Ching-Chu Lo

Endoscopic ligation vs. nadolol in the prevention of first variceal bleeding in patients with cirrhosis

BACKGROUND The value of band ligation for prevention of the first episode of variceal bleeding has not been fully evaluated. This study compared the efficacy and safety of band ligation vs. treatment with a beta-blocker for the prophylactic prevention of first bleeding in patients with cirrhosis and high-risk esophageal varices. METHODS A total of 100 patients with cirrhosis and endoscopically determined high-risk esophageal varices but no history of bleeding were randomized to band ligation (50 patients) or treatment with nadolol (50 patients). In the ligation group, two to 4 elastic bands were deployed during each session. Ligation was repeated at intervals of 3 to 4 weeks until variceal obliteration was achieved. In the nadolol group, the dose of the drug, administered once daily, was sufficient to reduce the pulse rate by 25%. RESULTS In the ligation group, variceal obliteration was achieved in 41 patients (82%), at a mean of 2.7 (1.1) ligation sessions. In the nadolol group, the mean daily dose of nadolol administered was 60 (20) mg. During follow-up (median approximately 22 months), 10 patients (20%) in the ligation group and 16 (32%) in the nadolol group had upper-GI bleeding (p=0.23). Esophageal variceal bleeding occurred in 5 patients (10%) in the ligation group and 9 (18%) in the nadolol group (p=0.31). By multivariate Cox analysis, Child-Pugh class was the only factor predictive of variceal bleeding. Minor complications were noted in 9 patients (18%) in the ligation group and 4 (8%) in the nadolol group (p=0.35). No serious complication was encountered. Twelve patients in the ligation group and 11 in the nadolol group died (p=0.62). One patient in the ligation group and 3 in the nadolol group died from uncontrollable variceal hemorrhage. CONCLUSIONS Variceal ligation is as effective and as safe as treatment with nadolol for prevention of first variceal bleeding in patients with cirrhosis.

A Prospective Randomized Trial of Esomeprazole- versus Pantoprazole-Based Triple Therapy for Helicobacter pylori Eradication

OBJECTIVE:This prospective, randomized, controlled, head-to-head study was conducted to compare the efficacies of esomeprazole- and pantoprazole-based triple therapies for Helicobacter pylori eradication.METHODS:From January 2002 to October 2003, 200 H. pylori-infected patients were randomly assigned to undergo twice daily treatment with esomeprazole 40 mg (n = 100) or pantoprazole 40 mg (n = 100) combined with clarithromycin 500 mg and amoxicillin 1 g for 1 wk (ECA and PCA groups, respectively). Follow-up endoscopy was performed at 8 wks after the end of treatment to assess the treatment response.RESULTS:Intention-to-treat analysis demonstrated a significantly higher eradication rate for the ECA group than for the PCA group (94% vs 82%, respectively, p = 0.009). Per-protocol analysis also showed similar results (97% vs 84%, p = 0.003). Both groups had similar frequencies of adverse events (15% vs 24%) and drug compliance (97% vs 96%). Multivariate analysis disclosed that the use of esomeprazole (OR: 1.56, 95% CI, 1.11–2.19) and good compliance 7.39 (95% CI, 1.27–42.95) were independent predictors of treatment success. Alcohol drinking was an independent predictor of eradication failure (OR: 0.18; 95% CI, 0.06–0.54).CONCLUSION:Esomeprazole-based triple therapy demonstrated a higher eradication rate than pantoprazole-based regimen. The differences in eradiation efficacies between the two study groups may be related to the more powerful acid inhibition effect and stronger anti-H. pylori activity of esomeprazole compared to pantoprazole.

Risks of interleukin-1 genetic polymorphisms and Helicobacter pylori infection in the development of gastric cancer

Background : The host genetic factors that determine the clinical outcomes of Helicobacter pylori‐infected individuals remain unclear.

Clinical Significance of Oral Urease in Diagnosis of Helicobacter pylori Infection by [13C]Urea Breath Test

This study was performed to evaluate the effect of oral flora on [13C]urea breath test in detecting H. pylori infection and find an optimal method and timing for sample collection. Forty-five volunteers were included in this study. The [13C]urea breath test was performed using mouthwash, endoscopic administration, and conventional methods. According to the receiver-operating characteristic curves, the earliest optimal time for discriminating H. pylori-positive and H. pylori-negative patients was at 25 min with the mouthwash method with 78% sensitivity and 82% specificity, at 2 min with the endoscopic administration method with 100% sensitivity and 100% specificity, and at 6 min with the conventional method with 100% sensitivity and 95% specificity. The study shows a significant effect of oral urease on the results of the [13C]urea breath test. The timing of sampling collection can be shortened to 6 min with the conventional method or to 2 min through endoscopic administration.

One-week quadruple therapy is an effective salvage regimen for Helicobacter pylori infection in patients after failure of standard triple therapy.

