Endoclip papillaplasty (ECPP) versus limited EST plus EPLBD for a decrease in recurrent choledocholithiasis: a prospective cohort study.

BACKGROUND AND AIMS: Limited EST plus EPLBD has been widely used for the therapy of large CBDS; however, long-term complication-relevant studies suggested that it damaged the function of the sphincter of Oddi (SO) and resulted in recurrent choledocholithiasis. Thus, we designed Endoclip papillaplasty (ECPP) and previous studies have shown that it successfully restored the function of SO. In this study, we designed a prospective cohort and aimed to verify the safety and effectiveness of ECPP. METHODS: Eligible patients were divided into the ECPP group and the limited EST plus EPLBD group based on papillary morphology and the ratio of maximum size of stones to length of intramural segments of CBD. All participants in the ECPP group received endoscopy at 3 weeks to retrieve the biliary stent, perform SOM, and were divided into grade A and grade B based on the healing grade of SO. All patients were followed up every 6 months until recurrent choledocholithiasis, patient death, or at the 36-month follow-up end. The primary outcome was the incidence of recurrent choledocholithiasis. The secondary outcomes included mechanical lithotrip usage and adverse events. RESULTS: The incidences of recurrent choledocholithiasis in the ECPP group and limited EST plus EPLBD group were 13.6 and 22.1%, respectively (P = 0.204). The ECPP-A group had a lower incidence of recurrent choledocholithiasis than the limited EST plus EPLBD groups (5.1 vs. 22.1%, P = 0.020*), and certified the function of SO successfully restored in the ECPP-A group. CONCLUSION: The ECPP-A group had a decrease in recurrent choledocholithiasis, and ECPP was safe and effective for CBDS.

Furfural Produces Dose-Dependent Attenuating Effects on Ethanol-Induced Toxicity in the Liver.

Background: Alcohol-associated liver disease (ALD) increases the health burden worldwide, but effective drugs to prevent ALD are lacking. Furfural is a small molecule that can limit alcohol production in microorganisms and may have the capacity to attenuate ethanol-induced toxicity. Methods: Human HepG2 cells were incubated with ethanol and furfural, and cell viability, NAD+/NADH ratio, and mitochondrial function assays were performed. RNA sequencing (RNA-seq) data were used to annotate enriched pathways, and these findings were confirmed by reverse transcription-quantitative PCR (RT-qPCR) and Western blotting. C57BL/6J mice were fed a Lieber-DeCarli liquid diet. After 4 weeks, biochemical analysis of mouse serum and histological analysis of mouse livers were performed. Results: Different concentrations of furfural exerted different effects on mitochondria: low-dose furfural reduced reactive oxygen species (ROS) production, maintained mitochondrial transmembrane potential, and inhibited apoptosis pathway activation, while high-dose furfural led to the opposite effects. In mice, furfural mitigated transaminase increases and attenuated the lipid metabolism disorder that had been induced by ethanol. Conclusion: Low-dose furfural reduced ethanol-induced toxicity in the liver. Consuming food or beverages containing the appropriate level of furfural when drinking alcohol may be a convenient and useful way to prevent ALD.

Enteral extended biliary stents versus conventional plastic biliary stents for the treatment of extrahepatic malignant biliary obstruction: a single-center prospective randomized controlled study.

