PubMed Health⌕ Search

Biomedical subjects

E Hentschel

Publications and source records attributed to E Hentschel.

At least 19 recordsLinked to original sources
PubMed2000

[Treatment of Helicobacter pylori infections].

The treatment of Helicobacter pylori (H.p.) infection is based on the recommendations of the Maastricht consensus conference 1996. The main indications for eradication of H.p. are peptic ulcer disease, gastritis with severe histological abnormalities, low grade gastric MALT lymphoma and a history of resection for gastric cancer. The results of recent studies demonstrate that the symptoms of non-ulcer dyspepsia are not improved by H.p. eradication. A family history of gastric cancer and an earlier operation for peptic ulcer are considered advisable indications for the treatment of H.p. infection. Triple therapies consisting of a proton pump inhibitor (PPI) or ranitidine bismuth citrate plus 2 antibiotics are established as effective and well-tolerated first line regimens. The most important antibiotics are clarithromycin and amoxicillin. The efficacy of metronidazole is impaired by an increasing rate of resistant strains. Only few new antibiotics are currently tested in clinical trials. After the failure of a first anti-H.p. treatment it is advisable to change antibiotics according to the probability of resistance, to increase dosage and duration of treatment and to include bismuth compounds in the second line regimen. An alternative option after failed triple therapies may be a high dosage and prolonged dual regimen with a PPI and amoxicillin or quadruple therapy consisting of a PPI, bismuth subcitrate, tetracycline and metronidazole.

Amoxicillin↗
PubMed1999

Famotidine versus omeprazole in combination with clarithromycin and metronidazole for eradication of Helicobacter pylori--a randomized, controlled trial.

BACKGROUND: One-week low-dose triple therapy is currently considered the gold standard regimen for treatment of Helicobacter pylori infection. However, the mechanisms involved in the synergy between antibiotics and proton pump inhibitors are controversial. AIMS: To test the hypothesis that acid suppression represents the crucial mechanism by which the antibacterial activity of antibiotics can be enhanced, and to assess the impact of primary resistance on treatment outcome. METHODS: One hundred and twenty patients with H. pylori infection and duodenal ulcer, gastric ulcer or non-ulcer dyspepsia were randomly assigned to a 1 week course of either famotidine 80 mg b.d., clarithromycin 250 mg b.d. and metronidazole 500 mg b.d. (FCM group; n = 60) or omeprazole 20 mg o.d., clarithromycin 250 mg b.d. and metronidazole 500 mg b.d. (OCM group; n = 60). Gastroscopy was performed at baseline and 5 weeks after completion of treatment. H. pylori status was assessed by biopsy urease test, histology and culture. RESULTS: In the intention-to-treat analysis, eradication of H. pylori was achieved in 47 of 60 patients (78%; 95% CI: 66-88%) in the FCM group, compared to 44 of 60 patients (73%; 95% CI: 60-84%) in the OCM group (N.S.). Using per protocol analysis, eradication therapy was successful in 47 of 52 patients (90%; 95% CI: 79-97%) treated with FCM and 44 of 57 patients (77%; 95% CI: 64-87%) treated with OCM (N.S.). Primary metronidazole resistance was present in 27% and primary clarithromycin resistance in 8% of strains. Overall per protocol eradication rates in strains susceptible to both antibiotics and strains with isolated metronidazole resistance were 93% and 84%, respectively. No patient with clarithromycin resistance responded to treatment. CONCLUSIONS: High-dose famotidine and omeprazole, combined with clarithromycin and metronidazole, are equally effective for eradication of H. pylori. In 1-week low-dose triple therapy, metronidazole resistance has no major impact on eradication rates whereas clarithromycin resistance is associated with a poor treatment outcome.

Adult↗
PubMed1997

Comparison of two dosing regimens of cisapride in the treatment of reflux oesophagitis.

AIM: In an international, multicentre, double-blind trial, to document the therapeutic equivalence of two dosing regimens of cisapride on endoscopic healing and symptom improvement in patients with proven reflux oesophagitis grade I or II (Savary-Miller). METHODS: Four hundred and seven patients were randomly allocated to treatment with either cisapride 10 mg q.d.s. or cisapride 20 mg b.d. for 8-12 weeks depending on whether complete healing was found at endoscopy. The primary parameters of efficacy were cure of oesphagitis and improvement of the reflux symptom score. RESULTS: The healing rates at endpoint were 73% in both treatment groups. The mean total reflux symptom score decreased from baseline to endpoint from 7.9-2.1 (cisapride 10 mg q.d.s) and 7.9-2.5 (cisapride 20 mg b.d.). Each of the two treatment regimens was well tolerated. The most frequently (6.9%) reported adverse event (diarrhoea) was mild or moderate in most cases and can be explained by pharmacological action of cisapride. CONCLUSIONS: The results of the study demonstrate that cisapride 10 mg q.d.s. and 20 mg b.d. are equivalent in terms of efficacy and safety in the treatment of reflux oesophagitis.

