Biomedical subjects

Full-Young Chang

Publications and source records attributed to Full-Young Chang.

At least 73 records · Page 4Linked to original sources

PubMed2004

Silent peptic ulcer disease: frequency, factors leading to "silence," and implications regarding the pathogenesis of visceral symptoms.

BACKGROUND: Peptic ulcer disease may occur in the absence of dyspeptic symptoms. The pathogenesis of dyspepsia in peptic ulcer disease is unclear. Whether the presence of Helicobacter pylori infection or use of non-steroidal anti-inflammatory drugs affects dyspeptic symptoms in patients with peptic ulcer disease has not been determined. The aim of the study was to determine the frequency and risk factors for peptic ulcer disease in a cohort of asymptomatic, unselected patients undergoing routine screening EGD. METHODS: This was a prospective study of a cohort of Chinese subjects undergoing screening EGD as part of a routine health maintenance program. Routine EGD screening was performed in 6457 consecutive subjects who underwent a self-paid, health evaluation. Those with endoscopy-confirmed peptic ulcer disease were enrolled to assess the risk factors that distinguish asymptomatic patients with peptic ulcer disease from patients with symptoms because of peptic ulcer disease. RESULTS: A total of 704 (10.9%) patients were found to have peptic ulcer disease, of which two thirds (n=496) were asymptomatic. Both uni- and multivariate analysis showed that the asymptomatic patients tended to have a larger body mass index, to be habitual tea drinkers, and to have an ulcer that was less than 1 cm in diameter and in a healing stage. Gender, blood group, history of hypertension and/or diabetes, ulcer location, Helicobacter pylori status, use of non-steroidal anti-inflammatories or sedative medications, habitual coffee drinking, and habits with respect to smoking of tobacco or ingestion of alcohol, had no association with symptoms. CONCLUSIONS: The results of this study suggest that silent peptic ulcer disease is common in Taiwan. Dyspeptic symptoms because of peptic ulcer disease may be influenced by intrinsic (body mass index and ulcer characters) and extrinsic (habitual tea drinking) factors. Non-steroidal anti-inflammatory drug use and Helicobacter pylori status had no significant effect on the symptomatology of peptic ulcer disease. These findings may contribute to the understanding of the pathogenesis in the visceral symptoms of peptic ulcer disease.

Adult↗

PubMed2004

Loss of sympathetic coordination appears to delay gastrointestinal transit in patients with spinal cord injury.

Patients with spinal cord injury (SCI) often suffer from many gastrointestinal (GI) complaints, while delayed GI transit exists in these patients. We are interested in whether the lost sympathetic activity is one of the mechanisms leading to disturbed GI transit in these subjects. Using a noninvasive hydrogen breath test representing orocecal transit time (OCTT) to study GI transit, 36 SCI patients and 12 age- and sex-matched healthy volunteers were enrolled in our study. Meanwhile, electrocardiogram was performed for all subjects. Finally, spectral analysis of heart rate variability (HRV) was then obtained to assess their sympathovagal balance. SCI patients had higher occurrences of GI symptoms, e.g., nausea/vomiting, belching/hiccup, and constipation, compared to controls (P < 0.05). OCTT was delayed in SCI patients compared to controls (180.8 +/- 10.7 vs 98.3 +/- 14.4 min; P < 0.001). The OCTTs of SCI patients were negatively correlated with their low frequencies of HRV (r = -0.384, P = 0.021). In addition, OCTT was further delayed in quadriplegic patients than paraplegic patients (195.8 +/- 14.5 vs 143.6 +/- 19.4 min; P = 0.031). However, neither the SCI etiology, the injury duration, nor the high frequency of HRV had any influence on the delayed OCTT in SCI patients. We conclude that the GI transit of SCI patients is delayed. This transit disturbance is probably due to loss of sympathetic activity, which is one of the essential components in the coordination of GI peristalsis.

