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Background: Endoscopy is useful for diagnosis and treatment of upper gastrointestinal bleeding (UGIB). However, both endoscopy and UGIB may compromise the cardiovascular function. The present study is to investigate the cardiovascular responses of emergency endoscopy for patients with UGIB and stable coronary artery disease (CAD)., Methods: Consecutive 50 patients with known CAD and 50 patients without CAD history (non-CAD group) in whom emergency endoscopy was requested for UGIB were prospectively enrolled. All patients received ambulatory electrocardiographic monitoring before, during, and after endoscopies. Cardiac indices including supraventricular and ventricular arrhythmia, ST ischemic change, and autonomic nervous function evaluated by heart rate variability were compared., Results: All patients in both groups had successful primary hemostasis, and peptic ulcer bleeding was the main etiology (82%). Compared with the non-CAD group, patients with CAD had a significantly higher incidence (42% vs 16%, P = .004) and frequency (1.19 vs 0.12 events per minute, P = .003) of ventricular arrhythmias during endoscopy. Nine patients with CAD and 1 patient without CAD had ischemic ST changes (P = .016). Comorbidity with congestive heart failure was not only associated with a higher frequency (P = .02) but also a more severe fluctuation (P = .002) of ventricular arrhythmia. None in both groups had angina or MI before, during, or after endoscopy. Heart rate variability did not show a difference., Conclusions: Ventricular arrhythmias and myocardial ischemia, although mostly subclinical, were common in patients with stable CAD undergoing emergent endoscopy for UGIB, especially in those with concomitant congestive heart failure.

The incidence of colorectal cancer (CRC) is rising substantially in Taiwan. Hence, both effective screening and management of colorectal neoplasms, including precursor lesions and early cancers, have become critically important. Colorectal cancer is not only curable, but also can be managed endoscopically if detected at the stage of precursor lesions or early cancer. Optimal management of colorectal neoplasia relies largely on accurate evaluation of the characteristics of lesions, including malignant transformation, and the depth of invasion of the malignant lesions. In this context, observation using image enhancing endoscopy (IEE) to magnify the image during colonoscopy is of utmost importance. Polypectomy or endoscopic mucosal resection is now the standard procedure for the treatment of colorectal adenoma or early cancerous lesions in Taiwan. Endoscopic submucosal dissection (ESD) is performed at only a few institutions; its long-term efficacy and cost-effectiveness require further elucidation. More attention from the government, academic societies, and individual clinicians is necessary.

The primary function of MHC polymorphism is considered as the foundation of self-defense mechanism of the host in surveillance against countless diverse invading pathogens. However, this biological function can also elicit undesirable immunological responses that jeopardize transplantations when compatibility between donors and recipients is unfavourable.

Background and Aims: Evidence from Japanese studies suggests that nonpolypoid colorectal neoplasia (NP-CRN) tends to be more pathologically advanced than polypoid neoplasia. However, data are limited regarding the prevalence of NP-CRN in an average-risk population. In addition, the diagnostic yield of the fecal occult blood test (FOBT) in relation to different types of colorectal neoplasms remains unclear. We prospectively investigated the prevalence and characteristics of polypoid and nonpolypoid colorectal lesions in an asymptomatic and average-risk Chinese population., Methods: The study included 12,731 asymptomatic Chinese subjects (8372 of whom were average-risk subjects) who underwent screening colonoscopy. The prevalence, histopathologic findings, and topographic distribution of polypoid and nonpolypoid colorectal lesions were determined and analyzed. The diagnostic yield of FOBT, in relation to lesion morphology, also was assessed., Results: NP-CRN was detected in 552 (4.3%) asymptomatic and 348 (4.2%) average-risk subjects. The prevalence of depressed NP-CRN was 0.18% in both asymptomatic and average-risk subjects. A higher proportion of smaller-sized but high-grade dysplasia and invasive carcinoma beyond the submucosal layer was noted for depressed NP-CRN compared with flat NP-CRN or polypoid neoplasia. The diagnostic yield of FOBT was comparable in depressed lesions and their polypoid counterparts., Conclusions: The prevalence of NP-CRN is substantial in both asymptomatic and average-risk Chinese individuals. Some subcategories of NP-CRN in this population tend to have more advanced pathologic characteristics. These findings may lead to modification of screening and prevention strategies for colorectal cancer.

Background: Early detection of esophageal cancer in patients with head and neck cancers may alter treatment planning and improve survival. However, standard endoscopic screening is not feasible for some patients with tumor-related airway compromise or postirradiation trismus., Objective: To evaluate a novel, sequential approach by integrating ultrathin endoscopy with narrow-band imaging and Lugol chromoendoscopy., Design: Cross-sectional study., Setting: Single center in Taiwan., Patients: Forty-four consecutive patients with transoral difficulty screened for synchronous or metachronous esophageal cancer., Main Outcome Measurements: Sensitivity, specificity, and accuracy in the detection of mucosal high-grade neoplasia or invasive cancer., Results: Fifty-four endoscopic interpretations were obtained, and 11 mucosal high-grade neoplasia and 7 invasive cancers were confirmed by histology. The mean examination time was 19.4 minutes (range 7.9-35.2 minutes), and all patients tolerated the procedure well. Sensitivity, specificity, and accuracy (with 95% CI) were 55.6% (95% CI, 33.5%-75.6%), 97.2% (95% CI, 85.8%-99.3%), and 83.3% (95% CI, 71.2%-90.9%), respectively, for standard endoscopy; 88.9% (95% CI, 66.9%-96.6%), 97.2% (95% CI, 85.8%-99.3%), and 94.4% (95% CI, 84.9%-97.9%), respectively, with the adjunct of narrow-band imaging; and 88.9% (95% CI, 66.9%-96.6%), 72.2% (95% CI, 55.9%-84.1%), and 77.8% (95% CI, 64.9%-86.8%), respectively, with the adjunct of Lugol chromoendoscopy. When we integrated all interpretations on the basis of the sequential approach, the estimated probability of false-negative findings was 1.2% (95% CI, 0.1%-4.6%)., Limitations: Inherent shortcomings of ultrathin endoscopy, such as its resolution, light source, and lack of magnification., Conclusions: The use of ultrathin endoscopy in a sequential approach for multimodal detection is feasible in patients with transoral difficulty and substantially increases the detection rate of synchronous or metachronous neoplasms.

Objective: This case report evaluates a 51-month follow-up of the hormonal profiles and the menopausal status after fresh autologous hemi-ovary transplantation to the Pfannenstiel incision site in a woman aged 32 years after a total hysterectomy and accidental bilateral salpingo-oophorectomy., Case Report: A 32-year-old, unmarried woman without sexual experience had undergone a total hysterectomy and accidental bilateral salpingo-oophorectomy for huge uterine fibroids and dense pelvic adhesion. A fresh autologous right normal hemi-ovary was transplanted into the adipose tissue on the right side of the Pfannenstiel incision site. During the 51-month follow-up after transplantation, a series of hormonal profiles for serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and progesterone were carried out, together with ultrasound detection of the presence of subcutaneous follicles and an analysis of menopausal symptoms. Postoperative hormone levels at months 14, 18, 22, 30 and 51 were as follows: (1) FSH, 17.06, 11.33, 51.44, 28.6 and 61.41 mIU/mL, respectively; (2) LH, 15.1, 6.7, 20.1, 15.7 and 28.9 mIU/mL, respectively; (3) E2, 79.7, 128, 55.9, 18.6 and < 10 pg/mL, respectively; and (4) progesterone, 4.52, 9.51, 0.67, 0.45 and 0.25 ng/mL, respectively. The hormonal levels after month 22 indicated a menopausal status. Ultrasound evidence of follicles was present until 30 months after transplantation., Conclusion: This case study showed a subcutaneous fresh autologous hemi-ovary transplant survived for at least 18 months after transplantation.

