Meta-analysis:Is combination of tetracycline and amoxicillin suitable for Helicobacter pylori infection?

AIM:To access the efficacy of combination with amoxicillin and tetracycline for eradication of Helicobacter pylori(H.pylori),thus providing clinical practice guidelines.METHODS:Pub Med,EMBASE,Cochrane Central Register of Controlled Trials,Science Citation Index,China National Knowledge Infrastructure,Wanfang,and Chinese Biomedical Literature databases and abstract books of major European,American,and Asian gastroenterological meetings were searched.All clinical trials that examined the efficacy of H.pylori eradication therapies and included both tetracycline and amoxicillin in one study arm were selected for this systematic review and meta-analysis.Statistical analysis was performed with Comprehensive Meta-Analysis Software(Version 2).Subgroup,meta-regression,and sensitivity analyses were also carried out.RESULTS:Thirty-three studies met the inclusion criteria.The pooled odds ratio(OR)was 0.90(95%CI:0.42-1.78)for quadruple therapy with amoxicillin and tetracycline vs other quadruple regimens,and total eradication rates were 78.1%by intention-to-treat(ITT)and 84.5%by per-protocol(PP)analyses in the experimental groups.The pooled eradication rates of 14-d quadruple regimens with a combination of amoxicillin and tetracycline were 82.3%by ITT and89.0%by PP,and those of 10-d regimens were 84.6%by ITT and 93.7%by PP.The OR by ITT were 1.21(95%CI:0.64-2.28)for triple regimens with amoxicillin and tetracycline vs other regimens and 1.81(95%CI:1.37-2.41)for sequential treatment with amoxicillin and tetracycline vs other regimens,respectively.CONCLUSION:The effectiveness of regimens employing amoxicillin and tetracycline for H.pylori eradication may be not inferior to other regimens,but further study should be necessary.

Differences in clinical features of Crohn's disease and intestinal tuberculosis

AIM: To investigate the clinical features of Crohn's disease(CD) and intestinal tuberculosis(ITB) with a scoring system that we have developed.METHODS: A total of 25 CD and 40 ITB patients were prospectively enrolled from August 2011 to July 2012.Their characteristics and clinical features were recorded. Laboratory, endoscopic, histologic and radiographic features were determined. The features with a high specificity were selected to establish a scoring system. The features supporting CD scored +1, and those supporting ITB scored-1; each patient received a final total score. A receiver operating characteristic(ROC) curve was used to determine the best cut-off value for distinguishing CD from ITB.RESULTS: Based on a high specificity of differentiating between CD and ITB, 12 features, including longitudinal ulcers, nodular hyperplasia, cobblestone-like mucosa, intestinal diseases, intestinal fistula, the target sign, the comb sign, night sweats, the purified protein derivative test, the interferon-γ release assay(T-SPOT.TB), ring ulcers and ulcer scars, were selected for the scoring system. The results showed that the average total score of the CD group was 3.12 ± 1.740, the average total score of the ITB group was-2.58 ± 0.984, the best cutoff value for the ROC curve was-0.5, and the diagnostic area under the curve was 0.997, which was statistically significant(P < 0.001). The patients whose total scores were higher than-0.5 were diagnosed with CD; otherwise, patients were diagnosed with ITB. Overall, the diagnostic accuracy rate and misdiagnosis rate of this scoring system were 97% and 3%, respectively. CONCLUSION: Some clinical features are valuable for CD and ITB diagnosis. The described scoring system is key to differentiating between CD and ITB.

Fecal microbiota transplantation as an effective initial therapy for pancreatitis complicated with severe Clostridium difficile infection:A case report

BACKGROUND Moderately severe acute pancreatitis (MSAP) is a critical form of acute pancreatitis that is related with high morbidity and mortality.Severe Clostridium difficile infection (sCDI) is a serious and rare nosocomial diarrheal complication,especially in MSAP patients.Fecal microbiota transplantation (FMT) is a highly effective treatment for refractory and recurrent CDI (rCDI).However,knowledge regarding the initial use of FMT in patients suffering from sCDI is limited.CASE SUMMARY Here,we report an MSAP patient complicated with sCDI who was treated by FMT as a first-line therapy.The patient was a 51-year-old man who suffered from diarrhea in his course of acute pancreatitis.An enzyme immunoassay was performed to detect toxins,and the result was positive for toxin-producing C.difficile and toxin B and negative for C.difficile ribotype 027.The colonoscopy revealed pseudomembranous colitis.Due to these findings,sCDI was our primary consideration.Because the patient provided informed consent for FMT treatment,we initially treated the patient by FMT rather than metronidazole.Diarrhea resolved within 5 d after FMT.The patient remained asymptomatic,and the follow-up colonoscopy performed 40 d after discharge showed a complete recovery.Our case is the first reported in China.CONCLUSION This case explores the possibilities of initially using FMT to treat severe CDI.Moreover,FMT may become a critical component of the treatment for severe CDI in MSAP patients.

Endoscopic management of gastrointestinal smooth muscle tumor

AIM: To systematically evaluate the efficacy and safety of endoscopic resection of gastrointestinal smooth muscle tumors (SMTs, including leiomyoma and leiomyosarcoma) and to review our preliminary experiences on endoscopic diagnosis of gastrointestinal SMTs. METHODS: A total of 69 patients with gastrointestinal SMT underwent routine endoscopy in our department. Endoscopic ultrasonography (EUS) was also performed in 9 cases of gastrointestinal SMT. The sessile submucosal gastrointestinal SMTs with the base smaller than 2 cm in diameter were resected by "pushing" technique or "grasping and pushing" technique while the pedunculated SMTs were resected by polypectomy. For those SMTs originating from muscularis propria or with the base size ≥ 2 cm, ordinary biopsy technique was performed in tumors with ulcers while the "Digging" technique was performed in those without ulcers. RESULTS: 54 cases of leiomyoma and 15 cases of leiomyosarcoma were identified. In them, 19 cases of submucosal leiomyoma were resected by "pushing" technique and 10 cases were removed by "grasping and pushing" technique. Three cases pedunculated submucosal leiomyoma were resected by polypectomy. No severe complications developed during or after the procedure. No recurrence was observed. The diagnostic accuracy of ordinary and the "Digging" biopsy technique was 90.0% and 94.1%, respectively. CONCLUSION: Endoscopic resection is a safe and effective treatment for leiomyomas with the base size ≤2 cm. The "digging" biopsy technique would be a good option for histologic diagnosis of SMTs.