bluuebunny/crossref_metadata_2025 huggingface dataset:
INTERACTION BETWEEN H. PYLORI AND NSAIDS: PREDICTIVE VALUE OF DENSITY OF POLYMORPHONUCLEAR LEUKOCYTES, MUCOSAL AND GASTRIC JUICE NUTRITE LEVELS
Authors: Shiotani Akiko , Yamaoka Yoshio , El‐Zimaity Hala , Saeed M. Ali , Graham David Y.
Published: March 2003

Background

Although nonsteroidal anti‐inflammatory drugs (NSAIDs) use and H. pylori are the most common causes of peptic ulcers, it remains unclear whether there is an interaction between them.

Aim

To test whether there was a relationship between polymorphonuclear leukocyte (PMN) infiltration of the gastric mucosa and severity of NSAID‐induced gastric mucosal injury.

Methods

H. pylori density, mucosal interleukin‐8 (IL‐8) levels as well as gastric mucosal and juice nitrite levels were assessed in normal volunteers before and after receiving 600 mg of naproxen (twice a day for 3 days). Histology was graded using a visual analogue scale from 0 (absent/normal) to 5 (maximal intensity). IL‐8 levels were assayed by ELISA and nitrite levels by Griess reaction. Endoscopic damage was graded from none to severe (large erosions or ulcers).

Results

Eleven healthy volunteers with active H. pylori infection and normal appearing gastric mucosa were entered. The post‐NSAID endoscopic scores were 0 = 3, mild = 1 moderate = 4, and severe = 3. None of the pretreatment histologic or biochemical parameters (e.g., PMN density, mucosal Il‐8 or nitrite levels) predicted endoscopic outcome nor was there a significant changes from pretreatment levels. There was an inverse correlation between endoscopic score and the pH of the gastric juice post‐therapy (R‐0.669, p=0.02).

Conclusions

The hypothesis that the intensity of PMN infiltration in the mucosa correlated with risk of ulcer development was not confirmed. PMN infiltration is likely a surrogate for an H. pylori infection‐related increased risk of NSAID ulcers.
CHANGES OF UREA AND AMMONIA CONCENTRATION IN GASTRIC JUICE ASPIRATION BY ENDOSCOPIC, IN DETECTION OF HELICOBACTER PYLORI INFECTION
Authors: M Sihombing , Zain Lukman Hakim , P Tarigan , P Barus
Published: March 2003

Introduction

The prevalence of H. pylori infection in Indonesia (Medan 52, Jakarta 40‐57, Mataram 51‐66%). And Non Serological Diagnostic test for H. pylori, with methods Invasive (CLO, Microbiology and Histopatology) and Non invasive (UBT), but cost this method is expensive for the lower class and rural area.

Background

H. pylori produces of Urease enzymes and urease activity is an important characteristic of the Organism, so How about Urea and Ammonium concentration in Gastric juice patients H. pylori infection?

Objective

Gastric juice analyzed for Urea and Ammonium H. pylori Infection, compare with non infection H. pylori, and the future Gastric juice aspiration to analyze by Naso gastric tube ?.

Material and methods

Patients with chronic dyspepsia, without consumption antibiotics, omeprazole/H2RA within 1 month, no ureami and investigation with upper endoscopi to gastric juice aspiration and CLO test. Gastric juice analyzed by colorimetric method and spectrophotometric assay. Patients control: no symptom dyspepsia, IgG anti HP negative, Upper endoscopy normal.

Result

Preliminary report H. pylori positive‐patients bad lower urea and higher ammonia concentration compared with non infection H. pylori (control)

Conclusion

The Third Western Pacific Helicobacter Congress, June 22‐24 Bali‐Indonesia.
HELICOBACTER INFECTION IN CHILDREN WITH APPENDICITIS AND LACTOSE INTOLERANCE
Authors: Soelaeman Eva J. , Purnomo Budi , Digdowirogo Hadjat S. , Soehardjo Hartati N
Published: March 2003

Helicobacter pylori eradication has been debated. Most investigators do not recommended treating the infection except in severe case. We report a unique case: H. pylori infection with appendicitis and lactose intolerance.

Case report:

A 6 year old girl was brought to children and maternity Hospital Harapan Kita due to abdominal pain and vomiting. She had 6‐ month history of epigastric pain. In the past 2 days, she suffered from abdominal pain arround Mc. Burney area. On physical examination, she was in pain. Her weight was 19 Kg. Vital signs were normal. Findings in heart, lung and extremities were also normal.

Abdomen:

severe pain in the epigastric and Mc. burney area.Laboratory investigations showed hemoglobin 12 g/dl, leukocyte 12800/ul. Platelets 289000/ul. Bleeding and clotting time were normal. Abdominal ultrasonography revealed inflammation of appendix with 9‐mm diameter. Stool examination was normal.Appendectomy was done at the same time with esofagogastroduodenoscopy (EGD). On EGD, we found moderete anthral gastritis. On histopathological examination, we found H. pylori at antral of the stomach. Breath hydrogen test was positive.After H. pylori eradication and milk avoidance, abdominal pain has never occurred.

Conclusion:

Abdominal: pain is not specific for H. pylori infection. The pain caused by many diseases including H. pylori infection. In our case, we can control abdominal pain by H. pylori eradication.
DYSPEPSIA SYNDROME AND HELICOBACTER PYLORI INFECTION IN END STAGE RENAL FAILURE
Authors: Mertasudira IS , Saketi JR , Djumhana A. , Widjojo J. , Abdurachman SA
Published: March 2003

Dyspepsia syndrome could be the result of several disorders in upper gastrointestinal tract. Most of end stage renal failure (ESRF) patients on regular hemodialysis have upper gastrointestinal symptoms, mostly anorexia, nausea, vornitus and sometimes bloating. Helicobacter pylori infection is one of the causes of dyspepsia syndrome and its prevalence in ESRF patients is higher than normal population. This study was performed to assess the association between Helicobacter pylori infection with dyspepsia syndrome in 30 ERSF patients in Dr. Hasan Sadikin General Hospital and Habibie Renal Hospital Bandung.

