The effect of helicobacter pylori eradication on atrophic gastritis and intestinal metaplasia : a retrospective single center research.

BACKGROUND AND STUDY AIMS: Gastric cancer (GC) is one of the major causes of cancer-related deaths worldwide. Helicobacter pylori (Hp) plays an important role in gastric carcinogenesis by inducing precancerous changes such as atrophic gastritis (AG) and intestinal metaplasia (IM). In our study, we aim to compare the grade of AG and IM before and after Hp eradication in patients who underwent esophagogastroduodenoscopy (EGD) in our center. PATIENTS AND METHODS: The data of 40.060 patients who underwent EGD for various reasons in our Endoscopy Unit between June 2011 and November 2017 were retrospectively evaluated. The grade of AG and IM before and after Hp eradication of patients meeting the study criteria were compared with each other. In addition, these findings were compared using OLGA and OLGIM staging systems. RESULTS: A total of 175 patients, 89 (50.9%) women and 86 (49.1%) men, were included in the study. The mean age was 55±12 years. The mean time between two EGD examinations was 38±14 months. Significant improvement was observed in the grade of AG on corpus and antrum after Hp eradication (P=0.000, P=0.008). In the corpus and antrum, the grade of IM was regressed but this was not significant (P=0.80 and P=0.370 respectively). There was a decrease in OLGA stages after Hp eradication (P=0.000). There was also a reduction in the OLGIM stages, but this was not significant(P=0.341). CONCLUSION: Our study demonstrates that Hp eradication may reduce the risk of developing GC by providing an improvement in AG and IM which are precancerous changes in GC.

Long term efficacy of pegylated interferone in the treatment of delta hepatitis: a single center experience.

BACKGROUND AND AIM: Currently there is no satisfactory treatment of chronic HDV. We aimed to evaluate the long term efficacy of PEG-interferones. PATIENTS METHODS: Patients who received PEG-interferone for chronic delta hepatitis during a 7-year period were retrospectively analysed. End of treatment response, virologic response at 6 months after treatment, and long term efficacy were evaluated. Predictors of treatment response were determined. RESULTS: The study group consisted of 31 patients. Twenty-three patients received either PEG-interferone alfa-2a (n=8) or PEG-interferone alfa-2b (n=15) for at least 48 weeks. Thirteen patients had an end of treatment virologic response (ITT:56.5%, PP:68.4%). HDV RNA negativity after 6 months off PEG-interferone treatment was achieved in 12 patients (ITT:52.1%, PP:63.1%). The patients were followed for a median duration of 36 months after PEG-interferone treatment (min-max:12-120 months). Four patients (33.3%) relapsed during the follow-up. Sustained virologic response (ITT) was 34.8% in the long term. Undetectable HDV RNA level at week 24 of treatment and biochemical response were independent predictors of end of treatment response and sustained virologic response in the long term, respectively. CONCLUSION: PEG-interferones have an unsatisfactory efficacy on the treatment of HDV because of a considerable relapse in the long term. (Acta gastro-enterol. belg., 2016, 79, 329-335).

Prevalence of advanced histologic features in diminutive colon polyps.

BACKGROUND/AIMS: Accurate in vivo differentiation of colon polyp histology may serve to prevent the resection of diminutive hyperplastic polyps in the distal colon or the need for histologic assesment of diminutive polyps after resection. The clinical implementation of these strategies depends on the prevalence of advanced histologic findings among diminutive polyps. We aimed to determine the prevalence of advanced histologic features (villous features, high-grade dysplasia, and adenocarcinoma) in diminutive colon polyps and compare it to small and larger polyps. PATIENTS/METHODS: The data of patients who had undergone elective colonoscopy at a tertiary-care referral center were retrospectively reviewed. The size, morphology, and location of all polyps were recorded. Polyps were divided into 3 groups according to their size: diminutive (≤ 5 mm), small (6-9 mm), and large (≥ 10 mm). RESULTS: A total of 7160 polyps in 3226 eligible patients were evaluated. The mean diameter of the polyps were 6.7 ± 4.9 mm. Histopathologic diagnosis were adenomatous in 4548 (63.5%) and non-adenomatous in 2612 (36.5%). Out of 7160 polyps, 4902 (68.5%) were diminutive (1-5 mm), 1360 (19%) were small (6-9 mm), and 898 (12.5%) large (≥ 10 mm) polyps. Among the diminutive polyps 2739 (55.9%) had adenomatous histology. There were 66 polyps (1.3%) with advanced histology in the diminutive group, 72 (5.2%) in the small group, 263 (29.2%) in the large polyp group. Diminutive polyps had a lower frequency of advanced histology compared to small and large polyps (p = 0.001). When the histology of the polyps were evaluated based on the size of the largest polyp the patient has, 2202 patients had polyp(s) ≤ 5 mm. The frequency of advanced histology was 2.2% in these patients. CONCLUSIONS: The prevalence of advanced histology in diminutive polyps is quite low (1.3%) which supports the clinical implementation of discard, resect and discard strategies in diminutive polyps.

