Complaints Of Dyspepsia Research Articles

Association Between Symptoms, Quality of Life, and Gastric Emptying in Dyspeptic Patients.

Background/AimsAssociation between symptoms, quality of life and gastric emptying in dyspepsia is inconsistent in the literature. The aim of our study is to investigate if gastric emptying is associated with specific symptoms and quality of life in dyspeptic patients.MethodsWe reviewed retrospectively gastric emptying measured by 13C-labelled octanoate breath testing for more than 6 hours in 198 consecutive patients with dyspepsia complaints. Gastrointestinal symptoms were assessed using a 5-points Likert scale and by a symptomatic composite score, whereas quality of life was measured by the GIQLI.ResultsIn our cohort, 90 patients (45%) had a delayed gastric emptying (half emptying time above 166 minutes when assessed over 6–8 hours). There was no difference in symptoms or quality of life between patients with or without delayed gastric emptying. However, patients with severely delayed gastric emptying (half emptying time above 200 minutes) had increased postprandial fullness (P = 0.012), abdominal pain (P = 0.026), bloating (P = 0.044), early satiety (P = 0.018), symptomatic composite score (P = 0.005), and a lower quality of life (P = 0.018). This association was no longer observed if the calculation of gastric emptying was limited to the first 4-hour samples.ConclusionsThere is no association between symptoms, quality of life and gastric emptying in an overall dyspeptic population. However, there is an association between symptoms, quality of life of delayed gastric emptying in the subgroup of patients with severely delayed gastric emptying. An 8-hour measurement of gastric emptying should be recommended.

Histopathological study of endoscopic gastric biopsies in dyspeptic patients with special correlation to helicobacter pylori

Aims: 1. To identify various pathological lesions in gastric biopsies in patients with dyspeptic symptoms 2. To determine that H. pylori is a major etiologic organism in the pathogenesis of chronic gastritis and to assess the graded variables of Helicobacter associated gastritis. Materials and methods: A total of 93 cases with complaint of dyspepsia were studied during the period July 2016 to July 2017. Endoscopic examinations as well as biopsy specimens from gastric mucosa were studied in all the cases for the various mucosal lesions. Results: Out of 93 cases studied, dyspepsia was most common clinical symptom seen in 80 patients. On endoscopy 18 patients showed normal appearance and erythema was the most common finding in 40 patients. On histopathology, 6 were normal, 80 cases showed various forms of chronic gastritis and 7 cases were malignant. Out of 80 cases of chronic gastritis, 43 showed H. pylori positivity. Most of the H. pylori positive cases were associated with activity and mononuclear inflammatory infiltrate. Conclusion: Prevalence of H. pylori in the present study was 46.2% in patients undergoing upper gastro-intestinal endoscopic biopsies. H. pylori associated gastritis is the predominant type of gastritis. Accurate endoscopic and histopathological examination of gastritis according to the Sydney grading system is a valuable indicator of H. pylori infection.

The Study of Proportion and Molecular Characterisation of Helicobacter pylori in Dyspeptic Patients in Sri Manakula Vinayagar Medical College and Hospital

Background: Helicobacter Pylori is the colonized in humans over 100,000 years, the prevalence of H.Pylori in different in various parts of the world. Complications of the organism are varies. This study helps in proportion of H.pylori in the patients attending in tertiary hospital. Aims: 1. The study of proportion of Helicobacter pylori in dyspepsia. 2. Molecular characterisation of Helicobacter pylori in dyspeptic patients in Sri Manakulavinayagar Medical College and Hospital. Methodology: A Hospital based cross section study conducted in Department of General Medicine. The study period was about one and half year after obtaining the ethical committee approval. The study population is of 95 who are came with the complaint of dyspepsia diagnosed by Rome category, patients underwent upper gastro endoscopy tissue sample obtained sent for histopathology staining, Urease test, PCR test. Results: Among the study participants, histopathology report for H.pylori positive for 19 out of 95 participants, percentage 20.0%.Urease report is positive for 22 out of 95 participants, percentage 23.16%.Among the histopathology positive for H.pylori in study participants, PCR for VacA Gene is positive in 10 out of 19 study participants, percentage 52.63%. P valve = 0.001 in Histopathology report, P valve = 0.003 in Urease report, P valve = <0.01 in PCR report. P value <0.05 will be considered statistically significant. Conclusions: H.pylori infections cause gastro-duodenal ulcers, carcinoma, MALT lymphoma. Identifying and treating the infection is important. Patients with VacA gene positive in this study can be treated with four drug regimens.