These subject were 18 males and 12 females, aged 47.8 ± 11.6 years old, and underwent hemodialysis for 5‐490 weeks (median 12 weeks). Dyspepsia is found in 23 (76.7%), which more frequence on age group 50‐59 (38.9%), and 10 females on age group 30‐39 (41.7%). Most common symptoms were nausea in 16 (69.5%), bloating in 4 (17.3%), epigastric pain in 2 (8.7%) and vomitus in 1 (4.3%). Helicobacter pylori was found histologically in 11 (36.7%) and serologically in 7 (23.3%). Statistically with Fischer’s exact test there was no significant association between dyspepsia syndrome with Helicobacter pylori infection serologycally p=0.467; OR 2.12; CI 95% 0.17<OR<56.72 and histologically p = 0.514; OR=0.71; CI 95% 0.09<OR<5.43.

Conclusion

In ESRF, the prevalence of Helicobacter pylori was 36.7% serologically and 23.3% histologically. Statiscally there was no significant association between dyspepsia syndrome with Helicobacter pylori infection.
ENDOSCOPIC FEATURES OF HELICOBACTER PYLORI‐INFECTED GASTRITIS
Authors: Urita Yoshihisa , Torii Naotaka , Hike Kazuo , Sasajima Masahiko , Kanda Eiko , Matsuzaki Hiroshi , Miki Kazumasa
Published: March 2003

Objective

It would be desirable to diagnose H. pylori‐related gastritis simply by endoscopic observation. However, it remains controversial whether certain endoscopic features can be used to diagnose H. pylori infection.

Material & Methods

A new modified endoscopic 13C‐urea breath test (Dig Endosc 12:29‐32,2000) was performed in 628 patients. Briefly, after endoscopic observation, 20ml of water containing 100mg of 13 (urea is sprayed onto the gastric mucosa. Thereafter, a sample of 150mlof intragastric gas is collected through a biopsy channel. A positive test was defined as an increase in the ratio of 10 per mil over baseline. Endoscopic features were evaluated by the presence of following findings; linear reddness, raised erosion, haemorrhagic erosion, haemorrhagic erosion, and spotty erythema.

Results

The sensitivity, specificity, positive predicts value (PPV), and negative predict value (NPV) of each feature is shown in the following table:

sensitivity
specificity
PPV
NPV

spotty erythema (body)

35.9%
89.6%
83.6%
48.7%

haemorrhagic

7.6%
86.5%
45.2%
38.8%

linear reddness
(antrum)
2.7%
69.3%
11.5%
32.6%

(body)
2.4%
95.2%
42.9%
39.8%

raised erosion
(antrum)
14.1%
73.3%
43.7%
36.7%

(body)
1.1%
99.6%
80.0%
40.6%

Conclusion

Spotty erythema in the gastric body was thought to reflect H. pylori infection. In contrast, it was suggested that linear reddness in the antrum indicated the absence of H. pylori.
Evaluation of lower oesophageal sphincter pressure using endoscopic manometric sleeve assembly
Authors: Hananoki Mutsumi , Haruma Ken , Tsuga Katsutoshi , Hata Jiro , Sumii Koji , Kajiyama Goro
Published: March 2003

Background
: The purpose of this study was to establish a method to determine lower oesophageal sphincter (LOS) pressure using an endoscopic manometric sleeve assembly.

Methods
: We used a 250‐cm, three‐lumen, 2.2‐mm external diameter silicon catheter with a 3‐cm sleeve sensor that was passed easily through the biopsy channel (2.8 mm diameter) of the gastroscope. Each lumen was perfused with distilled water using a low‐compliance, pneumohydraulic capillary infusion system. Forty‐seven healthy subjects and 35 patients with oesophageal disorders underwent study during routine diagnostic endoscopy. In 27 of the subjects, standard transnasal manometry with a three‐lumen, 4.5‐mm diameter polyvinyl catheter with a 5‐cm sleeve sensor was also performed.

Results
: Lower oesophageal sphincter pressure (LOS) was evaluated in all subjects (median pressure 16 mmHg, range 0–55 mmHg) for 6 min during routine endoscopic examination. The LOS pressure readings between standard and endoscopic manometry correlated well. The LOS pressure was significantly lower in healthy subjects with hiatal hernia than in those without hernia and was also significantly lower in patients with reflux oesophagitis than in healthy subjects.

Conclusions
: Endoscopic manometric sleeve assembly was used during routine endoscopic examination and was useful for easily determining LOS pressure. It could be used for evaluation of oesophageal motility disorders, thus avoiding the use of a more invasive and time‐consuming method.
Natural history of hepatitis C virus infection
Authors: Amarapurkar Deepak
Published: March 2003

Hepatitis C is a heterogeneous disease whose natural history is controversial and perplexing. However, it can be a pernicious disease and is responsible for considerable mortality and morbidity. More than 80% individuals infected with the hepatitis C virus (HCV) develop chronic infection; the remaining 10–20% develop spontaneous clearance with natural immunity. The majority of patients who develop chronic HCV infection are asymptomatic; but 60–80% develop chronic hepatitis as indicated by elevated ALT; around 30% maintain normal ALT. One‐third of chronically infected patients develop progressive liver injury, fibrosis and cirrhosis over a period of 20–30 years, and 15% develop hepatocellular carcinoma. Acquiring infection after the age of 40 years, male sex, excessive alcohol consumption, HBV or HIV co‐infection and the immunosuppressive state have been identified as factors associated with progression of fibrosis and development of cirrhosis. The relationship between virus load, HCV genotype I and quasispecies variability and progression of live disease is controversial. In the present study on 141 patients with chronic HCV infection and established chronic liver disease, the median time to develop cirrhosis was 20 years. Progression to cirrhosis was faster (16 vs 20 years) in those who acquired infection after the age of 35 years, and in immunosuppressed patients (8 vs 21 years), whereas diabetes, sex and HBV co‐infection were not associated with faster progression.
Diagnosis and treatment of gastro‐oesophageal reflux disease in infants and children
Authors: Vandenplas Yvan , Hegar Badriul
Published: March 2003

