RESUMO
BACKGROUND: Since the discovery, several decades ago, of the infection of the gastric mucosa with Helicobacter pylori and its association with chronic antral gastritis and peptic ulcer, the treatment of ulcer illness has recently been revolutionized. METHODS: In this study, the clinical effectiveness of three schemes of treatment with colloidal bismuth subcitrate (CBS) were compared. Fifty-three patients suffering from gastroduodenal peptic ulcer with Helicobacter pylori were distributed randomly into three groups. Group I (n = 17) received 240 mg CBS every 12 h for 6 weeks. Group II (n = 17) received 240 mg CBS every 12 h for 6 weeks, pus metronidazole 500 mg every 8 h plus tetracycline 500 mg every 8 h for 10 days. Group III (n = 19) received 240 mg CBS every 12 h for 6 weeks, plus metronidazole 500 mg every 8 h plus amoxicillin 750 mg every 12 h for 10 days. A duodenoscopy investigation with antrum biopsy for a morphologic study and detection of the germ was carried out by means of urease test and histological study (Warthin-Sarry and hematoxylin-eosin). RESULTS: The three schemes of treatment were effective for ulcerous healing with 70.5%, 82.3%, and 78.2%, respectively, without significant differences. The highest clearing index (52.6%) was obtained in group III. CONCLUSIONS: With these treatments, the Helicobacter pylori eradication was only observed in 47.3% of the patients studied.
Assuntos
Antibacterianos/uso terapêutico , Antiulcerosos/uso terapêutico , Gastrite/tratamento farmacológico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Compostos Organometálicos/uso terapêutico , Úlcera Péptica/tratamento farmacológico , Amoxicilina/administração & dosagem , Amoxicilina/uso terapêutico , Antibacterianos/administração & dosagem , Antiulcerosos/administração & dosagem , Coloides , Esquema de Medicação , Resistência Microbiana a Medicamentos , Quimioterapia Combinada/administração & dosagem , Quimioterapia Combinada/uso terapêutico , Úlcera Duodenal/tratamento farmacológico , Úlcera Duodenal/etiologia , Duodenoscopia , Feminino , Gastrite/complicações , Gastroscopia , Infecções por Helicobacter/complicações , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Metronidazol/administração & dosagem , Metronidazol/uso terapêutico , Compostos Organometálicos/administração & dosagem , Úlcera Péptica/etiologia , Úlcera Péptica/microbiologia , Úlcera Gástrica/tratamento farmacológico , Úlcera Gástrica/etiologia , Tetraciclina/administração & dosagem , Tetraciclina/uso terapêutico , Resultado do TratamentoRESUMO
Duodenal diverticuli has been associated with biliary stones, specially in the common bile duct. Its presence alters the anatomy of the region of the papilla difficulting its identification and cannulation. ERCP was performed in 800 patients with suspicion of bilio-pancreatic disease, 60 (7.5%) of these patients (39 male and 21 female) had juxtapapillary diverticuli (single diverticuli in 52, 2 in 7 and 3 in 1 patient). In these patient cannulation of the common bile duct was possible in 43 (72%), only the pancreatic duct in 5 (8%) and no cannulation in 12 (20%). Common bile duct stones were found in 22 patients, papillotomy was indicated in 14 patients and was performed in 12, in 2 patients it was not possible to position the papillotomy.