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Liu HN, Wang R, Cao Y, Xian F, Bi XJ, Wu DJ, Wang B, Wang XW, Lan CH. Comparison of the efficacy between the dual therapy of tegoprazan and the quadruple therapy of tegoprazan: A randomized, controlled, multicenter study. Clin Transl Gastroenterol 2024:01720094-990000000-00246. [PMID: 38557975 DOI: 10.14309/ctg.0000000000000699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Tegoprazan (TPZ), a potassium-competitive acid blocker, exerts a strong acid-suppression effect and a rapid onset of action. However, research on TPZ-amoxicillin (TA) dual treatment is limited. Here, we compared the safety and efficacy of TPZ-amoxicillin dual treatment and TPZ, bismuth potassium citrate, amoxicillin, and clarithromycin (TBAC) quadruple therapy in patients newly diagnosed with H. pylori infection over a 14-day treatment period. METHODS A total of 236 patients newly diagnosed with H. pylori were enrolled in this multi-center, prospective, open-label, and randomized controlled study. Patients randomly received either TA dual or TBAC quadruple therapy. The incidence of adverse reactions and treatment compliance were recorded and then analyzed. RESULTS The intention-to-treat analysis revealed that H. pylori-eradication rates were 83.9% (95% confidence interval [CI] 78.2%-91.3%) and 81.4% (95% CI 74.2%-88.5%) for the TA and TBAC groups, respectively, with no statistically significant difference between them (P = 0.606). The per-protocol analysis revealed that the H. pylori-eradication rates were 88.3% and 84.8% for the TA and TBAC groups, respectively (P = 0.447). The incidence of adverse reactions was significantly lower in the TA group than in the TBAC group (4.2% vs. 15.3%, P = 0.004). Moreover, the TA group demonstrated substantially higher treatment compliance than the TBAC group (94.1% vs. 89.0%, P = 0.020). CONCLUSION The TA dual therapy successfully eradicated H. pylori with a high eradication rate and a low incidence of adverse reactions. Therefore, this treatment is recommended as an alternative course for patients newly diagnosed with H. pylori infection.
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Affiliation(s)
- Han-Ning Liu
- Department of Gastroenterology, Third Affiliated Hospital, Army Medical University, Chongqing, China
| | - Rui Wang
- Department of Gastroenterology and Respiration, No.945 Hospital of Joint Logistic Support Force of Chinese PLA, Yaan, Sichuan, China
| | - Yan Cao
- Department of Gastroenterology, Third Affiliated Hospital, Army Medical University, Chongqing, China
| | - Feng Xian
- Department of Gastroenterology and Respiration, No.945 Hospital of Joint Logistic Support Force of Chinese PLA, Yaan, Sichuan, China
| | - Xian-Jin Bi
- Department of Gastroenterology and Respiration, No.945 Hospital of Joint Logistic Support Force of Chinese PLA, Yaan, Sichuan, China
| | - Ding-Jian Wu
- Department of Gastroenterology and Respiration, No.945 Hospital of Joint Logistic Support Force of Chinese PLA, Yaan, Sichuan, China
| | - Bin Wang
- Department of Gastroenterology, Third Affiliated Hospital, Army Medical University, Chongqing, China
| | - Xing-Wei Wang
- Department of Gastroenterology, Third Affiliated Hospital, Army Medical University, Chongqing, China
| | - Chun-Hui Lan
- Department of Gastroenterology, Third Affiliated Hospital, Army Medical University, Chongqing, China
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Su NY, Shi Q, Mei H, Hu J, Liu YX, Liu HN, Liu HQ, Guo Y, Wang XW, Lan CH. Efficacy and safety of vonoprazan-based dual therapy and esomeprazole-based dual therapy in eradicating primary Helicobacter pylori infection: A propensity score matching analysis. Helicobacter 2023; 28:e13003. [PMID: 37565458 DOI: 10.1111/hel.13003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/25/2023] [Accepted: 06/14/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND According to the Maastricht VI/Florence consensus report, potassium-competitive acid blockers (P-CAB) may improve Helicobacter pylori eradication treatment. MATERIALS AND METHODS A total of 213 H. pylori treatment-naive patients aged between 18 and 70 years were treated with two regimens. The two regimens are VDT: 20 mg vonoprazan twice a day and 1 g amoxicillin three times daily and EDT: 20 mg esomeprazole four times a day and 750 mg amoxicillin four times daily. 13 C-urea breath tests were used to evaluate eradication rate 4-6 weeks after treatment. Based on propensity score matching (PSM), this retrospective study analyzed the eradication rates, adverse events (AEs), compliance, and antibiotic resistance rates in VDT and EDT groups. RESULTS On intention-to-treat (ITT) analysis, the eradication rate in VDT group (89.0%; 95% CI 81.7-96.3) was non-inferior to that in EDT group (87.7%; 95% CI 80.1-95.3; p = 0.796). The corresponding per-protocol (PP) eradication rates were 94.1% (95% CI 88.4-99.8) and 92.8% (95% CI 86.7-98.9; p = 1.000), respectively. There were no significant between-group differences with respect to compliance or incidence of AEs. CONCLUSIONS The efficacy and safety of 14-day VDT and EDT were comparable. Therefore, 14-day VDT or EDT may be recommended for the first-line treatment of H. pylori infection.
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Affiliation(s)
- Na-Yun Su
- Department of Gastroenterology, Chongqing Key Laboratory of Digestive Malignancies, Daping Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Qing Shi
- Department of Gastroenterology, Chongqing Key Laboratory of Digestive Malignancies, Daping Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Hao Mei
- Department of Gastroenterology, Chongqing Key Laboratory of Digestive Malignancies, Daping Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Jie Hu
- Department of Gastroenterology, Chongqing Key Laboratory of Digestive Malignancies, Daping Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Yu-Xiang Liu
- Department of Gastroenterology, Chongqing Key Laboratory of Digestive Malignancies, Daping Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Han-Ning Liu
- Department of Gastroenterology, Chongqing Key Laboratory of Digestive Malignancies, Daping Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Heng-Qi Liu
- Department of Gastroenterology, Chongqing Key Laboratory of Digestive Malignancies, Daping Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Yan Guo
- Department of Gastroenterology, Chongqing Key Laboratory of Digestive Malignancies, Daping Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Xing-Wei Wang
- Department of Gastroenterology, Chongqing Key Laboratory of Digestive Malignancies, Daping Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Chun-Hui Lan
- Department of Gastroenterology, Chongqing Key Laboratory of Digestive Malignancies, Daping Hospital, Army Medical University, Third Military Medical University, Chongqing, China
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Hu J, Mei H, Su NY, Sun WJ, Zhang DK, Fan LL, He P, Pan J, Wang XW, Zou PY, Liu YX, Guo Y, Lan CH. Eradication rates of Helicobacter pylori in treatment-naive patients following 14-day vonoprazan-amoxicillin dual therapy: A multicenter randomized controlled trial in China. Helicobacter 2023:e12970. [PMID: 37160689 DOI: 10.1111/hel.12970] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Potassium-competitive acid blockers (P-CAB) are recommended for the treatment of Helicobacter pylori infections, but dual therapy of P-CAB with amoxicillin has been poorly studied. The current study compared the efficacy, adverse reactions, compliance, and effects on gut microbiota of 14-day vonoprazan-amoxicillin (VA) dual therapy with esomeprazole, bismuth potassium citrate, amoxicillin, and metronidazole (EBAM) quadruple therapy in treatment-naive patients with H. pylori. MATERIALS AND METHODS This was a multicenter, open-label, randomized, and controlled, non-inferiority study. Patients (n = 194) enrolled from six centers were randomly divided into either the VA or EBAM group. H. pylori eradication was determined using 13 C urea breath tests (UBT) 4-6 weeks post-treatment. Fecal samples were collected, and gut microbial populations were analyzed by 16S rDNA and metagenomic sequencing technology. RESULTS Eradication rates of H. pylori in the VA and EBAM groups were 88.7% and 91.8%, respectively, according to intention-to-treat (ITT) analysis; 95.6% and 96.7% with per-protocol (PP) analysis; and 94.5% and 96.7% with modified ITT (mITT) analysis (all p > 0.05). The incidence of adverse reactions in the VA group was significantly lower compared to the EBAM group, and compliance within both groups was good. There was no difference in α-diversity or microbial composition in the VA and EBAM groups at one-month post-treatment compared to baseline, except for a markedly reduced abundance of Bacteroides in the EBAM group. CONCLUSION VA therapy achieved excellent eradication rates with low adverse reactions, good compliance, and little impact on gut microbiota. VA therapy should be recommended as a first-line treatment against H. pylori.