Gastro‐oesophageal reflux is a frequent, aspecific phenomenon in infants and children. The recommended approach in infants with uncomplicated regurgitation consists of reassurance of the parents and, if this fails, dietary recommendations in formula‐fed infants. If, despite these efforts, symptoms persist, administration of prokinetics, such as cisapride, is recommended prior to investigations such as oesophageal pH monitoring. Oesophageal pH monitoring is also recommended to document gastro‐oesophageal reflux disease in children with unusual presentations such as chronic respiratory disease. Today, cisapride is the drug of choice because it has the best efficacy and safety profile. In infants and children presenting with symptoms suggesting oesophagitis, endoscopy of the upper gastrointestinal tract is recommended. If there is severe oesophagitis, acid suppression with histamine H2‐receptor antagonists or proton pump inhibitors in combination with prokinetics, are recommended. In life‐threatening situations, or in patients that are resistant to or dependent on acid‐suppressive medication, a surgical procedure such as laparascopic Nissen procedure should be considered.
Elevation of TFF1 gene expression during healing of gastric ulcer at non‐ulcerated sites in the stomach: Semiquantification using the single tube method of polymerase chain reaction
Authors: Saitoh Takashi , Mochizuki Tsutomu , Suda Takeshi , Aoyagi Yutaka , Tsukada Yoshihisa , Narisawa Rintaroh , Asakura Hitoshi
Published: March 2003

Background
: The Trefoil factor family 1 (TFF1), one of the trefoil peptides, has been considered to play protective and reparative roles of experimentally induced ulcers in the stomach. However, the alteration of the TFF1 mRNA in the non‐ulcerated areas of living human gastric mucosa in gastric ulcer is not well known. We examined TFF1 gene expression at non‐ulcerated sites during the healing of a gastric ulcer by semiquantitative determination of the TFF1 mRNA.

Methods
: Gastric mucosal biopsy specimens were taken before and after the healing of the gastric ulcer from seven consecutive patients and from seven patients diagnosed with non‐ulcer dyspepsia (NUD). The relative value of TFF1 mRNA (RTFF1) was calculated by the single tube method of polymerase chain reaction (ST‐PCR) and Southern hybridization. Immunohistochemistry using monoclonal antibodies was performed to confirm the presence of the TFF1 peptide. The status of Helicobacter pylori and the severity of gastritis were investigated simultaneously.

Results
: The mean relative values of TFF1 mRNA at both the gastric angle (RTFF1AS) and the gastric body (RTFF1BS) of patients with gastric ulcers at the healed stage were significantly higher than those at the open stage (P < 0.05). The mean RTFF1AS at both the open and healed stages were lower than those of RTFF1BS at the open and healed stages, respectively. The mean RTFF1B at the open stage was lower than that in NUD (not significant), but the mean of RTFF1B at the healed stage was significantly higher than that in NUD. The RTFF1AS and RTFF1BS of all patients did not correlate with H. pylori status nor with the severity of gastritis. The induction of TFF1 mRNA at the non‐ulcerated background sites seemed not to be related to the status of H. pylori or to the severity of gastritis.

Conclusions
: These results suggest that the increased levels TFF1 mRNA during the healing of gastric ulcers might be closely related to the protection and the cell differentiation at the non‐ulcerated areas of living human gastric mucosa.
Diagnostic criteria for gastrointestinal carcinomas in Japan and Western countries: Proposal for a new classification system of gastrointestinal epithelial neoplasia
Authors: Schlemper Ronald J , Kato Yo , Stolte Manfred
Published: March 2003

Abstract Background: Large differences have been found between Western and Japanese pathologists in their diagnosis of adenoma/dysplasia and early carcinoma for gastric, colorectal and oesophageal epithelial neoplastic lesions. Common worldwide terminology based on clinical usefulness, that is, on neoplastic severity and depth of invasion, is needed.

Methods: Thirty‐one pathologists from 12 countries reviewed 35 gastric, 20 colorectal and 21 oesophageal biopsy and resection specimens. The extent of diagnostic agreement between those with Western and Japanese viewpoints was assessed by kappa statistics.

Results: Suspected or definite carcinoma was diagnosed in 17–66% of gastric, in 5–40% of colorectal, and in 10–67% of oesophageal slides by pathologists with a Western viewpoint, but in 77–94% of gastric, in 45–75% of colorectal and in 81–100% of oesophageal slides by pathologists with a Japanese viewpoint (from Japan, Germany, Austria and UK). Overall, there was poor agreement between the conventional Western and Japanese diagnoses (kappa values lower than 0.3 for gastric, colorectal and oesophageal lesions). There was much better agreement among the pathologists (kappa values higher than 0.5 for gastric and colorectal lesions) when the original assessments of the slides were regrouped into the five categories of the following classification of GI epithelial neoplasia we hereby propose: C1, negative for neoplasia; C2, indefinite for neoplasia; C3, mucosal low‐grade neoplasia (low‐grade adenoma/dysplasia); C4, mucosal high‐grade neoplasia (high‐grade adenoma/dysplasia plus mucosal carcinoma); C5, submucosal invasion of neoplasia.

Conclusions: The intercountry differences in the diagnoses of adenoma/dysplasia and early carcinoma can, in large part, be resolved by adopting terminology based on neoplastic severity and depth of invasion. Problems with defining intramucosal invasion are thus avoided. Moreover, grouping high‐grade adenoma/dysplasia and mucosal carcinoma together in one category is clinically useful, as patients with small mucosal neoplastic lesions can be cured by endoscopic local resection.
Hepatitis C virus clearance is prominent in women in an endemic area
Authors: Inoue Gaku , Horiike Norio , Michitaka Kojiro , Onji Morikazu
Published: March 2003

Background
: The clinical and virological backgrounds of cases with previous hepatitis C virus (HCV) infection (positive for HCV antibody (anti‐HCV) and HCV‐RNA negative) in an HCV endemic area were examined to identify factors related to the clearance of HCV.

