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Seddik H, Benass J, Berrag S, Sair A, Berraida R, Boutallaka H. Optimized sequential therapy vs 10- and 14-d concomitant therapy for eradicating Helicobacter pylori: A randomized clinical trial. World J Gastroenterol 2024; 30:556-564. [PMID: 38463026 PMCID: PMC10921140 DOI: 10.3748/wjg.v30.i6.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/26/2023] [Accepted: 12/29/2023] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND A cure for Helicobacter pylori (H. pylori) remains a problem of global concern. The prevalence of antimicrobial resistance is widely rising and becoming a challenging issue worldwide. Optimizing sequential therapy seems to be one of the most attractive strategies in terms of efficacy, tolerability and cost. The most common sequential therapy consists of a dual therapy [proton-pump inhibitors (PPIs) and amoxicillin] for the first period (5 to 7 d), followed by a triple therapy for the second period (PPI, clarithromycin and metronidazole). PPIs play a key role in maintaining a gastric pH at a level that allows an optimal efficacy of antibiotics, hence the idea of using new generation molecules. AIM To compare an optimized sequential therapy with the standard non-bismuth quadruple therapies of 10 and 14 d, in terms of efficacy, incidence of adverse effects (AEs) and cost. METHODS This open-label prospective study randomized 328 patients with confirmed H. pylori infection into three groups (1:1:1): The first group received quadruple therapy consisting of twice-daily (bid) omeprazole 20 mg, amoxicillin 1 g, clarithromycin 500 mg and metronidazole 500 mg for 10 d (QT-10), the second group received a 14 d quadruple therapy following the same regimen (QT-14), and the third group received an optimized sequential therapy consisting of bid rabeprazole 20 mg plus amoxicillin 1 g for 7 d, followed by bid rabeprazole 20 mg, clarithromycin 500 mg and metronidazole 500 mg for the next 7 d (OST-14). AEs were recorded throughout the study, and the H. pylori eradication rate was determined 4 to 6 wk after the end of treatment, using the 13C urea breath test. RESULTS In the intention-to-treat and per-protocol analysis, the eradication rate was higher in the OST-14 group compared to the QT-10 group: (93.5%, 85.5% P = 0.04) and (96.2%, 89.5% P = 0.03) respectively. However, there was no statistically significant difference in eradication rates between the OST-14 and QT-14 groups: (93.5%, 91.8% P = 0.34) and (96.2%, 94.4% P = 0.35), respectively. The overall incidence of AEs was significantly lower in the OST-14 group (P = 0.01). Furthermore, OST-14 was the most cost-effective among the three groups. CONCLUSION The optimized 14-d sequential therapy is a safe and effective alternative. Its eradication rate is comparable to that of the 14-d concomitant therapy while causing fewer AEs and allowing a gain in terms of cost.
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Affiliation(s)
- Hassan Seddik
- Department of Gastroenterology II, Mohammed V Military Teaching Hospital of Rabat, Rabat 10100, Morocco
- Department of Gastroenterology, Mohammed V University in Rabat, Rabat 10100, Morocco
| | - Jihane Benass
- Department of Gastroenterology II, Mohammed V Military Teaching Hospital of Rabat, Rabat 10100, Morocco
- Department of Gastroenterology, Mohammed V University in Rabat, Rabat 10100, Morocco
| | - Sanaa Berrag
- Department of Gastroenterology, Mohammed V University in Rabat, Rabat 10100, Morocco
- Department of Gastroenterology I, Mohammed V Military Teaching Hospital of Rabat, Rabat 10100, Morocco
| | - Asmae Sair
- Department of Gastroenterology II, Mohammed V Military Teaching Hospital of Rabat, Rabat 10100, Morocco
- Department of Gastroenterology, Mohammed V University in Rabat, Rabat 10100, Morocco
| | - Reda Berraida
- Department of Gastroenterology II, Mohammed V Military Teaching Hospital of Rabat, Rabat 10100, Morocco
- Department of Gastroenterology, Mohammed V University in Rabat, Rabat 10100, Morocco
| | - Hanae Boutallaka
- Department of Gastroenterology II, Mohammed V Military Teaching Hospital of Rabat, Rabat 10100, Morocco
- Department of Gastroenterology, Mohammed V University in Rabat, Rabat 10100, Morocco
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Aourarh B, Bangda Y, Berrag S, Adioui T, Tamzaourte M, Elgraini S, Belkouchi L, Saouab R, Belkouchi O, Ait Ali A. An atypical cause of vomiting: Coexisting Wilkie's syndrome and a left renal malformation mimicking a nutcracker phenomenon-A case report. SAGE Open Med Case Rep 2023; 11:2050313X231176395. [PMID: 37250817 PMCID: PMC10214067 DOI: 10.1177/2050313x231176395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
The superior mesenteric artery syndrome and nutcracker phenomenon are rare vascular disorders due to the abnormal development of the superior mesenteric artery stemming from the abdominal aorta with reduced angle (<22°) and resultant compression of the left renal vein and duodenum. It is an underreported entity due to the absence of specific pathognomonic signs. We report the case of a 59-year-old man, admitted for acute bilious vomiting, who underwent a gastroscopy and a computed tomography scan revealing a Wilkie's syndrome associated with a dilated posterior left renal vein communicating with the left ascending lumbar vein without connection with the inferior vena cava mimicking a nutcracker phenomenon.
