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Does open access urea breath testing really affect outpatient endoscopy? — a district hospital's perspective
AGAA1269
April 2000
5800
5802
DOES OPEN AC CE SS UREA BREATH TESTING REALLY AF· FECT O UTPATIENT E NDOSCOPY?· A DISTRICT HOSPITAL'S PERSPECTIVE. Sanji v Ma hadeva. James Connelly. Pulak Sah ay, Ponte fract Gen Infirmary. Ponte fract, United Kingdom .
PREVALENCE OF DYSPEPSIA AT IN PRE-SCHOOL AND SCHOOL AGE CHILDREN ATTENDING DAY CARE CENTERS. Hoda M. Malaty, David Y. Graham . Siddharta G. Redd y, Nancy D. Log an. VAMC and Baylor Coli of Medicine. Houston, TX ; Xxx, X.
Open Acces s Urea Breath testing has been cla imed to reduce the referrals for endoscopy in young dyspep tics in some centres and provide equally satisfying management. Aim . To assess the imp act a Urea Breath Test (UBT) serv ice has had on the outpatient endoscopy (OE) workload in a district hospit al with a heavy demand on service. Method. An Open Access UBT serv ice was initiated in this hospital in Octobe r 1995 for <40 year old patient s with dyspepsia with out alarm sympto ms. A retrospective review of all outpatient endoscopy data was performed in a 12 month perio d befo re (October 1994 - October 1995) and afte r (Oc tober 1997 - October 1998) the UBT service . Serious pathology was defined as pep tic ulcer disease. oesop hagitis and sequelae, and malignancy. The results of patients who attended the UBT service from October 1997 to October 1998 were also analysed. Results. In the pre-UBT year , a total of 798 patient s attended for OE (18 % < 40 years, 82% > 40 year s). Thi s total had increased to 1905 patie nts (16 % < 40 yea rs. 84% > 40 years)in the post-UBT year. The Standardised Referral Ratio (SRR) for both age groups were signific ant ly higher in the post-UBT year: 210 in the < 40 group (95 %CI = 187 to 235 ) and 244 in the > 40 group (95%CI = 233 to 257 ). The SRR for both age groups in the pre-UBT year was defined as 100. 6% of the post-UBT year in the <40 gro up had serious pathology compared to 7% pre-UBT (p >O . I , chi squar e analysis). However, in the > 40 group , the proportion of serio us pathology decreased from 37% to 27% (p 40 yea r gro up cannot be ex plained at present.
Hypothesis: Ch ildhood is the time of high risk for H. pylori acquisition. Aims: To exa mine the freq uency of uppe r GI symptoms and its relationsh ip with H. pylori infection in children attending day care centers. Methods: Child ren from 10 licen sed day care centers serving low socioeconomic families from different locat ions in Houst on were studied. Demographic inform ation and socio economic factors were eva luated including parent(s) edu cational level, place of res idence. living conditions. The diagnosis of dyspep sia was based on the mother s ref,0rt ing of the presence of symptoms. Hp status was dete rmined by I C UBT. Result s: 489 blacks and white Hispanic childre n, 246 boys and 243 girls. between the age s of 2 and 16 years partici pated. Th e crude pre valence of dyspeptic symptoms was 14% with no difference between age groups (16% for children younger than six years old vs. 13% for children between the age s of II and 16 yea rs) (p = 0.7). Th e prevalence of dyspepsia amo ng Black and Hispanic children was similar ( 13% vs. 17%, respectively, p =0.2) and it wa s almost identica l in boys (14 %) and girls (15%) (P = 0.8). Act ive H. pylori infec tion was found in 25% overall; the prevalence increased with age (fro m 14% for children youn ger than six years old to 45% for children between the ages of II and 16 years) . Th ere was no difference in Hp positivity among child ren with or without dy spepsia (26 % vs. 25% ; respectively). While there was an inverse correlation betwe en the mother's education and Hp positivity in children (OR = 6.3 , (95% CI = 2.6 to 16.7, p < O.OOI) . There was no assoc iation between mother' s edu cational level and dyspeptic symptoms amo ng children. Conclu sions: Th e result s of the study showed no sig nificant associ ation between Hp infec tion and dyspeptic symptoms. However, dyspept ic symptoms are frequently present among childre n in the community and community-base d studies on childre n for development and eva luatio n of scales for the meas urements of dyspep sia are needed .
