Efficacy of thalidomide for refractory gastrointestinal bleeding from vascular malformation.

BACKGROUND & AIMS: Patients with recurrent bleeding from gastrointestinal vascular malformations are a challenge to treat. We investigated the long-term efficacy and safety of thalidomide for refractory bleeding from gastrointestinal vascular malformations in an open-label, randomized study. METHODS: Eligible patients were randomly assigned to groups that were given either 100 mg thalidomide (n = 28) or 400 mg iron (n = 27, controls), daily for 4 months; patients were followed for at least 1 year (mean, 39 months). Bleeding was defined by a positive result from an immunoassay fecal occult blood test. The primary end point was the effective response rate, defined as the proportion of patients in whom bleeding episodes had decreased by ≥ 50% in the first year of the follow-up period. The secondary end points included the rates of cessation of bleeding, blood transfusion, overall hospitalization, and hospitalization for bleeding. We also quantified yearly bleeding episodes, bleeding duration, levels of hemoglobin, and yearly requirements for transfusions of red cells, numbers of hospitalizations for bleeding, and hospital stays. Plasma levels of vascular endothelial growth factor were measured in the group given thalidomide. RESULTS: Rates of response in the thalidomide and control groups were 71.4% and 3.7%, respectively (P < .001). All secondary end points differed significantly different between groups; thalidomide was more effective. No severe adverse effects were observed, although minor side effects were common among patients in the thalidomide group. Levels of vascular endothelial growth factor were significantly reduced by thalidomide (P < .001). CONCLUSIONS: Thalidomide is an effective and relatively safe treatment for patients with refractory bleeding from gastrointestinal vascular malformations. Mechanisms of thalidomide activity might involve vascular endothelial growth factor.

[The potential pathogenesis of gastrointestinal vascular malformation and the potential mechanism of thalidomide in the treatment of gastrointestinal vascular malformation].

OBJECTIVE: To study the pathogenesis of gastrointestinal vascular malformation (GIVM) and the potential mechanism of thalidomide in the treatment of gastrointestinal bleeding due to GIVM. METHODS: We collected the surgical intestinal specimens from 10 patients who suffered from massive hemorrhage of gastrointestinal tract owning to GIVM and the normal intestinal mucosa around the lesions, as well as normal intestinal mucosa from healthy subjects. Immunohistochemical (IHC) staining was carried out to investigate the differences of angiopoietin 2 (Ang2), Notch1 and delta like ligand 4 (Dll4) in the above three intestinal mucosa to find the relationship with the pathogenesis of GIVM. Human umbilical vein endothelial cells (HUVECs) were cultured with 0, 25, 50, 100 and 200 mg/L thalidomide for 24 or 48 hours to observe their mRNA and protein expressions of Ang2, Notch1, Dll4 by real-time PCR and Western blot. RESULTS: By IHC staining, more expressions of Ang2, Notch1 and Dll4 in the lesions were detected than those in the normal intestinal mucosa around the lesions and the normal intestinal mucosa in healthy people. The expressions of Ang2, Notch1 and Dll4 were significantly correlated (P = 0.016, r = 0.732), and the expressions of Notch1 and Dll4 were absolutely correlated (P = 0.000, r = 1.000). Real-time PCR and Western blot showed that thalidomide could down-regulate the expressions of them, which were in a concentration-dependent manner. CONCLUSION: Ang2, Notch1 and Dll4 may correlate with the pathogenesis of GIVM, while thalidomide can concentration-dependently down-regulate the expression of Ang2, Notch1 and Dll4, which may be one of the mechanism that thalidomide play a therapeutic role in GIVM.

Endoscopic capsule placement improves the completion rate of small-bowel capsule endoscopy and increases diagnostic yield.

