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Primary B-cell gastric lymphoma of mucosa-asso-ciated lymphoid tissue without helicobacter pylori infection
April 2000
AGAA1209
5546 PRIMARY B-CELL GASTRIC LYMPHOMA OF MUCOSA-ASSOCIATED LYMPHOID TISSUE WITHOUT HEUCOBACTER rrLORI INFECTION. Taiji Akamatsu, Hideharu Miyabayashi, Kazuya Fujimori, Taimei Kaneko, Toru Fujisawa, Masahiro Matsuzawa, Kendo Kiyosawa, Tsutomu Katsuyama, Shinshu Univ, Matsumoto, Japan. Primary gastric lymphoma of mucosa-associated lymphoid tissue (MALT) is known to be linked to infection with Helicobacter pylori (H. pylori) , and many cases of regression of gastric MALT lymphoma after eradication of H.pylori has been reported. We report 6 cases of gastric MALT lymphoma without H.pylori infection. The sex ratio was same (1:1). The patients' ages ranged from 59 to 77 years, the average being 68.8. Biopsy spepecimens revealed characteristic findings of MALT lymphoma including centrocytelike cells within the lamina propria infiltrating the glandular epithlium to form Iymphoepitheliallesions in all ceses. Five of 6 cases were diagnosed low-grade MALT lymphoma, and remaining I case contained high-grade compornent. The absence of H.pylori was assessed by histological finding with immunostaining using anti-H.pylori antibody, culture, and rapid urease test. One case was positive of hepatitis C antiboby, and another I case hapatitis B antigen. Five of 6 cases received antibacterial treatment consist of proton pump inhibitor, amoxicillin, and clarithromycin. Four of 5 cases showed no response, but remaining I case showed partial regression of lymphoma in the endoscopic and histological findings. H.pylori negativegastric MALT lymphomas were few, and antibacterial treatment was usually ineffective.
5547 CHANGES IN ANGIOGENIC FACTORS DURING HEALING OF ACETIC-ACID-INDUCED GASTRIC ULCERS IN RATS AND THE EFFECT OF TREATMENT WITH A PROTON PUMP INHIBITOR. Masumi Akimoto, Hiroshi Hashimoto, Mutsuo Shigemoto, Katsuko Yamashita, Tokyo Women's Med Univ, Tokyo, Japan. In fetal angiogenesis,VEGF and its receptors are required from the early stage of lumen formation.These factors nonspecifically act on systemic blood vessels. During vascular maturation in the late stage of lumen formation, SDF-I and its receptor CXCR4 participate in an organ-specific manner in the formation of large blood vessels supplying the gastrointestinal tract. At the 100thAGA in 1999, we reported that KDR and FIt-I appear during early ulcer formation and that CXCR4 increases during healing and scar formation.This time we studied changes in SDFI,CXCR4,and KDR during healing of acetic-acid -induced ulcers in rats and assessed the effects of treatment with a proton pump inhibitor (PPI). Subjects and methods:Male Wistar rats were used.Ulcers were induced by the application of 100% acetic acid as described by Okabe.The stomach was removed 3days(C3),7days(C7),12days(CI2),and 28days(C28) after ulcer induction. The expressions of SDF-I,CXCR4,and KDR mRNA in frozen gastric tissue were measured by RT-PCR.The PPI group(P) was given rabeprazole in a subcutaneous dose of 30 mg/kg from the day after ulcer induction.The control group(CO) was not treated with acetic acid. Discussion: In the PPI-untreated group,all three factors peaked at C7. In the PPI groups,CXCR4 increased with time,and the value at PI2 was higher than that at CO(P <0.01 ).On day 12, thePPI-untreated group showed a trend toward decreased expression of three factors, whereas high values persisted in the PPI group. On day 28,both C28 and P28 showed a trend toward a decrease in all three factors,but the values remained higher in the PPI group. Our results suggest that these factors promote the maturation of blood vessels in the gastric wall and PPI may be involved in ulcer healing and the prevention of recurrence.
