J Behav Med 2006 May 16; (Read article online)

Goodwin RD, Cox BJ, Clara I

To examine the association between neuroticism and physical disorders among adults in the United States, data were drawn from the National Comorbidity Survey (n = 5877). Multiple logistic regression analyses were used to examine the relationship between neuroticism and physical disorders among adults in the community, adjusting for differences in demographic characteristics and comorbid mental disorders.Results indicated that neuroticism was associated with significantly elevated rates of a wide range of physical disorders, with the exception of stroke. After adjusting for differences in demographic characteristics and comorbid mental disorders, neuroticism was associated with increased odds of arthritis (OR = 1.5), diabetes (OR = 3.33), kidney/liver disease (OR = 2.56), stomach/gallbladder problems (OR = 2.27), and ulcer (OR = 3.23). Based on those findings, neuroticism appears to be a general predictor of a range of physical health problems among adults in the United States. Much of this association appears to be partially mediated by comorbid mental disorders, yet the association between neuroticism and arthritis, diabetes, kidney/liver disease, stomach problems, and ulcer persist even after adjusting for differences in demographic characteristics and comorbid mental disorders. Future studies that can examine the nature and mechanism of these linkages across the lifespan are needed next.

Khirurgiia (Mosk) 2006; 4-10 (Read article online)

Kuzin I P PN, Nauk Iu KM

Results of surgical treatment of patients with gastric ulcer and cancer of the stomach using resection of the stomach with Roux technique were analyzed. Acid-producing and evacuatory functions of the stomach were assessed in different periods after surgery. Dynamic scintigraphy provided evaluation of indices of duodenogastric reflux and state of gastric mucous barrier after various types of surgeries. Quality of life was studied late after surgery with original questionnaire. It is concluded that Roux resection of the stomach is not inferior to Bilrot-I resection by functional results, but it has advantages by quality life and rate of operated stomach diseases compared with Bilrot-I and Bilrot-II techniques.

JSLS 2006; 10(1): 97-100 (Read article online)

Lu B, Cai X, Lu W, Huang Y, Jin X

OBJECTIVES: We explored the feasibility, difficulty, and indications for laparoscopic pancreaticoduodenectomy.METHODS: Since November 11, 2002, we have successfully completed 5 laparoscopic pancreaticoduodenectomies. Patients included 4 males and 1 female, average age 43 years. Three patients had duodenal papillary cancer, one had cancer of the head of the pancreas, and one had pancreatic mixed cancer (duodenal papillary cancer, hepatobiliary ductal adenocarcinoma). The average mass size was 1.5/1.8 cm to 2.6/2.5 cm.RESULTS: The pathology diagnosis was well-differentiated duodenum papillary adenocarcinoma in 3 patients, head of pancreas endocrine small cell carcinoma in 1, and duodenum papillary adenoma with malignancy ductal intermediate differentiation adenocarcinoma in 1. During surgery, average blood loss was 770 mL. Operation time averaged 528 minutes. The main difficulties during surgery were estimation and identification of pancreatoduodenal tumor resection and hepatoduodenal ligament venation changes. After surgery, 1 patient had a small amount of pancreatic leakage, another developed stress ulcer bleeding; both patients became normal after appropriate treatment. The fourth patient developed severe recurrence of pancreatitis with pneumonia and on the 39th day after surgery developed stress ulcer bleeding. This patient died during the second operation.CONCLUSION: Laparoscopic pancreaticoduodenectomy is a very difficult and risky operation. It requires ample clinical experience in traditional pancreaticoduodenectomy, perfect laparoscopic surgery technique, consultation and cooperate with the surgical team, updated laparoscopy equipment, and very strict surgical indications. For hospitals that meet the above conditions and requirements, laparoscopic pancreaticoduodenectomy is very safe and feasible.