BACKGROUND: The methods for increasing the rate of complete small-bowel examinations by capsule endoscopy (CE) demonstrate conflicting results, and it is unknown whether improving the completion rate of CE transit is correlated with improvement in diagnostic yield. OBJECTIVE: The aim of this study was to determine whether a higher rate of complete small-bowel examinations results in a higher diagnostic yield of CE. DESIGN: Case-control comparison. SETTING: Tertiary care university hospital. PATIENTS: A total of 273 patients underwent conventional CE (group A), and 261 patients underwent real-time CE (group B). Furthermore, the patients in groups A and B were divided into 2 subgroups by pyloric transit time (A1, A2 and B1, B2, respectively). INTERVENTIONS: After swallowing the capsule, each patient was monitored with a real-time viewer in group B, and the patients underwent endoscopic placement if the capsule was delayed in the esophagus or stomach. MAIN OUTCOME MEASUREMENTS: Pyloric transit time, small-bowel transit time, the rate of complete small-bowel examinations, and the diagnostic yield. RESULTS: The rate of complete small-bowel examinations was significantly higher in group B than in group A (87.4% vs 78.0%, respectively; P = .004). The diagnostic yield was significantly higher in group B2 than in group A2 (60.0% vs 41.7%, respectively; P = .019). LIMITATIONS: Nonrandomized study. CONCLUSIONS: Endoscopic placement improves the rate of complete small-bowel examinations, resulting in a higher diagnostic yield of CE.

[Reduced expression of miR-218 and its significance in gastric cancer].

OBJECTIVE: To investigate the expression and function of miR-218 in gastric cancer. METHODS: miR-218 levels were evaluated in 20 non-cardia gastric cancer tissues using TaqMan stem-loop real-time PCR analysis. Pre-miR-218 and anti-miR-218 inhibitor were used to change the miR-218 expression level and examine its effects on cell proliferation, apoptosis, cell cycle and cell invasion. RESULTS: Comparing with the corresponding normal tissues, miR-218 expression was significantly reduced in the gastric cancer tissue (P < 0.01). Forced expression of miR-218 increased apoptosis in AGS cells. The proportion of apoptosis cells induced by transfection of pre-miR-218 was greater than that induced by control (21.6% vs. 10.4%, P = 0.032). Pre-miR-218 resulted in a significantly decreased cell growth activity (P < 0.01) and cell invasion (P < 0.05) of AGS cells compared with that of the control. CONCLUSION: miR-218 expression is reduced in gastric cancer. miR-218 may function as a tumor suppressor in gastric carcinoma.

Biomarkers of altered coagulation and fibrinolysis as measures of disease activity in active inflammatory bowel disease: a gender-stratified, cohort analysis.

BACKGROUND: Growing evidence recognizes inflammatory bowel disease (IBD) as a chronic inflammatory condition characterized by a hypercoagulable state and prothrombotic conditions. The aims of our study were to evaluate the abnormalities in coagulation and fibrinolysis status in patients with IBD, and to analyze parameters of altered coagulation and fibrinolysis status which can correlated with and predict inflammatory parameters of disease activity. METHODS: A cohort of 271 consecutive IBD patients was compared with healthy controls for coagulation and fibrinolysis status. Associations between altered coagulation and fibrinolysis status stratified by gender and inflammatory parameters were analyzed. RESULTS: The mean levels of platelet, platelet distribution width, prothrombin time, fibrinogen, activated partial thromboplastin time were significantly higher in IBD patients than in healthy controls (all P<0.05). Mean platelet volume was lower in male patients with IBD than in healthy controls (P<0.01). Furthermore, multiple linear regression indicated that fibrinogen was an independent predictor of ESR (beta=1.316, P=<0.001) and CRP (beta=1.233, P=0.015) in male patients with active ulcerative colitis. Platelet (beta=0.436, P=0.037) and prothrombin time (beta=0.810, P=<0.001) were predictors of Crohn's Disease Activity Index in female patients with Crohn's disease. CONCLUSIONS: To our knowledge, this study provides characteristics on altered coagulation and fibrinolysis status in active IBD patients using the largest number of cases assembled in one study to date. Our data suggest that in IBD patients, abnormalities in coagulation and fibrinolysis status were associated with disease activity. Fibrinogen, platelet and prothrombin time were predictors of inflammation.

Second Asia-Pacific Consensus Guidelines for Helicobacter pylori infection.

