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Association between Helicobacter pylori Seropositivity and the Coronary Artery Calcium Score in a Screening Population.

Min Jung PARK ; Seung Ho CHOI ; Donghee KIM ; Seung Joo KANG ; Su Jin CHUNG ; Su Yeon CHOI ; Dae Hyun YOON ; Seon Hee LIM ; Young Sun KIM ; Jeong Yoon YIM ; Joo Sung KIM ; Hyun Chae JUNG

Gut and Liver.2011;5(3):321-327.

BACKGROUND/AIMS: Helicobacter pylori causes numerous extragastric manifestations, including coronary heart disease. The coronary artery calcification (CAC) score, measured using computed tomography (CT) has been used as a screening test for coronary atherosclerosis. This study investigated the association between H. pylori seropositivity and CAC scores in a screening population. METHODS: Patients who underwent a health checkup between October 2003 and July 2007 and who did not have a history of ischemic heart disease were enrolled in the study. Subjects were screened with a multidetector CT scan to determine the CAC score and for anti-H. pylori antibody immunoglobulin G; traditional risks for coronary heart disease were evaluated using a structured questionnaire, anthropometric measurements, and laboratory tests. RESULTS: Of the 2,029 subjects enrolled (1,295 males), 1,214 (59.8%) subjects were H. pylori positive and 815 were H. pylori negative. There were no significant differences in the baseline characteristics of the seropositive and seronegative patients. When the CAC presence or absence scores were considered, multivariate analysis revealed that H. pylori seropositivity was statistically associated with the presence of CAC and that this association was stronger in the mild CAC score category. CONCLUSIONS: H. pylori seropositive patients are at a higher risk for coronary atherosclerosis regardless of traditional cardiovascular risk factors. This association is particularly applicable for early coronary atherosclerosis.
Calcium ; Coronary Artery Disease ; Coronary Disease ; Coronary Vessels ; Helicobacter ; Helicobacter pylori ; Humans ; Immunoglobulins ; Mass Screening ; Multivariate Analysis ; Myocardial Ischemia ; Risk Factors ; Surveys and Questionnaires

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Relationship between the Extent of DNA Damage and Gastritis in Normal and Helicobacter pylori-Infected Patients.

Mohammed Ali M MARIE ; Isam Elshaikh ALTAHIR

Gut and Liver.2011;5(3):315-320.

BACKGROUND/AIMS: The role of Helicobacter pylori in gastric carcinogenesis is unclear, but H. pylori infection is thought to predispose carriers to gastric cancer. The aim of this study was to investigate the relationship between the extent of DNA damage in normal gastric epithelial cells and H. pylori-positive and -negative gastritis according to histological diagnosis. We also compared the percentage of cometed cells on the surface of the gastric epithelial cells to the percentage beneath the gastric mucosal cells using serial incubations times. METHODS: The comet assay is a rapid, efficient and reproducible measure of DNA damage in single cell and it was used in this study. DNA damage was evaluated in 52 cases using alkaline single cell gel electrophoresis (comet assay). Comparisons were made between 19 normal individuals, 19 patients with H. pylori-positive and -negative gastritis and 14 mixed cases with different histology gradings to determine if there was a relationship between histological diagnosis and DNA damage (comet percentage). RESULTS: The comet percentages in specimens from cases with normal histology were significantly higher than the comet percentages in specimens from cases with H. pylori-positive gastritis. In addition, there was a significant increase in the percentage of cometed cells on the surface of gastric epithelial cells in both normal and H. pylori-infected cells compared to the subsequent gastric cell layers of the same specimen. CONCLUSIONS: A relationship between the comet percentage and the histological diagnosis was observed.
Comet Assay ; DNA ; DNA Damage ; Electrophoresis ; Epithelial Cells ; Gastritis ; Helicobacter ; Helicobacter pylori ; Humans ; Stomach Neoplasms

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Role of 18F-FDG PET Scans in Patients with Helicobacter pylori-Infected Gastric Low-Grade MALT Lymphoma.

Kyung Ho SONG ; Mijin YUN ; Jie Hyun KIM ; Woo Ick YANG ; Dae Ryong KANG ; Jae Bock CHUNG ; Yong Chan LEE

Gut and Liver.2011;5(3):308-314.

