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7188 The role of hla class ii gene dqb1 in the development of duodenal ulcer disease in helicobacter pyloriinfected patients.
7185 THE ROLE OF ERCP IN THE MANAGEMENT OF PANCREATIC PSEUDOCYSTS (PP): FURTHER SUPPORT FOR AN ERCPBASED ALGORITHM. Klaus Mergener, Jeffrey B. Mundorf, Theodore N. Pappas, Gail RobuckMangum, Paul S. Jowell, Malcolm S. Branch, Katrina L. Swartz, John Baillie, Duke Univ Med Ctr, Durham, NC. Background: Our previously published algorithm (1) for the management of PP assumes a high recurrence rate after percutaneous drainage when there is pancreatic duct (PD) obstruction or the pseudocyst communicates with the duct. We have recommended surgical intervention in this group. In an earlier review (2), this triage of PP cases seemed to offer good results. In order to validate the algorithm, we applied it to a large number of patients with PPs seen at our tertiary care center. Gastroenterologists and surgeons managing PP patients were allowed to make independent (i.e. not algorithm-driven) decisions regarding management. Methods: Computerized endoscopic, surgical and radiological databases were reviewed retrospectively to identify patients undergoing percutaneous and surgical treatment of PPs (as defined by Atlanta criteria) between 1992 and 1998. Patients with multiple (>3) PPs, those suspicious for malignancy, and those treated endoscopically were excluded. Health status, comorbidities, severity of pancreatitis, PP characteristics, PD anatomy, management strategy and outcome (success, recurrence, complications) were recorded. Results: 121 patients (ages 25-79yr) were included in this analysis. Outcomes in relation to the ERCP findings are shown below. Overall, 60/77 (78%) interventions that followed, and 18/44 (41%) that did not follow the algorithm succeeded (p <0.02). Patients were well matched for age, health status, severity of pancreatitis, size, number and location of PPs. Conclusion: ERCP is a valuable tool for predicting the outcome of percutaneous drainage of PPs. In the presence of PD obstruction or PD/PP communication, surgery is likely to be needed. The role of endoscopic management (e.g. cystgastrotomy) was not addressed by this study, nor was the contribution of new imaging techniques (e.g. MRCP). References: (1) Ahearne PM et al., Am J Surg 1992;163:111-116. (2) Mundorf JB et al., Gastrointest Endosc 1996;43:411A.
7187 PROSPECTIVE ANALYSIS OF THE CLINICAL FEATURES OF PATIENTS WITH STREAKY ERYTHEMA IN THE ANTRUM: A NEGATIVE ENDOSCOPIC SIGN FOR HELICOBACTOR PYROLI INFECTION. Takao Kawabe, Shin Maeda, Haruhiko Yoshida, Yasushi Shiratori, Masao Omata, Univ of Tokyo, Tokyo, Japan. [Background] We previously reported that H. pylori infection rate was extremely low in patients with streaky erythema (SE) in the antrum, which was an independent negative sign for H. pylori infection by logistic regression analysis . Then we conducted the present study to investigate prospectively the clinical features of patients with SE including H. pylori infection and other endoscopic findings. [Patients] The subjects were the consecutive 100 patients with SE undergoing endoscopy of the gastrointestinal tract since Oct 1998 to Aug 1999. The 85 age and gender-matched patients were employed as controls. [Results] The diagnostic tests for H. pylori infection were positive as following: 0% (0/85) of the patients with SE and 48% (41/85) of the control patients in rapid urease tests (p<0.01), 1.2% (1/84) and 48% (39/84) in culture of H. pylori (p<0.01), 1.5% (1/69) and 44% (35/69) in anti-H. pylori antibodies (p<0.01), 0% (0/21) and 52% (13/25) in 13C-urea breathing tests (p<0.05). Other endoscopic findings were as followings: gastric/duodenal ulcer (including scar) in 0% (0/85) of the patients with SE and 15% (13/85) of the controls (p<0.01), gastric cancer in 0% (0/85) and 1.2% (1/85), hyper plastic polyps in 0% (0/85) and 2.4% (2/85), fundic gland polyps in 13% (11/85) and 2.4% (2/85), erosions in 8.2% (7/85) and 14% (12/85) (p<0.01). [Conclusion] The infection rate of H. pylori in patients with SE was extremely low and they had rarely peptic ulcer diseases, but often had fundic gland polyps.