"Squamos cell lung cancer" case applying with dyspepsia complaints

Abstract We present a patient with uncommon metastases of lung cancer. The patient has been followed-up for early stage laryngeal carcinoma in the remission and has had dyspeptic complaints as well. A 62-year-old male patient had epigastric complaints for three months. In the upper endoscopy, a biopsy specimen taken from the polyp in the second region of the duodenum was reported as squamous cell cancer. Immunohistochemical staining of tumor cells were positive for CK5/6, p40, and p63. A mass in the right lung was detected on thorax tomography. The result of the transthoracic needle biopsy indicated squamous cell cancer. Duodenal metastasis of lung cancer is highly unlikely. Lesions below 1 cm can be safely removed endoscopically. Duodenal metastasis of primary lung cancer can be considered in the differential diagnosis of resistant dyspepsia.

NONULCER DYSPEPSIA

Objectives: To determine the frequency of nonulcer dyspepsia in patientspresenting with the peptic ulcer like symptoms and to determine the effect of H. pylori eradicationon dyspeptic symptoms and the effect of six weeks trial of proton pump inhibitor as treatmentmeasure. Study design: Cross-sectional study. Setting: Combined Military hospital Quetta,Department of medicine. Period: Six months from Oct, till March 2009. Subjects and Methods:Patients coming to medicine department with complaints of dyspepsia. Results: Total no ofpatients were 145 out of which male were 90 while 55 were females. The mean age was 29.68+ 4.53. These subjects were given H pylori eradication therapy and response was graded aspatients responded or no response. 89 subjects (61.4%) responded to H pylori eradicationtreatment while 56 subjects (38.6%) showed no symptomatic benefit. Non responder toeradication i.e., 37 males and 36 females were given further six week treatment with omeprazole,and subjective response to treatment was graded as complete resolution found in 31 patients (21.4% ), while partial resolution was present in 15 patients (10.3%). 07 patients (4.8%) showedno improvement while 03 patients (2.1%) showed worsening of symptoms. Conclusions: Theprevalence of non-ulcer dyspepsia is high among symptomatic individuals. The response toH pylori eradication was significant. Non responders also showed considerable symptomaticbenefit with PPI. Therefore, individuals with recurrent dyspeptic symptoms should be given trialof H. pylori eradication.

Helicobacter pylori in lacrimal secretions.

The aim of this study was to investigate the presence of Helicobacter pylori in human lacrimal and nasal secretions. Eighty patients with complaints of dyspepsia who had undergone endoscopies and gastric antrum biopsies were included in the study. A total of five specimens, including 2 lacrimal secretion samples, 2 nasal mucosal swab samples, and 1 gastric antrum biopsy, were collected from each patient and investigated with polymerase chain reaction (PCR) methods consisting of the urease enzyme coding gene GlmM (UreC) and the H pylori-specific 16S rRNA coding gene. The Reflux Symptom Index and ophthalmologic complaints of the patients were recorded. The detected positivity rates of the H pylori 16S rRNA coding gene in gastric biopsies and nasal mucous and lacrimal secretions were 55, 11.2, and 20%, respectively. The patients were grouped as gastric-antrum-biopsy-negative (Group I [n = 36]) and -positive (Group II [n = 44). In Group II, H pylori positivity in the lacrimal and nasal mucous secretions was 36.3 and 18%, respectively. A comparison between the groups in terms of H pylori presence in nasal mucous and lacrimal secretions yielded statistically significant differences (p = 0.0001, p = 0.003). The simultaneous presence of H pylori in nasal mucous and lacrimal secretions was 13.6% in Group II. H pylori positivity in nasal mucous and lacrimal secretions had a positive moderate correlation (r = 0.40; p = 0.0003). The present study is the first report on the presence of H pylori in lacrimal secretions through nested PCR, which suggested the presence of a number of mechanisms for H pylori transmission to lacrimal secretions.

