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Biomedical subjects

Javier P Gisbert

Publications and source records attributed to Javier P Gisbert.

At least 55 records · Page 3Linked to original sources
PubMed2003

'Rescue' therapy with rifabutin after multiple Helicobacter pylori treatment failures.

AIM: Eradication therapy with proton pump inhibitor, clarithromycin and amoxicillin is extensively used, although it fails in a considerable number of cases. A 'rescue' therapy with a quadruple combination of omeprazole, bismuth, tetracycline and metronidazole (or ranitidine bismuth citrate with these same antibiotics) has been recommended, but it still fails in approximately 20% of cases. Our aim was to evaluate the efficacy and tolerability of a rifabutin-based regimen in patients with two consecutive H. pylori eradication failures. PATIENTS AND METHODS DESIGN: Prospective multicenter study. PATIENTS: Consecutive patients in whom a first eradication trial with omeprazole, clarithromycin and amoxicillin and a second trial with omeprazole, bismuth, tetracycline and metronidazole (three patients) or ranitidine bismuth citrate with these same antibiotics (11 patients) had failed were included. INTERVENTION: A third eradication regimen with rifabutin (150 mg bid), amoxicillin (1 g bid) and omeprazole (20 mg bid) was prescribed for 14 days. All drugs were administered together after breakfast and dinner. Compliance with therapy was determined from the interrogatory and the recovery of empty envelopes of medications. OUTCOME: H. pylori eradication was defined as a negative 13C-urea breath test 8 weeks after completing therapy. RESULTS: Fourteen patients have been included. Mean age +/- SD was 42 +/- 11 years, 41% males, peptic ulcer (57%), functional dyspepsia (43%). All patients took all the medications and completed the study protocol. Per-protocol and intention-to-treat eradication was achieved in 11/14 patients (79%; 95% confidence interval = 49-95%). Adverse effects were reported in five patients (36%), and included: abdominal pain (three patients), nausea and vomiting (one patient), and oral candidiasis (one patient); no patient abandoned the treatment due to adverse effects. CONCLUSION: Rifabutin-based rescue therapy constitutes an encouraging strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole and tetracycline.

Adult↗
PubMed2003

Helicobacter pylori infection and perforated peptic ulcer prevalence of the infection and role of antimicrobial treatment.

Although the role of Helicobacter pylori infection on noncomplicated peptic ulcer disease has been definitively established, the precise relationship between the organism and complicated ulcer has hardly been studied. The mean prevalence of H. pylori infection in patients with perforated peptic ulcer is of only about 65-70%, which contrasts with the almost 90-100% figure reported in noncomplicated ulcer disease. However, H. pylori infection rates in various studies range markedly from 0% to 100%, suggesting that differences in variables as number and type of diagnostic methods used to diagnose H. pylori infection, or frequency of nonsteroidal anti-inflammatory drug intake, may be responsible for the low prevalence reported in some studies. Recurrent ulcer disease after peptic ulcer perforation mainly occurs in patients with H. pylori infection, which suggests that the microorganism plays an important role in this complication. All patients with perforated peptic ulcer should be treated by simple closure of the perforation and with therapy aimed at healing of the ulcer and eradicating the H. pylori infection, as disappearance of the organism prevents, or at least decreases, ulcer recurrence and ulcer perforation in patients with H. pylori-associated perforated ulcers after simple closure. Therefore, H. pylori eradicating treatment should be started during the immediate postoperative period. The patients with intractable recurrent symptoms of peptic ulcer despite adequate medical treatment, but without H. pylori infection (e.g. a patient using nonsteroidal anti-inflammatory drugs), is probably the only remaining indication for elective definitive surgical treatment of peptic ulcer disease.

Anti-Bacterial Agents↗
PubMed2003

Prevalence of hepatitis C virus infection in B-cell non-Hodgkin's lymphoma: systematic review and meta-analysis.

