Search PubMed⌕ Search

Biomedical subjects

D Boixeda

Publications and source records attributed to D Boixeda.

At least 91 records · Page 5Linked to original sources
PubMed1996

[Erradicating treatment of Helicobacter pylori with lansoprazole and amoxicillin in duodenal ulcer patients].

OBJECTIVE: To study the efficiency of the combination lansoprazole and amoxicillin on the eradication of Helicobacter pylori and duodenal ulcer healing. METHODS: Twenty-nine duodenal ulcer patients infected with H. pylori were prospectively studied (mean age, 46 +/- 11 years, 90% males). During endoscopy biopsies were obtained from gastric antrum and body for histologic examination (H & E); a urea breath test with 13C was also performed. Therapy with lansoprazole 30 mg/12 h and amoxicillin 500 mg/6 h for two weeks was prescribed. One month after completing therapy another endoscopy was performed (with biopsies obtained from gastric antrum and body) and again a urea breath test performed. Eradication was defined as the absence of H. pylori by both diagnostic methods. RESULTS: Eradication was achieved in 48% of patients (n = 14). Ulcer healing was obtained in 62% of cases (n = 18). When eradicating therapy was successful the percentage of healing reached 100%, versus 27% in those patients with persisting infection (p < 0.001). In patients with eradication obtained an histological improvement was noted both at gastric antrum and body, whereas when therapy failed no significant changes were observed. In all cases compliance with therapy was completed, and in no patient were secondary effects observed. CONCLUSION: The association of lansoprazole and amoxicillin at the administered doses has a low efficiency on H. pylori eradication in duodenal ulcer patients. Further studies are warranted to definitely assess the eradicating efficiency of such combination and also to determine the optimal dose of its components, the minimal duration of therapy and the ideal moment for its administration.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1996

[Breath test in the diagnosis of Helicobacter pylori infection: concordance with histological methods and correlation with anatomopathological lesions of the gastric mucosa].

PURPOSE: To study the concordance between 13C-urea breath test and histology in the diagnosis of Helicobacter pylori infection, and to evaluate whether there is a correlation between breath test values and histologic lesions of the gastric mucosa. METHODS: Sixty-nine patients with duodenal ulcer were prospectively studied. An endoscopy with biopsy samples (H&E stain) taken from the antrum and body was performed, and a 13C-urea breath test (measuring 13C difference: delta 13CO2) was also done. Both procedures were repeated one month after completing therapy ["classic" triple therapy (n = 28), and omeprazole+amoxycillin (n = 41)]. Eradication was defined as the absence of H. pylori both by histological and breath test methods. RESULTS: At the beginning of the study, 94.2% of patients (n = 65) were H. pylori positive by histological methods, and 98.6% (n = 68) were positive by the breath test (ratio of positive agreement = 0.96). Kappa for H. pylori diagnosis after therapy was 0.83 (95% CI: 0.69-0.96). A correlation between delta 13CO2 and histologic lesions was observed, both in the antrum at before treatment (Spearman coef = 0.34; p = 0.007) and after therapy in both the gastric antrum (0.63; p < 0.001) and body (0.35; p = 0.005). A significant difference was observed when comparing mean delta 13CO2 in patients with different degrees of histologic gastritis, both before treatment (antrum: W Kruskal-Wallis = 6; p < 0.05) and after therapy (antrum: W = 17; p < 0.001; body: W = 10; p < 0.05). CONCLUSION: A high concordance was observed between the 13C-urea breath test and histology in the diagnosis of H. pylori infection. A correlation exists between breath test values and histologic lesions of the gastric mucosa.

Adult↗
PubMed1995

[Is there any association between Helicobacter pylori infection and peptic esophagitis?].

BACKGROUND: To describe the prevalence of Helicobacter pylori infection in patients with reflux esophagitis, and compare it with that in patients with normal endoscopy. METHODS: Fifty-five patients with endoscopic peptic esophagitis and 55 symptomatic patients with normal endoscopy were studied. Age and sex distribution were similar in both groups. At endoscopy biopsy specimens were taken from gastric antrum and body (H & E, Gram stain and culture). RESULTS: H. pylori was found in 74.5% (95% CI = 62-84%) of patients with reflux esophagitis, and in 76.4% (CI = 64-86%) of cases with normal endoscopy (a non-significant difference). In patients with esophagitis and H. pylori infection normal histologic antral mucosa was observed in 7.3% of cases (CI = 2.5-19.4%). In patients with normal endoscopy the corresponding figure was 4.8% (CI = 1.3-15.8%) (a non-significant difference). At gastric body from infected patients the percentages of patients with normal histologic mucosa was 29.3% (n = 12) and 23.8% (n = 10), in both groups respectively. CONCLUSIONS: The prevalence of H. pylori infection in patients with reflux esophagitis was 74.5%, and no difference was observed when comparing with infection rate in patients with normal endoscopy (76.4%). Therefore, a non-significant association was found between this esophageal disorder and H. pylori infection.

