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Age-specific seropositivity for H. pylori and dyspepsia in school-children in Cayman Brac, Cayman Islands
2450
Abstracts
133 Endoscopic ultrasound (EUS) in the staging and follow-up of gastric MALT lymphoma L. Caro, M.D., M. Ghigliani, M.D., H. Uehara, M.D., D. Estrin, M.D. Divisio´n de Gastroenterologia Seccio´n Endoscopı´a, Hospital de Clı´nicas “Jose´ de San Martin”, Instituto Quiru´rgico del Callao, Buenos Aires, Argentina. Introduction: EUS is an appropriate procedure for assessing depth of invasion to the gastric wall, which may be divided into 5 layers. In patients with low-grade lymphoma located in the mucosa (MALT) it is possible to correctly stage pretreatment and evaluate the response to medical therapy by studying the gastric layers at the end of treatment. Results: Between March 1994 and July 1999, 19 patients with Malt lymphoma were examined using Olympus UM 20 and 30. Of the 16 patients, 5 revealed the same condition after a median follow-up of 10 months (7 and 12 months). 5 patients with partial remission showed decreased thickness or number of affected layers, and in 6 patients cure was revealed by EUS and histology, which allowed us to clarify the location of MALT lymphoma. In 8 patients, lesions were located in the ceiling and in the upper body, in 5 in the mesogastrium and in 6 in the antrum. The affected layer extended by 84% to the submucosa, and only in 30.76% adenopathy was evident. Discussion: EUS is useful for obtaining a response to the treatment of MALT lymphoma. After reviewing and consulting the references we could confirm that MALT lymphoma may extend to the submucosal tissue without compromising the muscularis propia. In 6 patients, the mucosa did not reveal endoscopic or histological pathology. The submucosa was confirmed to be affected by thickening and had alteration of echogenity. According to Sackmann, this sign may show a probable relapse of MALT lymphoma. We are presently obtaining identical results. Conclusions: EUS was shown to be useful for evaluating the response to eradication of Helicobacter pylori and the behavior of the gastric wall in response to chemotherapy. The method is even more important in those cases when the biopsy was MALT negative and when EUS showed a thickened submucosa and echogenetically altered in “patches”. In these cases, it was advised to repeat the biopsy by marking these alternate areas using the biopsy-on-biopsy method to achieve a greater efficacy.
134 Age-specific seropositivity for H. pylori and dyspepsia in schoolchildren in Cayman Brac, Cayman Islands Charles C DM FACG⫹, Mohanty S⫹, Jefferson D⫹, Brisson S⫹, Jones N⫹, Martin M⫹, Dilbert V⫹, Harper P⫹, Morta M⫹, Paramlall M⫹, Onyonyor A⫹, Sue M#, Peura D#. ⫹Faith Hospital, C.I., #Univ. of Virginia Health Sciences, VA. Introduction: Age-specific sero-positivity for Helicobacter pylori infection (HP) in childhood rises sharper in developing vs. developed countries. The Cayman Islands, though physically Caribbean, have developed-world socioeconomic and health indices. Evaluation of HP status vs. dyspepsia in Cayman Brac (CB) school children allows regional and international comparisons. Methods: Questionnaires on past (⬎4 weeks, PD), current (⬍4 weeks, CD) and familial dyspepsia (FD) were administered to volunteers (200/400 [50%]) from CB schools (3-primary, 1-secondary). CD mean symptom score (SS) was computed: epigastric pain, nausea/vomiting, heartburn, bloating, belching, hunger pains, pain-relief-after-meals, graded 0 –3 (absent, mild-moderate, severe; Max 21). FD was classified for “peptic disease” and “gastric cancer”. Finger stick whole blood FlexSure diagnosed HP.
