Improvement of Work Productivity and Quality of Life with Anti-Tumor Necrosis Factor Treatment Used in Crohn's Disease in Routine Clinical Practice in Turkey

BACKGROUND

Patients with Crohn's disease experience major deterioration in work productivity and quality of life. We aimed to provide the long-term effects of anti-tumor necrosis factor agents on work productivity and activity impairment and quality of life in patients with Crohn's disease using the Inflammatory Bowel Disease Questionnaire and the Short-Form Health Survey-36.

METHODS

Patients with Crohn's disease and initiated an anti-tumor necrosis factor treatment were included and followed up for 12 months in this observational study.

RESULTS

A total of 106 patients were included in this study, and 64.2% of the patients were males. Mean [± standard deviation] age was 36.8 [± 10.9] years. At baseline, mostly perianal fistulas [65.7%] were observed [n = 23]. Intestinal stenosis was detected in 34.9% of the patients [n = 37], and most of the stenosis was located in the ileum [70.6%] followed by the colon [20.6%]. Extraintestinal symp- toms were observed in 24 patients [22.6%]. Most frequent extraintestinal symptom was arthritis with 71.4% [n = 15]. Mean time from first symptom to initiation of anti-tumor necrosis factor treatment was 6.3 [± 5.0] years. Improvements in work productivity and activ- ity impairment scores throughout 12 months were -24.1% [P = .003] for work time missed, -18.0% [P = .006] for impairment at work, -8.5% [P = .160] for overall work impairment, and -17.0% [P < .001] for daily activity impairment. Similarly, significant improvements [P < .001] were detected in all components of the Inflammatory Bowel Disease Questionnaire when compared to baseline. Statistically sig- nificant improvements [P < .05] were detected for all components of Short-Form Health Survey-36 except for mental health [P = .095].

CONCLUSION

Our study indicates the significant improvement in work productivity and activity impairment and quality of life of patients with Crohn's disease who receive long-term anti-tumor necrosis factor treatment.

A new technique for endoscopic treatment of gastric phytobezoars: fragmentation using guidewire

BACKGROUND AND STUDY AIMS

Bezoars result from accumulation of indigestible materials in the gastrointestinal tract and often occur in the stomach. In this study, we evaluated the use of guidewires in patients with gastric phytobezoars (PBs) as a new method for PB removal and examined the safety of the procedure.

PATIENTS AND METHODS

Between February 2009 and January 2013, we analyzed data from 11 patients with gastric PBs. We fitted a transparent cap to a standard endoscope (EG450WR5, Fujinon), and a 0.025 inch guidewire was passed through the standart endoscope. PBs were surrounded by a loop in the guidewire and destroyed. After 2 weeks of treatment, patients were re-evaluated for effectiveness.

RESULTS

PB fragmentation time was 5-11 minutes. In five patients with a history of gastric surgery, we needed an additional 16-28 minutes for removal of the fragments. In six patients additionally treated with enzymatic degradation after the breaking procedure, PBs completely disappeared within 2 weeks. There were no complications during the procedure.

CONCLUSIONS

The guidewire and fragmentation procedure for PBs is an efficient and reliable method. When combined with enzymatic degradation, PBs can be managed quickly and effectively.

The relationship between resistin and ghrelin levels with fibrosis in nonalcoholic fatty liver disease

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease. It is generally accepted that insulin resistance is a pathophysiological factor in the development of NAFLD. In the present study, the aim was to determine the relationship between resistin and ghrelin levels, which were found to be closely related to insulin resistance and fibrosis scores in NAFLD.

MATERIALS AND METHODS

A total of 40 (21 male, 19 female) NAFLD patients whose diagnosis was confirmed with biopsy and 40 (18 male, 22 female) healthy controls were included in the study.

