INTRODUCTION:Cure of Helicobacter pylori infection in patients with gastric lymphoma of mucosa-associated lymphoid tissue (MALT) leads to long-term clinical remission in the initial stages. As it is a rare disease, its management in clinical practice remains largely unknown and heterogeneity of care remains a concern. The aim was to audit the management and evolution of a large series of low-grade gastric MALT lymphomas from thirteen Spanish hospitals. MATERIALS AND METHODS:Multicentre retrospective study including data on the diagnosis and follow-up of patients with gastric low-grade MALT lymphoma from January 1998 to December 2013. Clinical, biological and pathological data were analyzed and survival curves were drawn. RESULTS:One-hundred and ninety-eight patients were included. Helicobacter pylori was present in 132 (69%) patients and 103 (82%) in tumors confined to the stomach (stage EI) and was eradicated in 92% of patients. Chemotherapy was given in 90 (45%) patients and 43 (33%) with stage EI. Marked heterogeneity in the use of diagnostic methods and chemotherapy was observed. Five-year overall survival was 86% (89% in EI). Survival was similar in EI patients receiving aggressive treatment and in those receiving only antibiotics (p=0.577). DISCUSSION:Gastric MALT lymphoma has an excellent prognosis. We observed, however, a marked heterogeneity in the use of diagnostic methods or chemotherapy in early-stage patients.

BACKGROUND AND AIM:Transient elastography is the reference method for liver stiffness measurement (LSM) in the general population, having lower applicability in obese patients. We evaluated the applicability and diagnostic accuracy of the M and XL probes in overweight/obese patients to establish the most appropriate approach. METHODS:From May 2013 to March 2015, we evaluated patients with a body mass index (BMI) ≥ 28 kg/m2 . We constructed an algorithm with variables independently related to unreliable LSM with the M probe. RESULTS:A total of 1084 patients were evaluated. M and XL probe applicability was 88.8% and 98%, respectively. Waist circumference (WC) (OR; 95% CI; P) (0.97; 0.94-0.99; P < 0.001) and skin-capsule distance (SCD) (0.83; 0.79-0.87; P < 0.001) were independently related to unreliable LSM (M probe). The SCD was > 25 mm in 5.5% of individuals with a BMI ≤ 35 kg/m2 and a WC ≤ 117 cm, with LSM (M probe) applicability rising to 94.3%. In contrast, 36.9% of patients with a BMI > 35 kg/m2 and/or a WC > 117 cm presented an SCD > 25 mm, with M probe applicability being 73.1%. The diagnostic accuracy (area under the receiver operator characteristic) using the M probe to identify significant steatosis (0.76), fibrosis (0.89), and cirrhosis (0.96) was very high in patients with a BMI ≤ 35 kg/m2 and a WC ≤ 117 cm. CONCLUSIONS:The applicability and accuracy of the FibroScan® M probe to identify fibrosis and steatosis was excellent in overweight and obesity grade I (BMI ≤ 35 kg/m2 ) with a WC ≤ 117 cm. The XL probe increased the applicability of transient elastography in obesity grade II-III (BMI > 35 kg/m2 ).

Cryopreservation of serum samples is a standard procedure for biomedical research in tertiary centers. However, studies evaluating the long-term biological stability of direct liver fibrosis markers using cryopreserved samples are scarce.We compared the stability of hyaluronic acid (HA), tissue inhibitor of metalloproteinases (TIMP-1) and amino-terminal propeptide of type III procollagen (PIIINP) in 225 frozen serum samples of HCV-infected patients with a paired liver biopsy for up to 25 years (1990-2014). Moreover, we assessed the diagnostic accuracy (AUROC) of the Enhanced Liver Fibrosis (ELF®) score to identify significant fibrosis (F2-4) and its predictive capacity to identify clinical events during follow-up.Seventy-six patients (39,8%) had mild fibrosis (F0-1) and 115 (60,2%) significant fibrosis (F2-4). HA, PIIINP and TIMP-1 values remained stable during the period from 1995 to 2014 while those of 1990-94 were slightly higher. We did not find significant differences in the median ELF® values during the 20-year period from 1995-2014 in patients with mild (from 8,4 to 8,7) and significant fibrosis (from 9,9 to 10,9) (p = ns between periods and fibrosis stages). The AUROCs of ELF® to identify significant fibrosis were high in all the periods (from 0,85 to 0,91). The ELF® score showed a good predictive capability to identify clinical events during follow-up.The biological stability of direct serum markers (HA, PIIINP and TIMP-1) using HCV-infected samples cryopreserved for 20 years is good. Therefore, the diagnostic accuracy of the ELF® score to identify significant fibrosis and clinical events during follow-up is very high.