Adolescent↗
PubMed1997

Short-course therapy with amoxycillin-clarithromycin triple therapy for 10 days (ACT-10) eradicates Helicobacter pylori and heals duodenal ulcer. ACT-10 Study Group.

BACKGROUND: Whilst the role of Helicobacter pylori eradication in managing duodenal ulcers has been established, consensus regarding the ideal regimen has not been achieved. METHODS: Patients with H. pylori-positive active duodenal ulcer were randomly assigned to receive triple therapy with amoxycillin 1000 mg b.d. + clarithromycin 500 mg b.d. + omeprazole 20 mg daily for 10 days (ACT-10) or dual therapy with clarithromycin 500 mg t.d.s. + omeprazole 40 mg daily for 14 days (Dual). No additional acid suppression was provided following eradication therapy. Endoscopy, with biopsy for culture and histology, as well as 13C-urea breath testing (13C-UBT) were performed pre-treatment to assess H. pylori infection. H. pylori eradication was established at 4-6 weeks follow-up with culture (2 antral, 1 corpus biopsies), histology (2 antral biopsies), and 13C-UBT. Ulcer healing by endoscopy and change in clinical symptoms were also assessed at 4-6 weeks. RESULTS: Two hundred and sixty-seven (267) patients were randomized to ACT-10 (n = 137) or Dual therapy (n = 130). By per-protocol and intention-to-treat analyses, H. pylori eradication at 4-6 weeks follow-up was 91% (115/127) and 88% (120/136), respectively, for ACT-10 patients and 59% (68/115) and 55% (72/130), respectively, for Dual therapy patients (P < 0.001 for both analyses). Ulcer healing was high in both treatment groups: ACT-10, 93% (118/127) and 90% (122/136), respectively; and Dual therapy, 91% (104/114) and 85% (111/130), respectively. Pre-treatment resistance to clarithromycin was low (4%, 8/214) as compared to metronidazole resistance which was over 40%. Emergence of resistance to clarithromycin was observed in 2% of patients receiving ACT-10 and in 25% of those receiving Dual therapy. ACT-10 and Dual therapy patients experienced similar rates of drug-related adverse events (33% vs. 32%, respectively) and discontinuation from therapy due to an adverse event (1.5% vs. 5%, respectively). More than 90% of patients were compliant with each prescribed medication. CONCLUSION: In patients with active duodenal ulcer, a 10-day course of amoxycillin-clarithromycin-based triple therapy without additional acid suppression is highly effective in eradicating H. pylori and healing duodenal ulcer.

Adult↗
PubMed1997

Double-blind study of the effect of cisapride on constipation and abdominal discomfort as components of the irritable bowel syndrome.

AIM: To study the effect of prokinetic treatment with cisapride in patients with constipation-predominant irritable bowel syndrome. PATIENTS AND METHODS: Ninety-six patients were randomly assigned to treatment with either cisapride 5 mg three times daily or placebo three times daily for a period of 12 weeks. The dosage could be doubled after 4 weeks. Presence of the target symptoms abdominal pain, constipation and abdominal bloating was an obligatory criterion for inclusion in the study. RESULTS: After 12 weeks of treatment, 31%, 56% and 27% of the cisapride treated patients were found to be without the three target symptoms (P < 0.05). The corresponding percentages for the placebo-treated patients were 31%, 58% and 19%, respectively, (P < 0.05). The visual analogue scale (VAS) symptom scores assessed by the patients for global rating of bowel disease, general well-being and frequency of stool passage improved significantly within each treatment group (P < 0.05). Evaluation of efficacy parameters using intention-to-treat analysis showed no statistically significant differences between the groups. Using efficacy analysis, the difficulty of stool passage showed a significantly higher improvement with cisapride (P < or = 0.05). CONCLUSIONS: These results indicate that cisapride is not superior to placebo in the treatment of constipation and abdominal discomfort as components of irritable bowel syndrome. It may, however, be of use in improving the difficulty of stool passage.

Abdominal Pain↗
PubMed1996

Clarithromycin or amoxycillin plus high-dose ranitidine in the treatment of Helicobacter pylori-positive functional dyspepsia.