Methods
: The study population comprised 3117 inhabitants, 1037 male and 2080 female, from an HCV endemic area. Hepatitis C virus antibody was detected by a passive haemagglutination test. The HCV‐RNA and the HCV genotype were detected by using the polymerase chain reaction method. The HCV serotype was determined by enzyme immunoassay by using the peptides of the core region.

Results
: Twenty‐two per cent of the inhabitants were positive for anti‐HCV, with males and the elderly having a significantly higher antibody titre (P < 0.01) than youths and females. Hepatitis C virus‐RNA was detected in 78% of the HCV antibody‐positive cases. The rate of HCV‐RNA positivity was significantly higher in males than in females (P < 0.01). No relationship was found between HCV‐RNA positivity and age. The HCV genotype 1b was the predominant genotype among the HCV‐RNA‐positive cases. Mixed genotypes (1b + 2a) were observed in 12% of cases, primarily in elderly males and females. In cases with previous HCV infection, serotype 1 was the most common serotype, and there appeared to be no relationship between the distribution of HCV serotypes and age and gender. There was a female predominance with regard to previous HCV infection, but not to being HCV carriers (P < 0.01).

Conclusions
: Gender, not HCV genotype, is the primary factor influencing HCV clearance.
A balanced 5:1 carbohydrate : protein diet: A new method for supplementing protein to patients with chronic liver disease
Authors: Ilan Yaron , Sobol Tamar , Sasson Odelia , Ashur Yafa
Published: March 2003

Background and Aims

Protein malnutrition in patients with chronic liver disease contributes to bone and muscle weakness and compromises immune function and survival. In contrast, high‐protein diets may induce or exacerbate hepatic encephalopathy. The aim of the present study was to test whether increased amounts of protein, balanced by dietary carbohydrate in a 1:5 ratio, may be given to chronic liver disease patients in order to minimize postprandial increases in plasma amino acid (AA) concentrations.

Methods

Eight patients with chronic liver disease were studied. Each received, in a randomized order, three different diets of 2510 kJ of either high protein (37:50:28, carbohydrate : protein : fat), high carbohydrate (126:10:6) or a balanced 5:1 carbohydrate : protein diet (105:21:11). All patients were followed for plasma AA, glucose and insulin levels, as well as for cognitive and behavioral changes.

Results

Following the high protein diet, AA concentrations were significantly increased. In contrast, after the balanced diet, AA levels were practically constant enabled. All diets was well tolerated and no cognitive or behavioral changes appeared.

Conclusion

The administration of a balanced 5:1 carbohydrate : protein diet may enable patients with chronic liver disease to tolerate increased amounts of dietary protein, without altering plasma amino acid concentrations.
Detection of intracellular interleukin‐2 production in peripheral T lymphocytes by flow cytometry in patients with pancreatobiliary malignancies
Authors: Uchida Moriaki , Ichida Takafumi , Sato Kazunari , Yonekura Kenji , Yamagiwa Satoshi , Sugahara Satoshi , Asakura Hitoshi
Published: March 2003

Abstract Background and Aims: To date, it has been reported that cellular immunity is decreased in patients with cancer and investigations into cytokine production has been insufficient. Therefore, we examined intracellular cytokine production by using flow cytometry in patients with cancer and discussed the reasons for the impairment of their immune system.

Methods: Eleven patients with hepatobiliary malignancies (68.5 ± 11.8 years of age), eight age‐matched controls (70.0 ± 12.0 years of age) and 10 young volunteers (31.9 ± 3.1 years of age) were used in the present study. Stimulated peripheral blood mononuclear cells from these patients were stained with fluorescence‐labeled anticytokine monoclonal antibodies and analyzed with a Fluorescence activated cell sorter (FAC)Scan™.

Results: The percentage of positively stained T cells was calculated and compared with controls. Repeated measured ANOVA was used for statistical analysis. Interleukin (IL)‐2 production was significantly decreased in patients with cancer compared to controls (P = 0.0122), and it may suggest decreased cellular immune activity of the patients. Simultaneously, spontaneous intracellular IL‐4 production was observed in patients and age‐matched controls, but levels were significantly increased when compared with the young volunteers (P = 0.0052, P = 0.031, respectively).

Conclusions: It was of interest that spontaneous intracellular IL‐4 production was detected in elderly subjects.
Endoscopic characteristics of low‐grade gastric mucosa‐associated lymphoid tissue lymphoma after eradication of Helicobacter pylori
Authors: Urakami Yoshihito , Sano Toshiaki , Begum Shahnaz , Endo Hideko , Kawamata Hitoshi , Oki Yuko
Published: March 2003

Abstract Background and Aims: It was recently reported that low‐grade gastric lymphoma of mucosa‐associated lymphoid tissue (MALT) was regressed by the eradication of Helicobacter pylori. The aim of this study was to confirm the effect of H. pylori eradication on low‐grade gastric MALT lymphoma and to investigate the whitish mucosa that appeared with regression of the lesions.

Methods: Forty‐seven H. pylori‐positive patients with low‐grade gastric MALT lymphoma were treated by using triple therapy. Biopsy specimens were histologically graded and B cell clonality was examined by using reverse transcription–polymerase chain reaction before and after eradication treatment. The relationship between the appearance of whitish mucosa and the degree of gastric gland loss was evaluated.

Results: Histologic regression was observed 2 months after eradication therapy in 42 of 47 patients. However, B cell monoclonality changed to polyclonality in only 23 patients during the follow‐up period. The appearance of whitish mucosa in patients who showed histologic regression became more frequent as the degree of gastric gland loss increased (P < 0.001).

