Filaggrin and Periostin Expression Is Altered in Eosinophilic Esophagitis and Normalized With Treatment.

OBJECTIVES: Previous data have suggested that filaggrin (FLG) and periostin (POSTN) genes may be dysregulated in eosinophilic esophagitis (EoE). We aimed to further evaluate the expression patterns of FLG and POSTN proteins in esophageal tissue samples of patients with EoE, as compared to those of patients with gastroesophageal reflux disease (GERD) and normal controls. METHODS: A total of 61 prospectively collected cases, including 40 children with EoE and 21 children with GERD, and a control group of 14 sex- and age-matched healthy children were enrolled. Patients with EoE were treated with skin testing-driven elimination diet and/or corticosteroids. The immunohistochemical expression of FLG and POSTN was evaluated in esophageal biopsies obtained from patients and controls, and the results were correlated with EoE-related clinicopathological parameters. RESULTS: Positive FLG and negative POSTN staining were observed in all esophageal biopsies from normal controls. In contrast, FLG and POSTN stained negative and positive, respectively, in all pretreatment biopsies obtained from patients with EoE, whereas FLG and POSTN stained positive in 57.1% and 95.2% of GERD cases, respectively (P < 0.001). A statistically significant decrease of the proportion of cases with negative FLG and positive POSTN staining was observed from the first (pretreatment) to the second (post-treatment) biopsy in the subgroup of patients with EoE (P < 0.001 in both correlations). CONCLUSIONS: FLG and POSTN expression may be downregulated and upregulated, respectively, in the esophageal mucosa of patients with active EoE, and these changes may be restored with treatment in a significant percentage of cases.

Allergy-test-driven elimination diet is useful in children with eosinophilic esophagitis, regardless of the severity of symptoms.

BACKGROUND: A combination of PPIs and corticosteroids is the pharmacotherapy mostly used to treat eosinophilic esophagitis (EoE), while dietetic manipulations consist also an efficient option. The aim of this study was to compare the efficacy of allergy-test-driven elimination diet in children with mild symptoms of EoE to a group of children with moderate/severe symptoms. METHODS: Thirty-five children, aged 7 months to 12 yr, with EoE were enrolled in the study. They had a clinical history of GERD-like (21 children, Group A) or more severe symptoms (14 children, Group B). The diagnosis had been confirmed after two preliminary months of therapy with PPIs and an esophagogastroduodenoscopy. Soon after diagnosis, they were allergy-tested, using IgE detection (SPT and serum-specific IgE) and atopy patch tests (APTs). A 12-month tailor-made diet was prescribed according to the tests. Patients of Group B continued PPIs for two more months, while swallowed topical steroids were also prescribed to them for the first 5 months after diagnosis, followed by an 'as-needed' use of them for the rest of the study. Endoscopy was repeated at the end of the study. RESULTS: Milk and egg were the most common APT-positive allergens. Thirty-two patients were instructed to follow an elimination diet, which was completed by 15/18 of Group A and 12/14 of Group B. An improvement of symptoms was reported by 26/27 patients that completed the study. The use of swallowed corticosteroids was noticeably decreased during the as-needed period, in Group B. A remarkable reduce of eosinophils was noticed in biopsies; from 42.84 ± 18.08, they decreased to 6.41 ± 3.20, a year after. CONCLUSION: All children with EoE and mild symptoms had resolution of symptoms and normal eosinophils in the esophageal mucosa a year after an allergy-driven elimination diet. Patients with moderate/severe EoE symptoms had the same improvement, indicating that an elimination diet is an efficient complementary treatment to corticosteroids.

Evaluation of the lipid profile in type 2 diabetes mellitus patients in Greece.

BACKGROUND: Diabetes mellitus (DM) is one of the most serious global health problems. In Greece, DM constitutes a public health problem and is highly associated with decreasing levels of physical activity, increasing obesity rates, population ageing, and unhealthy lifestyle and dietary behaviors. MATERIALS: In this study we evaluated the sera from 800 type 2 diabetic patients recruited during a three year period of time and 200 age matched controls without any clinical history of diabetes. For each subject we measured levels of fasting glucose (GLU), total cholesterol (TCHOL), triglycerides (TRG), high density lipoproteins (HDL-C), and glycosylated hemoglobin (GHbA1c) and calculated levels of low density lipoproteins (LDL-C). The aims of our study were to find characteristics of lipid parameters in the population under study, to find gender differences in the parameters, to evaluate correlations between pairs of lipid parameters, and to compare the lipid parameters between patients and healthy controls focusing on patient gender. For this purpose we analyzed the data using descriptive statistics, x-square test, logistic regression and ROC curve analysis. RESULTS: According to our results, 70.0% of diabetic patients presented at least one lipid abnormality. Elevated LDL-C, elevated TCHOL, elevated TRG, and reduced HDL-C levels were noted in 28.37%, 36.37%, 39.01%, and 30.12% of the patients, respectively. The combination of elevated TRG and reduced HDL-C was the most preva- lent of the combined lipid abnormalities. Moreover, there are statistically significant differences in the levels of HDL-C, TCHOL, TRG, and GLU between men and women. In contrast, no differences were observed in levels of GHbA1c. CONCLUSIONS: We identified an important linear relationship between LDL-C and TCHOL (LDL-C = -28.69 + TCHOL * 0.75, adjusted R2 = 76.96%. Finally, we calculated optimal thresholds for GLU and GHb1Ac levels using two methodologies: overall accuracy maximization or sensitivity-specificity minimization for the identification of patient from healthy controls. Differences in the optimal thresholds between men and women were not observed.

