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Vitamin B deficiency in patients with inflammatory bowel disease (IBD) is well-documented; however, few studies have explored genomic damage in patients with IBD using the cytokinesis-block micronucleus cytome (CBMN-Cyt) assay. This study investigated the frequency of micronuclei (MNi) using the CBMN-Cyt assay and the level of vitamin B in patients with IBD. This prospective study was conducted in 15 patients with ulcerative colitis, 15 patients with Crohn’s disease, and 30 healthy controls from one tertiary hospital. Serum vitamin B and homocysteine levels were measured, and the MNi status was analyzed using the CBMN-Cyt assay. The patients with IBD showed significantly lower serum pyridoxine levels and significantly higher homocysteine levels than controls. The frequencies of binucleated cells (BNCs) with MNi, nucleoplasmic bridges (NPBs), and nuclear buds (Nbuds) were 8.5 [5.8–13.5], 1.0 [0.0–1.9], and 5.4 [4.3–7.4] for the IBD group, and 5.9 [4.8–7.7], 0.2 [0.0–1.0], and 3.5 [2.9–5.4] for the control group ( P = 0.011, P = 0.010, and P = 0.002), respectively. This study suggests that patients with IBD have increased frequencies of MNi and decreased levels of pyridoxine than healthy controls.

Background and Aims Endoscopy is performed with air insufflation and is usually associated with abdominal pain. It is well recognized that carbon dioxide (CO 2 ) is absorbed more quickly into the body than air; however, to date, few studies have investigated the use of CO 2 insufflation during consecutive EGD and colonoscopy (CEC). Thus, this study evaluated the efficacy of CO 2 insufflation compared with air insufflation in CEC. Methods From March 2014 to April 2016, a total of 215 consecutive patients were randomly assigned to receive CO 2 insufflation (CO 2 group, n = 108) or air insufflation (air group, n = 107). Abdominal pain after CEC was recorded on a visual analogue scale (VAS). The amount of sedatives administered, use of analgesics, polyp detection rate (PDR), adenoma detection rate (ADR), abdominal circumference, and adverse events were also analyzed. Results Baseline patient characteristics were not significantly different between the groups. Abdominal pain on the VAS in the CO 2 group and air group 1 hour after CEC was, respectively, 13.8 and 20.1 ( P = .010), 3 hours after CEC was 8.3 and 12.5 ( P = .056), 6 hours after CEC was 3.5 and 5.3 ( P = .246), and 1 day after CEC was 1.8 and 3.4 ( P = .192). The dose of sedative administered, analgesic usage, PDR, ADR, and adverse events were not statistically different between the groups. However, the increase in abdominal circumference was significantly higher in the air group than in the CO 2 group. Conclusions CO 2 insufflation was superior to air insufflation with regard to the pain score on the VAS in the hour after CEC. (Clinical trial registration number: KCT0001491.)

The resistance of Helicobacter pylori to antibiotics has increased the need for new empirical, first-line treatments. However, the efficacy of sequential therapy (ST) and concomitant therapy (CT) compared with triple therapy (TT) has not been adequately evaluated.In this study, we evaluated the efficacy of these empirical three regimens.The 517 patients enrolled in the study were prospectively randomized to receive 10 days of TT (n=171), ST (n=170), and CT (n=176) at 5 university-affiliated hospitals from May 2013 to March 2015. The post-treatment H. pylori status was determined using the (13)C-urea breath test.The baseline characteristics were similar among the three groups. The intention-to-treat eradication rates were 62.6%, 70.6%, and 77.8% in the TT, ST, and CT groups, respectively (p0.01). The corresponding per-protocol eradication rates were 82.8%, 89.5%, and 94.4%, respectively (p0.01). There were no significant differences in the compliance, side effects, and follow-up loss rates.A higher eradication rate was achieved with empirical 10-day ST, and CT than with the TT regimen, with similar rates of compliance and treatment side effects.

