Chung-Kwe Wang

Hybrid vs sequential therapy for eradication of Helicobacter pylori in Taiwan: A prospective randomized trial.

AIM To evaluate the efficacy of sequential vs hybrid therapy in patients with Helicobacter pylori (H. pylori) infection. METHODS From March 2013 to May 2014, one hundred and seventy-five H. pylori infected patients who had not been treated for H. pylori before were randomized to receive either sequential therapy (rabeprazole 20 mg and amoxicillin 1 g twice daily for 5 d, followed by rabeprazole 20 mg, clarithromycin 500 mg and metronidazole 500 mg twice daily for 5 d) or hybrid therapy (rabeprazole 20 mg and amoxicillin 1 g for 7 d, followed by rabeprazole 20 mg, amoxicillin 1 g, clarithromycin 500 mg and metronidazole 500 mg twice daily for 7 d). H. pylori status was confirmed by positive results of both rapid urease test and histology examination or a positive result of culture. Eradication efficacy was assessed by follow-up endoscopy with rapid urease test and histological examination 8 wk after the end of anti-H. pylori therapy, or (13)C-urea breath test at least 4 wk after completion of treatment. The primary outcome was H. pylori eradication by intention-to-treat (ITT) and per-protocol (PP) analyses. RESULTS One hundred and sixty-seven patients (83 patients in the sequential group and 84 patients in the hybrid group) completed the study. The compliance rates were 97.6% and 97.7% for the two groups, respectively. The eradication rate was 78.2% for the sequential group and 92% for the hybrid group by ITT analysis (P = 0.01). The eradication rate was 81.9% for the sequential group and 96.4% for the hybrid group by PP analysis (P = 0.01). Univariate analysis for the clinical and bacterial factors did not identify any risk factors associated with treatment failure. Severe adverse events were observed in 2.3% of patients in the sequential group and 2.4% of those in the hybrid group. CONCLUSION Due to a grade A (> 95%) success rate for H. pylori eradication by PP analysis, similar compliance and adverse events, hybrid therapy seems to be an appropriate eradication regimen in Taiwan.

Performance of Routine Helicobacter pylori Invasive Tests in Patients with Dyspepsia

Background. This study was designed to compare the accuracy of three different invasive methods for the detection of Helicobacter pylori (H. pylori) infection in patients with dyspepsia. These tests included culture, histology, and the rapid urease test (CLO test). Methods. H. pylori infection was diagnosed prospectively in 246 untreated dyspeptic patients who underwent upper gastrointestinal endoscopy. The gold standard for H. pylori infection was based on a positive culture or both a positive histological examination and a CLO test. Results. H. pylori was diagnosed in 33.3% of the patients. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were as follows: histology from the antrum (95.12; 95.12; 90.7; 97.5; 95.12%); histology from the antrum and corpus (95.12; 95.12; 90.7; 97.5; 95.12%); histology from the corpus (76.83; 96.95; 92.65; 89.33; 90.24%); culture (91.46; 100; 100; 95.91; 97.15%); a CLO test from the antrum and corpus (85.59; 100; 100; 93.71; 95.52%); a CLO test from the antrum (64.63; 100; 100; 84.97; 88.21%); a CLO test from the corpus (69.51; 100; 100; 96.77; 89.83%), respectively. Conclusions. Antral biopsy histology and culture are the best methods for the diagnosis of H. pylori infection in our cohort of patients with dyspepsia.

Clinical Significance of Hepatitis B Virus Pre-S Deletion Mutants in Patients with Chronic Hepatitis B Virus Infection: A Case Control Study

