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H J O'Connor

Publications and source records attributed to H J O'Connor.

At least 19 recordsLinked to original sources
PubMed2006

Impact of Helicobacter pylori on the management of dyspepsia in primary care.

BACKGROUND: It is unclear what impact Helicobacter pylori infection has had on the management of dyspepsia in primary care and to what extent published guidelines on H. pylori are implemented in routine clinical practice. AIM: To assess the impact of H. pylori infection on the management of dyspepsia in primary care. METHODS: Patients referred by primary care doctors to an open-access 13-carbon urea breath test service over a 2-year period for their first urea breath test were included in the study. Individual breath results were linked with data on prescribing obtained from the General Medical Services prescription database. RESULTS: Of 805 patients, 374 (47%) had a positive urea breath test and 431 (54%) a negative urea breath test. Of positive urea breath test patients, only 245 (64%) were prescribed eradication therapy in the 3 months after the breath test and only 43% were referred back for re-testing. In the year after the urea breath test, there was a significant fall in prescribing of antisecretory therapy which was greatest in the patients who received H. pylori therapy (P < 0.001). CONCLUSIONS: There appears to be under and inappropriate treatment of H. pylori infection in primary care, and a low rate of re-testing after eradication, indicating that current guidelines are not well implemented in practice.

Adult↗
PubMed2006

Oxegen 2004: the impact of a major music festival on the workload of a local hospital.

This prospective observational study was undertaken to assess the impact of a major music festival on the workload of a local hospital. Data were collected on all attendances at Naas General Hospital from the nearby Oxegen 2004 music festival. Patient demographics, disposition and diagnoses were recorded. Emergency department activity levels were compared before, during and after the festival. Seventy-two attendees were referred to Naas emergency department over a 3-day period, representing a 45% increase in the hospital's emergency department attendance rate. Thirty-seven of these attendees (51%) required inpatient or tertiary centre services. Thirty-four attendees (47%) were noted as having consumed alcohol and/or used illicit substances. We conclude that despite the provision of on-site medical facilities, major music events are associated with a significant increase in local health care activity and expenditure.

Adolescent↗
PubMed2005

Proton pump inhibitors: a survey of prescribing in an Irish general hospital.

Prescription rates and attendant costs of proton pump inhibitors (PPIs) continue to rise. The aim of this study was to assess the extent and appropriateness of PPI prescribing in an Irish general hospital. Using a structured pro forma, we conducted a 1-day comprehensive survey of the prescription charts of all inpatients. Of the 157 inpatients, 48 (30.6%) were on PPI therapy and omeprazole was the most widely prescribed PPI. Rabeprazole, the least expensive PPI, was the least prescribed. Prescription of PPI therapy was for an approved indication in 32 patients (66.6%) but was for an unapproved or unknown indication in 16 (33.3%). Prescribing had been initiated in hospital in 34 patients (70.8%) but only one-third of the patients on PPI therapy had undergone endoscopy. Over 90% of patients were on additional, often multiple, prescribed medications. Our results suggest that PPIs are overprescribed in hospital practice, and there is scope to improve the quality and cost-effectiveness of PPI prescribing.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2003

Review article: test and treat or test and scope for Helicobacter pylori infection. Any change in gastric cancer prevention?

A 'test and treat' strategy is advocated for patients with dyspepsia under the age of 45 years, with endoscopy reserved for those with alarm symptoms or aged over 45 years. One of the consequences of this strategy will be a reduction in population infection rates of Helicobacter pylori. It is now clear that H. pylori is one of the prime initiators of gastric cancer with up to 70% of gastric cancers attributable to H. pylori. What remains unclear is if H. pylori reduction will lead to a reduction in gastric cancer.

Helicobacter Infections↗
PubMed2002

Symposium: Helicobacter pylori and clinical risks--focus on gastro-oesophageal reflux disease.

Helicobacter pylori is a gastric pathogen that is a major cause of peptic ulcer disease, has a role in mucosa-associated lymphoid tissue (MALT) lymphoma and is associated with gastric cancer. Yet, in a large proportion of the human population, H. pylori infection has no apparent adverse clinical consequences. Furthermore, recent research suggests that H. pylori may even confer protection against gastroesophageal reflux disease. The conflicting evidence surrounding H. pylori infection was discussed at a sponsored symposium in Helsinki, introduced by Professor P. Malfertheiner, with papers presented by Dr H. J. O'Connor, Professor R. M. Genta, Dr P. Unge and Professor A. T. R. Axon. Emerging epidemiological and retrospective evidence suggests that the presence of H. pylori infection may provide some protection against gastroesophageal reflux disease, but there is other evidence that shows no benefit of H. pylori for the protection of the oesophagus. It was felt that prospective, multicentre studies are needed to explore the H. pylori-gastroesophageal disease relationship further, to avoid confusing potential benefits with known risks. Following the symposium, a discussion on the relative risks and benefits for H. pylori eradication was provided by Professor Axon and Professor Blaser. Eradication of H. pylori has been recommended in a series of management guidelines issued by consensus groups. However, accurate estimates of the relative risks and benefits of H. pylori infection in the general population, as well as in specific patient groups, is essential in order to develop a management strategy.

