Low and high doses of rabeprazole vs. omeprazole for cure of Helicobacter pylori infection.

BACKGROUND: Low-dose rabeprazole-based triple therapy was effective for Helicobacter pylori eradication in a few Japanese studies. AIM: To compare the effectiveness of 1-week low-dose and high-dose rabeprazole-based triple therapy with those of omeprazole. METHODS: One hundred and sixty-two H. pylori-infected dyspeptic patients were randomized to receive twice daily for 1 week either rabeprazole 10 mg (R10), rabeprazole 20 mg (R20) or omeprazole 20 mg (O) in combination with amoxicillin 1,000 mg (A) and clarithromycin 500 mg (C). H. pylori status assessment was by the CLO test and histology at entry and by the 13C-urea breath test at 4-6 weeks after cessation of therapy. RESULTS: H. pylori eradication rates in intention-to-treat groups were 85%, 96% and 83% for R10AC, R20AC and OAC, respectively. Eradication rates in per protocol groups were 86%, 96% and 90% for R10AC, R20AC and OAC, respectively. On an intention-to-treat analysis, the R20AC group had a significantly higher eradication rate than did R10AC or OAC (P < 0.05). However, the higher eradication rate with R20AC did not reach statistical significance in the per protocol analysis. Drug intolerance was found in three OAC patients. CONCLUSION: High-dose rabeprazole-based triple therapy is more effective than its low-dose equivalent or omeprazole in eradicating H. pylori infection.

Liver involvement in murine typhus.

Liver involvement was retrospectively evaluated in 137 patients with murine typhus. Fifteen (10.9%) were jaundiced. One patient had been subjected to cholecystectomy after misdiagnosis of acute cholecystitis. Serum aminotransferase levels were abnormal in 48/52 measurements, and there were elevations of > 5-fold in 14 patients. Liver biopsies and/or necropsies from four jaundiced patients showed portal tract and sinusoidal infiltrates, cloudy swelling/and necrosis of the hepatocytes and occasional pseudogranuloma formation. There were striking mitoses even in the early stage, suggesting rapid hepatocellular regeneration. Haemolytic diseases (G6PD deficiency or haemoglobinopathies), alcoholism, and a second infection probably also contributed to the pathogenesis of jaundice in murine typhus. This rickettsiosis should be included among differential diagnoses of acute hepatitis in patients exposed to areas endemic for Rickettsia typhi.

Gastrointestinal lesions in patients over 40 years of age with iron deficiency anemia and hookworm infection.

A prospective study of 41 patients (24 male and 17 female) aged over 40 years with iron deficiency anemia and hookworm infection was performed by endoscopy and barium enema to determine the incidence of GI lesions. Alcohol ingestion, smoking, abdominal pain, anorexia, loss in weight, bowel habit change, analgesic consumption and stool occult blood test were analyzed for their positive predictive value of GI lesions. The mean age of the patients was 62.8 years (SD = 10.1). The mean hemoglobin was 5.99 gm.% (SD = 1.9). Twenty patients (48.8%) had GI lesions. The lesions included 10 erosive gastritis, 1 erosive duodenitis, 5 gastric ulcers, 2 duodenal ulcers, 1 carcinoma of stomach and 1 carcinoma of colon. Gastric ulcer, duodenal ulcer and carcinoma were regarded as significant lesions. Abdominal pain was found in 16 of the 20 patients with GI lesions and 8 of the 21 without GI lesion (Chi square with Yate's correction, x2 = 5.78 p = 0.02). Four of the 17 patients without pain had GI lesions but only one of these 4 (5.8%) had gastric ulcer. Abdominal pain had an 80% sensitivity and 62% specificity for the positive prediction of GI lesions based on the above findings. GI investigation is recommended for all patients with abdominal pain. In those without pain, treatment of hookworm and iron therapy with follow-up may be justified.

Pneumatic dilatation for achalasia of the esophagus: report of three patients treated with self-constructed pneumatic bags using the endoscopic technique.

Three patients with achalasia of the esophagus treated with pneumatic bag dilatation were reported. The preliminary result is encouraging. To what extent the difference in the type of bags and technical variations contributed to the ultimate outcome of the treatment is not known. The endoscopically aided pneumatic dilatation was found to be safe and simple.

Peptic stricture of the esophagus: report of a case with perforation and Barrett's esophagus.

A 79-year-old man with peptic stricture of the esophagus was treated by endoscopic aid dilatation using Eder-Peustow dilator. Esophageal perforation was suspected after the second dilatation and conservative treatment was initiated with full recovery. The patient developed Barrett's esophagus despite continuous treatment with ranitidine and metoclopramide. The role of medical treatment in esophageal perforation due to instrumentation was emphasized. Peptic stricture of esophagus is probably not common in our community. The conventional treatment of esophagitis with ranitidine and metoclopramide is not adequate in preventing the occurrence of Barrett's esophagus.

Tetracycline-induced esophageal ulcer: a condition that probably more common than it appears to be.

Ten cases of tetracycline derivatives related drug induced esophageal ulceration were described. Five cases were due to minocycline and another five were due to doxycycline. Recumbent posture after drug ingestion was one of the predisposing factors. Odynophagia was the main symptom but may not be the presenting symptom. The diagnosis was easily confirmed by endoscopy. Single-contrast barium study was not sensitive for the demonstration of the esophageal ulcers. The recommended treatment includes cessation of the offending drug and symptomatic treatment. All recovered without any sequela within 3 to 11 days. The most important measure to prevent this condition is to instruct patients to take drugs in the upright position with at least 100 ml of water.