This clinical study was performed to evaluate whether supplementation of proton pump inhibitor (PPI)-based triple therapy with Korean red ginseng can enhance Helicobacter pylori (H. pylori) eradication and reduce levels of halitosis-associated volatile sulfur compounds (VSCs) in the stomach. Seventy-six patients were randomized into an eradication regimen-only group (n=45) or an eradication regimen plus 10 weeks of Korean red ginseng supplementation group (n=31). The eradication regimen consisted of PPI b.i.d., clarithromycin 500 ㎎ b.i.d., and amoxicillin 1 g b.i.d.. for seven days. Korean red ginseng supplementation commenced on the last day of the eradication regimen. ¹³C-urea breath test and halimeter measurements were performed prior to protocol repetition. By intention-to-treat analysis, the H. pylori eradication rate in the Korean red ginseng group (77.4%, 24 of 31) was higher than that in the control group (45.0%, 26 of 45). However, by per protocol analysis, the eradication rate in the Korean red ginseng group was significantly higher than that in the control group (92.3%, 24/26 vs. 69.4%, 26/38; p＜0.05). H. pylori infection was significantly associated with increased VSC levels. However, VSC levels decreased significantly in the Korean red ginseng group (p＜0.05). In conclusion, supplementation of triple therapy with Korean red ginseng increased the H. pylori eradication rate and led to significant reductions in VSC levels, suggesting the usefulness of this substance in combating H. pylori infection.

Ginseng has been reported to reduce the risk of cancer in diverse organs, including the lip, oral cavity, pharynx, larynx, esophagus, lung, liver, pancreas, ovary, colon, rectum, and stomach, as demonstrated in clinical and epidemiological studies. studies, base on which findings, Panax ginseng has been classified as a “non-organ-specific cancer preventive.” However, the recent keen interest in traditional medicinal herbs has been frequently questioned, about exact mode of action and the use of panaceic compounds has been a prime issue discussed in terms of complementary and alternative medicine. Several in vitro and in vivo studies have shown the mitigating effects of Korean red ginseng on Helicobacter pylori (H. pylori)-associated atrophic changes and carcinogenesis; However, evidence-based medicine, consisting of large-scale or well designed clinical studies, is still warranted whether Korean red ginseng is to be recognized as an essential therapeutic strategy regarding a “H. pylori-associated gastric cancer preventive.” Specifically, comprehensive clinical trials of Korean red ginseng are needed to demonstrate that mucosal regeneration in patients with atrophic gastritis is feasible using Korean red ginseng supplements after the eradication of H. pylori infection. Ginseng is a good example of a natural herb and its ubiquitous properties may include the reduction or delay of inflammation carcinogenesis. Korean red ginseng contains ample amounts of active ginsenosides and we have demonstrated their effects in in vitro and in vivo studies with positive outcomes. In this review, the quantitative and qualitative benefits of Korean red ginseng in the treatment of H. pylori infection are described.

predict a poor bowel cleansing. Aim: To determine potential patient-related factors that could be related to a poor bowel preparation prior to colonoscopy. Materials and Methods: Adult subjects undergoing a colonoscopy for CRC screening were prospectively enrolled in two endoscopy referral centers in Argentina. Colonoscopies were performed by six trained endoscopists. A split-dose preparation regime was used. Bowel preparation quality was scored according to the Boston Bowel Preparation Scale. Inadequate bowel preparation was defined as a global score of!6. The following variables were recorded: age, sex, functional constipation (according to Rome III criteria), diveticulosis and obesity (defined as a body mass index of R 30), type of purgative administered (polyethylene glycol or sodium phosphate). Univariate analysis as well as multivariate analysis following a logistic regression model were performed. Results: From April 2013 to November 2013, 350 patients were enrolled. Eighty four percent of patients used polyethylene glycol as a purgative. Overall, 18.2% of enrolled subjects had a poor bowel preparation. No significant difference was found in bowel preparation quality when comparing polyethylene glycol and sodium phosphate. Table 1 describes the prevalence of potential patientbased risk factors affecting bowel preparation quality. On multivariate analysis, only age [OR 1.06 (1.02-1.1)] and obesity [OR 2.15 (1-4.77)] were found to be significantly associated with poor bowel preparation. Conclusion: Some patient-related factors, such as increasing age and obesity, are risk factors of inadequate bowel cleansing. Detection of these factors should aid clinicians in modifying bowel preparation regimes accordingly, so that colonoscopy performance can be optimised. AB322 GAST Poor Bowel

