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PubMed1991

Use of H2-receptor antagonists in patients with dyspepsia and heartburn: a cost comparison.

OBJECTIVE: Under the Pharmaceutical Benefits Scheme, the use of H2-receptor antagonists (H2A) in the treatment of dyspepsia and heartburn is only subsidised when there is a proven diagnosis of ulcer. This study compared the costs of this Australian practice with a simulation of British practice, which allows unrestricted prescribing of subsidised H2A. DESIGN: Patients with heartburn and/or dyspepsia were prospectively randomised to either a "British" group treated freely at the discretion of their general practitioner without necessarily being investigated or an "Australian" group where use of H2A was allowed only after gastroscopy or a barium meal had demonstrated a peptic ulcer or ulcerative oesophagitis. The patients were followed up for six months and all direct and indirect costs were recorded. SETTING: Forty-nine Sydney general practitioners recruited primary care patients for the study. PATIENTS: Any patient with heartburn or dyspepsia was considered for recruitment; 139 patients entered the study and 137 completed it. MAIN OUTCOME MEASURES: The outcome measures were the costs of general practitioner consultations, specialist consultations, radiology and gastroscopy, other tests, H2A, other medications, personal costs, and total cost per patient. RESULTS: The cumulative total cost per patient at the end of the study was equivalent in the "Australian" ($392) and "British" ($406) groups. A higher initial cost per patient of H2A in the "British" group was offset by a rapid decrease in the proportion that continued to use H2A and by the cost of specialist consultations and investigations in the "Australian" group. CONCLUSION: Over a six-month period the cost of early investigation of heartburn and dyspepsia was equivalent to the cost of a therapeutic trial of H2A.

Adult↗
PubMed2000

Demographic and endoscopic characteristics of patients with Helicobacter pylori positive and negative peptic ulcer disease.

OBJECTIVE: To identify demographic and endoscopic characteristics of patients with Helicobacter pylori positive and negative chronic peptic ulcer disease. DESIGN: Cross-sectional study of peptic ulcer disease in prospectively recruited PATIENTS undergoing gastroscopy. PATIENTS: 277 consecutive patients referred for gastroscopy in 1996-1998. MAIN OUTCOME MEASURES: Rapid urease test, culture and histological examination for H. pylori infection; anti-H. pylori IgG antibodies in serum; demographic data, intake of non-steroidal anti-inflammatory drugs (NSAIDs) in the preceding 3 months, and size, number and location of ulcers. RESULTS: 54 patients (19%) had evidence of peptic ulcer disease (34 gastric ulcer, 14 duodenal ulcer and 6 both gastric and duodenal ulcer); 45 had active chronic peptic ulcer disease and were analysed in detail. H. pylori was present in 25 (56%) of these patients; 10 (22%) had used NSAIDs and 7 of the NSAID group also had H. pylori infection. Of the patients with gastric ulcers, those with non-H. pylori, non-NSAID ulcers were significantly younger than both those with H. pylori-associated ulcers (mean age, 48 v. 65 years, P = 0.02) and those with NSAID-associated ulcers (mean age, 48 v 68 years, P = 0.02). The average size and number of gastric ulcers did not differ between patients with and without H. pylori infection. Of patients with duodenal ulcers, those with H. pylori infection had significantly fewer ulcers (1.1 v. 1.8, P = 0.04), although ulcer size was similar in the infected and uninfected groups. CONCLUSIONS: Gastric ulcers may now be more common than duodenal ulcers. Gastric ulcers associated with H. pylori infection and/or NSAID use occurred mostly in older people, while non-H. pylori, non-NSAID gastric ulcers were more common in younger patients. In the duodenum, single ulcers were associated with H. pylori infection, and multiple ulcers were more frequent in the non-H. pylori, non-NSAID group.

Adolescent↗
PubMed1999

Antral histopathological changes in acid peptic disease associated with Helicobacter pylori.