The Asia-Pacific Consensus Conference was convened to review and synthesize the most current information on Helicobacter pylori management so as to update the previously published regional guidelines. The group recognized that in addition to long-established indications, such as peptic ulcer disease, early mucosa-associated lymphoid tissue (MALT) type lymphoma and family history of gastric cancer, H. pylori eradication was also indicated for H. pylori infected patients with functional dyspepsia, in those receiving long-term maintenance proton pump inhibitor (PPI) for gastroesophageal reflux disease, and in cases of unexplained iron deficiency anemia or idiopathic thrombocytopenic purpura. In addition, a population 'test and treat' strategy for H. pylori infection in communities with high incidence of gastric cancer was considered to be an effective strategy for gastric cancer prevention. It was recommended that H. pylori infection should be tested for and eradicated prior to long-term aspirin or non-steroidal anti-inflammatory drug therapy in patients at high risk for ulcers and ulcer-related complications. In Asia, the currently recommended first-line therapy for H. pylori infection is PPI-based triple therapy with amoxicillin/metronidazole and clarithromycin for 7 days, while bismuth-based quadruple therapy is an effective alternative. There appears to be an increasing rate of resistance to clarithromycin and metronidazole in parts of Asia, leading to reduced efficacy of PPI-based triple therapy. There are insufficient data to recommend sequential therapy as an alternative first-line therapy in Asia. Salvage therapies that can be used include: (i) standard triple therapy that has not been previously used; (ii) bismuth-based quadruple therapy; (iii) levofloxacin-based triple therapy; and (iv) rifabutin-based triple therapy. Both CYP2C19 genetic polymorphisms and cigarette smoking can influence future H. pylori eradication rates.

[Epigallocatechin gallate induces apoptosis in human hepatocellular carcinoma HepG2 cells via TGF/Smad signaling pathway].

OBJECTIVE: To investigate the cytotoxic effect of epigallocatechin gallate (EGCG) on human hepatocellular carcinoma cell line HepG2 cells and corresponding changes of TGF-beta1-Smad pathway. METHODS: The cytotoxic effect of EGCG on HepG2 cells was determined by MTT assay. Cell cycle and apoptosis rate were detected by flow cytometry. RT-PCR and luciferase assay were used to verify whether TGF-beta1-Smad signaling pathway is intact in HepG2. The mRNA expression of Smad 2, Smad3, Smad4 and Smad7 was detected by real-time PCR. RESULTS: EGCG induced apoptosis in the HepG2 cells in a time- and concentration-dependent manner. The proportion of G(1) phase cells was increased gradually as the concentration increased. However, the percentage of cells in S phase was decreased gradually. Annexin V/PI assay demonstrated that early apoptosis increased as the concentration increased, and late apoptosis also increased, when treated with high-concentration EGCG. The intact TGF-beta1-Smad pathway was verified by luciferase assay and RT-PCR. There was no significant effect of EGCG on mRNA level of Smad 2, Smad 3, and Smad 4 in HepG2 cells, but downregulated mRNA level of Smad 7. CONCLUSION: EGCG can reduce apoptosis in human hepatocellular carcinoma cell line HepG2 cells. The activation of TGF-beta1-Smad signaling pathway may be involved in its cytotoxicity mechanisms.

[The mechanisms of thalidomide in treatment of angiodysplasia due to hypoxia].

OBJECTIVE: To investigate the inhibitory effect of thalidomide on angiodysplasia. METHODS: Excisional intestinal specimens were collected and immunohistochemical examination was carried out. The human umbilical vein endothelial cells were cultured in vitro to exponential phase of growth, divided into six groups and synchronized for 24 hours. They were then stimulated with thalidomide (40 - 100 microg/ml) for 72 hours. MTT assay was used to assess cellular proliferation. ELISA, real-time quantitative PCR and western blot were applied to detect the expression of VEGF/HIF-1alpha of human umbilical vein endothelial cells (HUVEC). RESULTS: Immunohistochemical analysis of intestinal pathological specimens demonstrated higher expression of VEGF. ELISA showed that the expression of VEGF under hypoxia was obviously higher than that under normoxia [(1199.3 +/- 61.4) ng/L vs (864.7 +/- 41.2) ng/L, P < 0.05]. Real-time quantitative PCR and Western blot discovered that thalidomide inhibited the expression of VEGF/HIF-1alpha of HUVEC (P < 0.05). The effect of thalidomide was dose-dependent. CONCLUSIONS: Thalidomide can suppress the expression of HIF-1alpha and VEGF in HUVEC in vitro and then inhibit angiodysplasia, which may play a significant role in stopping the rebleeding in patients with recurrent gastrointestinal bleeding.