Background and Aims: The effect of metabolic risk factors on the natural course of gastro-oesophageal reflux disease (GORD), which remains elusive, was quantified., Methods: The population included 3669 subjects undergoing repeated upper endoscopy. Data were analysed using a three-state Markov model to estimate transition rates (according to the Los Angeles classification) regarding the natural course of the disease. Individual risk score together with the kinetic curve was derived by identifying significant factors responsible for the net force between progression and regression., Results: During three consecutive study periods, 12.2, 14.9 and 17.9% of subjects, respectively, progressed from non-erosive to erosive disease, whereas 42.5, 37.3 and 34.6%, respectively, regressed to the non-erosive stage. The annual transition rate from non-erosive to class A-B disease was 0.151 per person year (95% CI 0.136 to 0.165) and from class A-B to C-D was 0.079 per person year (95% CI 0.063 to 0.094). The regression rate from class A-B to non-erosive disease was 0.481 per person year (95% CI 0.425 to 0.536). Class C-D, however, appeared to be an absorbing state when not properly treated. Being male (relative risk (RR) 4.31; 95% CI 3.22 to 5.75), smoking (RR 1.20; 95% CI 1.03 to 1.39) or having metabolic syndrome (RR 1.75; 95% CI 1.29 to 2.38) independently increased the likelihood of progressing from a non-erosive to an erosive stage of disease and/or lowered the likelihood of disease regression. The short-term use of acid suppressants (RR 0.54; 95% CI 0.39 to 0.75) raised the likelihood of regression from erosive to non-erosive disease., Conclusions: Intraoesophageal damage is a dynamic and migratory process in which the metabolic syndrome is associated with accelerated progression to or attenuated regression from erosive states. These findings have important implications for the design of effective prevention and screening strategies.

Background/purpose: Although evidence suggests that gastroesophageal reflux disease (GERD) may interrupt sleep, the effects of symptomatic and endoscopically diagnosed GERD remain elusive because the patient population is heterogeneous. Accordingly, we designed a cross-sectional study to assess their association., Methods: Consecutive participants in a routine health examination were enrolled. Definition and severity of erosive esophagitis were assessed using the Los Angeles classification system. Demographic data, reflux symptoms, sleep quality and duration, exercise amount, alcohol consumption, and smoking habits were recorded. Factors affecting sleep quality and sleep duration were revealed by a polytomous logistic regression analysis., Results: A total of 3663 participants were recruited. Subjects with reflux symptoms, female gender, higher body mass index, and regular use of hypnotics had poorer sleep quality. Exercise was associated with better sleep quality. Either symptomatically or endoscopically, GERD did not disturb sleep duration. Among the 3158 asymptomatic patients, those with erosive esophagitis were more likely to have poor sleep quality. The risk increased with the severity of erosive changes (p = 0.03)., Conclusion: The present study highlights the adverse effect of gastroesophageal reflux on sleep, even in the absence of reflux symptoms. This finding has therapeutic implications in patients with silent erosive disease, and future trials are warranted.

Objectives: Chronic inflammation has been implicated in the development of colorectal cancer (CRC). The presence of low-grade systemic inflammation, as determined by an elevation of high-sensitivity C-reactive protein (CRP), has been associated with an increased risk of cardiovascular diseases and cancers. However, previous studies of CRP and CRC in cohorts that comprised different genders have yielded conflicting results and little is known about CRP levels in individuals with colorectal adenomas, the precursor lesion of CRC. This study aims to elucidate the association of CRP and colorectal neoplasia., Methods: Plasma CRP levels were examined using a cross-sectional design in 6,695 consecutive ethnic Chinese adults who had undergone a complete colonoscopy following a thorough routine health evaluation. Logistic regression analysis was used to correlate the risk of colorectal neoplasia with CRP levels., Results: Plasma CRP levels were significantly higher in subjects with colorectal neoplasia than in those without neoplasia (1.85 mg/L vs 1.55 mg/L, P= 0.04). The presence of synchronous neoplasia, advanced neoplasia, and concurrent synchronous and advanced neoplasia were associated with elevated levels of plasma CRP, after adjustment for other risk factors. Gender stratification revealed a positive association between elevated CRP levels and the risk of colorectal neoplasia in men, but no such corresponding association existed in women., Conclusions: Elevated plasma CRP levels are independently associated with an increased risk of colorectal neoplasia in men, but not in women. These data support the association between chronic inflammation and colorectal neoplasia in men and provide new insights into the underlying mechanisms that warrant further investigation.

Colorectal cancer (CRC) is rapidly increasing in Asia, but screening guidelines are lacking. Through reviewing the literature and regional data, and using the modified Delphi process, the Asia Pacific Working Group on Colorectal Cancer and international experts launch consensus recommendations aiming to improve the awareness of healthcare providers of the changing epidemiology and screening tests available. The incidence, anatomical distribution and mortality of CRC among Asian populations are not different compared with Western countries. There is a trend of proximal migration of colonic polyps. Flat or depressed lesions are not uncommon. Screening for CRC should be started at the age of 50 years. Male gender, smoking, obesity and family history are risk factors for colorectal neoplasia. Faecal occult blood test (FOBT, guaiac-based and immunochemical tests), flexible sigmoidoscopy and colonoscopy are recommended for CRC screening. Double-contrast barium enema and CT colonography are not preferred. In resource-limited countries, FOBT is the first choice for CRC screening. Polyps 5-9 mm in diameter should be removed endoscopically and, following a negative colonoscopy, a repeat examination should be performed in 10 years. Screening for CRC should be a national health priority in most Asian countries. Studies on barriers to CRC screening, education for the public and engagement of primary care physicians should be undertaken. There is no consensus on whether nurses should be trained to perform endoscopic procedures for screening of colorectal neoplasia.

Background: Men are more susceptible to gastric cancer (GC) than women. However, the genetic factors associated with the sex difference are not well understood. Chemokines have been shown to modulate tumor behavior, and the sex-specific effect of the chemokine polymorphisms on the host susceptibility to several diseases has been reported. We aimed to determine the role of chemokine polymorphisms on host susceptibility to GC, with special interest on their sex-specific effect., Methods: A hospital-based case-control study, including 177 patients with GC and 217 age-matched unaffected healthy controls, was performed in three major tertiary care hospitals. Genotyping for regulated upon activation, normal T-cell expressed and secreted (RANTES) -403 A/G and -28 C/G, CC chemokine receptor 5 (CCR5) deletion, and CCR2-V64I was performed using peripheral blood DNA., Results: The RANTES -403 GA and AA genotypes were independently associated with a 2.3-fold reduced risk of developing GC (OR=0.44, 95% CI 0.22-0.90, P=0.025) compared with GG genotype in women, but not in men. The RANTES -28C/G and CCR2-V64I polymorphisms were not associated with different risk of developing GC. The tumor stage, histological features, and survival rate were not different when stratified by RANTES -403 and -28 and CCR2-V64I genotypes., Conclusions: Our data indicate that women who inherit A allele at RANTES -403 may be at reduced risk of GC.