BACKGROUND & AIMS: The aim of our study was to conduct a systematic review of studies evaluating prevalence of hepatitis C virus (HCV) infection in B-cell non-Hodgkin's lymphoma (B-NHL) and to perform a meta-analysis of case-control studies comparing this prevalence with that of a reference group. METHODS DATA SOURCES: Electronic databases and the Cochrane Controlled Trials Register. STUDY SELECTION: Studies evaluating prevalence of HCV infection in patients with B-NHL. Studies comparing HCV prevalence in B-NHL (cases) and in a reference group (controls) were included in the meta-analysis. DATA EXTRACTION: Author/country, diagnostic method (serology/PCR), control type, matching/design, and VHC prevalence. DATA SYNTHESIS: Prevalence of HCV infection and meta-analysis combining the odds ratios (OR). RESULTS: Forty-eight studies (5542 patients) were identified. Mean HCV infection prevalence was 13% (95% CI: 12%-14%), which was higher in Italy (20%) and Japan (14%). Ten studies compared HCV prevalence in B-NHL (17%) and healthy controls (1.5%) (OR: 10.8; 95% CI: 7.4-16), results being homogeneous; OR increased up to 14.1 when only Italian studies were considered. Sixteen studies compared HCV prevalence in B-NHL (13%) and in other hematologic malignancies (2.9%) (OR: 4.2; 95% CI: 2.5-7), also with homogeneous results; OR increased up to 7.8 when subanalysis included only Italian studies. CONCLUSIONS: HCV prevalence in patients with B-NHL is approximately 15%, higher than that reported not only in general population (1.5%) but also in patients with other hematologic malignancies (2.9%), suggesting a role of HCV in the etiology of B-NHL. The striking geographic variation in this association suggests that genetic and/or environmental factors are also involved in the pathogenesis of this disorder.

Hepatitis C↗
PubMed2003

Breath test using a single 50-mg dose of 13C-urea to detect Helicobacter pylori infection in children.

BACKGROUND: The 13C-urea breath test is an accurate, noninvasive method for the diagnosis of in adults. A dose of 75 to 100 mg of urea is generally used, especially in adults, but the optimal dose in children is still unknown. Our aim was to determine whether urea breath test performed with a single 50-mg dose of 13C-urea was sufficient and accurate for diagnosing infection in children. METHODS: Consecutive children 4 to 14 years of age undergoing upper intestinal endoscopy to evaluate symptoms of recurrent abdominal pain were prospectively included. Exclusion criteria included use of antibiotics or proton pump inhibitors during the last month, gastric surgery, and previous eradication therapy. Reference criteria for diagnosis of infection were based on histology, culture, and serology. Urea breath test (TAU-KIT; Isomed, S.L., Madrid, Spain) was performed as follows: citric acid (Citral pylori) dissolved in 100 mL of water was initially given. Ten minutes later, a baseline exhaled breath sample was collected, and thereafter 50 mg of 13C-urea dissolved in 50 mL of water was given. A second breath sample was obtained 30 minutes later. Breath samples were analyzed by isotope ratio mass spectrometry. The endoscopist, the pathologist, the microbiologist, and the person responsible for reading the serology and the urea breath test were all unaware of status by the other diagnostic methods. RESULTS: One hundred children were included (40% males; mean age, 9.2 +/- 2 years; mean weight, 33.9 +/- 12 kg). Based on the reference criteria, 45% were infected, 37% were not infected, and 18% were indeterminate. Sensitivity, specificity, positive predictive value, and negative predictive value were, respectively, 91% (95% confidence interval [CI], 79%-96%), 97% (95% CI, 86%-99%), 98% (95% CI, 87%-91%), and 90% (95% CI, 76%-96%). Positive and negative likelihood ratios were of 33 and 0.09. Any cutoff point between 2 and 14 delta units had the same high diagnostic accuracy. The area under the receiver operating characteristic curve was 0.94. No adverse effects were reported. CONCLUSION: Urea breath test using 50 mg of urea is sufficient and accurate for the diagnosis of infection in children. Use of a small test dose significantly lowers the cost of the test.

Adolescent↗
PubMed2002

[Clinical and endoscopic prognostic factors in patients with bleeding peptic ulcer].