Adult↗

PubMed2004

Impaired gastric myoelectrical activity in patients with Parkinson's disease and effect of levodopa treatment.

The aim of this study was to evaluate gastric myoelectrical activity in patients with Parkinson's disease during and after levodopa treatment. Thirteen Parkinson's patients and 13 age-matched Parkinson's-free controls were enrolled. Electrogastrography was used to record gastric myoelectrical activity in all subjects for 30 min before and 30 min after a standard meal. In the group with Parkinson's disease, gastric myoelectrical activity was recorded during both the "on" (with levodopa treatment) and the "wearing-off" (without levodopa for at least 12 hr) periods. Results were as follows. (1) The patients without treatment showed a significantly lower percentage of regular slow waves and a significantly higher instability coefficient of the dominant frequency; (2) the patients showed an absence of the normal postprandial increase in gastric slow wave frequency which was seen in the controls: and (3) treatment with levodopa resulted in an improvement in the fed state, including a marginal increase in the percentage of regular slow waves (P = 0.1), a significant decrease in the instability coefficient, and an enhanced postprandial power increase. In conclusion, patients with Parkinson's disease have reduced slow wave rhythmicity and an impaired postprandial response in gastric myoelectrical activity. These abnormalities may be partially corrected with levodopa treatment in the fed state.

Aged↗

PubMed2004

Percutaneous injection therapy for hepatocellular carcinoma in patients with chronic renal insufficiency.

OBJECTIVES: Percutaneous injection therapy using acetic acid or pure ethanol is effective for hepatocellular carcinoma (HCC). However, its efficacy in HCC patients with coexisting chronic renal insufficiency (CRI), defined as a serum creatinine level of 1.5 mg/dl or above, is not known. This study compared the survival in HCC patients with and without CRI undergoing percutaneous injection therapy. METHODS: A total of 172 patients (129 male; age 67 +/- 10 years) during a 4-year period were included. Thirty-five of these patients had CRI (creatinine level 2.7 +/- 1.8 mg/dl) before treatment Fourteen patient- and tumour-related parameters were included for survival analysis. RESULTS: The mean follow-up period was 24 +/- 9 (range 4-40) months. Seven (20%) and 39 (28%) patients in the groups with and without CRI, respectively, died. There was no significant survival difference in patients with and without CRI. The cause of death was related to renal failure in two (29%) patients in the former group and one (3%) patient in the latter group. For the patients with CRI, the presence of ascites and a serum creatinine level of 2.3 mg/dl or above were poor prognostic factors in the univariate analysis; the latter was the only independent factor predicting a poor survival by the Cox multivariate proportional model. CONCLUSIONS: CRI does not affect overall survival in HCC patients undergoing percutaneous injection therapy. However, a serum creatinine level of 2.3 mg/dl or above is an independent poor prognostic predictor among patients with existing CRI.

Acetic Acid↗

PubMed2004

Incidence and risk factors for acute renal failure in patients with hepatocellular carcinoma undergoing transarterial chemoembolization: a prospective study.

BACKGROUND: Transarterial chemoembolization (TACE) is effective for hepatocellular carcinoma (HCC). Considerable amounts of radiocontrast agent are used for TACE and may induce renal dysfunction. METHOD: This study prospectively investigated the incidence and risk factors of acute renal failure (ARF), defined as an increase of serum creatinine level >1.5 mg/dl after TACE. RESULTS: ARF developed in 12 (8.6%) of 140 patients after TACE. Univariate analysis showed that number of treatment sessions (2.3 +/- 1.4 vs 1.3 +/- 1.6, P=0.013), Child-Pugh class B (50% vs 21%, P=0.035) and the occurrence of severe postembolization syndrome (75% vs 30%, P=0.020) were significantly associated with the development of ARF. Multivariate logistic regression analysis disclosed that the proportional increased risk of ARF was 65% for each additional TACE therapy (odds ratio [OR]: 1.65, 95% confidence interval [CI]: 1.13-2.41, P=0.010). Other independent risk factors were Child-Pugh class B (OR: 12.82, 95% CI: 2.44-67.29, P=0.003) and severe postembolization syndrome (OR: 6.64, 95% CI: 1.60-27.49, P=0.009). Four (33%) of the patients with ARF developed irreversible renal function impairment, and diabetes mellitus was the only associated factor (P=0.067) in this group. CONCLUSIONS: ARF after TACE is closely associated with number of treatment sessions, severity of cirrhosis and development of severe postembolization syndrome. Effective preventive measures should be undertaken especially in high-risk patients.