Standard triple therapy remains an important option for eradicating Helicobacter pylori (Hp) in developing countries because of its relatively low cost. However, salvage therapies after failure of this regimen remain undefined. The authors therefore investigate the efficacy of 1-week quadruple therapy as a second-line treatment of Hp infection after failure of standard triple therapy. Seventy-eight patients who failed Hp eradication using a 2-week bismuth-based triple therapy were enrolled and received a course of 1-week quadruple therapy (lansoprazole, 30 mg twice daily; bismuth subcitrate, 120 mg four times daily; clarithromycin, 500 mg twice daily; and amoxicillin, 1,000 mg twice daily) as a salvage regimen. The Hp status was reassessed 7 weeks after cessation of therapy. Among the 78 patients, Hp eradication was achieved in 65 (83%, 95% confidence interval = 75–91%) by intention-to-treat analysis. Only five (6%) patients had side effects, and all (100%) showed good drug compliance. Multivariate analysis disclosed that coffee drinking was an independent factor for treatment failure (odds ratio = 5.3, 95% confidence interval = 1.2–23.6, p = 0.028). The authors therefore conclude that their 1-week quadruple therapy is an effective salvage regimen for Hp infection after failure of standard triple therapy in the population examined. The benefits of this regimen include the high eradication rate, the short duration of treatment, fewer side effects, and good drug compliance. Coffee consumption possibly is an important factor in failure of the rescue regimen. The mechanisms underlying the association between coffee drinking and eradication failure require further research.

The Interleukin‐1 RN Polymorphism and Helicobacter pylori Infection in the Development of Duodenal Ulcer

Background.  The host genetic factors that determine the clinical outcomes for Helicobacter pylori‐infected individuals remain unclear.

Endoscopic 13C-urea breath test for the diagnosis of Helicobacter pylori infection.

BACKGROUND Endoscopic 13C-urea breath test may avoid contamination of oral urease and rapidly discriminate Helicobacter pylori-positive and Helicobacter pylori-negative patients. AIMS To compare the accuracy of endoscopic 13C-urea breath test with conventional invasive methods in diagnosis of Helicobacter pylori infection. PATIENTS One hundred patients who attended for routine upper gastrointestinal endoscopy were included. METHODS 13C-urea was applied to the stomach through the working channel of endoscope at the end of endoscopic examination. Breath samples were collected before endoscopy and 2, 4, 6, 8, 10 min after consumption of 100 or 50 mg 13C-urea. Helicobacter pylori infection was defined as those with positive culture or positive results of both histology and CLO test. RESULTS The accuracy of 100 mg endoscopic 13C-urea breath test was significantly higher than that of culture and CLO test (100% vs. 88% and 92%, p = 0.02 and 0.03, respectively). The accuracy of 50 mg endoscopic 13C-urea breath test was higher than that of histology and CLO test (98% vs. 90% and 96%, respectively), although the differences were not statistically significant. CONCLUSIONS Endoscopic 13C-urea breath test has a higher accuracy compared with biopsy-based modalities. It may be a good choice to diagnose Helicobacter pylori infection if endoscopy is indicated for a dyspeptic patient.

Comparison of clinical, serological and histological findings between non‐ulcer dyspepsia patients with and without Helicobacter pylori infection

Background and Aims: The role of Helicobacter pylori (H. pylori) infection in non‐ulcer dyspepsia (NUD) remains controversial. This study investigates the clinical, serological and histological differences between patients with H. pylori‐positive and ‐negative NUD.

Comparison of Infrared Spectrometer and Mass Spectrometry for 13C-Urea Breath Test in the Diagnosis of Helicobacter pylori Infection

Background: Infrared spectrometer has been developed recently as an alternative tool of mass spectrometry for quantitative gas analysis in 13C-urea breath test (UBT). This investigation is to compare the diagnostic efficacy of infrared spectrometer with mass spectrometry for UBT in the evaluation of Helicobacter pylori (H. pylori) infection. Methods: Sixty-three patients with 114 breath tests were included. Fifty-one patients received both endoscopic UBT and conventional UBT, the others received conventional UBT only. On endoscopic UBT, 13C-urea was injected into the stomach through the working channel of endoscope at the end of endoscopic examination, and breath samples were collected 2 min after consumption of 13C-urea. On conventional UBT, breath samples were collected before and 15 min after consumption of 13C-urea. All samples were analyzed with both infrared spectrometer and mass spectrometry. Results: There was a high agreement of H. pylori-positive and H. pylori-negative on endoscopic UBT (100%) and conventional UBT (95.2%) between infrared spectrometer and mass spectrometry. The quantitative analysis of UBT between infrared spectrometer and mass spectrometry is highly correlated (r = 0.968 on endoscopic UBT, r = 0.974 on conventional UBT). Conclusion: Infrared spectrometer is as effective as mass spectrometry for UBT in the diagnosis and quantitative analysis of H. pylori infection.