RESULTS

In the comparison of resistin and ghrelin levels, only resistin values were found to be significantly higher in NAFLD group while there was no significant difference in ghrelin values (respectively P < 0.05; P = 0.078). In according to the fibrosis groups there was no difference about fasting plasma glucose, insulin values, Homeostatic Measurement Assessment-Insulin Resistance measurements and also resistin and ghrelin levels.

CONCLUSION

It has been understood that insulin resistance plays an important part in NAFLD. Larger studies are required that investigate the gene expression of hormones influencing insulin resistance, particularly resistin and ghrelin in order to determine their role in NAFLD.

Valsartan-induced acute pancreatitis

Gastrointestinal toxicity is uncommon among patients treated with angiotensin II receptor antagonists. A 58-year-old man presented with nausea, vomiting and constant pain in the epigastrium that radiated to the flanks. He received treatment with valsartan (160 mg daily) for hypertension. The clinical, biochemical and radiological findings were compatible with a diagnosis of acute pancreatitis. After the patient achieved a clinical and biochemical recovery, the valsartan therapy was started again. Six weeks later, he returned to the hospital with an attack of pancreatitis. Subsequently, he returned with repeated attacks of pancreatitis twice, and the valsartan was discontinued. Ten months after the treatment, the patient had no complaints. When severe abdominal symptoms occur for no apparent reason during treatment with valsartan, a diagnosis of pancreatitis should be considered.

Nonresponsive celiac disease due to Strongyloides stercoralis infestation

Celiac disease (CD) is treated by eliminating all gluten from the diet. A 49-year-old man with CD was admitted to our clinic with complaints of recurrent diarrhea and abdominal pain despite strict adherence to a gluten-free diet. The duodenum was seen to be edematous on gastroduodenoscopic examination. Histological examination of the biopsy specimen taken from the duodenum showed multiple round shaped Strongyloides stercoralis (S. stercoralis) larvae within the crypts. He was successfully treated with albendazole. This case emphasizes the importance of duodenal biopsy in CD. To our knowledge, this is the first case in the literature showing CD and S. stercoralis together.

Frequency and mutation patterns of resistance in patients with chronic hepatitis B infection treated with nucleos(t)ide analogs in add-on and switch strategies

BACKGROUND

Treatment for chronic hepatitis B (CHB) has improved over the last 10 years mainly due to the development of effective oral antiviral agents [nucleoside/nucleotide analogs (NUCs)].

OBJECTIVES

The aim of the present study is to identify the frequency and major patterns of resistance to the hepatitis B virus (HBV) in a Turkish population of CHB patients treated with NUCs using add-on and switch therapy strategies.

PATIENTS AND METHODS

The investigation involved a total of 194 patients (88 were treated using add-on therapy, and 106 were treated using switch therapy). We analyzed the HBV polymerase gene by amplification and direct sequencing procedures.

RESULTS

Primary drug-resistance mutations were detected in 84 patients (43%; 42 in add-on therapy, and 42 in switch therapy) taking lamivudine (LAM), 10 patients (5%; 6 in add-on therapy, and 4 in switch therapy) taking entecavir (ETV), and 16 patients (8%; 8 in add-on therapy, and 8 in switch therapy) taking adefovir (ADV). The most common LAM and ETV resistance mutations were rtM204I/V, rtL180M and rtT184A/I/S, respectively, while rtA181T/V and rtN236T substitutions were the most frequently observed ADV resistance mutations.

CONCLUSIONS

Patients with CHB who developed NUC resistance were managed using 2 different rescue strategies. The frequency and mutation pattern of resistance were similar in patients treated with add-on and switch strategies. These findings may be helpful in the management of rescue strategies in LAM-resistant patients.

Endoscopic submucosal dissection for premalignant lesions and noninvasive early gastrointestinal cancers

AIM: To investigate the indication, feasibility, safety, and clinical utility of endoscopic submucosal dissection (ESD) in the management of various gastrointestinal pathologies.

