Tzong-Hsi Lee

Helicobacter pylori infection in a randomly selected population, healthy volunteers, and patients with gastric ulcer and gastric adenocarcinoma. A seroprevalence study in Taiwan.

To investigate the association of Helicobacter pylori and gastric ulcer and adenocarcinoma, IgG antibodies against H. pylori were examined in 823 randomly selected subjects, 92 healthy volunteers, 117 patients with gastric ulcer, and 148 with gastric adenocarcinomas in Taiwan, where the prevalence of gastric adenocarcinoma is high. The seropositivity of this population in Taiwan was 54.4%. Gastric ulcer patients had a higher seropositivity (83.8%) than healthy volunteers (62.0%) and gastric adenocarcinoma patients (62.2%) (P < 0.001). Gender difference, blood type, and habit of smoking were not associated with the seroprevalence in any study groups. Gastric ulcer coexistent with duodenal ulcer had a higher seropositivity (94.7%) (P < 0.05). The seropositivity of H. pylori in gastric adenocarcinoma patients was higher than in healthy volunteers only in younger age and was not associated with histologic type, invasion, and location of major tumors. The results reemphasize the association of H. pylori infection with gastric ulcer but not with gastric adenocarcinoma in Taiwan.

Clinical manifestations and management of buried bumper syndrome in patients with percutaneous endoscopic gastrostomy

Pediatric Surgery Clinic University of Padova Padova, Italy Alessandro Pane, MD Luigi Dall’Oglio, MD Digestive Surgery and Endoscopy Unit Ospedale Pediatrico Bambino Gesù Roma, Italy Gian Luigi de’Angelis, MD Pediatric Gastroenterology and Endoscopic Unit University of Parma Parma, Italy Mariano Caldore, MD Pediatric Department Hospital Santobono Napoli, Italy Claudio Romano, MD Policlinico Universitario University of Messina Messina, Italy PierGiorgio Gamba, MD Pediatric Surgery Clinic University of Padova Padova, Italy Vincenzo Baldo, MD Department of Environmental Medicine and Public Health Institute of Hygiene University of Padova Padova, Italy

Changes in Gastroesophageal Reflux in Patients With Nasogastric Tube Followed by Percutaneous Endoscopic Gastrostomy

BACKGROUND/PURPOSEnDespite frequent use of percutaneous endoscopic gastrostomy (PEG) for enteral feeding, the relationship between it and gastroesophageal reflux (GER) remains an incompletely answered question. We conducted this study to compare the GER between the same patients fed with a nasogastric (NG) tube and later with a PEG tube.nnnMETHODSnWe enrolled 15 patients who had received NG tube feeding for > 6 months and were about to receive PEG tube insertion. We used Ponskys pull method with 24 Fr feeding tubes. They received two GER scans, one just before PEG tube insertion and another 1 week after insertion. We drew regions of interest of radioactivity in the esophagus and stomach manually. The ratios of radioactivity of the region of interest in the esophagus over the stomach (GER ratio) were calculated to evaluate the severity of GER and compared.nnnRESULTSnThe GER ratios of these patients were all small and <3% except one that was 4.7% in one patient before PEG tube insertion. There was a small but substantial decrease (65% risk reduction) in GER ratio after PEG tube insertion. After arcsine transformation, the difference in the transformed data between patients fed with an NG tube and after PEG tube insertion was significant (t= 2.46, p = 0.028), and was lower after PEG tube insertion.nnnCONCLUSIONnOur study demonstrates by scintigraphy a small but significant reduction of GER after shifting from NG to PEG tube feeding.

Effect of mouth washing on the [13C]‐urea breath test

Background: Mouth washing is often mentioned as a possible method to eliminate the interference of urease activity in the oral cavity before the [13C]‐urea breath test (UBT). However, the effectiveness of mouth washing prior to testing has not been demonstrated clearly in the literature. Thus, the present study was designed to examine the consistency of the [13C]‐UBT and the effects of mouth washing on it.