with one week oral PPI treatment, followed in both case by 4 weeks H2 blocker treatment in the management of H. pylori positive, bleeding duodenal ulcer (Forrest I.B, II.B). Patients and methods: 46 patients, who were accepted because of bleeding duodenal ulcer, or with signs of recent hemorrhage, - not taking NSAIDs, aspirin or coumarol - and proved to be H. pylori positive by rapid urease test and serology, were randomly divided into two groups: 24 patients received eradication therapy (2x30 mg lansoprazole, 2xlOOO mg amoxicillin, 2x500 mg clarithromycin for one week) followed by 4 weeks famotidine treatment (40 mg/day), while 22 patients received solely oral PPI treatment (2x30 mg lansoprazole) for one week, followed also by famotidine (40 mg/day) for 4 weeks. Eradication was also carried out in the second group, just after the famotidine treatment. If necessary, endoscopic management of bleeding was performed at the beginning (heat probe unit or injection of diluted adrenaline), endoscopic revision was carried out after 72 hours and 5 weeks, UBT 8 weeks following the eradication. Several laboratory data were compared between the two groups. Results: One patient did not complete the trial in the first group and two in the other. Among those, who returned to control endoscopy, ulcer healing rate after 5 weeks was 100 % in both groups, H. pylori eradication was successful in 20123 vs. 17120 cases, no severe rebleeding occured and there was no need of surgical intervention. No significant difference in the need of transfusion and decrease of haemoglobine level could be found between the two groups. However, although no laxative treatment was given, blood urea level returned to normal within 3,2 days vs. 3,8 days and fecal occult blood test became negative within 4,4 days vs, 5,3 days in the two groups. Conclusion: Although the number of patients has still to be increased to obtain more convincing results, according to our preliminary observation, immediate eradication therapy seems to be beneficial by accelerating the healing process in the management of H. pylori positive bleeding duodenal ulcer.
5549 DOES PRIOR USE OF ACID SUPPRESSIVE THERAPY PREDICT ETIOLOGY OR AFFECT OUTCOME IN ACUTE UPPER GI BLEEDING? Rafael Amaro, Manuel F. Bustamante, Jorge Lascano, Neil H. Stollman, Univ of Miami, Miami, FL. Background: With the increasing use of proton-pump inhibitors (PPls) and H-2 blockers, many patients are being maintained on acid-suppressive therapy (AST). The aim of this study was to determine if pre-hospital use of AST would alter etiology andlor outcome in patients presenting with acute upper GI bleeding (UGIB). Methods: We retrospectively reviewed all patients presenting to the ER with acute UGIB from l/99-6/99. Patients with GI malignancies were excluded. History, endoscopic findings and hospital course were recorded. Patients were divided into two groups based on their use (Group I) or non-use (Group 2) of AST prior to admission. Results: 100 patients (76 male, 24 female) were included. Mean age was 54 years (range: 24-87). 29 patients were taking AST (12 PPls, 17 H2blockers). Both groups were similar for age/sex. The etiology of the UGIB was similar in Group I vs Group 2: PUD (48% vs 46%), varices (21% vs 18%), others (31% vs 35%). There were significantly more patients taking NSAIDs in Group 2 than in Group I (39% vs 10%, p<0.005), and significantly more patients with a past history of PUD in Group I than in Group 2 (55% vs II %, p
Results' SDF-1 CXCR4 KDR
CO 0.85 0.88 0.99
C3 1.12 1.48 0.97
C7 1.48 2.03 1.52
C12 1.41 1.53 1.40
C27 1.10 1.22 1.00
P3 1.47 1.34 0.83
P7 1.96 1.55 1.12
P12 1.75 230 1.20
P27 1.51 1.40 1.01
5548 IMMEDIATE ERADICATION OF HELICOBACTER PYLORI INFECTION SEEMS TO BE BENEFICIAL COMPARED TO SOLELY "PPI" TREATMENT IN THE MANAGEMENT OF BLEEDING DUODENAL ULCER. Istvan F. Altorjay, Zsuzsa S. Vitalis, Robert R. Szasz, Karoly K. Palatka, Miklos M. Udvardy, 2nd Dept Medicine, Debrecen, Hungary. Background: It is widely accepted that following the eradication of H.pylori infection the recurrence of ulcer bleeding is rare. Hardly any reliable data however have been published about the effect of immediate eradication therapy, in the management of bleeding duodenal ulcer. The aim of our study was to compare the effect of acute, one week eradication therapy
