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Jaafar MH, Safi SZ, Tan MP, Rampal S, Mahadeva S. Efficacy of Rebamipide in Organic and Functional Dyspepsia: A Systematic Review and Meta-Analysis. Dig Dis Sci 2018; 63:1250-1260. [PMID: 29192375 DOI: 10.1007/s10620-017-4871-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/24/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The role of gastritis in dyspepsia remains controversial. We aimed to examine the efficacy of rebamipide, a gastric mucosal protective agent, in both organic and functional dyspepsia. DESIGN A systematic review and meta-analysis was performed. The following databases were searched using the keywords ("rebamipide" OR "gastroprotective agent*" OR "mucosta") AND ("dyspepsia" OR "indigestion" OR "gastrointestinal symptoms"): PubMed, Wed of Science, Embase, CINAHL, Cochrane Clinical Trials Register. The primary outcome was dyspepsia or upper GI symptom score improvement. Pooled analysis of the main outcome data were presented as risk ratio (RR) for dichotomous data and standardized mean difference (SMD) for continuous data. RESULTS From an initial 248 records, 17 randomised controlled trial (RCT) publications involving 2170 subjects (1224 rebamipide, 946 placebo/control) were included in the final analysis. Twelve RCTs were conducted in subjects with organic dyspepsia (peptic ulcer disease, reflux esophagitis or NSAID-induced gastropathy) and five RCTs were conducted in patients with functional dyspepsia (FD). Overall, dyspepsia symptom improvement was significantly better with rebamipide compared to placebo/control drug (RR 0.77, 95% CI = 0.64-0.93; SMD -0.46, 95% CI = -0.83 to -0.09). Significant symptom improvement was observed both in pooled RR and SMD in subjects with organic dyspepsia (RR 0.72, 95% CI = 0.61-0.86; SMD -0.23, 95% CI = -0.4 to -0.07), while symptom improvement in FD was observed in pooled SMD but not RR (SMD -0.62, 95% CI = -1.16 to -0.08; RR 1.01, 95% CI = 0.71-1.45). CONCLUSION Rebamipide is effective in organic dyspepsia and may improve symptoms in functional dyspepsia.
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Affiliation(s)
- Mohamed Hasif Jaafar
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Sher Zaman Safi
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
- Interdisciplinary Research Center in Biomedical Materials (IRCBM), COMSATS Institute of Information Technology, Lahore, Pakistan
| | - Maw-Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Sanjay Rampal
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjiv Mahadeva
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Tatishchev SF, VanBeek C, Wang HL. Helicobacter pylori infection and colorectal carcinoma: is there a causal association? J Gastrointest Oncol 2012; 3:380-385. [PMID: 23205318 PMCID: PMC3492471 DOI: 10.3978/j.issn.2078-6891.2012.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 10/30/2012] [Indexed: 12/21/2022] Open
Affiliation(s)
- Sergei F. Tatishchev
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Christine VanBeek
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hanlin L. Wang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, USA
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Sekino Y, Yamada E, Sakai E, Ohkubo H, Higurashi T, Iida H, Endo H, Takahashi H, Koide T, Sakamoto Y, Nonaka T, Gotoh E, Maeda S, Nakajima A, Inamori M. Influence of sumatriptan on gastric accommodation and on antral contraction in healthy subjects assessed by ultrasonography. Neurogastroenterol Motil 2012; 24:1083-e564. [PMID: 22882753 DOI: 10.1111/j.1365-2982.2012.01984.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Oral sumatriptan administration has been reported to delay gastric emptying after liquid meals. The aim of this study was to determine whether delayed gastric emptying is caused by enhanced gastric accommodation, impaired antral contractions, or both using ultrasonography. METHODS Ten healthy volunteers were enrolled in this randomized two-way crossover study. After overnight fasting, the subjects received the liquid meal 60 min after ingesting a 50 mg sumatriptan tablet with 50 mL of water or 50 mL of water alone (control). The cross-sectional area of the proximal stomach was measured in a supine position after every 100 mL. The frequency and amplitude of the antral contractions were measured in a slightly backward sitting position. The intragastric distribution of the liquid meal was assessed by calculating the proximal stomach/distal stomach ratio (prox/distal ratio). KEY RESULTS The cross-sectional area after drinking 100, 200, and 300 mL of the liquid meal (oral sumatriptan vs control) was 34.49 vs 15.11 cm(2) (P = 0.0051), 48.00 vs 30.61 cm(2) (P = 0.0166), and 58.67 vs 47.19 cm(2) (P = 0.0125), respectively. There was no significant difference in the amplitude of contractions, contraction cycle, motility index, and prox/distal ratio (97.15 vs 97.93%, P = 0.0745; 19.42 vs 19.5 s, P= 0.8590; and 887.58 vs 889.22, P = 0.5751; 9.75 vs 8.41, P = 0.8785; respectively). CONCLUSIONS & INFERENCES Oral sumatriptan administration enhanced gastric accommodation after the ingestion of liquid nutrients, but had no significant effect on antral contractions or intragastric distribution in healthy subjects.
