Asunto(s)
Clostridioides difficile , Enterocolitis Seudomembranosa/complicaciones , Enterocolitis Seudomembranosa/terapia , Trasplante de Microbiota Fecal , Cirrosis Hepática/complicaciones , Anciano , Anciano de 80 o más Años , Enterocolitis Seudomembranosa/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Resultado del TratamientoRESUMEN
OBJECTIVE: To analyse the evolution of a multidisciplinary heredofamilial cancer unit (HFCU) in a university hospital. METHODS: This was a retrospective analysis of the activity of our HFCU in its first 5 years of existence. RESULTS: Between July 2010 and July 2015, 1,518 patients from 1,318 families attended our HFCU. Genetic testing was offered to 862 patients. Of those, 833 (96.6%) accepted testing, with available results for 636 (76.4%). Pathogenic mutations in BRCA1 and BRCA2 were found in 175 patients. Lynch syndrome and adenomatous polyposis were the most frequent syndromes diagnosed (151/175, 86.3%) among 17 different syndromes studied. Of the 404 patients without a previous genetic diagnosis in the family, 62 (15.3%) were found to have mutations in disease-causing genes. Prophylactic surgery and follow-up (33.7%) or follow-up only (66.3%) was proposed for mutation carriers according to international guidelines and patients' preferences. CONCLUSION: We have a high mutation detection rate, genetic test acceptance, and compliance with risk reduction strategies. However, there is room for improvement, especially in genetic testing timing, considering that an increase in the indications for genetic testing is expected.
Asunto(s)
Hospitales Universitarios/organización & administración , Síndromes Neoplásicos Hereditarios/terapia , Femenino , Predisposición Genética a la Enfermedad , Pruebas Genéticas , Humanos , Masculino , Síndromes Neoplásicos Hereditarios/clasificación , Síndromes Neoplásicos Hereditarios/genética , Estudios Retrospectivos , EspañaRESUMEN
Three entomopathogenic fungal strains, Isaria farinosa (Holmsk.) Fr., Lecanicillium attenuatum (Zare & W. Games) and Beauveria pseudobassiana (Bals.) Vuill. were isolated in Spain from naturally infected Monochamus galloprovincialis (Olivier) (Coleoptera: Cerambycidae), the European vector of Pine Wilt Disease (PWD). This is the first time that these entomopathogenic fungi have been isolated from M. galloprovincialis beetles. Assays showed the B. pseudobassiana EABps 11/01-Mg strain to be highly virulent against the pine sawyer. Horizontal and vertical transmission were assessed for both aqueous (1×10(8)conidia/ml) and dry (4.25×10(9)conidia/g) conidial formulations. Evidence of horizontal or vertical transmission was not found when insects were inoculated with the aqueous conidial suspension. However, when dry conidia were applied, 100% of the horizontally-infected insects died and their average survival times (AST) were significantly reduced (from 21.10 and 25.00 days in controls to 10.40 and 10.00 days in infected males and females, respectively). Compared to control females, numbers of egg-laying wounds, eggs laid, live larvae after 5 days and larvae entering the xylem after 6 months were significantly reduced in both inoculated females and clean females that had mated with inoculated males, pointing to horizontally-induced reduction of progeny. These results validate the potential of the isolated B. pseudobassiana strain as an important natural population regulator. Through auto-dissemination techniques, it could be used for the integrated control of Pine Wood Nematode vectors and constitute a new tool for Pine Wilt Disease management.