Susceptibility for NSAIDs-induced apoptosis correlates to p53 gene status in gastric cancer cells.

The anti-tumor effect of non-steroidal anti-inflammatory drugs (NSAIDs) remains unclear. Here, we found that the susceptibility for NSAIDs-induced apoptosis might correlate with the status of the p53 gene in gastric cancer cells. Apoptosis in gastric cancer cells expressing wild-type p53 is induced through up-regulation of bax and down-regulation of bcl-2 and that regulation of the bax-bcl-2 heterodimer may be a major target of NSAIDs. As to gastric cancer cells expressing mutant-type p53, other key factors may exist in the NSAIDs' growth inhibition action.

Epigallocatechin-3-gallate ameliorates rats colitis induced by acetic acid.

BACKGROUND: Epigallocatechin-3-gallate (EGCG) has been recently proved to possess anti-inflammatory effects. AIMS: To investigate the effect and mechanism of epigallocatechin-3-gallate (EGCG) treatment in rats with acetic acid-induced colitis. METHODS: Sixty male rats were randomly assigned into 4 groups: normal control (n=10), model placebo (n=20), EGCG (n=15), and SASP (n=15). The normal group was treated with regular feeding, while the other 3 groups were treated orally with saline 2ml/d, EGCG 50mg/kg/d, and SASP 0.25g/kg/d, respectively, for 7 days using an established colitis model induced by 8% acetic acid. The disease activity index (DAI) and the therapeutic effects were evaluated. Colon mucosa damage index (CMDI) and histological score were determined. The activities of nitric oxide (NO), malondialdehyde (MDA), superoxide dismutase (SOD), tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) and tissue expression of nuclear factor-kappaBp65 (NF-kappaBp65) were measured. RESULTS: EGCG notably improved the DAI (1.1+/-0.9), CMDI (1.5+/-0.9) and histological scores (4.6+/-3.1) compared with the placebo (3.9+/-0.4, p<0.01; 3.3+/-0.6, p<0.05; 9.3+/-2.8, p<0.01) and SASP groups (3.0+/-1.2, p<0.01; 2.3+/-0.9, p<0.05; 7.9+/-4.0, p<0.05). Compared with the placebo and SASP groups, the levels of NO (9.1+/-5.6micromol/gprot), MDA (0.9+/-0.6nmol/gprot), TNF-alpha (24.4+/-1.6PG/ml), IFN-gamma (33.3+/-0.9PG/ml), and NF-kappaBp65 (28.0+/-2.8cells/mm(3)) in EGCG-treated group were significantly reduced (p<0.05 or p<0.01), while that of SOD (185.4+/-24.6U/mgprot) was increased remarkably (p<0.05). CONCLUSION: EGCG exerts its antioxidant activity via decreasing NO, MDA, and increasing SOD. It ameliorates mucosal inflammation by inhibiting the production of TNF-alpha, IFN-gamma and NF-kappaBp65 and may be a potential therapeutic agent in colitis.

Asia-Pacific consensus guidelines on gastric cancer prevention.

