Spontaneous abdominal esophageal perforation in a patient with mitochondrial neurogastrointestinal encephalomyopathy.

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive multisystem disorder caused by thymidine phosphorylase deficiency. Severe denutrition is almost constant during the course of the disease which leads to severe malnutrition and requires long-term parenteral nutrition in most cases. Patients with MNGIE syndrome and chronic intestinal pseudo-obstruction have a particularly poor prognosis and they usually die around 40 years of age. Gastrointestinal perforation associated with MNGIE is extremely rare. Herein we present our unique case with MNGIE associated abdominal esophageal perforation.

Ischaemic Colitis during Haemodialysis.

Ischaemic colitis results from a chronic or acute drop in the blood supply to the bowel and accounts for 6‒18% of the causes of acute lower gastrointestinal bleeding. Diabetes mellitus, hypotension, advanced age, aortic surgery and peripheral vascular disease have also been suggested to be predisposing factors for ischaemic colitis (1). In this report, we present a case of ischaemic colitis in haemodialysis with a good response to conservative treatment.

Helicobacter pylori in allergic inflammation--fact or fiction?

BACKGROUND: Although it has been hypothesized that infections may play a preventive role in allergic diseases, the role of Helicobacter pylori (H. pylori) is not clear. In this study we aimed to determine the association between H. pylori infection and allergic inflammation. METHODS: H. pylori infection was assessed in gastric mucosa tissue by microscopy. Skin prick tests (SPT) were performed with a battery of common inhalant and certain food allergens. Serum samples were tested for total immunoglobulin E (T.IgE). Predictive factors for H. pylori infection and atopy were examined by a questionnaire. RESULTS: A total of 90 subjects suffering dyspeptic symptoms were enrolled into the study. SPT positivity was similar between H. pylori (+) and H. pylori (-) subjects. Among the possible factors examined: age; gender; educational status; pet at home; BMI, family size; number of children and siblings; monthly income; drinking water source; smoking; and serum T.IgE levels were not related with H. pylori infection. However, perennial allergic symptoms were significantly higher in the H. pylori (-) group, seasonal allergic symptoms were related with an increased risk for H. pylori infection. CONCLUSIONS: In this sample group from a developing country H. pylori infection was not shown to be associated with atopic diseases. Therefore, the eradication of H. pylori may not be assumed to have an effect on allergic inflammation.

Helicobacter pylori in allergic inflammation ­ Fact or fiction?

Background: Although it has been hypothised that infections may play a preventive role in allergic diseases, the role of Helicobacter pylori (H. pylori) is not clear. In this study we aimed to determine the association between H. pylori infection and allergic inflammation. Methods: H. pylori infection was assessed in gastric mucosa tissue by microscopy. Skin prick tests (SPT) were performed with a battery of common inhalant and certain food allergens. Serum samples were tested for total immunglobulin E (T.IgE). Predictive factors for H. pylori infection and atopy were examined by a questionnaire. Results: A total of 90 subjects suffering dyspeptic symptoms were enrolled into the study. SPT positivity was similar between H. pylori (+) and H. pylori (­) subjects. Among the possible factors examined: age; gender; educational status; pet at home; BMI, family size; number of children and siblings; monthly income; drinking water source; smoking; and serum T.IgE levels were not related with H. pylori infection. However, perennial allergic symptoms were significantly higher in the H. pylori (­) group, seasonal allergic symptoms were related with an increased risk for H. pylori infection. Conclusions: In this sample group from a developing country H. pylori infection was not shown to be associated with atopic diseases. Therefore, the eradication of H. pylori may not be assumed to have an effect on allergic inflammation

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Effects of vitamin E treatment on peroxisome proliferator-activated receptor-alpha expression and insulin resistance in patients with non-alcoholic steatohepatitis: results of a pilot study.