Sero - Prevalence of &amp;lt;i&amp;gt;Helicobacter Pylori&amp;lt;/i&amp;gt; in HIV Positive Patients and HIV Negative Controls in St. Paul’s General Specialized Hospital, Addis Ababa, Ethiopia

Background. <i>Helicobacter pylori (H. pylori)</i> is recognized as a major human pathogen. Clinical symptoms associated with <i>H. pylori</i> infection have been reported in patients with human immunodeficiency virus (HIV). A high, normal, and a lower sero - prevalence of <i>H. pylori</i> infection in HIV positive patients than negative controls was found in different studies. The aim of this study was to assess the sero - prevalence of <i>H. pylori</i> infection in HIV positive patients and negative controls and determine the impact of CD4 cell count in patients with <i>H. pylori</i> in St. Paul’s General Specialized Hospital in Addis Ababa, Ethiopia. Methods. A comparative cross sectional study was conducted in HIV positive patients and controls with gastrointestinal symptoms using Serology test kit (ACON^® <i>H. pylori</i>, USA). All individuals who came to Voluntary Counselling and Testing and Anti - Retroviral Therapy to the Out Patient Department of the hospital were examined for complaints of dyspepsia and those with the complaint were tested for <i>H. pylori.</i> Results. Of the 106 HIV positive subjects, 68 (64.2%) were positive for anti - <i>H. pylori</i> IgG antibodies; and of the 106 HIV negative controls, 52 (49.1%) were positive for anti - <i>H. pylori</i> IgG antibodies (p=0.037). There was no significant difference of <i>H. pylori</i> seroprevalence between relatively higher and lower CD4 cell counts in the HIV positive cases (p>0.05). Conclusion. A significantly higher seroprevalence of <i>H. pylori</i> was demonstrated in the HIV positive subjects. There was no significant difference in the prevalence of <i>H. pylori</i> between different CD4+ cell counts in the HIV positive study group.

Dyspeptic symptoms in patients with type 1 diabetes: endoscopic findings, Helicobacter pylori infection, and associations with metabolic control, mood disorders and nutritional factors.

To evaluate, in a group of patients with long-standing type 1 diabetes (DM1), an association of dyspepsia symptoms with: changes in the gastroduodenal mucosa, infection by Helicobacter pylori, glycemic control, and psychological and nutritional factors. A total of 32 patient with DM1 were studied (age: 38 ± 9 years; females: 25; diabetes duration: 22 ± 5 years). All patients answered a standardized questionnaire for the evaluation of gastrointestinal symptoms and underwent upper gastrointestinal endoscopy, with gastric biopsies for the evaluation of Helicobacter pylori infection. The presence of anxiety and depression was evaluated by the HAD scale. Nutritional parameters were BMI, arm and waist circumference, skinfold measurement, and body fat percentage. Upper endoscopy detected lesions in the gastric mucosa in 34.4% of the patients, with similar frequency in those with (n = 21) and without dyspepsia (n = 11). The patients with dyspepsia complaints showed greater frequency of depression (60% vs. 0%; p = 0.001), higher values for HbA1c (9.6 ± 1.7 vs. 8.2 ± 1.3%; p = 0.01) and lower values for BMI (24.3 ± 4.1 vs. 27.2 ± 2.6 kg/m2; p = 0.02), body fat percentage (26.6 ± 6.2 vs. 30.8 ± 7.7%; p = 0.04), and waist circumference (78.7 ± 8 vs. 85.8 ± 8.1 cm; p = 0.02). No association was found between the symptoms and the presence of Helicobacter pylori. Dyspepsia symptoms in patients with long-standing DM1 were associated with glycemic control and depression, and they seem to negatively influence the nutritional status of these patients.

