Kuo-Ching Yang

Application of quantitative estimates of fecal hemoglobin concentration for risk prediction of colorectal neoplasia

AIM To determine the role of the fecal immunochemical test (FIT), used to evaluate fecal hemoglobin concentration, in the prediction of histological grade and risk of colorectal tumors. METHODS We enrolled 17881 individuals who attended the two-step colorectal cancer screening program in a single hospital between January 2010 and October 2011. Colonoscopy was recommended to the participants with an FIT of ≥ 12 ngHb/mL buffer. We classified colorectal lesions as cancer (C), advanced adenoma (AA), adenoma (A), and others (O) by their colonoscopic and histological findings. Multiple linear regression analysis adjusted for age and gender was used to determine the association between the FIT results and colorectal tumor grade. The risk of adenomatous neoplasia was estimated by calculating the positive predictive values for different FIT concentrations. RESULTS The positive rate of the FIT was 10.9% (1948/17881). The attendance rate for colonoscopy was 63.1% (1229/1948). The number of false positive results was 23. Of these 1229 cases, the numbers of O, A, AA, and C were 759, 221, 201, and 48, respectively. Regression analysis revealed a positive association between histological grade and FIT concentration (β = 0.088, P < 0.01). A significant log-linear relationship was found between the concentration and positive predictive value of the FIT for predicting colorectal tumors (R(2) > 0.95, P < 0.001). CONCLUSION Higher FIT concentrations are associated with more advanced histological grades. Risk prediction for colorectal neoplasia based on individual FIT concentrations is significant and may help to improve the performance of screening programs.

Comparison of Rabeprazole-Based Four- and Seven-Day Triple Therapy and Omeprazole-Based Seven-Day Triple Therapy for Helicobacter Pylori Infection in Patients with Peptic Ulcer

BACKGROUND AND PURPOSE Rabeprazole is a new proton pump inhibitor producing rapid inhibition of gastric acid secretion. This may potentiate the inhibitory effect of antibiotics against Helicobacter pylori. This study compared the efficacy, safety, and tolerability of 4- and 7-day rabeprazole-based triple therapies versus 7-day omeprazole-based triple therapy. METHODS A total of 70 H. pylori-infected peptic ulcer patients were randomly assigned to 1 of 3 groups: RAC4 (rabeprazole 20 mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice daily for 4 days), RAC7 (rabeprazole 20 mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice daily for 7 days), and OAC7 (omeprazole 20mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice daily for 7 days). Endoscopy, Campylobacter-like organism (CLO) test, H. pylori culture, and 13C-urea breath test were performed before randomization and 8 weeks after the start of triple therapy. RESULTS Intention-to-treat (ITT) eradication rates for the RAC4, RAC7, and OAC7 groups were 87% (20/23), 83%(19/23), and 88% (21/24), respectively, and per-protocol (PP) eradication rates were 91% (20/22), 95% (19/20), and 100% (21/21), respectively. There was no significant difference among the ITT or PP eradication rates of the 3 groups. All 3 regimens were well tolerated and compliance was excellent. CONCLUSIONS One-week RAC and 1-week OAC are equally effective for H. pylori eradication in peptic ulcer patients. The duration of RAC triple therapy can be shortened to 4 days without compromising its efficacy.

The efficacy of blueberry and grape seed extract combination on triple therapy for Helicobacter pylori eradication: a randomised controlled trial.

Abstract Helicobacter pylori is a major risk factor for gastritis, gastric ulcers and gastric cancer. Traditional therapy with proton pump inhibitor and antibiotics is regarded as optimal for H. pylori eradication whereas, the eradication rate is unsatisfactory. Studies have reported that cranberry may inhibit H. pylori adhesion to the human gastric mucus but lack of other berry extracts have been evaluated in clinical study. Thus, a 9-week add-on randomised controlled trial was conducted to explore the impact of blueberry and grape seed extract (BGE) combinations traditional therapy for H. pylori eradication. In results, we found that there was no significant difference of eradication rate between the berry extract group and placebo group in the intention-to-treat analysis and in the per-protocol analysis (94.64% versus 84.62%, p = 0.085). Diarrhoea, constipation and epigastric pain were observed increasing during ingestion of the berry extract in some cases. In conclusion, this study indicated that no significant difference existed between the BGE extract group and placebo group in eradication rate under triple therapy.