Adult↗
PubMed1995

[Is measurement of basal levels of serum pepsinogen II useful in proving the eradication of Helicobacter pylori by treatment?].

BACKGROUND: The aim of this study was to demonstrate the influence of the eradication of Helicobacter pylori on the basal concentrations of serum pepsinogen II in patients with duodenal ulcer. METHODS: Thirty-two patients with active duodenal ulcer were prospectively studied. A triple therapy was used consisting in bismuth, metronidazole and tetracycline. At the time of initial endoscopy and in those performed 5 months later on completion of the treatment, biopsies of the gastric mucosa were taken for histologic and microbiologic studies, and the basal concentrations of serum pepsinogen II are also determined. RESULTS: The eradication of H. pylori was accompanied by a significant pathologic improvement (p < 0.001) in both the antrum and the gastric body. On eradication of H. pylori, the basal pepsinogen II value (m +/- SD) decreased from 9.2 +/- 2.7 ng/ml to 6.4 +/- 1.7 ng/ml after treatment (p < 0.001). However, when eradication was not achieved, these values increased (11.8 ng/ml) with respect to the initial determination (9.3 ng/ml) (p < 0.05). The area under the ROC curve was 0.99 (SE 0.01) with a sensitivity of 92% and specificity of 100% with respect to the diagnosis of infection eradication (cut off point of the decrease of pepsinogen levels O). CONCLUSIONS: The eradication of Helicobacter pylori in patients with duodenal ulcer is associated with a significant decrease in the basal concentrations of serum pepsinogen II measured 5 months after completion of treatment. The verification of this decrease constitutes a useful, inexpensive non invasive method to prove the eradication of H. pylori with treatment.

Adult↗
PubMed1995

[The importance of obtaining biopsies of the gastric body in the follow-up after eradicating treatment of Helicobacter pylori].

BACKGROUND: The aim of the present was to study the usefulness of performing biopsies of the gastric body in addition to those normally obtained of the antrum in the control of the eradication of Helicobacter pylori after treatment. METHODS: Sixty-four patients with duodenal ulcer and infection by H. pylori were prospectively studied. Two therapeutic schedules were used: amoxycillin/clavulanic associated with omeprazole (n = 32) and the classical triple therapy (bismuth, metronidazole, tetracycline) (n = 32). At the time of initial endoscopy and one month after completion of the treatment biopsies of the antrum and gastric body were taken for histologic (hematoxylin-eosin) and microbiologic (Gram and culture) studies. A patient was considered to have H. pylori infection when its presence was demonstrated by histologic or microbiologic methods in either of the localizations. RESULTS: The eradication of H. pylori was globally achieved in 64% (n = 41) of the cases. In the patients in whom eradication was not achieved (n = 23), H. pylori was detected only in the antrum in 70% (30% false negatives) while this was seen in the gastric body in 96% of the cases (p < 0.05). CONCLUSIONS: Carrying-out biopsies of only the antrum after eradicating H. pylori treatment is associated with a high percentage of false negative diagnosis of infection. Therefore, additional biopsies of the gastric body are recommended.

Adult↗
PubMed1995

[A global study of gastric secretion in duodenal ulcers: gastrin, pepsinogen and acid secretion].

