Volume 77 - 2014 - Fasc.1 - Original articles
Modified sequential Helicobacter Pylori eradication therapy using high dose omeprazole and amoxicillin in the initial phase in the extensive metaboliser turkish patients for CYP2C19 polymorphism is ineffective
Aim : To investigate whether the sequential therapy composed of high dose omeprazole and high dose amoxicillin in the first step was effective in eradication of H. pylori and whether there was a relation between effectiveness of the therapy and CYP2C19 gene polymorphism.
Method : 134 dyspeptic patients with H. pylori were adminis- tered a modified sequential therapy composed of omeprazole 40 mg t.i.d. and amoxicillin 1000 mg t.i.d. for the first five days followed by omeprazole 20 mg b.d., metronidazole 500 mg t.i.d. and tetra- cycline 500 mg t.i.d. for the next five days. CYP2C19 genotype status was determined in patients. Hp eradication status was inves- tigated by C14 UNT four weeks after treatment.
Results : The eradication rates were 64,9% in ITT and 74,3% in PP analysis. In subgroup analyses, eradication rates were 73,8% and 60,8% (p : 0,145) in ITT for peptic ulcer and non-ulcer dyspep- sia patients respectively and 86,1% and 69,1% (p : 0,052) in PP analysis for peptic ulcer and non-ulcer dyspepsia patients respec- tively. The difference was not significant. As for the CYP2C19 gene status, 81,5% of the patients had HoeM and 17,3% of the patients had HeEM, and eradication rates were 72% and 75% in ITT analysis for HoeM and HeEM respectively (p : 0.803) and 73.9% and 85.7% in PP analysis for HoeM and HeEM respectively (p : 0.347). There was not a significant difference in H. pylori eradica- tion rates between the two groups.
Conclusion : This modified high-dose sequential therapy was ineffective in a Turkish sample, nearly all of whom had EM in terms of CYP2C19 gene status. (Acta gastroenterol. belg., 2014, 77, 3-7).
Gastrostomy use in children : a 3-year single centre experience
Aim : Monocentric retrospective paediatric study describing in- dications for gastrostomy and major complications, compared to literature data as part of a quality check.
Methods : Records of all gastrostomy patients consulting at the UZ Ghent paediatric gastro-enterology department between January 2007-December 2009 were reviewed in December 2010 re- garding indication, age and weight at tube insertion, insertion method, major complications and current gastrostomy tube type.
Results : 178 patients were included of which 165 (93%) were placed using the endoscopic pull technique, the others were placed surgically (n = 13). Neurodevelopmental disability with oral motor dysfunction was the major indication (113, 63%). Other indications were failure to thrive due to concomitant disease (65, 37%). Medi- an age at tube insertion was 3yr (interquartile range (IQR) 0.6-9) with median tube time of 3.9 yr (IQR 1.9-7.2).
Immediate complications were 1 peritonitis and 1 post-insertion fever episode. Late complications (10, 5.6%) were 1 gastrocolic -fistula,- 1- dislocation- and- 8- buried- bumpers- after- 4- yr- (range- 3.5- 10.4)-of-tube-insertion.-The-incidence-of-buried-bumper-increased significantly-with-increasing-PEG-tube-time-(P-<--0.01).
Gastro-oesophageal-reflux-disease-(GORD)-led-to-Nissen-fundo- plication-in-45-(25.3%)-patients.-The-proportion-of-patients-receiv- ing a fundoplication remained about 20% over time but the time lapse-between-the-2-procedures-decreased-significantly.-
Conclusion :-The-development-of-buried-bumper-is-associated-to prolonged-PEG-tube-use.-In-case-of-important-GORD-laparoscopic Nissen- procedure- and- PEG- placement- can- be- performed- simulta- neously without increasing complication rate. (Acta gastroenterol. belg., 2014, 77, 8-12).
Clinical significance of bowel wall thickening on computed tomography in HIV- infected patients : association of anemia and hypoalbuminemia
Computed tomography scanning of the abdomen and pelvis is a frequently used procedure. Advanced technol- ogy and the availability of superior scanning instruments [such as helical or multidetector scanners (MDCT)] have made detection of subtle gastrointestinal tract disorders facile. Thickening of the gastrointestinal or bowel wall is an increasingly recognized abnormality seen on comput- ed tomography (CT) scanning of the abdomen and pel- vis. Normally, on CT scanning of the abdomen, esopha- geal wall thickness is not greater than 5 millimeters (mm) in thickness (1), the stomach wall is usually less than 3 mm (2) or 5 mm (1) in thickness, the duodenal wall is less than 3 mm (2), the small bowel wall is less than 4 mm, and the colonic wall is less than 3 mm (1,2).
A Facebook survey to obtain alcohol-related information by young people and adolescents. An Italian study
Background : Alcohol consumption by adolescents and young adults is an issue of significant public concern. Internet-based Social Networking sites, such as FacebookTM, are potential avenues to reach young people easily.
