Scs Chung

Helicobacter pylori infection increases the risk of peptic ulcers in chronic users of non-steroidal anti-inflammatory drugs

The objective was to study the gastrointestinal complications in chronic NSAID users with Helicobacter pylori infection. Eighty-two Chinese patients on long-term NSAID or aspirin treatment were studied for the occurrence of H. pylori infection and gastroduodenal mucosal injuries by upper endoscopy. H. pylori infection was confirmed by CLO test, histology and bacteriological cultures. Frequency and severity of symptoms of dyspepsia were also assessed. Thirty-three (40%) patients were diagnosed to have H. pylori infection and 49 (60%) patients were not infected. The two groups were comparable in age, sex, smoking and drinking habit and the use of anti-ulcer drags. Twenty-four out of 33 (72.7%) H. pylori-positive patients and 31 out of 49 (63%) of H. pylori-negative patients were found to have macroscopic lesions by endoscopy. The overall incidence of gastroduodenal lesions in the H. pylori positive patients was not significantly different from the H. pylori-negative patients (p = 0.34). However a higher incidence of duodenal ulcers in the H. pylori-infected group than the H. pylori-negative group (33% vs 6%, p = 0.0001) was found. The difference in severity and frequency of dyspeptic symptoms between the two groups did not reach statistical significance. H. pylori infected chronic NSAID users is associated with a higher rate of duodenal ulcer.

Diagnostic accuracy of abdominal ultrasonography compared to magnetic resonance imaging in siderosis of the spleen

A prospective study to compare the diagnostic performance of ultrasonography with magnetic resonance imaging using gradient‐recalled echo technique in cases of siderosis of spleen was conducted in 53 cirrhotic patients with endoscopic proof of gastroesophageal varices. Of the 34 patients with splenic siderosis on MR imaging, punctate hyperechoic foci were detected in the spleen on ultrasonography in 24 patients. Using MR imaging as the reference standard for the diagnosis of splenic siderosis, the sensitivity of ultrasonography is 70.6%; specificity is 78.9%; positive predictive value is 85.7%; and negative predictive value is 40%. We conclude that ultrasonography is a fairly accurate technique in the diagnosis of splenic siderosis.

Large para-esophageal varices on endosonography predicts becurrence of esophageal varices and rebleeding

BACKGROUND & AIMSnRecurrence of varices and rebleeding after endoscopic therapy is very common. Data on the prediction of recurrent varices after initial obliteration by endoscopic therapy are few. The aim of this study was to correlate the presence and the size of paraesophageal varices (PEVs) in patients after endoscopic variceal ligation with recurrent varices and rebleeding.nnnMETHODSnForty patients who underwent endoscopic banding ligation for esophageal variceal bleeding were studied by endosonography within 4 weeks after obliteration of varices. PEVs were classified as none, small, or large (maximum diameter, > or =0.5 cm). Esophagoscopy and endosonography were then repeated every 6 months for up to 1 year.nnnRESULTSnTwo patients (5%) were not detected to have PEVs. Small and large PEVs were identified in 24 (60%) and 14 (35%) patients, respectively. During the follow-up period of 1-year, recurrent submucosal esophageal varices were detected in 24 patients, including 13 patients (93%) with large PEVs and 11 patients (46%) with no or small PEVs (P = 0.0019). Recurrent bleeding occurred in 6 patients (43%) with large PEVs and in 3 patients (12%) with small PEVs (P = 0.044).nnnCONCLUSIONSnPatients with large PEVs have a higher risk of developing recurrent varices and rebleeding.