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H Merki

Publications and source records attributed to H Merki.

10 recordsLinked to original sources
PubMed1999

Failure of a 1-day high-dose quadruple therapy for cure of Helicobacter pylori infection.

BACKGROUND: The optimal duration of treatment for eradication of Helicobacter pylori has still to be defined. A 1-day high-dose quadruple therapy with a combination of amoxycillin (or tetracycline), metronidazole, a bismuth salt and a proton pump inhibitor has led to eradication rates of 57-77%. In view of the high frequency of metronidazole-resistant strains of H. pylori in Europe, we hypothesized that by using clarithromycin in place of metronidazole and by increasing the dose of proton pump inhibitor, the efficacy of a 1-day high-dose quadruple therapy could be improved. METHODS: Patients were randomized to receive either amoxycillin 1000 mg b.d., clarithromycin 500 mg b.d. and lansoprazole 30 mg b.d. for 7 days, or amoxycillin 2000 mg q.d.s., clarithromycin 500 mg q.d.s., lansoprazole 30 mg t.d.s. and bismuth subcitrate 240 mg q.d.s. for 1 day. RESULTS: It was originally intended to include 100 patients. The first planned interim analysis performed after follow-up was completed for 30 patients revealed H. pylori eradication rates of 80% (12/15) in the 7-day triple therapy group and 20% (3/15) in the 1-day quadruple therapy group, the difference being highly significant (P = 0.003). Because the efficacy of the 1-day treatment was so low, the study was stopped for ethical reasons. Eleven patients who failed with the 1-day treatment were re-treated with the 7-day triple therapy: the eradication rate was 91% (10/11). CONCLUSIONS: One-day high-dose quadruple therapy with amoxycillin, clarithromycin, lansoprazole and bismuth subcitrate is dramatically less effective than the classic 7-day triple therapy with the same antibiotics.

Adult↗
PubMed1994

[Endoscopic findings in volunteers and dyspeptic patients].

Although more than a fourth of the adult population reports dyspeptic complaints, little is known about the prevalence of clinically relevant UGI endoscopic findings in these patients in comparison with asymptomatic volunteers. This type of information is required in order to assess the relative risks of organic dyspepsia and the sensitivity and specificity of dyspeptic complaints for peptic lesions. In an attempt to fill this gap, the authors compared two trials carried out in the German-speaking part of Switzerland: (a.) 172 adult asymptomatic volunteers (age 20-78 years, 74 females, 98 males) participated in an epidemiological trial to measure the prevalence of positive CLO-urease tests and of upper GI-tract lesions. (b.) 119 patients (age 18-84 years; 68 females, 51 males) consulting their family doctor because of upper digestive symptoms of at least 1 month's duration (epigastric pain or discomfort, heartburn, acid regurgitation, early satiety, bloating, etc.) were referred for UGI endoscopy as a screening procedure; functional dyspeptics were thereafter randomized to a double blind drug trial (not reported here). In both trials the gastric presence of Helicobacter pylori was measured by means of the CLO-urease test. Prevalences of lesions and of positive urease-tests in the dyspeptic population were compared with the sex and age adjusted prevalences registered in the control population.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Colonic motility].

Colonic motility is provided by contraction of intramural smooth muscle under the control of the enteric and the extrinsic nervous system and humoral connections. In vivo measurement of colonic motility remains difficult because of the complexity of these interactions and anatomical considerations. The possibility that symptoms are due to colonic dysmotility should be considered in patients with normal barium enema and colonoscopy. Examples of this are patients with chronic constipation, irritable bowel syndrome or colonic symptoms associated with diabetes mellitus or diseases of the nervous system. A number of techniques have been developed to assess colonic motility. The simplest is to assess colonic transient with a single abdominal x-ray following ingestion of radio-opaque markers. This is cheap, reproducible and easy to perform. Normal values for age and sex are available. Colonic transit of both liquid and solid can be determined by scintigraphic measurement. This technique provides information about regional variations in colonic function; it is however relatively demanding and requires access to a gamma camera. Manometry provides a more direct assessment of colonic motor activity. Changes in the electrical potential of the colonic smooth muscle can be determined by electromyography. Both techniques are however difficult to perform, and are currently only used for research purposes. It is likely that the combination of techniques that examine transit with more direct measurement of motor function will provide further insights into the mechanisms responsible for colonic dysmotility.

Barium Sulfate↗
PubMed1992

[Diagnosis of peptic ulcer disease].

