Effect of Helicobacter pylori Eradication on the Development of Reflux Esophagitis and Gastroesophageal Reflux Symptoms: A Nationwide Multi-Center Prospective Study

Background/Aims

A two-year, prospective, nationwide multicenter study was undertaken to evaluate the effect of Helicobacter pylori eradication on the development of reflux esophagitis (RE) and gastroesophageal reflux disease (GERD) symptoms in the Korean population.

Methods

In total, 1,489 subjects without RE were enrolled at the outpatient clinics of 12 tertiary hospitals nationwide, and 452 subjects underwent follow-up (F/U) for 2 years to evaluate the development of RE and GERD symptoms.

Results

RE was found in 33 subjects (7.3% of 452 subjects) and 14 subjects (7.3% of 192 subjects) during the first and second year of F/U, respectively. H. pylori status was not associated with the development of RE. RE was found in six (9.0%) of 67 H. pylori-negative patients, in 26 (11.2%) of 233 eradicated subjects and in eight (7.0%) of 114 noneradicated subjects (p=0.532). Multivariate analysis showed that age ≥60 years (odds ratio [OR], 7.11; 95% confidence interval [CI], 1.92 to 26.41), alcohol consumption (OR, 4.43; 95% CI, 1.03 to 19.19) and F/U cholesterol levels ≥200 mg/dL (OR, 5.03; 95% CI, 1.32 to 19.17) were significant risk factors for the development of RE. There was no significant difference in the development of GERD symptoms or weight according to H. pylori status during the 2-year F/U.

Conclusions

Eradication of H. pylori did not affect the development of reflux esophagitis or GERD symptoms among patients in outpatient gastroenterology clinics in South Korea.     

Induction of complement resistance in cloned pathogenic Entamoeba histolytica

The lytic effect of complement activated through the alternative pathway (AP) was studied on pathogenic and nonpathogenic Entamoeba histolytica recently isolated from stool samples. Recent nonpathogenic isolates were nearly unaffected by exposure to AP whereas recent pathogenic stool isolates were highly susceptible to AP dependent complement-mediated lysis. Complement susceptible pathogenic stool isolates developed complement resistance in vivo during hamster liver passage and in vitro during cultivation in the presence of increasing concentrations of normal human serum (NHS). Since a clone of pathogenic HM-l.IMSS which initially was highly susceptible also acquired complement resistance during cultivation in the presence of NHS, it is concluded that complement resistance was caused by induction rather than by selection alone. Because cultivation in the presence of heat-inactivated NHS did not affect complement susceptibility of the cloned HM-l.IMSS, complement activation itself might induce complement resistance in pathogenic E. histolytica.     

Child malnutrition and development processes in two Tanzanian villages

Despite drastic changes in the agricultural, educational andhealth sectors, Tanzania still has a high rate of child malnutrition.The differences in malnutrition rates between nearby villagesare often very large - in fact larger than between regions. This study of child malnutrition in two villages in the Rukwaregion, is an attempt to explain some of the underlying factorsand processes leading to differences in the malnutrition rate.An attempt has also been made to link this to developmentalprocesses. The villages had undergone development in the same areas: agriculturalmodernization, market integration, mass education and the expansionof the health service. However, the data from this study indicatesthat the balance in emphasis between the various parts of thedevelopment package was different in the two villages, and thatthis had implications for the food and nutritional situationin the households.     

Loss of Atrial Signal Detection with Increasing Sensitivity Settings: A Software Problem and its Practical Solution

A logic error in the software of Cosmos II results in apparent malsensing of atrial signals at high rather than low sensitivity settings. The paradoxical function was found in 54 out of 87 units tested (= 62%) if the atrial sensitivity was increased and the ventricular refractory period was lengthened beyond critical limits that could be defined individually. The problem inherent in both unipolar (66%) and bipolar systems (54%) is attributed to a summation of a physiological signal and internal noise, which has to be detected at the atrial level within a specific timing window to disable atrial sensing for the next pacing cycle. The malfunction virtually disappears if the ventricular refractory period does not exceed 210 msec. It is recommended, therefore, that Cosmos II pacemakers be left at their nominal ventricular refractory value (200 msec).     

