Tseng-Shing Chen

The Current Prevalence of Irritable Bowel Syndrome in Asia

Irritable bowel syndrome (IBS) has been one of the commonly presented gastrointestinal disorders. It is of interest how commonly it presents in the society. Western studies indicated that most population-based IBS prevalences range 10%-15%. It is believed that IBS is prevalent in both East and West countries without a significant prevalence difference. Most recently, the Asia IBS prevalence has a higher trend in the affluent cities compared to South Asia. Since many Asia IBS prevalence studies have been published in the recent decade, we could compare the IBS prevalence data divided by various criteria in looking whether they were also comparable to this of West community. Summarized together, most Asia community IBS prevalences based on various criteria are usually within the range 1%-10% and are apparently lower than these of selected populations. Within the same population, the prevalence orders are first higher based on Manning criteria, then followed by Rome I criteria and finally reported in Rome II criteria. Overall, the median value of Asia IBS prevalences defined by various criteria ranges 6.5%-10.1%. With regard to gender difference, female predominance is usually found but not uniquely existed. For the IBS subtypes, the proportions of diarrhea predominant-IBS distribute widely from 0.8% to 74.0%, while constipation predominant-IBS proportion ranges 12%-77%. In conclusions, current Asia IBS prevalence is at least equal to the Western countries. Female predominant prevalence in Asia is common but not uniquely existed, while the proportions of IBS subtypes are too variable to find a rule.

The prevalence and risk factors of reflux esophagitis among adult Chinese population in Taiwan.

Background Risk factors of reflux esophagitis among Chinese in Taiwan are at present not clear and the role of Helicobacter pylori infection in the development of reflux esophagitis is still controversial. Goals The aim of this study was to examine the prevalence of reflux esophagitis, and to identify risk factors associated with reflux esophagitis in a multivariate context and to evaluate if H. pylori is a predictive factor for reflux esophagitis. Study A total of 482 physical check-up subjects who underwent upper gastrointestinal endoscopy were investigated. The severity of esophagitis was evaluated by Los Angeles classification. H. pylori status was assessed by serology. Results Twelve percent (58/482) demonstrated reflux esophagitis with 87% of grade A or B. Of those with reflux esophagitis, 48.3% had reflux symptoms whereas 17.4% of those with reflux symptoms had reflux esophagitis. Univariate analysis identified hiatal hernia, male sex, smoking, alcohol drinking, and overweight as risk factors associated with reflux esophagitis. Multivariable logistic regression showed that hiatal hernia [odds ratio (OR)=12.2, 95% confidence interval (CI)=5.0-29.9, P<0.0001], male sex (OR=4.2, 95% CI=1.9-9.0, P<0.001), and chronic obstructive pulmonary disease sufferers (OR=3.4, 95% CI=1.1-10.9, P<0.05) were 3 independent risk factors for development of reflux esophagitis. Conclusions The prevalence of reflux esophagitis in Taiwanese is 12% and most are mild grade and free from reflux symptoms. Hiatus hernia, male sex, and chronic obstructive pulmonary disease are 3 independent risk factors for development of reflux esophagitis. H. pylori infection did not protect subjects from reflux esophagitis.

Simplified 13C‐urea breath test with a new infrared spectrometer for diagnosis of Helicobacter pylori infection

Background and Aim:  Infrared spectrometry has correlated excellently with mass spectrometry in detecting the ratio of 13CO2 to 12CO2 in breath samples. The present study aimed to evaluate the accuracy of the 13C‐urea breath test (13C‐UBT) using a new model of infrared analyzer.

Immunoglobulin G Antibody against Helicobacter pylori: Clinical Implications of Levels Found in Serum

