Similar subclinical enthesitis in celiac and inflammatory bowel diseases by ultrasound suggests a gut enthesis axis independent of spondyloarthropathy spectrum.

Objective: Higher subclinical enthesitis on US has been reported in IBD and celiac disease, separately. The objective of this study was to compare IBD and celiac disease for enthesitis on US. Higher enthesitis scores in IBD compared with celiac disease would support a shared pathogenic mechanism between IBD and spondyloarthritis, whereas similar scores may suggest a general impact of gut inflammation on the enthesis. Methods: Patients with IBD, celiac disease and healthy controls (HCs) were recruited and 12 entheses were scanned by US, blind to the diagnosis and clinical assessment. Elementary lesions for enthesitis were scored on a scale between 0 and 3, for inflammation, damage and total US scores. Results: A total of 1260 entheses were scanned in 44 patients with celiac disease, 43 patients with IBD and 18 HCs. The three groups were matched for age and BMI. Patients with celiac disease and IBD had higher inflammation scores than HCs [10.4 (6.5), 9.6 (5.4) and 5.6 (5.2), respectively, P = 0.007) whereas damage scores were similar. Both age and BMI had significant effects on the entheseal scores, mostly for inflammation scores but when controlling for these the US enthesopathy scores were still higher in celiac disease and IBD. Conclusion: The magnitude of subclinical enthesopathy scores is similar between celiac disease and IBD in comparison with HCs. These findings suggest that the common factor between both diseases and enthesopathy is abnormal gut permeability, which may be modified by the genetic architecture of IBD leading to clinical arthropathy.

Which Factors are Predictive for Mortality among Hospitalized Patients with Cirrhosis?

BACKGROUND/AIMS: Cirrhotic patients admitted to the hospital have a high mortality rate. The aim of this study was to evaluate predictors of mortality in patients hospitalized for specific complications of cirrhosis. METHODOLOGY: All patients admitted to the gastroenterology service with cirrhosis during a 2-year period were retrospectively identified. We compared the clinical characteristics of patients who died and those who survived. Multivariable analysis was performed to determine predictors of mortality. RESULTS: A total of 84 patients were included in the study. In hospital mortality rate was 35%. Hepatorenal syndrome development (41% vs 4%, p < 0.001), MELD score (17 vs 12, p = 0.003), Child Pugh score (11 vs 8, p < 0.001), serum creatinine (p < 0.001) and serum potassium values (p = 0.01) were significantly higher in patients who died. Stepwise logistic regression analysis revealed that the best model in prediction of death included serum potassium levels (OR = 2.182; 95% Cl: 1.189-4.006; p < 0.001) and Child Pugh score (OR = 2.140; 95% CI: 1.507-3,038; p = 0.012). CONCLUSIONS: The mortality of cirrhotic patients admitted to hospital is significantly high. Prevention of acute kidney injury will be an appropriate approach for improving the survival in hospitalized patients with cirrhosis.

[Investigation of Helicobacter pylori iceA1 and iceA2 genes in patients with chronic gastritis and gastric cancer]. / Kronik Gastrit ve Gastrik Kanserli Hastalarda Helicobacter pylori iceA1 ve iceA2 Genlerinin Arastirilmasi

