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Helicobacter pylori infection and idiophatic thrombocytopenic purpura: Does a relation exist?
Abstracts
7
5 HELICOBACTER PYLORI INFBCTION AND IDIOPHATIC THRoMBOCYToPENIc PURPURA: DOES A RELATION EXIST? Brosolo P, Grimaz S, Skert C*, Maieron R, Lanzafame PO, Baccarani M*, de Pretis G Gastroenterology Unit, AzOsp. S.M.d.M.; *Division of Hematology, Univerity Hospital, “Microbiology Unit, AzOsp. S.M.d.M. - Udine
INFLUENCE OF A LONG TERM THERAPY FOR HELICOBACTER PYLORI ERADICATION ON GASTRIC METAPLASIA: A BLIND RANDOMIZED STUDY R. Sunani. G. Rocca’, I. Ventuini, E. Cemtti I P Dusio”, M. Ravizza”, E Carda’ & Gastroenterology Subalpina Assocmtion. Dep. of Gastmenterology Ospedale Nuovo, Rwoli, “Dep. of Sperimental Gastroenterolagy, Ospedale Molinette, Torino; “Dep. of Gastroenterology Ospedale Valdese, Torino; ‘Dep of Pathology Ospcdale Martini, Torino; Italy.
Background: Idiophatic Thrombocytopenic Purpura (ITP) is characterized by the reduction of the platelet count due to autoantibodies, when other causes of thmmbocytopenia were excluded. Treatment is based on steroidal therapy, with different results. The report of regression of ITP after eradication of Helicobacter pylori (HP) infection and the observation that autoimmunity could play a role in this infection, has suggested that chronic immunological stimulus determined by Hp or cross mimicry between platelets and Hp antigens could be in caw in ITP. Aims: To study the prevalence of Hp infection in patients affected by ITP, and the relation among the two clinical situations. Methods: We have studied 13 patients with lTP (age 16-79; 5M/8F), of which 12 previously treated with steroids (6 with success). Hp infection was assessed by 13Cwea breath test (UBT) and Hp eradication was performed by triple therapy (Omeprazole 20mg daily, Clarithromicyn 5OOmg twice daily and Tinidazole 500mg twice daily, for one week). Eradication was assessed by UBT at last two months after the end of the antibiotic treatment. Results: Five patients have resulted positive by UBT. One ptient with Hp infection has refused antibiotic therapy, while an other has not completed it. In the three remainder patients eradications has been achieved in two. None of fhem has presented an expressive increase of platelet count to distance of six months from the end of triple therapy. Conclusions: In our preliminary experience prevalence of Hp infection is not so common, as reported by other Authors, in patients affected by ITP. Hp eradication in patients with lTP has not determined an increase of platelet count. A relation between ITP and Hp infection still have to be demonstrated.
6
Background/Aim: to determine d Helicobacter pylon (Hp) eradicatmn mod@ antrum gastric atrophy and metaplasia. MsterialsiMethods: prospectwly we studied before and after randomlsation to placebo 01 10 antibiotics respectively 16 patients (pts) ulth duodenal ulcers Hp posihve (GroupI- M/F 13/3, mean age 47 years) for mean f standard deviation (mean + SD). 11 + 22 and 59 -t 40 months and 22 pts (Group2: M/F 1616,mean age 53 years) for 13 f 22 and 87 f 29 months. In the Group 2 patients were persltently Hp negative after therapy. Two biopsy at the antmm were taken at each andoscopy (Group 1 mean * SD: 11 i 4 /pts, Group 2. 18 * 3ipts). The gastritis was blind scored 0 to 3 for Chronic-Inactive (CI), Chronic-Active (CA), Atrophic (AT) and Metaplasia (ME) from the same pathologist (Score Classification). 976 biopsy samples were scored. We classified also the types of gastritis as Increased, Decreased OI Fluctuate when was judged to rise, fall or vary irregularly (Mode Classification). The Mann-Whitney U test was performed on both Score and Mode classificatmns. Given the long follow-up, data uere also analysed as time-to-event with the Kaplan-Meier non parametric methods. Results: no difference was found on gastntm m Group I and 2 before randomisation After therapy only CI and CA were different on score @ = 0 00) and on Decreased Mode classifications @ = 0 00) at Mann Wlutney cross sectmnal analysis. However difference of AT, ME and CI gastritis on Fluctuate Mode was found with survwal analysts (SAS System-Long Rank) Conclusions Hp eradication decrease antrum CAiCl gastritis and mochfies Atrophy, and Metaplasia When the time-to-event component is correctly taken into account the gastrx metaplasia is markedly different and open to new and more interestmg interpretatmns.