Introduction: The increasing levels of antibiotic resistance have increased the need to develop new first-line treatments for Helicobacter pylori. We prospectively evaluate the 10-day sequential and conventional triple therapy. Methods: One hundred and fifty-nine patients who had peptic ulcer diseases confirmed by endoscopy were prospectively randomized to receive 10days of lansoprazole, amoxicillin, and clarithromycin (conventional therapy, CT) or 5 days of lansoprazole and amoxicillin followed by 5 days of lansoprazole , clarithromycin, and metronidazole (sequential therapy, ST). The post-treatmentH. pylori status was determined by the 13C-urea breath test. The eradication rates, antibiotics resistance rate, drug compliance, and side effects of each group were evaluated. Results: The intention-to-treat eradication rates were 75.9% (95% CI:66.5%-85.3%, 60/79) in the ST and 58.7.% (95% CI 78.292.0%,47/80) in the CT (P=0.01), while the per-protocol eradication rates were 86.8% (95% CI: 78.7%-94.8%, 59/68) and 67.6% (95% CI 56.5%-78.7%,46/68) (P=0.01), respectively. The number of patients having side effects was similar between both groups. In culture result, clarithromycin resistance was 19.5% (8/41) and metronidazole resistance was 41.4% (17/41), respectively. Conclusions: 10-day ST showed higher eradication rates than 10day conventional triple therapy. However, ST did not achieve satisfactory eradication rate. Therefore, more effective regimen would be required to overcome antibiotic resistance.

Introduction: Nowadays the main reason for antibacterial therapy inefficiency is considered to be the increase of H. pylori resistance to antibacterial drugs of standard triple therapy. Aims & Methods: Aim of the study was to compare the efficacy and tolerability of 2 dosage different first-line nifuroxazid-, metronidazole-based schemes for eradication of H. pylori infection in pediatrics. We enrolled 161 children ( 7-17 years aged: 77 girls & 84 boys) with stomach and duodenum H pylori infections. Pationts underwent 13C urea breath test, upper endoscopy, histology, rapid urease test. Upper endoscopy was assessed before treatment and 8 weeks after the end of therapy. Patients were randomized into group A: lancoprazole 60 mg/day, clarithromycin 500 mg/day (ages 7 years to 12 years), 1000mg/day (ages 12 years to 17 years), enterofuril suspension 400mg/day (ages 7 years to 12 years) and 800mg/day ( ages 12 years to 17 years)& group B: lansoprazole 60 mg/day, clarithromycin 500 mg/day (ages 7 years to 12 years), 1000mg/day (ages 12 years to 17 years), metronidazole 500mg/day (ages 7 years to 12 years), 1000mg/day (ages 12 years to 17 years), each administered twice a day. Results: All 161 patients finished anti-Hp therapy in both groups. Eradications rates were: group A 70%,p=0,036 (enterofuril 400 mg/day 66%, p=0,067, 800mg/day 87,5%, p=0,047), group B 46%,p=0,064. Mild side effects (nausea, diarrhea, allergic eruption) were reported in 12 patients. More side effects were in group B than A (group A: 4pts, group B: 3pts). No severe adverse events were observed. Epithalization of stomach ulcer and erosion was reported in 8 among 9 patients in group B. Conclusion: Nitrofuran-based triple therapy is more effective than metronidazole-based triple therapy for the eradication of H. pylori in children.

