Journals watch: H pylori, weight loss and wound healing

A GP research summary by Dr Tillmann Jacobi

H pylori: researchers have found longer treatment improved eradication rates
H pylori: researchers have found longer treatment improved eradication rates

Helicobacter pylori eradication

Can J Gastroenterol 2013; 27(7): 397-402

This prospective cohort study from Canada involved adult patients with confirmed H pylori infection and compared the outcomes of sevenand 14-day triple therapies.

More than 300 treatment-naive patients were treated with one or two weeks of effective therapy and their response was checked by urea breath test or gastric biopsies.

The two-week group had a significantly improved eradication rate of 85% compared to 70% or less (p ?0.001) in the one-week group. The authors acknowledge that longer treatment can affect compliance, but the results were encouraging.

Interviewing for weight loss

Gynecol Endocrinol 2013; Jul 15

This retrospective study of 187 women investigated if motivational interviewing was effective at improving weight loss among obese or overweight women before they had fertility treatment.

The women, who had a BMI of 30, could choose to participate in motivational interviewing with basic advice on diet and exercise.

Of the participants, 110 opted for motivational interviewing and 64 received indirect motivational support by telephone or email. Thirteen did not opt for motivational support.

The motivational interview group displayed a significantly greater weight loss and associated decrease in BMI than the control group (9.3kg versus 7.3kg, difference p = 0.01, 3.3kg/m2 versus 2.6kg/m2, difference p = 0.02) with an almost identical period of intervention.

With adequate resources, motivational interviewing could be a valuable non-invasive strategy.

The value of sleep in pregnancy

Psychosom Med 2013 doi. 10.1097/PSY.0b013e31829cc3e7

Problems such as disturbed sleep and depression in pregnancy can be risk factors for complications.

This study measured possible objective signs for homeostatic imbalance and stress in sleep-deprived or depressed pregnant women and related the findings to the rate of adverse outcomes of pregnancies.

For this purpose, levels of inflammatory cytokines were measured in cohorts of depressed and non- depressed pregnant women at intervals during the middle and later stages of pregnancy.

The examined outcomes included preterm birth, over birthweight and significant peripartum events.

The study found clearly increased levels of several interleukins, interferons and TNFs in women with depression and relative sleep deprivation (<7 hours="" of="" sleep="" which="" appeared="" to="" increase="" the="" risk="" preterm="" birth="" and="" low="" birthweight="" p="">

Although this theory may seem experimental at this stage, there could be scope for more research to come.

OCD and cognitive functioning

Psychol Med 2013; 19: 1-10

The influence of obsessive compulsive disorder (OCD) on cognitive functioning is suspected, but not established. This meta-analysis of 88 studies looked at neuropsychological performance and clinical and non-clinical factors.

A spectrum of performance criteria, such as visuospatial memory, executive function, and verbal memory and fluency, appeared to be moderately to sometimes quite severely impaired.

A meta-analysis of complex variable study designs is not fully reliable, but potentially more likely confounding factors, such as educational level, symptom severity, medication and comorbidities, did not appear to be significant. In practical terms, this is a good reminder to consider the impact of OCD on other functions.

 Inflammation in wound healing

Ann R Coll Surg Engl 2013; 95(4): 291-6

Wounds with excessive inflammation can be difficult to heal. This retrospective study looked at long-term management of 34 ulcers from 25 patients in a tertiary centre.

The researchers reviewed the possible benefit of using a combined topical steroid, antibiotic and antifungal preparation to facilitate the reduction of abnormal and excessive inflammation.

Quite strikingly, 24 ulcers (71%) demonstrated faster healing with the combination treatment, three showed no significant change in healing rates and seven healed more slowly (p = 0.0006). Patients reported reduced burden of pain and exudates in the process.

The authors suggest the observed benefit is mainly related to the influence of the steroid to reduce the dysfunctional inflammatory response, but further research will be needed.

  • Dr Jacobi is a GP in York and a member of our team who regularly review the journals
CPD IMPACT: EARN MORE CREDITS

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Discuss the rationale of local recommendations for H pylori with your CCG prescribing advisers or microbiology department.
  • Consider a review of your early pregnancy information pack for patients and check if the benefit (or necessity) of sufficient sleep is mentioned. Alternatively, consider a discussion with your practice midwife about the topic.
  • Increase your awareness and sensitivity regarding the potentially multiple impact of OCD on other cognitive functioning and enquire about any needs for additional support.

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

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