um
5803 5801 BREAST FEEDING PRACTICES AND HELlCOBACTER PYLORI ACQUISITION. Hoda M. Malaty, Nancy D. Logan, David Y. Graham, Siddharta G. Red dy, VAMC and Baylor Coli of Medicine. Houston, TX . Hypothe sis: Studies sugges t that huma n milk may inhibit adherence of the Hp to gas tric mucosa. Obj ect ive:To inves tigate the role of breast feedi ng practices and its relation to Hp acquisition. Methods:Children from 10 licensed day care centers from different locati ons in Houston were studied. Demo graph ic information and socioeco nomic factors were evaluat ed including parent(s) educational level, place of residence, living condition s, and history of breast feeding practice. H. pylori status was determ ined by DC-UBT. Results: 273 healthy Black and white Hispanic asy mptomatic children (1 19 boys and 154 gir ls) age s 2 to 10 yea rs, who were born in the U.S, were studied. The prevalence of Hp increase d from II % in children younger than 6 yr to 32% for childr en between the ages of 6 and 10 yr (p< O.OOI). There was no significant difference between boys and girls (21 % vs. 16%, respectively; p= O.4). The prevalence of Hp infecti on was 25% (44/176) in non breast -fed children compared to 7% (7/97) who were breast-fed, (crude OR=4.3, 95% CI = 1.85-9.9, p< O.OOI). No difference was obse rved in breast feeding pract ices with ethnicity: 35% of black mothers breast-fed their childre n vs. 38% among Hispanic (p = O.60) . Since our studied population was non-affluent , the mother' s educa tional level was the strongest soc ioeco nomic indica tor and wa s significantly associated with bre ast feeding practices. The odds ratio for educa ted mother that breast-fed her children was four times greater comp ared to those who were less educate d, (95% C I= 2-8.2, p< O.OOI). There was an inverse co rrelatio n between the mother ' s educat ion and Hp positivi ty in children (OR= 6.0, 95% CI = 2.4 to 15, p< O.OOI ). To adjust for pote ntia l co nfo unding varia bles. we applied mult iple regression analysis when all the stu died variabl es were fitted in the model included age, numb er of children, adults, and bedro oms in the househ old , mothers educational level. breast feeding practices. gender and ethnicity. The pattern for age, mothers educati onal level, and breast feeding practices held a statist ically significant trend at p< .05. Conclusions: Brea st feed ing practice s have a sig nificant protective effect aga inst acquiring the infection in young ch ildren . Understanding the epidemiology of H. pylori infection in childhood requ ires better understanding of the interac tions betwee n multiple factors e.g., enviro nment , ethnicit y, socioeconomic class. and breast feeding practices.
