Pyogenic Liver Abscesses with an Elevated Carcinoembryonic Antigen Level.

Serological tumor markers are useful for the detection of malignancies and evaluation of disease progression. These markers are not checked as part of a routine examination for patients with benign diseases and without any clinical suspicion of malignancy. However, some markers appear to be elevated in patients with benign diseases and without malignancies. We present a case of pyogenic liver abscesses with an elevated serum carcinoembryonic antigen (CEA) level associated with neither evidence of malignancy nor elevation of other tumor markers such as carbohydrate antigen (CA 19-9) and alpha-fetoprotein (AFP) levels. The serological level of CEA decreased and subsequently became within normal limits with treatment. This case also demonstrates that diabetic patients with a liver abscess may present with no infectious symptoms and that fine-needle aspiration is as effective as catheter drainage in the treatment of pyogenic liver abscess.

Adding Bismuth to Rabeprazole-Based First-Line Triple Therapy Does Not Improve the Eradication of Helicobacter pylori.

This randomized controlled study aimed to evaluate whether adding bismuth to the standard first-line triple therapy could improve the eradication rate of Helicobacter pylori. A total of 162 patients with Helicobacter pylori infection were randomly assigned to either the 7-day triple therapy group (RAK regimen: rabeprazole 20 mg, amoxicillin 1 g, and clarithromycin 500 mg bid; n = 81) or the bismuth plus triple therapy group (n = 81). In the RBAK group, bismuth subcitrate 360 mg twice daily was added to the RAK regimen. A follow-up endoscopy or urea breath test was performed at least 4 weeks after eradication to confirm the treatment efficacy. Comparable compliance and Helicobacter pylori eradication rates were observed in both groups in either intention-to-treat [RAK 72.8% (59/81) versus RBAK 77.8% (63/81); p = 0.47] or per protocol analysis [RAK 74.7% (59/79) versus RBAK 81.8% (63/77); p = 0.26]. Adverse effects were commonly reported (50.6% for both groups) although most of these did not cause cessation of treatment. The resistance rate was 27.2% for metronidazole and 12.3% for clarithromycin. Adding bismuth to the standard 7-day triple therapy did not substantially increase the eradication rate. Further study is needed clarifying whether extending the duration of RBAK regimen to 10-14 days can lead to a better result.

Diagnosis of Helicobacter pylori infection: Current options and developments.

Accurate diagnosis of Helicobacter pylori (H. pylori) infection is a crucial part in the effective management of many gastroduodenal diseases. Several invasive and non-invasive diagnostic tests are available for the detection of H. pylori and each test has its usefulness and limitations in different clinical situations. Although none can be considered as a single gold standard in clinical practice, several techniques have been developed to give the more reliable results. Invasive tests are performed via endoscopic biopsy specimens and these tests include histology, culture, rapid urease test as well as molecular methods. Developments of endoscopic equipment also contribute to the real-time diagnosis of H. pylori during endoscopy. Urea breathing test and stool antigen test are most widely used non-invasive tests, whereas serology is useful in screening and epidemiological studies. Molecular methods have been used in variable specimens other than gastric mucosa. More than detection of H. pylori infection, several tests are introduced into the evaluation of virulence factors and antibiotic sensitivity of H. pylori, as well as screening precancerous lesions and gastric cancer. The aim of this article is to review the current options and novel developments of diagnostic tests and their applications in different clinical conditions or for specific purposes.

Lansoprazole-based sequential and concomitant therapy for the first-line Helicobacter pylori eradication.

OBJECTIVE: The aim of this prospective study was to compare the efficacy of the first-line lansoprazole-based sequential therapy and concomitant therapy (lansoprazole, amoxicillin, clarithromycin and metronidazole) for Helicobacter pylori (H. pylori) eradication. METHODS: A total of 169 patients with H. pylori infection were randomly assigned to either the sequential therapy group (n = 85) or the concomitant therapy group (n = 84). A follow-up endoscopy or urea breath test was examined at least 12 weeks after eradication. RESULTS: Comparable H. pylori eradication rate was observed in both the sequential therapy and concomitant therapy groups by either intention-to-treat analysis [sequential 80.0% (68/85) vs concomitant 88.1% (74/84); P = 0.27] or per protocol analysis [sequential, 85.3% (64/75) vs concomitant, 94.6% (70/74); P = 0.60]. Adverse effects were reported and good compliance was observed in both groups (P = 0.72). Although dual antibiotics resistance affected the therapeutic efficacy of sequential therapy (P = 0.03), not concomitant therapy (P = 0.74), it was not an independent factor for predicting the treatment outcome. CONCLUSION: First-line lansoprazole-based sequential and concomitant therapy were well-tolerated and comparable in terms of their H. pylori eradication rate.

Ceftriaxone-associated gallbladder pseudolithiasis: report of one case.

Ceftriaxone is known to induce reversible precipitates in the gallbladders of adults and children. However, ceftriaxone-associated gallbladder pseudolithiasis in children is rarely reported in Taiwan. We report a case of 5-year-old boy with Salmonella gastroenteritis, who was treated with ceftriaxone due to multidrug resistance and severe course. Cholelithiasis developed five days after initiation of ceftriaxone therapy and completely resolved one month after the end of treatment. Pediatricians and radiologists must be aware of this complication to prevent anxiety and unnecessary cholecystectomy.