- Email: [email protected]
Quadruple Therapy Is an Effective Salvage Regimen for Helicobacter Pylori Infection in Patients After Failure of Standard Triple Therapy - Comparison of OMBT 7, 14 Days Regimen -
*M1722 Improving Endotherapy - A New Concept for Intraluminal Endoscopic Suturing Arnaldo B. Feitoza, Christopher Gostout, Elizabeth Rajan, Mary Knipschield, Lori Herman, Lawrence Burgart
*M1724 Peptic Ulcer Bleeding, NSAID Use and Helicobacter Pylori Infection: A Prospective Study Evaluating Prevalence and Outcome Monique E. Leerdam van, Dewkoemar Ramsoekh, Erik A. J. Rauws, Alfons A. M. Geraedts, Guido N. Tytgat
Advances in intraluminal endoscopic suturing may lead to new minimally invasive treatments for gastrointestinal disorders. However, unlike the serosa, the mucosal surface is challenging to induce tissue fusion. This study demonstrates a technique to create permanent intraluminal partitioning of the stomach that could be adapted for endoluminal surgery through gastrointestinal endoscopes. M&M: Six pigs underwent an open gastrostomy to access the gastric lumen. The aim was to suture opposing walls of the stomach using only intraluminal manipulation to induce a permanent partition. Gastric partitioning was performed at different levels and lengths for each animal. Initially, a one-cm wide mucosal resection of the walls to be sutured was performed. The exposed areas of muscularis propria were joined by suturing the two edges of the mucosectomy with Vicryl 3-0. Each animal had one gastric partitioning extending from 5 to 10 cm. The gastrostomy and the abdominal wall were closed. Animals were allowed to recover and had a liquid diet during the survival period. Endoscopy was performed after 3, 7 and 14 days to assess the sutured areas. Animals were sacrificed and areas fused by healing sent to histopathology. Results: A permanent fusion was observed endoscopically and histologically in 2/6 of the suture sites at day 14. Histopathology showed collagen deposition between the two layers of muscularis propria, characteristic of the maturation phase of healing, leading to a stable attachment between the walls. Dehiscence with re-epithelization of the mucosectomy sites was observed in 4/6 of the suture sites at days 3 and 7. Conclusions: 1) Intraluminal gastric partitioning can be obtained using mucosectomy followed by apposition of the muscularis propria with sutures. 2) Risk factors for dehiscence are still undetermined. 3) Novel endoscopic sewing devices could potentially reproduce this technique.
Background: Peptic ulcer bleeding is still a major health problem. Prevention of ulcer bleeding is therefore important. Concomitant use of proton pump inhibitors with NSAIDs or eradication of Helicobacter pylori may reduce peptic ulcer bleeding. A prospective study was conducted to determine prevalence of NSAID use and H. pylori infection in patients with peptic ulcer bleeding. Methods: In 2000, data of all patients presenting with peptic ulcer bleeding were prospectively collected in a defined area, including 14 hospitals and serving a catch area of 1.68 million people. Data collection included coexisting illness, use of NSAIDs and acid suppressive therapy, H. pylori status and eradication therapy, rebleeding and mortality. Follow up data was collected after a mean of 31 months. Results: 361 patients presented with peptic ulcer bleeding, giving an incidence of 21.5 cases per 100 000 persons per year. Mean age of the group was 71 years, 41% had severe or life threatening co morbidity. Duodenal ulcers were found in 56% and gastric ulcers in 44%. NSAIDs were used by 52% (table 1), and in only 17% concomitant acid suppressive therapy was given. H. pylori infection was tested in 64%. Of the patients tested for H. pylori, 43% was positive. Twenty-three percent was H. pylori negative and not using NSAIDs (table 1). Of the H. pylori positive patients, 89% received eradication therapy. Rebleeding during initial admission occurred in 19% of the patients and mortality was 14%. During follow up recurrence of acute upper gastrointestinal bleeding occurred in 2.5% and mortality was 30%. Conclusions: Half of all ulcer bleeding was associated with NSAID use. Only a minority of NSAID-users also used concomitant acid suppressive therapy. Helicobacter pylori was still not assessed systematically in all patients with ulcer bleeding and if positive not everyone received eradication therapy. Almost a quarter of the ulcers were not associated with H. pylori nor NSAID use. Rebleeding during hospitalisation and mortality, both during hospitalisation and follow up, were substantial.