Asunto(s)
Beauveria/fisiología , Insectos Vectores/parasitología , Nematodos/microbiología , Control Biológico de Vectores/métodos , Animales , Insectos Vectores/microbiología , Pinus/parasitología , Enfermedades de las Plantas/parasitologíaRESUMEN
La enfermedad de Kawasaki es una vasculitis sistémica que afecta sobre todo a niños de entre 6 meses y 5 años de edad. Su curso es habitualmente autolimitado, pero puede dejar secuelas importantes, sobre todo si no se instaura un tratamiento adecuado. La etiología es desconocida, pero parecen estar implicadas diferentes bacterias a través de la formación de superantígenos, generando una respuesta inflamatoria intensa. En este artículo se presenta una asociación entre el síndrome de Kawasaki y la infección del tracto urinario por Pseudomonas aeruginosa en una niña de 2 años, y se discute la posible relación existente entre ambos(AU)
Kawasakis disease is a systemic vasculitis that primarily affects children between 6 months and 5 years old. Its evolution is usually self-limiting but it can leave serious sequelae, especially if an appropriate treatment is not initiated. The etiology is unknown, but different bacteria appear to be involved through the formation of superantigens, causing an intense inflammatory response. This article presents an association between Kawasaki syndrome and urinary tract infection by Pseudomonas aeruginosa in a girl of 2 years old and discusses their possible relationship(AU)
Asunto(s)
Humanos , Femenino , Lactante , Preescolar , Síndrome Mucocutáneo Linfonodular/complicaciones , Síndrome Mucocutáneo Linfonodular/diagnóstico , Síndrome Mucocutáneo Linfonodular/tratamiento farmacológico , Infecciones Urinarias/complicaciones , Infecciones Urinarias/diagnóstico , Pseudomonas aeruginosa/aislamiento & purificación , Superantígenos , Inmunoglobulinas/uso terapéutico , Gentamicinas/uso terapéutico , Síndrome Mucocutáneo Linfonodular/sangre , Síndrome Mucocutáneo Linfonodular , Pseudomonas aeruginosa , Vasculitis Sistémica/diagnóstico , Vasculitis Sistémica/tratamiento farmacológicoRESUMEN
La mayoría de los casos de quilopericardio en la infancia aparecen tras cirugía torácica, especialmente tras cirugía cardiaca, aunque de forma excepcional también se producen en niños sin estos antecedentes, como los 2 pacientes presentados en este artículo. El primero se trata de un niño de 9 años con un episodio de quilopericardio como primera manifestación de una linfangiomiomatosis, y el segundo de una niña de 15 meses con antecedentes de síndrome de Down y enteropatía autoinmune, catalogado como quilopericardio congénito primario. Además, se realiza una revisión bibliográfica de los casos publicados en los últimos 13 años y se analiza el manejo de esta rara entidad (AU)
Most cases of chylopericardium in childhood are secondary to thoracic surgery, especially after cardiac surgery. However, it can also be present in children without this history, as we show in this report. First, a nine year-old boy in whom chylopericardium was the first manifestation of a lymphangiomatosis, and the second one, a fifteen months old girl with a history of Down's syndrome and autoimmune enteropathy, which was classified as primary congenital chylopericardium. Also, a review of literature over the last 13 years is made, and management of this rare entity is discussed (AU)
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Niño , Derrame Pericárdico/diagnóstico , Taponamiento Cardíaco/diagnóstico , Linfangioleiomiomatosis/diagnóstico , Síndrome de Down/complicacionesRESUMEN
Most cases of chylopericardium in childhood are secondary to thoracic surgery, especially after cardiac surgery. However, it can also be present in children without this history, as we show in this report. First, a nine year-old boy in whom chylopericardium was the first manifestation of a lymphangiomatosis, and the second one, a fifteen months old girl with a history of Down's syndrome and autoimmune enteropathy, which was classified as primary congenital chylopericardium. Also, a review of literature over the last 13 years is made, and management of this rare entity is discussed.