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Affiliation(s)
- Y Sekino
- Gastroenterology Division, Yokohama City University Hospital, Kanagawa, Japan
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Nardone G, Rocco A, Staibano S, Mezza E, Autiero G, Compare D, De Rosa G, Budillon G. Diagnostic accuracy of the serum profile of gastric mucosa in relation to histological and morphometric diagnosis of atrophy. Aliment Pharmacol Ther 2005; 22:1139-46. [PMID: 16305728 DOI: 10.1111/j.1365-2036.2005.02734.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Histology is the gold standard for diagnosis of atrophy but is hampered by observer variation. A reliable method to overcome this issue is morphometric analysis of gastric mucosa. Serum pepsinogens and gastrin have been proposed in the diagnostic work-up of gastric atrophy although diagnostic accuracy of these tests is considered unsatisfactory. AIM To evaluate the diagnostic accuracy of gastric serum profile in relation both to morphological and morphometric diagnosis of gastric atrophy. METHODS Ninety-four dyspeptic out-patients underwent upper endoscopy and evaluation of serum levels of PGI, PGII and 17-gastrin. Diagnostic accuracy of gastric serum profile was tested by receiver operating characteristic curves and by evaluation of sensitivity and specificity in relation to both histology and morphometric analyses. RESULTS As far as concern to histological evaluation, only PGI/PGII ratio showed an acceptable diagnostic accuracy in discrimination of gastric atrophy, while, when morphometric analysis was considered as reference, both serum PGI level and PGI/PGII ratio showed an excellent performance. However, both PGI and PGI/PGII ratio showed low sensitivity and high specificity. CONCLUSIONS Serological gastric profile corresponds better with the morphometric diagnosis of atrophy, even if, because of the low sensitivity, today this could only be used as screening test of chronic atrophic gastritis.
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Affiliation(s)
- G Nardone
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, University Federico II, Naples, Italy.
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Leontiadis GI, Minopoulos GI, Maltezos E, Kotsiou S, Manolas KI, Simopoulos K, Hatseras D. Effects of Helicobacter pylori infection on gastric emptying rate in patients with non-ulcer dyspepsia. World J Gastroenterol 2004; 10:1750-4. [PMID: 15188499 PMCID: PMC4572262 DOI: 10.3748/wjg.v10.i12.1750] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: The pathogenesis of delayed gastric emptying in patients with non-ulcer dyspepsia (NUD) remains unclear. We aimed to examine whether gastric emptying rate in NUD patients was associated with Helicobacter pylori (H pylori) infection and whether it was affected by eradication of the infection.
METHODS: Gastric emptying rate of a mixed solid-liquid meal was assessed by the paracetamol absorption method in NUD patients and asymptomatic controls (n = 17). H pylori status was assessed by serology and biopsy urease test. H pylori-positive NUD patients (n = 23) received 10-day triple eradication therapy. H pylori status was re-assessed by biopsy urease test four weeks later, and if eradication was confirmed, gastric emptying rate was re-evaluated.
