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Variability with omeprazole-amoxicillin combinations for treatment of Helicobacter pylori infection
A104
AGA ABSTRACTS
• VARIABILITYWITH OMEPRAZOLE-AMOXIC1LLINCOMBINATIONS FOR TREATMENT OF HELICOBACTERPYLORIINFECTION. K.S. Graham, H.M. Malaty, H. E1-Zimaity,1LM. Genta, 1LA. Cole, M.M. Yousfi, M.T. A1-Assi.G.A. Nell, D.Y. Graham. Departmentof Medicine, V.A. Medical Center and Baylor College of Medicine, Houston, TX and Astra Merck, WaynePA. Background: Althoughomeprazole co-therapyenhancesthe effectiveness of some antimicrobialsfor the treatment of H. pylori (Hp) infection, results are not uniform. A meta-analysis suggestedthat 20 rag of omepraz01e b.i.d, and 2 or more g of amoxiciUinwould yield >80°.4success (Gastroenterology 1994; 106:142A), Methods: Volunteers withHp infection were studied. Anti-Hptherapy was (omeprazole 20 mg b.i.d, plus amoxicillin 1 gm t.i.d., or omeprazole 20 mg b.i.d, plus amoxicillin 0.5 gm t.i.d.) with meals for 14 days. Four to 6 weeks after ending antimicrobialtherapy, endoscopywas performedand Hp was determined on biopsy specimensby the Genta stain. Results: Fifty-ninevolunteerscompleted the study. The overall success for either combinationof amoxicillin and omeprazole was 30.5% (18 of 59; 95% C.I. = 19% to 44°.4). The success rate with 500 mg amoxieillint.i.d, was 7 of 29 (24%; 95% C.I. = 10% to 43%). With 1 gm t.i.d, amoxieillin, the cure rate was higher (36.6%) (11 of 30; 95% C.I. = 20% to 56%) or intention-totreat result was 11 of 31 (35.4°.4)which includes the early drop out. The difference between the two therapies was not significant(p = 0.39). Compliancewas >95% for both therapies. Side effects were experienced by 8, 2 receiving 1.5 gm amoxicillin and 6 receiving 3 gm amoxicillin (p>0.2). Review of German trials suggested that one difference may be their use of amoxicillinsuspension given fasting. 30 treatment failures were retreated with 3 g amoxicillin suspensionand omeprazole20 mg b.i.d. The cure rate was not improved. Conclusion: Amoxicillin/omeprazolecombinationsfor treatment of lip infection do not yield consistentresults. The reason is unknown,but the reported high rate of success with 40 mg of omeprazoleand 750 mg t.i.d. suggests that almost complete inhibitionof acid secretionis necessaryto obtain consistent results with this combination. Finally, meta-analysesfrequentlyyield hypothesesinstead of firm conclusions.
GASTROENTEROLOGY,Vol. 108, No. 4
ERADICATION OF HELICOBACTER PYLORI (Hp) INFECTION: SIDE EFFECTS DURING DIFFERENT ANTIBIOTIC THERAPIES. Grasso _G~_,Pilotto A#, Kusstatscher S, Ferrana M, Salandin S, Del Bianco T, Vianello F, Battaglia G*, Di Mado F. Depts. of Gastroenterology, Padua and *Venice, #Dept. of Geriatrics, Vieenza, Italy. Hp eradication is the first choice in the management of peptic ulcer disease and of chronic Hp-associated gastritis. Different treatments use the association of one or more antibiotics with an antisecretOry drug, mostly Omeprazole. Several side effects are descdbed during antibiotic therapy, as candidiasis, allergy, diarrhea, pseudomembranous colitis. The aim o f this study was to evaluate the incidence of side effects using diffrent Hp"eratication therapy. We studied 322 patients (176 M;146 F; mean age 57.6; range 26-75) donsecutively referred to our Endoscopy Unit in Padua. All pts. presented Hp-positive gastriti S and most of them (258)had hystory for peptic ulcer disease. Therapeutic schedules consisted of Omeprazole 40 mg for 2 wks. in association with Amoxicyllin 2g/daily (139 pz) or Azithromycin 500 mg/daily (121 pz) or Cladthromycin 500 mg/daily; in 278 pts these drugs were associated with Metronidazole 1 g/daily for 1 wk. RESULTS: 10.5% of side effects occurred during the study distributed as follows: diarrhea, nausea, urticaria, abdominal pain. 9 pts required to suspend therapy because of the severity of side effects (2.8%). Side effects were subdivided as follows as regard the antibiotic used: Azithromycin 7/121 (5,7%, 1 withdrawal), Clarithromycin 10/62 (16.1%, 4 withdrawals); Amoxicyllin 17/139 (12,2%, 4 withdrawals). CONCLUSIONS: 1) A relatively low number of side effects has been registered in a large number of patients (322) consecutively treated for HP eradication. 