Several virulence factors of Helicobacter pylori play crucial role in the pathogenesis of the infections.H.pylori iceA gene which is induced by the contact with epithelium during the attachment of bacterium to the gastric mucosa, possess two variants (iceA1 and iceA2). Although there are some data indicating the relationship between H.pylori iceA1 and peptic ulcer, this concept is still controversial. The aims of this study were to investigate the presence and prevalence of H.pylori iceA1 and iceA2 gene regions in the tissue samples of patients diagnosed as chronic gastritis and gastric cancer, and to evaluate whether any correlation existed between these genotypes and clinical manifestations. A total of 109 tissue samples obtained from chronic gastritis (n= 55) and gastric cancer (n= 54) patients whose H.pylori infections have been confirmed by histopathologic examination of biopsy samples, were included in the study. The presence of H.pylori in the samples were also confirmed by amplification of the ureA gene region by inhouse polymerase chain reaction (PCR). H.pylori iceA1 and iceA2 genes were directly genotyped with the use of specific primers in the gastric biopsy specimens by PCR. The total positivity rates of iceA1 and ice- A2 genotypes in patients were found as 58% (63/109) and 24% (26/109), respectively. With the special attention to chronic gastritis and gastric cancer patients, the frequencies of iceA1 gene were 51% (28/55) and 65% (35/54), while the frequencies of iceA2 gene were 20% (11/55) and 28% (15/54), respectively. The difference of positivity rates of iceA1 and iceA2 genotypes between the patient groups were not statistically significant (p> 0.05). There was also no statistically significant correlation between the genotypes and clinical manifestation (r> 0.01). As a result, H.pylori iceA1 genotype was predominant (58%) in chronic gastritis and gastric cancer patients in our region, however the prevalence of iceA2 genotype was lower (24%) similar to those data reported in the literature. Our results supported the concept that iceA gene reflects geographical differences rather than determining the clinical picture and virulence. In conclusion, multicenter and large scaled studies are needed for better evaluation of H.pylori iceA gene and disease relationship.

Prevalence of cagA and vacA genotypes of Helicobacter pylori isolated from Turkish patients with active or non-active chronic gastritis.

Several virulence factors of Helicobacter pylori may contribute to gastric mucosal damage. In this study, the prevalence of cagA and vacA genotypes of H. pylori was examined in different patterns of chronic gastritis. Oesophagogastroendoscopy was performed in 147 dyspeptic patients. Antrum biopsies were obtained for isolation of H. pylori and for histopathological assessment. H. pylori vacAs1 and cagA genes were directly genotyped in the gastric biopsy specimens by polymerase chain reaction (PCR). A total of 102 dyspeptic patients, all H. pylori-positive by PCR, were included in the study. Of these, 59 had active chronic gastritis and 37 had non-active chronic gastritis. The prevalence of cagA and vacAs1 was higher among patients with active chronic gastritis than among those with non-active chronic gastritis (45.8% vs 21.6% (p = 0.02) and 78.0% vs 40.5% (p < 0.001), respectively). In conclusion, both cagA and vacAs1 genotypes are associated with the activity of chronic gastritis.

Does Helicobacter pylori-induced inflammation of gastric mucosa determine the severity of symptoms in functional dyspepsia?

BACKGROUND: Inflammation induces some structural and biochemical alterations and oxidative damage in gastric tissue. In this study, we aimed to investigate the relationship among the severity of symptoms, oxidative stress, and grading scales of Helicobacter pylori-induced gastric inflammation in functional dyspepsia. METHODS: Thirty-five patients with functional dyspepsia were enrolled in the study. The severity of dyspepsia within the last 6 months was evaluated by Glasgow Dyspepsia Severity Score. In biopsy specimens of gastric mucosa, severity of gastritis was estimated by the revised Sydney Classification System, and oxidative stress parameters were studied. RESULTS: Although there was no statistically significant relationship between symptom scores and degree of chronic inflammation, a tendency for symptoms to be more severe has been observed in low levels of gastritis. Levels of sulfhydryl groups were lower in subjects with high levels of chronic inflammation, and Helicobacter pylori intensity (P < 0.001 and P = 0.02, respectively). Levels of malondialdehyde were higher in subjects with high levels of chronic inflammation (P = 0.04). There was a statistically significant but a weak positive correlation between symptom scores and sulfhydryl levels (P < 0.001, r = 0.323). CONCLUSIONS: In conclusion, there may be an inverse relation between severity of symptoms and level of Helicobacter pylori induced gastric inflammation or oxidative stress in patients with functional dyspepsia.