BACKGROUND AND AIM: Gastric cancer is a major health burden in the Asia-Pacific region but consensus on prevention strategies has been lacking. We aimed to critically evaluate strategies for preventing gastric cancer. METHODS: A multidisciplinary group developed consensus statements using a Delphi approach. Relevant data were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. RESULTS: Helicobacter pylori infection is a necessary but not sufficient causal factor for non-cardia gastric adenocarcinoma. A high intake of salt is strongly associated with gastric cancer. Fresh fruits and vegetables are protective but the use of vitamins and other dietary supplements does not prevent gastric cancer. Host-bacterial interaction in H. pylori infection results in different patterns of gastritis and differences in gastric acid secretion which determine disease outcome. A positive family history of gastric cancer is an important risk factor. Low serum pepsinogens reflect gastric atrophy and may be useful as a marker to identify populations at high risk for gastric cancer. H. pylori screening and treatment is a recommended gastric cancer risk reduction strategy in high-risk populations. H. pylori screening and treatment is most effective before atrophic gastritis has developed. It does not exclude the existing practice of gastric cancer surveillance in high-risk populations. In populations at low risk for gastric cancer, H. pylori screening is not recommended. First-line treatment of H. pylori infection should be in accordance with national treatment guidelines. CONCLUSION: A strategy of H. pylori screening and eradication in high-risk populations will probably reduce gastric cancer incidence, and based on current evidence is recommended by consensus.

A subset of ulcerative colitis with positive proteinase-3 antineutrophil cytoplasmic antibody.

A small subset of patients with active ulcerative colitis is non-responsive to major known non-biological therapies. We reported 5 patients with positive serum proteinase-3 antineutrophil cytoplasmic antibody (PR3-ANCA) and tried to (1) identify the common clinical features of these patients; (2) investigate the efficacy of a novel therapy using a Chinese medicine compound; and (3) attract more gastroenterologists to be engaged in further study of this subset of patients. The common manifestations of disease in these 5 patients included recurrent bloody diarrhea and inflammatory lesions involving the entire colorectal mucosa. Initial treatment with intravenous methylprednisolone successfully induced remission. Four of these 5 patients were steroid-dependence, and immunosuppressants, such as azathioprine and cyclophosphamide, were ineffective. In 3 patients, only the particular Chinese medicine compound could induce and maintain remission. One patient underwent colectomy. No vascular inflammatory lesions were found by histopathological examination. Although more cases are needed for confirmation, our study indicates that ulcerative colitis with positive PR3-ANCA may belong to a subtype of refractory ulcerative colitis. The particular Chinese medicine compound used in our study is by far the most effective in the management of these patients, with additional advantages of having no noticeable side-effects and less financial burden.

Association between fecal bile acids and colorectal cancer: a meta-analysis of observational studies.

PURPOSE: To provide a systematic review with meta-analysis for addressing the relationship between fecal bile acids (FBAs) and colorectal cancer. MATERIALS AND METHODS: Electronic databases were searched for all observational studies that examined the relationship between FBAs and colorectal cancer or adenoma, and calculated weighted mean difference (WMD) and 95% confidence interval (CI). Publication bias was assessed with funnel plot. RESULTS: Twenty case-control or cohort studies were identified. All studies were pooled to assess the relationship between total FBAs and cancer/adenoma of the large bowel, however, no association was seen (WMD 0.61mg/g freeze-dried feces; 95% CI: -0.35-1.57). Significantly increased concentration of chenodeoxycholic acid (CDCA) was seen while pooling to assess the relationship between CDCA and cancer/adenoma of the large bowel (WMD 0.13 mg/g freeze-dried feces; 95% CI: 0.01-0.25), especially for colorectal cancer (WMD 0.28mg/g freeze-dried feces; 95% CI: 0.10-0.46). However, no significant differences in deoxycholic acid (DCA), lithocholic acid (LCA), and primary and secondary bile acids, were seen between patients with cancer and patients with matched controls regardless of fixed and random effects models. CONCLUSION: CDCA might play a role in the etiology of colorectal cancer.

[The application of Montreal classification in inflammatory bowel disease].