Anti-Ulcer Agents↗
PubMed2002

Helicobacter pylori and dyspepsia: physicians' attitudes, clinical practice, and prescribing habits.

BACKGROUND: Consensus guidelines have been published on the management of Helicobacter pylori infection and it is assumed that these guidelines are adhered to in clinical practice. AIM: To assess the changing attitudes of medical practitioners to H. pylori, and the impact of H. pylori infection on everyday clinical practice and prescribing patterns. METHODS: Data for this review were gathered up to December 2000 from detailed review of medical journals, the biomedical database MEDLINE, and relevant abstracts. RESULTS: Physician surveys show widespread acceptance of H. pylori as a causal agent in peptic ulcer disease. Gastroenterologists adopted H. pylori therapy for peptic ulcer earlier and more comprehensively than primary care physicians. Despite a low level of belief in H. pylori as a causal agent in non-ulcer dyspepsia and gastro-oesophageal reflux disease (GERD), H. pylori therapy is widely prescribed for these conditions. Proton pump inhibitor-based triple therapy is the eradication regimen of choice by all physician groups. In routine clinical practice, there appears to be significant under-treatment of peptic ulcer disease with H. pylori therapy, but extensive use for non-ulcer indications. Prescription of H. pylori treatment regimens of doubtful efficacy appears commonplace, and are more likely in primary care. Despite the advent of H. pylori therapy, the prescription of antisecretory therapy, particularly of proton pump inhibitors, continues to rise. CONCLUSIONS: Publication of consensus guidelines per se is not enough to ensure optimal management of H. pylori infection. Innovative and ongoing educational measures are needed to encourage best practice in relation to H. pylori infection. These measures might be best directed at primary care, where the majority of dyspepsia is managed.

Anti-Bacterial Agents↗
PubMed1999

Review article: Helicobacter pylori and gastro-oesophageal reflux disease-clinical implications and management.

A significant proportion of patients with gastro-oesophageal reflux disease (GERD) have Helicobacter pylori infection, but it is unclear whether or not H. pylori should be treated in this clinical setting. The aim of this review was to critically assess the relationship between H. pylori and GERD and its potential implications for the management of GERD. Data for this review were gathered from the following sources up to April 1998-the biomedical database MEDLINE, a detailed review of medical journals, and a review of abstracts submitted to relevant international meetings. On average, 40% of GERD patients carry H. pylori infection, with a reported infection prevalence ranging from 16% to 88%. To date, there has been no reported controlled trial of effective H. pylori therapy in GERD. GERD has been reported to develop de novo following the cure of H. pylori in peptic ulcer disease. In the presence of H. pylori, proton pump inhibitor therapy appears to accelerate the development of atrophic corpus gastritis, a potentially precancerous condition. Conversely, proton pump inhibitor therapy seems to become less effective after cure of H. pylori. The mechanisms underlying these important contrasting phenomena are poorly understood. The relationship between H. pylori and GERD is complex, and it is difficult to give definitive guidelines on the management of H. pylori infection in GERD. Controlled trials of H. pylori therapy in GERD are urgently needed, as well as further long-term data on both the natural history of gastric histopathological changes in the H. pylori-positive GERD patient treated with proton pump inhibitors, and the impact of H. pylori status on the clinical efficacy of antisecretory therapy. Pending these data, it is perhaps advisable to advocate cure of H. pylori in young patients with proton pump inhibitor-dependent GERD who, in the absence of anti-reflux surgery, are faced with the likelihood of long-term medical therapy.

Barrett Esophagus↗
PubMed1998

Lansoprazole triple therapy for Helicobacter pylori--is 5 days enough?

