Prevalence of Helicobacter pylori Infection in High-school Students on Lanyu Island, Taiwan: Risk Factor Analysis and Effect on Growth

Background/PurposeThe Yami inhabit Lanyu Island and are the smallest and most primitive aboriginal tribe in Taiwan. Lanyu Island is a closed environment and little information is available on the prevalence of Helicobacter pylori infection there. This study aimed to establish the prevalence of H. pylori infection in high-school students on Lanyu Island and its risk factors and effect on growth.MethodsA cross-sectional population-based study was conducted among high-school students to determine the prevalence of H. pylori infection by using the 13C urea breath test. A questionnaire was administered to the recruited population. Relevant personal and socioeconomic data for risk factors of infection were collected. Body height and weight of the recruited adolescents in relation to H. pylori infection were analyzed.ResultsA total of 106 high-school students (55 boys and 51 girls), with a mean age of 14.3 ± 1.4 years were enrolled. The overall prevalence of H. pylori infection was 54.7%. Those residing in Dongcing village had the highest rate of H. pylori infection (73.3%). There was no difference in the prevalence of H. pylori infection according to sex, ethnicity, socioeconomic level or parental education. Sixty-two students (54.8%) were completely asymptomatic and the others had at least one gastrointestinal symptom. H. pylori infection was asymptomatic in 56.8% and symptomatic in 53.2% of students. There was no significant difference between infected and uninfected children with regard to body weight, height and body mass index.ConclusionThe prevalence of H. pylori infection is high among high-school students on Lanyu Island. There is no evidence that infection is related to growth failure

Interleukin 10 promoter haplotype is associated with alcoholic liver cirrhosis in Taiwanese patients

AbstractAlcoholic liver cirrhosis is a severe form of alcohol-related liver damage. More than 95% of heavy drinkers develop a fatty liver, but only 35% of them develop cirrhosis. We postulate that genetic factors may play a role in this difference. Genetic polymorphisms of the cytokine genes may influence Kupffer cells cytokine genes expression. In this study, we evaluated the promoter polymorphisms of interleukin (IL) 1β, IL 6, IL 10, and tumor necrosis factor alpha (TNFα) and aimed to clarify the association between the polymorphisms and the disease. Forty alcoholic patients with liver cirrhosis and 64 healthy volunteers were included in our investigation. Genotyping on IL 1β –511 T>C, IL 6 –572 G>C, IL 10 –819 C>T, IL 10 –1082 G>A, and TNFα –308 G>A was done. Another 36 patients with recurrent alcoholic pancreatitis were included as an additional control group. Genotyping on IL 10 –819 C>T and IL 10 –1082 G>A was done. The polymorphisms on IL 1 and IL 6 showed no significant association. The p value for TNFα –308 G>A was 0.028 in comparison with healthy volunteers. Although the p value was less than 0.05, it did not reach significance after Bonferroni correction. The p values for IL 10 –819 C>T and IL 10 –1082 G>A were respectively 0.031 and 0.026 in healthy volunteers and 0.028 and 0.023 in the alcoholic pancreatitis group. The results also did not reach significance after Bonferroni correction. Among the participants with the GCC haplotype, healthy volunteers had p = 0.027 (p < 0.05) and an odds ratio (OR) of 0.124 [confidence interval (95%) CI, 0.015–0.997], whereas the alcoholic pancreatitis group had p = 0.023 (p < 0.05) and an OR of 0.106 (95% CI, 0.012–0.912). The odds ratio of people having one ATA haplotype was 6.233 (95% CI, 0.739–52.547) in healthy volunteers and 6.588 (95% CI, 0.727–59.679) in the alcoholic pancreatitis group; the corresponding rate was 10.521 (95% CI, 1.252–88.440) and 12.833 (95% CI 1.408–117.008) for people with two ATA haplotypes. The p values in these groups were 0.031 (p < 0.05) and 0.028 (p < 0.05), respectively. The presence of a GCC haplotype could have protective effect against alcoholic liver disease, whereas the presence of an ATA haplotype could predispose carriers to the disease. The IL 10 promoter haplotype is associated with alcoholic liver cirrhosis in Taiwanese patients

Percutaneous Endoscopic Gastrostomy in the Enteral Feeding of the Elderly

SummaryToday we are faced with an aging society that may develop malnutrition because of dysphagia related to dementia, stroke, and malignancy seen often in the elderly. The preferred form of nutritional supplementation for this group is enteral nutrition, and the most appropriate long-term method is by use of a gastrostomy. Percutaneous endoscopic gastrostomy (PEG) was first introduced in 1980 as an alternative to the traditional operative procedure and rapidly became the preferred procedure. In geriatric patients, the principal indications are neurological dysphagia and malnutrition, related to an underlying disease or anorexia-cachexia in very elderly. PEG is contraindicated in the presence of respiratory distress, previous gastric resection, total esophageal obstruction, coagulation disorders and sepsis in the elderly. Common complications include wound infection, leakage, hemorrhage, and fistula in the general population, but aspiration pneumonia is the major case of death in this group. Risks and complications of PEG must be discussed with patients and their families; and the decision for percutaneous endoscopic gastrostomy insertion should only be made after careful consideration and discussion between managing physicians, allied health professionals, and the patient and/or family. Four ethical principles may help make feeding decisions: beneficence, non-maleficence, autonomy and justice. Attentive long-term care after tube replacement is mandatory. Acceptance of percutaneous endoscopic gastrostomy placement by patients and their families tends to increase once favorable outcomes are offered

Spontaneous Splenic Infarction as an Uncommon Cause of Fever in a Cirrhotic Patient

Spontaneous splenic infarction is a relative rare disease and usually happens in patients with some disorders that have potential of thromboembolism formation. The symptoms are often subclinical and non-specific so physicians easily forget this diagnosis. However, splenic infarction could cause destructive consequences such as hemorrhagic shock, especially in old or weak patients. In this article, we present one case with fever and unexplained abdominal pain; the patient was ultimately diagnosed spontaneous splenic infarction. Although early suspicion or diagnosis may be challenged, physicians should remember this disease and arrange associated investigation to make correct management