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Biomedical subjects

G Maconi

Publications and source records attributed to G Maconi.

At least 55 records · Page 3Linked to original sources
PubMed1997

Dual therapy with high or low doses of omeprazole does not achieve an acceptable rate of Helicobacter pylori eradication in duodenal ulcer patients. A multicentre randomized long-term detailed study.

BACKGROUND: It has been reported that dual therapy with high doses of omeprazole and amoxycillin proves efficient for Helicobacter pylori eradication. AIM: To compare the efficacy, safety and tolerability of eradicating regimens with omeprazole/amoxycillin. METHODS: In this randomized multicentre study, 267 duodenal ulcer patients were treated for 2 weeks with omeprazole 40 bid (Group A) or 20 mg bid (Group B), respectively, and with amoxycillin 0.5 g. qid followed by 4 weeks of 20 mg omeprazole om. Helicobacter pylori status was assessed by both histology and urease test in the antrum and the corpus. The patients were then followed-up for 9 months. RESULTS: Helicobacter pylori infection was cured in 62.9% of group A (95% CI: 53.8-71.4) and in 44.8% of group B (95% CI: 35.6-54.3; p = 0.007). Healing was achieved in 91.9% of patients in group A (95% CI:85.7-96.1), and in 87.9% of patients in group B (95% CI:80.6-93.2). The estimated probability of being in ulcer remission for cured patients was 0.95 (95% CI: 0.90-0.99) and for the not cured was 0.41 (95% CI: 0.24-0.59; p = 0.0001). However, between the two treatment groups no significant differences in symptom relief or ulcer recurrence were observed. Both regimens were well tolerated with minor side-effects occurring likewise within the two groups. At two months in cured patients antral histology revealed a total (group A + B) prevalence of 13.7% of active chronic gastritis. CONCLUSIONS: This long-term, large-size study clearly indicates that dual therapy does not represent a truly effective eradication therapy and this regime cannot be recommended.

Adolescent↗
PubMed1997

Helicobacter pylori eradication in the healing and recurrence of benign gastric ulcer: a two-year, double-blind, placebo controlled study.

BACKGROUND: Helicobacter pylori infection is associated with idiopathic gastric ulcer in about 90% of the cases, but only a few controlled studies aimed at evaluating gastric ulcer healing and the natural history after Helicobacter pylori-eradication have been carried out. OBJECTIVE: The aim of the present study was to evaluate the efficacy of omeprazole coupled with amoxicillin in the eradication of Helicobacter pylori and healing and prevention of gastric ulcer recurrence. PATIENTS: Fifty-nine patients with active gastric ulcer were randomized under double-blind conditions to receive either omeprazole 20 mg twice daily for four weeks plus amoxicillin 3 g daily during the first and second week (29 patients, Group A) or omeprazole .20 mg twice daily for 4 weeks plus placebo for two weeks (30 patients, Group B). METHODS: Endoscopic studies were carried out at the end of the 4 weeks treatment (or after 8 weeks in non-healed patients) as well as 2, 6 and 12 months later. A total of 3 biopsies in the antrum, 3 in the gastric body and at least seven at the edge of the crater were taken at each endoscopic control for exclusion, of malignancy, histological detection of Helicobacter pylori and for evaluation of gastric histology according to the Sydney system. RESULTS: With intention to treat analysis, the percentage of healing after 4 and 8 weeks was 86% and 100% in Group A patients and 86% and 93% in Group B, respectively. Two patients dropped out in Group B for non medical reasons. The percentage of eradication was 63% in Group A and 7% in Group B. During a 12-month follow-up gastric ulcer relapsed in 20/32 (63%) of the persistently Helicobacter pylori positive patients. Only two out 20 (10%) Helicobacter pylori cured patients showed a gastric ulcer relapse and Helicobacter pylori reinfection. Twenty out of 30 patients, still healed after 12 months, underwent endoscopic control after two years. A gastric ulcer relapse was observed in three out of nine (33%) patients with persisting infection after treatment. No gastric lesions, but one case of erosive oesophagitis were observed in the 11 Helicobacter pylori-eradicated patients. CONCLUSIONS: In our experience, Helicobacter pylori eradication does not favour gastric ulcer healing but does positively influence the subsequent natural history.

