PubMed Health⌕ Search

Biomedical subjects

J Labenz

Publications and source records attributed to J Labenz.

At least 73 records · Page 4Linked to original sources
PubMed1997

[Helicobacter pylori: pretherapeutic resistance status in Germany (Ruhr area)].

BASIC PROBLEM AND OBJECTIVE OF STUDY: The situation of pretherapeutical antimicrobial drug resistance of Helicobacter pylori has therapeutical implications. For this reason the present study was designed to evaluate the frequency of resistance in Germany. MATERIAL AND METHODS: A total of 201 H. pylori isolates cultured on the basis of biopsies taken by routine gastroscopies were tested for resistance by E-test. The antibiotics examined were amoxicillin, tetracycline, clarithromycin and metronidazole. For further analysis the last 101 patients were asked for demographical and clinical data that were evaluated for a correlation with metronidazole resistance. RESULTS: Pretherapeutical resistance against amoxicillin and tetracycline was not detected. The rate of drug resistance against clarithromycin came to 3% and against metronidazole to 29%. There was a higher incidence of metronidazole resistance in female patients (Odds ratio 1.71; p = n.s.). Reliable predictors for metronidazole resistance, however, could not be identified. CONCLUSIONS: About 30% of H. pylori isolates are pretherapeutically resistant to metronidazole. Resistance to clarithromycin is still rare, but further monitoring remains necessary to detect changes in the community.

Amoxicillin↗
PubMed1997

Prevalence and pattern of Helicobacter pylori gastritis in the gastric cardia.

OBJECTIVES: Helicobacter pylori has a predilection for antral colonization. Local acid production is the major determinant of colonization. Because production is low in the antrum and cardia, H. pylori should also colonize the cardia. We therefore investigated the histologic pattern of gastritis and the prevalence of H. pylori in the cardia compared with the antrum and corpus. METHODS: From 135 H. pylori-infected patients with gastritis, ulcer disease, or reflux esophagitis, biopsies were obtained from the antrum, corpus, and cardia. The prevalence, topography, and histologic parameters of gastritis were examined. RESULTS: All 135 patients had active antral H. pylori gastritis: in the cardia, 132 of these patients (97.7%) showed active gastritis, and 124 patients (91.9%) had H. pylori visible on staining. Gastritis of the cardia in most patients resembled antral gastritis, but the density of bacteria and the inflammatory responses were less marked. The most striking finding in the cardia of patients with gastroesophageal reflux was a lower density of bacteria compared with antrum and corpus. Intestinal metaplasia was found in 32 patients in antral mucosa (23.7%) versus 28 patients in the cardia (20.7%), versus 11 patients in the corpus (8.1%), and was multifocal in 17 patients (12.6%). CONCLUSIONS: H. pylori gastritis commonly involves the cardia. The histologic density of the bacteria and inflammatory responses are lower than in the antrum. Intestinal metaplasia in the cardia is a common finding in H. pylori gastritis. The cause of the lower bacterial density in the cardia of patients with reflux esophagitis needs further investigation.

Atrophy↗
PubMed1996

[Ulcer healing through the elimination of Helicobacter pylori: is a week of therapy enough?].

AIM OF STUDY: To test whether one week's triple therapy with omeprazole and two antibiotics is enough to induce healing of a peptic (gastric and/or duodenal) ulcer. PATIENTS AND METHODS: 112 Patients (73 males, 39 females; median age 55 [18-88] years) proven by culture or histology to have an Helicobacter (H.) pylori infection and uncomplicated peptic (gastroduodenal) ulcer. For one week they received omeprazole (20 mg once or twice daily) plus two antibiotics (clarithromycin/metronidazole, clarithromycin/tetracycline, clarithromycin/amoxycillin or amoxycillin/metronidazole) to eradicate H. pylori. No further anti-ulcer treatment was given subsequently. Healing of the ulcer and H. pylori status were checked by the urease test, culture and histology (endoscopic biopsy) 4 weeks later. RESULTS: The 5-week ulcer healing rate was 94.6% (95% confidence interval: 89-98%). Persisting ulcers (n = 6) were associated with either treatment with aspirin or nonsteroidal antiinflammatory drugs (n = 3), persistent H. pylori infection (n = 2) or persistent H. pylori infection plus treatment with aspirin (n = 1). The ulcer healing rate was significantly higher in patients with eradicated infection than in those with posttherapy persistence of H. pylori (97.0 vs. 76.9%; P = 0.02). There were no significant differences after 5 weeks between patients with duodenal and those with gastric ulcer (97.4 vs. 89.3%). CONCLUSIONS: One-week effective eradication treatment is adequate to induce healing of H. pylori-positive peptic ulcers. Anti-ulcer treatment after eradication of H. pylori should be considered only if the patient is receiving treatment with ulcerogenic drugs or continues to have symptoms.