The histopathology of the antral mucosa of patients with acid peptic disease was studied in relation to Helicobacter pylori infection. Three hundred and fifty-five patients underwent gastroscopy and biopsy on 443 occasions. During each gastroscopy, two antral samples were taken for Rapid Urease Test (RUT) for H. pylori and two antral samples for histopathology. Haematoxylin and Eosin and modified Giemsa stained sections were studied. Histopathological changes in the antrum and the density of H. pylori were graded according to the Sydney System criteria. There was a significant association between the RUT and histology results for detection of H. pylori. The overall prevalence of H. pylori was 61.4% with a maximum incidence in the third and fourth decades of life, and an equal sex distribution. H. pylori colonisation was seen in 90.7% of patients with duodenal ulcer, 66.7% with gastric ulcer and 44.3% with non-ulcer dyspepsia. H. pylori colonisation was associated with more severe antral chronic active gastritis, lymphoid follicles, intestinal metaplasia and dysplasia. Elimination of H. pylori by treatment with anti-H. pylori regimens resulted in regression of the changes.

Adolescent↗
PubMed2000

[Diagnosis of stomach carcinoma in the horse].

In 10 horses, which were referred to the clinic with the suspicion of disorders of the gastrointestinal tract, gastroscopy revealed a gastric tumour. In ten cases the diagnosis of a squamous cell carcinoma was made on the basis of histology of biopsies or autopsy. The tumour always derived from the non-glandulary mucosa. The horses showed various clinical symptoms. All patients had a hypoalbuminemia and a hyperglobulinemia in the serum electrophoresis. This suggests that a gastric tumour can be suspected intra-vitam even without gastroscopy of the patient.

Animals↗
PubMed2001

Immunohistochemical assessment of an asymptomatic glucagonoma in a patient with hypergastrinemia and marked antral angiodysplasia.

A 58-year-old patient had been treated for recurrent gastritis. Numerous gastroscopies indicated hemorrhagic gastritis combined with increasingly severe anemia. The patient was admitted with a hemoglobin of 4.4 g/dL. Gastroscopy showed marked antral angiodysplasia. Serum samples for gastrin were taken and found to be elevated (170-250 U/mL). The search for a gastrin-producing tumor with abdominal ultrasound, computed tomography, octreotide scan, and secretin test was negative, but angiography detected a pancreas tumor with a 2-cm diameter. Partial pancreatectomy and partial gastrectomy were performed. Immunohistochemical examination of the tumor did not show a gastrinoma but did show glucagon-reactive tissue. Further tumors or elevated plasma hormone levels were not detected, and a multiple endocrine neoplasia type I syndrome could be excluded. We thus found antral angiodysplasia with hypergastrinemia leading to detection of a glucagonoma diagnosed by immunohistochemistry. After more than 4 years of follow-up, the patient is without any symptoms or signs of relapse or secondary hormone syndrome.

Diagnosis, Differential↗
PubMed2000

[Clinical and pathological characteristics of gastric stump cancer and recurrent gastric stump cancer].

OBJECTIVE: To study early diagnosis and rational treatment of gastric stump cancer and recurrent gastric stump cancer. METHODS: The data of 27 patients with gastric stump cancer and 23 patients with recurrent gastric stump cancer were analysed retrospectively during the past 20 years based on their clinical and pathological findings. RESULTS: The onset time was 10 years or more for gastric stump cancer and less than 10 years for recurrent gastric stump cancer after gastrectomy. Gastroscopy was better than double contrast radiography in diagnosis. Partial resection of gastric stump was performed for patients with early cancer at the anastomotic stoma of gastrojejunostomy. Total resection of gastric stump was made for other patients. Lymph node of the mesojejunum were dissected routinely because their metastasis rate was about 40.0% in patients with cancer of anastomotic stoma. The effect of surgical treatment was poor for patients with advanced cancer. CONCLUSIONS: Regular gastroscopy is useful in detecting gastric stump cancer in patients with gastric cancer after gastrectomy, or in those years after removal benign. Malignancy was more evident in recurrent gastric stump cancer than in primary gastric cancer. Prognosis is good for early stage cases and poor for late stage cases after surgical treatment.

Adult↗
PubMed1975

The Mallory-Weiss syndrome.