RESULTS: Thirty-three NUD patients and 17 controls were evaluated. NUD patients had significantly delayed gastric emptying compared with controls. The mean maximum plasma paracetamol concentration divided by body mass (Cmax/BM) was 0.173 and 0.224 mg/L·kg respectively (P = 0.02), the mean area under plasma paracetamol concentration-time curve divided by body mass (AUC/BM) was 18.42 and 24.39 mg·min/L·kg respectively (P = 0.01). Gastric emptying rate did not differ significantly between H pylori-positive and H pylori-negative NUD patients. The mean Cmax/BM was 0.172 and 0.177 mg/L·kg respectively (P = 0.58), the mean AUC/BM was 18.43 and 18.38 mg·min/ L·kg respectively (P = 0.91). Among 14 NUD patients who were initially H pylori-positive, confirmed eradication of the infection did not significantly alter gastric emptying rate. The mean Cmax/BM was 0.171 and 0.160 mg/L·kg before and after Hp eradication, respectively (P = 0.64), the mean AUC/BM was 17.41 and 18.02 mg·min/L·kg before and after eradication, respectively (P = 0.93).
CONCLUSION: Although gastric emptying is delayed in NUD patients compared with controls, gastric emptying rate is not associated with H pylori status nor it is affected by eradication of the infection.
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Affiliation(s)
- Grigoris I Leontiadis
- 2nd Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
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Treiber G, Schwabe M, Ammon S, Walker S, Klotz U, Malfertheiner P. Dyspeptic symptoms associated with Helicobacter pylori infection are influenced by strain and host specific factors. Aliment Pharmacol Ther 2004; 19:219-31. [PMID: 14723613 DOI: 10.1111/j.1365-2036.2004.01751.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dyspepsia can be associated with H. pylori infection. AIM To assess dyspeptic symptoms and potentially influencing factors before and up to 6 months following successful H. pylori eradication therapy. METHODS Prospective cohort study involving H. pylori positive subjects from ambulatory or hospitalized care. Main outcome measures were symptoms during baseline and follow-up, the proportion of symptom-free patients, and symptom scores. RESULTS After successful eradication, the summary score of all dyspeptic symptoms decreased and during follow-up, the proportion of symptom-free patients was higher in the group with peptic ulcers (69.4% vs. 40.9%, P < 0.0001) than with functional dyspepsia (FD). Regardless of diagnosis, virulent strains of H. pylori were associated with a higher prevalence of epigastric pain before treatment: absolute risk-difference (ARD) with Oip-A: 18.2%, Odds Ratio (OR) 2.35 [1.3-4.2, 95%-CI], P = 0.01; with Cag-A: 24.6%, OR 2.81 [1.6-5], P = 0.01. Low-dose aspirin in part was a major risk factor in FD for previous weight loss bdfore study entry. Post-treatment, non-ulcer patients were more likely to suffer from distention/bloating. Likewise, alcohol induced persistence of nausea and vomiting in this population. CONCLUSIONS Dyspeptic symptoms in H. pylori infected patients are more common with virulent strains. Symptoms are more likely to persist despite successful eradication if patients initially harboured virulent strains or concomitant aspirin or alcohol intake are present. In one-third of peptic ulcer patients, symptoms will not be cured 3 months after therapy.
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Affiliation(s)
- G Treiber
- Department of Gastroenterology/Hepatology, University Hospital, Magdeburg, Germany.