BACKGROUND: The main objectives of this study were to review the clinic and endoscopic variables of patients with upper gastrointestinal bleeding (UGB) due to peptic gastroduodenal lesions who were evaluated in our hospital during one year, to identify the characteristics associated with a negative evolution of the UGB and to analyse the characteristics of those patients who were discharged immediately after the endoscopy was performed. PATIENTS AND METHOD: A one-year retrospective analysis of all UGB episodes was performed. Patients having gastroduodenal ulcer or erosive gastritis/duodenitis at endoscopy were included. The prognostic value of several clinic, laboratory and endoscopic variables was evaluated. Persistence or recurrence of bleeding, surgery and mortality were considered as outcome variables (the variable evolution was categorized as negative when any of these was observed). RESULTS: 156 patients were identified, with a mean (SD) age of 61 (17) years. Melena was the most frequent UGB presentation (79%). 46% patients had associated diseases and 50% were taking gastroerosive drugs. Duodenal ulcer was the commonest cause of UGB (52%), followed by gastric ulcer (30%). The evolution of UGB was negative in 7% cases. Variables associated with a negative evolution in the multivariate analysis were: age, red hematemesis, systolic blood pressure >= 100 mmHg, heart rate >= 100 b.p.m. and a more severe Forrest endoscopic classification. 11% patients were discharged immediately, without complications afterwards. If predictive variables obtained in the multivariate analysis would have been applied, hospitalization would have been avoided in 59 patients (38%) without subsequent complications. CONCLUSIONS: A number of clinic and endoscopic variables (UGB presentation form, blood pressure, heart rate, and Forrest endoscopic classification) with prognostic value have been identified in this study. These variables are easy to obtain and apply in clinical practice, allowing a precise estimate of the UGB evolution. Thus, a relatively high number of patients with UGB susceptible of ambulatory treatment and management can be reliably identified.

Duodenoscopy↗
PubMed2002

[Stool antigen test for initial Helicobacter pylori diagnosis and for confirmation of eradication after therapy].

BACKGROUND: : Recently, a new diagnostic method based on the detection of Helicobacter pylori antigen in stools (HpSA) has been developed. Our aim was to prospectively evaluate the accuracy of HpSA both in the initial diagnosis of H. pylori infection and in the confirmation of the eradication after treatment. PATIENTS AND METHOD: Thirty dyspeptic patients were prospectively evaluated. During endoscopy, biopsies for histology and rapid urease test were obtained, and a 13C-urea breath test was performed. HpSA was determined by radioimmunoassay(Premier Platinum HpSA). Infected patients were administered H.pylori eradication treatment, and breath test and HpSA were performed again 4 weeks after finishing the therapy. Gold standard for H. pylori infection pre-treatment was based on rapid urease test, histology and breath test, whereas 13C-urea breath test was considered the post-treatment gold standard. RESULTS: Pre-treatment H. pylori prevalence was 57%. Eradication was achieved in 85% of patients. The area under ROC curve for HpSA pre-treatment was 0.98. Cut-off points with best pre-treatment diagnostic accuracy were those between 0.10 and 0.12: positive likelihood ratio (LR), negative LR, 0.06; 94% sensitivity (95% CI, 73-99%),100% specificity (75-100%), 100% positive predictive value (81-100%)and 93% negative predictive value (66-100%). After treatment,the area under ROC curve was 1, and all cut-off points between 0.10 and 0.18 had 100% diagnostic accuracy. HpSA levels decreased from 0.94 (0.9) to 0.08 (0.02) (p < 0.01) in patients withH. pylori eradication success. CONCLUSIONS: HpSA test can be considered an accurate, non-invasive method for the diagnosis of H. pylori infection both inuntreated patients and in the confirmation of H. pylori eradication after treatment.

Antigens, Bacterial↗
PubMed2002

[Helicobacter pylori infection and functional dyspepsia. Meta-analysis of efficacy of eradication therapy].