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Affiliation(s)
- Jie Hu
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Hao Mei
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Na-Yun Su
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Wen-Jing Sun
- Department of Gastroenterology, The 13th People's Hospital of Chongqing, Chongqing, China
| | - De-Kui Zhang
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou, China
| | - Li-Lin Fan
- Department of Gastroenterology, The Second People's Hospital of Chongqing, Chongqing, China
| | - Ping He
- Department of Gastroenterology, Yongchuan Hospital Affiliated to Chongqing Medical University, Chongqing, China
| | - Jie Pan
- Department of Gastroenterology, Wenzhou Central Hospital, Wenzhou, China
| | - Xing-Wei Wang
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Pei-Ying Zou
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Yu-Xiang Liu
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Yan Guo
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Chun-Hui Lan
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
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Mei H, Guo Y, Zhao JT, Yang J, Sun WJ, Zhang DK, He P, Shi G, Su NY, Han R, Lan CH. Efficacy and safety of high-dose esomeprazole and amoxicillin dual therapy versus bismuth-containing quadruple therapy for Helicobacter pylori infection: a multicenter, randomized controlled clinical trial. Therap Adv Gastroenterol 2022; 15:17562848221142925. [PMID: 36600686 PMCID: PMC9806404 DOI: 10.1177/17562848221142925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/25/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A high-dose proton pump inhibitor (PPI)-amoxicillin dual therapy has been investigated for treatment of patients with Helicobacter pylori (H. pylori) infection. Currently, the efficacy of this dual therapy remains inconclusive, with controversial findings from various single-center clinical trials. OBJECTIVES To assess the efficacy and safety of high-dose dual therapy (HDDT) compared with the bismuth-containing quadruple therapy (BQT) in treatment-naive patients with H. pylori infection. DESIGN A multicenter, open-label, randomized controlled clinical trial. METHODS Three hundred and forty treatment-naïve patients with H. pylori infection were prospectively recruited from seven participating hospitals. The enrolled patients were randomized into one of two treatment groups: the HDDT group (esomeprazole, 20 mg four times daily; amoxicillin, 750 mg four times daily) and the BQT group (esomeprazole, 20 mg, twice daily; bismuth potassium citrate, 600 mg, twice daily; amoxicillin, 1 g, twice daily; metronidazole, 400 mg, four times daily). The primary outcome was eradication rate, and secondary outcomes were safety and patient compliance. RESULTS The eradication rates in the HDDT group versus the BQT group were 86.47% versus 87.06% on intention-to-treat (ITT) analysis, 91.88% versus 92.50% on modified ITT (MITT) analysis, and 91.77% versus 93.04% on per-protocol (PP) analysis, with no significant differences between the two groups. The patient compliance rates in the HDDT group versus the BQT group were 97.02% versus 95.86%, and no significant difference was found between the two groups. Notably, the HDDT group exhibited significantly lower incidence in the drug-induced adverse events (AEs) compared to the BQT group (16.67% versus 47.94%). CONCLUSION HDDT is equally efficacious in eradicating H. pylori infection and resulted in good patient compliance and safety compared with BQT. These findings provide evidence in support of HDDT as a first-line treatment for H. pylori infection. REGISTRATION This clinical trial was registered at The Chinese Clinical Trial Registry (trial registration number: ChiCTR2000039096).
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Affiliation(s)
| | | | | | - Jun Yang
- Department of Gastroenterology, People’s
Hospital of Chongqing Banan District, Chongqing, China
| | - Wen-jing Sun
- Department of Gastroenterology, The 13th
People’s Hospital of Chongqing, Chongqing, China
| | - De-kui Zhang
- Department of Gastroenterology, Lanzhou
University Second Hospital, Lanzhou, China
| | - Ping He
- Department of Gastroenterology, Yongchuan
Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Shi
- Department of Gastroenterology, Chongqing Red
Cross Hospital, Chongqing, China
| | - Na-yun Su
- Department of Gastroenterology, Chongqing Key
Laboratory of Digestive Malignancies, Daping Hospital, Army Medical
University (Third Military Medical University), Chongqing 400042, P. R,
China
| | - Ran Han
- Department of Gastroenterology, Guizhou
Provincial People’s Hospital, Guiyang, China
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Zhao Z, Zou PY, Su NY, Guo Y, Wang XW, Zhao JT, Mei H, Shi Q, Wang B, Chen DF, Lan CH. High-dose dual therapy versus culture-based susceptibility-guided therapy as a rescue regimen for Helicobacter pylori infection: a randomized controlled trial. Therap Adv Gastroenterol 2022; 15:17562848221145566. [PMID: 36600682 PMCID: PMC9806367 DOI: 10.1177/17562848221145566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/23/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although the Maastricht VI/Florence consensus report recommended high-dose proton pump inhibitor-amoxicillin dual therapy as possible rescue therapy for Helicobacter pylori infection, clinical evidence of its efficacy was lacking. OBJECTIVES To compare the efficacy, safety, patient compliance, and cost between high-dose dual therapy (HDDT) and culture-based susceptibility-guided therapy (CB-SGT) as a rescue regimen for H. pylori infection. DESIGN A single-center, open-label, randomized controlled clinical trial. METHODS In all, 146 patients with a history of eradication failure were enrolled and randomly assigned to receive HDDT or CB-SGT. HDDT consisted of esomeprazole 20 mg and amoxicillin 750 mg, both given four times per day (qid). CB-SGT consisted of esomeprazole 20 mg twice daily (bid), amoxicillin 1000 mg bid plus clarithromycin 500 mg bid, metronidazole 400 mg bid, or levofloxacin 500 mg daily (qd) for sensitive patients, in that order. For patients with triple resistance, a bismuth-containing regimen with a high dose of metronidazole was chosen, including esomeprazole 20 mg bid, bismuth 220 mg bid, amoxicillin 1000 mg bid, and metronidazole 400 mg qid. All regimens were given for 14 days. RESULTS The eradication H. pylori rates achieved with HDDT in the intention-to-treat (ITT), per-protocol, and modified ITT analyses were all 84.9% [62/73, 95% confidence interval (CI): 76.5-93.9%], compared with 83.6% (61/73, 95% CI: 74.9-92.3%), 84.7% (61/72, 95% CI: 76.2-93.2%), and 84.7% (61/72, 95% CI: 76.2-93.2%) with CB-SGT, respectively. For patients with CYP2C19 polymorphisms of intermediate/poor metabolizers, the eradication rates of HDDT and CB-SGT were 90.70% (39/43, 95% CI: 77.86-97.41%) and 84.21% (32/38, 95% CI: 68.75-93.98%), respectively. The difference between groups was 6.49% (95% CI: -8.00% to 20.97%), and the non-inferiority p value was 0.0128. For patients with a treatment interval of more than 3 months, the eradication rates of the two regimens reached 88.71% (95% CI: 78.11-95.34%) and 71.97% (95% CI: 70.02-90.64%). The difference between groups was 6.74% (95% CI: -5.71% to 19.20%), with a non-inferiority p value of 0.0042. Patient adherence was high in both groups. The HDDT had a lower cost and rate of side effects (p < 0.001) compared with CB-SGT. CONCLUSIONS HDDT can reach an eradication rate of 85% in treatment-experienced patients of H. pylori infection and 91% in patients with CYP2C19 polymorphisms of intermediate/poor metabolizers, with good compliance, lower side effects and costs, and less use of antibiotics. In conclusion, HDDT offers an effective rescue regimen for H. pylori infection. REGISTRATION This clinical trial was registered at the Chinese Clinical Trail Registry (trail registration number: ChiCTR1900025044).