Amoxicillin↗
PubMed1996

Eradication of Helicobacter pylori and long-term outcome of functional dyspepsia. A clinical endoscopic study.

The aim of this study was to assess the effect of colloidal bismuth subcitrate (CBS) and metronidazole on Helicobacter pylori eradication and on the course of symptoms due to functional dyspepsia. Forty-one patients with functional dyspepsia were entered into the study and randomized to treatment with CBS (120 mg four times a day) for four weeks combined with metronidazole (250 mg four times a day) for one week (group A, N = 21) or matching placebo (group B, N = 20). The severity of gastritis and of bacterial colonization and the symptom score was assessed by endoscopy and clinical evaluation at baseline and after four, eight, and 24 weeks from the start of the treatment. With intent-to-treat analysis eradication was achieved in 16/25 (64%) patients in group A and in 6/24 (25%) in group B. At eight and 24 weeks the gastritis score was significantly lower only in those patients with eradication. No change was seen in patients in whom the bacteria was not eradicated. The symptom score at eight weeks was considerably lower both in patients with eradication and in those with infection. However, at 24 weeks a gradual decrease in the symptom score in patients with eradication and a worsening of symptoms in controls was observed. No differences were observed between patients with ulcerlike and those with dysmotility-like dyspepsia. The study confirms the need for a long observation period after antibacterial treatment in patients with functional dyspepsia and suggests that Helicobacter pylori-eradicating treatment improves the course of this functional syndrome.

Adolescent↗
PubMed1996

Ultrasonographic detection of intestinal complications in Crohn's disease.

The aim of this study was to evaluate the sensitivity and specificity of ultrasound (US) in assessing the main abdominal complications of Crohn's disease (CD), such as strictures, fistulas and abscesses. A series of 98 consecutive inpatients with complicated and uncomplicated Crohn's disease, having undergone a complete endoscopic and radiographic evaluation of the intestinal tract, entered the study. In particular, in these patients the presence of strictures, fistulas, and abscesses, detected by means of colonoscopy, small bowel x-ray, double-contrast barium enema, and computed tomography, was also assessed by means of transabdominal US. US sensitivity and specificity in the assessment of stenosis of Crohn's disease were 74.4% and 93.1%, respectively. When ileal and colonic stenosis were considered separately, transabdominal US correctly assessed 84.6% of ileal stenosis and 58.8% of colonic stenosis. Eight of 12 fistulas were detected, but only 50% of enteroenteric fistulas were diagnosed. The presence of abscesses was correctly detected in 83.3% of cases by means of US. Our data suggest that US is a suitable complementary method for the detection of abdominal complications of Crohn's disease, such as strictures and abscesses; however, its usefulness in assessing enteroenteric fistulas seems to be fairly limited.

Abscess↗
PubMed1996

Comparison of two lansoprazole-antibiotic combinations (amoxycillin or classical triple therapy) for treatment of H. pylori infection in duodenal ulcer patients.