Conclusions: Most low‐grade gastric MALT lymphoma histologically regressed after H. pylori eradication. The appearance of whitish mucosa after histologic regression reflected the degree of gastric gland loss. Whitish mucosa is an endoscopic characteristic and may be an endoscopic marker for regression of low‐grade gastric MALT lymphoma.
Hemodynamics in the left gastric vein after endoscopic ligation of esophageal varices combined with sclerotherapy
Authors: Mizumoto Hideaki , Matsutani Shoichi , Fukuzawa Takeshi , Ishii Hiroshi , Sato Goro , Maruyama Hitoshi , Saisho Hiromitsu
Published: March 2003

Background and Methods: We examined the changes in portal hemodynamics after endoscopic variceal ligation (EVL) combined with endoscopic injection sclerotherapy (EIS) in relation to post‐treatment relapse. The present study included 93 patients who underwent EVL–EIS combination therapy. Portal hemodynamics were examined by Doppler ultrasonography and percutaneous transhepatic portography (PTP).

Results: Therapy with EVL–EIS resulted in the complete disappearance of varices in 89 of 93 patients. Cumulative relapse‐free rates (Kaplan–Meier method) were 75.8 and 50.2%, respectively, 1 and 3–5 years after treatment. At the end of treatment, the flow in the left gastric vein was examined by Doppler ultrasonography. In 50 of 63 patients, the flow remained hepatofugal. In 23 of these patients, PTP was performed at the end of treatment; selective left gastric venography did not reveal any palisade zone vessels or varices. However, fine blood vessels were seen around the lower esophagus in nine patients, only the paraesophageal vein was found in 10 patients and these two findings were present in four patients, indicating that collateral blood flow remained in the lower esophagus in 13 of 23 patients. These findings suggest that frequent relapse of varices results from insufficient blockage of blood flow from the left gastric vein to the lower esophagus. However, in patients with a patent paraesophageal vein, long‐term effects obtained by EVL–EIS combination therapy were satisfactory.

Conclusions: The pattern of the development of collateral left gastric veins represents important hemodynamic changes that predict the long‐term prognosis of patients after treatment.
Pancreatitis‐associated protein‐I mRNA expression in mouse pancreas is upregulated by lipopolysaccharide independent of cerulein‐pancreatitis
Authors: Wang Xingpeng , Wang Bingxian , Wu Jianxin
Published: March 2003

Background and Aims: It is well known that endotoxemia, which is caused by a bacterial infection, can exacerbate acute pancreatitis, whereas pancreatitis‐associated protein (PAP) has the ability to induce bacterial aggregation. Pancreatitis‐associated protein is supposed to protect the tissue from infection during inflammation. In order to clarify the relationship between PAP mRNA expression and endotoxemia during acute pancreatitis, the kinetic patterns of PAP‐I mRNA in mouse pancreas treated with either cerulein or lipopolysaccharide (LPS) or both were investigated in this study.

Methods and Results: The administration of LPS (5 mg/kg) intraperitoneally resulted in a dramatic upregulation of PAP‐I mRNA expression, increasing 18.61‐fold to a maximum at 12 h, then decreasing, but still sustaining at a high level and reaching baseline on day five. These changes were accompanied by the upregulation of tumor necrosis factor (TNF)‐α, interleukin‐1β (IL‐1β), interleukin 6 (IL‐6) and interferon γ (IFNγ) mRNA expressions in the pancreas, but not by marked alterations of serum amylase, lactic dehydrogenase (LDH) and histology. Cerulein also increased PAP‐I mRNA expression. However, the combination of cerulein and LPS was not able to enhance PAP‐I mRNA expression further, although more prominent pancreatitis based on significant changes of serum amylase, LDH and histology were observed.

Conclusion: These results suggest that PAP‐I mRNA might be modulated by endotoxemia, independent of cerulein‐pancreatitis. There were no strong correlations between PAP‐I mRNA expression and the severity of pancreatitis.
Ulcer in the gastric tube for esophageal replacement: A comparison of 12 esophageal cancer patients with or without postoperative radiotherapy
Authors: Koide Naohiko , Hiraguri Manabu , Nishio Akihito , Hanazaki Kazuhiro , Adachi Wataru , Shikama Naoto , Oguchi Masahiko , Maezawa Takeshi , Amano Jun
Published: March 2003

Background and Aims: Ulcer in the gastric tube for esophageal replacement, which was caused by peptic factors or postoperative radiotherapy (Rx), are occasionally reported. The aim of this study was to clarify the clinicopathologic features of the ulcers in the gastric tube.

Methods: In 62 patients with a reconstructed gastric tube, after esophagectomy for esophageal cancer, esophagogastroduodenoscopy was performed. Ulcers of the gastric tube were detected in 12 patients: six with postoperative Rx and six without Rx. The 12 patients with gastric tube ulcers (GU‐group) were reviewed and compared to the remaining 50 patients without ulcers of the gastric tube (Control‐group). Clinicopathologic features of gastric tube ulcers were compared between the patients with and without Rx.

Results: There was no difference in any parameter between the patients of the GU‐ and Control‐groups. Comparing the patients of the GU‐group with and without Rx, the ulcers of the gastric tube in the patients without Rx were frequently located in the lower part of the gastric tube (P = 0.067), detected in a later period after surgery (P = 0.055), associated with cervical esophagitis (P = 0.03), and less associated with gastritis (P = 0.03). In three patients of the GU‐group without Rx, Helicobacter pylori was detected in the gastric tube. Two of the three patients had a history of peptic ulcers before surgery, and had recurrence of the gastric tube ulcers.

