Journal of Gastroenterology and Hepatology (2009) 24 (Suppl. 1)

01. Upper GI-123 The severity of endoscopic gastric atrophy could help to predict OLGA gastritis stage DT QUACH,1 HM LE,2 OT NGUYEN,1 TS NGUYEN,2 N UEMURA3 1 Department of Endoscopy, University Medical Center at Hochiminh City, Vietnam, 2Department of Surgical Pathology, University Medical Center at Hochiminh City, Vietnam, 3Department of Gastroenterology, International Medical Center of Japan, Tokyo, Japan Background and aims  OLGA high-stage gastritis has proved its role on identifying a subgroup of patients with higher risk of gastric cancer. Even in high-risk populations, however, this proportion is very low and taking routine mapped biopsies could be a burden. This study aims (1) to evaluate the role of moderate—to—severe endoscopic gastric atrophy (EGA) on predicting OLGA gastritis stage and (2) to assess the association of highstage OLGA gastritis with gastric neoplasia in Vietnamese population. Materials and methods  A prospective cross-sectional study was conducted on 280 dyspeptic outpatients. EGA was assessed according to Kimura—Takemoto classification. Histological gastric atrophy was assessed according to internationally validated criteria and gastritis stage was established according to the OLGA staging system. Gastric neoplasia was assessed based on the Vienna classification. The pathologists who read the specimens were kept blind to the endoscopic results. Results  The mean age of patients was 46.1 [range 20–78 years] with a male—to—female ratio of 1:1. High-stage gastritis (e.g. stage III or IV) was confirmed in 13 (4.6%) patients; who were all more than 40-year-old (p = 0.01), had H. pylori infection (p = 0.0006) and EGA (p < 0.001). Low grade dysplasia was found in 7 patients: 4/13 (30.7%) with high-stage gastritis versus 3/267 (1.1%) with low-stage gastritis (p < 0.0001). 6 of these 7 patients had EGA (p = 0.048). The sensitivity, specificity, positive predictive value and negative predictive value of EGA in high-stage gastritis diagnosis were 100%, 57.7%, 10.3% and 100% respectively. Conclusions  OLGA high-stage gastritis was associated with gastric dysplasia and mostly diagnosed in patients with EGA. The absence of this endoscopic finding could effectively rule out the possibility of having high-stage gastritis.

The association between endoscopic gastric atrophy finding and the characteristics of intestinal metaplasia DT QUACH,1 HM LE,2 OT NGUYEN,1 TS NGUYEN,2 N UEMURA3 1 Department of Endoscopy, University Medical Center at Hochiminh City, Vietnam, 2Department of Surgical Pathology, University Medical Center at Hochiminh City, Vietnam, 3Department of Gastroenterology, International Medical Center of Japan, Tokyo, Japan Aim  To evaluate the association between moderate– to–severe endoscopic gastric atrophy finding (EGA) with the characteristics of intestinal metaplasia (IM). Method  A cross-sectional study was conducted on 280 patients with endoscopic gastritis according to the Sydney system. EGA was evaluated according to the Kimura—Takemoto classification. Mapped biopsies  were taken according to the revised Sydney system. Histochemical staining was performed for IM subtyping using PAS and Alcian blue 2.5. The pathologists who read the specimens were kept blind to the endoscopic results.

Results  The mean age was 46.1 ± 10.5. The rate of IM was 28.9%. Incomplete IM subtype accounted for 29.6% and related to extensive IM (p = 0.01, OR = 3.9). Extensive IM with ≥3 bioptic sites accounted for 6.8% and was only found in the subgroup with EAG (p < 0.001). There were a significant association between EAG and IM (p < 0.001, OR = 15), incomplete IM subtype (p < 0.001, OR = 25.1) as well as extensive IM (p < 0.001, OR = 28.7). The sensitivity, specificity, positive predictive value and negative predictive value of this endoscopic finding in diagnosis of IM were: 86.4%, 71.9%, 55.6%, 92.9%; in diagnosis of incomplete IM subtype were: 95.8%, 61.2%, 19.5%, 99.3%; and in diagnosis of extensive IM were: 94.4%, 62.3%, 27% and 98.7%, respectively. Conclusion  EGA significantly relates to the extension and the incomplete subtype of IM. This endoscopic finding has a high sensitivity, negative predictive value for these high-risk characteristics of developing gastric cancer and should be widely applied.

The effectiveness of EAL and EBMT regimens as the second-line therapies for Helicobacter pylori eradication TT TRAN, DT QUACH, HK LY University Medical Center at Hochiminh City, Vietnam Aim  To evaluate the effectiveness of EAL and EBMT regimens as the second-line therapies for Helicobacter pylori eradication. Methods  Patients who had failed to eradicate H. pylori by first-line triple therapies were randomized to receive either EAL in 10 days or EBMT in 14 days. The EAL regimen comprised of Esomeprazole 20 mg bid, Amoxicillin 1000 mg bid and Levofloxacin 250 mg bid; while EBMT regimen comprised of Esomeprazole 20 mg bid, Bismuth 120 mg tid, Metronidazole 500 mg tid and Tetracycline 500 mg tid. H. pylori eradication was confirmed by rapid urease test and/or 13C breath test after stopping the treatment for at least 4 weeks. Results  There were 58 patients in our study including 35 patients with EBMT and 23 patients with EAL regimen. In intention-to-treat analysis, the eradication rates of EAL and EBMT were 60.8% (14/23) and 94.3% (33/35), respectively (p = 0.004). In per protocol analysis, the eradication rates of EAL and EBMT were 66.6% (14/21) and 96.9% (31/32), respectively (p = 0.009). The number-needed-to treat benefit of EBMT versus EAL was 3.3 (confidence interval 95%: 1.9–10.3). Conclusions  The quadruple regimen with EBMT in 14 days has shown to be much more effective than EAL and should be the second-line therapy of choice for H. pylori eradication.

Comparison of clinical features between Proton Pump Inhibitor (PPI) monotherapy and combination therapy with H2 Receptor Antagonist (H2RA) after Endoscopic hemostatic therapy on Gastric ulcer bleeding patients SH JUNG, SH KIM, HM KIM, YJ LEE, HI LEE, A KIM, HW YANG, SW CHA Departments of Internal Medicine, Eulji University College of Medicine, Eulji University Hospital, Daejeon, Korea Introduction  After introduction of Endoscopic hemostatic therapy and use of PPI in patients with bleeding peptic ulcers, rate of emergency  operation and mortality has decreased but still, 10 ~ 30% of patients suffer from rebleeding. Since coagulation enzyme activates above pH 5.4, it is

© 2009 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd Journal of Gastroenterology and Hepatology 2009; 24 (Suppl. 1): A1–A207

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