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Affiliation(s)
- Benayad Aourarh
- Department of Gastroenterology I, Mohammed V
Military Hospital, Mohammed V University, Faculty of Medicine and Pharmacy of Rabat, Rabat,
Morocco
| | - Yannick Bangda
- Department of Gastroenterology I, Mohammed V
Military Hospital, Mohammed V University, Faculty of Medicine and Pharmacy of Rabat, Rabat,
Morocco
| | - Sanaa Berrag
- Department of Gastroenterology I, Mohammed V
Military Hospital, Mohammed V University, Faculty of Medicine and Pharmacy of Rabat, Rabat,
Morocco
| | - Tarik Adioui
- Department of Gastroenterology I, Mohammed V
Military Hospital, Mohammed V University, Faculty of Medicine and Pharmacy of Rabat, Rabat,
Morocco
| | - Mouna Tamzaourte
- Department of Gastroenterology I, Mohammed V
Military Hospital, Mohammed V University, Faculty of Medicine and Pharmacy of Rabat, Rabat,
Morocco
| | - Soumya Elgraini
- Department of Radiology, Mohammed V Military
Hospital, Mohammed V University, Faculty of Medicine and Pharmacy of Rabat, Rabat,
Morocco
| | - Lina Belkouchi
- Department of Radiology, Mohammed V Military
Hospital, Mohammed V University, Faculty of Medicine and Pharmacy of Rabat, Rabat,
Morocco
| | - Rachida Saouab
- Department of Radiology, Mohammed V Military
Hospital, Mohammed V University, Faculty of Medicine and Pharmacy of Rabat, Rabat,
Morocco
| | - Omar Belkouchi
- Department of General Surgery 2, Mohammed V
Military Hospital, Mohammed V University, Faculty of Medicine and Pharmacy of Rabat, Rabat,
Morocco
| | - Abdelnaim Ait Ali
- Department of General Surgery 2, Mohammed V
Military Hospital, Mohammed V University, Faculty of Medicine and Pharmacy of Rabat, Rabat,
Morocco
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Aourarh B, Adioui T, Benhamdane A, Berrag S, Tamzaourte M, Aourarh A, Belkouchi L, Saouab R. Infected Biloma after Endoscopic Ultrasound-Guided Fine-Needle Aspiration. Case Rep Gastroenterol 2022; 16:154-158. [PMID: 35528767 PMCID: PMC9035947 DOI: 10.1159/000522410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/25/2022] [Indexed: 11/19/2022] Open
Abstract
Biloma is a severe complication that can result from bile duct disruption or hepatic trauma. It can occur after biliary surgery such as cholecystectomy or an endoscopic retrograde cholangiopancreatography manipulation and endoscopic biliary sphincterotomy. We present the case of a 59-year-old man admitted for jaundice, with pain in his right flank and fever, 10 days after an endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for an ill-defined pancreatic lesion, associated with an infected biloma. Severe complications can occur after an EUS-FNA; therefore, this diagnosis should not be neglected after the intervention in symptomatic patients, to ensure an early and proper treatment.
