Effects of Helicobacterpyloriinfection on gastric emptying rate in patients with non-ulcer dyspepsia

AIM:The pathogenesis of delayed gastric emptying in patients with non-ulcer dyspepsia(NUD)remains unclear. We aimed to examine whether gastric emptying rate in NUD patients was associated with Helicobacter pylori(Hpylori) infection and whether it was affected by eradication of the infection. METHODS:Gastric emptying rate of a mixed solid-liquid meal was assessed by the paracetamol absorption method in NUD patients and asymptomatic controls(n=17).Hpylori status was assessed by serology and biopsy urease test. H pylori-positive NUD patients(n=23)received 10-day triple eradication therapy.Hpyloristatus was re-assessed by biopsy urease test four weeks later,and if eradication was confirmed,gastric emptying rate was re-evaluated. RESULTS:Thirty-three NUD patients and 17 controls were evaluated.NUD patients had significantly delayed gastric emptying compared with controls.The mean maximum plasma paracetamol concentration divided by body mass (Cmax/BM)was 0.173 and 0.224 mg/L.kg respectively (P=0.02),the mean area under plasma paracetamol concentration-time curve divided by body mass(AUC/BM) was 18.42 and 24.39 mg.min/L.kg respectively(P=0.01). Gastric emptying rate did not differ significantly between H pylori-positive and H pylori-negative NUD patients.The mean Cmax/BM was 0.172 and 0.177 mg/L·kg respectively (P=0.58),the mean AUC/BM was 18.43 and 18.38 mg·min/ L·kg respectively(P=0.91).Among 14 NUD patients who were initially H pylori-positive,confirmed eradication of the infection did not significantly alter gastric emptying rate. The mean Cmax/BM was 0.171 and 0.160 mg/L.kg before and after Hp eradication,respectively(P=0.64),the mean AUC/BM was 17.41 and 18.02 mg.min/L.kg before and after eradication,respectively(P=0.93). CONCLUSION:Although gastric emptying is delayed in NUD patients compared with controls,gastric emptying rate is not associated with H pylori status nor it is affected by eradication of the infection.

A fairy tale of modern insulin therapy in type 1 diabetes

In type 1 diabetes,flexible,intensive insulin management improves not only glycemic control but also dietary freedom and treatment satisfaction.Such flexibility has been made possible with the new insulin analogues(as part of a basal-bolus regime) and is now gaining wide applicability,especially among children and adolescents.This approach requires appropriate individualized patient education.Especially for adolescents,the clinician should be able to guarantee insightful participation in direct response to their attitudes,wishes and needs.This patient-and-doctor collaboration is an ever-challenging duty and has the potential to change the future of the individual diabetic patient.

Antidiabetic treatment:Though lovers be lost,love shall not

The new position statement of the American Diabetes Association and the European Association for the Study of Diabetes on the management of type 2 diabetes mellitus represents a paradigm shift in our understanding of antidiabetic treatment.It emphasises the necessity to individualise management based on patient needs.Glycaemic targets should also be pursued on an individualised basis.New therapeutic combinations are discussed,and the uncertainty surrounding the ideal choice is acknowledged.Above all,it is the mindful and experienced clinician who will implement the best available evidence towards flexible and efficacious treatment.Some areas of uncertainty may ensue,but it is expected that the new position statement will improve patient healthcare and treatment satisfaction.This now remains to be seen in practice.