Three-day lansoprazole quadruple therapy for Helicobacter pylori-positive duodenal ulcers: a randomized contolled study

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β-Thalassemia intermedia caused by compound heterozygosity for Hb Malay (β codon 19 AAC→AGC; Asn→Ser) and codons 41/42 (-CTTT) β0-thalassemia mutation

We report a case of β-thalassemia intermedia caused by compound heterozygosity for hemoglobin (Hb) Malay and codon 41/42 (-CTTT) β0- thalassemia mutation in a 38-year-old Chinese woman. This patient has long- standing anemia with a baseline Hb level of around 70 g/L. She worked as a full-time cashier and had not required regular blood transfusions. Nevertheless, she had splenomegaly necessitating splenectomy, cholelithiasis, and iron overload. This case illustrates the varied phenotypic expression associated with compound heterozygosity for Hb Malay and other β-thalassemia mutations. Since Hb Malay migrates as Hb A on electrophoresis and chromatography, this variant Hb mutation ought to be included in the differential diagnosis for β-thalassemia major or intermedia patients of Southeast Asian descent who are reported to have Hb A on the basis of Hb analysis. The possible presence of this mutation should also be considered in appropriate cases for genetic counseling in couples at risk of conceiving fetuses with β-thalassemia major or intermedia. (C) 2000 Wiley-Liss, Inc.link_to_subscribed_fulltex

Treatment of hepatitis C in kidney transplant recipients with interferon alpha-2b plus ribavirin

Session B. Clinical Nephrology - B7. Hepatitis in glomerular disease, dialysis and transplant patientsLimited data is available for the treatment of hepatitis C virus (HCV) infection in renal allograft recipients, in whom interferon therapy is generally regarded as contraindicated due to potential risks of acute rejection or graft dysfunction. We treated 4 patients who acquired acute hepatitis C in the perioperative period of kidney transplantation. All four patients, who were not HCV carriers before renal transplantation, developed acute transaminitis with negative anti-HCV serology, but positive circulating HCV RNA detectable by PCR. All patients were on cyclosporin-based immunosuppressive protocol. They received interferon alpha-2b (3 MU s.c. thrice weekly) and ribavirin (800-1200 mg p.o. daily according to body weight and hemoglobin levels) treatment. As shown in Table 1, three patients had complete remission with normalization of serum alanine aminotransferase (ALT) level within 4-12 weeks of therapy, and disappearance of serum HCV RNA at 24 and 48 weeks of starting therapy. Two of them had persistently undetectable HCV RNA at 24 weeks after cessation of therapy, while one had just completed the 48-week treatment at the time of writing. The non-responder, in whom treatment was stopped after 24 weeks due to persistent HCV-viremia, was infected with HCV gentotype 1b, which is known to be associated with a less favorable treatment response. All patients had stable renal allograft function throughout the course of treatment. Ribavirin-induced hemolysis, which was dose-dependent, was the most common side-effect. We conclude that combination interferon/ribavirin therapy can be a valid therapeutic option in renal transplant recipients with hepatitis C, but the decision on treatment should take into consideration the severity, progression, and prognosis of the hepatitis, the potential efficacy based on the HCV genotype, and the risk of inducing allograft dysfunction.Link_to_subscribed_fulltex

Lamivudine in hepatitis B-associated membranous nephropathy

Background. Although lamivudine is effective for treatment of chronic hepatitis B (HBV) infection, its potential therapeutic impact on HBV-related membranous nephropathy (MN) in adults has not been characterized. Methods. We treated 10 HBsAg-positive patients with biopsy-proven MN, elevated serum alanine aminotransferase (ALT), and HBV-DNAemia (group 1), and compared their clinical course with 12 patients diagnosed to have HBV infection, elevated serum ALT, and MN in the pre-lamivudine era (group 2). Results. Baseline demographic and clinical parameters were not different between the 2 groups. In group 1, lamivudine treatment was associated with significant reduction in proteinuria, increase in serum albumin, normalization of ALT levels, and disappearance of circulating HBV-DNA during the first year. Four (40%) and 6 (60%) patients went into complete remission (proteinuria <0.3 g/d) at 6 and 12 months, respectively. In group 2, significant proteinuria persisted during the first year. One (8.3%) and 3 (25%) patients went into remission. Cumulative 3-year renal survival [using end-stage renal disease (ESRD) as primary end point] was 100% in group 1 and 58% in group 2 (P = 0.024, log rank test). Blood pressure control reached the target of below 130/85 mm Hg in both groups. Lamivudine was well tolerated and not associated with any adverse events. Hepatic decompensation or malignancy was not observed during follow-up in both groups. Conclusion. HBV-related MN leads to ESRD in a significant proportion of patients before the advent of antiviral therapy. Lamivudine treatment improves renal outcome in HBV carriers with MN and evidence of liver disease. © 2005 by the International Society of Nephrology.link_to_subscribed_fulltex

