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2017| September-October | Volume 23 | Issue 5
Online since
September 18, 2017
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ORIGINAL ARTICLES
Optimized high-dose amoxicillin–proton-pump inhibitor dual therapies fail to achieve high cure rates in China
Jia-Li Hu, Jun Yang, Yin-Bin Zhou, Ping Li, Ran Han, Dian-Chun Fang
September-October 2017, 23(5):275-280
DOI
:10.4103/sjg.SJG_91_17
PMID
:28937021
Background\Aim:
Quadruple daily administration of proton-pump inhibitor (PPI) therapy achieves potent acid inhibition, and combined with amoxicillin, with its pharmacodynamic and pharmacokinetic characteristics, may be efficient for
Helicobacter pylori
eradication. We compared the efficacy of two optimized high-dose dual therapies with a bismuth-containing quadruple regimen for treating
H. pylori
infection. Rabeprazole dosages for
H. pylori
eradication were also evaluated.
Patients and Methods:
Treatment-naive and
H. pylori
-positive subjects were recruited and randomly apportioned to three treatment groups: Group A (
n
= 87), rabeprazole 10 mg plus amoxicillin 750 mg (4 times/day for 14 days); Group B (
n
= 87), rabeprazole 20 mg plus amoxicillin 750 mg (4 times/day for 14 days); and Group C (
n
= 89), bismuth-containing quadruple regimen consisting of rabeprazole 20 mg, bismuth 220 mg, amoxicillin 1000 mg, and clarithromycin 500 mg (2 times/day for 14 days). Four weeks after treatment discontinuation, patients were examined for
H. pylori
infection by
13
C-urea breath test. The rates of adverse effects, compliance, and eradication were evaluated.
Results:
Eradication rates in groups A, B, and C were 78.1, 81.6, and 84.3%, respectively, based on intention-to-treat analysis, or 79.1, 83.5, and 86.2%, according to per-protocol analysis. Rates of adverse events and compliance of the three groups were similar.
Conclusion:
For treating
H. pylori
infection, optimized high-dose amoxicillin–PPI dual therapies failed to achieve high cure rates in China and held no advantage over a bismuth-containing quadruple regimen.
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SYSTEMATIC REVIEW/META-ANALYSIS
Unique characteristics of
ARID1A
mutation and protein level in gastric and colorectal cancer: A meta-analysis
Young-Sik Kim, Hoiseon Jeong, Jung-Woo Choi, Hwa Eun Oh, Ju-Han Lee
September-October 2017, 23(5):268-274
DOI
:10.4103/sjg.SJG_184_17
PMID
:28937020
Background/Aim:
Recently,
AT-rich interactive domain-containing 1A protein
(
ARID1A
) has been identified as a novel tumor suppressor gene in gastric cancer (GC) and colorectal cancer (CRC). However, the clinicopathologic value of
ARID1A
mutation or protein level in GC and CRC patients is controversial. Hence, we conducted a meta-analysis on the relationship between
ARID1A
aberrations and clinicopathologic parameters in GC and CRC.
Materials and Methods:
Relevant published studies were selected from PubMed and EMBASE. The effect sizes of
ARID1A
mutation or level on the patient's clinicopathologic parameters were calculated by prevalence rate or odds ratio (OR) or hazard ratio (HR), respectively. The effect sizes were combined using a random-effects model.
Results:
The frequency of
ARID1A
mutation and loss of
ARID1A
protein expression in GC patients was 17% and 27%, respectively. The loss of
ARID1A
protein expression of GC patients was significantly associated with advanced tumor depth (OR = 1.8,
P
= 0.004), lymph node metastasis (OR = 1.4,
P
= 0.001), and unfavorable adjusted overall survival (HR = 1.5,
P
< 0.001).
ARID1A
mutation of GC was significantly associated with microsatellite instability (MSI) (OR = 24.5,
P
< 0.001) and EBV infection (OR = 2.6,
P
= 0.001). The frequency of
ARID1A
mutation and
ARID1A
protein expression loss in CRC patients was approximately 12–13%. Interestingly, the loss of
ARID1A
protein expression in CRC patients was significantly associated with poorly differentiated grade (OR = 4.0,
P
< 0.001) and advanced tumor depth (OR = 1.8,
P
= 0.012).
Conclusion:
Our meta-analysis revealed that
ARID1A
alterations may be involved in the carcinogenesis of GC by EBV infection and MSI. The loss of
ARID1A
protein expression may be a marker of poor prognosis in GC and CRC patients.