Background: The ghrelin and leptin levels have been reported to be correlated with weight loss after bariatric surgery. However, the serial changes of ghrelin and leptin levels after laparoscopic minigastric bypass surgery (LMGBP) have not been reported yet. Therefore, we aimed to evaluate their serial changes and to analyze their relations to weight reduction after LMGBP., Methods: Serial fasting serum leptin and ghrelin concentrations were measured in 68 morbidly obese patients before (M0) and 1 (M1), 3 (M3), 6 (M6), and 12 (M12) months after LMGBP surgery. The correlations between ghrelin, insulin, and leptin concentrations and weight reduction were analyzed., Results: Leptin levels were significantly reduced at 1, 3, 6, and 12 months after surgery, respectively (vs M0, p < 0.001), whereas the ghrelin concentrations were not significantly changed after surgery. The percent of excess BMI lost (%EBL) 12 months after surgery was negatively correlated with higher preoperative ghrelin concentrations (p = 0.004) and larger preoperative BMI (p = 0.002) in the multivariate analysis., Conclusion: Higher preoperative ghrelin concentrations and larger BMI are predictive of less %EBL at 12 months after LMGBP surgery.

Background: Narrow-band imaging (NBI) is a novel, noninvasive optical technique that adjusts reflected light to enhance the contrast between the esophageal mucosa and the gastric mucosa. Whether the use of this optical technique may increase consistency in describing the presence and severity of mucosal breaks remains elusive., Objectives: We compared the intra- and interobserver variations in the endoscopic scoring of esophagitis by using conventional imaging with and without NBI., Design: Cross-sectional study of consecutive patients with reflux., Setting: Single center in Taiwan., Patients: Endoscopic photographs of 230 patients with gastroesophageal reflux were obtained with both methods. Images were randomly displayed twice to 7 endoscopists, who independently scored each photograph by using the Los Angeles classification., Main Outcome Measurements: We calculated intra- and interobserver kappa statistics to measure the consistency in interpretations., Results: With the addition of NBI, intraobserver reproducibility significantly improved with 3 of the 7 endoscopists. Interobserver reproducibility was more consistent with the combined approach than with conventional imaging alone, with an improved overall kappa value of 0.62 versus 0.45 (P < .05). Discordance between these methods was substantial in the grading of class A or B esophagitis., Limitations: A small sample of class D esophagitis might have produced insufficient statistical power in this category., Conclusions: Intra- and interobserver reproducibilities in grading esophagitis could be improved when NBI was applied with conventional imaging. The benefit appeared to derive from better depictions of small erosive foci.

Background and Aim: To evaluate the optimal dosage of rabeprazole for proton-pump inhibitor (PPI) testing of gastroesophageal reflux disease (GERD) and to test the influence of cytochrome P450 (CYP) 2C19 polymorphism in a population with a high prevalence of people who metabolize PPI poorly., Methods: In this randomized, open-label trial, patients with symptoms suggestive of GERD were randomized to receive a 2-week test with 20- or 40-mg rabeprazole after diagnostic endoscopy. Symptom response was assessed with a four-grade daily record; in addition, DNA from peripheral blood leukocytes was genotyped for CYP2C19 polymorphism with the polymerase chain reaction-restriction fragment length polymorphism technique., Results: Of the 164 patients who completed the study, 69 (42.1%) were endoscopically positive for esophagitis; the remaining 95 (57.9%) were diagnosed with endoscopy-negative reflux disease. Based on the best cut-off value for 50% symptom reduction, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detecting erosive esophagitis were 68%, 70%, 66%, 72%, and 69%, respectively, for the 20-mg regimen, and 84%, 71%, 64%, 88%, and 76%, respectively, for the 40-mg regimen, a non-significant difference. Regarding the genotype, 60 (39%) patients had two wild-type alleles, 63 (40.9%) had one variant allele, and 31 (20.1%) had two variant CYP2C19 alleles. The presence of a variant allele did not alter the diagnostic efficacy of PPI testing., Conclusions: Both dose levels of rabeprazole proved efficacious in the diagnosis of GERD. Various measures of test accuracy were unrelated to the status of the CYP2C19 genotype.

The objective of this research is to understand the interaction mechanism of beta-amyloid (Abeta) with cell and were basically divided into two parts. The first part focused on the time-dependent structural changes of Abeta (1-40) by circular dichroism (CD) spectroscopy, thioflavin T (ThT) fluorescence assay, and atomic force microscopy (AFM). The second part emphasized the kinetics and enthalpy of interaction between Abeta (1-40) and liposome by surface plasmon resonance (SPR) and isothermal titration microcalorimetry (ITC). Results obtained from CD, ThT and AFM confirmed the formation of 1 microm fibril after single day incubation. The driving force of kinetic interaction between Abeta and liposomes was revealed by SPR to be electrostatics. Further studies indicated that fresh Abeta has high GM1 affinity. Besides, addition of cholesterol to the liposome could alter membrane fluidity and affect the interactions of fresh Abeta with liposomes especially in the amount of Abeta absorbed and preserving the structure of liposome after adsorbing. Hydrophobicity was found to be the driving force leading to the interaction between Abeta fibrils and liposomes. These reactions are endothermic as supported by ITC measurements. When the composition of liposomes is zwitterionic lipids, the interaction of Abeta with liposomes is predominantly hydrophobic force. In contrast, the driving force of interaction of charged lipids with Abeta is electrostatic.

Introduction: A prospective analysis of 6 cases with multiple-level spondylolysis treated by direct repair with pedicle screw laminar hook is presented. The objective of the study was to evaluate the clinical outcome, plain radiographs, computed tomography (CT) scan, and magnetic resonance imaging to demonstrate the result of direct repair in the treatment of multiple-level spondylolysis., Materials and Methods: Ten patients with multiple-level spondylolysis of lumbar spine were treated with segmental pedicle screw hook fixation and autogenous bone graft. Four patients had lost follow-up. Six patients were followed up for a minimum of 2 years (mean 34.3 mo, range 24 to 55 mo). Patient's average age was 22 years old (range from 20 to 25 y old). All lytic defects were bilateral and located at 2 different lumbar vertebras (levels). CT scans and MR images were obtained at the latest follow-up postoperatively to assess the healing of the bony defects and the adjacent disc conditions. Fusion was considered to be presented when trabecula across the lytic defect was detected., Results: The union rate was 87% (21 pars/24 pars) on plain radiographs and 75% (18 pars/24 pars) on CT scans. Follow-up magnetic resonance imaging of lumbar spine showed no disc degeneration. All patients were satisfied (either excellent or good) with the postoperative outcomes., Conclusions: Direct repair of multiple-level spondylolysis by pedicle screw laminar hook and autogenous bone graft would be the alternative of treating patients with persistent back pain after 6 months of conservative treatment The favorable clinical outcome was correlated with bony healing rate in this series.