BACKGROUND: Seven-day proton pump inhibitor triple therapy is currently the treatment of choice for Helicobacter pylori infection. It is unclear whether triple therapy for less than 7 days might preserve efficacy while at the same time improving patient acceptability and compliance. AIM: To evaluate the Helicobactericidal efficacy, ulcer healing capacity and patient acceptability of a 5-day lansoprazole-based triple therapy regimen. METHODS: Sixty-nine consecutive patients with H. pylori-positive peptic ulcer received lansoprazole 30 mg twice daily in combination with metronidazole 400 mg twice daily and clarithromycin 250 mg twice daily for 5 days. Ulcer healing medication was not continued after the 5-day regimen. H. pylori status was assessed before and at least 4 weeks after therapy by rapid urease test and histology. Adverse events and compliance were assessed by direct questioning. RESULTS: All 69 patients attended for repeat endoscopy and 63 were H. pylori-negative after therapy giving a cure rate of 91%, (95%, Cl: 85-98%). Of the 59 patients with active ulcers, 58 were healed at repeat endoscopy giving an ulcer healing rate of 98% (95% Cl: 92-100%). All patients fully complied with therapy and mild adverse events, mainly gastrointestinal, were reported by 11 patients (16%). CONCLUSIONS: Five-day lansoprazole triple therapy is an effective regimen for H. pylori infection which combines a high cure rate and ulcer healing efficacy with the advantages of excellent patient acceptability and compliance.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1997

Suprapapillary fistulosphincterotomy at ERCP: a prospective study.

BACKGROUND AND STUDY AIMS: The role of the needle knife at endoscopic retrograde cholangiopancreatography (ERCP) remains controversial, with conflicting views being held on the value and safety of this device. The aim of the present study was to assess prospectively the value and safety of suprapapillary fistulosphincterotomy (FS) in the endoscopic management of biliary disease. PATIENTS AND METHODS: Suprapapillary fistulosphincterotomy was performed when biliary cannulation had failed after attempting to opacify the bile duct for 30 minutes, initially with a standard diagnostic cannula and then by further attempts with a tapered cannula. The second indication for suprapapillary fistulosphincterotomy was inability to obtain satisfactory cannulation with the sphincterotome in patients in whom cholangiopancreatography showed pathology requiring endoscopic sphincterotomy. Using this technique, an opening was created into the intraduodenal segment of the common bile duct at a point on the vertical axis 3-5 mm proximal to the papillary orifice. The opening was then cannulated, and extended as required to facilitate clearance of stones or stent insertion. RESULTS: Of 531 consecutive patients, 83 (16%) underwent suprapapillary fistulosphincterotomy, and biliary cannulation was achieved in 74 of the 83 (89%). If suprapapillary fistulosphincterotomy had not been used, the diagnostic success rate would have fallen from 513 out of 531 (97%) to 451 out of 531 (85%) (P = 0.0001); the clearance rate for duct stones would have fallen from 150 out of 156 (96%) to 130 out of 156 (83%) (P = 0.0003); and successful stent insertion would have fallen from 52 out of 59 (88%) to 38 out of 59 (64%) (P = 0.0044). There were no fatalities following suprapapillary fistulosphincterotomy. Complications occurred in five of the 83 patients (6%) who underwent fistulosphincterotomy, compared with five of the 448 patients (1%) who did not undergo the procedure (P = 0.01). CONCLUSIONS: Our results suggest that suprapapillary fistulosphincterotomy is a valuable adjunct in the management of biliary disease at ERCP, but, in view of the increased risk of complications, it should be reserved for patients in whom the index of suspicion for biliary disease is high and further endoscopic treatment is likely.

Adolescent↗
PubMed1997

One week triple therapy for Helicobacter pylori: does high-dose clarithromycin confer additional benefit?

BACKGROUND: Clarithromycin, a new acid stable macrolide antibiotic with proven efficacy against Helicobacter pylori, has been widely incorporated into eradication regimens but its optimal dosage schedule remains controversial. The standard dose of clarithromycin is 250 mg twice daily. METHODS: In a prospective study designed to evaluate the helicobactericidal efficacy, patient acceptability, and ulcer healing efficacy of a triple therapy regimen incorporating high dose clarithromycin, 100 consecutive patients with H. pylori-positive peptic ulcer received omeprazole 20 mg twice daily in combination with metronidazole 400 mg twice daily and clarithromycin 500 mg twice daily for seven days. H. pylori status was assessed before and at least 4 weeks after therapy by rapid urease test and histology. Adverse events and compliance were assessed by direct questioning. RESULTS: Only two patients failed to attend for repeat endoscopy, leaving 98 evaluable patients. Of these, 94 were H. pylori-negative after therapy, giving an intention-to-treat eradication rate of 94% (95% confidence interval, 89%-99%). The ulcer healing rate was 92% (86%-98%), and ulcer healing was significantly associated with H. pylori eradication (p < 0.01). Adverse events were reported by 33% of patients of which nausea was the commonest (14%). Noncompliance with therapy was significantly associated with H. pylori treatment failure (p < 0.001). CONCLUSIONS: Seven day triple therapy incorporating high dose clarithromycin effectively eradicates H. pylori and heals ulcers, but it is disadvantaged by a relatively high rate of adverse events. In view of these findings and the fact that no direct comparison to date has shown increased efficacy from high dose clarithromycin, we would recommend continued use of low dose clarithromycin when combined with omeprazole and a nitroimidazole.

