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Relationship between bile acid and H. pylori in cholecystectomized patients
AJG – September, 2000
medical complications as compared to patients not on prophylactic antibiotics. Whether prophylactic antibiotics are causing adverse outcomes or patients who appear more clinically ill are being administered the antibiotics needs to evaluated with further investigation.
230 The use of a low fat diet in the treatment of acute pancreatitis Haddad MD Tariq M, Grendell MD James, Pochapin MD* Mark B. Weill Medical College of Cornell University, New York, NY, United States. Purpose: A low fat diet hypothetically stimulates less pancreatic lipase secretion than a diet with a higher fat content, yet very little data exists on whether the use of a low fat diet during the oral refeeding of patients with acute pancreatitis improves recovery from the disease. Methods: We performed a retrospective study of 69 patients with acute pancreatitis to determine whether the choice of diet affects the severity of disease, following each patient’s severity of disease during the oral refeeding period with serum amylase and lipase levels, APACHE II scores, and onset of pain relapse, nausea or vomiting. Results: Nine patients were refed with a regular diet and nine patients with a low fat diet. The mean APACHE II scores the day before refeeding were 6.9 ⫾ 5.3 points in the regular diet group and 8.4 ⫾ 5.2 points in the low fat group. Refeeding was begun a mean of 6.7 ⫾ 6.3 days (range 3–23 days) following admission in the regular diet group and 8.0 ⫾ 3.4 days (range 5–12 days) in the low fat group. No statistically significant difference in the change in APACHE II score over the duration of the refeeding period was found in patients advanced using a low fat diet compared to those using a regular diet. From the day before to the day after advancement of patients’ diets, the APACHE II score changed an average of 0 points when a regular solid diet was used and decreased 0.25 points when a low fat diet was used (p ⬍ 0.15). From the day before to two days after advancement of patients’ diets, the APACHE II score increased by 1.0 points when a regular diet was administered, an increase that was statistically insignificant when compared to an increase of 1.05 points in the low fat diet group (p ⬍ 0.26). Differences in onset of pain relapse, nausea, or vomiting were not statistically significant as well and insufficient data on changes in serum amylase and lipase levels was obtained. Conclusions: A low fat diet may not significantly affect outcome in the management of acute pancreatitis.
Abstracts
2479
Conclusion: This study showed that the prevalence of H. pylori was not significantly different before and after cholecystectomy. To clarify the role of bile acid and H. pylori in cholecystectomized patients, further study with larger sample size is proposed.
232 Serum lipase, C-Reactive Protein (CRP) and Interleukin-6 (IL-6) levels in ERCP induced pancreatitis Kaw Madhukar, Singh Sandeep, Rafiq Kamran, Brodmerkel* George J. Medical College of Ohio, Toledo, Ohio, United States. Purpose: Several markers have been studied to assess the severity of acute pancreatitis. Studies linking specific markers to the severity of ERCP induced pancreatitis are limited. With this aim we studied the role of serum lipase, CRP and IL-6 levels in ERCP induced pancreatitis. Methods: 85 patients (62 F, 23 M) with a mean age of 43 years (range 16 – 85) were entered into this prospective study. Serum levels of lipase by Triolene assay (normal ⬍210 IU/L), CRP by nephelometric immunoassay (normal ⬍0.8 mg/dl) and IL-6 by Medgenix ELISA (normal ⬍10 ng/dl) were measured before ERCP and post ERCP 12–24 and 36 – 48 hours. Severity of pancreatitis was classified according to Cotton et al. Results: There was a significant difference in serum CRP and IL-6 and none in lipase levels in among mild, moderate and severe ERCP pancreatitis. Conclusions: Serum CRP and IL-6 levels may be useful markers in predicting severity of ERCP induced pancreatitis. ERCP Induced Pancreatitis Mild (n ⫽ 9) Mild (n ⫽ 9) Moderate (n ⫽ 7) Moderate (n ⫽ 7) Severe (n ⫽ 4) Severe (n ⫽ 4) NO PANCREATITIS Pre ERCP (n ⫽ 80) Post ERCP (n ⫽ 13)
12–24 hours 36–48 hours 12–24 hours 36–48 hours 12–24 hours 36–48 hours
Serum levels in mean ⴞ SEM Lipase (IU/ml) 3296 ⫾ 775 7185 ⫾ 1947 3455 ⫾ 825 7556 ⫾ 2782 4216 ⫾ 1172 6711 ⫾ 2025 106 ⫾ 7.64 856 ⫾ 336
CRP (mg/dl) IL-6 (ng/dl) 0.98 ⫾ 0.24 16.40 ⫾ 2.06 1.60 ⫾ 0.35 18.92 ⫾ 3.28 3.80 ⫾ 0.32 73.40 ⫾ 15.58 7.60 ⫾ 0.74 100.53 ⫾ 10.87 12.0 ⫾ 1.70 235.00 ⫾ 26.32 25.0 ⫾ 2.90 438.20 ⫾ 71.50 0.42 ⫾ 0.35 0.35 ⫾ 0.21
2.20 ⫾ 0.26 2.60 ⫾ 0.73
233 231 Relationship between bile acid and H. pylori in cholecystectomized patients Hahm Joonsoo, Jo Yunju, Son Byeungkwan, Lee Ohyoung, Yoon Byungchul, Lee Minho, Donghoo Lee, Choonsuhk Kee, Park Kyungnam. Hanyang University School of Medicine, Seoul, Korea. Purpose: Patients with gallstones may complain biliary colic or various kinds of dyspepsia, which may be relieved or persist after cholecystectomy. We tried to assess the prevalence of H. pylori and the incidence of bile reflux in cholecystectomized patients to identify the cause of dyspepsia associated with gallstones. Methods: Twenty patients were enrolled in this study to assess the prevalence of H. pylori before and after cholecystectomy. Samples were taken from gastric juice through endoscopy before and after cholecystectomy and examined for bile salts by HPLC as an indicator of duodenogastric reflux. The prevalence of H. pylori was assessed by histology or rapid urease test. Results: The prevalence of H. pylori was decreased after cholecystectomy, but the difference did not reach statistically significant value. Bile acid concentration in H. pylori positive group was higher in patients after cholecystectomy than in patients before cholecystectomy. Bile acid concentration was also slightly higher in H. pylori negative group after cholecystectomy.
