Post endoscopic retrograde cholangiopancreatography cholecystitis: The incidence and risk factors analysis.

BACKGROUND: For decades, endoscopic retrograde cholangiopancreatography (ERCP) has been widely performed as a diagnostic and therapeutic procedure for biliary and pancreatic diseases. Complications of ERCP include pancreatitis, hemorrhage, perforation, cholangitis, and cholecystitis. There are few studies that focus on the incidence of post-ERCP cholecystitis and its potential risk factors. METHODS: A retrospective single-center study was performed in 1345 ERCP procedures after excluding patients with current cholecystitis or post-cholecystectomy between January 2009 and December 2011. Potential risk factors for post-ERCP acute cholecystitis, including age, gender, biochemistry, imaging data, procedures such as endoscopic sphincterotomy (EPT), or endoscopic retrograde biliary drainage (ERBD), were obtained and analyzed by multivariate logistic regression analysis. RESULTS: Cholecystitis developed after 13 (0.96%) of the 1345 ERCP procedures. Univariate and multivariate logistic regression analyses showed that cystic duct stones (odds ratio [OR] = 198.26; 95% CI, 5.12-7835.44) and ERBD (OR = 37.58; 95% CI, 3.25-445.56) were important potential risk factors for post-ERCP cholecystitis. The percentage of ERBD procedures and cystic duct stones in patients with post-ERCP cholecystitis was 76.9% and 39.8%, respectively. The 13 patients with post-ERCP cholecystitis all received antibiotics, and four of them also received percutaneous gallbladder drainage. All patients recovered without significant clinical event or mortality. CONCLUSION: The incidence of post-ERCP cholecystitis was 0.96% in the 1345 ERCP procedures performed. Cyst duct stones and ERBD were found to be risk factors for post-ERCP cholecystitis.

Endoscopic papillary balloon dilatation less than three minutes for biliary stone removal increases the risk of post-ERCP pancreatitis.

OBJECTIVES: The adequate duration for EPBD was unclear. Therefore, we aimed to investigate the effect of balloon dilatation duration of EPBD on the occurrence of PEP. METHODS: One hundred and ninety-eight patients with common bile duct (CBD) stone treated by EPBD were retrospectively recruited. The dilatation duration was determined according to adequate opening of the biliary orifice without bleeding. The clinical outcomes and complications of EPBD were recorded. RESULTS: We stratified the patients according to dilatation duration (Group A, <3 minutes; Group B, 3-5 minutes; Group C, ≥5 minutes). The group C patients had a higher proportion of large CBD stones (stones ≥10 mm) (33.3% vs. 26.8% vs. 53.5%, p = 0.01). Patients in group A had a significantly higher PEP rate than patients in group B (13.3 vs. 3.1, p = 0.032). There were no significant differences in perforation and bleeding rate among the three groups. Univariate and multivariate analyses showed that a dilatation duration of <3 minutes, CBD diameter < 10 mm and age ≤ 75 years were independent risk factors of PEP in post-EPBD patients. CONCLUSIONS: In patients receiving EPBD, dilatation duration <3 minutes, lower CBD diameter, and younger age were independent risk factors of PEP.

Predictors of stent occlusion in patients with unresectable pancreatic cancer after biliary metal stents.

BACKGROUND: Self-expandable metal stents (SEMS) are a widely accepted biliary endoprosthesis for patients with unresectable malignant biliary obstruction. Here, we identified predictors for the occlusion of SEMS in unresectable pancreatic cancer patients with biliary tract obstruction. METHODS: Patients with a distal malignant biliary obstruction caused by unresectable pancreatic cancer who received partially covered SEMS (PC-SEMS) placement for the first time between January 2003 and January 2016 were retrospectively enrolled for analysis. The rates of PC-SEMS occlusion were evaluated. The possible predictors of PC-SEMS occlusion were analyzed using Cox regression analysis. RESULTS: In total, 120 patients who received PC-SEMS for unresectable pancreatic cancer were identified. The rate of PC-SEMS occlusion was 37%. The median time to occlusion of PC-SEMS was 359 days. The major causes of occlusion included biliary sludge (61%) and tumor ingrowth (30%). Cox multivariate regression analysis revealed that inadequate alkaline phosphatase/gamma-glutamyl transferase decline (defined by a decrease of <50% within 2 wk after PC-SEMS placement) was the only independent predictor of stent occlusion (hazard ratio, 2.86; 95% CI, 1.28-6.25; p = 0.01) CONCLUSION:: Inadequate alkaline phosphatase/gamma-glutamyl transferase decline is a predictor of occlusion of first-time PC-SEMS placement in unresectable pancreatic cancer patients with biliary tract obstruction.

