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Tirgar Fakheri S, Shokri-Afra H, Graham DY, Bari Z, Fakheri H. A pilot study evaluating high dose esomeprazole, bismuth subcitrate and amoxicillin for eradicating Helicobacter pylori infection in Iran. Helicobacter 2024; 29:e13061. [PMID: 38411303 DOI: 10.1111/hel.13061] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/04/2024] [Accepted: 02/14/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Helicobacter pylori (H. pylori) is strongly associated with peptic ulcer disease and gastric cancer. We evaluated two triple therapy regimens comprising esomeprazole, high dose bismuth, and different doses of amoxicillin for first-line H. pylori eradication. MATERIALS AND METHODS Two hundred patients with dyspepsia and naive H. pylori infection were randomly assigned into two groups (n = 100). Both groups were treated for 14 days similarly with esomeprazole (40 mg, twice daily) and bismuth subcitrate (240 mg, three times daily), but the dose of amoxicillin was varied between Groups A (750 mg) and B (1000 mg) three times daily. Treatment compliance and side effect were evaluated following the therapies and after 8 weeks, a negative test of stool H. pylori antigen confirmed eradication. RESULTS The two groups were comparable with respect to sex and age. According to intention to treat analysis, eradication rates were 80% (95% CI: 77.2%-82.8%) and 90% (95% CI: 84.1%-95.9%) in A and B groups, respectively (p = 0.22). Per-protocol eradication rates were 87% (95% CI: 80.4%-93.6%) and 92.8% (95% CI: 87.7%-97.9%), respectively (p = 0.23). Severe adverse effects were 3% and 2%, respectively (p = 0.34). CONCLUSION High dose esomeprazole, amoxicillin and bismuth achieved 92.8% cure rates per protocol in a country with a high background rate of resistance. Additional studies are needed to ascertain whether this therapy can be further improved. Until then, it can be recommended as a first-line H. pylori eradication in north of Iran.
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Affiliation(s)
- Sepehr Tirgar Fakheri
- Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hajar Shokri-Afra
- Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - David Y Graham
- Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Zohreh Bari
- Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hafez Fakheri
- Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Bari Z, Hadipour M, Fakheri H, Kazemi A, Maleki I, Taghvaei T, Hosseini V, Valizadeh SM, Masoumi D, Shahbazkhani B, Shokri Shirvani J, Tirgar Fakheri S, Ebrahimi R. Epidemiological, Endoscopic, Clinical, and Pathological Features of Patients with Celiac Diseases in Southern Littoral of Caspian Sea. Middle East J Dig Dis 2023; 15:257-262. [PMID: 38523893 PMCID: PMC10955989 DOI: 10.34172/mejdd.2023.355] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/29/2023] [Indexed: 03/26/2024] Open
Abstract
Background: Celiac disease is an autoimmune disorder resulting from gluten consumption in genetically predisposed individuals. The present study investigated the epidemiological, endoscopic, and clinicopathological features of patients with celiac disease in the southern littoral of the Caspian Sea. Methods: 140 patients with celiac disease were interviewed and examined regarding demographic characteristics, clinical symptoms, and serologic, endoscopic, and pathological findings. Results: 44 (31.4%) of the patients were male and 68.6% were female. The mean age of the patients at diagnosis was 27.13±13.4 years (ranging from 2 to 60 years). The most common gastrointestinal (GI) symptoms were bloating (47.8%), abdominal pain (47.1%) and diarrhea (30.7%), respectively. Also, 17 (12.1%) patients did not complain of any GI symptoms.18 (12.8%) patients had aphthous stomatitis, 10.7% had dermatitis herpetiformis, 3.6% suffered from itching without a rash, two (1.4%) mentioned psoriasis and one (0.7%) had lichen planus. 19 (19.7%) of the female patients complained of menstrual bleeding disorders, 4% mentioned infertility, and 2% experienced primary amenorrhea. The most common comorbid condition was hypothyroidism in 16 (11.4%) patients. The most common endoscopic finding was duodenal scalloping (37.25%). In addition, 7.8% of the patients had a normal endoscopic appearance. 43 (30.7%) patients were classified as Marsh IIIC, 25.7% Marsh IIIB, 17.8% Marsh IIIA, 12.8% Marsh II and 12.8% were classified as Marsh I. Conclusion: Since celiac disease can present with non-GI manifestations and the majority of our patients had Marsh III classification, it seems that celiac disease must be considered as a routine screening test in GI clinics, and also, it should be kept in mind as a differential diagnosis in other specialty fields.
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Affiliation(s)
- Zohreh Bari
- Department of Internal Medicine, Gut and Liver Research Center, Non-communicable Disease Research Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Hafez Fakheri
- Department of Internal Medicine, Gut and Liver Research Center, Non-communicable Disease Research Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Arash Kazemi
- Department of Internal Medicine, Gut and Liver Research Center, Non-communicable Disease Research Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Iradj Maleki
- Department of Internal Medicine, Gut and Liver Research Center, Non-communicable Disease Research Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tarang Taghvaei
- Department of Internal Medicine, Gut and Liver Research Center, Non-communicable Disease Research Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Vahid Hosseini
- Department of Internal Medicine, Gut and Liver Research Center, Non-communicable Disease Research Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Mohammad Valizadeh
- Department of Internal Medicine, Gut and Liver Research Center, Non-communicable Disease Research Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Danial Masoumi
- Student of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Bijan Shahbazkhani
- Department of Gastroenterology, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Shokri Shirvani
- Department of Internal Medicine, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Sepehr Tirgar Fakheri
- Gut and Liver Research Center, Non-communicable Disease Research Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reyhaneh Ebrahimi
- Gut and Liver Research Center, Non-communicable Disease Research Institute, Mazandaran University of Medical Sciences, Sari, Iran
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