Transfused Repeat EGO Hospital LOS ICU admit ICU LOS Surgery Mortality
AcidSuppression (Group 1) NoacidsuppresSion (Group 2) 13/29 (45%) 5/29 (17%) 5.2days 9/29 (31%) 3.3days 0 1/29 (3.4%)
25/71 (35%) 12/71 (17%) 6.7days 24/71 (34%) 5.5days 2/71 (3%) 3/71 (4.2%)
NS NS NS NS NS NS NS
AGAA1209
5546 PRIMARY B-CELL GASTRIC LYMPHOMA OF MUCOSA-ASSOCIATED LYMPHOID TISSUE WITHOUT HEUCOBACTER rrLORI INFECTION. Taiji Akamatsu, Hideharu Miyabayashi, Kazuya Fujimori, Taimei Kaneko, Toru Fujisawa, Masahiro Matsuzawa, Kendo Kiyosawa, Tsutomu Katsuyama, Shinshu Univ, Matsumoto, Japan. Primary gastric lymphoma of mucosa-associated lymphoid tissue (MALT) is known to be linked to infection with Helicobacter pylori (H. pylori) , and many cases of regression of gastric MALT lymphoma after eradication of H.pylori has been reported. We report 6 cases of gastric MALT lymphoma without H.pylori infection. The sex ratio was same (1:1). The patients' ages ranged from 59 to 77 years, the average being 68.8. Biopsy spepecimens revealed characteristic findings of MALT lymphoma including centrocytelike cells within the lamina propria infiltrating the glandular epithlium to form Iymphoepitheliallesions in all ceses. Five of 6 cases were diagnosed low-grade MALT lymphoma, and remaining I case contained high-grade compornent. The absence of H.pylori was assessed by histological finding with immunostaining using anti-H.pylori antibody, culture, and rapid urease test. One case was positive of hepatitis C antiboby, and another I case hapatitis B antigen. Five of 6 cases received antibacterial treatment consist of proton pump inhibitor, amoxicillin, and clarithromycin. Four of 5 cases showed no response, but remaining I case showed partial regression of lymphoma in the endoscopic and histological findings. H.pylori negativegastric MALT lymphomas were few, and antibacterial treatment was usually ineffective.
5547 CHANGES IN ANGIOGENIC FACTORS DURING HEALING OF ACETIC-ACID-INDUCED GASTRIC ULCERS IN RATS AND THE EFFECT OF TREATMENT WITH A PROTON PUMP INHIBITOR. Masumi Akimoto, Hiroshi Hashimoto, Mutsuo Shigemoto, Katsuko Yamashita, Tokyo Women's Med Univ, Tokyo, Japan. In fetal angiogenesis,VEGF and its receptors are required from the early stage of lumen formation.These factors nonspecifically act on systemic blood vessels. During vascular maturation in the late stage of lumen formation, SDF-I and its receptor CXCR4 participate in an organ-specific manner in the formation of large blood vessels supplying the gastrointestinal tract. At the 100thAGA in 1999, we reported that KDR and FIt-I appear during early ulcer formation and that CXCR4 increases during healing and scar formation.This time we studied changes in SDFI,CXCR4,and KDR during healing of acetic-acid -induced ulcers in rats and assessed the effects of treatment with a proton pump inhibitor (PPI). Subjects and methods:Male Wistar rats were used.Ulcers were induced by the application of 100% acetic acid as described by Okabe.The stomach was removed 3days(C3),7days(C7),12days(CI2),and 28days(C28) after ulcer induction. The expressions of SDF-I,CXCR4,and KDR mRNA in frozen gastric tissue were measured by RT-PCR.The PPI group(P) was given rabeprazole in a subcutaneous dose of 30 mg/kg from the day after ulcer induction.The control group(CO) was not treated with acetic acid. Discussion: In the PPI-untreated group,all three factors peaked at C7. In the PPI groups,CXCR4 increased with time,and the value at PI2 was higher than that at CO(P <0.01 ).On day 12, thePPI-untreated group showed a trend toward decreased expression of three factors, whereas high values persisted in the PPI group. On day 28,both C28 and P28 showed a trend toward a decrease in all three factors,but the values remained higher in the PPI group. Our results suggest that these factors promote the maturation of blood vessels in the gastric wall and PPI may be involved in ulcer healing and the prevention of recurrence.
