Infection with Helicobacter pylori is globally prevalent. It is a chronic infection, standard treatment of which includes two antibiotics, amoxicillin and clarithromycin, plus a proton pump inhibitor used for 1 or 2 weeks. However, owing to increased resistance in our country, definitive eradication of H pylori is difficult. We conducted this study to evaluate the efficacy of a regimen using levofloxacin for successful eradication of H pylori infection.
This is a prospective study conducted at a tertiary care hospital. After informed written consent, all patients with proven H pylori infection (either by biopsy or by stool antigen test) were included in this study on the basis of other inclusion and exclusion criteria. Patients were given levofloxacin-based sequential therapy and stool for H pylori antigen was performed as per protocol to assess the eradication rate (ie, efficacy of levofloxacin-based regimen). Patients were required to fill a Performa for assessment of symptoms. Chi-square test was used for analysis. P < 0.05 was considered as significant.
A total of 149 patients with active H pylori infection were included. Out of 149 cases, 80 (53.7%) were male and 69 (46.3%) female. H pylori eradication was successfully achieved in 128 (85.9%) patients, 13 (8.7%) patients remained positive after eradication therapy and 8 (5.4%) patients lost follow up. No serious adverse event was observed.
Levofloxacin-based sequential therapy was highly effective (85.9%) against chronic H pylori infection.
Colorectal endoscopic full-thickness resection using the full-thickness resection device is an emerging endoscopic therapy for non-lifting adenomas and subepithelial lesions. We aim to describe our initial experience and examine the outcomes of colorectal endoscopic full-thickness resection in our centre.
All colorectal endoscopic full-thickness resection performed from 2016 to 2021 were reviewed retrospectively. Demographic data, indication of endoscopic full-thickness resection, lesion size and location were collected. Outcomes assessed included technical success, complete resection, adverse events and need for surgery.
Thirteen patients were included in the study. Four patients had recurrent/ residual adenoma and nine had rectal neuroendocrine tumours (NETs). The resected specimens measured 20-mm. Mean lesion size was 9.77 mm. All but one lesions were located in rectum. Technical success and complete resection rates were 100%. One patient underwent right hemicolectomy for unsuspected T1 adenocarcinoma with deep submucosal invasion. Four patients had minor post-procedure bleeding. No major adverse events were identified.
Colorectal endoscopic full-thickness resection with full-thickness resection device for treatment of residual/recurrent colorectal adenoma and rectal NET is efficacious and safe. It had a significant positive impact on management as it could definitively establish the adequacy of endoscopic resection by histology and confirm the feasibility of curative resection.
A 21-year-old male presented with worsening, intermittent lower abdominal pain associated with 10 kg weight loss over the preceding 6 months. His past medical history was significant in view of a prior 12-cm small bowel resection secondary to subacute intestinal obstruction, with Meckel's diverticulum confirmed as the underlying cause on histology. Upon investigation, iron deficiency anaemia was noted, but oesophagogastroduodenoscopy and ileocolonoscopy were normal. Cross-sectional imaging only showed the surgical clips. However, on capsule endoscopy, the capsule was retained and an ischaemic small bowel loop was resected laparoscopically. Small bowel anastomotic ulcers are either rare or underdiagnosed, have a wide differential diagnosis and as for other small bowel pathology, are best diagnosed via capsule endoscopy.
Cholangiocarcinoma has a poor prognosis because of the poor early detection rate and limited treatment options. Therefore, it is important to understand the symptoms of paraneoplastic syndromes in order to detect occult malignancy early, when it is still at a highly treatable stage. Here, we report an extremely rare case of cholangiocarcinoma with paraneoplastic syndrome related to a clinical diagnosis of dermatomyositis (DM) sine dermatitis. A 74-year-old Caucasian man experienced 3 weeks of painless jaundice, progressive proximal muscle weakness and renal failure with rhabdomyolysis. Based on the results of laboratory tests and imaging (magnetic resonance cholangiopancreatography, endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography) and histological examination, the diagnosis was cholangiocarcinoma. The diagnosis was consistent with cholangiocarcinoma with paraneoplastic syndrome provoked by DM sine dermatitis. He was successfully treated with biliary stent insertion and supportive management. Eventually, Whipple surgery was successfully performed. Paraneoplastic syndrome is very rare in patients with cholangiocarcinoma, and it is extremely uncommon in the setting of DM. This is the first case in New Zealand.
Helicobacter pylori infection in dyspepsia is an important clinical problem with increasing antibiotic resistance.
To evaluate the efficacy of levofloxacin-based triple therapy compared with clarithromycin-based triple therapy for Helicobacter pylori eradication in chronic dyspepsia.
This was a prospective, single-blinded randomized trial. Rapid urease test and histology were performed in patients with chronic dyspepsia who underwent gastroscopy. H pylori-infected patients were randomly allocated into two equal groups prescribing 10-day course of levofloxacin-based or clarithromycin-based regime. Endoscopic responses and eradication status of both regimes were rechecked with gastroscopy 4 weeks after therapies.
Two hundred and ninety-one treatment-naïve patients were enrolled. Eradication rates were 40% vs 47.5% on intention to treat (ITT) analysis and 43.7% vs 50.8% on per-protocol (PP) for clarithromycin group vs levofloxacin group, respectively. In levofloxacin arm, eradication occurred in 62.5% (ITT) & 71.4% (PP) of ulcer dyspepsia and 43.2% (ITT) and 46.6% (PP) of nonulcer dyspepsia.
Among ulcer dyspepsia, 58.3% healed in clarithromycin group and 64.3% in levofloxacin group. In nonulcer dyspepsia, gastritis was resolved in 21% of clarithromycin group and 10% of levofloxacin group. Adverse effects occurred in 30% of clarithromycin group and 27.6% of levofloxacin group.
In the study, eradication rates of both therapies were very low to unacceptable level. Levofloxacin was not effective in both ulcer and nonulcer dyspepsia. The emergence of primary levofloxacin resistant strains due to widespread usages in various infections might be the reason.
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