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  • 2000-2004  (16)
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  • 1
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A new rapid urine test was developed to detect anti-Helicobacter pylori antibody in urine using the principle of immunochromatography. The accuracy of this test in the Chinese population remains to be defined.〈section xml:id="abs1-2"〉〈title type="main"〉Aim:To evaluate a new rapid urine test for the diagnosis of H. pylori infection in the Chinese population.〈section xml:id="abs1-3"〉〈title type="main"〉Methods:Eligible patients without previous treatment of H. pylori were recruited. In-house rapid urease test and histology were used as the gold standard. The rapid urine test (RAPIRUN H. pylori antibody) was performed and the results were compared with the gold standard.〈section xml:id="abs1-4"〉〈title type="main"〉Results:One hundred and twenty-three patients were eligible for analysis and 61 (50%) were H. pylori positive by the gold standard. The rapid urine test showed a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 96.7%, 95.2%, 95.2%, 96.7% and 95.9%, respectively. Results were obtained within 20 min and no special laboratory support was required.〈section xml:id="abs1-5"〉〈title type="main"〉Conclusions:The rapid urine test by immunochromatography is highly accurate for the diagnosis of H. pylori infection in untreated Chinese patients.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Aims : To study the prevalence, clinical characteristics and long-term outcome of oesophagitis in Chinese patients.Methods : Clinical and endoscopic data were collected prospectively from consecutive patients who underwent upper endoscopy between 1997 and 2001. Patients with endoscopic oesophagitis were graded according to the Los Angeles system and analysed according to their clinical presentation, endoscopic details, Helicobacter pylori status, non-steroidal anti-inflammatory drug history, co-morbidity and mortality.Results : A total of 22 628 upper endoscopies were performed in 16 606 patients. Of these, 631 (3.8%) had endoscopic oesophagitis, 14 had benign oesophageal stricture (0.08%) and 10 had Barrett's oesophagus (0.06%). Most patients (94%) had either Los Angeles grade A or grade B oesophagitis. Patients who died during follow-up had a significantly higher incidence of co-morbid illness (100% vs. 63%, P 〈 0.001). By Cox regression analysis, the presence of gastrointestinal bleeding (P = 0.008), advanced age (P = 0.004) and the use of Ryle's tube (P = 0.043) were identified to be independent factors associated with mortality.Conclusions : Complicated gastro-oesophageal reflux disease is uncommon in the Asian population. Advanced age, use of Ryle's tube and the presence of gastrointestinal bleeding are associated with a poor long-term outcome, which is a reflection of the severe underlying co-morbidity.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : We have previously shown that ranitidine bismuth citrate-based, clarithromycin-containing triple therapy achieves a higher eradication rate than proton pump inhibitor-based regimens in areas with a high prevalence of metronidazole resistance.Aim : To evaluate whether this higher efficacy of ranitidine bismuth citrate over proton pump inhibitor can be extended to non-clarithromycin-containing regimens.Methods : Helicobacter pylori-positive dyspeptic patients were randomized to receive either ranitidine bismuth citrate, 400 mg, amoxicillin, 1000 mg, and metronidazole, 400 mg, or omeprazole, 20 mg, amoxicillin, 1000 mg, and metronidazole, 400 mg, each given twice daily for 1 week. H. pylori eradication was confirmed by 13C-urea breath test 5 weeks later. The side-effects of the treatments were documented.Results : Two hundred and twenty-nine patients were eligible for analysis. By intention-to-treat and per protocol analysis, the eradication rates were 77% and 79%, respectively, in the ranitidine bismuth citrate–amoxicillin–metronidazole group and 77% and 82%, respectively, in the omeprazole–amoxicillin–metronidazole group (P = 0.58 and P = 0.65). However, patients in the omeprazole–amoxicillin–metronidazole group reported a significantly higher incidence of minor side-effects when compared to those in the ranitidine bismuth citrate–amoxicillin–metronidazole group (P = 0.001).Conclusions : Ranitidine bismuth citrate–amoxicillin–metronidazole was equally as effective as omeprazole–amoxicillin–metronidazole triple therapy, and may be considered as an alternative non-clarithromycin-based regimen in the Chinese population.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Conventional 13C-urea breath testing (13C-UBT) includes a test meal to delay gastric emptying, which, theoretically, improves the accuracy of the test. Citric acid has been proposed as the best test meal. However, recent studies have suggested that a test meal may not be necessary.〈section xml:id="abs1-2"〉〈title type="main"〉Aim:To investigate a new 13C-UBT protocol without a test meal in a Chinese population.〈section xml:id="abs1-3"〉〈title type="main"〉Methods:Consecutive dyspeptic patients referred for upper endoscopy were recruited. 