Asunto(s)
Derrame Pericárdico , Niño , Quilo , Femenino , Humanos , Lactante , Masculino , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/terapiaRESUMEN
Fungal infection of the kidneys is a rare condition that has been reported in premature babies and in diabetic or immunocompromised adult patients. Candida spp. is the most frequent micro-organism involved. This paper reports a case of an immunocompetent newborn with a bladder exstrophy who suffered from an acute renal failure caused by bilateral renal aspergilloma (Aspergillus flavus). The newborn was treated with amphotericin B urinary tract irrigation through bilateral nephrostomy catheters, combined with liposomal amphotericin B and voriconazole therapy, which improved his renal function. However, due to persistent fungal colonization, a long antifungal treatment and permanent ureterostomies were necessary to deal with new episodes of ureterorenal obstruction. As of November 2009, despite the renal injuries, renal function had been conserved. The management of the mechanical obstruction and the choice of antifungal drugs are discussed in this unusual case.
Asunto(s)
Aspergilosis/complicaciones , Aspergilosis/diagnóstico , Aspergillus flavus/aislamiento & purificación , Extrofia de la Vejiga/complicaciones , Extrofia de la Vejiga/diagnóstico , Insuficiencia Renal/tratamiento farmacológico , Insuficiencia Renal/cirugía , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Aspergilosis/tratamiento farmacológico , Aspergilosis/cirugía , Humanos , Recién Nacido , Masculino , Nefrostomía Percutánea , Pirimidinas/uso terapéutico , Resultado del Tratamiento , Triazoles/uso terapéutico , Ureterostomía , VoriconazolRESUMEN
BACKGROUND: Several 'rescue' therapies have been recommended to eradicate Helicobacter pylori, but they still fail in >20% of the cases, and these patients constitute a therapeutic dilemma. AIM: To evaluate the efficacy of different 'rescue' therapies empirically prescribed during 10 years to 500 patients in whom at least one eradication regimen had failed to cure H. pylori infection. DESIGN: Prospective single-centre study. PATIENTS: Consecutive patients in whom at least one eradication regimen had failed. INTERVENTION: Rescue regimens included: (i) quadruple therapy with omeprazole-bismuth-tetracycline-metronidazole; (ii) ranitidine bismuth citrate-tetracycline-metronidazole; (iii) omeprazole-amoxicillin-levofloxacin; and (iv) omeprazole-amoxicillin-rifabutin. Antibiotic susceptibility was unknown (rescue regimens were chosen empirically). OUTCOME: Eradication was defined as a negative (13)C-urea breath test 4-8 weeks after completing therapy. RESULTS: Five hundred patients were included (76% functional dyspepsia, 24% peptic ulcer). Compliance rates with first-, second- and third-line regimens were 92%, 92%, and 95%, respectively. Adverse effects were reported by 30%, 37%, and 55% of the patients receiving second-, third-, and fourth-line regimens. Overall, H. pylori cure rates with the second-, third-, and fourth-line rescue regimens were 70%, 74%, and 76%, respectively. Cumulative H. pylori eradication rate with four successive treatments was 99.5%. CONCLUSION: It is possible to construct an overall treatment strategy to maximize H. pylori eradication, on the basis of administration of four consecutive empirical regimens; thus, performing bacterial culture even after a second or third eradication failure may not be necessary.