Acute Kidney Injury↗

PubMed2004

Differential mechanism and prognostic impact of diabetes mellitus on patients with hepatocellular carcinoma undergoing surgical and nonsurgical treatment.

OBJECTIVES: Diabetes mellitus (DM) is prevalent in patients with hepatocellular carcinoma (HCC) due to coexisting cirrhosis. This study aimed to investigate the long-term impact of DM on HCC patients and its underlying mechanism. METHODS: A total of 567 (120 diabetic) HCC patients were included. The survival was compared between patients with and without DM according to the treatment modality. The occurrence of hepatic decompensation was defined as the sustained increment of the Child-Pugh score by 2 points or more during the follow-up period. RESULTS: Survival analysis showed that DM was not a significant prognostic predictor among the 255 (41 diabetic, 16%) patients who underwent resection (p= 0.155). However, DM was a poor prognostic predictor among those with small (< or = 5 cm) HCC (n = 159; relative risk [RR]: 2.3, 95% confidence interval [CI]: 1.2-5.1, p= 0.021) or those without postoperative tumor recurrence (n = 133; RR: 2.1, 95% CI: 1.2-4.8, p= 0.032) due to the occurrence of more diabetes-related deaths. Of the 312 (79 diabetic, 25%) patients who underwent nonsurgical treatment including transarterial chemoembolization and percutaneous injection, DM was a poor prognostic predictor among those with Child-Pugh A reserve (n = 222; RR: 1.6, 95% CI: 1.1-2.5, p= 0.044). Diabetic patients were more susceptible to develop hepatic decompensation in this group (RR: 1.7, 95% CI: 1.1-2.6, p= 0.012). CONCLUSIONS: There is a selective mechanism and prognostic impact of DM on HCC patients undergoing surgical and nonsurgical therapy. DM may affect the long-term survival through diabetes-related complications or inducing liver failure depending on treatment strategy and under the influence of tumoral and cirrhosis factors.

Aged↗

PubMed2004

Selective prognostic impact of serum alpha-fetoprotein level in patients with hepatocellular carcinoma: analysis of 543 patients in a single center.

The prognostic impact of serum alpha-fetoprotein (AFP) level in patients with hepatocellular carcinoma (HCC) is controversial. This study aimed to investigate the predictive ability of serum AFP in HCC patients. A total of 543 patients undergoing surgical resection (258 patients) and non-surgical treatment (285 patients) including transarterial chemoembolization and percutaneous injection therapy were retrospectively studied. Overall, AFP level >400 ng/ml was an independent poor prognostic predictor [relative risk (RR): 1.4, 95% confidence interval (CI): 1.0-1.9, p=0.049]. Stratified analysis showed that there was a sharp contrast of predictive power of AFP level in treatment strategy and tumor size. In surgical patients, serum AFP >400 ng/ml was a tumor size-independent predictor of tumor recurrence (RR: 1.7, 95% CI: 1.2-2.5, p=0.006) and survival (RR: 2.3, 95% CI: 1.3-3.8, p=0.002). However, there was no association between AFP level and survival in the non-surgical group (p=0.597). Alternatively, among the 157 patients with large (>5 cm) HCCs, AFP >400 ng/ml independently predicted a poor survival (RR: 1.9, 95% CI: 1.2-2.5, p=0.012), whereas no clear relationship between AFP level and survival was found among the 386 patients with small (< or =5 cm) HCCs (p=0.685). There was no differential prognostic impact of serum AFP levels in other variables. In conclusion, serum AFP level is a weak prognostic predictor in HCC patients. Its predictive ability is highly selective and dependent on treatment strategy and tumor size. Incorporation of serum AFP level into any prognostic prediction model should be based on its distinctive selective prognostic power.

