Can neutrophil to lymphocyte ratio be a non-invasive indicator of the presence of duodenal ulcer related Helicobacter pylori in dyspeptic patients?

Background and aims: Neutrophil to lymphocyte ratio (NLR), a novel inflammatory marker, has been shown to increase in various systemic inflammatory conditions. In this way, we want to evaluate the relationship between the presence of H. pylori, duodenal ulcer related H. pylori and NLR in dyspeptic patients. Material and methods: The patients were divided into three groups after evaluating of the EGD and histopathology results. The groups were determined as follow; Group A: H. pylori positive and DU negative, Group B: H. pylori positive and DU positive, Group C: H. pylori negative and DU negative. Then, groups were compared with each other for demographic features, laboratory tests and NLR. Results: There were significant differences between groups for NLR when groups compared with each other. Significantly high NLR was seen in group A (H. pylori positive, DU negative) and group B (H. pylori positive, DU positive) when compared with group C (H. pylori negative, DU negative) (respectively p < 0.042, p < 0.001). Significantly higher NLR was determined in the group B when compared with group A and group C (respectively p < 0.021, p < 0.001). The cut-off value for NLR was 2,17 with a specificity of 61% and sensitivity of 66% for group B comparing with Group C (AUC:0,66). Conclusions: Significantly higher NLR was determined in patients with H. pylori and DU. As a result, NLR may be used as a non-invasive test for documenting the presence of H. pylori and H. pylori related DU.

Iodine concentration and prevalence of thyroid disease in older people after salt iodization in Turkey.

BACKGROUND: Iodine uptake is a main factor affecting thyroid disease. In Turkey, mandatory salt iodization began in 1999-2000. AIMS: This study in 2009 determined the prevalence of thyroid diseases in older people in Mamak district, Ankara after iodization to ascertain if salt iodization alone is sufficient to reach adequate iodine levels in the older population. METHODS: All Mamak residents ≥ 65 years were eligible for inclusion in the study. Demographic data and medical history were recorded. All participants had a thyroid ultrasound. Blood samples were taken to assess thyroid function and autoantibodies, and urine samples to assess iodine concentration. Participants with low levels of thyroid stimulating hormone underwent scintigraphy to assess thyroid uptake. Fine-needle aspiration biopsy was done of nodules ≥ 1.5 cm where thyroid stimulating hormone was not suppressed. RESULTS: Of 1200 eligible residents, 979 were included. Their mean age was 70.9 (standard deviation (SD) 5.7) years; 49.7% were women. Mean urinary iodine concentration was 98 (SD 81.29) µg/L. Goitre was found in 18.2% (89/487) of women and 6.7% (33/492) of men (P < 0.001) and 43.8% (428/979) had nodules. Subclinical hypothyroidism was found in 5.8% (57/979) of the participants, overt hyperthyroidism in 0.8% (8/979), subclinical hyperthyroidism in 2.2% (22/979) and T3 thyrotoxicosis in 0.3% (3/979). Toxic multinodular goitre and toxic adenoma caused 80% of hyperthyroidism cases. Biopsy detected no malignant pathology. CONCLUSION: After salt iodization, iodine levels have not yet reached favourable levels in older people. Iodization of salt seems insufficient to achieve these levels in older people; alternative iodine supplementation should be considered.

Relationship between helicobacter pylori infection and pityriasis versicolor: can helicobacter pylori infection be a new etiologic factor for pityriasis versicolor?