Cholecystectomy decreased the recurrent cholangitis after clearance of bile duct stones by ERCP in patients with gallstone-related cholangitis.

BACKGROUND: This study assessed whether cholecystectomy can decrease recurrent cholangitis and all-cause mortality in patients who received endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and successful clearance of bile duct (BD) stones after gallstone-related cholangitis. METHODS: We analyzed data from the National Health Insurance research database of Taiwan. Patients who had gallstone-related cholangitis and underwent successful endoscopic clearance of BD stones were eligible for enrollment. This population-based, propensity score (PS)-matched cohort study involved 2 cohorts; (1) patients who underwent cholecystectomy after ERCP with BD stone clearance as the study group; and (2) those who had no cholecystectomy after ERCP with BD stone clearance as the control group. The primary endpoint was recurrent cholangitis, and the secondary endpoint was all-cause mortality. RESULTS: During a mean 5.7-year follow-up, the incidence rates of recurrent cholangitis were 20.47 per 1000 person-years in the cholecystectomy cohort, and 34.60 per 1000 person-years in the PS-matched control cohort. The risk of recurrent cholangitis was significantly lower in the cholecystectomy cohort than in the control cohort (HR, 0.62; 95% confidence interval [CI], 0.45-0.87; P = 0.006). The HR for all cause mortality among the cholecystectomy cohort was 0.70 (95% CI, 0.54-0.90; P = 0.006) compared with the control cohort. CONCLUSION: Cholecystectomy decreased the recurrent cholangitis and all-cause mortality in patients with endoscopic sphincterotomy and successful clearance of BD stones after gallstone-related cholangitis.

Clopidogrel inhibits angiogenesis of gastric ulcer healing via downregulation of vascular endothelial growth factor receptor 2.

BACKGROUND/PURPOSE: Although clopidogrel does not cause gastric mucosal injury, it does not prevent peptic ulcer recurrence in high-risk patients. We explored whether clopidogrel delays gastric ulcer healing via inhibiting angiogenesis and to elucidate the possible mechanisms. METHODS: Gastric ulcers were induced in Sprague Dawley rats, and ulcer healing and angiogenesis of ulcer margin were compared between clopidogrel-treated rats and controls. The expressions of the proangiogenic growth factors and their receptors including basic fibroblast growth factor (bFGF), bFGF receptor (FGFR), vascular endothelial growth factor (VEGF), VEGFR1, VEGFR2, platelet-derived growth factor (PDGF)A, PDGFB, PDGFR A, PDGFR B, and phosphorylated form of mitogenic activated protein kinase pathways over the ulcer margin were compared via western blot and reverse transcription polymerase chain reaction. In vitro, human umbilical vein endothelial cells (HUVECs) were used to elucidate how clopidogrel inhibited growth factors-stimulated HUVEC proliferation. RESULTS: The ulcer sizes were significantly larger and the angiogenesis of ulcer margin was significantly diminished in the clopidogrel (2 and 10 mg/kg/d) treated groups. Ulcer induction markedly increased the expression of phosphorylated form of extracellular signal-regulated kinase (pERK), FGFR2, VEGF, VEGFR2, and PDGFRA when compared with those of normal mucosa. Clopidogrel treatment significantly decreased pERK, FGFR2, VEGF, VEGFR2, and PDGFRA expression at the ulcer margin when compared with those of the respective control group. In vitro, clopidogrel (10(-6)M) inhibited VEGF-stimulated (20 ng/mL) HUVEC proliferation, at least, via downregulation of VEGFR2 and pERK. CONCLUSION: Clopidogrel inhibits the angiogenesis of gastric ulcer healing at least partially by the inhibition of the VEGF-VEGFR2-ERK signal transduction pathway.

