PubMed Health⌕ Search

Biomedical subjects

J P Gisbert

Publications and source records attributed to J P Gisbert.

At least 91 records · Page 5Linked to original sources
PubMed2001

Helicobacter pylori therapy: first-line options and rescue regimen.

In the present paper, several points regarding Helicobacter pylori treatment are reviewed, with the following conclusions: (1) all different proton pump inhibitors (PPIs) are equivalent when prescribed with antibiotics; (2) ranitidine bismuth citrate is equal to or, in some cases with antibiotic resistance, more effective than PPI; (3) previous treatment with PPI does not seem to affect the rate of eradication obtained with PPI plus two antibiotics; (4) just 1 week of PPI is enough to obtain duodenal ulcer healing, provided that H. pylori eradication is achieved; (5) the eradication rates seem to be higher in peptic ulcer than in nonulcer dyspepsia; (6) in areas where the prevalence of metronidazole resistance is high, triple therapy including a PPI, clarithromycin, and amoxicillin is the best option, and (7) quadruple therapy (PPI, bismuth, tetracycline, and metronidazole) is the recommended second-line therapy after PPI-clarithromycin-amoxicillin failure, although replacing the PPI and the bismuth compound by ranitidine bismuth citrate achieves also good results.

Amoxicillin↗
PubMed2001

Epidemiology of inflammatory bowel disease in Spain. A systematic review.

BACKGROUND AND OBJECTIVES: Incidence and prevalence of Inflammatory Bowel Disease (IBD) differ considerably depending on the geographical region studied. In Spain, both Ulcerative Colitis (UC) and Crohn's Disease (CD) seem to have experienced an important change in terms of incidence during the past decades. Our aim was to systematically review the experience in Spain regarding the epidemiology of IBD, in particular its incidence, its geographical differences and its evolution over time. METHODS: A bibliographical search till January 2000 was conducted in Internet using the PubMed search motor and the following descriptors or key words: "Crohn's disease", "Ulcerative colitis", "Inflammatory bowel disease", "Spain" and "Spanish". Only publications providing data on IBD incidence among Spanish patients were included. References from articles that fulfilled the selection criteria were also reviewed. The endpoints considered in the review were IBD incidence rate, its geographical differences, and its evolution over time. RESULTS: UC incidence reported by different studies performed in Spain ranges from 0.6 to 8 cases/10(5)/year, with a mean value of 3.8. CD incidence rates in Spain ranges from 0.4 to 5.5 cases/105/year, with a mean value of 1.9. Some studies have shown differences in IBD incidence between regions in our country. Many studies have reported an increase in IBD incidence in Spain over time, although such increase is more evident in the case of CD. CONCLUSIONS: UC incidence in Spain ranges from 0.6 to 8 cases/105/year, with a mean value of 3.8. CD figures range from 0.4 to 5.5 cases/105/year, with an average rate of 1.9. IBD incidence seems to be relatively different depending on the geographical region studied. Finally, several authors have demonstrated an increase in IBD incidence in Spain over time, although such increase seems to be more evident in the case of CD. Consequently, IBD in Spain is no longer considered a rare disease, but a relatively frequent one.

Humans↗
PubMed2001

Geographic differences and the role of cagA gene in gastroduodenal diseases associated with Helicobacter pylori infection.

Helicobacter pylori (H. pylori) is the major causal agent of gastritis, peptic ulcer and gastric cancer. Several bacterium genes seem to be involved in the pathogenicity mechanism. One of them, the cagA gene, has been extensively studied and characterized. In this article we have carried out a study of characteristics and genetic variability of cagA gene in different geographic areas of the world. At the same time, we have summarized several studies that evaluate possible relation of cagA with gastroduodenal diseases associated by H. pylori infection. In our study we found that the presence of the cagA gene has been confirmed in more than 60% H. pylori strains distributed throughout the world. The prevalence of cagA genotype is of 65.4% in gastritis patients, 84.2% in patients with peptic ulcer and 86.5% in those with gastric cancer. It shows a high genetic variability of cagA associated with gastroduodenal diseases that could serve as a virulence marker in H. pylori infected subjects. However, the high prevalence of H. pylori cagA positive strains in some geographic areas does not confirm the strong association between cagA and virulence of strains as described in other countries. Nowadays, cagA gene is considered as a marker for the presence of cag pathogenicity island (cag-PAI) in H. pylori genoma. This region contains several genes that has been involved with the production of cytokines that results in an increased inflammation of host gastric mucosa, but its function is unknown. Probably, others bacterium factors, such as susceptibility host and environmental cofactors could influence in the risk of developing different gastroduodenal diseases associated with H. pylori infection.

