Duodenal Erosions Research Articles

Primary bile reflux gastritis versus Helicobacter pylori gastritis: a comparative study

BackgroundBile reflux gastritis (BRG) is a common disorder, with few data on its pathophysiology and clinical course, whereas Helicobacter pylori is the well-known, commonest cause of chronic gastritis.AimThe aim of this study was to compare between BRG and H. pylori-related gastritis, as regards demographic data, comorbid conditions, and pattern of upper gastrointestinal involvement.Patients and methodsIt included 130 patients with endoscopic features of gastritis, subdivided into three groups: group A with BRG (56 patients); group B with H. pylori gastritis (58 patients); group C with gastritis in the presence of both H. pylori and bile reflux (16 patients). Statistical analysis was made to compare between the three groups as regards demographic data, history, and examination findings including endoscopic findings.ResultsBRG is more common among younger age (21–30 years) and elderly patients (71–80 years), whereas H. pylori gastritis is more common in patients in the middle age group (31–60 years), the female/male ratio was 1.5 : 1 in patients with BRG, 1 : 1 in H. pylori gastritis. Nausea was the commonest symptom in patients with BRG (69.6%), whereas epigastric pain/discomfort was the commonest symptom (77.6%) in H. pylori gastritis. Diabetes was found to be more common in patients with H. pylori gastritis (29.3%) followed by BRG (26.8%), whereas obesity was more common in patients with BRG (76.8%) followed by H. pylori gastritis (65.5%). Endoscopy showed antral gastritis in cases with BRG (57.1%), pangastritis in H. pylori and mixed etiology gastritis (60.3 and 68.8%, respectively), reflux esophagitis in both BRG and H. pylori gastritis (41.1 and 44.8%, respectively), higher than mixed etiology gastritis (25%). Endoscopic Barrett’s mucosa was diagnosed in 10.7% of cases with BRG and 12.1% of cases with H. pylori gastritis. Duodenitis, duodenal erosions, or ulcerations were more common in cases with mixed etiology gastritis (62.5%), than in H. pylori gastritis (24.1%), followed by BRG (14.3%).ConclusionBRG is a common, underdiagnosed condition, with distinct clinical and endoscopic features from H. pylori gastritis.

Extensive Portal Venous Gas After Hydrogen Peroxide Ingestion

Hydrogen peroxide is a clear, colorless liquid that is available in various concentrations ranging from 1.5% to more than 35%. We present a case of accidental hydrogen peroxide ingestion associated with extensive venous portal gas that was successfully treated conservatively. A 52 year old male patient with no significant history was transferred to our hospital after he accidentally ingested around 50 ml of 35% hydrogen peroxide solution few hours prior to presentation. Initially, the patient presented to outside facility with nausea, non-bloody vomiting and epigastric abdominal pain. Vitals were stable. Physical examination was significant for erythematous oral mucosa, epigastric tenderness, with no peritoneal signs. Neurologic and cardiopulmonary examinations were normal. Abdominal Computed tomography (CT) scan showed extensive portal venous gas throughout the liver (Image 1). CT and Magnetic resonance imaging (MRI) of the brain were negative for air embolism. Laboratory work up was normal. The patient underwent 5 hours of hyperbaric chamber therapy. Esophagogastroduodenoscopy (EGD) showed hemorrhagic gastropathy and mild duodenal bulb erosions (Image 2). The patient was treated with 72 hours of intravenous (IV) proton pump inhibitor (PPI) and had an uncomplicated hospital course. After 3 days, he was able to tolerate oral intake and was discharged with PPI treatment. We report a case of extensive portal vein gas to shed a light to the importance of reporting such cases, so we can have a better understanding of different presentations and its treatment.Figure: Abdominal Computed tomography (CT) scan showing extensive portal venous gas throughout the liver.Figure: Esophagogastroduodenoscopy (EGD) showing Hemorrhagic gastropathy and duodenal bulb erosions.