AJG – Vol. 95, No. 9, 2000
Results: Table 1. Age-specific HP sero-positivity* with respect to gender Age (yr)
0–4
5–9
10–14
Male Female Total
8 (0*) 3 (0*) 11 (0*)
31 (0*) 47 (1*) 78 (1*)
15–19
38 (1*) 42 (2*) 80 (3*)
Total
14 (2*) 17 (2*) 31 (4*)
91 (3*) 109 (5*) 200 (8*)
Table 2. HP status vs prevalence: past, current, familial dyspepsia
HP ⫹ve HP ⫺ve Total
n
PD
CDⴙ
FD
SSⴙ
8 192 200
1 16 17
2 39 41
1 37 38
1.1 0.7 0.7
Conclusion: (1). HP infection occurred in 4% (8/200) of CB school children (current dyspepsia [SS ⫽ 1.1]⫹ in 2/8). (2). HP ⫺ve school children had 8.5% past dyspepsia, 20.3% current dyspepsia (SS ⫽ 0.7)⫹ and 19% familial dyspepsia. 135 Prevalence of NSAIDs/ASA induced ulcers in patients attended at emergency units (EU): A prospective multicenter Brazilian study Decio Chinzon, MD, Jose Alves Freitas, MD, Jose Pimenta Modena, MD, Ismael Maguilnick, MD, Jorge Luiz Jorge, MD, Julio Cesar Pizzani, MD, Esther Dantas Correa, MD, Sonia Nadia Fylyk, MD, Edson Pedro Silva, MD, Schlioma Zaterka, MD, FACG*. Purpose: 1. Prevalence of upper GI ulcers and bleeding in patients seen at EU. 2. Prevalence of upper GI ulcers and bleeding due to NSAIDs/ASA, seen at EU. 3. Influence of age, gender, smoking and previous abdominal complaints, as risk factors for ulcer or bleeding in patients seen at EU. Methods: 317 patients from 10 Brazilian centers were enrolled in the study. Patients were divided in group I—non users of NSAIDs/ASA and group II— users of NSAIDs/ASA. Endoscopy was performed in the first 72 hs after symptoms started. Epigastric pain, pyrosis, nausea, vomiting, bleeding presence were recorded. Endoscopic findings were analysed in both groups. Results: 180 male and 137 female, aging 16 – 88 (mean 52.5). 127 of 317 had a previous history of NSAIDs/ASA ingestion (41.3%–16.9% NSAIDs; 24.4% ASA). The main reason for attendance was epigastric pain followed by melena and hematemesis in both groups with no statistical difference. No difference was observed in gender, smoking and the time of hospitalization in both groups. The mean age in group II (54.1y) was statistically higher than group I (48.8) p⫽0.012. Peptic ulcers were observed in 71.2% (226/317) of the patients (GU 97/317-30.5%; DU 92/317-29%; GU⫹DU 37/317-11.6%). In group I 151/190 (79.4%) had an ulcer and in group II 75/127 (59%) p ⬍ 0.0001. 25.2% of all ulcers bled. 37.3% in the NSAIDS/ ASA ulcer patients bled (GU 17/57-29.8%; DU 11/57-19.2%) and in group I 15.2% (29/190-GU 21/190-11%; DU 8/190 4.2%). The difference between group I and II bleeding ulcers was statistically significant p ⬍ 0.001. Conclusions: 1. Peptic ulcers is the most important cause of attendance at emergency units because of epigastric pain and or bleeding. The prevalence of ulcers was high in non NSAIDs/ASA users although the prevalence of bleeding ulcer was higher in the NSAID/s/ASA group. Gender, smoking and previous history of ulcer complaints did not distinguish users from non users of NSAIDs/ASA as a risk factor. NSAIDs/ASA users were older than non users. 136 Vitamin B12 absorption not affected by long term omeprazole therapy Lawrence B Cohen, MD, FACG, Marciano Reis, MD. Departments of Medicine and Clinical Pathology, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto, Toronto, Canada Vitamin B12 (B12) is extracted from dietary sources in the presence of gastric acid. Complete absence of gastric acid may decrease B12 bioavail-
Abstracts