Adult↗
PubMed1995

Effect of Helicobacter pylori eradication on peptic ulcer healing.

In a prospective study designed to assess the effect of Helicobacter pylori eradication on peptic ulcer healing, 85 consecutive patients with H. pylori-positive peptic ulcer disease were treated with a triple therapy regimen consisting of colloidal bismuth subcitrate 120 mg four times daily for 28 days, with metronidazole 400 mg three times daily and tetracycline 500 mg three times daily for the first seven days of treatment. H. pylori status was assessed by CLO test and histology at least four weeks after completing therapy. Of 75 patients (88%) H. pylori-negative after therapy, 69 (92%) had healed ulcers compared with only five of 10 patients (50%) who remained H. pylori-positive (p = 0.003). Cigarette smoking had no significant effect on ulcer healing. Our results suggest that H. pylori eradication may accelerate ulcer healing and provide further evidence that an effective helicobactericidal regimen is the treatment of choice in H. pylori-positive peptic ulcer.

Adult↗
PubMed1994

Helicobacter pylori and gastro-oesophageal reflux disease--a prospective study.

In a prospective evaluation of the relationship between Helicobacter pylori infection and gastro-oesophageal reflux disease (GORD), 93 consecutive patients (47 female: 46 male: mean age, 46 years: range 13-93) with symptoms and endoscopic evidence of GORD were studied. A total of 50 patients (54%) were H. pylori-positive on gastric antral biopsies. No significant correlation was detected between H. pylori status and grade of oesophagitis. The prevalence of H. pylori infection showed a gradual increase with age. Of 64 patients with a hiatal hernia, 28 (44%) had histological evidence of H. pylori infection of the hernia mucosa; 27 of these patients (96%) had associated H. pylori in the gastric antrum. Of the 36 patients whose hiatal hernia was H. pylori-negative, only 6 (17%) had antral H. pylori (P < 0.001). Of the 8 patients found to have Barrett's oesophagus, only 1 had H. pylori detected on the Barrett's mucosa. Our results do not support the presence of a significant association between H. pylori infection and GORD.

Adolescent↗
PubMed1994

Eradication of Helicobacter pylori.

PURPOSE: To critically review current indications and therapies for Helicobacter pylori eradication. DATA IDENTIFICATION: Studies selected for this review were identified from Medline and a manual search of the literature. RESULTS OF DATA ANALYSIS: The clearest indication for H. pylori eradication is in the treatment of H. pylori-positive duodenal and gastric ulcer since eradication of the infection prevents ulcer relapse, effectively curing the disease. The use of anti-H. pylori therapy in non-ulcer dyspepsia remains controversial and further studies are required. Despite strong circumstantial evidence linking H. pylori and gastric cancer, it is premature to advocate H. pylori therapy for primary prevention of neoplasia. Triple therapy (bismuth, metronidazole, tetracycline) can eradicate H. pylori in over 90% of cases but this multidrug regimen is not ideal because of side effects, possible non-compliance and doubtful efficacy against metronidazole-resistant infection. Proton-pump inhibitor-antibiotic combinations are a promising alternative to triple therapy with few side effects and good compliance, but there is uncertainty about the most effective combination. H. pylori reinfection after successful eradication is unusual (< 1% per year). CONCLUSIONS: H. pylori eradication is now the treatment of choice in H. pylori-positive peptic ulcer disease. The search continues for the ideal H. pylori treatment regimen which will combine high efficacy, safety and patient acceptability, with low cost.

Anti-Bacterial Agents↗
PubMed1994

The role of Helicobacter pylori in peptic ulcer disease.

There is now a persuasive body of evidence linking Helicobacter pylori infection and peptic ulcer disease. Over 90% of duodenal ulcer and 70% of gastric ulcer patients are infected with H. pylori. Only a minority of infected patients develop ulcers, however, and host cofactors, rather than H. pylori strain, are probably critical to the development of peptic ulcer in infected individuals. Conversely, not all ulcers are associated with H. pylori, and in these cases enterogastric reflux and non-steroidal anti-inflammatory drug ingestion may be important. Eradication of H. pylori dramatically reduces ulcer relapse, effectively curing the disease. Eradication may also accelerate duodenal ulcer healing. Triple therapy with bismuth and antibiotics is effective against H. pylori, but there are problems with side effects, compliance and antibiotic resistance. Encouraging results are emerging on the efficacy and safety of omeprazole/antibiotic combination therapy, and this novel approach to H. pylori eradication is an exciting development. H. pylori has established itself as a pivotal factor in peptic ulcer disease and an effective helicobactericidal regimen is now the most rational and cost-effective treatment.

Anti-Bacterial Agents↗