8 GASTRIC ESOPHAGITIS REFLUX DISEASE (GERD) AND ESOPHAGITIS IN DUODENAL ULCERS PATIENTS AFI-ER LONG TERM THERAPY FOR HELICOBACTER PYLORI ERADICATION R. Suiani, E. Cemiti, D. Mazzucco, E. Card&*, P Dusk?, M. Ravizza”, I iGlGE Dep. of Gastroenterology Ospedale Nuovo, Rivoli, *Dep.of Pathology Ospedale Martmi and ‘Dep. of Gastioenterology Ospedale Valdese, Torino; Italy Background/Aim: Strong evidence demonstrates that Helioobacter pylori (HP) is a causal factor in gastritis and duodenal ulcers (UD), but no causal relatlonsbip has been established with heartburn and esophaghis. We evaluated if patients, after long term eradication of Hp had developed endoscopic evidence of esophagitis and GERD Materials/Methods: Between January 1998 and December 1998), 53 consecutive patients (41 men and 12 women; medmn age, 59 years; range, 3092 years) with UD Hp positive were enrolled. Follow up after therapy occurred behveen mean f standard deviation (SD) 85 -t 43 months (range 8132). Ho eradication was v&f? in 21 oatients bv a&al bioosv. In 32 a CL0 test was performed in 1999 and endoscopy biopsy were taken from the amnun and the gastric body. AU patients were persistently Hp negative after therapy. Patients were asked about the presence of dyspeptic symptoms during the follow-up and the antacids intake. The esophagitis was scored according to Forrest c1assiiication. Statitstical ax&is was made bv the Wilcoxon test. Results: heartburn and esophagitis i&eased respec&ely from 15% to 24% @=0.286) and from 7% to 1‘8%&0.286) but were not si@icant. Enrolled Last follow up No data Present Assent Present Assent Heartburn 8 45 13 40 ESCl!JhaeitiS 4 49 10 43 I
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INCIDENCE OF CHOLANGIOCARCINOMA AND GASTRIC CANCER DISCOVERED DWG ENDOSCOPIC PROCEDURE FROM 1995 TO 1999 IN OUR INSTlTU’ITON R Sunani, D. Mazzucco,
I. Venturini
Dep. of Gastroenterology
Ospedale Nuovo Rivoli; Italy.
We evaluated the incidence of the Cholangiocarcinoma (CH) and Gastric Cancer (GC) in a cohort of patientes undergoing to endoscopic examination in order to verify if there is variation along these years of these two types of tumors in our population. Materials/Methods: We reviewed the records of the 445 patients undergoing to diagnostic or therapeutic endoscoplc retrograde cholangiopancreatography (ERCP) and of patients undergoing to Esophagogastroscopy (EGDS) between January 1, 1995 and november 20, Background/Aim:
1999. 648 ERCP were performed.
population undergoing
to ERCP
deviation (SD); (72 f 13 years, range 36-96) tile
in the same period GC
occurred in 44 patients. The linear regression analysis showed that there is not any variation
of
incidence
of CH and GC in these five
years
(P4.642). Years 1995
Total ERCP
1996 8 We& increasing 45 Antrum Gastric Atrophy 3 29 21 Conclusions: the absence of eastic tioohv found in the 96% of patients after treatment is presumed to proven esopl&itis and heartburn in patients that probably are genetically determinate to have high acid production. However her HZ antagonist nor PPI were necessary to &eve symptoms in every patient of our study. In conclusion heartburn is possible after Hp eradication, but it’s not clinically significative
The
included 194 males and 251 female with a mean age of 65 years old (max 98; min 22). Statistical analysis was performed using linear regrewon analysis. Results: As reported in the table, rn the years from 1995 to 1999, CH occurred in 28 patients (13 male and 15 female) mean age k standard
1997
1998 1999
Conclusions:
n’of Cholanglocarcinoma
88 113 98 111 107
n0of gastric cancer
4 5 8 4
7 I 10 10
I
10
Our data demonstrate that the incidence and frequencv of
CH and GC in our institution
has not changed along these 5 ye&s ani the
GC occurred in the last 3 years are % of total CH. Moreover it is important to stiess that while we needed 20 ERCP to find 1 Ch we needed 136 EGDS to find 1 GC.