OBJECTIVE: This study was intended to investigate the effect of ranitidine in dual anti-Helicobacter pylori therapy. Simultaneously, it was to evaluate the potential effect of H. pylori eradication on the symptomatology of H. pylori-positive dyspepsia. PATIENTS AND METHODS: Fifty-four patients with H. pylori infection and symptoms of non-ulcer dyspepsia were randomly assigned to treatment with either amoxycillin 500 mg four times daily plus ranitidine 300 mg four times daily, clarithromycin 500 mg twice daily plus ranitidine 300 mg twice daily, clarithromycin 500 mg four times daily plus ranitidine 300 mg twice daily or clarithromycin 500 mg four times daily plus ranitidine 300 mg four times daily for a period of 12 days. In addition, ranitidine 150 mg twice daily was given for a further 16 days. RESULTS: Eradication of H. pylori using the assigned treatments was achieved in 47% (seven out of 15), 50% (five out of 10), 70% (seven out of 10) and 77% (10 out of 13) of patients, respectively. Failure of therapy with clarithromycin was associated with primary or acquired resistance after treatment in 91% (10 out of 11). Symptom improvement was significant (P = 0.0001) and similar in all of the four treatment groups up to week 8. As regards H. pylori status, no differences in the mean symptom score improvement could be found between patients with eradication and those with persistent infection (12.3-7.0, P = 0.0001, n = 29 compared with 13.0-6.5, P = 0.004, n = 19). After 1 year the symptom score had increased both in patients with persistent H. pylori (9.1) and in those remaining free of infection (10.0). No reinfection could be found. CONCLUSION: These results suggest that clarithromycin plus high-dose ranitidine is a combination which achieves reasonably high H. pylori eradication rates. However, treatment failure inevitably leads to clarithromycin resistance. The improvement of non-ulcer dyspepsia symptoms during acute therapy is independent of H. pylori eradication. Long-term benefit of H. pylori eradication with respect to the symptoms of functional dyspepsia was not observed.

Adult↗
PubMed1995

Helicobacter pylori reinfection with identical organisms: transmission by the patients' spouses.

Reinfection with Helicobacter pylori after eradication is responsible for the recurrence of duodenal ulcer disease. The mode of transmission has not yet been established. In this study, 18 patients with chronic duodenal ulcers in whom H pylori had been eradicated with amoxicillin and metronidazole were entered into a prospective follow up study. Control endoscopies were performed 4, 8, 14, 27, and 43 months after starting treatment and the results of direct tests were compared with the kinetics of H pylori specific IgG titres. After eradication there was a noticeable and consistent fall in anti-H pylori IgG, while reinfections were characterised by a significant increase in specific titres. Reinfection was detected in two patients after 14 and 43 months, respectively. The H pylori strains responsible for these reinfections, the corresponding pretreatment isolates, and the strains isolated from the spouses of these patients were examined by polymerase chain reaction based DNA fingerprinting. Analysis showed that reinfection had been caused by the same H pylori strain and identified the spouses of these patients as carriers of the identical strain. Considering the genomic diversity and the interpatient heterogeneity of H pylori these results suggest a person to person transmission of H pylori reinfection. By the end of the observation period reflux oesophagitis had developed in 10 of the 16 patients who had not been reinfected. This surprising finding may be explained by the changed eating habits of patients after healing of duodenal ulcer disease.

Adult↗
PubMed1995

Sucralfate effervescent tablet: treatment of peptic ulcer disease and change in serum aluminium concentration.

In a single-centre randomised clinical trial, a new effervescent formulation of sucralfate was compared with the granular formulation of the drug in the treatment of peptic ulcer. The effervescent tablet had not been previously administered to human subjects. Fifty patients with endoscopically verified duodenal (40) and gastric (10) ulcers were treated with 2.0 g sucralfate twice daily, given either as a granular formulation or effervescent tablet. Control endoscopies were performed at weeks 4 and 8 and again at week 12 if gastric ulcers had not healed earlier. The healing rates in the effervescent tablet group were 71% (15/21) and 86% (18/21) after 4 and 8 weeks. In this group one gastric ulcer had to be treated for a further 4 weeks and had not healed at week 12. The corresponding rates in the sucralfate granulate group were 95% (18/19) after 4 and 8 weeks. Serum aluminium concentrations were measured simultaneously before and after treatment. The aluminium concentration almost doubled in both treatment groups during dosing with sucralfate. This effect has not been described previously in the course of therapy with sucralfate in patients with peptic ulcer disease and should be borne in mind when considering treatment with this drug.

Aluminum↗
PubMed1995

Double-blind dose-finding study of olsalazine versus sulphasalazine as maintenance therapy for ulcerative colitis.

