Kimura K, Ido K, Saifuku K, et al. A 1-h topical therapy for the treatment of Helicobacter pylori infection. American Journal of Gastroenterology. 1995;90:60-3.
In anti- Helicobacter pylori therapy, antimicrobial drugs are administered orally, either reaching the ecological niche of H. pylori in the stomach by topical penetration through the mucus or gastrointestinal absorption. We developed a new therapeutic method in which the former route is exclusively utilized. When drugs are kept in the stomach for a few hours, topical therapy is thus effected, curing H. pylori infection.
Methods & Patients
In an original form of topical therapy, we used an intestinal tube with a balloon at the tip, inserting it into the descending duodenum under fluoroscopy for preventing the leakage of the solution containing drugs. Now in the modified form, we use a thin hemostatic tube and can insert it along with endoscopy easily within five minutes. For 2 days before the therapy, patients were given orally lansoprazole 30 mg OD for preventing the decrease of antimicrobial activity of drugs in the low pH condition, and pronase 20,000 units bid for removal of the surface mucus. A tube is inserted into the duodenum, and a balloon is inflated with air and lodged post-bulbarly. Then the 100 ml of 7% sodium bicarbonate solution including drugs is instilled into the stomach through the biopsy channel of the endoscope. Endoscope is pulled out and the solution is kept in the stomach for a couple of hours. Finally, a solution is suctioned out through the tube. The therapy was not effective for patients with active duodenal ulcer (DU scar: cure rate 70%). Then, patients are limited to patients with NUD or gastric ulcers.
Two regimens have been evaluated: one regimen combined with ABM: amoxicillin 4.0 g, bismuth subnitrate 4.0 g and metronidazole 2.0g, and the other with CM: clarithromycin 1.6g and metronidazole 2.0g.
The cure rate of ABM was 77% (37/48), and that of CM was 81% 21/26). When patients with prior treatment were excluded, the cure rate of CM increased up to 4% (21/23). These results indicate that the topical therapy can achieve enough cure rate, except for patients with active DUs.
The merits of topical therapy are;
• It requires much less time than oral medication,
• Well tolerated,
• Few side effects by antibiotics absorbed from the intestine
• Drugs do not reach the stomach by way of the blood stream.
Further improvements of the method and regimens in topical therapy will increase the efficacy and availability for the salvage of eradication failure patients who received classic or new triple therapies.
Professor Ken Kimura is a graduate from the Faculty of Medicine, University of Tokyo . The year after being conferred the degree of Doctor of Medicine in 1973, he became an Associate Professor of Jichi Medical School. Ken was one of the pioneers who first studied the histology of the gastric mucosa in atrophic gastritis from specimens obtained at fiberoptic flexible gastroscopy. He noted that most Japanese developed atrophic gastritis as they aged.
Ken was the Chairman of the Committee of Public Relations and the International Committee of the Japanese Society of Gastroenterology (1990 - 1995) and was the President of the recently concluded 38th Annual Meeting of the Japanese Society of Gastroenterology (JSGL) in Yokohama. He maintains to be member to different societies in Gastroenterology, endoscopy, Hepatology and Internal Medicine.
Currently, Professor Ken Kimura holds the distinction of being Professor of Jichi Medical School; Chairman & Professor of Department of Gastroenterology and Professor of Division of Endoscopy. The above paper was presented at the International Workshop on Helicobacter pylori held in Hong Kong on 12/1/96 sponsored by The Chinese University of Hong Kong.