Elevated serum dopamine increases while coffee consumption decreases the occurrence of reddish streaks in the intact stomach.

BACKGROUND AND AIM: Reddish streaks in an intact stomach are an endoscopic feature of duodenogastric reflux. This study aimed to identify which factors are associated with gastric reddish streaks and thus help prevent mucosal damage from duodenogastric reflux. METHODS: Demographic data, personal habits, stressful life events, and psychological distress were compared between subjects with only gastric reddish streaks and those with normal mucosa who underwent upper gastrointestinal endoscopy as part of a self-paid physical checkup. Stress hormones dopamine and cortisol were also checked by high-performance liquid chromatography and radioimmunoassay methods respectively. RESULTS: There were 95 subjects with gastric reddish streaks and 52 subjects with normal mucosa. No significant differences in age, gender, blood groups, education levels, marital status, religion, aspirin or nonsteroidal anti-inflammatory drug (NSAID) use, smoking habit, alcohol consumption, and intake of tea was found between the two groups, but intake of coffee was borderline more common in subjects with normal mucosa (38.5% vs 22.1%, P = 0.055). Subjects with gastric reddish streaks had lower Helicobacter pylori infection rate (37.8% vs 19.3%, P < 0.05). There were no significant differences in psychological distress and stressful life events between the two groups. Multivariate analysis shows that serum dopamine concentrations (odds ratio = 11.31, 95% confidence interval = 2.11-60.48, P = 0.005) and being without the consumption of coffee (odds ratio = 2.97, 95% confidence interval = 1.27-6.94, P = 0.012) were associated with gastric reddish streaks. CONCLUSIONS: Elevated serum dopamine and less coffee consumption are associated with gastric reddish streaks. These findings implicate that increased dopamine level plays a role for abnormal duodenogastric reflux.

Risk factors for upper gastrointestinal bleeding in coronary artery disease patients receiving both aspirin and clopidogrel.

BACKGROUND: Dual therapy (aspirin and clopidogrel) increases the risk of upper gastrointestinal bleeding (UGIB). Acute coronary syndrome (ACS), a critical ill condition, may increase the risk of UGIB due to stress-related mucosal disease and the impact of receiving dual antiplatelet agents. We identified risk factors of UGIB in patients with coronary artery disease (CAD) receiving dual therapy. METHODS: Patients who received dual therapy due to ACS or postpercutaneous coronary intervention (elective, primary, or urgent) were enrolled retrospectively. We assessed the occurrence of UGIB and identified the risk factors for UGIB at early stage (dual therapy ≤ 2 weeks) and late stage (> 2 weeks) by Cox regression analysis. RESULTS: During a mean follow-up period of 125 days, 67 (12.5 %) out of 534 patients developed UGIB (32 patients at early stage, 35 patients at late stage). Cox regression analysis showed that use of proton pump inhibitor therapy has a protective role in these patients [hazard ratio (HR): 0.10, 95% confidence interval (CI): 0.01-0.71]. ACS (HR: 2.67, 95% CI: 1.33-5.34) has a high risk of developing UGIB at an early stage. Old age (>75 years of age) (HR: 2.13, 95% CI: 1.02-4.47) and prior history of peptic ulcer disease (HR: 3.27, 95% CI: 1.28-8.34) each have an associated high risk for developing UGIB at a late stage. The use of mechanical ventilation (HR: 5.85, 95% CI: 2.19-15.58) also increased UGIB risk at both the early and late stages. CONCLUSION: ACS and mechanical ventilation are important risk factors of UGIB at the early stage (≤ 2 weeks). Additionally, old age (>75 years), past peptic ulcer disease history, and the use of mechanical ventilation play important roles in the occurrence of UGIB at late stage (>2 weeks). However, it was also noted that use of PPI plays a protective role in patients with CAD receiving aspirin and clopidogrel therapy.

