Chung-Mou Kuo

The Efficacy of Second‐Line Anti‐Helicobacter pylori Therapy Using an Extended 14‐Day Levofloxacin/Amoxicillin/Proton‐Pump Inhibitor Treatment – A Pilot Study

Large meta‐analyses of second‐line Helicobacter pylori eradication with fluoroquinolone triple therapy have shown that neither 7‐day nor 10‐day therapy provides 90% or better treatment success. Reports describing second‐line H. pylori eradication using 14‐day fluoroquinolone‐containing triple therapy are few. Current study aimed to determine the efficacy of a 14‐day levofloxacin/amoxicillin/proton‐pump inhibitor regimen as second‐line therapy and the clinical factors influencing the outcome.

Liver abscess in patients with cirrhosis of the liver: a 12-year experience

Purpose. Liver abscess is rare in patients with cirrhosis of the liver. The aim of this retrospective study was to investigate the incidence, clinical presentation, causal pathogens, and outcome of liver abscess in cirrhotic patients. Methods. We collected 21 liver abscess specimens (from 14 male patients and 7 female patients; Child A: B: C, 4: 7: 10) from 22 731 admissions of 6450 cirrhotic patients, from 1986 through 1998. Results. The common clinical symptoms and signs included fever, chills, and abdominal tenderness. The major predisposing factors were biliary tract disease (52%) and diabetes mellitus (48%). The diagnosis rate with abdominal ultrasonography was 79%. Gram-negative aerobes were the predominant pathogens (Klebsiella pneumoniae, 66.7%; Escherichia coli, 23.8%), and occurred in 80% and 69% of blood and pus cultures, respectively, while 38% of cases showed polymicrobial pathogens. The location of the abscess was predominantly in the right lobe (71.4%), and 47.6% of patients had multiple abscesses. Six patients died (all with Child C cirrhosis). The overall mortality rate was 28.6% (6/21). Conclusions. The incidence of liver abscess in the cirrhotic patients was low, at 0.09% (21/22 731 admissions). The clinical presentations and pathogens were not different from those in noncirrhotic patients, except that in our cirrhotic patients, there was no significant difference in mortality between those with monomicrobial and those with polymicrobial abscess; nor was there a significant difference in mortality between those with single and those with multiple abscesses. The Child C patients were the high-risk group.

Clinical analysis of primary duodenal adenocarcinoma: an 11-year experience.

Background and Aim:  The impact of obstructive jaundice (OJ) complicated by primary duodenal adenocarcinoma (PDA) on survival, and its treatment options, has rarely been mentioned in literature. The aim of the present study was to review the clinical features of PDA patients in an attempt to determine the prognostic factors and the influence of OJ on survival.

Caroli's disease - a report of two siblings.

A 26-year-old man had suffered from several episodes of right upper-quadrant pain for 6 months. Abdominal ultrasonography showed multiple saccular dilatations of the intrahepatic biliary tract, with hepatolithiasis at the bilateral hepatic lobe. Abdominal computed tomography also revealed saccularly dilated intrahepatic ducts with hepatolithiasis. Communication between saccular dilatations of the intrahepatic biliary tract and normal bile ducts was demonstrated by endoscopic retrograde cholangiopancreatography. Choledochal cyst type V (Carolis disease) was diagnosed. The patients 29-year-old sister was also diagnosed with Carolis disease based on abdominal sonography. An ultrasonography survey was carried out on the family. Reports of Carolis disease occurring in two siblings are rare in the literature.

The Clinical and Bacteriological Factors for Optimal Levofloxacin-Containing Triple Therapy in Second-Line Helicobacter pylori Eradication

Quinolone has the disadvantage of easily acquired drug resistance. It is important to prescribe it wisely for a high eradication rate. The current study aimed to determine the clinical and bacteriological factors for optimal levofloxacin-containing triple therapies in second-line H. pylori eradication. We enrolled a total of 158 H. pylori-infected patients who failed H. pylori eradication using the 7-day standard triple therapy (proton-pump inhibitor [PPI] twice daily, 500 mg clarithromycin twice daily, and 1 g amoxicillin twice daily). They were prescribed with either a 10-day (group A) or 14-day (group B) levofloxacin-containing triple therapy group (levofloxacin 500 mg once daily, amoxicillin 1 g twice daily, and esomeprazole 40 mg twice daily for 10 days) by their clinicians. Follow-up studies to assess treatment responses were carried out 8 weeks later. The eradication rates attained by groups A and B were 73.6% (95% confidence interval [CI] = 63.9–85.3%) and 90.5% (95% CI = 84.5–98.1%), respectively in the per protocol analysis (P = 0.008 in the per protocol analysis) and 67.1% (95% CI = 56.6–78.5%) and 84.8% (95% CI = 76.8–93.4%), respectively, in the intention-to-treat analysis (P = 0.009). The subgroup analysis revealed that H. pylori eradication rates for group A patients with levofloxacin-susceptible strains were 92.9% (13/14) but it dropped to 12.5% (1/8) when levofloxacin-resistant strains existed. H. pylori was eradicated among all the group B patients with levofloxacin-susceptible strains, but only half of patients with levofloxacin-resistant strains were successfully eradicated. In conclusion, this study confirms the effectiveness of 14-day treatment. Importantly, the results imply that 10-day treatment duration should be optimal if a culture can be performed to confirm the existence of susceptible strains. The duration of H. pylori eradication and levofloxacin resistance were the influencing factors for successful treatment. This study suggests that tailored levofloxacin-containing therapy should be administered only for patients with susceptible strains because it can achieve >90% success rates.