Antigens, Bacterial↗
PubMed2000

[Effects of Helicobacter pylori eradication on the recurrence of gastric ulcer during a 12-month follow up].

BACKGROUND: To study the influence of Helicobacter pylori eradication on the incidence of ulcer recurrence during 12 months of follow-up in gastric ulcer patients. PATIENTS AND METHOD: Seventy-three patients with gastric ulcer were prospectively studied. At endoscopy two biopsies from both antrum and body for haematoxylin-eosin staining and one for rapid urease test were obtained. Likewise, serology and 13C-urea breath test were carried out. Fifty-six H. pylori infected patients were monitored after giving an eradication therapy with omeprazole, clarithromycin and amoxicillin. A first control endoscopy was performed immediately after completing treatment to confirm ulcer healing. A second control endoscopy (with histologic study) and a breath test were performed one month after completing therapy (eradication was defined as the absence of H. pylori by both methods). Finally, an endoscopy was repeated at 6 and 12 months to study ulcer recurrences. RESULTS: Mean age was 54 +/- 13 years (69% males). Cumulative ulcer recurrence rate for 12 months, respectively for patients with eradication success and failure, was 2.3% (95% CI, 0-12%) and 70% (34-93%) (chi 2: 23.9; p < 0.0001). Comparison between Kaplan-Meier curves for ulcer recurrence depending on H. pylori eradication showed significant differences (log-rank test; chi 2: 33.8; p < 0.0001). A patient successfully treated underwent ulcer recurrence while receiving treatment with acetylsalicylic acid, without recurrence of the infection. CONCLUSIONS: H. pylori eradication is associated with a dramatic reduction on the recurrence of gastric ulcer, with a cumulative recurrence rate during 12 months of only 2.3%, which suggests that definitive cure of gastric ulcer disease is possible by means of microorganism eradication.

Adult↗
PubMed2000

[Antibodies against Helicobacter pylori in saliva. Study of their validity versus breath test and its agreement with serology].

OBJECTIVES: To evaluate prospectively the validity of a new diagnostic method based on a saliva sample, taking as reference the breath test with 13C-marked urea, and to compare the results of this technique with another indirect method based on the detection of antibodies, "classical" serology using venous blood. METHODS: 48 individuals, 24 healthy volunteers and 24 consecutive patients with gastro-duodenal ulcer disease, were studied prospectively. Treatment during the previous month with gastro-erosive medication, antibiotics, proton-pump inhibitors or bismuth-derived drugs, prior treatment to eradicate H. pylori, gastric surgery and the presence of linked illnesses, were all considered criteria of exclusion from the study. For the diagnostic test in saliva a commercial enzyme-linked immunosorbent assay (ELISA, trademark Helisal) was used; and for blood serology, another commercial ELISA (Helico-G). The staff responsible for reading the saliva, serology and breath tests did not know the result of the other diagnostic methods. The result of the breath test with 13C-urea (TAU-kit) was taken as the reference standard for H. pylori infection. RESULTS: The mean age of the healthy volunteers was 23 +/- 0.7 years; and of ulcer patients, 55 +/- 18. The prevalence of H. pylori infection, valued by the gold standard, was 79.2% in the ulcer patients and 54% in the volunteers. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the saliva test in the ulcer patients were, respectively: 100% (95% CI, 79-99), 60% (17-93), 90% (68-98), 100% (31-97) and 92% (71-98). In the volunteers these figures were: 46% (20-74), 73% (39-93), 67% (31-91), 53% (27-78) and 58% (37-77). The serology results were better, with 100% sensitivity in both groups and outstanding diagnostic accuracy (92% and 96% for ulcer patients and volunteers, respectively). Concordance between serology and the saliva test in ulcer patients was perfect (kappa, 1). However, in asymptomatic individuals concordance was deficient (kappa, 0.28), and the prevalence of infection diagnosed with the two tests was not homogeneous (McNemar, 2.8; p < 0.05). CONCLUSION: The diagnostic test for H. pylori infection in saliva is lacking in diagnostic accuracy in healthy individuals, which indicates that it cannot be used for screening infection in the asymptomatic population. The technique is more valuable in ulcer patients, although it does not reach the specificity desirable. For these reasons, the saliva test evaluated in this study cannot be recommended for diagnosis of H. pylori infection.