BACKGROUND AND AIMS: The main limitation of plastic stents is the relatively short stent patency due to occlusion. We designed enteral extended biliary stents with lengths of 26 cm (EEBS-26 cm) and 30 cm (EEBS-30 cm) to prolong stent patency. This study aimed to compare patency among EEBS-26 cm, EEBS-30 cm, and conventional plastic biliary stent (CPBS). METHODS: A single-center prospective randomized controlled study was conducted. Eligible patients were randomized into the EEBS-26 cm, EEBS-30 cm, and CPBS groups, respectively. All patients were followed up every 3 months until stent occlusion, patient death, or at 12-month follow-up. The primary outcome was stent patency. The secondary outcomes included stent occlusion rate, patient survival, mortality, the rate of technical success, and adverse events. RESULTS: Totally 117 patients were randomized into the three groups. There were no significant differences among the three groups in technical success rate, hospital stay, mortality, patient survival, and adverse events (P = 1.000, 0.553, 0.965, 0.302, and 0.427, respectively). Median stent patency durations in the EEBS-26 cm, EEBS-30 cm, and CPBS groups were 156.0 (95% CI 81.6-230.4) days, 81.0 (95% CI 67.9-94.1) days, and 68.0 (95% CI 20.0-116.0) days, respectively (P = 0.002). The EEBS-26 cm group had longer stent patency compared with the CPBS (P = 0.007) and EEBS-30 cm (P < 0.001) groups. The EEBS-26 cm group had lower stent occlusion rates compared with the other groups at 6 months (48.1% vs. 90.5% vs. 82.8%, P = 0.001) and 9 months (75.0% vs. 100.0% vs. 92.9%, P = 0.022). CONCLUSION: EEBS-26 cm has prolonged stent patency and is safe and effective for the alleviation of unresectable extrahepatic malignant biliary obstruction.

Efficacy of oral steroid gel in preventing esophageal stricture after extensive endoscopic submucosal dissection: a randomized controlled trial.

BACKGROUND AND AIMS: Esophageal stricture is a distressing issue for patients with early esophageal cancer following extensive endoscopic submucosal dissection (ESD), and the current steroid-based approaches are unsatisfactory for stricture prophylaxis. We evaluated the efficacy of oral hydrocortisone sodium succinate and aluminum phosphate gel (OHA) for stricture prophylaxis after extensive ESD. METHODS: Patients undergoing > 3/4 circumferential ESD were randomized to either the endoscopic loco-regional triamcinolone acetonide injection (ETI) plus oral prednisone group or the OHA group. The primary endpoint was incidence of esophageal stricture, and the secondary endpoints included adverse events (AEs) and endoscopic balloon dilations (EBDs). RESULTS: The incidence of esophageal stricture in OHA group (per-protocol analysis, 9.4%, 3/32; intention-to-treat analysis, 12.1%, 4/33) was significantly less than that of control group (per-protocol analysis, 35.5%, 11/31, P = 0.013; intention-to-treat analysis, 39.4%, 13/33, P = 0.011). Two sessions of EBD were necessary to release all strictures in the OHA group, while the similar EBDs (median 2, range 1-4) for 11 of the control. Operation-related AEs included infection (control vs. OHA group = 9.7% vs. 31.3%, P = 0.034), operation-related hypokalemia (19.4% vs. 31.3%, P = 0.278), perforation (3.2% vs. 3.1%), post-ESD hemorrhage (6.5% vs. 0%), and cardiac arrhythmia (0% vs. 6.3%). Steroid-related AEs included steroid-related hypokalemia (16.1% vs. 25%) and bone fracture (3.2% vs. 0%). Multivariate logistic regression analysis demonstrated that OHA was an independent protective factor for stricture (OR 0.079; 95%CI 0.011, 0.544; P = 0.01) and mucosal defect > 11/12 circumference was an independent risk factor (OR 49.91; 95%CI 6.7, 371.83; P < 0.001). CONCLUSIONS: OHA showed significantly better efficacy in preventing esophageal stricture after > 3/4 circumferential ESD compared to ETI plus oral prednisone.

Endoscopic endoclip papilloplasty preserves sphincter of oddi function.

