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Bismuth Derivative

The Experts below are selected from a list of 12 Experts worldwide ranked by ideXlab platform

Sadegh Massarrat – 1st expert on this subject based on the ideXlab platform

  • Various durations of a standard regimen (amoxycillin, metronidazole, colloidal Bismuth sub-citrate for 2 weeks or with additional ranitidine for 1 or 2 weeks) on eradication of Helicobacter pylori in Iranian peptic ulcer patients. A randomized contro
    European Journal of Gastroenterology & Hepatology, 2001
    Co-Authors: Mohammad Javad Kaviani, Reza Malekzadeh, H Vahedi, Masoud Sotoudeh, Naser Kamalian, Mohsen Amini, Sadegh Massarrat

    Abstract:

    Introduction One of the most economical and effective therapeutic regimens for eradication of Helicobacter pylori is the classic triple therapy with amoxycillin or tetracycline, metronidazole and a Bismuth Derivative. Addition of H 2 -receptor antagonists to these drugs may heighten the rate of eradication and shorten the duration. We therefore performed a randomized controlled trial comparing twice daily metronidazole, Bismuth Derivative and amoxycillin for 2 weeks with additional ranitidine for 1 or 2 weeks. Patients and methods In total, 240 adult patients with duodenal ulcer and H. pylori infection were randomly assigned to one of the following regimens: (1) amoxycillin 1 g bid, metronidazole 500 mg bid, Bismuth sub-citrate 240 mg bid and ranitidine 300 mg bid for 1 week; (2) triple therapy without ranitidine for 2 weeks; or (3) triple therapy plus ranitidine 300 mg bid for 2 weeks. Side-effects of the drugs were evaluated two weeks after starting the treatment. The rapid urease test and histology from antrum and corpus, and/or 14 C- urea breath test were used to determine H. pylori eradication six weeks after starting the treatment. Results In total, 195 patients were followed up for 6 weeks. The most frequent drug side-effects were unpleasant taste (46%), dry mouth (41%) and fatigue (26%), which had an equal distribution in all treatment groups. Endoscopy and 14 C- urea breath test were performed for 178 and 123 patients, respectively. Eradication of H. pylori was documented in 19/64 (29.7%), 29/63 (46%) and 50/68 (73.5%) of patients in groups 1, 2 and 3, respectively (P< 0.000001 for group 1 versus group 3; P< 0.0014 for group 2 versus group 3; difference not significant for group 1 versus group 2). An intention-to-treat analysis showed eradication rates of 19/80 (23.75%), 29/80 (36.25%) and 50/80 (62.5%) for groups 1, 2 and 3, respectively. At four weeks post-treatment, the most sensitive test for evaluation of eradication of H. pylori was histology. Conclusion Although combined use of an H 2 -receptor antagonist and twice daily triple therapy in a two-week regimen is more effective than two-week triple or one-week quadruple therapy in Iranian patients, none of these regimens is ideal in countries with a probable high rate of resistant and strongly toxic strains of H. pylori.

  • Effect of triple therapy or amoxycillin plus omeprazole or amoxycillin plus tinidazole plus omeprazole on duodenal ulcer healing, eradication of Helicobacter pylori, and prevention of ulcer relapse over a 1-year follow-up period : a prospective, rand
    The American Journal of Gastroenterology, 1995
    Co-Authors: Mehdi Saberi-firoozi, Sadegh Massarrat, S. Zare, Mohammad Reza Fattahi, A. Javan, H. Etaati, N Dehbashi

    Abstract:

    Objectives : Triple therapy and amoxycillin plus omeprazole are the two most widely recommended regimens for the eradication of Helicobacter pylori. However, no controlled studies with a large number of cases are available for the reliable comparison of these two regimens. The aim of this controlled, randomized, prospective study was to compare the effect of these two regimens and a further regimen for metronidazole-resistant patients on duodenal ulcer healing, H. pylori eradication, and prevention of ulcer relapse. Methods : Patients (n = 144) with proven duodenal ulcer (DU) were randomized to one of the three following regimens : group A, omeprazole (2 x 40 mg) plus amoxycillin (4 x 500 mg) for 2 wk ; group B, triple therapy : Bismuth nitrate (4 x 375 mg) plus metronidazole (4 x 250 mg) and tetracycline (4 x 500 mg) daily for 2 wk and ranitidine (150 mg) for the first week and Bismuth nitrate (4 x 375 mg) alone for a further 2 wk ; group C, omeprazole (20 mg) plus amoxycillin (4 x 500 mg) and tinidazole (2 x 500 mg) for 2 wk. Results : A total of 46 patients in group A, 39 in group B, and 43 in group C completed the study. One patient in group A and three in group B did not tolerate the regimens and dropped out of the study. Control endoscopy was performed 8 wk after the start of treatment and when symptoms appeared (up to 1 yr after the start of treatment). In subjects who completed the study, both the healing rate of DU in group B (97% compared with 74 and 73% in A and C, respectively, p < 0.02) and the H. pylori eradication rate in group B (85 compared with 35%, p < 0.0001 in A and 58%, p < 0.02, in C) were significantly higher than in groups A and C. The symptomatic ulcer relapse during the 1-yr follow-up in patients with initially healed ulcers was similar in all groups (18, 16, and 19% in A, B, and C, respectively). The predictor of healing using logistic regression analysis was night pain (p < 0.05). The predictor of H. pylori eradication was sex (p < 0.05). Conclusion : The 2-wk triple therapy plus an additional 2-wk treatment with the Bismuth Derivative (without a prolonged administration of acid suppressing drugs) seems to be an effective and economic treatment not only for the eradication of H. pylori but also for the healing of acute DU. The higher incidence of side effects found after triple therapy compared with the other two regimens was tolerated by the patients.