Lamivudine in hepatitis B-associated membranous nephropathy

Background: Although lamivudine is effective for the treatment of chronic hepatitis B (HBV) infection, its potential therapeutic impact on HBV-related membranous nephropathy (MN) in adults has not been characterised. Methods: We treated 10 HBsAg-positive patients with biopsy-proven MN, elevated serum alanine aminotransferase (ALT), and HBVDNAemia (group 1), and compared their clinical course with 12 patients diagnosed to have HBV infection, elevated serum ALT, and MN in the pre-lamivudine era (group 2). Results: Baseline demographic and clinical parameters were not significantly different between the 2 groups. In group 1, lamivudine treatment was associated with significant reduction in proteinuria, increase in serum albumin, normalisation of ALT levels and disappearance of circulating HBV-DNA during the first year. Four (40%) and six (60%) patients went into complete remission (proteinuria < 0.3 g/day) at 6 and 12 months, respectively. In group 2, significant proteinuria persisted during the first year. One (8.3%) and three (25%) patients went into remission. Cumulative 3-year renal survival (using endstage renal disease as the primary end point) was 100% in group 1 and 58% in group 2 (p = 0.024, log rank test). Blood pressure control reached the target of < 130/85 mmHg in both groups. Lamivudine was well tolerated and not associated with any adverse events. Hepatic decompensation or malignancy was not observed during follow up in both groups. Conclusion: HBV-related MN led to end-stage renal disease in a significant proportion of patients before the advent of anti-viral therapy. Lamivudine treatment improves renal outcome in HBV carriers with MN and evidence of liver disease

Screening for colorectal cancer in Chinese: Comparison of fecal occult blood test, flexible sigmoidoscopy, and colonoscopy

Background & Aims: Fecal occult blood testing (FOBT), flexible sigmoidoscopy (FS), and colonoscopy are the most commonly recommended screening tests for colorectal cancer. The aim of this study was to compare the accuracy and safety of these 3 screening procedures in a general population of ethnic Chinese. Methods: Asymptomatic adults older than 50 years were recruited from the general public through health exhibitions. All enrolled subjects were offered FOBT and full colonoscopy under sedation. Advanced colonic lesions (defined as adenoma ≥ 10 mm, villous adenoma, adenoma with moderate or severe dysplasia, or invasive cancer) were recorded. Lesions at the distal 40 cm in the left colon and rectum were taken as findings of FS. Results: A total of 505 subjects (56% women; mean age ± SD, 56.5 ± 5.4 years) were enrolled, and 476 (94.3%) had a complete colonoscopy. Advanced colonic neoplasms were documented in 63 subjects (12.5%), of which 45 had lesions in the distal colon and 26 in the proximal colon. Among the 385 subjects with a normal distal colon, 14 (3.6%) had advanced lesions in the proximal colon that would be missed by FS alone. The sensitivity and specificity of FOBT for advanced colonic lesions were 14.3% and 79.2% and the sensitivity and specificity of FS were 77.8% and 83.9%, respectively. Combining FOBT with FS would not significantly improve the results of FS alone. Among these 505 subjects who underwent colonoscopy and 148 who underwent polypectomy, there was no perforation and only one occurrence of postpolypectomy bleeding recorded. Conclusions: Colonoscopy is a safe and accurate method for the screening of colorectal neoplasms in Chinese subjects.link_to_subscribed_fulltex

