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P.19.14 HIGH DOSE AMOXICILLIN-BASED FIRST LINE REGIMEN COMPARED TO SEQUENTIAL THERAPY IN THE ERADICATION OF H. PYLORI INFECTION
S212
Abstracts of the 18th National Congress of Digestive Diseases / Digestive and Liver Disease 44S (2012) S55–S220
not overestimate symptom relationship. If we consider that SAP is the only parameter utilized in many MII-pH classifications, we can conclude that a SI-SAP discordance is a negligible problem in our experience.
were observed in HD-LCA group compared to LACT (p=ns). Compliance and occurrence of adverse effects was similar among groups. Conclusions: High dose amoxicillin based eradicating treatment is superior to standard triple therapy and equivalent to sequential therapy; compared to the latter, the shorter duration may represent an advantage.
P.19.13 AUTOIMMUNE GASTRITIS ASSOCIATES WITH DUODENAL LYMPHOCYTOSIS
P.19.15
F. Azzaroli ∗ , P. Cecinato, N.C. Salfi, A. Lisotti, M. Montagnani, C. Calvanese, R. Arena, F. Bazzoli, G. Mazzella
GASTRIC AMYLOIDOSIS IN A PATIENT WITH HEMATEMESIS
Policlinico S.Orsola-Malpighi, Università di Bologna, Bologna, Italy
Azienda Ospedaliero Univeristaria di Trieste, Trieste, Italy
Background and aim: Duodenal lymphocytosis is frequently associated with celiac disease. However, it may be associated with other clinical conditions (i.e. food protein intolerance, GVHD, systemic autoimmune diseases, HP related gastritis, ...). The association with autoimmune gastritis has not been described yet. Material and methods: 19 consecutive patients (15 females; 4 males) with a mean age of 59.16± years with the diagnosis of autoimmune gastritis were evaluated for both gastric and duodenal histology. All patients underwent upper gastrointestinal endoscopy: four random biopsies were drawn from the four quadrants in the distal second portion of the duodenum as well as random gastric biopsies according to the Sydney protocol. Helicobacter Pylori (HP) infection was evaluated by histology. Duodenal lymphocytic count was made by immunohistochemistry using an anti-CD3 antibody. All patients underwent biochemical testing for celiac and autoimmune diseases. Results: The majority of the patients underwent their first upper gastrointestinal endoscopy because of dyspeptic symptoms. 17 out of 19 patients (89%) had a duodenal lymphocytic count above 25%, 8 of them around 40% (42%). Two patients (10%) were positive for HP infection even though in one patient it became negative on follow-up without any eradication treatment. Conclusions: Duodenal lymphocytosis is frequently associated with autoimmune gastritis. Therefore, whenever a duodenal lymphocytosis is encountered, autoimmune gastritis should be considered as a possible differential diagnosis.
Background and aim: Amyloidosis is a process involving the deposition of proteinaceous fibrillar material in a pattern that is commonly systemic, occasionally organ-limited and rarely a solitary localized mass. Only few reports of gastric amyloidosis exist today. In the case below we describe amyloidosis confined to the stomach. Material and methods: Our patient is a 54-year-old white woman with an episode of hematemesis that occurred after a sudden onset of severe epigastric pain. Her medical history included a monoclonal gammopathy of undeterminated significance diagnosed five years before. Her physical exam was only pertinent for severe pallor and laboratory evaluation revealed haemoglobin level of 10.5 gr/dl. On EGDS four 1cm circular flat non-bleeding ulcers were appreciated in the fundus, with poor evidence of non-fresh blood in the lumen. Results: Biopsies of the ulcers were obtained one week later and amyloidosis was diagnosed by histological and immunohistochemic findings characterized of plasma cell proliferation. She underwent extensive tests to identify the etiologies associated with systemic amyloidosis. Tests such rectal biopsy, bone marrow biopsy, echocardiogram, abdomen tomography, serum and urine protein electrophoresis, as well as liver function tests were all normal. The patient was discharged home after 2 weeks with PPI therapy and six months after discharge was doing well. Repeat EGDS demonstrated healed ulcers, but biopsy confirmed depostion of amorphous protein material consistent with amyloid in the fundus. Conclusions: Finally, in line with literature, our patient presented an AL amyloidosis of the stomach, typically associated with plasma cell dyscrasia and monoclonal light chains in serum. Treatment is primary symptomatic and includes monitoring for complications. Blood vessels fragility associated with amyloid deposition caries a risk of bleeding and therefore hematemesis could be an occasionally sign, but longer follow-up s neede to observe the real evolution.
