Chi-Hwa Wu

Comparison of invasive and noninvasive tests for detecting Helicobacter pylori infection in bleeding peptic ulcers

BACKGROUND Eradication of Helicobacter pylori infection has been shown to prevent recurrent bleeding from peptic ulcers. However, the detection rate for H pylori infection seems to be underestimated in this group of patients and has been scarcely investigated. METHODS Eighty patients with bleeding peptic ulcer were studied for evidence of H pylori infection. Seventy-seven of these patients were enrolled as having H pylori infection after any one of the following 3 tests were positive: culture, histologic study, or any 2 of rapid urease test (CLO test), carbon 13-labeled urea breath test (UBT), and serologic examination. Fresh blood or blood-containing material in the gastric antrum was noted by panendoscopy in 22 patients (group A). In the remaining 55 cases there was no blood in the antrum (group B). RESULTS The sensitivities of the CLO test, bacterial culture, histologic study, 13C-labeled UBT, and immunoglobulin G serologic test were 45.5%, 36.4%, 77.2%, 95.4%, and 100% in group A, respectively, and 70.9%, 40.0%, 70.9%, 92.7%, and 96.4%, respectively, in group B. There was a statistically significant difference between the sensitivities found for CLO test and 13C-labeled UBT (p < 0.05). Of these 5 tests, only the sensitivity of the CLO test showed a statistically significant difference between groups A and B (p < 0.05). A delayed positive CLO test result was recorded in 13 patients (3 in group A, 10 in group B). CONCLUSION Noninvasive tests seemed to be more sensitive than invasive tests in detecting H pylori infection in patients with bleeding peptic ulcers. Blood in the antrum might reduce the sensitivity of the CLO test but have no effect on the other tests. The CLO test should be observed for more than 24 hours because of the possibility of a delayed positive result in some patients with bleeding peptic ulcers.

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.

Portal blood flow in acute hepatitis with and without ascites: a non-invasive measurement using an ultrasonic Doppler.

Abstract To evaluate the role of portal blood flow in severe acute hepatitis leading to the formation of ascites, we studied the portal blood flow of 30 patients with severe acute hepatitis (20 without ascites and 10 with ascites), 20 patients with mild acute hepatitis and 20 healthy normal volunteers using duplex sonography. The portal blood flow of patients with severe acute hepatitis and ascites (421 ± 94 mL/min) was lower than that of the volunteers (725 ± 131 mL/min), the mild acute hepatitis (658 ± 148 mL/min), and the severe acute hepatitis (633 ± 108mL/min) without ascites (P < 0.001). The congestion index of severe acute hepatitis and ascites (0.16 ± 0.04 cm · s) was higher than that of the volunteers (0.09 ± 0.03 cm · s, P < 0.001), the mild acute hepatitis (0.09 ± 0.02 cm · s, P < 0.001), and the severe acute hepatitis (0.12 ± 0.04 cm · s, P < 0.02) without ascites. Portal blood flow was negatively correlated with prolonged prothrombin time (P < 0.001) and serum total bilirubin level (P= 0.002) and congestion index was positively correlated with heart rate (P= 0.006), prolonged prothrombin time (P < 0.001). and serum total bilirubin level (P= 0.001). Our study shows that in severe acute hepatitis, portal blood flow was reduced in patients with ascites. The non‐invasive ultrasonic Doppler is a safe and helpful method in the clinical evaluation of portal hypertension in severe acute hepatitis.

Prospective study of abdominal ultrasonography before laparoscopic cholecystectomy.

To investigate the role of abdominal ultrasonography (US) in predicting possible difficulties during laparoscopic cholecystectomy, we performed preoperative US evaluation prospectively in 82 consecutive patients. We correlated our predictions of “easy” and “difficult” with difficulties experienced at operation in surgery. The binary outcomes were analyzed by taking both easy category of US and surgical operation as positive results and both difficult category as negative results. We obtained satisfactory sensitivity (93.8%), accuracy (81.4%), and positive predictive value (84.7%), but low specificity (35.3%) and negative predictive value (60%). The highly positive results were the result of careful US examination. The low specificity and negative predictive value were attributed to the fact that most surgically difficult cases were due to adhesions around the gallbladder, difficult indeed to detect at US. We conclude that thorough abdominal US examination before laparoscopic cholecystectomy is useful in preoperative evaluation of patients undergoing laparoscopic cholecystectomy, even if it not infrequently fails to predict the surgically difficult cases mainly due to adhesions around the gallbladder.

Negative CLOtest pellet can be reused

BACKGROUND The CLOtest is based on the production of ammonia from urea in the presence of urease. In theory, substrate that has not been consumed in a negative test can be reused. METHODS We collected negative CLOtest pellets after their first use and stored them at room temperature. Whenever a CLOtest was needed during endoscopy, two biopsy specimens were taken from the antrum. One specimen was tested with a new CLOtest and the other with one that had been used previously. Time to color change was observed in paired tests. RESULTS We used 216 previously used CLOtest pellets with biopsy specimens obtained from 317 patients. Of the paired tests, 204 matched positive and 108 tested negative. Only 5 paired tests had discrepant results. Three had positive results only with a new CLOtest, and 2 were positive only with the reused test. In positive paired tests, there was significant linear correlation in log-transformed color change time between reused and new tests (p < 0.001). Ninety-two percent of previously used pellets were reused fewer than three times before they yielded a positive color change; the interval to this occurrence ranged from 2 to 15 days. Compared with the new CLOtest, the sensitivity of the reused CLOtest was 98. 6% and the specificity was 98.2%. CONCLUSIONS A negative CLOtest kept at room temperature can be reused within a short period of time, in circumstances in which there are environmental and economic considerations to be taken into account.