ONE-WEEK LOW·DOSE LANSOPRAZOLE TRIPLE THERAPY FOR ERADICATION OF HELICOBACTER PYLORI: A LARGE MULTICENTRE, RANDOMISED TRIAL. Peter Malfertheiner, Wol fgang Fischbach, Peter Layer, Joachim Moessner, Manfred Stolte, Kari n Demleitner, Winfried Am Fuchs , Otto- von-Guericke Univ, Magdeburg , Germany; Clin , Aschaffenburg, Germany; Israelitische s Krankenhaus, Hamburg, Germ any; Univ, Leipzig. Germ any; Cl in, Bayreuth, Germany; Taked a Pharma GmbH, Aachen, Germ any. Intr oduction: According to European guidelines PPI in sta ndard dose (i.e, lansopr azole 30 mg) is recommended for Helicobacter pylori (Hp) eradication therapy in co mbination with amo xicillin (A) I g and clarithro mycin (C) 500 mg twic e daily for seven days. Th e aim of this study was to inve stigate the effective ness of low-dose lansopra zole therapy in association with AC for eradica tion in Hp+ patients with functional dyspep sia (FD). Methods: Hp + patients with FD in Germ any entered this doubleblind, randomised, controlled trial. Hp status assessment at entry based on histology , campylobacter-like organism test (CLO test) and I3C urea breath lest ( 13C-UBT). Patients were randomised to: I) lansoprazole 30 mg bid, clarithromycin 500 mg bid and amoxicillin I g bid from Days I to 7 (L30A C gro up), 2) lansoprazo le 15 mg bid , c1arit hromycin 500 mg bid and amoxicillin I g bid from Days I to 7 (L15A C gro up) or 3) lansoprazole 15 mg qd from Days I to 14 (LI S group). Hp eradication was assessed after 2 and 6 months by 13C_UBT and was regarded as success ful if both results were Hp-. Result s: Of 860 patient s screened, 674 patient s fulfilled the criteria for the ITT analyses and 479 patients for the PP analyses . The results of the PP analyses agreed with those obtained in the corresponding ITT ana lyses as show n in the table. The eradication results obtained for the triple therap ies with lansoprazole 30 mg and 15 mg are well co mparable. Th ey are in the range to be expected in a mult icentre trial in patient s with FD . The global ju dgement for toler ability by patients and investi gators showed positive result s for the majority of patients in all thre e treatment group s. Conclusion: One-w eek triple therapy comprising lansoprazole 15 mg , amoxic illin 1 g and clarithromycin 500 mg twice daily for erad icating Hp is ju st as effective as triple therapy with the standard dose of Iansoprazolc (30 mg). It combines high efficac y and good tolerability with a low price and thus appears highly suitable for widespread use in general practice. manalysis L30AC (n=227) L15AC (n=216) L15 (n=204)
PPanalysis
82.4% 77.3 % 7.4%
L30AC (n=168) L15AC (n=162) L15 (n=143)
81.0% 80.9% 6.3%
April 2000
5800
5802
DOES OPEN AC CE SS UREA BREATH TESTING REALLY AF· FECT O UTPATIENT E NDOSCOPY?· A DISTRICT HOSPITAL'S PERSPECTIVE. Sanji v Ma hadeva. James Connelly. Pulak Sah ay, Ponte fract Gen Infirmary. Ponte fract, United Kingdom .
PREVALENCE OF DYSPEPSIA AT IN PRE-SCHOOL AND SCHOOL AGE CHILDREN ATTENDING DAY CARE CENTERS. Hoda M. Malaty, David Y. Graham . Siddharta G. Redd y, Nancy D. Log an. VAMC and Baylor Coli of Medicine. Houston, TX ; Xxx, X.