Asunto(s)
Antiácidos/uso terapéutico , Antiinfecciosos/uso terapéutico , Antiulcerosos/uso terapéutico , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori/efectos de los fármacos , Amoxicilina/administración & dosificación , Amoxicilina/uso terapéutico , Antiácidos/administración & dosificación , Antiinfecciosos/administración & dosificación , Antiulcerosos/administración & dosificación , Pruebas Respiratorias , Quimioterapia Combinada , Infecciones por Helicobacter/microbiología , Helicobacter pylori/aislamiento & purificación , Humanos , Metronidazol/administración & dosificación , Metronidazol/uso terapéutico , Persona de Mediana Edad , Omeprazol/administración & dosificación , Omeprazol/uso terapéutico , Compuestos Organometálicos/administración & dosificación , Compuestos Organometálicos/uso terapéutico , Estudios Prospectivos , Ranitidina/administración & dosificación , Ranitidina/uso terapéutico , Rifabutina/administración & dosificación , Rifabutina/uso terapéutico , Tetraciclina/administración & dosificación , Tetraciclina/uso terapéutico , Insuficiencia del TratamientoRESUMEN
In 1979, Warren was first to observe these bacteria in an inflamed gastric epithelium, and subsequently in peptic ulcer-associated gastritis. In 1981, Marshall starts his research and cultivates the bacteria, performs prospective studies, and administers therapy regimens using antibiotics and bismuth salts. The organism was designated Campylobacter-like after its similarity with said genus. In 1984, Marshall manages to meet Koch s postulates using self-inoculation by ingesting a bacterial culture, which resulted in gastritis that was then treated and cured with bismuth salts and metronidazole. The Gastroenterological Society of Australia rejected the abstract with preliminary data. In 1983, "The Lancet" published such data in two brief letters with the same heading, with each being signed by one of these two researchers. Cooperating with microbiologists they classify the new bacteria within the Helicobacter genus as the pylori species. Gastritis and peptic ulcer are currently considered infectious diseases. Their diagnosis and therapy include bacterial detection methods and antibiotics, respectively. In addition, a causal relationship between Helicobacter pylori and both gastric adenocarcinoma and gastric lymphoma has been established, and its association with some extra-digestive conditions has been suggested.
Asunto(s)
Gastroenterología/historia , Helicobacter pylori , Investigación Biomédica/historia , Historia del Siglo XX , HumanosRESUMEN
BACKGROUND: In patients with a first eradication failure, a second (rescue) therapy still fails in > 20% of cases. AIM: To compare rifabutin and levofloxacin rescue regimens in patients with two consecutive Helicobacter pylori eradication failures. METHODS: Patients, in whom first treatment with omeprazole-clarithromycin-amoxicillin and a second trial with omeprazole-bismuth-tetracycline-metronidazole (or ranitidine bismuth citrate with these antibiotics) had failed, received 10 days of treatment with either rifabutin (150 mg b.d.) or levofloxacin (500 mg b.d.), plus amoxicillin (1 g b.d.) and omeprazole (20 mg b.d.). Cure rates were evaluated by the (13)C-urea breath test. RESULTS: Twenty patients received rifabutin, and 20 levofloxacin. All the patients returned for follow-up. Compliance in the rifabutin group was 100%. Four patients in the levofloxacin group did not take the medication correctly (in two cases due to adverse effects: myalgia and rash). Side effects in the rifabutin and levofloxacin groups were reported in 60% and 50% of the cases, respectively. Five patients (25%) treated with rifabutin presented with leucopenia, and six (30%) treated with levofloxacin presented with myalgias. Per-protocol cure rates were 45% (95% confidence interval, 26-66%) in the rifabutin group, and 81% (57-93%) in the levofloxacin group (P < 0.05). Intention-to-treat cure rates were, 45% (26-66%) and 85% (64-95%), respectively (P < 0.01). CONCLUSIONS: After two previous H. pylori eradication failures, a 10-day triple levofloxacin-based rescue regimen is more effective than the same regimen with rifabutin.
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori/efectos de los fármacos , Levofloxacino , Ofloxacino/uso terapéutico , Rifabutina/uso terapéutico , Anciano , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia del TratamientoRESUMEN
OBJECTIVES: to analyze scientific output from Spanish hospitals in relation to Helicobacter pylori infection. METHODS: papers collected from the Medline database between January 1988 and December 2003 were selected. Our search strategy was: "Helicobacter pylori" [MeSH] AND ((Spain [AD] OR Espana [AD] OR Spanien [AD] OR Espagne [AD] OR Espanha [AD]) OR (Spanish [LA]) OR Spain). The following was analyzed: geographic area, Spanish or foreign publication, topic, and year of publication. Output and impact bibliometric markers were evaluated. RESULTS: in all, 691 papers were identified, of which 241 were excluded. Number of papers went from 2 in 1988 to 47 in 2002 and 13 in 2003. There were more reports in Spanish versus foreign journals (58 vs. 42%). In the first 5 years the areas with greater output were associated with diagnosis and microbiology (33 and 20%), whereas therapy was the predominating subject during the last 5 years (27%). Original papers were most common among publications (69%). Hospitals with highest output included La Princesa (24%) and Ramón y Cajal (17.6%) in Madrid, and Parc Taulí in Barcelona (6.4%). Mean impact factor progressively increased from 1.826 in 1988 to 2.142 in 2002 and 2.493 in 2003. CONCLUSIONS: the production and impact of documents published by Spanish scientists regarding H. pylori infection considerably increased during the past two decades.
