News - Part 73

Routine second look endoscopy: Evidence from six randomized trials (Part 4)

multicentre randomized trialRutgeerts et al published the fourth study, a very large (854-patient) multicentre randomized trial that included three groups: polidocanol; fibrin glue; and daily fibrin glue injections until high risk stigmata disappeared. Recurrent bleeding occurred in 19% of the 266 patients in the fibrin glue arm and 15% of the 270 patients randomized to repeated fibrin glue injections. There were no significant differences in rates of rebleeding, surgery or death. Read more »

Routine second look endoscopy: Evidence from six randomized trials (Part 3)

The third randomized trial by Saeed et al was restricted to extremely high risk patients, in that they had high risk stigmata as well as a high Baylor bleeding score (pre-endoscopy score greater than five or postendoscopy score greater than 10). Many patients were excluded because they failed to meet the latter criteria, despite having high risk stigmata. Heater probe was the main method of hemostasis, but epinephrine was used in 50% of patients (eg, combination therapy). Read more »

Routine second look endoscopy: Evidence from six randomized trials (Part 2)

second look endoscopyAt the second look endoscopy, potentially treatable lesions were seen in 59% of patients, a small proportion of which were actively bleeding. Of the 11 patients who had recurrent bleeding in this group, two (18%) rebled before the date of their second endoscopy and, therefore, would not have been helped by this strategy. Another five (45%) rebled despite retreatment of their lesions and four (36%) did so despite having no high risk stigmata at the second endoscopy. Read more »

Routine second look endoscopy: Evidence from six randomized trials (Part 1)

Third, endoscopic high risk stigmata are frequently discovered at the second endoscopy and this observation is often used to justify repeat endoscopic therapy; however, the natural history of these lesions after therapy has already been applied is unknown. A randomized trial addresses the above problems, allowing known and unknown con-founders to be balanced, and allows the natural history of residual high risk stigmata to be documented. Therefore, the remainder of the discussion focuses on randomized trials. Read more »

Routine second look endoscopy: Ineffective, costly and potentially misleading (Part 2)

Yang et al studied the natural history of high risk stigmata in 34 patients with or without injection therapy. They found that, within three or four days, more than one-half of the visible vessels had converted to flat spots or clean-based ulcers, and 90% of all high risk lesions were gone by six days. The only type of lesion that appeared to respond to endoscopic injection therapy was the visible vessel, for which progression to a lower risk lesion was accelerated by approximately half a day. Read more »

Routine second look endoscopy: Ineffective, costly and potentially misleading (Part 1)

endoscopic treatmentDespite advances in the endoscopic treatment of bleeding peptic ulcer disease, there remains a significant rebleeding rate of 10% to 20% . Adjuvant intravenous proton pump inhibitor therapy has been proven to reduce the rebleeding rate when used with successful endoscopic hemostasis . Endoscopic hemoclip application also appears to be effective in selected cases. Certainly more controversial, however, is the question of whether a routine second look endoscopy in those patients with high risk lesions, with or without additional endoscopic therapy, would further reduce that rebleeding rate. Read more »

Helicobacter pylori and endothelial adhesion molecules: DISCUSSION (Part 4)

Although LPS is present in membranes of Gram-negative bacteria such as H pylori and is an important nonprotein proinflammatory molecule, previous studies have shown that H pylori LPS has less biological activity than E coli LPS. We did not examine H pylori LPS directly, but 0.74 EU/mL of E coli LPS did not upregulate adhesion molecules on HUVEC. In addition, final concentrations of LPS in HPE derived from NCTC11637 were less than 0.74 EU/mL, and no correlation was found between adhesion molecule-inducing activities and LPS concentrations in HPE. Read more »

Helicobacter pylori and endothelial adhesion molecules: DISCUSSION (Part 3)

The cagA and vacA genes have been reported to be related to the pathogenecity of H pylori strains, especially with respect to cytokine production from epithelial cells . In the present study, though all strains had both genes, there was no relation between these genes and upregulation of adhesion molecules on HUVEC. In our fractionation study, low-molecular-weight fractions (approximately 7 kDa) showed peak adhesion molecule-inducing activity. This fraction showed a nonprotein character, resisting heat and trypsin incubation. Read more »

Helicobacter pylori and endothelial adhesion molecules: DISCUSSION (Part 2)

However, in the present study, because there is little opportunity for direct contact between bacteria and endothelial cells in gastric mucosa, we used HPE which contains water-soluble components of the membrane or the cytosol. A recent report showed that H pylori alters the barrier properties of the epithelium in vitro. Therefore, HPE, especially low molecular substance in HPE, may permeate into the gastric mucosa and directly affect the endothelial cells. Read more »

Helicobacter pylori and endothelial adhesion molecules: DISCUSSION (Part 1)

leukocyte-endothelial cell interactionsIn the present study, we demonstrated that HPE derived from NCTC11637 induces upregulation of ICAM-1, VCAM-1 and E-selectin on HUVEC. These adhesion molecules play very important roles in leukocyte-endothelial cell interactions which are the initial steps in local inflammation. Inflammatory mediators or cytokines which are increased on tissues by various stimulants activate endothelial cells, and ICAM-1, VCAM-1, E-selectin and other adhesion molecules are expressed on endothelial cells. Read more »

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