BACKGROUND: Endoscopic sphincterotomy (EST) can destroy sphincter of Oddi (SO) structure and function. The purpose of this study was to assess the feasibility of endoscopic endoclip papilloplasty (EEPP) in restoring SO function after EST. METHODS: Seven 26-week-old domestic pigs were divided into control and EEPP groups. Necropsy and haematoxylin-eosin staining plus anti-α-smooth muscle actin (α-SMA) staining of papilla and sphincter of Oddi manometry (SOM) were conducted in animals at three independent time points. RESULTS: EST and EEPP were safely performed in all 7 pigs without serious adverse events. For primary outcome, compared to the controls, EEPP generated smaller dilation and less inflammation. Fibrous repair of the papilla was observed at 24 weeks after EEPP. For secondary outcome, in the control group, SO basal pressure (17.25 ± 18.14 to 5.50 ± 0.71 mmHg), SO contraction amplitude (46.00 ± 19.20 to 34.50 ± 48.79 mmHg), peak (4.50 ± 4.04 to 1.50 ± 2.12) and frequency (3.05 ± 3.29 to 1.41 ± 2.19/min) were reduced after EST. Further reductions to almost 0 of these SOM parameters were observed 3 weeks later, including common bile duct pressure and SO contraction period. In contrast, in the EEPP group, these manometric data were recovered to pre-EST levels, including CBD pressure (11.5 ± 7.31 vs 11 ± 2.16 mmHg), SO pressure (17.50 ± 17.75 vs 18.20 ± 21.39 mmHg) and SO contraction amplitude (53.67 ± 21.54 vs 60.00 ± 36.08 mmHg). However, no significant differences were observed between control and EEPP groups by Student t test. CONCLUSIONS: In this porcine study, EEPP accelerated and improved papillary healing after EST, further preserved SO function.

Endoclip papillaplasty restores sphincter of Oddi function: Pilot study.

OBJECTIVES: Endoscopic sphincterotomy (EST) damaged the sphincter of Oddi (SO) function. This study aimed to explore the feasibility and efficacy of endoclip papillaplasty in restoring SO function. METHODS: This prospective pilot study included consecutive patients with choledocholithiasis (stone size ≥10 mm) who underwent large-EST for stone removal, followed by endoclip papillaplasty, between May 2018 and March 2019. RESULTS: Thirty patients were enrolled in this trail. Overall, 80% of the patients had a SO basal pressure of >10 mmHg after endoclip papillaplasty. Manometric parameters, including SO basal pressure, phasic wave contraction amplitude, phasic waves per minute, recovered after endoclip papillaplasty (P > 0.05). There were no significant differences in the manometric parameters of SO between healing grades A and B. Six patients developed mild post-endoscopic retrograde cholangiopancreatography pancreatitis, including three that had pancreatic stenting. Bile duct stone recurrence developed in 3.3% of the patients (1/30) during an 18-month follow-up. CONCLUSIONS: Endoclip papillaplasty might restore SO function and possibly prevented biliary stone and cholangitis recurrence.

Efficacy of hydrocortisone sodium succinate and aluminum phosphate gel for stricture prevention after ≥3/4 circumferential endoscopic submucosal dissection.

OBJECTIVE: Endoscopic submucosal dissection (ESD) is widely used in early-stage esophageal cancer, but the quality of life of patients with postoperative stricture is markedly reduced, requiring long-term repeat, periodic endoscopic balloon dilatation. We evaluated the combination of hydrocortisone sodium succinate and aluminum phosphate gel administered orally for stricture prevention. METHODS: We retrospectively assigned 27 patients who underwent ≥3/4 circular ESD for esophageal superficial squamous cell cancer to one of two groups according to the preventative strategy: endoscopic intralesional steroid injection and systemic steroid (IT+ST group) and oral combination of hydrocortisone sodium succinate and aluminum phosphate gel (OHA group). Stricture rate was compared between the two groups. RESULTS: There were six and seven complete and ≥3/4 circular ESD cases, respectively, in the IT+ST group and four and ten cases in the OHA group. Stricture rates in the IT+ST and OHA groups were 53.8% and 7.1%, respectively. Nine patients in each group developed hypokalemia after glucocorticoid administration. CONCLUSIONS: OHA is a promising treatment strategy for stricture prevention following large-circumference ESD in patients with early stage esophageal carcinoma.

