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G. Manes, [1] O. Pieramico [2] A. Balzano [1]. [15/35] Efficacy of an Eradicating Regimen with Higher Dosage of PPI. Preliminary Results Background: Triple therapy represents the standard treatment for [...]

M.V. Zanetti [1] O. Pieramico [2] R. Vendramin [2] [3/25] Assessment of H. pylori CagA-Status: Evaluation of the Accuracy of a New 'Rapide' Serum Test Helicobacter pylori (HP) expresses its [...]

M. Zanetti [1] O. Pieramico [2] R. Vendramin [2] [1/26] Evolution of in-vitro Primary and Secondary Resistance of H. pylori to Metronidazole and Clarithromycin In vitro Resistance to Metronidazole (MTR) [...]

Triple therapy based on the association of a proton pump inhibitor and two antibiotics is actually the standard treatment for cure of H. pylori (HP) infection. However, in a percentage of patients of about 20%, infection may persist after this therapy mainly due to antibiotic resistance. In such patients, a quadruple therapy might be a useful re-treatment option. Aim of this study was therefore to evaluate the efficacy of a quadruple therapy as "second line" treatment in persisting HP infection after standard triple therapy. Patients and Methods: Fifty symptomatic patients with HP infection persisting after standard triple therapy were included. HP was assessed before and 8-12 weeks after therapy by endoscopy with biopsies taken from antrum and corpus for rapid urease test, culture and histology. Culture was performed using blood-free agar plates and HP-positive cultures were then tested to metronidazole and clarithromycin by disk-diffusion technique using a cut-off of 8 mg/l and 2 mg/l for metronidazole and claritromycin, respectively. Quadruple therapy consisted of omeprazole 20 mg bid, bismuth subcitrate 120 mg qid, metronidazole 500 mg bid and tetracycline 500 mg bid for two weeks. Results: Forty-seven patients completed therapy according to the protocol and were then evaluated, twenty-nine cultures were resistant to metronidazole and thirty-six to clarithromycin. Overall, HP was cured with quadruple therapy in 42/47 patients (98% per protocol, 87.5% ITT). Two patients interrupted therapy because of side effects. One patient refused post-treatment endoscopy. Mild side effects were reported by 13/47 patients (27%). Conclusions: Low-dose metronidazole-based quadruple therapy for two weeks is an effective treatment for persisting HP infection after triple therapy and may therefore have a role as "second line" treatment. [ABSTRACT FROM AUTHOR]

Clarithromycin resistance (Cla R) has a great impact on cure of H. pylori (HP). Quadruple therapy is a valid alternative with high efficacy against HP resistant strains. Aim: To compare standard triple therapies with a quadruple therapy in Cla R. Patients and Methods: Sixty-one patients (28 M, 33 F, mean age 53 yrs, range 26-73 yrs) with HP and Cla R were included. Forty-one patients had primary Cia R and twenty secondary Cla R. Thirty-three patients had also metronidazole (Met) resistance. HP was assessed before and 8-12 weeks after therapy by endoscopy with biopsies taken for rapid urease test, culture and histology. Culture was performed using blood-free agar plates and HP-positive cultures were tested to Met and Cla by disk-diffusion technique using a cut-off of 8 mg/l and 2 mg/l for Met and Cla, respectively. Patients received: 1) Omeprazole (Ome) 20 mg bid, amoxicillin 1 g bid and Cla 500 mg bid (OAC) for 1 week; or 2)Ome 20 mg bid, Met 500 mg bid and Cla 500 mg bid (OMC) for 1 week; or 3)Ome 20 mg bid, Met 500 mg bid, bismuth subcitrate 120 mg qid and tetracycline 500 mg bid (OMBT) for 2 weeks. Results: 59 patients completed therapy. Overall, HP was cured in 42/59 patients (71%). Cure rate was significantly lower (p < 0.05) with OMC (13/20, 65%, 42-88% 95%CI) and OAC (14/23, 61%, 39-82%) as respect to OMBT (15/16, 94%, 80-100%). Mild side effects were reported by 20%, 17% and 25%, during OMC, OAC and OMBT, respectively. Two patients treated with OMBT did not complete therapy. Conclusions: 1) Cla R is associated with a decreased efficacy of standard triple therapies; 2) despite concomitant Met R, quadruple therapy for 2 weeks is significantly better than triple therapies and it represents a valid treatment option for patients with Cla R. [ABSTRACT FROM AUTHOR]

Culture is one of the most important diagnostic tools for assessment of H. pylori infection before and after therapy. Aim: to evaluate the diagnostic value of new vials (Pyloriset® urease, Orion Diagnostica) for rapid assessment of HP infection and culture in comparison with rapid urease test (CP test) and standard culture technique. Materials and Methods: Gastric biopsies from a total number of 36 patients who underwent gastroscopy for dyspeptic symptoms, were taken. All subjects had not received antibiotics during the last three months before endoscopy. During gastroscopy, five biopsies were taken from antrum (three biopsies) and corpus (two biopsies) and used (one biopsy) for rapid urease test (CP test), standard culture with refrigerated NaCl 0.9% as transport medium (two biopsies), and two biopsies were put in the new vials containing new medium (Pyloriset® urease) for rapid HP diagnosis and subsequent culture. Results from culture perfomed from biopsies transported with the standard medium in NaCl 0.9% were compared with results of CP test at 30 (CP 30) and 120 (CP 120) min., with rapid HP test from biopsies put into Pyloriset® vials (Orion 30 and Orion 120), and with culture wit H. pyloriset® urease as transport medium (Culture Orion). Results: are shown in the following table: Conclusions: 1) Cultures performed from vials Pyloriset® urease shown high rates of sensibility and specificity and are therefore comparable with standard culture technique; 2) the result of the rapid HP test using the new vials are similar to those obtained with CP test; 3) Bioptic assessment of HP by means of rapid test and culture wit H. pyloriset® urease represents therefore a promising technical advance. [ABSTRACT FROM AUTHOR]