The role of cholecystokinin 1 receptor in prolactin inhibited gastric emptying of male rat.

BACKGROUND/AIMS: Prolactin (PRL) is essential for the lactating mammals, while cholecystokinin (CCK) does inhibit gastric emptying (GE). Present study attempted to determine whether both peptides interacted on the male rat GE, particularly the role of putative CCK1 receptor. METHODS: Acute hyperprolactinemia of male rats was induced by the intraperitoneal injection of ovine PRL (oPRL) in several divided doses 15 minutes before motility study. Rat chronic hyperprolactinemia was induced by the graft of 2 pituitary glands into the capsule of left kidney, while control rats received cerebral cortex graft only. Motility study was conducted 6 weeks later after graft surgery. Fifteen minutes after the intragastric feeding of radiochromium, rat was sacrificed to measure GE via the distribution of radioactivities within stomach and intestine. Among the CCK1 receptor blocking study using lorglumide, rats were divided to receive the regimens in terms of oPRL-vehicle plus lorglumide-vehicle, oPRL plus lorglumide-vehicle, oPRL-vehicle plus lorglumide and oPRL plus lorglumide. Plasma CCK level was measured using a homemade radioimmunoassay kit. RESULTS: Compared to vehicle treatment, acute hyperprolactinemic rats under highest dose (2.0 mg/kg) of oPRL treatment showed delayed GE (70.6% ± 3.0% vs 42.1% ± 6.6%, P < 0.05). Chronic hyperprolactinemic rats under graft surgery also showed inhibited GE (70.5% ± 1.7% vs 54.5% ± 4.7%, P < 0.05). Both models finally obtained elevated plasma CCK levels (P < 0.05). Lorglumide itself did not influence GE, however, delayed GE under oPRL treatment was restored following the concomitant lorglumide treatment. CONCLUSIONS: Our study suggests that PRL may delay male rat GE via a mechanism of endogenous CCK activation involving the peripheral CCK1 receptor.

Additional corpus biopsy enhances the detection of Helicobacter pylori infection in a background of gastritis with atrophy.

BACKGROUND: The best sites for biopsy-based tests to evaluate H. pylori infection in gastritis with atrophy are not well known. This study aimed to evaluate the site and sensitivity of biopsy-based tests in terms of degree of gastritis with atrophy. METHODS: One hundred and sixty-four (164) uninvestigated dyspepsia patients were enrolled. Biopsy-based tests (i.e., culture, histology Giemsa stain and rapid urease test) and non-invasive tests (anti-H. pylori IgG) were performed. The gold standard of H. pylori infection was defined according to previous criteria. The sensitivity, specificity, positive predictive rate and negative predictive rate of biopsy-based tests at the gastric antrum and body were calculated in terms of degree of gastritis with atrophy. RESULTS: The prevalence rate of H. pylori infection in the 164 patients was 63.4%. Gastritis with atrophy was significantly higher at the antrum than at the body (76% vs. 31%; p<0.001). The sensitivity of biopsy-based test decreased when the degree of gastritis with atrophy increased regardless of biopsy site (for normal, mild, moderate, and severe gastritis with atrophy, the sensitivity of histology Giemsa stain was 100%, 100%, 88%, and 66%, respectively, and 100%, 97%, 91%, and 66%, respectively, for rapid urease test). In moderate to severe antrum or body gastritis with atrophy, additional corpus biopsy resulted in increased sensitivity to 16.67% compare to single antrum biopsy. CONCLUSIONS: In moderate to severe gastritis with atrophy, biopsy-based test should include the corpus for avoiding false negative results.

The evaluation of otilonium bromide treatment in asian patients with irritable bowel syndrome.