Adult↗
PubMed2000

[Efficacy of four widely used techniques of the diagnosis of Helicobacter pylori infection in gastric ulcer disease].

OBJECTIVE: To study the accuracy of four currently used tests for the diagnostic of Helicobacter pylori infection among gastric ulcer patients with a gold standard as reference which combines several diagnostic methods. MATERIAL AND METHODS: Seventy-three consecutive gastric ulcer patients were prospectively studied. From all patients, three biopsies each were obtained from both antrum and body (two for haematoxylin-eosin staining and one for rapid urease test--Jatrox H.p. Test--. Also, IgG ELISA serology (Helico G) and 13C-urea breath test were performed. According to the gold standard, a patient was considered to be infected with H. pylori when at least two tests were positive; a patient was considered not to be infected with H. pylori when at least three tests were negative. RESULTS: Among gastric ulcer patients, the prevalence of H. pylori infection was 87.6% (95% CI: 78%-93%) with the gold standard as reference. The sensitivity and specificity values were as follows: histology (antrum), 96.8% (89%-99%) and 100% (66%-100%), respectively; histology (body), 98.4% (91%-100%) and 100% (66%-100%); urease test (antrum), 71.8% (60%-81%) and 100% (66%-100%); urease test (body), 96.8% (89%-99%) and 100% (66%-100%); breath test, 100% (94%-100%) and 100% (66%-100%), and serology, 95.3% (87%-98%) and 100% (66%-100%). The sensitivity of the urease test was higher with a body biopsy specimen (McNemar: 15; p < 0.001). CONCLUSIONS: All diagnostic tests (histology, rapid urease test, 13C-urea breath test and serology) are highly accurate for the diagnosis of H. pylori infection among gastric ulcer patients with the exception of the rapid urease test performed with antrum biopsy specimens, where this test displays a lower sensitivity for bacterial detection.

Biopsy↗
PubMed2000

[Effect of Helicobacter pylori eradication on histological lesions of gastric mucosa. An 18-month follow-up study].

OBJECTIVE: To evaluate the effect of Helicobacter pylori eradication on pathologic lesions over the gastric mucosa during an 18-month follow-up period. PATIENTS AND METHODS: A total of 122 duodenal ulcer patients infected with H. pylori were prospectively studied. Patients were randomized to receive: ranitidine alone, ranitidine plus antibiotics, or bismuth plus antibiotics. An endoscopy was performed at 3, 6, 12 and 18 months. Haematoxylin-eosin, Giemsa, and Warthin-Starry staining methods were used. Histologic lesions were classified according to the following score: normal (0); superficial chronic gastritis (CG): mild (0.5), moderate (1) and severe (1.5); atrophic CG: mild (2), moderate (3) and severe (4); intestinal metaplasia: absence (0), mild (1), moderate (2) and severe (3). The acute inflammatory activity (active CG) was scored from 0 to 3 (absence, mild, moderate, severe) regarding: inflammatory density in the lamina propria, density of plymorphonuclear leukocytes in the lamina propria, density of intra-epithelial polymorphonuclear leukocytes and superficial erosions. RESULTS: H. pylori eradication was achieved in 31% of patients (0% in the group of ranitidine alone and 48% in patients who received antibiotics). The score corresponding to CG declined progressively after H. pylori eradication, with average values of 2.1 +/- 1.3, 1.98 +/- 1.4, 1.73 +/- 1.6, 1.43 +/- 1.9 and 1.38 +/- 1.9 (p < 0.0001) at 0, 3, 6, 12 and 18 months, respectively. The corresponding score for active CG also improved progressively after eradication: 7.82 +/- 1, 2.51 +/- 0.7, 1.24 +/- 0.6, 0.45 +/- 1.6 and 0.12 +/- 0.5 (p < 0.0001). Nevertheless, no changes were observed regarding atrophia or intestinal metaplasia conditions. CONCLUSIONS: H. pylori eradication is associated with a histologic improvement of gastric mucosa. It begins early and continues for the 18 months after therapy. The improvement in the overall inflammatory component is slow and progressive. In contrast, improvement of the acute component in gastritis is more marked early, and is observed immediately after eradication. Nevertheless, H. pylori eradication is not followed by an improvement in atrophy or intestinal metaplasia.

