[Show abstract][Hide abstract] ABSTRACT: The resistance rates of Helicobacter pylori to amoxicillin and metronidazole therapy are higher in eastern Taiwan as compared to national and worldwide rates. The high resistance rate in this territory justified a search for a better eradication regimen. We conducted an open-labeled, prospective, randomized, and controlled study in a tertiary referral hospital in eastern Taiwan. Between December 2007 and December 2009, a total of 153 Helicobacter pylori-positive, therapy-naïve patients with a positive rapid urease test were recruited for random assignment to two seven-day treatment groups: levofloxacin (500 mg), amoxicillin/clavulanate (875 mg/125 mg), and rabeprazole (20 mg) twice per day (LAcR) or clarithyromicin (500 mg), amoxicillin (1000 mg), and rabeprazole (20 mg) twice per day (CAR). Helicobacter pylori eradication was assessed using the (13)C-urea breath test or rapid urease test performed at least 4 weeks after the end of treatment. After exclusion, 146 patients were enrolled and allocated in the study. The Helicobacter pylori eradication rates analyzed by both intention to treat (78.1% versus 57.5%, P = 0.008) and perprotocol (80.9% versus 61.8%, P = 0.014) were significantly higher for the LAcR group. In conclusion, the seven-day LAcR regimen provided improved Helicobacter pylori eradication efficacy when compared with the standard CAR triple therapy in eastern Taiwan.
BioMed Research International 01/2014; 2014:158520. · 2.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Achalasia is characterized by esophageal aperistalsis and a failure of lower esophageal sphincter (LES) relaxation. Combined multichannel intraluminal impedance and manometry (MII-EM) allows the simultaneous recording of esophageal peristalsis and bolus transport patterns. The aim of this study was to evaluate the feasibility of MII-EM for the assessment of esophageal motility and to characterize patterns of esophageal bolus transport in patients with achalasia with or without Heller myotomy.
Materials and methods
A total of nine patients (2 men and 7 women, age range 25–46 years) were enrolled in this study. Two of the patients had previously undergone Heller myotomy. All patients underwent combined MII-EM with a nine-channel esophageal function testing catheter containing four impedance measuring segments and five solid-state pressure transducers. Each patient received 10 liquid and 10 viscous swallows in a sitting position. All tracings were recorded and analyzed for esophageal contractions and bolus transit.
None of the patients with achalasia, whether they had undergone a Heller myotomy or not, had manometrically normal esophageal peristalsis during saline or viscous swallowing. They had a normal LES resting pressure, incomplete LES relaxation, and lower distal esophageal contraction. The LES relaxation percentages in the patients who had undergone Heller myotomy (97% and 51%) were higher than those of the untreated patients (mean 47%). All patients demonstrated a low baseline impedance level in the distal esophagus. Air trapping in the proximal esophagus was also detected in nearly all of the patients. None of the patients in either group had complete bolus transit with either saline or viscous swallows.
Patients with achalasia are characterized by poor esophageal contraction and absent esophageal bolus clearance and such abnormalities are still noticeable after Heller myotomy. Although combined MII-EM can provide additional information regarding esophageal bolus transit, a low baseline impedance level and air trapping in the proximal esophagus may limit its utility in the diagnosis of esophageal dysmotility in patients with achalasia.
