Celecoxib-related gastroduodenal ulcer and cardiovascular events in a randomized trial for gastric cancer prevention

AIM: To evaluate the long-term risk of gastroduodenal ulcer and cardiovascular events induced by celecoxib in a population-based, randomized, double-blind, placebo-controlled study.METHODS: From 2004 to 2006, a total of 1024 Chinese patients (aged 35 to 64 years) with severe chronic atrophic gastritis, intestinal metaplasia or dysplasia were randomly assigned to receive 200 mg of celecoxib twice daily or placebo in Linqu County (Shandong Province, China), a high-risk area of gastric cancer. All gastroduodenal ulcer and cardiovascular events occurred were recorded and the patients were followed up for 1.5 years after treatment. At the end of the trial, a systematic interview survey about other adverse events was conducted. RESULTS: Gastroduodenal ulcer was detected in 19 of 463 (3.72%) patients who received celecoxib and 17 of 473 (3.31%) patients who received placebo, respectively (odds ratio = 1.13, 95% CI = 0.58-2.19). Cardiovascular (CV) events occurred in 4 patients who received celecoxib and in 5 patients who received placebo, respectively. Compared with those who received placebo, patients who received celecoxib had no signif icant increase in occurrence of CV events (hazard ratio = 0.84, 95% CI = 0.23-3.15). Among the adverse events acquired by interview survey, only the frequency of bloating was signif icantly higher in patients treated with celecoxib than in those treated with placebo. CONCLUSION: Treatment of gastric cancer with celecoxib is not associated with increased risk of gastroduodenal ulcer and cardiovascular events.

Effects of the myeloperoxidase 463 gene polymorphisms on development of atrophy in H pylori infected or noninfected gastroduodenal disease

AIM： To investigate the relationship between myeloperoxidase polymorphisms as a host-related factor and atrophy caused by H pylori. METHODS： Our study enrolled 77 patients. Biopsy materials obtained during gastrointestinal endoscopies were evaluated for the presence of H pylori. Polymerase chain reaction-restriction fragment length polymorphism assay was used to characterize myeloperoxidase genothpes. RESULTS： Forty four patients （57.1%） were lip （＋） and 33 （42.9%） were Hp （-）. Sixty six （85.7%） had GG genotype, 10 （12.9%） had GA genotype and 1 （1.29%） had AA genotype. The change in atrophy in relation to neutrophil infiltration was significant in Hp （＋） patients （P = 0.0001）. The change in atrophy in relation to neutrophil infiltration in patients with GG genotype was significant （P = 0.002）. However, the change in atrophy in relation to neutrophil infiltration was not significiant in patients with Hp （＋） GG genotype （r = 0.066, P = 0.63）. CONCLUSION： Myeloperoxidase genotype is critical for development of atrophy in relation to the severity of inflammation. However, it is interesting to note that, H pylori does not show any additive effect on development of atrophy.

Surgical treatment of annular pancreas in adults:a report of two cases

Annular pancreas is a congenital anomaly which .consists of a ring of pancreatic tissue partially or completely encircling the descending portion of the duodenum. It was first described by Tiedemann in 1818 and named ＂annular pancreas＂ by Ecker in 1862. The first surgical treatment of obstructive annular pancreas was performed on a neonate by Vidal et al in 1905. In the past, the diagnosis of this anomaly was usually made by surgery or autopsy. With the widespread use of endoscopic retrograde cholangiopancreatography （ERCP） and magnetic resonance cholangiopancreatography （MRCP）, more cases are diagnosed preoperatively. We reported two adult cases of annular pancreas with unsuccessful ERCP because of obstruction above the Vater＇s papilla and undefinitive diagnostic MRCP, and discussed its clinical characteristics of this anomaly.