Lack of effect of Helicobacter pylori on symptom improvement with a prokinetic medication, cisapride, in patients with non-ulcer dyspepsia.

OBJECTIVE: This study was undertaken to determine whether H. pylori infection has an effect on the improvement of dyspeptic symptoms in response to a prokinetic agent, cisapride, in patients with non-ulcer dyspepsia (NUD). MATERIAL AND METHOD: 35 NUD patients (16 M, 19 F) who had no underlying medical condition and negative upper endoscopy were included in the present study. Each patient received a 2-wk treatment of cisapride (Prepulsid, 10 mg, tid ac). H. pylori infection was determined using a rapid urease test (CLO test). Gastric emptying (GE) scintigraphy and dyspeptic symptom scores were evaluated before and at the end of the treatment. GE was evaluated in 22 healthy volunteers as normal controls. RESULTS: Half time (T1/2) GE of NUD patients was 90.9 +/- 28 min which was significantly longer than controls (77.6 +/- 14 min; p < 0.05) and was shortened to 73.6 +/- 22 min (p < 0.0001) at the end of the treatment. Cisapride significantly improved total dyspeptic symptom scores [7 (2-18) to 3 (0-11), p < 0.0001]. The symptom score improvement was not affected by H. pylori infection [H. pylori positive: 6 (2-18) to 2.5 (0-9), p < 0.0001; H. pylori negative: 9 (4-16) to 3 (0-11), p < 0.0001] or GE status [delayed GE: 10 (5-16) to 3 (15), p < 0.05; non delayed GE: 6 (2-18) to 2 (0-11); p < 0.0001]. CONCLUSIONS: Cisapride improves dyspeptic symptoms regardless of H. pylori and GE status. These results suggest that gastric emptying and H. pylori infection are not essential to determine prior to prescribing a prokinetic agent, cisapride, in patients with NUD.

Causes of idiopathic constipation in Thai patients: associations between the causes and constipation symptoms as defined in the Rome II criteria.

The authors investigated 103 consecutive Thai patients (29M, 74F age 50 +/- 20) with chronic idiopathic constipation (symptom duration; median 5 yr, range 0.25-45 yr) as defined by Rome II criteria using colonic transit test, anorectal manometry, and balloon expulsion tests. Constipation symptoms were evaluated by a questionnaire. RESULTS: There were 30, 14, 11, and 48 patients who fulfilled the criteria of anorectal dysfunction, colonic inertia, anorectal dysfunction plus colonic inertia, and the normal transit constipation, respectively. The proportion of female gender in the normal transit constipation group (F:M=37:11) was significantly greater than the anorectal dysfunction group (16.14, p<0.05%). Patients with colonic inertia and colonic inertia plus anorectal dysfunction had a higher prevalence of infrequent bowel movement compaired to anorectal dysfunction and normal transit constipation (p<0.001). The prevalence of straining, hard stool, incomplete evacuation, sense of anal obstruction, and use of manual maneuver to facilitate defecation, were not different among the constipation subgroups (p>0.05). CONCLUSIONS: Prevalence of pathophysiologic conditions associated with idiopathic constipation in Thai patients are similar to Western countries. 29%, 13%, and 11% of Thai patients with idiopathic constipation were associated with anorectal dysfunction, colonic inertia, and anorectal dysfunction plus colonic inertia, respectively. Among the 6 constipation symptoms defined by Rome II criteria, only infrequent bowel movements was associated with delayed colonic transit.

Evaluation of inhouse rapid urease test for detection of Helicobacter pylori from gastric biopsy specimens.

Inhouse rapid urease test for detecting Helicobacter pylori was evaluated. Biopsy specimens were taken for inhouse urease test, commercial rapid urease CLO test, culture, gram stain and histology from the antrium or duodenum of patients who had peptic ulcer. The culture and/or histologic examination and CLO test were used as the gold standard. One hundred and twelve specimens were evaluated. The sensitivity and specificity of the inhouse urease test was 100 per cent and 90 per cent respectively. The inhouse urease test was suitable for detecting Helicobacter pylori from gastric antral biopsy specimens. The medium can be kept in a refrigerator for up to 6 months.