Antibiotics with or without a choleratic agent do not prevent plastic stent occlusion or mortality in patients with malignant biliary obstruction: a meta-analysis Khurana MD Sandeep, Sharma MD Virender K. University of Arkansas for Medical Sciences, Little Rock, AR. Plastic stents are commonly used to relieve benign and malignant biliary obstruction. Stent occlusion is the commonest problem with long term stenting. Prevention of stent occlusion is a highly desirable goal. Aim: To ascertain if antibiotics ⫾ choleretic agent (UDCA/Rowachol) reduces the risk of stent occlusion by meta-analysis. Methods: A recursive literature search for RCTs of use of antibiotic ⫾ a choleratic versus no treatment for prevention of plastic stent occlusion in patients with malignant biliary obstruction was conducted. Homogeneity of RCTs was assessed by Breslow-Day method. RCTs were pooled and overall stent occlusion rates, 95% CI’s, absolute risk reduction (ARR), relative risk reduction (RRR) and numbers need to treat (NNT) were calculated for individual RCTs and pooled data. Results: Six RCTs without significant heterogeneity were identified with 147 patients receiving antibiotics ⫾ choleratic agent and 149 controls receiving no treatment for the prevention of stent occlusion. Neither the individual trials nor the pooled data should any benefit of the treatment in preventing stent occlusion (Figure 1) or mortality (Figure 2).
medical complications as compared to patients not on prophylactic antibiotics. Whether prophylactic antibiotics are causing adverse outcomes or patients who appear more clinically ill are being administered the antibiotics needs to evaluated with further investigation.
230 The use of a low fat diet in the treatment of acute pancreatitis Haddad MD Tariq M, Grendell MD James, Pochapin MD* Mark B. Weill Medical College of Cornell University, New York, NY, United States. Purpose: A low fat diet hypothetically stimulates less pancreatic lipase secretion than a diet with a higher fat content, yet very little data exists on whether the use of a low fat diet during the oral refeeding of patients with acute pancreatitis improves recovery from the disease. Methods: We performed a retrospective study of 69 patients with acute pancreatitis to determine whether the choice of diet affects the severity of disease, following each patient’s severity of disease during the oral refeeding period with serum amylase and lipase levels, APACHE II scores, and onset of pain relapse, nausea or vomiting. Results: Nine patients were refed with a regular diet and nine patients with a low fat diet. The mean APACHE II scores the day before refeeding were 6.9 ⫾ 5.3 points in the regular diet group and 8.4 ⫾ 5.2 points in the low fat group. Refeeding was begun a mean of 6.7 ⫾ 6.3 days (range 3–23 days) following admission in the regular diet group and 8.0 ⫾ 3.4 days (range 5–12 days) in the low fat group. No statistically significant difference in the change in APACHE II score over the duration of the refeeding period was found in patients advanced using a low fat diet compared to those using a regular diet. From the day before to the day after advancement of patients’ diets, the APACHE II score changed an average of 0 points when a regular solid diet was used and decreased 0.25 points when a low fat diet was used (p ⬍ 0.15). From the day before to two days after advancement of patients’ diets, the APACHE II score increased by 1.0 points when a regular diet was administered, an increase that was statistically insignificant when compared to an increase of 1.05 points in the low fat diet group (p ⬍ 0.26). Differences in onset of pain relapse, nausea, or vomiting were not statistically significant as well and insufficient data on changes in serum amylase and lipase levels was obtained. Conclusions: A low fat diet may not significantly affect outcome in the management of acute pancreatitis.
Abstracts
2479
Conclusion: This study showed that the prevalence of H. pylori was not significantly different before and after cholecystectomy. To clarify the role of bile acid and H. pylori in cholecystectomized patients, further study with larger sample size is proposed.