FFA2 activation combined with ulcerogenic COX inhibition induces duodenal mucosal injury via the 5-HT pathway in rats

Serotonin (5-HT), predominantly synthesized and released by enterochromaffin cells, is implicated in gastrointestinal symptoms such as emesis, abdominal pain, and diarrhea. Because luminal short-chain fatty acids (SCFAs) release 5-HT from enterochromaffin cells, which express the SCFA receptor free fatty acid receptor 2 (FFA2) in rat duodenum, we examined the effects of the selective FFA2 agonist phenylacetamide-1 (PA1) on duodenal 5-HT release with consequent bicarbonate secretion [duodenal bicarbonate secretion (DBS)] and on indomethacin (IND)-induced enteropathy. Intestinal injury was induced by IND (10 mg/kg sc) with or without PA1. We measured DBS in vivo in a duodenal loop perfused with PA1 while measuring 5-HT released in the portal vein. Duodenal blood flow was measured by laser-Doppler flowmetry. IND induced small intestinal ulcers with duodenal sparing. PA1 given with IND (IND + PA1) dose dependently induced duodenal erosions. IND + PA1-induced duodenal lesions were inhibited by the FFA2 antagonist GLPG-0974, ondansetron, or omeprazole but not by RS-23597 or atropine. Luminal perfusion of PA1 augmented DBS accompanied by increased portal blood 5-HT concentrations with approximately eight times more release at 0.1 mM than at 1 µM, with the effects inhibited by coperfusion of GLPG-0974. Luminal PA1 at 1 µM increased, but at 0.1 mM diminished, duodenal blood flow. Cosuperfusion of PA1 (0.1 mM) decreased acid-induced hyperemia, further reduced by IND pretreatment but restored by ondansetron. These results suggest that, although FFA2 activation enhances duodenal mucosal defenses, FFA2 overactivation during ulcerogenic cyclooxygenase inhibition may increase the vulnerability of the duodenal mucosa to gastric acid via excessive 5-HT release and 5-HT3 receptor activation, implicated in foregut-related symptoms such as emesis and epigastralgia.NEW & NOTEWORTHY Luminal free fatty acid receptor 2 agonists stimulate enterochromaffin cells and release serotonin, which enhances mucosal defenses in rat duodenum. However, overdriving serotonin release with high luminal concentrations of free fatty acid 2 ligands such as short-chain fatty acids injures the mucosa by decreasing mucosal blood flow. These results are likely implicated in serotonin-related dyspeptic symptom generation because of small intestinal bacterial overgrowth, which is hypothesized to generate excess SCFAs in the foregut, overdriving serotonin release from enterochromaffin cells.

An optimized clarithromycin-free 14-day triple therapy for Helicobacter pylori eradication achieves high cure rates in Uruguay

BackgroundStrong acid inhibition increases cure rates with triple therapy and 14-day are more effective than 7-day treatments. The combination of amoxicillin plus metronidazole at full doses has been shown to overcome metronidazole resistance and to achieve good eradication rates even in patients harboring resistant strains. No previous studies have been reported in Latin-America with this optimized triple-therapy scheme. AimsThe aim of the present study was to assess the eradication rate and tolerance of a new first-line treatment regimen associating strong acid inhibition, amoxicillin and metronidazole. MethodsPatients from the Clínica de Gastroenterología of the Hospital de Clínicas (Montevideo, Uruguay) were included. Hp status was mainly assessed by at least one of the following: histologyor urea breath test (UBT). A 14-day treatment was prescribed comprising esomeprazole 40mg twice a day plus amoxicillin 1g and metronidazole 500mg, both three times a day. H. pylori cure was assessed by UBT. ResultsForty-one patients were enrolled. Mean age was 53.3±13 years and 17.1% of patients were male. Main indications for treatment were: functional dyspepsia (27.5%), gastritis (45%), gastric or duodenal erosions (20%), gastric ulcer (5%) and intestinal metaplasia (2.5%). H. pylori eradication was achieved in 33 of the 37 patients who returned for follow-up. Eradication rates were 80.5% (95% CI: 68.4–92.6) by intention-to-treat (ITT) analysis and 89.2% (95% CI; 79.2–99.2) per protocol (PP). No major side effects were reported; 26 patients (65.8%) complained of mild side effects (nausea, diarrhea and headache). ConclusionsCure rates of this triple therapy including esomeprazole, amoxicillin and metronidazole were 81% per ITT and the treatment was well tolerated. These optimal results with a simple clarithromycin-free triple therapy are better than described for standard triple therapy but there is still room for improvement to reach the desired target of 90% per ITT.