Asunto(s)
Bibliometría , Helicobacter pylori , MEDLINE , Publicaciones Periódicas como Asunto/estadística & datos numéricos , Edición/estadística & datos numéricos , EspañaRESUMEN
AIM: To study the incidence of Helicobacter pylori recurrence, its chronological aspects, and the variables that might influence it. METHODS: A total of 1000 patients in whom H. pylori had been eradicated were prospectively studied. Therapies were classified as low and high efficacy regimens. Four to eight weeks after completion of therapy, 13C-urea-breath-test was performed, and it was repeated yearly up to 5 years. In some patients, endoscopy with biopsies was also performed to confirm H. pylori eradication. RESULTS: A total of 1000 patients were included, giving 2744 patient-years of follow-up. Seventy-one H. pylori recurrences were observed (2.6% per patient-year). Probability of being H. pylori-negative at 1 year was 94.7%, and at 5 years 90.7%. In the multivariate analysis, low age (OR: 1.84; 95% CI: 1.04-3.26) and low efficacy therapies (OR: 2.5; 1.23-5.04) correlated with 1-year H. pylori recurrence. Differences were observed when Kaplan-Meier curves were compared depending on age and therapy regimen. CONCLUSION: Risk of posteradication H. pylori recurrence is higher during the first year, which suggests that most recurrences during this period are recrudescence and not true reinfections. H. pylori recurrence is more frequent in younger patients and in those treated with low efficacy therapies, but is exceptional if high efficacy therapies are used, in which case post-therapy eradication can be safely confirmed at 4 weeks with 13C-urea-breath-test.
Asunto(s)
Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori/aislamiento & purificación , Amoxicilina/administración & dosificación , Antiinfecciosos/administración & dosificación , Antiulcerosos/administración & dosificación , Claritromicina/administración & dosificación , Esquema de Medicación , Quimioterapia Combinada , Femenino , Humanos , Masculino , Metronidazol/administración & dosificación , Persona de Mediana Edad , Omeprazol/administración & dosificación , Compuestos Organometálicos/administración & dosificación , Estudios Prospectivos , Recurrencia , Factores de Riesgo , TetraciclinaRESUMEN
BACKGROUND: The precise choice of cut-off point for the 13C-urea breath test to define whether it is positive or negative represents a controversial issue. AIM: To quantify the 13C-urea breath test result for several years following Helicobacter pylori eradication, and to evaluate the frequency and the significance of borderline delta13CO2 values. METHODS: Two-hundred H. pylori eradicated patients confirmed by 13C-urea breath test (100 mg of urea, citric acid), and having had repeated this test yearly up to 5 years, were studied. Delta13CO2 values between 2 and 5/1000 were considered as borderline results. RESULTS: Eight H. pylori recurrences were observed during 406 patient-years of follow-up (1.97% yearly). In two of eight reinfected patients, the reinfection was preceded by a negative delta13CO2 value >2/1000. Borderline delta13CO2 values were detected in 4% of the 606 urea breath tests performed, and in 25% when only patients in whom H. pylori recurrence was detected in subsequent urea breath tests were included (P < 0.05). The negative-predictive value of a post-treatment delta13CO2 >2/1000 for the diagnosis of H. pylori recurrence was 99%. CONCLUSIONS: Positive and negative urea breath test results tend to cluster outside the range between 2/1000 and 5/1000. Nevertheless, a borderline urea breath test delta value (e.g. very close to the selected cut-off point) should be interpreted cautiously, and the result should probably be confirmed either by repeating the urea breath test or by other diagnostic methods. On the contrary, a delta13CO2 value <2/1000 very confidently confirms H. pylori eradication.