Aged↗

PubMed2004

Fenofibrate-induced acute cholestatic hepatitis.

Fenofibrate-induced acute or chronic hepatitis is rare, and only 11 reports from French, Italian or Spanish literature have been published up to date. We report a case of fenofibrate-induced acute cholestatic hepatitis. To the best of our knowledge, this is the first one reported in Taiwan. A 61-year-old man developed acute cholestatic hepatitis after taking fenofibrate 100 mg tid for 10 days. Laboratory profile on admission showed serum total bilirubin 9.3 mg/dL, direct bilirubin 2.7 mg/dL, alanine aminotransferase 249 IU/L, aspartate aminotransferase 259 IU/L, alkaline phosphatase 259 IU/L, and gamma-glutamyl transpeptidase 1014 IU/L. Pathology proved hepatocanalicular cholestasis in liver. Fenofibrate was discontinued immediately. His clinical manifestations and liver function tests improved gradually and returned to nearly normal in 2 months. We suggest that liver function tests, including total bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and gamma-glutamyl transpeptidase, be checked at least 2 weeks after taking the drug and that serum aminotransferase be monitored every 3 months during the first 12 months of therapy. Treatment should be discontinued if alanine aminotransferase values increase by more than 100 IU/L.

Acute Disease↗

PubMed2004

Nitric oxide synthase expression in the splanchnic hyposensitivity to glypressin of a hemorrhage-transfused rat model with portal hypertension.

BACKGROUND: Nitric oxide (NO) has been proposed to participate in the vascular hyporesponsiveness to vasopressin and its long-acting analogue glypressin during hemorrhage in portal hypertensive states. This study surveyed the role of NO regarding splanchnic hyporeactivity to glypressin and NO synthases (NOS) expression in different vascular beds in bleeding portal-hypertensive rats. METHODS: Under general anesthesia with ketamine, partially portal vein-ligated male Sprague-Dawley rats without or with bleeding were used to investigate the hemodynamic effects of glypressin (0.07 mg/kg intravenously) and constitutive (cNOS) and inducible NOS (iNOS) mRNA expression over the abdominal aorta and superior mesenteric artery. RESULTS: Splanchnic hyposensitivity to glypressin was noted in the hemorrhage-transfused rats with enhanced cNOS expression of superior mesenteric artery. No significant differences of cNOS and iNOS expression in abdominal aorta and iNOS in superior mesenteric artery were found between the with-bleeding and without-bleeding groups. CONCLUSIONS: In rats with portal hypertension and acute hemorrhage, cNOS over-expression in superior mesenteric artery may take a part in the splanchnic hyposensitivity to glypressin.

Animals↗

PubMed2003

Concurrent chemoradiotherapy treatment of locally advanced pancreatic cancer: gemcitabine versus 5-fluorouracil, a randomized controlled study.