Conclusions: Gastric tube ulcers without postoperative Rx may have different characteristics compared to those induced by Rx.
Endotoxin treatment causes an upregulation of the endothelin system in the liver: Amelioration of increased portal resistance by endothelin receptor antagonism
Authors: Gandhi Chandrashekhar R , Kuddus Ruhul H , Nemoto Edwin M , Murase Noriko
Published: March 2003

Background:Mechanisms underlying hepatic microcirculatory failure during endotoxemia are incompletely understood. Because endothelin‐1 (ET‐1) has been implicated in endotoxin‐induced liver injury, we investigated the hepatic ET‐1 system in endotoxin‐treated rats.

Methods:Rats were treated with endotoxin (Escherichia colilipopolysaccharide; 3 mg/kg, i.p.), and various determinations were made 24 h later.

Results:Endotoxin treatment caused 11.2 ± 1.6% weight loss, a decrease in mean arterial pressure (MAP; 96 ± 5 mmHgvs108 ± 3 mmHg;P< 0.05) and an increase in portal pressure (11.6 ± 1.3 mmHgvs7.4 ± 1 mmHg;P< 0.02). No significant changes in the serum levels of liver enzymes or hepatocellular necrosis were observed. Endotoxin caused increases in hepatic ET‐1 (from 345 ± 31 to 565 ± 38 pg/g;P< 0.01), ET‐1 receptor density (from 179 ± 16 to 340 ± 26 fmol/mg;P< 0.02), and mRNA expression of preproendothelin‐1, and ETAand ETBreceptors. While the serum nitric oxide (nitrite + nitrate) concentration was increased in endotoxin‐treated rats, that of ET‐1 remained unchanged. A mixed ETA/ETBreceptor antagonist, TAK‐044 (10 mg/kg, i.v.), reduced the weight loss from 11.2 ± 1.6% to 5.9 ± 2.9% (P< 0.05) and the portal pressure from 11.6 ± 1.3 mmHg to 8.6 ± 0.7 mmHg (P< 0.05) in endotoxin‐treated rats. The mixed ETA/ETBreceptor antagonist also caused an increase in serum ET‐1 concentration, but did not affect serum nitric oxide and MAP in endotoxin‐treated rats.

Conclusions:These results suggest that the upregulated hepatic ET‐1 system is an important mechanism of increased portal resistance and related complications of endotoxemia.
Long‐term interferon therapy for 1 year or longer reduces the hepatocellular carcinogenesis rate in patients with liver cirrhosis caused by hepatitis C virus: A pilot study
Authors: Ikeda Kenji , Saitoh Satoshi , Kobayashi Masahiro , Suzuki Yoshiyuki , Suzuki Fumitaka , Tsubota Akihito , Arase Yasuji , Murashima Naoya , Chayama Kazuaki , Kumada Hiromitsu
Published: March 2003

Background and Methods: In order to elucidate the influence of a long‐term administration of interferon on the appearance rates of hepatocellular carcinoma (HCC) in hepatitis C virus (HCV)‐related cirrhosis, we retrospectively analyzed 694 patients with cirrhosis. A total of 113 patients underwent interferon therapy, including 25 patients with a long‐term administration of interferon for 1 year or more, and the other 581 patients received no antiviral drugs.

Results: Crude cumulative appearance rates of HCC in the interferon and the untreated groups were 14.1, and 28.4% at the end of the 5th year, and 36.7 and 52.5% at the end of the 10th year, respectively (P = 0.0028). As there was a waiting time between diagnosis and treatment (median 2.0 months, average 21.3 months) in the treated group, Cox proportional hazard analysis using a time‐dependent covariate was introduced to evaluate the anticarcinogenic effect of interferon. Although male sex, higher α‐fetoprotein, older age, lower albumin concentration, and lower platelet count significantly increased the carcinogenesis rate, interferon was not a significant contributing factor to the carcinogenesis rate as a whole (hazard ratio = 0.83, P = 0.32). When the patients with interferon were divided into two groups according to therapy duration, long‐term interferon therapy significantly decreased the hepatocellular carcinogenesis rate after an adjustment by significant covariates (hazard ratio = 0.28, P = 0.0048).

Conclusion: When interferon is administered for 12 months or longer, effective cancer prevention will be achieved, even in patients with HCV‐related cirrhosis.
Prevalence of endoscopic reflux esophagitis among Koreans
Authors: Lee Seong J , Song Chi W , Jeen Yoon T , Chun Hoon J , Lee Hong S , Um Soon H , Lee Sang W , Choi Jai H , Kim Chang D , Ryu Ho S , Hyun Jin H
Published: March 2003

Background and Aim: Although reflux esophagitis is believed to be common in the Western population, very few epidemiologic data on reflux esophagitis in Koreans are available. The aims of this study were to evaluate the prevalence of endoscopic reflux esophagitis in patients who came for a physical check‐up at Korea University Hospital, and to study the relationship between various factors relevant to reflux disease.

Methods: This study was carried out prospectively on 7015 patients who received an esophagogastroduodenoscopy from September 1996 to December 1997. Most of the patients were free of symptoms and had come for their self‐paid check‐up.

Results: The overall prevalence of reflux esophagitis was 3.4%, and most of the patients had a mild degree of esophagitis representing grade 1 in 98.3% and grade 2 in 1.7%. The male : female ratio for esophagitis was 7 : 1, and the body mass index (BMI) was significantly higher in patients with reflux esophagitis. A hiatal hernia was found in 166 patients with esophagitis (68.6%), but only in 9.2% patients without esophagitis (P < 0.05). Smoking and alcohol consumption were associated with the development of reflux esophagitis (P < 0.05).