METHODS: The medical records of 60 consecutive patients (34 female, 26 male) who underwent ESD at the gastroenterology department of Kocaeli University from 2006-2010 were examined. Patients selected for ESD had premalignant lesions or non-invasive early cancers of the gastrointestinal tract and had endoscopic and histological diagnoses. Early cancers were considered to be confined to the submucosa, with no lymph node involvement by means of computed tomography and endosonography.

RESULTS: Sixty ESD procedures were performed. The indications were epithelial lesions (n = 39) (33/39 adenoma with high grade dysplasia, 6/39 adenoma with low grade dysplasia), neuroendocrine tumor (n = 7), cancer (n = 7) (5/7 early colorectal cancer, 2/7 early gastric cancer), granular cell tumor (n = 3), gastrointestinal stromal tumor (n = 2), and leiomyoma (n = 2). En bloc and piecemeal resection rates were 91.6% (55/60) and 8.3% (5/60), respectively. Complete and incomplete resection rates were 96.6% (58/60) and 3.3% (2/60), respectively. Complications were major bleeding [n = 3 (5%)] and perforations [n = 5 (8.3%)] (4 colon, 1 stomach). Two patients with colonic perforations and two patients with submucosal lymphatic and microvasculature invasion (1 gastric carcinoid tumor, 1 colonic adenocarcinoma) were referred to surgery. During a mean follow-up of 12 mo, 1 patient with adenoma with high grade dysplasia underwent a second ESD procedure to resect a local recurrence.

CONCLUSION: ESD is a feasible and safe method for treatment of premalignant lesions and early malignant gastrointestinal epithelial and subepithelial lesions. Successful en bloc and complete resection of lesions yield high cure rates with low recurrence.

Thrombophilic Risk Factors in Patients With Inflammatory Bowel Disease

Background

Inflammatory bowel disease (IBD) patients have an increased risk for thromboembolism. The aim of this study was to assess the presence of thrombophilic risk factors in IBD patients and to assess the associations of these factors with disease activity.

Methods

Forty-eight patients with IBD (24 ulcerative colitis, 24 Crohn’s disease) and 40 matched healthy control individuals were enrolled. In addition to routine biochemical analysis, fasting blood samples were studied for prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, protein-C, protein-S, antithrombin III, factor VII, factor VIII, D-dimer, vitamin B₁₂, folic acid and homocysteine.

Results

Levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fibrinogen, D-dimer and the number of platelets were significantly higher in patients with IBD. When compared to control group, in patients with Crohn’s disease serum homocystein levels were significantly higher (p = 0.025) while serum folic acid levels were significantly lower (p < 0.019). Levels of fibrinogen, D-dimer, protein C, factor VIII, total homocystein and the number of platelets were found to be significantly higher in Crohn’s disease patients who were in active period of the disease.

Conclusions

Thrombophilic defects are multifactorial and might be frequently seen in IBD patients. They might contribute to thrombotic complications of this disease.

Erythema Annulare Centrifugum: A Rare Skin Finding of Autoimmune Hepatitis

Erythema annulare centrifugum is characterized by dermal perivascular lymphocytic infiltrates. It is often associated with infections, autoimmune or neoplastic diseases but in most cases the cause is unexplained. A case of erythema annulare centrifugum related to autoimmune hepatitis in a 24-year-old woman is described in this case report. Clinical response of the autoimmune hepatitis to a combination therapy with corticosteroids and azothiopurine was achieved. Although partially regressed for the first 12 months of theraphy, the skin lesions did not disappear completely. However, after 18 months of continious treatment there was no skin lesion.

Diffrential Diagnosis of Hepatic Hydrothorax by 99mTc Sulfur Colloid Peritoneal Scintigraphy: Two Cases

Large symptomatic pleural effusions can be seen in cirrhotic patients with ascites. In this report, two cirrhotic patients with ascites and large pleural effusions were evaluated. To determine the cause of pleural effusion and to understand whether there was a communication of fluid between peritoneal and pleural cavities, ^99mTc sulfur colloid peritoneal scintigraphy was used. According to the scintigraphic results, the diagnosis of hepatic hydrothorax and tuberculosis was confirmed easily and the treatments of the patients were managed rapidly.

