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P.02.4: Efficacy of Bismuth-Based Helicobacter Pylori Treatment in Patients with Atrophic Body Gastritis
Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
P.02.3 CORRELATION BETWEEN ORAL AND GASTRIC H. PYLORI: STILL A CONTROVERSIAL ISSUE S. Segato 1 , A. De Monti 1 , M. Parravicini 1 , C.C. Cortelezzi ∗,1 , A. Lorenzo 2 , A. Tagliabue 2 Unit ASST Sette Laghi, Varese, Italy; 2 Morphological and Surgical Sciences Departiment. Università dell’Insubria., Varese, Italy
1 Gastroenterology
Background and aim: It has long been said that dental plaque and saliva might act as a reservoir of H.Pylori (HP); as such, oral cavity could be a source of re-infection of gastric mucosa. Therefore, to be effective in the long-term, eradication therapy should be accompanied by adequate oral hygiene. Data from literature are controversial. Aim: the aim of the study is to investigate the relationship between oral and gastric HP. Material and methods: We studied 60 pts (24 males/36 females) aged 18 and older (mean age 53,1 years; range 18/76 years). Informed consent was obtained from each individual. Gastric HP was detected using C13 Urease Breath Test (UBT). No antibiotics, bismuth-based compounds or Proton Pump Inhibitors were assumed during the 4 weeks preceding the test. 37 pts had undergone eradication therapy. Oral specimens, consisting of saliva and dental plaque in periodontal pockets were collected with filter paper cones. DNA was detected using the Real-Time PCR technique. The mean probing depth was calculated for every patient to detect periodontal pockets and a patient was considered to be healthy from a periodontal point of view when his/her mean probing depth was under 3mm, and to be affected when his/her probing depth was ≥3mm. Data analysis was carried out using the Student’s T Test. Results: 31 patients tested negative for periodontal disease, while 29 tested positive. The mean load of Helicobacter pylori registered among the periodontal healthy patients was 10.52, while it was 22.78 among affected patients. (p=0.024). Periodontal patients showed an increased level of HP in saliva compared with healthy patients (p=0.05). 30 pts had a positive UBT; 8 of them (26.6%) had a positive detection in oral cavity. 30 pts had a negative UBT; 14 of them (46.6%) had a positive oral PCR (p=0.268). 11 naïve patients had a negative UBT; 6 of them (54%) had a positive oral PCR. 19 patients had a negative UBT after eradication therapy; 8 of them (42.1%) had a positive oral detection (p=0.390). Conclusions: Although the study involved a small group of patients, the results show a relationship between periodontal disease and oral HP, but a lack of significant correlation between oral and gastric HP. The hypothesis that the oral cavity may be a permanent reservoir of viable H. pylori and the role of oral HP in gastric re-infection still remain controversial issues.
P.02.4 EFFICACY OF BISMUTH-BASED HELICOBACTER PYLORI TREATMENT IN PATIENTS WITH ATROPHIC BODY GASTRITIS G. Scalese ∗,1 , E. Lahner 1 , M. Carabotti 2 , L. Cocomello 1 , G. Esposito 1 , E. Pilozzi 3 , E. Di Giulio 1 , B. Annibale 1 1 Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sant’Andrea Hospital, School of Medicine, University Sapienza, Roma, Italy; 2 Department of Internal Medicine and Medical Specialites, University Sapienza, Roma, Italy; 3 Pathology Unit, Sant’Andrea Hospital, University Sapienza, Roma, Italy
Background and aim: Atrophic body gastritis (AG) is characterized
e139
by oxyntic mucosa atrophy and reduced gastric acid secretion. Helicobacter pylori (Hp) infection is considered one major pathogenetic factor for AG. Classical Hp eradication regimens contain proton pump inhibitors (PPIs) and antibiotics. In AG, due to impaired gastric acid secretion, PPIs are not indicated and bismuth-based therapies represent a reasonable alternative. Data on efficacy of Hp bismuth-based eradication treatments in AG patients are lacking. The study aim was to assess the efficacy of two bismuth-based Hp eradication therapies in AG patients. Material and methods: 39 consecutive patients with histological diagnosis of AG (updated Sydney System) and active Hp infection detected by histology (positive Giemsa stain or presence of neutrophil infiltration) were treated with two different bismuth-based therapies: 1st group (23 patients, 78.3% female, median age 51 years (32–78), BMI 24 kg/m2 (20–33) treated with a bismuth-based triple therapy (14 days bismuth salts 480mg bid, 7 days metronidazole 750mg and amoxicillin 3g tid), compared to a 2nd group (16 patients, 87.5% female, median age 51 years (31–75), BMI 24 kg/m2 (18–32) treated with an all-in-one formulation (Pylera® : 13 days bismuth salts 1260mg, metronidazole and tetracycline 1125mg tid). Both treatments excluded PPIs. All patients underwent endoscopy 6 months after the end of treatment to evaluate treatment efficacy and possible histological changes. Results: Successful eradication was achieved in 60.9% (14/23) and in 87.5% (14/16) of patients treated with bismuth-based triple therapy and Pylera® , respectively (p=0.08, Fisher’s exact test). Side effects were present in 17.4% (4/23) and in 18.7% (3/16) respectively (p=1.00). In all patients, side effects were mild not leading to treatment withdrawal. At 6 months after treatment in successfully treated patients, the proportions of unchanged, worsened or improved body atrophy and intestinal metaplasia scores were similar in both treatment groups. Conclusions: In AG, bismuth-based Hp eradication regimens seem to be efficacious and safe. The all-in-one formulation Pylera® showed a higher eradication rate (87%) compared to triple therapy (61%), without reaching statistical significance. In Hp positive AG patients with impaired gastric acid secretion, bismuth-based eradication regimens might be proposed as first-line approach.