Background & Aims Guanine is easily attacked by ROS to yield oh8dG and oh8dG, the most common DNA adduct known to be mutagenic or carcinogenic, is used as a marker of oxidative stress. Fortunately, mammalian cells have multiple repair systems such as BER or NER to remove oh8dG formed by overwhelming stress. We performed the study to know whether exogenous oh8dG can ameliorate the degree of water immersion restraint stress (WIRS)-induced gastritis through anti-inflammatory and anti-oxidative actions, a novel action of synthetic oh8dG as gastroprotective agent. Methods Electron spin resonance (ESR, Joel) measurement based on Fenton reaction using DMPO as spin adductor was done to check antioxidative action of oh8dG. In Vivo animal model of WIRS were treated with several kinds of drug, PPI, rebamipide, vitamine E, and oh8dG, and we progressed to identify molecular mechanisms how oh8dG did impose anti-inflammatory actions in E. coli LPS (1μg/ml) stimulated Raw264.7 mouse macrophage cell. Results On ESR measurement, OH radical was detected with iron based Fenton reaction using DMPO adductor, but oh8dG in >50pg dose completely scavenged OH radicals, of which action was further confirmed by DCFDA spectroscopy and confocal measurement. oh8dG efficiently preventedWIRS-induced gastritis and ulceration, equivalent efficacy to PPI, for which mucosal levels of TNF-α and IL-1β were significantly attenuated. In a translational study to document the action mechanisms of anti-inflammatory and anti-oxidative action of oh8dG, we checked NOXs expression after oh8dG. oh8dG treatment was associated with marked attenuations of NOX1, NOXO1, and NOXA1 in addition to decreased expression of LPS-induced inflammatory mediators, iNOS, COX-2, IL-1β, and IL-6. These inhibitory actions of NOXs with oh8dG were associated with either plasma membrane or nuclear membrane attenuation of NOXs expression on confocal imaging study, coinciding with decreased levels of oxidized products. oh8dG inactivated p38 and inhibited nuclear translocation of NF-κB, but did not affect Akt activation. Instead of Akt regulation, oh8dG antagonized GTP toward Rac, a small GTP binding protein Conclusions oh8dG is not a simple byproduct, but a functional molecule regulating oxidative stressinduced gastritis through antagonizing small GTP-binding proteins like Rac and blocking the stream to stress-induced inflammatory and oxidative bursts.

Introduction: Nowadays the main reason for antibacterial therapy inefficiency is considered to be the increase of H. pylori resistance to antibacterial drugs of standard triple therapy. Aims & Methods: Aim of the study was to compare the efficacy and tolerability of 2 dosage different first-line nifuroxazid-, metronidazole-based schemes for eradication of H. pylori infection in pediatrics. We enrolled 161 children ( 7-17 years aged: 77 girls & 84 boys) with stomach and duodenum H pylori infections. Pationts underwent 13C urea breath test, upper endoscopy, histology, rapid urease test. Upper endoscopy was assessed before treatment and 8 weeks after the end of therapy. Patients were randomized into group A: lancoprazole 60 mg/day, clarithromycin 500 mg/day (ages 7 years to 12 years), 1000mg/day (ages 12 years to 17 years), enterofuril suspension 400mg/day (ages 7 years to 12 years) and 800mg/day ( ages 12 years to 17 years)& group B: lansoprazole 60 mg/day, clarithromycin 500 mg/day (ages 7 years to 12 years), 1000mg/day (ages 12 years to 17 years), metronidazole 500mg/day (ages 7 years to 12 years), 1000mg/day (ages 12 years to 17 years), each administered twice a day. Results: All 161 patients finished anti-Hp therapy in both groups. Eradications rates were: group A 70%,p=0,036 (enterofuril 400 mg/day 66%, p=0,067, 800mg/day 87,5%, p=0,047), group B 46%,p=0,064. Mild side effects (nausea, diarrhea, allergic eruption) were reported in 12 patients. More side effects were in group B than A (group A: 4pts, group B: 3pts). No severe adverse events were observed. Epithalization of stomach ulcer and erosion was reported in 8 among 9 patients in group B. Conclusion: Nitrofuran-based triple therapy is more effective than metronidazole-based triple therapy for the eradication of H. pylori in children.