OBJECTIVE: To investigate the clinical features of Crohn's disease (CD) and ulcerative colitis (UC) according to the Montreal classification. METHODS: The clinical data of 110 cases of CD or UC were reviewed. The age at diagnosis, location and clinical behavior were assessed with the Montreal criteria. RESULTS: CD patients diagnosed at an age younger than 16 years were rare (3.6%), the majority of the CD patients was diagnosed at 17 - 40 years old (65.5%). Although ileocolon lesions were most common in the patients diagnosed at 17 - 40 years old (37.3%), yet ileum lesions were a little more than those of other parts of digestive tract in the patients diagnosed after 40 years old (14.5%), the difference was not significant (P = 0.054). Stricture frequently occurred (50.4%), especially when the lesions were located at ileum or ileocolon. Perforation rarely happened (5.3%). There was no significant difference between different location groups for clinical behaviors (P = 0.096). The incidence of stricture or perforation was almost same among different age groups (P = 0.984). UC patients mostly presented with mild or moderate symptoms even in the group with extensive lesion. UC patients with severe symptoms were rare (6.8%). There was no significant difference in severity between the groups with different extent of lesion (P = 0.056). CONCLUSIONS: The majority of CD patients was diagnosed at 17 - 40 years old. Stricture is much more than perforation, penetrating, occurring mostly at ileum. UC patients mostly present mild or moderate symptoms, no matter how extensive the lesion is. The extent of the lesion detected with colposcopic examination is not correlated to the severity of clinical manifestations.

[An analysis of failure and safety profiles of capsule endoscopy].

OBJECTIVE: To analyse the incidence of technical breakdown and clinical problem leading to the failure of capsule endoscopy examination and their influence on the diagnosis and to evaluate its feasibility and safety in special patient population. METHODS: A retrospective study of 300 consecutive patients referred to Renji Hospital for evaluation of suspected small bowel diseases between May 2002 and May 2006 was done. This included 300 consecutive patients. The median age of the patients was 51 y (range, 3 - 91 y). The young children group was defined as less than 10 years and the elderly group as more than 80 years. Technical problems were those related to the functioning of the equipment and clinical problems were those related to the patient. The incidence and the type of above-mentioned events and their influence on the diagnosis were analyzed. The safety and feasibility of the capsule endoscopy procedure were evaluated in the young children group, elderly group and patients with pacemakers, gastrectomy and Billroth II gastrojejunostomy, intestinal diverticula, Crohn's disease and polyp of small intestine. RESULTS: A total of 300 patients were involved. The incidence of technical problems was 1.3%, including one case of failing in activating the capsule, one case of failing in loading the data and two cases of short life of battery. Failure of diagnosis was encountered in two cases. The incidence of clinical problems was 33.0% (99 cases) and they caused 35.4% (35 cases) failure of diagnosis in the 99 cases. Three patients in the young children group were unable to swallow the capsule and endoscope-guided overtube technique was used with success in all. In the elderly group, the incidence of capsule retaining in the oesophagus and stomach was as high as 23.0%. In two patients with pacemaker no interference between pacemaker and capsule was detected. In two patients with Billroth II gastrojejunostomy no capsule retention occurred. In 16 patients with diverticulum, capsule retention occurred in 1 case (6.0%). In 42 patients with Crohn's disease, capsule retention occurred in 5 cases. No acute gastrointestinal obstruction was found in the 42 patients with Crohn's disease and in 5 patients with polyp of small intestine. CONCLUSIONS: With capsule endoscopy technical mistakes causing failure were very rare. The majority of the clinical problems were related to the inability capsule to reach the colon during the recording time. Capsule endoscopy provides a well-tolerated, safe and effective tool to investigate the gastrointestinal diseases, especially some small bowel diseases.

Apoptotic effect of Epigallocatechin-3-gallate on the human gastric cancer cell line MKN45 via activation of the mitochondrial pathway.

AIM: To investigate whether Epigallocatechin-3-gallate (EGCG) can induce apoptosis of the gastric cancer cell line MKN45 and its apoptotic pathway. METHODS: To determine this, apoptotic rates of MKN45 cells after EGCG treatment with or without caspase-3 inhibitor were evaluated by Annexin V-FITC + PI staining The influence of EGCG on the activity of caspase-3 in the MKN45 cells was determined by ELISA. By Rhodamine123 staining, the membrane potential change of the mitochondrion was also investigated, and mRNAs and protein expression of the bcl-2 family were analyzed by RT-PCR and Western blot. RESULTS: EGCG can induce apoptosis of MKN45 cells in time- and dose-dependent manner. Eight hours after EGCG treatment, the activity of caspase-3 in the MKN45 increased, especially 12 h after treatment. The mitochondrial membrane potential was significantly weakened 4 h after EGCG insult. The mRNA and protein expression levels of pro-apoptotic members, such as Bax, Bid and Bad, were upregulated gradually as treated time increased. Moreover, the mRNA and protein expression levels of anti-apoptotic members, such as Bcl-xL and Bcl-2, were inhibited. CONCLUSION: These data support that EGCG can induce apoptosis of the human gastric cancer cell line MKN45, and the effect is in a time- and dose-dependent manner. The apoptotic pathway triggered by EGCG in MKN45 is mitochondrial-dependent.

