Tegaserod Treatment for Dysmotility-Like Functional Dyspepsia: Results of Two Randomized, Controlled Trials

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74639/1/j.1572-0241.2008.01953.x.pd

Antimicrobial Resistance Incidence and Risk Factors among Helicobacter pylori–Infected Persons, United States

Helicobacter pylori is the primary cause of peptic ulcer disease and an etiologic agent in the development of gastric cancer. H. pylori infection is curable with regimens of multiple antimicrobial agents, and antimicrobial resistance is a leading cause of treatment failure. The Helicobacter pylori Antimicrobial Resistance Monitoring Program (HARP) is a prospective, multicenter U.S. network that tracks national prevalence rates of H. pylori antimicrobial resistance. Of 347 clinical H. pylori isolates collected from December 1998 through 2002, 101 (29.1%) were resistant to one antimicrobial agent, and 17 (4.8%) were resistant to two or more antimicrobial agents. Eighty-seven (25.1%) isolates were resistant to metronidazole, 45 (12.9%) to clarithromycin, and 3 (0.9%) to amoxicillin. On multivariate analysis, black race was the only significant risk factor (p < 0.01, hazard ratio 2.04) for infection with a resistant H. pylori strain. Formulating pretreatment screening strategies or providing alternative therapeutic regimens for high-risk populations may be important for future clinical practice

BOB CAT: a Large-Scale Review and Delphi Consensus for Management of Barrett’s Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia

OBJECTIVES: Barrett’s esophagus (BE) is a common premalignant lesion for which surveillance is recommended. This strategy is limited by considerable variations in clinical practice. We conducted an international, multidisciplinary, systematic search and evidence-based review of BE and provided consensus recommendations for clinical use in patients with nondysplastic, indefinite, and low-grade dysplasia (LGD). METHODS: We defined the scope, proposed statements, and searched electronic databases, yielding 20,558 publications that were screened, selected online, and formed the evidence base. We used a Delphi consensus process, with an 80% agreement threshold, using GRADE (Grading of Recommendations Assessment, Development and Evaluation) to categorize the quality of evidence and strength of recommendations. RESULTS: In total, 80% of respondents agreed with 55 of 127 statements in the final voting rounds. Population endoscopic screening is not recommended and screening should target only very high-risk cases of males aged over 60 years with chronic uncontrolled reflux. A new international definition of BE was agreed upon. For any degree of dysplasia, at least two specialist gastrointestinal (GI) pathologists are required. Risk factors for cancer include male gender, length of BE, and central obesity. Endoscopic resection should be used for visible, nodular areas. Surveillance is not recommended for <5 years of life expectancy. Management strategies for indefinite dysplasia (IND) and LGD were identified, including a de-escalation strategy for lower-risk patients and escalation to intervention with follow-up for higher-risk patients. CONCLUSIONS: In this uniquely large consensus process in gastroenterology, we made key clinical recommendations for the escalation/de-escalation of BE in clinical practice. We made strong recommendations for the prioritization of future research

Are There Geographical and Regional Differences in Helicobacter pylori Eradication?

An important area of controversy in Helicobacter pylori eradication is the apparent difference in eradication rates seen in different countries and populations. A recent meta-analysis showed that several factors may affect the outcome of therapy. Individuals residing in northeast Asia had higher eradication rates than those residing in Europe or other areas of Asia. Triple and quadruple drug therapies had significantly higher eradication rates than did dual drug therapies. Treatment regimens that lasted longer than 14 days were better than those that lasted less than seven days, but there was no significant advantage for 10 day therapy over seven day therapy. A number of factors may play a role in determining the regional and geographical differences in H pylori eradication therapy. Included in these factors are genetic differences in the metabolism of the proton pump inhibitor, which can alter the availability of antimicrobials in the stomach. Regional differences in antimicrobial resistance also affect the outcome of therapy. Some studies suggest that the degree of gastritis and the nature of the underlying disease may affect the outcome of therapy, but the data are controversial. Understanding the regional and geographical differences in H pylori eradication can help physicians select the optimal treatment regimen in different regions

Rationale for a helicobacter pylori test and treatment strategy in gastroesophageal reflux disease

Conflicting data have been published on the effect of long-term proton pump inhibitor therapy on the gastric mucosa in Helicobacter pylori-infected subjects. In this article, the available data are reviewed and a rationale is offered for why infected patients who are about to commence long-term proton pump inhibitor therapy should be offered eradication therapy