[Show abstract][Hide abstract] ABSTRACT: Abstract Objective. Ineffective esophageal motility is frequently found in patients with gastroesophageal reflux diseases. Secondary peristalsis contributes to esophageal acid clearance. Mosapride improves gastrointestinal (GI) motility by acting on 5-hydroxytrypatamine4 receptors. The authors aimed to evaluate the effect of mosapride on secondary peristalsis in patients with ineffective esophageal motility. Material and methods. After recording primary peristalsis baseline, secondary peristalsis was stimulated by slowly and rapidly injecting mid-esophageal air in 18 patients. Two separate experiments were randomly performed with 40 mg oral mosapride or placebo. Results. Mosapride had no effect on the threshold volume of secondary peristalsis during slow air distension (9.8 ± 0.97 vs. 10.2 ± 1.0 mL; p = 0.84), but decreased the threshold volume during rapid air distension (4.1 ± 0.2 vs. 4.6 ± 0.3 mL; p = 0.001). The efficiency of secondary peristalsis during rapid air distension increased with mosapride (70% [40-95%]) compared with placebo (60% [10-85%]; p = 0.0003). Mosapride had no effect on the amplitudes of distal pressure wave of secondary peristalsis during slow (94.3 ± 9 vs. 101.9 ± 9.1 mmHg; p = 0.63) or rapid air distension (89.3 ± 9 vs. 95.2 ± 8.3 mmHg; p = 0.24). Conclusions. Mosapride improves esophageal sensitivity of secondary peristalsis by abrupt air distension but has limited effect on the motor properties of secondary peristalsis in ineffective esophageal motility patients. Despite its well-known prokinetic effect, mosapride enhances the efficiency of secondary peristalsis in patients with ineffective esophageal motility through augmenting esophageal sensitivity instead of motility.
Scandinavian Journal of Gastroenterology 10/2013; · 2.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We aimed to investigate the hypothesis whether the presence of Ineffective esophageal motility would affect physiological characteristics of secondary peristalsis.
Secondary peristalsis was performed with slow and rapid air injections into mid-esophagus of 18 ineffective esophageal motility patients and 15 age matched controls. Severity of ineffective esophageal motility was defined by the application of combined multichannel intraluminal impedance and manometry.
Ineffective esophageal motility patients included eleven patients without impedance abnormality and seven patients with impedance abnormality during liquid and/or viscous swallowing. The prevalence of failed secondary peristaltic response during slow air injection was significantly greater in ineffective esophageal motility patients without impedance abnormality (3/11[27%], P < 0.001) and with impedance abnormality (4/7 [57%], P = 0.04) than healthy subjects. The threshold volume for inducing secondary peristalsis during rapid air injection was significantly greater in ineffective esophageal motility patients with impedance abnormality (6.1 ± 0.3 mL) than healthy subjects (4.6 ± 0.3 mL, P < 0.05) and ineffective esophageal motility patients without impedance abnormality (4.1 ± 0.4 mL, P < 0.05). The frequency of peristaltic response during rapid air injection was significantly lower in ineffective esophageal motility patients with impedance abnormality (40% [20-50%] than healthy subjects (90% [90-100%], P < 0.05).
Defective activation of secondary peristalsis is present in ineffective esophageal motility patients with impedance abnormality. Our study indicates that increased ineffective esophageal motility severity associated with defective triggering of secondary peristalsis may contribute to impaired esophageal clearance in patients with gastroesophageal reflux disease.
Journal of Gastroenterology and Hepatology 08/2013; · 3.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Detailed characterization of the ultrastructural morphology of intercellular space in gastroesophageal reflux disease has not been fully studied. We aimed to investigate whether subtle alteration in intercellular space structure and tight junction proteins might differ among patients with gastroesophageal reflux disease.
Esophageal biopsies at 5 cm above the gastroesophageal junction were obtained from 6 asymptomatic controls, 10 patients with reflux symptoms but without erosions, and 18 patients with erosions. The biopsies were morphologically evaluated by transmission electron microscopy, and by using immunohistochemistry for tight junction proteins (claudin-1 and claudin-2 proteins).
The expressions of tight junction proteins did not differ between asymptomatic controls and gastroesophageal reflux disease patients. In patients with gastroesophageal reflux disease, altered desmosomal junction morphology was only found in upper stratified squamous epithelium. Dilated intercellular space occurred only in upper stratified squamous epithelium and in patients with erosive esophagitis.
This study suggests that dilated intercellular space may not be uniformly present inside the esophageal mucosa and predominantly it is located in upper squamous epithelium. Presence of desmosomal junction alterations is associated with increased severity of gastroesophageal reflux disease. Besides dilated intercellular space, subtle changes in ultrastructural morphology of intercellular space allow better identification of inflamed esophageal mucosa relevant to acid reflux.
