Thailand Consensus on Helicobacter pylori Treatment 2015.

Management of Helicobacter pylori infection is an important aspect of many upper gastrointestinal tract diseases, such as chronic gastritis, peptic ulcer disease, gastric cancer and mucosa-associated lymphoid tissue (MALT) lymphoma. The Thailand Consensus on H. pylori treatment 2015 consisted of 22 national experts who took active roles, discussed all important clinical information and investigated clinical aspects in four workshops, focuising on: (1) Diagnosis (2) Treatment (3) Follow-up after eradication and (4) H. pylori infection and special conditions. Experts were invited to participate on the basis of their expertise and contribution to H. pylori works and/or consensus methodology. The results of each workshop were taken to a final consensus vote by all experts. Recommendations were developed from the best evidence and availability to guide clinicians in management of this specific infection associated with variety of clinical outcomes.

Characteristics and Treatment Outcomes of Colonic Diverticulitis in Hospitalized Patients in Thailand.

BACKGROUND: Colonic diverticular disease exhibits mucosal outpouchings through the large intestine. Common complications of this disease are diverticular bleeding and diverticulitis. The prevalence of the disease is age-dependent, and some patients with diverticulitis develop complications especially the elderly, the obese and those with co-morbid diseases. In a retrospective study in Chiang Mai, Thailand, the mortality rate was 3.6% at 30 days and 9.2% at 1 year. OBJECTIVE: To determine the financial burden, clinical characteristics and factors associated with severity and mortality of patients with colonic diverticulitis. MATERIAL AND METHOD: This was a retrospective study of in-patients from hospitals nationwide, and data were retrieved from three major health care system databases in the fiscal year 2010, searching for ICD code 10. Patients diagnosed with diverticular disease of the large intestine were included in this study, and baseline characteristics and clinical outcomes were analyzed. The study was approved by the institutional ethics committee of Rajavithi Hospital. RESULTS: One thousand seven hundred and fifty patients with colonic diverticulitis were enrolled in the study and their data were analyzed. The mean age of the patients was 61.15+16.12 years old, about 70% of patients had co-morbid diseases, and the incidence of complicated colonic diverticulitis was 14.51%. The median length of hospital stay (LOS) was 6 days, half of the patients underwent surgery, and the mortality rate was 3.26%. Multivariate regression analysis revealed that the parameters associated with disease severity were number of co-morbid diseases, the universal coverage health care system, and surgical treatment, while the parameters associated with mortality were having more than two co-morbid diseases and being in the universal coverage health care system. CONCLUSION: Colonic diverticulitis was common in elderly patients and associated with co-morbid diseases. Most patients had mild severity but a high rate of surgery, and the mortality rate was higher than in western countries. Parameters associated with disease severity and mortality were having co-morbid disease, being in the universal coverage healthcare system and having surgical treatment.

Association of colonic diverticular disease and irritable bowel syndrome in Thai patients.

BACKGROUND: Colonic diverticular disease exhibits mucosal outpouchings through the large intestine. Common complications of this disease are diverticular bleeding and diverticulitis. Some patients with colonic diverticular disease have abdominal symptoms resembling irritable bowel syndrome (IBS). IBS is a functional gastrointestinal disorder with abdominal discomfort, bloating or pain associated with disturbed defecation and unclear etiology. Some studies have shown a high prevalence of colonic diverticular disease in patients with IBS. OBJECTIVE: To determine the association, clinical characteristics and factors associated with colonic diverticular disease in IBS patients compared with a control group. MATERIAL AND METHOD: A cross-sectional prospective study was conducted at the Gastroenterology Unit, Department of Medicine, Rajavithi Hospital, Bangkok during December 2007 to January 2009. The study collected data regarding clinical characteristics, demographics and colonoscopic findings of colonic diverticular disease comparing among IBS patients, defined by Rome III criteria and control group patients. The study was approved by the institutional ethics committee of Rajavithi Hospital. Demographic data of patients were collected. The presence of diverticula, their location and number from colonoscopic findings were recorded. RESULTS: One hundred and fifty patients were enrolled and analyzed. The patients comprised 75 patients in the IBS group and 75 patients in the control group. The prevalence ofcolonic diverticular disease in the total population was 17.3% (26 of 150). The IBS group had a higher prevalence of colonic diverticular disease than the control group with statistical significance (18 of 75, 24.0% in the IBS group vs. 8 of 75 or 10.7% in the control group, p = 0.031). Body mass index (BMI) more than 25 kg/m2, age more than 60 years and being male were associated with colonic diverticular disease without significance (28.1% in BMI >25 kg/m2 vs. 14.3% in BMI ≤25 kg/m2, p = 0.071, 23.0% in age >60 years vs. 13.5% in age ≤60 years, p = 0.132 and 20.3% males vs. 15.1% females, p = 0.406). Type of IBS (IBS-C vs. IBS-D) did not affect the prevalence of colonic diverticular disease (25.8% in IBS-C and 23.1% in IBS-D, p = 0.791). There were no difference in the location of colonic diverticular disease and number ofdiverticuli between the IBS group and control group (p = 0.149 and 0.095). CONCLUSION: An increased frequency of colonic diverticular disease was observed in patients with IBS. Increasing age, high BMI and being male were factors associated with colonic diverticular disease. These results suggest that IBS and colonic diverticular disease may have a common pathogenesis.

