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.

Ulcerative colitis in Thailand: a clinical study and long term follow-up.

Ulcerative colitis (UC) is uncommon in Thailand. Few reports have been published and confirmation of the diagnosis was difficult. To make a firm diagnosis of UC in Thailand, long-term follow-up and demonstration of chronic and relapsing clinical courses should help to confirm the existence of UC in Thailand. OBJECTIVE: To review the demographic data, clinical presentation and clinical courses of the diagnosed UC cases in Thailand. MATERIAL AND METHOD: Diagnosed UC patients who were followed-up for longer than 3 months at the Diarrhea Clinic, Siriraj Hospital between 1988-2000 were included. RESULTS: Forty cases of UC were followed-up. The duration of follow-up ranged from 3-75 months (mean 27 months). Male to female ratio was 19:21 and age of onset varied from 13-77 years (mean 37.7 years). Extents of the disease was left-sided colitis in 58 per cent, left and right-sided colitis in 8 per cent, pancolitis in 21 per cent, proctosigmoiditis in 13 per cent and ileal involvement in 8 per cent. At presentation, the disease was mild in 28 per cent, moderate in 60 per cent, severe in 13 per cent and fulminant in 2. Clinical presentations were diarrhea in 97.5 per cent, lower GI bleeding in 17.5 per cent, abdominal pain in 50 per cent, fever in 27.5 per cent, weight loss in 62.5 per cent and extraintestinal manifestations in 20 per cent. Diagnoses were made in all cases by sigmoidoscopy plus barium enema or colonoscopy and biopsies were taken in all cases. Histologic findings supported the diagnoses in 69 per cent of cases. Seventy per cent responded to sulfasalazine or 5-ASA with or without corticosteroid, but in 30 per cent, azathioprine was added for a period during the treatment. Clinical courses of the diseases were chronic intermittent with remission and relapse in 44 per cent, chronic continuous activity without remission in 27 per cent, single episode without relapse in 27 per cent and acute fulminating course in 6 per cent. One patient died from fulminant pancolitis with colonic perforation. There was no colonic cancer in our cases throughout the follow-up period. CONCLUSIONS: UC is very uncommon in Thailand. Firm diagnosis of UC can be made through long-term follow-up and demonstration of chronic and relapsing clinical courses. The disease severity and extent of disease involvement was slightly different from that in Western countries. Incidence of extraintestinal manifestation was 20 per cent. Most cases responded to sulfasalazine, 5-ASA or corticosteroids.

Effects of cigarette smoking on duodenal ulcer healing and relapse rate.

104 duodenal ulcer patients were classified into non-smokers (76) and smokers (28). Their age range was between 14-72 years. They were randomly treated with cimetidine (28 non-smokers and 8 smokers), colloidal bismuth (27 non-smokers and 10 smokers) and sucralfate (21 non-smokers and 10 smokers). Follow-up endoscopic examination at 4, 6 and 8 weeks showed that overall healing rates were better in the non-smokers than in the smokers (64.5% against 46.4% at 4 weeks and 92.1% against 67.8% at 6 weeks) and almost all ulcers had healed at the end of 8 weeks (100% in non-smokers and 96.4% in smokers). Among non-smokers, there were no statistically significant differences in the healing rates by any medication at any period of time. Among smokers, colloidal bismuth had significant better healing rate at 6 weeks over cimetidine and sucralfate. (p = 0.04 and p = 0.041 respectively). Overall relapse rates were higher among smokers (32.1%) than non-smokers (10.5%). Of the 3 medications, sucralfate had the lowest relapse rate in both smokers (20%) and non-smokers (9.5%), while colloidal bismuth had the highest relapse rates (40% for smokers and 11.1% for non-smokers).

Comparison study between fasting total serum bile acid and post prandial bile acid in hepatic diseases: a preliminary study.

Fasting bile acid, two-hour post prandial bile acid and other liver function tests (Bili, AST, ALT, ALB, Glob, ALP) were measured in 22 normal and 28 liver diseased patients. In normal volunteers, the mean value of fasting total serum bile acid (FTBA) and postprandial serum bile acid (PTBA) were 3.08 mumole/L (S.D. 1.65) range 0.21-6.26 mumol/L, and 8.07 mumole/L (S.D. 2.99) range 4.06-15.65 mumole/L. Comparison between FTBA, PTBA and other liver function tests in various liver diseases from this study the PTBA was not statistically significant superior to FTBA. Therefore, it is not necessary to do the PTBA at this time until more data is available.

Gastric acid secretion in Thai patients with particular reference to the characteristics differentiating types of gastric and duodenal ulcer.

Acid secretion in both basal and stimulated states (using augmented histalog test) was studied in 31 normal control patients, 64 duodenal ulcer patients and 101 gastric ulcer patients. Having had the result of acid output study, the 64 DU patients could be classified according to their acid secretion results as 35 DU type I or Normosecretor (54.7%) and 29 DU type II or Hypersecretor (45.3%). For the GU patients which were classified according to the sites of lesions as GU type I (GU above angulus), GU type II (GU associated with DU) and GU type III (GU below the angulus). Their acid output study showed that the GU type I had a rather low BAO and a high MAO close to that of the Normosecretor, but the GU type II and III had their BAO and MAO significantly higher than that of the normal control and close to that of the Hypersecretor. Comparison of acid secretion in this study group to other racial groups showed that the Thai population had acid secretion patterns close to other Asian populations, except that the Chinese in Singapore had a higher proportion of Normosecretor (69.0%) than Hypersecretor (31%). The MAO of the Asian population was found to be lower than that of Europeans.

Amoebic liver abscess in Thailand, clinical analysis of 418 cases.

From 1975 to 1983, 418 cases of amoebic liver abscess were admitted to the Department of Medicine, Siriraj Hospital without definite increase or decrease in the overall incidence and without seasonal preponderance. The age range was 16-81 yrs and mean age 42.4 yrs. Male to female ratio was 5:1. Pertinent clinical features were pain, fever and hepatomegaly with predominant involvement of the right lobe. Principal treatment consisted of needle aspiration combined with amoebicidal drugs, i.e. metronidazole, tinidazole and ornidazole. The efficacy of each was similar. Surgical drainage was required in only 2.1 per cent of uncomplicated cases and mortality rate was 0.7 per cent. Ruptures into pleural, pericardial and peritoneal cavity were found in 15.4 per cent and secondary infection in 11.9 per cent. Mortality rate of cases with complication was 7.14 per cent. Length of hospital stay was 12.8 days for the uncomplicated cases and 24.1 days for cases with complications (excluding the nonsurvivals).

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.