Carotid hemodynamic parameters in hemodialysis patients.

BACKGROUND: Atherosclerotic vascular disease is a major cause of morbidity and mortality for patients with end-stage renal disease on maintenance hemodialysis. Early atherosclerotic changes of the arterial wall can be evaluated by intima-media thickness (IMT), presence and structure of plaques and parameters of vascular resistance. The aim of the present study has been to investigate the relationship between carotid IMT and pulsatility index (PI) or resistive index (RI) values in hemodialysis patients. METHODS: We studied 36 hemodialysis patients (21 female, 15 male; median age 39.5 years, IQR 33.0-54.7 years) and 38 healthy volunteers (20 women, 18 men; median age 41.0 years IQR 32.5-53.5 years). All subjects underwent ultrasonography of common carotid artery, with determination of IMT, PI and RI. RESULTS: Bilateral and mean carotid IMT were found to be significantly higher in hemodialysis patients than in the control group (P<0.0001). Right and left carotid artery RI values were determined to be lower in hemodialysis patients than in the control group (P=0.007 for both). Similarly, right and left carotid PI values were also determined significantly lower in the hemodialysis group (P=0.005 and P=0.004, respectively). There was a moderate negative correlation between the right carotid IMT and right PI (r=-0.258, P=0.026). CONCLUSIONS: In contrast to previous studies in patients with diabetes, hypertension or cerebrovascular disease, PI and RI values decrease when IMT increases in hemodialysis patients. This finding may be a result of peripheral vasodilatation secondary to anemia in hemodialysis patients.

Comparison of sleep quality between hemodialysis and peritoneal dialysis patients.

AIM: Sleep disorders are common in patients with end-stage renal disease. Although studies have been conducted on the type and frequency of sleep disturbances in hemodialysis and peritoneal dialysis patients, there has been no study comparing the sleep quality between these two groups. Therefore, we aimed to compare sleep quality between hemodialysis and peritoneal dialysis patients. METHODS: A total of 102 patients (52 hemodialysis and 50 peritoneal dialysis) were included in the study. The Pittsburgh sleep quality index (PSQI) was used for the assessment of sleep quality. Two groups were compared for seven components of the PSQI questionnaire and global score as well as for clinical and laboratory findings. We also assessed the independent predictors of sleep quality. RESULTS: There were 51 male and 51 female patients (29 male and 23 female in hemodialysis group versus 22 male and 28 female in peritoneal dialysis group). The mean age was 55.5+/-14.6 years in the hemodialysis and 51.5+/-18.1 years in the peritoneal dialysis group. The median dialysis duration was 36 (77.0) months. The sleep quality was poor in 88.5% of the hemodialysis patients and 78.0% of the peritoneal dialysis patients. However, this difference in sleep quality was not significant between the two groups (P>0.05). There was a significant association between the sleep quality and the age, presence of diabetes mellitus, and serum albumin. Among these variables, only age was found to be an independent predictor of sleep quality. CONCLUSIONS: Hemodialysis and peritoneal dialysis patients had a similar high rate of poor sleep quality. Further studies are necessary to investigate the causes of poor quality of sleep and to investigate methods to improve sleep quality in this population.

The relationship between arteriovenous fistula blood flow rate and pulmonary artery pressure in hemodialysis patients.