AIM: To examine gastric secretion in duodenal ulcer patients; simultaneous assessment of serum gastrin and pepsinogen I levels and acid secretion. METHODS: 32 patients with duodenal ulcer disease were studied (mean age: 44.7 +/- 14 years, 24 males (75%). At endoscopy, biopsy specimens from duodenal bulb, antrum, body and gastric fundus were taken. Basal levels of acid secretion, pepsinogen I and gastrin were measured, as well as stimulated levels (with pentagastrin and beef meal). RESULTS: Mean (+/- SD) BAO and MAO was 5.5 +/- 4 and 27.7 +/- 10 mEq/h, respectively. BAO in males were higher than in females (p < 0.05). A positive correlation (p < 0.01) was observed between MAO, and basal and stimulated pepsinogen I. Basal and stimulated (integrated-90 min) gastrin levels were 43.4 +/- 12 pg/ml and 5,260 pg/ml min, respectively. No correlation between such levels and acid secretion or pepsinogen I was observed. Mean basal and stimulated (integrated-120 min) pepsinogen levels were 109.3 +/- 35 ng/ml and 4,950 +/- 160 ng/ml min, respectively, and they were higher in males (p < 0.01), and in smokers (p < 0.05). CONCLUSION: It was confirmed, in a group of duodenal ulcer patients, that BAO is higher in males than in females. There is a positive correlation between MAO and pepsinogen I levels, although this correlation is not present between gastrin levels and acid secretion or pepsinogen I. Pepsinogen I levels are higher in males and smokers.

Adult↗
PubMed1995

[Is there a relationship between digestive symptoms and H. pylori infection?].

UNLABELLED: Infection by H. pylori is a common finding in the general population, its prevalence being higher in certain gastroduodenal diseases, particularly peptic ulcer and chronic gastritis. There is no general agreement on whether there is an association between digestive symptoms and the presence of H. pylori infection. AIM: To study whether there is an association between digestive symptoms and H. pylori infection. METHODS: 328 patients with symptoms related to the upper gastrointestinal tract who underwent a diagnostic endoscopy were studied. Symptoms were classified as: epigastric pain, epigastric burning, heartburn, nausea or vomiting, and dyspeptic symptoms suggestive of motility disorders. During endoscopy 3 biopsy samples were obtained from both the gastric antrum and the body of the stomach. One of the samples from each location was processed for microbiology studies, the other two for histological studies. A patient was considered to be infected by H. pylori when the organism was detected by microbiology and/or histology in any of the locations. RESULTS: The mean age of patients was 47.3 + 15.2 years; the male/female ratio was 2.4/1. The endoscopic findings and the corresponding percentages of H. pylori infection were: normal endoscopy 55 (80%); gastritis 87 (82.7%); gastric ulcer 49 (100%); duodenal ulcer 88 (100%); duodenitis 20 (95%); gastric cancer 7 (100%), and gastrectomy 22 (71.4%). The frequency of the different clinical entities according to a positive or negative microbiological result was, respectively: epigastric pain (78.3/81.8%), epigastric burning (56.9/45.4%), heartburn (30.1/27.3%), nausea or vomiting (28.4/33.3%), and dyspeptic symptoms suggestive of motility disorders (53.8/54.5%); no significant differences were observed between the different groups. CONCLUSION: We found no association between digestive symptomatology and H. pylori infection, considering overall the most frequent gastrointestinal entities and the subgroup of patients with non-ulcer dyspepsia.

Adult↗
PubMed1995

[The effect of "triple therapy" on the eradicating of H. pylori and the healing of a duodenal ulcer. The initial study and 6 months later].

UNLABELLED: Helicobacter pylori plays an important role in the pathogenesis of peptic ulcer disease, and many therapy regimens have been used to eradicate it. AIM: To assess the efficacy of triple therapy in duodenal ulcer patients, in ulcer healing and eradication of H. pylori, early after treatment and 6 months later. METHODS: In a prospective study, 32 patients with duodenal ulcer disease and H. pylori infection were studied. Biopsy specimens from the duodenal bulb, antrum, body and gastric fundus were taken and were analyzed by a microbiology (Gram and specific culture) and histology process (hematoxylin and eosin). All patients were treated with triple therapy (bismuth, tetracyclin and metronidazole). Patients were investigated endoscopically one month after cessation the triple therapy and 4 months later, with taking of antrum and body biopsy specimens. RESULTS: During the therapy, adverse events were elucidated in 3 patients (9.4%). Eradication (no evidence on ongoing H. pylori infection 4 wk after cessation treatment) was obtained in 26 patients (81.25%). Eradication reached 92% when H. pylori was metronidazole sensitive (N:25; 78.13%) and 42.86% (p < 0.05) when it was resistant. Reinfection rate was 3.85% (N = 1). Healing ulcer was observed in 28 patients (87.5%) 1 month after cessation of treatment. When triple therapy regimen was successful the healing rate was 96.15%, and it was 50% (p < 0.05) when it failed. CONCLUSION: Triple therapy (with low doses of metronidazole, and tetracyclins) has a high efficacy (81.25%) in the eradication of H. pylori (metronidazole sensitivity plays an important role), with few (9.4%) and non-serious adverse events. Healing rate is 96.15% when eradication is obtained and 50% (p < 0.05) when it failed.