ABSTRACT The clinical significance of high levels of antibody against Helicobacter pylori is still unclear. We sought to evaluate whether the serum antibody levels could predict the presence of macroscopic gastroduodenal disease, to identify factors that correlate with antibody levels in a multivariate context, and to determine the predictive value of antibody levels for diagnosing H. pylori infection. The grades of gastritis and density of H. pylori colonization were scored separately using the updated Sydney system for antral and body mucosa. An enzyme-linked immunosorbent assay (ELISA) for the quantitative detection in serum of IgG antibodies to H. pylori was performed. Of the 170 dyspeptic patients, 105 (62%) had H. pylori infection. There was no difference in antibody levels among endoscopic findings of normal mucosa, chronic gastritis, and duodenal ulcer. On multivariate linear regression analysis, the status of H. pylori infection, mononuclear cell infiltration of body mucosa, and age correlated with antibody levels. The negative predictive value for antibody levels of <30 U/ml is 94%, and the positive predictive value of antibody levels of >70 U/ml is 98%. We conclude that serum antibody levels do not predict the severity of gastroduodenal diseases or the density of H. pylori colonization in H. pylori-infected dyspeptic patients. Higher levels are associated with the presence of H. pylori infection, the chronic gastritis score of the corpus, and older age. Setting a gray zone is necessary for ELISA, since the accuracy in this zone does not allow a precise determination of H. pylori status.

Can computed tomography with coronal reconstruction improve the diagnosis of choledocholithiasis

Background and Aim:  Many technical developments of computed tomography (CT) made in recent years have improved imaging quality. However, the diagnostic efficacy of CT with coronal reconstruction for choledocholithiasis remains uncertain. This study aimed to investigate if CT with coronal reconstruction can aid in the diagnosis of choledocholithiasis.

Additional corpus biopsy enhances the detection of Helicobacter pylori infection in a background of gastritis with atrophy

BackgroundThe best sites for biopsy-based tests to evaluate H. pylori infection in gastritis with atrophy are not well known. This study aimed to evaluate the site and sensitivity of biopsy-based tests in terms of degree of gastritis with atrophy.MethodsOne hundred and sixty-four (164) uninvestigated dyspepsia patients were enrolled. Biopsy-based tests (i.e., culture, histology Giemsa stain and rapid urease test) and non-invasive tests (anti-H. pylori IgG) were performed. The gold standard of H. pylori infection was defined according to previous criteria. The sensitivity, specificity, positive predictive rate and negative predictive rate of biopsy-based tests at the gastric antrum and body were calculated in terms of degree of gastritis with atrophy.ResultsThe prevalence rate of H. pylori infection in the 164 patients was 63.4%. Gastritis with atrophy was significantly higher at the antrum than at the body (76% vs. 31%; p<0.001). The sensitivity of biopsy-based test decreased when the degree of gastritis with atrophy increased regardless of biopsy site (for normal, mild, moderate, and severe gastritis with atrophy, the sensitivity of histology Giemsa stain was 100%, 100%, 88%, and 66%, respectively, and 100%, 97%, 91%, and 66%, respectively, for rapid urease test). In moderate to severe antrum or body gastritis with atrophy, additional corpus biopsy resulted in increased sensitivity to 16.67% compare to single antrum biopsy.ConclusionsIn moderate to severe gastritis with atrophy, biopsy-based test should include the corpus for avoiding false negative results.

Triple therapy for the eradication of Helicobacter pylori and reduction of duodenal ulcer relapse: Comparison of 1 week and 2 week regimens and recrudescence rates over 12 months

Abstract The aim of this study is to assess the relationship between Helicobacter pylori and the relapse of duodenal ulcer, and also to evaluate the differences in efficacy and side effects between 1 week and 2 week triple therapy. Sixty‐two patients with active duodenal ulcer, which healed within 8 weeks of nizatidine treatment, were randomly allocated to one of two groups. Group 1 (n= 29) received no drugs, Group II (n= 33) received triple threapy for 1 week (IIa, n= 16) or 2 weeks (IIb, n= 17). Eleven patients whose ulcer did not heal after an 8 week nizatidine treatment period were randomly assigned into Group IIa (n= 5) and IIb (n= 6). Seven patients whose ulcer recurred after discontinuation of nizatidine were allocated to receive 2 weeks of triple therapy. All patients received endoscopy 6 weeks after entry, and again at 3, 6 and 12 months unless both ulcer recurrence and H. pylori infection were found. The frequency of ulcer relapse 6 weeks after the active duodenal ulcer had healed was 83% (24/29) in Group I, 13% in Group IIa and 14% in Group IIb. The cumulative rate of recurrence was significantly higher in Group I than in Group II (90 vs 30% at 12 months, P < 0.01). Ulcer relapse was associated with persistence of H. pylori infection (P < 0.0001). No statistical difference was found between the 1 week and 2 week regimens in ulcer relapse rate (30 vs 30% in 1 year), H. pylori eradication rate (86 vs 100%), incidence of side effects (48 vs 53%) or recrudescence rate (17 vs 23%). Our study suggests that a 1 week regimen and a 2 week regimen are equally effective in the eradication of H. pylori and reduction of ulcer recurrence in 1 year.