Background and Aim: The cytopathic effects of pre-S deletion mutant on natural course of chronic hepatitis B remain largely unclear. In the case-control study, we therefore investigated the clinical significance of pre-S deletion mutant in Taiwanese hepatitis B virus (HBV) carriers. Methods: By using molecular assays, pre-S deletion mutant of HBV were determined in 160 patients with chronic HBV infection, including 80 carriers with persistently normal serum alanine aminotransferase levels (PNALT) and 80 chronic hepatitis B patients. They were matched for gender and each 10-year categories of age. Results: The overall prevalence of pre-S deletion mutant was 20.6%. Compared to HBV carriers with PNALT, chronic hepatitis B patients had a significantly higher frequency of pre-S deletion mutant (31.2% vs. 10%, P=0.002). The prevalence of pre-S deletion mutant in HBeAg-positive patients was significantly higher than HBeAg-negative patients (27.8% vs. 13.6%; P=0.032). In addition, the frequency of pre-S deletion mutant was significantly higher in genotype C patients than genotype B patients (33.8% vs. 11.6%, P=0.01). By multiple logistic regression analysis, presence of pre-S deletion mutant was the only independently risk factor associated with hepatitis activity (odds ratio, 3.91; 95% CI, 1.57-9.76, P=0.003). Conclusion: Pre-S deletion mutant is more frequent in HBeAg-positive HBV carriers, particular in those with genotype C infection. Taiwanese HBV carriers with pre-S deletion mutants might have an increased risk for hepatitis activity, irrespective of HBeAg status.

Risk factors for 1-year mortality in patients with intermediate-stage hepatocellular carcinoma treated solely with transcatheter arterial chemoembolization

Transcatheter arterial chemoembolization (TACE) is a main therapy for patients with intermediate‐stage hepatocellular carcinoma (HCC). The purpose of our study was to determine the risk factors for 1‐year mortality in patients treated solely with TACE.

CYP2C19 polymorphism has no influence on rabeprazole-based hybrid therapy for Helicobacter pylori eradication

AIM To evaluate the impact of cytochrome P450 2C19 (CYP2C19) and interleukin-1β (IL-1β) polymorphisms on the efficacy of Helicobacter pylori (H. pylori) eradication by using rabeprazole-based hybrid therapy. METHODS A total of 88 H. pylori-infected patients were recruited to receive 14-d of hybrid therapy from March 2013 to May 2014. Three patients were excluded from analysis because of incomplete compliance. Either a follow-up endoscopy or 13C-urea test was performed to determine the results of H. pylori eradication therapy. The genotypes of CYP2C19 and IL-1β were analyzed to investigate the impact on treatment effect. RESULTS The total eradication rate of H. pylori was 92.94% (79/85). According to the CYP2C19 genotypes, the rates of H. pylori eradication were 89.19% in extensive metabolizers (EM) and 95.83% in non-EM. The H. pylori eradication rates regarding the IL-1β genotypes were 92.59% in the normal acid secretion group and 93.10% in the low acid secretion group. After multivariable logistic regression analysis, both the genotypes of CYP2C19 and IL-1β had no significant influences on the eradication rates of H. pylori. CONCLUSION The CYP2C19 and IL-1β polymorphisms are not significantly independent factors of H. pylori eradication using rabeprazole-based hybrid therapy.

Undifferentiated embryonal sarcoma of the liver in an adult: Case report and literature review

Undifferentiated embryonal sarcoma of the liver often presents in the childhood. Its occurrence rate in adults is extremely low. A 70‐year‐old woman suffered from right upper quadrant abdominal pain, fever, and body weight loss of 10 kg over half a year. Abdominal ultrasonography and computed tomography revealed one 9‐cm tumor with a cystic component at S6/S7 of the liver. The tumor markers, such as serum alpha‐fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19‐9, were in the normal range. Repeated biopsies showed no malignancy. After exclusion of infectious diseases through an inflammation scan, she underwent S6/7 bisegmentectomy. The final report of pathology was undifferentiated embryonal sarcoma. No evidence of recurrence or metastases was noted during follow‐up visits. The rate of misdiagnosis before operation is high. The enhancing of radiological feature‐reading skills and clinical awareness are considered to be necessary to reduce misdiagnosis. The prognosis was considered to be poor before. Multimodal treatment with complete surgical excision and chemotherapy provided the best chance of long‐term disease‐free survival. We concluded that undifferentiated embryonal sarcoma should be included in the differential diagnostic list of malignant liver tumors in adults.

CYP2C19 polymorphism has no influence on rabeprazole-based sequential therapy

The aim of this prospective study was to evaluate the impact of cytochrome P450 2C (CYP2C19) and interleukin‐1β (IL‐1β) polymorphisms on the efficacy of Helicobacter pylori (H. pylori) eradication by using rabeprazole‐based sequential therapy.