Khirurgiia (Mosk) 2006; 11-14 (Read article online)

Koshelev PI, Fedorov AV, Glukhov AA

The results of treatment of 249 patients aged 15 to 78 years with perforated gastroduodenal ulcers were analyzed. The study group consisted of 128 patients in whom videolaparoscopic procedure was used for suturing of ulcer, control group - of 107 patients treated conventionally. Conversion of laparoscopic procedure to open surgery was in 14 cases. It is demonstrated that the intensity of pain syndrome, hospital stay and the number of postoperative complications in the study group were less that in the control group. Indications and contraindications for videolaparoscopic method in these patients were formulated.

Presse Med 2006 May; 35(5-C1): 769-778 (Read article online)

Barbut F, Parzybut B, Boëlle PY, Neyme D, Farid R, Kosmann MJ, Luquel L

PREVALENCE, RISK FACTORS, AND MANAGEMENT: OBJECTIVES:>To determine the prevalence of pressure sores, their risk factors, and the responsible microbial agents in an acute-care hospital and to evaluate their management. Method>A prevalence survey was conducted from 5 July through 9 July 2004. Investigators completed a standardized questionnaire for each hospitalized patient, including demographic data (age, sex, previous hospitalizations, etc.) and Braden scale risk factors (sensory perception, humidity, activity, mobility, nutrition, and friction and shear). Two experts in skin care detected pressure sores by physical examination of the patients. Each pressure sore was swabbed and inoculated on selective media. Management was evaluated by reviewing the clinical charts of each patient with a pressure sore. RESULTS:>The study included 535 adult patients (aged 59 +/- 19 years): 75 ulcer sores were observed in 37 patients (prevalence=6.9%). Stage I sores accounted for 24% of the total, stage II for 29%, stage III 31%, and stage IV 16%. The most frequent site was the heel (41%), followed by the sacrum (20%), elbow (11%), back (7%) and ischial tuberosities (7%). Sixty (80%) were acquired while hospitalized. Age-adjusted multivariate analyses found that the risk factors significantly associated with pressure sores were Braden score<=15 (OR=5.9, 95% CI: 2.4-13.7, p<0.0001) and previous pressure sores (OR=5.0 95% CI: 2.2-11.6, p<0.0001). Eleven sores (24.5%), mostly stage III and IV, were colonized by multiple-drug-resistant bacteria (i.e., methicillin resistant Staphylococcus aureus, extended spectrum beta-lactamase Enterobacteriaceae). Seven (9.3%) of the 75 ulcers were diagnosed only during the survey, by the experts; of the 68 diagnosed before the survey, 57 (83.8%) had been under treatment. Treatment was considered inappropriate according to French guidelines in 31.6% of the cases. CONCLUSION:>This prospective prevalence study resulted in better awareness of the patients at risk for pressure sores. It also made the recently created mobile geriatrics unit better known within the hospital.

J Gastroenterol Hepatol 2006 Feb; 21(1 Pt 1): 103-9 (Read article online)

Terano A, Arakawa T, Sugiyama T, Yoshikawa T, Haruma K, Asaka M, Shimosegawa T, Sakaki N, Ishii H, Sakamoto C, Takahashi S, Kinoshita Y, Fujioka T, Kobayashi K

Background and Aim: Controversies remain over the need for antiulcer treatment following 1-week eradication triple therapy for Helicobacter pylori-positive peptic ulcers. The usefulness of combination therapy for gastric ulcers in Japanese patients, which consists of H. pylori eradication followed by gastroprotective therapy with rebamipide, was therefore evaluated. Methods: The study was conducted in 52 H. pylori-positive patients with an endoscopically-proven open gastric ulcer. All patients received 1-week triple therapy (lansoprazole, amoxicillin and clarithromycin) followed by 7-week rebamipide therapy. After completion of the combination therapy, all patients underwent evaluation of ulcer healing by endoscopy, gastric ulcer symptoms and H. pylori eradication by rapid urease test and (13)C-urea breath test. Results: The ulcer healing rates were 85.7% (36/42) at 8 weeks, 83.3% (30/36) in eradicated patients and 100% (6/6) in non-eradicated patients. The overall gastrointestinal symptom-free rate improved from 19.0% at baseline to 88.1% at 8 weeks. H. pylori was effectively eradicated in 85.7% (36/42) of patients. Conclusions: The results suggested that the combination therapy for open gastric ulcer was safe, well-tolerated and effective. However, data from a double-blind placebo-controlled study is necessary to confirm these findings.