During a 41/2-year period, 1970-74, 174 patients with upper gastro-intestinal bleeding were admitted to the Department of Surgical Gastroenterology, Rigshospitale, Copenhagen, Denmark. In 11, a Mallory-Weiss syndrome was diagnosed. In 10, the diagnosis was made by means of gastroscopy, and in 1 patient at operation. It was not possible to make the diagnosis by means of X-ray examination of the oesophagus or the stomach. In one patient, a hiatal hernia was found. The etiology was violent and repeated vomiting. In 9 of the cases the syndrome was cuased by chronic alcoholic debauch and migraine. In 1 patient, the disease was caused by an abrupt external trauma of the abdomen after a traffic accident. In the last patient, the cause of the disease was uncertain. The treatment was entirely conservative, i.e. blood replacement, in 10 of the patients. The bleeding stopped after this treatment, and it was not necessary to use a Sengstaken-Blakemore tube, nor was a later surgical exploration needed, except in one patient in whom an emergency operation was required because of extensive and persistent bleeding. At operation, 3 mucosal tears were sutured. At the time of discharge, all 11 patients were feeling well. Based on the present material, and cases reported in the literature, we have concluded that emergency gastroscopy is the most reliable diagnostic measure in patients with the Mallory-Weiss syndrome. The treatment ought to be as conservative as possible with replacement of the blood, and surgical intervention should be performed only in the few patients with incontrollable bleeding.

Adult↗
PubMed2001

Correlation between liver damage and degree of gastric mucose colonization by Helicobacter pylori in subjects with parenchymatous liver damage.

BACKGROUND: Helicobacter pylori (H. pylori) is an important factor responsible for chronic inflammatory conditions of the gastric mucosa. It has been demonstrated in numerous animal studies that some Helicobacter species may cause parenchymatous liver damage. The aim of the study was to investigate whether there is any correlation between the incidence of parenchymatous liver damage, and the incidence and degree of colonization of the gastric mucosa by H. pylori. MATERIAL AND METHODS: The study was carried out in the group of 30 patients (14 females, 16 males) whose mean age was 37 years, hospitalized because of parenchymatous liver damage without clinical symptoms of cirrhosis. All the patients had gastroscopy and urease tests performed, and mucosal biopsies were taken for immunomorphological investigations. The patients were divided into groups, group I comprising those with positive, and group II with negative urease test results. RESULTS: Positive urease tests were obtained in 26/30 patients (group I), 18/26 of whom demonstrated macroscopic changes of the gastric mucosa visible in gastroscopy. Group II with negative urease test results comprised 4/30 patients, 2/4 of whom had detectable changes in the gastric mucosa. The presence of H. pylori antigens was demonstrated by gastric mucosa immunomorphology in all 30 patients. The degree of invasion of H. pylori was visualized by immunofluorescence, which allowed to differentiate deep mucosal invasion of H. pylori (bacterial antigens present in lymph follicles and at the base of muciferous glands) observed in group I in 14/26 and in group II in 1/4 cases and superficial invasion (epithelium and mucosal surface) observed in group I in 12/26, in group II in 3/4. CONCLUSIONS: The obtained results may suggest more frequent H. pylori infections in subjects with parenchymatous liver damage than in the population without liver damage. Immunofluorescence seems to be a highly sensitive method allowing for detection of even small degrees of gastric mucosa colonization by H. pylori.

Adult↗
PubMed1975

[The value of gastrocytograms in gastroenterologic practice].

Gastroenterological diagnostics practised in out-patient departments requires a good correlation between costs and rate of success; for this reason the swab probe technique was used for examining the morphology of the stomach. Evaluating the gastrocytogram will have to suffice as a practical method until the day when gastroscopy, cytological tests or biopsies can be done on a large scale in out-patient departments. Since -- despite constant probing for tumors -- only a minority of the patients reveal any lesions of a suspect nature in the X-ray, the majority of cases involves gastritis. The gastrocytogram may replace some of the X-rays and secretion analyses; however, it does not constitute an alternative to purposive gastroscopy and biopsy. Eosinophiles and micro-adenomatous cell associations were found to occur in some cases of atrophic gastritis as a special cytological characteristic.

Adult↗
PubMed2002

A case-control study on risk factors of helicobacter pylori infection in out-patients with stomach diseases.