PURPOSE: Although there is an increased prevalence of pulmonary hypertension in hemodialysis patients, the relationship between arteriovenous (AV) fistula blood flow and pulmonary hemodynamics is not known. The aim of this study was to evaluate the relationship between blood flow rate of AV fistula and pulmonary artery pressure (PAP) in hemodialysis patients. METHODS: Thirty-two hemodialysis patients were included in this study. Within 1 h of completion of dialysis, blood flow rate of AV fistula and pulmonary hemodynamics were evaluated using Doppler sonography. Pulmonary hypertension was defined as mean PAP > or = 25 mmHg at rest. RESULTS: Mean PAP, median blood flow rate of AV fistula, and mean cardiac index were 22.5 +/- 10.0 mmHg (range 8-39), 978.0 ml/min (interquartile range 762.0-1,584.5) and 3,043.0 +/- 694.3 ml/ min per m2 (range 1,251-4,140), respectively. Mean PAP has a relationship to cardiac index (r = 0.453, P = 0.014). However, there was no correlation between mean PAP and blood flow rate of AV fistula, hemoglobin, calcium-phosphorus (CaxP) product, and parathormone. Pulmonary hypertension was present in 43.7% of patients. Patients with pulmonary hypertension had significantly higher cardiac index (P = 0.036). CONCLUSIONS: We found there was no direct relationship between blood flow rate of AV fistula and PAP. Other factors may play a role in the development of pulmonary hypertension.

The effects of weight loss on normal transaminase levels in obese patients.

BACKGROUND: Obesity is associated with insulin resistance, which is the main pathogenic factor for nonalcoholic fatty liver disease (NAFLD). NAFLD can progress without associated elevations in liver enzymes. Therefore, we investigated the effects of weight loss on normal transaminase levels in obese subjects who are at risk for NAFLD. METHODS: Thirty-seven obese patients with normal ALT levels were evaluated. All patients received an individualized low-calorie diet over at least 6 months. Twenty-two patients who achieved weight loss of at least 5% body weight were identified as the study group and the others as the control group. Transaminases, insulin resistance, and body mass index were compared before and after the intervention. RESULTS: Hepatic steatosis was found in 83.8% of obese patients. ALT was correlated with HOMA-IR in all patients at baseline (r = 0.363, P = 0.027). At the end of the follow-up, mean weight loss achieved in the study and control groups were 9.2% (8.7 +/- 3.0 kg) and 0.3% (0.5 +/- 2.8 kg), respectively. In the study group, HOMA-IR and ALT decreased from 4.0 +/- 1.8 to 2.4 +/- 0.9 and from 21.4 +/- 6.6 IU/L to 16.8 +/- 5.5 IU/L, respectively (P = 0.005 and P = 0.044). CONCLUSIONS: The results demonstrate that weight loss results in a decrease in normal ALT levels as well as insulin resistance. Therefore, the normal range for ALT may need to be reassessed.

[Investigation of hemodialysis patients in terms of the presence of occult hepatitis B]. / Hemodiyaliz hastalarinin gizli hepatit B varligi yönünden arastirilmasi.

The presence of hepatitis B virus (HBV) DNA in case of negative HBV surface antigen (HBsAg) in serum is known as "occult hepatitis B". There are many reports indicating that occult HBV infections are more frequently encountered in case of hepatocellular carcinoma, hemodialysis practice and co-infections with hepatitis C virus (HCV). The aim of this study was to investigate the presence of HBV-DNA in HBsAg negative hemodialysis. patients and subjects who had never experienced hemodialysis. A total of 226 HBsAg negative sera were included to the study, of which 153 were from hemodialysis patients (97 male, 56 female; mean age: 41.3 +/- 5.8 years), and 73 were from non-hemodialyzed individuals (46 male, 27 female; mean age: 36.5 +/- 6.9 years) who had serological evidence of previous HBV and HCV infections. Of these 73 subjects, 41 were anti-HCV positive, 22 were "anti-HBc IgG positive alone", seven were anti-HBc IgG and anti-HBs positive, and three were anti-HBc IgG and anti-HBe positive, while 40 of 153 (26.1%) hemodialysis patients were anti-HCV positive. HBV and HCV markers were detected by commercial enzyme immunoassays (bioMerieux, France and Murex, UK, respectively), and HBV-DNA testing was performed by a commercial real-time polymerase chain reaction (PCR; 5700 and 7700 Sequence Detection System, Applied Biosystems, UK) assay. Nineteen (12.4%) of HBsAg-negative hemodialysis patients and five (6.8%) of the non-hemodialyzed subjects were found positive for HBV-DNA (viral loads were > or =10(4) copies/ml, and 10(3)-10(4) copies/ml, repectively). The rates of occult HBV infection in the anti-HCV positive hemodialysis patients and anti-HCV positive non-hemodialyzed subjects were detected as 27.5% (11/40) and 2.4% (1/41), respectively. These rates in the other groups were found as follows; 7.1% (8/113) in the anti-HCV negative hemodialysis patients, 9.1% (2/22) in the "anti-HBc positive alone" subjects, and 20% (2/10) in the subjects positive for anti-HBc+anti-HBs or anti-HBe. The results of this study indicated that the prevalence of HBV viremia (12.4%) in hemodialysis patients being more prominent in those of anti-HCV positive patients (27.5%) should not be overlooked. In conclusion, the hemodialysis patients should be screened by sensitive PCR-based methods for occult HBV infections, even if they were negative for HBsAg, in order to prevent or at least to decrease the transmission risk of HBV infection which is still an important health problem in dialysis units.