BACKGROUND: To establish a causal link between Helicobacter pylori infection and functional dyspepsia it is necessary to demonstrate that H. pylori eradication induces an improvement in dyspeptic symptoms. Our aim was to perform a meta-analysis of randomized studies comparing, in functional dyspepsia, the efficacy of H. pylori eradication treatment with that of treatments with no effect on H. pylori infection. PATIENTS AND METHODS DATA SOURCES: PubMed database, Cochrane Controlled Trials Register, and abstracts from congresses until 2001. SELECTION CRITERIA: a) studies including patients with functional dyspepsia and H. pylori infection; b) randomized trials comparing H. pylori eradication treatment with treatment (control) with no effect on H. pylori infection, and c) follow-up of at least 6 months. The quality of studies was assessed by a validated score. STATISTICS: the main outcome was the percentage of patients improving in each therapeutic group. A meta-analysis was performed combining the odds ratios (OR) of individual studies in a global OR. RESULTS: Nine studies fulfilled the inclusion criteria and were thus included in the meta-analysis. Overall, 953 patients received an eradication treatment and 958 received a control treatment. The overall percentage of patients with symptomatic improvement in the eradication group was 43% (95% CI, 40-46%), and it was 39% (95% CI, 36-42%) in the control group. The OR for the effect of the eradication treatment vs. the control treatment was 1.20 (95% CI, 0.91-1.58). The number needed to treat (NNT) with eradication therapy to achieve a symptomatic improvement, compared with the control group, was 25. Although heterogeneity was demonstrated, it disappeared when one study showing positive, clearly discordant results was excluded. Thus, the percentage of patients with symptomatic improvement in the eradication treatment group was 47% (95% CI, 43-50%) and it was 45% (95% CI, 41-48%) in the control group (OR: 1.06; 0.85-1.31; NNT: 50). CONCLUSIONS: H. pylori eradication treatment is not associated with a statistically significant improvement of symptoms in patients with functional dyspepsia.

Dyspepsia↗
PubMed2002

The stool antigen test for detection of Helicobacter pylori after eradication therapy.

BACKGROUND: Current noninvasive tests to confirm the eradication of Helicobacter pylori must be performed 4 weeks or more after eradication therapy is completed. OBJECTIVE: To determine whether the stool antigen test, a relatively new noninvasive test for H. pylori, administered at various times after eradication therapy correctly identifies persons with persistent H. pylori infection. DESIGN: Prospective blinded study. SETTING: Six clinical centers in the United States and Europe. PATIENTS: 84 H. pylori --infected patients undergoing endoscopy for upper abdominal symptoms. MEASUREMENTS: At baseline and on day 35 after the completion of triple eradication therapy, all patients underwent endoscopy with histologic examination, rapid urease test and culture, urea breath test, and a stool antigen test. The stool antigen test was also performed on days 3, 7, 15, 21, 28, and 35 after completion of therapy. RESULTS: Compared with the gold-standard endoscopic tests on day 35 after antimicrobial therapy, the urea breath test had a sensitivity of 94% (95% CI, 71% to 100%) and a specificity of 100% (CI, 94% to 100%). The stool antigen test had a sensitivity of 94% (CI, 71% to 100%) and a specificity of 97% (CI, 89% to 100%). On day 7 after treatment, the stool antigen test was predictive of eradication (positive predictive value, 100% [CI, 69% to 100%]; negative predictive value, 91% [CI, 82% to 97%]). CONCLUSION: A positive result on the stool antigen test 7 days after completion of therapy identifies patients in whom eradication of H. pylori was unsuccessful.

Adult↗
PubMed2002

[Helicobacter pylori CagA antibodies in various gastroduodenal diseases from 2 different populations].

BACKGROUND: We aimed at studying the prevalence of infection by H. pylori along with the CagA status of the strain in two populations (Spain and Cuba) and the relationship with several gastroduodenal lesions. We also studied the role of the test-and-scope strategy in the decrease of unnecessary gastroscopies. PATIENTS AND METHOD: 100 dyspeptic patients from Spain and 100 from Cuba were included. At endoscopy, antrum biopsies were obtained and H. pylori status was evaluated by rapid urease test. CagA status of the strain was assessed by Western Blot. The test-and-scope strategy was evaluated according to H. pylori infection and CagA status. RESULTS: Mean age of Spanish and Cuban patients was 45 (16) and 46 (15) years, respectively. Dyspeptic symptoms were similar in both groups. Prevalence of infection by H. pylori was higher in Cuban (73%) than in Spaniards (40%) (p < 0.01). Prevalence of CagA+ strains was also higher in Cuban (81 vs. 27%) (p < 0.01). Among CagA+ Spanish patients, 11% had a duodenal ulcer, whereas this lesion was not found in any CagA patient (p < 0.05). Duodenal ulcer prevalence in CagA+ and CagA Cuban patients was 31 and 0%, respectively (p < 0.05). The test-and-scope strategy would have avoided endoscopy in only 24% Spanish and 15% Cuban patients. CONCLUSIONS: The prevalence of H. pylori infection is higher in Cuban than in Spanish dyspeptic patients. H. pylori strains of Cuba seem to be more virulent than those of Spain. CagA protein is a marker of peptic ulcer in both populations. These differences could partly explain the variations in the prevalence of different gastroduodenal disorders between both countries. The test-and-scope strategy appears to avoid a low number of endoscopies.

