Briefs

One-Day Therapy Eliminates H. Pylori

A four-drug regimen lasting one day is as effective as a traditional seven-day, three-drug therapy in eliminating Helicobacter pylori (H. pylori) in dyspeptic patients. Investigators compared eradication rates between the therapies in 160 patients with dyspepsia who tested positive for H. pylori.

The one-day therapy (which included bismuth subsalicylate, metronidazole, amoxicillin and lansoprazole) eliminated H. pylori in 95 percent of patients; the seven-day therapy (which included clarithromycin, amoxicillin and lansoprazole) eliminated H. pylori in 90 percent of patients.

There was a dramatic cost savings associated with the oneday regimen. “An important consideration is the significantly lower cost of the 1-day regimen ($32), vs. the 7-day regimen of the control group ($182),” write the researchers. “Quadruple therapy, typically including bismuth, is very efficacious to treat patients for whom triple therapy has failed. Acceptable eradication rates have been achieved in as few as seven days of quadruple therapy ... The results observed in the present study demonstrate that eradication of H. pylori infection can be achieved with a short treatment regimen ... the approach to H. pylori eradication reported in this study is cost-effective, promotes patient compliance, and could simplify the role of primary care physicians in the treatment of H. pylori infection.”

Crohn’s Disease Treatment Fuels Controversy

A potential treatment for Crohn’s disease counters the theory that suppressing the immune system is the most effective means of alleviating symptoms associated with the disease.

Research by physicians at Washington University in St. Louis theorizes that Crohn’s disease may be the manifestation of a compromised immune system. The researchers performed a study in Crohn’s disease patients using sargramostim, a drug indicated for patients with acute myelogenous leukemia following the induction of chemotherapy.

The drug, which “boosts” the immune system, appeared to provide relief from cramping, diarrhea and other Crohn’s-related symptoms. Patients’ disease severity was measured by the Crohn’s Disease Activity Index (CDAI); a lower CDAI score indicates less severe disease activity.

The Phase II study showed that patients receiving sargramostim had significantly greater clinical responses and remission rates than those receiving placebo; 48 percent of patients treated with the drug demonstrated a CDAI decrease of more than 100 points, and 40 percent achieved clinical remission by the end of the study, compared to 26 percent and 19 percent, respectively, of patients receiving a placebo.

The length of time to response and time to remission were also significantly better in the patients receiving sargramostim. Adverse events associated with sargramostim were most commonly mild to moderate infection-site reactions and bone pain.

The investigators theorize that a flaw in the body’s first response to bacteria allows infection to go unchecked and compels “second-line responders” in the immune system to become overactive.

However, Stephen Targan, an expert on Crohn’s disease and the head of gastroenterology at Cedars-Sinai Medical Center in Los Angeles, disputes the results, suggesting that the modest response rate to the drug may only apply to a minority of patients with Crohn’s disease.

Targan also questions the feasibility of asking patients to self-inject the drug into the abdomen daily for eight weeks.

The investigators agree that the treatment may not apply to all Crohn’s disease sufferers, but point out that their study was intended to bear out their theory and expect response rates might improve if the dosage and administration of the drug were refined.

Hypnotherapy Can Improve IBS Symptoms

Hypnotherapy is a viable therapeutic option to treat irritable bowel syndrome (IBS), says a group of British researchers. Of 204 patients who completed questionnaires before and after the hypnosis, 71 percent initially responded to therapy, while 81 percent of those responders maintained the improvement.

Patients had up to 12 sessions of hypnotherapy, usually on a weekly basis, with each session lasting up to one hour, says lead researcher Wendy Gonsalkorale.

“Quality of life and anxiety or depression scores were similarly still significantly improved at follow up but did show some deterioration,” the authors report. “Patients also reported a reduction in consultation rates and medication use following the completion of hypnotherapy.”

“Hypnosis alters motility or muscle movement in the gut and the sensitivity of the gut lining,” the investigators note. “We also emphasize that the patient is developing control over the gut, and this is probably also a crucial factor in how the patient improves.”

After the hypnotherapy, patients reported taking fewer drugs and seeing their physicians less frequently. “The beneficial effects of hypnotherapy appear to last at least five years,” the authors conclude.

Glucagon May Help Esophageal Food Impaction

Intravenous glucagon appears to be an effective initial treatment for esophageal food impaction (EFI), researchers found in a retrospective review of the charts of 81 patients presenting to an emergency room with EFI symptoms.

Each patient received intravenous glucagon as initial therapy; 35 percent of the cases resolved with no emergent endoscopy. The remaining 65 percent underwent endoscopy; of these, 71 percent had esophageal strictures or rings, and one had previously had esophageal cancer.

Source: Ferguson D et al. The Use of Glucagon in Acute Esophageal Food Impaction (EFI): How Often Does it Work? Am J Gastroenterol;98:S10 View the abstract online at
www.medicinedirect.com/journal/journal/article?
acronym=AMGAST&format=abstract&uid=PIIS0002927003007998  

Reduced Volume Solutions For Pre-Colonoscopy Cleansing

Researchers have discovered a reduced volume lavage regimen with 2 L of sulfate-free electrolyte lavage plus 20 mg p.o. bisacodyl is safe and effective when compared with the traditional 4 L of sulfate-free electrolyte lavage.

Two hundred patients scheduled for colonoscopy were randomized to receive either the reduced volume or standard 4 L prep the day before a scheduled colonoscopy. Physicians found no difference between the groups in terms of cleansing. Certain adverse effects (such as fullness, nausea, vomiting and overall discomfort) associated with the preparation were significantly reduced in the reduced volume group.

Share this article: Email, Slashdot, Digg, Del.icio.us, Yahoo!MyWeb, Windows Live Favorites, Furl
Add this article feed to: RSS, My Yahoo, Newsgator, Bloglines