PURPOSE: To determine the efficacy and tolerability of gemcitabine (GEM)-concurrent chemoradiotherapy (CCRT) vs. 5-fluorouracil (5-FU) CCRT for locally advanced pancreatic cancer. METHODS AND MATERIALS: Thirty-four patients with locally advanced pancreatic cancer were studied. Eighteen patients were randomized to receive GEM CCRT (600 mg/m(2)/wk for 6 weeks) and 16 patients to receive bolus 5-FU CCRT (500 mg/m(2)/d for 3 days repeated every 2 weeks for 6 weeks). All patients were to receive 3D-CRT 50.4-61.2 Gy at 1.8-Gy/d fractions and GEM (1000 mg/m(2) weekly for 3 weeks repeated every 4 weeks) after RT. RESULTS: The median survival and median time to progression were 14.5 months and 7.1 months for the GEM CCRT group and 6.7 months and 2.7 months for the 5-FU CCRT group (p = 0.027 and p = 0.019, respectively). The quality-adjusted life month survival time was 11.2 +/- 0.5 months for GEM CCRT and 6.0 +/- 0.3 months for 5-FU CCRT patients (p <0.001). The response rate was 50% (four complete responses and five partial responses) for GEM CCRT and 13% (two partial responses) for 5-FU CCRT (p = 0.005). Pain control was 39% for GEM CCRT and 6% for 5-FU CCRT (p = 0.043). Grade 3-4 neutropenia (34% vs. 19%), thrombocytopenia (0% vs. 7%), nausea (33% vs. 31%), vomiting (17% vs. 19%), hospitalization days per month of survival (7.4 +/- 1.7 days vs. 8.0 +/- 1.3 days), and full dose of RT received (78% vs. 75%) were not significantly different between the GEM CCRT and 5-FU CCRT patients. CONCLUSION: GEM CCRT appears more effective than 5-FU CCRT for locally advanced pancreatic cancer and has comparable tolerability.

Adult↗

PubMed2003

Pharmacological effects of oxytocin on gastric emptying and intestinal transit of a non-nutritive liquid meal in female rats.

The effects of oxytocin (OT) on gastric emptying, gastrointestinal transit, and plasma levels of cholecystokinin (CCK) were studied in female rats. Gastrointestinal motility was assessed in rats 15 min after intragastric instillation of a test meal containing charcoal and Na(2)(51)CrO(4). Gastric emptying was determined by measuring the amount of radiolabeled chromium contained in the small intestine as a percentage of the initial amount received. Gastrointestinal transit was evaluated by calculating the geometric center of distribution of the radiolabeled marker. Blood samples were collected for CCK radioimmunoassay. After administration of OT (0.2-0.8 mg/kg), gastric emptying and gastrointestinal transit were inhibited, whereas the plasma concentration of CCK was increased in a dose-dependent manner. Atosiban, an oxytocin receptor antagonist, effectively attenuated the OT- induced inhibition of gastric emptying and gastrointestinal transit. However, administration of atosiban alone had no effect on gastric emptying and gastrointestinal transit. The selective CCK(1) receptor antagonists, devazepide and lorglumide, effectively attenuated the OT-induced inhibition of gastric emptying and gastrointestinal transit. L-365, 260, a selective CCK(2) receptor antagonist, did not alter the OT-induced inhibition of gastric emptying and gastrointestinal transit. These results suggest that OT inhibits gastric emptying and gastrointestinal transit in female rats via a mechanism involving CCK stimulation and CCK(1) receptor activation.

Animals↗

PubMed2003

Infrared spectrometry based 13C-octanoic acid breath test in measuring human solid gastric emptying.

BACKGROUND AND AIMS: Because of the convenience of non-dispersive infrared spectrometry (NDIRS), we attempted to validate the usefulness of NDIRS compared with scintigraphy in human solid gastric emptying (GE) measurement, and tried to establish the normal range of solid GE based on NDIRS. METHODS: Twelve healthy volunteers (three men, nine women) were recruited for simultaneous scintigraphy and 13C-octanoic acid breath test (13C-OABT) studies. Stomach half-emptying time (t1/2) and lag phase (tlag) were the two main GE parameters measured and correlated. The breath samples were analyzed using NDIRS every 10-15 min for a total of 6 h, while scintigraphy was taken minute by minute for the first 30 min, then hourly for 4 h. Another 32 healthy volunteers (19 men, 13 women) received only the 13C-OABT to measure their solid GE. RESULTS: A significant correlation for t1/2 was found between the breath test and scintigraphy (r = 0.85, P = 0.001), while tlag was also positively correlated (r = 0.73, P = 0.007). The reference range of t1/2B based on all 44 subjects was 89.4-185.1 min (135.9 +/- 21.1 min (mean +/- SD)), while the range for tlagB was 37.1-117.8 min (81.9 +/- 17.4 min). No demographic characteristics were found to influence the GE parameters. CONCLUSIONS: 13C-octanoic acid breath test determined by NDIRS is a simple, non-invasive and reliable measurement, which may provide an 'office-based' tool to detect solid GE.

