Outcome of acute upper gastrointestinal bleeding in patients with coronary artery disease: A matched case-control study.

BACKGROUND/AIM: The risk of upper gastrointestinal bleeding (UGIB) increases in patients with coronary artery disease (CAD) due to the frequent use of antiplatelets. There is some data reporting on treatment outcomes in CAD patients presenting with UGIB. We aim to determine the clinical characteristics and outcomes of UGIB in patients with CAD, compared with non-CAD patients. PATIENTS AND METHODS: We conducted a prospective multi-center cohort study (THAI UGIB-2010) that enrolled 981 consecutive hospitalized patients with acute UGIB. A matched case-control analysis using this database, which was collected from 11 tertiary referral hospitals in Thailand between January 2010 and September 2011, was performed. RESULT: Of 981 hospitalized patients with UGIB, there were 61 CAD patients and 244 gender-matched non-CAD patients (ratio 1:4). UGIB patients with CAD were significantly older, and had more frequently used antiplatelets and warfarin than in non-CAD patients. Compared with non-CAD, the CAD patients had significantly higher Glasgow-Blatchford score, full and pre-endoscopic Rockall score and full. Peptic ulcer in CAD patients was identified more often than in non-CAD patients. UGIB patients with CAD and non-CAD had similar outcomes with regard to mortality rate, re-bleeding, surgery, embolization, and packed erythrocyte transfusion. However, CAD patients had longer duration of hospital stays than non-CAD patients. Two CAD patients died from cardiac arrest after endoscopy, whereas three non-CAD patients died from pneumonia and acute renal failure during their hospitalization. CONCLUSION: In Thailand, patients presenting with UGIB, concomitant CAD did not affect clinical outcome of treatment, compared with non-CAD patients, except for longer hospital stay.

Prospective comparison of three risk scoring systems in non-variceal and variceal upper gastrointestinal bleeding.

BACKGROUND AND AIM: Data regarding the efficacy of the Glasgow Blatchford score (GBS), full Rockall score (FRS) and pre-endoscopic Rockall scores (PRS) in comparing non-variceal and variceal upper gastrointestinal bleeding (UGIB) are limited. Our aim was to determine the performance of these three risk scores in predicting the need for treatment, mortality, and re-bleeding among patients with non-variceal and variceal UGIB. METHODS: During January, 2010 and September, 2011, patients with UGIB from 11 hospitals were prospectively enrolled. The GBS, FRS, and PRS were calculated. Discriminative ability for each score was assessed using the receiver operated characteristics curve (ROC) analysis. RESULTS: A total of 981 patients presented with acute UGIB, 225 patients (22.9%) had variceal UGIB. The areas under the ROC (AUC) of the GBS, FRS, and PRS for predicting the need for treatment were 0.77, 0.69, and 0.61 in non-variceal versus 0.66, 0.66, and 0.59 in variceal UGIB. The AUC for predicting mortality and re-bleeding during admission were 0.66, 0.80, and 0.76 in non-variceal versus 0.63, 0.57, and 0.63 in variceal UGIB. AUC score was not statistically significant for predicting need for therapy and clinical outcome in variceal UGIB. The GBS ≤ 2 and FRS ≤ 1 identified low-risk non-variceal UGIB patients for death and re-bleeding during hospitalization. CONCLUSION: In contrast to non-variceal UGIB, the GBS, FRS, and PRS were not precise scores for assessing the need for therapy, mortality, and re-bleeding during admission in variceal UGIB.

Prevalence of single nucleotide mutation in clarithromycin resistant gene of Helicobacter pylori: a 32-months prospective study by using hybridization real time polymerase chain reaction.

Polymerase chain reaction (PCR) for detection of single nucleotide mutations in 23S rRNA gene of clarithromycin resistance Helicobacter pylori were investigated worldwide. In Thailand, the prevalence of these mutations had not been extensively investigated. The authors conducted a 32-months prospective study to estimate the prevalence of clarithromycin resistant Helicobacter pylori and to compare the sensitivity and specificity of hybridization real time PCR for 23S rRNA gene of Helicobacter pylori detection with the combination of rapid urease test, immunohistochemistry straining and Helicobacter pylori culture. A total of 200 patients with endoscopic examination with gastric biopsy were enrolled from January 2006 to September 2008. Eight gastric specimens were biopsied and performed rapid urease test, immunohistochemistry straining for Helicobacter pylori, Helicobacter pylori culture and hybridization real time PCR for 23S rRNA dectection, as well as single nucleotide mutation detection, such as G2111A, A2115G A2142G, A2143G andA2144G. The clarithromycin susceptibility of Helicobacter pylori isolated was determined by E-test. The prevalences of clarithromycin, amoxicillin, metronidazole and tetracycline resistance were 13.8%, 21.3%, 55.0% and 8.8%, respectively. Most of clarithromycin resistant Helicobacter pylori (81.80%) had very high minimal inhibition concentration (MIC) more than 256 microg/ml. The resistance to mutation gene at A2142G was found in 4 patients (36.40%). Two patients were found to have multiple mutations at G2111A, A2115G and A2144G (18.20%). The sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio to test positive and likelihood ratio to test negative of hybridization RT-PCR in detecting 23S rRNA gene of Helicobacter pylori was 95.6%, 94.4%, 93.2%, 96.7%, 17.2 and 4.6, respectively. In conclusion A2142G mutation was most common and associated with high MIC. Hybridization RT-PCR had good sensitivity and specificity to detect 23S rRNA gene, as well as clarithromycin resistance gene mutation of Helicobacter pylori.

Infection of less virulent Helicobacter pylori strains in asymptomatic healthy individuals in Thailand as a potential contributing factor to the Asian enigma.

In Thailand, gastric cancer incidence is considerably low despite the high prevalence of Helicobacter pylori infection. We investigated the prevalence of H. pylori infection and the genotypes of cagA by using 179 stool specimens obtained from asymptomatic Thai individuals. In this study, the prevalence of H. pylori infection was 43.6%, and the detection rate of cagA-positive strains was 43.5%. In addition, the proportion of the highly virulent East-Asian type of cagA was 7.2%. These results indicate that the low prevalence of cagA-positive H. pylori strain as well as the low prevalence of East-Asian genotype cagA-positive strains may contribute to the low gastric cancer incidence.