G A A b st ra ct s to yield these reduction products that are directly toxic to the bacterium. Although mutational inactivation of the rdxA gene is strongly associated with the development of resistance to MNZ, a number of MNZ-resistant strains have also been reported that show no evident change in the rdxA gene (Aliment. Pharmacol. Ther. 24:81-87, 2006), suggesting the potential existence of other mechanisms of resistance. We assumed that these resistant strains exhibit enhanced ability to defend themselves against superoxide radicals by overexpressing bacterial superoxide dismutase (SodB). The present study was designed to examine the expression of sodB and the function of the ferric uptake regulator (Fur) that acts as a transcriptional repressor protein exhibiting iron-dependent binding to the sodB promoter. Methods. H. pylori strain ATCC 700392 was used as the MNZ-susceptible strain and the MNZ-resistant strains used for the study (KS0033, KS0048 and KS0145) were isolated from patients at Keio University Hospital. The expression of sodB under exposure to MNZ was measured by quantitative RT-PCR, and the levels in the susceptible strain and resistant strains were compared. The complete fur of resistant strains was amplified by PCR, cloned into the pCR2.1-TOPO vector, and then sequenced. The Fur proteins were aligned using Genetyx and the protein structures were modeled using Swiss-Model and DeepView-SwisspdbViewer. Results.While sodB expression was scarcely induced by MNZ in ATCC 700392, overexpression of sodB by about 1.7, 2.6 and 2.1-fold was observed in KS0033, KS0048 and KS0145, respectively, under MNZ exposure. Thus, these MNZ-resistant strains showed enhanced sodB expression, as compared with that in ATCC 700392, under exposure to MNZ. The MNZ-resistant strains had a mutant-type of Fur protein, in which Asn 118 was replaced by His (N118H). From the results of the homologymodeling, Asn 118 was predicted to be located in the 5th alpha-helix region that projected outward. It is conceivable that the N118H of Fur affected the affinity of Fur for iron or the sodB promoter region, resulting in sodB overexpression. Conclusion. Fur mutation in H. pylori, resulting in substitution of Asn 118 by His, is associated with the development of resistance to MNZ.

BACKGROUND: The incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing inWestern countries. It is not well known whether similar changes are occurring in Asia. The present study examined the incidence of AEG in Korea, and characterized the tumors according to Siewert's classification. METHODS: The study retrospectively examined records of 16811 patients diagnosed with esophageal cancer and gastric adenocarcinoma between 1992 and 2006. Patients were divided into three 5-year cohorts (cohort 1 [19921996]: n=2734, cohort 2 [1997-2001]: n=5727, cohort 3 [2002-2006]: n=8340). Cohorts were compared in terms of the ratio of AEG versus ESC plus GNCA. Siewert's classification was used to categorize tumors into one of three types. Demographic features, 5-year survival rate and stage were compared between the three tumor types. RESULTS: The numbers of patients diagnosed with AEG, esophageal squamous cell carcinoma (ESC) and gastric noncardiac adenocarcinoma (GNCA) were 610, 1450 and 14751, respectively. The ratio of AEG versus ESC plus GNCA did not change over time (0.037, 0.034 and 0.038 for cohorts 1, 2 and 3, respectively; p=0.040). The incidence of stage I, II cancer increased over time, as did the 5-year survival rate (p

Background/Aims: The role of double balloon enteroscopy (DBE) is still evolving. The aim of this study was to compare the diagnostic yield of DBE with that of small bowel series (SBS). Methods: We enrolled patients with suspected small bowel disease consecutively, and performed both DBE and SBS in all patients. Results: Eighteen patients (M:F=12:6, 14-82 years) were included. Indications for small bowel evaluation were obscure gastrointestinal bleeding (10), abdominal pain (5), diarrhea (2) and abnormal CT finding (1). Of 10 obscure gastrointestinal bleeding patients, 6 showed the same findings in both studies. However, 4 showed negative findings in SBS while DBE detected erosions or ulcerations. Of 5 abdominal pain patients, 3 showed the same results in both studies. However, 2 demonstrated different results. One was suspected of early Crohn’s disease in SBS, but proved to be normal in DBE, and the other was suspected of malignancy in SBS but was suspected of benign ulcers in DBE. Of 2 chronic diarrhea patients, one was diagnosed as Crohn’s disease in both studies. The other was suspected of tuberculosis in SBS but diagnosed as lymphangiectasia by DBE with biopsy. One patient with jejunal wall thickening in CT proved to be normal in both DBE and SBS. There were no serious complications associated with DBE and SBS. Conclusions: DBE is better than SBS in terms of diagnostic accuracy. DBE may become an important method for the evaluation of small bowel diseases. (Korean J Gastroenterol 2006;48: 25-31) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