Hwai-Jeng Lin

Endoscopic injection for the arrest of peptic ulcer hemorrhage: Final results of a prospective, randomized comparative trial

A prospective, randomized comparative study was performed to compare the hemostatic effect of endoscopic injection with normal saline, 3% NaCl solution, 50% glucose/water solution, and pure alcohol during a period of 2 years. Only patients with peptic ulcers and active bleeding or nonbleeding visible vessels were considered. Each group comprised 50 patients. The four groups were matched at random for age, sex, location of bleeders, stigmata of recent hemorrhage, shock, hemoglobin, and concomitant illness. No statistically significant difference was observed among patients injected with normal saline, 3% NaCl solution, 50% glucose/water solution, or pure alcohol in achieving initial hemostasis (82%, 90%, 86%, and 92%, respectively); rebleeding rates (7.3%, 24.4%, 14%, and 10.9%, respectively); ultimate hemostasis (78%, 68%, 78%, and 84%, respectively); number of emergency operations (5, 7, 4, and 3, respectively); and average number of days in the hospital (6.7, 6.1, 6.1, and 5.8, respectively). A tendency toward a lower blood transfusion requirement was observed in the pure alcohol group, but this tendency failed to achieve statistical significance. One patient had a perforated ulcer develop 5 days after injection of 3 ml 50% glucose/water. Otherwise, no major complication was observed. We suggest that endoscopic injection with any of the above solutions can be used as the first-line modality for the arrest of peptic ulcer hemorrhage.

Helicobacter pylori stool antigen test in patients with bleeding peptic ulcers

Background.  Helicobacter pylori has been linked to chronic gastritis, peptic ulcers, gastric cancer and mucosa‐associated lymphoid tissue lymphoma. Invasive tests are less sensitive than noninvasive tests in diagnosing H. pylori infection in patients with bleeding peptic ulcers. The H. pylori stool antigen test has been useful in diagnosing H. pylori in patients with peptic ulcers before and after eradication of H. pylori. The aim of this study was to evaluate the H. pylori stool antigen test in patients with bleeding peptic ulcers.

Helicobacter pylori cagA, iceA and vacA status in Taiwanese patients with peptic ulcer and gastritis

Background:  Helicobacter pylori causes chronic gastritis, peptic ulcer, gastric cancer and mucosa‐associated lymphoid tissue (MALT) lymphoma. Different genotypes of H. pylori are confirmed from diverse geographical areas. Its association with clinical diseases remains controversial. The aim of the present study was to investigate the H. pylori vacuolating cytotoxin (vacA) alleles, cytotoxin‐associated gene (cagA) and iceA, in patients with peptic ulcer and gastritis.

A randomized controlled trial comparing two different dosages of infusional pantoprazole in peptic ulcer bleeding

AIM The optimal dosage of proton pump inhibitor in bleeding peptic ulcers remains controversial. The aim was to compare the clinical effectiveness of two doses of infusional pantoprazole in peptic ulcer bleeding. METHODS Peptic ulcer patients (n= 120) with bleeding stigmata were enrolled after successful endoscopic therapy. After an initial bolus injection of 80 mg pantoprazole, patients were randomized to receive continuously infused pantoprazole at either 192 mg day(-1) or 40 mg every 6 h (i.e. 160 mg day(-1)) for 3 days. Clinical outcomes between the two groups within 14 days were compared, with 14-day recurrent bleeding regarded as the primary end-point. RESULTS Both groups (n= 60 each) were well matched in demographic and clinical factors upon entry. Bleeding totally recurred in 11 (9.2%) patients, with six (10%) in the 192 mg day(-1) group and five (8.3%) in the 160 mg day(-1) group (relative risk of bleeding recurrence between two treatments 1.2; 95% CI 0.39, 3.72). All secondary outcomes between the two groups were similar, including the amount of blood transfusion (mean 1179 ml vs. 1203 ml, P > 0.1), hospital stay (mean 9.5 days vs. 9.9 days, P > 0.1), need for surgery (n= 1 vs. n= 0, P > 0.1), and mortality (n= 1 vs. n= 0, P > 0.1). CONCLUSIONS Following endoscopic haemostasis, infusional pantoprazole at either 192 mg day(-1) or 40 mg every 6 h appear similar.

W1109 Mosapride as Adjunct to Lansoprazole for Symptom Relief of Reflux Esophagitis: Double-Blind Randomized Trial

Background: Clopidogrel is a prodrug requiring a cytochrome (CYP)2C19-dependent conversion to become active. Usage of proton pump inhibitors (PPIs) might attenuate clopidogrels platelet inhibitory effect. Methods: We performed a meta-analysis of studies in Pubmed, Ovid, ISI Science, and Embase. Primary analysis was based on definite outcomes including all cause mortality, cardiac death, myocardial infarction, and/or stroke. Secondary analysis also incorporated probable cardiac events which included re-hospitalization for cardiac symptoms or revascularization procedures. Odds ratios were obtained for studies with definite and probable endpoints and were combined using a random-effects model. Risk difference (RD) was defined as the difference in disease/event rate between the control and treatment. Results: We reviewed 898 publications and found 8 relevant studies: 2 were excluded due to data quality and 1 was excluded because controls used PPIs. 5 studies were analyzed, including 2 published articles and 3 abstracts. 2 meta-analysis were conducted: the first considered only the published articles and the second considered all 5 studies. (Figure) Usage of clopidogrel + PPI was associated with a small non-significant increase in definite events (Risk Difference (RD) 0.0083, 95% CI -0.00022 to 1.2). When probable events were included, the risk difference was significant (RD 0.066, 95% CI 0.055 to 0.077). There was evidence of heterogeneity (p=0.028) between studies. Conclusions: This metaanalysis does not support an adverse relationship between clopidogrel and PPIs when the primary focus was death or definite cardiovascular events.