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Affiliation(s)
| | | | | | - Yan Guo
- Department of Gastroenterology, Chongqing Key
Laboratory of Digestive Malignancies, Daping Hospital, Army Medical
University (Third Military Medical University), Chongqing, P.R. China
| | - Xing-Wei Wang
- Department of Gastroenterology, Chongqing Key
Laboratory of Digestive Malignancies, Daping Hospital, Army Medical
University (Third Military Medical University), Chongqing, P.R. China
| | - Jing-Tao Zhao
- Department of Gastroenterology, Chongqing Key
Laboratory of Digestive Malignancies, Daping Hospital, Army Medical
University (Third Military Medical University), Chongqing, P.R. China
| | - Hao Mei
- Department of Gastroenterology, Chongqing Key
Laboratory of Digestive Malignancies, Daping Hospital, Army Medical
University (Third Military Medical University), Chongqing, P.R. China
| | - Qing Shi
- Department of Gastroenterology, Chongqing Key
Laboratory of Digestive Malignancies, Daping Hospital, Army Medical
University (Third Military Medical University), Chongqing, P.R. China
| | - Bin Wang
- Department of Gastroenterology, Chongqing Key
Laboratory of Digestive Malignancies, Daping Hospital, Army Medical
University (Third Military Medical University), Chongqing 400042, P.R.
China
| | - Dong-Feng Chen
- Department of Gastroenterology, Chongqing Key
Laboratory of Digestive Malignancies, Daping Hospital, Army Medical
University (Third Military Medical University), Chongqing 400042, P.R.
China
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Zhou B, Zhao Z, Wang XW, Fan L, Zhu JR, Yang YY, Zou PY, Chen DF, Shen XC, Lan CH. Prediction of Esophageal Stricture after Endoscopic Submucosal Dissection in Patients with Early Esophageal Cancer. J Gastrointest Surg 2022; 26:2434-2443. [PMID: 36219368 DOI: 10.1007/s11605-022-05467-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/20/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) treatment of early esophageal cancer is effective and safe. It is currently the first-line treatment for early esophageal cancer. However, a common side effect is the development of esophageal strictures after ESD. This study was designed to identify the risk factors for esophageal stricture development and to predict its occurrence after ESD. METHODS In this retrospective study, 150 consecutive patients with early esophageal cancer treated with ESD at Daping Hospital, Chongqing, were enrolled between January 2016 and December 2020. Data on patient demographics, esophageal tumor characteristics, procedure-related factors, and postoperative situations were collected. We identified independent risk factors of esophageal stricture formation using univariate analysis and multivariate logistic regression. The predictive probability was obtained after multivariate logistic analysis. In addition, patients were divided into six groups based on these risk factors and the rate of esophageal stricture in each group was analyzed. RESULTS The postoperative esophageal stricture rate was 14% (21/150). Tumor location (OR = 5.655, 95% CI: 1.245-25.691, P = 0.025) and circumferential resection range (OR = 16.113, 95% CI: 4.294-60.466, P < 0.001) are independent risk factors for the development of esophageal strictures. According to predictive probability analysis and the rates of stricture in six groups, we developed a possible flow chart to predict stricture formation. CONCLUSIONS Tumor location and circumferential resection range are reliable risk factors to predict the occurrence of esophageal strictures. Our prediction flow chart suggests that tumors with a circumferential resection range of 1/2-3/4 and located above the upper thoracic segment or a circumferential resection range of > 3/4 have a high risk of postoperative stricture. Thus, timely and effective preventive measures should be taken in these patients following ESD.
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Affiliation(s)
- Bo Zhou
- Department of Gastroenterology, Daping Hospital, The Army Medical University, Chongqing, China
| | - Zhe Zhao
- Department of Gastroenterology, Daping Hospital, The Army Medical University, Chongqing, China
| | - Xing-Wei Wang
- Department of Gastroenterology, Daping Hospital, The Army Medical University, Chongqing, China
| | - Ling Fan
- Department of Gastroenterology, Daping Hospital, The Army Medical University, Chongqing, China
| | - Jian-Ru Zhu
- Department of Gastroenterology, Daping Hospital, The Army Medical University, Chongqing, China
| | - Ying-Ying Yang
- Department of Gastroenterology, Daping Hospital, The Army Medical University, Chongqing, China
| | - Pei-Ying Zou
- Department of Gastroenterology, Daping Hospital, The Army Medical University, Chongqing, China
| | - Dong-Feng Chen
- Department of Gastroenterology, Daping Hospital, The Army Medical University, Chongqing, China
| | - Xiao-Chun Shen
- Department of Gastroenterology, Daping Hospital, The Army Medical University, Chongqing, China.
| | - Chun-Hui Lan
- Department of Gastroenterology, Daping Hospital, The Army Medical University, Chongqing, China.
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Ding SZ, Du YQ, Lu H, Wang WH, Cheng H, Chen SY, Chen MH, Chen WC, Chen Y, Fang JY, Gao HJ, Guo MZ, Han Y, Hou XH, Hu FL, Jiang B, Jiang HX, Lan CH, Li JN, Li Y, Li YQ, Liu J, LI YM, Lyu B, Lu YY, Miao YL, Nie YZ, Qian JM, Sheng JQ, Tang CW, Wang F, Wang HH, Wang JB, Wang JT, Wang JP, Wang XH, Wu KC, Xia XZ, Xie WF, Xie Y, Xu JM, Yang CQ, Yang GB, Yuan Y, Zeng ZR, Zhang BY, Zhang GY, Zhang GX, Zhang JZ, Zhang ZY, Zheng PY, Zhu Y, Zuo XL, Zhou LY, Lyu NH, Yang YS, Li ZS. Chinese Consensus Report on Family-Based Helicobacter pylori Infection Control and Management (2021 Edition). Gut 2022; 71:238-253. [PMID: 34836916 PMCID: PMC8762011 DOI: 10.1136/gutjnl-2021-325630] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/03/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Helicobacter pylori infection is mostly a family-based infectious disease. To facilitate its prevention and management, a national consensus meeting was held to review current evidence and propose strategies for population-wide and family-based H. pylori infection control and management to reduce the related disease burden. METHODS Fifty-seven experts from 41 major universities and institutions in 20 provinces/regions of mainland China were invited to review evidence and modify statements using Delphi process and grading of recommendations assessment, development and evaluation system. The consensus level was defined as ≥80% for agreement on the proposed statements. RESULTS Experts discussed and modified the original 23 statements on family-based H. pylori infection transmission, control and management, and reached consensus on 16 statements. The final report consists of three parts: (1) H. pylori infection and transmission among family members, (2) prevention and management of H. pylori infection in children and elderly people within households, and (3) strategies for prevention and management of H. pylori infection for family members. In addition to the 'test-and-treat' and 'screen-and-treat' strategies, this consensus also introduced a novel third 'family-based H. pylori infection control and management' strategy to prevent its intrafamilial transmission and development of related diseases. CONCLUSION H. pylori is transmissible from person to person, and among family members. A family-based H. pylori prevention and eradication strategy would be a suitable approach to prevent its intra-familial transmission and related diseases. The notion and practice would be beneficial not only for Chinese residents but also valuable as a reference for other highly infected areas.