AIM: To compare the eradicating capacity of two different antibiotic-lansoprazole combinations (amoxycillin vs. standard triple therapy) with that of lansoprazole alone in Helicobacter pylori-positive duodenal ulcer patients. METHODS: Ninety-six out-patients with H. pylori-positive duodenal ulcer were randomly assigned to receive one of the following three antiulcer regimens: (1) lansoprazole 30 mg b.d. for 4 weeks plus amoxycillin 1 g t.d.s. during the last 2 weeks; or (2) lansoprazole 30 mg once daily for 4 weeks plus classical triple therapy (tripotassium dicitratobismuthate 240 mg b.d., amoxycillin 1 g t.d.s. and tinidazole 500 mg b.d.) for the last 2 weeks; or (3) lansoprazole 30 mg once daily for 4 weeks. Endoscopy was repeated at the end of treatment and 1 month later. A rapid urease test and histology were used to determine H. pylori status. RESULTS: Duodenal ulcer healing rates at 4 weeks were 96% after both lansoprazole with amoxycillin, and lansoprazole with triple therapy, and 97% after lansoprazole alone. Eradication of H. pylori was significantly better with lansoprazole with triple therapy than with either lansoprazole with amoxycillin or lansoprazole alone (90% vs. 55% vs. 3%, respectively). CONCLUSION: Classical triple therapy combined with lansoprazole is significantly more effective than the lansoprazole with amoxycillin combination for the eradication of H. pylori in duodenal ulcer patients pre-treated with lansoprazole.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1996

Prevalence of Helicobacter pylori infection and related gastroduodenal lesions in spouses of Helicobacter pylori positive patients with duodenal ulcer.

BACKGROUND: To date, very few studies have evaluated the risk of infection among spouses of Helicobacter pylori positive patients and their results are conflicting. AIM: To assess the seroprevalence of H pylori infection in spouse of H pylori positive patients with duodenal ulcer as compared with age and sex matched volunteer blood donors, as well as the frequency of endoscopic gastroduodenal lesions in these spouses, according to the presence or absence of gastrointestinal complaints. METHODS: Some 124 spouses (48% males) of patients with duodenal ulcer consecutively seen over a 10 month period were studied. They were all screened for serum IgG anti-H pylori antibodies and asked to complete a questionnaire with particular reference to the presence of chronic or recurrent dyspepsia. Upper gastrointestinal tract endoscopy with antral and corpus biopsy specimens taken for histological examination and urease rapid test was offered to all seropositive spouses. Volunteer blood donors (248), living in Milan and matched for age, sex, north-south origins, and socioeconomic status to the cases, were used as controls. RESULTS: Spouses of patients with duodenal ulcer had a significantly higher seroprevalence of H pylori infection than controls (71% v 58%, p < 0.05); 30 of 88 (34%) H pylori positive spouses complained of dyspeptic symptoms compared with only four of 34 (12%) seronegative spouses (p < 0.02). At endoscopy, H pylori infection was confirmed in 48 of 49 (98%) seropositive spouses. The endoscopic findings in those spouses showed active duodenal ulcer in eight (17%), duodenal scar and cap deformity in two (4%), active gastric ulcer in two (4%), erosive duodenitis in three (6%), antral erosions in two (4%), antral erosions plus duodenitis in one, and peptic oesophagitis in another patient. The prevalence of major endoscopic lesions was significantly higher in symptomatic spouses than in those who had never been symptomatic. CONCLUSIONS: These findings show that being the spouse of an H pylori positive patient with duodenal ulcer may increase the risk of H pylori colonisation and perhaps of peptic ulcer disease, and raises questions as to whether serological screening of cohabiting partners of H pylori positive patients with duodenal ulcer may be indicated.

Adult↗
PubMed1996

Doppler ultrasound measurement of intestinal blood flow in inflammatory bowel disease.

BACKGROUND: Our aim was to assess the role of Doppler ultrasound (US) in detecting changes in the splanchnic hemodynamic variables measured in patients with active or quiescent inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS) and healthy subjects. METHODS: Sixty-five patients, 31 with Crohn's disease (CD), 24 with ulcerative colitis (UC), 10 with IBS, and 10 matched normal subjects were evaluated by means of Doppler US. The mean velocity of portal and mesenteric venous flow, the blood flow volume of portal and mesenteric veins, and the resistance index (RI) of the superior mesenteric artery (SMA) were studied in all patients. RESULTS: Patients with active IBD had a splanchnic venous flow that was significantly higher, and an RI of the SMA significantly lower, than the IBS patients and healthy controls; however, a higher portal and mesenteric blood flow and lower RI of the SMA was documented in patients with active UC but not in those in whom the disease was quiescent. Patients with quiescent CD had significantly higher portal and mesenteric blood flow and lower RI of the SMA than IBS and healthy controls. No significant differences were found between IBS patients, quiescent UC patients, and healthy controls. CONCLUSION: This study shows that Doppler US can demonstrate splanchnic hemodynamic changes in active IBD patients and, in particular, can be used to differentiate between active and quiescent UC. However, the assessment of CD activity by means of Doppler US requires further investigation.