The prevalence of Helicobacter pylori in acid peptic disease

Background: Acid peptic disease is a common problem world over resulting from imbalance of acid and pepsin present in gastric secretions. It encompasses many conditions, including gastritis and peptic ulcer with dyspepsia being a common complaint. Prevalence of H. pylori is high in developing countries and low in developed countries. We study the prevalence of H. pylori and its association with age, sex, and dietary factors in patients with acid peptic disease. Materials and Methods: The study was conducted on 200 patients >= 18 yrs visiting SGRD hospital with complaints of dyspepsia, in a period of 2 years. Patients who refused endoscopy, who were medically unstable, those with suspected perforation, those with deranged coagulation profile, patients with history of intake of PPIs, bismuth compounds, antibiotics (metronidazole, amoxicillin, clindamycin, clarithromycin) in previous 1 week, those suffering from cholecystitis, cholelithiasis, pancreatitis, were excluded from the study. Patients were advised to stop all anti-ulcer drugs, antibiotics and bismuth containing drugs at least 1 week prior to the study. Informed consent was taken from the patients. These patients were subjected to detailed history and physical examination. A detailed questionnaire which collected presenting complaints, sociodemographic characteristics, dietary habits, smoking and drinking habits, history of regular intake of NSAIDs, any other co-morbid condition present, and abdominal ultrasonography findings, was filled. On upper GI endoscopy, gastric antral biopsies were taken and subjected to rapid urease test using a commercially available test kit. The results were noted and analyzed statistically. Results: Overall prevalence of H. pylori came out to be 80.5%. It was more in males than females. Prevalence increased with increasing age and was highest (90.9%) in age group >70 yrs. Most common dyspeptic symptom was fullness after meals. Prevalence was seen more in non-vegetarians (83.7%) than in vegetarians (78.1%) but statistically insignificant. Chronic gastritis was most common endoscopic finding with 96.1% prevalence of H. pylori associated with it and this was significant statistically (P < 0.05). Association with peptic ulcer did not come out to be statistically significant (P > 0.05). Conclusions: Prevalence of H. pylori is very high in our part of the world and rapid urease test presents an easy, accurate, cost-effective method for its detection. No significant association seen with gender, dietary factors, NSAIDs, smoking and alcohol intake. Chronic gastritis shows a significant association, while both duodenal and gastric ulcer did not show any significant association with H. pylori. So, taking into account the high prevalence, and association with chronic gastritis, treatment should be offered to every patient with such complaints and findings on endoscopy.

HUBUNGAN PAJANAN BISING KONTINYU TROMOL EMAS DENGAN KELUHAN DISPEPSIA PADA MASYARAKAT DESA TATELU

Abstract: Gold is a mining commodity that has a high value. Tatelu’s gold processing is traditionally done with tromol machines that produce high intensity continous noise. Noise is a trigger of stress, which is one of the causes of dyspepsia. This study aimed to find out the relationship between continous noise exposure of the mining tromol and dyspepsia complaints among Tatelu villagers. The study was done by using a cross sectional design. The samples were divided into two groups: the control and the exposed groups. Each group consisted of 20 people. Interviews used structured questionnaires, and dyspepsia diagnostics were based on Rome Consensus III. The characteristics of samples and the prevalence of dyspepsia complaints were assessed using univariate analysis. Chi square was used to assess the relationship between continous noise exposure of the tromols with complaints of dyspepsia. The results showed that in residential areas exposed to noise, 70% of the samples had complaints of dyspepsia, while in the control area there were only 25%. The results of the statistical analysis using the Chi square showed the value x2count (8.12) &gt; x2table (3.84) and the P-value = 0.004 &lt; 0.05 with α &lt; 5%. Conclusion: There was a significant relationship between the continous noise exposure from the gold tromols with the complaints of dyspepsia among Tatelu villagers. Keywords: noise, stress, dyspepsia. Abstrak: Emas merupakan komoditi tambang yang mempunyai nilai tinggi. Pengolahan emas di desa Tatelu dilakukan secara tradisional dengan menggunakan mesin tromol yang menghasilkan bising kontinyu dengan intensitas tinggi. Bising merupakan pemicu terjadinya stres yang merupakan salah satu penyebab terjadinya dispepsia. Penelitian ini bertujuan untuk mengetahui hubungan pajanan bising kontinyu tromol emas terhadap keluhan dispepsia pada masyarakat desa Tatelu. Penelitian ini menggunakan rancangan cross sectional. Sampel terdiri dari 20 orang kelompok kontrol dan 20 orang kelompok terpajan. Penelitian menggunakan teknik wawancara dengan kuesioner terstruktur. Diagnosis dispepsia ditegakkan dengan kriteria Konsensus Roma III. Karakteristik sampel dan prevalensi keluhan dispepsia dinilai dengan analisis univariat. Hubungan antara pajanan bising kontinyu tromol emas dengan keluhan dispepsia dinilai dengan chi square. Hasil penelitian menunjukan pada daerah terpajan bising 70% sampel mengalami dispepsia sedangkan pada daerah kontrol hanya 25%. Hasil analisis statistika dengan menggunakan chi square menunjukan nilai x2hitung (8,12) &gt; x2tabel (3,84) dan nilai P = 0,004 &lt; 0,05 dengan &lt; 5 %. Simpulan: Terdapat hubungan bermakna antara pajanan bising kontinyu tromol emas dengan keluhan dispepsia pada masyarakat Desa Tatelu. Kata kunci: bising, stres, dispepsia.