J Am Podiatr Med Assoc 2006 May-June; 96(3): 264-268 (Read article online)

Fikar CR, Delinois B

An updated selection of high-quality Internet resources related to wound and ulcer care is presented. Of potential use to the podiatric medical practitioner, educator, resident, and student, some Web sites that cover hyperbaric medicine, antibiotic use, and wound and ulcer prevention are also included. These Web sites have been evaluated on the basis of their potential to enhance the practice of podiatric medicine, in addition to contributing to the educational process. Readers who require a quick reference source to wound and ulcer care may find this report useful.

Zhongguo Zhong Yao Za Zhi 2006 Feb; 31(4): 316-9 (Read article online)

Qiu JB, Long QC, Yao MC

OBJECTIVE: To explore the effects of slenderstyle acanthopanax root-bark on cyclooxygenase in vivo and in vitro. METHOD: Contents of 6-keto-PGF1alpha in bovine aorta endothelial cells, PGE2 in mouse abdominal macrophages, and 6-keto-PGF1alpha in rat stomach tissue were determined. The ulcer index in rat gastric mucosa was measured. RESULT: COX-1 and COX-2 were inhibited by slenderstyle acanthopanax root-bark, and the inhibitive rate of COX-2 was higher than that of COX-1 at the same concentration. Necrotic injuries in health gastric mucosa were not produced, but the injuries previously induced by the ethanol worsened. CONCLUSION: One of the antirheumatic mechanisms of slender-root-bark might probably be mediating through inhibition of cyclooxygenase. style acanthopanax

Zhong Nan Da Xue Xue Bao Yi Xue Ban 2005 Dec; 30(6): 714-8 (Read article online)

Zhou B, Li JB, Cai GX, Ling JH, Dai XP

OBJECTIVE: To explore the therapeutic effects and mechanisms of the combination of traditional Chinese medicine and western medicine on patients with peptic ulcers. METHODS: One hundred and twenty patients were randomly divided into 6 groups. Another 10 patients as the control group were confirmed with no peptic ulcers by endoscope, but had digestive tract symptoms. The clinical effects were compared among each group after the one month treatment. RESULTS: The clinical effects of the combination of Jianweiyuyang granules and ranitidine capsules were better than those of western medicine, with improvement in symptoms and syndrome (P < 0.01 to 0.05), but there was not significant difference with the rate of ulcer healing and the Hp clearance among the combination of Jianweiyuyang granules and ranitidine capsules, Jianweiyuyang granules, and ranitidine capsules (P > 0.05). The combination of Jianweiyuyang granules and ranitidine capsules could significantly upregulate the expression of MUCSAC mRNA (P < 0.01), while downregulate the expression of ETAR mRNA (P < 0.01). CONCLUSION: There is obvious advantage in treating peptic ulcers by the combination of Jianweiyuyang granules and ranitidine capsules, and its mechanisms may be to protect the gastric mucosal barrier by up-regulating the expression of MUCSAC mRNA and to improve the gastric mucosal blood flow by down-regulating the expression of ETAR mRNA.

Am J Chin Med 2006; 34(3): 461-469 (Read article online)

Liu DY, Zhao HM, Zhao N, Xin ZP, Lu AP

Ba-Wei-Xi-Lei powder is a classical herbal mixture, and is widely used for the treatment of oral ulcer and ulcerative colitis. This study aimed to explore the effect of Ba-Wei-Xi-Lei powder with enema application on ulcerative colitis in rats. Ulcerative colitis was induced by immunization with rabbit's colonic mucosal protein emulsified with Completely Freund's Adjuvant. The mucosal inflammatory reaction and ulcer have been observed in the model rats. Characteristic changes of ulceractive colitis include that CD4 lymphocyte increased in peripheral blood while CD8 lymphocyte decreased; CD8 lymphocyte and TNF-alpha expression area increased in colonic mucosa, while CD4 lymphocyte decreased. Ba-Wei-Xi-Lei powder and sulfasalazine with enema application could alleviate the pathological changes in the model rats. The results suggest that the pharmacological effects of Ba-Wei-Xi-Lei powder on ulcerative colitis in rats are similar to the effect of sulfasalazine.