OBJECTIVE: To investigate the risk factors of Helicobacter Pylori (Hp) infection. METHODS: All cases and controls came from 561 cases of out-patients with stomach diseases seeking gastroscopy in the Zhejiang Province First Hospital between April and July in 2000. The tissue samples of patients were stained for Hp by the improved Warthin-Starry technique and by methylene blue stain for routine histopathology. We classified patients as cases or controls based on the detection of Hp or not. Before gastroscopy, a questionnaire on lifestyle and health condition of was administered to patients by the interviewers. RESULTS: The overall prevalence of Hp infection was 50.21% and the risk factors of Hp infection were significantly different between males and females. As for males, the duration of daily heavy physical activities, numbers of siblings in the household, family history of oliver disease, preference of spicy food and smoking were the risk factors for Hp infection. However, preference of beans and bean products, drinking well water, drinking tea, eating regularly and good education appears to decrease the prevalence of infection. As for females, consumption of caffeine contained beverages seemed to increase risk for infection. By analyzing with unconditional Logistic Regression Model in male and female groups combined, it brought to light that intake of egg and peppery food were the risk factors of infection, and intake of beans and drinking tea were the protective factors. CONCLUSION: Consumption of beans and drinking tea must be advocated and the consumption of spicy food should be discouraged.

Case-Control Studies↗
PubMed2002

[Clinical analysis of 31 patients with gastric stromal tumors].

OBJECTIVE: To investigate the clinical manifestations, diagnosis and treatment of gastric stromal tumors. METHODS: 31 patients with gastric stromal tumors treated from 1993, 1 - 2001, 9 were analyzed retrospectively. All cases were diagnosed by pathological and immunohistochemistry examinations. According to Levin's standard combining with Hurliman's and Goldbum's methods, the patients were classified. RESULTS: There are no significant difference between male and female patients. 50 - 60 years old patients have high incidence. The distribution of gastric tromal tumors is fundus > body > antrum. Diagnosis of this condition is sometimes difficult and treatment is often delayed because patients usually present with nonspecific abdominal symptoms. The main manifestations of gastric stromal tumors are upper gastrointestinal hemorrhage 61.3% (19/31), 7 patients with acute hemorrhage and 12 with chronic hemorrhage. Most of them were malignant. Abdominal malaises and/or distention 32.3% (10/31) and abdominal pain 22.6% (7/31). Gastroscopy, ultrasound gastroscopy, computed tomography, B type ultrasound and upper gastrointestinal X-ray series are helpful to diagnosis. But the final diagnosis is decided by pathological and immunohistochemistry examinations. Gastric stromal tumors exhibit consistent immunohistochemical expressions of CD(117) and/or CD(34). The operative treatment is thought of the first choice. Effect of the chemotherapy isn't satisfied. There is no standard chemotherapy for gastric stromal tumors. CONCLUSIONS: Gastric stromal tumor is a kind of separated submucosal tumor which is different from leiomyoma, leiomyosarcoma and neurogenic tumors. Pathological and immunohistochemistry inspectations are very important to make clear diagnosis. Early diagnosis and rational treatment are the keys to improve the prognosis.

Adult↗
PubMed2002

Digestive anisakiasis: clinical manifestations and diagnosis according to localization.

OBJECTIVES: Digestive anisakiasis is a parasitic disease whose clinical manifestations depend on the effect of Anisakis simplex on the digestive tract wall. Larvae are acquired by eating raw or poorly cooked fish. It is estimated that this entity is currently under-diagnosed, although publications are becoming increasingly common. We analyse our series of digestive anisakiasis checking localization and studying its relationship with symptoms and method of diagnosis. PATIENTS AND METHOD: We review 23 cases of digestive anisakiasis registered between 1989 and 2001, and confirmed by the measurement of specific serum Ig E antibodies. We analyse clinical symptoms and method of diagnosis according to whether localization was gastro-duodenal or intestinal, evaluating whether surgical intervention was needed for a correct diagnosis. The statistical analysis is made using Fisher's test. RESULTS: 23 patients were included between 1989 and 2001, 8 with gastro-duodenal localization and 15 with intestinal localization. All patients with intestinal localization had abdominal pain. Symptoms were less severe for gastro-duodenal cases, and diagnosis was made by clinical suspicion and subsequent gastroscopy, whereas more than a half of intestinal cases required histological examination of a surgical specimen for correct diagnosis. In the remaining half, diagnosis was made by abdominal ultrasonography. We also observed that the need for surgery has decreased with time from 6/6 cases in the 1989-1996 period of time to 2/9 in the 1997-2001 period of time. CONCLUSIONS: Clinical manifestations of anisakiasis vary depending on localization, symptoms being more severe in intestinal forms. The diagnosis of gastro-duodenal anisakiasis did not need surgery and was based mainly on gastroscopy findings, whereas intestinal forms frequently required histological examination of the surgical specimen. In our hospital, a higher index of clinical suspicion allowed us to diagnose intestinal anisakiasis without examination of surgical specimens in the last years.