Conclusions: The prevalence of endoscopic reflux esophagitis among Koreans is 3.4%, and most of the patients had a mild grade esophagitis. Smoking, alcohol consumption, the presence of a hiatal hernia and a higher BMI are associated with the development of reflux esophagitis.
Two patients with severe alcoholic hepatitis accompanied by hypercytokinemia and granulocytic hyperelastasemia, successfully treated by intravenous infusion of urinastarine (Miraclid)
Authors: Furukawa Koichi , Kamimura Tomoteru , Mahune Yoshio , Ohota Hironobu , Yoshida Toshiaki , Ishihara Noriko , Tazaki Kazuyoshi , Suzuki Yasushi , Honda Shigeru , Ito Kazuhiko , Miki Iwao , Suzuki Koji , Honma Akira
Published: March 2003

Abstract Severe alcoholic hepatitis (SAH) is not simply a disease of the liver, but it also causes infection and multiple organ failure, and therefore carries an extremely poor prognosis. We report the successful treatment of two patients with SAH. Case 1: The patient was a 55‐year‐old man. He was a heavy drinker whose alcohol intake had increased for some 3 years to 1.8 L sake a day. Slight clouding of consciousness, fever, and jaundice were evident on his admission to our hospital. Laboratory data showed leukocytosis with a predominance of polymorphonuclear leukocytes, and a decline in coagulability. He tested negative for various hepatitis virus markers. With the diagnosis of SAH made, steroid pulse therapy and bilirubin adsorption therapy were administered. The jaundice improved and the interleukin‐8 (IL‐8) level decreased. Continuous intravenous infusion of urinastarine (Miraclid) normalized the granulocyte elastase level. Improvement was also seen in coagulability, ascites, icterus and consciousness. Case 2: The patient was a 49‐year‐old man. He was a heavy drinker whose alcohol intake had increased for 1 month. Fever, jaundice, ascites, and mild disturbance of consciousness were evident at the time of admission. Examination on admission diagnosed SAH. Bilirubin adsorption and continuous intravenous infusion of urinastarine were initiated. As a result, circulating IL‐8 level was decreased and coagulability was improved. Therapy for granulocytic hyperelastasemia and hypercytokinemia supervening on SAH is a new effective approach on improvement in the disease.
Prevalence of gallstone disease in Iran
Authors: Massarrat Sadegh
Published: March 2003

Background: Prevalence of gallstone disease is different depending on the geographic region involved. Few studies, in Asia but not from Iran, about the frequency of gallstone disease have been published. The aim of this study is to examine the prevalence of gallstone disease in Iran.

Methods: Four hundred and seventy‐seven nomads from southern Iran, 513 industrial laborers older than 34 years, and 421 laborers from a pharmaceutical company above 30 years of age, and 471 elderly persons from three nursing homes near Tehran underwent abdominal sonography.

Results: There were 1373 men and 509 women. Eighty‐nine subjects had gallstone disease and 10.1% of them were cholecystectomized. While the prevalence in the men and women in the age group 31–40 years was very low (0.3% in men and 1.8% in women), it increases sharply in men older than 60 years and women older than 50 years to more than 10‐fold (12.5 and 24.6% in male and female with an age 71–80 years, respectively).

Conclusion: In Iran, gallstone disease is very uncommon in middle‐aged people, but increases sharply in older people. However, this does not reach the high prevalence seen in Western countries. The intake of a high fiber‐containing diet, a low number of overweight people, smoking habit and hyperlipidemia are probably the cause for this low prevalence.
Modulation of acid secretion in common bile duct ligation‐related gastropathy in Wistar rats
Authors: Kaur Simran , Kaur Upjeet , Agnihotri Navneet , Tandon Chandan D , Majumdar Siddhartha
Published: March 2003

Background: Portal hypertensive gastropathy is associated with fundic gland atrophy, resulting in a decrease in chief and parietal cells, and diminished acid secretion.

Methods: Acid secretion by isolated parietal cells was measured (acridine orange retention), along with the levels of various second messengers (intracellular Ca2+, cyclic adenosine monophosphate and protein kinase C) in the common bile duct, ligated portal hypertensive rats and compared with sham‐operated controls.

Results: There was a significant decrease in the response of isolated parietal cells to the secretagogues histamine and carbachol. This resulted in the blunted acid secretion in the common bile duct ligated group. In addition, all the second messengers studied were significantly decreased as compared with the sham‐operated controls.

Conclusion: These results suggest that the blunted acid secretory response in the portal hypertensive rat is caused by an alteration in the intracellular signal transduction mechanism.
Embolization of the left portal vein to inferior vena cava shunts for chronic recurrent hepatic encephalopathy via the mesenteric vein
Authors: Takayama Yuichi , Moriura Shigeaki , Nagata Junichi , Akutagawa Atsushi , Hirano Atsushi , Ishiguro Seiji , Matsumoto Takatoshi , Sato Taichiro
Published: March 2003

Abstract Diagnostic imaging and embolization therapy for very rare intrahepatic portal‐systemic shunts with liver cirrhosis are reported. An 82‐year‐old woman was admitted to the hospital (Yachiyo Hospital) because of hepatic encephalopathy. Computed tomography with contrast enhancement demonstrated anomalous vessels between the portal vein and the inferior vena cava. Those shunts were suspected as the cause of her encephalopathy with hyperammonemia. Portography through McBurney's laparotomy demonstrated two portal‐caval shunts; one was from the bifurcation of the portal vein and the other was from the left portal vein. They seemed to originate from the vascular system of the caudate lobe, and were obstructed with stainless coils. The patient is well with a normal serum ammonia level 40 months following the intervention.
Therapeutic effects on intestinal Behçet’s disease of an intravenous drug delivery system using dexamethasone incorporated in lipid emulsion
Authors: Nakase Hiroshi , Okazaki Kazuichi , Kawanami Chiharu , Uchida Kazushige , Ohana Masaya , Uose Suguru , Nishi Toshiki , Itoh Toshiyuki , Okano Akihiro , Nishio Akiyoshi , Takakuwa Hiroshi , Chiba Tsutomu
Published: March 2003