We showed that glucose absorption is accelerated in the proximal intestine of morbidly obese humans, associated with increased expression of sodium dependent glucose co-transporter 1 (SGLT1), an altered incretin profile, hyperinsulinemia and hyperglycemia.This study aimed to examine the effects of energy restriction on glucose absorption, expression of intestinal glucose transporters and sweet taste receptors (STR), incretin hormone responses and glycemia in the morbidly obese.Methods: 10 non-diabetic, morbidly obese subjects (2M:8F; 45±3yrs, BMI: 46±3kg/m2) were studied before and after a 2-week VLCD (750kcal/day).On each occasion, endoscopic duodenal biopsies were collected before and after intraduodenal glucose infusion (30g glucose over 30 min, with 3g 3-O-methylglucose (3-OMG) to estimate glucose absorption).Blood glucose and plasma concentrations of 3-OMG, glucosedependent insulinotropic polypeptide (GIP), glucagon-like peptide-1 (GLP-1), and insulin were measured over 240 min.Absolute expression of SGLT-1, GLUT2 and STR (T1R2) transcripts was quantified by PCR.Results After 2 weeks of VLCD, body weight (-5.6±0.5kg,P<0.001), HbA1c (-0.32±0.08%,P=0.001), fasting blood glucose (-0.5±0.1mmol/L,P=0.02) and fasting expression of T1R2 (-54±22%, P=0.03), SGLT1 (-30±7%, P=0.004) and GLUT2 (-50±15%, P=0.008) were lower than at baseline.Prior to VLCD, intra-duodenal glucose had no impact onT1R2, SGLT-1 and GLUT2 expression, but after VLCD, intra-duodenal glucose stimulated increased expression of T1R2 (45±30%, P=0.03) and GLUT2 (57±14%, P=0.003).The blood glucose (P=0.002),plasma GIP (P=0.03) and plasma insulin (P=0.002)responses to intra-duodenal glucose were all reduced after VLCD, while plasma 3-OMG and GLP-1 concentrations were unchanged.CONCLUSIONS: The improvement in glycemic control after short-term VLCD in morbid obesity is most likely mediated by reduced insulin resistance from weight loss, but not via a reduction in intestinal glucose absorption or an increased incretin response.Although VCLD reduces the fasting expression of both STR and glucose transporters, these increase rapidly on exposure to glucose.Further studies with inhibitors of STR and/or glucose transporters are warranted to determine whether the changes in receptor expressional dynamics are responsible for the observed incretin responses.

The first generation protease inhibitors, boceprevir (BOC) and telaprevir (TVR), are both CYP3A4 inhibitors, which predispose drug–drug interactions (DDIs). The aim of this study was to evaluate the prevalence of potential DDIs, the management of outpatient medication and its impact on adherence and efficacy to antiviral treatment in hepatitis C virus (HCV)‐monoinfected and human immunodeficiency virus (HIV)/HCV‐coinfected patients receiving BOC and TVR.