Adult↗
PubMed1996

Omeprazole coupled with two antibiotics for Helicobacter pylori eradication and prevention of ulcer recurrence.

BACKGROUND: Numerous therapeutic trials aimed at eradicating Helicobacter pylori (HP) from the gastric mucosa and preventing ulcer recurrence have been carried out; however, an optimal treatment has not yet been established with carefully controlled randomized studies. OBJECTIVE: The aim of our study was to evaluate the efficacy of an association of omeprazole (OM) coupled with two antibiotics in the eradication of HP and prevention of duodenal ulcer (DU) recurrence. METHODS: One hundred and eighty three patients with active DU were randomized under double-blind conditions to receive either OM 20 mg for 4 wk plus amoxycillin 3 g daily and metronidazole 1 g daily during the 2nd and 3rd wk (91 patients, group A) or OM 20 mg for 4 wk plus matching placebo (92 patients, group B). Endoscopy was performed before and at the end of the 4-wk treatment as well as 2, 6, and 12 months later. Biopsies were taken from the duodenum, antrum, and gastric body at each endoscopic examination for HP histological detection and for evaluation of inflammatory changes according to the Sydney system. RESULTS: After 4 wk, 84/86 patients (98%) of group A and 80/86 (93%) of group B were healed of their ulcers. The percentage of eradication was 90% in group A and 1% in group B. During a 12-month follow-up, DU relapsed in 4/63 (6%, including two of three reinfected cases) HP-eradicated group A patients, 4/8 (50%) HP-noneradicated group A patients, and 52/65 (80%) persistently HP-positive group B patients. Rapid, complete, and persistent suppression of gastroduodenitis activity and gastric surface epithelium lesions was observed in most HP-eradicated group A patients, whereas a transient decrease of bacterial colonization and inflammatory scores in the antrum and a transient worsening of corpus gastritis were found in group B patients. CONCLUSIONS: The combined therapy with amoxycillin, metronidazole, and omeprazole is highly effective in both HP eradication and prevention of duodenal ulcer recurrence.

Adult↗
PubMed1996

Abdominal ultrasound in the assessment of extent and activity of Crohn's disease: clinical significance and implication of bowel wall thickening.

AIMS: The aim of this study was to evaluate the relevance of ultrasound (US) in assessing disease extent and activity in a series of patients with quiescent or active Crohn's disease (CD). In particular, the study was aimed at evaluating whether US may be useful in distinguishing between active disease and bowel wall thickening (BWT) due to fibrosis. PATIENTS AND METHODS: A series of consecutive patients with ileal, ileo-colonic, or colonic CD previously studied with x-ray and/or endoscopy, underwent abdominal US. The following parameters were also determined in these patients: CD activity index (CDAI), erythrocyte sedimentation rate, C reactive protein, length of disease, previous surgical resection, and number of recurrences. The relationship between BWT and the aforesaid parameters was assessed by means of univariate and multiple regression analysis. RESULTS: Overall sensitivity and specificity of US for the assessment of anatomical distribution of CD were 89% and 94%, respectively, and there was also a significant correlation between the extent of ileal disease measured by US and that determined by small bowel x-ray. By univariate analysis, statistically significant correlations were found between BWT, CDAI, and biological indices of inflammation (erythrocyte sedimentation rate and C reactive protein), although all the correlation coefficients were low with values not exceeding 0.40, and among these, backward multiple regression analysis identified only CDAI, along with ileo-colonic localization, as the subset of predictive variables of bowel wall thickness. However, both predictions were rather weak and accounted for only 20% of the variability of the BWT. In addition, a significant relationship was found between disease US extent and clinical or biochemical disease activity. However, in a subgroup of patients characterized by quiescent disease and high BWT, CD was complicated by higher prevalence of strictures, as detected by radiological and endoscopic examinations, and more frequent surgical outcome than others. CONCLUSIONS: Abdominal US is an accurate method for determining the abdominal distribution of CD and appears to be accurate in detecting and evaluating the disease length of ileal lesions. In contrast, despite a weak but significant correlation between BWT and clinical and biochemical parameters, the usefulness of US as an index of disease activity seems to be fairly limited. However, a high BWT in quiescent patients suggests the presence of fibrosis, which is poorly responsive to steroid treatment.

