Sek-Kwong Poon

Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial.

To determine the efficacy and tolerability of an enteric-coated peppermint-oil formulation (Colpermin), we conducted a prospective, randomized, double-blind, placebo-controlled clinical study in 110 outpatients (66 men/44 women; 18–70 years of age) with symptoms of irritable bowel syndrome. Patients took one capsule (Colpermin or placebo) three to four times daily, 15–30 min before meals, for 1 month. Fifty-two patients on Colpermin and 49 on placebo completed the study. Forty-one patients on Colpermin (79%) experienced an alleviation of the severity of abdominal pain (29 were pain-free); 43 (83%) had less abdominal distension, 43 (83%) had reduced stool frequency, 38 (73%) had fewer borborygmi, and 41 (79%) less flatulence. Corresponding figures for the placebo group were: 21 patients (43%) with reduced pain (4 were pain-free) 14 (29%) with reduced distension, 16 (32%) with reduced stool frequency, 15 (31%) with fewer borborygmi, and 11 (22%) with less flatulence. Symptom improvements after Colpermin were significantly better than after placebo (P<0.05; Mann-Whitney U-test). One patient on Colpermin experienced heartburn (because of chewing the capsules) and one developed a mild transient skin rash. There were no significant changes in liver function test results. Thus, in this trial, Colpermin was effective and well tolerated.

Increased accuracy of the carbon-14d-xylose breath test in detecting small-intestinal bacterial overgrowth by correction with the gastric emptying rate

To date, there is no general agreement as to which test is to be preferred for the diagnosis of small-intestinal bacterial overgrowth. The 1-g carbon-14d-xylose breath test has been proposed as a very sensitive and specific test for the diagnosis of bacterial overgrowth. However, in patients with severe gastrointestinal motor dysfunction, the lack of consistent delivery of14C-d-xylose to the region of bacterial contamination may result in a “negative” result. The aim of this study was to determine whether the accuracy of14C-d-xylose breath test for detecting bacterial overgrowth can be increased by correction with the gastric emptying rate of14C-d-xylose. Ten culture-positive patients and ten culture-negative controls were included in the study. Small-intestinal aspirates for bacteriological culture were obtained endoscopically. A liquid-phase gastric emptying study was performed simultaneously to assess the amount of14C-d-xylose that entered the small intestine. The results of the percentage of expired14CO2 at 30 min were corrected with the amount of14C-d-xylose that entered the small intestine. There were six patients in the culture-positive group with a14CO2 concentration above the normal limit. Three out of four patients with initially negative results using the uncorrected method proved to be positive after correction. All these three patients had prolonged gastric emptying of14C-d-xylose. When compared with cultures of small-intestine aspirates, the sensitivity and specificity of the uncorrected14C-d-xylose breath test were 60% and 90%, respectively. In contrast, the sensitivity and specificity of the corrected14C-d-xylose breath test improved to 90% and 100%, respectively. In conclusion, using the gastric emptying rate of14C-d-xylose as a correcting factor, we found a higher sensitivity and specificity for the14C-d-xylose breath test in the detection of small-intestinal bacterial overgrowth than were achieved with the conventional method.

Long-term follow up of gastric low-grade mucosa-associated lymphoid tissue lymphoma by endosonography emphasizing the application of a miniature ultrasound probe.

Background and Aims:  Endoscopic ultrasonography (EUS) is a useful tool for the evaluation of gastric wall infiltration including gastric lymphoma. The aims of this study were to characterize gastric low‐grade mucosa‐associated lymphoid tissue (MALT) lymphoma according to EUS findings and to evaluate the role of a miniature ultrasound probe in the long‐term follow up.

CASE REPORT: Spontaneous Gas-Forming Liver Abscess Caused by Salmonella Within Hepatocellular Carcinoma: A Case Report and Review of the Literature

: In conclusion, pyogenic liver abscess in hepatocellular carcinoma is unusual. Most of the reported cases occurred after a treatment such as transcatheter arterial embolization or percutaneous ultrasound-guided ethanol injection. Salomonella very rarely causes pyogenic liver abscesses. Only 14 cases have been reported in the English literature since 1911. Salmonella liver abscess occurring within a primary neoplasm is even rarer. There were only two such cases described in patients with hepatocellular carcinoma before. The present case is the third one, but it may be the first case of obvious spontaneous gas-forming liver abscess caused by Salmonella within hepatocellular carcinoma.

Role of Helicobacter pylori in cirrhotic patients with dyspepsia: a 13C-urea breath test study.