Open Acces s Urea Breath testing has been cla imed to reduce the referrals for endoscopy in young dyspep tics in some centres and provide equally satisfying management. Aim . To assess the imp act a Urea Breath Test (UBT) serv ice has had on the outpatient endoscopy (OE) workload in a district hospit al with a heavy demand on service. Method. An Open Access UBT serv ice was initiated in this hospital in Octobe r 1995 for <40 year old patient s with dyspepsia with out alarm sympto ms. A retrospective review of all outpatient endoscopy data was performed in a 12 month perio d befo re (October 1994 - October 1995) and afte r (Oc tober 1997 - October 1998) the UBT service . Serious pathology was defined as pep tic ulcer disease. oesop hagitis and sequelae, and malignancy. The results of patients who attended the UBT service from October 1997 to October 1998 were also analysed. Results. In the pre-UBT year , a total of 798 patient s attended for OE (18 % < 40 years, 82% > 40 year s). Thi s total had increased to 1905 patie nts (16 % < 40 yea rs. 84% > 40 years)in the post-UBT year. The Standardised Referral Ratio (SRR) for both age groups were signific ant ly higher in the post-UBT year: 210 in the < 40 group (95 %CI = 187 to 235 ) and 244 in the > 40 group (95%CI = 233 to 257 ). The SRR for both age groups in the pre-UBT year was defined as 100. 6% of the post-UBT year in the <40 gro up had serious pathology compared to 7% pre-UBT (p >O . I , chi squar e analysis). However, in the > 40 group , the proportion of serio us pathology decreased from 37% to 27% (p
Hypothesis: Ch ildhood is the time of high risk for H. pylori acquisition. Aims: To exa mine the freq uency of uppe r GI symptoms and its relationsh ip with H. pylori infection in children attending day care centers. Methods: Child ren from 10 licen sed day care centers serving low socioeconomic families from different locat ions in Houst on were studied. Demographic inform ation and socio economic factors were eva luated including parent(s) edu cational level, place of res idence. living conditions. The diagnosis of dyspep sia was based on the mother s ref,0rt ing of the presence of symptoms. Hp status was dete rmined by I C UBT. Result s: 489 blacks and white Hispanic childre n, 246 boys and 243 girls. between the age s of 2 and 16 years partici pated. Th e crude pre valence of dyspeptic symptoms was 14% with no difference between age groups (16% for children younger than six years old vs. 13% for children between the age s of II and 16 yea rs) (p = 0.7). Th e prevalence of dyspepsia amo ng Black and Hispanic children was similar ( 13% vs. 17%, respectively, p =0.2) and it wa s almost identica l in boys (14 %) and girls (15%) (P = 0.8). Act ive H. pylori infec tion was found in 25% overall; the prevalence increased with age (fro m 14% for children youn ger than six years old to 45% for children between the ages of II and 16 years) . Th ere was no difference in Hp positivity among child ren with or without dy spepsia (26 % vs. 25% ; respectively). While there was an inverse correlation betwe en the mother's education and Hp positivity in children (OR = 6.3 , (95% CI = 2.6 to 16.7, p < O.OOI) . There was no assoc iation between mother' s edu cational level and dyspeptic symptoms amo ng children. Conclu sions: Th e result s of the study showed no sig nificant associ ation between Hp infec tion and dyspeptic symptoms. However, dyspept ic symptoms are frequently present among childre n in the community and community-base d studies on childre n for development and eva luatio n of scales for the meas urements of dyspep sia are needed .
um
5803 5801 BREAST FEEDING PRACTICES AND HELlCOBACTER PYLORI ACQUISITION. Hoda M. Malaty, Nancy D. Logan, David Y. Graham, Siddharta G. Red dy, VAMC and Baylor Coli of Medicine. Houston, TX . Hypothe sis: Studies sugges t that huma n milk may inhibit adherence of the Hp to gas tric mucosa. Obj ect ive:To inves tigate the role of breast feedi ng practices and its relation to Hp acquisition. Methods:Children from 10 licensed day care centers from different locati ons in Houston were studied. Demo graph ic information and socioeco nomic factors were evaluat ed including parent(s) educational level, place of residence, living condition s, and history of breast feeding practice. H. pylori status was determ ined by DC-UBT. Results: 273 healthy Black and white Hispanic asy mptomatic children (1 19 boys and 154 gir ls) age s 2 to 10 yea rs, who were born in the U.S, were studied. The prevalence of Hp increase d from II % in children younger than 6 yr to 32% for childr en between the ages of 6 and 10 yr (p< O.OOI). There was no significant difference between boys and girls (21 % vs. 16%, respectively; p= O.4). The prevalence of Hp infecti on was 25% (44/176) in non breast -fed children compared to 7% (7/97) who were breast-fed, (crude OR=4.3, 95% CI = 1.85-9.9, p< O.OOI). No difference was obse rved in breast feeding pract ices with ethnicity: 35% of black mothers breast-fed their childre n vs. 38% among Hispanic (p = O.60) . Since our studied population was non-affluent , the mother' s educa tional level was the strongest soc ioeco nomic indica tor and wa s significantly associated with bre ast feeding practices. The odds ratio for educa ted mother that breast-fed her children was four times greater comp ared to those who were less educate d, (95% C I= 2-8.2, p< O.OOI). There was an inverse co rrelatio n between the mother ' s educat ion and Hp positivi ty in children (OR= 6.0, 95% CI = 2.4 to 15, p< O.OOI ). To adjust for pote ntia l co nfo unding varia bles. we applied mult iple regression analysis when all the stu died variabl es were fitted in the model included age, numb er of children, adults, and bedro oms in the househ old , mothers educational level. breast feeding practices. gender and ethnicity. The pattern for age, mothers educati onal level, and breast feeding practices held a statist ically significant trend at p< .05. Conclusions: Brea st feed ing practice s have a sig nificant protective effect aga inst acquiring the infection in young ch ildren . Understanding the epidemiology of H. pylori infection in childhood requ ires better understanding of the interac tions betwee n multiple factors e.g., enviro nment , ethnicit y, socioeconomic class. and breast feeding practices.