BACKGROUND/AIMS: Antispasmodics including otilonium bromide (OB) are recommended to treat irritable bowel syndrome (IBS). However, reports about OB experience in Asia is sparse. The purpose of present study was to provide the efficacy of OB in treating Asian IBS patients. METHODS: Overall, 117 IBS patients meeting Rome II criteria were enrolled in an 8-week, double-blind, active-controlled and single center trial. Randomized participants received either OB 40 mg or mebeverine 100 mg 3 doses daily. The primary endpoints were to evaluate the net changes of abdominal pain/discomfort frequency score (APDFS) and safety profile, while the secondary endpoints were to assess the changes in abdominal pain/discomfort intensity, flatulence, abdominal bloating, satisfied stool frequency etc. RESULTS: Finally, 49 OB and 52 mebeverine subjects were eligible for efficacy analysis. Compared to baselines in per protocol populations, the reduced APDFSs in OB and mebeverine were 0.55 ± 1.20 (P = 0.011) and 0.37 ± 1.11 (P = 0.042), respectively, to show similarly reduced scores. The most reported side effects included dry mouth, nausea and dizziness. Besides, the improved APDFSs at 4th week visit, final alleviations in abdominal pain intensity, flatulence, abdominal bloating and satisfied stool frequency with global assessments filled by both patients and investigators were significantly achieved by both treatments, and OB was not inferior to mebeverine in treating these parameters. CONCLUSIONS: In Orientals, OB is as effective as mebeverine for alleviating IBS symptoms in terms of abdominal pain, flatulence, abdominal bloating etc. However, obvious side effects are also observed. A large-scaled trial and post-marketing surveillance are recommended to confirm its efficacy and safety.

The current prevalence of irritable bowel syndrome in Asia.

Irritable bowel syndrome (IBS) has been one of the commonly presented gastrointestinal disorders. It is of interest how commonly it presents in the society. Western studies indicated that most population-based IBS prevalences range 10%-15%. It is believed that IBS is prevalent in both East and West countries without a significant prevalence difference. Most recently, the Asia IBS prevalence has a higher trend in the affluent cities compared to South Asia. Since many Asia IBS prevalence studies have been published in the recent decade, we could compare the IBS prevalence data divided by various criteria in looking whether they were also comparable to this of West community. Summarized together, most Asia community IBS prevalences based on various criteria are usually within the range 1%-10% and are apparently lower than these of selected populations. Within the same population, the prevalence orders are first higher based on Manning criteria, then followed by Rome I criteria and finally reported in Rome II criteria. Overall, the median value of Asia IBS prevalences defined by various criteria ranges 6.5%-10.1%. With regard to gender difference, female predominance is usually found but not uniquely existed. For the IBS subtypes, the proportions of diarrhea predominant-IBS distribute widely from 0.8% to 74.0%, while constipation predominant-IBS proportion ranges 12%-77%. In conclusions, current Asia IBS prevalence is at least equal to the Western countries. Female predominant prevalence in Asia is common but not uniquely existed, while the proportions of IBS subtypes are too variable to find a rule.

Immunoglobulin G antibody against Helicobacter pylori is an accurate test for atrophic gastritis.

BACKGROUND: Enzyme-linked immunosorbent assay (ELISA) is the most commonly used serologic test for Helicobacter pylori. This study aimed to investigate the effects of age and atrophic gastritis on the diagnostic accuracy of an immunoglobulin G (IgG) antibody test against H. pylori in adults. METHODS: One hundred and seventy dyspeptic patients (age range, 20-70 years) were evaluated. H. pylori infection was diagnosed when culture or both urease and histological tests were positive. Serum pepsinogen-I (P-I) and pepsinogen-II (P-II) levels were measured. Atrophic gastritis was defined when P-I < or = 70 microg/L and P-I/P-II < or = 3. A quantitative ELISA test (HEL-pTEST II) was used for IgG antibodies against H. pylori. RESULTS: The H. pylori prevalence rate was 62.1%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ELISA were 93.5%, 94.4%, 95.6%, 91.9%, and 93.9% in patients aged < 45 years, and 100%, 81.3%, 94.3%, 100%, and 95.6% in patients aged > or = 45 years, respectively. Twenty-six patients had atrophic gastritis. There was 100% sensitivity and 86.7% specificity in atrophic gastritis and 96.5% sensitivity and 91.9% specificity in non-atrophic gastritis. CONCLUSION: The quantitative ELISA test is a good noninvasive test even in older age groups and is a suitable test in patients with atrophic gastritis due to its excellent sensitivity.