Baseline and serial liver stiffness measurement in prediction of portal hypertension progression for patients with compensated cirrhosis

Liver stiffness measurement (LSM) using transient elastography is useful in prediction of significant portal hypertension (PHT). To evaluate the usefulness of baseline and serial LSM in predicting clinical disease progression (CDP) for patients with compensated hepatic cirrhosis.

Ten-Day versus 14-Day Levofloxacin-Containing Triple Therapy for Second-Line Anti-Helicobacter pylori Eradication in Taiwan.

Second-line Helicobacter pylori (H. pylori) eradication with fluoroquinolone-containing triple therapy is one of the recommended treatment options, but neither 7-day nor 10-day regimens provide >90% success rates. The current retrospective study aimed to clarify the effects of 10-day and 14-day levofloxacin-containing triple therapies for second-line H. pylori eradication in a Taiwanese cohort and to evaluate the potential clinical factors influencing eradication. A total of 200 patients who failed H. pylori eradication using the standard triple therapy were prescribed with either a 10-day (EAL-10) or a 14-day (EAL-14) levofloxacin-containing triple therapy group (levofloxacin 500 mg once daily, amoxicillin 1 g twice daily, and esomeprazole 40 mg twice daily). Follow-up studies to assess treatment response were carried out 8 weeks later. Eradication rates attained by EAL-10 and EAL-14 were 75.6%; 95% CI = 63.9–85.3% and 92.5%; 95% CI = 84.5–98.1%, P = 0.002 in the per protocol analysis and 68%; 95% CI = 56.6–78.5% and 86%; 95% CI = 76.8–93.4%, P = 0.002 in the intention-to-treat analysis. The duration of H. pylori therapy is the independent risk factor of H. pylori eradication (P = 0.003). In conclusion, 14-day levofloxacin-containing triple therapy can provide a >90% H. pylori eradication rate, but 10-day treatment duration may be suboptimal. The longer duration of H. pylori therapy (14 days) is the independent risk factor.

Gastric metastasis of hepatocellular carcinoma via a possible existing retrograde hematogenous pathway

Background and Aim:  Hepatocellular carcinoma (HCC) tends to metastasize to extrahepatic organs. Stomach involvement has been seldom reported and has always been considered as direct invasion. This study aims to propose a possible existing pathway for the hematogenous metastasis of HCC to the stomach.

Elevated p21 expression is associated with poor prognosis of rectal stromal tumors after resection

The pathogenic role of alteration of cell‐cycle proteins in rectal stromal tumors (GISTs) remains unclear. This study aimed to elucidate the prognostic role of p21 to compare with p53, PCNA, and Ki‐67 in rectal GISTs.

Endoscopic Papillary Balloon Dilation for Removal of Bile Duct Stones: Evaluation of Outcomes and Complications in 298 Patients

Background: Endoscopic papillary balloon dilation (EPBD) is a therapeutic procedure for extraction of bile duct stones. Goals: To evaluate the therapeutic outcomes, postoperative complications, and associated risk factors of EPBD in patients with bile duct stones. Study: A total of 298 patients with bile duct stones were treated with EPBD. Their immediate outcomes were assessed and they were followed up for late complications. The modified Cotton criteria were used to determine the incidence of post-EPBD pancreatitis. Results: Complete removal of bile duct stones was achieved in 273 patients (91.6%). Removal was successful in 94.6% of stones ⩽1 cm and 82.9% of stones >1 cm (P=0.001). Thirty patients (10.1%) had acute pancreatitis after EPBD with bile duct stone extraction, including 20 women (P=0.044), 20 patients under 60 years old (P=0.003) and 19 who received contrast medium injection to the pancreas (P=0.016). Symptomatic bile duct stones recurred in 12 patients (4%) 1 to 65 months after EPBD. The duration of balloon dilation was >3 minutes in 11 of these 12 patients (P=0.025) and all recurrent stones were brown and black pigment stones. Conclusions: EPBD is an effective and safe treatment for bile duct stone removal. Small bile duct stones (⩽1 cm) can easily be extracted by EPBD. Contrast medium injection to the pancreas, female sex, and age under 60 years were significant risk factors for post-EPBD pancreatitis. Balloon dilatation duration >3 minutes was the only risk factor for recurrent symptomatic bile duct stones.