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.

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.

Gastrointestinal and hepatobiliary manifestations in systemic lupus erythematosus.

OBJECTIVE: To report GI and Hepatobiliary manifestations in SLE from Chulalongkorn Hospital in the year 2000. MATERIAL AND METHOD: A retrospective study of SLE patients in the Rheumatological Clinic, Medical Department, Chulalongkorn University. RESULTS: A total 225 SLE patients were found being mainly female (93.3%). The mean age was 32.13 +/- 11.65 years and they almost all lived in the central part of Thailand (79.1%). At diagnosis, the majority of SLE cases are active vital organ (72.1%), kidney and central nervous system are the main organ of involvement. GI and hepatobiliary manifestations were found in 32.89% but did not lead to SLE diagnosis. The duration between SLE diagnosis and first GI and hepatobiliary manifestations is 4.6 +/- 4.4 years. The 3 common manifestations are abnormal liver function test, diarrhea and abdominal pain, with the prevalance rate of 34, 17 and 11% respectively. CONCLUSION: GI and hepatobiliary manifestations of SLE patients in Chulalongkorn Hospital were found in 32.89% but were not specific and could be found in any part of the alimentary tract. The 3 common manifestations were abnormal liver function tests, diarrhea and abdominal pain which were not specific enough to diagnose SLE.

D-xylose absorption in non-chronic diarrhea AIDS patients with the wasting syndrome.

OBJECTIVE: To compare the intestinal absorptive capacity, permeability function and duodenal histopathology in human immunodeficiency virus (HIV) patients with or without wasting syndrome who had not suffered from chronic diarrhea. METHOD: Adult HIV patients who attended Chulalongkorn Hospital were included. The subjects were classified into wasting and non-wasting groups (group I and group II). 25 g oral D-xylose test, oral phenolsulfonephthalein test and duodenal histopathology were performed. RESULTS: Of thirty-two HIV patients, aged between 25-50 years enrolled, there were 18 and 14 patients in group I and group II, respectively. In both groups, the baseline data, permeability function and histopathology were similar. Intestinal absorptive capacity was statistically different, i.e. 5-hour urine D-xylose was 3.96 +/- 2.81 g and 5.95 +/- 2.47 g in group I and group II respectively (p < 0.05). CONCLUSION: This study demonstrated that D-xylose absorption was decreased in non-diarrheal, wasting HIV infected patients. Abnormal absorptive capacity is a common phenomenon found in HIV patients with wasting syndrome as determined by standard 25 g oral D-xylose test.