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Daudén E, Cabrera MM, Oñate MJ, Pajares JM, García-Díez A. Helicobacter pylori CagA seropositivity is not strongly associated with lichen planus. J Am Acad Dermatol 2004; 49:1199. [PMID: 14639425 DOI: 10.1016/s0190-9622(02)61465-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kiltz U, Pfaffenbach B, Schmidt WE, Adamek RJ. The lack of influence of CagA positive Helicobacter pylori strains on gastro-oesophageal reflux disease. Eur J Gastroenterol Hepatol 2002; 14:979-84. [PMID: 12352217 DOI: 10.1097/00042737-200209000-00008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Helicobacter pylori infection of the gastric mucosa may influence gastro-oesophageal reflux disease (GORD). The protein of cytotoxin associated gene A (CagA) is assumed to be a virulence factor of H. pylori. CagA positive strains may induce severe gastroduodenal peptic ulcer disease. The aim of this study was to evaluate the association between H. pylori strains expressing CagA and GORD. SUBJECTS AND METHODS Nine hundred and thirty patients were examined by endoscopy. Antral and corpus biopsies for the urease test and serum samples for the detection of IgG antibodies to CagA were taken. Serum samples were assayed by using the western blot technique. RESULTS The results from 811 patients were analysed statistically. This study population consisted of 264 H. pylori infected patients (264/811, 32%). The H. pylori prevalence was 33% (89/266) in patients with reflux oesophagitis and did not differ from those patients without oesophagitis (175/545, 32%). In contrast, patients with Barrett's oesophagus showed a significantly lower prevalence of H. pylori infection than the other three groups (8/35, 23%). There was no significant influence of CagA, as one of the H. pylori virulence factors, on GORD. Antibodies against CagA were slightly, but insignificantly, more frequent in patients with oesophagitis (55/89, 62%) than in patients without oesophagitis (94/175, 54%). CONCLUSIONS In a large cohort of GORD patients no significant difference in the prevalence of H. pylori in patients with and without GORD was found. In addition, there is no correlation between patients carrying CagA positive strains and development of reflux oesophagitis. However, in the case of histopathologically proven Barrett's oesophagus the prevalence of H. pylori was significantly lower. The influence of CagA positive strains on oesophageal mucosa is discussed.
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Affiliation(s)
- Uta Kiltz
- Department of Medicine I, St Josef Hospital, Ruhr University of Bochum Medical School, Gudsrunstrasse 56, D-44791 Bochum, Germany.
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Abstract
Although up to 50% of patients diagnosed with nonulcer dyspepsia (NUD) have Helicobacter pylori infection and underlying chronic gastritis, it remains controversial whether any causal relationship exists. The results of worldwide epidemiological studies have been unconvincing. No clear-cut link has been documented between H. pylori and any specific symptom profile or pathophysiological mechanism in NUD. In the randomized controlled trials, methodological weaknesses may explain in part the conflicting results, but even in the well-conducted trials controversy persists. Although meta-analyses have attempted to resolve the issue, inherent methodological difficulties with meta-analysis remain a problem. Moreover, even the methodologically sound meta-analyses have reported conflicting results. In addition, predictors of treatment response remain obscure, and there continue to be theoretical concerns about the treatment of H. pylori infection in all patients with NUD. Hence, the management of these patients is challenging, but eradication of H. pylori infection may be beneficial in a small subgroup of cases with NUD that cannot be identified before treatment.
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Affiliation(s)
- N J Talley
- University of Sydney, Nepean Hospital, Penrith, Australia.
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Abstract
Nonulcer dyspepsia, characterized by unexplained persistent or recurrent epigastric pain or discomfort, affects approximately 20% of the general population. Symptom-based diagnostic criteria, first developed by an international group of experts, have been refined in the past year in an effort to increase the applicability of the criteria (Rome II criteria). New disease-specific questionnaires that were developed to measure quality of life in patients with dyspepsia are now available and are expected to be widely used in clinical research studies. Studies on the pathophysiology and management of nonulcer dyspepsia were other major topics in the past year, including three large, well-conducted randomized controlled trials of Helicobacter pylori eradication and symptom resolution.
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Affiliation(s)
- J Hammer
- Universitätsklinik für Innere Medizin IV, Abteilung für Gastroenterologie und Hepatologie, Vienna, Austria
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