Adult↗
PubMed1995

[Decrease of basal levels of gastrin following H. pylori eradication].

UNLABELLED: Hypergastrinemia has long been considered an important factor in the pathophysiology of duodenal ulcer. Moreover, H. pylori infection has been reported in virtually all duodenal ulcers. AIM: To demonstrate the influence of H. pylori eradication on the basal levels of serum gastrin in patients with duodenal ulcer. METHODS: Seventy-six patients with endoscopically proved duodenal ulcer were prospectively studied. At endoscopy three biopsy samples each were taken from duodenal bulb, gastric antrum, corpus and fundus. Two samples from every location were submitted for conventional histological examination and the other for microbiological examination (Gram staining and culture). Endoscopy was repeated one month after the end of therapy, when endoscopy samples were again obtained from the gastric antrum and corpus. Basal levels of gastrin were measured both at initial and repeat endoscopies. Different therapeutic regimes were used: Amoxycillin/Clavulanate plus omeprazole or ranitidine, and triple therapy. RESULTS: H. pylori eradication was associated with a significant histological improvement (p < 0.001), both in antrum and corpus. In those patients with eradicated H. pylori the differences in basal gastrin levels both at diagnosis and after therapy were 45.4 +/- 11 pg/ml and 36.7 +/- 10 pg/ml, respectively; these differences were statistically significant (p < 0.001). When eradication was not achieved differences were not significant. The area under the ROC curve constructed from the different cutoff points for the gastrin decreases was 0.68 (EE 0.06). CONCLUSION: H. pylori eradication in patients with duodenal ulcer was associated with a significant decrease in basal levels of serum gastrin. Although the verification of such a decrease doesn't have an optimal relationship between sensitivity and specificity, it could be an aid as a useful non-invasive method to monitor the efficiency of therapy, both in H. pylori eradication and in the resolution of the associated gastritis. This procedure is also associated with early results and a low cost.

Adult↗
PubMed1995

[A decrease in the basal levels of serum pepsinogen I after H. pylori eradication].

Hyperpepsinogenaemia has long been considered an important factor in the pathophysiology of duodenal ulcer. Moreover, H. pylori infection has been reported in virtually all duodenal ulcers. OBJECTIVE. To demonstrate the influence of H. pylori eradication on basal pepsinogen I levels in patients with duodenal ulcer. METHODS. 86 patients with endoscopically proven duodenal ulcer were prospectively studied. Different therapeutic regimens were used: Amoxycillin/clavulanate plus omeprazole or ranitidine, triple therapy, omeprazole and ranitidine. At diagnostic endoscopy and after therapy, three biopsy samples were taken from different levels and analyzed by microbiological and histological methods; also, basal pepsinogen I levels were measured. RESULTS. H pylori eradication was associated with a significant histological improvement (p < 0.001), both in gastric antrum and corpus. In patients where H. pylori was eradicated pepsinogen I levels decreased from 107.6 +/- 31 ng/ml to 79.7 +/- 32 ng/ml after therapy (p < 0.001); however, when eradication was not achieved differences were not significant. CONCLUSION. H pylori eradication in patients with duodenal ulcer was associated with a significant decrease in basal pepsinogen I levels. The verification of such a decrease could represent a useful non-invasive method to monitor the efficiency of therapy, both in H. pylori eradication and in the resolution of the associated gastritis. This procedure is also associated with early results and a low cost.

Adult↗
PubMed1995

[H. pylori infection at the duodenal bulb in different endoscopic diagnoses].