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Affiliation(s)
- Song-Ze Ding
- Department of Gastroenterology and Hepatology, People's Hospital, Zhengzhou University, Zhengzhou, Henan, China .,Department of Gastroenterology and Hepatology, People's Hospital, Henan University, Kaifeng, Henan, China
| | - Yi-Qi Du
- Gastroenterology Division, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hong Lu
- GI Division, Renji Hospital, Shanghai Institution of Digestive Diseas, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei-Hong Wang
- Department of Gastroenterology and Hepatology, Peking University First Hospital, Beijing, China
| | - Hong Cheng
- Department of Gastroenterology and Hepatology, Peking University First Hospital, Beijing, China
| | - Shi-Yao Chen
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Min-Hu Chen
- Division of Gastroenterology and Hepatology, Sun Yat-Sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Wei-Chang Chen
- Department of Gastroenterology and Hepatology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ye Chen
- Department of Gastroenterology and Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jing-Yuan Fang
- Renji Hospital, Gastroenterology Division, Shanghai Jiao Tong University, Shanghai, China
| | - Heng-Jun Gao
- Department of Gastroenterology and Hepatology, School of Medicine, Tongji University, Shanghai, China
| | - Ming-Zhou Guo
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Ying Han
- Department of Gastroenterology and Hepatology, The Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Hua Hou
- Department of Gastroenterology and Hepatology, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Fu-Lian Hu
- Department of Gastroenterology and Hepatology, Peking University First Hospital, Beijing, China
| | - Bo Jiang
- Department of Gastroenterology and Hepatology, Changgeng Hospital, Tsinghua University, Beijing, China
| | - Hai-Xing Jiang
- Department of Gastroenterology and Hepatology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Chun-Hui Lan
- Department of Gastroenterology and Hepatology, Daping Hospital, Army Medical University, Chongqing, China
| | - Jing-Nan Li
- Department of Gastroenterology and Hepatology, Peking Union Medical College Hospital, Beijing, China
| | - Yan Li
- Department of Gastroenterology and Hepatology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yan-Qing Li
- Department of Gastroenterology and Hepatology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Jie Liu
- Department of Gastroenterology and Hepatology, Huashan Hospital, Fudan University, Shanghai, China
| | - You-Ming LI
- Department of Gastroenterology and Hepatology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Bin Lyu
- Department of Gastroenterology and Hepatology, First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - You-Yong Lu
- Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital, Beijing, China
| | - Ying-Lei Miao
- Department of Gastroenterology and Hepatology, First Affilliated Hospital, Kunming Medical University, Kunming, Yunnan, China
| | - Yong-Zhan Nie
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University, Xian, Shaanxi, China
| | - Jia-Ming Qian
- Department of Gastroenterology and Hepatology, Peking Union Medical College Hospital, Beijing, China
| | - Jian-Qiu Sheng
- Department of Gastroenterology, The Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Cheng-Wei Tang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fen Wang
- Department of Gastroenterology and Hepatology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China,Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Changsha, Hunan, China
| | - Hua-Hong Wang
- Department of Gastroenterology and Hepatology, Peking University First Hospital, Beijing, China
| | - Jiang-Bin Wang
- Department of Gastroenterology and Hepatology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Jing-Tong Wang
- Department of Gastroenterology and Hepatology, Peking University Third Hospital, Beijing, China
| | - Jun-Ping Wang
- Department of Gastroenterology and Hepatology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xue-Hong Wang
- Department of Gastroenterology and Hepatology, Qinghai University Hospital, Qinghai University, Xining, Qinghai, China
| | - Kai-Chun Wu
- Department of Gastroenterology and Hepatology, Xijing Hospital, Air Force Medical University, Xian, Shaanxi, China
| | - Xing-Zhou Xia
- Department of Gastroenterology and Hepatology, The Fifth Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Wei-Fen Xie
- Department of Gastroenterology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yong Xie
- Department of Gastroenterology and Hepatology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jian-Ming Xu
- Department of Gastroenterology and Hepatology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chang-Qing Yang
- Division of Gastroenterology and Hepatology, Tongji Hospital, Tongji University, Shanghai, China
| | - Gui-Bin Yang
- Department of Gastroenterology and Hepatology, Aerospace Central Hospital, Beijing, China
| | - Yuan Yuan
- Key Laboratory of GI Cancer Etiology and Prevention in Liaoning Province, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhi-Rong Zeng
- Department of Gastroenterology and Hepatology, First Affiliated Hospital, Zhongshan University, Guangzhou, Guangdong, China
| | - Bing-Yong Zhang
- Department of Gastroenterology and Hepatology, People's Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Gui-Ying Zhang
- Department of Gastroenterology and Hepatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guo-Xin Zhang
- Department of Gastroenterology and Hepatology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jian-Zhong Zhang
- Department of Communicable Disease Diagnostics(DCDD), National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhen-Yu Zhang
- Department of Gastroenterology and Hepatology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Peng-Yuan Zheng
- Department of Gastroenterology and Hepatology, The Fifth Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Yin Zhu
- Department of Gastroenterology, First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
| | - Xiu-Li Zuo
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Li-Ya Zhou
- Department of Gastroenterology and Hepatology, Peking University Third Hospital, Beijing, China
| | - Nong-Hua Lyu
- Department of Gastroenterology and Hepatology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yun-Sheng Yang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Zhao-Shen Li
- Department of Gastroenterology and Hepatology, Changhai Hospital, Naval Medical University, Shanghai, China
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Zou PY, Hu J, Zhao JT, Zhao Z, Mei H, Yang J, Zhu YJ, Zhang Y, Lan CH. 10-Day and 14-day high-dose dual therapy for the treatment of Helicobacter pylori: A propensity score matching analysis. Helicobacter 2021; 26:e12833. [PMID: 34318966 DOI: 10.1111/hel.12833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Inconsistent eradication rates for Helicobacter pylori have been reported worldwide with dual therapy, perhaps owing to the difference in dose administration and treatment duration. This retrospective study aimed to determine whether high-dose dual therapy (HDDT) with different regimens leads to different eradication rates. The study compares the efficacy and safety of HDDT 10-day vs 14-day and investigates the factors that might affect the eradication rates. MATERIALS AND METHODS Two comparable treatment groups were based on propensity score matching (PSM). Patients were divided into two groups based on the therapy they underwent: 10-day HDDT and 14-day HDDT (20 mg esomeprazole and 750 mg amoxicillin, administered four times daily). The eradication rates, adverse events (AEs), patient compliance, CYP2C19 gene polymorphisms, and antibiotic resistance rates of the two groups were compared. RESULTS The intention to treat (ITT) analysis showed that the eradication rates for 10-day and 14-day groups were 78.4% (95% CI 69.6%-87.2%) and 89.7% (95% CI 83.3%-96.2%; p = .039), respectively, while the per-protocol (PP) eradication rates were 80.0% (95% CI 71.3%-88.7%) and 92.9% (95% CI 87.4%-98.5%; p = .014), respectively. The corresponding drug-related AEs were 6.8% (6/88) and 5.7% (5/88; p = .755). No significant differences were observed between the compliance rates of the two groups. The CYP2C19 gene polymorphism had no effect on the eradication rates of the two groups. CONCLUSION The results showed that the 14-day HDDT affords a higher H. pylori eradication rate than the 10-day HDDT.
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Affiliation(s)
- Pei-Ying Zou
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Jie Hu
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Jing-Tao Zhao
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Zhe Zhao
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Hao Mei
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Jing Yang
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Yang-Jie Zhu
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Yi Zhang
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Chun-Hui Lan
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
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Zhang L, Liu Q, Liu KW, Qin ZY, Zhu GX, Shen LT, Zhang N, Liu BY, Che LR, Li JY, Wang T, Wen LZ, Liu KJ, Guo Y, Yin XR, Wang XW, Zhou ZH, Xiao HL, Cui YH, Bian XW, Lan CH, Chen D, Wang B. SHARPIN stabilizes β-catenin through a linear ubiquitination-independent manner to support gastric tumorigenesis. Gastric Cancer 2021; 24:402-416. [PMID: 33159601 DOI: 10.1007/s10120-020-01138-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Aberrant activation of Wnt/β-catenin signaling by dysregulated post-translational protein modifications, especially ubiquitination is causally linked to cancer development and progression. Although Lys48-linked ubiquitination is known to regulate Wnt/β-catenin signaling, it remains largely obscure how other types of ubiquitination, such as linear ubiquitination governs its signaling activity. METHODS The expression and regulatory mechanism of linear ubiquitin chain assembly complex (LUBAC) on Wnt/β-catenin signaling was examined by immunoprecipitation, western blot and immunohistochemical staining. The ubiquitination status of β-catenin was detected by ubiquitination assay. The impacts of SHARPIN, a core component of LUBAC on malignant behaviors of gastric cancer cells were determined by various functional assays in vitro and in vivo. RESULTS Unlike a canonical role in promoting linear ubiquitination, SHARPIN specifically interacts with β-catenin to maintain its protein stability. Mechanistically, SHARPIN competes with the E3 ubiquitin ligase β-Trcp1 for β-catenin binding, thereby decreasing β-catenin ubiquitination levels to abolish its proteasomal degradation. Importantly, SHARPIN is required for invasiveness and malignant growth of gastric cancer cells in vitro and in vivo, a function that is largely dependent on its binding partner β-catenin. In line with these findings, elevated expression of SHARPIN in gastric cancer tissues is associated with disease malignancy and correlates with β-catenin expression levels. CONCLUSIONS Our findings reveal a novel molecular link connecting linear ubiquitination machinery and Wnt/β-catenin signaling via SHARPIN-mediated stabilization of β-catenin. Targeting the linear ubiquitination-independent function of SHARPIN could be exploited to inhibit the hyperactive β-catenin signaling in a subset of human gastric cancers.