P.19.14 HIGH DOSE AMOXICILLIN-BASED FIRST LINE REGIMEN COMPARED TO SEQUENTIAL THERAPY IN THE ERADICATION OF H. PYLORI INFECTION F. Franceschi ∗ ,1 , A. Tortora 1 , M.C. Campanale 1 , F. Bertucci 1 , S. Pecere 1 , V. Gerardi 1 , F. Barbaro 1 , G. Gigante 1 , V. Cesario 1 , P. Iacomini 1 , A. Granato 1 , C. Cordischi 1 , M. Sabbatini 1 , N. Gentiloni Silveri 1 , D. Curro’ 1 , G. Cammarota 1 , G. Gasbarrini 2 , A. Gasbarrini 1 1 Ospedale
Gemelli, Roma, Italy; 2 Fondazione Ricerca In Medicina, Bologna,
Italy Background and aim: Helicobacter pylori eradication rates with standard first-line triple therapy have declined to unacceptable levels. Ten days sequential therapy has been shown to increase eradication rate and is now considered to be one of the best options as-first line treatment. To date, amoxicillinresistant H. pylori strains have rarely been detected. Whether increasing the dosage of amoxicillin in a standard 7 days eradicating regimen may enhance the efficacy is not known. Aim: To compare the efficacy of a 7 days high-dose amoxicillin based first-line regimen with sequential therapy. Material and methods: 300 sex and age matched patients were randomized into 3 different therapeutic schemes: (1) standard LCA, lansoprazole 15 mg bid, clarithromycin 500 mg bid and amoxicillin 1000 mg bid for 7 days; (2) high dose LCA (HD-LCA), lansoprazole 15 mg bid, clarithromycin 500 mg bid and amoxicillin 1000 mg tid for 7 days; (3) sequential LACT, lansoprazole 15 mg bid plus amoxicillin 1000 mg bid for 5 days, followed by lansoprazole 15 mg bid, clarithromycin 500 mg bid and tinidazole 500 mg bid for 5 days. Eradication was confirmed by 13C-urea breath test. Compliance and occurrence of adverse effects were assessed by a validated questionnaire. Results: Eradication rates were: LCA (55% PP, 53% ITT), HD-LCA (75% PP, 72% ITT), LACT (73% PP; 72% ITT). Eradication rates were higher in HD-LCA group compared to LCA (p<0.01), while no significant differences
C. Simeth ∗ , L. Buri
P.19.16 LACTOBACILLUS REUTERI IMPROVES THE ERADICATION RATE OF HELICOBACTER PYLORI C. Efrati ∗ , G. Nicolini, R. Finizio, C. Cannaviello Ospedale Israelitico, Roma, Italy Background and aim: Several studies report an inhibitory effect of probiotics on Helicobacter pylori. In particular, Lactobacillus Reuteri (LR) exerts a competition of binding to glycolipid receptor of and suppresses H. pylori urease activity. The aim of this study is to evaluate whether adding LR to antibiotic therapy may improve the H. pylori eradication rate. Material and methods: H. pylori infection was diagnosed in 90 adult dyspeptic patients. Patients were excluded if previously treated for H.pylori infection and if they were taking PPI, H2-receptor antagonist or antibiotics in the four weeks preceding the study. Patients were assigned to receive one of the following therapies: (a) 7- day triple plus LR supplementation during the antibiotic treatment; (b) 7-day triple plus LR supplementation after the antibiotic treatment; (c) sequential regimen plus LR supplementation during the antibiotic treatment; (d) sequential regimen plus LR supplementation after the antibiotic treatment. Successful eradication therapy was defined as a negative UBT or SAT performed at least 4 weeks following the eradication treatment. Results: Eighty-three patients (30 males and 53 females; mean age 57±13 years) completed the study. Seven patients discontinued: lost to follow up (1
Abstracts of the 18th National Congress of Digestive Diseases / Digestive and Liver Disease 44S (2012) S55–S220
not overestimate symptom relationship. If we consider that SAP is the only parameter utilized in many MII-pH classifications, we can conclude that a SI-SAP discordance is a negligible problem in our experience.