Etiological and Endoscopic Profile of Middle Aged and Elderly Patients with Upper Gastrointestinal Bleeding in a Tertiary Care Hospital in North India: A Retrospective Analysis.

Background:Upper gastrointestinal (GI) bleeding is a common medical emergency associated with significant morbidity and mortality. The clinical presentation depends on the amount and location of hemorrhage and the endoscopic profile varies according to different etiology. At present, there are limited epidemiological data on upper GI bleed and associated mortality from India, especially in the middle and elderly age group, which has a higher incidence and mortality from this disease.Aim:This study aims to study the clinical and endoscopic profile of middle aged and elderly patients suffering from upper GI bleed to know the etiology of the disease and outcome of the intervention.Materials and Methods:Out of a total of 1790 patients who presented to the hospital from May 2015 to August 2017 with upper GI bleed, and underwent upper GI endoscopy, data of 1270 patients, aged 40 years and above, was compiled and analyzed retrospectively.Results:All the patients included in the study were above 40 years of age. Majority of the patients were males, with a male to female ratio of 1.6:1. The most common causes of upper GI bleed in these patients were portal hypertension-related (esophageal, gastric and duodenal varices, portal hypertensive gastropathy, and gastric antral vascular ectasia GAVE), seen in 53.62% of patients, followed by peptic ulcer disease (gastric and duodenal ulcers) seen in 17.56% of patients. Gastric erosions/gastritis accounted for 15.20%, and duodenal erosions were seen in 5.8% of upper GI bleeds. The in-hospital mortality rate in our study population was 5.83%.Conclusion:The present study reported portal hypertension as the most common cause of upper GI bleeding, while the most common endoscopic lesions reported were esophageal varices, followed by gastric erosion/gastritis, and duodenal ulcer.

Gastroduodenal lesions detected during small bowel capsule endoscopy: incidence, diagnostic and therapeutic impact.

Capsule endoscopy was primarily designed for the investigation of the small bowel. However, it may also identify lesions in other segments of the gastrointestinal tract. The aim of the current study was to evaluate the incidence of gastroduodenal abnormalities during small bowel capsule endoscopy and its impact on patient diagnosis and management. This study is a retrospective analysis of data from 2,217 consecutive capsule endoscopy procedures performed at a single tertiary-care center between January 2008 and February 2016. Patient baseline characteristics, gastroduodenal lesions, diagnosis and management before and after capsule endoscopy were recorded and a descriptive analysis was performed. Two thousands and two hundred seventeen patients were finally included in the analysis. One thousand and seventy patients were male (48.2%) and the mean age was 56.1 ± 19.5 years (range: 12-93). Obscure gastrointestinal bleeding (52.3%) and inflammatory bowel disease (18.3%) were the main procedure indications. Gastroduodenal abnormalities were detected by capsule endoscopy in 696 (31.4%) of 2,217 patients. The most common types of missed gastric and duodenal lesions found were gastric erosions (35.4%), findings suggestive of chronic gastritis (22.9%), duodenal erosions (28.1%) and duodenal erythema (23.5%). This information had a clinical or diagnostic impact of 26.2% and a therapeutic impact of 15.5%. Capsule endoscopy detects not only small bowel lesions but also some gastroduodenal lesions that may be overlooked during an initial gastroscopy. Therefore, all gastroduodenal images should be read during small bowel capsule endoscopy as it may provide relevant information that result in changes in patient management.

Distal Migration of Percutaneous Endoscopic Gastrostomy Tube Causing Gastric Outlet Obstruction

An 80-year-old woman has been carrying percutaneous endoscopy gastrostomy (PEG) 20Fr for 3 years due to post-stroke dysphagia. She complains of 2 months of vomiting and recurrent abdominal pain. Analyses were unremarkable. Plain abdominal X-ray revealed hidroaereal levels and distention of the bowel loops. Abdominal CT showed concentric thickening of the antrum of oedematous nature, the PEG balloon at the duodenum first portion without pneumoperitoneum (Figure 1). The PEG was functional with easy rotation, but only with possible traction up to the 7 cm mark. After gastric content aspiration, the esophagogastroduodenoscopy showed duodenal migration of the PEG balloon causing gastric drainage obstruction (Figure 2) and duodenal bulb erosions by PEG balloon trauma. The PEG tube was repositioned at the level of the gastrocutaneous fistula after deflation of the balloon (Figure 3A) and then reinflated with 20 mL of distilled water. Additionally, a second external fixator was placed 3.5cm from the anterior abdominal wall to avoid recurrence of this complication (Figure 3B). No PEG migration recurrence was verified during 11 months of follow-up.

