An elderly woman with chronic ulcerative colitis who developed proximal muscle weakness, increased serum creatine phosphokinase activity, and histological and electromyographic abnormalities characteristic of polymyositis is described. Treatment with corticosteroids and 5-acetylsalicylic acid was followed by a remission in bowel symptoms, improvement in muscle power, and reversal of electromyographic changes. An autoimmune link between the two disorders seems likely. (Gut 1993; 34: 567-569) Case report A 78 year old woman was admitted to hospital for investigation and management of diarrhoea and muscle weakness. She had been having recurrent episodes of diarrhoea associated with the passage of blood and mucus, low grade fever, and a feeling of exhaustion for the past 15 years. Each episode lasted for 7 to 10 days, followed by a symptom free period of 2-3 months. She had never visited hospital and was treated symptomatically by general practitioners with antidiarrhoeal drugs. During the past 15 days, she had started having arthralgias that affected multiple joints and appreciable proximal muscle weakness of both lower and upper limbs. The patient was prescribed indomethacin (25 mg thrice daily) for arthralgia by her treating physician. She had lost about 4 kg of weight over the previous 2 weeks.Physical examination at the time of hospital admission showed moderate pallor and mild dehydration. The patient's pulse rate was 96 bpm and the volume was slightly decreased. Her blood pressure was 100/60 mm Hg. The small joints of the hands were tender to pressure and movement. Abdominal examination showed mild tenderness in the hypogastrium, and the patient's spleen was palpable 2 cm below the left costal margin and was firm in consistency. Neurological examination showed weakness of the proximal muscles of the lower and upper Laboratory investigations showed a haemoglobin concentration of 78 g/l and a haematocrit of 23%. The patient's total leukocyte count was 8600/mm3 (8-6x 109/l), with neutrophils 85%, lymphocytes 13%, and eosinophils 2%. The erythrocyte sedimentation rate was 67 mm in the first hour (Westergren) and reticulocyte count 5%. A coagulogram was normal. Platelets were 110000/mm3 (110x109/l). Serum Na was 135 mmol/l and K 3-3 mmol/l. Blood urea was 28 mg/dl (9 9 mmol/l) and serum creatinine 1-0 mg/dl (88-4 mmol/l). Serum bilirubin was 0-8 mg/dl (13-6 mmol/l); SGOT was 13 U/1, SGPT was 7 U/l and alkaline phosphatase was 10 KAU. The total serum protein was 74 g/l with an albumin concentration of 36 g/l, globulin 38 g/l, and an albumin/globulin ratio of 0 95. The patient's urine was negative for protein and sugar, and microscopy showed 10-12 pus cells/ high power field. Urine culture showed growth of Pseudomonas aeruginosa. Stools showed the presence of red cells (+++++) but no ova or cysts, and culture grew Candida albicans. Upper gastrointestinal endoscopy showed features of oesophagitis and erosive gastritis. A barium enema showed extensive ulceration in the entire large bowel (Figs 1 and 2) and...
Background: there has not been yet any research on the effectiveness of H. pylori eradication of bismuth-containing quadruple regimen on chronic gastritis patients in our country. Objective: to evaluate H. pylori eradication rate of bismuth-containing quadruple regimen according to intention to treat (ITT), per protocol (PP) analysis, the rate of side effects and medication compliance. Subjects and Methods: from March 2014 to January 2016 we used bismuth-containing quadruple regimen (EBMT) 10 days for H. pylori eradication therapy for 166 chronic gastritis patients diagnosed based on clinical, endoscopic, rapid urease test, histology and culture. Patients were evaluated side effects and medication compliance at the end of treatment (day 11-14). To assess the eradication, repeating endoscopy with both rapid urease test and histological examination were performed at 4 to 8 weeks after stopping treatment course. Results: H. pylori eradication rates on ITT and PP analysis overall, for naïve patients, after one and more two eradication failures were respectively: 80.72-89.33%, 79.51-90.65%, 91.67-91.67% and 75.00-78.95%. Medication adherence rate was 96.99%. The rates of patients experiencing moderate, severe and very severe side effects were: 19.88%, 0.60% and 1.81%. Conclusion: the EBMT 10-day regimen attained high eradication rates in chronic gastritis patients with rare serious side effects and the high compliance rate. We should apply bismuth-containing quadruple regimen in H. pylori eradication therapy for naïve patients or after one eradication failure. Key words: bismuth-containing quadruple regimen, EBMT, eradication, chronic Helicobacter pylori gastritis
Background: The Maastricht IV consensus recommended that if patients who failed after two eradication attempts need to be treated with the third-line treatment based on the antimicrobial susceptibility. However, there was few researches in Vietnam about the true effectiveness of this approach. Objectives: To determine the antibiotic resistance prevalances of H.pylori and the success rates of antibiogram-based on H.pylori eradication treatment according to modified intention to treat and per protocol analysis. Method: This cross-sectional, intervention study involved 62 dyspeptic patients who had two or more eradication failures, examined at Thong Nhat-Dong Nai General Hospital from 05/2014- 05/2015, diagnosed gastritis endoscopically and H.pylori positive at rapid urease test. Antibiogram for H.pylori was used both to evaluate antibiotic resistance and to treat patients. Results: The prevalances of H.pylori resistance to AMX, CLR, LFX, MTZ, TET were7.6- 77.4- 66.1- 86.2- 1.7%, respectively. The rate of H.pylori strains resistance to LFX was significantly higher in female than in male, 75.0% versus 44.4%, OR = 0.3 (95% CI 0.1 - 0.8), p = 0.03. 90.6% of H.pylori strains were susceptible to both AMX and TET and 54.8% of those were resistant to both CLR and LFX. Using mITT and PP analysis, the success rates of antibiogram-based regimen were: 69.2% và 76.6%, respectively. Conclusion: In patients who failed two or more H.pylori eradication treatments, both AMX and TET were still susceptible. The rates of H.pylori strains were resistant to CLR, LFX and dual rather high. The efficacy of antibiogram-based H.pylorieradication treatment was acceptable. Key words: H.pylori, antibiotic resistance, antibiogram-based, eradication, failure, mITT, PP.
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