ONE-WEEK LOW·DOSE LANSOPRAZOLE TRIPLE THERAPY FOR ERADICATION OF HELICOBACTER PYLORI: A LARGE MULTICENTRE, RANDOMISED TRIAL. Peter Malfertheiner, Wol fgang Fischbach, Peter Layer, Joachim Moessner, Manfred Stolte, Kari n Demleitner, Winfried Am Fuchs , Otto- von-Guericke Univ, Magdeburg , Germany; Clin , Aschaffenburg, Germany; Israelitische s Krankenhaus, Hamburg, Germ any; Univ, Leipzig. Germ any; Cl in, Bayreuth, Germany; Taked a Pharma GmbH, Aachen, Germ any. Intr oduction: According to European guidelines PPI in sta ndard dose (i.e, lansopr azole 30 mg) is recommended for Helicobacter pylori (Hp) eradication therapy in co mbination with amo xicillin (A) I g and clarithro mycin (C) 500 mg twic e daily for seven days. Th e aim of this study was to inve stigate the effective ness of low-dose lansopra zole therapy in association with AC for eradica tion in Hp+ patients with functional dyspep sia (FD). Methods: Hp + patients with FD in Germ any entered this doubleblind, randomised, controlled trial. Hp status assessment at entry based on histology , campylobacter-like organism test (CLO test) and I3C urea breath lest ( 13C-UBT). Patients were randomised to: I) lansoprazole 30 mg bid, clarithromycin 500 mg bid and amoxicillin I g bid from Days I to 7 (L30A C gro up), 2) lansoprazo le 15 mg bid , c1arit hromycin 500 mg bid and amoxicillin I g bid from Days I to 7 (L15A C gro up) or 3) lansoprazole 15 mg qd from Days I to 14 (LI S group). Hp eradication was assessed after 2 and 6 months by 13C_UBT and was regarded as success ful if both results were Hp-. Result s: Of 860 patient s screened, 674 patient s fulfilled the criteria for the ITT analyses and 479 patients for the PP analyses . The results of the PP analyses agreed with those obtained in the corresponding ITT ana lyses as show n in the table. The eradication results obtained for the triple therap ies with lansoprazole 30 mg and 15 mg are well co mparable. Th ey are in the range to be expected in a mult icentre trial in patient s with FD . The global ju dgement for toler ability by patients and investi gators showed positive result s for the majority of patients in all thre e treatment group s. Conclusion: One-w eek triple therapy comprising lansoprazole 15 mg , amoxic illin 1 g and clarithromycin 500 mg twice daily for erad icating Hp is ju st as effective as triple therapy with the standard dose of Iansoprazolc (30 mg). It combines high efficac y and good tolerability with a low price and thus appears highly suitable for widespread use in general practice. manalysis L30AC (n=227) L15AC (n=216) L15 (n=204)
PPanalysis
82.4% 77.3 % 7.4%
L30AC (n=168) L15AC (n=162) L15 (n=143)
81.0% 80.9% 6.3%