsia, H. pylon-positive active antral gastritis can be diagnosed (18,25), and although controversy about the clinical relevance of chronic gastritis remains, several investigators have found that these patients profit from elimination of H. pylon in terms of symptomatic improvement (14,26). Bismuth salts, like colloidal bismuth subcitrate, and a variety of antibiotic drugs are able to eliminate the bacterium from the antral mucosa (15, 23), but recolonization within 1 month after therapy is the rule (24, 25). The reason for this incomplete elimination has not been sufficiently elucidated; it may be due either to reinfection from a bacterial reservoir in the upper gastrointestinal tract or to subbactericidal drug concentrations at the desired site of action during therapy. To investigate the latter possibility, we measured gastric mucosal concentrations of amoxicillin, a drug with excellent in vitro activity against H. pylori, given in the usual therapeutic dosage of 1 g in tablet form or in water-dissolved form. To compare the role of local diffusion of the drug with its systemic availabi...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Local gastric and serum amoxicillin concentrations after different oral application forms

Cooreman

Krausgrill

Hengels

1993

Antimicrob Agents Chemother

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“…Nineteen of the trials were conducted in Europe [15][16][17][18]20,[23][24][25][27][28][29][30]37,40,[42][43][44][45]47] , eight in the Far East [21,22,32,35,36,38,46,48] , four in the USA [31,33,34,41] , one in the Middle East [26] , one in South America [19] , one in Australia [7] , and one was a multi-national study [39] . Eleven of the studies were multicentre RCTs [15,21,25,29,31,32,34,39,41,44,45] .…”

Section: Trial Characteristicsmentioning

confidence: 99%

Adverse events with bismuth salts for Helicobacter pylori eradication: Systematic review and meta-analysis

Ford

Malfertheiner²,

Giguere³

et al. 2008

WJG

110

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INTRODUCTIONBismuth salts have been used for centuries in medicine. From a gastroenterology perspective these drugs have been used to treat peptic ulcer disease, dyspepsia, parasitic infections, microscopic colitis, and infectious diarrhoea [1] . The discovery of Helicobacter pylori (H pylori) in 1983 by Warren and Marshall revolutionised the management of peptic ulcer disease [2] , and led to a renewed interest in bismuth compounds, largely because bismuth was found to inhibit the growth of H pylori and was effective in eradicating the organism (when combined with antibiotics or in combination with antibiotics and acid suppression therapy [3,4] ). The first randomised controlled trial (RCT) of bismuth in H pylori-positive individuals suggested that bismuth was superior to erythromycin monotherapy in eradicating the infection [5] . A further RCT of 6 wk of colloidal bismuth subcitrate versus cimetidine, in H pylori-positive duodenal ulcer patients, demonstrated that bismuth successfully eradicated the bacterium in up to 50% of patients [6] . Subsequently, an RCT of both colloidal bismuth subcitrate and cimetidine, alone or in combination with tinidazole, confirmed that colloidal bismuth subcitrate and tinidazole cleared the infection in almost 75% of patients [7] . With the addition of a second antibiotic, tetracycline or amoxicillin, eradication rates in later RCTs exceeded 80% [8][9][10] . However, there were some problems associated with bismuth-based triple therapy, which included the number of tablets patients were required to take, the duration of therapy, and side effects such as altered taste, nausea, and diarrhoea. Abstract AIM: To assess the safety of bismuth used in Helicobacter pylori (H pylori ) eradication therapy regimens. METHODS:We conducted a systematic review and meta-analysis. MEDLINE and EMBASE were searched (up to October 2007) to identify randomised controlled trials comparing bismuth with placebo or no treatment, or bismuth salts in combination with antibiotics as part of eradication therapy with the same dose and duration of antibiotics alone or, in combination, with acid suppression. Total numbers of adverse events were recorded. Data were pooled and expressed as relative risks with 95% confidence intervals (CI). RESULTS: We identified 35 randomised controlled trials containing 4763 patients. There were no serious adverse events occurring with bismuth therapy. There was no statistically significant difference detected in total adverse events with bismuth [relative risk (RR) = 1.01; 95% CI: 0.87-1.16], specific individual adverse events, with the exception of dark stools (RR = 5.06; 95% CI: 1.59-16.12), or adverse events leading to withdrawal of therapy (RR = 0.86; 95% CI: 0.54-1.37).CONCLUSION: Bismuth for the treatment of H pylori is safe and well-tolerated. The only adverse event occurring significantly more commonly was dark stools.

