Km Chu

CagA positive strains increase the risk of gastric cancer in Hong Kong with moderate prevalence of Helicobacter pylori infection and gastric cancer mortality

This journal suppl. entitled: The American Gastroenterological Association and Digestive Disease Week

Helicobacter pylori infection, interleukin 1 beta polymorphism andpredisposition to gastric cancer through the CpG island methylation pathway

Aims: Artificial neural networks (ANN) are computer programs used to identify complexrelations within data that cannot be detected with conventional linear-statistical analysis.The routine clinical predictions of need for lower gastrointestinal endoscopy have beenbased on population statistics with little meaning for individual patient. This results in largenumber of unnecessary colonoscopies. We aimed to develop a neural network algorithmwhich can accurately predict presence of pathology in patients attending routine outpatientclinics. Methods: 300 patients undergoing lower gastrointestinal endoscopy prospectivelycompleted a specifically developed questionnaire which included 40 variables based onclinical symptoms, signs, past and family history. Complete data sets of 50 percent of serieswere used to train the artificial neural network; the remaining 50 percent were used forinternal validation. The primary output used was a positive finding on the colonoscopy,including polyps, cancer, diverticular disease or colitis. Results: The outcome and pathologyreports of all the patients were obtained and assessed. Clear correlation between actual datavalue and artificial neural network value were found (r = 0.931; P = 0.0001). The predictiveaccuracy of neural network was 95% in the training group and was 89% (95% CI 84-96)in the validation set. This accuracy was significantly higher than the clinical accuracy (69%).Conclusions: We have shown that ANN is more accurate than standard statistics whenapplied to prediction in individual patients of need for lower gastrointestinal endoscopy.These results have obvious implications, with at least 20% resultant decrease in need forunnecessary lower gastrointestinal endoscopy. The logistic and economic impact with thisdevelopment is tremendous.Andrea M. Harrington, Margaret Lee, Sim-Yee Ong, Eric Yong, Pam Farmer, John M. Hutson and Bridget R. Southwell

Orlistat maintains biliary lipid composition and hepatobiliary function in obese subjects undergoing moderate weight loss

OBJECTIVES: Orlistat, an intestinal lipase inhibitor, has recently been approved by the US Food and Drug Administration for treatment of obesity. The effects of orlistat on hepatobiliary function have not been previously defined. A 4 wk study was performed involving modest weight loss in obese subjects to observe any short-term hepatobiliary responses that occur after initiating treatment with orlistat and a hypocaloric diet. METHODS: A total of 23 obese (BMI 30–41 kg/m2) subjects were randomized to a double blind t.i.d. treatment with 120 mg of orlistat or a placebo in conjunction with a hypocaloric diet (1200–1500 kcal/day). The study was designed to achieve similar modest weight loss in both groups in order to be able to directly assess the effects of orlistat. Cholesterol saturation, bile composition, and gallbladder motility were measured. RESULTS: At the end of the treatment period, mean weight loss of 3.8 kg was achieved in the orlistat group (vs 2.3 kg with placebo, p = NS). Total bile acid concentration decreased significantly with placebo (–18.57 ± 6.99 mmol/L; 95% CI = –32.26 to –4.87), but not with orlistat. Biliary phospholipid concentration decreased significantly with placebo (−4.38 ± 1.91 mmol/L; 95% CI = –8.13 to –0.64) but not with orlistat. Mean changes from the baseline in cholesterol saturation index and gallbladder motility were similar in both groups. Microscopy of bile failed to reveal cholesterol microcrystals before or after treatment in either group. CONCLUSIONS: Our findings indicate a primary initial effect of weight loss is a reduction in biliary bile acids and phospholipids. Orlistat blocks these adverse changes in biliary lipid composition and maintains hepatobiliary function. We speculate that the risk of formation of gallstones during weight loss may actually be lowered with orlistat.