First-line eradication for Helicobacter pylori-positive gastritis by esomeprazole-based triple therapy is influenced by CYP2C19 genotype

AIM: To evaluate the effect of first line esomeprazole(EPZ)-based triple therapy on Helicobacter pylori(H. pylori) eradication.METHODS: A total of 80 Japanese patients with gastritis who were diagnosed as positive for H. pylori infection by endoscopic biopsy-based or ^(13)C-urea breath tests were included in this study. The average age of the patients was 57.2 years(male/female, 42/38). These patients were treated by first-line eradication therapy with EPZ 40 mg/d, amoxicillin 1500 mg/d, and clarithromycin 400 mg/d for 7 d. All drugs were given twice per day. Correlations between H. pylori eradication, CYP2C19 genotype, and serum pepsinogen(PG) level were analyzed. This study was registered with the UMIN Clinical Trials Registry(UMIN000009642).RESULTS: The H. pylori eradication rates by EPZbased triple therapy evaluated by intention-to-treat and per protocol were 67.5% and 68.4%, respectively, which were similar to triple therapies with other first-generation proton pump inhibitors(PPIs). The eradication rates in three different CYP2C19 genotypes, described as extensive metabolizer(EM), intermediate metabolizer, and poor metabolizer, were 52.2%, 72.1%, and 84.6%, respectively. The H. pylori eradication rate was significantly lower in EM than non-EM(P < 0.05). The serum PG?Ⅰ?level and PG?Ⅰ/Ⅱ ratio were significantly increased after eradication of H. pylori(P < 0.01), suggesting that gastric atrophy was improved by H. pylori eradication. Thus, first-line eradication by EPZbased triple therapy for patients with H. pylori-positive gastritis was influenced by CYP2C19 genotype, and the eradication rate was on the same level with other firstgeneration PPIs in the Japanese population.CONCLUSION: The results from this study suggest that there is no advantage to EPZ-based triple therapy on H. pylori eradication compared to other firstgeneration PPIs.

Endoscopic snare papillectomy for a solitary Peutz-Jeghers-type polyp in the duodenum with ingrowth into the common bile duct: Case report

Solitary duodenal Peutz-Jeghers(PJ)-type hamartomatous polyps are rare and considered a different disease entity than classic PJ syndrome.We describe the case of an 89-year-old man admitted to our emergency department with symptoms of acute cholangitis,liver dysfunction,and slight jaundice.Magnetic resonance imaging showed multiple signal voids,reflecting choledocholithiasis,and an ovalshaped tumor in the common bile duct(CBD).Following endoscopic retrograde cholangiopancreatography,the patient was diagnosed with a lower CBD tumor 20 mm in diameter.Endoscopic sphincterotomy was performed for choledocholithotomy,resulting in the expulsion of a large tumor with a stalk connected to the papilla of Vater.The tumor was successfully excised en bloc by endoscopic snare papillectomy.Histopathologic examination showed that the tumor was a PJ-type hamartomatous polyp.No mucocutaneous pigmentation of the skin was evident and the patient's family history was negative.Solitary duodenal PJ-type hamartomatous polyps are usually diagnosed incidentally during endoscopy for other indications because most of these tumors are asymptomatic or have nonspecific presentations.To our knowledge,this is the first reported solitary PJ-type polyp with intra-CBD growth treated by endoscopic snare papillectomy.

Effect of the Suppression of Cariesitic Bacterial Growth and Biofilm Formation Using Hydrogen/Free Chlorine Mixed Water Produced by an Electrolysis-Type Hydrogen Generator

OBJECTS: Hydrogen has been shown to possess antibacterial effects at high concentrations. In addition, chlorine has a strong bactericidal effect even at low concentrations. Electrolysis is a way to simultaneously generate these two components. However, the concentration of hydrogen/free chlorine mixed water generated through electrolysis decreases quickly. It is predicted that the concentration of hydrogen/free chlorine mixed water will vary depending on the quality of water used. After investigating the optimum generation conditions, the effects of the most stable concentration of hydrogen/free chlorine mixed water on carious tooth fungus were evaluated in vitro. Thus, in this experiment, our goal was to evaluate the effects of hydrogen/free chlorine mixed water on oral bacteria. MATERIALS AND METHODS: Using a device that generates hydrogen/free chlorine through electrolysis, the differences in the concentrations of hydrogen and free chlorine based on electrolysis time were evaluated using tap water. Additionally, various concentration changes due to electrolysis time on the hydrogen/free chlorine mixed water were evaluated. Distilled tap water as a control group, hydrogen/free chlorine mixed water, and commercially available mouthwash were added for 1 minute to cultured Streptococcus mutans and then rinsed out with the culture medium. Bacterial growth (600 nm) and biofilm formation (590 nm) were measured at 3 and 6 hours after the addition of the medium. RESULTS: The concentration of hydrogen/chlorine mixed water produced by electrolysis varied depending on electrolysis time and the water used. The inhibitory effect of bacterial growth was enhanced depending on the chlorine concentration. Regarding the inhibitory effect on biofilm formation, only the mixed water of hydrogen/free chlorine concentration (500 ppb - 1.0 mg/L) had a suppressing effect after 6 hours. CONCLUSION: It was suggested that hydrogen/chlorine mixed water can be easily produced by electrolysis and has the effect of suppressing the growth of dental caries;therefore, it could be used as a cleaning agent in oral care products.