Stress ulcer prophylaxis in patients being weaned from the ventilator in a respiratory care center: A randomized control trial

BACKGROUND/PURPOSEnNo data has been available on prophylaxis for stress ulcer development during the process of weaning patients off mechanical ventilators. We conducted a randomized study to evaluate the efficacy of stress ulcer prophylaxis with lansoprazole OD in patients being weaned from mechanical ventilators.nnnMETHODSnA total of 120 patients were randomly allocated into two groups using blocked randomization, with 60 patients in each group. Group A was the treatment group, receiving lansoprazole OD 30xa0mg from a nasogastric tube for 14 days, while Group B, the control group, received no proton pump inhibitors or other medications for treating peptic ulcers. The primary end point of our study was apparent upper gastrointestinal bleeding within 2 weeks of enrollment.nnnRESULTSnApparent upper gastrointestinal bleeding occurred in zero patients and five patients in Groups A and B, respectively (Group A: 0% vs. Group B: 8.3%, pxa0=xa00.057). There was no significant difference between the two groups in ventilator-associated pneumonia (Group A: 6.7% vs. Group B: 10.0%, pxa0=xa00.509) and 30-day survival rates (Group A: 96.7% vs. Group B: 100%, pxa0=xa00.496).nnnCONCLUSIONnStress ulcer prophylaxis with lansoprazole in patients being weaned from mechanical ventilators led to a lower but not statistically significant incidence of apparent upper gastrointestinal bleeding. There was no significant increase of incidence of ventilator-associated pneumonia in the prophylaxis group. Further larger scale studies are needed to clarify the benefit of stress ulcer prophylaxis in such patients.

Real-world practice and Expectation of Asia-Pacific physicians and patients in Helicobacter Pylori eradication (REAP-HP Survey)

The aims of the study were: 1, to survey the most popular anti‐H. pylori regimens in Asia‐Pacific region and the real‐world effectiveness of these regimens; and 2, to investigate the expectation gaps of eradication rate between physicians and patients.

Gastrointestinal: Fasciolopsis buski infestation diagnosed by upper gastrointestinal endoscopy

A 35-year-old male immigrant from Vietnam to Taiwan 2 years previously presented with two-months of postprandial nausea. There was no body weight loss or other constitutional symptoms. Dietary history included ingestion of uncooked vegetables. Physical examination and complete blood count, including eosionphil count were normal.Upper gastrointestinal endoscopy revealed a 2.5 cm-long, flesh-color, oval-shaped plaque lesion adherent to the medial wall of the second portion of duodenum (Figure 1). This plaque-like lesion was retrieved with polypectomy snare. During removal, the plaque-like lesion showed active twitching movement. Grossly, this lesion measured 3.5 cm long, 2.0 cm wide, and 0.4 cm thick with a ventral sucker, resembling a fluke parasite (Figure 2). Our parasitologist diagnosed this as an adult Fasciolopsis buski. Stool examination did not reveal any F. buski ova. The patient received a single dose of praziquantel (25 mg/kg) and had no recurrence of nausea at 1-year follow-up. Fasciolopsis buski is the largest human intestinal trematode, prevalent in SoutheastAsia. The source of infection is ingestion of encysted metacercariae on fresh water plants. The metacercariae excyst in the duodenum and inhabit the upper small intestinal tract. They mature into adulthood at approximately 3 months with size ranging from 2.5 to 7.5 cm and start to lay eggs. Most infection of F. buski is mild and subclinical. In severe cases, patients may present with abdominal pain, chronic diarrhea, anemia, or systemic allergic reaction. The diagnosis of F. buski infestation is usually supported by the presence of ova in stool. In our case, a parasite in the duodenum may be from an intestinal fluke or liver fluke not yet entering the biliary system. Endoscopic snare-assisted retrieval is an effective method for removal of the intestinal fluke for parasitologic identification.Although the F. buski infection is endemic in Southeast Asia, it may be diagnosed in the rest of the world because of increased immigration, globalization and international travel. Contributed by

Single-balloon enteroscopy for the management of a bleeding Dieulafoy lesion in the jejunal diverticulum

Please cite this article in press as: Ch jejunal diverticulum, Journal of the 0929-6646/

Identification of risk factors for neoplastic colonic polyps in young adults with bloody stool in comparison with those without symptom: Risk factors for neoplastic colonic polyps

see front matter Copyr doi:10.1016/j.jfma.2011.09.011 Abstract Approaching the “dark continent” of gastrointestinal tract, i.e., the small bowel, is always challenging to gastroenterologists. With the coming era of balloon-assisted enteroscopy, deep intubation of the small intestine for both diagnostic and therapeutic purposes has become possible. Here we describe a 60-year-old man who came to our emergency department because of overt gastrointestinal bleeding. An antegrade single-balloon enteroscopy showed a Dieulafoy lesion in the jejunal diverticulum. Argon plasma coagulation of the lesion followed by hemoclipping were performed. The patient showed no complications on a 90-day follow-up. Copyright a 2011, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.

An atypical infection of the esophagus mimicking malignancy

The incidence and disease burden of colorectal cancer (CRC) in young adults were increasing. However, there was a dearth of advice on how to identify young population at risk for neoplastic colonic polyps (NCPs) and CRC. We aimed to identify risk factors for NCPs and CRC in young adults presenting with bloody stool.