Taiwanese consensus recommendations for acute pancreatitis.

The incidence of acute pancreatitis and related health care utilization are increasing. Acute pancreatitis may result in organ failure and various local complications with risks of morbidity and even mortality. Recent advances in research have provided novel insights into the assessment and management for acute pancreatitis. This consensus is developed by Taiwan Pancreas Society to provide an updated, evidence-based framework for managing acute pancreatitis.

Heterotopic pancreas involved muscularis propria mimicking mesenchymal tumor in stomach.

Heterotopic pancreas is defined as pancreatic tissue found outside the usual anatomic location of the pancreas. It is often an incidental finding and can be found at various sites in the gastrointestinal tract. It is usually asymptomatic, however, symptoms such as abdominal pain, nausea, vomiting or even gastrointestinal bleeding could be possible. In this report, a 38-year-old woman with epigastric fullness and endoscopic impression of the gastric submucosal tumor is described. Preoperative surveys including endoscopic ultrasound and computed tomography suggested gastric mesenchymal tumor such as leiomyoma. A surgical operation was arranged with a diagnosis of the heterotopic pancreas as confirmed by pathological assessment.

Comparison of 10-day sequential therapy with 7-day standard triple therapy for Helicobacter pylori eradication in inactive peptic ulcer disease and the efficiency of sequential therapy in inactive peptic ulcer disease and non-ulcer dyspepsia.

BACKGROUND: Eradication rates of standard triple therapy for Helicobacter pylori infections have decreased in recent years due to a worldwide increase in bacterial resistance. Sequential therapy has the advantage of a two-phase treatment regimen and achieves a superior result for H. pylori eradication in peptic ulcer disease. However, no study has yet compared the efficacy of sequential therapy for H. pylori eradication exclusively in inactive duodenal ulcer (iDU) or non-ulcer dyspepsia (NUD). METHOD: We retrospectively recruited 408 patients with endoscopic proven iDU (170 patients) or NUD (238 patients) infected with H. pylori. Patients with iDU were assigned into two groups: iDU triple therapy group, 44 patients treated with 40 mg pantoprazole, 1000 mg amoxicillin and 500 mg clarithromycin, twice daily for 7 days; iDU sequential therapy group, 126 patients treated with 40 mg pantoprazole and 1000 mg amoxicillin, twice daily for the first 5 days, followed by 40 mg pantoprazole, 500 mg clarithromycin and 500 mg tinidazole, twice daily for the next 5 days. All patients with NUD were treated with sequential therapy and assigned as the NUD sequential group. Post-treatment H. pylori status was confirmed by a (13)C-urea breath test. RESULT: The eradication rates of intention-to-treat (ITT) and per-protocol (PP) analysis were 77.3 % (95 % CI 64.9-89.7 %) and 85.0 % (95 % CI 73.9-96.1 %) in the iDU triple therapy group and 87.3 % (95 % CI 81.5-93.1 %) and 92.4 % (95 % CI 87.6-97.2 %) in the iDU sequential therapy group. The overall eradication efficacy was superior in the sequential group than in the triple group, both with ITT analysis (83.5 % vs. 77.3 %, P = 0.29) and PP analysis (88.1 % vs. 85.0 %, P = 0.57). Eradication rates for ITT and PP analysis were 81.5 % (95 % CI 76.6-86.4 %) and 85.8 % (95 % CI 83.5-88.2 %) in the NUD sequential therapy group. Eradication rate was statistically better in the iDU sequential therapy group than the NUD sequential therapy group according to per protocol analysis (P = 0.04). Eradication rate was not significantly different between the iDU sequential- and iDU triple therapy groups according to protocol analysis (P = 0.14). CONCLUSION: The sequential regimen has a better eradiation rate in the iDU group than in the NUD group. There is no statistically difference between 10-day sequential therapy and 7-day standard triple in iDU group.

Lowly expressed ribosomal protein s19 in the feces of patients with colorectal cancer.

Colorectal cancer (CRC) has become one of the most common fatal cancers. CRC tumorigenesis is a complex process involving multiple genetic changes to several sequential mutations or molecular alterations. P53 is one of the most significant genes; its mutations account for more than half of all CRC. Therefore, understanding the cellular genes that are directly or indirectly related to p53 is particularly crucial for investigating CRC tumorigenesis. In this study, a p53-related ribosomal protein, ribosomal protein S19 (RPS19), obtained from the feces of CRC patients is evaluated by using specifically quantitative real-time PCR and knocked down in the colonic cell line by gene silencing. This study found that CRC patients with higher expressions of RPS19 in their feces had a better prognosis and consistent expressions of RPS19 and BAX in their colonic cells. In conclusion, the potential mechanism of RPS19 in CRC possibly involves cellular apoptosis through the BAX/p53 pathway, and the levels of fecal RPS19 may function as a prognostic predictor for CRC patients.

