Clinical Features and Outcomes of Ulcerative Colitis Complicated with Acute Massive Lower Gastrointestinal Hemorrhage / 中国医学科学院学报

To analyze the clinical features and prognosis of ulcerative colitis(UC)complicated with acute massive lower gastrointestinal bleeding(LGIB). Methods Eleven patients hospitalized in Peking Union Medical College Hospital from January 2006 to December 2017 for treatment of UC,suffering from acute massive LGIB,were enrolled and descriptively analyzed. Results The proportion of UC patients with acute massive LGIB was 0.7% among all 1486 UC patients hospitalized during the study period.The disease was moderately or severely active in these 11 patients,among whom 9 patients(81.8%)had chronic relapsing pancolitis.Cytomegalovirus infection was present in 5 patients,among whom 4 patients received antiviral treatments.All the 11 patients received treatments including food and water fasting,rehydration,blood transfusion,and use of somatostatin.Four patients received emergency surgical treatment after the first episode of massive bleeding,and 3 of them suffered from re-bleeding after the surgery.Among the remaining seven patients,two underwent emergency total colectomy+subtotal rectectomy+ileostomy and three received elective total resection of colon and rectum or total colectomy+subtotal rectectomy+ileostomy.Thus,9 patients underwent emergency surgery,1 patient did not receive surgey during follow-up,and 1 patient was lost to follow-up. Conclusions Acute massive LGIB is a manifestation of active UC and can be associated with poor prognosis.Optimized perioperative management is important for improving the outcomes of such patients.

Amoxicillin-Clarithromycin-Containing Bismuth Quadruple Therapy for Primary Eradication of Helicobacter pylori / 中国医学科学院学报

Objective To evaluate the efficacy and safety of amoxicillin-clarithromycin-containing bismuth quadruple regimen as a primary therapy for Helicobacter pylori (Hp) eradication.Methods A total of 102 Hp-infected outpatients diagnosed by C-or C-urea breath test from December 2015 to June 2017 were enrolled and received 14-day bismuth quadruple therapy (esomeprazole 20 mg bid,bismuth potassium citrate 220 mg bid,amoxicillin 1000 mg bid,and clarithromycin 500 mg bid for 14 days). Hp status was assessed by C-or C-urea breath test 4 weeks,8 weeks,6 months,and 12 months after the treatment. The primary outcome was Hp eradication rate,which was analyzed by intention-to-treat (ITT) and per-protocol (PP) analyses. The second outcomes were Hp infection recurrence,symptomatic benefit from Hp eradication,and safety. Results A total of 101 patients,of which 65 patients had dyspeptic symptoms before eradication,completed the study. Hp eradication rates by ITT analysis and by PP analysis were 88.2% and 89.1%,respectively. Only in two of 84 patients,who were followed for 8 weeks after eradication,Hp became positive. No Hp recurrence happened at the 6-month and 12-month follow-up and the annual recurrence rate was 2.4%. The symptomatic relief rates at the 4-week,8-week,6-month and 12-month follow-up were 81.5%,75.4%,71.2%,and 70.2% respectively. Eleven of 101 patients had mild and similar side-effects,which were well tolerated.Conclusion Amoxicillin-clarithromycin-containing bismuth quadruple regimen can be used as the standard therapy for Hp eradication.

Values of Different Laboratory Diagnostic Approaches for Tuberculous Peritonitis / 中国医学科学院学报

Objective To evaluate the diagnostic accuracy of different laboratory approaches for tuberculous peritonitis(TP).Methods The clinical data of patients with suspected TP who were mainly manifested as ascites in Peking Union Medical College Hospital from January 2014 to June 2017 were retrospectively analyzed. Ascites samples were tested with different diagnostic approaches,including acid fast stain,culture for mycobacterium,real-time polymerase chain reaction for identifying DNA of mycobacterium tuberculosis,and T-cell spot of tuberculosis test(T-SPOT.TB). Results Totally 163 cases aged 15-84 years [mean±SD:(50±17)years] with complete data were enrolled,among whom 82(50.3%) were males and 81(49.7%) were females. Finally,27 patients were confirmed as TP,which was excluded in the other 136 cases. The sensitivity and specificity of ascites acid fast stain were 0% and 100%,respectively,followed by ascites culture for mycobacterium(21.74% and 100%),real-time polymerase chain reaction for DNA of mycobacterium tuberculosis in ascites(18.52% and 100%),T-SPOT.TB on ascites(95.42% and 61.90%),and T-SPOT.TB on peripheral blood(76.19% and 80.18%). Conclusion The diagnosis of tuberculous peritonitis remains challenging because of the limitations of the currently available diagnostic tests. Diagnosis should also be based on clinical manifestations and auxiliary examinations.