BACKGROUND/AIMS: Endoscopic ultrasound (EUS) plays a crucial role in the assessment and treatment of low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma; however, interobserver variation, inadequate accuracy in judging the depth of tumor invasion, and histological heterogeneity of the tumor can limit its role. Thus, we have assessed the role of 18F-FDG PET scans in the management of Helicobacter pylori-infected gastric MALT lymphoma. METHODS: Eighteen patients with H. pylori-infected low-grade gastric MALT lymphoma underwent an 18F-FDG PET scan prior to receiving H. pylori eradication therapy. We analyzed these patients' clinicopathologic data and measured the baseline and change in the metabolic activity of the tumor using standardized uptake values (SUVs). RESULTS: Two patients failed to achieve complete remission of the low-grade gastric MALT lymphoma after successful H. pylori eradication. The baseline SUVs were significantly higher in these patients compared to successfully treated patients, 13.35+/-0.07 vs 2.98+/-0.93, respectively (n=2 vs n=16, p<0.001). The reduction in the SUV was significantly greater in the complete remission patients compared to treatment failure patients (p=0.018). CONCLUSIONS: A high SUV at baseline 18F-FDG PET and a lower reduction in the SUV within 3 months after eradication therapy are associated with treatment failure in H. pylori-positive low-grade gastric MALT lymphoma patients undergoing eradication treatment.
Fluorodeoxyglucose F18 ; Helicobacter ; Helicobacter pylori ; Humans ; Lymphoid Tissue ; Lymphoma, B-Cell, Marginal Zone ; Observer Variation ; Population Characteristics ; Positron-Emission Tomography ; Treatment Failure

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A Multicenter, Randomized, Comparative Study to Determine the Appropriate Dose of Lansoprazole for Use in the Diagnostic Test for Gastroesophageal Reflux Disease.

Si Hyung LEE ; Byung Ik JANG ; Seong Woo JEON ; Joong Goo KWON ; Eun Young KIM ; Kwang Bum CHO ; Chang Geun PARK ; Chang Heon YANG

Gut and Liver.2011;5(3):302-307.

BACKGROUND/AIMS: The diagnostic proton pump inhibitor test (PPI test) is a method used in diagnosing gastroesophageal reflux disease (GERD). This study aimed to determine the appropriate dose of lansoprazole for use in the diagnostic test for GERD. METHODS: This study was a randomized, controlled, multicenter trial in the Daegu-Gyeongbuk area. Patients with typical reflux symptoms such as regurgitation and heartburn for at least three months were enrolled in this study. Patients were divided into two groups, the erosive reflux disease (ERD) group and the non-erosive reflux disease (NERD) group, and randomized to 14 days of treatment with lansoprazole at a dose of 15 mg, 30 mg or 60 mg once daily. The PPI test was considered positive if the patient's symptoms improved by more than 50%. RESULTS: A total of 218 patients were enrolled, and analysis was performed on the 188 patients who completed the study. The PPI test was positive in 93.2% of the ERD group and 87.2% of the NERD group. A positive PPI test was observed in 91.7%, 89.4%, and 87.2% of the 15 mg, 30 mg, and 60 mg groups, respectively. Significant symptom score changes were observed starting on day 8 for the 15 mg, 30 mg, and 60 mg groups. CONCLUSIONS: In this multicenter, randomized study of Korean patients, the standard dose of lansoprazole was as effective as a high dose of lansoprazole in relieving the symptoms of GERD, regardless of the presence of ERD, by day 14 of treatment.
2-Pyridinylmethylsulfinylbenzimidazoles ; Diagnostic Tests, Routine ; Gastroesophageal Reflux ; Heartburn ; Humans ; Proton Pumps

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Cow's Milk Allergy among Children with Gastroesophageal Reflux Disease.

Fatemeh FARAHMAND ; Mehri NAJAFI ; Pedram ATAEE ; Vajiheh MODARRESI ; Turan SHAHRAKI ; Nima REZAEI

Gut and Liver.2011;5(3):298-301.

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) and cow's milk allergy (CMA) are two common conditions that occur in infancy. This study was performed to investigate the frequency of CMA in a group of patients with GERD. METHODS: Eighty-one children with signs and symptoms of GERD were enrolled in this study. All subjects received omeprazole for 4 weeks after the initial evaluation. Empirical elimination of cow's milk from the diet was started for the patients who did not respond to the omeprazole treatment. RESULTS: Seventy-two cases presented with gastrointestinal signs and symptoms, whereas the remaining nine cases presented with respiratory complaints. After the initial treatment with omeprazole, two thirds of the cases (54 patients, 66.7%) responded well, and all of their symptoms were resolved. Cow's milk was eliminated from the diets of the remaining 27 patients. All signs and symptoms of GERD were resolved in this group after a 4 week elimination of cow's milk from the diet. CONCLUSIONS: A diagnosis of CMA was considered in one third of the pediatric cases with signs and symptoms of GERD. This finding shows that CMA can mimic or aggravate all signs and symptoms of severe GERD during infancy.
Child ; Diet ; Food Hypersensitivity ; Gastroesophageal Reflux ; Humans ; Hydrazines ; Milk ; Milk Hypersensitivity ; Omeprazole

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Short-Term Healing Process of Artificial Ulcers after Gastric Endoscopic Submucosal Dissection.