were observed in HD-LCA group compared to LACT (p=ns). Compliance and occurrence of adverse effects was similar among groups. Conclusions: High dose amoxicillin based eradicating treatment is superior to standard triple therapy and equivalent to sequential therapy; compared to the latter, the shorter duration may represent an advantage.
P.19.13 AUTOIMMUNE GASTRITIS ASSOCIATES WITH DUODENAL LYMPHOCYTOSIS
P.19.15
F. Azzaroli ∗ , P. Cecinato, N.C. Salfi, A. Lisotti, M. Montagnani, C. Calvanese, R. Arena, F. Bazzoli, G. Mazzella
GASTRIC AMYLOIDOSIS IN A PATIENT WITH HEMATEMESIS
Policlinico S.Orsola-Malpighi, Università di Bologna, Bologna, Italy
Azienda Ospedaliero Univeristaria di Trieste, Trieste, Italy
Background and aim: Duodenal lymphocytosis is frequently associated with celiac disease. However, it may be associated with other clinical conditions (i.e. food protein intolerance, GVHD, systemic autoimmune diseases, HP related gastritis, ...). The association with autoimmune gastritis has not been described yet. Material and methods: 19 consecutive patients (15 females; 4 males) with a mean age of 59.16± years with the diagnosis of autoimmune gastritis were evaluated for both gastric and duodenal histology. All patients underwent upper gastrointestinal endoscopy: four random biopsies were drawn from the four quadrants in the distal second portion of the duodenum as well as random gastric biopsies according to the Sydney protocol. Helicobacter Pylori (HP) infection was evaluated by histology. Duodenal lymphocytic count was made by immunohistochemistry using an anti-CD3 antibody. All patients underwent biochemical testing for celiac and autoimmune diseases. Results: The majority of the patients underwent their first upper gastrointestinal endoscopy because of dyspeptic symptoms. 17 out of 19 patients (89%) had a duodenal lymphocytic count above 25%, 8 of them around 40% (42%). Two patients (10%) were positive for HP infection even though in one patient it became negative on follow-up without any eradication treatment. Conclusions: Duodenal lymphocytosis is frequently associated with autoimmune gastritis. Therefore, whenever a duodenal lymphocytosis is encountered, autoimmune gastritis should be considered as a possible differential diagnosis.
Background and aim: Amyloidosis is a process involving the deposition of proteinaceous fibrillar material in a pattern that is commonly systemic, occasionally organ-limited and rarely a solitary localized mass. Only few reports of gastric amyloidosis exist today. In the case below we describe amyloidosis confined to the stomach. Material and methods: Our patient is a 54-year-old white woman with an episode of hematemesis that occurred after a sudden onset of severe epigastric pain. Her medical history included a monoclonal gammopathy of undeterminated significance diagnosed five years before. Her physical exam was only pertinent for severe pallor and laboratory evaluation revealed haemoglobin level of 10.5 gr/dl. On EGDS four 1cm circular flat non-bleeding ulcers were appreciated in the fundus, with poor evidence of non-fresh blood in the lumen. Results: Biopsies of the ulcers were obtained one week later and amyloidosis was diagnosed by histological and immunohistochemic findings characterized of plasma cell proliferation. She underwent extensive tests to identify the etiologies associated with systemic amyloidosis. Tests such rectal biopsy, bone marrow biopsy, echocardiogram, abdomen tomography, serum and urine protein electrophoresis, as well as liver function tests were all normal. The patient was discharged home after 2 weeks with PPI therapy and six months after discharge was doing well. Repeat EGDS demonstrated healed ulcers, but biopsy confirmed depostion of amorphous protein material consistent with amyloid in the fundus. Conclusions: Finally, in line with literature, our patient presented an AL amyloidosis of the stomach, typically associated with plasma cell dyscrasia and monoclonal light chains in serum. Treatment is primary symptomatic and includes monitoring for complications. Blood vessels fragility associated with amyloid deposition caries a risk of bleeding and therefore hematemesis could be an occasionally sign, but longer follow-up s neede to observe the real evolution.