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Affiliation(s)
- Liang Zhang
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China
| | - Qin Liu
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China
| | - Ke-Wei Liu
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China
| | - Zhong-Yi Qin
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China
| | - Guang-Xi Zhu
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China
| | - Li-Ting Shen
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China
| | - Ni Zhang
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China
| | - Bi-Ying Liu
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China
| | - Lin-Rong Che
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China
| | - Jin-Yang Li
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China
| | - Tao Wang
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China
| | - Liang-Zhi Wen
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China
| | - Kai-Jun Liu
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China
| | - Yan Guo
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China
| | - Xin-Ru Yin
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China
| | - Xing-Wei Wang
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China
| | - Zhi-Hua Zhou
- Department of Pathology, The 904 Hospital of People Liberation Army, Wuxi, People's Republic of China
| | - Hua-Liang Xiao
- Department of Pathology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China
| | - You-Hong Cui
- Institute of Pathology and Southwest Cancer Center, Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, People's Republic of China
| | - Xiu-Wu Bian
- Institute of Pathology and Southwest Cancer Center, Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, People's Republic of China
| | - Chun-Hui Lan
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China.
| | - Dongfeng Chen
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China.
| | - Bin Wang
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, People's Republic of China. .,Institute of Pathology and Southwest Cancer Center, Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, People's Republic of China.
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Zhu YJ, Zhang Y, Wang TY, Zhao JT, Zhao Z, Zhu JR, Lan CH. High dose PPI-amoxicillin dual therapy for the treatment of Helicobacter pylori infection: a systematic review with meta-analysis. Therap Adv Gastroenterol 2020; 13:1756284820937115. [PMID: 33110448 PMCID: PMC7559363 DOI: 10.1177/1756284820937115] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/31/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Helicobacter pylori resistance to amoxicillin remains rare in many regions. Proton pump inhibitor-amoxicillin-containing high dose dual therapy (HDDT) has been proposed to treat H. pylori infection. We aimed to assess the effectiveness and safety of PPI-amoxicillin HDDT for treatment of H. pylori infection in comparison with other regimens. METHODS Databases, including PubMed, Embase, and the Cochrane Register of Controlled Trials, were searched to find relevant publications. Randomized controlled trials comparing HDDT with control regimens for H. pylori eradication in adult patients were included. The primary outcome was eradication rate by intention-to-treat analysis. Adverse events were analyzed as second outcome. RESULTS A total of 15 trials with 3818 patients qualified for inclusion. The eradication rate of HDDT was neither significantly inferior nor superior to the recommended regimens such as triple therapy, bismuth quadruple therapy, and non-bismuth quadruple therapy [relative risk (RR): 1.00, 95% confidence interval (CI): 0.96-1.05, p = 0.870]. This finding was robust through subgroup analyses and sensitivity analyses. Trial sequential analysis showed that HDDT was equivalent to control regimens, and further similar trials were unlikely to alter the conclusions of this analysis. The frequency of adverse events was significantly lower in HDDT group (RR: 0.48, 95% CI: 0.37-0.64, p < 0.001). CONCLUSION HDDT was equivalent to recommended first-line or rescue regimens with fewer adverse effects. The evidence from this meta-analysis supports the use of HDDT as first-line or rescue treatment for H. pylori infection. TRIAL REGISTRATION PROSPERO CRD42019133002.
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Affiliation(s)
| | | | - Ting-Yi Wang
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Jing-Tao Zhao
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Zhe Zhao
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Jian-Ru Zhu
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
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Wang YJ, Lang XQ, Wu D, He YQ, Lan CH, Xiao X, Wang B, Zou DW, Wu JM, Zhao YB, Dettmar PW, Chen DF, Yang M. Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-types of Gastroesophageal Reflux Disease and Gastroesophageal Reflux Disease-related Disorders. J Neurogastroenterol Motil 2020; 26:74-84. [PMID: 31650768 PMCID: PMC6955190 DOI: 10.5056/jnm19032] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/14/2019] [Accepted: 07/23/2019] [Indexed: 12/13/2022] Open
Abstract
Background/Aims To determine the value of salivary pepsin in discriminating sub-types of gastroesophageal reflux disease (GERD) and GERD-related disorders. Methods Overall, 322 patients with different sub-types of GERD and 45 healthy controls (HC) were studied. All patients took Gastroesophageal Reflux Disease Questionnaire (GerdQ) and underwent endoscopy and 24-hour esophageal pH monitoring and manometry. Salivary pepsin concentration (SPC) was detected by using colloidal gold double-antibody immunological sandwich assay. Oral esomeprazole treatment was administrated in the patients with non-erosive reflux disease (NERD) and extra-esophageal symptoms (EES). Results Compared to HC, patients with erosive esophagitis, NERD, EES, EES plus typical GERD symptoms, or Barrett’s esophagus had a higher prevalence of saliva and SPC (all P < 0.001). There was no significant difference in the positive rate for pepsin in patients with functional heartburn or GERD with anxiety and depression, compared to HC. After esomeprazole treatment, the positive rate and SPC were significantly reduced in NERD (both P < 0.001) and in EES (P = 0.001 and P = 0.002, respectively). Of the 64 NERD patients, 71.9% (n = 46) were positive for salivary pepsin, which was significantly higher than the rate (43.8%, n = 28) of pathological acid reflux as detected by 24-hour esophageal pH monitoring (P = 0.002). Conclusions Salivary pepsin has an important significance for the diagnosis of GERD and GERD-related disorders. Salivary pepsin and 24-hour esophageal pH monitoring may complement with each other to improve the diagnostic efficiency.
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Affiliation(s)
- Yan-Jun Wang
- Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, China
| | - Xiu-Qiong Lang
- Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, China
| | - Dan Wu
- Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, China
| | - Yu-Qin He
- Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, China
| | - Chun-Hui Lan
- Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, China
| | - Xiao Xiao
- Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, China
| | - Bin Wang
- Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, China
| | - Duo-Wu Zou
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ji-Min Wu
- Department of Gastroenterology, Department of Gastroesophageal Reflux Disease, PLA Rocket Force General Hospital, Beijing, China
| | - Yong-Bin Zhao
- Department of Gastroenterology, Xinqiao Hospital, Chongqing, China
| | | | - Dong-Feng Chen
- Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, China
| | - Min Yang
- Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, China
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Feng ZH, Fan L, Yang J, Huo XY, Guo Y, Zhang Y, Lan CH. Mutant selection window of clarithromycin for clinical isolates of Helicobacter pylori. BMC Microbiol 2019; 19:176. [PMID: 31382897 PMCID: PMC6683470 DOI: 10.1186/s12866-019-1558-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 07/29/2019] [Indexed: 12/18/2022] Open
Abstract
Background Clarithromycin-resistance is becoming a global health concern in the treatment of Helicobacter pylori (H. pylori). The mutant prevention concentration (MPC) represent the propensities of antimicrobial agents to select resistant mutants. The concentration range between the minimum inhibitory concentration (MIC) and the MPC is defined as mutant selection window (MSW). In this study, we aimed to determine the cause of increasing clarithromycin resistance by investigating the MSW for clinical isolates of H. pylori. Results A retrospective subgroup, which included 68 clarithromycin-sensitive H. pylori strains, was selected from a double-blind trial. The MICs and MPCs were determined using agar plate assays. Genotypic tests were performed using Sanger sequencing. All isolates were wild-type, and 33.82% (23/68) had a 0.016 mg/L MIC, 45.59% (31/68) had a 0.031 mg/L MIC, 16.18% (11/68) had a 0.062 ≤ MIC ≤ 0.125 mg/L, and 4.41% (3/68) had a 0.25 mg/L MIC. The MPC50/90 (mg/L) of the isolates were: 0.062/0.125, 0.125/0.5, 0.25/0.25 and 1/2, respectively. The MPCs showed a moderate correlation with the MICs (rs = 0.65, P < 0.0001). Using published data and MPC90, we calculated the time inside the MSW (TMSW) for low- and high-dose (200 or 500 mg bid) clarithromycin that were 6 and 0 h, 24 and 4 h, 15 and 2 h, 5 and 17 h for the strains with MICs (mg/L) of 0.016, 0.031, 0.062–0.125, and 0.25, respectively. Conclusions This study showed that in the clarithromycin-sensitive clinical isolates of H. pylori, low-dose clarithromycin may lead to decreased drug sensitivity or even clarithromycin resistance; strains with a 0.25 mg/L MIC display a high risk of treatment failure.