Objective: The present study is done to assess the relative cost-effectiveness, optimal initial age, and interscreening interval between primary and secondary prevention strategies for gastric cancer., Methods: Base-case estimates, including variables of natural history, efficacy of intervention, and relevant cost, were derived from two preventive programs targeting a high-risk population. Cost-effectiveness was compared between chemoprevention with (13)C urea breath testing followed by Helicobacter pylori (H. pylori) eradication and high-risk surveillance based on serum pepsinogen measurement and confirmed by endoscopy. The main outcome measure was cost per life-year gained with a 3% annual discount rate., Results: The incremental cost-effectiveness ratio (ICER) for once-only chemoprevention at age 30 years versus no screening was U.S. $17,044 per life-year gained. Eradication of H. pylori at later age or with a periodic scheme yielded a less favorable result. Annual high-risk screening at age of 50 years versus no screening resulted in an ICER of U.S. $29,741 per life-year gained. The ICERs of surveillance did not substantially vary with different initial ages or interscreening intervals. Chemoprevention could be dominated by high-risk surveillance when the initial age was older than 44 years. Otherwise, chemoprevention was more cost-effective than high-risk surveillance, either at ceiling ratios of U.S. $15,762 or up to U.S. $50,000. The relative cost-effectiveness was most sensitive to the infection rate of H. pylori and proportion of early gastric cancer in all detectable cases., Conclusions: Early H. pylori eradication once in lifetime seems more cost-effective than surveillance strategy. However, the choice is still subject to the risk of infection, detectability of early gastric cancer, and timing of intervention.

The aim of this study was to determine the clinicopathological features of sporadic colon cancers with loss of imprinting (LOI) of insulin-like growth factor II (IGF-II) in Chinese patients. DNA from peripheral blood leucocytes and RNA from tumours were amplified and then digested with ApaI to determine the LOI status. Of the 316 patients enrolled for analysis, 149 were informative for IGF-II LOI. The positive rate of IGF-II LOI of colon cancer tissue was 47% (70/149) in Chinese patients. Proximal colon (64%) cancers were more likely to have LOI of IGF-II in tumour than distal colon (40.9%) cancers (odds ratio (OR)=2.60, 95% confidence intervals (CI)=1.21-5.56, p=0.014). LOI of IGF-II in tumours was also associated with more advanced diseases (OR=2.90, 95% CI=1.05-8.04, p=0.04). IGF-II LOI is present in high frequency in Chinese colon cancer patients, especially those with proximal cancer.

Purpose: The Chinese population has been shown to have more distal colonic neoplasm and a higher sensitivity of sigmoidoscopic screening strategy for detecting advanced neoplasm compared with Western populations. This study was designed to evaluate the efficacy of the mixed screening strategy with sigmoidoscopy and colonoscopy in the average-risk Chinese population., Methods: Consecutive average-risk adults aged >/=50 years who underwent colonoscopy as part of a health checkup were enrolled. Data were analyzed in a hypothetical graded screening strategy using colonoscopy on patients older than a certain cutoff age or those with distal sentinel polyps. The sensitivity in detecting advanced colonic neoplasm and advanced proximal neoplasm as well as the number of colonoscopies reduced were assessed., Results: Of the 2,106 persons eligible for analysis, 1,193 (56.6 percent) were males and 913 (43.4 percent) were females. If the cutoff ages were 55, 60, and 65 years, and adenoma detected in the distal colon was the indication for subsequent colonoscopy, the detection rate for 1) advanced colonic neoplasm in the entire colon would be 94, 93.1, and 83.6 percent, respectively, and 2) advanced proximal neoplasm would be 84.8, 82.6, and 58.7 percent, respectively. The number of colonoscopic procedures could be reduced by 28, 48, and 65 percent if the cutoff ages were 55, 60, and 65 years, respectively., Conclusions: The mixed screening strategy using a cutoff age at 60 years and distal adenoma as the sentinel lesion is an effective screening program in the average-risk Chinese population.

Background: The heritability of Helicobacter pylori infection from twin studies has been reported to be 0.66. However, few data were available on the host susceptibility to H. pylori infection in Chinese. We aimed to evaluate the impact of the IL-1B and IL-1RN single-nucleotide polymorphisms (SNP) and ABO blood types on the host susceptibility to H. pylori infection., Methods: Individuals who underwent routine health check-up were enrolled. Genotyping was assessed by polymerase chain reaction (PCR) followed by direct sequencing and size fractionation using DNA from peripheral blood samples. Odds ratios (OR) for the susceptibility of H. pylori infection were computed from logistic regression models., Results: The overall prevalence of H. pylori was 62% among the 663 healthy individuals, with 54.7, 63.5, and 66.9% in persons genotyped C/C, C/T, and T/T at IL-1B-511, respectively. Age (OR 1.05, 95% CI = 1.03-1.07, p < .001) and T carrier at IL-1B-511 (OR = 1.56, 95% CI = 1.06-2.30, p = .026) were independent factors associated with increased risks of H. pylori infection in the multivariate analysis. The risks of H. pylori infection were not related to IL-1RN SNP and ABO blood types., Conclusions: These findings support that a proinflammatory polymorphism at IL-1B promoter gene is associated with increased host susceptibility to H. pylori infection in Chinese.

Background: Discrimination between neoplastic and non-neoplastic lesions is crucial in colorectal cancer screening. Application of narrow-band imaging (NBI) in colonoscopy visualises mucosal vascular networks in neoplastic lesions and may improve diagnostic accuracy., Aim: To compare the diagnostic efficacy of NBI in differentiating neoplastic from non-neoplastic colorectal lesions with diagnostic efficacies of standard modalities, conventional colonoscopy, and chromoendoscopy., Methods: In this prospective study, 180 colorectal lesions from 133 patients were observed with conventional colonoscopy, and under low-magnification and high-magnification NBI and chromoendoscopy. Lesions were resected for histopathological analysis. Endoscopic images were stored electronically and randomly allocated to two readers for evaluation. Sensitivity, specificity and diagnostic accuracy of each endoscopic modality were assessed by reference to histopathology., Results: NBI and chromoendoscopy scored better under high magnification than under low magnification in comparison with conventional colonoscopy. The diagnostic accuracy of NBI with low or high magnification was significantly higher than that of conventional colonoscopy (low magnification: p = 0.0434 for reader 1 and p = 0.004 for reader 2; high magnification: p<0.001 for both readers) and was comparable to that of chromoendoscopy., Conclusion: Both low-magnification and high-magnification NBI were capable of distinguishing neoplastic from non-neoplastic colorectal lesions; the diagnostic accuracy of NBI was better than that of conventional colonoscopy and equivalent to that of chromoendoscopy. The role of NBI in screening colonoscopy needs further evaluation.

Background & Aims: Metabolic syndrome and its associated morbidities have become a major public health problem in both developed and developing countries. Insulin resistance, the core mechanism of metabolic syndrome, has been associated with the development of colorectal neoplasm, but the interrelation between metabolic syndrome and colon cancer is rarely addressed. Our study aimed to determine whether metabolic syndrome is associated with the risk and clinical presentation of colorectal neoplasia., Methods: Consecutive 4277 ethnic Chinese who received complete total colonoscopy and thorough health checkups were enrolled. Both National Cholesterol Education Program's Adult Treatment Panel III and modified Asian criteria were used for defining metabolic syndrome. Logistic regression modeling was used to elucidate the association between colorectal neoplasia and metabolic syndrome. The impact of metabolic syndrome on distribution and number of colorectal neoplasia was also assessed., Results: Of all those enrolled, 27.1% of men and 18.9% of women met the criteria of metabolic syndrome, and 9.8% had colorectal neoplasia. Metabolic syndrome was associated with odds ratio (OR) of 1.35 (95% confidence interval [CI], 1.05-1.73) for colorectal neoplasia. OR was 0.96 (95% CI, 0.67-1.38) for distal lesions, 1.62 (95% CI, 1.14-2.30) for proximal lesions, 2.15 (95% CI, 1.40-3.31) for synchronous lesions, and 2.30 (95% CI, 1.42-3.72) for synchronous lesions located at both sides of colon., Conclusions: Subjects with metabolic syndrome have a higher risk of colon neoplasia at the proximal colon and synchronous lesions at both sides of the colon. These findings will help future colon cancer screening and prevention in patients with metabolic syndrome.