code for colectomy after exclusion of potential confounding colonic diseases, ranging from malignancy to diverticulosis or bleeding.Age cohort, sex, ethnic background, insurance coverage, comorbidities and complications during the hospitalization were captured.Resource utilization, defined by emergency room (ER) visits or admissions were captured for periods before and after the colectomy using data for CA and FL.RESULTS: Between 1998 and 2011, colectomy rates for CC rose from 104 to 310 (or by 200%), amounting to at least 2% of the annual colectomies performed in the US.Most of the patients are female (93.4%) and have a low perioperative risk as defined by young age and limited comorbidities.Consistent with the known patient profile for functional diseases, clinical depression was present in 14.8% and psychotic diseases in 5.8% of patients.Perioperative complications arose in 27.8 % during the index hospitalization.A longitudinal analysis based on the CA and FL State inpatient database and State emergency database was performed.Out of 181 patients undergoing colectomy, 131 patients had at least one event (admission or ED visit) within first 30 days with a readmission rate of 72.4% within this time period.Resource utilization as defined above could be tracked for 181 patients for a median time of 630 (0-2489) before and 446 (0-2488) days after colectomy.Neither the number of ER visits (median: 1 vs. 1) nor that of hospitalizations (median 2 vs. 2) changed for times before and after surgery.CONCLUSIONS: Using a very conservative approach, we determined that colectomies for CC are rising and account for at least 2% of colectomies performed annually in the United States.Despite a relatively young patient population, perioperative complication and 30-day readmission rates are high, demonstrating a significant morbidity.In contrast, the persistently high resource utilization suggests a limited benefit, which should prompt us to question the utility of surgery in functional illnesses, such as chronic constipation.

BACKGROUND:Helicobacter pylori infection is usually treated with a proton pump inhibitor (PPI), amoxicillin and clarithromycin, but it fails in ≥ 20% of patients.AIM: To estimate, by a systematic review and meta-analyses, the most effective rescue treatments after the failure of a first-line therapy with PPI, amoxicillin and clarithromycin in H. pylori eradication.METHODS: Selection of studies: Meta-analyses were performed with randomized clinical trials (RCT) that assessed the efficacy of second-line regimens; the generic inverse variance was applied on prospective and retrospective studies.Inclusion criteria: studies treating H. pylori-positive patients after clarithromycin-amoxicillin-PPI failure.Exclusion criteria: Secondline treatment based on the antibiotic sensitivity, or if the confirmation of eradication were made only by serology, PCR or polyclonal stool antigen test.Search strategy: Bibliographical searches were performed in PubMed, CINAHL, Cochrane Library, ClinicalTrials.gov,DDW y EHSG, up to April 2013.Data synthesis: Intention to treat eradication rate.RESULTS: The efficacies of the second-line treatments are shown on the table attached.A metaanalysis comparing the triple therapy with levofloxacin-amoxicillin-PPI against the quadruple bismuth-metronidazole-tetracycline-PPI regimen showed a non-statistically significant tendency towards better results levofloxacin (OR = 1.74; 95% C.I. = 0.83-3.67;p = 0.14; I2 = 79%; 6 studies; 1,057 patients).CONCLUSION: The most effective second-line treatments, after a clarithromycin-amoxicillin-PPI failure, are the metronidazole-amoxicillin-PPI or a 10 days levofloxacin-amoxicillin-PPI therapy.More high quality trials, performed outside Japan, are needed to verify the efficacy of the 14 days dual therapy with amoxicillin-PPI.

Background: Second-line bismuth-containing quadruple therapy is complex and frequently induces adverse effects. A triple rescue regimen containing levofloxacin is a potential alternative; however, resistance to quinolones is rapidly increasing. Aim: To evaluate the efficacy and tolerability of a second-line triple-regimen–containing levofloxacin in patients whose Helicobacter pylori eradication treatment failed and to assess whether the efficacy of the regimen decreases with time. Methods: Design: Prospective multicenter study. Patients: In whom treatment with a regimen comprising a proton-pump inhibitor, clarithromycin, and amoxicillin had failed. Intervention: Levofloxacin (500 mg bid), amoxicillin (1 g bid), and omeprazole (20 mg bid) for 10 days. Outcome: Eradication was confirmed using the 13C-urea breath test 4 to 8 weeks after therapy. Compliance/tolerance: Compliance was determined through questioning and recovery of empty medication envelopes. Incidence of adverse effects was evaluated by means of a questionnaire. Results: The study sample comprised 1000 consecutive patients (mean age, 49±15 y, 42% men, 33% peptic ulcer) of whom 97% took all medications correctly. Per-protocol and intention-to-treat eradication rates were 75.1% (95% confidence interval, 72%-78%) and 73.8% (95% confidence interval, 71%-77%). Efficacy (intention-to-treat) was 76% in the year 2006, 68% in 2007, 70% in 2008, 76% in 2009, 74% in 2010, and 81% in 2011. In the multivariate analysis, none of the studied variables (including diagnosis and year of treatment) were associated with success of eradication. Adverse effects were reported in 20% of patients, most commonly nausea (7.9%), metallic taste (3.9%), myalgia (3.1%), and abdominal pain (2.9%). Conclusions: Ten-day levofloxacin-containing therapy is an encouraging second-line strategy, providing a safe and simple alternative to quadruple therapy in patients whose previous standard triple therapy has failed. The efficacy of this regimen remains stable with time.