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association.

### Background The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. ### Frequency The frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin.1–9 For intracavitary grafts, the infection rate is ≈1% to 5%.1–6 Graft infection is most common after emergency procedures and after reoperation.1–4,10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction.11, …

PTH-021 Reassessing The Value of Gastroscopy for The Investigation of Dyspepsia

Introduction The National Institute of Health and Clinical Excellence (NICE) first recommended a policy of H. pylori test and treat or empirical full dose proton pump inhibitor therapy for uninvestigated dyspepsia in 2004. 1 Following an initial fall in demand for gastroscopy (OGD), there has been a 30% increase in the last five years. 2 Whilst regarded as the gold standard, it is uncomfortable, costly, may require sedation and carries the risks of intubation. In an era when non-invasive tests are emerging, the role of OGD requires re-evaluation. Methods Data from consecutive OGDs performed between September 2015 and January 2016 to investigate dyspepsia was analysed. We determined the percentage of patients in whom OGD ± biopsy changed management as defined by an approach other than the non-invasive NICE recommendations. 1 Results 500 patients (39.8% male; mean age 58±16.1) underwent OGD for dyspepsia, some of whom also had dysphagia (6%), anaemia (4%), vomiting (4.2%) or suspected gastrointestinal (GI) bleeding (0.6%). 145 (29%) were sedated (midazolam (mean±SEM) 2.0 mg±1.0; fentanyl (when used) 50 mcg±23). 381 patients (76.2%) had abnormal endoscopy; 417 (83.4%) had biopsies taken (15.8% for histological assessment, 27.4% for rapid urease tests, 40.2% for both). Findings of uncertain relevance, or which could have been managed with empirical therapies, were seen in 299 patients (59.8%; including oesophagitis (n = 122), hiatus hernias (n = 178), gastric polyps (n = 34), gastritis (n = 236), gastric ulcers (n = 9), gastric erosions (n = 32), duodenitis (n = 40), duodenal ulcer (n = 1), duodenal erosions (n = 15) and a duodenal polyp (n = 1)). Diagnoses which would not have been appropriately managed by empirical therapies numbered 82 (16.4%). These included 71 (14.2%) patients with Barrett’s oesophagus (n = 39), oesophageal stricture (n = 2), oesophageal cancer (n = 1) and gastric cancer (n = 4) diagnosed at the time of endoscopy. An additional 11 (2.2%) diagnoses were made solely by histology, which included eosinophilic oesophagitis (n = 1), eosinophilic gastritis (n = 1), intestinal metaplasia (n = 3) and coeliac disease (n = 6). Conclusion Diagnoses which alter management are made by endoscopy in only 14.2% of patients with dyspepsia. Although the majority of patients have biopsies taken, the added value increases the yield to only 16.4%. Non-invasive, cost-effective diagnostic strategies are needed to better guide patient management and select the minority of patients who need endoscopic biopsy or therapy. References 1 www.nice.org.uk/guidance/CG184 (2014 update) 2 https://www.england.nhs.uk/statistics Disclosure of Interest None Declared

Upper gastrointestinal endoscopy in patients with liver cirrhosis: Spectrum and prevalence of lesions