J Gastroenterol Hepatol 2006 Feb; 21(1 Pt 1): 110-5 (Read article online)

Tan HJ, Rizal AM, Rosmadi MY, Goh KL

Background and Aim: The role of Helicobacter pylori (HP) in non-ulcer dyspepsia is debatable. Eradicating HP will help a small group of non-ulcer dyspeptic patients. However, it is unclear which subgroup of patients will benefit from eradication therapy. The aim of the present study was to compare the cagA and cagE status, as well as vacA genotypes, of HP in non-ulcer dyspeptic patients who responded successfully to eradication therapy compared with those patients who did not. Methods: Consecutive patients with moderate to severe (Likert 2 or 3) non-ulcer dyspepsia with HP were recruited prospectively. Gastric biopsies were taken, DNA extracted and polymerase chain reaction performed to determine the cagA and cagE status and vacA alleles. Eradication therapy was offered until HP was eradicated successfully. The HP status was checked 1 month after eradication therapy using the [(13)C]-urea breath test. All patients were assessed by one interviewer using Gastrointestinal Symptom Rating Scale (GSRS), a four-point Likert scale, and SF-36 for quality of life over 12 months. Treatment success was defined as minimal or no symptoms (Likert 1 or 0). The cagA, cagE and vacA status was blinded to the investigators until completion of the study. Results: Seventy-three patients (36 males, 37 females) were recruited to the study. The mean +/- SD patient age was 53.38 +/- 12.09 years. When the 36 patients who improved (group A) were compared with the 37 (group B) who did not, no significant difference was found in the cagE positive rate (55.6 vs 43.2%, respectively; P = 0.638), cagA positive rate (83.1 vs 73.0%, respectively; P = 0.247), vacA m1 versus m2 subtype (84.0 vs 55.6%, respectively; P = 0.472) or vacA s1a versus s1c (39.4 vs 57.1%, respectively; P = 0.166). There was also no significant difference noted in the SF-36 scores between the two groups after the conclusion of eradication therapy. Conclusions: Stratification of HP genotypes and virulence factor has no significant impact on the treatment success of non-ulcer dyspepsia.

J Gastroenterol Hepatol 2006 Feb; 21(1 Pt 1): 98-102 (Read article online)

Kamada T, Hata J, Kusunoki H, Sugiu K, Tanimoto T, Mihara M, Hamada H, Kido S, Dongmei Q, Haruma K

Background and Aim: Helicobacter pylori infection and non-steroidal anti-inflammatory drugs (NSAIDs) are deeply involved in the etiology of gastric ulcers. The aim of our study was to clarify the endoscopic characteristics and H. pylori infection status of NSAID-associated gastric ulcers. Methods: The study group comprised 50 patients (23 men, 27 women; mean age 66.5 years) with NSAID-associated gastric ulcers and 100 sex- and age-matched patients with gastric ulcer associated with other factors (control group). Ulcer morphology, size and number of lesions, onset site and incidence of hemorrhagic ulcers were investigated endoscopically in both groups. H. pylori infection was diagnosed by serology, histology and (13)C-urea breath test. Results: Multiple lesions (68% vs 20%, P < 0.001), occurrence in the antrum (56% vs 6%, P < 0.001), and hemorrhagic ulcer (34% vs 4%, P < 0.001) were significantly more prevalent in patients with NSAID-associated gastric ulcers than in patients with non-NSAID-associated gastric ulcer. The H. pylori infection rate was significantly lower in NSAID-associated gastric ulcer patients than in non-NSAID-associated gastric ulcer patients (48% vs 96%, P < 0.001). In the NSAID-associated gastric ulcer group, the prevalence of H. pylori infection was significantly lower in patients with ulcers in the antrum than in those with ulcers in the angulus or corpus (25% vs 77.3%, P < 0.001). Conclusions: In contrast to non-NSAID-associated gastric ulcers, NSAID-associated gastric ulcers frequently occur in the antrum with bleeding. The rate of H. pylori infection in NSAID-associated gastric ulcers is significantly lower than that in non-NSAID-associated gastric ulcers.