Background and Aim: Polymorphisms of GABA(A)alpha6 (GABRA6)-1521 and IL-1beta-511 have been linked with susceptibility to stress and gastric acid secretion. The aim of this study was to assess psychiatric profiles and GABRA6 and IL-1beta genotypes in functional heartburn, an important esophageal reflux condition., Methods: Psychological symptoms were assessed with a Brief Symptom Rating Scale and personality traits with a short-form Maudsley Personality Inventory. DNA from 452 healthy controls, 80 controls with neurosis, and 122 patients with functional heartburn was genotyped with PCR-RFLP technique., Results: Symptom-scale parameters (except hostility) were significantly higher in patients with functional heartburn than in healthy controls; their neuroticism scores were also higher, but extroversion scores were lower. Distribution of GABRA6 genotypes in patients with functional heartburn showed more heterozygotes than among healthy controls and neurotic subjects, but distributions of IL-1beta genotypes were similar. Multiple logistic regression analysis showed GABRA6 heterozygosity was significantly associated with functional heartburn (odds ratio, 2.37; 95% confidence interval, 1.36-4.12; P < 0.01) even after adjustment for age, sex, Helicobacter pylori infection, General Symptom Index, and score of neuroticism., Conclusions: Chinese patients with certain psychiatric characteristics and GABRA6 heterozygosity are probably predisposed to functional heartburn, providing insight into this condition's psychopathology and genetics.

Objectives: Timing of colon preparation might influence the cleansing condition of the colon and therefore affect the quality and diagnostic yield of colonoscopy. This study compared two different timings of colon preparation to assess the efficacy of colon cleansing and diagnostic yield of colorectal neoplasms during colonoscopy., Methods: One hundred twenty-one eligible subjects who had colorectal neoplasms detected at a screening colonoscopy were randomly assigned to receive colon preparation with polyethylene glycol electrolyte lavage solution (PEG-ELS) either on the day of (on the day group) or the night before (previous night group) a second colonoscopy. The condition of colon preparation and the diagnostic yield of colorectal neoplasms were recorded and compared between the two groups for the initial and second colonoscopies., Results: Fifty-nine subjects received colon preparation on the night before and 60 subjects received colon preparation the day of a second colonoscopy. Colon preparation for the second colonoscopy was better in the on-the-day group than in the previous night group (P= 0.003). Colon preparation for the second colonoscopy was better for each group in comparison with the initial colonoscopy (P < 0.0001). An interobserver variability analysis using 20 randomly selected colonoscopies from the two groups revealed good correlation among four colonoscopists. More lesions were detected in group A during the second colonoscopy (P= 0.028)., Conclusion: Colon preparation on the day of colonoscopy has a better cleansing quality and higher diagnostic yield. Subjects who had lesions detected during the initial screening colonoscopy had better colon cleansing for the second colonoscopy regardless of the timing of preparation.

Background: Although eradication of Helicobacter pylori infection can decrease the risk of gastric cancer, the optimal regimen for treating the general population remains unclear. We report the eradication rate (intention-to-treat and per protocol) of a community-based H. pylori therapy using the strategy of test, treat, retest, and re-treat initial treatment failures., Materials and Methods: In 2004, a total of 2658 residents were recruited for 13C-urea breath testing. Participants with positive results for infection received a standard 7-day triple therapy (esomeprazole 40 mg once daily, amoxicillin 1 g twice daily, and clarithromycin 500 mg twice daily), and a 10-day re-treatment (esomeprazole 40 mg once daily, amoxicillin 1 g twice daily, and levofloxacin 500 mg once daily) if the follow-up tests remained positive. Both H. pylori status and side-effects were assessed 6 weeks after treatment., Results: Among 886 valid reporters, eradication rates with initial therapy were 86.9% (95% confidence interval [CI]: 84.7-89.1%) and 88.7% (95%CI: 86.5-90.9%) by intention-to-treat and per protocol analysis, respectively. Re-treatment eradicated infection in 91.4% (95%CI: 86-96.8%) of 105 nonresponders. Adequate compliance was achieved in 798 (90.1%) of 886 subjects receiving the initial treatment and in all 105 re-treated subjects. Mild side-effects occurred in 24% of subjects. Overall intention-to-treat and per protocol eradication rates were 97.7% (95%CI: 96.7-98.7%) and 98.8% (95%CI: 98.5-99.3%), respectively, which were only affected by poor compliance (odds ratio, 3.3; 95%CI, 1.99-5.48; p < .0001)., Conclusions: A comprehensive plan using drugs in which the resistance rate is low in a population combined with the strategy of test, treat, retest, and re-treat of needed can result in virtual eradication of H. pylori from a population. This provides a model for planning country- or region-wide eradication programs.

Background: Factors determining post-colonoscopy abdominal pain remain poorly understood. Accordingly, a prospective study was conducted to reveal the key determinants., Methods: One thousand consecutive and asymptomatic patients (569 men, 431 women; mean age 51 years, range 19-84 years) undergoing total colonoscopy were evaluated to assess their abdominal pain. Their demographic data, psychological profiles (determined on the Brief Symptom Rating Scale and Maudsley Personality Inventory), and endoscopic findings were treated as independent variables in polytomous logistic regression in which pain severities were treated as outcome variables. Factors affecting the duration of pain were evaluated on multivariate linear regression., Results: Colonoscopy duration (s; odds ratio [OR]: 1.001, 95% confidence interval [CI]: 1-1.002, P<0.01) and female sex (OR: 1.368, 95%CI: 1.02-1.853, P=0.03) were significantly associated with abdominal pain, but age, body mass index, psychological traits, conscious sedation, use of i.v. hyoscine butylbromide, and colonic preparation were not. Duration of the colonoscopy was longer in female than male subjects (P=0.04). On stepwise linear regression, irritable bowel syndrome (regression coefficient: 27.47, 95%CI: 6.99-47.67, P<0.01) and conscious sedation (regression coefficient: -22.17, 95%CI: -42.52 to -1.42, P = 0.036) were the best predictors of prolonged pain in 485 patients who had pain., Conclusions: Female sex and duration of colonoscopy increased the likelihood of post-procedural abdominal pain. Conscious sedation temporarily suppressed the pain but had no effect on its occurrence. Irritable bowel syndrome may have prolonged the discomfort.

A 38-year-old man was admitted due to intermittent right upper quadrant pain for 1 month. Leukocytosis with marked eosionphilia and elevated serum alkaline phosphatase were noted. Stool examinations revealed no parasites or ova. Ultrasonography and computed tomography disclosed multiple hepatic tumors. Biopsy of the hepatic tumor was performed due to non-conclusive imaging studies and revealed eosinophil infiltration in portal areas only. Endoscopic retrograde cholangiography showed mild dilatation with irregularity of bilateral intrahepatic ducts, compatible with chronic cholangitis. Bile was aspirated and biliary lavage with normal saline was performed during endoscopy-guided biliary cannulation. Microscopic examination of the aspirate showed the characteristic ova of Clonorchis sinensis. The patient received Praziquantel therapy for 1 day. Abdominal pain reduced in intensity gradually. Eosinophilia and multiple hepatic lesions resolved after adequate treatment of Clonorchis sinensis. The rare manifestation of multiple hepatic tumors in Clonorchis sinensis should be differentiated from other primary or metastatic neoplasms, while biliary lavage for parasite ova is a valuable diagnostic tool when stool examination is negative.