P.02.5 PPI TEST FOR DIAGNOSIS OF BODY ATROPHIC GASTRITIS: A PROSPECTIVE STUDY F. Di Mario ∗,1 , S. Landi 1 , S. Grillo 1 , V. Corrente 1 , M. Franceschi 2 , G. Baldassarre 2 , G. Grande 3 , R. Cannizzaro 5 , M. Rugge 4 1 Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy; 2 Endoscopic Unit, Department of Surgery, ULSS4, Alto Vicentino, Santorso, Italy; 3 Endoscopic Unit, Deparment of Gastroenterology, Baggiovara General Hospital, Baggiovara, Modena, Italy; 4 Department of Pathology, University of Padova, Padova, Italy; 5 Oncology Center, Aviano General Hospital, Aviano, Italy
Background and aim: Pepsinogen 1 (PG1) is a non-invasive test for diagnosis of body chronic atrophic gastritis (with a negative predictive value of 98%) but the upper cut-off to make the diagnosis is controversial, as in Europe is claimed to be under 30 mcg/l, while in Japan is considered under 70 mcg/l. Furthermore there is a “gray zone ”, of not clear interpretation, in which patients with PG1 values ranging between 30 and 50 mcg/l could show histologic finding of CAG. In the literature it’s claimed that PG1 are increasing after PPI administration, within one week from the start of the therapy. To identify patients with body chronic atrophic gastritis (CAG) in a population group showing serological PG1 levels borderline (30–50 mcg/l) by means of a PPI -test.
P.02.3 CORRELATION BETWEEN ORAL AND GASTRIC H. PYLORI: STILL A CONTROVERSIAL ISSUE S. Segato 1 , A. De Monti 1 , M. Parravicini 1 , C.C. Cortelezzi ∗,1 , A. Lorenzo 2 , A. Tagliabue 2 Unit ASST Sette Laghi, Varese, Italy; 2 Morphological and Surgical Sciences Departiment. Università dell’Insubria., Varese, Italy
1 Gastroenterology
Background and aim: It has long been said that dental plaque and saliva might act as a reservoir of H.Pylori (HP); as such, oral cavity could be a source of re-infection of gastric mucosa. Therefore, to be effective in the long-term, eradication therapy should be accompanied by adequate oral hygiene. Data from literature are controversial. Aim: the aim of the study is to investigate the relationship between oral and gastric HP. Material and methods: We studied 60 pts (24 males/36 females) aged 18 and older (mean age 53,1 years; range 18/76 years). Informed consent was obtained from each individual. Gastric HP was detected using C13 Urease Breath Test (UBT). No antibiotics, bismuth-based compounds or Proton Pump Inhibitors were assumed during the 4 weeks preceding the test. 37 pts had undergone eradication therapy. Oral specimens, consisting of saliva and dental plaque in periodontal pockets were collected with filter paper cones. DNA was detected using the Real-Time PCR technique. The mean probing depth was calculated for every patient to detect periodontal pockets and a patient was considered to be healthy from a periodontal point of view when his/her mean probing depth was under 3mm, and to be affected when his/her probing depth was ≥3mm. Data analysis was carried out using the Student’s T Test. Results: 31 patients tested negative for periodontal disease, while 29 tested positive. The mean load of Helicobacter pylori registered among the periodontal healthy patients was 10.52, while it was 22.78 among affected patients. (p=0.024). Periodontal patients showed an increased level of HP in saliva compared with healthy patients (p=0.05). 30 pts had a positive UBT; 8 of them (26.6%) had a positive detection in oral cavity. 30 pts had a negative UBT; 14 of them (46.6%) had a positive oral PCR (p=0.268). 11 naïve patients had a negative UBT; 6 of them (54%) had a positive oral PCR. 19 patients had a negative UBT after eradication therapy; 8 of them (42.1%) had a positive oral detection (p=0.390). Conclusions: Although the study involved a small group of patients, the results show a relationship between periodontal disease and oral HP, but a lack of significant correlation between oral and gastric HP. The hypothesis that the oral cavity may be a permanent reservoir of viable H. pylori and the role of oral HP in gastric re-infection still remain controversial issues.