Adolescent↗
PubMed2000

13C-phenylalanine and 13C-methacetin breath test to evaluate functional capacity of hepatocyte in chronic liver disease.

BACKGROUND: To grade liver damage, Child-Pugh classification is used but these tests do not reflect the quantitative functional hepatic reserve. AIMS: 13C-Phenylalanine Breath Test and 13C-Methacetin Breath Test are evaluated as possible tools, being both safe and easy to perform, to quantify functional hepatic reserve in chronic liver disease patients. PATIENTS: Both tests were performed in 48 healthy volunteers and 48 chronic liver disease patients. METHODS: Breath samples were collected after taking 13C-Phenylalanine (100 mg) and 13C-Methacetin (75 mg). 13CO2 enrichment was measured using mass spectrometry RESULTS: Both tests discriminated the hepatic function, decreasing results of the 13CO2 enrichment agreeing with the increasing severity of the hepatic patient (13C-Phenylalanine Breath Test multiple correlation coefficient: 0.72, global p<0.001; Methacetin Breath Test: 0.73, p<0.001). Correlation between 13C-Phenylalanine Breath Test and Methacetin Breath Test was 0.63, p<0.001. If both tests were pathological, the sensitivity for the diagnosis of hepatic dysfunction was high (98%), although the specificity decreased to 60%. Best results were obtained at 30 minutes with 13C-Phenylalanine Breath Test and at 10 minutes with Methacetin Breath Test. CONCLUSIONS: Both 13C-Phenylalanine Breath Test and Methacetin Breath Test are safe and easy tests to perform and both are able to discriminate the hepatic functional capacity between the different groups studied.

Acetamides↗
PubMed2000

A meta-analysis of short versus long therapy with a proton pump inhibitor, clarithromycin and either metronidazole or amoxycillin for treating Helicobacter pylori infection.

BACKGROUND: Although triple therapies with a proton pump inhibitor, clarithromycin and either amoxycillin or metronidazole are the most widely accepted treatment for Helicobacter pylori infection, there is no consensus on how long treatment should be maintained for. AIM: To evaluate whether increasing the length of triple therapies beyond 7 days improves treatment efficacy. METHODS: An extensive search of the literature was performed. Reports of randomized trials comparing different lengths of therapy were selected. Short (7-day) vs. long (10/14-day) therapies were compared, and three-way comparison of 7-day vs. 10-day, 10-day vs. 14-day and 7-day vs. 14-day therapies was performed. Meta-analysis was conducted using conventional shareware (Review Manager 4.0). The Peto Odds Ratio using a fixed model analysis was calculated for each comparison. RESULTS: Thirteen studies were identified. Pooled 10- to 14-day therapies achieved better results than 7-day schedules. In head-to-head comparisons, only 14-day therapies were significantly better than 7-day treatments. Improvement in cure rates ranged from 7 to 9%. Comparisons of 7-day vs. 10-day and 10-day vs. 14-day also showed a non-significant trend towards better cure rates with longer therapies. CONCLUSIONS: Fourteen-day, proton pump inhibitor-based triple therapy achieves better results than 7-day schedules. Additional data are necessary to evaluate 10-day therapies.

Amoxicillin↗
PubMed2000

Helicobacter pylori eradication: proton pump inhibitor vs. ranitidine bismuth citrate plus two antibiotics for 1 week-a meta-analysis of efficacy.

