38 research outputs found
Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial
BACKGROUND: Helicobacter pylori gastritis may progress to glandular
atrophy and intestinal metaplasia, conditions that predispose to gastric
cancer. Profound suppression of gastric acid is associated with increased
severity of H pylori gastritis. This prospective randomised study aimed to
investigate whether H pylori eradication can influence gastritis and its
sequelae during long term omeprazole therapy for gastro-oesophageal reflux
disease (GORD). METHODS: A total of 231 H pylori positive GORD patients
who had been treated for > or =12 months with omeprazole maintenance
therapy (OM) were randomised to either continuation of OM (OM only; n =
120) or OM plus a one week course of omeprazole, amoxycillin, and
clarithromycin (OM triple; n = 111). Endoscopy with standardised biopsy
sampling as well as symptom evaluation were performed at baseline and
after one and two years. Gastritis was assessed according to the Sydney
classification system for activity, inflammation, atrophy, intestinal
metaplasia, and H pylori density. RESULTS: Corpus gastritis activity at
entry was moderate or severe in 50% and 55% of the OM only and OM triple
groups, respectively. In the OM triple group, H pylori was eradicated in
90 (88%) patients, and activity and inflammation decreased substantially
in both the antrum and corpus (p<0.001, baseline v two years). Atrophic
gastritis also improved in the corpus (p<0.001) but not in the antrum. In
the 83 OM only patients with continuing infection, there was no change in
antral and corpus gastritis activity or atrophy, but inflammation
increased (p<0.01). H pylori eradication did not alter the dose of
omeprazole required, or reflux symptoms. CONCLUSIONS: Most H pylori
positive GORD patients have a corpus predominant pangastritis during
omeprazole maintenance therapy. Eradication of H pylori eliminates gastric
mucosal inflammation and induces regression of corpus glandular atrophy. H
pylori eradication did not worsen reflux disease or lead to a need for
increased omeprazole maintenance dose. We therefore recommend eradication
of H pylori in GORD patients receiving long term acid suppression
A evolução do sistema de pagamentos brasileiro: uma abordagem comparada com os países selecionados no período 1995-2003
Geometry and field theory in multi-fractional spacetime
We construct a theory of fields living on continuous geometries with
fractional Hausdorff and spectral dimensions, focussing on a flat background
analogous to Minkowski spacetime. After reviewing the properties of fractional
spaces with fixed dimension, presented in a companion paper, we generalize to a
multi-fractional scenario inspired by multi-fractal geometry, where the
dimension changes with the scale. This is related to the renormalization group
properties of fractional field theories, illustrated by the example of a scalar
field. Depending on the symmetries of the Lagrangian, one can define two
models. In one of them, the effective dimension flows from 2 in the ultraviolet
(UV) and geometry constrains the infrared limit to be four-dimensional. At the
UV critical value, the model is rendered power-counting renormalizable.
However, this is not the most fundamental regime. Compelling arguments of
fractal geometry require an extension of the fractional action measure to
complex order. In doing so, we obtain a hierarchy of scales characterizing
different geometric regimes. At very small scales, discrete symmetries emerge
and the notion of a continuous spacetime begins to blur, until one reaches a
fundamental scale and an ultra-microscopic fractal structure. This fine
hierarchy of geometries has implications for non-commutative theories and
discrete quantum gravity. In the latter case, the present model can be viewed
as a top-down realization of a quantum-discrete to classical-continuum
transition.Comment: 1+82 pages, 1 figure, 2 tables. v2-3: discussions clarified and
improved (especially section 4.5), typos corrected, references added; v4:
further typos correcte
Cytokeratin immunoreactivity of intestinal metaplasia at normal oesophagogastric junction indicates its aetiology
BACKGROUND AND AIMS—Cytokeratin (CK) 7 and 20 patterns are specific for long and short segments of Barrett's oesophagus but their use has not been assessed in intestinal metaplasia arising in macroscopically normal gastro-oesophageal junction (GOJ).