2) In our experience, clarithromycin is the antibiotic related to an augmented frequency of side effects (16.1%). 3) 2.8 % of pts. needed to stop the drug assumption because of side effects occurrence. 4) The side effects therapeutic efficacy ratio points out azthromycin as most efficient antibiotic, in the tested therapeutic schedules
AUDIT OF AN OPEN-ACCESS OESOPHAGEAL MANOMETRY SERVICE. RRSH Greaves. TM Taylor, DA Gerard, EM Alstead, MJG Farthing. Digestive Disease Research Centre, Medical College of St. Bartholomew's Hospital, London EC1M 6BQ
ISCHEMIA-INDUCED TISSUE REMODELING: MAGNETIC ENTERAL GASTROSTOMY IN A PORCINE MODEL. J.F. Grier, M.B. Ibach, C.F, Gholson. Department of Medicine, Louisiana State University, Shreveport, LA
Oesophageal manometry has been shown to be of diagnostic value and cost-effective in established oesophageal centres. We have therefore examined the referral patterns and diagnostic usefulness of a new, nonscreened oesophageal manometry service. 95 consecutive first manometries from between May 1991-May 1994 were studied retrospectively. 61% of referrals were "in-house" and 39 % were from other GI units or individual consultants.Reasons for referral were: dysphagia (42%), suspected achalasia (25.3%), reflux symptoms (17.9%), non-cardiac chest pain (9.5%), and miscellaneous (5.3%). Previous investigations included both barium swallow and endosopy (57.9%), barium swallow alone (25.3%), endoscopy alone. (14.8%) or no oesophageal investigations (2.2%). Manometry was normal in 56.8%, confirmed achalasia in 21%, aperistalsis in 11.6%, diffuse oesophageal spasm in 6.3%, non-specific motility disorder in 2.1% and "nutcracker" oesophagus in 1.1%. A positive diagnosis was established in 95.8% of referrals with suspected achalasia, 33.3% with non-cardiac chest pain, 27.5% with dysphagia, 20% with "miscellaneous" and 17.6% with symptoms of reflux. Outcome was judged clinically useful if manometry either changed the diagnosis (17.9%) or provided sufficient reassurance with a normal study to terminate the investigative process (26.3%). Outcome was considered non-contributory if manometry simply confirmed a radiological diagnosis (28.4%), or failed to reassure with a normal study (27,3%). In contrast to previous studies, the number of positive findings (excluding confirmation of achalasia on barium swallow) was relatively low, as was the overall rate of successful outcomes. These data support use of a screening procedure for oesophageal manometry.
Backeround/Aims:
To obviate surgery, laparoscopy and percutaneous puncture, we hypothesized that a gastrostomy could be formed by ischemia-induced tissue remodeling, Methods: A small intragastric magnet was engaged with a larger topical magnet on the abdominal wall of three young pigs. Results: In each case, the intragastric magnet migrated externally over ten to twelve days, leaving a gastrostomy in its path. Necropsy demonstrated wellformed tracts in the gastric body, firmly a d h e r e n t to the abdominal wall with no perforation or leakage. Antibiotic coverage was not employed, and analgesics were not needed. The pigs appeared unaffected by the magnets and developed normally on an oral diet with the magnets in situ. Conclusions: Based on our small series, we conclude that the process of ischemia-induced tissue remodeling can be utilized to create gastrostomies. This process could be applied elsewhere in the gastrointestinal tract and in other organ systems for clinical and research purposes.