The role of capsule endoscopy combined with double-balloon enteroscopy in diagnosis of small bowel diseases.

BACKGROUND: The diagnosis of small bowel diseases remains relatively inefficient using traditional imaging techniques. Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) are two novel methods of enteroscopy for examining the entire small bowel. The aim of this study was to evaluate the detection rate and diagnostic accuracy of CE and DBE in patients with suspected small bowel diseases and to investigate the clinical significance of combined use of these two novel modalities. METHODS: Two hundred and eighteen patients were evaluated for suspected small bowel disease, including 116 with obscure gastrointestinal bleeding and 102 with obscure abdominal pain or chronic diarrhea. One hundred and sixty-five out of these patients underwent CE first and 53 patients underwent DBE (under anesthesia with propofol) first. DBE was recommended after negative or equivocal evaluation on CE and vise versa. Introduction of the endoscope during DBE was either orally or anally and the patients were referred for a second procedure using the opposite route several days later when no abnormalities were found on the first procedure. The detection rates, diagnostic accuracy, tolerance and frequency of adverse events of these two modalities were then analyzed. RESULTS: Failure of the procedure was seen in one patient with CE and in two patients with DBE. Sixty-four DBE procedures were carried out in 51 patients; by the oral route in 34 cases, the anal route in 4 and both routes in 13 cases. The overall detection rate of small bowel diseases using CE (72.0%, 118/164) was superior to that with DBE (41.2%, 21/51); chi(2) = 16.1218, P < 0.0001. The diagnostic rate (51.8%, 85/164) was also higher than that with the latter procedure (39.2%, 20/51), but was not significantly different (chi(2) = 2.4771, P > 0.05). Furthermore, the detection rate of small bowel diseases in patients with obscure gastrointestinal bleeding using CE (88.0%, 88/100) was superior to that of DBE (60.0%, 9/15); chi(2) = 7.7457, P = 0.0054. Lesions were detected by DBE in 1 out of 4 patients in whom CE had a negative result. Suspected findings by CE were confirmed by DBE combined with biopsy in 12 out of 15 patients. On the other hand, small bowel lesions were identified by CE in all 3 patients after negative evaluations by DBE. There were no severe complications during or after either of the two procedures. CONCLUSIONS: The detection rate of small bowel diseases by CE is very high. CE should be selected for the initial diagnosis in patients with suspected small bowel diseases, especially in patients with obscure gastrointestinal bleeding. DBE appears to be inferior to CE in the diagnosis of small bowel diseases. However, it was shown that abnormalities could still be identified by DBE in patients with normal images or used to confirm suspected findings from CE. DBE can also serve as a good complementary approach after an initial diagnostic imaging using CE.

[Chemopreventive effect of oxymatrine on N-methyl-N'-nitro-N-nitrosoguanidine induced gastrointestinal cancer: experiment with rats].