PATIENTS AND METHODS—This study was carried out in a large prospective series of 254 patients who underwent upper endoscopy, had normal gastro-oesophageal anatomy, and who had biopsies of the antrum, fundus, cardia, GOJ, and lower oesophagus. Intestinal metaplasia of the GOJ was typed by histochemistry with high iron diamine-alcian blue staining and by immunohistochemistry using CK7 and CK20 antibodies. Results were correlated with clinical, endoscopic, and pathological data.
RESULTS—Sixty (23.6%) of our patients presenting with a normal GOJ had intestinal metaplasia. The CK7/CK20 pattern identified two groups of patients: one highly correlated with Barrett's and the other with characteristics of Helicobacter pylori gastritis. The Barrett's type CK7/CK20 pattern was related to a high frequency of gastro-oesophageal reflux symptoms (p<0.02) and normal endoscopic appearance of the stomach (p<0.03). In contrast, the gastric type CK7/CK20 pattern was linked to atrophic (p<0.02) or erythematous (p<0.05) appearance of the stomach (p<0.03), high frequency of H pylori infection (p<0.04), antral inflammation (p<0.006) with atrophy (p<0.02), and intestinal metaplasia (p<0.02).
CONCLUSION—In patients presenting with intestinal metaplasia in normal appearing GOJ, the cytokeratin pattern identifies two groups of patients, one with features identical to those of long segment Barrett's oesophagus and one with features seen in H pylori gastritis. These data may be used by clinicians and should result in improved endoscopic surveillance strategies targeted specifically at patients at increased risk of Barrett's oesophagus and thus cancer.
Keywords: Barrett's oesophagus; cardia; intestinal metaplasia; cytokeratin
Comparison of omeprazole + amoxicillin versus omeprazole + amoxicillin + clarithromycin in the eradication of Helicobacter pylori (Hp) - results from a randomized study involving 120 patients
Prevention of relapse of gastro-oesophageal reflux disease by lansoprazole : 30 mg every other day or 15 mg daily ?
Le but de cette étude était de comparer l'efficacité et la tolérance de deux schémas thérapeutiques : lansoprazole 30 mg un jour sur deux ou lansoprazole 15 mg tous les jours, dans la prévention des récidives de l'oesophagite par reflux. 52 patients ayant présenté une oesophagite par reflux de grade supérieur ou égal à II, cicatrisée après 4 ou 8 semaines de traitement par inhibiteur de la pompe à protons (lansoprazole 30 mg, oméprazole 20 mg ou pantoprazole 40 mg) ont été inclus dans cet essai multicentrique, contrôlé, réalisé en double aveugle. Selon une liste de randomisation pré-établie, les patients ont reçu pendant 6 mois soit du lansoprazole 30 mg les jours pairs et du placebo les jours impairs (groupe L30), soit du lansoprazole 15 mg tous les jours (groupe L15) Les symptômes du reflux gastro-œsophagien étaient recherchés après 3 et 6 mois de traitement. Une endoscopie était réalisée en fin d'étude ou en cours d'essai en cas de récidive de la symptomatologie. Le taux de rémission endoscopique à 6 mois était de 64 % dans le groupe L30 et de 74,1 % dans le groupe L15 (NS). Une aggravation du pyrosis et de la gêne fonctionnelle était constatée dans le groupe L30 (p < 0,05), alors que la symptomatologie des patients restait stable dans le groupe L15. Cette étude n'a pas mis en évidence de différence en terme d'efficacité entre les deux schémas thérapeutiques dans la prévention des récidives endoscopiques de l'oesophagite par reflux. Cependant, les meilleurs résultats obtenus avec le lansoprazole 15 mg sur la symptomatologie suggèrent une possible supériorité du traitement quotidien à demi-dose par rapport au traitement à pleine dose un jour sur deux