AIM:To investigate the clinical impact of capsule endoscopy (CE) after an obscure gastrointestinal bleeding (OGIB) episode, focusing on diagnostic work-up, follow-up and predictive factors of rebleeding.METHODS:Patients who were referred to Hospital del Mar (Barcelona, Spain) between 2007 and 2009 for OGIB who underwent a CE were retrospectively analyzed. Demographic data, current treatment with non-steroid anti-inflammtory drugs or anticoagulant drugs, hemoglobin levels, transfusion requirements, previous diagnostic tests for the bleeding episode, as well as CE findings (significant or non-significant), work-up and patient outcomes were analyzed from electronic charts. Variables were compared by χ (2) analysis and Student t test. Risk factors of rebleeding were assessed by Log-rank test, Kaplan-Meier curves and Cox regression model.RESULTS:There were 105 patients [45.7% women, median age of 72 years old (interquartile range 56-79)] and a median follow-up of 326 d (interquartile range 123-641) included in this study. The overall diagnostic yield of CE was 58.1% (55.2% and 63.2%, for patients with occult OGIB and overt OGIB, respectively). In 73 patients (69.5%), OGIB was resolved. Multivariate analysis showed that hemoglobin levels lower than 8 g/dL at diagnosis [hazard ratios (HR) = 2.7, 95%CI: 1.9-6.3], patients aged 70 years and above (HR = 2.1, 95%CI: 1.2-6.1) and significant findings in CE (HR = 2.4, 95%CI: 1.1-5.8) were independent predictors of rebleeding.CONCLUSION:One third of the patients presented with rebleeding after CE; risk factors were hemoglobin levels < 8 g/dL, age ≥ 70 years or the presence of significant lesions.

Background: Second-line bismuth-containing quadruple therapy is complex and frequently induces adverse effects. A triple rescue regimen containing levofloxacin is a potential alternative; however, resistance to quinolones is rapidly increasing. Aim: To evaluate the efficacy and tolerability of a second-line triple-regimen–containing levofloxacin in patients whose Helicobacter pylori eradication treatment failed and to assess whether the efficacy of the regimen decreases with time. Methods: Design: Prospective multicenter study. Patients: In whom treatment with a regimen comprising a proton-pump inhibitor, clarithromycin, and amoxicillin had failed. Intervention: Levofloxacin (500 mg bid), amoxicillin (1 g bid), and omeprazole (20 mg bid) for 10 days. Outcome: Eradication was confirmed using the 13C-urea breath test 4 to 8 weeks after therapy. Compliance/tolerance: Compliance was determined through questioning and recovery of empty medication envelopes. Incidence of adverse effects was evaluated by means of a questionnaire. Results: The study sample comprised 1000 consecutive patients (mean age, 49±15 y, 42% men, 33% peptic ulcer) of whom 97% took all medications correctly. Per-protocol and intention-to-treat eradication rates were 75.1% (95% confidence interval, 72%-78%) and 73.8% (95% confidence interval, 71%-77%). Efficacy (intention-to-treat) was 76% in the year 2006, 68% in 2007, 70% in 2008, 76% in 2009, 74% in 2010, and 81% in 2011. In the multivariate analysis, none of the studied variables (including diagnosis and year of treatment) were associated with success of eradication. Adverse effects were reported in 20% of patients, most commonly nausea (7.9%), metallic taste (3.9%), myalgia (3.1%), and abdominal pain (2.9%). Conclusions: Ten-day levofloxacin-containing therapy is an encouraging second-line strategy, providing a safe and simple alternative to quadruple therapy in patients whose previous standard triple therapy has failed. The efficacy of this regimen remains stable with time.