Biopsy samples obtained by endoscopy to diagnose infection by H. pylori usually come from the antral region. Nevertheless, there are few reports documenting the prevalence of infection at duodenal level. OBJECTIVE. To investigate the prevalence of H. pylori infection in duodenal bulb in different endoscopic diagnosis. METHODS. 331 patients with the following endoscopic diagnosis were studied: normal appearance (n = 55), gastritis (87), gastric ulcer (49), duodenal ulcer (120), and duodenitis (20). At endoscopy, different samples from duodenal bulb were obtained (apart from gastric fundus, body and antrum), which were processed for microbiology (Gram stain and culture) and histology (hematoxilin-eosin). RESULTS. Patients with duodenal ulcer or duodenitis had the highest H. pylori infection rate at duodenal bulb (47.7% and 65%, respectively). Differences were significant when compared with normal appearance (14.5%; p < 0.001) and gastritis (25%; p < 0.05). In all patients with H. pylori at duodenal bulb this organism was also detected at antral region. CONCLUSIONS. 1) The highest prevalence rates for H. pylori infection in duodenal bulb were found in patients with duodenal ulcer or duodenitis. 2) Diagnosis of H. pylori infection should not be based on the duodenal bulb samples alone, as this sample yields high false-negative results.

Adult↗
PubMed1995

[Course of histological lesions of the gastric mucosa after eradication of H. pylori in patients with duodenal ulcer. Initial study and 6-month follow-up].

UNLABELLED: Helicobacter pylori is the major etiologic agent of chronic active gastritis, and it may be isolated from the gastric mucosa in a high proportion of patients with duodenal ulcer. AIM: To study, in duodenal ulcer patients, the histological changes associated with H. pylori infection in gastric antrum and body, and the improvement of such lesions after eradication, at an early stage and after 6 months. METHODS: 76 patients with duodenal ulcer disease were investigated prospectively. Biopsy specimens taken by endoscopy from the duodenal bulb, antrum, body and gastric fundus were analyzed by microbiological and histological methods. A patient was considered to be H. pylori-positive when microbiology or/and histology demonstrated colonization in any of the locations. An endoscopy with biopsy samples from the antrum and gastric body was performed 1 month after therapy and 4 months later. Different therapy regimens were used: amoxicillin/clavulanic plus omeprazole or ranitidine; triple therapy; and omeprazole or ranitidine alone. RESULTS: All patients were positive by microbiology. Eradication was reached as a whole in 47% (N = 36). In those patients, in gastric antrum, rates of chronic gastritis/chronic active gastritis previous to treatment and 2 and 6 months later were 100%/96%; 38%/23% and 16%/5.6% respectively. At gastric body they were: 54%/38%; 12%/12% and 12%/5.6% respectively. A favourable histologic evolution, globally and of the acute inflammatory component, was observed 1 month after therapy (p < 0.001). Six months later, there was further improvement which did not reach a statistically significant difference compared with the results obtained at the first month. No differences were observed when eradication failed. CONCLUSION: An improvement of antral and gastric body gastritis is associated with H. pylori eradication in duodenal ulcer patients. This successful evolution is observed immediately after eradication, and it is confirmed six months after the diagnosis.

Adult↗
PubMed1995

[Prevalence of Helicobacter pylori infection in gastrectomy and vagotomy].

OBJECTIVE: To report the prevalence of Helicobacter pylori infection in patients undergoing gastrectomy or vagotomy plus pyloroplasty because of peptic ulcer disease. METHODS: Eighty-five patients were studied (mean age = 61 years; 85% males) who had undergone gastric surgery: Billroth I gastrectomy (n = 25), Billroth II (n = 51) and vagotomy plus pyloroplasty (n = 9). During endoscopy biopsy specimens were obtained from fundus and both sides of anastomosis for histological (hematoxylin-eosin) and microbiological (Gram stain and culture) investigations. RESULTS: The overall percentage of Helicobacter pylori infection was 43.6% (Billroth I = 40%; Billroth II = 37%; vagotomy = 89%) and no differences were observed between both types of surgical reconstruction. However, differences were indeed observed (p < 0.01) when comparing percentages of infection between patients undergoing gastrectomy and vagotomy. Among infected gastrectomized patients H. pylori was detected in fundus in 93% of cases, whereas the recovery rate from anastomotic mouth biopsies was only 72% (p < 0.05). CONCLUSIONS: The prevalence of H. pylori infection in gastrectomized patients (Billroth I and II) was low regarding the cause of surgery (peptic ulcer disease), and no differences were observed between both types of surgical reconstruction. The prevalence of infection after vagotomy and pyloroplasty was significantly higher. Among infected gastrectomized patients, H. pylori was detected more frequently in gastric fundus compared with biopsy specimens obtained from the anastomotic mouth.

Adult↗