WCIM 2014 SEOUL KOREA 517
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0783 Upper GI Tract
Effectiveness of 14 Versus 7 Days of Moxifl oxacin- Containing Triple Therapy as Second-Line Eradication Treatment of Helicobacter pylori Infection
Jae Jin Hwang1, Dong Ho Lee1, Ae-Ra Lee1, Yong Hwan Kwon1, Yeon Sang Jeong1, Hyun Joo Lee1, KiChul Yoon1, Hyuk Yoon1, Cheol Min Shin1, Young Soo Park1, Nayoung Kim1
Department of Internal Medicine, Seoul National University Bundang Hospital, Korea1
Background: The aim of this study was to evaluate the effi cacy of 14-day moxifl oxa- cin-containing triple therapy compared with 7-day moxifl oxacin-containing triple thera- py as second-line eradication treatment of Helicobacter pylori (H. pylori) infection.
Methods: Between 2011 and 2013, one hundred and thirty-three patients with failure of first-line proton pump inhibitor-based eradication therapy of H. pylori infection were randomized to moxifl oxacin-containing triple therapy (oral 20mg rabeprazole b.i.d., 1000mg axoxicillin b.i.d., and 400mg moxifloxacin q.d.) for either 7 (RAM-7 group, n = 52) or 14 days (RAM-14 group, n = 81). Success of eradication therapy of H. pylori infection was defi ned by a negative results of 13C-urea breath test 4 weeks after eradication treatment.
Results: The eradication rates by intention-to-treat analysis were 69.2% (36/52) and 81.4% (66/81) in the RAM-7 group and the RAM-14 group, respectively (p = 0.031).
The eradication rates by per-protocol analysis were 73.5% (36/49) and 90.4% (66/73) in the RAM-7 group and the RAM-14 group, respectively (p = 0.013). Compliance was very good in the both groups (RAM-7/RAM-14 group: 100%/100%). The adverse event rates were 28.5% (14/49) and 20.5% (15/73) in the RAM-7 group and the RAM-14 group, respectively (p = 0.441).
Conclusions: Second-line H. pylori eradication therapy with moxifl oxacin-containing triple therapy is very effective and show excellent compliance and safety. A 14-day moxifloxacin-containing triple therapy is significantly higher effective second-line eradication treatment than 7-day moxifl oxacin-containing triple therapy for H. pylori infection.
PS 0784 Upper GI Tract
Effectiveness of Helicobacter pylori Eradication for Increasing Platelets of Patients with Idiopathic Thrombocytopenic Purpura
Jae Jin Hwang1, Dong Ho Lee1, Ae-Ra Lee1, Yong Hwan Kwon1, Yeon Sang Jeong1, Hyun Joo Lee1, KiChul Yoon1, Hyuk Yoon1, Cheol Min Shin1, Young Soo Park1, Nayoung Kim1
Department of Internal Medicine, Seoul National University Bundang Hospital, Korea1
Background: The eradication therapy of Helicobacter pylori (H. pylori) can increase platelets of patients with idiopathic thrombocytopenic purpura (ITP) is still a contro- versial issue. The effectiveness of H. pylori eradication therapy given to ITP patients was assessed in relation to the ability of the treatment to increase platelet counts in these patients.
Methods: In this retrospective study patients, with diagnosed with chronic ITP were assessed for H. pylori infection by use of a 13C-urea breath test and patients who had positive result were received standard triple therapy. At the 6 months after eradication therapy, patients who had increasing platelet count recovery of greater than 100 x 103/μL were categorized in the responder group.
Results: A total 42 patients were studied. Fourteen patients among the total were able to maintain their platelet count at 100 x 103/μL or higher during the follow-up period of up to 6 months and these were placed in the responder group, and 28 pa- tients were categorized in the non-responder group. The total rates of patients with H. pylori infection were 52.4% (22/42). The eradication rate was signifi cantly higher in the responder group (8/8, 100%) than the non-responder group (6/14, 42.9%, p
= 0.018). The eradication of H. pylori increased the odds ratio (OR) of the increasing platelet count in ITP patients (OR : 5.35, 95% CI: 1.09-26.33, p = 0.039).
Conclusions: H. pylori eradication therapy was related to increasing platelet count in ITP patients. Success of H. pylori eradication therapy affected the increase in the platelec count.