Adolescent↗
PubMed1996

One-week triple therapy with omeprazole, amoxycillin and either clarithromycin or metronidazole for cure of Helicobacter pylori infection.

AIM: The present study was designed to evaluate the efficacy and tolerability of 1-week triple therapy regimens for Helicobacter pylori. METHODS: In two consecutive series, 120 patients with proven H. pylori infection and peptic ulcer disease or functional dyspepsia were treated with either omeprazole 20 mg b.d., amoxycillin 1 g b.d. and clarithromycin 250 mg b.d. (OAC; n = 60) or with omeprazole 20 mg b.d., amoxycillin 1 g b.d. and metronidazole 400 mg b.d. over 1 week (OAM; n = 60). H. pylori infection was assessed by rapid urease test, culture and histology before and 4 weeks after cessation of the eradication therapy. RESULTS: H. pylori eradication succeeded in 53 out of 60 patients by omeprazole-amoxycillin-clarithromycin (OAC) (88%; 95% CI 77-95%) and in 47 out of 60 patients by omeprazole-amoxycillin-metronidazole (OAM) (78%; 95% CI 66-88%) (P = 0.22). Nine patients of each group available for follow-up reported adverse events (15.0 and 15.5%, respectively) without necessity of discontinuation of the study medications. Serious adverse events were not observed. CONCLUSIONS: Simple and convenient 1-week triple therapies consisting of omeprazole, amoxycillin and either clarithromycin or metronidazole are sufficiently effective in eradicating H. pylori infection.

Adolescent↗
PubMed1996

Helicobacter pylori augments the pH-increasing effect of omeprazole in patients with duodenal ulcer.

BACKGROUND & AIMS: Omeprazole is less effective in healthy subjects than in patients with duodenal ulcers. The aim of this study was to determine whether Helicobacter pylori augments the pH-increasing effect of omeprazole in patients with duodenal ulcers. METHODS: In 16 patients with duodenal ulcers, baseline intragastric acidity was measured before and 4-6 weeks after the cure of H. pylori infection. In 17 patients with duodenal ulcers, 24-hour pH metry was performed during treatment with 20 mg omeprazole once daily before as well as after eradication of H. pylori. Intragastric acidity was measured using a glass electrode placed 5 cm below the cardia. H. pylori infection was assessed by [13C] urea breath test, culture, histology, and rapid urease test. RESULTS: H. pylori eradication resulted in marked decrease of the pH-increasing effect of omeprazole (24-hour median gastric pH, 5.5 vs. 3.0; P<0.002) that was most pronounced during nighttime (median gastric pH, 6.4 vs. 2.1; P=0.001). On the other hand, baseline intragastric pH remained unchanged after eradication (median gastric pH, 1.0 vs. 1.1; P=0.5). CONCLUSIONS: In patients with duodenal ulcers treated with omeprazole, intragastric pH depends significantly on the presence or absence of H. pylori, whereas baseline pH remained unchanged after H. pylori eradication.

Adult↗
PubMed1996

Intragastric pH during treatment with omeprazole: role of Helicobacter pylori and H. pylori-associated gastritis.

BACKGROUND: Omeprazole treatment produces lower intragastric pH values 4 weeks after cure of Helicobacter pylori infection than before. We therefore investigated the effect of healing H. pylori-associated gastritis on intragastric pH in the presence and in the absence of omeprazole therapy. METHODS: Before and on day 8 of omeprazole, 20 mg once daily, 24-h intragastric pH-recordings were performed in 14 subjects with H. pylori infection and repeated 4 and 52 weeks after cure of infection. Gastritis severity in corpus and antrum was graded by using a modified Sydney system. RESULTS: In the absence of omeprazole administration, median 24-h pH values before cure did not differ from those 4 and 52 weeks after cure. On day 8 of omeprazole administration, 24-h pH values were much higher before cure (median, 5.15; 95% confidence interval (CI), 4.3-6.0) than 4 weeks (3.6; 2.1-4.4; P < 0.001) and 52 weeks after cure (3.0; 2.1-4.4; P < 0.001). The activity of corpus and antral gastritis was not associated with the magnitude of H+ change induced by omeprazole. CONCLUSION: The increased pH produced by omeprazole during H. pylori infection is likely to be due to neutralizing substances produced by H. pylori and not to H. pylori-induced gastritis.

Adult↗
PubMed1996

Long-term consequences of Helicobacter pylori eradication: clinical aspects.