Abdomen↗

PubMed2003

Validation of Rome II criteria for functional gastrointestinal disorders by factor analysis of symptoms in Asian patient sample.

BACKGROUND: It has been unclear as to whether the Rome II criteria could be applied to patients in the Asia region with functional gastrointestinal (GI) diseases. The aim of the present study was to determine if symptoms of Asian patients with functional gastrointestinal disorders formed groups which corresponded to the Rome II diagnostic criteria. METHODS: A modified English version of Talley's bowel disease questionnaire was developed in collaboration with various research teams in accordance with the Rome II criteria. This instrument was translated into the local languages of the following nine Asian regions: China, Hong Kong, Indonesia, Korea, Malaysia, Singapore, Taiwan, Thailand and Vietnam. From September to December 2001, newly enrolled outpatients attending 14 GI or medical clinics in these regions were invited to complete the questionnaire. From these respondents, patients with functional gastrointestinal disorders fulfilling the '12 weeks out of 12 months' criteria were separated for further analysis. Principal component factor analysis with varimax rotation was used to identify symptom clusters or factors. These factors were compared with the existing classification of functional GI diseases derived from the Rome II criteria. RESULTS: Factor analysis of symptoms from 1012 functional GI patients supported the Rome II classification of the following groups of functional GI disorders: diarrhea-predominant irritable bowel syndrome, functional constipation, functional dyspepsia, functional abdominal pain syndrome, functional heartburn, and functional vomiting. Functional diarrhea was combined with functional anorectal disorders, and globus merged with functional dysphagia into one factor. Some of the functional dyspepsia, abdominal bloating and belching symptoms were loaded into one factor. CONCLUSIONS: Factor analysis of symptoms from a sample of Asian patients with functional GI disorders partially supported the use of the Rome II classification.

Asia↗

PubMed2003

Simplified 13C-urea breath test with a new infrared spectrometer for diagnosis of Helicobacter pylori infection.

BACKGROUND AND AIM: Infrared spectrometry has correlated excellently with mass spectrometry in detecting the ratio of 13CO(2) to 12CO(2) in breath samples. The present study aimed to evaluate the accuracy of the 13C-urea breath test (13C-UBT) using a new model of infrared analyzer. METHODS: A total of 600 patients who were undergoing upper endoscopy without receiving eradication therapy were entered into the study. Culture, histology, and rapid urease test on biopsies from the antrum and corpus of the stomach were used for the determination of Helicobacter pylori infection. Breath samples were collected before and 20 min after drinking 100 mg 13C-urea in 100 mL water. The optimal cutoff value was determined by the receiver operating characteristic curve. RESULTS: Of the 586 patients who were eligible for analysis, 369 were positive for H. pylori infection, 185 were negative for H. pylori infection, and 32 were indeterminate. When the appropriate cutoff value was set at 3.5 per thousand, a sensitivity of 97.8%, a specificity of 96.8% and an accuracy of 97.5% were obtained using the 13C-UBT. The accuracy of the 13C-UBT decreased when CO(2) concentration in the breath sample was <2%, as compared with > or = 2% (93.6%vs 97.7%), mainly because of a decrease in specificity (81.8%vs 97.7%). There were 2.7% of patients with Delta13CO(2) values that fell between 3.0-4.5 per thousand, in whom the risk of error was 47%. CONCLUSIONS: The 13C-UBT performed with infrared spectrometry is a highly sensitive, specific, and non-invasive method for the detection of H. pylori infection. The immediate availability of the test result and technical simplicity make it particularly effective in routine clinical practice.