13C-UBT was performed on two separate days with or without a test meal (2.4 Gm citric acid) and compared with the ‘gold standard’ (CLO test and histology).〈section xml:id="abs1-4"〉〈title type="main"〉Results:Two hundred and two patients were tested. Using receiver operating characteristics (ROC) analysis, the optimal delta-value and optimal measurement interval for UBT were 5% and 30 min, respectively, both with or without a test meal. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 13C-UBT with citric acid (96.5%, 97.7%, 98.2%, 95.6%, 97.0%) were similar to 13C-UBT without a test meal (94.7%, 97.7%, 98.2%, 93.5%, 96.0%).〈section xml:id="abs1-5"〉〈title type="main"〉Conclusion:This simplified 13C-UBT protocol without a test meal produced highly accurate and reliable results in the Chinese population.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: To compare the efficacy and tolerability of a 3-day quadruple therapy with a standard 7-day triple therapy in eradicating Helicobacter pylori infection and healing duodenal ulcers.〈section xml:id="abs1-2"〉〈title type="main"〉Methods:Patients with H. pylori-positive duodenal ulcers were randomized to receive either lansoprazole 30 mg, clarithromycin 500 mg, and metronidazole 400 mg twice daily for 7 days (LCM-7) or lansoprazole 30 mg, clarithromycin 500 mg, metronidazole 400 mg, and bismuth subcitrate 240 mg twice daily for 3 days (LCMB-3). No pre- or post-treatment acid suppression was used. Follow-up endoscopy was performed at week 6.〈section xml:id="abs1-3"〉〈title type="main"〉Results:A total of 118 patients were recruited. Sixty patients in the LCM-7 group and 53 patients in the LCMB-3 group returned for endoscopy. Intention-to-treat eradication rates were 87% and 86% (P=0.94) and per protocol eradication rates were 87% and 94% (P=0.29) in the LCM-7 and LCMB-3 groups, respectively. Per protocol and intention-to-treat ulcer healing rates were 98% and 98% in LCM-7 and 100% and 91% in LCMB-3, respectively. There were no significant differences in efficacy in relation to the initial metronidazole and clarithromycin susceptibility. Significant reduction in the duration of side-effects was found in the LCMB-3 group.〈section xml:id="abs1-4"〉〈title type="main"〉Conclusion:The 3-day quadruple therapy is highly effective, better tolerated and can be considered as a first-line therapy in duodenal ulcer management.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : Population-based data on gastro-oesophageal reflux disease in Chinese are lacking. The prevalence, clinical spectrum and health care-seeking behaviour of subjects with gastro-oesophageal reflux disease were studied.Methods : Ethnic Chinese (3605) were invited to participate in a telephone survey using a validated gastro-oesophageal reflux disease questionnaire and the Hospital Anxiety and Depression Scale.Results : A total of 2209 subjects (58% female; mean age, 40.3 years) completed the interview. The annual, monthly and weekly prevalence rates of gastro-oesophageal reflux disease were 29.8%, 8.9% and 2.5%, respectively. Gastro-oesophageal reflux disease symptoms were associated with non-cardiac chest pain [odds ratio (OR), 2.3; 95% confidence interval (95% CI), 1.7–3.1], dyspepsia (OR, 1.9; 95% CI, 1.4–2.5), globus (OR, 1.8; 95% CI, 1.2–2.7), acid feeling in the stomach (OR, 5.8; 95% CI, 4.5–7.5) and the use of non-steroidal anti-inflammatory drugs (OR, 2.3; 95% CI, 1.5–3.6), but not with dysphagia, bronchitis, asthma, hoarseness and pneumonia. Patients with gastro-oesophageal reflux disease had a significantly higher anxiety and depression score and required more days off work when compared with subjects without. The frequency of heartburn (P = 0.032), female gender (P 〈 0.001), degree of depression (P = 0.004) and social morbidity (P 〈 0.001) were independent factors associated with health care-seeking behaviour.Conclusion : The prevalence of gastro-oesophageal reflux disease was lower than that in Western populations, but carried a significant socio-economic burden in the studied Chinese population. The frequency of heartburn, female gender and psychosocial factors were associated with health care utilization in gastro-oesophageal reflux disease.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Aim : To study whether prophylaxis with lansoprazole could prevent relapse of ulcers after eradication of Helicobacter pylori in patients with NSAID-related peptic ulcers.Methods : Patients who presented with peptic ulcers and were found to be infected with H. pylori while receiving NSAIDs were recruited into the study. They received, twice daily, lansoprazole 30 mg, amoxicillin 1 g and clarithromycin 500 mg for 1 week, followed by lansoprazole 30 mg daily for 4 weeks. Patients with healed ulcers and H. pylori eradicated were given naproxen 750 mg daily, and randomly assigned to receive lansoprazole 30 mg daily or no treatment for 8 weeks. The primary endpoint was the cumulative recurrence of symptomatic and complicated ulcers.Results : At the end of the 8-week treatment period, significantly fewer patients (1/22, 4.5%, 95% confidence interval [CI] 0–23) in the lansoprazole group compared with the group that received H. pylori eradication alone (9/21, 42.9%, 95% CI 22–66) developed recurrence of symptomatic and complicated ulcers (log rank test P = 0.0025).Conclusions : Lansoprazole significantly reduced the cumulative relapse of symptomatic and complicated ulcers in patients requiring NSAIDs after eradication of H. pylori.