Evaluation of total cerebral blood flow volume in cerebral atrophy.

The goal of our study is to determine total cerebral blood flow volume (tCBFV) via extracranial Doppler ultrasound and to investigate its value in the differential diagnosis of dementia. Twenty-eight outpatients with cerebral atrophy confirmed by cranial computed tomography were enrolled into the study. Nine patients with Alzheimer's disease (AD) and nine patients with vascular dementia (VaD) based on neuropsychologic test and imaging findings, as well as 10 neurologically normal elderly subjects underwent Doppler sonographic examination of extracranial internal carotid artery (ICA) and vertebral artery (VA). Angle corrected time averaged flow velocity and cross-sectional areas of vessels have been measured. Flow volumes and tCBFV have been calculated. The measures of tCBFV, anterior CBFV (aCBFV), right CBFV (rCBFV) and right ICA flow volume were significantly lower in patients with dementia. The amounts of tCBFV, aCBFV, rCBFV and right ICA flow volume have been found to be low in AD and VaD patients compared with normal elderly group. Of all parameters measured for AD and VaD, no significant difference was found except Mini-Mental State Examination (MMSE) scores. To the best of our knowledge, this is the first reporting the CBF measurements using Doppler ultrasound of extracranial ICA and VA in the differential diagnosis of dementia in cerebral atrophy. The tCBFV, aCBFV, rCBFV and right ICA flow volumes and MMSE scores are significant in the diagnosis of dementia, whereas only MMSE scores are significant in the differential diagnosis of AD and VaD.

Drug-Induced Liver Injury by Glatiramer Acetate Used for Treatment of Multiple Sclerosis: A Case Report.

Glatiramer acetate (GA, Copaxone) is an approved drug for the treatment of relapsing-remitting multiple sclerosis. Most common side effects observed with GA are local injection site reactions, which can include pain, swelling, or redness. However, systemic adverse event such as hepatotoxicity related to GA is rarely seen. In this report, we present a case of GA-induced toxic hepatitis associated with cholestatic and hepatocellular damage.

Five methods for detection of Helicobacter pylori in the Turkish population.

AIM: To compare culture analysis, Helicobacter pylori (H. pylori) stool antigen (HpSA) test, polymerase chain reaction (PCR) and fluorescence in situ hybridization (FISH) for H. pylori detection. METHODS: One hundred and thirty-two consecutive adult dyspeptic patients receiving diagnostic endoscopy at the department of gastroenterology were enrolled in this study. Culture and histological examination were performed on biopsy specimens. PCR and FISH tests were applied to histopathological samples. Stool samples that were simultaneously collected were tested for the H. pylori antigen using the HpSA test and bacterial DNA using stool PCR. RESULTS: H. pylori was positively identified by histological examination in 85/132 (64.4%) of the patients, while positive samples were found in 56 (42.4%), 64 (48.5%), 98 (74.2%), 28 (21.2%) and 81 (61.4%) of the patients by culture, HpSA, PCR, stool PCR and FISH methods, respectively. The results of the culture, biopsy PCR, HpSA and FISH tests, with the exception of the stool PCR, were found to correlate with the histological examination as a gold standard. CONCLUSION: The HpSA test is a rapid, simple, and noninvasive test for monitoring therapy. FISH is an accurate, rapid, cost-effective, and easy-to-use test for H. pylori detection.

