Clinical Briefs
Clinical Briefs
Absence of Benefit of Eradicating H. Pylori in Patients with Nonulcer Dyspepsia
Most upper abdominal discomfort (dyspepsia) does not arise from peptic ulcer disease but is due to as yet unexplained derangements. In the course of evaluation for dyspepsia symptoms, most ulcer disease that is not NSAID-induced is secondary to Helicobacter pylori infection, and about 30% of patients who emerge with a diagnosis of nonulcer dyspepsia harbor this pathogen. Several trials have attempted to determine whether Helicobacter eradication influences clinical outcome in nonulcer dyspepsia; unfortunately, contradictory results and flawed methodology have precluded a conclusive answer.
The currently reported study reflects a one-year evaluation of Helicobacter positive adults (n = 337) with nonulcer dyspepsia, treated with twice-daily omeprazole, amoxicillin, and clarithromycin vs. placebo. Endoscopic studies confirmed that these patients were not sufferers of esophagitis, Barrett’s esophagus, ulcers, erosions, or carcinoma. Dyspepsia was rated using the Gastrointestinal Symptom Rating Scale of 0 (no symptoms) to 6 (very severe symptoms).
Urea breath testing indicated that 90% of patients were free of Helicobacter at 4-6 weeks, and 80% remained so at the 12-month conclusion of the trial. Eradication of Helicobacter did not appear to influence symptomatology. Whether long-term Helicobacter infection merits treatment for reasons other than symptomatology or ulcer disease remains a hotly debated issue. These data suggest that treatment of Helicobacter in an attempt to resolve nonulcer dyspepsia is ineffectual.
Talley NJ, et al. N Engl J Med 1999; 341:1106-1111.
Fruit and Vegetable Intake in Relation to Risk of Ischemic Stroke
Although epidemiologic data are supportive of enhanced intake of fiber, potassium, and antioxidants for prevention of cardiovascular disease, little data are available specifically relating fruit and vegetable intake to cardiovascular end points. The study population assessed in this report, comprised of participants in the Nurses’ Health Study and Health Professionals Follow-up Study, was distinctively larger (n = 112,279) than any previous investigation. End points examined included the relationship of specific fruits and vegetables, and overall fruit and vegetable intake, to ischemic stroke.
There was an inverse relationship between overall fruit and vegetable intake and ischemic stroke. Comparing the highest quintile of intake to the lowest, there was a 0.69 relative risk overall, subgrouped into 0.74 (women) and 0.61 (men), despite the fact that the median daily intake of total fruits and vegetables was consistently higher for women than men (5.8 vs 5.1 servings daily). For each additional daily serving of fruit, there was an associated 7% lower risk of ischemic stroke for women and 4% for men.
Cruciferous vegetables (like broccoli, brussel sprouts, cabbage, cauliflower), green leafy vegetables and citrus fruits were associated with lowest risk. No single fruit or vegetable stood out as distinctively superior to another for its protective effect. Joshipura and colleagues conclude that this data supports the recommendation to consume at least five servings of fruits and vegetables daily.
Joshipura KJ, et al. JAMA 1999;282: 1233-1239.
Calcium and Magnesium in Drinking Water and the Risk of Death from Hypertension
A relationship between public water supply calcium and magnesium content (known as water hardness’) and cardiovascular mortality has been detected in more than one observational study. In Taiwan, where hypertension is recognized as one of the 10 most common causes of death in men and women, there is definite geographic variation in hypertension mortality, suggesting that environmental factors may play a role. This study evaluated the relationship between water hardness and death from hypertension (n = 2336) in a variety of geographically distinct districts from 1990 to 1994.
Subjects were stratified into quintiles by level of drinking water calcium and magnesium; a comparison was made between water hardness in controls vs. persons succumbing to hypertensive sequelae.
Water calcium content was inversely associated with hypertension death risk, and significantly so for persons in the top two quintiles vs. the lowest. Similarly, when compared with the lowest quintile, people in the highest quintile intake of magnesium in drinking water were at a 20% less odds ratio of hypertension-related death.
Yang C, Chiu H. Am J Hypertens 1999;12:894-899.
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