Methylenetetrahydrofolate reductase gene polymorphisms in patients with nonalcoholic steatohepatitis (NASH)

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of abnormal hepatic steatosis in the absence of a history of alcohol use. Nonalcoholic steatohepatitis (NASH) is the progressive form of NAFLD. Hyperhomocysteinemia causes steatosis, and the methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms result in hyperhomocysteinemia. To examine whether the C677T and A1298C polymorphisms of the MTHFR gene were associated with NASH, we analysed the allele and genotype distribution of the MTHFR C677T and A1298C polymorphisms in 57 well-diagnosed NASH patients, 324 healthy controls in a case-control study of Turkish subjects of Caucasian origin. The diagnosis of the NASH patients was based on liver biopsy. The method used in the analysis of genotypes was PCR-RFLP. The MTHFR A1298C polymorphism was significantly associated with NASH (chi(2) = 8.439; p = 0.015) in the total NASH patients compared with healthy controls. The MTHFR 1298C allele (odds ratio (OR) = 2.480; 95%CI = 1.286-4.782; chi(2) = 7.703; df = 1; p = 0.006) was significantly associated with NASH in the total NASH patients. The MTHFR C677C/A1298C compound genotype (OR = 2.218; 95%CI = 1.003-4.906; chi(2) = 3.998; df = 1; p = 0.046) in men patients was also significantly associated with NASH. Likewise the MTHFR C1298C genotype was significantly associated with NASH in women patients with NASH (OR = 2.979; 95%CI = 1.027-8.641; chi(2) = 4.343; df = 1; p = 0.037). In conclusion, the MTHFR 1298C allele in all NASH patients, C1298C genotype, C677C/C1298C compound genotype in women NASH patients and C677C/A1298C compound genotype in men NASH patients were genetic risk factors for NASH.

Role of ursodeoxycholic acid in prevention of methotrexate-induced liver toxicity

AIM

Methotrexate (MTX)-induced hepatotoxicity restricts the clinical use of this immunosuppressive drug. In this study, our aim was to research the role of oxidative stress in the hepatic toxicity of MTX and the protective effect of ursodeoxycholic acid (UDCA) in this setting.

METHODS

Wistar type rats (n = 32) were divided into four groups; group-1 as the MTX + UDCA, group-2 as the MTX, group-3 as the UDCA, group-4 as the saline-receiving groups. The MTX + UDCA and MTX groups of rats received 50 mg/kg of UDCA administered orally; whilst physiological saline was administered orally to the MTX and saline groups and continued for the next 6 days. On the second day of the study, the MTX + UDCA and MTX groups had a single intraperitoneal dose of MTX of 20 mg/kg. The UDCA and saline groups also received similar volumes of physiological saline intraperitoneally. On the sixth day, serum samples were collected and analyzed for ALT, alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) and homogenated liver tissues were examined for reactive oxygen metabolites (ROM); luminol, lucigenin, lipid peroxygenation product malondialdehyde (MDA) and glutathione (GSH) levels.

RESULTS

In the MTX group, serum ALT, ALP, GGT and tissue ROM levels were higher and GSH level was lower. On the histopathological examination, hepatocellular necrosis was clearly more evident in the MTX group than the MTX + UDCA group.

CONCLUSIONS

UDCA treatment protects against MTX-induced liver toxicity. Histopathologically hepatocyte necrosis can be prevented by UDCA treatment, indicating clearly the hepatoprotective effect of this agent on MTX-induced liver injury.

