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  • 1
    Electronic Resource
    Electronic Resource
    Oxford UK : Blackwell Science Ltd.
    Alimentary pharmacology & therapeutics 16 (2002), S. 0 
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Helicobacter pylori is a gastric pathogen that is a major cause of peptic ulcer disease, has a role in mucosa-associated lymphoid tissue (MALT) lymphoma and is associated with gastric cancer. Yet, in a large proportion of the human population, H. pylori infection has no apparent adverse clinical consequences. Furthermore, recent research suggests that H. pylori may even confer protection against gastroesophageal reflux disease.The conflicting evidence surrounding H. pylori infection was discussed at a sponsored symposium in Helsinki, introduced by Professor P. Malfertheiner, with papers presented by Dr H. J. O'Connor, Professor R. M. Genta, Dr P. Unge and Professor A. T. R. Axon. Emerging epidemiological and retrospective evidence suggests that the presence of H. pylori infection may provide some protection against gastroesophageal reflux disease, but there is other evidence that shows no benefit of H. pylori for the protection of the oesophagus. It was felt that prospective, multicentre studies are needed to explore the H. pylori–gastroesophageal disease relationship further, to avoid confusing potential benefits with known risks.Following the symposium, a discussion on the relative risks and benefits for H. pylori eradication was provided by Professor Axon and Professor Blaser.Eradication of H. pylori has been recommended in a series of management guidelines issued by consensus groups. However, accurate estimates of the relative risks and benefits of H. pylori infection in the general population, as well as in specific patient groups, is essential in order to develop a management strategy.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Ninety-eight patients (26 females), who presented with erosive and/or ulcerative oesophagitis, despite at least a 3-month period of treatment with standard doses of cimetidine (≥ 1200 mg daily) or ranitidine (≥ 300 mg daily), were included in a double-blind, randomized trial to compare omeprazole (40 mg o.m.) with a high dose of ranitidine (300 mg b.d.). The treatment was given for 4–12 weeks; endoscopy assessment and laboratory screening were performed on entry to the trial and thereafter every fourth week. Endoscopic healing was defined as complete epithelialization of all macroscopic erosions or ulcers in the squamous epithelium. An ‘intention-to-treat’analysis of the clinical datarevealed omeprazole to be superior to ranitidine : 63 % of those patients who were given omeprazole were heaIed endoscopically after a 4-week period of treatment, compared with only 17 % of those given ranitidine. This difference in healing rate persisted during the 12-week study period (90% DS 47% after 12 weeks; P 〈 0.0001). Reflux symptoms were more rapidly and completely relieved with omeprazole : heartburn resolved completely in 86% of patients treated with omeprazole for 4 weeks compared with 32% in the ranitidine group (P 〈 0.0001). The mean basal gastrin concentrations increased only in those given omeprazole from 18.9 pmol/L at pre-entry to a mean value of 31.7 pmol/L on the last day of omeprazole administration. In ranitidine-treated patients no significant increase in basal gastrin concentration was observed. Both drugs were well tolerated with few adverse events, which were mainly mild and transient. These results demonstrate the superiority of omeprazole over a high dose of ranitidine in the treatment of resistant reflux oesophagitis.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Alimentary pharmacology & therapeutics 11 (1997), S. 0 
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Although Helicobacter pylori gastritis, that is, H. pylori infection and its complications, is currently the focus of tremendous research activity, there is no gold standard test for its detection. Current methods of assessment of H. pylori infection are reviewed in this paper, and the diseases associated with the bacterium are discussed. Histological tests can indicate the presence of infection with H. pylori. Culture tests, however, are more specific but rely on the presence of viable bacteria, and the polymerase chain reaction (PCR) can detect DNA from H. pylori. Indirect methods of detecting infection include urease tests, but these recognize only active bacteria. Serological tests are usually satisfactory screening methods but are not suitable for assessing treatment outcome. There are now many reports that associate diseases other than peptic ulcer disease with the presence of H. pylori infection. In 1994, the International Agency for Research on Cancer, sponsored by the World Health Organization, classified the bacterium as a group I carcinogen. Results of studies on patients with functional dyspepsia indicate that eradication of H. pylori gives a range of levels of symptom relief, from no relief to significant relief, with a geometric mean value indicating a positive effect on a sub-group of this category of patients. Other groups of patients with symptoms similar to functional dyspepsia and a significant risk for negative investigation are those with endoscopy negative reflux, mucosa-associated lymphoid tissue (MALT) lymphoma or mild non-steroidal anti-inflammatory drug (NSAID) lesions. Both MALT lymphoma and NSAID lesions are partly linked to H. pylori infection, while the possible correlation between reflux disease and H. pylori infection is controversial. In conclusion, H. pylori gastritis seems to be associated with a number of complications, some of which are serious. There are no reliable data showing any positive aspects of the infection. Eradication of H. pylori infection should therefore, in most cases, be regarded as an appropriate therapeutic strategy.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: : To study the efficacy of omeprazole triple therapy in the eradication of Helicobacter pylori in patients with active gastric ulcer, and to assess healing and relapse of gastric ulcer.〈section xml:id="abs1-2"〉〈title type="main"〉Methods: A double-blind, randomized study was carried out in 18 centres in Germany, Hungary and Poland. Patients (n = 160) with gastric ulcer and a positive H. pylori screening test were randomized to a 7-day twice daily treatment with omeprazole 20 mg, clarithromycin 500 mg and amoxycillin 1000 mg (OAC) or omeprazole 20 mg, clarithromycin 250 mg and metronidazole 400 mg (OMC), or with omeprazole 20 mg once daily (O). After completion of this 1-week treatment, patients were treated with omeprazole until healing (maximum 12 weeks), and followed for 6 months. H. pylori was assessed by urea breath test (UBT) and histology.〈section xml:id="abs1-3"〉〈title type="main"〉Results: Eradication rates ITT were OAC 79% (95% CI: 65–90%), OMC 86% (95% CI: 73–94%) and O 4% (95% CI: 0–14%). Eradication rates PP were OAC 83% (95% CI: 68–93%), OMC 93% (95% CI: 80–98%) and O 3% (95% CI: 0–13%). Gastric ulcer relapses occurred in 5, 0 and 11 patients in the groups, respectively.〈section xml:id="abs1-4"〉〈title type="main"〉Conclusions: The results from the study demonstrate that OMC and OAC 1-week regimens are safe and effective for eradication of H. pylori in gastric ulcer patients, and that ulcer relapse is infrequent after successful eradication.
    Type of Medium: Electronic Resource
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