232 Serum lipase, C-Reactive Protein (CRP) and Interleukin-6 (IL-6) levels in ERCP induced pancreatitis Kaw Madhukar, Singh Sandeep, Rafiq Kamran, Brodmerkel* George J. Medical College of Ohio, Toledo, Ohio, United States. Purpose: Several markers have been studied to assess the severity of acute pancreatitis. Studies linking specific markers to the severity of ERCP induced pancreatitis are limited. With this aim we studied the role of serum lipase, CRP and IL-6 levels in ERCP induced pancreatitis. Methods: 85 patients (62 F, 23 M) with a mean age of 43 years (range 16 – 85) were entered into this prospective study. Serum levels of lipase by Triolene assay (normal ⬍210 IU/L), CRP by nephelometric immunoassay (normal ⬍0.8 mg/dl) and IL-6 by Medgenix ELISA (normal ⬍10 ng/dl) were measured before ERCP and post ERCP 12–24 and 36 – 48 hours. Severity of pancreatitis was classified according to Cotton et al. Results: There was a significant difference in serum CRP and IL-6 and none in lipase levels in among mild, moderate and severe ERCP pancreatitis. Conclusions: Serum CRP and IL-6 levels may be useful markers in predicting severity of ERCP induced pancreatitis. ERCP Induced Pancreatitis Mild (n ⫽ 9) Mild (n ⫽ 9) Moderate (n ⫽ 7) Moderate (n ⫽ 7) Severe (n ⫽ 4) Severe (n ⫽ 4) NO PANCREATITIS Pre ERCP (n ⫽ 80) Post ERCP (n ⫽ 13)
12–24 hours 36–48 hours 12–24 hours 36–48 hours 12–24 hours 36–48 hours
Serum levels in mean ⴞ SEM Lipase (IU/ml) 3296 ⫾ 775 7185 ⫾ 1947 3455 ⫾ 825 7556 ⫾ 2782 4216 ⫾ 1172 6711 ⫾ 2025 106 ⫾ 7.64 856 ⫾ 336
CRP (mg/dl) IL-6 (ng/dl) 0.98 ⫾ 0.24 16.40 ⫾ 2.06 1.60 ⫾ 0.35 18.92 ⫾ 3.28 3.80 ⫾ 0.32 73.40 ⫾ 15.58 7.60 ⫾ 0.74 100.53 ⫾ 10.87 12.0 ⫾ 1.70 235.00 ⫾ 26.32 25.0 ⫾ 2.90 438.20 ⫾ 71.50 0.42 ⫾ 0.35 0.35 ⫾ 0.21
2.20 ⫾ 0.26 2.60 ⫾ 0.73
233 231 Relationship between bile acid and H. pylori in cholecystectomized patients Hahm Joonsoo, Jo Yunju, Son Byeungkwan, Lee Ohyoung, Yoon Byungchul, Lee Minho, Donghoo Lee, Choonsuhk Kee, Park Kyungnam. Hanyang University School of Medicine, Seoul, Korea. Purpose: Patients with gallstones may complain biliary colic or various kinds of dyspepsia, which may be relieved or persist after cholecystectomy. We tried to assess the prevalence of H. pylori and the incidence of bile reflux in cholecystectomized patients to identify the cause of dyspepsia associated with gallstones. Methods: Twenty patients were enrolled in this study to assess the prevalence of H. pylori before and after cholecystectomy. Samples were taken from gastric juice through endoscopy before and after cholecystectomy and examined for bile salts by HPLC as an indicator of duodenogastric reflux. The prevalence of H. pylori was assessed by histology or rapid urease test. Results: The prevalence of H. pylori was decreased after cholecystectomy, but the difference did not reach statistically significant value. Bile acid concentration in H. pylori positive group was higher in patients after cholecystectomy than in patients before cholecystectomy. Bile acid concentration was also slightly higher in H. pylori negative group after cholecystectomy.
Antibiotics with or without a choleratic agent do not prevent plastic stent occlusion or mortality in patients with malignant biliary obstruction: a meta-analysis Khurana MD Sandeep, Sharma MD Virender K. University of Arkansas for Medical Sciences, Little Rock, AR. Plastic stents are commonly used to relieve benign and malignant biliary obstruction. Stent occlusion is the commonest problem with long term stenting. Prevention of stent occlusion is a highly desirable goal. Aim: To ascertain if antibiotics ⫾ choleretic agent (UDCA/Rowachol) reduces the risk of stent occlusion by meta-analysis. Methods: A recursive literature search for RCTs of use of antibiotic ⫾ a choleratic versus no treatment for prevention of plastic stent occlusion in patients with malignant biliary obstruction was conducted. Homogeneity of RCTs was assessed by Breslow-Day method. RCTs were pooled and overall stent occlusion rates, 95% CI’s, absolute risk reduction (ARR), relative risk reduction (RRR) and numbers need to treat (NNT) were calculated for individual RCTs and pooled data. Results: Six RCTs without significant heterogeneity were identified with 147 patients receiving antibiotics ⫾ choleratic agent and 149 controls receiving no treatment for the prevention of stent occlusion. Neither the individual trials nor the pooled data should any benefit of the treatment in preventing stent occlusion (Figure 1) or mortality (Figure 2).