Adult↗
PubMed1995

Behaviour of acid secretion, gastrin release, serum pepsinogen I, and gastric emptying of liquids over six months from eradication of helicobacter pylori in duodenal ulcer patients. A controlled study.

The behaviour of basal and stimulated acid secretion, gastrin release, serum pepsinogen I, and gastric emptying of liquids was studied in 19 consecutive patients with Helicobacter pylori positive duodenal ulcer, over a follow up period of six months. Eleven patients were studied before and at three and six months after eradication with lansoprazole plus amoxicillin and tinidazole (case group), whereas the remainder, with persistent H pylori infection, were studied before and after three and six months from ulcer healing, thus constituting the control group. In the case group, three months after eradication, fasting serum pepsinogen I fell from (mean (SEM)) 91.9 (6.9) (pretreatment) to 72.2 (5.1) ng/l and the integrated gastrin response to a meal reduced from 11,470 (1174) (pretreatment) to 8130 (608) pg/ml/h (p < 0.05). Fasting serum gastrin concentrations and maximal acid output reduced significantly only six months after eradication. In contrast, no significant change of any of these measurements was seen in the control group either at three or six months from healing compared with the pretreatment values. Gastric emptying of liquids did not change over the entire period of follow up in both study groups. In conclusion, eradication of H pylori in duodenal ulcer patients is accompanied by a rapid fall in serum pepsinogen I and plasma gastrin concentrations, whereas a slight but significant reduction of maximal acid secretion takes place later on. In contrast, gastric emptying of liquids does not seem to be influenced by H pylori status.

Adult↗
PubMed1995

Meta-analysis of the effect of placebo on the outcome of medically treated reflux esophagitis.

BACKGROUND: To ascertain the placebo-induced effect in the treatment of reflux esophagitis, we reviewed all the English-language literature concerning the results of placebo-controlled trials of erosive/ulcerative esophagitis from 1976 to 1990. Twenty-two studies fulfilled our meta-analytic criteria. RESULTS: After 4 to 8 weeks of treatment, active drugs (cimetidine, ranitidine, nizatidine, omeprazole, metoclopramide, sucralfate) were significantly more effective than placebo in the healing of esophagitis, with a pooled rate difference (PRD) of 0.22 in favor of the active drug, an odds ratio (OR) of 2.57 (confidence interval (CI) = 2.0-3.3). Pooled mean healing rate (+/- SD) with the active drug was 47.3 +/- 24.0%, as compared with 26.8 +/- 18.0% obtained with placebo after 4 to 8 weeks of treatment. With regard to symptomatic response, complete disappearance of symptoms was observed in an average of 31.6% active-treated patients and in 11.8% of placebo-treated patients, respectively. The PRD was 0.20, and the OR 2.25 (CI = 1.65-3.06). The incidence of side effects was not statistically different for the two treatment groups. CONCLUSION: Placebo is a relatively inactive drug in the short-term treatment of erosive ulcerative reflux and does not appear to change the natural history of the disease.

