Wei-Yi Lei

Levofloxacin-Amoxicillin/Clavulanate-Rabeprazole versus a Standard Seven-Day Triple Therapy for Eradication of Helicobacter pylori Infection

The resistance rates of Helicobacter pylori to amoxicillin and metronidazole therapy are higher in eastern Taiwan as compared to national and worldwide rates. The high resistance rate in this territory justified a search for a better eradication regimen. We conducted an open-labeled, prospective, randomized, and controlled study in a tertiary referral hospital in eastern Taiwan. Between December 2007 and December 2009, a total of 153 Helicobacter pylori-positive, therapy-naïve patients with a positive rapid urease test were recruited for random assignment to two seven-day treatment groups: levofloxacin (500 mg), amoxicillin/clavulanate (875 mg/125 mg), and rabeprazole (20 mg) twice per day (LAcR) or clarithyromicin (500 mg), amoxicillin (1000 mg), and rabeprazole (20 mg) twice per day (CAR). Helicobacter pylori eradication was assessed using the 13C-urea breath test or rapid urease test performed at least 4 weeks after the end of treatment. After exclusion, 146 patients were enrolled and allocated in the study. The Helicobacter pylori eradication rates analyzed by both intention to treat (78.1% versus 57.5%, P = 0.008) and perprotocol (80.9% versus 61.8%, P = 0.014) were significantly higher for the LAcR group. In conclusion, the seven-day LAcR regimen provided improved Helicobacter pylori eradication efficacy when compared with the standard CAR triple therapy in eastern Taiwan.

Predictive factors of silent reflux in subjects with erosive esophagitis

BACKGROUND Asymptomatic erosive esophagitis by definition is a condition lacking any reflux symptom. AIMS We aimed to investigate the prevalence of asymptomatic erosive esophagitis in a general population undergoing periodic health checkup. METHODS Consecutive subjects undergoing a medical checkup were enrolled for evaluation of reflux disease with upper endoscopy and a validated reflux questionnaire. The presence and severity of erosive esophagitis were evaluated. In all subjects, demographic characteristics and biochemical data were recorded, and sleep and psychological characteristics were assessed by means of self-administered Pittsburgh Sleep Quality Index score, Taiwanese Depression Questionnaire score, and State-Trait Anxiety Inventory score. RESULTS Of 2568 subjects eligible for this study, erosive esophagitis was found in 676 subjects (26.3%), in whom the proportions of asymptomatic and symptomatic erosive esophagitis were 59.2% (400 subjects) and 40.8% (276 subjects) respectively. At a univariate analysis, it was found that asymptomatic erosive esophagitis subjects were more frequently of female gender, of older age, with a lower level of education. They also showed less alcohol and tea consumption, less depression, less anxiety, lower serum level of triglyceride, and lower prevalence of metabolic syndrome. Multivariate analysis revealed that female sex (OR = 1.645, p = 0.0146) was a positive predictive factor for asymptomatic erosive esophagitis, whereas higher level of education (OR = 0.564, p = 0.044), higher Taiwanese Depression Questionnaire score (OR = 0.922, p < 0.001), and the presence of metabolic syndrome (OR = 0.625, p = 0.0379) were negative predictive factors. CONCLUSIONS Asymptomatic erosive esophagitis is a common feature in otherwise healthy subjects and is independently associated with female gender, lower education level, less depression, and lower prevalence of metabolic syndrome.

Clinical, metabolic, and psychological characteristics in patients with gastroesophageal reflux disease overlap with irritable bowel syndrome.

ObjectivesGastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) are highly prevalent in the general population, with significant symptom overlap, whereas the interaction between both remains poorly understood. We aim to identify the clinical and psychological factors that contribute toward the overlap of GERD and IBS. Patients and methodsWe carried out a case–control study among 806 GERD and 176 IBS patients from a health check-up cohort (n=2604). All participants were evaluated using the Reflux Disease Questionnaire score, the Pittsburgh Sleep Quality Index score, the Taiwanese Depression Questionnaire score, and the State-Trait Anxiety Inventory score. Endoscopic findings were classified according to the Los Angeles classification. IBS was diagnosed on the basis of Rome III criteria, and metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III definition. ResultsAmong the study population, 727 individuals had GERD, 97 individuals had IBS, and 79 individuals had a diagnosis of both GERD and IBS (GERD-I). GERD-I patients had more severe GERD symptoms compared with patients with GERD or IBS alone (P<0.0001). Moreover, GERD-I patients had more frequent healthcare-seeking behavior, decreased quality of sleep, and higher depression scores than patients with GERD (P<0.0001) or IBS alone (P<0.05). In addition, GERD-I patients had lower blood pressure, waist-to-hip ratio, and higher serum high-density lipoprotein levels than those with GERD alone (P<0.05). ConclusionGERD patients overlapping with IBS have different clinical and psychological profiles than those with GERD or IBS alone. Our study suggests that awareness of these symptom presentations will help optimize the treatment of these conditions.

Disease Characteristics in Non-Erosive Reflux Disease with and without Endoscopically Minimal Change Esophagitis: Are They Different?