PS 0785 Upper GI Tract
Clinicopathologic and Molecular Risk Factors for Development of Metachronous Gastric Neoplasm in Patients Who Underwent Endoscopic Resection of Gastric Neoplasm
Hyuk Yoon1, Nayoung Kim1, Cheol Min Shin1, Hye Seung Lee3, Bo Kyoung Kim2, Gyeong Hoon Kang4, Jung Mogg Kim5, Joo Sung Kim2, Dong Ho Lee1, Hyun Chae Jung2
Department of Internal Medicine, Seoul National University Bundang Hospital, Korea1, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Korea2, Department of Pathology, Seoul National University Bundang Hospital, Korea3, Department of Pathology, Laboratory of Epigenetics, Cancer Research Institute, Seoul National University College of Medicine, Korea4, Department of Microbiology, College of Medicine, Hanyang University, Korea5
Background: The aim of this study was to identify clinicopathologic and molecular risk factors for metachronous gastric neoplasm (MGN) in the patients who underwent endoscopic resection (ER) of gastric neoplasm.
Methods: We prospectively collected clinicopathologic data and measured methyl- ation levels of HAND1, THBD, APC, and MOS in the gastric mucosa by methylation specifi c RT-PCR in the patients who underwent ER of gastric neoplasm.
Results: A total of 257 patients with gastric neoplasm (113 low-grade dysplasia, 25 high-grade dysplasia, and 119 early gastric cancers) were enrolled. MGN developed in 19 patients (7.4%) during a mean follow-up of 52 ± 29 months. The 5-year cumula- tive incidence of MGN was 4.8%. In univariate analysis, moderate/severe corpus IM was the only risk factor for MGN (hazard ratio 3.11; 95% CI 1.24-7.80, P = 0.016). In multivariate cox-proportional hazards model, moderate/severe corpus IM and family history of gastric cancer were independent risk factors for MGN after adjusting for other variables; hazard ratios were 4.12 (95% CI 1.23-13.87, P = 0.022) and 3.52 (95%
CI 1.09-11.40, P = 0.036), respectively. Methylation level of MOS was signifi cantly el- evated in patients with MGN as compared to age- and sex-matched patients without MGN (P = 0.020).
Conclusions: In the patients who underwent ER of gastric neoplasm, moderate/severe corpus IM and family history of gastric cancer were independent risk factors for MGN and the methylation level of MOS was signifi cantly higher in patients with MGN than in those without MGN, urging for more intensive surveillance in these individuals.
PS 0786 Upper GI Tract
Mucosal-Incision Assisted Biopsy for Suspicious Gastrointestinal Stromal Tumors
Jaeil Chung1, Yoonchul Seok1, Donggeun Kim1, Myunggi Shim1, Haejae Jo2
Sahmyook Medical Center, Internal Medicine, Gastroenterology Department, Korea1, Sahmyook Medical Center, Department of Pathology, Korea2
Background: Tissue sampling is necessary for defi nitive diagnosis of GIST. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been developed for tissue sampling of suspected GIST and is generally accepted to be a very useful for the diag- nosis of this lesion, but the success rate for histology does not seem to be satisfactory (62%). Recently Eikichi at al has published retrospective review of mucosal incision as- sisted biopsy (MIAB) of suspected GISTs. So we performed prospective study of MIAB associated with suspicious GISTs.
Methods: To evaluate the diagnostic yield of the procedure, mucosal-incision assisted biopsy (MIAB), for the histological diagnosis of gastric gastrointestinal stromal tumor (GIST),and to know the complications of MIAB, we performed prospective study of the 14 patients with suspected gastric GIST who underwent MIAB in our hospitals.
Results: Tissue samples obtained by MIAB were suffi cient to make a histological di- agnosis (diagnostic MIAB) in 12 out of the 14 patients (86%), where the lesions had intraluminal growth patterns. Histologic diagnosis were GIST (9, 64%), Leiomyoma (2, 14%) and infl ammatory change (1,7%). Locations were fundus (3, 21%), cardia (3,21%), body (5, 36%) and antrum (3, 21%). Mean size 15.3 ± 0.8. One patient had signifi cant bleeding after MIAB but well controlled by endoscopic hemostasis.
Conclusions: Although it is generally accepted that EUS-FNA is the gold standard for obtaining biopsies for histological and cytological analysis of suspected gastric GIST, MIAB may be chosen as an alternative diagnostic modality only when the lesion has an intraluminal growth pattern. Further studies will be required to further assess MIAB, including randomized controlled trials to compare MIAB with EUS-FNA.