Intussusception of the appendix vermiformis is an uncommon cause of abdominal pain. Several imaging modalities are of limited value in diagnosing this rare condition, including barium enema, transabdominal sonography, and CT. We report a case of intussusception of the appendix vermiformis with the clinical presentation of intermittent abdominal pain in the right lower quadrant. Colonoscopy revealed an erythematous polypoid lesion at the cecal base. Endoscopic sonography demonstrated a multiconcentric structure and enabled the tentative diagnosis of intussusception of the appendix vermiformis. Laparoscopic surgery with a reduction of the appendix and appendectomy was performed and confirmed the diagnosis.

Background and Aim: Although autonomic alterations are observed in patients with gastroesophageal reflux disease (GERD), the influence of visceral receptor responses on the dynamics of autonomic function remains unknown. The aim of this study was to investigate the autonomic functional changes in association with intra-esophageal pH under ambulation., Methods: Thirty patients referred for 48 h ambulatory pH monitoring underwent simultaneous 24 h cardiac monitoring for heart rate variability (HRV). We used linear mixed-effects models to estimate the relationship between esophageal acid exposure and power spectral analysis of HRV, including low-frequency power (0.04 < LF < 0.15 Hz), high-frequency power (0.15 < or = HF < 0.4 Hz), and LF/HF power ratio., Results: Over the 24-h period, patients with pathological reflux had lower average LF and HF powers than patients with functional heartburn, but the LF/HF power ratios were similar for the two patient groups. As we stratified the data according to waking and sleeping times, a significantly higher HF power but lower LF/HF power ratio was found during sleeping time regardless of diagnosis. In the regression analysis, esophageal pH was positively associated with change (not basal tone) of both LF and HF powers during waking, but only with change of HF power during sleeping time. The significant associations between pH values and changes in HRV decreased gradually with time. The LF/HF power ratio did not alter significantly with pH., Conclusion: Esophageal acid exposure is generally associated with decreases in autonomic tone. A predominant parasympathetic fluctuation during sleeping and a superimposed sympathetic interaction during waking dictate diurnal characteristics of autonomic regulation.

Background/aims: The role of endoscopic intervention for cholangitis caused by the juxtapapillary duodenal diverticulum without choledocholithiasis, i.e., the Lemmel's syndrome remains controversial. The aims of the study were to characterize these patients and evaluate endoscopic therapy for Lemmel's syndrome., Methodology: This study retrospectively reviewed 1923 endoscopic retrograde cholangiopancreatograms of patients with cholangitis during a three-year period, and 337 of these patients with juxtapapillary duodenal diverticula were included. Two groups (i.e., one with and one without Lemmel's syndrome) were compared., Results: Lemmel's syndrome was diagnosed in 39 patients (39/337, 11.6%). Both groups had similar cannulation success rates (94.9% vs. 87.9%, p = 0.28) and complication rates (2.6% vs. 8%, p = 0.33). Patients with Lemmel's syndrome were significantly older (mean 74.5 years vs. 66.6 years, p < 0.001) and had significantly larger diverticula (mean 3.9cm vs. 1.9cm, p < 0.001). Of these 39 patients, 15 received endoscopic sphincterotomy (38.5%), 3 received stenting (7.7%), 6 had impacted bezoars (15.4%), 2 underwent surgery due to failed cannulation (5.1%), 19 (48.7%) received conservative treatment after diagnostic cholangiography, and 1 had significant bleeding (2.6%)., Conclusions: Patients with Lemmel's syndrome are older and have larger juxtapapillary duodenal diverticula. Endoscopic cannulation is not hampered by this anatomical difference and is not associated with higher complication rate.

Background/aims: The aim of this study was to evaluate the accuracies of using ultrasonography in determining the levels and causes of gastrointestinal obstruction in the emergency department., Methodology: 229 patients who visited the emergency department with the clinical impression of gastrointestinal obstruction were studied. The gastrointestinal tract was systematically scanned from the anatomically fixed portions to movable portions in the peritoneum by "bisection approximation method". The obstructive levels and possible etiologies were investigated. The finding was correlated with final surgical or further radiological diagnosis., Results: The sensitivity, specificity and accuracy of ultrasonography in determining the obstruction of gastrointestinal tract were 97%, 87% and 93%. In 150 patients with diagnosis of gastrointestinal obstruction by ultrasonography, the accuracies of predicting obstructive levels in the gastric outlet and duodenum, the jejunum and ileum, and the colon were 100%, 74%, and 98% respectively. 67%, 36%, and 78% of obstructive etiologies could be correctly judged in these segments respectively., Conclusions: Ultrasonography is a useful tool in the localization of obstructive levels and the determination of etiologies of gastrointestinal obstruction in the emergency room. It can guide physicians to choose further appropriate confirmation studies.

Ingested foreign bodies rarely cause gastrointestinal perforation, because the majority are passed out uneventfully in the feces. However, long, sharp, slender, hard, indigestible objects such as toothpicks are dangerous and may lead to potentially life-threatening complications. We report a case of duodenal perforation caused by a toothpick and complicated by liver abscess and methicillin-resistant Staphylococcus aureus sepsis. Although laparotomy was not performed because of the patient's refusal to undergo surgery, the liver abscess and sepsis were controlled successfully with antibiotics. We also conducted a literature search for reports on injuries caused by ingested toothpicks.

Background: Associations between psychological and endoscopic profiles are not clearly validated among the heterogeneous patients with gastroesophageal reflux disease (GERD). The purpose of the present paper was therefore to identify any associations by means of cross-sectional study., Methods: Consecutive participants in a health screening program were enrolled. Definition and severity of erosive esophagitis were assessed with Los Angeles classification. Frequency and severity of psychological symptoms were measured with a 30-item Brief Symptom Rating Scale (BSRS) and personality traits with a short form of the Maudsley Personality Inventory (MPI). Statistic analyses were performed based on the presence of GERD symptoms or endoscopic esophagitis., Results: A total of 4600 participants were recruited. There were 1331 subjects (29%) with manifestations suggesting GERD, including non-erosive reflux disease (NERD) in 488 (10.6%), symptomatic erosive esophagitis (SEE) in 164 (3.6%), and asymptomatic erosive esophagitis (AEE) in 679 (14.8%). The BSRS parameters were significantly higher in symptomatic subjects (i.e. NERD and SEE subjects; P < 0.001); neuroticism scores were also higher (P < 0.001), but extroversion scores (P < 0.001) were lower than those of asymptomatic subjects. Following logistic regression analysis, independent risk factors for GERD symptoms were female gender (odds ratio [OR]: 1.596; 95% confidence interval [CI]: 1.303-1.955) and higher neuroticism scores (OR: 1.046; 95%CI: 1.032-1.06). For erosive esophagitis, independent risk factors were male gender (OR: 2.943; 95%CI: 2.359-3.671) and higher body mass index scores (OR: 1.098; 95%CI: 1.069-1.127)., Conclusions: Psychological characteristics predict likelihood of GERD symptoms but not structural state of esophagus. Male gender and obesity are risk factors for erosive esophagitis; whereas female gender and neuroticism are more likely to be associated with GERD symptoms.