Dermatol Surg 2006 May; 32(5): 749-52 (Read article online)

Lloret P, Redondo P, Sierra A, Cabrera J

Pedro Lloret, MD, Pedro Redondo, MD, Alejandro Sierra, MD have indicated no significant interest with commercial supporters, and Juan Cabrera, MD, was formerly a consultant for provensis.

Int J Epidemiol 2006 May 18; (Read article online)

Sonnenberg A

BACKGROUND: Since humans have been infected with Helicobacter pylori for millennia, it has remained an enigma why the occurrence of gastric and duodenal ulcer rose suddenly during 19th century. The study aim is to present a mathematical model of H. pylori epidemiology that explains the peculiar long-term trends of ulcer disease. METHODS: Gastric and duodenal ulcer mortality data from England and Wales between 1911 and 2000 were used to validate a model based on two simple and straightforward assumptions about H. pylori infection. First, the infection rate fell in the general population between 1800 and 2000. Second, gastric ulcer was caused by H. pylori infection contracted between the ages 5 and 15 and duodenal ulcer was caused by H. pylori infection contracted after the age of 15. As the infection receded in the general population, the two fractions of subjects who became infected between the ages 5 and 15 or after the age of 15 increased among consecutive birth cohorts. RESULTS: The analysis of the actual long-term mortality from gastric and duodenal ulcer indicates an underlying birth-cohort pattern. These birth-cohort patterns of gastric and duodenal ulcer could be simulated by the interaction of two opposing time trends, namely a declining infection rate and a rising fraction of individuals acquiring their infection at increasingly older ages. The superimposition of a declining and a rising trend resulted in a bell-shaped curve of ulcer occurrence affecting consecutive birth-cohorts born between 1830 and 1970. Similar to the real data, the modelled cohort pattern of gastric ulcer preceded that of duodenal ulcer by 20 years. CONCLUSION: The birth-cohort phenomenon of ulcer disease can be explained by a receding H. pylori infection accompanied by a simultaneous shift in its age of acquisition.

Gut 2006 May 18; (Read article online)

Ohki T, Yamato M, Murakami D, Takagi R, Yang J, Namiki H, Okano T, Takasaki K

BACKGROUND: With the recent development of endoscopic submucosal dissection (ESD), large oesophageal cancers can be removed with a single procedure with little limits on the resectable range. However, after aggressive ESD, a major complication that arises is the post-operative inflammation and stenosis that can significantly affect the patient's quality of life. AIMS: We examined a novel treatment combining ESD and the endoscopic transplantation of tissue engineered cell sheets created using autologous oral mucosal epithelial cells, in a clinically relevant large animal model. METHODS: Oral mucosal epithelial cells harvested from beagle dogs were cultured under normal conditions at 37 degrees C, on temperature-responsive dishes. After ESD (5 cm in length, 180 degrees in range) cell sheets were harvested by simple temperature reduction to 20 degrees C, and transplanted by endoscopy. RESULTS: The transplanted cell sheets were able to adhere and survive on the underlying muscle layers within the ulcer sites, providing an intact, stratified epithelium. Four weeks after surgery, complete wound healing, with no observable stenosis was seen in the animals receiving autologous cell sheet transplantation. In contrast, noticeable fibrin mesh and host inflammation; consistent with the intermediate stages of wound healing were observed in the control animals that received only ESD. CONCLUSIONS: These findings in a clinically relevant canine model demonstrate the effectiveness of a novel combined endoscopic approach for the potential treatment of oesophageal cancers that can effectively enhance wound healing and possibly prevent post-operative oesophageal stenosis.

