Hepatitis E virus genotype 3 is associated with gallstone-related disease.

Objective: Hepatitis E virus (HEV) genotype 3 is endemic in Northern Europe and despite a high seroprevalence of anti-HEV IgG antibodies among blood donors (≈17%), few clinical cases are notified in Sweden. Low awareness of hepatitis E and its possible symptoms may contribute to this discrepancy. The aim of this study was to investigate the prevalence of acute HEV infection among hospital admitted patients with abdominal pain and elevated liver enzymes.Materials and methods: During 2016-2017, 148 adult patients with serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > twice normal levels were prospectively enrolled at surgical wards at three Swedish hospitals. Serum samples were analyzed for HEV RNA as well as anti-HEV IgM and IgG, and medical records were reviewed.Results: Six (6/148, 4.1%) patients were HEV infected confirmed by detectable HEV RNA, but only one of these patients had detectable anti-HEV antibodies. Four of the HEV infected patients were diagnosed with gallstone-related disease: three with biliary pancreatitis and one with biliary colic. The remaining two were diagnosed with bowel obstruction and pancreatic malignancy. Four HEV strains were typed by sequencing to genotype 3.Conclusions: This study identified acute HEV3 infection in 4% of the patients with elevated liver enzymes admitted to a surgical ward. HEV infection was not the solitary disease leading to hospitalization, instead it was found to be associated with other surgical conditions such as gallstone-related disease including biliary pancreatitis. Additionally, HEV RNA might be the preferential diagnostic tool for detecting ongoing HEV infection.

Effect of body mass index on groin hernia surgery.

OBJECTIVE: To analyze the effect of underweight, overweight, and obesity in relation to clinical characteristics, the risk of postoperative complications, 30-day mortality, and reoperations for recurrence after groin hernia surgery. SUMMARY OF BACKGROUND DATA: Groin hernia surgery is one of the most frequent operations performed in general surgery. Several studies have demonstrated a protective effect of overweight and obesity on the risk of developing primary groin hernia. However, obesity has also been suggested to increase the risk for recurrence of groin hernia. METHODS: Through the Swedish Hernia Register, 49,094 primary groin hernia operations were identified between January 1, 2003 and December 31, 2007. Patients were divided into 4 body mass index (BMI) groups: BMI 1, <20 kg/m2; BMI 2, 20 to 25 kg/m2; BMI 3, 25-30 kg/m2; and BMI 4, >30 kg/m2. RESULTS: Of the 49,094 patients, 3.5% had a BMI <20 kg/m2 and 5.2% were obese. Altogether, women constituted only 7.7% of the studied group, but among patients with BMI <20 kg/m2 that had surgical procedures for femoral hernia, 81.4% were women. The relation between BMI and postoperative complications was U-shaped and after adjustment for age, gender, and emergency procedure, patients with BMI <20 and >25 had a significant increased risk when compared with patients with BMI from 20 to 25. Reoperation for recurrence of groin hernia has an increased hazard ratio of 1.20 (95% confidence interval, 1.00-1.40) in overweight, which was particularly evident after open suture and preperitoneal mesh techniques. CONCLUSIONS: In this large and unselected population of patients with a first surgical procedure for groin hernia a relative dominance of female and femoral hernias presented as an emergency condition was observed in the low BMI group. The prevalence of obesity was markedly low. Both lean and obese patients had an increased risk for postoperative complications.

Body mass index and groin hernia: a 34-year follow-up study in Swedish men.