Objective : to underline the innovation in proposing surveys to collect health-related information regarding young people alcohol consumption and other substances abuse by using Social Network- ing Websites, particularly FacebookTM.
Methods : A questionnaire investigating modalities of alcohol consumption, drinking patterns' risk behaviors and other sub- stances abuse was proposed through a "Facebook event" to young Italian Facebook users aged between 16 and 32. Each Facebook user invited to the event was free to participate, to answer to the questionnaire and to invite his "Facebook friends".
Results : During the 89 days of permanence on the Social Net- work, 1846 Facebook users participated the event and 732 of them decided spontaneously to answer the questionnaire. The frequency of answering was 8,2 people per day. About 200 users wrote a posi- tive comment to the initiative on the wall of the event. Sixty% of subjects participating the survey were females. Ninety-one% of people answering the questionnaire were alcohol consumers. More than 50% of alcohol consumers were also smokers. Approximately 50% of subjects were binge drinkers. Illegal drugs were used by the 22.2% of the interviewed people.
Conclusions : FacebookTM resulted an efficient and rapid tool to reach young people from all over Italy and to propose surveys in order to investigate alcohol consumption and alcohol-related health problems in the youth. (Acta gastroenterol. belg., 2014, 77, 18-24).
Diagnosing and treating pediatric Crohn's disease patients : is there a differ- ence between adult and pediatric gastroenterologist's practices ? Results of the BELCRO cohort
In many countries the cut off age for pediatric care lies between 15-18 y of age (1). Above that age, patients are transferred to gastroenterologists for adult patients. Ad- equate transition for these patients has been the subject of many publications (1-3). Even though pediatric Crohn's disease (CD) patients differ from adults (4), there is often a grey zone for teenagers, whom gastroenterologists ac- cept under their care.
Characteristics, treatment, and virologic responses of chronic hepatitis C patients treated with peginterferon alfa-2a and ribavirin in Belgium : a sub-analysis of the PROPHESYS study
Background and study aims : PROPHESYS was a prospective, international cohort study of monoinfected, treatment-naive chronic hepatitis C patients treated with a combination of peginter- feron alfa-2a or alfa-2b and ribavirin. It included worldwide 7,163 patients from 19 countries (including 384 patients from Belgium alone) and demonstrated that sustained virologic response rates in the real world were similar to those achieved in well-controlled clinical trials. The objective of this sub-analysis was to present an overview of the baseline characteristics, anti-hepatitis C drug treat- ment, and virologic responses of the patients treated in Belgium, infected with HCV genotype 1, 2, 3, or 4, and administered pegin- terferon alfa-2a. Moreover, the impact of ribavirin dosage on the response to treatment was studied.
Patients and methods : 356 patients were included in this sub- analysis. All variables were summarized using descriptive statistics. Results : Compared to the published data of the whole study population (1), the Belgian data presented some significant differ- ences in terms of genotype distribution and response to treatment (e.g. lower prevalence of HCV genotype 1 infection, lower virologic response rates in HCV genotype 2 patients). Deviations from exist- ing recommendations were identified (e.g. higher dose of ribavirin in HCV genotype 2 or 3 patients). Patients who received less than 80% of the target dose of ribavirin experienced a significantly
weaker response to treatment.
Conclusion : This sub-analysis provided an interesting profile of
the Belgian experience in the treatment of chronic hepatitis C. (Acta gastroenterol. belg., 2014, 77, 30-40).
Depth of remission in Crohn's disease patients seen in a referral centre : associ- ated factors and impact on disease outcome
Introduction : Our goals were to assess the prevalence of biologi- cal and tissue remission in routine practice in Crohn's disease, and to evaluate the correlation between biological or tissue remission and clinical or demographic characteristics as well as their impact on disease outcome.
Methods : We performed a retrospective monocenter study. Bio- logical remission was defined by a CRP < 5 mg/l. Tissue remission was defined by the absence of ulcer at endoscopy and/or absence of signs of acute inflammation at MRI. Association with demographic, clinical and laboratory markers was studied by logistic regression models and rates of relapses, hospitalizations and surgeries were compared using the logrank test.
Results : Among the 263 patients included, 147 were in clinical remission ; 102/147 (69%) were in biological remission. Fifty-six patients also had morphological evaluation : 37 (66%) were in tissue remission. Biological remission was associated with older age, higher hemoglobin and lower BMI. Tissue remission was associated with older age, lower platelets count, absence of previ- ous surgery, and the use of immunosuppressant. Time-to-relapse was significantly longer in patients with biological remission and in patients with tissue remission as compared to patients without bio- logical or tissue remission.
Conclusions : Among the patients in clinical remission seen as outpatients, two thirds were either in biological and/or tissue re- mission. Biological and/or tissue remission was associated with a better outcome than clinical remission alone. (Acta gastroenterol. belg., 2014, 77, 41-46).