Clinical application of Carlsson's questionnaire to predict erosive GERD among healthy Chinese.

BACKGROUND: Gastroesophageal reflux disease (GERD) is a common gastrointestinal disease, yet there is no definitive gold standard to describe and diagnose it. AIM: We used endoscopic examination and Carlsson's questionnaire to evaluate the prevalence of erosive esophagitis during health examinations of individuals in Taiwan. METHODS: From October 2001 to March 2002, 778 people underwent self-paid health examinations including esophagogastroduodenoscopic examinations. All subjects completed Carlsson's questionnaire before endoscopy. We determined the positive predict rate, negative predict rate, sensitivity, and specificity of the Carlsson's score for predicting esophagitis and relationships of the score (score > or =4 vs score <4) and esophagitis based on sex, age, body mass index (BMI), smoking, peptic ulcer and drinking habits. RESULTS: One hundred and thirty-one people with scores > or =4 were highly suspected to have GERD. Of them, 21 were diagnosed as having reflux erosive esophagitis (16.0%) on endoscopic examination. Of 647 people whose scores were <4, 49 were diagnosed with having reflux erosive esophagitis (7.6%). Thus, 70 people were diagnosed as having erosive esophagitis for a prevalence of 9% (70 of 778). The difference between scores > or =4 and <4 to detect esophagitis differed significantly (P < 0.001). Total esophagitis differed significantly according to BMI, drinking habit and sex. CONCLUSION: The prevalence of reflux esophagitis is 9.00% at a single medical center in Taiwan. Esophagitis is positively related to higher BMI, alcohol consumption and being of male sex. Predicting the prevalence of esophagitis in a general population by using Carlsson's questionnaire was unsatisfactory.

Accuracy of three diagnostic tests used alone and in combination for detecting Helicobacter pylori infection in patients with bleeding gastric ulcers.

OBJECTIVE: Accuracy of diagnostic methods for detecting Helicobacter pylori (H. pylori) infection among patients with bleeding peptic ulcers has not been thoroughly investigated. The aim of this study was to compare the diagnostic tests and their combined usage in detection of H. pylori infection in patients with bleeding gastric ulcers and without the use of nonsteroidal anti-inflammatory drugs. METHODS: A total of 57 patients who presented with bleeding gastric ulcers by endoscopy were enrolled. The status of H. pylori was identified by performing the rapid urease test (RUT), histology and (13)C-labeled urea breath test (UBT). The criteria for having H. pylori infection was a minimum of two positive tests. RESULTS: The prevalence of H. pylori infection in our patient group was 80.7%. Among the three tests used: RUT, histology, and UBT, sensitivities were 56.5%, 97.8% and 100%, while specificities were 100%, 45.5% and 81.8%, respectively. The overall accuracies of the tests were 78.3%, 71.6% and 90.9%, respectively. Although UBT obtained significantly higher accuracy than histology (P = 0.02) as opposed to RUT (P = 0.11), UBT had significantly higher sensitivity than RUT (P < 0.001). In terms of combining any two of the three tests, more accuracy (98.9%) was achieved when both UBT and histology were used to confirm the diagnosis of the other. Conversely, failure to use combined tests generated the potential of missing a proper H. pylori diagnosis. CONCLUSIONS: UBT is superior to the other two tests in bleeding gastric ulcers. RUT lacks sensitivity for detection of H. pylori infection. However, the concomitant use of UBT and histology seems to be more accurate when gastric ulcers present with bleeding.

Combination of interferon alfa-2a and amantadine does not improve the efficacy of interferon therapy in patients with chronic hepatitis C.

BACKGROUND/AIMS: A recent pilot study suggested that 18% of patients with hepatitis C viral infection achieved a sustained response to a 6-month course of 200 mg of oral amantadine alone with disappearance of serum hepatitis C virus ribonucleic acid. We prospectively studied 30 naive patients with chronic hepatitis C viral infection for the possible role of amantadine in improving the efficiency of interferon for the treatment of chronic hepatitis C. METHODOLOGY: Patients were assigned into two groups on a double-blind and randomized controlled basis. Placebo group received 4.5 MU of interferon alfa-2a thrice weekly and oral placebo daily for 24 weeks. Amantadine group received a combination of the interferon and 200 mg of oral amantadine daily for 24 weeks. Patients were observed and tested for blood chemistry every week for the initial 4 weeks and every 2 weeks thereafter during the treatment until 24 weeks. After the end of treatment, patients were followed up at 4-week intervals for an additional 12 months. RESULTS: At the end of treatment, 5 (33.3%) patients responded to the combination therapy, and 7 (46.7%) patients responded to interferon therapy alone. Twelve months after cessation of the treatment, 3 (21.4%) patients had a sustained complete response to the combination therapy, and 3 (20.0%) patients had a sustained complete response to interferon alone (P = 0.64). CONCLUSION: Amantadine does not increase the efficacy of interferon in the treatment of chronic hepatitis C.