Normal Solid Gastric Emptying Values Measured by Scintigraphy Using Asian-style Meal:A Multicenter Study in Healthy Volunteers.

BACKGROUND/AIMS: To report gastric emptying scintigraphy, normal values should be established for a specific protocol. The aim of this study was to provide normal gastric emptying values and determine factors affecting gastric emptying using Asian rice-based meal in healthy volunteers. METHODS: One hundred and ninety-two healthy volunteers were included at 7 tertiary care centers across Thailand. Gastric emptying scintigraphy was acquired in 45 degree left anterior oblique view immediately after ingestion of a 267 kcal steamed-rice with technetium-99m labeled-microwaved egg meal with 100 mL water for up to 4 hours. RESULTS: One hundred and eighty-nine volunteers (99 females, age 43 ± 14 years) completed the study. The medians (5-95th percentiles) of lag time, gastric emptying half time (GE T1/2) and percent gastric retentions at 2 and 4 hours for all volunteers were 18.6 (0.5-39.1) minutes, 68.7 (45.1-107.8) minutes, 16.3% (2.7-49.8%) and 1.1% (0.2-8.8%), respectively. Female volunteers had significantly slower gastric emptying compared to male (GE T1/2, 74 [48-115] minutes vs. 63 (41-96) minutes; P < 0.05). Female volunteers who were in luteal phase of menstrual cycle had significantly slower gastric emptying compared to those in follicular phase or menopausal status (GE T1/2, 85 [66-102] mintes vs. 69 [50-120] minutes or 72 [47-109] minutes, P < 0.05). All of smoking volunteers were male. Smoker male volunteers had significantly faster gastric emptying compared to non-smoker males (GE T1/2, 56 [44-80] minutes vs. 67 [44-100] minutes, P < 0.05). Age, body mass index and alcohol consumption habits did not affect gastric emptying values. CONCLUSIONS: A steamed-rice with microwaved egg meal was well tolerated by healthy volunteers. Gender, menstrual status and smoking status were found to affect solid gastric emptying.

Effect of 4% gelofusine plus antibiotics on renal impairment and mortality in high-risk cirrhotic patients with spontaneous bacterial peritonitis.

BACKGROUND: Spontaneous bacterial peritonitis (SBP) increases the rates of renal impairment and mortality in cirrhotic patients. A previous study showed that cefotaxime plus albumin treatment decreased renal impairment more than antibiotic treatment alone in patients with serum bilirubin > 4 mg/dL or creatinine > 1 mg/dL. 4% Gelofusine is a colloidal volume replacement fluid used for fluid resuscitation and hemodynamic stabilization. Only one study showed that intravenous 4% gelofusine plus antibiotic could decrease the rates of renal impairment and mortality in comparison with the treatment with albumin plus antibiotic in high-risk cirrhotic patients with SBP OBJECTIVE: To evaluate the effects of 4% gelofusine plus antibiotics on renal impairment and mortality rates in high-risk cirrhotic patients with spontaneous bacterial peritonitis. MATERIAL AND METHOD: Eighteen cirrhotic patients with SBP and serum bilirubin > 4 mg/dL or creatinine > 1 mg/dL were enrolled. Ceftriaxone was given intravenously in doses of 2 g/day. Gelofusine 4% was given intravenously at 1.5 g/kg of body weight at the time of the diagnosis, followed by 1 g/kg on the 3 day. Renal impairment and mortality rates were evaluated during and after treatment. RESULTS: Five patients (27.8%) had pre-existing renal failure. Infection resolved in 15 patients (83.3%). Renal impairment developed in three patients (16.7%), and six patients (33.3%) died during hospitalization. After one month, the mortality rate was 33.3% (a total of 6 deaths). Patients with renal impairment had higher levels of plasma renin activity than those without renal impairment but the values were not statistically significant. CONCLUSION: In high-risk cirrhotic patients with spontaneous bacterial peritonitis, treatment with 4% gelofusine intravenously plus antibiotic reduced the incidence of renal impairment but did not reduce mortality in comparison with previous studies. Studies with larger sample sizes may be useful to evaluate these effects.

