Helicobacter pylori:High dose amoxicillin does not improve primary or secondary eradication rates in an Irish cohort

BACKGROUND Helicobacter pylori(H.pylori)eradication rates have fallen globally,likely in large part due to increasing antibiotic resistance to traditional therapy.In areas of high clarithromycin and metronidazole resistance such as ours,Maastricht VI guidelines suggest high dose amoxicillin dual therapy(HDADT)can be considered,subject to evidence for local efficacy.In this study we assess efficacy of HDADT therapy for H.pylori eradication in an Irish cohort.AIM To assess the efficacy of HDADT therapy for H.pylori eradication in an Irish cohort as both first line,and subsequent therapy for patients diagnosed with H.pylori.METHODS All patients testing positive for H.pylori in a tertiary centre were treated prospectively with HDADT(amoxicillin 1 g tid and esomeprazole 40 mg bid×14 d)over a period of 8 months.Eradication was confirmed with Urea Breath Test at least 4 wk after cessation of therapy.A delta-over-baseline>4%was considered positive.Patient demographics and treatment outcomes were recorded,analysed and controlled for basic demographics and prior H.pylori treatment.RESULTS One hundred and ninety-eight patients were identified with H.pylori infection,10 patients were excluded due to penicillin allergy and 38 patients refused follow up testing.In all 139 were included in the analysis,55%(n=76)were female,mean age was 46.6 years.Overall,93(67%)of patients were treatment-naïve and 46(33%)had received at least one previous course of treatment.The groups were statistically similar.Self-reported compliance with HDADT was 97%,mild side-effects occurred in 7%.There were no serious adverse drug reactions.Overall the eradication rate for our cohort was 56%(78/139).Eradication rates were worse for those with previous treatment[43%(20/46)vs 62%(58/93),P=0.0458,odds ratio=2.15].Age and Gender had no effect on eradication status.CONCLUSION Overall eradication rates with HDADT were disappointing.Despite being a simple and possibly better tolerated regime,these results do not support its routine use in a high dual resistance country.Further investigation of other regimens to achieve the>90%eradication target is needed.

Extended 72-hour patency capsule protocol improves functional patency rates in high-risk patients undergoing capsule endoscopy

BACKGROUND Capsule endoscopy(CE)is a pivotal diagnostic tool for gastrointestinal(GI)disorders,yet capsule retention poses a significant risk,especially in patients with known risk factors.The patency capsule(PC)helps assess the functional patency of the GI tract to mitigate this risk.However,the standard 28-hour protocol for confirming patency often results in high false-positive rates,unnecessarily excluding many patients from undergoing diagnostic CE.AIM To investigate the use of a 72-hour extended patency protocol to improve functional patency rates in patients at risk of capsule retention.METHODS We performed a prospective,open-label study evaluating an extended 72-hour protocol for confirming functional patency with the PC.Conducted over six months,135 patients with risk factors for capsule retention were enrolled.The primary endpoint was the capsule retention rate in patients with confirmed functional patency.Secondary endpoints included the rates of confirmed patency via self-reporting or radiology,small bowel transit times,and adverse events.RESULTS Functional patency was confirmed in 48.9%(n=66)of patients within 28 hours,with an additional 17.4%(n=12)confirmed within 72 hours,increasing the overall patency rate to 57.8%.There was no significant difference in small bowel transit time between patients confirmed for patency at 28 hours vs those confirmed at 72 hours.Importantly,no capsule retention was observed in patients who were confirmed for patency under the extended protocol.Notably,50%(n=39)of patients who proceeded to CE had clinically significant findings.CONCLUSION Extending the patency assessment protocol to 72 hours significantly improves the rate of confirmed functional patency without increasing the risk of capsule retention.This protocol is safe,effective,and cost-neutral,allowing more patients to benefit from CE.Further studies are recommended to refine the protocol and enhance its clinical utility.