Clinicopathological features of duodenal bulb biopsies and their relationship with upper gastrointestinal diseases.

AIM: To assess the prevalence of the lesions in duodenal bulb mucosa and the relationship between duodenal lesions and upper gastrointestinal diseases, including helicobacter pylori infection. METHODS: Clinical, endoscopic and pathological data of the cases with duodenal bulb and gastric mucosal biopsy from January 2005 to May 2017 were analyzed retrospectively. RESULTS: A total of 3540 patients were enrolled. The biopsy from protuberant lesions with endoscopic morphology are mostly duodenal gastric heterotopia or adenoma. The biopsy from duodenal ulcers are often observed in inflammatory changes and gastric metaplasia. Patients with gastric heterotopia had a significantly lower prevalence of chronic atrophic gastritis, intestinal metaplasia, and gastric ulcer; and much higher prevalence of gastroesophageal reflux disease and gastric fundic polyps. Patients with gastric metaplasia had been positively associated with gastroesophageal reflux disease, and negatively associated with gastric fundic polyps. There were positive correlation between helicobacter pylori infection and duodenal active inflammation, Brunner gland hyperplasia, gastric metaplasia and duodenal ulcer. However, Patients with gastric heterotopia in bulb had been negatively associated with helicobacter pylori infection. CONCLUSIONS: The mucosa lesions in duodenal bulb were associated with concurrent gastric fundic gland polyps, gastroesophageal reflux disease, duodenal ulcer, and helicobacter pylori infection.

Effectiveness of an orally administered steroid gel at preventing restenosis after endoscopic balloon dilation of benign esophageal stricture.

BACKGROUND: Restenosis occurs in 10% to 30% of patients after endoscopic balloon dilation (EBD) of benign esophageal stricture. This study aimed to investigate whether an orally administered steroid/gel mixture would inhibit restenosis after EBD for benign esophageal stricture. METHODS: This retrospective analysis included patients with benign esophageal stricture treated with EBD at the Peking University Third Hospital, China (September 2005 to October 2017). The patients were divided into an EBD alone group (EBD only) and EBD/OHA group (EBD plus oral hydrocortisone sodium succinate/aluminum phosphate gel mixture). Patients were followed-up for 3 months. EBD was repeated for persistent dysphagia. The outcome measures included the restenosis rate and the number of additional EBD sessions required during follow-up. Any side effects were noted. RESULTS: Thirty-two patients were included (EBD alone group, n = 12; EBD/OHA group, n = 20). Baseline demographic and clinical characteristics (including age, sex, etiology, stricture location, and diameter of narrowest segment) did not differ between groups. Restenosis rate was significantly lower in the EBD/OHA group than in the EBD alone group (5/20, 25.0% vs 8/12, 66.7%; P = .025). The median number of EBD sessions required was numerically lower in the EBD/OHA group (median, 1.0; interquartile range, 1.0-1.8) than in the EBD alone group (median 2.0, interquartile ranged 1.0-2.5), but statistical significance was not attained (P = .071). The only side effects occurred in the EBD/OHA group: hypokalemia in 4/20 (20.0%) and apathy/somnolence in 1/20 (5.0%). CONCLUSIONS: An orally administered steroid/gel mixture might reduce the incidence of restenosis after EBD for benign esophageal stricture, but it requires confirmation by prospective trials.

Suspended over length biliary stents versus conventional plastic biliary stents for the treatment of biliary stricture: A retrospective single-center study.