Aim: This was to describe the different types of lesions that can be found in patients with liver cirrhosis during upper gastrointestinal endoscopy. Patients and Methods: Consecutive patients with liver cirrhosis who gave their consent to participate in the study were recruited. The diagnosis of liver cirrhosis was made by clinical and radiological features and a total of 56 patients were recruited. After taking informed consent, upper gastrointestinal endoscopy was performed on all the patients. Results: The patients consisted of 43 (76.8%) males and 13 (23.2%) females. Mean age was 45.5 ΁ 13.8 years (range: 20-77 years). Analysis showed that 21 (37.5%) patients were less than 40 years of age, 16 (28.6%) were between 40 years and 49 years, and 19 (33.9%) were 50 years and above. Esophageal varices was diagnosed in 54 (96.4%) patients. The esophageal mucosal findings observed were erosions (7.1%), ulcer (1.8%), candidiasis (8.9%) while one (1.8%) patient had both esophageal erosions and candidiasis. Gastric varices were observed in 11 (19.6%) patients and the analysis showed that the most frequent form was isolated gastric varices type 1 (IGV1) was recorded in six (10.7%) patients. Portal hypertensive gastropathy (PHG) was seen in 45 (80.4%) patients. Other gastric mucosal lesions were erosions (12.5%) and ulcers (10.7%). Duodenal varices were not seen in any of the patients. Other lesions seen were duodenitis, duodenal erosions, and duodenal ulcers in one (1.8%) patient, one (1.8%) patient, and four (7.1%) patients, respectively. Conclusion: This study has revealed different pattern of lesions that can be seen in patients with liver cirrhosis apart from varices.

The role of vagal insulin signaling and enteric hormones in acute stomach and duodenal erosions and ulcers associated with severe concomitant traumatic head injuries

Aim. Clinical and experimental study of vagal insulin signaling and enteric hormones in occurrence of acute stomach and duodenal erosions and ulcers complicated by bleeding and associated with severe concomitant traumatic head injuries.
 Methods. Data of 347 patients with severe concomitant traumatic head injuries for 2011-2012 were used for clinical part of the study. Serum levels of insulin, gastrin, C-peptide, histamine, growth hormone, -amylase were determined. In the experimental part, the model of acute stomach and duodenal erosions and ulcers associated with traumatic head injury were modeled. The first group consisted of 5 intact rats, the second group included 45 rats with modeled isolated traumatic head injury, the third group included 45 rats with modeled traumatic head injury associated with traumatic lung and chest injury, the fourth group included 45 rats with modeled traumatic head injury associated with abdominal organs traumatic injury, the fifth group included 45 rats with modeled traumatic head injury associated with limb and pelvic fractures.
 Results. Acute stomach and duodenal erosions and ulcers were found in 21 (6.1%) of 347 patients at endoscopy, mainly in those with the highest parameters of vagal insulin signaling and enteric hormones. At the experiment, all types of combined traumatic head injury increased the incidence of erosions as compared to the second group, with the highest incidence in the group of associated abdominal injury. Vagal stimulation and stimulation of enteric hormones secretion in animals of groups 2-5 was associated with higher incidence of erosions. In contrast, decreased vagal stimulation and enteric hormones secretion leaded to statistically significant reduction of erosions incidence in animals of groups 2-5 as compared both to the natural history of the process (first subgroup), and to animals which were administered 5% dextrose (glucose) and 0.1% histamine solutions (second subgroup).
 Conclusion. The incidence of erosions and ulcers, as well as the indicators of vagal stimulation and enteric hormones secretion depend on the nature of the accompanying injury that may be taken into account in the prevention and treatment of such complications.

Potential humoral markers of gastric and duodenal stress ulcers accompanied by concomitant head injury

Aim. To evaluate the significance of a number of humoral indicators in gastrointestinal bleeding at various stages of severe concomitant head injury.Methods. The study included 347 patients with severe head injuries (brain contusion, intracerebral hemorrhage) associated with fractures of the extremities and pelvis (215 patients), abdominal organs injuries (75 patients), chest and lung injuries (57 patients). Samples of blood and stomach contents were taken on the 1st, 3rd, 5th, 8th, 9th, 12th, 15th and 18th days after the injury. Esophagogastroduodenoscopy was performed on the 3rd, 5th, 7th and 10th day after the trauma. Anti-streptolysin O, antihyaluronidase, C-reactive protein, sialic acids levels were determined by serum titration and precipitate formation.Results. On the 1st day, anti-streptolysin O level exceeded normal values (by 4.1±1.3 IU/ml), reaching a maximum value by 8-10th day (exceeding the normal range by 61.3±1.7 IU/ml) with further decrease after the 15th day. Antihyaluronidase level was permanently increased from the 5th day of observation. C-reactive protein level was higher than normal from the first day of study (0.1±0.17 mg/l), with further upward trend, reaching its peak on day 9, indicating continuous inflammation. Sialic acids level in the first days was twice as high as the normal level, and remained almost at the same level until the end of the study. Endoscopic examinations in 21 patients with gastrointestinal bleeding showed that in 11 (52.4%) cases, the source of bleeding were acute gastric and duodenal erosions and ulcers, in 5 (23.8%) cases - chronic gastric and duodenal ulcers, in 5 (23.8%) cases bleeding occurred due to exacerbation of chronic duodenal ulcer.Conclusion. Changes in serum anti-streptolysin O, antihyaluronidase, sialic acids levels in patients with severe head injuries, combined with other injuries may reflect the pathogenesis of acute gastroduodenal erosions and ulcers and be considered as the markers for their development.