Epidemiology of Helicobacter pylori in Bhutan: The Role of Environment and Geographic Location

Bhutan is small mountainous country bordering India and China and consists of four geographic regions, west, east, central, and south. The epidemiology of Helicobacter pylori infection and risk factors associated with in Bhutan are not previously studied. The World Health Organization reported the incidence of stomach cancer to be very high in Bhutan. We conducted a cross-sectional study to determine the seroepidemiologic pattern of H.pylori among Bhutanese from the four regions with emphasis on water source and household sanitation. Between June and November 2012, blood samples from patients with complaints of dyspepsia were collected after obtaining an informed consent. Demographic information, occupation, family size living in the same household, consumption of betel nut, and aspects of household environment including type of latrines, source of drinking water were collected. All serum samples were tested for H.pylori immunoglobulin G (IgG) by enzyme-linked immunosorbent assay (ELISA) using MAGIWELL ELISA kit from United Biotech, USA. Two hundred and forty-four patients between 17 and 75years of age participated in the study, of them, 102 were men, and the mean age was 38 (±14.2) years. The overall prevalence of H.pylori among patients was 86% with no difference between men and women (90 vs 83%, respectively, p=.12). The prevalence was almost identical among all age groups: 81% at 17-20, 84% at 20-29, 93% at 30-39, 82% at 40-49, 87% at 50-59, and 82% at ≥60years (p=.51). H.pylori prevalence was lower in the southern region of Bhutan (78%) compared with the central region (97%) (OR=8.6; 95% CI=1.1-55; p=.02), eastern region (91%) (OR=2.7; 95% CI=1.1-7.2, p=.004) or the western region (83%) (OR=1.4, 95% CI=0.8-3.1, p=.07). The prevalence of H.pylori was significantly lower among household with less than 4 persons living in the same household. Source of drinking water, type of occupation, type of latrines, or consumption of betel nut showed no association with H.pylori prevalence. Logistic regression analysis revealed that residing region was the only significant variable. The high prevalence of antibodies to H.pylori among patients and in all groups could contribute to the high incident rate of gastric cancer in Bhutan. Crowded living condition and the residing region contribute to the variation of the prevalence of the infection. The lowest prevalence in southern part of the country could be due to the difference in the ethnicity as most of its population is of Indian and Nepal origin. Further data regarding H.pylori in Bhutan are critical to developing surveillance and prevention strategies for gastric cancer.

Clinical Efficacy and Side Effects of Nabumeton Compared to Meloxicam in Osteoarthritis Pain

Background : Most patients who use non steroid anti-inflammatory drug (NSAID) in long-term or high-dose will experience NSAID gastropathy that appears as dyspepsia complaints. The aim of this study is to assess the efficacy of nabumeton and incidence of dyspepsia as side effect of treatment using nabumeton compared to meloxicam in patients with pain due to osteoarthritis. Methods : Sixty patients with pain due to osteoarthritis at internal medicine clinic in Koja Hospital were included in this study and were given meloxicam or nabumeton within February 29th to March 25 in double-blind manner. Primary disease pain degree and heartburn pain degree were evaluated three days after administration of the drug and a week was added if necessary. The statistical analysis used were student t-test to compare changes in pain scores between the 2 groups, and Chi-square test to assess differences in the number of dyspepsia in both groups. Results: Pain scale reduction in meloxicam group was 0.57 ± 0.67 points, which is less than 1.27 ± 0.74 points in nabumeton group. In addition, the average recurrence of heartburn in the meloxicam was 18 out of 30 (60%) patients in total, while the average recurrence of heartburn in nabumeton was 2 out of 30 (60%) patients. Conclusion : The use of nabumeton pain medication is better in terms of efficacy and side effects of heartburn compared to meloxicam. Keywords : osteoarthritis, joint pain, meloxicam, nabumeton