The role ofHelicobacter pylori in dyspeptic, cirrhotic patients remains unclear. This prospective outpatient study, conducted to assess the relationship of gastroduodenal disease andH. pylori as determined by the (13C) urea breath test, enrolled 109 consecutive cirrhotic patients with dyspepsia. All patients underwent upper-gastrointestinal endoscopy, which revealed respective prevalences of peptic ulcer, gastric ulcer, and duodenal ulcer of 41.3%, 23.9%, and 22.9%;H. pylori infection was found in 52.3%. The rate of peptic ulcer disease in theH. pylori-positive (45.6%) and -negative (36.5%) groups was not significantly different; neither was the prevalence ofH. pylori in patients with or without portal hypertensive gastropathy and with or without esophageal varices. The relationship between peptic ulcer disease andH. pylori in dyspeptic patients with cirrhosis appears to be weak. Likewise, no significant relationship was evident betweenH. pylori and portal hypertensive gastropathy or esophageal varices. This organism may not be a major pathogenetic factor in gastroduodenal diseases in dyspeptic patients with cirrhosis.

Clinical Predictors of Large Esophagogastric Varices in Patients with Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide, especially in Asia. Gastrointestinal bleeding due to esophagogastric variceal hemorrhage is one of the leading causes of death in HCC patients. The aim of study was to determine whether clinical variables were predictive of the presence of large esophagogastric varices (EGV) before performing endoscopy. Three hundred and four HCC patients who received endoscopy were enrolled and studied retrospectively. Univariate and stepwise logistic regression analysis were used to evaluate associations between the presence of large EGV and patient characteristics. There were 248 patients with small or no EGV and 56 patients with large EGV. The optimal critical values determined by a receiver operating characteristic curve for platelet count and albumin level were 135,000/mm3 and 3.5 g/dl, respectively. Stepwise logistic regression analysis demonstrated that splenomegaly [odds ratio (OR): 9.72; confidence interval (CI): 3.75–25.17], portal vein thrombosis (OR: 2.73; CI: 1.50–4.97), low platelet count (<135,000/mm3) (OR: 3.78; CI: 2.07–6.90) and low albumin level (<3.5 g/dl) (OR: 3.44; CI: 1.73–6.82) were significant, independent predictors for large EGV. Large EGV also could be independently predicted by Child-Pugh classification, splenomegaly (OR: 4.93; CI: 1.87–13.01), or portal vein thrombosis (OR: 2.37; CI: 1.28–4.39) while excluding the non-cirrhotic patients. In conclusion, splenomegaly, low platelet count (<135,000/mm3), and low albumin level (<3.5 g/dl) are clinical predictors to stratify HCC patients at risk of developing large EGV. Besides factors related to liver cirrhosis, portal vein thrombosis is also an important predictor for HCC patients with large EGV.

7236 Endosonographic evaluation of low-grade gastric malt lymphoma- miniprobe sonography versus conventional endoscopic ultrasound.

Background: The application of endosonography (EUS) has been considered as a valuable tool in the evaluation of low-grade gastric MALT lymphoma. Miniprobe sonography (MPS) has been applied more frequently in recent years for various GI diseases. The aim of this study is to evaluate the role of miniprobe sonography (MPS) in the evaluation of low-grade gastric MALT lymphoma in comparison with the conventional EUS for the diagnosis and long-term follow up. Methods: From January 1994 to July 1999, 16 patients were proved to have gastric low-grade MALT lymphoma. Endosonography was performed for either initial diagnosis or follow up with conventional echoendoscope (Olympus UM20) in 7 patients and with miniprobe (Olympus UM2R) in 9 patients. Helicobacter pylori treatment was given for all the positive patients. The related endoscopic, endosonographic patterns and clinical outcomes were reviewed. Results: H. pylori was found in 12 (75%) of 16 patients. The initial endoscopic patterns include shallow ulcers and/or atypical mucosal relief in 12 patients, large ulcers in 2 patients and polypoid folds in 2 patients. The EUS findings include normal wall thickness in 2 patients, predominantly mucosal thickening in 5 patients, predominantly submucosal thickening in 5 and mixed mucosal and submucosal thickening in 4 patients. Mild proper muscle infiltration was noted in only 1 patient. Complete regression was observed in 6 (37.5%) patients, partial regression in 5 (31.2%) patients and no response in 5 (31.2%) patients. The full range of infiltration in each patient can be detected efficiently by either conventional echoendoscope or MPS. No peri-gastric lymph node was detected by both modalities. The application of MPS allows the performance of endoscopy and EUS to be completed in a single session. Such simplicity obtains much better patients compliance in the long-term follow-up courses. MPS also provides accurate correlation between endoscopic and sonographic findings and helps to find the best location for endoscopic biopsy. Conclusions: MPS is as equally effective as conventional EUS in the evaluation of the infiltration of gastric MALT lymphoma and has several advantages over conventional EUS. The advantages of MPS include excellent endoscopic and endosonographic correlation, better patients compliance and physicians convenience. MPS is a more useful tool than conventional EUS in the diagnosis and long-term follow up of low-grade gastric MALT lymphoma.