To compare patency between suspended over length biliary stents (SOBSs; made from nasobiliary tube) and conventional plastic biliary stents (CPBSs).We retrospectively analyzed 61 patients with extrahepatic biliary stricture who underwent SOBS placement (intrahepatic bile duct) and 74 patients who underwent CPBS placement. Stent patency and complications were compared.The SOBS group was slightly older and contained more females than the CPBS group but other baseline characteristics were similar. Malignant biliary obstruction accounted for 57.4% (SOBS group) and 45.9% (CPBS group) of cases. Technical success rate, hospital stay and post-procedure complications were similar between groups. Median patency in the CPBS and SOBS group was 116 (2-360) days and 175 (3-480) days, respectively (P <.001). The SOBS group had lower stent occlusion rates than the CPBS group at 3 months (9.8% vs 36.5%), 4 months (22.0% vs 55.4%), 5 months (35.6% vs 67.6%), and 6 months (39.3% vs 77.0%) (all P <.01). In Cox regression analysis, stent type (SOBS vs CPBS) was the only factor associated with patency (hazard ratio [HR]: 3.449; 95% CI: 1.973-6.028; P <.001).SOBS may have better medium-term patency than CPBS for benign/malignant biliary stricture.

Free amino acid profiling of gastric juice as a method for discovering potential biomarkers of early gastric cancer.

Background: Prior studies showed that aromatic amino acids (AAAs) could be used as potential gastric juice biomarkers in screening gastric cancer (GC). To identify new biomarkers for early diagnosis of GC, the characteristics of gastric juice free amino acid (GJFAA) profiling was determined. Method: First, gastric juice was collected from 130 consecutive patients who underwent gastroscopy. They were divided into GC group (n = 47) and non-neoplastic gastric disease (NGD) group (n = 83) according to the pathological diagnosis. The concentrations of 34 GJFAAs were examined by amino acid analyzer. Multivariate and univariate analyses were used for comparing the alterations of GJFAA profiles between the two groups. Then candidate differential GJFAAs were verified by LC-MS/MS in another set of patients, which included 32 GC patients and 38 NGD patients. The diagnostic performance of GJFAAs was evaluated by ROC curve. Results: Significant alterations in GJFAA profiles were observed in GC patients compared to NGD patients in the training set. A total of 14 amino acids were screened as differential GJFAAs. Leucine, threonine and serine were the most frequently altered. Combined AUC of the three non-AAAs [0.869 (95% CI, 0.805-0.934)] was superior to the combined three AAAs [0.841 (95% CI, 0.773-0.908)]. In addition, a combined AUC comprisingthe six ones was further improved to 0.871 (95% CI, 0.809-0.933) in the diagnosis of GC. A similar variation trend and diagnostic value were observed in the validation set. Conclusion: This study indicates the potential of GJFAA profiling as a promising approach for the early detection and screening of GC.

Effect of Helicobacter pylori eradication on reflux esophagitis therapy: a multi-center randomized control study.

BACKGROUND: Helicobacter pylori (H. pylori) frequently colonizes the stomach. Gastroesophageal reflux disease (GERD) is a common and costly disease. But the relationship of H. pylori and GERD is still unclear. This study aimed to explore the effect of H. pylori and its eradication on reflux esophagitis therapy. METHODS: Patients diagnosed with reflux esophagitis by endoscopy were enrolled; based on rapid urease test and Warth-Starry stain, they were divided into H. pylori positive and negative groups. H. pylori positive patients were randomly given H. pylori eradication treatment for 10 days, then esomeprazole 20 mg bid for 46 days. The other patients received esomeprazole 20 mg bid therapy for 8 weeks. After treatment, three patient groups were obtained: H. pylori positive eradicated, H. pylori positive uneradicated, and H. pylori negative. Before and after therapy, reflux symptoms were scored and compared. Healing rates were compared among groups. The χ2 test and t-test were used, respectively, for enumeration and measurement data. RESULTS: There were 176 H. pylori positive (with 92 eradication cases) and 180 negative cases. Healing rates in the H. pylori positive eradicated and H. pylori positive uneradicated groups reached 80.4% and 79.8% (P = 0.911), with reflux symptom scores of 0.22 and 0.14 (P = 0.588). Healing rates of esophagitis in the H. pylori positive uneradicated and H. pylori negative groups were, respectively, 79.8% and 82.2% (P = 0.848); reflux symptom scores were 0.14 and 0.21 (P = 0.546). CONCLUSIONS: Based on esomeprazole therapy, H. pylori infection and eradication have no significant effect on reflux esophagitis therapy.

