The effect of Helicobacter pylori infection on gastric emptying of digestible and indigestible solids in patients with nonulcer dyspepsia

OBJECTIVE

There is no general agreement with regard to the effect of Helicobacter pylori infection on gastric emptying in patients with nonulcer dyspepsia.

METHODS

We performed the 14C urea breath test as well as simultaneous recordings of scintigraphic gastic emptying and gastric clearance of radiopaque markers to determine the effect of Helicobacter pylori infection on gastric emptying of digestible and indigestible solids in nonulcer dyspepsia patients.

RESULTS

Sixty patients, 30 males and 30 females, were enrolled in the study. There were 22 patients (36.7%) without and 38 patients (63.3%) with H. pylori infection. Twenty-four of the 60 patients (40%) showed normal and 36 patients (60%) showed delayed gastric emptying of digestible solids. In addition, 21 patients (35%) showed normal and 39 patients (63%) showed delayed gastric emptying of indigestible solids. There was no correlation between delayed gastric emptying of digestible and indigestible solids (p > 0.05, difference not significant). Although not statistically significant, the incidence of delayed indigestible solid emptying was higher than that of delayed digestible solid emptying (65% vs. 60%). Among different patterns of gastric emptying, no difference was noted between the patients with and without H. pylori infection.

CONCLUSION

Delayed gastric emptying of indigestible solids is as common as delayed gastric emptying of digestible solids in nonulcer dyspepsia patients. The status of H. Pylori infection appeared not to influence the incidence of delayed gastric emptying of digestible and indigestible solids.

Gastric clearance of radiopaque markers in non-ulcer dyspepsia patients

BACKGROUND

The use of radiopaque markers has been proposed as an easy, non-invasive method for measuring gastric emptying. In this study we intended to evaluate the effectiveness of this test in determining the gastric motor function in patients with non-ulcer dyspepsia.

METHODS

Simultaneous recording of scintigraphic solid gastric emptying and gastric clearance of radiopaque markers were conducted in 65 non-ulcer dyspepsia patients.

RESULTS

Forty-two patients (64.4%) showed abnormal gastric clearance of radiopaque markers, and 38 patients (58.5%) showed delayed solid gastric emptying. There was no correlation between delayed solid gastric emptying and abnormal gastric clearance of radiopaque markers (p > 0.05). Although the frequency of abnormal gastric clearance of radiopaque markers was higher than that of delayed solid gastric emptying (64.6% versus 58.5%), it was not statistically significant.

CONCLUSIONS

On the basis of the results of our study, gastric clearance of radiopaque markers may be used as an easy, non-invasive screening test for the purpose of detecting gastric motor dysfunction. However, this test is not superior to scintigraphic gastric emptying studies.

Increased accuracy of the carbon-14 D-xylose breath test in detecting small-intestinal bacterial overgrowth by correction with the gastric emptying rate

To date, there is no general agreement as to which test is to be preferred for the diagnosis of small-intestinal bacterial overgrowth. The 1-g carbon-14 D-xylose breath test has been proposed as a very sensitive and specific test for the diagnosis of bacterial overgrowth. However, in patients with severe gastrointestinal motor dysfunction, the lack of consistent delivery of 14C-D-xylose to the region of bacterial contamination may result in a "negative" result. The aim of this study was to determine whether the accuracy of 14C-D-xylose breath test for detecting bacterial overgrowth can be increased by correction with the gastric emptying rate of 14C-D-xylose. Ten culture-positive patients and ten culture-negative controls were included in the study. Small-intestinal aspirates for bacteriological culture were obtained endoscopically. A liquid-phase gastric emptying study was performed simultaneously to assess the amount of 14C-D-xylose that entered the small intestine. The results of the percentage of expired 14CO2 at 30 min were corrected with the amount of 14C-D-xylose that entered the small intestine. There were six patients in the culture-positive group with a 14CO2 concentration above the normal limit. Three out of four patients with initially negative results using the uncorrected method proved to be positive after correction. All these three patients had prolonged gastric emptying of 14C-D-xylose. When compared with cultures of small-intestine aspirates, the sensitivity and specificity of the uncorrected 14C-D-xylose breath test were 60% and 90%, respectively. In contrast, the sensitivity and specificity of the corrected 14C-D-xylose breath test improved to 90% and 100%, respectively. In conclusion, using the gastric emptying rate of 14C-D-xylose as a correcting factor, we found a higher sensitivity and specificity for the 14C-D-xylose breath test in the detection of small-intestinal bacterial overgrowth than were achieved with the conventional method.

Endoscopic injection for the treatment of bleeding ulcers: local tamponade or drug effect?

Fifty-two patients with Forrest Ia or Ib bleeding ulcers were randomized to receive endoscopic injection therapy with either 1:10,000 epinephrine in water (Group I) or distilled water (Group II). Twenty-five out of 27 patients in group I, versus 22 out of 25 patients in group II, achieved initial hemostasis after endoscopic injection therapy (p > 0.05). Five patients who did not respond to local injection had bleeding controlled by heater probe thermocoagulation or surgical intervention. Three patients in each group developed rebleeding after initial hemostasis. Four of these patients had bleeding controlled by surgical intervention, while the other two died of underlying diseases. No change in systemic blood pressure, but a significant drop in the pulse rate were noted in both groups after injection therapy. Patients with shock at admission or ulcer size greater than 2 cm had a significantly higher rebleeding rate after initial hemostasis than patients with normal blood pressure and ulcers under 2 cm (p < 0.05). No serious complications were observed after injection therapy, and no significant difference in the amounts of solution required for successful hemostasis was noted between the two groups. We conclude that a local tamponade with distilled water is as effective and safe as diluted epinephrine solution for endoscopic injection therapy.