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Affiliation(s)
- Zi-Han Feng
- College of Basic Medical Sciences, Army Medical University, Chongqing, 400042, China
| | - Ling Fan
- Department of Gastroenterology, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Chongqing, 400042, China
| | - Jing Yang
- Department of Gastroenterology, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Chongqing, 400042, China
| | - Xing-Yue Huo
- Department of Gastroenterology, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Chongqing, 400042, China
| | - Yan Guo
- Department of Gastroenterology, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Chongqing, 400042, China
| | - Yi Zhang
- Department of Gastroenterology, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Chongqing, 400042, China
| | - Chun-Hui Lan
- Department of Gastroenterology, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Chongqing, 400042, China.
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Cao Y, Yang J, Li J, Ao X, Zhang KY, Shen XC, Chen DF, Lan CH. Comparison of procedural sequences in same-day painless bidirectional endoscopy: Single-center, prospective, randomized study. Dig Endosc 2017; 29:330-337. [PMID: 28211094 DOI: 10.1111/den.12847] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/13/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM To compare the efficacy and safety of esophagogastroduodenoscopy (EGD)-colonoscopy and colonoscopy-EGD sequences for patients subjected to same-day bidirectional endoscopy under remifentanil and propofol sedation. METHODS A total of 209 eligible outpatients scheduled for diagnostic same-day bidirectional endoscopy between 16 February 2016 and 30 April 2016 were randomly assigned to the EGD-colonoscopy (n = 106) and colonoscopy-EGD (n = 103) sequence groups. Primary endpoint was total dose of propofol required for the procedure. Secondary endpoints included duration of endoscopy, patient satisfaction, adverse effects, endoscopy findings, and cardiopulmonary responses of the patients. RESULTS Patients in the two groups were similar in terms of demographic and clinical data (P > 0.05). EGD-colonoscopy sequence group had lesser requirement of propofol for sedation (P < 0.05), faster recovery (P < 0.001), and lesser influence on mean arterial pressure (MAP) during the endoscopy (P < 0.05). Duration of EGD and colonoscopy, patient satisfaction, adverse effects, and pathological findings did not differ between the two groups. CONCLUSIONS The EGD-colonoscopy sequence may be considered the preferred sequence for same-day bidirectional endoscopy as a result of less cardiovascular stress, lessened need for sedation with propofol, and faster recovery.
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Affiliation(s)
- Yan Cao
- Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, China
| | - Jun Yang
- Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, China
| | - Jiao Li
- Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, China
| | - Xin Ao
- Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, China
| | - Kai-Yuan Zhang
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing, China
| | - Xiao-Chun Shen
- Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, China
| | - Dong-Feng Chen
- Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, China
| | - Chun-Hui Lan
- Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, China
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Yang Z, Li X, Li J, Long JD, Lan CH, Wang T, Dong P, He JL. Note: Self-biased voltage to suppress secondary electrons by a ZnO varistor in a compact pulsed neutron generator. Rev Sci Instrum 2017; 88:036106. [PMID: 28372413 DOI: 10.1063/1.4978797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A large amount of back streaming electrons will bring about a part of current drain on power supply, cause sparking or high-voltage breakdowns, and affect the neutron yield and waveform for a compact sealed-tube pulsed neutron generator. A novel idea which uses a ZnO varistor to provide a constant self-biased voltage to suppress the secondary electrons is introduced. The I-V curve for the ZnO varistor was measured in the experiment. The effects of suppressing the secondary electrons were investigated using a ZnO varistor, linear resistors, and an independent power supply, respectively. The results show that the secondary electrons are suppressed effectively by the compact ZnO varistor, while not increasing the size and the component of the device. It is a promising design for compact sealed-tube neutron generators.
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Affiliation(s)
- Z Yang
- Institute of Fluid Physics, CAEP, P.O. Box 919-106, Mianyang 621900, China
| | - X Li
- Institute of Fluid Physics, CAEP, P.O. Box 919-106, Mianyang 621900, China
| | - J Li
- Institute of Fluid Physics, CAEP, P.O. Box 919-106, Mianyang 621900, China
| | - J D Long
- Institute of Fluid Physics, CAEP, P.O. Box 919-106, Mianyang 621900, China
| | - C H Lan
- Institute of Fluid Physics, CAEP, P.O. Box 919-106, Mianyang 621900, China
| | - T Wang
- Institute of Fluid Physics, CAEP, P.O. Box 919-106, Mianyang 621900, China
| | - P Dong
- Institute of Fluid Physics, CAEP, P.O. Box 919-106, Mianyang 621900, China
| | - J L He
- Institute of Fluid Physics, CAEP, P.O. Box 919-106, Mianyang 621900, China
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Tan RJ, Sun HQ, Zhang W, Yuan HM, Li B, Yan HT, Lan CH, Yang J, Zhao Z, Wu JJ, Wu C. A 21-35 kDa Mixed Protein Component from Helicobacter pylori Activates Mast Cells Effectively in Chronic Spontaneous Urticaria. Helicobacter 2016; 21:565-574. [PMID: 27061753 DOI: 10.1111/hel.12312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Helicobacter pylori (H. pylori) seem to involve in the etiology of chronic spontaneous urticaria (CSU). But studies of the pathogenic mechanism are very little. METHODS In this study, we detected the serum-specific anti-H. pylori IgG and IgE antibodies in 211 CSU and 137 normal subjects by enzyme-linked immunosorbent assay (ELISA), evaluated the direct activation effects of H. pylori preparations and its protein components on human LAD2 mast cell line in vitro, and analyzed the specific protein ingredients and functions of the most effective H. pylori mixed protein component using liquid chromatography-mass spectrometry and ELISA assay. RESULTS In CSU patients, the positive rate of anti-H. pylori IgG positive rate was significantly higher than that in normal controls, and the anti-H. pylori IgE levels had no statistical difference between H. pylori-infected patients with and without CSU. Further studies suggested that H. pylori preparations can directly activate human LAD2 mast cell line in a dose-dependent manner and its most powerful protein component was a mixture of 21-35 kDa proteins. Moreover, the 21-35 kDa mixed protein component mainly contained 23 kinds of proteins, which can stimulate the release of histamine, TNF-a, IL-3, IFN-γ, and LTB4 by LAD2 cells in a dose-dependent or time-dependent manner. CONCLUSIONS A 21-35 kDa mixed protein component should be regarded as the most promising pathogenic factor contributing to the CSU associated with H. pylori infection.
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Affiliation(s)
- Ran-Jing Tan
- Department of Dermatology, Daping Hospital, The Third Military Medical University, Chongqing, 400042, China.,Department of Microbiology and Biochemical Pharmacy, National Engineering Research Center of Immunological Products, College of Pharmacy, The Third Military Medical University, Chongqing, 400038, China
| | - He-Qiang Sun
- Department of Microbiology and Biochemical Pharmacy, National Engineering Research Center of Immunological Products, College of Pharmacy, The Third Military Medical University, Chongqing, 400038, China
| | - Wei Zhang
- Department of Dermatology, Daping Hospital, The Third Military Medical University, Chongqing, 400042, China
| | - Han-Mei Yuan
- Department of Microbiology and Biochemical Pharmacy, National Engineering Research Center of Immunological Products, College of Pharmacy, The Third Military Medical University, Chongqing, 400038, China
| | - Bin Li
- Department of Microbiology and Biochemical Pharmacy, National Engineering Research Center of Immunological Products, College of Pharmacy, The Third Military Medical University, Chongqing, 400038, China
| | - Hong-Tao Yan
- Department of Dermatology, Daping Hospital, The Third Military Medical University, Chongqing, 400042, China
| | - Chun-Hui Lan
- Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, 400042, China
| | - Jun Yang
- Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, 400042, China
| | - Zhuo Zhao
- Department of Microbiology and Biochemical Pharmacy, National Engineering Research Center of Immunological Products, College of Pharmacy, The Third Military Medical University, Chongqing, 400038, China
| | - Jin-Jin Wu
- Department of Dermatology, Daping Hospital, The Third Military Medical University, Chongqing, 400042, China
| | - Chao Wu
- Department of Microbiology and Biochemical Pharmacy, National Engineering Research Center of Immunological Products, College of Pharmacy, The Third Military Medical University, Chongqing, 400038, China
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Lan CH, Long JD, Zheng L, Dong P, Yang Z, Li J, Wang T, He JL. Note: Triggering behavior of a vacuum arc plasma source. Rev Sci Instrum 2016; 87:086105. [PMID: 27587176 DOI: 10.1063/1.4959980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Axial symmetry of discharge is very important for application of vacuum arc plasma. It is discovered that the triggering method is a significant factor that would influence the symmetry of arc discharge at the final stable stage. Using high-speed multiframe photography, the transition processes from cathode-trigger discharge to cathode-anode discharge were observed. It is shown that the performances of the two triggering methods investigated are quite different. Arc discharge triggered by independent electric source can be stabilized at the center of anode grid, but it is difficult to achieve such good symmetry through resistance triggering. It is also found that the triggering process is highly correlated to the behavior of emitted electrons.