Helicobacter pylori is probably the most important factor in the pathogenesis of peptic ulcer disease in the absence of other precipitating factors, such as the intake of ulcerogenic drugs. Clinical studies have shown convincingly that eradication of H. pylori dramatically alters the long-term natural history of this chronic relapsing disorder, and that ulcer recurrences following eradication are rare. Available evidence also suggests that figures for H. pylori reinfection are low in adults in developed countries following eradication. In addition, H. pylori eradication may prevent peptic ulcer bleeding or rebleeding. Curing H. pylori infection significantly increases the quality of life of patients with duodenal ulcer disease and is, to date, the most cost-effective treatment in the long-term management of this disease. Ulcer patients presenting with recurrent dyspeptic symptoms after apparently successful eradication of H. pylori should be checked for ulcer and H. pylori recurrence, as well as for reflux oesophagitis, which has been shown to occur in about 9% of patients with duodenal ulcer disease and previously cured of H. pylori infection. We would also argue that H. pylori infection in young patients with dyspepsia should be treated, although this issue will remain controversial until well-designed, placebo-controlled studies establish the real benefits of eradication therapy in the long-term treatment of this disease.

Adult↗
PubMed1995

Intragastric acidity as a predictor of the success of Helicobacter pylori eradication: a study in peptic ulcer patients with omeprazole and amoxicillin.

Omeprazole plus amoxicillin cures Helicobacter pylori infection. The hypothesis was tested that low acidity is a predictor of outcome. Fifty patients with relapsing or complicated, or both H pylori positive duodenal (n = 25) or gastric ulcer (n = 25) were randomly treated with either omeprazole 20 mg twice daily plus amoxicillin 1 g twice daily or with omeprazole 40 mg twice daily plus amoxicillin 1 g twice daily over two weeks. After one week of combined treatment, a 24 hour gastric pH measurement was performed in all patients. H pylori cure rate was 67%. Patients who later turned out to be cured had higher pH values during night time and after meals (p < 0.05). In an explorative analysis drug compliance, smoking, location of the ulcer (duodenum versus stomach), age, and grade of body gastritis were additional predictors of the outcome. Smoking (p = 0.006), compliance (p = 0.037), duodenal ulcer disease (p = 0.065), and young age (p = 0.021) were related to high acidity. In conclusion, the success of eradication treatment with omeprazole and amoxicillin in ulcer patients infected with H pylori depends on intragastric pH. Drug compliance, smoking habits, location of ulcer, age, and activity of body gastritis are other predictors and in part related to intragastric acidity.

Adult↗
PubMed1995

Effect of curing Helicobacter pylori infection on intragastric pH during treatment with omeprazole.

It has been shown that omeprazole treatment produces higher intragastric pH values in Helicobacter pylori positive subjects than in H pylori negative subjects. This study aimed to investigate the effect of curing H pylori on the intragastric pH in both the presence and absence of omeprazole therapy. Twenty four hour intragastric pH recordings were performed before and after a one week course of omeprazole (20 mg once daily) in 18 H pylori positive subjects and were repeated after the infection had been cured. In the absence of omeprazole, the total 24 hour pH values before cure did not differ from those afterwards. During omeprazole treatment the 24 hour pH values were much higher before (median (95% CI) 5.4: 4.3, 6.0), than after cure of infection (3.6: 2.1, 4.4; p < 0.001). The omeprazole induced fall in H+ activity before cure of H pylori did not, however, differ from that afterwards. It is concluded that the apparently greater antisecretory effect of omeprazole during H pylori infection may be a result of the production of acid neutralising compounds by the H pylori. Although a direct interaction between H pylori and omeprazole cannot be excluded, it seems unlikely.

Adult↗
PubMed1995

High-dose omeprazole plus amoxicillin or clarithromycin cures Helicobacter pylori infection in duodenal ulcer disease.

Treatment with omeprazole plus amoxicillin or clarithromycin resulted in encouraging Helicobacter pylori cure rates in pilot and controlled studies. The present prospective, randomized study was designed to compared the efficacy and safety of amoxicillin and clarithromycin as constituents of omeprazole-enhanced antibiotic therapy of H. pylori infection. Fifty patients with active duodenal ulcer disease and histologically and/or culturally confirmed H. pylori colonization of the gastric mucosa were treated with omeprazole (day 1-14: 40 mg twice daily, day 15-42: 20 mg once in the morning). The patients were randomly assigned to receive either amoxicillin (1 g twice daily; group I: n = 25) or clarithromycin (500 mg twice daily; group II: n = 25) during the first 2 weeks of treatment. The patients of group I and II had comparable demographic and clinical characteristics. One patient of group I was lost to follow-up. H. pylori infection was cured in 87.5% of group I and 84.0% of group II (p = 1.00). All ulcers had healed after 6 weeks of omeprazole treatment. Pain relief occurred within the first day of treatment in the majority of patients of both groups (p = 0.89). Minor side effects were recorded in 6 patients of group I and in 4 patients of group II (25 vs. 16%; p = 0.50). In 1 female patient amoxicillin had to be withdrawn after 3 days because of nausea and emesis. In conclusion, 2 weeks of treatment with omeprazole plus amoxicillin or clarithromycin are highly and equally effective regimens to cure H. pylori infection in patients with duodenal ulcer disease.

Amoxicillin↗