OBJECTIVE: To investigate the chemopreventive effect of oxymatrine on the N-methyl-N-nitro-N-nitrosoguanidine (MNNG)-induced gastrointestinal cancer. METHODS: Ninety-nine male Wistar rats were randomly allocated into four groups: MNNG treated group (36 rats, fed with MNNG for 28 weeks so as to establish rat model of gastrointestinal cancer), oxymatrine intervention group (n = 23, fed with MNNG and oxymatrine), negative control group (20 rats, fed with mixed feed), and oxymatrine control group (20 rats. fed with normal food and oxymatrine). 28 weeks later all the rats began to be fed with normal food for 4 weeks. two rats in the MNNG treated group were killed at the 28 th, 32 nd, and 40 th weeks of the experiment respectively to observe the tumor growth in the gastrointestinal tract. At the 44 th week all the rats were sacrificed and assessed for the presence of gastrointestinal tumor. Immunohistochemistry was used to detect the expression of Ki67, an antigen associated to the proliferation of nucleus. The cell apoptosis rate in the tumor tissue was detected by TUNEL method. RESULTS: Experiment was completed in 92 rats (92.93%). The incidence of gastrointestinal tumor in the MNNG treated group was 58.62% (17/29), significantly higher than that in the oxymatrine treated group (30.43%, 7/23, P < 0.05). Duodenum tumor was found in 1 rat of the negative control group and no tumor was found in the oxymatrine control group. The average volume of tumor in the MNNG treated group was 2.56 (full range 49.5) cm(3), significantly larger than those of the oxymatrine treated group [0.03 (full range 0.009) cm(3)], and negative control group (0.5 cm(3)) (both P < 0.05). The incidence rates of gastrointestinal mucosal ulceration and dysplasia of the MNNG treated group were higher than those of the oxymatrine treated group (both P < 0.05). The expression rate of Ki67 in the tumor tissue of the MNNG treated group was (48 +/- 18)%, significantly higher than that of the oxymatrine treated group [(25 +/- 24)%, P < 0.05]. The apoptotic rate of tumor cell in the MNNG treated group was (11 +/- 7)%, significantly lower than that in the oxymatrine treated group [(30 +/- 16)%, P = 0.002]. CONCLUSION: Inhibiting the development and inducing the apoptosis of gastrointestinal tumor induced by MNNG, oxymatrine can be used as a chemopreventive agent against gastrointestinal tumor.

Eradication of H pylori infection in a rural population: one-day quadruple therapy versus 7-day triple therapy.

AIM: To compare the one-day quadruple therapy with a standard 7-d triple therapy for H pylori eradication in a rural population of China. METHODS: A total of 396 patients with (13)C-urea breath test positive for H pylori were assigned into two groups: 239 patients received one-day quadruple therapy (amoxicillin 2000 mg qid; metronidazole 500 mg qid; bismuth citrate 900 mg qid and lansoprazole 60 mg once daily) and 157 patients received 7-d standard triple therapy (amoxicillin 1000 mg bid; clarithromycin 500 mg bid and lansoprazole 30 mg bid). All the patients underwent a (13)C-UBT to assess the eradication of H pylori infection six weeks after treatment. RESULTS: Two hundred and twenty-nine patients completed the one-day therapy (95.8%) and 148 patients completed the 7-d therapy (94.2%). The one-day therapy eradicated H pylori infection in 64 patients (27.95%). In contrast, 103 patients (69.59%) were H pylori negative after the 7-d therapy (P < 0.01). CONCLUSION: This pilot study suggests there is no beneficial effect of the one-day therapy in treatment of H pylori infection compared with the 7-d standard therapy.

Diet and gastric cancer: a case-control study in Shanghai urban districts.

OBJECTIVE: The incidence rates of gastric cancer in Shanghai urban districts have been markedly declining over the past three decades. From 1972 to 2001 the age-adjusted incidence rates of gastric cancer decreased from 62.0 to 32.5 per 100,000 in men and from 23.9 to 16.9 per 100,000 in women. This study aimed to investigate the relationship between environmental factors, in particular dietary factors, and the development of gastric cancer in those who lived in Shanghai urban districts for more than 15 years, and to explore the causes that led to the reduction of the incidence rates of gastric cancer in Shanghai. METHODS: One hundred and eighty-nine patients with gastric cancer and 567 age and sex-matched controls were surveyed with a questionnaire. SPSS software package was used to perform the univariate and multivariate unconditional logistic regression analysis modeling. RESULTS: Vitamin supplements, use of home refrigerators, high consumption of fresh fruits and vegetables, bean and dairy products, and good meal habits were protective factors against gastric cancer. However, family history of cancer, chronic gastric diseases, increased intake of salted, pickled, fried and smoked foods, poor meal habits, smoking and alcohol drinking were risk factors for gastric cancer. CONCLUSIONS: The reduction of the incidence of gastric cancer in Shanghai urban district in the past three decades is closely related to environmental factors, in particular dietary factors and wide use of home refrigerators.