Incidence and possible risk factors for clinical upper gastrointestinal events in patients taking selective cyclooxygenase-2 inhibitors: A prospective, observational, cohort study in Taiwan.

BACKGROUND: Use of selective cyclooxygenase (COX)-2 inhibitors is associated with a better gastrointestinal (GI) safety profile than use of other NSAIDs. However, the risk factors for clinical upper GI events (symptomatic ulcers and ulcer complications) in COX-2 inhibitor users have been rarely evaluated in the past. OBJECTIVE: The aim of this study was to assess the annual incidence of and identify the risk factors for clinical upper GI events in chronic COX-2 inhibitor (celecoxib and etoricoxib) users. METHODS: A prospective, hospital-based, observational cohort study was conducted in patients taking COX-2 inhibitors (celecoxib or etoricoxib) without comorbidity. COX-2 inhibitor prescription was conducted according to the guidelines issued by the Taiwan National Health Insurance and was identified by the computerized prescribing system of the Taipei Veterans General Hospital, Taipei, Taiwan. Patients with cardiovascular disease, pulmonary, hepatic or renal insufficiency, or malignancy were excluded. Patients received regular follow-up once a month. Between visits, patients were asked to report to the outpatient clinic if they had persistent ulcer or GI symptoms (dyspepsia, vomiting, nausea, heartburn, or acid regurgitation) not relieved by antacids for 1 week, or to the emergency department if they had evidence of GI bleeding or ulcer complications (melena, hematemesis, hematochezia, or sudden onset of severe epigastric pain). Endoscopy was performed to document any gastroduodenal ulcers with or without ulcer complications. The primary end point was the annual incidence and the significant risk factors for clinical upper GI events (symptomatic ulcers and ulcer complications). RESULTS: A total of 1158 COX-2 inhibitor users were identified; 96 refused to participate and 129 were excluded. The mean (SD) age of the remaining 933 COX-2 inhibitor users was 69 (15) years with 528 women (56.6%) and 405 men (43.4%). Mean time of follow-up was 12.4 months. The annual incidence of clinical upper GI events in these patients taking COX-2 inhibitors was 4.6% (44 events/959 patient-years), with symptomatic ulcers in 3.6% and ulcer complications in 1.0%. Multivariate logistic regression analysis found that a history of peptic ulcer disease (PUD) (odds ratio [OR = 4.61; 95% CI, 1.86-11.40; P = 0.001), concomitant use of steroids (OR = 2.99; 95% CI, 1.39-6.46; P = 0.005), aspirin (OR = 13.47; 95% CI, 5.89-30.82; P < 0.001), and other NSAIDs (OR = 60.49; 95% CI, 11.93-306.64; P < 0.001) were significant independent risk factors for clinical upper GI events in these patients taking COX-2 inhibitors. Age >60 years was not found to be a risk factor. CONCLUSIONS: The annual incidence of clinical upper GI events was 4.6% in these Taiwanese patients without comorbidity taking COX-2 inhibitors. A history of PUD and concomitant use of steroids, aspirin, or other NSAIDs, were found to be significant risk factors for clinical upper GI events in these patients.

Gastric reddish streaks in the intact stomach: endoscopic feature of reactive gastropathy.

The pathogenesis of reddish streaks in the intact stomach is unclear. Sixty-three functional dyspeptic patients with gastric reddish streaks were recruited for the study. Fifty-five patients (group I) had only reddish streaks while nine patients (group II) had additional lesions such as reddish patches or spots randomly scattered throughout the stomach. Updated Sydney system and parameters of reactive gastropathy were used to score the biopsy specimens from reddish streaks separately. Helicobacter pylori infection rate was found to be markedly lower in group I than group II patients (13% vs 89%, P < 0.001). H. pylori-infected patients had higher scores for acute and chronic inflammation (P < 0.001) and foveolar hyperplasia (P < 0.005) than non-infected patients, while other parameters for gastritis and gastropathy were similar between infected and non-infected patients. In H. pylori-non-infected patients all biopsy specimens had at least one histological feature of reactive gastropathy. Bile reflux was observed in 54% of patients (34/63). Only 7.9% used non-steroidal anti-inflammatory drugs and 4.9% drank alcohol. The present data indicate that the fundamental histological features of gastric reddish streaks are reactive gastropathy with low H. pylori infection, and are probably enterogastric reflux related in etiology. Coincidental H. pylori infection increased acute and chronic inflammatory cell infiltration, and enhanced the grade of foveolar hyperplasia.