Triphasic Computed Tomography Enterography with Polyethylene Glycol to Detect Renal Cell Carcinoma Metastases to the Small Bowel

Enteroclysis was first used to diagnose small bowel obstruction in 1996. However, nasojejunal intubation required during enteroclysis causes discomfort to the patient. Triphasic computed tomography (CT) enterography, a noninvasive procedure that does not require intubation, was found to be an efficient method to diagnose small bowel lesions. We describe our experience of using triphasic CT enterography with polyethylene glycol (PEG) for diagnosing renal cell carcinoma (RCC) metastases to the small intestine. RCC can metastasize to many organs and can cause variable clinical presentations. We report the case of a 56-year-old man with RCC who had psoas muscle involvement and lung metastasis. The patient presented with melena and intermittent abdominal pain. Two conventional CT and small bowel series examinations had shown no obstructive lesion in the small intestine. However, triphasic CT enterography with PEG detected two enhanced masses suggestive of small bowel metastasis. The patient underwent laparotomy and segmental resection of the jejunum with primary anastomosis. Histologic examination was compatible with RCC. This is the first report where RCC metastasis to the small bowel was diagnosed using triphasic CT enterography. Our study emphasizes the importance of triphasic CT enterography in cases of obscure gastrointestinal bleeding, especially in patients suspected of having small bowel metastasis.

Efficacy of Hepatocellular Carcinoma Screening with Abdominal Ultrasonography for Family Relatives of Index Cases

Background and Aim: The invitation of family relatives of index Hepatocellular Carcinoma (HCC) cases to undergo Ultrasonography (US) examination may provide an alternative approach to be efficient in detection of HCC at early stage. It is of great interest to report long-term survival by detection modes and also the efficacy of US in reducing mortality from HCC with adjustment for other significant factors and lead-time using the data from Taiwan Multicentre Cancer Screening (TAMCAS) project that is a screening program for three cancers (breast, colorectal, and liver cancer). For liver cancer screening program, family relatives of index HCC cases were invited to have the uptake of ultrasound screening. We aimed to assess the efficacy of ultrasound screening for first-and second-degree relatives of HCC index cases.Materials and Methods: A total of 20,348 first- or second-degree relatives of patients with HCC diagnosed in multiple hospitals were enrolled between 1992 and 1997 has been followed up over 15 years since 1992. Cumulative survival rates of HCC by detection modes are presented. We used Cox proportional hazards regression models to assess the efficacy of US in reducing mortality from HCC.Results: The 1-year, 3-year, 5-year, 10-year and 15-year case-specific survival (CSS) rates of patients with HCC were 65%, 48%, 40.3%, 32.8% and 30.9%, respectively. Clinically-detected HCC cases (including interval cancer and post-screening cancer) had lower survival than screen-detected HCC cases. By comparing the hazard rate of the screened group (screen-detected cases plus interval cancers) with that of post-screening group, the efficacy of screening with ultrasonography conferred a 27% (95% confidence interval: 1%-46%)) reduction in mortality from HCC after adjusting for other biological factors, degrees of relative relationship and lead-time.Conclusions: Our study reveals ultrasound screening for family members of HCC cases can lead to a third of mortality reduction, which suggests the intensive screening seems necessary for first-degree or second-degree of family relatives of HCC index cases.

Helicobacter Pylori Testing at Home-A Prospective Study with the (superscript 13)C-Urea Breath Test

The (superscript 13)C-urea breath test ((superscript 13)C-UBT) is a non-invasive and reliable mean of diagnosing Helicobacter pylon (H. pylori) injection. To popularize its use, we studied the feasibility of having patients perform the test at home without supervision. One hundred and four patients (70 men and 34 women, median age 43.5 years) were recruited; 37 were H. pylon-positive and 57 H. pylon-negative according to the results of rapid urease tests and modified Giemsa stains. The (superscript 13)C-UBTs were performed at home by collecting a baseline and a 30 minutes post-dosing samples. Patients visited the hospital on the next day to return breath samples and undergo upper gastrointestinal endoscopy. Sensitivity, specificity, and positive and negative predictive values of the home-based (superscript 13)C-UBTs were 97.3%(36/37), 91.1%(51/56), 87.8%(36/41) and 98.1%(51/52), respectively, with a diagnostic accuracy of 93.5%. Only three patients found the test complicated. One patient failed to collect enough breath samples for analysis. Our study suggests that having patients perform the (superscript 13)C-UBTat home is feasible. A thorough instruction, however is essential to maintain the accuracy of the test.

Pneumatic Dilatation in Achalasia under Fluoroscopic Guidance Fluoroscopic Guidance

Pneumatic dilatation is a first-line treatment for primary achalasia. Various balloons and guiding methods have been used. We used the 30-mm Rigiflex achalasia dilator under fluoroscopic guidance for 11 consecutive cases (6 males, 5 females, mean age of 51) of achalasia. A total of thirteen dilatations were performed. Ten cases (91%) were treated successfully after the first dilatation; among these cases, one (10%) had symptomatic recurrence 4 months after the treatment. However, no response to initial dilatation occurred in one case (9%). A second dilatation with a balloon of the same size failed to improve the nonresponder and the recurrent patient. The final success rate was 82% (9/11). The mean follow-up period is 15.6 months (range 3-31 months). Mild gastroesophageal reflux occurred in one case (9%). We conclude that it is effective and safe to treat achalasia with pneumatic dilatation using a 30-mm Rigiflex dilator under fluoroscopic guidance. Moreover, if repeated dilatation is needed, we recommend that a balloon of larger diameter be chosen to improve the outcome.