OBJECTIVE: To determine the therapeutic efficacy and safety of three doses of olsalazine compared with the standard dose of sulphasalazine. DESIGN: Randomized double-blind multicentre 6-month study comparing three doses of olsalazine (0.5, 1.25 and 2.0 g daily) and sulphasalazine 2.0 g daily for maintaining remission in patients with ulcerative colitis. SETTING: Public hospitals and private practices in Germany, Austria and Switzerland. PATIENTS: A total of 162 patients with ulcerative colitis in remission. RESULTS: According to intention-to-treat analysis, the failure rates of the different treatment groups were not significantly different (36, 49 and 24% for 0.5, 1.25 and 2.0 g olsalazine daily and 32% for 2.0 g sulphasalazine daily). Olsalazine and sulphasalazine showed a tendency towards lower failure rates in extended (28%) than in distal disease (44%). The withdrawal rate due to adverse effects was 4%, the most frequent single event being diarrhoea (2.5, 5.2 and 11.7% for 0.5, 1.25 and 2.0 g olsalazine daily and 0% for sulphasalazine daily). CONCLUSION: This study found no significant differences between the therapeutic efficacy or safety of 0.5-2.0 g olsalazine daily. Because of its sulpha-free formulation olsalazine may, however, be preferred to sulphasalazine.

Adolescent↗
PubMed1995

Duodenal ulcer healing after 7-day treatment: a pilot study with lansoprazole, amoxicillin and clarithromycin.

OBJECTIVE: To evaluate the efficacy and safety of a one-week triple therapy without bismuth and metronidazole in duodenal ulcer healing and symptom relief. PATIENTS AND METHODS: Forty-five patients with duodenal ulcers and Helicobacter pylori (H. pylori) infections were given a 7-day treatment with lansoprazole 30 mg bid, amoxicillin 1.000 mg bid, and clarithromycin 500 mg bid. Endoscopies with urease tests and histologic examinations were performed before initiation and four weeks after cessation of therapy. RESULTS: Using efficacy analysis, 41 of 42 duodenal ulcers (98%; 95% CI 0.87-1.00) were healed after one week of treatment. H. pylori was eradicated in 40 of 42 patients (95%; 95% CI 0.84-1.00). Two patients with healed ulcers showed a persistent infection, whereas H. pylori was eradicated in the one patient with persisting ulcer. Using intention-to-treat analysis, ulcer healing was achieved in 41 of 45 (91%; 95% CI 0.79-0.98) and H. pylori eradication in 40 of 45 patients (89%; 95% CI 0.76-0.96). After a mean of five days, 40 of 41 patients (98%; 95% CI 0.87-1.00) with ulcer healing became completely pain-free. CONCLUSIONS: One-week therapy with lansoprazole, amoxicillin and clarithromycin is highly effective in duodenal ulcer healing and symptom improvement. Prolonged acid suppression does not seem to be essential for duodenal ulcer treatment.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1994

[Supportive therapy of pancreatic carcinoma].

Due to the progressive clinical course and unchanged poor prognosis of pancreatic cancer supportive therapy has to focus on improvement of the quality of life. Pain control is best achieved with slow release opiates and by chemoablation of the coeliac plexus. Furthermore, management of anorexia with megestrol acetate and tumor-adapted enteral and parenteral nutritional therapy are discussed. The treatment of chemotherapy-induced side effects with haemopoetic growth factors and antiemetics is dealt with as well. Finally, the therapeutic principles of the management of post-pancreatectomy diabetes mellitus and postoperative steatorrhoea are pointed out.

Combined Modality Therapy↗
PubMed1994

[Current therapy of Helicobacter pylori-induced chronic gastritis and/or peptic ulcer].

Helicobacter pylori (H.p.) induced chronic gastritis cannot at present be considered as an absolute indication for eradication therapy of H.p. Clinical trials with antimicrobial compounds, mainly bismuth, have not convincingly demonstrated appreciable symptomatic benefit for patients with H.p.-positive gastritis and non-ulcer dyspepsia. However, new results indicate that possibly a longer follow-up period may be necessary to prove a symptomatic improvement after H.p. eradication in patients with chronic gastritis. In contrast, eradication of H.p. reduces the relapse rates of recurrent non-iatrogenic peptic ulcer to virtually zero. Antimicrobial treatment of H.p. infection is, therefore, clearly indicated in chronic duodenal and gastric ulcers. In the case of success, drug maintenance therapy or operation becomes superfluous. The combination of amoxicillin plus metronidazole with ranitidine or of omeprazole with amoxicillin or clarithromycin results in eradication rates of about 85%. Triple therapy with bismuth, metronidazole, and amoxicillin or tetracycline is successful in about 90% of patients but the incidence of side effects is higher.