AGA ABSTRACTS
• VARIABILITYWITH OMEPRAZOLE-AMOXIC1LLINCOMBINATIONS FOR TREATMENT OF HELICOBACTERPYLORIINFECTION. K.S. Graham, H.M. Malaty, H. E1-Zimaity,1LM. Genta, 1LA. Cole, M.M. Yousfi, M.T. A1-Assi.G.A. Nell, D.Y. Graham. Departmentof Medicine, V.A. Medical Center and Baylor College of Medicine, Houston, TX and Astra Merck, WaynePA. Background: Althoughomeprazole co-therapyenhancesthe effectiveness of some antimicrobialsfor the treatment of H. pylori (Hp) infection, results are not uniform. A meta-analysis suggestedthat 20 rag of omepraz01e b.i.d, and 2 or more g of amoxiciUinwould yield >80°.4success (Gastroenterology 1994; 106:142A), Methods: Volunteers withHp infection were studied. Anti-Hptherapy was (omeprazole 20 mg b.i.d, plus amoxicillin 1 gm t.i.d., or omeprazole 20 mg b.i.d, plus amoxicillin 0.5 gm t.i.d.) with meals for 14 days. Four to 6 weeks after ending antimicrobialtherapy, endoscopywas performedand Hp was determined on biopsy specimensby the Genta stain. Results: Fifty-ninevolunteerscompleted the study. The overall success for either combinationof amoxicillin and omeprazole was 30.5% (18 of 59; 95% C.I. = 19% to 44°.4). The success rate with 500 mg amoxieillint.i.d, was 7 of 29 (24%; 95% C.I. = 10% to 43%). With 1 gm t.i.d, amoxieillin, the cure rate was higher (36.6%) (11 of 30; 95% C.I. = 20% to 56%) or intention-totreat result was 11 of 31 (35.4°.4)which includes the early drop out. The difference between the two therapies was not significant(p = 0.39). Compliancewas >95% for both therapies. Side effects were experienced by 8, 2 receiving 1.5 gm amoxicillin and 6 receiving 3 gm amoxicillin (p>0.2). Review of German trials suggested that one difference may be their use of amoxicillinsuspension given fasting. 30 treatment failures were retreated with 3 g amoxicillin suspensionand omeprazole20 mg b.i.d. The cure rate was not improved. Conclusion: Amoxicillin/omeprazolecombinationsfor treatment of lip infection do not yield consistentresults. The reason is unknown,but the reported high rate of success with 40 mg of omeprazoleand 750 mg t.i.d. suggests that almost complete inhibitionof acid secretionis necessaryto obtain consistent results with this combination. Finally, meta-analysesfrequentlyyield hypothesesinstead of firm conclusions.
GASTROENTEROLOGY,Vol. 108, No. 4
ERADICATION OF HELICOBACTER PYLORI (Hp) INFECTION: SIDE EFFECTS DURING DIFFERENT ANTIBIOTIC THERAPIES. Grasso _G~_,Pilotto A#, Kusstatscher S, Ferrana M, Salandin S, Del Bianco T, Vianello F, Battaglia G*, Di Mado F. Depts. of Gastroenterology, Padua and *Venice, #Dept. of Geriatrics, Vieenza, Italy. Hp eradication is the first choice in the management of peptic ulcer disease and of chronic Hp-associated gastritis. Different treatments use the association of one or more antibiotics with an antisecretOry drug, mostly Omeprazole. Several side effects are descdbed during antibiotic therapy, as candidiasis, allergy, diarrhea, pseudomembranous colitis. The aim o f this study was to evaluate the incidence of side effects using diffrent Hp"eratication therapy. We studied 322 patients (176 M;146 F; mean age 57.6; range 26-75) donsecutively referred to our Endoscopy Unit in Padua. All pts. presented Hp-positive gastriti S and most of them (258)had hystory for peptic ulcer disease. Therapeutic schedules consisted of Omeprazole 40 mg for 2 wks. in association with Amoxicyllin 2g/daily (139 pz) or Azithromycin 500 mg/daily (121 pz) or Cladthromycin 500 mg/daily; in 278 pts these drugs were associated with Metronidazole 1 g/daily for 1 wk. RESULTS: 10.5% of side effects occurred during the study distributed as follows: diarrhea, nausea, urticaria, abdominal pain. 9 pts required to suspend therapy because of the severity of side effects (2.8%). Side effects were subdivided as follows as regard the antibiotic used: Azithromycin 7/121 (5,7%, 1 withdrawal), Clarithromycin 10/62 (16.1%, 4 withdrawals); Amoxicyllin 17/139 (12,2%, 4 withdrawals). CONCLUSIONS: 1) A relatively low number of side effects has been registered in a large number of patients (322) consecutively treated for HP eradication. 