*M1723 Quadruple Therapy Is an Effective Salvage Regimen for Helicobacter Pylori Infection in Patients After Failure of Standard Triple Therapy Comparison of OMBT 7, 14 Days Regimen Rok Son Choung, Sang Woo Lee, Hyung Joon Yim, Min Jeong Kim, Yong Sik Kim, Hong Sik Lee, Hoon Jai Chun, Jai Hyun Choi, Ho Sang Ryu, Jin Hai Hyun Backgrounds/Aims. At present, triple therapy schemes are recommended by national and international consensus conferences. But, even with the currently most effective treatment regimens, about 10-20% of patients will fail to obtain eradication of Helicobacter pylori infection. Therefore, We need adequate strategy for primary therapy failed patients and so, we are about to evaluate the efficacy of the quadruple therapy and compare 7- with 14- day quadruple regimens in secondline treatment. Methods: Seventy one consecutive patients who failed to respond to standard triple therapy(clarithromycin, amoxicillin, PPI) were randomly assigned to a OMBT(omeprazole 20 mg b.d., metronidazole 500 mg t.d.s., bismuth salt 120 mg q.d.s., tetracycline 500 mg q.d.s.) 7 or 14 days regimen. H. pylori status and side-effects were assessed 4 weeks after treatment. Results: 51 male and 20 female (mean age, 50.6) patients were enrolled. The overall eradication rate of H. pylori in quadruple therapy was 83.1% and the eradication rate was higher in OMBT 14 days regimen than 7 days regimen ( 88.9% in OMBT 14 days, 73.1% in OMBT 7 days, respectively p = 0.089). Comparison of sideeffects in two groups were not significance. Conclusions: Quadruple therapy is an effective salvage regimen for H. pylori infection after failure of standard triple therapy and 14 days quadruple therapy are better than 7 days regimen as secondline option for H. pylori eradication.
P152
GASTROINTESTINAL ENDOSCOPY
*M1725 No Influence of Helicobacter Pylori and Previous NSAID/ASA Therapy on Early Rebleeding Rate in Patients with Peptic Ulcer Bleeding Istvan Racz, Katalin Bircher, Andrea Szabo, Gyula Pecsi, Artur Nemeth Background: Endoscopic treatment of peptic ulcer bleeding is effective but early rebleeding occurs in 15-25% of treated patients. There is little information available about the influence of H. pylori infection and previous NSAID treatment on the acute rebleeding rate in peptic ulcer bleeding. Aim: In our prospective study we investigated, whether H. pylori infection or previous NSAID medication can influence the early rebleeding rate in bleeding peptic ulcer after achieving initial haemostasis. Method and patients: Previous NSAID and/or ASA treatments were checked on the basis of medical history evaluated NSAID/ASA positive those who were taking this medication more than two days during the week before the bleeding started. H. pylori status was evaluated by rapide urease test and/or histology. Biopsies were taken during initial and/or second look endoscopies. Intravenous PPI (pantoprazole 8 mg/h) was administrated for 72 hours in every case but no patient received eradication therapy. A total of 292 patients were analysed after successful initial endoscopic treatment (duodenal ulcer: 189, gastric ulcer: 103). Results: Rebleedings within the first 72 hours occurred in 14.7% of DU patients and 11.8% of GU patients. Rebleeding rates in the NSAID/ASA user and non-user groups were 12.1% versus 14.6%, while in the H. pylori positive and negative patients 11.9% versus 15.6%. Interestingly only 3% of the H. pylori positive and NSAID/ASA treated patients re-bled, while the rebleeding rate among H. pylori negative non-NSAID/ASA patients was 16.2%. Conclusion: According to our results neither H. pylori infection, nor previous NSAID treatment are risk factors for early rebleeding during 72 hours in ulcer patients after successful initial haemostasis.
