ENDOSCOPIC TOPICAL THERAPY FOR THE TREATMENT OF HELICOBACTER-PYLORI INFECTION

We modified a novel topical therapeutic method for the treatment of He licobacter pylori infection to increase its effectiveness and tolerabi lity. Sixty-six patients (with nonulcer dyspepsia, inactive ulcer, or active ulcer) were given lansoprazole (30 mg, h.s.) and pronase (18000 tyrosine units, b.i.d.) orally for 2 days before the topical therapy. One hundred milliliters of 7% sodium bicarbonate solution containing bismuth subnitrate, amoxicillin, metronidazole (at two different regim ens), and pronase was instilled into the stomach through an endoscope. A double-lumen tube with a balloon at the tip was inserted into the d uodenum along with the endoscope. The balloon was inflated with 25 ml of air and was lodged postbulbarly. The solution was kept in the stoma ch for 2h, and the patient's position was changed every 14 min from th e sitting to the supine, prone, and right lateral position, each posit ion to the supine, prone, and right lateral position, each position be ing maintained twice, to expose the entire gastric mucosa. The solutio n was aspirated at the end of the procedure. H. pylori infection was c ured in 16/22 (72.7%) of patients with nonulcer dyspepsia, in 21/26 (8 0.7%) of patients with inactive ulcer, and in 1/18 (5.6%) patients wit h active ulcer. H. pylori eradication was confirmed 4 weeks after the therapeutic procedure by smear, culture, and histology of antral and c orpus biopsy specimens. side effects (loose stools) were observed in t wo patients only, and one patient had loss of appetite. These effects were transient. This endoscopic topical therapy for H. pylori infectio n is a safe, effective, and well tolerated procedure. With further mod ifications of the drug regimens and the method itself, this procedure could be of interest as anti-H. pylori therapy.