Impact of body mass index and gender on quality of life in patients with gastroesophageal reflux disease

AIM： To investigate the symptom presentation and quality of life in obese Chinese patients with gastro- esophageal reflux disease （GERD）. MKTHODS： Data from patients diagnosed with GERD according to the Montreal definition, were collected between January 2009 to March 2010. The enrolled patients were assigned to the normal [body mass in- dex （BMI） 〈 25 kg/m2], overweight （25-30 kg/m2）, and obese （BMI 〉 30 kg/m2） groups. General demographic data, endoscopic findings, and quality of life of the three groups of patients were analyzed and compared.and 15 patients were classified in the normal, over- weight, and obese, respectively. There was significantly more erosive esophagitis （73.3% vs 64.3% vs 39.2%, P = 0.002）, hiatal hernia （60% vs 33.9% vs 16.7%, P = 0.001）, and males （73.3% vs 73.2% vs 32.4%, P = 0.001） in the obese cases. The severity and frequency of heartburn, not acid regurgitation, was positively cor- related with BMI, with a significant association in men, but not in women. Obese patients were prone to have low quality of life scores, with obese women having the lowest scores for mental health. CONCLUSION： In patients with GERD, obese men had the most severe endoscopic and clinical presenta- tion. Obese women had the poorest mental health.

The impact of intravenous cefazolin to the outcomes of cirrhotic patients with esophageal varices bleeding

Background and Method: Prophylatic antibiotics in cirrhotic patients with acute esophageal varices (EV) bleeding has been shown to increase survival and decrease the rate of bacterial infections and recurrent bleeding. This study aimed to compare the outcome of intravenous cefazolin, a first-generation cephalosporin, in the cirrhotic patients with EV bleeding. 92 consecutive cirrhotic patients with EV bleeding but without evidence of infection were retrospectively analyzed from December 2006 to February 2009, and 50 with cefazolin prophylaxis and 42 without antibiotic prophylaxis were enrolled in the antibiotic prophylaxis group and control group respectively. The outcomes were compared between both groups. Results: The incidence of infection was significantly lesser in the antibiotic prophylaxis group than that of the control group (6% vs. 33.3%, P prophylaxis group when compared with control group (6.6 vs. 7.8 days). Conclusion: Intravenous cefazolin can effectively reduce the rate of infection in cirrhotic patients with acute EV bleeding, but cannot significant benefit for preventing recurrent EV bleeding and mortality within 10 days after initial bleeding.

Benefits of the Seattle biopsy protocol in the diagnosis of Barrett's esophagus in a Chinese population

AIMTo investigate the benefits of the Seattle protocol in the diagnosis of Chinese individuals with Barrett’s esophagus.METHODSSubjects enrolled were patients from one center with endoscopically-suspected esophageal metaplasia. These patients first received narrow-band imaging-targeted biopsy, and later, the Seattle protocol-guided biopsy, within a period from October 2012 to December 2014. Those cases without initial pathologic patterns of intestinal metaplasia （IM） and then appearance or loss of IM tissue were designated as Group A or B, respectively. Those with initial pathologic patterns ofIM, which then persisted or were lost were designated as Group C or D, respectively.RESULTSThe number of cases for each group was as follows： A： 20, B： 78, C： 31 and D： 14. The distribution of the Prague criteria M levels of Group A was significantly higher than Group B （ P = 0.174）. Among these groups, Group C had the highest proportions of hiatus hernia （54.8%）, long segment Barrett’s esophagus （29%）, and also the highest Prague criteria M levels. The sensitivity of IM detection was 69.2% for the narrow-band imaging-targeted biopsy and 78.5% for the Lee SW et al . Seattle protocol for Barrett’s esophagusSeattle protocol-guided biopsy. The difference was not signifcant （P = 0.231）. The number of detectable dysplasias increased from one case via the NBI-target biopsy to five cases via the Seattle protocol-guided biopsy, including one case of adenocarcinoma.CONCLUSIONThe Seattle protocol improved the IM detection in our subjects with higher Prague criteria M levels and disclosed more cases with dysplastic tissues.

Clinical values of Barcelona Clinic Liver Cancer subgroup and up-to-7 criteria in intermediate stage hepatocellular carcinoma with transcatheter arterial chemoembolization

BACKGROUND Transarterial chemoembolization(TACE)is a recommended treatment for patients with intermediate stage hepatocellular carcinoma(HCC)but with variable treatment outcomes.AIM To determine factors for predicting outcomes of TACE in patients with intermediate stage B HCC.METHODS Patients with Barcelona Clinic Liver Cancer(BCLC)stage B HCC who underwent TACE as the primary treatment were enrolled at Taichung Veterans General Hospital from January 2005 to December 2009.Patients were assigned to either the objective responder(OR)group or the non-OR group according to mRECIST criteria.Clinical and radiological characteristics were compared between the 2 groups.The overall survival of enrolled subjects was analyzed.RESULTS In 128 enrolled patients,66(51.6%)were in the OR group and 62(48.4%)in the non-OR group.Compared with the non-OR group,the OR group had a significantly smaller HCC size(6.55 cm vs 9.50 cm,P=0.001)and was within the up-to-7 criteria(50%vs 26.7%,P=0.001).After multivariable analyses,these significant associations still existed.Overall survival rate of all the subjects averaged 20.65±13.26 mo.The survival rate at 1-year was 64.8%,2-year was 46.9%,and 3-year was 31.2%.For those patients with OR to TACE,smaller tumor size and within up-to-7 criteria were associated with significantly better overall survival.Those patients with subgroup B1 had the highest OR ratio(75%)and better overall survival(26.70±12.07 mo)after TACE.CONCLUSION BCLC stage B HCC patients with smaller tumor size or within up-to-7 criteria had better survival outcomes to TACE.BCLC stage B subgroup is useful to predict refractoriness to TACE.