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Affiliation(s)
- Benayad Aourarh
- Department of Gastroenterology I, Mohammed V Military Hospital, Faculty of medicine and pharmacy of Rabat, Mohammed V University, Rabat, Morocco
- *Benayad Aourarh,
| | - Tarik Adioui
- Department of Gastroenterology I, Mohammed V Military Hospital, Faculty of medicine and pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Ahlame Benhamdane
- Department of Gastroenterology I, Mohammed V Military Hospital, Faculty of medicine and pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Sanaa Berrag
- Department of Gastroenterology I, Mohammed V Military Hospital, Faculty of medicine and pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Mouna Tamzaourte
- Department of Gastroenterology I, Mohammed V Military Hospital, Faculty of medicine and pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Aziz Aourarh
- Department of Gastroenterology I, Mohammed V Military Hospital, Faculty of medicine and pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Lina Belkouchi
- Department of Radiology, Mohammed V Military Hospital, Faculty of medicine and pharmacy, Mohammed V University, Rabat, Morocco
| | - Rachida Saouab
- Department of Radiology, Mohammed V Military Hospital, Faculty of medicine and pharmacy, Mohammed V University, Rabat, Morocco
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Aourarh B, Tamzaourte M, Benhamdane A, Berrag S, Adioui T, Aourarh A, Belkouchi L, Outznit M, Saouab R. An Unusual Cause of Biliary Tract Obstruction: Lemmel Syndrome. Clin Med Insights Case Rep 2022; 14:11795476211063321. [PMID: 34987301 PMCID: PMC8721704 DOI: 10.1177/11795476211063321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/08/2021] [Indexed: 11/15/2022] Open
Abstract
Background Lemmel syndrome is a rare and misdiagnosed etiology of obstructive jaundice due to a periampullary duodenal diverticulum causing a mechanical obstruction of the common bile duct. It represents an obstructive jaundice with the absence of choledocholithiasis or pancreaticobiliary tumors. It is an underreported entity due to the absence of specific pathognomonic signs. Case presentation A 77-year-old-woman admitted for sepsis, due to an ascending cholangitis, underwent a MRCP and a gastroduodenoscopy revealing Lemmel's syndrome. Due to failure of ERCP, the patient underwent surgical derivation. Conclusion Lemmel syndrome represents an uncommon diagnosis of obstructive jaundice, that shouldn't be neglected if no other organic cause is detected. It is usually asymptomatic, however some patients can develop symptoms and complications such as cholangitis, as is the case of our patient. Imaging allows diagnosis, with MRCP as the modality of choice to confirm diagnosis. Endoscopy is the first line treatment.
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Affiliation(s)
- Benayad Aourarh
- Department of Gastroenterology I, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy, Rabat, Morocco
- Benayad Aourarh, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy, Rabat 10100, Morocco.
| | - Mouna Tamzaourte
- Department of Gastroenterology I, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Ahlame Benhamdane
- Department of Gastroenterology I, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Sanaa Berrag
- Department of Gastroenterology I, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Tarik Adioui
- Department of Gastroenterology I, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Aziz Aourarh
- Department of Gastroenterology I, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Lina Belkouchi
- Department of Radiology, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Mustapha Outznit