Therapeutic effect of esophageal foreign body extraction management: flexible versus rigid endoscopy in 216 adults of Beijing.

BACKGROUND: The aim of this study was to assess the effectiveness and complications of rigid endoscopy (RE) and flexible endoscopy (FE) for the extraction of esophageal foreign bodies (FB) in adults. MATERIAL AND METHODS: A retrospective analysis was conducted on the medical records of 216 adult patients with esophageal FB impaction treated at Peking University Third Hospital, Beijing, China, between January 2008 and December 2012. RESULTS: The success rate of FB extraction was 100% (142/142) in patients treated with RE compared to 97.3% (72/74) in those treated with FE (P=0.045). The total incidence of complications in RE-treated patients was lower than that in FE-treated patients (28.2% vs. 45.9%, P=0.009), but the perforation rate was higher (5.6% vs. 1.4%, P=0.135). The incidences of total complications and perforation were associated with the duration of FB impaction in patients who underwent RE (both P<0.05) but not in patients who underwent FE. RE was more frequently used in extraction of FBs located in the upper esophagus (88.7%, 126/142) compared to FE (60.8%, 45/74) (P<0.05). The size of extracted FB was significantly larger in patients treated with FE compared to those treated with RE (P<0.05). CONCLUSIONS: Both RE and FE were effective in the extraction of esophageal FB. However, the perforation rate and the need for general anesthesia were higher in RE-associated extraction. FE may be the preferred endoscopic treatment for the extraction of esophageal FB, except possibly for those impacted in the upper esophagus. FB extraction may produce better outcomes if endoscopy is employed early.

Relationship of Helicobacter pylori eradication with gastric cancer and gastric mucosal histological changes: a 10-year follow-up study.

BACKGROUND: Helicobacter pylori (Hp) is a common and potentially curable cause of gastric mucosa lesion. This study investigated the relationship of Hp infection with histological changes in gastric mucosa and gastric cancer in Hp-positive patients compared with Hp-eradication patients followed up for ten years. METHODS: From an initial group of 1 006 adults, 552 Hp-positive subjects were randomly assigned to a treatment group (T; n = 276) or a placebo group (P; n = 276). In the randomized, double-blind, placebo-controlled, parallel trial, T group subjects received oral doses of omeprazole, amoxicillin and clarithromycin for 1 week; those in the P group received a placebo. One month after treatment ended, a 13C urea breath test was performed, and Hp was undetectable in 88.89% of the T group. All subjects were followed at 1, 5, 8, and 10 years after treatment, with endoscopy and biopsies for histological examination. RESULTS: Gastric mucosa inflammation was significantly milder in the T group than that in the P group one year after Hp eradication and this persisted for 10 years. Glandular atrophy and intestinal metaplasia (IM) had deteriorated in both groups during ten years. However, the increased score of glandular atrophy at both the gastric antrum and corpus, and IM only at the gastric antrum, in the P group was more obvious than that in the T group. During the 10 years, 9 patients were diagnosed with gastric cancer (2 in the T group; 7 in the P group; P = 0.176). When mucosal atrophy was absent at the gastric antrum and corpus when entering the study, the incidence of gastric cancer in the P group (n = 6) was much higher than that in the T group (n = 0, P = 0.013). CONCLUSIONS: Hp eradication may significantly diminish and help halt progression of gastric mucosal inflammation and delay the development of IM and atrophy gastritis. Hp eradication is helpful for reducing the risk for gastric cancer, especially in the early stage of Hp infection.

[Analysis for 171 cases of esophageal foreign bodies impacted in upper esophagus with endoscopic treatment].

