Wen-Ming Wang

Novel biomarkers predict liver fibrosis in hepatitis C patients: alpha 2 macroglobulin, vitamin D binding protein and apolipoprotein AI

BackgroundThe gold standard of assessing liver fibrosis is liver biopsy, which is invasive and not without risk. Therefore, searching for noninvasive serologic biomarkers for liver fibrosis is an importantly clinical issue.MethodsA total of 16 healthy volunteers and 45 patients with chronic hepatitis C virus (HCV) were enrolled (F0: n = 16, F1: n = 7, F2: n = 17, F3: n = 8 and F4: n = 13, according to the METAVIR classification). Three serum samples of each fibrotic stage were analyzed by two-dimension difference gel electrophoresis (2D-DIGE). The differential proteins were identified by the cooperation of MALDI-TOF/TOF and MASCOT; then western blotting and Bio-Plex Suspension Array were used to quantify the protein levels.ResultsThree prominent candidate biomarkers were identified: alpha 2 macroglobulin (A2M) is up regulated; vitamin D binding protein (VDBP) and apolipoprotein AI (ApoAI) are down regulated. The serum concentration of A2M was significantly different among normal, mild (F1/F2) and advanced fibrosis (F3/F4) (p < 0.01). The protein levels of VDBP and ApoAI were significantly higher in normal/mild fibrosis, when compared to those in advanced fibrosis (both p < 0.01).ConclusionsThis study not only reveals three putative biomarkers of liver fibrosis (A2M, VDBP and ApoAI) but also proves the differential expressions of those markers in different stages of fibrosis. We expect that combination of these novel biomarkers could be applied clinically to predict the stage of liver fibrosis without the need of liver biopsy.

Lansoprazole-based sequential and concomitant therapy for the first-line Helicobacter pylori eradication

OBJECTIVE:  The aim of this prospective study was to compare the efficacy of the first‐line lansoprazole‐based sequential therapy and concomitant therapy (lansoprazole, amoxicillin, clarithromycin and metronidazole) for Helicobacter pylori (H. pylori) eradication.

Tetracycline-Resistant Clinical Helicobacter pylori Isolates with and without Mutations in 16S rRNA-Encoding Genes

ABSTRACT Tetracycline-resistant Helicobacter pylori strains have been increasingly reported worldwide. However, only a small number of tetracycline-resistant strains have been studied with regard to possible mechanisms of resistance and those studies have focused on mutations in the tetracycline binding sites of 16S rRNA-encoding genes. We here report studies of 41 tetracycline-resistant H. pylori strains (tetracycline MICs, 4 to 32 μg/ml) from North America (n = 12) and from East Asia (n = 29). DNA sequence analyses of 16S rRNA-encoding genes revealed that 22 (54%) of the resistant isolates carried one of five different single-nucleotide substitutions (CGA, GGA, TGA, AGC, or AGT) at the putative tetracycline binding site (AGA965-967). Single-nucleotide substitutions were associated with reduced ribosomal binding and with slightly increased tetracycline MICs (1 to 2 μg/ml). The 19 tetracycline-resistant isolates with no detectable mutations in the tetracycline binding site had normal tetracycline-ribosome binding. All tetracycline-resistant isolates, including those with and those without mutations in the tetracycline binding site, showed decreased accumulation of tetracycline. These results suggest that tetracycline resistance is multifactorial, involving alterations both in ribosomal binding and in membrane permeability.

Comparison of the clinical feasibility of three rapid urease tests in the diagnosis of Helicobacter pylori infection.

Rapid urease tests (RUTs) are a fast, accurate, and inexpensive method to diagnose H. pylori infection in the endoscopy suite. Of these, the CLO test is both common and widely used. The aim of our study was to evaluate the accuracy and positive reaction times of two new rapid urease tests (ProntoDry and HpONE) in comparison with the CLO test. Fifty-one patients (26 men, 25 women; mean age, 52.4 years) were included in this study, and all underwent esophagogastroduodenoscopy (EGD). None of the patients had received any prior H. pylori eradication therapy. H. pylori infection status was evaluated by histology, culture, 13C–UBT, and RUT. H. pylori infection was considered to be positive if the culture was positive or if two of the other three tests (histology, RUT, and 13C–UBT) were positive. If culture was negative and only one of the other three tests was positive, or if all four tests were negative, the result was interpreted as negative. Of these 51 patients, 2 were excluded and 29 (59.1%) were infected with H. pylori. The sensitivities, specificities, positive predictive values, and negative predictive values of the three RUTs were not significantly different. The mean positive reaction times of the three RUTs (CLO test, ProntoDry, and HpONE) were 67.8 ± 12.0, 16.5 ± 2.2, and 17.8 ± 2.1 min, respectively. ProntoDry (P < 0.001) and HpONE (P < 0.001) had significantly faster reaction times than the CLO test, but there was no significant difference between ProntoDry and HpONE. Different media of RUTs may influence the rapidity of a positive reaction time. Both ProntoDry and HpONE were superior to the CLO test in terms of accuracy, reaction time, and cost-effectiveness.

