SUMMARYPatients (454) referred for gastroscopy to the General Hospital of Athens were examined to determine (1) if non-secretors were over-represented among patients with ulcers and (2) is there was an association with ABO blood group or secretor status and carriage of Helicobacter pylorn.Compared with the local population, among patients with either gastric ulcer (51) or duodenal ulcer (96) there was a significant increase in the proportion of those who were blood group 0 (P < 0 025); however, there were no significant differences in the proportions of non-secretors. H. pylori was identified in 62 % of the 454 patients: 59.5 % of those without evidence of ulcers; 62-5 % of those with gastric ulcer; 88 % of those with duodenal ulcer (P < 0-0005). These bacteria were cultured more often and in higher numbers from patients with duodenal ulcer (P < 0 025). There was no association between ABO blood group and prevalence of H. pylori. The prevalence of H. pylorn among non-secretors with gastric ulcer (12-5 %) was significantly lower than that for non-secretors with duodenal ulcer (100 %) (P < 0 0005). This was not observed for secretors.
Background:
Whilst the role of Helicobacter pylori eradication in managing duodenal ulcers has been established, consensus regarding the ideal regimen has not been achieved.
Methods:
Patients with H. pylori‐positive active duodenal ulcer were randomly assigned to receive triple therapy with amoxycillin 1000 mg b.d. + clarithromycin 500 mg b.d. + omeprazole 20 mg daily for 10 days (ACT‐10) or dual therapy with clarithromycin 500 mg t.d.s. + omeprazole 40 mg daily for 14 days (Dual). No additional acid suppression was provided following eradication therapy. Endoscopy, with biopsy for culture and histology, as well as 13C‐urea breath testing (13C‐UBT) were performed pre‐treatment to assess H. pylori infection. H. pylori eradication was established at 4–6 weeks follow‐up with culture (2 antral, 1 corpus biopsies), histology (2 antral biopsies), and 13C‐UBT. Ulcer healing by endoscopy and change in clinical symptoms were also assessed at 4–6 weeks.
Results:
Two hundred and sixty‐seven (267) patients were randomized to ACT‐10 (n=137) or Dual therapy (n=130). By per‐protocol and intention‐to‐treat analyses, H. pylori eradication at 4–6 weeks follow‐up was 91% (115/127) and 88% (120/136), respectively, for ACT‐10 patients and 59% (68/115) and 55% (72/130), respectively, for Dual therapy patients (P<0.001 for both analyses). Ulcer healing was high in both treatment groups: ACT‐10, 93% (118/127) and 90% (122/136), respectively; and Dual therapy, 91% (104/114) and 85% (111/130), respectively. Pre‐treatment resistance to clarithromycin was low (4%, 8/214) as compared to metronidazole resistance which was over 40%. Emergence of resistance to clarithromycin was observed in 2% of patients receiving ACT‐10 and in 25% of those receiving Dual therapy. ACT‐10 and Dual therapy patients experienced similar rates of drug‐related adverse events (33% vs. 32%, respectively) and discontinuation from therapy due to an adverse event (1.5% vs. 5%, respectively). More than 90% of patients were compliant with each prescribed medication.
Conclusion:
In patients with active duodenal ulcer, a 10‐day course of amoxycillin–clarithromycin‐based triple therapy without additional acid suppression is highly effective in eradicating H. pylori and healing duodenal ulcer.
Background-In recent studies, familial coinfection with the same Helicobacter pylori strains has been indicated, but more data are necessary to confirm intrafamilial spread of the micro-organism. Aims-The aim of this study was (a) to assess the frequency of H pylori infection in spouses ofpatients with duodenal ulcers and (b) to investigate the possibility of intraspousal transmission of H pylori by molecular typing of the respective strains. Patients-Sixty four patients with duodenal ulcer and their spouses were included in the study. Methods-The Hpylori infection was confirmed after endoscopy by culture and histological examination of biopsy specimens, and CLO test. The isolates were compared on the basis of their rRNA gene patterns (ribopatterns) after digestion of chromosomal DNA by the restriction endonucleases HaeIII or HindIII. Results-Of the patients, 54 were found to
The homology of the H. pylori genome in members of the same family strongly supports the hypothesis of transmission of H. pylori from person-to-person or from a common source.
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