VOLUME 59, NO. 5, 2004
*M1724 Peptic Ulcer Bleeding, NSAID Use and Helicobacter Pylori Infection: A Prospective Study Evaluating Prevalence and Outcome Monique E. Leerdam van, Dewkoemar Ramsoekh, Erik A. J. Rauws, Alfons A. M. Geraedts, Guido N. Tytgat
Advances in intraluminal endoscopic suturing may lead to new minimally invasive treatments for gastrointestinal disorders. However, unlike the serosa, the mucosal surface is challenging to induce tissue fusion. This study demonstrates a technique to create permanent intraluminal partitioning of the stomach that could be adapted for endoluminal surgery through gastrointestinal endoscopes. M&M: Six pigs underwent an open gastrostomy to access the gastric lumen. The aim was to suture opposing walls of the stomach using only intraluminal manipulation to induce a permanent partition. Gastric partitioning was performed at different levels and lengths for each animal. Initially, a one-cm wide mucosal resection of the walls to be sutured was performed. The exposed areas of muscularis propria were joined by suturing the two edges of the mucosectomy with Vicryl 3-0. Each animal had one gastric partitioning extending from 5 to 10 cm. The gastrostomy and the abdominal wall were closed. Animals were allowed to recover and had a liquid diet during the survival period. Endoscopy was performed after 3, 7 and 14 days to assess the sutured areas. Animals were sacrificed and areas fused by healing sent to histopathology. Results: A permanent fusion was observed endoscopically and histologically in 2/6 of the suture sites at day 14. Histopathology showed collagen deposition between the two layers of muscularis propria, characteristic of the maturation phase of healing, leading to a stable attachment between the walls. Dehiscence with re-epithelization of the mucosectomy sites was observed in 4/6 of the suture sites at days 3 and 7. Conclusions: 1) Intraluminal gastric partitioning can be obtained using mucosectomy followed by apposition of the muscularis propria with sutures. 2) Risk factors for dehiscence are still undetermined. 3) Novel endoscopic sewing devices could potentially reproduce this technique.
Background: Peptic ulcer bleeding is still a major health problem. Prevention of ulcer bleeding is therefore important. Concomitant use of proton pump inhibitors with NSAIDs or eradication of Helicobacter pylori may reduce peptic ulcer bleeding. A prospective study was conducted to determine prevalence of NSAID use and H. pylori infection in patients with peptic ulcer bleeding. Methods: In 2000, data of all patients presenting with peptic ulcer bleeding were prospectively collected in a defined area, including 14 hospitals and serving a catch area of 1.68 million people. Data collection included coexisting illness, use of NSAIDs and acid suppressive therapy, H. pylori status and eradication therapy, rebleeding and mortality. Follow up data was collected after a mean of 31 months. Results: 361 patients presented with peptic ulcer bleeding, giving an incidence of 21.5 cases per 100 000 persons per year. Mean age of the group was 71 years, 41% had severe or life threatening co morbidity. Duodenal ulcers were found in 56% and gastric ulcers in 44%. NSAIDs were used by 52% (table 1), and in only 17% concomitant acid suppressive therapy was given. H. pylori infection was tested in 64%. Of the patients tested for H. pylori, 43% was positive. Twenty-three percent was H. pylori negative and not using NSAIDs (table 1). Of the H. pylori positive patients, 89% received eradication therapy. Rebleeding during initial admission occurred in 19% of the patients and mortality was 14%. During follow up recurrence of acute upper gastrointestinal bleeding occurred in 2.5% and mortality was 30%. Conclusions: Half of all ulcer bleeding was associated with NSAID use. Only a minority of NSAID-users also used concomitant acid suppressive therapy. Helicobacter pylori was still not assessed systematically in all patients with ulcer bleeding and if positive not everyone received eradication therapy. Almost a quarter of the ulcers were not associated with H. pylori nor NSAID use. Rebleeding during hospitalisation and mortality, both during hospitalisation and follow up, were substantial.