Journal of neurogastroenterology and motility 07/2013; 19(3):324-31.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND AND AIMS: We aimed to evaluate whether acute esophageal instillation of capsaicin and hydrochloric acid had different effects on distension-induced secondary peristalsis. METHODS: Secondary peristalsis was induced by slow and rapid air injections into the mid-esophagus after the evaluation of baseline motility in 16 healthy subjects. The effects on secondary peristalsis were determined by esophageal instillation with capsaicin-containing red pepper sauce (pure capsaicin, 0.84 mg) and hydrochloric acid (0.1N). RESULTS: The administration of capsaicin induced a significant increase in the visual analogue scale score for heartburn as compared with hydrochloric acid (P = 0.002). The threshold volume for generating secondary peristalsis during slow and rapid air distensions did not differ between capsaicin and hydrochloric acid infusions. Hydrochloric acid significantly increased the frequency of secondary peristalsis in response to rapid air distension compared with capsaicin infusion (P = 0.03). Pressure wave amplitude during slow air distension was greater with the infusion of hydrochloric acid than capsaicin infusion (P = 0.001). The pressure wave duration during rapid air distension was longer after capsaicin infusion than hydrochloric acid infusion (P = 0.01). The pressure wave amplitude during rapid air distension was similar between capsaicin and hydrochloric acid infusions. CONCLUSIONS: Despite subtle differences in physiological characteristics of secondary peristalsis, acute esophageal instillation of capsaicin and hydrochloric acid produced comparable effects on distension-induced secondary peristalsis. Our data suggest the co-existence of both acid and capsaicin sensitive afferents in human esophagus which produce similar physiological alterations in secondary peristalsis.
Journal of Gastroenterology and Hepatology 06/2013; · 3.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: Patients with non-obstructive dysphagia (NOD) report symptoms of impaired esophageal bolus transit without evidence of bolus stasis. In such patients manometric investigation may diagnose esophageal motility disorders however many have normal motor patterns. We hypothesised that patients with NOD would demonstrate evidence of high flow-resistance during bolus passage which in turn would relate to the reporting of bolus hold up perception. METHODS: Esophageal pressure-impedance recordings of 5ml liquid and viscous swallows from 18 NOD patients (11 male; 19-71 years) and 17 control subjects (9 male; 25-60 years) were analysed. The relationship between intrabolus pressure and bolus flow timing in the esophagus was assessed using the pressure flow index (PFI). Bolus perception was assessed swallow by swallow using standardised descriptors. RESULTS: NOD patients were characterised by a higher PFI than controls. The PFI defined a pressure-flow abnormality in all patients who appeared normal based on the assessment esophageal motor patterns and bolus clearance. The PFI was higher for individual swallows during which subjects reported perception of bolus passage. CONCLUSION: Bolus flow-resistance is higher in NOD patients compared to controls as well as higher in relation to perception of bolus transit suggesting the presence an esophageal motility disorder despite normal findings on conventional analysis.
Journal of Gastroenterology and Hepatology 02/2013; · 3.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Secondary peristalsis contributes to clearance of retained refluxate or material from the esophagus. AIM: The goal of our study was to investigate the effects of hydrochloric acid (HCl) on physiological characteristics of esophageal secondary peristalsis in healthy adults. METHODS: After recording esophageal motility baseline for primary peristalsis, secondary peristalsis was stimulated with slow and rapid air injections in the mid-esophageal in 16 healthy subjects. Normal saline and HCl (0.1 N) were separately infused into the esophagus to test whether they had effects on secondary peristalsis. RESULTS: After infusion of HCl, the threshold volume to generate secondary peristalsis was significantly decreased during rapid and slow air infusions (both P < 0.05). The frequency of secondary peristalsis was increased after HCl infusion (90 % [72.5-100 %] versus 85 % [72.5-90 %], P = 0.002). Infusion of HCl significantly increased pressure wave amplitude during rapid and slow air infusions (both P < 0.05). Infusion of saline did not affect any parameters of secondary peristalsis. The occurrence of heartburn was generated in 7 of 16 subjects after infusion of HCl with an increase in visual analogue scale score (12.5). CONCLUSIONS: Our data show that acute esophageal acid infusion enhances sensitivity of distension-induced secondary peristalsis and enhances secondary peristaltic activity. The study supports the evidence of the presence of acid-sensitive afferents in the modulation of distension-induced secondary peristalsis in humans.