Anti-Bacterial Agents↗
PubMed1993

Effect of ranitidine and amoxicillin plus metronidazole on the eradication of Helicobacter pylori and the recurrence of duodenal ulcer.

BACKGROUND: Persistent infection with Helicobacter pylori is associated with the recurrence of duodenal ulcer. Whether the efficacy of bismuth therapy in reducing the rate of recurrence of duodenal ulcer is due to its antimicrobial effects on H. pylori or to a direct protective action on the mucosa is still a matter of debate. METHODS: To study the effect of the eradication of H. pylori on the recurrence of duodenal ulcer, we treated 104 patients with H. pylori infection and recurrent duodenal ulcer with either amoxicillin (750 mg three times daily) plus metronidazole (500 mg three times daily) or identical-appearing placebos, given orally for 12 days. All patients also received ranitidine (300 mg each night) for 6 or 10 weeks. Endoscopy was performed before treatment and periodically during follow-up for up to 12 months after healing. RESULTS: Among the 52 patients given antibiotics, H. pylori was eradicated in 46, as compared with 1 of the 52 given placebo (89 percent vs. 2 percent, P < 0.001). After six weeks, the ulcers were healed in 48 patients given antibiotics and 39 given placebo (92 percent vs. 75 percent, P = 0.011). Side effects, mainly diarrhea, occurred in 15 percent of the patients given antibiotics. Among the patients followed up for 12 months, duodenal ulcers recurred in 4 of 50 patients given antibiotics and 42 of 49 given placebo (8 percent vs. 86 percent, P < 0.001). Ulcers recurred in 1 of 46 patients in whom H. pylori had been eradicated, as compared with 45 of 53 in whom H. pylori persisted (2 percent vs. 85 percent, P < 0.001). CONCLUSIONS: In patients with recurrent duodenal ulcer, eradication of H. pylori by a regimen that does not have any direct action on the mucosa is followed by a marked reduction in the rate of recurrence, suggesting a causal role for H. pylori in recurrent duodenal ulcer.

Adult↗
PubMed1993

Effect of cisapride on relapse of esophagitis. A multinational, placebo-controlled trial in patients healed with an antisecretory drug. The Italian Eurocis Trialists.

The effect of a prokinetic agent, cisapride, on the relapse of reflux esophagitis was investigated in a randomized, double-blind trial conducted in 443 patients whose esophagitis had previously been healed with an acid antisecretory drug. Patients received cisapride, 20 mg at night, cisapride 10 mg twice daily, or placebo for 12 months or until endoscopic relapse was confirmed endoscopically. In 88% of all patients (respectively 133, 132, and 124), endoscopic data were available at discontinuation of treatment. In comparison with placebo, the two cisapride regimens prolonged both the time to endoscopically confirmed relapse (Kaplan-Meier analysis; P = 0.001) and the time to symptomatic relapse (P = 0.012). The life-table endoscopic relapse rates at 12 months were 51% for placebo, 32% for cisapride 20 mg at night (P = 0.005), and 34% for cisapride 10 mg twice daily (P = 0.02). Patients with more severe esophagitis before healing relapsed more rapidly during maintenance therapy, regardless of the treatment regimen. Adverse events were infrequent in all three groups. These findings indicate that maintenance treatment with the prokinetic drug cisapride prevents the relapse of esophagitis after it has been healed by acid antisecretory therapy.

Cisapride↗
PubMed1993

Kinetics of specific IgG antibodies for monitoring the effect of anti-Helicobacter pylori chemotherapy.

A total of 104 patients with recurrent duodenal ulcer were treated with either ranitidine plus amoxicillin plus metronidazole or ranitidine plus placebo. To study the effect of the eradication of Helicobacter pylori on the systemic immune response in an IgG ELISA, sera were drawn from all patients before the onset of therapy and at 6, 16 +/- 2, 32 +/- 2, and 60 +/- 2 weeks after therapy. In patients with eradication of the organism, a significant (P < .001) reduction of the specific IgG titer occurred. This was not observed in patients without bacterial eradication. If a titer reduction of > 50% was taken as an indicator for eradication of H. pylori, the sensitivity of the serologic test was 97.6%-99.7%. Its specificity increased with the interval to the onset of chemotherapy from 56.3% to 97.6%. Serologic tests are simple to perform and cause very little discomfort to the patient.

Amoxicillin↗