Antibodies, Bacterial↗
PubMed2002

Role of partner's infection in reinfection after Helicobacter pylori eradication.

AIM: To evaluate whether the Helicobacter pylori status of the patient's spouse plays a role in reinfection after eradication success, and to assess the possibility of transmission of H. pylori among partners by using molecular methods. METHODS: We studied prospectively 120 patients in whom H. pylori had been eradicated. Endoscopy with biopsies and a 13C-urea breath test were performed 1 month after completing therapy. The breath test was repeated in all patients at 6 and 12 months. At the 1-year follow-up visit (or before if reinfection occurred), a breath test was also performed on the patient's partner. Samples for the molecular study included gastric biopsies from patients and gastric content obtained by the string test from partners. The heterogeneity of ureC was studied by enzymatic digestion with MseI and HhaI enzymes of a polymerase chain reaction (PCR) product of 1179 bp belonging to the ureC gene, and different band patterns were generated after electrophoresis. RESULTS: Four reinfections were diagnosed at 6 months, and four were diagnosed from 6 to 12 months (incidence 6.8% per patient-year). Seven of eight (87%) of the reinfected patients' spouses were infected, but H. pylori infection of spouses was also frequent (76%) among non-reinfected patients. In the multivariate analysis, age of the patient (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.87 to 0.99, P < 0.05), delta(13)CO(2) value after therapy (OR 2.51, 95% CI 1.14 to 5, P < 0.05), and therapy regimen (OR 6.23, 95% CI 1.25 to 31, P < 0.05) were the only variables that correlated with H. pylori recurrence. However, family variables (H. pylori status of spouse, breath test value of spouse, length of time couple had lived together, number of children living at home, household density) did not correlate with recurrences. Thus, the OR for the H. pylori status of spouse (adjusted by age, delta(13)CO(2) and therapy) was 2.93 (95% CI 0.29 to 29, P > 0.05). H. pylori recurrence occurred in seven of 92 (7.6%) patients when the spouse was infected (95% CI 3.7% to 15%), and in one of 28 (3.6%) patients when the spouse was H. pylori-negative (95% CI 0.6% to 18%) (P > 0.05; however, the power of this comparison was < 20%). Therefore, even if the spouse was infected, 92.4% of patients will remain uninfected 1 year after H. pylori eradication. Three reinfected patients (at 1 year) and their partners (also infected) agreed to have the endoscopy and string test performed, respectively. The molecular study revealed that H. pylori strains involved were different in all cases. CONCLUSION: Recurrence of H. pylori infection seems to be relatively infrequent, even if the patient's spouse is H. pylori-positive. The molecular study demonstrated that the strains in reinfected patients and their partners are different, suggesting that the patient's partner does not act as a reservoir for H. pylori reinfection.

Adult↗
PubMedDate not supplied

[Vascular development in inflammatory bowel disease].

There are 4 major concepts in vascular development: vasculogenesis (formation of blood vessels from angioblasts), angiogenesis (formation of vascular sprouts from preexisting vessels), arteriogenesis (thickening and development of vessels) and lymphangiogenesis (formation of lymphatic vessels). In the last decade, these concepts, especially angiogenesis and lymphangiogenesis, have acquired major importance due to their role in tumoral growth and metastatic dissemination. Moreover, the activity of various diseases that involve chronic inflammation, such as asthma, psoriasis and rheumatoid arthritis, has been associated with vascular development. Several growth factors and cytokines are involved in this process and consequently investigation into these elements, both in peripheral blood and their expression in affected tissues, could elucidate the role of vascular development in diseases whose pathogenesis involves chronic inflammation, such as inflammatory bowel disease. The presence of distinct molecules involved in vascular development processes, such as vascular endothelial growth factor (VEGF), basic fibroblastic growth factor and placental growth factor, among others, has been studied in both ulcerative colitis and Crohn's disease, although not extensively. It has been suggested that the phenomena of vasculogenesis, angiogenesis and lymphangiogenesis play a critical, although not exclusive, role in the inflammation that characterizes inflammatory bowel disease. In general, the results obtained to date suggest that new vascular formation is involved in the pathogenesis of these diseases.