Anti-Ulcer Agents↗
PubMed1995

Efficacy of omeprazole combined with antibiotics for Helicobacter pylori eradication and duodenal ulcer recurrence.

OBJECTIVE: To establish the efficacy of omeprazole combined with two antibiotics for Helicobacter pylori eradication and duodenal ulcer relapse. PATIENTS: Thirty-seven patients with endoscopically proven duodenal ulcer and H. pylori infection. METHODS: Treatment consisted of 20 mg omeprazole daily for 4 weeks with the addition, during the second and third weeks, of amoxycillin (1 g three times daily) and metronidazole (1 g daily) (group A) or placebo (group B). Endoscopy and biopsy to assess ulcer recurrence and H. pylori status were performed at entry to the study, after 4 weeks of therapy, and 1 and 6 months after treatment. RESULTS: Duodenal ulcers healed in all patients. H. pylori infection was eradicated in 15 (79%) out of 19 patients in group A and one (6%) out of 16 patients in group B (P < 0.01). One patient in each of the groups was lost to follow-up after 6 weeks. During the 6 month follow-up period, duodenal ulcers recurred in three of the 16 patients with H. pylori eradication, compared with 16 of the 19 patients with persistent H. pylori infection (19 versus 84%; P < 0.01). CONCLUSION: The combination of omeprazole with amoxycillin and metronidazole is effective in H. pylori eradication. This triple therapy, which eradicates H. pylori, also significantly reduced duodenal ulcer relapse.

Adult↗
PubMed1994

Effect of single dose of oral erythromycin on gastric and gallbladder emptying. Simultaneous assessment by ultrasound.

To evaluate the effects of a single oral dose of erythromycin on gastric and gallbladder emptying, 10 volunteers, without a known history of gastrointestinal disease, were investigated. Erythromycin stearate (500 mg) or placebo was given on separate mornings 30 min before a standard solid meal in a randomized, double-blind, crossover study. Gastric and gallbladder emptying rates were simultaneously evaluated by means of real-time ultrasonography. Gastric antral area and gallbladder volume were determined before the meal and 30, 60, 120, 180, 240, and 300 min after commencing eating. Erythromycin, compared to placebo, significantly accelerates and increases the degree of both gastric and gallbladder emptying. As previously reported for intravenous and chronic oral assumption, also a single dose of oral erythromycin is able to accelerate gastric and gallbladder emptying in normal human subjects.

Administration, Oral↗
PubMed1994

The effects of levosulpiride on gastric and gall-bladder emptying in functional dyspepsia.

BACKGROUND: 50% of patients with functional dyspepsia have delayed gastric emptying. Levosulpiride is an orthopramide drug that stimulates gastrointestinal motility. Aim of our study was to evaluate the effect of levosulpiride on symptoms and gastric and gall-bladder emptying, in dyspeptic patients. METHODS: Thirty adult patients, treated for 20 days with levosulpiride (75 mg/day) or placebo, were evaluated in a randomized double-blind study. Symptoms were assessed by a cumulative index and overall intensity (visual analogue line). Gastric and gall-bladder emptying were evaluated by epigastric impedance (liquid meal) and real-time ultrasonography (mixed meal). RESULTS: Levosulpiride, with respect to placebo, accelerated the mean gastric half-emptying time of liquids (P < 0.05), gastric emptying (P < 0.001 at 180 min; P < 0.05 at 240 min), and gall-bladder emptying (P < 0.05 at 60 and 120 min) emptying after a solid-liquid mixed meal. Both the mean cumulative index (P < 0.05) and the overall intensity (P < 0.025) of dyspeptic symptoms were reduced significantly by levosulpiride. CONCLUSIONS: Our results showed that levosulpiride can be usefully employed in patients affected by functional dyspepsia.

Adult↗