Journal of gastroenterology and hepatology
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J. Gastroenterol. Hepatol. · Feb 2003
Comparative StudyAnti-Helicobacter pylori therapy in India: differences in eradication efficiency associated with particular alleles of vacuolating cytotoxin (vacA) gene.
The efficiency of Helicobacter pylori eradication varies geographically, as do many parameters that might affect therapeutic efficiency, including bacterial genotype. The aim of the present study was to determine the efficiency of H. pylori eradication using a 10-day proton pump inhibitor-based triple-therapy regimen (omeprazole, clarithromycin and amoxycillin) in an eastern Indian patient population, and to find out the relationship, if any, of the success or failure of the therapy to known features of bacterial genotype. ⋯ This study highlights the public health need for cheaper, more cost-effective anti-H. pylori therapies for developing countries, and suggests that subtle features of bacterial genotype can influence therapeutic efficiency. The possibility that particular vacA mid region alleles affect persistence, perhaps through toxin action on particular gastric cell types, merits further study.
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J. Gastroenterol. Hepatol. · May 2002
Perioperative changes in carbonylhemoglobin and methemoglobin during abdominal surgery: alteration in endogenous generation of carbon monoxide.
Carbon monoxide (CO), which is homologous to nitric oxide (NO) as a monoxide, has been recently studied as a novel gaseous mediator for the maintenance of circulatory homeostasis and as a regulator of organ functions. Abdominal surgery is supposed to modulate the gaseous mediator by the reduction of heme oxygenase (HO) activity or transcriptional regulation of inducible HO. Therefore, we investigated perioperative changes in CO generation during abdominal surgery. ⋯ Changes in COHb and metHb concentrations in arterial blood occur during abdominal surgery, although these amplitudes are small when compared with CO intoxication and methemoglobulinemia. It is likely that organ perfusion and functions are affected by these monoxide gas mediators during abdominal surgery.
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J. Gastroenterol. Hepatol. · Apr 2002
ReviewTreatment of chronic hepatitis B: case selection and duration of therapy.
Hepatitis B viral (HBV) infection is a major health burden in the Asia-Pacific region. The seriousness of chronic hepatitis B (CHB) is often realized at a late stage. The resultant morbidity and mortality from cirrhosis complications is considerable, with a high human cost. ⋯ Antiviral action in conjunction with immune modulation may have a better chance of eradicating HBV and its cccDNA in the hepatocytes as the basis for an eventual successful outcome. The key points are: (i) approved therapeutic agents for chronic hepatitis B (CHB) are IFN, lamivudine and thymosin (in a few countries only); (ii) indications for IFN therapy are viremia in compensated CHB patients with moderately raised ALT; (iii) lamivudine has broader therapeutic indications: it is effective in subgroups of CHB patients with compensated or decompensated liver diseases, but generally works better if patients have raised ALT; (iv) lamivudine has a potent suppressive action on HBV replication, including HBeAg-negative variants, but cannot eliminate cccDNA; this is the reason for the relapse of disease after discontinuing treatment, unless HBeAg seroconversion is obtained; (v) successful use of lamivudine aims at HBeAg seroconversion or profound suppression of HBV-DNA to serum levels of less than 100 000 viral copies/mL, in order to prevent emergence of drug-resistant YMDD mutants (which commences from 6 months onward); (vi) YMDD mutants may cause a flare of hepatitis, resulting in deterioration of liver histology and, occasionally, liver failure; (vii) combination therapy of lamivudine with IFN (standard or pegylated) or other nucleoside analogs should be the next advance. Preliminary data from IFN and lamivudine combination therapy show some promise, but there are conflicting results.