The association between Helicobacter pylori infection and functional dyspepsia in patients with irritable bowel syndrome.

OBJECTIVE:Irritable bowel syndrome (IBS) is associated with an exaggerated response to a variety of physiological and nonphysiological gastrointestinal stimuli. Many patients with IBS also have functional dyspepsia. Our aim was to examine the hypothesis that Helicobacter pylori (H. pylori) infection may predispose IBS patients to functional dyspepsia.METHODS:In 69 IBS patients, dyspeptic symptoms, H. pylori status, and sociodemographic and psychological variables (perceived stress, trait anxiety, and depression) were assessed. Sociodemographic and psychological variables were also evaluated in 52 control subjects.RESULTS:Mean scores for perceived stress (17.1 ± 6.0 vs 14.9 ± 6.0, p = 0.05), trait anxiety (45.6 ± 9.1 vs 41.1 ± 7.8, p = 0.004) and depression (9.9 ± 8.4 vs 5.0 ± 5.5, p = 0.0002) were higher in IBS patients than in controls. In all, 33 of the 69 patients (47.8%) had H. pylori infection, and this was associated with relevant symptoms of epigastric pain (odds ratio [OR] = 6.77, 95% confidence interval [CI] 1.89–24.3) and postprandial upper abdominal fullness (OR = 4.23, 95% CI 1.38–13.2). H. pylori infection and female gender were independent predictors of the presence of relevant dyspepsia (OR = 8.31, 95% CI 2.35–29.5 and 6.06, 95% CI 1.71–21.5, respectively). Symptom intensity was associated with the level of perceived stress (total relevant symptom number ≥3 vs <3, OR = 1.16 per point on a 40-point perceived stress scale, 95% CI 1.01–1.34).CONCLUSIONS:In IBS patients, the presence of dyspepsia is associated with H. pylori infection, female gender, and perceived stress.

Isolation and characterization of human gastric cell lines with stem cell phenotypes.

Aim:  The aim of this study was to develop an in vitro human gastric stem and/or progenitor cell model that may be used to study the mechanism of gastric carcinogenesis induced by Helicobacter pylori infection.

Randomized comparison of two rescue therapies for Helicobacter pylori infection

Background  Bismuth salts are not available worldwide. It remains unknown whether clarithromycin can replace bismuth salts as an adjuvant agent in the rescue regimens for Helicobacter pylori infection. We therefore designed the prospective study to compare the efficacies of two rescue therapies for H. pylori infection after standard triple therapies.

Feasibility of Shortening 14-day Hybrid Therapy While Maintaining an Excellent Helicobacter pylori Eradication Rate

The need for new effective Helicobacter pylori eradication therapy has focused efforts on the development and optimization of regimens with excellent eradication rates such as 14‐day hybrid therapy. This study evaluated whether the duration of hybrid therapy could be reduced while maintaining a high eradication rate and to examine the effect of antibiotic resistance on outcome.

Rabeprazole- versus Esomeprazole-Based Eradication Regimens for H. pylori Infection

Background:  Different kinds of proton pump inhibitor‐based triple therapies could result in different Helicobacter pylori eradication rates.

Acute Hemorrhagic Rectal Ulcer Syndrome: A New Clinical Entity? Report of 19 Cases and Review of the Literature

PURPOSE:Acute hemorrhagic rectal ulcer syndrome is characterized by sudden onset, painless, and massive hemorrhage from rectal ulcer(s) in patients with serious underlying illnesses. It is a matter of controversy whether acute hemorrhagic rectal ulcer syndrome is a distinct clinical entity. This is the first Asian report on acute hemorrhagic rectal ulcer syndrome to be made outside Japan.METHODS:From January 1989 to December 1999, 8,085 patients underwent total colonoscopy at our institution. We retrospectively analyzed the medical records and colonoscopic files. The diagnosis of acute hemorrhagic rectal ulcer syndrome was made by means of the clinical, histologic, and colonoscopic findings.RESULTS:Among the 8,085 patients, 19 patients (11 males; mean age, 71.2 ± 10.1 years) were diagnosed with acute hemorrhagic rectal ulcer syndrome, which accounted for 2.8 percent of the patients with massive lower gastrointestinal bleeding. The duration from hospitalization to the onset of massive bleeding ranged from 3 to 14 (mean, 9 ± 3.3) days. Characteristics of colonoscopic appearance were solitary or multiple rectal ulcer(s), with round, circumferential, geographical, or Dieulafoy-like lesions located within a mean of 4.7 cm ± 1.5 cm from the dentate line. Histopathologically, the lesions appeared as necrosis with denudation of covering epithelium, hemorrhage, and multiple thrombi in the vessels of the mucosa and underlying stroma, which is considered to be similar to stress-related mucosa injury. Successful hemostasis was obtained in 74 percent (14/19) of patients with direct therapeutic maneuvers. Prognosis was largely dependent on accurate diagnosis and management of the underlying disorders.CONCLUSIONS:We assert that acute hemorrhagic rectal ulcer syndrome is a rare but important entity and stress that awareness of this clinical entity should lead to a high index of suspicion resulting in early detection, diagnosis, and appropriate therapy.