Background/aim: H. pylori has been found to be related to certain dermatological diseases. However, there is no data as yet to propose an association between H. pylori and pityriasis versicolor. In this study, we aimed to evaluate the association between H. pylori and pityriasis versicolor. Materials and methods: This was a prospective study performed in the Gastroenterology and Dermatology and Venereology departments of the Health Sciences University, Ankara Training and Research Centre. A total of 57 consecutive patients (27 pityriasis versicolor, 30 telogen effluvium) were enrolled from the Department of Dermatology and Venereology. All patients were screened for H. pylori IgG and CagA. In addition, urea breath test was carried out to detect the existence of H. pylori infection. Results: There were significantly higher rates of H. pylori positivity, H. pylori IgG in serum in the pityriasis versicolor group compared to the telogen effluvium group (P < 0.05). In addition, the number of patients with dyspeptic complaints was higher in the pityriasis versicolor group than in the telogen effluvium group. The odds ratio for dyspepsia, H. pylori positivity, and H. pylori IgG were 2.48, 1.67, and 1.78, respectively. Conclusion: In this study, we found a statistically significant relationship between H. pylori infection and pityriasis versicolor. Therefore, H. pylori eradication could be considered in recurrent pityriasis versicolor patients with dyspepsia. New studies are required to clarify the effect of eradication treatment on the clinical course of pityriasis versicolor.

Midkine level may be used as a noninvasive biomarker in Crohn's disease

Background/aim: Crohn's disease (CD) is a kind of inflammatory bowel disease. Midkine (MDK) is an endogenous inflammatory marker. We aimed to investigate the relationship between MDK levels and inflammation and hence determine whether MDK can be used as a noninvasive biomarker in active CD. Materials and methods: Sixty-five consecutive patients over the age of 18 with CD and 36 healthy controls were included in this study. CD patients' venous blood samples were taken before treatment. Serum MDK levels were determined in human plasma samples by enzyme-linked immunosorbent assay (ELISA) method. Results: The mean age of the study patients was 44.8 ± 12.5 years, 35 patients were female, and 30 were male. Of these 65 patients, 37 had active CD and 28 were in the remission phase. MDK levels were significantly higher in active and remission CD than in healthy controls (P = 0.01, P = 0.038, respectively). Conclusion: e report that there is an association between MDK levels and CD activation, and therefore with enhanced inflammation. MDK levels were significantly correlated with inflammatory indices. In line with our findings, we suggest the theory that MDK inhibitors may be useful in treating Crohn's disease.

A Rare and Late Postoperative Complication of Nissen Fundoplication: Mixed Hiatus Hernia.

How to cite this article: Kekilli M, Dogan Z, Karaahmet F. A Rare and Late Postoperative Complication of Nissen Fundoplication: Mixed Hiatus Hernia. Euroasian J Hepatogastroenterol, 2018;8(2):172.

Inefficacy of triple therapy and comparison of two different bismuth-containing quadruple regimens as a firstline treatment option for helicobacter pylori.

BACKGROUND/AIM: Increasing resistance of Helicobacter pylori to antimicrobials necessitated the development of new regimens and the modification of existing regimens. The present study aimed to compare the efficacy of two bismuth-containing quadruple regimens-one including clarithromycin (C) instead of metronidazole (M) and triple therapy. PATIENTS AND METHODS: Patients with H. pylori infection given the following regimens were sequentially enrolled in this retrospective study: (1) Triple therapy: Lansoprazole 30 mg b.i.d., clarithromycin 500 mg b.i.d., and amoxicillin 1 g b.i.d., (2) bismuth group C: Lansoprazole 30 mg b.i.d., clarithromycin 500 mg b.i.d., amoxicillin 1 g b.i.d., and bismuth subsalicylate 524 mg b.i.d., and (3) bismuth group M: Lansoprazole 30 mg b.i.d., amoxicillin 1 g b.i.d., metronidazole 500 mg t.i.d., and bismuth subsalicylate 524 mg b.i.d. for 14 days. Gastroscopy and 14 C-urea breath test were performed before enrollment, and urea breath test was repeated four weeks after the treatment. RESULTS: At per-protocol analysis, the eradication rates were 64.7% (95% confidence interval 60.4-68.7) with the triple therapy (n = 504), 95.4% (95% confidence interval 91.5-99.4) with the bismuth group C (n = 501), and 93.9% (95% confidence interval 89.7-98.7) with the bismuth group M (n = 505). The eradication rates were similar between the two bismuth groups (P > 0.05) but significantly greater than that of the triple therapy (P < 0.05). CONCLUSION: In our study, both of the bismuth-containing quadruple therapies reached high eradication rates, whereas triple therapy was shown to be ineffective. Moreover, clarithromycin may also be a component of bismuth-containing quadruple therapy.