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Affiliation(s)
- C H Lan
- Institute of Fluid Physics, China Academy of Engineering Physics, Mianyang 621900, People's Republic of China
| | - J D Long
- Institute of Fluid Physics, China Academy of Engineering Physics, Mianyang 621900, People's Republic of China
| | - L Zheng
- Institute of Fluid Physics, China Academy of Engineering Physics, Mianyang 621900, People's Republic of China
| | - P Dong
- Institute of Fluid Physics, China Academy of Engineering Physics, Mianyang 621900, People's Republic of China
| | - Z Yang
- Institute of Fluid Physics, China Academy of Engineering Physics, Mianyang 621900, People's Republic of China
| | - J Li
- Institute of Fluid Physics, China Academy of Engineering Physics, Mianyang 621900, People's Republic of China
| | - T Wang
- Institute of Fluid Physics, China Academy of Engineering Physics, Mianyang 621900, People's Republic of China
| | - J L He
- Institute of Fluid Physics, China Academy of Engineering Physics, Mianyang 621900, People's Republic of China
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Wang CH, Liao ST, Yang J, Li CX, Yang YY, Han R, Chen DF, Lan CH. Effects of daily telephone-based re-education before taking medicine on Helicobacter pylori eradication: A prospective single-center study from China. World J Gastroenterol 2015; 21:11179-11184. [PMID: 26494972 PMCID: PMC4607915 DOI: 10.3748/wjg.v21.i39.11179] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/15/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effects of daily telephone-based re-education (TRE) before taking medicine for the eradication of Helicobacter pylori (H. pylori) on the compliance and the eradication rate in a Chinese patient population.
METHODS: A prospective, physician-blinded, randomized, controlled clinical study was conducted. The patients were randomly assigned to receive TRE every day before taking medicine (TRE group) or no TRE (control group). The patients in the TRE group received regular instructions before taking medicine for the eradication of H. pylori during the entire course of treatment through telephone calls. The patients in the control group received detailed instructions at the time of seeing a doctor for the guidance. The primary outcome was the H. pylori eradication rate after treatment. The secondary outcomes included the clinical remissions after treatment, adverse events, compliance, and patients’ satisfaction.
RESULTS: A total of 140 patients were randomized, 70 to the TRE group and 70 to the control group. As the primary outcome, the H. pylori eradication rates in the TRE and control groups were 62.7% and 71.2% in per protocol analysis (P = 0.230), and 52.9% and 52.9% in intention-to-treat analysis (P = 0.567), respectively. As the secondary outcomes, there were no significant differences in the patients’ satisfaction between the two groups (good, 79.7% vs 76.9%; fair, 13.6% vs 19.2%; poor, 6.7% vs 3.9%, for the TRE group and control group, respectively; P > 0.05 for all); the rates of adverse effects were 15.2% and 63.5% in the TRE and control groups, respectively (P < 0.001); the compliance rates in the TRE and control groups were 85.7% and 74.3%, respectively (P = 0.069).
CONCLUSION: Daily TRE before taking medicine had no significant impact on the patients’ compliance, satisfaction, or H. pylori eradication, but reduced the rate of adverse events.
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Shen XC, Ao X, Cao Y, Lan L, Liu XM, Sun WJ, Li P, Lan CH. Etomidate-remifentanil is more suitable for monitored anesthesia care during gastroscopy in older patients than propofol-remifentanil. Med Sci Monit 2015; 21:1-8. [PMID: 25553506 PMCID: PMC4288392 DOI: 10.12659/msm.891183] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background This prospective and randomized study was designed to compare safety, potential complications, and patient and examiner satisfaction of 2 anesthetic combinations – etomidate-remifentanil and propofol-remifentanil – in elderly patients undergoing diagnostic gastroscopy. Material/Methods A group of 720 patients, aged 60–80 years, scheduled for diagnostic gastroscopy under sedation were prospectively randomized. After 0.4–0.6 μg kg−1 of remifentanil was infused, etomidate or propofol was administered. Patients in the etomidate group received doses of etomidate at 0.1–0.15 mg kg−1 followed by 4–6 mg. Patients in the propofol group received doses of propofol at 1–2 mg kg−1 followed by 20–40 mg. Physiological indexes were evaluated for the 715 of 720 patients that completed the treatment. The onset time, duration time, and discharge time were recorded. Physicians, anesthetists, and patients were surveyed to assess their satisfaction. Results Systolic pressure and diastolic pressure decreased significantly after the procedure in the propofol group (P<0.001). The average heart rate was significantly lower in the propofol group (P<0.05). No periods of desaturation (SpO2 <95%) were observed in either group. The onset time was earlier in the etomidate group (P=0.00). All adverse events, with the exception of myoclonus, were greater in the propofol group, and physician and patient satisfaction in both groups was similar. Conclusions Etomidate-remifentanil administration for sedation and analgesia during gastroscopy resulted in more stable hemodynamic responses and less adverse events in older patients.
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Affiliation(s)
- Xiao-Chun Shen
- Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China (mainland)
| | - Xing Ao
- Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China (mainland)
| | - Yan Cao
- Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China (mainland)
| | - Li Lan
- Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China (mainland)
| | - Xin-Man Liu
- Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China (mainland)
| | - Wen-Jing Sun
- Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China (mainland)
| | - Ping Li
- Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China (mainland)
| | - Chun-Hui Lan
- Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China (mainland)
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Yu YY, Fang DC, Fan LL, Chang H, Wu ZL, Cao Y, Lan CH. Efficacy and safety of esomeprazole with flupentixol/melitracen in treating gastroesophageal reflux disease patients with emotional disorders. J Gastroenterol Hepatol 2014; 29:1200-6. [PMID: 24955450 DOI: 10.1111/jgh.12552] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM This study was designed to demonstrate the safety and efficacy of esomeprazole combined with flupentixol/melitracen for the treatment of gastroesophageal reflux disease (GERD) patients with emotional disorders. METHODS Two hundred eighty-nine GERD patients with emotional disorders were divided randomly into two groups: group 1 received esomeprazole only (monotherapy) and group 2 received esomeprazole and flupentixol/melitracen (combination therapy). The patients' GERD questionnaire (GerdQ) and hospital anxiety and depression (HAD) scores were obtained before and after treatment. Changes in the scores, rates of symptom remission, and adverse effects were compared between the two groups. RESULTS After 2 weeks of treatment, the average decrease in GerdQ score in the combination group (4.04 ± 2.34) was significantly greater than that in the monotherapy group (3.34 ± 2.74; P < 0.05). Significant differences between the two groups were also found for changes in HAD anxiety scores (5.45 ± 2.41 vs 3.34 ± 2.43, P < 0.05), depression scores (5.47 ± 2.47 vs 3.00 ± 3.28, P < 0.05), and anxiety-depression scores (5.20 ± 2.71 vs 3.60 ± 2.56, P < 0.05). The remission of symptoms (eructation, abdominal pain, anorexia, and other accompanying symptoms) in the combination group was significantly better than that in the monotherapy group, and no significant difference in the incidence of adverse events was observed between the two groups. CONCLUSIONS The combination therapy has better efficacy than the monotherapy in improving the symptoms of gastroesophageal reflux in patients with emotional disorders. In addition, this combination treatment is safe, with a low incidence of adverse events.