Osamu GOTO ; Mitsuhiro FUJISHIRO ; Shinya KODASHIMA ; Chihiro MINATSUKI ; Keiko NIIMI ; Satoshi ONO ; Nobutake YAMAMICHI ; Kazuhiko KOIKE

Gut and Liver.2011;5(3):293-297.

BACKGROUND/AIMS: The relationship between the appearance of an ulcer and postoperative bleeding after gastric endoscopic submucosal dissection (ESD) is not well understood. To explore this potential relationship, we retrospectively analyzed the short-term healing process of ESD. METHODS: A total of 520 consecutive lesions in 434 patients seen between January 2004 and December 2009 were retrospectively investigated. At the second-look endoscopy, which occurred between 1 and 8 days after ESD, artificial ulcers were categorized into 6 patterns according to Forrest's classification: spurting bleeding, oozing bleeding, non-bleeding visible vessel, adherent clot, black base/spot, and clean base. From these data, a short-term healing model of the artificial ulcer was generated. RESULTS: Ulcer base changed gradually from a bloody to a clean one. The bleeding or non-bleeding visible vessel categories, which occurred in approximately one quarter of the ulcers within 3 days of ESD, were rarely observed 4 days after ESD. CONCLUSIONS: Ulcers that occur after gastric ESD heal in line with a specific time course, and it appears that most healing occurs without massive bleeding.
Endoscopy ; Glycosaminoglycans ; Hemorrhage ; Humans ; Retrospective Studies ; Stomach Neoplasms ; Ulcer

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Percutaneous Endoscopic Gastrostomy Prevents Gastroesophageal Reflux in Patients with Nasogastric Tube Feeding: A Prospective Study with 24-Hour pH Monitoring.

Sung Hoon JUNG ; Seok Ho DONG ; Jae Yeon LEE ; Nam Hoon KIM ; Jae Young JANG ; Hyo Jong KIM ; Byung Ho KIM ; Young Woon CHANG ; Rin CHANG

Gut and Liver.2011;5(3):288-292.

BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) has been widely used for patients with swallowing dysfunction. However, its beneficial effects in the treatment of gastroesophageal reflux (GER) are controversial. The aim of this study was to evaluate the effect of PEG on the prevention of GER in patients with nasogastric tube (NGT) feeding. METHODS: Continuous 24-hour pH monitoring was performed prospectively in 21 patients receiving NGT feeding before and 7.3+/-2.2 days after PEG placement to compare the severity of GER. RESULTS: We studied 21 patients with a mean age of 59.8+/-14.1 years. The mean duration of NGT placement was 5.8+/-5.4 months. The causes of swallowing dysfunction included cerebral infarction, cerebral hemorrhage and other central nervous system (CNS) lesions. When all of the patients were considered, there were no significant differences in reflux parameters after PEG placement compared to before PEG placement. However, all seven patients who had preexisting GER showed significant improvement (p<0.05) of the reflux parameters, including the frequency of acid reflux, duration of acid reflux, total time with a pH below 4.0 and the fraction of time with a pH below 4.0, after PEG placement. CONCLUSIONS: PEG might prevent GER in patients receiving NGT feeding, especially in those patients with GER.
Central Nervous System ; Cerebral Hemorrhage ; Cerebral Infarction ; Deglutition ; Gastroesophageal Reflux ; Gastrostomy ; Humans ; Hydrogen-Ion Concentration ; Prospective Studies

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Current Nucleos(t)ide Analogue Therapy for Chronic Hepatitis B.

Soon Sun KIM ; Jae Youn CHEONG ; Sung Won CHO

Gut and Liver.2011;5(3):278-287.