Helicobacter pylori infection and polycystic ovary syndrome in adolescent and young adult patients.

AIM: Polycystic ovary syndrome (PCOS) is the most common cause of infertility among women of reproductive age. Chronic systemic inflammation has been considered to play a role in the development of PCOS. Helicobacter pylori has been shown to lead to both local gastric and chronic systemic inflammation. In the light of this, the aim of the present study was to investigate a possible link between H. pylori and PCOS. METHODS: A total of 167 nullipar and single adolescent and young adults (AYA) were recruited for the study: 86 (51.5%) had PCOS and 81 (48.5%) were age-matched controls. The average age was 18.57 ± 2.40 (range, 14-24 years). The recent Amsterdam European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine (ESHRE/ASRM) guidelines including all three of the Rotterdam criteria were used to diagnose PCOS, and enzyme-linked immunosorbent assay kit was used to measure H. pylori IgG. RESULTS: There was no significant association between the PCOS and non-PCOS groups with regard to the presence of H. pylori IgG (P = 0.924), white blood count or C-reactive protein (P = 0.064; P = 0.383, respectively). CONCLUSION: The prevalence of H. pylori was not different with regard to PCOS status in AYA. More studies are needed to investigate a possible link between PCOS and H. pylori.

Comparison of first-year results of tenofovir and entecavir treatments of nucleos(t)ide-naive chronic hepatitis B patients with hepatosteatosis.

BACKGROUND/AIM: Hepatic steatosis may influence the response to antivirals in chronic hepatitis B patients. This study aimed to compare the efficacy of entecavir and tenofovir in nucleos(t) ide-naive chronic hepatitis B patients with hepatosteatosis during 48 weeks of therapy. PATIENTS AND METHODS: We retrospectively reviewed our data for chronic hepatitis B patients. Nucleos(t) ide-naive patients with hepatosteatosis who took entecavir or tenofovir for at least 48 weeks were included. We compared entecavir and tenofovir after 48 weeks of therapy with respect to virological, biochemical, and serological responses in patients with hepatosteatosis. RESULTS: Of the 63 patients, 21 received entecavir and 42 received tenofovir. Baseline characteristics of the patients were similar except for body mass index. At the end of week 48, there was no statistically significant difference between tenofovir and entecavir treatment regarding total HBV-DNA negativity and alanine transferase normalization in patients with chronic hepatitis B and hepatosteatosis. CONCLUSIONS: Entecavir and tenofovir are similarly effective in nucleos(t)ide-naive chronic hepatitis B patients with hepatosteatosis after 48 weeks of therapy.

Intestinal fatty acid binding protein (I-FABP) as a promising test for Crohn's disease: a preliminary study.

BACKGROUND: Crohn's disease (CD) is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract from the mouth to the anus. The clinical course presents with remissions and activations. Also, clinical findings or endoscopic activity do not always reflect the overall appropriate disease activity. This is why specific markers are always an issue of concern for the diagnosis, prediction of relapse, and monitoring of CD activity. Fatty acid binding proteins (FABPs) are intracellular proteins that are expressed abundantly in several tissues. Intestinal FABP (I-FABP) is a plasma and urine marker that indicates intestinal damage. In this preliminary study, we aimed to determine whether serum I-FABP levels are a useful marker for CD. METHODS: Seventy-four patients with CD (41 active and 33 in remission) and 37 healthy controls were included in the study. The level of serum I-FABP was determined by ELISA. Crohn's disease activity index (CDAI) and CRP were used to assess the activity of Crohn's disease and to evaluate whether I-FABP is a useful laboratory marker. RESULTS: Serum I-FABP levels of patients with active disease were observed to be statistically higher than patients in the remission and control groups (p = 0.012 and p = 0.038, respectively). No statistically significant difference was observed among patients in the remission and control groups (p = 0.145). Correlation analysis showed a positive correlation between I-FABP and CDAI (r = 0.319, p = 0.006). In addition, a positive correlation was found between CRP and I-FABP levels. CONCLUSIONS: I-FABP seems to be a useful systemic marker for CD activity.