Ductal Abnormalities* Present Success YES NO
P. Drain 8 24
Absent
Surgery 44 12
P. Drain
Surgery
16 5
10 2
* ductal abnormalities = PD obstruction or PP/PD communication
7186 RAYNAUD’S SYNDROME AND HELICOBACTER PYLORI. Istvan Gal, 3rd Dept of Internal Medicine, Med Universiy Debrecen, Debrecen, Hungary. Aims To study the effect of eradication of Helicobacter pylori on complains and symptoms of infected patients with primary Raynaud s syndrome. Patients, methods Altogether 92 Helicobacter pylori positive patients with primary Raynaud s syndrome received eradication therapy. Before and after the eradication we recorded the severity and frequency of the complains and symptoms of the patients partially with the help of semiquantitative scales. Results The eradication was performable in 89 patients; in 75 cases the eradication was successfull. Successfully eradicated patients has proven significant improvement in several complains and symptoms related to that of not eradicated group. Conclusion Considering the potential aetiopathogenetical role of Helicobacter pylori infection in primary Raynaud s syndrome, the presence of the microorganism must be confirmed or excluded in these patients. The diagnostic importance or indications of the examinations for the Helicobacter in primary Raynaud s syndrome could established in larger scale, double blind, comparative prospective studies.
VOLUME 51, NO. 4, PART 2, 2000
7188 THE ROLE OF HLA CLASS II GENE DQB1 IN THE DEVELOPMENT OF DUODENAL ULCER DISEASE IN HELICOBACTER PYLORI INFECTED PATIENTS. Sung Joon Lee, Hoon Jae Chun, Byung Won Hur, Yoon Tae Jeen, Yoon Jung Cho, Chi Wook Song, Soon Ho Um, Sang Woo Lee, Jae Hyun Choi, Chang Duk Kim, Ho Sang Ryu, Jin Hae Hyun, Korea Univ Coll of Medicine, Seoul, South Korea. Objects: We evaluated the HLA DQ to examine the host genetic factors that increase the risk of duodenal ulcer among H. pylori-infected persons. Methods: Consecutive patients who were diagnosed duodenal ulcer by endoscopic examinations and control who had normal endoscopic findings were studied. H. pylori infection status was confirmed by CLO test and 13C-urea breath test in all patients with duodenal ulcer. HLA DQ alleles were determined by PCR using SSOP(sequence specific oligonucleotide probes). Results: Allele frequency of HLA DQA1 was not significant different between the H. pylori(+) duodenal ulcer patients and controles. In addition, the allele frequency of HLA DQB1*04 was significantly lower in the H. pylori(+) duodenal ulcer patients than in controls. Conclusion: The HLA DQB1 allele may contribute to protective role for H. pylori associated duodenal ulcer, whereas the absence of DQB1*04 may be a host genetic risk foctor for H. pylori associated duodenal ulcer.