Villous Adenoma of Duodenum: A Rare Case Presentation with Review of Literature

In the year 2008, a 42 years old female presented to the medical outpatient with complaints of dyspepsia for 3 months with mild vague pain abdomen off and on. Her bowel and bladder habits were normal. She had no other associated comorbidity. She had no history of jaundice, malaena or haematemesis. There was no significant family history or past history. On clinical examination, she had moderate pallor and rest of the general and systemic examination was normal. Her routine blood investigations showed Hb% of 7.5 gm% and serum electrolyte, creatinine and LFT were within normal limits. She was advised ultrasound abdomen which was normal. Thereafter she was planned for Upper Gastrointestinal Endoscopy which was done and revealed a cauliflower like growth in the second part of the duodenum with stomach and esophagus being normal. Endoscopic biopsy was done which was reported as adenomatous polyp with no evidence of malignancy. CECT abdomen was done which showed duodenal growth with ? pancreatic head invasion and ampullary region was spared. Patient was planned for exploratory laparotomy, frozen section and proceed. After two units of blood tansfusion for her anaemia, exploratory laparotomy was done and a growth was felt in second part of duodenum which was soft to firm in consistency. A dimpling was noted on the anterior wall of the second part of the duodenum and a small paraduodenal node found anterior to duodenum. Rest of the abdominal structures were normal. Duodenotomy was done and excision of the duodenal polyp, which was about 5.5×5×2.5 cms, cauliflower like in appearance, was done. The ampulla was found to be normal. Frozen section was sent which was suggestive of adenomatous polyp with mild to moderate dysplastic changes and no evidence of malignancy and reactive lymphadenitis in the paraduodenal node hence, duodenoplasty performed and an abdominal drain kept in right subhepatic space and abdomen closed (Figs. 1 and 2). Post-operative period was uneventful and the patient was discharged in good health on the tenth post-operative day. Final biopsy was of Villous adenoma of the duodenum. A repeat UGIE was done at 6 months and 1 year and then annually for 3 years and was found to be normal. In view of the high association of duodenal and colonic polyps, the patient was also advised colonoscopy, but did not agree. At present she is in follow-up and asymptomatic with good quality of life after 3 years follow-up (Figs. 3, 4 and 5).

Extrahepatic aneurysm of the portal venous system and portal hypertension

Portal venous aneurysm (PVA) is a rare condition characterized by dilatation of the portal venous system. PVA manifestation of symptoms is varied and depends on the aneurysm size, location and related-complications, such as thrombosis. While the majority of reported cases of PVA are attributed to portal hypertension, very little is known about the condition's pathophysiology and clinical management remains a challenge. Here, we describe a 67-year-old woman who presented with complaint of dyspepsia and without a significant medical history, for whom PVA was incidentally diagnosed. The initial upper abdominal ultrasound revealed marked dilatation of the main portal vein, and subsequent contrast-enhanced computed tomography with angiography revealed a large aneurysm arising from the extrahepatic troncus portion of the portal vein, as well as gastroesophageal varices. A conservative approach using beta-blocker therapy was chosen. The patient was followed-up for 60 mo, during which time the asymptomatic status was unaltered and the PVA remained stable.

Hepatic solitary fibrous tumor: Report of a rare case

Solitary fibrous tumor (SFT) of the liver is an extremely rare neoplasm of mesenchymal origin. In the English literature, less than 40 cases of SFTs of the liver have been reported. The present case concerns a 34-year-old female who presented to us with complaint of dyspepsia. On examination, there was hepatomegaly. On ultrasound examination, an SOL in the liver was detected. Large tumor measuring 14.5 × 10 × 8 cm was resected. Microscopic evaluation of the tumor showed a well-circumscribed, low to moderately cellular tumor demonstrating spindle- and fibroblast-like cells within the collagenous stroma. Immunohistochemistry revealed diffuse strong cytoplasmic immunopositivity of CD34, Bcl2, and vimentin. A diagnosis of a benign SFT was given. The patient remained well 4 years after surgery. SFT is a rare mesenchymal neoplasm that occasionally involves the liver in adult patients. Most SFTs are benign, but some may have malignant histological features. With less than 40 reported cases in the literature, little can be said regarding its natural history or the benefits of adjuvant radio chemotherapy. Complete surgical resection remains the cornerstone of its treatment.

Relationship of the Intensity of Helicobacter pylori and Severity of Inflammation with Beta-2 Microglobulin Levels in Serum According to the Updated Sydney System

Helicobacter pylori (HP) is a cause of chronic gastritis. Beta-2 microglobulin has been used as a simple inflammatory indicator in some diseases. We investigate the usability of beta-2 microglobulin as a simple marker that may reflect the severity of inflammation and intensity of HP in gastric mucosa. A total of 114 patients was included in the study, who applied to an outpatient gastroenterology clinic with complaint of dyspepsia. Serum beta-2 microglobulin levels were evaluated in 109 patients. Esophagogastroduodenoscopy was performed on patients included in the study, and histological analysis was performed by obtaining two specimens from each of antrum, corpus, and incisura angularis. All specimens were evaluated according to the updated Sydney System. No statistically significant result was found between serum beta-2 microglobulin levels and the intensity of HP and the severity of inflammation of gastric mucosa. However, it was observed that the serum beta-2 microglobulin level in specimens taken from corpus was found to be higher in patients with moderate-severe HP intensities compared to those with lower HP intensities. Although HP is the cause of the chronic active gastritis characterized with the infiltration of lymphocytes, plasma cells, and neutrophils, it is accompanied by local involvement apart from diseases with a course of systemic involvement. We suggest that the serum beta-2 microglobulin level cannot be used as a simple marker of HP intensity and severity of inflammation in gastric endoscopic biopsies.

The Relationship Between Mean Platelet Volume Levels and the Inflammation in Helicobacter Pylori Gastritis

Helicobacter pylori is a cause of chronic gastritis. Mean platelet volume (MPV) has been started to be used as a simple inflammatory indicator in some diseases. We have aimed especially to investigate the usability of MPV as a simple indicator that may reflect severity of inflammation in gastric mucosa. Included in the study were a total of 114 patients who visited the outpatient clinic of gastroenterology with complaint of dyspepsia. Blood MPV levels in hemogram results were evaluated. Esophagogastroduodenoscopy was performed on patients included in the study, and histological analysis was performed by obtaining 2 specimens from each of antrum, corpus, and incisura angularis. All specimens were evaluated according to the updated Sydney System. No statistically significant result was found among blood MPV levels, the intensity of H pylori, and the severity of inflammation of gastric mucosa. However, it is interesting that mean MPV levels in cases with lymphoid follicle were lower. We suggest that MPV level cannot be used as a simple marker to reflect H pylori intensity and severity of inflammation in gastric endoscopic biopsies.

Azithromycin based triple therapy versus standard clarithromycin based triple therapy in eradication of Helicobacter pylori infection in Iran: a randomized controlled clinical trial

In regarding to azithromycin's high tissue concentration, long biologic half life, low cost, and excellent anti bacterial profile for Helicobacter pylori in Iran, we sought to compare an azithromycin-based regimen with an already established clarithromycinbased regimen in regards to the eradication of Helicobacter pylori infection. A prospective, open label, randomized controlled trial was conducted on 165 patients who presented to gastrointestinal clinics of QOM Medical University Clinics, with complaint of dyspepsia. All patients received upper gastrointestinal endoscopy, and underwent rapid urease test to confirm Helicobacter pylori infection. Patients were randomized to a treatment arm, which consisted of, clarithromycin, amoxicillin, and omeprazole, or another treatment arm consisting of azithromycin, amoxicillin, and omeprazole. Informed consent was obtained from all patients participating in the trial. Urease breath test was performed in patients 6 weeks after end of treatment to assess eradication. All side effects were recorded. Comparison between the two groups was made using a chi-square test. Seventy six and 89 patients received regimen clarithromycin, amoxicillin, and omeprazole and azithromycin, amoxicillin, and omeprazole, respectively, and completed the study course. Per protocol, eradication rate was 83% with clarithromycin, amoxicillin, and omeprazole and 75% with azithromycin, amoxicillin, and omeprazole (p =0.158). Eradication rate for a subgroup of patients with peptic ulcer disease in two groups were 83% and 74%, respectively (p=0.134). Only one patient in each group was compelled to stop the treatment due to a severe skin hypersensitivity reaction. Other lesser side effects were comparable within the two groups. The results of this study suggest that azithromycin, amoxicillin, and omeprazole at best is as effective as clarithromycin, amoxicillin, and omeprazole; and this new therapy could be considered as an alternative choice for Helicobacter pylori eradication, especially in geographic areas with lower economic status.

Dyspepsia Due to Metastatic Breast Cancer

Purpose: Introduction: Metastatic spread of breast cancer to the upper gastrointestinal tract has been infrequently reported in the literature (1). The common sites of spread include bones, lung and liver. We report a rare case of metastatic lobular breast cancer to stomach. Methods: Case: A 51 year-old African-american woman presented with complaints of dyspepsia and weight loss. She denied any melena, hematochezia or vomiting. Lab work revealed HB 7.6%; AST 129; ALT 125; Alk P 360; Direct/Total Bilirubin 1.3/2.5; Albumin/Protein 2.3/5.8; BUN/Creatinine 11/1.4; Amylase 102; Lipase 82; HAV and HBV immune and HCV negative. Contrast CT abdomen showed double duct sign with pancreatic head fullness, which were confirmed by MRCP. Bone scan revealed diffuse metastatic bone disease. Two years prior to this presentation, she underwent modified radical mastectomy with adjuvant chemotherapy and radiotherapy for Stage IIIa (ER/PR +ve HER 2 NEU −ve) invasive lobular carcinoma of the left breast. She subsequently was taking Tamoxifen and till recently remained symptom-free. Results: EUS during this presentation revealed 12 mm antral mass which was biopsied; pancreatic head fullness which unfortunately could not be sampled due to technical difficulties. Antral biopsy immunohistochemistry demonstrated staining for AE1/AE3; cytokeratin 7 +ve/ cytokeratin 20 −ve. This immunoprofile pattern confirmed a metastatic breast carcinoma. Conclusion: Discussion: Despite improvement in treatment of breast cancer, distant metastatic disease continues to occur. The incidence of breast cancer metastasis to the stomach, especially lobular cancer is higher then other variants including ductal cancers (2). A high index of suspicion for metastatic disease to the stomach of previous breast cancer should be maintained when new gastrointestinal symptoms develop. 1. Menuck LS, Amberg JR. Metastatic disease involving the stomach. Am J Dig Dis. 1975;20:903–13. 2. Taal BG, den Hartog Jager FC, Steinmetz R, Peterse H. The spectrum of gastrointestinal metastases of breast carcinoma, I: stomach. Gastrointest Endosc. 1992;38:130–135.Figure: H&E staining of metastatic breast carcinoma to stomach

Volcano Ulcers in Stomach – an Unusual Presentation of Metastatic Non Pigmented Melanoma

Purpose: Malignant melanoma is one of the most common malignancies to metastasize to the gastrointestinal (GI) tract. Metastases to GI tract can present at time of primary diagnosis or decades later as first sign of recurrence. Metastatic melanoma to GI tract is found during diagnostic workup in 1%-4% of patients with cutaneous primary and up to 60% of melanoma patients in autopsy. Methods: Our patient is a 45 year old white male with history of primary non-pigmented urinary bladder melanoma who presented with complaint of dyspepsia for 2 months. Patient had received full course of chemotherapy with Tamodar for 5 months with good response. He denied any nausea, vomiting, dysphagia or bleeding. He had no primary skin lesion found on extensive detailed physical exam. Whole body PET scan showed markedly thickened stomach walls with multiple omental lesions in the perigastric region. Upper endoscopy revealed two large, non-pigmented ulcerating masses in body of stomach on the greater curvature. These masses had “volcano appearance” with heaped up edges and central crater. Multiple biopsies were taken which were consistent with non pigmented metastatic melanoma confirmed by immunohistochemical stains. Patient was subsequently started on carboplatin and has had mild improvement in symptoms. Results: Conclusion: Gastrointestinal invasion by melanoma is a rare condition and is often associated with invasion of other visceral organs. The endoscopic classification of the gastric metastases comprises three main types: (a) melanotic nodules, often ulcerated at the tip; most common (b) submucosal mass, melanotic or not, elevated and ulcerated at apex; typical aspect of “bull's eye” lesion and (c) mass lesions with varying incidence of necrosis and melanosis. Gastric metastases may appear even as a simple ulcer. Majority of gastric metastases are reported to occur in body and fundus, most often on the greater curvature. Most frequent sites of melanoma metastases include small bowel, stomach, colon, and anorectum in decreasing order. Symptoms may include abdominal pain, dysphagia, small bowel obstruction and GI bleed. Diagnosis requires careful inspection of mucosa and biopsy with special immunohistochemical stains. Management may include surgical resection, chemotherapy, immunotherapy, observation, or enrollment in clinical trials. Surgery seems to be of limited value and should be performed in carefully selected patients and in patients with complications. Prognosis is poor, with median survival time in patients presenting with GI invasion being less than 1 year. Endoscopic “Volcano ulcers” in the stomach have been reported in many secondary neoplasms of the stomach and their presence should always raise suspicion for an underlying malignancy.