Prevalence of Helicobacter pylori infection in patients with peptic disease.

BACKGROUND: Helicobacter pylori is one of the most common human infections worldwide. It has been established as etiology of chronic gastritis and peptic ulcer disease, gastric adenocarcinoma and mucosal associated lymphoid tissue lymphoma (MALT). During this decade, there have been some reports showing a decline in global prevalence of H. pylori infection and peptic diseases including in many Asian countries. OBJECTIVE: To study the H. pylori infection in patients with peptic diseases, association with other factors and comparison to previous data. MATERIAL AND METHOD: Retrospective observational study of endoscopic reports for upper gastrointestinal tract diseases in patients with peptic diseases from October 2009 to September 2010 at the Endoscopic Unit, Department of Medicine, Rajavithi Hospital. Patients were examined for the presence of H. pylori infection by rapid urease test (RUT) or histology staining. RESULTS: Five hundred and seventy patients with a mean age of 55.0 +/- 16.02 years with peptic diseases were studies. Endoscopic findings showed 106 GU patients (18.6%), 29 DU patients (5.1%), 3 combined GU and DU patients (0.5%) and 432 NUD patients (75.8%). The prevalence of H. pylori infection were 64% (365 of 570 patients). Prevalence of H. pylori infection were 61.3% of NUD cases, 68.9% of GU cases, 82.8% in DU cases and 100% in combined GU and DU cases. Comparison with previous data (Anantapunpong S. Rajavithi Med J 1999; 10: 17-26), the prevalence of H. pylori infection overall and in DU are not changed but in NUD and GU are increased. CONCLUSION: The prevalence of H. pylori infection is still high in peptic diseases. The patients with age more than 50 years have more GU, less NUD than the younger groups. In comparison with a previous study, the prevalence of H. pylori infection in overall and in DU are not changed but in NUD and GU are increased.

Prevalence of single nucleotide mutation in clarithromycin resistant gene of Helicobacter pylori: a 32-months prospective study by using hybridization real time polymerase chain reaction.

Polymerase chain reaction (PCR) for detection of single nucleotide mutations in 23S rRNA gene of clarithromycin resistance Helicobacter pylori were investigated worldwide. In Thailand, the prevalence of these mutations had not been extensively investigated. The authors conducted a 32-months prospective study to estimate the prevalence of clarithromycin resistant Helicobacter pylori and to compare the sensitivity and specificity of hybridization real time PCR for 23S rRNA gene of Helicobacter pylori detection with the combination of rapid urease test, immunohistochemistry straining and Helicobacter pylori culture. A total of 200 patients with endoscopic examination with gastric biopsy were enrolled from January 2006 to September 2008. Eight gastric specimens were biopsied and performed rapid urease test, immunohistochemistry straining for Helicobacter pylori, Helicobacter pylori culture and hybridization real time PCR for 23S rRNA dectection, as well as single nucleotide mutation detection, such as G2111A, A2115G A2142G, A2143G andA2144G. The clarithromycin susceptibility of Helicobacter pylori isolated was determined by E-test. The prevalences of clarithromycin, amoxicillin, metronidazole and tetracycline resistance were 13.8%, 21.3%, 55.0% and 8.8%, respectively. Most of clarithromycin resistant Helicobacter pylori (81.80%) had very high minimal inhibition concentration (MIC) more than 256 microg/ml. The resistance to mutation gene at A2142G was found in 4 patients (36.40%). Two patients were found to have multiple mutations at G2111A, A2115G and A2144G (18.20%). The sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio to test positive and likelihood ratio to test negative of hybridization RT-PCR in detecting 23S rRNA gene of Helicobacter pylori was 95.6%, 94.4%, 93.2%, 96.7%, 17.2 and 4.6, respectively. In conclusion A2142G mutation was most common and associated with high MIC. Hybridization RT-PCR had good sensitivity and specificity to detect 23S rRNA gene, as well as clarithromycin resistance gene mutation of Helicobacter pylori.