GASTROINTESTINAL ENDOSCOPY
AB289
7187 PROSPECTIVE ANALYSIS OF THE CLINICAL FEATURES OF PATIENTS WITH STREAKY ERYTHEMA IN THE ANTRUM: A NEGATIVE ENDOSCOPIC SIGN FOR HELICOBACTOR PYROLI INFECTION. Takao Kawabe, Shin Maeda, Haruhiko Yoshida, Yasushi Shiratori, Masao Omata, Univ of Tokyo, Tokyo, Japan. [Background] We previously reported that H. pylori infection rate was extremely low in patients with streaky erythema (SE) in the antrum, which was an independent negative sign for H. pylori infection by logistic regression analysis . Then we conducted the present study to investigate prospectively the clinical features of patients with SE including H. pylori infection and other endoscopic findings. [Patients] The subjects were the consecutive 100 patients with SE undergoing endoscopy of the gastrointestinal tract since Oct 1998 to Aug 1999. The 85 age and gender-matched patients were employed as controls. [Results] The diagnostic tests for H. pylori infection were positive as following: 0% (0/85) of the patients with SE and 48% (41/85) of the control patients in rapid urease tests (p<0.01), 1.2% (1/84) and 48% (39/84) in culture of H. pylori (p<0.01), 1.5% (1/69) and 44% (35/69) in anti-H. pylori antibodies (p<0.01), 0% (0/21) and 52% (13/25) in 13C-urea breathing tests (p<0.05). Other endoscopic findings were as followings: gastric/duodenal ulcer (including scar) in 0% (0/85) of the patients with SE and 15% (13/85) of the controls (p<0.01), gastric cancer in 0% (0/85) and 1.2% (1/85), hyper plastic polyps in 0% (0/85) and 2.4% (2/85), fundic gland polyps in 13% (11/85) and 2.4% (2/85), erosions in 8.2% (7/85) and 14% (12/85) (p<0.01). [Conclusion] The infection rate of H. pylori in patients with SE was extremely low and they had rarely peptic ulcer diseases, but often had fundic gland polyps.
Ductal Abnormalities* Present Success YES NO
P. Drain 8 24
Absent
Surgery 44 12
P. Drain
Surgery
16 5
10 2
* ductal abnormalities = PD obstruction or PP/PD communication
7186 RAYNAUD’S SYNDROME AND HELICOBACTER PYLORI. Istvan Gal, 3rd Dept of Internal Medicine, Med Universiy Debrecen, Debrecen, Hungary. Aims To study the effect of eradication of Helicobacter pylori on complains and symptoms of infected patients with primary Raynaud s syndrome. Patients, methods Altogether 92 Helicobacter pylori positive patients with primary Raynaud s syndrome received eradication therapy. Before and after the eradication we recorded the severity and frequency of the complains and symptoms of the patients partially with the help of semiquantitative scales. Results The eradication was performable in 89 patients; in 75 cases the eradication was successfull. Successfully eradicated patients has proven significant improvement in several complains and symptoms related to that of not eradicated group. Conclusion Considering the potential aetiopathogenetical role of Helicobacter pylori infection in primary Raynaud s syndrome, the presence of the microorganism must be confirmed or excluded in these patients. The diagnostic importance or indications of the examinations for the Helicobacter in primary Raynaud s syndrome could established in larger scale, double blind, comparative prospective studies.
VOLUME 51, NO. 4, PART 2, 2000
7188 THE ROLE OF HLA CLASS II GENE DQB1 IN THE DEVELOPMENT OF DUODENAL ULCER DISEASE IN HELICOBACTER PYLORI INFECTED PATIENTS. Sung Joon Lee, Hoon Jae Chun, Byung Won Hur, Yoon Tae Jeen, Yoon Jung Cho, Chi Wook Song, Soon Ho Um, Sang Woo Lee, Jae Hyun Choi, Chang Duk Kim, Ho Sang Ryu, Jin Hae Hyun, Korea Univ Coll of Medicine, Seoul, South Korea. Objects: We evaluated the HLA DQ to examine the host genetic factors that increase the risk of duodenal ulcer among H. pylori-infected persons. Methods: Consecutive patients who were diagnosed duodenal ulcer by endoscopic examinations and control who had normal endoscopic findings were studied. H. pylori infection status was confirmed by CLO test and 13C-urea breath test in all patients with duodenal ulcer. HLA DQ alleles were determined by PCR using SSOP(sequence specific oligonucleotide probes). Results: Allele frequency of HLA DQA1 was not significant different between the H. pylori(+) duodenal ulcer patients and controles. In addition, the allele frequency of HLA DQB1*04 was significantly lower in the H. pylori(+) duodenal ulcer patients than in controls. Conclusion: The HLA DQB1 allele may contribute to protective role for H. pylori associated duodenal ulcer, whereas the absence of DQB1*04 may be a host genetic risk foctor for H. pylori associated duodenal ulcer.
GASTROINTESTINAL ENDOSCOPY
AB289