7
5 HELICOBACTER PYLORI INFBCTION AND IDIOPHATIC THRoMBOCYToPENIc PURPURA: DOES A RELATION EXIST? Brosolo P, Grimaz S, Skert C*, Maieron R, Lanzafame PO, Baccarani M*, de Pretis G Gastroenterology Unit, AzOsp. S.M.d.M.; *Division of Hematology, Univerity Hospital, “Microbiology Unit, AzOsp. S.M.d.M. - Udine
INFLUENCE OF A LONG TERM THERAPY FOR HELICOBACTER PYLORI ERADICATION ON GASTRIC METAPLASIA: A BLIND RANDOMIZED STUDY R. Sunani. G. Rocca’, I. Ventuini, E. Cemtti I P Dusio”, M. Ravizza”, E Carda’ & Gastroenterology Subalpina Assocmtion. Dep. of Gastmenterology Ospedale Nuovo, Rwoli, “Dep. of Sperimental Gastroenterolagy, Ospedale Molinette, Torino; “Dep. of Gastroenterology Ospedale Valdese, Torino; ‘Dep of Pathology Ospcdale Martini, Torino; Italy.
Background: Idiophatic Thrombocytopenic Purpura (ITP) is characterized by the reduction of the platelet count due to autoantibodies, when other causes of thmmbocytopenia were excluded. Treatment is based on steroidal therapy, with different results. The report of regression of ITP after eradication of Helicobacter pylori (HP) infection and the observation that autoimmunity could play a role in this infection, has suggested that chronic immunological stimulus determined by Hp or cross mimicry between platelets and Hp antigens could be in caw in ITP. Aims: To study the prevalence of Hp infection in patients affected by ITP, and the relation among the two clinical situations. Methods: We have studied 13 patients with lTP (age 16-79; 5M/8F), of which 12 previously treated with steroids (6 with success). Hp infection was assessed by 13Cwea breath test (UBT) and Hp eradication was performed by triple therapy (Omeprazole 20mg daily, Clarithromicyn 5OOmg twice daily and Tinidazole 500mg twice daily, for one week). Eradication was assessed by UBT at last two months after the end of the antibiotic treatment. Results: Five patients have resulted positive by UBT. One ptient with Hp infection has refused antibiotic therapy, while an other has not completed it. In the three remainder patients eradications has been achieved in two. None of fhem has presented an expressive increase of platelet count to distance of six months from the end of triple therapy. Conclusions: In our preliminary experience prevalence of Hp infection is not so common, as reported by other Authors, in patients affected by ITP. Hp eradication in patients with lTP has not determined an increase of platelet count. A relation between ITP and Hp infection still have to be demonstrated.
6
Background/Aim: to determine d Helicobacter pylon (Hp) eradicatmn mod@ antrum gastric atrophy and metaplasia. MsterialsiMethods: prospectwly we studied before and after randomlsation to placebo 01 10 antibiotics respectively 16 patients (pts) ulth duodenal ulcers Hp posihve (GroupI- M/F 13/3, mean age 47 years) for mean f standard deviation (mean + SD). 11 + 22 and 59 -t 40 months and 22 pts (Group2: M/F 1616,mean age 53 years) for 13 f 22 and 87 f 29 months. In the Group 2 patients were persltently Hp negative after therapy. Two biopsy at the antmm were taken at each andoscopy (Group 1 mean * SD: 11 i 4 /pts, Group 2. 18 * 3ipts). The gastritis was blind scored 0 to 3 for Chronic-Inactive (CI), Chronic-Active (CA), Atrophic (AT) and Metaplasia (ME) from the same pathologist (Score Classification). 976 biopsy samples were scored. We classified also the types of gastritis as Increased, Decreased OI Fluctuate when was judged to rise, fall or vary irregularly (Mode Classification). The Mann-Whitney U test was performed on both Score and Mode classificatmns. Given the long follow-up, data uere also analysed as time-to-event with the Kaplan-Meier non parametric methods. Results: no difference was found on gastntm m Group I and 2 before randomisation After therapy only CI and CA were different on score @ = 0 00) and on Decreased Mode classifications @ = 0 00) at Mann Wlutney cross sectmnal analysis. However difference of AT, ME and CI gastritis on Fluctuate Mode was found with survwal analysts (SAS System-Long Rank) Conclusions Hp eradication decrease antrum CAiCl gastritis and mochfies Atrophy, and Metaplasia When the time-to-event component is correctly taken into account the gastrx metaplasia is markedly different and open to new and more interestmg interpretatmns.