Digestive Diseases and Sciences 02/2013; · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Globus sensation is common, but its pathogenesis is not yet clear. AIMS: Our purpose was to investigate subjective perception of swallowing and esophageal motility by combined multichannel intraluminal impedance and manometry (MII-EM) for patients with globus sensation. METHODS: Combined MII-EM was performed for 25 globus patients and 15 healthy controls. Swallows were abnormal if hypocontractivity or simultaneous contractions occurred. Esophageal bolus transit was incomplete if bolus exit was not found at one or more of all measurement sites. Perception of each swallow was assessed by use of a standardized scoring system, and was enhanced if the score was >1. RESULTS: Few globus patients reported enhanced perception during viscous or solid swallows. Incomplete bolus transit and enhanced perception occurred similarly between viscous and solid boluses. Agreement between enhanced perception and proximal bolus clearance was greater during solid swallows (κ = 0.45, 95 % CI: 0.32-0.58) than during viscous swallows (κ = 0.13, 95 % CI: 0-0.25) (P < 0.05). Similarly, agreement between enhanced perception and total bolus clearance was greater during solid swallows (κ = 0.46, 95 % CI: 0.34-0.58) than during viscous swallows (κ = 0.11, 95 % CI: 0-0.22) (P < 0.05). CONCLUSIONS: Enhanced swallow perception is uncommon in patients with globus sensation, although there is a significant association between enhanced esophageal perception and solid bolus clearance. Application of a solid bolus may help better delineation of the interrelationship between the subjective perception of bolus passage and the objective measurement of bolus clearance.
Digestive Diseases and Sciences 10/2012; · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Atypical symptoms are common in gastroesophageal reflux disease (GERD). Patients with non-erosive reflux disease (NERD) and erosive reflux disease (ERD) exhibit different clinical characteristics and responses to acid suppression treatment. We aimed to compare atypical characteristics in patients with NERD and ERD. We also investigated the presence of histological esophagitis in patients with NERD and ERD.
Eligible patients completed a questionnaire regarding reflux symptoms and concomitant atypical symptoms. Endoscopic biopsies with histological examination were performed.
Of the 210 patients with GERD, 90 patients with ERD and 120 patients with NERD were studied. ERD patients were characterized by higher prevalence of hiatal hernia (P = 0.001) and smoking (P = 0.047). The prevalence of GERD was greater in the age group between 41 and 60 years regardless of endoscopic finding. There was no difference in the prevalence of atypical symptoms or histological esophagitis between NERD and ERD. In all subjects, heartburn was associated with dysphagia (r = 0.16, P = 0.01), dyspepsia (r = 0.22, P = 0.008) and hiccup (r = 0.19, P = 0.003), whereas acid regurgitation was associated with dyspepsia (r = 0.21, P = 0.014), belching (r = 0.15, P = 0.018) and hiccup (r = 0.19, P = 0.002).
Atypical symptoms did not correlate with the presence of histological esophagitis. Atypical symptoms were equally prevalent in patients with NERD and ERD. The existence of atypical symptoms appears to be associated with the presence of typical reflux symptoms irrespective of endoscopic and histological reflux esophagitis.
Journal of neurogastroenterology and motility 07/2012; 18(3):278-83.
[Show abstract][Hide abstract] ABSTRACT: Ineffective oesophageal motility (IOM) often occurs in patients with gastro-oesophageal reflux disease. We aimed to examine the hypothesis of whether the presence of IOM differs between patients with gastro-oesophageal reflux disease with different symptom profiles.
