Helicobacter pylori in New Zealand: current diagnostic trends and related costs.

AIM: To ascertain Helicobacter pylori (Hp) diagnosis trends and cost in a New Zealand cohort. METHODS: All Hp tests within Canterbury between 2013-2018 were retrospectively reviewed, exclusive of histology. Overall numbers for each test modality, expenditure and test positivity rates were calculated and matched to ethnicity. RESULTS: Over the six-year period, Hp testing increased 37% and associated cost by 42.6%, compared with population growth of 11.1%. Primary care requested 82% of the non-invasive tests. Despite guidelines recommending against Hp serology, this was the most frequent test and duplicate testing in the same patient was common. Mean annual test positivity rates were: Hp serology 12.3%; Campylobacter-like organism 7.2%; Hp stool antigen test 10.2%; urea breath test 17.5%. The mean across all test modalities was 10.4%. Test proportion per ethnicity was lower in Maori (48.2%) and Pasifika (67.8%), compared with Europeans (82.7%). This was in contrast with significantly higher test positivity rates (Maori 21.2%, Pasifika 37.8%) compared with Europeans 8.4%. CONCLUSION: Hp testing and related costs increase is disproportionate to population growth. At risk ethnicities are under-represented in the tested cohort despite higher test positivity rates. Primary care-focussed intervention could lead to reduced cost and improved equity in Hp diagnosis.

Clinical outcomes of campylobacteriosis: a case series analysis of hospitalisations associated with the Havelock North Campylobacter outbreak.

AIM: In August 2016, a large waterborne campylobacteriosis outbreak occurred in Havelock North, New Zealand. This analysis describes the clinical complications of cases admitted to hospital as a result of acute infection, identifies risk factors for hospitalisation and compares deaths between hospitalised and non-hospitalised cases. Hospital admissions with post-infectious sequelae were excluded as they are the subject of a separate analysis. METHODS: A case series analysis was undertaken by reviewing the electronic medical records of 933 residents of Hawke's Bay District Health Board with probable and confirmed campylobacteriosis linked to the Havelock North Campylobacter outbreak. RESULTS: A total of 67 hospital admissions, among 58 individuals, are described. Pre-existing comorbidity and advanced age were significant risk factors for hospital admission in univariate analysis. Dehydration (74.1%), electrolyte imbalance (35.8%) and acute kidney injury (27.6%) were common among hospitalised cases. The proportion of hospitalised cases that died within one year was significantly higher when compared to deaths among non-hospitalised cases (OR 5.0, 95% CI: 2.3-10.7), although this trend was not statistically significant after adjusting for age and comorbidity (OR 2.3, 95% CI: 0.96-5.3). CONCLUSIONS: This study highlights the serious health impacts that occurred from a campylobacteriosis outbreak of this magnitude.

Vitamin D levels in IBD: a randomised trial of weight-based versus fixed dose vitamin D supplementation.

Objectives: Body weight is one of the factors affecting blood levels of 25-hydroxyvitamin D (25OHD). The aim of this study was to establish whether a vitamin D (vitD) weight-based dosing is more appropriate to a fixed daily dose in patients with inflammatory bowel disease (IBD).Materials/methods: This was an open label randomised trial. Patients with IBD were assigned to receive oral cholecalciferol at a dose of 28 IU/kg (IU/kg) or 2000 IU per day (IU/day) for 12 weeks during winter months. 25OHD plasma levels and other biochemical parameters were measured at baseline and after supplementation period. The primary outcome measure was 25OHD level after a follow-up period.Results: A total of 173 patients were analysed. The mean BMI was 25.5 ± 5.1 and initial mean 25OHD level was 62.7 ± 25.5 nmol/l. A similar increase (9.7 ± 26.9 vs 9.8 ± 26.7 nmol/l) in 25OHD levels occurred both in IU/kg and IU/day group. The proportion of subjects with normal and sub-normal levels following the substitution was comparable irrespective of body weight. The change in 25OHD level correlated positively only with the dose of vitD (p < .001) and negatively with the baseline 25OHD level (p < .001). A sustained 25OHD level of 75 nmol/l corresponds with a calculated daily vitD dose of 2034 IU.Conclusions: Weight-based dosing of vitamin D is not superior to a fixed dose in order to maintain stable 25OHD levels in IBD patients. Cholecalciferol dose of 2,000 IU/day is safe and sufficient during winter period.

Pyogenic liver abscess: incidence, causality, management and clinical outcomes in a New Zealand cohort.

AIMS: The determinants, management and outcomes of pyogenic liver abscess [PLA] are changing. We aimed to compare these in a New Zealand cohort. METHODS: We have retrospectively reviewed all PLA cases presenting to Christchurch Hospital over 12 months between 2014 and 2015. RESULTS: Twenty-five cases presented over this period. The incidence was 5/100,000. Eighty percent were Caucasian with overall 4:1 male preponderance. Commonest comorbidities were diabetes, hypertension, atrial fibrillation and immunosuppression. Underlying pancreatico-biliary disease featured in 20%, preceding Whipple's or hepatic resection in 24% and inflammatory bowel disease [IBD] in 12%. Commonest complication was septic shock with intensive care unit admission in four cases. The evident cause was recent Whipple's procedure or hepatic resection (24%), pancreatico-biliary (16%), diverticulitis (12%) and active IBD (8%). Cause remained cryptogenic in 28%. The commonest microorganism was Streptococcus intermedius. The management comprised of: antibiotics alone (n=6), needle aspiration (n=2), catheter drainage (n=14), biliary drainage (n=3), surgical drainage (n=2). These interventions were in accordance with current international recommendations. There were no deaths and the mean length of stay was 10.3 days. CONCLUSION: PLA continues to carry significant morbidity. Demographics, including ethnicity, play an important role. Our tertiary centre cohort may account for higher incidence and better clinical outcomes.

Complete esophageal obstruction following endoscopic variceal ligation: a case report and literature review.

Endoscopic variceal ligation (EVL) is an important treatment modality in managing complications of portal hypertension. Since its advent 30 years ago, the procedural complications have decreased significantly, especially when compared with variceal sclerotherapy. With the current widespread use of EVL, rare complications are now becoming increasingly recognized. We present a case of complete esophageal obstruction, its management, and clinical course. Our literature review identified only eight reported cases. We compare the varied treatment approaches and outcomes in the cited articles.

Over-the-scope-clip system secured nasojejunal tube feeding in refractory hyperemesis gravidarum.

Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy. It complicates up to 2% of all pregnancies and can be associated with adverse outcomes. Its management commonly involves a combination pharmacotherapy, however, the efficacy of such treatment is limited. Supplemental nutrition is often required in refractory cases. Enteral route is preferred over parenteral, given the high rate of intravenous catheter-related complications. Enteral feeding tube placement can be challenging and is commonly thwarted by dislodgement. We present a pharmacotherapy refractory HG case where the over-the-scope-clip (OTSC) system was successfully used for durable mucosal fixation of the nasojejunal feeding tube.