P.19.14 HIGH DOSE AMOXICILLIN-BASED FIRST LINE REGIMEN COMPARED TO SEQUENTIAL THERAPY IN THE ERADICATION OF H. PYLORI INFECTION F. Franceschi ∗ ,1 , A. Tortora 1 , M.C. Campanale 1 , F. Bertucci 1 , S. Pecere 1 , V. Gerardi 1 , F. Barbaro 1 , G. Gigante 1 , V. Cesario 1 , P. Iacomini 1 , A. Granato 1 , C. Cordischi 1 , M. Sabbatini 1 , N. Gentiloni Silveri 1 , D. Curro’ 1 , G. Cammarota 1 , G. Gasbarrini 2 , A. Gasbarrini 1 1 Ospedale
Gemelli, Roma, Italy; 2 Fondazione Ricerca In Medicina, Bologna,
Italy Background and aim: Helicobacter pylori eradication rates with standard first-line triple therapy have declined to unacceptable levels. Ten days sequential therapy has been shown to increase eradication rate and is now considered to be one of the best options as-first line treatment. To date, amoxicillinresistant H. pylori strains have rarely been detected. Whether increasing the dosage of amoxicillin in a standard 7 days eradicating regimen may enhance the efficacy is not known. Aim: To compare the efficacy of a 7 days high-dose amoxicillin based first-line regimen with sequential therapy. Material and methods: 300 sex and age matched patients were randomized into 3 different therapeutic schemes: (1) standard LCA, lansoprazole 15 mg bid, clarithromycin 500 mg bid and amoxicillin 1000 mg bid for 7 days; (2) high dose LCA (HD-LCA), lansoprazole 15 mg bid, clarithromycin 500 mg bid and amoxicillin 1000 mg tid for 7 days; (3) sequential LACT, lansoprazole 15 mg bid plus amoxicillin 1000 mg bid for 5 days, followed by lansoprazole 15 mg bid, clarithromycin 500 mg bid and tinidazole 500 mg bid for 5 days. Eradication was confirmed by 13C-urea breath test. Compliance and occurrence of adverse effects were assessed by a validated questionnaire. Results: Eradication rates were: LCA (55% PP, 53% ITT), HD-LCA (75% PP, 72% ITT), LACT (73% PP; 72% ITT). Eradication rates were higher in HD-LCA group compared to LCA (p<0.01), while no significant differences
C. Simeth ∗ , L. Buri
P.19.16 LACTOBACILLUS REUTERI IMPROVES THE ERADICATION RATE OF HELICOBACTER PYLORI C. Efrati ∗ , G. Nicolini, R. Finizio, C. Cannaviello Ospedale Israelitico, Roma, Italy Background and aim: Several studies report an inhibitory effect of probiotics on Helicobacter pylori. In particular, Lactobacillus Reuteri (LR) exerts a competition of binding to glycolipid receptor of and suppresses H. pylori urease activity. The aim of this study is to evaluate whether adding LR to antibiotic therapy may improve the H. pylori eradication rate. Material and methods: H. pylori infection was diagnosed in 90 adult dyspeptic patients. Patients were excluded if previously treated for H.pylori infection and if they were taking PPI, H2-receptor antagonist or antibiotics in the four weeks preceding the study. Patients were assigned to receive one of the following therapies: (a) 7- day triple plus LR supplementation during the antibiotic treatment; (b) 7-day triple plus LR supplementation after the antibiotic treatment; (c) sequential regimen plus LR supplementation during the antibiotic treatment; (d) sequential regimen plus LR supplementation after the antibiotic treatment. Successful eradication therapy was defined as a negative UBT or SAT performed at least 4 weeks following the eradication treatment. Results: Eighty-three patients (30 males and 53 females; mean age 57±13 years) completed the study. Seven patients discontinued: lost to follow up (1