Clindamycin-induced acute cholestatic hepatitis

We report a case of acute hepatotoxicity in a 42-year-old woman after administration of clindamycin for a dental infection. After 6 d of treatment, she had fatigue, nausea, vomiting, anorexia, pruritus and jaundice. Her laboratory analysis showed alanine aminotransferase (ALT), 1795 IU/L (normal range 0-40); aspartate aminotransferase (AST), 1337 IU/L (normal range 5-34); alkaline phosphatase (ALP), 339 IU/L (normal range 40-150); γ-glutamyl transpeptidase (GGT), 148 IU/L (normal range 9-64 IU/L); total bilirubin, 4.1 mg/dL; direct bilirubin, 2.9 mg/dL and prothrombin time (PT), 13.5 s, with international normalized ratio (INR), 1.04. She was hospitalized, with immediate drug discontinuation. Her liver biopsy specimen showed mixed-type (both hepatocellular and cholestatic) hepatic injury, compatible with a diagnosis of drug-induced hepatitis. An objective causality assessment using the Naranjo probability scale suggested that clindamycin was the probable cause of the acute hepatitis. In susceptible individuals, clindamycin use may lead to acute mixed-type liver toxicity. Complete recovery may be possible if the drug is discontinued before severe liver injury is established.

Endothelial dysfunction in Turkish patients with non-alcoholic fatty liver disease

BACKGROUND

The components of the metabolic syndrome are closely related with endothelial dysfunction, which is a pathophysiological issue of cardiovascular diseases. Non-alcoholic fatty liver disease (NAFLD) is considered as one of the components of the metabolic syndrome. The aim of this study was to evaluate the endothelial-dependent dilatation (EDD) and endothelial-independent dilatation (EID) of the brachial artery in NAFLD.

METHODS

Fifteen non-alcoholic steatohepatitis (NASH), 17 patients with simple steatosis and 16 healthy subjects formed the study group. Non-alcoholic fatty liver disease group was composed of patients admitted to the gastroenterology outpatient clinic because of increased liver enzymes. Endothelial functions of the brachial artery were evaluated by vascular ultrasound. EDD was assessed by establishing reactive hyperaemia, and EID was determined by using sublingual nitrate.

RESULTS

No statistical difference for the basal diameter of brachial artery was found between the groups (P = 0.49). The values for EDD and EID were significantly different across all three groups (P < 0.0001 and P < 0.0001, respectively). EDD and EID were significantly lower in NASH compared with simple steatosis (P = 0.01 and P < 0.01, respectively). However, there was no statistical significance for EDD and EID in simple steatosis groups compared with controls (P = 0.58 and P = 0.98, respectively).

CONCLUSIONS

Our study showed that patients with NASH had significantly worse endothelial dysfunction compared with patients with simple steatosis and healthy subjects. The treatment strategies with ameliorative effects for endothelial dysfunction might be effective for delaying the development of cardiovascular complications in NAFLD.

Endothelial dysfunction in patients with ulcerative colitis

BACKGROUND

Human intestinal microvessels from chronically inflamed ulcerative colitis (UC) show microvascular endothelial dysfunction. Whether generalized endothelial dysfunction could associate with UC has not been explored yet. Our aim was to assess the endothelial function in the patients with different UC activity and to hypothesize about the relationship of endothelial function to activity-related extraintestinal complications (AREC) of UC.

METHODS

Twelve patients with mild UC, 14 patients with moderate UC, 16 patients with severe UC, and 24 healthy subjects were included in the study. The activity of UC is calculated according to the Seo Index. Endothelial functions of the brachial artery were evaluated by using high-resolution vascular ultrasound. Endothelial-dependent dilatation (EDD) was assessed by establishing reactive hyperemia and endothelial-independent dilatation (EID) was determined by using sublingual isosorbide dinitrate.