Psychosocial distress is associated with abnormal gastric myoelectrical activity in patients with functional dyspepsia

Objective. Functional dyspepsia (FD) is a heterogeneous and loosely defined clinical syndrome that is characterized by persistent or recurrent abdominal pain or discomfort centered in the upper abdomen without any identifiable structural or biochemical basis. Gastric myoelectrical activity in functional dyspepsia patients with gastric reddish streaks as a subgroup has not previously been investigated and the potential role of psychosocial distress in the genesis of gastric dysrhythmia in patients with FD is unclear. Material and methods. Electrogastrography was performed in 45 patients with FD and 35 healthy controls for 30 min in the fasting state and 30 min postprandially. Psychological distress and the number and severity of stressful life events were measured using self-rating questionnaires. Results. FD patients had a higher percentage of pre- and postprandial dysrhythmia, lower dominant frequency, and a higher instability coefficient as compared to healthy controls. In FD patients, severity of stressful life events was positively correlated with the percentage of tachygastria in the fasting state (r=0.43, p=0.005) and marginally positively correlated with the percentage of postprandial tachygastria (r=0.253, p=0.098) and instability coefficient of the dominant frequency (r=0.256, p=0.093). Total number of stressful life events was marginally positively correlated with fasting tachygastria (r=0.25, p=0.098) and instability coefficient of the postprandial dominant frequency (r=0.287, p=0.056). Interpersonal sensitivity was found to be negatively correlated with fasting dominant frequency in FD patients (r= − 0.311, p<0.05). Conclusions. FD patients with gastric reddish streaks have abnormal fasting and postprandial gastric myoelectrical activity. Perceived severity of stressful life events and interpersonal sensitivity are associated with disturbance of gastric myoelectrical activity.

Gastric mucosal injury in systemic lupus erythematosus patients receiving pulse methylprednisolone therapy

AIMS Whether glucocorticoids induce gastric mucosal injury remains uncertain. We investigated whether very high-dose steroids caused gastric mucosal injury in systemic lupus erythematous (SLE) patients and evaluated the possible risk factors for mucosal injury. METHODS In this prospective paired study, 67 SLE patients who had received pulse methylprednisolone therapy were enrolled. Each patient underwent endoscopic examination and tissue and blood sampling before and after pulse steroid therapy. Mucosal injury was diagnosed if the follow-up injury scale was higher than the initial scale. Examined parameters included Helicobacter pylori infection, cyclooxygenase (COX)-1 and COX-2 activity, and current nonsteroidal anti-inflammatory drug (NSAID) usage including aspirin. RESULTS Eleven (16.4%) of 67 cases who developed gastric mucosal injury after pulse therapy had significantly higher rates of peptic ulcer history, NSAID/aspirin use, lower gastric thromboxane B(2) and prostaglandin E(2) levels when compared with cases without gastric mucosal injury (P < 0.05). Infection by H. pylori was not a risk factor for gastric mucosal injury. Multivariate logistic regression analysis showed that NSAID/aspirin use was the only risk factor for gastric mucosal injury in these patients (odds ratio 26.99, 95% confidence interval 4.91, 148.57, P < 0.0001). Pulse steroid therapy alone did not induce gastric mucosal injury in fifty SLE patients without taking any NSAID/aspirin. CONCLUSIONS Use of NSAIDs/aspirin, but not H. pylori infection, increases gastric mucosal injury in SLE patients receiving pulse methylprednisolone therapy. Very high-dose steroids de novo seem not to induce gastric mucosal injury in these patients. A larger case-controlled study enrolling a heterogeneous population is needed to clarify the role of glucocorticoids in gastric mucosal injury.

Prevalence of Helicobacter pylori infection in duodenal ulcer and gastro-duodenal ulcer diseases in Taiwan

Background and Aim:  The prevalence of Helicobacter pylori‐negative duodenal ulcer (DU) is increasing in Western countries but is rare in Japan. We aimed to examine the prevalence of H. pylori infection and the characteristics in DU and gastro‐duodenal ulcer (GDU) diseases in Taiwan.