title: Insulin-dependent diabetes mellitus affects eradication rate of Helicobacter pylori infection.
abstract: BACKGROUND
  Patients with insulin-dependent diabetes mellitus (IDDM) are often affected by chronic infections; however, antibiotic absorption may be influenced by the disease. Helicobacter pylori, the most common gastric infection worldwide, is the main acquired factor in the pathogenesis of gastritis and peptic ulcer. The aim of the study was to compare the H. pylori eradication rate obtained with a standard 7-day antibiotic regimen in a group of IDDM H. pylori infected patients and in a control group of infected dyspeptic patients.
  
  
  METHODS
  Thirty-one patients (18 male, 13 female, 39+/-12 years) affected by IDDM and H. pylori infection, and 50 dyspeptic infected patients (23 male, 17 female, 37+/-10 years) were evaluated. H. pylori infection was assessed through 13C-urea breath test. A triple therapy with amoxycillin (1 g b.i.d.), clarithromycin (250 mg t.i.d.) and pantoprazole (40 mg b.i.d.) was given to both groups at the time of diagnosis for 7 days. Cure was defined as the absence of H. pylori infection, assessed by 13C-urea breath test, 6 weeks after completing anti-microbial therapy. Effects of H. pylori eradication on gastrointestinal symptoms (pyrosis, epigastric pain, belching, bloating, halitosis and nausea) were also evaluated.
  
  
  RESULTS
  All enrolled patients completed the study. When compared to dyspeptic patients, the eradication rate was significantly lower in IDDM patients: 92% (46/50) versus 65% (20/31), respectively (P < 0.002). IDDM patients infected by H. pylori showed a different prevalence of some of the gastrointestinal symptoms assessed when compared to the infected dyspeptic patients; in particular, pyrosis, epigastric pain and belching were significantly more prevalent in the infected dyspeptic group. After H. pylori eradication, both groups showed a significant reduction of the intensity of all the gastrointestinal symptoms evaluated, except for nausea.
  
  
  CONCLUSIONS
  IDDM patients showed a significantly lower H. pylori eradication rate when compared to that observed in dyspeptic subjects. The dosage and/or the duration of a standard eradication regimen does not appear to be sufficient to eradicate the infection in IDDM patients. The impairment of the gastrointestinal mucosa microvasculature with a reduction of antibiotic absorption, or the frequent use of antibiotics for other infections with development of resistant strains, may be the mechanisms underlying the observation.
authors.affiliation: Department of Medical Pathology, Catholic University of Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gasbarrini
authors.forename: V
authors.initials: V
authors.lastname: Ojetti
authors.forename: D
authors.initials: D
authors.lastname: Pitocco
authors.forename: F
authors.initials: F
authors.lastname: Franceschi
authors.forename: M
authors.initials: M
authors.lastname: Candelli
authors.forename: E S
authors.initials: ES
authors.lastname: Torre
authors.forename: M
authors.initials: M
authors.lastname: Gabrielli
authors.forename: G
authors.initials: G
authors.lastname: Cammarota
authors.forename: A
authors.initials: A
authors.lastname: Armuzzi
authors.forename: R
authors.initials: R
authors.lastname: Pola
authors.forename: P
authors.initials: P
authors.lastname: Pola
authors.forename: G
authors.initials: G
authors.lastname: Ghirlanda
authors.forename: G
authors.initials: G
authors.lastname: Gasbarrini
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000378:metabolism; D005260:Female; D016481:Helicobacter Infections / Q000150:complications* / Q000188:drug therapy* / Q000378:metabolism; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents