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Background: Resistance of Helicobacter pylori to many antibiotics, which lowers the efficacy of eradication therapy, is increasingly prevalent. High-dose proton pump inhibitor (PPI)-amoxicillin dual therapy (HDDT) has been used for H. pylori eradication for years, and resistance to amoxicillin is relatively rare. Although many studies have compared the eradication rate of HDDT with that of guideline therapies, the reported efficacy of HDDT varies greatly and is inconsistent., Aims: This study investigated the eradication rate and adverse effects of HDDT compared with the guidelines at the time of the study., Methods: Several open public databases, including Cochrane, EMBASE, PubMed, and MEDLINE, were searched. The results of the current literature on the eradication and adverse event rates of HDDT compared with the latest recommended first-line therapies were analysed. Notably, 14 out of the 16 included studies were conducted in Asian regions., Results: The eradication rate of HDDT was lower but not significantly different from those of control therapies (odds ratio [OR] = 0.92, 95% confidence interval [CI] = 0.67-1.26) in the intent-to-treat (ITT) analysis. A similar trend was observed in the per-protocol (PP) analysis (OR = 0.88, 95% CI = 0.47-1.63). Notably, the adverse effect risk in HDDT was significantly lower than in other therapies (I 2 = 67.75%, OR = 0.42, 95% CI = 0.33-0.54, P = 0.00004). When the eradication rate of the control group was lower than 81%, HDDT was significantly better than control therapies (OR = 2.44, 95% CI = 1.23-4.84)., Conclusion: HDDT used four times a day for 14 days showed better efficacy and safety than the guideline treatments for H. pylori infection in areas with high antimicrobial resistance., (Copyright © 2024 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.)

In 2006, the US Centers for Disease Control and Prevention issued recommendations supporting routine HIV testing in health care settings for all persons aged 13 to 64 years. Despite these recommendations, physicians are not offering HIV testing routinely. We apply a model that has previously identified 3 central, inter-related factors (knowledge-, attitude-, and behavior-related barriers) for why physicians do not follow practice guidelines in order to better understand why physicians are not offering HIV testing routinely. This model frames our review of the existing literature on physician barriers to routine HIV testing. Within the model, knowledge barriers include lack of familiarity or awareness of clinical recommendations, attitude barriers include lack of agreement with guidelines, while behavioral barriers include external barriers related to the guidelines themselves, to patients, or to environmental factors. Our review reveals that many physicians face these barriers with regards to implementing routine HIV testing. Several factors underscore the importance of determining how to best address physician barriers to HIV testing, including: provisions of the Affordable Care Act that are likely to require or incentivize major payers to cover HIV testing, evidence which suggests that a physician's recommendation to test for HIV is a strong predictor of patient testing behavior, and data which reveals that nearly 20% of HIV-positive individuals may be unaware of their status. In April 2013, the US Preventive Services Task Force released a recommendation supporting routine HIV testing; strategies are needed to help address ongoing physician barriers to testing.

Context: Assistant-administered abdominal pressure is usually required to reduce loop formation during a colonoscopy. The effect of patient self-administered abdominal pressure has not been evaluated., Objective: To compare the effectiveness of patient self-administered abdominal pressure with assistant-administered abdominal pressure to reduce loop formation during colonoscopy performed with minimal sedation., Patients: Consecutive patients who underwent colonoscopy were randomized to receive either patient self-administered abdominal pressure (patient group, n = 51) or assistant-administered abdominal pressure (assistant group, n = 52) when looping occurred during colonoscopy minimally sedated with meperidine. When patient-administered abdominal pressure failed to reduce the loop formation, an assistant took over and delivered the abdominal pressure., Results: No difference was found regarding cecal intubation rate, intubation time, mean pain scores, and overall satisfaction of patients between groups. However, fewer patients required assistant-administered pressure in the patient group than in the assistant group (18/51 vs. 41/52, P < 0.001)., Conclusions: Patient self-administered pressure is effective in reducing looping during minimally sedated colonoscopy.

Background/aims: To investigate the influence of human leukocyte antigen (HLA) class I and II alleles on the response in chronic hepatitis C (CHC) patients receiving combination therapy with pegylated interferon-alfa and ribavirin., Methodology: One hundred and six CHC patients who accomplished combination treatment were enrolled. Sixty-seven patients achieved sustained virologic response (SVR). HLA-A, -B, -C, -DR, and -DQ loci were determined by sequence-based genotyping. The effects of virologic variables and HLA alleles on SVR were evaluated by logistic regressions., Results: Univariate analyses showed that SVR was significantly associated with low pre-treatment HCV RNA levels, HCV genotype non-1, high pre-treatment ALT levels, a significant decline of ALT levels from baseline to week 4, and the low body mass index. Among HLA class I and II alleles, the occurrence of SVR was significantly associated with lack of HLA-B60 and existence of HLA-A33 in univariate analyses (OR, 0.33; 95% CI, 0.14-0.77; p = 0.01; OR, 2.16; 95% CI, 0.86-5.45; p = 0.30 with a trend, respectively). Multivariate analyses revealed that HLA-A33 significantly favored SVR after adjusted for potential confounders (OR, 7.86; 95% CI, 1.43-43.30; p value after Holm's procedure = 0.03)., Conclusions: HLA-A33 is associated with the achievement of SVR in Taiwanese CHC patients receiving combination therapy with pegylated interferon-alfa plus ribavirin.

Background: High seroprevalence of human herpesvirus type 8 (HHV-8) in patients with cirrhosis has been reported to be associated with thrombocytopenia. Severe cirrhosis is always complicated with ascites. HHV-8 DNA levels in effusion from patients with primary effusion lymphoma has been reported to be significantly greater than in blood. The status of HHV-8 antibody and DNA in cirrhotic ascites is unclear., Aims: To assess the status of HHV-8 antibody and DNA in cirrhotic ascites compared to that in cirrhotic plasma., Methods: Plasma and ascites samples were collected from 85 patients with cirrhosis. HHV-8 antibody and DNA were detected by immunofluorescence assay and PCR, respectively., Results: Male patients seropositive for HHV-8 antibody were significantly younger than seropositive female patients (p=0.0039). The seropositive rate in patients with cirrhosis was not associated with thrombocytopenia (p=0.6860). Both positive rate and titres of antibody in plasma were much greater than in ascites (p<0.0001). More male or Child-Pugh class C than female or class B seropositive patients were positive for ascites. No hepatitis C virus-related ascites were positive for antibody. Neither plasma nor ascites samples from any subject were positive for HHV-8 DNA., Conclusions: In patients with cirrhosis, the seropositive rate for HHV-8 antibody is independent of thrombocytopenia. The positive rate for HHV-8 antibody in cirrhotic ascites seems to be associated with sex, disease severity and disease aetiology.

Aim: Anemia during combination therapy with pegylated interferon alfa-2b plus ribavirin (RBV) for chronic hepatitis C virus (HCV) patients usually leads to RBV dose reduction or discontinuation. This study evaluated the effect of erythropoietin-beta (EPO-beta) to maintain RBV dose and hemoglobin (Hb) level in chronic HCV patients treated with antiviral combination therapy., Methods: Eighty-eight chronic HCV patients who developed anemia during therapy were enrolled into this retrospective study: 55 in the EPO-beta group and 33 in the untreated group. The study endpoints were to assess the RBV maintenance and the changes in Hb., Results: A higher percentage of patients with RBV maintenance was observed in the EPO-beta group compared with the untreated group (nadir Hb level <10.5 g/dL; 70% vs. 38%, P = 0.020; nadir Hb < 10 g/dL; 62% vs. 27%, P = 0.046). The mean Hb change from week 12 to week 20 was higher in the EPO-beta group when compared with the untreated group, especially for patients receiving a total EPO-beta dose of more than 16 000 U (+0.70 g/dL vs. -0.32 g/dL, P = 0.023) and of 10 000 U-14 000 U (+0.60 g/dL vs. -0.32 g/dL, P = 0.023)., Conclusions: Low-dose EPO-beta can maintain RBV dose and increase Hb levels in anemic chronic HCV patients receiving combination therapy.