*M1723 Quadruple Therapy Is an Effective Salvage Regimen for Helicobacter Pylori Infection in Patients After Failure of Standard Triple Therapy Comparison of OMBT 7, 14 Days Regimen Rok Son Choung, Sang Woo Lee, Hyung Joon Yim, Min Jeong Kim, Yong Sik Kim, Hong Sik Lee, Hoon Jai Chun, Jai Hyun Choi, Ho Sang Ryu, Jin Hai Hyun Backgrounds/Aims. At present, triple therapy schemes are recommended by national and international consensus conferences. But, even with the currently most effective treatment regimens, about 10-20% of patients will fail to obtain eradication of Helicobacter pylori infection. Therefore, We need adequate strategy for primary therapy failed patients and so, we are about to evaluate the efficacy of the quadruple therapy and compare 7- with 14- day quadruple regimens in secondline treatment. Methods: Seventy one consecutive patients who failed to respond to standard triple therapy(clarithromycin, amoxicillin, PPI) were randomly assigned to a OMBT(omeprazole 20 mg b.d., metronidazole 500 mg t.d.s., bismuth salt 120 mg q.d.s., tetracycline 500 mg q.d.s.) 7 or 14 days regimen. H. pylori status and side-effects were assessed 4 weeks after treatment. Results: 51 male and 20 female (mean age, 50.6) patients were enrolled. The overall eradication rate of H. pylori in quadruple therapy was 83.1% and the eradication rate was higher in OMBT 14 days regimen than 7 days regimen ( 88.9% in OMBT 14 days, 73.1% in OMBT 7 days, respectively p = 0.089). Comparison of sideeffects in two groups were not significance. Conclusions: Quadruple therapy is an effective salvage regimen for H. pylori infection after failure of standard triple therapy and 14 days quadruple therapy are better than 7 days regimen as secondline option for H. pylori eradication.
P152
GASTROINTESTINAL ENDOSCOPY
*M1725 No Influence of Helicobacter Pylori and Previous NSAID/ASA Therapy on Early Rebleeding Rate in Patients with Peptic Ulcer Bleeding Istvan Racz, Katalin Bircher, Andrea Szabo, Gyula Pecsi, Artur Nemeth Background: Endoscopic treatment of peptic ulcer bleeding is effective but early rebleeding occurs in 15-25% of treated patients. There is little information available about the influence of H. pylori infection and previous NSAID treatment on the acute rebleeding rate in peptic ulcer bleeding. Aim: In our prospective study we investigated, whether H. pylori infection or previous NSAID medication can influence the early rebleeding rate in bleeding peptic ulcer after achieving initial haemostasis. Method and patients: Previous NSAID and/or ASA treatments were checked on the basis of medical history evaluated NSAID/ASA positive those who were taking this medication more than two days during the week before the bleeding started. H. pylori status was evaluated by rapide urease test and/or histology. Biopsies were taken during initial and/or second look endoscopies. Intravenous PPI (pantoprazole 8 mg/h) was administrated for 72 hours in every case but no patient received eradication therapy. A total of 292 patients were analysed after successful initial endoscopic treatment (duodenal ulcer: 189, gastric ulcer: 103). Results: Rebleedings within the first 72 hours occurred in 14.7% of DU patients and 11.8% of GU patients. Rebleeding rates in the NSAID/ASA user and non-user groups were 12.1% versus 14.6%, while in the H. pylori positive and negative patients 11.9% versus 15.6%. Interestingly only 3% of the H. pylori positive and NSAID/ASA treated patients re-bled, while the rebleeding rate among H. pylori negative non-NSAID/ASA patients was 16.2%. Conclusion: According to our results neither H. pylori infection, nor previous NSAID treatment are risk factors for early rebleeding during 72 hours in ulcer patients after successful initial haemostasis.
VOLUME 59, NO. 5, 2004