Adult↗

PubMed2003

Plasma erythropoietin level in patients with cirrhosis and its relationship to the severity of cirrhosis and renal function.

BACKGROUND AND AIM: The level of plasma erythropoietin (EPO) in patients with cirrhosis is controversial. It is known that overproduction of nitric oxide (NO) plays, in part, a role for the development of peripheral arterial vasodilatation in cirrhosis with portal hypertension. It has also been hypothesized that a possible interaction is noted between endogenous EPO and NO production. The current study was undertaken to evaluate the relationship between plasma EPO levels and the severity of liver disease, hemodynamic values, renal functions, and plasma nitrate/nitrite levels in patients with cirrhosis. METHODS: The authors measured the biochemistry, plasma EPO and nitrate/nitrite levels in 67 patients with cirrhosis (Child-Pugh class A in 23 and Child-Pugh class B and C in 44) and compared their values with those in 34 healthy subjects. Systemic and splanchnic hemodynamic measurements and effective renal plasma flow were obtained from cirrhotic patients. RESULTS: Plasma EPO and nitrate/nitrite levels were significantly increased in patients with cirrhosis compared with healthy subjects. Additionally, plasma EPO values were higher in cirrhotic patients with ascites or with anemia than in those without ascites or without anemia, respectively. Plasma EPO levels were positively correlated to the hepatic venous pressure gradient (HVPG) and Child-Pugh score, negatively correlated to the renal and hepatic blood flows, but were not correlated to nitrate/nitrite level and systemic vascular resistance in cirrhotic patients. Multiple regression analysis showed that HVPG and renal plasma flow were independent predictors for the elevated EPO level in cirrhotic patients. CONCLUSIONS: Plasma EPO levels were increased in patients with cirrhosis compared with those in healthy subjects. The increase in plasma EPO levels is related to the degree of portal hypertension, the severity of cirrhosis and the renal plasma flow. In contrast, the EPO levels had no correlation to the nitrate/nitrite levels and systemic vascular resistance in patients with cirrhosis.

Anemia↗

PubMed2003

Effect of Helicobacter pylori eradicated therapy on water gastric emptying in patients with active duodenal ulcer.

BACKGROUND AND AIMS: It remains debatable if duodenal ulcer (DU) or Helicobacter pylori infection has a definite impact on human gastric emptying (GE). We explored the nature of water GE in active DU patients before and after ulcer healing and the influence of H. pylori eradication on GE. METHODS: A home made applied potential tomography (APT) was used to measure liquid GE. Twelve electrodes were placed in a circular array around the upper abdomen of studied subjects. After drinking 500 mL of ion-free water, paired electrodes injected electrical current and the remaining 10 electrodes recorded signals, one-by-one in a rotating order. Based on tomographical calculation, the serial changes of averaged signals from altered resistivities were constructed to display GE. Initially, 64 H. pylori infected active DU patients were enrolled. After APT measurement, one-week triple therapy (omeprazole, amoxicillin and clarithromycin) was dispensed. Patients were asked back to determine ulcer/H. pylori status and GE on a scheduled date 3 months later. Finally, 58 patients finished the trial with valid and readable GE data obtained. RESULTS: The ulcer healing and H. pylori eradicated rates were 91.4% and 82.8%, respectively. In general, liquid GE was prolonged in all DU patients at follow up. Of 48 eradicated patients, 35.4% manifested either enhanced or delayed GE before treatment, whereas only five (10.4%) had abnormal GE after treatment (P < 0.0001). In contrast, this characteristically normalized GE was not found in non-eradicated patients. CONCLUSIONS: Water GE of active DU patients ranges from enhanced to delayed, while an effective H. pylori triple therapy is useful not only for healing ulcers, but also for restoring abnormal GE.