Recurrent intestinal ulcer is a frequent problem in the management of Behçet’s disease. However, no standard therapy for intestinal Beheçt’s disease has been established. We report two patients with intestinal Behçet disease and recurrent ileal ulcers who were treated successfuly with a lipid emulsion of dexamethasone. In one patient, the cecal ulcer did not relapse after the intravenous administration initiation of a lipid emulsion of dexamethasone once a week, despite the discontinuation of prednisolone. In the other patient, the cecal ulcer showed a healing tendency, and oral administration of prednisolone was reduced from 40 to 15 mg/day after intravenous administration of a lipid emulsion of dexamethasone. Both patients experienced no complications associated with the administration of the emulsion. These results suggest that an intravenous drug delivery system using a lipid emulsion of dexamethasone is useful for treatment of intestinal Behçet’s disease.
Cisapride improves gallbladder emptying and bile lipid composition in patients with gallstones
Authors: Dhiman Radha K , Reddi Rajashekhar , Sharma Arpita , Singh Rajinder , Kohli Krishan K , Gupta Sanjay , Suri Sudha , Chawla Yogesh
Published: March 2003

Background and Aim: Biliary cholesterol supersaturation, gallbladder stasis and delayed intestinal transit are the key events in cholesterol gallstone formation. We studied the effect of cisapride, a prokinetic drug, on gallbladder emptying and bile composition in patients with gallstone disease undergoing cholecystectomy.

Methods: Gallbladder emptying, cholesterol saturation index (CSI) and nucleation time were studied in 21 patients with gallstone disease. Eleven patients (cisapride group, age 41.9 ± 2.9 years) received tablet cisapride 10 mg t.i.d. for 2 weeks, while 10 patients (placebo group, age 42.1 ± 1.9 years) received placebo for the same duration. Gallbladder emptying was repeated in all patients after a 2‐week treatment with cisapride or placebo. Gallbladder bile was obtained at the time of surgery for the measurement of CSI and nucleation time.

Results: Residual volume of the gallbladder decreased (mean ± SE, 18.6 ± 2.5 mL vs 10.0 ± 1.1 mL, P = 0.007), and the ejection fraction increased (43.5 ± 5.3%vs 60.0 ± 3.2%, P = 0.007) in patients in the cisapride group, while no change was observed in placebo group patients. Nucleation time was higher in the cisapride group than in the placebo group (14.9 ± 1.3 days vs 8.0 ± 0.9 days, P = 0.003). Patients in the cisapride group had a significantly lower cholesterol concentration (molar percentage, 5.1 ± 0.3%vs 6.8 ± 0.8%, P = 0.049) and CSI (1.0 ± 0.1 vs 1.36 ± 0.11, P = 0.034) than patients in the placebo group.

Conclusion: Cisapride improves gallbladder emptying and bile lithogenicity in patients with gallstone disease.
Comparison of real‐time quantitative polymerase chain reaction with three other assays for quantitation of hepatitis C virus
Authors: Enomoto Masaru , Nishiguchi Shuhei , Shiomi Susumu , Tanaka Motoharu , Fukuda Katsuhiko , Ueda Tadashi , Tamori Akihiro , Habu Daiki , Takeda Tadashi , Yano Yoshihisa , Otani Shuzo
Published: March 2003

Background and Aims: Evaluation of serum levels of hepatitis C virus (HCV) is important for predicting the response to interferon treatment and monitoring its therapeutic efficacy. The aim of this study was to evaluate real‐time quantitative polymerase chain reaction (PCR) as a method for the measurement of HCV‐RNA.

Methods: The subjects were 50 patients with chronic hepatitis C: 36 with genotype 1b, eight with genotype 2a, and six with genotype 2b. Samples were tested for HCV‐RNA by using real‐time quantitative PCR with the ABI Prism 7700 sequence detection system, a branched DNA signal amplification assay, and an Amplicor monitor test; and for HCV core protein by using a fluorescent enzyme immunoassay.

Results: The detection range of the real‐time quantitative PCR was between 101–108 copies/mL of HCV‐RNA. Hepatitis C virus RNA was detectable in all 50 samples by the use of real‐time quantitative PCR, but was undetectable in 14 samples by the use of a branched DNA assay and in two samples by using the Amplicor monitor test; HCV core protein was undetectable in three samples. A significant correlation was found between the results of real‐time quantitative PCR and those of the three other assays: branched DNA assay (r = 0.837, P < 0.0001), Amplicor monitor test (r = 0.853, P < 0.0001), and HCV core protein concentrations (r = 0.549, P < 0.0001).

Conclusions: Our results showed that the real‐time quantitative PCR was a highly sensitive assay for the measurement of HCV‐RNA.
An audit of metal stent palliation for malignant biliary obstruction
Authors: Mcdougall Neil I , Edmunds Simon EJ
Published: March 2003

Background and Aims: Endoscopic stent insertion is the optimum method of palliation for malignant biliary obstruction. Metal stents have several advantages over the polyethylene alternatives, but are significantly more expensive. It has been reported that patients need to survive beyond 6 months to make metal stents more cost‐effective. The aim of this study was to audit the performance of expanding metal biliary stents in our endoscopy unit, and to identify factors that might help with patient selection.

Methods: The records of all patients who were selected for endoscopic metal stent insertion at the Royal Perth Hospital for malignant biliary obstruction between September 1994 and November 1998 were reviewed.

Results: Thirty‐two patients (16 males, mean age 71 years (range 34–88 years) were identified and followed up for a mean 201 days (range 3–810 days). Fifteen (47%) had cholangiocarcinoma, 13 (41%) had pancreatic cancer, and four had metastatic disease as the cause of obstruction. Mortality rates after metal stent insertion were 16, 41 and 55% at 30, 90 and 180 days, respectively. In total, 24 (75%) patients died during the follow‐up period. Eleven (34%) stents became obstructed during follow up with a median time to occlusion of 125 days (range 44–729 days). Patients with cholangiocarcinoma had significantly longer survival than pancreatic cancer cases (median 286 vs 58 days, P = 0.04). No other factors were found to correlate with the survival or stent complications.

Conclusions: Less than half of this mixed cohort survived beyond 6 months. Metal stent palliation of malignant biliary obstruction should probably be targeted at those with cholangiocarcinoma, as these patients tend to survive longer.