SMERNICE ZA PREPREČEVANJE IN ZDRAVLJENJE NEŽELENIH UČINKOV NESTEROIDNIH PROTIVNETNIH IN ANTIAGREGACIJSKIH UČINKOVIN NA PREBAVILA

Adverse effects of nonsteroidal antiinflammatory drugs and antiaggregants on gastrointestinal tract can be prevented or reduced by rational prescribing, use of proton pump inhibitors and Helicobacter pylori eradication.Nonsteroidal antiinflammatory drugs should not be used to treat patients with high risk for serious adverse effects on either upper gastrointestinal or cardiovascular system. Proton pump inhibitors in standard oral dosages are used for treatment of dyspepsia or gastric and duodenal erosions and ulcers, caused by nonsteroidal antiinflammatory drug or antiaggregant use. Peptic ulcer hemorrhage is treated with endoscopic hemostasis and proton pump inhibitors (72-hour continuous infusion followed by 4 – 8 week standard dose oral treatment).Patients can be stratified into three groups based on risk for upper gastrointestinal system adverse effects associated with nonsteroidal antiinflammatory drugs or antiaggregants use. Absence of risk factors denotes low-risk patient population, one or two risk factors are associated with medium risk; high-risk patients harbor either three or more risk factors or history of complicated peptic ulcer disease. Helicobacter pylori should be eradicated (if present) in all medium and high-risk patients prior to introduction of nonsteroidal antiinflammatory drugs or antiaggregants and proton pump inhibitors in standard daily dose should be prescribed for the duration of the treatment.Risk of gastrointestinal hemorrhage should be considered when planning invasive cardiovascular procedures or introduction of antiaggregant or anticoagulant treatment. In the context of acute gastrointestinal hemorrhage, antiaggregants should not be discontinued for longer than 7 days and oral anticoagulant therapy should be stopped and converted to low-molecular-weight heparin after complete hemostasis.

Review of clinical and endoscopic features of metastatic tumors of the gastrointestinal tract

Abstract Aim: The aim was to determine the utility of capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB). Materials and Methods: A prospective study of patients who underwent CE at our institution from 2002 to 2010. Results: A total of 259 patients were included in this study (mean age 52.3 years; 200 male and 59 female), including 175 with overt OGIB, and 20 with occult OGIB, underwent CE. One hundred eighty-nine of 195 patients (96%) with OGIB had positive findings. Gastric erosions (23%), duodenal erosions (13%) and ileal erosions (11%) were the most frequent findings. Conclusion: Capsule endoscopy is a useful diagnostic technique in patients with OGIB.

Prevalence of lesions detected at upper endoscopy: An Italian survey

BackgroundPrevalence of gastroduodenal lesions is changing in the last decades. Prevalence of Helicobacter pylori infection, non-steroidal anti-inflammatory drugs (NSAIDs), and proton pump inhibitor (PPI) therapy may be involved in such a phenomenon. We assessed gastroduodenal lesions prevalence in a nationwide study. Materials and methodsConsecutive patients who underwent upper endoscopy for the first time in 24 Italian centres between January 2012 and 31 March 2012 were enrolled. Prevalence of gastric ulcer (GU), duodenal ulcer (DU), gastric erosions (GE), duodenal erosions (DE), gastric polyp (GP), Barrett's oesophagus (BE), and neoplasia was assessed. ResultsOverall, 1054 (M/F: 388/666; Mean age: 57.5±5years) patients were enrolled. H. pylori infection was detected in 356 (33.9%) patients, 358 (34%) were taking NSAIDs, and 532 (50.5%) PPIs. PPI therapy was associated with a significantly lower H. pylori detection rate (27.8% vs 39.8%; OR: 0.6, 95% CI 0.45–0.77; P<0.001). GU, DU, GE, DE, GP and BE were detected in 17 (1.6%), 13 (1.2%), 150 (14.2%), 50 (4.7%), 51 (4.8%) and 17 (1.6%), respectively. Moreover, 3 (0.3%) distal gastric cancers were observed. H. pylori infection remained the most prevalent factor for all gastroduodenal lesions, but gastric polyp. One third of patients with GU and GE were taking only NSAIDs therapy. ConclusionsThe prevalence of peptic ulcer was very low (<3%), with a similar rate between DU and GU. As many as half patients were on ongoing PPI therapy. Such a therapy could affect both the detection rate of H. pylori infection and the real prevalence of gastroduodenal lesions.