The effect of Helicobacter pylori eradication on insulin resistance and HbA1c level in people with normal glucose levels: a prospective study.

BACKGROUND AND AIM: Helicobacter pylori (H. pylori) infection is reported to be associated with various extragastrointestinal conditions such as insulin resistance, diabetes mellitus and metabolic syndrome. These conditions are attributed to systemic inflammation, leptin or ghrelin changes due to H. pylori infection. Therefore, increasing trends in the management of H. pylori infection are ordered to maintain glycemic control. In this study, we evaluated the effect of H. pylori eradication on insulin resistance in patients with normal blood glucose concentrations. METHOD: A total of 370 patients with successful eradication were included in the study. Patients with H. pylori were given triple eradication treatment. All patients with H. pylori infection were tested for fasting glucose, fasting insulin, glicated hemoglobin (HbA1c) at baseline and 6 months after eradication treatment. Also, insulin resistance was calculated using the homeostatic model assessment of insulin resistance (HOMA-IR). Body mass index was also determined as a metabolic syndrome criteria effecting insulin resistance. RESULTS: There were significant differences in fasting glucose, fasting insulin, HbA1c, and HOMA-IR values between before treatment and after treatment(P <0.04, <0.01, <0.01, <0.01). The favorable effect of eradication was more significant in patients with BMI≥25 mg/m(2)(P<0.05). CONCLUSION: Eradication treatment has beneficial effects on insulin resistance in patients with normal glucose concentrations.

Efficacy and safety of gum chewing in adjunct to high-dose senna for bowel cleansing before colonoscopy: a single-blind randomized controlled trial.

BACKGROUND/AIMS: Inadequate bowel cleaning leads to a suboptimal colonoscopic examination. Gum chewing has been reported to have a favorable effect on postoperative bowel functions. We conducted this study to establish if gum chewing added to high-dose senna before colonoscopy promotes bowel cleaning. PATIENTS AND METHODS: In this randomized controlled study, consecutive outpatients scheduled for elective colonoscopy were randomized into two groups. Group 1 patients (n = 65) used senna solution 150 mL (300 mg senna) the night before colonoscopy. The patients also used sennoside tablet 80 mg daily for 3 days before the colonoscopy. Patients in group 2 (n = 64) were additionally advised to chew sugarless gum half an hour three-times daily after meals for these 3 days. The overall quality of colonoscopy cleaning was evaluated using the Aronchick scale by a single endoscopist who was blinded to the intervention. Difficulty of procedure, patients' tolerance, and adverse events were also evaluated. RESULTS: A total 129 patients were enrolled in the study. Superior cleaning was found in gum chewing group when compared with other group particularly in the cecum and ascending colon. Cecal intubation time was significantly shorter in the gum-chewing group (8.6 ± 5.1 and 7.1 ± 2.8 min, P = 0.03). Adverse events were more common in group 1 compared to the gum-chewing group. CONCLUSIONS: Gum chewing enhances colonoscopy bowel preparation quality. Moreover, it is a physiologically sound, safe, and an inexpensive part of the colonoscopy bowel preparation. Gum chewing could be advised in addition to high-dose senna containing bowel preparation.

The protective effect of Echinacea spp. (Echinacea angustifolia and Echinacea purpurea) in a rat colitis model induced by acetic acid.

Ulcerative colitis (UC) is a chronic disease that causes an inflammatory condition in the colon. Several cytokines, including tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1ß) and transforming growth factor beta (TGF-ß) are crucial components of these inflammatory pathways. New therapeutic strategies are needed for improved clinical outcomes in UC and with less adverse effects. That is why alternative therapies such as herbal remedies are increasingly being used with favorable effects in the treatment of UC. Hence, in the present study, we aimed to evaluate the protective effect of Echinacea spp in an experimental rat colitis model induced by acetic acid (AA). Acetic acid was given via a rectal route to induce acute colitis in rats. Rats were placed in four groups: control, Echinacea, Echinacea-colitis and colitis. Tumor necrosis factor alpha, IL-1ß and TGF-ß levels were measured. Histopathological comparison of the groups was also performed. The disease activity index (DAI) was significantly higher in the colitis group compared to the control, Echinacea and Echinacea-colitis groups (p<0.001). There was no significant difference between the DAI of control, Echinacea and Echinacea-colitis groups (p>0.07). The inflammatory mediators IL-1ß and TNF-α were significantly elevated in the colitis group compared to the other groups (p<0.007, <0.001 respectively). Therefore, Echinacea spp. may likely have some therapeutic favorable effects in the management of UC.