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Aim : To test the efficacy of rabeprazole, levofloxacin and rifabutin triple therapy vs. quadruple therapy for the second-line treatment of Helicobacter pylori infection.Methods : One hundred and nine patients who had failed previous H. pylori eradication were randomized to receive: (i) rabeprazole, 20 mg b.d., rifabutin, 300 mg once daily, and levofloxacin, 500 mg once daily, for 7 days (triple therapy); or (ii) rabeprazole, 20 mg b.d., metronidazole, 400 mg t.d.s., bismuth subcitrate, 120 mg q.d.s., and tetracycline, 500 mg q.d.s., for 7 days (quadruple therapy). Endoscopy and culture were performed before treatment.Results : The clarithromycin (79% vs. 21%, P 〈 0.001) and metronidazole (89% vs. 40%, P 〈 0.001) resistance rates were significantly higher in patients with previous exposure than in those with no previous exposure. The intention-to-treat and per protocol eradication rates were 91%/91% for the triple therapy group and 91%/92% for the quadruple therapy group. For patients with double resistance to metronidazole and clarithromycin, the eradication rates were 85% (17/20) in the triple therapy group and 87% (13/15) in the quadruple therapy group. Compliance was greater than 95% for both regimens.Conclusion : Rabeprazole, levofloxacin and rifabutin-based triple therapy and quadruple therapy were equally effective as second-line treatments for H. pylori infection.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Aim : To determine whether symptomatic response to lansoprazole predicts abnormal acid reflux in endoscopy-negative patients with non-cardiac chest pain.Methods : Patients who complained of chest pain, but had normal coronary angiography, were asked to undergo upper endoscopy. Those without gastric and oesophageal lesions were recruited for 24-h ambulatory oesophageal pH monitoring, and were randomly given lansoprazole 30 mg or placebo, both daily for 4 weeks. Chest pain symptoms were recorded before and 1 month after treatment on a locally validated questionnaire. The symptom score was calculated by multiplying the severity and frequency of the symptom, and symptom improvement was defined as 〉 50% reduction in symptom score.Results : Overall, 68 patients, 36 on lansoprazole and 32 on placebo, completed the trial. The symptom score was reduced significantly in both groups (P 〈 0.001). In the lansoprazole group, more patients with than without abnormal reflux showed symptom improvement (92% vs. 33%; odds ratio = 22; 95% confidence interval, 2.3–201.8; χ2 = 10.9; P = 0.001), giving a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 92%, 67%, 58%, 94% and 75%, respectively. In the placebo group, the rates of symptom improvement were similar between those with and without abnormal reflux (33% vs. 35%, P = N.S.).Conclusions : Treatment with lansoprazole is a useful test in diagnosing endoscopy-negative gastro-oesophageal reflux disease in Chinese patients with non-cardiac chest pain.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: To compare 1-week ranitidine bismuth citrate-based (RBC) triple therapy vs. omeprazole-based (O) triple therapy for the eradication of Helicobacter pylori infection in Hong Kong with high prevalence of metronidazole resistance.〈section xml:id="abs1-2"〉〈title type="main"〉Methods:Patients with non-ulcer dyspepsia and H. pylori infection were randomized to receive either: (i) RBCCM: ranitidine bismuth citrate (pylorid) 400 mg, clarithromycin 250 mg and metronidazole 400 mg; or (ii) OCM: omeprazole 20 mg, clarithromycin 250 mg and metronidazole 400 mg, each given twice daily for 1 week. Endoscopy (CLO test, histology and culture) and 13C-urea breath test were performed before randomization and 6 weeks after drug treatment.〈section xml:id="abs1-3"〉〈title type="main"〉Results:A total of 180 patients were randomized. H. pylori eradication rates (intention-to-treat, n=180/per protocol, n=166) were 83%/92% for RBCCM and 66%/70% for OCM (P=0.01, intention-to-treat and P=0.001, per protocol, respectively). RBCCM treatment was unaffected by metronidazole susceptibility and achieved a significantly higher eradication rate in metronidazole-resistant cases (89%) than the OCM group (45%, P=0.0064).〈section xml:id="abs1-4"〉〈title type="main"〉Conclusion:One-week ranitidine bismuth citrate-based triple therapy is significantly better than omeprazole-based triple therapy for the eradication of H. pylori infection, especially in metronidazole-resistant cases. It is an effective regimen for the eradication of H. pylori infection in regions with a high prevalence of metronidazole resistance.
    Type of Medium: Electronic Resource
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