Sphincter of Oddi manometry in various biliary diseases: a report in 20 Thai patients.

This is the first report of sphincter of Oddi manometry study in 20 Thai patients with various biliary diseases. The yield of abnormal SOM in 3 of 17 in our study was low and was comparable to other reports. The successful rate of 85 per cent and complication rate were acceptable. Careful clinical assessment is mandatory before SOM study in order to gain the best benefit and minimize the risk of SOM.

Liquid meal emptying in non-ulcer dyspepsia: a study in 22 Thai patients.

Twenty-four patients with non-ulcer dyspepsia (NUD) were recruited for gastric emptying study of liquid meal before and after 1 week's treatment with domperidone (80 mg in 19, 40 mg in 2, dropout 1 and excluded 2). Delayed gastric emptying was found in 8 of 22 (36.36%). Clinical improvement was found in 11 patients after treatment. Gastric emptying improvement was found in 3 patients (2 without clinical improvement). No correlation was found between the clinical and gastric emptying improvement. (Fisher exact test p greater than 0.25). Impaired liquid emptying is common in NUD and domperidone improved clinical symptoms in 50 per cent of NUD in this study.

Biliary stent: a report of experience in 25 Thai patients.

Biliary stent insertion was done in 25 patients. Eighteen were successful, 14 by endoscopic method and 4 by combined endoscopic percutaneous method. Twelve with malignant diseases and 4 with benign diseases had satisfactory drainage. Failed stent insertion occurred in 7 cases. Stent malfunction was found in 30 per cent and occlusion was the most common problem. Complications occurred in 32 per cent and most were mild. The 4 per cent mortality of the procedure is acceptable. Biliary stent should be considered as an alternative or as an adjunctive treatment to surgery.

Endoscopic removal of stone in patients with retained common bile duct stone and T-tube after cholecystectomy. Is it justified?

Fifteen patients with retained common bile duct (CBD) stones and T-tube and twenty patients with CBD stones without T-tube had stones removed by endoscopic method. The result of endoscopic sphincterotomy, stone extraction, stone clearance and complication in patients with T-tube was similar to the results in patients without T-tube. The presence of T-tube did not create much difficulty in stone removal and the successful rate of 86.6 per cent (13/15) was satisfactory. Endoscopic removal of retained stones in patients with T-tube is recommended when retrieval via T-tube is not available since the later has fewer reported complications with very low mortality compared to the endoscopic technique.

The magnitude of nocturnal acid suppression by ranitidine 300 mg given at 18.00 hours.

Ranitidine 300 mg given at 18.00 hours in 5 patients with CVA resulted in 99.5 per cent acid suppression for 12 hours. Intragastric pH of 4 or greater was obtained in only 58 per cent of the 12-hour period. An early evening dose of ranitidine is probably more effective and dosage reduction may be applicable for the healing of duodenal ulcers. However, ranitidine as given in this study is probably not adequate for stress ulcer prophylaxis.

Medication-induced esophageal injury: report of 17 cases with endoscopic documentation.

We report on medication-induced esophageal injury (MIEI) in 17 patients (six male, 11 female) seen from October 1986 to May 1990. The mean age of patients was 27.3 (SD = 5.7) yr; mean duration of drug ingestion prior to the occurrence of symptoms 10.2 (SD = 11.5) days, and mean duration of symptoms before seeking medical attention 4.6 (SD = 3.8) days. Symptoms subsided after treatment, with a mean of 6 (SD = 2.5) days. Symptoms included odynophagia (in 17), chest pain (six), epigastric pain (three), and retrosternal pain (one). Symptoms occurred after the drug was stopped in three. MIEI was caused by doxycycline (seven), minocycline (five), Pantozyme (one), cloxacillin (one), unknown (two), and dicloxacillin + Danzen (one). Reclining after drug ingestion was the predominant risk factor. Endoscopy showed most ulcers to be multiple and at midesophagus. Barium swallows done in two patients were negative. There is no previous report of Pantozyme (pancreatic enzyme), Danzen (serratio-peptidase), cloxacillin, and dicloxacillin causing MIEI.

Findings and benefit of liver biopsies in 46 patients infected with human immunodeficiency virus.

AIMS: The aim of this work is to evaluate the role of liver biopsy and to determine the histological findings in patients infected with the human immunodeficiency virus (HIV) who have abnormal liver function tests (LFT). METHODS: We performed a percutaneous liver biopsy in 46 HIV-seropositive patients with abnormal LFT. Parts of biopsied tissue were used for bacterial and fungal culture and the rest was processed for histological examination including special staining. RESULTS: Of these 46 patients, 41 patients were males and five were females. The median age was 31+/-6 years. Mycobacterium tuberculosis was the most common histological finding (15 cases). Of 15 tuberculosis patients, 11 (73.3%) had lymphadenopathy and positive acid-fast bacilli (AFB) in node aspiration or biopsy. The other findings included AFB-negative granuloma (eight cases), histoplasmosis (six cases), cryptococcosis (six cases), penicillosis (four cases), viral hepatitis: hepatitis C virus (HCV; one case), hepatitis B virus and HCV infection (one case), fatty liver (two cases), drug-induced hepatitis (one case) and non-specific changes (five cases). There were double infections in three patients. We were able to demonstrate opportunistic infections in 41 cases (89.3%). CONCLUSIONS: Mycobacterium tuberculosis was the most common histological finding in HIV patients with abnormal LFT in Thailand. Liver biopsy was a useful procedure in evaluating abnormal LFT in HIV patients.