Wen Zhong Liu

Efficacy of Thalidomide for Refractory Gastrointestinal Bleeding From Vascular Malformation

BACKGROUND & AIMS Patients with recurrent bleeding from gastrointestinal vascular malformations are a challenge to treat. We investigated the long-term efficacy and safety of thalidomide for refractory bleeding from gastrointestinal vascular malformations in an open-label, randomized study. METHODS Eligible patients were randomly assigned to groups that were given either 100 mg thalidomide (n = 28) or 400 mg iron (n = 27, controls), daily for 4 months; patients were followed for at least 1 year (mean, 39 months). Bleeding was defined by a positive result from an immunoassay fecal occult blood test. The primary end point was the effective response rate, defined as the proportion of patients in whom bleeding episodes had decreased by ≥ 50% in the first year of the follow-up period. The secondary end points included the rates of cessation of bleeding, blood transfusion, overall hospitalization, and hospitalization for bleeding. We also quantified yearly bleeding episodes, bleeding duration, levels of hemoglobin, and yearly requirements for transfusions of red cells, numbers of hospitalizations for bleeding, and hospital stays. Plasma levels of vascular endothelial growth factor were measured in the group given thalidomide. RESULTS Rates of response in the thalidomide and control groups were 71.4% and 3.7%, respectively (P < .001). All secondary end points differed significantly different between groups; thalidomide was more effective. No severe adverse effects were observed, although minor side effects were common among patients in the thalidomide group. Levels of vascular endothelial growth factor were significantly reduced by thalidomide (P < .001). CONCLUSIONS Thalidomide is an effective and relatively safe treatment for patients with refractory bleeding from gastrointestinal vascular malformations. Mechanisms of thalidomide activity might involve vascular endothelial growth factor.

Fourth Chinese National Consensus Report on the management of Helicobacter pylori infection

BackgroundSince the Fourth Chinese National Consensus Report on the management of H.pylori infection′ was published in 2012, three important consensuses (Kyoto global consensus report on H.pylori gastritis, The Toronto Consensus for the Treatment of H.pylori Infection in Adults and Management of H.pylori infectionthe Maastricht V/Florence Consensus Report) have been published regarding the management of H.pylori infection. Materials and MethodsA Delphi method was adopted to develop the consensus of relevant statements′. First, the established statements′ were sent to experts via email. Second, after undergoing two rounds of consultation, the initial statements were discussed face to face and revised in the conference item by item on 16 December 2016. Finally, 21 core members of conferees participated in the final vote of statements. Voting for each statement was performed using an electronic system with levels of agreements shown on the screen in real time. ResultsConsensus contents contained a total of 48 statements and related 6 parts, including indications for H. pylori eradication, diagnosis, treatment, H. pylori and gastric cancer, H. pylori infection in special populations, H. pylori and gastrointestinal microbiota. ConclusionsRecommendations are provided on the basis of the best available evidence.

Consensus on chronic gastritis in China--Second National Consensus Meeting on Chronic Gastritis (14-16 September 2006 Shanghai, China).

Blackwell Publishing Asia Melbourne, Australia CDD hines Journal of Digestive Diseases 1443-9611

Third Chinese National Consensus Report on the management of Helicobacter pylori infection1 (August 2007, Lushan, Jiangxi Province, China)

Blackwell Publishing Asia Melbourne, Australia CDD hines Journal of Digestive Diseases 1443-9611 573

Role of Helicobacter pylori infection on neuronal expression in the stomach and spinal cord of a murine model

OBJECTIVE:  To investigate the effect of Helicobactor pylori (H. pylori) infection on neuronal expressions in the stomach and spinal cord of mice so as to explain dyspepsia symptoms in H. pylori infected patients.

Duodenal gastric metaplasia and Helicobacter pylori infection in patients with diffuse nodular duodenitis

Whether the regression of gastric metaplasia in the duodenum can be achieved after eradication of Helicobacter pylori is not clear. The aim of the present study was to investigate the relationship between H. pylori infection and gastric metaplasia in patients with endoscopic diffuse nodular duodenitis. Eighty-six patients with endoscopically confirmed nodular duodenitis and 40 control patients with normal duodenal appearance were investigated. The H. pylori-positive patients with duodenitis received anti-H. pylori triple therapy (20 mg omeprazole plus 250 mg clarithromycin and 400 mg metronidazole, all twice daily) for one week. A control endoscopy was performed 6 months after H. pylori treatment. The H. pylori-negative patients with duodenitis received 20 mg omeprazole once daily for 6 months and a control endoscopy was performed 2 weeks after treatment. The prevalence of H. pylori infection was 58.1%, and the prevalence of gastric metaplasia was 57.0%. Seventy-six patients underwent endoscopy again. No influence on the endoscopic appearance of nodular duodenitis was found after eradication of H. pylori or acid suppression therapy. However, gastric metaplasia significantly decreased and complete regression was achieved in 15/28 patients (53.6%) 6 months after eradication of H. pylori, accompanied by significant improvement of other histological alterations. Only mild chronic inflammation, but not gastric metaplasia, was found in the control group, none with H. pylori infection in the duodenal bulb. Therefore, H. pylori infection is related to the extent of gastric metaplasia in the duodenum, but not to the presence of diffuse nodular duodenitis.

The role of HIF-1, angiopoietin-2, Dll4 and Notch1 in bleeding gastrointestinal vascular malformations and thalidomide-associated actions: a pilot in vivo study.

OBJECTIVE:  To investigate plasma levels of hypoxia inducible factor‐1 (HIF‐1), angiopoietin‐2 (Ang‐2), Delta‐like ligand 4 (Dll4) and Notch1 in patients with recurrent gastrointestinal bleeding due to gastrointestinal vascular malformation (GIVM) with or without thalidomide treatment.

Fifth Chinese National Consensus Report on the management of Helicobacter pylori infection

Since the ‘Fourth Chinese National Consensus Report on the management of H. pylori infection’ was published in 2012, three important consensuses (Kyoto global consensus report on H. pylori gastritis, The Toronto Consensus for the Treatment of H. pylori Infection in Adults and Management of H. pylori infection—the Maastricht V/Florence Consensus Report) have been published regarding the management of H. pylori infection.

Chinese consensus on chronic gastritis (2017, Shanghai): 2017 Chinese consensus on CG

Since the Chinese Consensus on Chronic Gastritis1 was established at the National Chronic Gastritis Symposium in Shanghai in November 2012, the Kyoto global consensus report on Helicobacter pylori gastritis2 (hereinafter referred to as the Kyoto consensus), which emphasizes both the role of Helicobacter pylori (H. pylori) and the classification and staging system for chronic gastritis based on the operative link for gastritis assessment (OLGA)3,4 and even the operative link for gastric intestinal metaplasia assessment (OLGIM), was internationally promulgated, as well as the ABC classification, the Maastricht V consensus,5 and the fifth Chinese national consensus report on management of Helicobacter pylori infection6 .