Asunto(s)
Pruebas Respiratorias/métodos , Infecciones por Helicobacter/diagnóstico , Helicobacter pylori/aislamiento & purificación , Isótopos de Carbono , Femenino , Estudios de Seguimiento , Infecciones por Helicobacter/tratamiento farmacológico , Humanos , Cuidados a Largo Plazo/métodos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Recurrencia , Sensibilidad y Especificidad , UreaRESUMEN
This paper studies the chemical activation of mesophase pitches of different origins in order to obtain activated carbons suitable for use as electrodes in supercapacitors. The effect that the activating agent (NaOH, LiOH, and KOH), the alkaline hydroxide/pitch ratio, and the activation temperature had on the characteristics of the resultant activated carbons was studied. LiOH was found to be a noneffective activating agent, while activation with NaOH and KOH yielded activated carbons with high apparent surface areas and pore volumes. The increase of the KOH/pitch ratio caused an increase of the chemical attack on the carbon, producing higher burnoffs and development of porosity. Extremely high apparent surface areas were obtained when the petroleum pitch was activated with 5:1 KOH/carbon ratio. The increase of the activation temperature caused an increase of the burnoff, although the differences were not as significant as those derived from the use of different proportions of activating agent.
RESUMEN
AIM: To study if there is a correlation between 13C-urea breath test values prior to treatment and the response to first-line and rescue Helicobacter pylori eradication therapies. METHODS: Six-hundred patients with peptic ulcer or functional dyspepsia infected by H. pylori were prospectively studied. Pre-treatment H. pylori infection was established by 13C-urea breath test. Three-hundred and twelve patients were treated with first-line eradication regimen, and 288 received a rescue regimen. H. pylori eradication was defined as a negative 13C-urea breath test, 8 weeks after completion of treatment. RESULTS: H. pylori eradication was achieved in 444 patients. No statistically significant differences were demonstrated when mean delta 13C-urea breath test values were compared between patients with eradication success and failure (49.4+/-33 versus 49.2+/-31). Differences in mean pre-treatment delta 13CO2 between patients with eradication success/failure were not demonstrated either when first-line or rescue regimens were prescribed. With the cut-off point of pre-treatment delta 13CO2 set at 35 units, sensitivity and specificity for the prediction of H. pylori eradication success was 43 and 60%. The area under the receiver operating characteristic curve evaluating all the cut-off points of the pre-treatment delta 13CO2 for the diagnosis of H. pylori eradication was 0.5. Finally, delta 13CO2 values did not influence the eradication in the logistic regression model. CONCLUSION: No correlation was observed between 13C-urea breath test values before treatment and the response to first-line and rescue H. pylori eradication therapies. Therefore, we conclude that the quantification of delta 13CO2 prior to treatment is not useful to predict the success or failure of eradicating therapy.