Endoscopic evaluation of dyspeptic patients

It was observed that most of the dyspeptic patients are showing normal endoscopic findings. In this study our aims were to obtain the endoscopic findings in patient having dyspeptic symptoms and to improve the management of patient in the light of the findings that are more common. This cross sectional descriptive hospital based study was carried out in the gastroenterology department of the Shaheed Suhrawardy Medical College Hospital, Dhaka. A total 72 cases were included in this study based on the selection criteria. Among them 46 were male and 26 were female patients. Most of the dyspeptic patients had normal endoscopic findings (55.6%). Gastric erosion was found in 22.2%, reflux oesophagitis in 8.3% cases and rest were duodenal ulcer, duodenal erosions and gastric ulcer. DOI: http://dx.doi.org/10.3329/bmj.v42i3.19001 Bangladesh Med J. 2013 Sept; 42 (3): 82-84

1030 Socio Economic Status and Type of Insurance Affects In-hospital Mortality From Peptic Ulcer Bleeding

Background: The Canadian North Helicobacter pylori (CANHelp) Working Group conducts community Helicobacter pylori projects to address public concerns about health risks from this infection in Arctic Canada, where H.pylori prevalence and stomach cancer rates are elevated. At the request of community leaders of Fort McPherson, Northwest Territories (population~800, ~95% Aboriginal), the ongoing Fort McPherson H. pylori Project launched in 2012 to investigate the disease burden related to H.pylori infection and identify strategies for reducing related health risks. Methods: A local planning committee guided the design and implementation of the project, which includes six components: surveys of risk factors, urea breath test (UBT) screening for H. pylori infection, upper gastrointestinal endoscopy with biopsies collected and histopathology, treatment, knowledge exchange, and policy development. During 2012-13, all residents of Fort McPherson were invited to participate in UBT screening and questionnaire-based risk factor interviews; residents ≥15 years of age were invited to undergo endoscopy in temporary endoscopy units in the local health centre. Participants could also enrol in a randomized trial comparing two 10-day H.pylori therapies: sequential therapy (ST) consisted of a proton pump inhibitor (PPI) and amoxicillin for days 1-5, followed by a PPI, clarithromycin, and metronidazole for days 6-10; quadruple therapy (QT) consisted of a PPI, bismuth, metronidazole, and tetracycline for days 1-10. Treatment outcomes were classified by UBT at >=10 weeks after treatment. Results: To date, 226 residents, aged 4-98 years, have consented to participate. Parental consent and child's assent were obtained for residents <17 years of age. Of the 226 project participants, 180 have completed risk factor interviews, 217 had a UBT (positivity=59%), 53 had endoscopy with biopsies collected, 71 consented to treatment and 60 enrolled in the treatment trial, with 24 to date completing a post-treatment UBT. Of the 53 participants who had endoscopy, gastroenterologists identified gastritis in 15%, gastric ulcer in 4%, gastric erosion in 11%, duodenitis in 4%, duodenal erosion in 2%, and esophagitis in 11%. Histopathology (Sydney classification) of gastric biopsies from 53 Fort McPherson H. pylori Project participants is shown in table 1. Preliminary findings from the treatment trial to date are: 86% treatment success for participants randomized to ST (12/14; 95% CI 57%-98%) and 100% treatment success for participants randomized to QT (10/10; 95% CI 74%-100%). Discussion: These results add to evidence that shows Arctic Aboriginal communities to be disproportionately affected by H. pylori infection. The high prevalence of moderate-severe gastritis shows that public concern over risks from H. pylori infection is warranted. Histology Results

