Zhi Zheng Ge

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.

PillCam colon capsule endoscopy versus conventional colonoscopy for the detection of severity and extent of ulcerative colitis.

To evaluate PillCam colon capsule endoscopy (PCCE) in detecting the severity and extent of active ulcerative colitis (UC), in comparison with conventional endoscopy.

Endoscopic capsule placement improves the completion rate of small-bowel capsule endoscopy and increases diagnostic yield

BACKGROUND The methods for increasing the rate of complete small-bowel examinations by capsule endoscopy (CE) demonstrate conflicting results, and it is unknown whether improving the completion rate of CE transit is correlated with improvement in diagnostic yield. OBJECTIVE The aim of this study was to determine whether a higher rate of complete small-bowel examinations results in a higher diagnostic yield of CE. DESIGN Case-control comparison. SETTING Tertiary care university hospital. PATIENTS A total of 273 patients underwent conventional CE (group A), and 261 patients underwent real-time CE (group B). Furthermore, the patients in groups A and B were divided into 2 subgroups by pyloric transit time (A1, A2 and B1, B2, respectively). INTERVENTIONS After swallowing the capsule, each patient was monitored with a real-time viewer in group B, and the patients underwent endoscopic placement if the capsule was delayed in the esophagus or stomach. MAIN OUTCOME MEASUREMENTS Pyloric transit time, small-bowel transit time, the rate of complete small-bowel examinations, and the diagnostic yield. RESULTS The rate of complete small-bowel examinations was significantly higher in group B than in group A (87.4% vs 78.0%, respectively; P = .004). The diagnostic yield was significantly higher in group B2 than in group A2 (60.0% vs 41.7%, respectively; P = .019). LIMITATIONS Nonrandomized study. CONCLUSIONS Endoscopic placement improves the rate of complete small-bowel examinations, resulting in a higher diagnostic yield of CE.

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

Minimally invasive treatment of laparoscopic and endoscopic cooperative surgery for patients with gastric gastrointestinal stromal tumors

To evaluate the feasibility and safety of laparoscopic and endoscopic cooperative surgery (LECS) for the treatment of gastric gastrointestinal stromal tumors (GISTs).

Role of bile reflux and Helicobacter pylori infection on inflammation of gastric remnant after distal gastrectomy

OBJECTIVE:  The influence of the main pathogenic factors on remnant gastritis is still to be evaluated. The aim of this study was to investigate the role of bile reflux and Helicobacter pylori infection on endoscopic inflammation and histological changes of gastric remnant after distal gastrectomy.

Long-term outcome in patients with obscure gastrointestinal bleeding after capsule endoscopy

This study aimed to identify the risk factors associated with rebleeding and long‐term outcomes after capsule endoscopy (CE) for obscure gastrointestinal bleeding (OGIB) in a follow‐up study.

New dual therapy for primary treatment of Helicobacter pylori infection: A prospective randomized study in Shanghai, China.

To evaluate the eradication rates, side effects and the patient compliance of a dual therapy with rabeprazole and amoxicillin as the first‐line therapy in patients with Helicobacter pylori (H. pylori) infection.

Successful treatment with thalidomide for a patient with recurrent gastrointestinal bleeding due to angiodysplasia diagnosed by capsule endoscopy

Angiodysplasia is a common vascular abnormality which can cause obscure gastrointestinal bleeding (OGIB), especially in patients elder than 60 years. Patients may present with maroon-colored stool, melena, hematochezia and even hematemesis. The lesions usually present in the mucosal and submucosal layers of the bowel wall, consisting of dilated, tortuous and thin-walled small veins, capillaries and arteries lined by endothelium with little smooth muscle. Conventional therapies such as endoscopic argon plasma coagulation, surgical resection and angiographic embolization, can treat the focal vascular lesion effectively but are less effective for multiple lesions. The effect of hormonal therapy or octreotide still remains controversial. Several studies have shown the successful outcome of thalidomide treatment on angiodysplasia, but none have reported on its long-term effects. Here we reported the use of thalidomide on a case of OGIB that was diagnosed by capsule endoscopy (CE). CASE REPORT

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.