Genotype distribution in chronic hepatitis C patients in Greece.

BACKGROUND: Hepatitis C is a major public health problem. HCV infection contributes to progressive liver disease, cirrhosis, and hepatocellular carcinoma. HCV has high genetic heterogeneity and is classified into various genotypes and subtypes. Regional differences exist in their distribution. The aim of this study was to investigate the relative frequency of HCV genotypes in Greek patients with chronic infection. METHODS: We evaluated 82 patients with chronic HCV infection, both males and females, belonging to different risk groups. We performed viral load measurement and HCV genotyping in all specimens. RESULTS: HCV genotype 3 was the most prevalent (41.5%) followed by genotype 1 (34.1%), 2 (12.2%), 4 (10.9%), and 5 (1.2%). Genotype 6 was not detected in any patient. Most prevalent subtypes were 3a (32.9%), 1b (26.8%), and 2a (6.1%). Fourteen subjects revealed mixed infections within types. There were no cases with mixed infections across types. CONCLUSIONS: Our data indicate that genotypes 3a and 1b are the most prevalent in Greek patients. Genotype 3a is predominant in younger patients and also in male patients. Moreover, HCV genotype distribution is in continuous temporal change in Greece.

Food allergy-related paediatric constipation: the usefulness of atopy patch test.

The aims of this study were to evaluate the implication of food allergy as a cause of paediatric constipation and to determine the diet period needed to tolerate the constipation-causing foods. Fifty-four children aged 6 months to 14 years (median, 42 months) suffering from chronic constipation (without anatomic abnormalities, cοeliac disease or hypothyroidism), unresponsive to a 3-month laxative therapy, were prospectively evaluated. All participants were evaluated for allergy to cow's milk, egg, wheat, rice, corn, potato, chicken, beef and soy, using skin tests (SPT), serum specific IgE and atopy patch test (APT). A withdrawal of the APT-positive foods was instructed. Thirty-two children had positive APT; 15 were positive to one; six, to two and 11, to three or more food allergens, wheat and egg being the commonest. After withdrawing the APT-positive foods for an 8-week period, constipation had improved in 28/32 children, but a relapse of constipation was noticed after an oral food challenge, so they continued the elimination diet. Tolerance to food allergens was achieved in only 6/28 after 6 months, compared to 25/28 after 12 months and to all after a 2-year-long elimination. Food allergy seems to be a significant etiologic factor for chronic constipation not responding to treatment, in infants and young children. APT was found to be useful in evaluating non-IgE allergy-mediated constipation, and there was no correlation of APT with IgE detection. Tolerance was adequately achieved after 12 months of strict food allergen elimination.

Magnetic resonance imaging of the small bowel in children with idiopathic inflammatory bowel disease: evaluation of disease activity.

BACKGROUND: Examinations using ionizing radiation are frequently used in the evaluation of disease activity in children affected by idiopathic inflammatory bowel disease (IBD). OBJECTIVE: To develop an MR imaging protocol without the need for fluoroscopic insertion of an enteral tube and to assess the disease activity in children with IBD. MATERIALS AND METHODS: Included in the study were 37 children (22 girls and 15 boys; age range 7-15 years, mean 11.67 years) with IBD who underwent MR imaging of the small bowel. Of these 37 children, 32 had Crohn disease and 5 had indeterminate colitis. A water solution containing herbal fibres was administered orally or through a nasogastric tube. Patients were imaged on a 1.5-T MR scanner with T1-weighted and Tau2-weighted sequences followed by a dynamic study using 3-D T1-W images after intravenous administration of gadolinium. RESULTS: The percentage enhancement of the bowel wall was significantly increased in patients with abnormal C-reactive protein (CRP) values compared to patients with CRP values in the normal range (P<0.001). A relatively weak but significant correlation between percentage enhancement of the bowel wall and CRP values was noted during all phases of enhancement. CONCLUSION: This MR imaging protocol is a safe and well-tolerated method for evaluating disease activity and extraintestinal manifestations of IBD in children.