1029 Community-Driven Research on Helicobacter pylori Infection in the Canadian Arctic: the Fort Mcpherson H. pylori Project

Background: The Canadian North Helicobacter pylori (CANHelp) Working Group conducts community Helicobacter pylori projects to address public concerns about health risks from this infection in Arctic Canada, where H.pylori prevalence and stomach cancer rates are elevated. At the request of community leaders of Fort McPherson, Northwest Territories (population~800, ~95% Aboriginal), the ongoing Fort McPherson H. pylori Project launched in 2012 to investigate the disease burden related to H.pylori infection and identify strategies for reducing related health risks. Methods: A local planning committee guided the design and implementation of the project, which includes six components: surveys of risk factors, urea breath test (UBT) screening for H. pylori infection, upper gastrointestinal endoscopy with biopsies collected and histopathology, treatment, knowledge exchange, and policy development. During 2012-13, all residents of Fort McPherson were invited to participate in UBT screening and questionnaire-based risk factor interviews; residents ≥15 years of age were invited to undergo endoscopy in temporary endoscopy units in the local health centre. Participants could also enrol in a randomized trial comparing two 10-day H.pylori therapies: sequential therapy (ST) consisted of a proton pump inhibitor (PPI) and amoxicillin for days 1-5, followed by a PPI, clarithromycin, and metronidazole for days 6-10; quadruple therapy (QT) consisted of a PPI, bismuth, metronidazole, and tetracycline for days 1-10. Treatment outcomes were classified by UBT at >=10 weeks after treatment. Results: To date, 226 residents, aged 4-98 years, have consented to participate. Parental consent and child's assent were obtained for residents <17 years of age. Of the 226 project participants, 180 have completed risk factor interviews, 217 had a UBT (positivity=59%), 53 had endoscopy with biopsies collected, 71 consented to treatment and 60 enrolled in the treatment trial, with 24 to date completing a post-treatment UBT. Of the 53 participants who had endoscopy, gastroenterologists identified gastritis in 15%, gastric ulcer in 4%, gastric erosion in 11%, duodenitis in 4%, duodenal erosion in 2%, and esophagitis in 11%. Histopathology (Sydney classification) of gastric biopsies from 53 Fort McPherson H. pylori Project participants is shown in table 1. Preliminary findings from the treatment trial to date are: 86% treatment success for participants randomized to ST (12/14; 95% CI 57%-98%) and 100% treatment success for participants randomized to QT (10/10; 95% CI 74%-100%). Discussion: These results add to evidence that shows Arctic Aboriginal communities to be disproportionately affected by H. pylori infection. The high prevalence of moderate-severe gastritis shows that public concern over risks from H. pylori infection is warranted. Histology Results

Simultaneous Gastric and Duodenal Erosions due to Adjustable Gastric Banding for Morbid Obesity.

Erosion is an uncommon but feared late complication of adjustable gastric banding for morbid obesity. A high index of clinical suspicion is required, since symptoms are usually vague and nonspecific. Diagnosis is confirmed on upper gastrointestinal endoscopy and band removal is the mainstay of treatment, with band revision or conversion to other bariatric modalities at a later stage. Duodenal erosion is a much rarer complication, caused by the connection tubing of the band. We present our experience with a case of simultaneous gastric and duodenal erosions, managed by laparoscopic explantation of the band, primary suture repair of the duodenum, and omentopexy.

Luffa echinata

Bristly luffa (Luffa echinata), a member of the cucurbitaceae family is an Ayurvedic medicinal plant, which has been used in the traditional system of medicine for variety of symptoms. The active constituents like cucurbitacin, saponin, echinatin, β-Sitosterol, oleanolic acid and flavonoids have important pathophysiological effects on human body. However, there is no earlier published report of any toxicity on humans. We report a case of a 50-year-old gentleman, who presented with gastrointestinal bleeding, deranged liver function and shock following consumption of dried fruits of Luffa echinata soaked overnight in water. He had antral gastritis and duodenal erosions on upper gastrointestinal endoscopy and was managed conservatively and recovered completely.