Although the prevalence of chronic hepatitis B has decreased considerably in recent years due to widespread use of the hepatitis B virus (HBV) vaccine, its prevalence still remains high in adults, and this can place a significant burden on health care in areas with endemic HBV. Since the introduction of nucleos(t)ide analogues (NUCs), there has been marked improvement in the care of patients with chronic hepatitis B, resulting in increased survival. However, the emergence of drug resistance in patients treated with NUCs is a major concern. The number of multi-drug resistant patients is increasing, and many patients may not respond to the currently available drugs. In this review, we describe the current status of NUC therapy for antiviral-naive and -resistant patients.
Adult ; Delivery of Health Care ; Drug Resistance ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Hypogonadism ; Mitochondrial Diseases ; Ophthalmoplegia ; Prevalence

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Clinical Significance of Hiatal Hernia.

Jong Jin HYUN ; Young Tae BAK

Gut and Liver.2011;5(3):267-277.

The relationship between hiatal hernias and gastroesophageal reflux disease (GERD) has been greatly debated over the past decades, with the importance of hiatal hernias first being overemphasized and then later being nearly neglected. It is now understood that both the anatomical (hiatal hernia) and the physiological (lower esophageal sphincter) features of the gastroesophageal junction play important, but independent, roles in the pathogenesis of GERD, constituting the widely accepted "two-sphincter hypothesis." The gastroesophageal junction is an anatomically complex area with an inherent antireflux barrier function. However, the gastroesophageal junction becomes incompetent and esophageal acid clearance is compromised in patients with hiatal hernia, which facilitates the development of GERD. Of the different types of hiatal hernias (types I, II, III, and IV), type I (sliding) hiatal hernias are closely associated with GERD. Because GERD may lead to reflux esophagitis, Barrett's esophagus and esophageal adenocarcinoma, a better understanding of this association is warranted. Hiatal hernias can be diagnosed radiographically, endoscopically or manometrically, with each modality having its own limitations, especially in the diagnosis of hiatal hernias less than 2 cm in length. In the future, high resolution manometry should be a promising method for accurately assessing the association between hiatal hernias and GERD. The treatment of a hiatal hernia is similar to the management of GERD and should be reserved for those with symptoms attributable to this condition. Surgery should be considered for those patients with refractory symptoms and for those who develop complications, such as recurrent bleeding, ulcerations or strictures.
Adenocarcinoma ; Barrett Esophagus ; Constriction, Pathologic ; Esophageal Sphincter, Lower ; Esophagitis, Peptic ; Esophagogastric Junction ; Gastroesophageal Reflux ; Hemorrhage ; Hernia, Hiatal ; Humans ; Manometry ; Ulcer

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Pharmacologic and Complementary and Alternative Medicine Therapies for Irritable Bowel Syndrome.

William D CHEY ; Monthira MANEERATTAPORN ; Richard SAAD

Gut and Liver.2011;5(3):253-266.

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by episodic abdominal pain or discomfort in association with altered bowel habits (diarrhea and/or constipation). Other gastrointestinal symptoms, such as bloating and flatulence, are also common. A variety of factors are believed to play a role in the development of IBS symptoms, including altered bowel motility, visceral hypersensitivity, psychosocial stressors, altered brain-gut interactions, immune activation/low grade inflammation, alterations in the gut microbiome, and genetic factors. In the absence of biomarkers that can distinguish between IBS subgroups on the basis of pathophysiology, treatment of this condition is predicated upon a patient's most bothersome symptoms. In clinical trials, effective therapies have only offered a therapeutic gain over placebos of 7-15%. Evidence based therapies for the global symptoms of constipation predominant IBS (IBS-C) include lubiprostone and tegaserod; evidence based therapies for the global symptoms of diarrhea predominant IBS (IBS-D) include the probiotic Bifidobacter infantis, the nonabsorbable antibiotic rifaximin, and alosetron. Additionally, there is persuasive evidence to suggest that selected antispasmodics and antidepressants are of benefit for the treatment of abdominal pain in IBS patients. Finally, several emerging therapies with novel mechanisms of action are in development. Complementary and alternative medicine therapies including probiotics, herbal therapies and acupuncture are gaining popularity among IBS sufferers, although concerns regarding manufacturing standards and the paucity of high quality efficacy and safety data remain.
Abdominal Pain ; Acupuncture ; Alprostadil ; Anti-Bacterial Agents ; Antidepressive Agents ; Carbolines ; Complementary Therapies ; Constipation ; Diarrhea ; Flatulence ; Gastrointestinal Diseases ; Humans ; Hypersensitivity ; Inflammation ; Irritable Bowel Syndrome ; Metagenome ; Parasympatholytics ; Placebos ; Probiotics ; Rifamycins ; Serotonin ; Biomarkers ; Lubiprostone

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