antibody response for getting insights in the immune response related to H. pylori clearance.were randomly assigned to receive three intramuscular doses of the IVAC or placebo at 0, 1 and 2 months.One month after the third vaccination/placebo all subjects received the infective challenge with a well characterized CagA positive H. pylori strain.The primary end point for the presence of infection has been set at 12 weeks post challenge.Serum Anti-CagA, Anti-NAP, and Anti VacA antibodies (IgG) were quantified via ELISA in all subjects on a weekly base (visit V2-10).Results: All verum vaccinated subjects (n=19) responded with mounted immunoglobulin G antibody titers to all 3 antigens (CagA, VacA and NAP) until V10.Vaccinated subjects (n=11) that became H. pylori negative three months after challenge (V10) showed significantly earlier antibody response to CagA with highest titer at V4.In comparison, vaccinated H. pylori positive subjects (n=8) at V10 showed later antibody response with the maximum at V8 (p,0.05).Furthermore, vaccinated H. pylori negative subjects developed overall higher antibody titers to NAP and VacA in comparison to vaccinated H. pylori positive subjects.Interestingly, almost all subjects in the placebo group developed a late (V10) and weaker antibody response to CagA and VacA but not for NAP after challenge with H. pylori.Conclusion: The stronger CagA immune response in vaccinated subjects that became H. pylori negative during the observation period candidates as a possible predictive factor for the clearance of H. pylori after vaccination which includes a Cag antigen.Our results further provide interesting insights in the humoral immune response after challenge with H. pylori.

Objectives No trial has compared non-bismuth quadruple ‘sequential’ and ‘concomitant’ regimens in settings with increasing clarithromycin rates. The study aims to compare the effectiveness and safety of these therapies for Helicobacter pylori treatment. Design Prospective randomised clinical trial in 11 Spanish hospitals. Patients naïve to eradication therapy with non-investigated/functional dyspepsia or peptic ulcer disease were included. Randomised (1:1) to sequential (omeprazole (20 mg/12 h) and amoxicillin (1 g/12 h) for 5 days, followed by 5 days of omeprazole (20 mg/12 h), clarithromycin (500 mg/12 h) and metronidazole (500 mg/12 h)), or concomitant treatment (same drugs taken concomitantly for 10 days). Eradication was confirmed with 13C-urea breath test or histology 4 weeks after treatment. Adverse events (AEs) and compliance were evaluated with questionnaires and residual medication count. Results 338 consecutive patients were randomised. Mean age was 47 years, 60% were women, 22% smokers and 20% had peptic ulcer. Concomitant and sequential eradication rates were, respectively, 87% vs 81% by intention-to-treat (p=0.15) and 91% vs 86% (p=0.131) per protocol. Respective compliances were 83% vs 82%. Treatment-emergent AEs were reported in 59% of patients (no differences found between treatments). AEs were mostly mild (60%), and average length was 6.1 days, causing discontinuation only in 12 patients. Multivariate analysis: ‘concomitant’ treatment showed an OR of 1.5 towards better eradication rate in a borderline significance CI (95% CI 0.9 to 2.8). Conclusions Concomitant therapy led to a non-statistically significant advantage (5%) over sequential therapy, coming closer to 90% cure rates. Both therapies showed an acceptable safety profile. ClincialTrials.gov:NCT01273441.

