Endoscopic hemostasis techniques for upper gastrointestinal hemorrhage: A review

Upper gastrointestinal hemorrhage (UGIH) is an urgent disease that is often encountered in daily medical practice. Endoscopic hemostasis is currently indispensable for the treatment of UGIH. Initially, when UGIH is suspected, a cause of UGIH is presumed from the medical interview and physical findings. After ample primary treatment, urgent endoscopy is performed. Many methods of endoscopic hemostasis are in wide use, including hemoclip, injection and thermo-coagulation methods. Although UGIH develops from a wide variety of diseases, such as esophageal varices and gastric and duodenal ulcer, hemostasis is almost always possible. Identification of the causative diseases, primary treatment and characteristic features of endoscopic hemostasis are needed to allow appropriate treatment.

Right recumbent position on gastric emptying of water evidenced by ^(13)C breath testing

AIM:To compare the impact of the right recumbent position with the sitting position on gastric emptying of water. METHODS:In eight healthy male volunteers,the 13C acetate breath test was performed twice to assess gastric emptying of 100 mL tap water.Subjects were seated in one test and lying on their right side in the other.In both positions,pulmonary 13CO2 exhalation curves were obtained by plotting breath data against time.Percent gastric retention curves were created by analyzing data using the Wagner-Nelson protocol. RESULTS:No significant posture effect was found in pulmonary 13CO2 output curves(P=0.2150),whereas a significant effect was seen in gastric retention curves (P=0.0315).The percent retention values at 10 min and 15 min were significantly smaller when subjects were in the right recumbent position compared with the seated position(P<0.05).Our results verified the accelerating effect of the right recumbent position on gastric emptying of non-nutritive solutions.Concerning clinical implications,this study suggests that placing patients with acute pain on their right side after oral administration of analgesic drugs in solution is justified as an effective practice for rapid pain relief.For patients with gastrointestinal reflux symptoms,sleeping in the right recumbent position may reduce nocturnal symptoms,as delayed gastric emptying can cause reflux symptoms. CONCLUSION:Gastric emptying of water occurs more quickly when a subject lies on the right side compared with sitting.

Reliability of urinary tests for antibody to Helicobacterpylori in patients with pulmonary tuberculosis

AIM: Although the quality of currently available urinary tests for detecting antibody to Helicobacter pylori (H pylori)have been proved in some populations, the accuracy has not been studied regarding patients who suffer from pulmonary tuberculosis with multi-drug treatments. The present study was conducted to evaluate the accuracy of these urinary tests for antibody to H pylori in these patients.METHODS: Serum samples from 61 inpatients with pulmonary tuberculosis were tested using enzyme immunoassay, and urine samples were assayed by enzyme-linked immunosorbent assay method (URINELISA) and immunochromatography method (RAPIRAN). Medicines prescribed to the patients were recorded for medical charts, to evaluate the influences on the results of urinary tests.RESULTS: The sensitivity, specificity, and consistency of URINELISA against the serum test were 93.1%, 65.6%, and 78.6% respectively, and those of RAPIRAN were 86.2%,93.7%, and 90.1% respectively, which were almost equal to the data previously reported. Prescribed medicines had little influence on the results.CONCLUSION: The two urinary tests for detecting H pylori antibody have a diagnostic accuracy in patients with pulmonary tuberculosis given multiple anti-tuberculosis drugs.

Incidence of <i>Clostridium difficile</i>-associated diarrhea in patients using proton pump inhibitors: A Japanese study

Objective: The incidence of Clostridium difficile-associated diarrhea (CDAD) has increased in many developed countries. In addition to previous use of antimicrobials, use of proton pump inhibitors (PPIs) is thought to increase the incidence of CDAD. However, most previous studies that showed a positive relationship between PPI use and CDAD were conducted retrospectively in Western countries. We investigated whether the use of PPIs increases the incidence of CDAD in Japan. Methods: The study was carried out with all the patients admitted to the department of internal medicine of Teikyo University Hospital from April 2009 to June 2009. Clinical data were obtained from medical records. CDAD was defined as detection of CD toxin from stool samples in diarrheal patients. PPI users were defined as patients that were prescribed with PPI for more than 30 days at the detection of CD toxin. The results of Clostridium difficile (CD) toxin were collected until April 2011. Results: A total of 793 patients were included, and PPIs were prescribed to 489 patients (59.8%). The average age of PPI users was higher than that of PPI nonusers (68.9 vs. 63.1 years). Among the 489 PPI users, 19 patients developed CDAD, while 4 developed CDAD among the 304 PPI nonusers. The relative risk of PPI use on the incidence of CDAD was 3.20 in univariate analysis (95% confidence interval, 1.10 to 9.32, p = 0.04), although the hazard ratio in multivariate analysis was 1.23 (95% confidence interval, 0.35 to 3.83, p = 0.82). Conclusions: There was no association between CDAD occurrence and PPI use in patients in Japan.