Predictive Value of Unenhanced Computerized Tomography for Detecting Hepatosteatosis in Living Liver Donors.

OBJECTIVE: Macrovesicular hepatosteatosis is related to post-transplantation complications, so preoperative hepatosteatosis determination plays a critical role in donor selection. The aim of this study was to evaluate the efficacy of unenhanced computerized tomography (CT) in determining hepatosteatosis in liver donor candidates. METHODS: Information about donor candidates was retrospectively reviewed. In this screening, 27 donor candidates who underwent liver biopsy because of suspected hepatosteatosis in routine abdominal CT examination before transplantation, were reviewed. Liver biopsies and CT images were reevaluated by an experienced pathologist and radiologist. Macrovesicular hepatosteatosis was graded according to percentage and divided into 3 groups. Three radiologic liver attenuation indices were used: 1) hepatic attenuation value (CT(L)); 2) the difference between hepatic attenuation and spleen attenuation (CT(L-S)); and 3) the ratio of hepatic attenuation to splenic attenuation (CT(L/S)). RESULTS: CT(L), CT(L-S), and CT(L/S) values of donors with hepatosteatosis were significantly higher than the donors without hepatosteatosis. In receiver operating characteristic analysis, the optimal cutoff value of these indices for determining hepatosteatosis were; 42.5, -5, and 0.98, respectively. At these cutoff values, the sensitivity and specificity of these indices were calculated to be 80% and 75%, 93.3% and 83.3%, and 93.3% and 83.3%, respectively. There were no statistical differences between their diagnostic performances. When these 3 indices were used for detect significant hepatosteatosis (>20%) it was observed that hepatosteatosis of only one donor could not be determined whereas it was seen that specificity was decreased markedly. CONCLUSIONS: Despite the high diagnostic yield of unenhanced CT, it is not suitable to use alone for assessment of hepatosteatosis in clinical practice.

Tick-borne encephalitis in Latvia 1973-2009: epidemiology, clinical features and sequelae.

BACKGROUND AND PURPOSE: To report a 37-year observational experience in Latvia relating the incidence of human tick-borne encephalitis (TBE) and its clinical manifestations, to the field abundance of ticks. METHODS: Tick abundance was measured by standard flagging techniques. Incidence of human tick-borne disease was derived from Public Health reporting data. Clinical and follow-up data were determined from hospital cohorts from 1973 to 2009. RESULTS: Two TBE incidence peaks in the mid-1970s and the 1990s correlated with increased field abundance of ticks. Increased human TBE in the 1970s was associated with higher field abundance of both Ixodes ricinis and I. Persulcatus. The 1990s peak was particularly associated with I. ricinus, the species predominating in western/central Latvia, and with other factors, including changed agricultural land usage. Proportions of patients with meningitic or focal forms of TBE were similar in the two outbreaks and the intervening periods. Meningeal irritation occurred in 90%, altered consciousness in 19%, ataxia in 34%, seizures in 9%, bulbar features in 2-3% and limb weakness in 15% with shoulder amyotrophy predominating in 5%. Annual mortality varied from 0 to 1.3% and was not related to the overall incidence of TBE. Follow-up for 1-13 years of a cohort of 100 patients revealed long-term sequelae in over 50%, more commonly in those suffering focal forms of acute TBE. CONCLUSIONS: Clinical features and mortality of the 1970s and 1990s TBE outbreaks were similar and did not point to a change in virulence.