Maintenance treatment is not necessary after Helicobacter pylori eradication and healing of bleeding peptic ulcer: a 5-year prospective, randomized, controlled study.

BACKGROUND: It is well accepted that in patients with uncomplicated peptic ulcers, Helicobacter pylori eradication therapy does not need to be followed by further antisecretory treatment. However, it is uncertain whether patients with bleeding peptic ulcers should receive maintenance antiulcer therapy after successful H pylori eradication and ulcer healing. The aim of this 5-year, prospective, randomized, controlled study was to investigate the role of long-term maintenance therapy after successful H pylori eradication and healing of bleeding ulcers. METHODS: A total of 82 consecutive patients with H pylori-associated bleeding peptic ulcers were enrolled in the study. After successful H pylori eradication with the 1-week proton pump inhibitor-based triple therapy and an additional 3-week treatment with 20 mg of omeprazole daily for ulcer healing, the patients were assigned to one of four 16-week maintenance treatment groups as follows: group A received 15 mL of an antacid suspension 4 times daily; group B received 300 mg of colloidal bismuth subcitrate 4 times daily; group C received 20 mg of famotidine twice daily; and group D, the control group, received placebo twice daily. Follow-up included an urea breath test labeled with carbon 13, biopsy-based tests, and repeated endoscopic examination. RESULTS: An analysis of variance revealed no difference in mean age and mean follow-up time among the groups. During a mean follow-up of 56 months, there was no peptic ulcer recurrence among the 3 treatment groups, and all of the patients remained free of H pylori infection during the study period. CONCLUSIONS: In patients with bleeding peptic ulcers, antiulcer maintenance treatment was not necessary to prevent ulcer recurrence after successful H pylori eradication and ulcer healing. In addition, the 1-week proton pump inhibitor-based triple therapy had the efficacy to ensure long-term eradication of H pylori in a region of high prevalence.

Esophageal manometry in patients with clinical symptoms mimicking esophageal origin: a hospital-based ten-year experience.

BACKGROUND: Primary esophageal motility disorder, which can cause chest pain or dysphagia, is seldom reported in Chinese. With the introduction of an easy and less uncomfortable method to perform esophageal manometry by low-compliance perfusion system, we studied symptomatic patients for more than 10 years. These data were analyzed and were compared to Western reports. METHODS: From August 1989 to June 1999, 264 patients with symptoms mimicking esophageal origin, such as chest pain, dysphagia or odynophagia, but without secondary motility disorders were enrolled. Esophageal manometry was performed on each patient. RESULTS: Among 264 manometric tracings, 142 (54%) were normal and 122 (46%) were abnormal. In patients with abnormal tracings, 73 were nonspecific esophageal motility disorder (NEMD), 20 were achalasia, 9 were diffuse esophageal spasm (DES), 8 were nutcracker esophagus, 7 were hypotensive low esophageal sphincter (LES), 3 were abnormal provocative test by edrophonium, and 2 were hypertensive LES. As in Western countries, the most common abnormality was NEMD. However, our series did not find many patients with DES, nutcracker esophagus and hypertensive LES. Similar results were noted in patients with NEMD, that most had increased nontransmitted contractions and low contraction amplitude. CONCLUSIONS: We found that primary esophageal motility disorder is not uncommon in Taiwan. Esophageal manometry should always be considered in patients with symptoms mimicking esophageal origin.

Reuse of CLO test in the diagnosis of helicobacter pylori infection.

Negative CLO test pellets can be reused repeatedly in diagnostic endoscopy within a short period of time. However, the duration that these pellets can be stored at room temperature before second use remains unclear. A total of 360 patients, 190 males and 170 females, who required a CLO test during endoscopy, were enrolled in this study. Two biopsies were taken from the gastric antrum of each patient, one for testing with a new pellet and the other for testing with a reused pellet. The reused pellets were used randomly and were divided into five groups according to the time interval between their initial and second usages (1, 2, 3, 6, and > 6 mo). When a positive result was found, the time to color change was recorded. Good correlation was noted for nearly all the paired CLO tests in all groups with either both positive or both negative. Only four pairs produced discrepant results. There was no significant difference when the results of both new and reused CLO tests were compared using McNemar's test (p > 0.05). In positive pairs, there was no significant difference in the color change time of both tests in all five groups by two-tailed t-test (p > 0.05); Pearson's correlation and linear regression showed a strong correlation between the color time change in the five groups (p < 0.0001). Only 54 of the 427 negative pellets stored for more than 6 months could be reused because most were dried out or no longer yellow in color. In conclusion, negative CLO test pellets may be reused within 6 months after initial usage provided they are stored at room temperature.