RESULTS

EDD was significantly worse in patients with severe UC as compared with patients with mild UC (8.7 +/- 1.6% versus 17.3 +/- 5.6%, P < 0.05) and even in patients with moderate UC as compared with patients with mild UC (13.1 +/- 3.2% versus 17.3 +/- 5.6%, P < 0.05). EDD was not significantly worse in patients with mild UC as compared with healthy subjects (17.3 +/- 5.6% versus 18.1 +/- 8.1%, P > 0.05). EID was significantly worse in patients with severe UC compared with patients with moderate UC (10.5 +/- 2.9% versus 13.4 +/- 3.7%, P < 0.05) and even in patients with mild UC compared with healthy subjects (20 +/- 6.7% versus 31.1 +/- 12.6%, P < 0.05). EDD and EID were significantly worse in patients with AREC compared with patients with no AREC (9.5 +/- 2.5% versus 14.9 +/- 5.1%, P < 0.05; 11.6 +/- 4.3% versus 16 +/- 6.1%, P < 0.05, respectively).

CONCLUSIONS

Increased activity of UC is associated with significant endothelial dysfunction, which may relate to the pathophysiology of AREC of UC.

Serum levels of hepatoprotective peptide adiponectin in non-alcoholic fatty liver disease

OBJECTIVE

Adiponectin is an adipose tissue-specific protein that has anti-inflammatory, antidiabetic and antiobesity effects. It has been suggested that adiponectin has a hepatoprotective role. Non-alcoholic fatty liver disease (NAFLD) is becoming more prevalent with increasingly adverse clinical outcomes. In this study, serum adiponectin levels were investigated in patients with NAFLD to determine its possible role on hepatic inflammation and injury.

METHODS

Twenty-nine biopsy-proven NAFLD patients (14 women, 15 men) with elevated liver enzymes, 20 clinically diagnosed NAFLD patients (13 women, seven men) with normal liver enzymes, and 20 healthy adults (10 women, 10 men) were enrolled. From fasting blood samples, serum adiponectin levels were measured by enzyme-linked immunosorbent assay. The body mass index, serum glucose, insulin, cholesterol and triglyceride levels were determined.

RESULTS

Serum adiponectin levels were 4.99+/-2.1, 9.49+/-3.91 and 7.74+/-4.41 micro/ml in the NAFLD with elevated liver enzymes, NAFLD with normal liver enzymes and healthy adult control groups, respectively. The mean serum adiponectin level in the NAFLD with elevated liver enzymes group was significantly lower than those of other groups tested (P<0.001). Insulin, cholesterol and triglyceride levels of NAFLD patients with elevated liver enzymes were significantly higher than control groups (P<0.05) but were not significantly different from the NAFLD group with normal liver enzymes (P>0.05). On histopathologic examination, the mean serum adiponectin levels of non-alcoholic steatohepatitis patients with grade 2 or more inflammatory activity was significantly lower than patients with grade 1 inflammatory activity (P=0.013).

CONCLUSION

Serum adiponectin levels are significantly lower in NAFLD patients with elevated liver enzymes. Non-alcoholic steatohepatitis patients show lower levels of adiponectin with higher grades of inflammation.

Bochdalek's hernia in an adult with colon necrosis

The improper fusion of the posterolateral foramina of the diaphragm was first described by Bochdalek in 1848. The true incidence of this congenital anomaly ranges from 1/7,000 to 6%. Although it is a well-known neonatal disease, it can also be diagnosed incidentally in adult patients. Until now, a total of around 100 cases of occult asymptomatic Bochdalek's hernia have been reported. The symptomatic cases are encountered more rarely. Colon necrosis among the symptomatic cases was reported in some cases. We herein report a case of a 21-year-old man with a left-sided Bochdalek's hernia which led to total necrosis of the transverse colon. Following resection and colocolonic anastomosis, the defect on the diaphragm was repaired. After an uneventful recovery period, he was discharged from the hospital on the 10th postoperative day. Being aware of this rarely encountered disease and of the factors for early diagnosis is of utmost importance to decrease mortality and morbidity.