Incidence of gastroesophageal malignancy in patients with dyspepsia in Hong Kong: Implications for screening strategies

Background: A "test-and-treat" strategy for H pylori infection has been recommended in Europe and North America as safe and cost-effective for management of patients with dyspepsia. The primary aim of this study was to determine the frequency of gastroesophageal cancer in 2 groups of patients with dyspepsia: those 45 years of age or younger without "alarm" symptoms (low-risk group) and patients over 45 years of age or any patient with "alarm" symptoms (high-risk group). A secondary aim was to determine the frequency of gastric cancer among patients in the low-risk group with or without a positive serology for H pylori. Methods: Patients with persistent dyspepsia were recruited from 4 regional hospitals in Hong Kong. Those in the low-risk group were evaluated for H pylori by using a whole blood serology test; they underwent endoscopy within 1 week.Those in the high-risk group and those taking non-steroidal anti-inflammatory drugs (NSAIDs) underwent endoscopy promptly. Alarm symptoms were as follows: weight loss (10 or more pounds over 8 weeks), recurrent vomiting, dysphagia, bleeding, or anemia. Results: Of 2627 patients enrolled, 1017 were in the low-risk group and 1610 in the high-risk group. Twenty-three patients (0.9%) had gastroesophageal cancers (20 gastric, 3 esophageal). Four patients with cancer (17.4%) were in the low-risk group (3 gastric, 1 esophageal); all except the patient with esophageal cancer had a positive serology test. In the high-risk group, 19 patients had cancer (17 gastric, 2 esophageal). Conclusion: Gastric cancer is relatively frequent among young patients with dyspepsia who have no alarm features in Hong Kong.This finding raise concerns as to the safety of the "test-and-treat" strategy for the management of patients with dyspepsia in Asia.link_to_subscribed_fulltex

Three-day lansoprazole quadruple therapy for Helicobacter pylori positive duodenal ulcers: a randomized controlled study

Link_to_subscribed_fulltextDigestive Disease Week and the 102nd Annual Meeting of the American Gastroenterological Association Atlanta, GA, USA, 20–23 May 2001. In Gastroenterology, 2001, v. 120 n. 5, Suppl. 1, p. A582, abstract no. 295

Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding

BACKGROUND: Concurrent therapy with a proton-pump inhibitor is a standard treatment for patients receiving aspirin who are at risk for ulcer. Current U.S. guidelines also recommend clopidrogel for patients who have major gastrointestinal intolerance of aspirin. We compared clopidogrel with aspirin plus esomeprazole for the prevention of recurrent bleeding from ulcers in high-risk patients. METHODS: We studied patients who took aspirin to prevent vascular diseases and who presented with ulcer bleeding. After the ulcers had healed, we randomly assigned patients who were negative for Helicobacter pylori to receive either 75 mg of clopidogrel daily plus esomeprazole placebo twice daily or 80 mg of aspirin daily plus 20 mg of esomeprazole twice daily for 12 months. The end point was recurrent ulcer bleeding. RESULTS: We enrolled 320 patients (161 patients assigned to receive clopidogrel and 159 to receive aspirin plus esomeprazole). Recurrent ulcer bleeding occurred in 13 patients receiving clopidogrel and 1 receiving aspirin plus esomeprazole. The cumulative incidence of recurrent bleeding during the 12-month period was 8.6 percent (95 percent confidence interval, 4.1 to 13.1 percent) among patients who received clopidogrel and 0.7 percent (95 percent confidence interval, 0 to 2.0 percent) among those who received aspirin plus esomeprazole (difference, 7.9 percentage points; 95 percent confidence interval for the difference, 3.4 to 12.4; P=0.001). CONCLUSIONS: Among patients with a history of aspirin-induced ulcer bleeding whose ulcers had healed before they received the study treatment, aspirin plus esomeprazole was superior to clopidogrel in the prevention of recurrent ulcer bleeding. Our finding does not support the current recommendation that patients with major gastrointestinal intolerance of aspirin be given clopidogrel. Copyright © 2005 Massachusetts Medical Society.link_to_subscribed_fulltex