2) In our experience, clarithromycin is the antibiotic related to an augmented frequency of side effects (16.1%). 3) 2.8 % of pts. needed to stop the drug assumption because of side effects occurrence. 4) The side effects therapeutic efficacy ratio points out azthromycin as most efficient antibiotic, in the tested therapeutic schedules
AUDIT OF AN OPEN-ACCESS OESOPHAGEAL MANOMETRY SERVICE. RRSH Greaves. TM Taylor, DA Gerard, EM Alstead, MJG Farthing. Digestive Disease Research Centre, Medical College of St. Bartholomew's Hospital, London EC1M 6BQ
ISCHEMIA-INDUCED TISSUE REMODELING: MAGNETIC ENTERAL GASTROSTOMY IN A PORCINE MODEL. J.F. Grier, M.B. Ibach, C.F, Gholson. Department of Medicine, Louisiana State University, Shreveport, LA
Oesophageal manometry has been shown to be of diagnostic value and cost-effective in established oesophageal centres. We have therefore examined the referral patterns and diagnostic usefulness of a new, nonscreened oesophageal manometry service. 95 consecutive first manometries from between May 1991-May 1994 were studied retrospectively. 61% of referrals were "in-house" and 39 % were from other GI units or individual consultants.Reasons for referral were: dysphagia (42%), suspected achalasia (25.3%), reflux symptoms (17.9%), non-cardiac chest pain (9.5%), and miscellaneous (5.3%). Previous investigations included both barium swallow and endosopy (57.9%), barium swallow alone (25.3%), endoscopy alone. (14.8%) or no oesophageal investigations (2.2%). Manometry was normal in 56.8%, confirmed achalasia in 21%, aperistalsis in 11.6%, diffuse oesophageal spasm in 6.3%, non-specific motility disorder in 2.1% and "nutcracker" oesophagus in 1.1%. A positive diagnosis was established in 95.8% of referrals with suspected achalasia, 33.3% with non-cardiac chest pain, 27.5% with dysphagia, 20% with "miscellaneous" and 17.6% with symptoms of reflux. Outcome was judged clinically useful if manometry either changed the diagnosis (17.9%) or provided sufficient reassurance with a normal study to terminate the investigative process (26.3%). Outcome was considered non-contributory if manometry simply confirmed a radiological diagnosis (28.4%), or failed to reassure with a normal study (27,3%). In contrast to previous studies, the number of positive findings (excluding confirmation of achalasia on barium swallow) was relatively low, as was the overall rate of successful outcomes. These data support use of a screening procedure for oesophageal manometry.
Backeround/Aims:
To obviate surgery, laparoscopy and percutaneous puncture, we hypothesized that a gastrostomy could be formed by ischemia-induced tissue remodeling, Methods: A small intragastric magnet was engaged with a larger topical magnet on the abdominal wall of three young pigs. Results: In each case, the intragastric magnet migrated externally over ten to twelve days, leaving a gastrostomy in its path. Necropsy demonstrated wellformed tracts in the gastric body, firmly a d h e r e n t to the abdominal wall with no perforation or leakage. Antibiotic coverage was not employed, and analgesics were not needed. The pigs appeared unaffected by the magnets and developed normally on an oral diet with the magnets in situ. Conclusions: Based on our small series, we conclude that the process of ischemia-induced tissue remodeling can be utilized to create gastrostomies. This process could be applied elsewhere in the gastrointestinal tract and in other organ systems for clinical and research purposes.