OBJECTIVE: To assess the effectiveness and complications of rigid endoscopy (RE) and flexible endoscopy (FE) for the extraction of esophageal foreign bodies (FBs) in adults. METHODS: A retrospective analysis was conducted on the medical records of 171 adult patients with the upper esophageal FB impaction treated at Peking University Third Hospital, Beijing, China, between January 2008 and December 2012. RESULTS: In the study, 126 patients with the upper esophageal foreign body impaction were treated with RE, while 45 patients received FE. (1)The size of FBs in FE group was the same as RE group(P = 0.495, P = 0.125). (2)The period impacted in the esophagus of RE group (25.8 ± 28.6) h was longer than that of FE group (13.9 ± 14.5) h (P = 0.009). (3)71.4% of the patients in RE and 88.9% in FE group went to hospital for treatment within 24 hours from being impacted, while 15.1% in RE group and 8.9% in FE group were between 24 and 48 hours.13.5% in RE and 2.2% in FE group went to hospital beyond 48 hours.(4)The proportion of FBs puncturing into one or two esophageal walls in RE group (67.5%) was higher than that in FE group (35.6%).(5) The positive rates with the upper gastrointestinal barium contrast and chest X-ray or abdominal plain film were 98.3%,23.6% and 100%,14.3% for diagnosing esophageal FBs in RE and FE groups.(6)The successful rate, complication rate and perforation rate were 100%,38.1% and 6.3%and 95.6%,48.9%,and 2.2% in RE and FE groups, respectively with no statistical difference (P > 0.05). CONCLUSION: Both RE and FE were effective in the extraction of upper esophageal FBs with no difference in the complication and perforation rates. But FE was cheaper and no need for general anesthesia.

[Complication related factors and efficacy with flexible endoscopy of 101 esophageal foreign bodies].

OBJECTIVE: To analyze the related factors of complications and treatment efficacy with flexible endoscopy for esophageal foreign body (FB). METHODS: In a retrospective study with consecutive data, 101 adults including 52 males and 49 females with esophageal FB impaction between January 2005 and December 2012 admitted into Department of Gastroenterology's Endoscopic Unit at Peking University Third Hospital were included, aged (49 ± 21) years. RESULTS: (1) FB impaction in upper and middle esophagus accounted for 87.1% (n = 88) of all esophageal FBs. No significant difference existed in interval time from impaction to removal of FB impacted between upper, middle and lower esophagus (P > 0.05) . (2) Patients with esophageal FB seeking hospital treatment accounted for 82.2% (n = 83) within 24 h and 99.0% (n = 100) within 48 h. Food lump, fish bone, chicken bone and fruit seeds accounted for 76.2% (n = 77). (3) Positive rates were 91.3% (21/23) and 24.1% (7/29) with upper gastrointestinal barium contrast and chest or abdominal plain film. The success rate was 94.1% (n = 95) with flexible endoscopy for removal of FB. (4) Denture was the most difficult FB for removal. Four patients in all 11 patients with denture impacted were not removed successfully with flexible endoscopy. (5) The complication (except for mild scratch) rate was 48.5% (n = 49) and the perforation rate 3.0% (n = 3) . Whether complications took place or not was independent of age, location of impaction, time from impaction to removal and size of FB (all P > 0.05) , but dependent on piercing into esophageal wall, concomitant with esophageal stricture and types of FB (all P < 0.01) . Whether perforation or not was independent of any above factor. CONCLUSION: Esophageal FB should be removed as soon as possible within 24 h especially for those with sharp edges and piercing into esophageal wall.

Recent changes in the prevalence of Helicobacter pylori infection among children and adults in high- or low-incidence regions of gastric cancer in China.