Today the upper gastrointestinal endoscopy is the diagnostic tool of choice to detect peptic gastroduodenal lesions. In case of substantial gastric outlet obstruction or strong suspicion of perforated ulcer, an upper gi-transit with barium or water soluble contrast medium in suspected perforated ulcers may be useful. Gastric ulcers are endoscopically controlled up to their complete healing and biopsies taken at each endoscopy in order to rule out gastric cancer. In contrast, duodenal ulcers are rarely malignant and uncomplicated duodenal ulcers, correctly treated with omeprazole over 8 weeks do not necessarily need a final endoscopic control. Since about 5% of duodenal ulcers treated with H2 blockers or mucosal protective agents do not heal within 8 weeks however, an endoscopic control of the healing is recommended. In peptic ulcer patients tests for detection of helicobacter pylori are only needed in presence of a hard indication for immediate eradication: Frequent ulcer recurrencies, complicated ulcer disease or very painful ulcer relapses, because the eradication therapy is often not well tolerated and the patient compliance therefore compromised. 30% of helicobacter infected patients have antibiotic resistant strains and there is no sufficient longterm experience with the eradication therapy available (4) to 8 weeks after treatment of the helicobacter pylori infection the effect on ulcer healing and infection should be verified. Determinations of plasma gastrin levels in peptic ulcer patients are mandatory in patients with suspected Zollinger-Ellison syndrome or patients with treatment resistant ulcers or recurrent ulcers after vagotomy or partial gastric resection.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Ulcer Agents↗
PubMed1988

Early evening ranitidine administration promotes faster duodenal ulcer healing.

In a prospective double-blind clinical trial, 141 patients with endoscopically diagnosed duodenal ulcer were randomly assigned to treatment with ranitidine 300 mg, taken either at 6 PM or at 10 PM. After 2 wk of treatment, 52 of 70 patients (74%) in the 6 PM treatment group had healed, compared with 32 of 64 patients (50%) taking ranitidine at 10 PM (p less than 0.01). After 4 wk, the cumulative healing rates were 100% and 94%, respectively, for the 6 PM and 10 PM treatment regimens. These results suggest that ranitidine, taken as a single daily 300-mg dose at 6 PM after dinner, provides more rapid duodenal ulcer healing than the same dose of the drug taken at 10 PM.

Adolescent↗
PubMed1987

Single dose treatment with H2 receptor antagonists: is bedtime administration too late?

Using ambulatory ph-metry, intragastric acidity was measured over three separate 24 hour periods in each of 12 healthy volunteers receiving either (a) placebo (1800 h and 2200 h), (b) 300 mg ranitidine (1800 h) and placebo (2200 h), or (c) placebo (1800 h) and 300 mg ranitidine (2200 h). Ranitidine was significantly more effective in decreasing 24 h median intragastric acidity when the drug was administered at 1800 h rather than at 2200 h. Median pH (and interquartile range) was 1.45 (1.4-1.7) on placebo, 2.55 (2.05-3.2) on ranitidine given at 2200 h and 3.35 (2.5-3.85) on ranitidine given at 1800 h (p less than 0.004). The total duration of highly acidic electrode readings (pH less than 1.5) over a 24 h period was reduced significantly by administering the H2-receptor antagonist at 1800 h compared with the later administration. It is suggested that treatment of duodenal ulcers by single administration of ranitidine in the early evening should be evaluated by clinical trial.

Adult↗
PubMed1985

[Continuous intragastric pH-metry].

Ambulatory intragastric pH-metry is a suitable method of assessing gastric acidity under conditions of normal daily life. A detailed profile of intragastric acidity is given which is a reproducible individual characteristic. There is a circadian rhythm of gastric acidity in which pH rises during the night and after meals. pH-metry was used to determine the effects of H2-antagonists and antacids, and the results are the basis for the clinical use of intragastric pH-metry.

Antacids↗
PubMed1985

Prophylactic endoscopic sclerotherapy of oesophageal varices. A prospective controlled study.

Of 109 patients with cirrhosis and endoscopically demonstrated oesophageal varices who had not bled, 56 were treated by sclerotherapy and 53 were treated conservatively. Patients were assigned to one of three categories according to varix size and Child's classification of severity of liver disease. Severity of liver disease increased with varix size. Frequency of haemorrhage in the control group also increased with varix size: haemorrhage occurred from small varices in 35% of patients, from medium varices in 53%, and from large varices in 83%. Prophylactic sclerotherapy diminished the frequency of variceal bleeding and overall mortality: over 25 months, frequency of bleeding was 9% in the therapy group and 57% in the controls, with mortality rates of 23% and 55%, respectively.

Adult↗
PubMed1976

[Surgery of mitral valve stenosis: open or closed commissurotomy?].

Up to October 1975 a total of 206 mitral commissurotomies were performed in Berne. 170 patients underwent closed commissurotomy (CMC). In the period from 1973, 36 patients underwent open commissurotomy (OMC). To compare results and operative risk as between OMC and CMC, the last 36 consecutive patients of the CMC group were selected for critical evaluation. Though not coinciding chronologically the 2 groups turned out to be essentially comparable with regard to preoperative clinical and hemodynamic findings. In neither group was there a hospital death. Frequency and severity of postoperative complications did not prove to be greater following OMC. Cerebral embolism was observed in 3 cases after CMC, whereas this complication occurred only once following OMC. On the basis of clinical, radiological and electrocardiographic data, OMC must be considered superior to CMC. The incidence of significant residual stenosis and the risk of causing mitral regurgitation appear to be lower. Without involving a higher operative risk, the open approach to mitral commissurotomy offers the following main advantages: safe removal of intraatrial thrombi, precise and complete incision of the fused commissures under direct vision, avoidance of leaflet tears, separation of fused chordae tendineae and incision of papillary muscles in order to remove subvalvular stenosis, debridement of calcium from leaflets, and repair of concomitant mitral regurgitation by valvuloplasty.

Adult↗