OBJECTIVE: To compare the efficacy of proton pump inhibitor vs. ranitidine bismuth citrate (RBC) with two antibiotics for 1 week in Helicobacter pylori eradication. METHODS: Randomized trials comparing 1-week regimens with (i) proton pump inhibitor plus two antibiotics [clarithromycin (C) and amoxycillin (A) or a nitroimidazole (N)]; or (ii) RBC plus the same antibiotics. Eradication was confirmed by histology or 13C-urea breath test at least 4 weeks after therapy. Data sources included PubMed database and abstracts from congresses until October 1999. Statistical analysis was by meta-analysis combining the odds ratios (OR) of the individual studies in a global OR (Peto method). RESULTS: Twelve studies met the selection criteria. Nine compared proton pump inhibitor vs. RBC plus C and A, and five compared proton pump inhibitor vs. RBC plus C and N. With RBC, C and A, mean H. pylori eradication efficacy by intention-to-treat analysis (pooled data) was 76.6% (95% CI: 72-81%) and 73.7% (95% CI: 69-78%) with proton pump inhibitor, C and A. The OR for the effect of RBC vs. proton pump inhibitor (plus C and A) on H. pylori eradication was 1.15 (95% CI: 0.8-1.64%). Mean H. pylori eradication with RBC, C and N was 87. 2% (95% CI: 83-91%), and 74.9% (95% CI: 74-84%) with proton pump inhibitor plus these two antibiotics. The OR for the effect of RBC vs. proton pump inhibitor (plus C and N) on H. pylori eradication was 1.76 (95% CI: 1.08-2.85%). CONCLUSION: RBC and proton pump inhibitor have similar efficacy for H. pylori eradication when given with C and A for 1 week, but RBC seems to have a higher efficacy than proton pump inhibitor when C and N are the co-prescribed antibiotics.

Amoxicillin↗
PubMed2000

Proton pump inhibitor, clarithromycin and either amoxycillin or nitroimidazole: a meta-analysis of eradication of Helicobacter pylori.

AIM: To perform a meta-analysis of studies comparing twice daily, one-week triple therapy with a proton pump inhibitor, clarithromycin (C) and amoxycillin (A) (PCA) vs. those using proton pump inhibitor, clarithromycin and a nitroimidazole (N) (PCN) for H. pylori eradication. REVIEW METHODS SELECTION CRITERIA: Comparative randomized trials of PCA vs. PCN were included. DATA SOURCES: PubMed database and abstracts from congresses until September 1999. STATISTICS: Meta-analysis was performed combining the Odds Ratios (OR) of the individual studies in a global OR (Peto method) both on an intention-to-treat (ITT) and on a per protocol (PP) basis. RESULTS: Twenty-two studies fulfilled the inclusion criteria. Eighteen studies reported ITT and 20 PP analysis. Mean H. pylori eradication rates were 81% (95% CI: 79-83%) ITT, and 84% (82-86%) PP with PCA, and 81% (78-83%) ITT and 84% (82-86%) PP with PCN; the odds ratio for the effect of PCA vs. PCN was 1 (0.83-1.22) on an ITT, and 0.98 (0.8-1.2) on a PP basis. Subanalysis showed that mean H. pylori eradication efficacy with PC(250 b.d.)A was 81% (78-85%) ITT, vs. 86% (83-89%) with PC(250 b.d.)N. The odds ratio for this comparison was 0.68 (0.48-0.98). Finally, when comparing PC(500 b.d. )A against PC(250 b.d.)N ITT cure rates were 77% (74-80%), and 75% (72-78%) with an odds ratio of 1.18 (0.93-1.5). CONCLUSION: Overall, one-week combination regimens of PCA and PCN present similar H. pylori eradication efficacy. Nevertheless, the PCN regimen obtains significantly better results when using low doses of C (250 mg b.d.).

Amoxicillin↗
PubMed2000

Value of quantitative serology for confirmation of Helicobacter pylori eradication: an 18-month follow-up study.

In this study several therapies were administered to 124 H. pylori-positive patients and IgG antibody titers were measured by ELISA at months 0, 2, 3, 6, 12, and 18 months. Serum titers of IgG antibody progressively decreased after H. pylori eradication; at 3 months, the area under the receiver operating characteristic curve for the decrease of IgG antibody titers for confirming H. pylori eradication was 0.99, with 100% sensitivity and 99% specificity (when the cutoff point was set at 3 U/mL). We conclude that a decrease in serum titers of IgG antibody to H. pylori relatively early after completion of therapy (1 month after ranitidine or bismuth therapy is completed and 2.5 months after antibiotic therapy is completed) can be used as a noninvasive, simple, and inexpensive method to confirm H. pylori eradication.

Adult↗
PubMed2000

Concordance between noninvasive tests in detecting Helicobacter pylori and potential use of serology for monitoring eradication in gastric ulcer.