133 Endoscopic ultrasound (EUS) in the staging and follow-up of gastric MALT lymphoma L. Caro, M.D., M. Ghigliani, M.D., H. Uehara, M.D., D. Estrin, M.D. Divisio´n de Gastroenterologia Seccio´n Endoscopı´a, Hospital de Clı´nicas “Jose´ de San Martin”, Instituto Quiru´rgico del Callao, Buenos Aires, Argentina. Introduction: EUS is an appropriate procedure for assessing depth of invasion to the gastric wall, which may be divided into 5 layers. In patients with low-grade lymphoma located in the mucosa (MALT) it is possible to correctly stage pretreatment and evaluate the response to medical therapy by studying the gastric layers at the end of treatment. Results: Between March 1994 and July 1999, 19 patients with Malt lymphoma were examined using Olympus UM 20 and 30. Of the 16 patients, 5 revealed the same condition after a median follow-up of 10 months (7 and 12 months). 5 patients with partial remission showed decreased thickness or number of affected layers, and in 6 patients cure was revealed by EUS and histology, which allowed us to clarify the location of MALT lymphoma. In 8 patients, lesions were located in the ceiling and in the upper body, in 5 in the mesogastrium and in 6 in the antrum. The affected layer extended by 84% to the submucosa, and only in 30.76% adenopathy was evident. Discussion: EUS is useful for obtaining a response to the treatment of MALT lymphoma. After reviewing and consulting the references we could confirm that MALT lymphoma may extend to the submucosal tissue without compromising the muscularis propia. In 6 patients, the mucosa did not reveal endoscopic or histological pathology. The submucosa was confirmed to be affected by thickening and had alteration of echogenity. According to Sackmann, this sign may show a probable relapse of MALT lymphoma. We are presently obtaining identical results. Conclusions: EUS was shown to be useful for evaluating the response to eradication of Helicobacter pylori and the behavior of the gastric wall in response to chemotherapy. The method is even more important in those cases when the biopsy was MALT negative and when EUS showed a thickened submucosa and echogenetically altered in “patches”. In these cases, it was advised to repeat the biopsy by marking these alternate areas using the biopsy-on-biopsy method to achieve a greater efficacy.
134 Age-specific seropositivity for H. pylori and dyspepsia in schoolchildren in Cayman Brac, Cayman Islands Charles C DM FACG⫹, Mohanty S⫹, Jefferson D⫹, Brisson S⫹, Jones N⫹, Martin M⫹, Dilbert V⫹, Harper P⫹, Morta M⫹, Paramlall M⫹, Onyonyor A⫹, Sue M#, Peura D#. ⫹Faith Hospital, C.I., #Univ. of Virginia Health Sciences, VA. Introduction: Age-specific sero-positivity for Helicobacter pylori infection (HP) in childhood rises sharper in developing vs. developed countries. The Cayman Islands, though physically Caribbean, have developed-world socioeconomic and health indices. Evaluation of HP status vs. dyspepsia in Cayman Brac (CB) school children allows regional and international comparisons. Methods: Questionnaires on past (⬎4 weeks, PD), current (⬍4 weeks, CD) and familial dyspepsia (FD) were administered to volunteers (200/400 [50%]) from CB schools (3-primary, 1-secondary). CD mean symptom score (SS) was computed: epigastric pain, nausea/vomiting, heartburn, bloating, belching, hunger pains, pain-relief-after-meals, graded 0 –3 (absent, mild-moderate, severe; Max 21). FD was classified for “peptic disease” and “gastric cancer”. Finger stick whole blood FlexSure diagnosed HP.