Adult↗

PubMed2003

Stomach myoelectrical response of patients with gastroesophageal reflux disease receiving omeprazole treatment.

BACKGROUND AND AIM: Proton pump inhibitor treatment is effective for gastroesophageal reflux disease (GERD). It is unknown whether these agents effect any change in the stomach myoelectricity of GERD patients. Electrogastrographic (EGG) recording was used to study the probable effect of omeprazole on GERD patients. METHODS: Nineteen endoscopically confirmed GERD patients and 38 dyspepsia-free controls were invited to receive EGG recording. After daily omeprazole treatment for 4 weeks, the symptomatic response of GERD patients was scaled, healing of erosive esophagitis was endoscopically assessed, and EGG recording was repeated for comparison. RESULTS: Before treatment, GERD patients and controls displayed similar dominant frequency, whereas the former had higher dominant power compared with controls, either in fasting (29.2 +/- 6.0 dB compared with 25.3 +/- 3.8 dB, P < 0.01) or postprandial (31.9 +/- 5.6 dB compared with 27.7 +/- 3.8 dB, P < 0.001) recording. They also had diminished percentile normal rhythm (2-4 c.p.m.), irrespective of fasting (40.2 +/- 14.5% compared with 65.8% +/- 23.5%, P < 0.001) or postprandial (47.5 +/- 23.3% compared with 77.9 +/- 16.8%, P < 0.001) recording. After omeprazole treatment, healing was achieved in 12 patients (63.2%). Among the abnormal EGG parameters, only the postprandial percentile normal rhythm was restored (47.5 +/- 23.3% compared with 65.2 +/- 20.8%, P < 0.01). CONCLUSIONS: Gastroesophageal reflux disease patients may have obvious dysrhythmia and higher myoelectrical power. Effective omeprazole treatment only improves the postprandial myoelectrical regularity, whereas abnormal EGG parameters remain impaired.

Adult↗

PubMed2003

Cytochrome P450 2E1 genotype and the susceptibility to antituberculosis drug-induced hepatitis.

Most cases with antituberculosis drug-induced hepatitis have been attributed to isoniazid. Isoniazid is metabolized by hepatic N-acetyltransferase (NAT) and cytochrome P450 2E1 (CYP2E1) to form hepatotoxins. However, the role of CYP2E1 in this hepatotoxicity has not yet been reported. The aim of this study was to evaluate whether the polymorphism of the CYP2E1 gene is associated with antituberculosis drug-induced hepatitis. A total of 318 tuberculosis patients who received antituberculosis treatment were followed prospectively. Their CYP2E1 and NAT2 genotypes were determined using a polymerase chain reaction with restriction fragment length polymorphism method. Twenty-one healthy volunteers were recruited for CYP2E1 phenotype study using a chlorzoxazone test. Forty-nine (15.4%) patients were diagnosed to have drug-induced hepatotoxicity. Patients with homozygous wild genotype CYP2E1 c1/c1 had a higher risk of hepatotoxicity (20.0%; odds ratio [OR], 2.52) than those with mutant allele c2 (CYP2E1 c1/c2 or c2/c2, 9.0%, P =.009). If CYP2E1 c1/c2 or c2/c2 genotype combined with rapid acetylator status was regarded as the reference group, the risk of hepatotoxicity increased from 3.94 for CYP2E1 c1/c1 with rapid acetylator status to 7.43 for CYP2E1 c1/c1 with slow acetylator status. After adjustment for acetylator status and age, the CYP2E1 c1/c1 genotype remained an independent risk factor for hepatotoxicity (OR, 2.38; P =.017). Furthermore, under the administration of isoniazid, the volunteers with CYP2E1 c1/c1 genotype had higher CYP2E1 activity than those with other genotypes had and, hence, might produce more hepatotoxins. In conclusion, CYP 2E1 genetic polymorphism may be associated with susceptibility to antituberculosis drug-induced hepatitis.

Acetylation↗