Comparison of non-invasive tests with invasive tests in the diagnosis of celiac disease.

BACKGROUND/AIMS: Today, invasive diagnostic tests are necessary for definite diagnosis of adult celiac disease (CD). However, in selected children patients, the need for invasive tests is ceased. In this study, we evaluated adult patients according to the ESPGHAN (European Pediatric Gastroenterology Hepatology and Nutrition Society) criteria. METHODS: Thirty-nine patients (aged 17-66) with symptoms of CD were included. Serum samples were tested for total IgA, tTG-IgA (antitissue transglutaminase), tTG-IgG, DGP-IgA (antideamidated gliadin peptide), DGP-IgG, and EMA (endomysial antibodies). HLA-DQ typing was studied with PCR-SSP (sequence-specific primers) method. Biopsy samples were evaluated according to Marsh scoring. RESULTS: In CD patients, 71.4% (15/21) of the patients were diagnosed without biopsy according to the EPSGHAN criteria but when ESPGHAN's IgA tTG threshold value for children was taken into consideration (>200 IU/mL), the sensitivity decreased to 81%. Celiac disease diagnosed and control groups were compared in terms of HLA tissue types. DQ2.5 homozygous or DQ2.5/DQ2.2 was significantly higher in CD group, and DQ2- or DQ8-negative HLA tissue type was significantly higher in control group. CONCLUSION: When serological tests, HLA typing, and clinical symptoms are all in favor of CD, biopsy may not be performed in selected adult CD patients.

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 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.

Detection of Blastocystis sp. and Dientamoeba fragilis using conventional and molecular methods in patients with celiac disease.

Blastocystis sp. and Dientamoeba fragilis are intestinal protists, which are common worldwide, but the pathogenic role of these organisms in gastrointestinal diseases is still controversial. This study aimed to investigate the frequency of Blastocystis sp. and D. fragilis in stool samples from adult patients with celiac disease (CD) by using conventional and molecular methods. A total of 75 patients with CD and 75 healthy individuals were included in this study. Fresh stool specimens collected from each individual were analyzed by conventional and molecular methods. The overall prevalence of Blastocystis sp. and D. fragilis was 41.3% (31/75) and 24% (18/75) in patients with CD, and 46.7% (35/75) and 13.3% (10/75) in healthy controls, respectively. There was no statistically significant difference in the prevalence of Blastocystis sp. and D. fragilis between CD patients and healthy individuals. Blastocystis sp. subtypes were identified in 20 CD and 16 control patients and the overall subtype distribution was observed as ST1 13.9%, ST2 30.6%, and ST3 55.6%. The prevalence of Blastocystis sp. and D. fragilis in adults with CD is similar to the prevalence of protozoa in healthy adults. In this study, the most prevalent Blastocystis subtype was ST3 and the most frequent allele was a34 in both CD patients and healthy individuals. No significant difference was found between the two groups in terms of the detection rates of Blastocystis sp. and D. fragilis, and it is thought that both protists may be colonisers of the intestinal microbiome.

The efficacy of two-week quadruple first-line therapy with bismuth, lansoprazole, amoxicillin, clarithromycin on Helicobacter pylori eradication: a prospective study.

AIM: To document the efficacy and tolerability of 14-day bismuth-lansoprazole-amoxicillin-clarithromycin (BLAC) regimen for Helicobacter pylori (H. pylori) eradication as a first-line therapy. METHOD: Patients were considered eligible for the study if they underwent upper gastrointestinal endoscopy, and H. pylori infection was diagnosed through histologic examination of antral and body biopsy samples. Primary end point of this study was to evaluate the eradication rate of 14-day BLAC regimen therapies. H. pylori eradication was assessed using the 13C urea breath test performed 6 weeks after the completion of treatment. All patients were asked to fill in a validated questionnaire to report therapy-related side effects. Each symptom was graded from absent or present. RESULTS: Ninety-seven (21 men and 76 women) were enrolled. All the patients completed the study. The H. pylori eradication rate was 90.7% (88 of 97 patients). Side effects were observed in reasonable percentages, and none of the patients left the study because of drug side effect. CONCLUSION: Bismuth-lansoprazole-amoxicillin-clarithromycin regimen as a 2-week course achieved an acceptable eradication rate with relatively mild side effects.