BACKGROUND & AIMS:Adherence to antiviral treatment is important to achieve sustained virological response (SVR) in chronic hepatitis C (CHC). We evaluated the efficiency of a multidisciplinary support programme (MSP), based on published HIV treatment experience, to increase patient adherence and the efficacy of pegylated interferon alfa-2a and ribavirin in CHC. METHODS:447 patients receiving antiviral treatment were distributed into 3 groups: control group (2003-2004, n=147), MSP group (2005-2006, n=131), and MSP-validation group (2007-2009, n=169). The MSP group included two hepatologists, two nurses, one pharmacist, one psychologist, one administrative assistant, and one psychiatrist. Cost-effectiveness analysis was performed using a Markov model. RESULTS:Adherence and SVR rates were higher in the MSP (94.6% and 77.1%) and MSP-validation (91.7% and 74.6%) groups compared to controls (78.9% and 61.9%) (p<0.05 in all cases). SVR was higher in genotypes 1 or 4 followed by the MSP group vs. controls (67.7% vs. 48.9%, p=0.02) compared with genotypes 2 or 3 (87.7% vs. 81.4%, p=n.s.). The MSP was the main predictive factor of SVR in patients with genotype 1. The rate of adherence in patients with psychiatric disorders was higher in the MSP groups (n=95, 90.5%) compared to controls (n=28, 75.7%) (p=0.02). The cost per patient was € 13,319 in the MSP group and € 16,184 in the control group. The MSP group achieved more quality-adjusted life years (QALYs) (16.317 QALYs) than controls (15.814 QALYs) and was dominant in all genotypes. CONCLUSIONS:MSP improves patient compliance and increases the efficiency of antiviral treatment in CHC, being cost-effective.

Javier P. Gisberta,∗,1, Xavier Calvetb,1, Fernando Bermejoc, Daniel Boixedad, Felipe Borye, Luis Bujandaf, Manuel Castro-Fernandezg, Enrique Dominguez-Munozh, Juan Ignasi Elizalde i, Montserrat Fornej, Emili Genek, Fernando Gomollon l, Angel Lanasm, Carlos Martin de Argilad, Adrian G. McNicholl a, Fermin Mearinm, Javier Molina-Infanten, Miguel Montoroo, Jose Maria Pajaresa, Angeles Perez-Aisap, Emilio Perez-Tralleroq y Jordi Sanchez-Delgadob

Background: The use of fluoroscopy to aid endoscopic retrograde cholangiopancreatography (ERCP) places both the patient and the endoscopy staff at the risk of radiation-induced injury. Previous reports have demonstrated a linear relationship between radiation dose and fluoroscopy duration. Aim: To identify predictive factors of fluoroscopy time and radiation exposure to patients undergoing ERCP by using pulsed fluoroscopy. Methods: Four hundred and four consecutive ERCPs performed from January 2010 to November 2010 at 2 tertiary centers in Spain were prospectively studied. Patients and procedural variables were analyzed. Philips BV Pulsera mobile fluoroscopy system was used on the endoscopy unit. Entrance surface dose, dose-area product, and fluoroscopy time were recorded for each patient. Results: A total of 404 ERCPs on 404 consecutive patients were studied (mean age 73 y). The average entrance surface dose and dose-area product were 12.0 mGy and 0.37 mGy/m2, respectively. Mean fluoroscopy time was 2.31 minutes. The biliary ducts were adequately visualized in 371 (92%) cases. After analysis with a univariable model, the factors found to significantly increase the radiation dose (P75>19.6 mGy) were as follows: alkaline phosphatase serum levels (P=0.047), balloon dilation (P=0.005), biliary stent placement (P=0.001), and ERCP diagnosis (P=<0.0001). In a multivariate analysis, only stent insertion significantly increased the radiation dose (risk ratio 4.75; 95% confidence interval, 1.84-7.63). Conclusions: In this prospective analysis, multiple factors affected the radiation dose. Stent insertion was the only independent predictor significantly associated with prolonged fluoroscopy.