BACKGROUND: Insulin resistance (IR) is commonly associated with non-alcoholic steatohepatitis (NASH). Peroxisome proliferator-activated receptor-alpha (PPAR-alpha) may also play a role in the pathogenesis of NASH. A pivotal role in NASH pathogenesis depends on the hypothesis of increased oxidative stress. The aim of our study was to evaluate the effects of supplemental oral vitamin E, a potent antioxidant, on liver functions, PPAR-alpha expression and IR in patients with NASH. METHODS: Nine patients with biopsy-proven NASH were given oral vitamin E 800 mg daily for 24 weeks. Liver functions, lipid parameters, IR index with homeostatic metabolic assessment and liver histology and PPAR-alpha staining index in biopsy specimens were detected before and after the treatment. RESULTS: Seven patients (78%) had IR initially. After 6 months of therapy in nine patients, fasting insulin improved (P = 0.01), but serum cholesterol, triglyceride, fasting blood glucose levels and body mass index remained unchanged. Aspartate aminotransferase and alanine aminotransferase levels decreased (P = 0.01 and P = 0.01, respectively). IR index with homeostatic metabolic assessment resistance improved (P = 0.01), but PPAR-alpha staining index did not change (P = 0.37). Although the histological grade of steatosis decreased (P = 0.01), necroinflammation and fibrosis remained unchanged. In seven patients with IR, however, necroinflammation and PPAR-alpha staining index were improved (P = 0.04 and P = 0.02). CONCLUSION: Vitamin E treatment, in addition to its previously shown beneficial effect by suppressing oxidative stress, may also achieve improvement by reducing IR and PPAR-alpha expression in NASH.

Frequencies of serum antibodies to Helicobacter pylori CagA and VacA in a Turkish population with various gastroduodenal diseases.

Infection with Helicobacter pylori (H. pylori) strains secreting cytotoxin-associated gene A (CagA) and vacuolating cytotoxin A (VacA) proteins is associated with more severe gastroduodenal pathologies. However, this association varies among geographical regions and ethnic groups. We investigated the frequencies of antibodies to CagA and VacA proteins in 131 H. pylori-infected dyspeptic patients [40 duodenal ulcer (DU), 19 gastric ulcer (GU), 28 gastric cancer (GC), and 44 non-ulcer dyspepsia (NUD)] across 30 H. pylori-infected and endoscopically normal asymptomatic subjects (AS). Anti-CagA and anti-VacA antibodies were detected by Western blotting. The positivity rates of anti-CagA and anti-VacA antibodies were higher in patients with DU (92.5 and 75%), GU (89.5 and 84.2%) and GC (96.4 and 85.7%) than patients with NUD (70.5 and 50%) and AS (50 and 23.3%) (p < 0.05). CagA+ VacA+ phenotype was more frequent in patients with DU, GU and GC than patients with NUD and AS (75, 84.2, 85.7 vs. 47.7 and 20%, respectively) (p < 0.01). Our results showed that there is a significantly positive association between the presence of anti-CagA and anti-VacA antibodies and DU, GU and GC in our region.

Irritable bowel syndrome in young and elderly patients with stable asthma.

BACKGROUND: It has been speculated that asthma and irritable bowel syndrome may share common pathophysiological processes. AIM: To estimate the prevalence of irritable bowel syndrome in young and elderly patients with stable asthma. PATIENTS AND METHODS: Sixty-five young (age < 60 years) and 66 elderly (age > or = 60 years) stable asthmatics, and 119 age-matched healthy volunteers were enrolled. In all participants, presence of irritable bowel syndrome, quality of life and psychological status were evaluated. RESULTS: The prevalence of irritable bowel syndrome in asthmatic group was higher than that in the control group (27.5% versus 16.8%; odds ratio, 1.8 [1.0-3.4]; p=0.04). The prevalence of irritable bowel syndrome was significantly higher in young asthmatics than in age-matched healthy controls (36.9% versus 20.3%; odds ratio, 2.2 [1.0-5.1]; p=0.04) and than in elderly asthmatics (36.9% versus 18.2%; odds ratio, 0.3 [0.1-0.8]; p=0.01). Logistic regression analysis identified the younger age (odds ratio, 2.1 [1.1-3.8]; p=0.01), and the presence of asthma (odds ratio, 1.9 [1.0-3.5]; p=0.03) as independent risk factors for irritable bowel syndrome in all participants after adjusting for gender. We also found impaired quality of life to be associated with the presence of irritable bowel syndrome and asthma in all participants after adjusting for age and gender. CONCLUSION: The prevalence of irritable bowel syndrome appears to be significantly higher in young asthmatics, but not in elderly asthmatics, compared to age-matched healthy counterparts. Potential pathogenic mechanisms of higher irritable bowel syndrome prevalence in young asthmatics need to be explained by further studies.