Novel approach for the prevention of contrast nephropathy.

OBJECTIVE: To date, there is no effective treatment of contrast medium (CM)-induced nephropathy. Multiple studies documented a protective role of hydration and N-acetylcystein (NAC) as prophylactic agents against CM-induced nephropathy in a high-risk population. In the present study, we investigated a new antioxidant agent, caffeic acid phenethyl ester (CAPE), and compare with NAC against contrast nephropathy. METHODS: Forty-two adult male rats were divided into six experimental groups, which were control, injected with intravenous (i.v.) CM, injected with i.p. CAPE, injected with i.p. NAC, injected with i.v. CM pretreated with i.p. CAPE, injected with i.v. CM pretreated with i.p. NAC. CAPE and NAC were given daily throughout the study. All rats were deprived of water for 24h at the third day of the study and then contrast medium was administered to CM, CAPECM and NACCM groups. The rats were sacrificed at the fifth day. Oxidant-antioxidant status was determined in renal tissues. The severity of injury was scored with a light microscope in renal tissue. Plasma creatinine levels were measured. RESULTS: Renal injury scores were higher in CAPECM and NACCM groups than in control, CAPE and NAC groups, but lower than the CM group. Likewise, creatinine levels of CAPECM and NACCM groups were higher than the control groups but they were significantly lower than the level of the CM group. Creatinine levels of the NACCM group were significantly higher than the CAPECM group. Malondialdehyde levels were significantly lower in CAPECM and NACCM groups than the CM group. CONCLUSION: CAPE might protect renal structure and functions as well as NAC against CM injury.

Activation of peripheral opioid receptors has no effect on heart rate variability.

Opioid receptors involved in regulating the motility of the gastrointestinal tract have been localized in both contractile and neuronal tissues. Trimebutine, a peripheral opioid receptor agonist, modulates gastrointestinal motor activity in both directions and also may act on cardiac tissue. This study investigated the effects of trimebutine in clinical doses on cardiac autonomic functions with heart rate variability. The effect of trimebutine on cardiac autonomic outflows was evaluated in 11 healthy subjects. Trimebutine (200 mg) or placebo was administered orally at random in a double-blind, cross-over manner. Continuous electrocardiography recordings were obtained before and after drug administration during three states: rest, controlled breathing, and a hand grip exercise. Heart rate variability analysis showed that there was no significant difference between subjects administered with placebo or trimebutine throughout rest, controlled breathing, or the hand grip exercise. We concluded that trimebutine, in clinical doses, has no significant effect on cardiac autonomic functions.

Transient postpartum diabetes insipidus associated with HELLP syndrome.

Diabetes insipidus in pregnancy has different causes. The association of diabetes insipidus with disturbances of liver function has been reported, however, diabetes insipidus has rarely been reported in HELLP syndrome. We present a 23-year-old primigravida with a singleton gestation complicated by HELLP syndrome who developed postpartum diabetes insipidus. Labor was induced promptly to terminate pregnancy because of intrauterine fetal death and liver dysfunction. 1-deamino-8-D-arginine-vasopressin was administered. Diabetes insipidus and liver dysfunction resolved within 2 weeks. Development of diabetes insipidus may result from increased vasopressinase activity mainly caused by deterioration of liver functions caused by HELLP syndrome. In pregnant women with liver disease as a result of any cause, the development of diabetes insipidus should be assessed with particular attention.