Eligible patients were subclassified according to their predominant symptom of heartburn (HB) or acid regurgitation (AR). All patients underwent combined multichannel intraluminal impedance and oesophageal manometry. IOM was further graded according to the presence of oesophageal transit abnormalities.
Fourteen healthy individuals, 16 HB patients and 24 AR patients participated in this study. The percentage of swallows with complete bolus transit was lower in AR than in HB patients during liquid and viscous swallowing (P<0.05). Abnormal bolus transit occurred more frequently in AR patients than in HB patients with liquid swallows (P<0.001) and viscous swallows (P<0.05). IOM occurred more frequently in AR patients than in HB patients (42.7 vs. 12.5%, P=0.049). In patients with IOM, severe functional abnormality was more frequently found in AR patients than in HB patients (P<0.05).
This study suggests a potential link between oesophageal body dysfunction and individual reflux symptom. Patients with a predominant symptom of AR are characterized by greater IOM and defective bolus clearance.
European journal of gastroenterology & hepatology 05/2012; 24(9):1059-65. · 1.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background/Aims: Difficult or incomplete colonoscopes occasionally occur due to variable colonic anatomy and fixation. The aim of this study was to determine whether different types of colonoscopes used would affect the colonoscopic performance and sedation practice. Methodology: Consecutive patients attending for health examination were randomized to examination with either the Olympus GIF-Q260 (OS) or Fujinon EC-450 (FS). The cecal intubation rate and time were evaluated. The dose for sedation was also compared. Results: Among 86 subjects, 44 were performed with the OS scope and 42 with the FS. Intubation time was quicker with the FS than OS (3.6±0.3 vs. 4.7±0.4min, p=0.024). The intubation rate was not statistically different between the OS and FS groups (p=ns). The total dose of sedation used was similar between OS and FS groups (p=ns). The intubation time correlated negatively with body weight (r=-0.28, p=0.01). Conclusions: The FS colonoscope appears to provide additional advantage by improving the speed of cecal intubation without compromising the intubation rate or increasing sedation dose, although the two types of colonoscopes are equally efficient in colonoscopic performance.
[Show abstract][Hide abstract] ABSTRACT: The majority of patients with gastroesophageal reflux disease (GERD) appear to have non-erosive reflux disease (NERD). NERD may include minimal change esophagitis (MCE) and no endoscopic abnormalities (MCE-). We aimed to determine whether intraesophageal acid reflux as well as esophageal motility differed between patients with and without MCE.
Consecutive patients with classic reflux symptoms were enrolled in the study. Patients without any mucosal injury were considered to be MCE-. Esophageal acid exposure as well as intragastric pH (<4) was determined by dual-channel ambulatory 24-hour pH monitoring.
A total of 100 patients (MCE-, 52 patients; MCE, 48 patients) were studied. The percentage of effective peristalsis was found similar between patients with and without MCE (p = NS). Esophageal acid contact as well as the DeMeester score did not differ between the groups (p = NS). The prevalence of positive symptom index was greater in MCE- patients than in MCE patients (p = 0.001). Intragastric acidity (pH <4) was similar between MCE- and MCE groups (p = NS).
NERD, regardless of the presence of MCE, might exhibit similar disease characteristics in terms of esophageal acid exposure and motor dysfunction.
[Show abstract][Hide abstract] ABSTRACT: Sleep dysfunction is associated with altered gastrointestinal functioning and the presence of irritable bowel syndrome (IBS). We aimed to investigate whether sleep dysfunction would influence anorectal motility in IBS patients.
A total of 16 healthy volunteers and 15 IBS patients underwent anorectal manometry. The anorectal parameters included resting and squeeze sphincter pressure, sensory thresholds in response to balloon distension, and rectoanal inhibitory reflex. Sleep dysfunction was assessed by using the Pittsburgh Sleep Quality Index (PSQI).