Urticaria induced by preservatives and dye additives in food and drugs

Fifty-two patients with recurrent urticaria or angio-oedema and thirty-three controls have been provoked with five different food dyes and the preservatives sodium benzoate and 4-hydroxy-benzoic acid, as well as aspirin, sulphanilic acid and a placebo. The reaction was judged as positive in thirty-nine patients who developed urticaria within 14 h. Of these, thirty-five reacted to aspirin, twenty-seven to benzoic acid compounds and twenty-seven to azo dyes. The four patients who did not have urticaria after aspirin, reacted with urticaria to benzoic acid compounds, and three of them to azo dyes. No definite pattern for the reaction to the different azo dyes was seen. None had an urticarial reaction from sulphanilic acid, Patent Blue (a non-azo dye) or placebo. The doses of additives used in the provocation tests are easily exceeded in daily life by the consumption of foods and drugs. Recurrences of urticaria could be prevented through the avoidance of food and drugs containing azo dyes and preservatives.     

Threshold and Polarization Properties of Modern Active Fixation Atrial Leads

The purpose of the study was to compare the stimulation characteristics of two modern active fixation leads (E1a 583F, vitreous carbon tip [ELA] and Intermedics 82–0008–1601, iridium oxide tip [IROX]) with a standard lead (Osypka KY 67 VC, carbon-covered elgiloy tip [OSY]). In three groups of ten patients each, minimum charge threshold δQ_min and polarization properties were determined via charge telemetry of the pacemaker (Intermedics Cosmos II and Relay) 0, 2, 5, 10, 28, 90, and 180 days after implant (dai). The polarization parameters global capacitance C_g, global resistance R_g, polarization voltage U_p, and a time constant t* (t*= C_gċ R_g) were obtained by nonlinear regression. U_p was always significantly (sig) lower in ELA and IROX (0.04–0.10 V) compared to OSY (0.54–0.76 V). R_g was sig lower in ELA (330–437 Ω) compared to OSY and IROX (414–588 Ω) from 0 to 28 dai. From 2 to 10 dai, C_g was sig higher in ELA and IROX (3.8–4.2 μF) compared to OSY (3.3–3.4 μF). In the three groups, BQ_min reached a comparable maximum (1–1.2 μC) at 5 dai. Therefore, vitreous carbon and iridium oxide atrial fixation leads exhibit low chronic polarization effects compared to a standard elgiloy lead, but do not show a sig reduction in charge threshold.     

Rate Response During Submaximal Exercise: Comparison of Three Different Sensors

Since 1983, 248 rate responsive pacemakers were implanted at our hospital. The main emphasis during clinical follow-up has to be placed on (he adjustment and control of its rate adaption, to meet the requirements of the aged patient's daily life. Repeated submaximal exercise but not extreme strain, come to the fore. Kaltenbach's step test (individually by stencils defined normal ranges of the heart rate during a 6 minute submaximal exercise and a 6 minute recovery period; age and sex dependent work load relative to body surface area) is able to mimic everyday efforts in an easy and reliable way. Nineteen patients with QT-related pacemaker, 12 patients with respiratory dependent pacemaker and 45 patients with body activity directed pm Activitrax were exercised using Kaltenbach's step test (mean wattage QT: 56 ± 14, HDP: 75 ± 29, Activitrax: 64 ± 20). Fifty-two patients performed 3 rounds. In comparison, 42 patients with DDD-pm underwent the same test (75 ± 28 Watt). The average curve [heart rate] with QT-pm settled in the normal range of the step test but was distorted. Only 42% of the patients reached normal range in ail three rounds. The mean heart rate of the RDP-group bordered on the basis of the normal range. The average curve (heart rate) of patients with Activitvax or DDD settled exactly in the desirable range. Problems with the rate response under repeated exercise did not occur either in the RDP or in the DDD group. The rate response behavior of the QT-related pm, the RDP and the Activitrax was of different quality. The Activitrax, with all its limitations as a device witb a non physioiogical sensor, came off very well; even though modifications of the programmable gradings of the rate response (thresholds) should be considered. Kaltenbach's step test is an excellent method to adjust and control rate responsive pacemaker.     

A new intra-oral screw jack

A new pattern of screwjack for assessing the vertical dimension for occlusion utilizing an edentulous patient's proprioceptive sensation is described. It provides a greater range of movement than other, giving infinitely variable heights between 9 and 21 mm. The elements being captive, it cannot come to pieces in use. Laboratory experiments were contrived to define the magnitude of reading errors and the play in the screw threads. It was found that, only in instances where a graduation related closely to the datum mark, did errors of interpretation arise. These were found to exceed the height set for test purposes by 0-1 mm consistently. An error of this order is of no practical significance clinically and is no impediment to such an application of the device. Mean play in the new pattern jacks was 0-01 mm compared to 0-05 mm in the Timmer versions. In a clinical experiment the performance of the screw was compared to that of Timmer. Statistical evidence was found which suggested a functional difference between the two, the new pattern being significantly more accurate.