Mohammad Javad Kaviani – 2nd expert on this subject based on the ideXlab platform

  • Various durations of a standard regimen (amoxycillin, metronidazole, colloidal Bismuth sub-citrate for 2 weeks or with additional ranitidine for 1 or 2 weeks) on eradication of Helicobacter pylori in Iranian peptic ulcer patients. A randomized contro
    European Journal of Gastroenterology & Hepatology, 2001
    Co-Authors: Mohammad Javad Kaviani, Reza Malekzadeh, H Vahedi, Masoud Sotoudeh, Naser Kamalian, Mohsen Amini, Sadegh Massarrat

    Abstract:

    Introduction One of the most economical and effective therapeutic regimens for eradication of Helicobacter pylori is the classic triple therapy with amoxycillin or tetracycline, metronidazole and a Bismuth Derivative. Addition of H 2 -receptor antagonists to these drugs may heighten the rate of eradication and shorten the duration. We therefore performed a randomized controlled trial comparing twice daily metronidazole, Bismuth Derivative and amoxycillin for 2 weeks with additional ranitidine for 1 or 2 weeks. Patients and methods In total, 240 adult patients with duodenal ulcer and H. pylori infection were randomly assigned to one of the following regimens: (1) amoxycillin 1 g bid, metronidazole 500 mg bid, Bismuth sub-citrate 240 mg bid and ranitidine 300 mg bid for 1 week; (2) triple therapy without ranitidine for 2 weeks; or (3) triple therapy plus ranitidine 300 mg bid for 2 weeks. Side-effects of the drugs were evaluated two weeks after starting the treatment. The rapid urease test and histology from antrum and corpus, and/or 14 C- urea breath test were used to determine H. pylori eradication six weeks after starting the treatment. Results In total, 195 patients were followed up for 6 weeks. The most frequent drug side-effects were unpleasant taste (46%), dry mouth (41%) and fatigue (26%), which had an equal distribution in all treatment groups. Endoscopy and 14 C- urea breath test were performed for 178 and 123 patients, respectively. Eradication of H. pylori was documented in 19/64 (29.7%), 29/63 (46%) and 50/68 (73.5%) of patients in groups 1, 2 and 3, respectively (P< 0.000001 for group 1 versus group 3; P< 0.0014 for group 2 versus group 3; difference not significant for group 1 versus group 2). An intention-to-treat analysis showed eradication rates of 19/80 (23.75%), 29/80 (36.25%) and 50/80 (62.5%) for groups 1, 2 and 3, respectively. At four weeks post-treatment, the most sensitive test for evaluation of eradication of H. pylori was histology. Conclusion Although combined use of an H 2 -receptor antagonist and twice daily triple therapy in a two-week regimen is more effective than two-week triple or one-week quadruple therapy in Iranian patients, none of these regimens is ideal in countries with a probable high rate of resistant and strongly toxic strains of H. pylori.

N Dehbashi – 3rd expert on this subject based on the ideXlab platform

  • Effect of triple therapy or amoxycillin plus omeprazole or amoxycillin plus tinidazole plus omeprazole on duodenal ulcer healing, eradication of Helicobacter pylori, and prevention of ulcer relapse over a 1-year follow-up period : a prospective, rand
    The American Journal of Gastroenterology, 1995
    Co-Authors: Mehdi Saberi-firoozi, Sadegh Massarrat, S. Zare, Mohammad Reza Fattahi, A. Javan, H. Etaati, N Dehbashi

    Abstract:

    Objectives : Triple therapy and amoxycillin plus omeprazole are the two most widely recommended regimens for the eradication of Helicobacter pylori. However, no controlled studies with a large number of cases are available for the reliable comparison of these two regimens. The aim of this controlled, randomized, prospective study was to compare the effect of these two regimens and a further regimen for metronidazole-resistant patients on duodenal ulcer healing, H. pylori eradication, and prevention of ulcer relapse. Methods : Patients (n = 144) with proven duodenal ulcer (DU) were randomized to one of the three following regimens : group A, omeprazole (2 x 40 mg) plus amoxycillin (4 x 500 mg) for 2 wk ; group B, triple therapy : Bismuth nitrate (4 x 375 mg) plus metronidazole (4 x 250 mg) and tetracycline (4 x 500 mg) daily for 2 wk and ranitidine (150 mg) for the first week and Bismuth nitrate (4 x 375 mg) alone for a further 2 wk ; group C, omeprazole (20 mg) plus amoxycillin (4 x 500 mg) and tinidazole (2 x 500 mg) for 2 wk. Results : A total of 46 patients in group A, 39 in group B, and 43 in group C completed the study. One patient in group A and three in group B did not tolerate the regimens and dropped out of the study. Control endoscopy was performed 8 wk after the start of treatment and when symptoms appeared (up to 1 yr after the start of treatment). In subjects who completed the study, both the healing rate of DU in group B (97% compared with 74 and 73% in A and C, respectively, p < 0.02) and the H. pylori eradication rate in group B (85 compared with 35%, p < 0.0001 in A and 58%, p < 0.02, in C) were significantly higher than in groups A and C. The symptomatic ulcer relapse during the 1-yr follow-up in patients with initially healed ulcers was similar in all groups (18, 16, and 19% in A, B, and C, respectively). The predictor of healing using logistic regression analysis was night pain (p < 0.05). The predictor of H. pylori eradication was sex (p < 0.05). Conclusion : The 2-wk triple therapy plus an additional 2-wk treatment with the Bismuth Derivative (without a prolonged administration of acid suppressing drugs) seems to be an effective and economic treatment not only for the eradication of H. pylori but also for the healing of acute DU. The higher incidence of side effects found after triple therapy compared with the other two regimens was tolerated by the patients.