Effect of treatment on Campylobacter pylori in peptic disease: a randomised prospective trial.

Abstract

SUMMARY This study investigated the effect of colloidal bismuth subcitrate and cimetidine on Campylobacter pylori in peptic disease. In 74% of 135 patients with peptic disease diagosed at endoscopy C pylon was detected before treatment. Compared with cimetidine, colloidal bismuth subcitrate significantly decreased the incidence ofCpylori after six weeks oftreatment (p<O-OO1). In the colloidal bismuth subcitrate group, subsequent healing of the lesion was correlated with the clearance of C pylon, unlike in the cimetidine group. C pylon was strongly associated with the presence of histological gastritis, which was decreased by colloidal bismuth subcitrate (p<0001).Campylobacter pylori was first isolated from gastric mucosa by Warren and Marshall in 1983.' A number of studies have shown an association between the presence of these organisms and duodenal ulcer.`3 There is a strong correlation between C pylori and chronic non-autoimmune histological gastritis.3'The role that these organisms might play in the aetiology and pathogenesis of peptic disease remains unclear.Colloidal bismuth subcitrate (CBS) has been used successfully in the treatment of peptic disease for over two decades. It is classified as a mucosal protecting agent but its mode of action is not fully understood. Colloidal bismuth subcitrate has an antibacterial action6 and its efficacy in the treatment of peptic disease may be explained by the eradication of C pylori. Cimetidine, a H2 histamine receptor antagonist causes an increase in the gastric pH and may facilitate the multiplication of C pylori. Neither CBS or cimetidine affect the natural history of peptic disease, but patients treated for duodenal ulcer with CBS have a lower relapse rate.'8The purpose of this study was to investigate the effect of CBS and cimetidine on C pylori and histological gastritis and to determine the relationship between the presence of this bacterium and healing in patients with peptic disease. Methods PATIENTSOne hundred and thirty five consecutive patients undergoing endoscopy for upper gastrointestinal symptoms in whom a diagnosis of duodenal ulcer, benign gastric ulcer, endoscopic gastritis or oesophagitis was made, were entered into this study. Details of cigarette smoking and previous antacid therapy were recorded. Endoscopic gastritis was defined as macroscopic evidence of micro-ulceration, punctate haemorrhages and erythema. Two biopsies were obtained from the gastric antrum within 5 cm of the pylorus for microbiological and histological examination. Gastroscopy was carried out in a routine fashion with intravenous sedation after a fast of at least eight hours including medications. As previously recommended,6 patients gargled with but did not swallow a local anaesthetic spray; simethicone was not used during the procedure. Between procedures, biopsy forceps were sterilised with 2% glutaraldehyde and rinsed with tap water. There was no clinical microbiological or histological evidence to suggest crossinfection with C pylon between patients. After endoscopy, pa...

Lansoprazole, a novel benzimidazole proton pump inhibitor, and its related compounds have selective activity against Helicobacter pylori

“…Since their report, numerous groups of investigators worldwide have shown that the distribution of H. pylori is highly associated with both gastritis and peptic ulcers (3,9,15,20,38), and Marshall et al (17) and Morris and Nicholson (26) have reported that ingestion of H. pylori cultures induces gastritis in human volunteers. There are also several reports indicating that eradication of H. pylori by treatment with bismuth salts or bismuth-antibiotic combinations leads to a persistent improvement of gastritis and a lower relapse rate of peptic ulcers (4,12,16,18,23,28,29). Thus, it is now widely accepted that H. pylori is an important human pathogen causing type B gastritis of stomachs and probably a major predisposing cause of duodenal ulcers.…”

Local gastric and serum amoxicillin concentrations after different oral application forms

“…There is also convincing evidence that H. pylon plays an important role in duodenal ulcer disease (2, 5, 12), especially since eradication of the bacterium is associated with a significantly lower recurrence rate compared with H2 receptor blocker therapy (6,13,19). Moreover, in up to 70% of patients with nonulcer dyspepsia, H. pylon-positive active antral gastritis can be diagnosed (18,25), and although controversy about the clinical relevance of chronic gastritis remains, several investigators have found that these patients profit from elimination of H. pylon in terms of symptomatic improvement (14,26).…”

Gastroenterology

“…The first agents to be used were bismuth salts, encouraged by the discovery that relapse rates for recurrent ulceration were much lower after ulcers had been healed with oral bismuth than after healing by H2 antagonists. 19 The bacteria proved difficult to eradicate with monotherapy and it was only after the realisation that concurrent use of proton pump inhibitors greatly enhanced the efficacy of antibiotics that eradication rates rose above 80%. Quadruple combination therapy, including a bismuth preparation, is still used in intransigent cases.…”