Our aim was to determine concordance between 13C-urea breath test and serology in detecting Helicobacter pylori and to study their potential use for monitoring eradication in patients with gastric ulcer. We prospectively studied 73 gastric ulcer patients. On endoscopy, biopsies were taken for hematoxylineosin staining and rapid urease testing. Blood samples were drawn for immunoglobulin G antibody determination by enzyme-linked immunosorbent assay (ELISA). A 13C-urea breath test was performed as well. Histology, serology, and urea breath tests were all repeated 1, 6, and 12 months after therapy completion in 56 infected patients. A proportion of positive agreement between serology and breath test results as high as 0.95 was found. McNemar statistic was 3 (p = 0.08), whereas kappa statistic was 0.83 (p < 0.0001). At month 6, significant differences in patients successfully treated relative to baseline serologic values were observed (chi2 = 11.7; p < 0.001). The area under the receiver operating characteristic (ROC) curve for diagnostic efficiency was 0.76, sensitivity was 74%, and specificity was 90% (for H. pylori eradication) when the fall of at least one category in serologic levels was considered as cut-off point. No further decreases in serologic levels were noted over the next 6 months, and 48.8% of patients remained seropositive 1 year after completion of successful treatment. A high concordance between serology and 13C-urea breath test results is observed when the two procedures are used for H. pylori infection diagnosis in patients with gastric ulcer. Also, serology can be successfully used for monitoring H. pylori eradication 6 months after therapy completion.

Adult↗
PubMed2000

One-week therapy with pantoprazole versus ranitidine bismuth citrate plus two antibiotics for Helicobacter pylori eradication.

AIM: A combination of omeprazole plus amoxycillin (Amo) and clarithromycin (CIa) for 7 days has been studied extensively. However, the role of other proton pump inhibitors, such as pantoprazole (Pan), in this therapy is not well known. On the other hand, ranitidine bismuth citrate (RBC) also seems to be effective when combined with Amo and CIa. Our aim was to evaluate and to compare these two novel short-term triple therapies (Pan+Amo+Cla and RBC+Amo+Cla) for treatment of Helicobacter pylori. METHODS: In a randomized clinical trial 150 consecutive patients (38 with duodenal ulcer, 112 with non-ulcer dyspepsia) infected by H. pylori were studied prospectively. Exclusion criteria were: previous H. pylori eradication therapy, gastroerosive drug use, gastric surgery, and associated diseases. One of two regimens was given for 7 days: Pan (40 mg b.i.d.), Amo (1 g b.i.d.), Cla (500 mg b.i.d.) (group Pan+Amo+Cla, n = 75); or RBC (400 mg b.i.d.), Amo (1 g b.i.d.), Cla (500 mg b.i.d.) (group RBC+Amo+Cla, n = 75). All drugs were administered together after meals. Compliance was evaluated by return tablet count. Data were analysed by univariate (chi2) and multivariate (multiple logistic regression) analysis. Eradication was defined as a negative 13C-urea breath test 1 month after completing therapy. RESULTS: The distribution of studied variables (age, gender, smoking, duodenal ulcer/non-ulcer dyspepsia) was similar in both therapy groups. Per-protocol eradication was achieved in 48/71 (68%) in group Pan+Amo+Cla, and in 61/70 (87%) in group RBC+Amo+Cla (P= 0.01). Intention-to-treat (ITT) eradication was achieved in, respectively, 48/ 75 (64%) and in 61/75 (81%) (P= 0.03). The RBC+ Amo+Cla regimen was more effective than Pan+Amo+Cla in non-ulcer dyspepsia patients (ITT, 84% vs 58%; P = 0.005), but statistically significant differences were not demonstrated in duodenal ulcer patients (72% vs 80%). In the multivariate analysis the odds ratio for the effect of the type of therapy on H. pylori eradication in patients with non-ulcer dyspepsia was 3.8 (95% Cl, 1.6-9.3; P = 0.003). No relevant adverse effects were reported with any regimen. CONCLUSION: A RBC+Amo+Cla regimen for only 1 week is a promising therapy for H. pylori infection, due to its high efficacy, simple posology, and excellent tolerability. Combination of Pan with Amo and Cla, although effective in duodenal ulcer patients, but in non-ulcer dyspepsia has not achieved the favourable results previously reported with other proton pump inhibitors.

2-Pyridinylmethylsulfinylbenzimidazoles↗