Humans↗
PubMedDate not supplied

Rapid urease test utility for Helicobacter pylori infection diagnosis in gastric ulcer disease.

BACKGROUND/AIMS: To establish rapid urease test utility for initial diagnosis of Helicobacter pylori infection in gastric ulcer patients and to determine the best site for sampling for gastric biopsies. METHODOLOGY: Seventy consecutive gastric ulcer patients were prospectively studied. All these patients underwent three biopsies from both antrum and body (two for hematoxylin-eosin staining and one for rapid urease test -Jatrox H. p. Test-). Likewise, IgG ELISA serology and 13C-urea breath test were carried out. Gold standard for H. pylori infection was defined as two or more tests (i.e., histology, serology, breath test) with positive results. RESULTS: Rapid urease test yielded 96.8% sensitivity (95% CI = 89-99%) and 100% (66-100%) specificity when using biopsy specimens from the body, with identical results when biopsy specimens from both antrum and body were considered together. However, when only biopsy specimens from the antrum were used, sensitivity dropped to 72.6% (60-82%) and specificity was 100% (66-100%). As far as concordance between rapid urease test and histology is concerned, we found a "proportion of positive agreement" of 0.78 for the antrum, with 0.46 kappa statistic (P < 0.0001) and 15 McNemar statistic (P < 0.0001). For the gastric body, "proportion of positive agreement" was 0.98, with 0.94 kappa statistic (P < 0.0001) and 1 McNemar statistic (P = 0.3). Larger (P < 0.01) prevalence of both glandular atrophy (17.8%, 11-28%) and intestinal metaplasia (68.5%, 57-78%) was observed in the antrum in comparison with that in the body (4.1%, 1-11%; and 16.4%, 10-26%, respectively). CONCLUSIONS: Biopsy specimens from the body should always be obtained when the rapid urease test is performed to diagnose H. pylori infection in gastric ulcer, since this procedure is less accurate when biopsy specimens from the antrum are used, probably due to larger prevalence of both glandular atrophy and intestinal metaplasia in the latter site. Likewise, it seems that rapid urease test from body biopsies is sufficient to reach a reliable infection diagnosis in gastric ulcer patients as this procedure performed with antrum biopsies fails to improve its overall results.

Aged↗
PubMedDate not supplied

Lack of benefit of treating Helicobacter pylori infection in patients with functional dyspepsia. Randomized one-year follow-up study.

BACKGROUND/AIMS: To assess whether H. pylori therapy is significantly better than control therapy in patients with functional dyspepsia, and to assess whether curing the infection relieves symptoms of dyspepsia. METHODOLOGY: We prospectively included consecutive H. pylori-positive patients in whom a gastroscopy was carried out and who were diagnosed of functional dyspepsia. At endoscopy, biopsies were obtained (histology and rapid urease test), and a 13C-urea breath test was carried out. Patients were randomly assigned to 10 days of treatment with either eradication therapy (omeprazole, amoxicillin and clarithromycin) or with ranitidine. No antisecretory therapy was prescribed thereafter. Breath test was repeated four weeks after completing eradication treatment. A validated five-point Likert scale was used to measure severity of symptoms, both at the beginning of the study and 6 and 12 months after treatment. RESULTS: Fifty patients were included in the study. Sixteen patients were randomized to ranitidine and 34 to eradication treatment. The two groups were well balanced for base-line characteristics. One patient in each treatment arm was lost to follow-up at 12 months. Differences between ranitidine and eradication groups were not demonstrated in any of the symptom comparisons, either initially or at 12 months. The rates of treatment success for each symptom were similar in both groups. H. pylori was eradicated in 76% of the patients receiving antibiotics. Differences between groups of patients with eradication success and failure were not demonstrated in any of the symptom comparisons, either initially or at 12 months. Among the groups given eradication regimen, the rates of treatment success for each symptom were similar in the group with H. pylori eradication success and failure. CONCLUSIONS: H. pylori eradication is not likely to play a major role in the treatment of symptoms in patients with functional dyspepsia.

Adult↗