BACKGROUND: The prevalence of Helicobacter pylori (H. pylori) infection varies by geographic locations. Studies indicate that the infection rate of H. pylori was previously high in China but that rates had been declining worldwide over recent decades. THE AIMS OF OUR STUDY WERE: (1) to determine the current prevalence of H. pylori infection among children and adults residing in areas with high (Muping County, Shandong) and low (Yanqing County, Beijing) incidences of gastric cancer in China, and (2) to compare the prevalence for 2006 with the prevalence for the early 1990s. METHODS: Using Warthin-Starry silver staining of gastric mucosal biopsy specimens and H. pylori stool antigen tests (HpSA), we tested a total of 2065 asymptomatic children aged 8 - 15 years and adults aged 40 - 79 years in the above two regions from May to July 2006. We evaluated 520 children and 526 adults from Muping, and 516 children and 503 adults from Yanqing. Subjects were selected randomly and H. pylori status was determined by HpSA in children and either HpSA or histology of gastric biopsies in adults. Data obtained in the early 1990s in the same two areas of China were also collected and studied. RESULTS: For children, the prevalence of H. pylori infection was significantly higher in Muping (37.69%) than it was in Yanqing (25.58%, P < 0.001). In both regions, the prevalence of H. pylori increased with age but was not related to gender. A significant difference was observed between 8 - 9-years old and 10 - 11-years old (P < 0.05), but not between other adjoining age groups (P > 0.05). From 1991 to 2006 H. pylori prevalence among 8 - 10-year-old children decreased in Muping (60.00% vs 32.07%, P < 0.001), but not Yanqing (24.06% vs 19.10%, P > 0.05). In the adult group, H. pylori prevalence was 50.95% in Muping, which was significantly higher than the 41.35% positive rate in Yanqing (P < 0.01). But there were no statistically significant differences between different age groups of 40 - 49, 50 - 59, and 60 - 79 years, or between males and females. A significant decrease in H. pylori prevalence in both regions was observed when the results of 2006 were compared with the data obtained in 1990 in Muping (50.95% vs 73.78%, P < 0.001) and in 1992 in Yanqing (41.35% vs 55.35%, P < 0.01). CONCLUSIONS: After fifteen years, the prevalence of H. pylori infection among both children and adults remained significantly higher in areas with a high incidence of gastric cancer in China compared with that in areas with a low incidence of gastric cancer. H. pylori infection rates have decreased in the general Chinese population during recent years.

[Epidemiology of Helicobacter pylori infection in Shandong and Beijing areas.].

OBJECTIVES: To study the current prevalence and recent epidemiological changes of Helicobacter pylori (H. pylori) infection among children and adults residing in regions with high (Muping, Shandong) and low (Yanqing, Beijing) incidence of gastric cancer in China. METHODS: A total of 2065 asymptomatic children aged 8 - 15 years and adults aged 40 - 79 years in the above two regions were examined from May to July 2006. The data obtained in early 1990s in the same two areas and those of 11 656 patients undergoing endoscopy in our hospital in 1991 and 2006 were also collected and studied. RESULTS: The prevalence of H. pylori infection in Muping was significantly higher than that in Yanqing among both children (37.69% vs 25.58%, P < 0.001) and adults (50.95% vs 41.35%, P < 0.01). From 1991 to 2006 H. pylori prevalence among children aged 8 - 10 years decreased in Muping (60.00% vs 32.07%, P < 0.001), but not in Yanqing (24.06% vs 19.10%, P > 0.05). A significant decrease in H. pylori prevalence among adults in both regions was observed when the results of 2006 were compared with the data obtained in 1990 in Muping (50.95% vs 73.78%, P < 0.001) and in 1992 in Yanqing (41.35% vs 55.35%, P < 0.01). The detected rate of H. pylori infection in patients undergoing endoscopy in our hospital decreased from 51.88% in 1991 to 33.59% in 2006 (P < 0.001). CONCLUSIONS: The prevalence of H. pylori infection is significantly higher in areas with a high incidence of gastric cancer in China as compared with that in areas with a low incidence of gastric cancer among both children and adults. H. pylori infection may be a risk factor in gastric carcinogenesis. In the past decade or more, H. pylori infection rates have decreased in Chinese population.