Asunto(s)
Pruebas Respiratorias , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/tratamiento farmacológico , Urea , Antiácidos/uso terapéutico , Antibacterianos/uso terapéutico , Antiulcerosos/uso terapéutico , Isótopos de Carbono , Quimioterapia Combinada , Dispepsia/tratamiento farmacológico , Dispepsia/microbiología , Femenino , Helicobacter pylori , Humanos , Masculino , Persona de Mediana Edad , Úlcera Péptica/tratamiento farmacológico , Úlcera Péptica/microbiología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Curva ROC , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: Recently, several new diagnostic methods aimed to detect Helicobacter pylori stool antigens have been developed. Our aim was to evaluate the accuracy of 3 different stool tests to confirm H. pylori eradication. PATIENTS AND METHODS: Twenty-six patients received H. pylori eradication treatment. Eradication was confirmed with 13C-urea breath test 6-8 weeks later, when stool samples were analyzed by polyclonal (Premier-Platinum-HpSATM), monoclonal (Amplified-IDEIATM-HpStARTM), and rapid test (ImmunoCard-STAT-HpSATM). RESULTS: H. pylori was eradicated in 85% of the cases. Sensitivity, specificity, positive predictive value and negative predictive value with the polyclonal test were: 25%, 91%, 33% and 87%. Corresponding results with the monoclonal test, using the cut-off point recommended by the manufacturer, were 100%, 46%, 25% and 100%. However, the best cut-off point in our study had 100% sensitivity and 91% specificity. The area under ROC curve for the polyclonal and the monoclonal tests was 0.65 and 0.95. Diagnostic accuracy with the rapid test was 75%, 90%, 60% and 95%. CONCLUSION: Neither the polyclonal stool antigen test nor the rapid stool antigen test can be recommended to confirm H. pylori eradication after treatment. The monoclonal test has better diagnostic accuracy, although more studies are necessary to definitively recommend its use for the confirmation of H. pylori eradication success.
Asunto(s)
Antígenos Fúngicos/análisis , Ensayo de Inmunoadsorción Enzimática , Heces/química , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori/inmunología , Inmunoensayo , Anticuerpos Monoclonales/inmunología , Especificidad de Anticuerpos , Pruebas Respiratorias , Cromatografía , Ensayo de Inmunoadsorción Enzimática/métodos , Infecciones por Helicobacter/inmunología , Helicobacter pylori/aislamiento & purificación , Humanos , Úlcera Péptica/microbiología , Proyectos Piloto , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Método Simple Ciego , Urea/análisisRESUMEN
The urea breath test is a noninvasive and very accurate test for the diagnosis of Helicobacter pylori infection. However, false negative urea breath test results have been reported to occur in a considerable percentage of the individuals taking proton pump inhibitors; the interval needed to be completely confident that false negative tests had been excluded has varied among the different studies between 6 and 14 days. The impact of H(2)-receptor antagonists on the accuracy of urea breath test remains controversial, although, in contrast with proton pump inhibitors, the data suggest that H(2)-receptor antagonists, for the most part, have little effect on the result of the urea breath test. The urea breath test does not represent a suitable tool for estimating the density of H. pylori colonization. The only quantitative information to be obtained from the urea breath test is that the higher the delta value, the lower the probability of a false-positive urea breath test result. Although some authors have demonstrated a correlation between urea breath test values and histological lesions of the gastric mucosa, the practical utility of this relationship remains unclear. It has been suggested that the pretreatment urea breath test has the potential to identify patients who require modification of the standard therapeutic regimen (for example, prolonging the duration of treatment or increasing the pharmacological dose when bacterial density is high), but other studies could not confirm this relationship. Some studies have shown that the urea breath test is less accurate in patients who have undergone partial gastrectomy. Finally, in contrast with biopsy-based methods, which are responsible for a high number of false-negative results when used to diagnose H. pylori infection in patients with upper gastrointestinal bleeding, urea breath test seems not to be negatively influenced by the presence of this complication.