J Gerontol Nurs 2006 May; 32(5): 25-33; quiz 34-5 (Read article online)

DiBartolo MC

Individuals with dementia inevitably experience decreased oral intake when they are no longer able to recognize food, feed themselves independently, or experience swallowing difficulties. There is mounting evidence that routine insertion of a percutaneous endoscopic gastrostomy (PEG) does not significantly affect survival, nor does it reduce the risk of aspiration pneumonia and pressure ulcer formation. Although there is relatively little published on assisted oral feeding, its advantages include allowing the patient to enjoy the gratification of eating and socialization that accompanies mealtime, as well as avoiding restraint use that often accompanies PEG placement. Nurses can play a pivotal role in assessment of feeding difficulties, implementation of innovative mealtime programs, educating families about specific strategies to optimize oral intake, and participating in research to evaluate patient outcomes.

Equine Vet J 2006 May; 38(3): 209-13 (Read article online)

Jonsson H, Egenvall A

REASONS FOR PERFORMING STUDY: There is little information about the prevalence of gastric ulcers in Standardbred trotters and potential correlations between ulcers and various traits, e.g. age, sex, performance, temperament and feeding regimens, need further elucidation. OBJECTIVES: The prevalence of ulcers in the gastric squamous mucosa of Swedish Standardbreds was estimated and the associations between ulcer score and age, sex, performance, temperament and feeding regimens were determined. METHODS: Eighty Swedish Standardbreds in active race training, trained by 9 different trainers, underwent gastroscopy. Information on age, gender, status of training, performance over the last 4 months compared with the trainer's expectations before that period, behaviour, eating habits, feed type, bedding type, time spent outdoors per day and medical treatment during the last month was collected. Gastroscopy was performed and lesions in the squamous gastric mucosa were scored from 0 to 4 (0 = no lesions; 4 = > 5 lesions with haemorrhage, > 10 lesions with no haemorrhage, or a large area of diffuse loss of surface epithelium). RESULTS: Twenty-four (30%) of the horses had no lesions in the squamous mucosa, 22 (27.5%) had a score of 1; 21 (26.2%) score 2; 9 (11.2%) score 3; and 4 (5%) score 4. Horses that were in preparatory training and those that had raced during the last month were significantly more affected than horses that were fit for racing but had not raced during the last month, using a logistic regression model with trainer incorporated as a random effect. CONCLUSIONS: The study confirmed a high prevalence of ulcers in the gastric squamous mucosa of Standardbreds in race training. Of the studied parameters only status of training showed a significant association with gastric ulcers of the squamous mucosa. POTENTIAL RELEVANCE: Gastric ulceration is a common disease and diagnosis should be made by endoscopic examination of the gastric mucosa, since parameters such as age, gender, performance, behaviour, eating habits provide only weak clues as to which horses might be affected. Further studies are needed to determine the aetiology of the syndrome and to find ways to reduce, if possible, the frequency of gastric ulcers.

Dig Dis 2006; 24(1-2): 189-94 (Read article online)

Hollenz M, Stolte M, Leodolter A, Labenz J

Background and Aim: Nonsteroidal anti-inflammatory drugs (NSAIDs) cause dyspeptic complaints and lesions in the upper gastrointestinal tract. The true incidence of these side effects in the everyday situation remains uncertain. We therefore investigated as to how often patients on NSAIDs in the primary care setting must be expected to develop troublesome dyspepsia and/or ulcers in the upper gastrointestinal tract. Patients and Methods: Admitted to the study were consecutive patients requiring NSAID treatment for at least 2 weeks, who were free of treatment-requiring dyspeptic symptoms, and who were not receiving any prophylactic co-medication. After a minimum of 2 weeks of treatment with a NSAID, a standardized questionnaire and endoscopy of the upper gastrointestinal tract were obtained. Results: 104 patients (median age 53 years, 91 women) were recruited to the study. Four patients had to be excluded for protocol violations. NSAID treatment was applied mainly with diclofenac (n = 67), followed by ibuprofen (n = 22) and rofecoxib (n = 9). The main indication was degenerative complaints affecting the vertebral column and joints. Under treatment, 35% of the patients developed troublesome dyspepsia that required treatment. The frequency of dyspepsia was independent of the duration of NSAID use. Ulcer prevalence was 16% (duodenal ulcer: n = 5; gastric ulcer: n = 11; cardiac ulcer: n = 1). Relevant epigastric pain was experienced more frequently by ulcer patients than those with no ulcer (35 vs. 18%, p = n.s.), but their overall symptom frequency was no higher than in the latter. Predictors for the development of ulcer were smoking (odds ratio 5.11 [1.59-16.48]), regular use of alcohol (odds ratio 4.49 [1.34-15.07]) and duration of treatment less than 1 month (odds ratio 4.95 [1.06-23.09]). No ulcer complications occurred during the period under observation. Overall, 44% of the patients developed troublesome dyspepsia and/or ulcer. Conclusion: Primary care patients with an average risk profile frequently develop dyspeptic symptoms requiring treatment, and ulcers while on NSAIDs. Patients who developed an ulcer were not identifiable on the basis of symptoms or risk factors. Copyright (c) 2006 S. Karger AG, Basel.