Animals↗
PubMed2002

Efficiency of the glutaraldehyde test strip for monitoring the concentration of glutaraldehyde in reused solutions for disinfecting endoscopes.

BACKGROUND: Glutaraldehyde has been widely used for low-temperature disinfection of endoscopes. The current practice at Siriraj Hospital is to change the glutaraldehyde solution every 21 days or when the solution appears turbid. The disadvantages of this practice include inadequate disinfection of endoscopes if the concentration of glutaraldehyde in a reused solution is insufficient or wasted if the discarded solution is still active. OBJECTIVE: To determine the efficiency of a glutaraldehyde test strip (GTS) in monitoring the amount of glutaraldehyde in a reused solution for disinfecting endoscopes. METHOD: Reused glutaraldehyde solutions for disinfecting bronchoscopes, gastroscopes and colonoscopes were tested for the concentration of glutaraldehyde with a GTS thrice weekly for the first week and then every working day up to 56 days. If the GTS indicated a concentration of glutaraldehyde > or = 1.8 per cent after 21 days, 5 ml of the solution was taken to the laboratory to determine its mycobactericidal activity. RESULTS: All samples of the reused glutaraldehyde solution up to 56 days with a concentration of > or = 1.8 per cent glutaraldehyde on GTS from testings showed mycobactericidal activity. If the glutaraldehyde solution was reused for up to 28, 42 or 56 days, it could save 9,603; 22,813 and 29,415 baht per year respectively for the gastroscopy and colonoscopy units. The corresponding figures were -949; 2,726 and 4,564 baht per year for the bronchoscopy unit. It is estimated that up to 400,000 baht per year could be saved by adopting the strategy of GTS monitoring in all endoscopy units at Siriraj Hospital. CONCLUSION: The current strategy of discarding reused glutaraldehyde solution in the gastroscopy, colonoscopy and bronchoscopy units at Siriraj Hospital may be inappropriate since the reused solution is still mycobactericidal for up to 56 days.

Bronchoscopes↗
PubMed2003

Endoscopic evaluation of the upper gastrointestinal tract is worthwhile in premenopausal women with iron-deficiency anaemia irrespective of menstrual flow.

BACKGROUND: In premenopausal women, iron-deficiency anaemia is common and menstrual flow is often held responsible, but it is not clear whether these women should be submitted to gastrointestinal (GI) evaluation. We aim to prospectively investigate whether premenopausal women with iron-deficiency anaemia benefit from GI evaluation regardless of menstrual flow. METHODS: The study population comprised 59 consecutive premenopausal women with iron-deficiency anaemia. Excluded were women with obvious or suspected causes of anaemia and those < or = 21 years. Heavy menstrual loss was not considered an exclusion criterion. All subjects had: complete blood count, ferritin, non-invasive testing by faecal occult blood (FOB), 13C-urea breath test (13C-UBT), anti-tissue transglutaminase antibodies (tTG) and gastrin levels. Gastroscopy with antral (n = 3), corporal (n = 3) and duodenal (n = 2) biopsies was performed in women with positive 13C-UBT or tTG titre or hypergastrinaemia. RESULTS: Heavy menstrual loss was present in 50.8%. Non-invasive tests were positive in 40/59 (67.8%): 30 had positive 13C-UBT, 12 had hypergastrinaemia, 7 had positive tTG and 3 had positive FOB. Women tested positive were similar to those tested negative as far as concerned age, haemoglobin and ferritin levels and heavy menstrual flow (55% versus 42.1%). All 40 women tested positive underwent gastroscopy with biopsies. Four (10%) had bleeding-associated lesions and 34 (85%) had non-bleeding-associated lesions. As regards upper GI findings, no differences were observed between women with normal and those with heavy menstrual flow. No lower GI tract lesions were detected in the three women with positive FOB. CONCLUSIONS: Our data suggest that premenopausal women with iron-deficiency anaemia benefit from endoscopic evaluation of the upper GI tract irrespective of menstrual flow.