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EDITORIAL
Failure of optimized dual proton pump inhibitor amoxicillin therapy: What now?
David Y Graham, Hong Lu, Akiko Shiotani
September-October 2017, 23(5):265-267
DOI
:10.4103/sjg.SJG_292_17
PMID
:28937019
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ORIGINAL ARTICLES
The efficacy and safety of the left lateral position for endoscopic retrograde cholangiopancreatography
Tae Young Park, Sang Hyeon Choi, Young Joo Yang, Suk Pyo Shin, Chang Seok Bang, Ki Tae Suk, Gwang Ho Baik, Dong Joon Kim
September-October 2017, 23(5):296-302
DOI
:10.4103/sjg.SJG_121_17
PMID
:28937025
Background/Aim
: Endoscopic retrograde cholangiopancreatography (ERCP) is typically performed in prone position. In cases of difficulty in prone position, ERCP can be performed in left lateral position. We aimed to evaluate the efficacy and safety of left lateral position for ERCP compared with those of prone position.
Patients and Methods:
Between August 2015 and March 2016, a total of 62 patients with native papilla who underwent ERCP were randomly assigned to undergo the procedure in left lateral position (
n
= 31) or prone position (
n
= 31). The outcomes of procedures were compared between the two groups.
Results:
There were no significant differences between the two groups in terms of the demographic data, indications for ERCP, comorbidities, anticoagulation agents, the types and doses of sedative agents, and procedural durations. The rates of technical success and adverse events were similar (96.8 and 40%, respectively, in left lateral group and 100 and 32.3%, respectively, in prone group). The rates of unintentional pancreatic duct (PD) cannulation and the acquisition of pancreatograms in left lateral group were significantly greater than those in prone group (9/30, 30.0% vs. 3/31, 9.7%,
P
= 0.046; 7/30, 23.3% vs. 1/31, 3.2%,
P
= 0.020, respectively). However, there was no significant difference in the rate of post-ERCP pancreatitis (6/30, 20% vs. 5/31, 16.1%,
P
= 0.694).
Conclusion:
The left lateral position for ERCP can be as effective and safe as prone position. Due to increased rates of unintended PD cannulation and contrast injection, the initial use of left lateral position may be limited to cases that exhibit difficulty in prone position.
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Yield of p53 expression in esophageal squamous cell cancer and its relationship with survival
Tushar H Sankalecha, Sudhir J Gupta, Nitin R Gaikwad, Nikhil U Shirole, Harit G Kothari
September-October 2017, 23(5):281-286
DOI
:10.4103/sjg.SJG_56_17
PMID
:28937022
Background/Aims:
Esophageal squamous cell carcinoma (ESCC) is the most aggressive type of cancer. Mutation of tumor suppressor gene p53 is observed in many gastrointestinal malignancies including ESCC. The immunohistochemical protein expression of mutant p53 has been proposed as a potential tool to evaluate the biological behavior of ESCC. Predictive value of p53 for survival is debatable, hence this study was formulated to know the survival of patients with p53 expression in ESCC.
Patients and Methods:
We prospectively included 91 consecutive patients of ESCC from August 2014 to August 2016. Biopsy specimens were treated immunohistochemically and expression of p53 gene was analyzed by Immunoreactive Score (IRS). These findings were then compared with clinicopathological parameters such as age, gender, histological grades, and TNM stages. All patients received treatment and were kept under regular follow-up.
Results:
M: F ratio was 2.03:1. p53 expression analyzed by IRS showed low expression (score ≤6) in 35 patients (38.46%) and high expression (>6) in 56 patients (61.54%). Level of p53 expression increased significantly with increasing histological grades of ESCC and TNM stage (
P
≤ 0.001). Multivariate analysis shows p53 expression as independent predictor of survival. After 1 year of follow up, survival in the p53 high-expression group was 67.86% [standard error (SE) = 0.0473, confidence interval (CI) = 0.75–0.97) and in low p53 expression group was 91.43% (SE = 0.06, CI = 0.53–0.78) with statistically significant difference
P
= 0.0001 when analyzed with Kaplan–Meier method.
Conclusion:
Expression of p53 correlates with the survival and is a simple, effective and reproducible modality to determine the prognosis and survival in ESCC.
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326
Pre-illness diet as risk factor in pediatric inflammatory bowel disease in Saudi Arabia
Mohammad I El Mouzan, Mohammad A Al Mofarreh, Ahmad A Al Sarkhy, Asaad M Assiri, Yassin M Hamed
September-October 2017, 23(5):287-290
DOI
:10.4103/sjg.SJG_619_16
PMID
:28937023
Background/Aim:
Inflammatory bowel disease (IBD) is increasing in Saudi Arabia but there's little knowledge about its risk factors. Our aim is to investigate the dietary risk factors of this disease in Saudi children.