with one week oral PPI treatment, followed in both case by 4 weeks H2 blocker treatment in the management of H. pylori positive, bleeding duodenal ulcer (Forrest I.B, II.B). Patients and methods: 46 patients, who were accepted because of bleeding duodenal ulcer, or with signs of recent hemorrhage, - not taking NSAIDs, aspirin or coumarol - and proved to be H. pylori positive by rapid urease test and serology, were randomly divided into two groups: 24 patients received eradication therapy (2x30 mg lansoprazole, 2xlOOO mg amoxicillin, 2x500 mg clarithromycin for one week) followed by 4 weeks famotidine treatment (40 mg/day), while 22 patients received solely oral PPI treatment (2x30 mg lansoprazole) for one week, followed also by famotidine (40 mg/day) for 4 weeks. Eradication was also carried out in the second group, just after the famotidine treatment. If necessary, endoscopic management of bleeding was performed at the beginning (heat probe unit or injection of diluted adrenaline), endoscopic revision was carried out after 72 hours and 5 weeks, UBT 8 weeks following the eradication. Several laboratory data were compared between the two groups. Results: One patient did not complete the trial in the first group and two in the other. Among those, who returned to control endoscopy, ulcer healing rate after 5 weeks was 100 % in both groups, H. pylori eradication was successful in 20123 vs. 17120 cases, no severe rebleeding occured and there was no need of surgical intervention. No significant difference in the need of transfusion and decrease of haemoglobine level could be found between the two groups. However, although no laxative treatment was given, blood urea level returned to normal within 3,2 days vs. 3,8 days and fecal occult blood test became negative within 4,4 days vs, 5,3 days in the two groups. Conclusion: Although the number of patients has still to be increased to obtain more convincing results, according to our preliminary observation, immediate eradication therapy seems to be beneficial by accelerating the healing process in the management of H. pylori positive bleeding duodenal ulcer.
5549 DOES PRIOR USE OF ACID SUPPRESSIVE THERAPY PREDICT ETIOLOGY OR AFFECT OUTCOME IN ACUTE UPPER GI BLEEDING? Rafael Amaro, Manuel F. Bustamante, Jorge Lascano, Neil H. Stollman, Univ of Miami, Miami, FL. Background: With the increasing use of proton-pump inhibitors (PPls) and H-2 blockers, many patients are being maintained on acid-suppressive therapy (AST). The aim of this study was to determine if pre-hospital use of AST would alter etiology andlor outcome in patients presenting with acute upper GI bleeding (UGIB). Methods: We retrospectively reviewed all patients presenting to the ER with acute UGIB from l/99-6/99. Patients with GI malignancies were excluded. History, endoscopic findings and hospital course were recorded. Patients were divided into two groups based on their use (Group I) or non-use (Group 2) of AST prior to admission. Results: 100 patients (76 male, 24 female) were included. Mean age was 54 years (range: 24-87). 29 patients were taking AST (12 PPls, 17 H2blockers). Both groups were similar for age/sex. The etiology of the UGIB was similar in Group I vs Group 2: PUD (48% vs 46%), varices (21% vs 18%), others (31% vs 35%). There were significantly more patients taking NSAIDs in Group 2 than in Group I (39% vs 10%, p<0.005), and significantly more patients with a past history of PUD in Group I than in Group 2 (55% vs II %, p
Results' SDF-1 CXCR4 KDR
CO 0.85 0.88 0.99
C3 1.12 1.48 0.97
C7 1.48 2.03 1.52
C12 1.41 1.53 1.40
C27 1.10 1.22 1.00
P3 1.47 1.34 0.83
P7 1.96 1.55 1.12
P12 1.75 230 1.20
P27 1.51 1.40 1.01
5548 IMMEDIATE ERADICATION OF HELICOBACTER PYLORI INFECTION SEEMS TO BE BENEFICIAL COMPARED TO SOLELY "PPI" TREATMENT IN THE MANAGEMENT OF BLEEDING DUODENAL ULCER. Istvan F. Altorjay, Zsuzsa S. Vitalis, Robert R. Szasz, Karoly K. Palatka, Miklos M. Udvardy, 2nd Dept Medicine, Debrecen, Hungary. Background: It is widely accepted that following the eradication of H.pylori infection the recurrence of ulcer bleeding is rare. Hardly any reliable data however have been published about the effect of immediate eradication therapy, in the management of bleeding duodenal ulcer. The aim of our study was to compare the effect of acute, one week eradication therapy
Transfused Repeat EGO Hospital LOS ICU admit ICU LOS Surgery Mortality
AcidSuppression (Group 1) NoacidsuppresSion (Group 2) 13/29 (45%) 5/29 (17%) 5.2days 9/29 (31%) 3.3days 0 1/29 (3.4%)
25/71 (35%) 12/71 (17%) 6.7days 24/71 (34%) 5.5days 2/71 (3%) 3/71 (4.2%)
NS NS NS NS NS NS NS