MethodsPatients attending for routine diagnostic gastroscopy and likely to need omeprazole were invited to take part in, and give written consent to this study, which was approved by the Parkside Ethical Committee. Patients with previous gastric surgery, known bleeding diathesis, taking oral anticoagulants, or who had been treated with bismuth compounds, omeprazole, or antibiotics known to be active against H pylori within the previous two months, were excluded. To determine H pylori status biopsy specimens were taken from the antrum (within 2 cm of the pylorus, two for histology and two for microbiology), corpus (half way along greater curvature, two for histology), and fundus (two for histology).After each examination the endoscopes were disinfected by an automatic washing machine (Olympus EW20)13 and the biopsy forceps were sterilised by autoclaving.
There is no ideal method for detecting Helicobacter pylori. The 'standard' 13Carbon urea breath test (13C-UBT), which involves collecting eight to 15 breath samples and subsequent costly analysis, was modified by pooling 2 1 samples of expired breath taken at five minute intervals for 40 minutes into a collecting bag, from which a single 20 ml aliqt ot was taken and analysed by mass spectrometry. This test was evaluated on 50 patients after routine upper gastrointestinal endoscopy, and results were compared with those from the standard 13C-UBT, bacteriology, ELISA serology, and histology -the latter being taken as the gold standard. Hpylori were seen in 34 of 50 (68%) patients (in three it was detected in biopsy specimens from the corpus alone). The modified 13C-UBT was positive (pooled excretion 613CO2>5 per mil) in 31 patients and negative in 19 (three false negative results), specificity was 100% (standard 13C-UBT 94%) and sensitivity 92% (standard 13C-UBT 93%). The modified '3C-UBT had a coefficient ofvariation within subjects of 3.7%. For the ELISA serology and culture the specificities were both 100%, but the sensitivities were 82% and 68% respectively. The '3C-UBT results correlated with the grade of histological gastritis. The modified 1 C-UBT is simpler, cheaper, more reproducible, and provides an easy non-invasive method for the detection of H pylon. subject (helpful for the serial monitoring of treatment), and makes it ideal for epidemiological studies, particularly as it can be used in children and women of child bearing age and because no radiation is involved, a licence is not required.Since the initial report of the 13C-UBT,' however, the technique has not been further refined; little is known of its reproducibility and as multiple samples are required to produce an excretion curve, interpretation of results may be difficult and the test costly. Therefore, the test has so far remained essentially a research tool.We describe a modified protocol for the '3C-UBT and results of reproducibility studies, which together should make this test for H pylori easier to use in routine clinical practice.Patients and methods Fifty patients attending for routine upper gastrointestinal endoscopy were invited to enter the study, which had Parkside District Health Authority ethical committee approval. The patients gave written informed consent. Height, weight, and respiratory function (measured by peak flow, forced vital capacity, and forced expiratory volume in one second) were recorded. Exclusion criteria were recent (within two months) use of bismuth containing compounds, antibiotics known to be active in vivo against H pylori, or previous resective gastric surgery.
Clarithromycin, a new and well tolerated, acid stable macrolide antibiotic, has a similar antimicrobial spectrum to erythromycin but a better in vitro MIC90 (0.03 itg/l-1) against Helicobacter pylon (H pylori). This study aimed at determining the eradication rate using clarithromycin 500 mg thrice daily and omeprazole 40
Objective To evaluate the efficacy of oral cimetidine as a treatment for painful bladder disease (PBD, variously described as a ‘symptom complex’ of suprapubic pain, frequency, dysuria and nocturia in the absence of overt urine infection) by assessing symptom relief and histological changes in the bladder wall tissue components, compared with placebo. Patients and methods The study comprised 36 patients with PBD enrolled into a double‐blind clinical study with two treatment arms, i.e. oral cimetidine or placebo, for a 3‐month trial. Patients were asked to complete a symptom questionnaire (maximum score 35), and underwent cystoscopy and bladder biopsy before treatment allocation. On completing treatment the patients were re‐evaluated by the questionnaire and biopsy. The symptom scores and bladder mucosal histology were compared before and after treatment, and the results analysed statistically to assess the efficacy of cimetidine. Results Of the 36 patients recruited, 34 (94%) completed the study. Those receiving cimetidine had a significant improvement in symptoms, with median symptom scores decreasing from 19 to 11 (P < 0.001). Suprapubic pain and nocturia decreased markedly (P = 0.009 and 0.006, respectively). However, histologically the bladder mucosa showed no qualitative change in the glycosaminoglycan layer or basement membrane, or in muscle collagen deposition, in either group. The T cell infiltrate was marginally decreased in the cimetidine group (median 203 before and 193 after) and increased in the placebo group (median 243 and 250, P > 0.3 and > 0.2, respectively). Angiogenesis remained relatively unchanged. The incidence of mast cells and B cells was sporadic in both groups. Conclusions Oral cimetidine is very effective in relieving symptoms in patients with PBD but there is no apparent histological change in the bladder mucosa after treatment; the mechanism of symptom relief remains to be elucidated.
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