Rev Esp Quimioter 2006 Mar; 19(1): 34-8 (Read article online)

Diaz-Reganon J, Alarcon T, Domingo D, Lopez-Brea M

Helicobacter pylori possess various virulence factors, including cagA and vacA genes, that are associated with more aggressive symptoms such as bleed-ing ulcer and gastric cancer. Although there are different treatment regimens, there is still a failure rate of up to 20% due to antibiotic resistance, among other causes. In our country resistance to metronidazole and clarithromycin is increasing, especially in children, although they are still susceptible to amoxicillin and tetracycline. In order to determine the susceptibility pattern to these antibiotics 36 H. pylori clinical isolates were studied. MIC was determined by agar diffusion and agar dilution, and vacA and cagA genes were detected by conventional PCR. All isolates were susceptible to amoxicillin and tetracycline. Resistance to metronidazole by diffusion or dilution tests was 35.7% and 36.1%, respectively, and to clarithromycin, 21.4% and 22.3%, respectively. There was one strain that showed intermediate resistance to clarithromycin (MIC 0.38 mg/l), using agar diffusion, and that was included among the resistant strains. Three discrepancies were observed between the diffusion and dilution methods. The vacA s1 allele was detected in 17.2% of the strains, and vacA s2 in 82.8%; 51.7% of the total were cagA+. In conclusion, all strains tested in our study were susceptible to amoxicillin and tetracycline, allowing them to be considered as first-line antibiotics, while clarithromycin and metronidazole maintain a slight increase in their resistance level. The cagA+ strains were detected in expected quantities, while the s1 allele of the vacA gene was detected in lower quantities.

Aliment Pharmacol Ther 2006 Jun 1; 23(11): 1607-13 (Read article online)

Pais SA, Nathwani RA, Dhar V, Nowain A, Laine L

Summary Background Treatment with a continuous i.v. proton pump inhibitor is presumed to promote clot formation and stability by sustaining intragastric pH >/= 6. Aim We postulated that very frequent oral dosing of proton pump inhibitors should simulate i.v. infusion and achieve similar pH control. Methods Twenty healthy volunteers were stratified by Helicobacter pylori status (10 positive; 10 negative) and had determination of CYP2C19 status. After an overnight fast, an intragastric pH probe was placed. Subjects received 120 mg of lansoprazole at 8 am and 30 mg every 3 h until 8 pm. Intragastric pH was measured over 24 h, and lansoprazole plasma concentrations were determined at five time points. Results Intragastric pH was >/=6 for 41% (95% CI: 30-53%) of the 15-h period from 8 am-11 pm and 46% (95% CI: 35-56%) of the 24-h period (8-8 am). The mean proportion of patients with pH >/=6 was not significantly different in H. pylori-positive vs. negative patients. Only 25% of subjects sustained pH >/=6 for at least 60% of the 15-h period, and 35% had a sustained pH >/=6 for at least 60% of the 24-h period. Conclusions A dose of 120 mg of oral lansoprazole followed by standard 30 mg doses of lansoprazole every 3 h did not reliably sustain pH at the desired level of 6.