It is known that Helicobacter pylori (HP) infection may be detected by invasive and/or not invasive techniques. Urea breath-test (UBT) and Stool test (ST) are the most accurate, reliable and widely used non-invasive techniques. After the enzyme immunoassay using polyclonal antibodies against HP antigens in human stool, a second generation technique of tests based on polyclonal, monoclonal antibodies anti-HP or immunochromatographic techniques has been proposed. In a previous investigation (Int J Med Microbiol 2001, Vol. 291, Suppl. 31, 2001:52 (F-28) we have compared the accuracy of a polyclonal vs. a monoclonal stool test to evaluate the efficacy of eradication therapy. Aim: To evaluate the accuracy of a second generation of immunoenzymatic polyclonal and monoclonal (HpSA Meridian; Humatec; Medic) and immunochromatographic (Medimar) stool test for post-treatment assessment of HP infection. Materials and Methods: Thirty-six patients (19 F, 17 M age 21-74 years) with HP infection and treated with standard triple therapy (omeprazole 20 mg bid, claritromycin 500 mg. bid and metronidazole 500 mg. bid or amoxicillin 1 g. bid for one week) have been evaluated. UBT was performed between 4 and 10 weeks after therapy to evaluate post-treatment situation. Stool specimens were collected between 4 and 8 weeks after therapy and were stored, frozen (-20°C) and tested at the same day with three different immunoenzymatic tests (Meridian, Medic, Humatec) and with one immunochromatographic (Medimar) and the results were then compared with UBT. Results: are shown in the following table. Conclusions: 1) All 4 compared tests were simple, fast to perform and the results were easy to evaluate. 2) Immunoenzymatic tests showed a higher specificity, sensibility, PPV, NPV and concordance with UBT as respected to immunochromatographic test for post-treatment assessment of HP infection. [ABSTRACT FROM AUTHOR]

Introduction: Antibiotic resistance is an important factor for successful eradication therapy. In vitro susceptibility test of H. pylori (HP) to the most used antibiotics metronidazole (MTR) and clarithromycin (CLA) is an important tool for better choice of therapy. However, culture is a time consuming investigation because it requires subcultures and can be complicated by the presence of coccoid forms of HP. Recently, it has been shown that a new test of hibridization in situ (FISH test) on gastric biopsies might be a useful alternative to culture for assessment of HP infection and CLA resistance. Aim of this study was therefore to evaluate the accuracy of FISH test for assessment of CLA resistance in comparison with standard disk diffusion (DD) technique. Materials and Methods: Sixty gastric biopsies taken during endoscopy from thirty patients with HP infection were investigated. Bioptic specimens from the same patient were transported in NaCl 0.9% and investigated with both DD and FISH test. Susceptibility test to CLA tested with DD [15µg./ml] was performed taking a cut-off of Ø = 30 mm. FISH test was performed after homogenisation of biopsies in accordance wit the protocol of manufacturer (Oxoid Ltd, Basingstoke, Hampshire, England; creaFAST® H. pylori Combi Kit). Results: A total of 22/60 (37%) subcultures with susceptibility test for CLA performed with DD showed a CLA R. FISH test showed CLA R in 24/60 (40%) biopsies and in all biopsies CLA R with DD. FISH test had therefore a sensibility 95%, specificity 100%, PPV 100%, NPV 92%, concordance 97%. With DD, 6/60 coltures (10%) needed at least three subcultures due to coccoid forms. Conclusions: assessment of CLA R by means of FISH test as compared to DD showed: 1) similar accuracy; 2) faster results (3-4 hours); 3) no influence of coccoid forms. [ABSTRACT FROM AUTHOR]

Background & Aims: Secretions from the exocrine and endocrine pancreas may modulate interdigestive motility. To test this hypothesis in humans, we investigated interdigestive cycling in patients with chronic pancreatitis (CP) as a model of impaired pancreatic function., Methods: Antroduodenal motility, pancreatic enzyme output, and pancreatic polypeptide release were monitored for two consecutive interdigestive cycles in 13 controls and 9 patients with CP., Results: Interdigestive enzyme output was severely impaired in patients with CP (> 80% decrease); however, secretory cycling was still evident in most patients. All parameters describing interdigestive motility were similar in controls and patients with CP (duration of the migrating motor complex [MMC] was 107 +/- 19 minutes in patients with CP vs. 114 +/- 15 minutes in controls). The time between cyclic peaks of enzyme secretion (76 +/- 4 minutes vs. 101 +/- 4 minutes in controls) and pancreatic polypeptide (63 +/- 4 minutes vs. 106 +/- 7 minutes in controls) was shortened in patients with CP, and peaks were no longer temporally related to the MMC. Only 56% of phase III activity fronts were associated with a concomitant secretory peak in patients with CP compared with 92% in healthy subjects., Conclusions: CP not only decreases pancreatic secretion but interrupts the coordination among interdigestive cyclic phenomena. Our findings in several animal and human models refute the concept that pancreatic mechanisms exert a major regulatory influence on interdigestive motor activity.