OBJECTIVE: Inguinal hernias are very common disorders, especially in men, with inguinal herniorrhaphy being one of the most frequently performed general surgical procedures in men. Theoretically, obesity might increase the risk of groin hernia by increasing intra-abdominal pressure. The objective of the present study was to investigate whether overweight and obesity in middle age could significantly predict future groin hernia in men. DESIGN: Prospective cohort study; SETTING: General population of men living in Gothenburg, Sweden; PARTICIPANTS: A community-based sample of 7483 men aged 47 to 55 years were followed-up from baseline (1970-1973) for a maximum of 34 years. MAIN OUTCOME MEASURES: A diagnosis of groin hernia according to the Swedish hospital discharge register. RESULTS: A total of 1017 men (13.6%) were diagnosed with groin hernia. An inverse relationship was found between body mass index (BMI) and risk of groin hernia. With each BMI unit (3-4 kg), the relative risk for groin hernia decreased by 4% (P < 0.0001). Compared with men of normal weight, obese men had a 43% lower risk (P = 0.0008, 95% confidence interval 21%-59%). Heavy smokers demonstrated a 26% lower risk for groin hernia (P = 0.003, 95% confidence interval 10%-39%). Diabetes, high physical activity, and blood pressure were not associated with groin hernia. Entering other variables potentially associated with groin hernia, as age, BMI, smoking, and serum cholesterol, in a multivariable analysis left the risk estimates for BMI and smoking virtually unchanged. CONCLUSIONS: In a large community-based sample of middle-aged men overweight and obesity were associated with a lower risk for groin hernia during an extended follow-up. Obesity, in comparison with normal weight, reduced the risk of groin hernia by 43%. A reduced risk of groin hernia was also noted in heavy smokers. Obviously, hernia may be more easily detected in lean men but a true protective effect cannot be excluded.

Body mass index and diverticular disease: a 28-year follow-up study in men.

PURPOSE: Diverticular disease increased steadily concomitant with elevated rates of overweight and obesity during the 20th century. Therefore, the objective of this study was to investigate whether overweight and obesity in midlife predict future diverticular disease in men. METHODS: This was a prospective cohort study of a general population of men living in Göteborg, Sweden. A community-based sample of 7,494 men, investigated when aged 47 to 55 years, were followed from baseline in 1970 to 1973 for a maximum of 28 years. Hospitalization with a discharge diagnosis of diverticular disease according to the Swedish hospital discharge register was measured. RESULTS: Totally, 112 men (1.5 percent) were hospitalized with diverticular disease. A relationship between body mass index and diverticular disease was demonstrated; men with a body mass index between 20 and 22.5 kg/m2 had the lowest risk. After adjustment for covariates, the risk increased linearly in men who had a body mass index of 22.5 to 25 (multiple-adjusted hazard ratio, 2.3; 95 percent confidence interval, 0.9-6; 25-27.5 (hazard ratio, 3 (1.2-7.6)), 27.5-30 (hazard ratio 3.2, (1.2-8.6)), and 30 or greater (hazard ratio 4.4, (1.6-12.3)) kg/m2 (P for linear trend = 0.004). Men with a body mass index of < or =20 kg/m2 had a nonsignificantly elevated risk (hazard ratio, 3 (0.7-12.5)). Smoking (hazard ratio, 1.6 (1.1-2.3) and diastolic blood pressure (hazard ratio, 1.02 (1.01-1.04) per mmHg) also were independently related to risk of diverticular disease. CONCLUSIONS: In a large community-based sample of middle-aged men, overweight and obesity were strongly linked to future severe diverticular disease leading to hospitalization.

Increased concentration of tissue-degrading matrix metalloproteinases and their inhibitor in complicated diverticular disease.

OBJECTIVE: Complicated diverticular disease is associated with extensive structural changes of the colonic wall. Turnover of extracellular matrix (ECM) plays a pivotal role in this process. Proteolytic enzymes, including matrix metalloproteinases (MMPs), are capable of degrading most components of ECM. Their activity is regulated by inhibitors, tissue inhibitors of metalloproteinases (TIMPs). Disturbances of the MMP-TIMP balance can cause tissue degradation or fibrosis. The aim of this study was to assess the concentration and distribution of MMPs and TIMPs in colonic biopsies. MATERIAL AND METHODS: Twenty-seven patients who had undergone sigmoid colectomy were included in the study. Full-thickness biopsies from affected and non-affected parts of each resected specimen were collected. Expressions of the proteins MMP-1, -2, -3, -9, TIMP-1 and TIMP-2 were quantified by ELISA and localized by immunohistochemistry. RESULTS: The concentrations of MMP-1, MMP-2 and TIMP-1 were significantly higher in affected tissue than concentrations in non-affected tissue (MMP-1 p=0.005, MMP-2 p=0.0003 and TIMP-1 p<0.0001). In affected segments in general, there was an increased expression in the entire bowel wall, predominantly for MMP-2, MMP-3 and TIMP-1. CONCLUSIONS: Concentrations of MMP-1, MMP-2 and TIMP-1 were increased in intestinal segments affected by complicated diverticular disease and distributed throughout the entire bowel wall, which may explain the structural changes.