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“…15 That is not to say, though, that a certain endoscopic appearance is not closely related to Hp infection. Such an association would be of clinical importance since Hp infection has been reported to be both symptomatic, 16 associated with an increased risk of ulcer recurrence 17 and possible to treat. 17,18 An endoscopic diagnosis of Hp infection is desirable since both culture and histology are slow processes.…”

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confidence: 99%

Varioliform Gastritis — An Endoscopic Presentation Form of Helicobacter Pylori

Hedenbro

Offenbartl

Wïllén

1995

Annals of Saudi Medicine

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JL Hedenbro, K Offenbartl, R Willen, Varioliform Gastritis -An Endoscopic Presentation form of Helicobacter Pylori. 1995; 15(5): 532-534 There are two forms of gastric erosion -incomplete and complete. The latter type is, when occurring multiply, known as "varioliform gastritis", as named by Moiter and Martin.1 In contrast to the NSAID-related incomplete erosions, this type of erosion is of obscure origin. Through the endoscope, they appear as small nodules with central erosions, usually on the top of somewhat swollen gastric folds. They are covered with a whitish exudate, sometimes with an erythematous margin 2 and may occur in the antrum or in the body of the stomach. On histology, the lesions comprise large numbers of inflammatory cells. 3 The etiology of this condition is not understood. The term "lymphocytic gastritis" has been coined and an allergic-etiology suggested due to the finding of increased numbers of immunoglobulin E-producing plasma cells in the lesions. Patients And ResultsDuring a 17-month period, we found 34 patients with no pathology visible on upper GI endoscopy other than multiple gastric erosions confined to the antrum, 10 with the appearance of complete erosions and 24 with incomplete erosions. The patients with complete erosions were eight women and two men, ages 35 to 48 years. The patients with incomplete erosions were 16 women and eight men, ages 28 to 60 years. The indication for endoscopy was epigastric pain or evidence of upper gastrointestinal bleeding. A summary of patient material and findings is given in Table 1.Two patients with complete erosions admitted to regular or recent NSAID intake, whereas 18/24 patients with incomplete erosions did (P=0.0054; two-tailed Fisher's exact test). The pathological findings at endoscopy were confined to the prepyloric region. Patients in the group labeled "complete erosions" all had partially confluent nodules on top of swollen antral folds, with central fibrincovered erosions, some of which were surrounded by erythematous halos (Figure 1). Incomplete erosions were defined endoscopically as distinct, shallow mucosal defects on top of the antral folds. They often had a small hematin base and the folds were not swollen. Multiple biopsies were sent for routine histology as well as for Warthin-Starry staining. 6 This latter method has a high sensitivity and specificity for the presence of Helicobacter pylori.7 Additional cultures were sent for H. pylori culture 8 and blood was obtained for H. pylori serology. 9Histological sections stained with hematoxylin and eosin demonstrated identical findings in the cases with complete erosions. The mucosa on the surface of the lesions was eroded and covered with fibrin. There were granulocytes and severe infiltration of lymphocytes and plasma cells in the lamina propria. Only a few lymphocytes were detected within epithelial cells but some granulocytes and plasma cells were present. There was hyperplasia of the surface epithelial cells together with a severe inflammatory atypia and glandular atrophy (...

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Non-ulcer dyspepsia and short term De-Nol therapy: a placebo controlled trial with particular reference to the role of Campylobacter pylori.

Abstract: SUMMARYThis double blind randomised study tested the effectiveness of colloidal bismuth subcitrate (De-Nol)

Cited by 129 publications

References 21 publications

Local gastric and serum amoxicillin concentrations after different oral application forms

Local gastric and serum amoxicillin concentrations after different oral application forms

Adverse events with bismuth salts for Helicobacter pylori eradication: Systematic review and meta-analysis

Varioliform Gastritis — An Endoscopic Presentation Form of Helicobacter Pylori

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