AJG – Vol. 95, No. 9, 2000
Results: Table 1. Age-specific HP sero-positivity* with respect to gender Age (yr)
0–4
5–9
10–14
Male Female Total
8 (0*) 3 (0*) 11 (0*)
31 (0*) 47 (1*) 78 (1*)
15–19
38 (1*) 42 (2*) 80 (3*)
Total
14 (2*) 17 (2*) 31 (4*)
91 (3*) 109 (5*) 200 (8*)
Table 2. HP status vs prevalence: past, current, familial dyspepsia
HP ⫹ve HP ⫺ve Total
n
PD
CDⴙ
FD
SSⴙ
8 192 200
1 16 17
2 39 41
1 37 38
1.1 0.7 0.7
Conclusion: (1). HP infection occurred in 4% (8/200) of CB school children (current dyspepsia [SS ⫽ 1.1]⫹ in 2/8). (2). HP ⫺ve school children had 8.5% past dyspepsia, 20.3% current dyspepsia (SS ⫽ 0.7)⫹ and 19% familial dyspepsia. 135 Prevalence of NSAIDs/ASA induced ulcers in patients attended at emergency units (EU): A prospective multicenter Brazilian study Decio Chinzon, MD, Jose Alves Freitas, MD, Jose Pimenta Modena, MD, Ismael Maguilnick, MD, Jorge Luiz Jorge, MD, Julio Cesar Pizzani, MD, Esther Dantas Correa, MD, Sonia Nadia Fylyk, MD, Edson Pedro Silva, MD, Schlioma Zaterka, MD, FACG*. Purpose: 1. Prevalence of upper GI ulcers and bleeding in patients seen at EU. 2. Prevalence of upper GI ulcers and bleeding due to NSAIDs/ASA, seen at EU. 3. Influence of age, gender, smoking and previous abdominal complaints, as risk factors for ulcer or bleeding in patients seen at EU. Methods: 317 patients from 10 Brazilian centers were enrolled in the study. Patients were divided in group I—non users of NSAIDs/ASA and group II— users of NSAIDs/ASA. Endoscopy was performed in the first 72 hs after symptoms started. Epigastric pain, pyrosis, nausea, vomiting, bleeding presence were recorded. Endoscopic findings were analysed in both groups. Results: 180 male and 137 female, aging 16 – 88 (mean 52.5). 127 of 317 had a previous history of NSAIDs/ASA ingestion (41.3%–16.9% NSAIDs; 24.4% ASA). The main reason for attendance was epigastric pain followed by melena and hematemesis in both groups with no statistical difference. No difference was observed in gender, smoking and the time of hospitalization in both groups. The mean age in group II (54.1y) was statistically higher than group I (48.8) p⫽0.012. Peptic ulcers were observed in 71.2% (226/317) of the patients (GU 97/317-30.5%; DU 92/317-29%; GU⫹DU 37/317-11.6%). In group I 151/190 (79.4%) had an ulcer and in group II 75/127 (59%) p ⬍ 0.0001. 25.2% of all ulcers bled. 37.3% in the NSAIDS/ ASA ulcer patients bled (GU 17/57-29.8%; DU 11/57-19.2%) and in group I 15.2% (29/190-GU 21/190-11%; DU 8/190 4.2%). The difference between group I and II bleeding ulcers was statistically significant p ⬍ 0.001. Conclusions: 1. Peptic ulcers is the most important cause of attendance at emergency units because of epigastric pain and or bleeding. The prevalence of ulcers was high in non NSAIDs/ASA users although the prevalence of bleeding ulcer was higher in the NSAID/s/ASA group. Gender, smoking and previous history of ulcer complaints did not distinguish users from non users of NSAIDs/ASA as a risk factor. NSAIDs/ASA users were older than non users. 136 Vitamin B12 absorption not affected by long term omeprazole therapy Lawrence B Cohen, MD, FACG, Marciano Reis, MD. Departments of Medicine and Clinical Pathology, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto, Toronto, Canada Vitamin B12 (B12) is extracted from dietary sources in the presence of gastric acid. Complete absence of gastric acid may decrease B12 bioavail-