Patients and Methods:
The children investigated for IBD were prospectively enrolled. Those with confirmed IBD were designated cases and the others were controls. The average food frequency intake at least 3 months before onset of illness was obtained by direct interview and recorded on a modified food frequency questionnaire. Fast food, sweet gaseous soft drinks, fruits, and vegetables were selected. Statistical analysis included descriptive statistics, multivariate logistic regression was used, and the odds ratio was calculated to report the statistical significance of the results.
Results:
A total of 91 children, 52 IBD (38 CD, 14 UC) and 39 controls were enrolled. Consumption of fast food and sweet gaseous drinks was more frequent in children with IBD than controls, whereas consumption of fruits and vegetables was less frequent in children with IBD. Only less fruits consumption was significantly associated with IBD as the odds of children getting IBD was 2.89 (1.06, 7.87).
Conclusions:
We report statistically significant positive association between less fruits consumption and IBD. Awaiting the results of larger sample size and more quantitative studies, the benefits of frequent fruit consumptions should be part of public health education.
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CASE REPORT
Intrahepatic cholestasis in two omani siblings associated with a novel homozygous
ATP8B1
mutation, c.379C>G (p.L127V)
Hassib Narchi, Suhailah Alhefeiti, Fatmah Althabahi, Jozef Hertecant, AS Knisely, Abdul-Kader Souid
September-October 2017, 23(5):303-305
DOI
:10.4103/sjg.SJG_178_17
PMID
:28937026
We report two Omani brothers with intrahepatic cholestasis that resolved with supportive care. In one, cholestasis began in infancy; in the other, only at the age of 18 months. Whole exome sequencing identified a novel homozygous variant, c.379C>G (p.L127V) in
ATP8B1
. Those attending patients with cholestasis from the Arabian peninsula should be aware of this mutation and of the variation in its phenotypic effects.
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LETTER TO EDITOR
Ascariasis and pancreatitis
Vipul D Yagnik
September-October 2017, 23(5):306-306
DOI
:10.4103/sjg.SJG_301_17
PMID
:28937027
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ORIGINAL ARTICLES
Celiac disease-related osteopathy among Saudi celiac patients: Are we adherent to recommendations?
Mona A Fouda
September-October 2017, 23(5):291-295
DOI
:10.4103/sjg.SJG_58_17
PMID
:28937024
Background/Aims:
There are no reports from Saudi Arabia documenting the picture of osteopathy in celiac disease (CD) and the adherence of physicians to the guidelines and recommendations to screen for bone disease. We conducted this study to document the prevalence of CD-related osteopathy and the Saudi physicians' adherence to the screening recommendations.
Patients and Methods:
We identified the biopsy proven CD cases diagnosed between 2003 and 2012. In addition to demographic data, we collected laboratory (serum calcium, phosphate, alkaline phosphatase, 25-dihydroxy vitamin D, and parathyroid hormone levels) and imaging [Dual-energy X-ray absorptiometry (DEXA)] data. Vitamin D levels of <50 nmol/L and 50−<75 nmol/L defined deficiency and insufficiency, respectively. T score (of lumbar spine and femoral neck) of ≤−2.5 defined osteoporosis and a score of ≤−1 and >−2.5 defined osteopenia.
Results:
We identified 80 children and 128 adults with CD. Only 42% of children and 67% of adults had their serum vitamin D level measured. DEXA was ordered in 7% of children and 36% of adults. Vitamin D deficiency was widely prevalent and significantly higher in adults (95.3%) than children (76.3%). Low bone mass density (BMD) in adults was 86.9% (45.6% with osteopenia and 41.3% with osteoporosis).
Conclusions:
We document low adherence of physicians to recommended guidelines to recommendations to screen for osteopathy in CD. Vitamin D deficiency and low BMD are highly prevalent among Saudi CD patients. This may be a reflection of the low vitamin D stores in the Saudi general population.
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RESPONSE TO LETTER TO EDITOR
A rare etiology of idiopathic acute pancreatitis
Malay Sharma, Piyush Somani
September-October 2017, 23(5):307-307
DOI
:10.4103/sjg.SJG_317_17
PMID
:28937028
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© Saudi Journal of Gastroenterology (Official journal of The Saudi Gastroenterology Association) | Published by Wolters Kluwer -
Medknow
Online since 15
th
October, 2006