Clinical characteristics of Helicobacter pylori-negative drugnegative peptic ulcer bleeding

AIM:To investigate the clinical characteristics and outcomes of idiopathic Helicobacter pylori(H.pylori)-negative and drug-negative]peptic ulcer bleeding(PUB).METHODS:A consecutive series of patients who experienced PUB between 2006 and 2012 was retrospectively analyzed.A total of 232 patients were enrolled in this study.The patients were divided into four groups according to the etiologies of PUB:idiopathic,H.pylori-associated,drug-induced and combined(H.pylori-associated and drug-induced)types.We compared the clinical characteristics and outcomes between the groups.When the silver stain or rapid urease tests were H.pylori-negative,we obtained an additional biopsy specimen by endoscopic re-examination and performed an H.pylori antibody test 6-8 wk after the initial endoscopic examination.For a diagnosis of idiopathic PUB,a negative result of an H.pylori antibody test was confirmed.In all cases,re-bleeding was confirmed by endoscopic examination.For the risk assessment,the Blatchford and the Rockall scores were calculated for all patients.RESULTS:For PUB,the frequency of H.pylori infection was 59.5%(138/232),whereas the frequency of idiopathic cases was 8.6%(20/232).When idiopathic PUB was compared to H.pylori-associated PUB,the idiopathic PUB group showed a higher rate of rebleeding after initial hemostasis during the hospital stay(30%vs 7.4%,P = 0.02).When idiopathic PUB was compared to drug-induced PUB,the patients in the idiopathic PUB group showed a higher rate of rebleeding after initial hemostasis upon admission(30%vs 2.7%,P < 0.01).When drug-induced PUB was compared to H.pylori-associated PUB,the patients in the drug-induced PUB were older(68.49 ± 14.76 years vs 47.83 ± 15.15 years,P< 0.01) and showed a higher proportion of gastric ulcer(77%vs 49%,P < 0.01).However,the Blatchford and the Rockall scores were not significantly different between the two groups.Among the patients who experienced drug-induced PUB,no significant differences were found with respect to clinical characteristics,irrespective of H.pylori infection.CONCLUSION:Idiopathic PUB has unique clinical characteristics such as re-bleeding after initial hemostasis upon admission.Therefore,these patients need to undergo close surveillance upon admission.

Spontaneous resolution of multiple lymphangiomas of the colon:A case report

Lymphangioma of the colon is a relatively rare nonepithelial tumor and usually presents as a submucosal polypoid lesion.Many cases incidentally discovered are usually asymptomatic.However,they may present as abdominal pain or bleeding,and their resection is normally required.Lymphangioma itself is generally recognized as a benign tumor and no cases of malignant transformation have yet been reported,although its natural history is currently unknown.To the best of our knowledge,this study is the first to describe a case of spontaneous resolution in multiple colonic lymphangiomas without any specific treatment.

Microbiology and risk factors for gram-positive Cocci bacteremia in biliary infections

Background:The rapid antibiotics treatment targeted to a specific pathogen can improve clinical outcomes of septicemia.We aimed to evaluate the clinical characteristics and outcomes of biliary septicemia caused by cholangitis or cholecystitis according to causative organisms.Methods:We performed a retrospective cohort study in 151 patients diagnosed with cholangitis or cholecystitis with bacterial septicemia from January 2013 to December 2015.All patients showed clinical evidence of biliary tract infection and had blood isolates that demonstrated septicemia.Results:Gram-negative,gram-positive,and both types of bacteria caused 84.1%(127/151),13.2%(20/151),and 2.6%(4/151)episodes of septicemia,respectively.The most common infecting organisms were Escherichia coli among gram-negative bacteria and Enterococcus species(Enterococcus casseliflavus and Enterococcus faecalis)among gram-positive bacteria.There were no differences in mortality,re-admission rate,and need for emergency decompression procedures between the gram-positive and gram-negative septicemia groups.In univariate analysis,previous gastrectomy history was associated with gram-positive bacteremia.Multivariate analysis also showed that previous gastrectomy history was strongly associated with gram-positive septicemia(Odds ratio=5.47,95%CI:1.19–25.23;P=0.029).Conclusions:Previous gastrectomy history was related to biliary septicemia induced by gram-positive organisms.This information would aid the choice of empirical antibiotics.