Helicobacter pylori eradication reduces microalbuminuria in type-2 diabetic patients: a prospective study.

AIM: To evaluate the effect of Helicobacter Pylori (H. pylori) eradication on microalbuminuria in type 2 diabetic patients. METHODS: Consecutive patients with dyspepsia, type 2 diabetes mellitus and microalbuminuria were recruited. Upper gastrointestinal endoscopy and rapid urease test (H. pylori fast) were performed for detecting H. pylori infection. Patients with H. pylori infection were given triple treatment. Urea breath tests were performed for all patients after eradication treatment. According to the eradication status, patients were divided into two groups, as H. pylori negative, group 1 (successful eradication group) and H. pylori positive, group 2 (unsuccessful eradication group). Twenty-four hour urine was also collected from all patients at baseline and after H. pylori eradication treatment. RESULTS: A total of 69 patients were included in the study. There were no significant differences between groups for anthropometric measurements and laboratory tests at baseline (p > 0.05). An expected significant difference was found for microlabuminuria and fasting glucose between the two groups. Microalbuminuria and fasting glucose levels were signicantly reduced in the H. pylori negative group compared with the H. pylori positive group after eradication treatment (p < 0.05). Although there was no significant decline in HbA1c levels in the H. pylori negative group, there were relatively lower HbA1c levels compared with baseline for both groups. The rate of attaining normoalbuminuria after eradication was significantly higher in group 1 compared to group 2 (p < 0.05). CONCLUSION: H. Pylori eradication was found to have a favorable effect on reducing microalbuminuria in diabetic patients.

Relationship between Helicobacter pylori infection and vitiligo: a prospective study.

BACKGROUND: Helicobacter pylori is a worldwide bacteria that may affect several extra-gastric systems, including the endocrine, hematologic, vascular, respiratory, immune, and skin. Several skin diseases, including chronic urticaria, alopecia areata, psoriasis, and systemic lupus erythematosis have been found to be associated with H. pylori infection. AIM: To our knowledge, there are no data showing an association between H. pylori and vitiligo. Therefore, in this study, we wanted to evaluate the relationship between H. pylori and vitiligo. METHODS: This study is a prospective study carried out in our Gastroenterology and Dermatology and Venereology departments of the Ankara Education and Research Hospital (Ankara, Turkey) between July 2013 and December 2013. Seventy-nine consecutive patients with vitiligo and 72 patients with telogen effluvium (TE) were recruited from the dermatology outpatient clinic. A total of 133 patients with vitiligo (n=68) and TE (n=65) [excluding 18 patients who had suspicious urea breath test (UBT) results] were included in the study. All individuals were tested for H. pylori IgG and CagA. Also, a UBT was performed to detect the presence of H. pylori infection. RESULTS: There were significantly higher rates of H. pylori positivity, H. pylori CagA, and IgG in serum in the vitiligo group than in the TE group (p<0.05). The number of patients with dyspepsia was significantly higher in the vitiligo group than in the TE group. No statistically significant relationship was seen between H. pylori positivity, CagA, H. pylori IgG, dyspepsia, and the Vitiligo Disease Activity score (p>0.05). Also, when patients with vitiligo were divided into localized and generalized types of vitiligo, there was no association between vitiligo involvement pattern and H. pylori positivity, CagA, H. pylori IgG, and dyspepsia (p>0.05). CONCLUSION: Additional studies are necessary to evaluate the effect of H. pylori eradication on the clinical course of vitiligo. Further studies are also needed to explain the relationship between H. pylori and the pathogenesis of vitiligo.