P.02.4 EFFICACY OF BISMUTH-BASED HELICOBACTER PYLORI TREATMENT IN PATIENTS WITH ATROPHIC BODY GASTRITIS G. Scalese ∗,1 , E. Lahner 1 , M. Carabotti 2 , L. Cocomello 1 , G. Esposito 1 , E. Pilozzi 3 , E. Di Giulio 1 , B. Annibale 1 1 Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sant’Andrea Hospital, School of Medicine, University Sapienza, Roma, Italy; 2 Department of Internal Medicine and Medical Specialites, University Sapienza, Roma, Italy; 3 Pathology Unit, Sant’Andrea Hospital, University Sapienza, Roma, Italy
Background and aim: Atrophic body gastritis (AG) is characterized
e139
by oxyntic mucosa atrophy and reduced gastric acid secretion. Helicobacter pylori (Hp) infection is considered one major pathogenetic factor for AG. Classical Hp eradication regimens contain proton pump inhibitors (PPIs) and antibiotics. In AG, due to impaired gastric acid secretion, PPIs are not indicated and bismuth-based therapies represent a reasonable alternative. Data on efficacy of Hp bismuth-based eradication treatments in AG patients are lacking. The study aim was to assess the efficacy of two bismuth-based Hp eradication therapies in AG patients. Material and methods: 39 consecutive patients with histological diagnosis of AG (updated Sydney System) and active Hp infection detected by histology (positive Giemsa stain or presence of neutrophil infiltration) were treated with two different bismuth-based therapies: 1st group (23 patients, 78.3% female, median age 51 years (32–78), BMI 24 kg/m2 (20–33) treated with a bismuth-based triple therapy (14 days bismuth salts 480mg bid, 7 days metronidazole 750mg and amoxicillin 3g tid), compared to a 2nd group (16 patients, 87.5% female, median age 51 years (31–75), BMI 24 kg/m2 (18–32) treated with an all-in-one formulation (Pylera® : 13 days bismuth salts 1260mg, metronidazole and tetracycline 1125mg tid). Both treatments excluded PPIs. All patients underwent endoscopy 6 months after the end of treatment to evaluate treatment efficacy and possible histological changes. Results: Successful eradication was achieved in 60.9% (14/23) and in 87.5% (14/16) of patients treated with bismuth-based triple therapy and Pylera® , respectively (p=0.08, Fisher’s exact test). Side effects were present in 17.4% (4/23) and in 18.7% (3/16) respectively (p=1.00). In all patients, side effects were mild not leading to treatment withdrawal. At 6 months after treatment in successfully treated patients, the proportions of unchanged, worsened or improved body atrophy and intestinal metaplasia scores were similar in both treatment groups. Conclusions: In AG, bismuth-based Hp eradication regimens seem to be efficacious and safe. The all-in-one formulation Pylera® showed a higher eradication rate (87%) compared to triple therapy (61%), without reaching statistical significance. In Hp positive AG patients with impaired gastric acid secretion, bismuth-based eradication regimens might be proposed as first-line approach.
P.02.5 PPI TEST FOR DIAGNOSIS OF BODY ATROPHIC GASTRITIS: A PROSPECTIVE STUDY F. Di Mario ∗,1 , S. Landi 1 , S. Grillo 1 , V. Corrente 1 , M. Franceschi 2 , G. Baldassarre 2 , G. Grande 3 , R. Cannizzaro 5 , M. Rugge 4 1 Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy; 2 Endoscopic Unit, Department of Surgery, ULSS4, Alto Vicentino, Santorso, Italy; 3 Endoscopic Unit, Deparment of Gastroenterology, Baggiovara General Hospital, Baggiovara, Modena, Italy; 4 Department of Pathology, University of Padova, Padova, Italy; 5 Oncology Center, Aviano General Hospital, Aviano, Italy
Background and aim: Pepsinogen 1 (PG1) is a non-invasive test for diagnosis of body chronic atrophic gastritis (with a negative predictive value of 98%) but the upper cut-off to make the diagnosis is controversial, as in Europe is claimed to be under 30 mcg/l, while in Japan is considered under 70 mcg/l. Furthermore there is a “gray zone ”, of not clear interpretation, in which patients with PG1 values ranging between 30 and 50 mcg/l could show histologic finding of CAG. In the literature it’s claimed that PG1 are increasing after PPI administration, within one week from the start of the therapy. To identify patients with body chronic atrophic gastritis (CAG) in a population group showing serological PG1 levels borderline (30–50 mcg/l) by means of a PPI -test.