Usefulness of vonoprazan,a potassium ion-competitive acid blocker,for primary eradication of Helicobacter pylori

AIM To investigate usefulness of triple therapy with vonoprazan,a potassium ion-competitive acid blocker and antibiotics,for Helicobacter pylori(H.pylori) eradication.METHODS The H.pylori eradication rate was examined in 2507 patients(2055 undergoing primary eradication and 452 undergoing secondary eradication,excluding patients with subtotal gastrectomy) at the Japanese Red Cross Kyoto Daiichi Hospital from March 2013 to September 2015.For patients treated from March 2013 to February 2015,a proton pump inhibitor(PPI) was used to reduce acid secretion,while vonoprazan was used after March 2015.The success rates of the 2 regimens(PPI + amoxicillin + clarithromycin/metronidazole,or vonoprazan + amoxicillin + clarithromycin/metronidazole) were compared.RESULTS The success rate of primary H.pylori eradication was significantly higher in the vonoprazan group.When stratified by the underlying disease,a significant increase of the H.pylori eradication rate was observed in patients with chronic gastritis.A significantly lower H.pylori eradication rate was observed in younger patients compared to older patients in the PPI group,but there was no difference according to age in the vonoprazan group.On the otherhand,the success rate of secondary eradication was similar at approximately 90% in both groups.CONCLUSION Vonoprazan is very useful for primary eradication of H.pylori,and may become a first-line acid secretion inhibitor instead of PPIs.

Late-onset severe biliary bleeding after endoscopic pigtail plastic stent insertion

Here, we report our experience with a case of severe biliary bleeding due to a hepatic arterial pseudoaneurysm that had developed 1 year after endoscopic biliary plastic stent insertion. The patient, a 78-year-old woman, presented with hematemesis and obstructive jaundice. Ruptured hepatic arterial pseudoaneurysm was diagnosed, which was suspected to have been caused by long-term placement of an endoscopic retrograde biliary drainage(ERBD) stent. This episode of biliary bleeding was successfully treated by transarterial embolization(TAE). Pseudoaneurysm leading to hemobilia is a rare but potentially fatal complication in patients with long-term placement of ERBD. TAE is a minimally invasive procedure that offers effective treatment for biliary bleeding.

A randomized controlled trial of lifestyle self-monitoring for irritable bowel syndrome in female nursing school students

Background: The aim of this study was to verify the efficacy of lifestyle self-monitoring for the improvement of the IBS and reveal what has been changed due to the intervention. Methods: A total of 111 nursing school students were randomized into three groups, two intervention groups (a two-month intervention group, n = 34, and a four-month intervention group, n = 35) and a control group (n = 34). The intervention groups conducted lifestyle self-monitoring in conjunction with a 15-minutes group work for either two or four months. The primary outcome measure was Rome II criteria for IBS. Other outcome measures were the Hospital Anxiety and Depression Scale (HADS) and the Gastrointestinal Symptom Rating Scale (GSRS). They were assessed at the baseline and the end of both of the intervention periods. Analysis was conducted as intention-to-treat. Results: The prevalence of IBS did not change significantly after the intervention in any of the groups. The HAD-A score, a subscale of the HADS score for anxiety, decreased 1.4 points in the two-month intervention group (p = 0.02) and 2.3 points in the four-month intervention group of (p = 0.01) after intervention. The average GSRS decreased 0.2 points in the control group (p = 0.05) and 0.3 points in the four-month intervention group (p < 0.01). Conclusions: Lifestyle self-monitoring for two or four months did not reduce the prevalence of the IBS significantly, but it did decrease anxiety and improved the QOL related to gastrointestinal symptoms in female nursing school students.

Irritable bowel syndrome in Chinese nursing and medical school students—Related lifestyle and psychological factors

Background: Previous studies have shown that the prevalence of irritable bowel syndrome (IBS) is 10% - 15% in the general population. IBS is a functional gastrointestinal disorder characterized by abdominal pain, abdominal discomfort and disordered defecation associated with a stressful lifestyle. However, the cause of IBS has not been clarified yet. Based on a similar, previous study in Japan, this study investigated the prevalence of IBS and the relationship between IBS and stress, lifestyle and dietary habits among nursing and medical school students in China. Methods: Designed to investigate IBS symptoms, life- style, dietary intake, life events, anxiety and depresssion, a blank self-administrated questionnaire was used to survey 2500 nursing or medical students in China. Questionnaires were collected from 2141 stu- dents (85.6%) and responses obtained from 1934 students (90.3%) were analyzed. Results: On the whole, the prevalence of IBS was 32.1% in this study, 26.6% in males and 33.6% in females. In females, the IBS group showed a bedtime later than that in the non-IBS group, and the length of time asleep in the IBS group was shorter than that in the non-IBS group (p p = 0.005). In females, the IBS group showed a frequency for the intake of vegetables and potatoes that was lower than that of the non-IBS group (p = 0.007, p = 0.023). The prevalence of IBS among nursing and medical school students in China (32.1%) was significantly lower than that in Japan (35.5%). Especially, the number of females in the constipation dominant IBS subgroup in China (11.8%) was less than that found in Japan (20.4%). Conclusions: The prevalence of IBS was high among nursing and medical students in China, but lower than that shown in Japan.