Primary hydatid cyst of vastus lateralis muscle

Musculoskeletal system is rarely involved by hydatid cyst,the larval form of Echinococcus Granulosus. A 37-year old man was diagnosed as having a cystic mass within his left thigh musculature. Preoperative computerized tomography suggested an unusual location of echinococcus although serology could not confirm the diagnosis. During surgery, a white coloured cyst within left vastus lateralis muscle was enucleated. Pathological examination after removal of the mass revealed hydatid cyst of vastus lateralis muscle. This case emphasizes that hydatidosis should be included in differential diagnosis of any soft tissue mass especially in regions where it is endemic.

Improvement of complete blood count in patients with iron deficiency anemia and Helicobacter pylori infection after the eradication of Helicobacter pylori

BACKGROUND/AIMS

Recent reports support the possible association between Hp infection and iron deficiency anemia. In the present study, the effects of the eradication therapy on iron deficiency anemia were investigated.

METHODOLOGY

Fourteen women with iron deficiency anemia were enrolled (mean age: 36.4 years; range: 20-52 years old). None of the patients received iron supplementation. Several examinations including upper and lower gastrointestinal endoscopy were performed to reveal any gastrointestinal bleeding sites in all patients. Gastric biopsies during endoscopy were taken from the subjects except one whose serum anti-Hp IgG was positive. After diagnosing the Hp infection by means of microbiology, histology and Gram stain, a combination therapy consisting of lansoprosol, clarithromycin and amoxicillin was administered to each patient. Hematologic examinations and the body iron status were evaluated periodically, following the eradication therapy.

RESULTS

Endoscopic findings were as follows: Seven patients with antral gastritis, two patients with pangastritis, whereas five patients were found to be endoscopically normal. None of the subjects were found to have gastrointestinal bleeding of any type. Serum hemoglobin, iron and transferrin saturations of the patients were found to be increased at 20-24 weeks of follow-up after the eradication therapy. Serum ferritin levels were not found to be increased.

CONCLUSIONS

Hp infection may be involved in cases of iron deficiency anemia of unknown origin, and the eradication of the infection may improve blood parameters other than serum ferritin levels.

Helicobacter pylori status and cell proliferation activity in chronic antral gastritis

BACKGROUND

Helicobacter pylori is known to cause antral gastritis and multifocal atrophic gastritis. In addition to its inflammatory effect, H. pylori has a direct effect on gastric mucosa. Increased epithelial proliferation, which may be an early biologic change in the development of gastric carcinoma, can be measured using silver stain for nuclear organizer regions (AgNOR).

AIM

To detect the relation between H. pylori colonization and AgNOR index.

METHODS

One hundred and twenty consecutive antral endoscopic biopsy specimens from patients with dyspepsia were examined for H. pylori colonization, polymorphonuclear infiltrate, mononuclear infiltrate, germinal center formation, mucus depletion and AgNOR index.

RESULTS

AgNOR indices were not significantly related to grades of H. pylori colonization and chronic and active inflammation. The index increased significantly (p=0.03; ANOVA) with increasing mucin depletion.

CONCLUSION

H. pylori colonization and presence of gastric antral inflammation are not related to cell proliferation activity; the latter is associated with mucin depletion.

Prevalence and comparisons of five different diagnostic methods for Helicobacter pylori in diabetic patients

Helicobacter pylori is now regarded as a major gastroduodenal pathogen that is etiologically linked with duodenal and gastric disease. It has been suggested recently as an important factor for nongastroenterologic conditions such as coronary heart disease and diabetes mellitus. In this study, we planned to investigate the prevalence of H. pylori in diabetic patients and to evaluate five different diagnostic tests. Group I consisted of 67 patients with type II diabetes mellitus and seventy-three aged-matched health people served as control in group II. Group I was divided in two subgroups with good (Group IA) and poor (Group IB) glycemic control. H. pylori was diagnosed by five different tests: 1) biopsy, 2) culture, 3) gram staining, 4) imprint cytology and 5) brushing cytology. The usefulness of each test for each group was statistically compared. There was a higher prevalence for H. pylori in diabetic patients. This study showed that two positive out of five tests was most reliable for predicting the H. pylori in diabetic and nondiabetic patients. In conclusion, the prevalence of H. pylori is high in diabetic patients. Peristaltic activity, and impaired nonspecific immunity must be evaluated as risk factors in diabetics. We recommend that the 'gold standard' should be regarded as two positive out of these five different tests.