- Department of Radiology, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Rachida Saouab
- Department of Radiology, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy, Rabat, Morocco
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Bellabah A, Benkirane A, Ibrahimi A, Nakhli A, Sair A, Nakhli A, Essaid A, Blel A, Ibrahimi A, Lahchaichi A, Ben Slama A, Ouni A, Amouri A, Jemaa A, Cherif A, Khsiba A, Hssine A, Djobbi A, Guedich A, Laabidi A, Mensi A, Ouakaa A, Sriha A, Choukri A, Green A, Belkhamsa A, Hammami A, Bourigua A, Filali A, Belabeh A, Ouakaa A, Sentissi A, Ait Errami A, Nadi A, Filankembo A, Lamine A, Badre W, Ben Kaab B, Ben Slimane B, S B, Hasnaoui B, Bouchabou B, Bouguerra C, Baccouche C, Ayadi C, Bennasrallah C, Benajah D, Gargouri D, Zehi D, Issaoui D, Cherif D, Ben Ghachem D, Trad D, Bouaiti E, Boutouria E, Bel Hadj Mabrouk E, Chalbi E, Aait E, Bouhamou F, Haddad F, Lairani F, Saffar F, Torjmen F, Haj Kacem F, Hamdane F, Chabib FZ, Elrhaoussi FZ, Moumayez FZ, Loukil F, Ahmed Djouldé Diallo F, Aissaoui F, Ajana F, Chabib F, Hamdoun F, Moumayez F, Hamdane F, Haddad F, Bennani Kella G, Bennani G, Abid H, Cheikhani H, Ouazzani H, Romdhane H, Seddik H, Sghir H, Debbabi H, Ben Jeddi H, Garraoui H, Letaief H, Kchir H, Elloumi H, Hammami H, Jaziri H, Ben Abdallah H, Chaabouni H, Ben Romdhane H, Yacoub H, Ben Jeddi H, Elloumi H, Gdoura H, Kchir H, Sahli H, Loghmari H, Bouguerra H, Maghrebi H, Ben Nejma H, Jlassi H, Elloumi H, Fourati H, Alaoui H, Ismail H, Benelbarhdadi I, Cohen I, Errabih I, Koti I, Doghri I, Cohen I, Elhidaoui I, Haraki I, Cheikh I, Abdelaali I, Jemni I, Bouennene I, Akoch I, H I, Boubaker J, Krati K, Eljery K, Temani K, Bellil K, Chabbouh K, Boughoula K, Ouazzani L, Ben Yaghlene L, Kallel L, A L, Hamzaoui L, Chtourou L, Ben Farhat L, Bouabid L, Mnif L, Mouelhi L, Safer L, Zouiten Mekki L, Bourehma M, El Akbari M, El Khayari M, Elyousfi M, Firwana M, Lahlali M, Tahiri M, Mestouri M, Abdelwahed M, Ben Hamida M, Ben Chaabane M, Moalla M, Yakoubi M, Sabbah M, Serghini M, Amri M, Ben Abbes M, Ben Cheikh M, Ghribi M, Hafi M, El Khayari M, Ben Abdelwahed M, Ksiaa M, Essid M, Zakhama M, Yousfi M, Sabbah M, Ayari M, Belhadj M, Cheickh M, Kacem M, Horma Alaoui M, Abid M, Bennour MA, Ghanem M, Loghmari MH, Douggui MH, Azouz MM, Abdelli MN, Boudabous M, Feki M, Fekih M, Kacem M, Mahmoudi M, Boudabbous M, Figuigui M, Medhioub M, Safer M, Azzouz M, Yakoubi M, Abbes M, Amri M, El Abkari M, Aqodad N, Azib N, Bellil N, Benhoumane N, Benzoubbeir N, Elkhabiz N, Hemdani N, Lahmidani N, Abdelli N, Ben Chaabane N, Tahri N, Azib N, Benhoummane N, Ben Jaafar N, Ben Mustapha N, Maamouri N, Elkhabiz N, Bellil N, Hannachi N, Hemdani N, Ben Alaya N, Bibani N, Trad N, Elleuch N, Lahmidani N, Kharmach O, Bahri O, Bousnina O, Gharbi O, Kharmach O, Benjira R, Ennaifer R, Dabbèche R, Jouini R, Zgolli R, Baklouti R, Bouali Mohamed R, Marouani R, Kallel R, Ennaifer R, Berrag S, El Yazal S, Jiddi S, Mechhour S, Morabit S, Oubaha S, Sentissi S, Bouaziz S, Soua S, Hachicha S, Elaboudi S, Ajmi S, Mallat S, Bouchoucha S, Mrabti S, Ben Slama S, Hamdi S, Laabidi S, Ayadi S, Hidri S, Bizid S, Ben Hamida S, Zertiti S, Ben Amor S, Nsibi S, Bellakhal S, Bahja S, Jomni T, Hliwa W, Rebai W, Ben Mansour W, Ben Othmen W, Dhouib W, Hammoumi W, Zaatour W, Bouhlel W, Feki W, Triki W, Said Y, Zaimi Y, Gorgi Y, Bouhnoun Z, Samlani Z, Hamidi Z, Mnif Z, Ben Safta Z. Oral communication and poster abstracts of the 22nd National Congress of Gastroenterology joint to the 4th Maghrebian Congress of Gastroenterology. December 2018. Tunis Med 2018; 96:932-1007. [PMID: 31131873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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