Background/aims: Serum levels of carbohydrate antigen (CA) 19-9 have long been employed as a biomarker in diagnosing pancreatic cancer in symptomatic patients. We assessed the clinical usefulness of serum CA 19-9 in screening pancreatic cancer and other malignancies in individuals without symptoms., Methodology: The study enrolled 5,343 consecutive asymptomatic individuals who completed a health check-up comprising serum CA 19-9, chest film, abdominal ultrasonography, esophagogastroduodenoscopy, and colonoscopy or sigmoidoscopy. The sensitivity, specificity and positive predictive rate of CA 19-9 in detecting cancers were analyzed., Results: There were 385 patients (7.2%) with CA 19-9 higher than 37 U/mL. Two patients diagnosed with pancreatic cancer had CA 19-9 levels of 46,885 U/mL and 88.4 U/mL, respectively. Thirteen among 58 patients with other cancers had CA 19-9 levels higher than 37 U/mL. If the cut-off value of CA 19-9 was set at 37 U/mL, the sensitivity and specificity for pancreatic cancer and other cancers were 100% and 92.8%, as well as 22.4% and 92.9%, respectively. However, the positive predictive rates for pancreatic cancer and other cancers were as low as 0.5% and 3.4%, respectively., Conclusions: Efficacy of CA 19-9 in predicting either pancreatic cancer or other cancers in the asymptomatic population is low.

Background: Although the wireless Bravo pH system is effective, some patients experience retrosternal sensations possibly caused by esophageal sensitivity that may complicate clinical application., Methods: Ambulatory pH of 40 consecutive patients with GERD who had erosive esophagitis or nonerosive reflux disease, were monitored for 2 days with the Bravo system. Results were stratified and compared on the basis of self-awareness of the intraesophageal capsule., Results: Pathologic acid reflux was diagnosed in 20 patients and normal reflux was diagnosed in 20 patients. Seventeen patients (42.5%) reported retrosternal discomfort, and 12 of them (70.6%) had normal reflux. Patients with retrosternal discomfort were less likely to have moderate endoscopic esophagitis, i.e., Los Angeles classification grades B, C, and D endoscopic esophagitis (p = 0.006), and were less likely to have significantly elevated esophageal acid exposure (p = 0.0036) than those who did not perceive the discomfort. Reported discomfort was not associated with age, gender, or the presence of endoscopic esophagitis., Conclusions: The negative correlation between Bravo-capsule-induced retrosternal discomfort and esophageal-acid exposure indicates modified mechanical afferent nerve function after long-term acid stimulation. Capsule-induced retrosternal discomfort in the presence of normal acid exposure suggests functional heartburn.

Background: The goal of this study was to determine the frequency of colorectal neoplasia in an asymptomatic Taiwanese population and the topographic distribution of lesions relative to age and gender., Methods: Colonoscopy was performed in 1846 consecutive asymptomatic adults undergoing a health evaluation in 2003. Neoplastic lesions were considered advanced if they exceeded 10 mm in size, had a villous component, or contained moderately or severely dysplastic tissue or invasive cancer. Lesions at and proximal to the splenic flexure were considered proximal in location; those distal to the splenic flexure were classified as distal in location., Results: Of 1741 (94.3%) patients (1041 men, 700 women; mean 52.5 years) enrolled, 1708 (98.1%) underwent total colonoscopy. Of these patients, 263 (15.4%) had colorectal neoplasia; 51 (3.0%) had advanced lesions. A total of 331 lesions were detected; 125 (37.8%) were proximal in location. Two thirds of patients with proximal advanced lesions (66.7%, 10/15) had no distal lesion. The proportion of patients with proximal or proximal plus distal lesions increased with age ( p = 0.027)., Conclusions: Colonoscopy is an effective primary screening modality for colorectal neoplasia in asymptomatic Chinese patients. Many lesions would be missed, especially in the elderly, if only sigmoidoscopy was used for initial screening.

Background: Autonomic nervous dysfunction has frequently been observed in patients with gastroesophageal reflux diseases (GERD) and impacts the pathogenesis of GERD. However, the characteristics that distinguish between GERD patients with different manifestations remain unknown., Aim: To investigate the autonomic nervous function in subgroups of GERD patients., Patients: Of the 164 participants in this study, 57 were healthy controls, 34 had non-erosive reflux disease (NERD), 40 had symptomatic esophagitis (SE), and 33 asymptomatic esophagitis (AE)., Methods: Resting autonomic activity was assessed by measuring the 5-min heart rate variability (HRV) and HRV indices including time-domain parameters (standard deviation of normal-to-normal intervals [SDNN] and root mean square of successive differences [RMSSD]) and frequency-domain parameters (low-frequency power [LF; 0.04-0.15 Hz], high-frequency power [HF; 0.15-0.4 Hz], and LF/HF power ratio). Mental stress was assessed by use of a self-reported questionnaire (Brief Symptom Rating Scale [BSRS])., Results: HF power was (ANOVA, p=0.041) but time-domain parameters, LF power, LF/HF power ratio, and BSRS parameters were not significantly different between the four groups. A higher HF power was found in examinees with NERD than in those with SE and AE (LSD methods: both p=0.02). When split into two groups (erosive vs. non-erosive), nearly all measures of autonomic tonus were significantly lower in the erosive than non-erosive group. Age and the presence of endoscopic esophagitis influenced the RMSSD and HF power results in the regression analysis. Mental stress or gender did not correlate with any HRV index., Conclusion: In comparison with NERD subjects, autonomic tonus in patients with endoscopically confirmed esophagitis (even without symptom) is lower. This finding may suggest that the structural state of esophagus but not symptomatology dictates autonomic function status.

Background/aims: A new wireless esophageal pH monitoring device, the Bravo system, had been tested in the US with favorable results over conventional systems. However, its clinical application in eastern countries remains limited. The aim of the study was to assess the efficacy of the Bravo system in an Asian population, and compare it with the western results., Methodology: Thirty consecutive patients with clinically evident gastroesophageal reflux disease underwent esophageal pH monitoring by using the Bravo system. The Bravo capsule capable of measuring and transmitting pH data was introduced into the squamocolumnar junction and fixed on the esophageal mucosa through a locking pin. All patients were instructed to carry the receiver for a 48-hour study., Results: Twenty-nine (97%) of the 30 patients were successfully tested. In most cases (26/30, 87%) the capsules were placed without conscious sedation. All patients had successful capsule placement; however, two of them had failed the initial capsule attachment and required a second capsule. All patients had successful 24-hour recordings (30/30, 100%), while the successful 48-hour recording rate was 97% (29/30). A minor mucosal injury caused by inadvertent capsule extraction was the only complication (1/30, 3.3%)., Conclusions: Compared to the western experience, the new wireless pH monitoring system achieved a comparable attaching rate and recording efficacy. Potential complication was rare and self-limited.

