GastroPanel® test for non-invasive diagnosis of atrophic gastritis in patients with dyspepsia.

AIM: Atrophic gastritis (AG), first step in the cascade leading to gastric adenocarcinoma, is related to Helicobacter pylori (H. pylori) infection. Currently, the gold standard for the diagnosis of AG is esophagogastroduodenoscopy (EGD) with histological examination of the biopsy specimens. However, since the latter are taken in random order and the distribution of AG is often patchy, histology is only representative of mucosal status. Considering this limitation, a test named GastroPanel®, that measures the blood concentrations of pepsinogen I and II, gastrin-17 and H. pylori antibodies, has been developed as a potential non-invasive biopsy. Aim of this study has been to assess the accuracy of GastroPanel® in patients with AG. METHODS: Forty-seven dyspeptic patients (24 males, mean age 52.2±9.3 years), in follow-up for antral or diffuse AG, were enrolled. All underwent at least two EGDs with random biopsies and blood collection for GastroPanel® parameters examination. RESULTS: Of the 47 patients, 16 (34.1%) had histological diagnosis of antral and 31 (65.9%) multifocal AG; 17 (36.2%) patients had mild and 30 (63.8%) had moderate-severe AG. H. pylori was detected in 39 (82.9%) and intestinal metaplasia was found in all patients. GastroPanel® showed 82.9% sensitivity for the diagnosis of AG and 53.8% for the diagnosis of H. pylori infection. The prediction of advanced atrophy was not sufficiently accurate, neither in patients with antral nor in those with multifocal AG. CONCLUSION: GastroPanel® can be useful for detecting patients with AG. However, it does not reflect the severity of atrophy.

Liver steatosis in celiac disease: the open door.

Non-alcoholic fatty liver disease (NAFLD) is a common disease of unknown origin characterized by histological features similar to alcoholic-like liver injury but in the absence of significant alcohol intake. Non-alcoholic fatty liver disease refers to a spectrum of diseases of the liver ranging from simple steatosis (i.e., fatty infiltration of the liver) to nonalcoholic steatohepatitis (i.e., steatosis with inflammation and hepatocyte necrosis) to cirrhosis. Non-alcoholic fatty liver disease is frequently associated with disorders such as insulin resistance, obesity, type 2 diabetes mellitus, hyperlipidemia and protein-calorie malnutrition. However, in a subgroup of NAFLD patients, the true relevant cause remains undetermined. Celiac disease (CD) is a common immune-mediated disorder and develops in genetically susceptible subjects after the ingestion of gluten proteins. Celiac disease has been found in about 10% of patients with unexplained abnormal liver tests, and in about 3.5% of patients with NAFLD as the only manifestation of the disease. The frequency of subclinical or silent presentations in older children and adults highlights the importance of CD screening in patients with unexplained chronic abnormal liver function tests and NAFLD without any specific etiology. The pathogenesis of liver steatosis in CD is uncertain. The aims of this review are to describe the possible mechanisms involved in the occurrence and progression of liver steatosis in CD patients.

Effects of the mode of delivery on ANP and renin-aldosterone system in the fetus and the neonate.

Plasma ANP and aldosterone levels, plasma renin activity (PRA), haematocrit, systolic and diastolic blood pressure (BP), were evaluated in 15 full-term infants delivered by elective Caesarean section (CS group) and in 15 full-term infants delivered vaginally (vaginal group). The mode of delivery did not influence the cord blood levels of ANP and their increase at the 24th hour of life. Instead, PRA was lower and plasma aldosterone levels were higher in the CS group than in the vaginal group. Also haematocrit and BP were influenced by mode of delivery. The haematocrit values were lower in the CS group than in the vaginal group at birth as well at the 24th hour of life. The values of systolic and diastolic BP were the same in both groups, at birth, but at the 24th hour of life increases were observed only in the vaginal group. On the fourth day of life weight loss was the same in both groups. Our findings suggest that the mode of delivery has more influence on neonatal BP adaptation than on neonatal volume homeostasis.

Serum adipokine levels in overweight patients and their relationship with non-alcoholic fatty liver disease.

AIM: Non-alcoholic fatty liver disease (NAFLD) is a relevant public health matter in Western countries. The pathogenetic link between visceral fat, insulin resistance (IR) and NAFLD has been reported in literature. However, there are contradictions on the changes of adipokine levels in serum related to the presence of NAFLD. The aim of the present study was to evaluate the serum concentrations of a selected set of adipokines, that is, adiponectin, leptin, resistin and the pro-inflammatory cytokine interleukin-6 (IL-6) in overweight patients, and to clarify their relationship with NAFLD. METHODS: Fasting serum levels of adipokines were determined in 42 consecutive overweight patients and in 25 lean controls. The degree of ultrasound (US) liver steatosis was graded according to the Hamaguchi score. RESULTS: Liver steatosis was detected in 33 patients (78%) by US examination. Twelve patients with elevated transaminases levels showed significantly higher values of IR, leptin and resistin levels (P<0.05). Patients with steatosis presented a significantly higher leptin and a lower adiponectin levels (P<0.05) than controls. A significant inverse correlation was found between US steatosis progression and adiponectin and resistin levels (p<0.05). Considering the multiple logistic regression, adiponectin and leptin were good predictors to detect the presence of steatosis (p<0.05). CONCLUSION: Our data support the concept that adipokine level changes are closely linked with IR. In addition, serum adiponectin and leptin levels may be used as diagnostic markers to determine the presence of NAFLD in overweight patients.

Atrial natriuretic peptide and renin-aldosterone relationship in healthy newborn infants.

Plasma atrial natriuretic peptide (ANP) and aldosterone concentrations, and plasma renin activity (PRA) were measured by radioimmunoassay concurrently in 20 healthy full term infants, in cord blood, at 24 hours after birth and on the 4th day of life. ANP and aldosterone increased significantly at 24 hours and was persistently elevated on the 4th day of life. PRA remained unchanged during the first four days of life. In cord blood, ANP concentrations were correlated with aldosterone concentrations (r = 0.49, p less than 0.05) and hematocrit (r = 0.58, p less than 0.02). At the 24 hours of life, plasma ANP concentrations were correlated with weight loss observed on the 4th day of life (r = -0.70, p less than 0.005), while the percentage changes in plasma aldosterone concentrations were correlated with percentage changes in systolic blood pressure (BP) (r = 0.49, p less than 0.05). These findings suggest that during the early newborn period ANP and aldosterone act as an integrated system which has a role in regulation blood pressure and intravascular volume homeostasis.