Stress, but not Helicobacter pylori, is associated with peptic ulcer disease in a Thai population.

The purpose of this study was to clarify the relation between psychological and other risk factors, notably helicobacter pylori (H. pylori) infection, in contributing to the occurrence of peptic ulcer (PU) disease. A retrospective case-control study was conducted at Siriraj Hospital, Bangkok from March to December 2000. Seventy endoscopically diagnosed patients with new PU or peptic perforation were compared with 70 patients with other diseases as well as blood donors control matched for age and sex. Historical risk factors, H. pylori Immunoglobulin G antibody (H. pylori IgG Ab), stress (Perceived Stress Questionnaire) and hostility (MMPI Hostility Scale) were assessed. Data were analyzed using logistic regression analysis. The results showed that PU was associated with chronic stress (aOR 2.9, p = 0.01; 95% CI, 1.3-6.5) and family history of PU (aOR 2.4, p < 0.03; 95% CI, 1.1-5.1), with an interaction effect between stress and irregular mealtimes (aOR 4.8, p = 0.01; 95% CI, 1.3-16.9). The incidence rate of H. pylori infection in PU patients was similar to the control group (61.4% and 50.0%, respectively, OR 1.2). The authors conclude that stress and family history, not H. pylori infection, are important risk factors for PU in this population. This finding supports previous studies in Thailand, showing a high prevalence of H. pylori in the population but a low association with PU, in contrast to developed countries. It remains to be seen whether the impact of a family history is due to genetic factors or shared life-style patterns.

Upper gastrointestinal endoscopy in children with recurrent abdominal pain.

Over a 3 year period from 1992 to 1995, 62 patients with recurrent abdominal pain (RAP) underwent upper gastrointestinal endoscopy showing normal findings in 30 patients (48.4%), gastroduodentis 17 (27.4%), H. pylori gastritis 11 (17.7%) and esophagitis 4 (6.5%). Duodenal or gastric ulcer was not found. This study demonstrated more evidence of increased prevalence of organic causes of RAP than previous reports. Duration of illness of more than one year and vomiting were more common in H. pylori gastritis. Other symptoms including diarrhea, constipation, nocturnal awakening and pain related to meals could not differentiate between organic and functional cause. Major cases of H. pylori gastritis and gastroduodenitis responded to triple drug therapy and H2 blockers respectively.

Helicobacter pylori infection in Thai children with recurrent abdominal pain.

Sixty-five children with recurrent abdominal pain underwent gastrointestional endoscopy which showed Hp gastritis without duodenal ulcer in 16.9 per cent of cases. The prevalences of infection in recurrent abdominal pain and asymptomatic children were not different. Either urease test or histological method was appropriate for diagnosis of this infection. Triple therapy including bismuth subcitrate, amoxicillin and metronidazole improved abdominal pain symptom in 72.7 per cent without any side effect.

The upper endoscopy in upper gastrointestinal hemorrhage of children.

Between 1992-1994, 20 children aged 3 months to 16 years who were admitted to Department of Pediatrics, Faculty of Medicine, Siriraj Hospital with problems of hematemesis and melena underwent gastrointestinal endoscopy. Thirteen children developed bleeding before admission and underlying diseases in 3 of these were chronic renal failure, pulmonary TB and malignant mesenchymoma. The main causes of hemorrhage in this group were gastritis (5 cases), esophagitis (3 cases) and esophageal varices (2 cases). The underlying disease of 7 children with hemoeehage during hospitalization were blood disease, SLE with renal failure and gastroesophageal reflux. The esophagitis, candida esophagitis, and gastric esosion were the etiologies of bleeding. Nine children needed blood transfusion and one had further investigations including meckel scan, tagged red cell scan and colonoscopy. Four patients died due to sepsis. The endoscopy had the value of establishing the etiology of upper gastrointestinal hemorrhage in 19 cases.

Helicobacter pylori: a comparison of CLO test and Giemsa's stain with culture in dyspeptic patients.

The prevalence of H.pylori in Thailand is high compared with Western countries and is the same as in China. We suggest either rapid urease test (CLO test) or Giemsa stain to be a rapid, reliable and convenient detection method for H.pylori and is also suitable for use in follow-up studies by gastroenterologists.

Helicobacter pylori and peptic ulcer diseases: prevalence and association with antral gastritis in 210 patients.

Evidence is accumulating that Helicobacter pylori infection plays a major contributory role in peptic ulcer disease [Duodenal Ulcer (DU) and Gastric ulcer (GU)] and non-ulcer dyspepsia (NUD). We, therefore, studied prospectively 210 consecutive patients with upper gastrointestinal symptoms (62 DU, 38 GU and 110 NUD) to determine the prevalence of H. pylori infection and to investigate their association with histological gastritis. Using endoscopic biopsy of the gastric antrum for diagnosing H. pylori infection by Campylobacter-like Organism (CLO) test, histology or bacteriology, the overall prevalence of H. pylori was 63.3 per cent. When H. pylori infection was related to diagnosis, DU had the highest prevalence rate of H. pylori infection (66%), GU and NUD were less frequently associated with H. pylori infection (55% and 44% respectively). We found a close association between H. pylori infection and histologically antral gastritis, in that 72.7, 61.7, and 62.6 per cent of the DU, GU and NUD patients with antral gastritis (respectively) had H. pylori infection. In contrast, none of these patients seen with normal antrum had H. pylori infection. We also found that the prevalence of H. pylori in our patient series was not age related. Of the three procedures used to demonstrate H. pylori, the CLO test and histological staining method gave the highest yields of 84.9 and 79.6 per cent respectively, and bacteriology in only 44.3 per cent, we conclude that the prevalence of H. pylori infection in Thai patients with upper gastrointestinal symptoms is high. H. pylori infection commonly occurs in the patients with antral gastritis, suggesting a possible etiologic role for the bacterium in the histologic lesion.

Acute systemic melioidosis: an autopsy study of six cases.

Autopsy findings of six cases of the acute systemic melioidosis from Siriraj Hospital, Bangkok, Thailand during the years 1977 to 1986 are presented. Five out of six cases had some underlying conditions. Multiple abscesses and multiple organs involvement were the rule. The organs most commonly involved were lung and liver. Three patients had pericardial and one had adrenal gland involvement. Other significant pathological findings were fibrin thrombi (5/6 cases), haemorrhage (6/6 cases), tissue necrosis (4/6 cases) and granular casts in renal tubules (1/6 case). Abscess alone cannot explain the death of patients. Toxaemia, both exotoxins and endotoxin, is the most likely explanation from the death of patients.