Gastritis cystica polyposa in an unoperated stomach

Gastritis cystica polyposa is relatively rare and characterized by polypoid hyperplasia and cystic dilatation of the gastric glands in stomach. Most cases are related to previous gastric surgeries, but a few cases have been reported in unoperated stomachs. We present a 34‐year‐old man who had anemic symptoms with melena and exertional dyspnea for 3 weeks. He denied any surgical history. An esophagogastroduodenoscopy revealed diffuse giant folds extending from the lower to the upper body of the stomach with nodularity and no obvious bleeding site. A pathologic diagnosis of a punch biopsy specimen from the giant folds revealed only moderately active chronic inflammation with a high Helicobacter pylori density. After serial studies, the patient received a whole layer gastric biopsy during a laparoscopy. Gastritis cystica polyposa was diagnosed on the pathology report. Our present case highlights the rare clinical and endoscopic condition of gastritis cystica polyposa in an unoperated stomach.

Primary Pancreatic Squamous Cell Carcinoma: Report of a Case

Primary pancreatic squamous cell carcinoma is rarely recognized in pancreatic malignancies. Prior reported incidence was 0.2% to 0.5% in all pancreatic malignancies. Here we describe a 65-year-old woman with epigastric pain radiating to back for one month. After extensive workup, a large pancreatic head mass with pathology proven squamous cell carcinoma was diagnosed. Survey of other common site of primary sqaumous cell carcinoma was all negative. We discuss the possible oncogenic pathogenesis, clinical manifestations, treatment and prognosis of this rare disease. Existing literatures were also reviewed in order for better understanding of this rare pancreatic malignancy.

Association between Gastroesophageal Flap Valve and Erosive Esophagitis

Objectives: Gastroesophageal flap valve (GEFV) can be divided into a four-grade system and this system can well predict the prevalence of gastroesophageal reflux disease (GERD). We tried to use this GEFV grading system to examine the correlation of GEFV to erosive esophagitis. Methods: We enrolled 398 individuals that underwent one-day self-paid health examination, including esoph agogastroduodenoscopy (EGD) in 3-month period. GEFV grade I and Ⅱ were considered normal, whereas grade Ⅲ and Ⅳ were abnormal. We compared and analyzed the correlation of sex, body mass index (BMI) and GEFV grading with erosive esophagitis. Results: There were 37 subjects being diagnosed as abnormal gastroesophageal flap valve (37/398, 9.3%). 18 of them (18/37, 48.6%) had erosive esophagitis also. The remaining 361 subjects were diagnosed as normal flap valve (361/398, 90.7%) and 53 subjects were diagnosed as erosive esophagitis (53/361, 14.7%). Abnormal gastroesophageal flap valve subjects had higher chance to had erosive esophagitis (Odds Ratio=7.51, 95% CI=3.53-15.98). Males had higher prevalence of erosive esophagitis (Odds Ratio=3.74, 95% CI=1.90-7.38) and the prevalence of erosive esophagitis was 17.8%. Age and BMI did not increase the risk of esophagitis remarkably in the initial analyses (P=0.15 and 0.2) Conclusion: Male gender and subject, who have abnormal gastroesophageal flap valve, are prone to develop erosive esophagitis. Age and BMI do not increase the risk of esophagitis remarkably.

Identification of Factors That Impact on Patient Satisfaction of Unsedated Upper Gastrointestinal Endoscopy

This study is designed to validate clinical predictors to patient satisfaction and tolerance for unsedated upper GI endoscopy in Taiwanese patients. Patients who underwent diagnostic upper GI endoscopy at Cathay General Hospital, in Taipei, Taiwan from September 2005 to December 2005 were enrolled. A questionnaire was filled by patient after endoscopic procedure. The clinical predictors for patient satisfaction were analyzed in this study. A total of 3,087 patients underwent endoscopic examinations during this period. A satisfactory endoscopy procedure included the male gender (OR=1.75), advanced age (OR=1.03), procedure time in the morning (OR=1.58), presence of assistant (OR=1.67), previous experience (OR=2.16) for upper endoscopy. Unsedated upper GI endoscopy is a feasible, acceptable, and cost-effective alternative to sedated procedure. It is our suggestion that patients with the above characteristics had merit in selecting unsedated procedure.

An Unusual Image of Acinar Cell Carcinoma of Pancreas: Report of a Case

Acinar cell carcinomas (ACCs) are uncommon tumors of the exocrine pancreas, constituting 1% to 2% of all pancreatic neoplasms. They are more common during the 5th through the 7th decades of life. ACCs are defined as carcinomas exhibiting pancreatic enzyme production by neoplastic cells. These tumors have highly characteristic histological features reflecting their acinar derivation. Typically they present as a sizable pancreatic mass with a well-defined enhancing capsule and internal calcification on the image of computed tomography. We report an ACC of pancreas in a 79-year-old female who presented with a 3-cm gastric submucosal mass and a history of anemia initially. The external compression from pancreas exhibited typical acinar morphology. The thickness of peritoneal membrane showed ”omental cake” appearance. Immunohistochemical studies demonstrated strong positive reactivity for cytokeratin, polyclonal CEA and antitrypsin. A complete workup identified a primary pancreatic tumor.