Asunto(s)
Pruebas Respiratorias/métodos , Infecciones por Helicobacter/diagnóstico , Helicobacter pylori , Gastropatías/diagnóstico , Urea/metabolismo , Inhibidores Enzimáticos/farmacología , Gastrectomía , Hemorragia Gastrointestinal , Antagonistas de los Receptores Histamínicos/farmacología , Humanos , Valor Predictivo de las Pruebas , Inhibidores de la Bomba de Protones , Reproducibilidad de los Resultados , Tracto Gastrointestinal SuperiorRESUMEN
BACKGROUND: Helicobacter pylori eradication is a challenge in patients allergic to penicillin, especially those who have failed a first-eradication trial. AIM: To assess the efficacy and tolerability of H. pylori first-line treatment and rescue options in patients allergic to penicillin. METHODS: Prospective single centre study including 40 consecutive treatments administered to patients allergic to penicillin. Therapy regimens: First-line (12 patients) omeprazole, clarithromycin and metronidazole for 7 days; second-line (17 patients) ranitidine bismuth citrate, tetracycline and metronidazole for 7 days; third-line (nine patients) rifabutin, clarithromycin and omeprazole for 10 days; and fourth-line (two patients) levofloxacin, clarithromycin and omeprazole for 10 days. OUTCOME VARIABLE: a negative (13)C-urea breath test 8 weeks after completion of treatment. RESULTS: Per-protocol/intention-to-treat eradication rates were: first-line (64/58%); second-line (ranitidine bismuth citrate; 53/47%); third-line (rifabutin; 17/11%) and fourth-line regimen (levofloxacin; 100/100%). Compliance with treatment was generally good, except with the rifabutin-based regimen, which presented adverse effects in 89% of the patients, including four cases of myelotoxicity. CONCLUSIONS: H. pylori-infected patients who are allergic to penicillin may be treated with a first-line treatment combining a proton-pump inhibitor, clarithromycin and metronidazole. Rescue options may include a regimen with ranitidine bismuth citrate, tetracycline and metronidazole. A levofloxacin-based rescue regimen (with proton-pump inhibitor and clarithromycin) may also represent an alternative, even when two or more consecutive eradication treatments have previously failed. However, rifabutin + clarithromycin + proton-pump inhibitor regimen is ineffective and poorly tolerated.
Asunto(s)
Antiinfecciosos/uso terapéutico , Antiulcerosos/uso terapéutico , Hipersensibilidad a las Drogas/complicaciones , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Penicilinas/efectos adversos , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Antiinfecciosos/efectos adversos , Antiulcerosos/efectos adversos , Farmacorresistencia Bacteriana , Quimioterapia Combinada , Femenino , Infecciones por Helicobacter/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosAsunto(s)
Apoptosis , Células Epiteliales , Mucosa Gástrica , Infecciones por Helicobacter , Helicobacter pylori , Apoptosis/genética , Proliferación Celular , Células Epiteliales/citología , Células Epiteliales/metabolismo , Células Epiteliales/patología , Mucosa Gástrica/citología , Mucosa Gástrica/metabolismo , Mucosa Gástrica/patología , Genotipo , Infecciones por Helicobacter/genética , Infecciones por Helicobacter/metabolismo , Infecciones por Helicobacter/patología , Helicobacter pylori/genética , Helicobacter pylori/patogenicidad , Humanos , Interleucina-8/genética , Estrés OxidativoRESUMEN
AIMS: To systematically review the efficacy on ulcer healing of 1-week combination of a proton pump inhibitor plus two antibiotics and to perform a meta-analysis of randomized clinical trials to evaluate whether 7 days of proton pump inhibitor-based triple therapy is sufficient to heal peptic ulcer. METHODS: Studies where 1-week proton pump inhibitor-based triple therapy was administered to heal peptic ulcer were included. Randomized clinical trials comparing the efficacy on ulcer healing of 7-day proton pump inhibitor-based triple therapy versus this same regimen but prolonging the proton pump inhibitor for several more weeks were included in the meta-analysis. Electronic and manual bibliographical searches were conducted. Meta-analysis was performed combining the odds ratios of the individual studies. RESULTS: Twenty-four studies (2342 patients) assessed ulcer healing with 1-week proton pump inhibitor-based triple therapy. Mean healing rate was 86%, and 95% in Helicobacter pylori-eradicated patients. Six studies (862 patients), were included in the meta-analysis. Mean ulcer healing rate with a 7-day treatment was 91% versus 92% when proton pump inhibitor was prolonged for 2-4 more weeks (odds ratio = 1.11; 95% confidence interval = 0.71-1.74). CONCLUSION: In patients with peptic ulcer and H. pylori infection, prolonging therapy with proton pump inhibitor after a triple therapy for 7 days with a proton pump inhibitor and two antibiotics is not necessary to induce ulcer healing.