Effect of G-CSF on ethanol-induced hemorrhagic gastritis model in diabetes mellitus-induced rats

Diabetes mellitus can affect every organ system, including large and small vessels, eyes, nerves, kidneys and gastrointestinal system. Acid peptic disease is an inflammatory condition involving the upper gastrointestinal tract. The elevated serum glucose levels of diabetics affect traditional host defenses such as neutrophil counts and functions. We aimed to investigate changes of gastric mucosa and the role of impaired neutrophil functions in a diabetes-induced experimental model and whether G-CSF, which modulates neutrophil counts and function, has protective effects against gastric mucosal injury in diabetic rats. Fifty rats were divided into three groups. Diabetes mellitus was induced by a single dose of streptozotocin in 40 of 50 rats. Controls had a sham injection. The gastric mucosal lesions were produced by intragastric administration of 1 ml of 95% ethanol in all three groups. Granulocyte colony-stimulating factor (G-CSF) was subcutaneously injected to twenty of diabetes-induced rats. Stomach histology and tissue malondialdehyde and glutathione levels were determined. White blood cell count, neutrophil counts and functions were determined. Peripheral blood cell counts, neutrophil phagocytosis index were decreased but neutrophil adhesivity index was not different in diabetes-induced groups. G-CSF administration improved netrophil counts and function. Macroscopic and microscopic gastric mucosal injury were significantly greater in control and only diabetes group compared with G-CSF pretreated group (p < 0.05). The tissue malondialdehyde and glutathione levels were significantly decreased in G-CSF-administrated diabetic group compared to untreated diabetics (p < 0.001). Finally, G-CSF has been shown to cause neutrophilia and improve neutrophil phagocytosis in diabetic. G-CSF may be cytoprotective for gastric mucosa in diabetes mellitus-induced rats.

Action of cisapride on gallbladder contraction in patients with diabetes mellitus

BACKGROUND/AIMS

Gallbladder emptying abnormalities are common in patients with diabetes mellitus, and it has been hypothesized that they contribute to the increased incidence of gallbladder stones and biliary pain observed in these patients. Cisapride is a drug that exerts a prokinetic effect in both animals and humans. Recently, we demonstrated that cisapride decreased the fasting and post-prandial gallbladder volume in healthy subjects. Therefore, we investigated the action of cisapride on gallbladder contraction in diabetic patients.

METHODOLOGY

Twenty diabetes mellitus patients and 20 healthy volunteers participated in this study. On the day of the study, ultrasonography was performed at 9 am, after 12 hours of fasting. After the basal measurement was obtained, the diabetic patients and healthy subjects received 10 mg cisapride or a placebo peroral. Two hours later, gallbladder volumes were rescanned by ultrasonography at 15-minute intervals for 60 minutes.

RESULTS

The fasting gallbladder volume was 19.8 +/- 6.7 ml in the diabetic patients, and after the administration of cisapride, the gallbladder volume decreased by 32.2%-38.6% as compared to the baseline (p<0.02, 0.05, 0.01) and by 35.0%-45.8% as compared to the diabetic controls (p<0.02, 0.05, 0.001). In the healthy subjects, cisapride did not change the fasting mean gallbladder volume as compared to the baseline. After the administration of cisapride in the diabetic patients, the mean gallbladder volume decreased more than in the healthy subjects. The mean gallbladder volumes of the diabetic patients were between 12.1 +/- 4.2-13.4 +/- 4.2 ml. In the healthy volunteers, after the administration of cisapride, the volume was reduced by 1.9%-11.3% as compared to the healthy control group, but the volume changes of these two groups were not statistically significant.

CONCLUSION

This study shows that the administration of cisapride causes gallbladder volume reduction in diabetic patients.