Prevalence of Helicobacter pylori infection in duodenal ulcer and gastro-duodenal ulcer diseases in Taiwan.

BACKGROUND AND AIM: The prevalence of Helicobacter pylori-negative duodenal ulcer (DU) is increasing in Western countries but is rare in Japan. We aimed to examine the prevalence of H. pylori infection and the characteristics in DU and gastro-duodenal ulcer (GDU) diseases in Taiwan. STUDY: All patients with an endoscopic diagnosis of DU or GDU from September 2003 to May 2004 at Taipei Veterans General Hospital were included. Rapid urease test was done for all patients, while urea breath test was carried out on those with negative rapid urease tests. A patient was considered infected if either test was positive. RESULTS: The prevalence of H. pylori was 88.7% (555/626) in DU and 90.5% (95/105) in GDU patients. There was no difference in sex and prevalence of H. pylori between the two groups but age was higher in the GDU patients (60.1 +/- 15.5 vs. 55.4 +/- 15.5, P = 0.005). Of H. pylori-negative DU patients, 28.2% (20/71) reported using non-steroidal anti-inflammatory drugs (NSAIDs)/aspirin, which were used by all 10 H. pylori-negative GDU patients (100%) (P < 0.001). There was no difference in sex and age between H. pylori-positive and negative DU patients. The prevalence rate of H. pylori in DU was not statistically different among outpatients, inpatients, and physical check-up subjects (86.8% vs. 93.3% vs. 90.7%, P = 0.163). CONCLUSION: The prevalence of H. pylori infection in DU appears to be decreasing in Taiwan. Thus, eradication therapy without confirming the presence of H. pylori in DU patients cannot be recommended. NSAIDs/aspirin is the major risk factor for H. pylori-negative DU patients, especially those with co-morbid gastric ulcer.

Psychosocial-spiritual factors in patients with functional dyspepsia: a comparative study with normal individuals having the same endoscopic features.

OBJECTIVES: The aim of the study is to identify factors that are associated with dyspeptic symptoms in patients with functional dyspepsia (FD) in a multivariate context. METHODS: Demographic data, personal habits, stressful life events, and psychological distress were compared between functional dyspeptic patients with gastric reddish streaks and asymptomatic counterparts who underwent upper gastrointestinal endoscopy as part of a self-paid physical check-up. RESULTS: There were 93 patients in the symptomatic group and 67 patients in the asymptomatic group. FD patients had a lower proportion of tea consumption (38 vs. 61%, P = 0.004), more were single (20 vs. 6%, P<0.05), less belief in religion (46 vs. 66%, P<0.05), a greater number (median+/-interquartile range, 3.0+/-2.0 vs. 2.0+/-2.0, P<0.001) and more severity (1.5+/-0.9 vs. 1.0+/-1.0, P<0.001) with regard to stressful life events, greater scores of symptom dimensions of somatization, depression, anxiety, and psychotism and general severity index of psychopathology as compared with asymptomatic counterparts. Only tea consumption [odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.15-0.72, P<0.01)], religion (OR = 0.42, 95% CI = 0.19-0.91, P<0.05), number of stressful life events (OR = 2.74, 95% CI = 1.28-5.88, P<0.01), and somatization (OR = 6.80, 95% CI = 1.21-38.08, P<0.05) remained statistically significant in multivariate analysis. CONCLUSION: FD with gastric reddish streaks exhibited increased somatization, more stressful life events, less belief in religion, and less tea consumption as compared with asymptomatic counterparts. The findings of the study suggest the importance of adopting a more comprehensive holistic bio-psycho-socio-spiritual model when dealing with FD patients.