Background/Aims: The majority of patients with gastroesophageal reflux disease (GERD) appear to have non-erosive reflux disease (NERD). NERD may include minimal change esophagitis (MCE) and no endoscopic abnormalities (MCE–). We aimed to determine whether intraesophageal acid reflux as well as esophageal motility differed between patients with and without MCE. Methods: Consecutive patients with classic reflux symptoms were enrolled in the study. Patients without any mucosal injury were considered to be MCE–. Esophageal acid exposure as well as intragastric pH (<4) was determined by dual-channel ambulatory 24-hour pH monitoring. Results: A total of 100 patients (MCE–, 52 patients; MCE, 48 patients) were studied. The percentage of effective peristalsis was found similar between patients with and without MCE (p = NS). Esophageal acid contact as well as the DeMeester score did not differ between the groups (p = NS). The prevalence of positive symptom index was greater in MCE– patients than in MCE patients (p = 0.001). Intragastric acidity (pH <4) was similar between MCE– and MCE groups (p = NS). Conclusions: NERD, regardless of the presence of MCE, might exhibit similar disease characteristics in terms of esophageal acid exposure and motor dysfunction.

Influence of repeated infusion of capsaicin-contained red pepper sauce on esophageal secondary peristalsis in humans.

The transient receptor potential vanilloid 1 has been implicated as a target mediator for heartburn perception and modulation of esophageal secondary peristalsis. Our aim was to determine the effect of repeated esophageal infusion of capsaicin‐contained red pepper sauce on heartburn perception and secondary peristalsis in healthy adults.

Physiological augmentation of esophageal distension pressure and peristalsis during conditions of increased esophageal emptying resistance

Abdominal compression has been implemented as a provocative maneuver in high‐resolution impedance manometry (HRIM) to “challenge” normal esophageal physiology with the aim of revealing abnormal motor patterns which may explain symptoms. In this study, we measured the effects of abdominal compression on esophageal functioning utilizing novel pressure‐impedance parameters and attempted to identify differences between healthy controls and globus patients.

Influence of GABA-B Agonist Baclofen on Capsaicin-Induced Excitation of Secondary Peristalsis in Humans

Objectives:Esophageal instillation of capsaicin enhances secondary peristalsis, but the γ-aminobutyric acid receptor type B (GABA-B) agonist baclofen inhibits secondary peristalsis. This study aimed to investigate whether baclofen could influence heartburn perception and secondary peristalsis subsequent to capsaicin infusion in healthy adults.Methods:Secondary peristalsis was performed by slow and rapid mid-esophagus air injections in 15 healthy subjects. Two different sessions including esophageal infusion of capsaicin-containing red pepper sauce (0.84 mg) following pre-treatment with placebo or baclofen were randomly performed to test the effects on heartburn perception and secondary peristalsis.Results:The intensity of heartburn symptom subsequent to capsaicin infusion was significantly greater after pre-treatment of baclofen as compared with the placebo (P=0.03). Baclofen significantly increased the threshold volume of secondary peristalsis to slow air injections subsequent to esophageal capsaicin infusion (P<0.001). Baclofen significantly increased the threshold volume of secondary peristalsis to rapid air injections subsequent to esophageal capsaicin infusion (P<0.01). The frequency of secondary peristalsis subsequent to capsaicin infusion was significantly decreased with baclofen as compared with the placebo (P<0.002). Baclofen had no effect on any of the peristaltic parameters of secondary peristalsis subsequent to capsaicin infusion.Conclusions:The GABA-B agonist baclofen appears to attenuate the esophagus to capsaicin-induced excitation of secondary peristalsis in healthy adults. Our study suggests the inhibitory modulation for GABA-B receptors on capsaicin-sensitive afferents mediating secondary peristalsis in human esophagus.

Altered anorectal function in rotating shift workers: Association with autonomic dysfunction and sleep disturbance

We aimed to investigate whether disruption of the circadian rhythm in rotating shift work (RSW) workers would change anorectal motility and cardiac autonomic function. We also determined whether sleep and psychological status (e.g., anxiety and depression) would affect anorectal motility in RSW workers.

Comparison of rectal suction versus rectal tube insertion for reducing abdominal symptoms immediately after unsedated colonoscopy.

Background and study aims: Abdominal discomfort and bloating are common symptoms after colonoscopy. We aimed to compare the effects of direct rectal suction with insertion of a rectal tube on reducing abdominal symptoms after unsedated colonoscopy. Patients and methods: Consecutive patients undergoing colonoscopy were randomized to have direct rectal suction or placement of a rectal tube immediately after colonoscopy. Post-procedure abdominal pain and bloating were measured with a 0 – 100 visual analogue scale. All participants ranked their satisfaction with either direct rectal suction or insertion of a rectal tube. Results: Abdominal pain and bloating were significantly reduced by direct rectal suction and placement of a rectal tube at 1 minute (both P < 0.05) and 3 minutes (both P < 0.05) after the colonoscopy. Direct rectal suction significantly reduced abdominal pain at 1 minute (P = 0.001) and 3 minutes (P = 0.005) after colonoscopy compared with rectal tube insertion. Bloating was significantly lower in patients with direct rectal suction compared to those with rectal tube insertion at 1 minute (P = 0.03) after colonoscopy. Greater satisfaction was found in patients with direct rectal suction compared to those with rectal tube insertion (P = 0.009). Conclusion: Direct rectal suction is more effective than rectal tube placement in reducing abdominal symptoms immediately after colonoscopy. Our study suggests that direct rectal suction is useful in providing relief of symptoms when patients are having difficulty expelling air or are experiencing abdominal symptoms following colonoscopy.

Influence of prucalopride on esophageal secondary peristalsis in reflux patients with ineffective motility

Ineffective esophageal motility (IEM) is associated with gastroesophageal reflux disease. Secondary peristalsis contributes to esophageal clearance. Prucalopride promotes secondary peristalsis by stimulating 5‐hydroxytrypatamine 4 receptors in the esophagus. We aimed to determine whether prucalopride would augment secondary peristalsis in gastroesophageal reflux disease patients with IEM.