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Lan C, Shen X, Cui H, Liu H, Li P, Wan X, Lan L, Chen D. Comparison of nitrous oxide to no sedation and deep sedation for diagnostic upper gastrointestinal endoscopy. J Gastrointest Surg 2013; 17:1066-72. [PMID: 23546559 DOI: 10.1007/s11605-013-2160-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 01/29/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND In China, great efforts are dedicated to reducing discomfort and minimizing undesirable complications for patients undergoing upper gastrointestinal (UGI) endoscopy. METHODS This study was conducted to compare the diagnostic accuracy, safety, complications, and patient and examiner satisfaction for different sedation approaches. We carried out a prospective and randomized study on 450 patients undergoing diagnostic UGI endoscopy. During the procedure, patients received N(2)O by inhalation; an intravenous mixture of midazolam, remifentanil, and propofol; or no sedative. The cardiorespiratory functions, procedure duration, recovery time, length of hospital stay, complications, and ratings of patient and examiner satisfaction were recorded. RESULTS Compared to those deeply sedated, patients inhaling N(2)O had comparable diagnostic accuracy, significantly shorter procedure and recovery times, a lower risk of cardiorespiratory distress, but a higher number of minor complications and post-procedure mental issues. The procedural satisfaction ratings were highest for those receiving deep sedation; fewer patients reported willingness to reconsider N(2)O for a future upper GI endoscopy. The lowest satisfaction rating was given by those who received no sedation. CONCLUSIONS Multiple factors should be considered before selecting N(2)O as the sedative for diagnostic UGI endoscopy, including the patient's economic status, potential risk of cardiorespiratory distress, and sensitivity to potential adverse effects of N(2)O administration.
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Affiliation(s)
- ChunHui Lan
- Department of Gastroenterology, Daping Hospital, Third Military Medical University, 10 Changjiang Branch Road, Chongqing, 400042, China.
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21
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Ai ZL, Lan CH, Fan LL, Lan L, Cao Y, Li P, Song O, Chen DF. Unsedated transnasal upper gastrointestinal endoscopy has favorable diagnostic effectiveness, cardiopulmonary safety, and patient satisfaction compared with conventional or sedated endoscopy. Surg Endosc 2012; 26:3565-72. [DOI: 10.1007/s00464-012-2367-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 05/02/2012] [Indexed: 01/01/2023]
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Fan LL, Chen DF, Lan CH, Liu KY, Fang DC. Knockdown of ezrin via RNA interference suppresses Helicobacter pylori-enhanced invasion of gastric cancer cells. Cancer Biol Ther 2011; 11:746-52. [PMID: 21282970 DOI: 10.4161/cbt.11.8.14691] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIM H. pylori interacts with gastric epithelial cells, which may activate signaling pathways important for gastric cancer invasion. Ezrin, a membrane cytoskeletal crosslinker protein, is well documented to regulate cell adhesion and cell motility. The aim of the present study was to determine whether ezrin is involved in H. pylori-induced cancer cell motility and invasion. METHODS The VIL-2 of RNA interference plasmid vector and control plasmid vector were constructed. AGS (a human gastric adenocarcinoma cell line) cells were transfected by these plasmid vectors. The stable expression cell lines AGS(ezrin) was obtained by G418 resistance screening. The express levels of ezrin protein and the cellular invasive potential of four groups, including the AGS control, AGS(ezrin) control, AGS co-culture with H. pylori, AGS(ezrin) co-culture with H. pylori were detected. Meanwhile, the morphology, cell migration and adhesion were determined respectively. RESULTS Co-culture with H. pylori stimulated AGS cell motility and invasion, up-regulated ezrin expression at the protein level and induced a Hummingbird phenotype. The silencing of ezrin expression suppressed the motility and invasion of gastric cancer cells and inversed the cell invasion phenotype and enhanced the ability for cell adhesion. CONCLUSION Knockdown of ezrin by RNAi suppresses H. pylori-enhanced migration and invasion of gastric cancer cells. These findings indicate that ezrin may play a key role in the migration and invasion of gastric cancer cells, and thus may be a therapeutic target to prevent metastasis of gastric cancer promoted by H. pylori infection.
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Affiliation(s)
- Li-Lin Fan
- Department of Gastroenterology, Southwest Hospital, Chongqing, China
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Abstract
BACKGROUND AND AIMS To clarify the role of the mitochondrial pathway in apoptosis induced by H. pylori infection in gastric epithelial cells. METHODS Cells of a gastric adenocarcinoma cell line SGC-7,901 were co-cultured with H. pylori NCTC 11,637, with or without preincubation with the inhibitors of caspases -3, -8, and -9. Apoptosis was determined by flow cytometry. RT-PCR was used to determine the expression of Bid, Bax, and Bcl-2 mRNA, and Western blotting was used to determine the expression of Bid, Bax, and Bcl-2 proteins, and the activation of caspases -3 and -9. RESULTS H. pylori directly induced apoptosis in SGC-7,901 cells. Apoptotic indices (AIs) were 6.30 +/- 0.40%, 11.57 +/- 0.78%, 8.63 +/- 0.67%, and 7.22 +/- 0.97%, respectively, at 6, 12, 24, and 48 h after SGC-7,901 cells were co-cultured with H. pylori. H. pylori up-regulated the expression of Bid and Bax at both protein and mRNA levels, and induced a time-dependent activation of caspases -3 and -9. Apoptosis was inhibited significantly by the preincubation of SGC-7,901 cells with the inhibitors of caspase-3 (AIs were 1.72 +/- 0.59%, 2.97 +/- 0.55%, 4.38 +/- 1.56%, and 3.29 +/- 0.83%, respectively, at 6, 12, 24, and 48 h), and caspase -9 (AIs were 2.47 +/- 0.53%, 6.68 +/- 0.47%, 5.97 +/- 0.46%, and 5.43 +/- 0.15%, respectively, at 6, 12, 24, and 48 h). The caspase-8 inhibitor also reduced H. pylori-induced apoptosis by 20%. CONCLUSIONS H. pylori infection induces apoptosis and the activation of caspases -3 and -9 in gastric cancer cells. Moreover, the caspase inhibitors significantly suppress H. pylori-induced apoptosis. These findings suggest that the mitochondrial pathway may be the major pathway in H. pylori-induced apoptosis in gastric epithelial cells.
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Affiliation(s)
- Hao Zhang
- Department of Gastroenterology, South-west Hospital, Third Military Medical University, Chongqing, China
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Pan TL, Goto S, Lord R, Huang YC, Huang CM, Wang PW, Lin YC, Kawamoto S, Ono K, Liao PC, Lin CL, Lai CY, Chang HL, Lan CH, Lee TH, Wang YC, Wu ML, Jawan B, Cheng YF, Chen ST, Chen CL. Proteome analysis in liver transplantation. Transplant Proc 2001; 33:156. [PMID: 11266756 DOI: 10.1016/s0041-1345(00)01952-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T L Pan
- Department of Surgery and Liver Transplant Program, Chang Gung Memorial Hospital Kaohsiung, Niao Sung, Kaohsiung, Taiwan
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Chang YH, Liao RM, Lan CH, Shen YL. Operant performance following tail-pinch in the rat: effects of d-amphetamine. CHINESE J PHYSIOL 2000; 43:105-11. [PMID: 11132086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
To extend the investigation of tail-pinch induced behavioral changes, rats performing on a differential reinforcement of low rates of 10 sec (DRL10), a fixed-interval of 60 sec (F160), and a fixed-ratio of 20 (FR20) schedules were exposed to a paper clip applied to the tail. While a 10 min tail-pinch conducted 1 hr before operant sessions significantly altered the DRL10 behavior, this stressor had little effect on either F160 or FR20 responding. Marked DRL10 behavior performance changes following tail-pinch included increases in the number of lever presses, decreases in the number of the reinforcers, and disruption in the frequency distribution of inter-response times (IRT). These DRL10 operant deficits were diminished when the subject received a tail-pinch pretreatment followed by d-amphetamine treatment (0.2 and 2.0 mg/kg). In combination with biochemical data from others, the present results suggest that catecholamine systems are involved in modulation of DRL10 behavior following tail-pinch.
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Affiliation(s)
- Y H Chang
- Department of Psychology, National Cheng-Chi University, Taipei, Taiwan, ROC
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Abstract
In considering the heterogeneous function of the nucleus accumbens (NAC), the present work evaluated the conditioned place preference (CPP) after local infusion of d-amphetamine (AMP; 10, 15 microg/side) or cocaine (COC; 50, 100 microg/side) into two subareas of NAC, core and shell. A regular two-compartment CPP apparatus was used to test the place conditioning effects after 6 pairings of drug in one compartment and 6 pairings of vehicle in the other one. Significant CPP was observed with either AMP infused in the core area or COC infused into the shell area. Neither AMP in shell nor COC in core significantly produced CPP. These results indicate important differences between two neural substrates within NAC for the rewarding effects of AMP and COC on the CPP task.
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Affiliation(s)
- R M Liao
- Department of Psychology, National Cheng-Chi University, Taipei, Taiwan, Republic of China.
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