IBS patients had a lower threshold volume for urge (p = 0.04) and pain (p = 0.002) as compared with the controls. IBS patients with sleep dysfunction had a significantly lower threshold volume for urge (p = 0.04) and anal sphincter pressure for maximal squeeze (p = 0.048) as compared with those without sleep dysfunction. In IBS patients, the PSQI score significantly correlated with threshold volume for first sensation (r = -0.55; p = 0.03), urge (r = -0.56; p = 0.03) and pain (r = -0.58; p = 0.03).
IBS patients with sleep dysfunction are characterized by lower thresholds for rectal perception. Sleep disturbance might be associated with anorectal dysfunction and appears to create some degree of rectal hyperalgesia in patients with IBS.
[Show abstract][Hide abstract] ABSTRACT: Sleep dysfunction is associated with altered gastrointestinal function and subsequently exacerbations of gastrointestinal problems. We aimed to investigate whether sleep dysfunction would influence anorectal motility as determined by anorectal manometry. The effect of anxiety on anorectal motility was also determined.
A total of 24 healthy volunteers underwent anorectal manometry. The anorectal parameters included resting and squeeze sphincter pressure, sensory thresholds in response to balloon distension, sphincter length, rectal compliance, and rectoanal inhibitory reflex. Sleep dysfunction was subjectively assessed by using Pittsburgh Sleep Quality Index (PSQI). Anxiety was assessed by the application of the State-Trait Anxiety Inventory questionnaire.
There were sixteen subjects without sleep dysfunction (7 women; mean age, 22 years) and eight subjects with sleep dysfunction (2 women; mean age, 22 years). There was no group difference in the volume threshold for rectoanal inhibitory reflux, rectal compliance or sphincter length (P = NS). Anal sphincter pressure did not differ between the groups (P = NS). The rectal sensitivity for different levels of stimulation did not differ between the groups (P = NS). Sleep quality as determined by PSQI correlated with rectal compliance (r = 0.66, P = 0.007). Although there was no differences in any manometric parameters between subjects with and without anxiety, the anxiety score correlated with rectal compliance (r = 0.57, P = 0.003).
Despite a positive association between rectal compliance and the level of subjective sleep or anxiety, sleep dysfunction did not apparently affect most of anorectal function in healthy subjects, nor did anxiety.
Journal of neurogastroenterology and motility 04/2011; 17(2):180-4.
[Show abstract][Hide abstract] ABSTRACT: Hemorrhagic cholecystitis is a rare and potentially fatal complication of biliary tract disease. Nontraumatic hemorrhagic cholecystitis is related to a variety of etiologies. Here, the authors reported an elderly patient who developed hemorrhagic cholecystitis after heparin and aspirin usage for unstable angina. Laparoscopic cholecystectomy was performed with the histopathology report disclosing adenocarcinoma in situ. As demonstrated in this case, underlying malignant changes in its early stage increase the risk of bleeding concomitant with anticoagulation usage.
The American Journal of the Medical Sciences 10/2010; 340(4):338-9. · 1.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aimed to compare the effect of intraluminal acidification on esophageal sensory perception and motor activity between older and younger patients with gastroesophageal reflux disease (GERD).
All 40 subjects had saline and hydrochloric acid infused into the mid-esophagus. The esophageal perception to acid infusion was documented including lag time, intensity rating, and sensitivity score. Esophageal body motility was recorded.
The younger group had a shorter lag time to initial heartburn perception (p = 0.01) and a greater sensory intensity rating (p = 0.001). The acid infusion sensitivity score was lower in the older patients (p = 0.001). Age positively correlated to lag time to initial symptom perception (r = 0.44, p = 0.005), but negatively correlated to sensory intensity (r = -0.40, p = 0.01) and acid infusion sensitivity score (r = -0.39, p = 0.01). When compared with saline infusion, acid infusion induced a significant increase in the deglutition frequency in younger patients (0.51 vs. 0.67, p = 0.005), but not in older patients (0.59 vs. 0.65, p = 0.67).
Age-related decrease in sensorimotor response to esophageal acidification may be an important element in the pathogenesis and clinical presentation of GERD in older adults.
Scandinavian Journal of Gastroenterology 10/2010; 45(10):1150-5. · 2.33 Impact Factor