8 GASTRIC ESOPHAGITIS REFLUX DISEASE (GERD) AND ESOPHAGITIS IN DUODENAL ULCERS PATIENTS AFI-ER LONG TERM THERAPY FOR HELICOBACTER PYLORI ERADICATION R. Suiani, E. Cemiti, D. Mazzucco, E. Card&*, P Dusk?, M. Ravizza”, I iGlGE Dep. of Gastroenterology Ospedale Nuovo, Rivoli, *Dep.of Pathology Ospedale Martmi and ‘Dep. of Gastioenterology Ospedale Valdese, Torino; Italy Background/Aim: Strong evidence demonstrates that Helioobacter pylori (HP) is a causal factor in gastritis and duodenal ulcers (UD), but no causal relatlonsbip has been established with heartburn and esophaghis. We evaluated if patients, after long term eradication of Hp had developed endoscopic evidence of esophagitis and GERD Materials/Methods: Between January 1998 and December 1998), 53 consecutive patients (41 men and 12 women; medmn age, 59 years; range, 3092 years) with UD Hp positive were enrolled. Follow up after therapy occurred behveen mean f standard deviation (SD) 85 -t 43 months (range 8132). Ho eradication was v&f? in 21 oatients bv a&al bioosv. In 32 a CL0 test was performed in 1999 and endoscopy biopsy were taken from the amnun and the gastric body. AU patients were persistently Hp negative after therapy. Patients were asked about the presence of dyspeptic symptoms during the follow-up and the antacids intake. The esophagitis was scored according to Forrest c1assiiication. Statitstical ax&is was made bv the Wilcoxon test. Results: heartburn and esophagitis i&eased respec&ely from 15% to 24% @=0.286) and from 7% to 1‘8%&0.286) but were not si@icant. Enrolled Last follow up No data Present Assent Present Assent Heartburn 8 45 13 40 ESCl!JhaeitiS 4 49 10 43 I
.
_
.
.
.
_
INCIDENCE OF CHOLANGIOCARCINOMA AND GASTRIC CANCER DISCOVERED DWG ENDOSCOPIC PROCEDURE FROM 1995 TO 1999 IN OUR INSTlTU’ITON R Sunani, D. Mazzucco,
I. Venturini
Dep. of Gastroenterology
Ospedale Nuovo Rivoli; Italy.
We evaluated the incidence of the Cholangiocarcinoma (CH) and Gastric Cancer (GC) in a cohort of patientes undergoing to endoscopic examination in order to verify if there is variation along these years of these two types of tumors in our population. Materials/Methods: We reviewed the records of the 445 patients undergoing to diagnostic or therapeutic endoscoplc retrograde cholangiopancreatography (ERCP) and of patients undergoing to Esophagogastroscopy (EGDS) between January 1, 1995 and november 20, Background/Aim:
1999. 648 ERCP were performed.
population undergoing
to ERCP
deviation (SD); (72 f 13 years, range 36-96) tile
in the same period GC
occurred in 44 patients. The linear regression analysis showed that there is not any variation
of
incidence
of CH and GC in these five
years
(P4.642). Years 1995
Total ERCP
1996 8 We& increasing 45 Antrum Gastric Atrophy 3 29 21 Conclusions: the absence of eastic tioohv found in the 96% of patients after treatment is presumed to proven esopl&itis and heartburn in patients that probably are genetically determinate to have high acid production. However her HZ antagonist nor PPI were necessary to &eve symptoms in every patient of our study. In conclusion heartburn is possible after Hp eradication, but it’s not clinically significative
The
included 194 males and 251 female with a mean age of 65 years old (max 98; min 22). Statistical analysis was performed using linear regrewon analysis. Results: As reported in the table, rn the years from 1995 to 1999, CH occurred in 28 patients (13 male and 15 female) mean age k standard
1997
1998 1999
Conclusions:
n’of Cholanglocarcinoma
88 113 98 111 107
n0of gastric cancer
4 5 8 4
7 I 10 10
I
10
Our data demonstrate that the incidence and frequencv of
CH and GC in our institution
has not changed along these 5 ye&s ani the
GC occurred in the last 3 years are % of total CH. Moreover it is important to stiess that while we needed 20 ERCP to find 1 Ch we needed 136 EGDS to find 1 GC.