Background: Upper endoscopy provides information that can be used to predict complications and to facilitate clinical decisions for patients who have ingested corrosive substances. The role of EUS in corrosive injury has not been investigated. The aim of this study was to determine whether concurrent catheter-probe EUS provides additional information that predicts complications after corrosive injury., Methods: Eighteen patients were referred (from 1997 to 2003) for EGD and concurrent EUS within 24 hours after ingestion of a caustic agent. Two patients were excluded (1 pneumoperitoneum, 1 markedly swollen cricoarytenoid cartilage/epiglottis). The severity of injury in the different segments of the esophagus and stomach was graded (0, 1, 2a, 2b, 3a, 3b) by endoscopy and by EUS (0, M, SM, MP, SS). The development of complications during hospitalization and 3-month follow-up were recorded., Observations: All 16 patients underwent EGD with EUS without complication. The frequency of early and late complications increased as the endoscopic and the EUS severity grades increased. The accuracy of prediction of bleeding or stricture was 100% when endoscopic grade 3a was used as a cutoff. For EUS, the highest accuracy was observed in the prediction of bleeding (75%) and stricture (100%) when EUS grade MP was used as a cutoff., Conclusions: EUS can be performed safely within 24 hours of ingestive of corrosive substances. However, when used in conjunction with conventional endoscopic observation, it does not increase the accuracy for prediction of early or late complications. Standard endoscopy alone is sufficient for evaluation and prediction of bleeding and stricture complications after corrosive injury in the upper-GI tract.

Genes involved in regulating antimicrobial immunity and inflammation may modulate the risk of Helicobacter pylori-associated diseases. IL-1 and TNF-alpha are major cytokines detected in H. pylori-infected tissues. We aimed to determine the role of gene polymorphisms for these cytokines and their receptors in 2 distinct H. pylori-related gastric malignancies, adenocarcinoma (GAC) and maltoma. Genotyping for IL-1beta (-31 C/T, -511 C/T), TNF-alpha (-238 G/A, -308 G/A, -857 C/T, -863 C/A, -1031 T/C), TNFR1 (-383 A/C) and TNFR2 (196 G/T) was undertaken for 70 patients with maltoma and 204 patients with noncardia GAC and compared to 210 unrelated healthy controls. Genotype frequencies showed no differences among patients with GAC or maltoma and controls for IL-1beta, TNFR1 or TNFR2. The TNF-alpha -857 T variant was significantly underrepresented in maltoma compared to controls (6.4% vs. 14.3%, p = 0.018), conferring a 3-fold decrease in risk (OR = 0.33, 95% CI 0.15-0.75). Comparison of allele frequencies between GAC and controls failed to show any statistical significance for TNF-alpha polymorphisms. We concluded that TNF-alpha -857 T itself or a neighboring gene may modify the risk of maltoma. The differences in genetic background as well as divergent clinicopathologic features between GAC and maltoma support the notion that fundamental mechanistic differences exist in these 2 well-defined H. pylori-related malignancies., (Copyright 2004 Wiley-Liss, Inc.)

Cholangitis rarely occurs after sphincteroplasty if there is no biliary obstruction. We report the case of a patient who developed recurrent cholangitis despite having a patent biliary tract after sphincteroplasty. Duodenobiliary reflux was demonstrated on sonography after enhancement of the reflux flow with a novel oral contrast agent, a carbonated soda beverage. Sonography with contrast enhancement provided by soda solution may prove satisfactory to detect duodenobiliary reflux after sphincteroplasty safely, effectively, and economically., (Copyright 2004 Wiley Periodicals, Inc.)

Background and Aims: The role of Helicobacter pylori infection in gastroduodenal lesions might be different between the general population and AIDS patients. The aim of the present study was to compare the prevalence of H. pylori and cytomegalovirus (CMV) infection in AIDS patients and HIV-negative controls. The impact of CD4 lymphocyte counts on H. pylori and CMV infection in the same subjects was also assessed., Methods: One hundred and fifty-six patients (52 HIV-positive, 104 HIV-negative) with gastrointestinal symptoms were evaluated with upper gastrointestinal endoscopy and biopsy. Comparison of the prevalence of H. pylori and CMV infection was made by dividing AIDS patients into two groups: those with CD4 counts >100/mm3 and those with CD4 counts <100/mm3, and ulcer and non-ulcer patients., Results: In comparison with HIV-negative controls, AIDS patients had a lower prevalence of H. pylori infection (P < 0.0001) but a higher prevalence of CMV infection (P < 0.0001). Cytomegalovirus infection was frequently found in AIDS patients with CD4 count <100/mm3, in comparison with those with a CD4 count >100/mm3. In AIDS patients, CMV was more frequently detected in subjects with peptic ulcers (P = 0.0125). Conversely, the prevalence of H. pylori infection in AIDS patients was not different between those with and without peptic ulcers., Conclusions: The low prevalence of H. pylori infection and peptic ulcer in AIDS patients suggests a different role of H. pylori infection in peptic ulcer or even a different mechanism of peptic ulcerogenesis in HIV-positive subjects. Cytomegalovirus, rather than H. pylori, may be the main causative pathogen of peptic ulcers in AIDS patients.

Objectives: To determine the incidence of sonographic hepatic portal venous gas (HPVG) and to clarify the relationship between the presence of HPVG and clinical outcomes in patients with out-of-hospital cardiac arrest (OHCA)., Methods: From April 2002 to January 2003, patients with non-traumatic OHCA were prospectively enrolled in a tertiary medical centre in Taipei, Taiwan. Emergency abdominal sonography during resuscitation was performed to detect the presence of HPVG within the first 10 min on arrival of the emergency department (ED)., Results: HPVG was detected in 16 (36%) of the 44 patients enrolled in this study. The patients with HPVG were older (P = 0.039), their cardiac arrest was witnessed less frequently (P = 0.01), they received more prolonged resuscitation (P = 0.008), and needed more accumulated doses of adrenaline (epinephrine) (P = 0.002). These patients had a considerably lower incidence of return of spontaneous circulation (ROSC) (P < 0.001), less survival to hospital admission (P < 0.001), less 24 h survival (P < 0.001) and less survival to discharge (P = 0.036). In a multiple regression analysis, HPVG was noted as an independent factor negatively associated with ROSC., Conclusion: HPVG is not uncommon in patients receiving resuscitation for OHCA and is associated with poor outcome in these patients.

Inflammatory pseudotumor is one of the etiologies that may cause small bowel intussusception. Because of its emergency, early diagnosis plays a pivotal role in successful management. Ultrasonography is a safe and handy diagnostic tool without invasiveness and it is advantageous for early preoperative diagnosis. We present a case of ileal intussusception caused by inflammatory pseudotumor, which was diagnosed preoperatively with ultrasonography and was proven by operation. The ultrasonographic feature of the inflammatory pseudotumor was heterogeneously hyperechoic and it should be included in the differential diagnosis of hyperechoic leading lesions of small bowel intussusception in adults.

A novel expanded tip wire (ETW) catheter antenna is proposed for microwave ablation for the treatment of atrial fibrillation (AF). The antenna is designed as an integral part of coaxial cable so that it can be inserted via a 6F catheter. A numerical model based on the rotationally symmetric finite-difference time-domain technique incorporating the generalized perfectly matched layer as the absorbing boundary condition has been utilized to accurately model the interaction between the antenna and the myocardium. Numerical and in-vitro experimental results are presented for specific absorption rate, return loss and heating pattern produced by the antenna. Both numerical modeling and in-vitro experimentation show that the proposed ETW antenna produces a well-defined electric field distribution that provides continuous long and linear lesions for the treatment of AF.