Objectives: We previously showed that gut-directed hypnotherapy (HT) is highly effective in the treatment of children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS).Aim of this follow-up study was to investigate the long-term effects of hypnotherapy versus standard medical treatment plus supportive therapy (SMT).Methods: All 52 participants of our previous randomized controlled trial (RCT) were invited to complete a standardized abdominal pain diary, on which pain frequency and pain intensity were scored.Furthermore, the Children's Somatization Inventory (CSI) and a general quality of life questionnaire were filled out.Clinical remission was defined as > 80% improvement in pain scores compared to baseline.Results: All 27 HT patients and 22 out of 25 SMT patients participated in this study.Two patients of the SMT group were lost to follow-up and one refused to participate.After a mean duration of 4.8 years follow-up (3.4 -6.7), hypnotherapy was still highly superior to conventional therapy with 68% versus 20% of the patients in remission after treatment (P=0.005).Pain intensity and pain frequency scores at follow-up were 2.8 and 2.3 resp. in the HT group compared to 7.3 and 7.1 in the SMT group (p<0.01).Also somatization scores were lower in the HT group (15.2 vs 22.8;p=0.04).No differences were found in quality of life, doctors' visits, and missed days of school or work between the two groups.Conclusion: The beneficial effects of gut-directed hypnotherapy are long lasting in children with FAP or IBS with two thirds still in remission almost 5 years after treatment, making it a highly valuable therapeutic option.

fibrosis.CP patients have lesser FN and PFAN, with fibrosis morphologically limiting the damage.This may be related to reduction of lipolytic flux by fibrosis between adipocytes and acinar cells, thereby limiting the damage due to unsaturated fatty acids generated by the lipolytic degradation of adipocyte triglyderide.Therefore, fibrosis may be responsible for reducing the severity of acute exacerbations in CP.

Background: Helicobacter pylori infection induces chronic inflammation in gastric mucosa and promotes the occurrence of gastric cancer.Although the relationship between Helicobacter pylori infection and gastric cancer has been evaluated in many studies, the effect of Helicobacter pylori treatment on recurrence after endoscopic mucosal resection (EMR) of gastric cancer remain uncertain because of contradictory opinions.Methods: A total of 2089 adult patients aged between 28 and 88 years had undergone EMR of gastric adenoma and early gastric cancer from November 1, 2004 to December 31, 2008 were investigated retrospectively.Among them, the 521 patients had been excluded from the study because of short follow up duration (<1 year) (n=377) and short recurrence interval (<3 months) (n=4) and no tests of urea breath test or rapid urease test or histology for diagnostic test of H. pylori (n= 140).We investigated group without H. pylori infection (n=555.35.4%) and group with H. pylori infection (n=1013, 64.4%) for recurrence rate, recurrence interval, recurrence location.Results: Among group with H. pylori infection (n=1013), group without H. pylori treatment were 25.8% (n=262) and group with H. pylori treatment were 74.2% (n=751).Among group with H. pylori treatment, group with successful treatment were 96.6% (n=727) and group failed treatment of H. pylori were 3.4% (n=25).Among total enrolled patients, male was 70%, mean age was 61.6 ± 9 years old, mean follow up durations were 43 months and mean recurrence interval was 22 months.The baseline parameters of age, sex, depth of invasion, alcohol, smoking, proportion of early gastric cancer, mean follow up duration were homogenously distributed in the group without H. pylori infection and group with H. pylori infection.There was no significant difference in recurrence interval, recurrence location, proportions of local recurrence in the both groups.Recurrence rate of group without H. pylori infection and group with H. pylori infection was 4.1% (n=23) and 13.6% (n=138).(p<0.01,odds ratio 3.6) In a subgroup of patients with H. pylori infection, recurrence rate of group without H. pylori treatment and group with H. pylori treatment was 24.0% (n=6) and 8.1% (n=57) (p<0.01,odds ratio 2.7).In a subgroup of patients with H. pylori treatment, recurrence rate of group with successful treatment and group failed treatment of H. pylori was 9.2% (n=67) and 24.8% (n=65) (p<0.01,odds ratio 2.9).Conclusions: A retrospective study showed that H. pylori eradication may reduce the recurrence in the patients received EMR of adenoma and early gastric cancer.Group failed treatment of H. pylori showed as high recurrence rate as group without H. pylori treatment , therefore H. pylori test after H. pylori eradication treatment is needed and salvage therapy must be considered if treatment of H. pylori is failed.