Adult↗
PubMed2002

The effect of chronic alcohol abuse on gastric and duodenal mucosa.

Alcohol consumed in small quantities is not dangerous for health but if it is drunk in big amounts it has a negative effect on somatic and psychical health. A number of studies have been published on the harmful effect of ethanol on the nervous system, circulation, endocrine and immune systems. Ethyl alcohol can directly damage the mucosa of the alimentary tract. The studies conducted and published so far have estimated acute ethanol damage of gastric mucosa in experimental animals. The views found in literature on the effect of continuous consumption of ethanol on the stomach are differentiated. The purpose of the paper was to provide a morphological and functional analysis of stomach and duodendum in patients who continuously abuse alcohol. Besides, at attempt was made to find the answer to the question whether the changes observed in gastric mucosa point to any connection with the period of alcohol abuse. The study referred to 79 persons: 61 male aged 17-65 who had been chronically drinking alcohol for the period of 5-37 years and 18 persons aged 17-59 (9 male and 9 female) who had never drunk alcohol or who had drunk it only rarely and in small were divided into three groups differing with the period of addiction (I--5-10 years; II--10-20 years; III--over 20 years). Hydrochloric acid secretion in gastric juice was marked and gastroscopy was performed in all the examined patients. Gastroscopy estimated the appearance of the gastric and duodenal mucosa, while biopsy specimens were taken for histological examination from the pyloric area, the body of the stomach and the duodendal bulb. Hydrochloric acid secretion was determined using the Kay's aspiration method. Pentagastrin was used to stimulate gastric secretion. Within the group of 79 patients, gastric mucosa inflammation was observed in all patients chronically drinking alcohol and in 72% patients who were the control. Both groups differed considerably with the degree of progression of the inflammatory process, which was estimated with histological examination. Atrophic gastritis was observed only in patients addicted to alcohol. The appearance of atrophic changes pointed to a close relation with the period of addiction. 13 out of 14 people with this type of inflammation had been drinking alcohol for at least 10 years. The studies did not show any relation existing between the percentage of cases with atrophic inflammation and the kind of drinks or the content of ethanol in them. Examinations concerning the secretory function of the stomach showed lower values of hydrochloric acid secretion, both in basic conditions and after pentagastrin stimulation, in patients addicted to alcohol as compared to the control. The results prove that continuous abuse of alcohol predisposes to atrophic inflammation of the gastric mucosa, and the appearance of this type of inflammatory changes is related to the duration of addiction. The longer the addiction, the lower the secretion of hydrochloric acid is.

Adolescent↗
PubMed2003

Assessment of correlation between histopathologic changes of gastric mucosa according to Whitehead's classification and extent of liver damage according to Knodell's scale in patients with chronic hepatopathy.

AIM OF THE STUDY: Patients with chronic liver damage often suffer from functional disturbances and pathologic changes in the stomach, including ulceration, erosions and chronic gastritis. It was attempted to establish whether there is a correlation between histopathologic abnormalities of the gastric mucosa and the extent of histopathologic changes in liver bioptates, i.e. inflammatory activity and fibrosis (Knodell's index) in patients with chronic hepatopathy. MATERIAL/METHODS: The study was carried out in 4 groups of patients: groups I--10 subjects with autoimmune hepatitis, group II--9 patients with chronic toxic liver damage, group III--11 patients with chronic hepatitis caused by HBV, and group IV--36 patients with chronic hepatitis caused by HCV. All the patients underwent gastroscopy with collection of gastric mucosa bioptates (from the antrum and the gastric body) as well as liver biopsy. RESULTS: The most frequent gastroscopy finding in all the studied groups were signs of gastritis: in group I--90%, in group II--78%, in group III--64% and in group IV--99%. Gastric mucosa histopathology assessed according to Whitehead's classification most frequently led to the diagnosis of gastritis chronica profunda (Group I--80%, Group II--78%, Group III--73% and Group IV--58%). No correlation was found between inflammatory activity in the liver assessed according to Knodell's scale and the extent of changes in histopathology of the gastric mucosa (p = 0.1). A negative correlation which, however, does not reach significance level (p = 0.054), is observed between the extent of fibrosis in liver bioptates and histopathologic abnormalities in the gastric mucous membrane. CONCLUSION: No statistically significant correlation between the extent of gastric mucosa damage and severity of inflammatory lesions and hepatic fibrosis was found.