Background/aims: Adefovir dipivoxil treatment leads to higher HBeAg seroconversion rates than placebo. The study was to evaluate which clinical or virological variables correlate with endpoints (e.g. HBeAg seroconversion and HBV DNA <10(5) copies/mL) during Adefovir dipivoxil or placebo therapy., Methodology: Fifty-two patients were enrolled with 33 in the ADV group and 19 in the placebo group. The correlation between clinical/virological variables and endpoints was evaluated by logistic regression as well as stratified analyses using Fisher's exact test., Results: After one year of treatment, HBeAg seroconversion was associated with low pre-treatment HBV DNA levels. HBeAg seroconversion rates categorized by pre-treatment HBV DNA levels were distinct in the placebo group (<10(7) vs. >10(7) copies/mL, P=0.037) and in the ADV group (<10(8) vs. >10(8) copies/mL, P=0.039). In addition, HBV DNA levels reductions at week 4, week 8 and week 12 were associated with higher rates of HBeAg seroconversion., Conclusions: Low pre-treatment HBV DNA level is predictive of HBeAg seroconversion in patients treated with Adefovir dipivoxil or placebo. Adefovir dipivoxil may provide additional benefits for HBeAg seroconversion in patients with pre-treatment HBV DNA levels between 10(7) and 10(8) copies/mL. Profound early HBV DNA reduction may contribute to HBeAg seroconversion.

A gastric carcinoid tumor concomitant with gastrointestinal stromal tumor (GIST) is rarely encountered in clinical practice. We report a 65-year-old female who had a 0.8 cm gastric carcinoid tumor on the posterior wall of the upper gastric corpus detected during an esophagogastroduodenoscopy at a routine physical examination, and a concomitant 1.1 cm GIST on the anterior wall of the upper gastric corpus incidentally found during surgery of the gastric carcinoid tumor. Normal serum gastrin level and histological findings suggested that she had a type III gastric carcinoid tumor and a GIST which were categorized a very low risk of malignancy, based on their small size and lack of mitosis. Both tumors were treated successfully by surgical excision. The patient had an uneventful recovery. Neither recurrence nor metastasis was found after a 28-mo follow-up.

Immunologic abnormalities in patients with cirrhosis strongly correlate with severity of liver cirrhosis. The association between cirrhosis and human herpesvirus type 8 (HHV-8) infection is unclear. Plasma samples were obtained from 74 healthy control subjects and 59 patients with cirrhosis. The seropositive rates for HHV-8 antibodies in patients with cirrhosis (25/59 [42%]) were significantly higher than that in healthy control subjects (18/74 [24%]; P = .027), particularly in men (P = .027), patients with alcohol-related cirrhosis (P = .032), and patients with thrombocytopenia (P = .019) or Child-Pugh class C cirrhosis (P = .018) or both (P = .015), or hepatitis B virus (HBV) infection (P = .003). Antibody titers in seropositive patients also significantly exceeded those in healthy control subjects (P = .008). All subjects were negative for anti-HIV. In Taiwan, cirrhosis is associated with HHV-8 infection, particularly in men, patients with Child-Pugh class C cirrhosis and/or thrombocytopenia, and patients with alcohol- or HBV-related cirrhosis.

Background/aims: Peroral cholangioscopy with a mother-baby scope system has been introduced for two decades. The paper presents the experience of peroral cholangioscopy at a university hospital in Taiwan where the prevalence of hepatocellular carcinoma and choledocholithiasis was high., Methodology: A total of 27 sessions of peroral cholangioscopy were performed in 26 patients during a period of 4 years. Of them, 20 patients were for diagnosis and the rest 6 for removing the retained biliary stones., Results: The overall successful rate was 96.3%. The post-procedure complication rate was 11.5% with 2 cholangitis and 1 gram-negative septicemia. There were a total of 19 successful diagnostic sessions. These resulted in definite histological diagnosis in 5 patients and more precise diagnoses subsequently confirmed by surgery in 5 patients. In the remaining 9 patients with tentative diagnoses, 5 confirmed their diagnoses but 4 patients changed their diagnoses after peroral cholangioscopy. By this procedure, hepatocellular carcinoma and choledocholithiasis can be well identified and differentiated., Conclusions: Peroral cholangioscopy is a safe and valuable modality in diagnosing and treating difficult biliary tract disease when handled with care. It is particularly useful in an endemic area with high prevalence of hepatocellular carcinoma and choledocholithiasis.

A 73 year-old female patient suffered from anemia and a palpable abdominal mass. Abdominal ultrasonography and magnetic resonance imaging revealed a lesion with papillary excrescences at the pancreatic tail. Endoscopic retrograde cholangiopancreatography showed a normal pancreatic duct, but a small submucosal tumor was found in the stomach incidentally. Laparotomy disclosed an exophytic tumor arising from the submucosal layer of the stomach. Pathology revealed a gastric leiomyosarcoma with remarkable liquefaction and cystic change. Gastric leiomyosarcoma can be so necrotic as to be mistaken for a cystic tumor. It is critically important to differentiate the peripancreatic cystic lesion because the treatment strategy is totally different.