Adolescent↗
PubMed2004

[Triplex operations for children with extrahepatic portal hypertension].

OBJECTIVE: To evaluate the effect of triplex operations (splenopneumopexy, portal azygous devascularization and ligation of splenic artery) for children with extrahepatic portal hypertension. METHODS: From March 1993 to November 1998, 7 children with extrahepatic portal hypertension underwent triplex operations. The diagnosis for these patients were confirmed by gastroscopy, barium meal and Doppler ultrasonography. The number of WBC and platelet and the hepatic function were checked before and after operations. And the free portal pressures were checked before and after ligations of the splenic artery. All patients were followed up for 2 to 8 years (5.6 years on average). The episodes of upper gastrointestinal bleeding were recorded. The degrees of varices of distal esophagus and proximal stomach were assessed by barium meal and gastroscopy. The diameters of the splenic and portal veins were obtained by B ultrasound. The portopulmonary shunt and portal blood flow were evaluated by color Doppler flow image. The indices of hemorheology such as hematocrit, viscosity of whole blood and plasma, and the index of deformability and aggregability of RBC were obtained through viscometer (R-20 Seerle, Beijing). RESULTS: There was no operative fatal case in this group. Postoperatively, hemorrhage from the esophagus and gastric varices was completely controlled. Although the diameter of spleen reduced progressively, no patient's spleen recovered to normal size during the follow up period. The degree of varices was mitigated and the free portal pressure was significantly decreased to (34.48+/-5.71) cm H2O from the preoperative one (42.62+/-6.72) cm H2O (P<0.05). The rate of portal flow was also decreased. The direction of portal vein was bidirection (one part was away from the liver and the other was toward the liver). The number of WBC and platelet and the viscosity of whole blood and hematocrit were increased to normal value after operation. CONCLUSION: The triplex operation is an effective procedure for the control of hemorrhage from varices in children with extrahepatic portal hypertension.

Child↗
PubMed2004

[The value of Helicobacter pylori stool antigen ImmunoCard STAT in diagnosis of HP infection and assessing of eradication of HP].

OBJECTIVE: To evaluate the value of Helicobacter pylori (Hp) stool antigen ImmunoCard STAT (HpSA ImmunoCard STAT) in diagnosis of Hp infection and assessment of eradication of Hp. METHODS: Stool specimens were collected from 80 patients with upper gastrointestinal symptoms, 41 males and 39 females, aged 18 - 73, 40 of which undergoing gastroscopy and having never received Hp eradicating regimen (group A) and another 40 of which undergoing follow-up examination (group B). HpSA ImmunoCard STAT was used to detect the Hp status in the specimens of stool. Rapid urease test, Hp culture, and Warthin-Starry silver staining were used as "gold standards" to evaluate the Hp status of the biopsy specimens. (13)C-urea breath test ((13)C-UBT) was used as the "gold standard" for the patients that did not undergo gastroscopy. Part of the biopsy specimens of gastric mucosa underwent HpSA test too. The result was considered positive when 2 of the 3 tests in the "gold standard" were positive or culture of Hp was positive. RESULTS: The sensitivity, specificity, and accuracy of HpSA test for the 80 patients as a whole were 100%, 93.2%, and 96.3%, not significantly different from those of the "gold standard". The sensitivity, specificity, and accuracy of HpSA test for the 40 patients in the group A were 100%, 86.7%, and 95.0% respectively; and the sensitivity, specificity, and accuracy of HpSA test for the 40 patients in the group B were 100%, 96.6%, and 97.5% respectively. The sensitivity and specificity of the 26 gastric biopsy specimens were both 92.3%. CONCLUSIONS: HpSA test by HpSA ImmunoCard STAT is a simple and accurate test in diagnosis of Hp infection and assessment of eradication of Hp.

Adolescent↗