Volume 81 - 2018 - Fasc.2 - Original articles
Frequency of food hypersensitivity in patients with Functional Gastrointestinal Disorders
Background and study aims : Food hypersensitivity (FH), irritable bowel syndrome (IBS) and functional dyspepsia (FD) have many overlapping symptoms, including abdominal discomfort, bloating, and altered bowel habits. We aimed to determine the frequency of FH in patients with IBS and functional FD.
Patients and Methods : Adult patients of either gender diagnosed with IBS and/or FD as per the Rome ? criteria were recruited. Patients underwent serological testing against 6 food allergens: beef, shrimp, egg white, milk, peanut, and soy-bean. Those testing positive were subjected to a food elimination diet for 4 weeks. Those showing improvement on elimination diet were subjected to re-challenge. Changes in symptoms were documented by the Global overall improvement scale (GOS) and Gastrointestinal symptom rating scale (GSRS).
Results : Two hundred patients were screened. Average age of the patients was 38.6, and 55 % were male. Nineteen (38%) patients tested positive, and were subjected to a food elimination diet. The most common food hypersensitivity was shrimp (17/89%), followed by 4/21% for egg-white, and peanut. Off these, 8 showed improvement. They were re-challenged, and were evaluated 2 weeks later, when all suffered symptom relapse. These 8 (4%) patients were diagnosed with FH. There was a statistically significant difference in both GSRS (total and component) and GOS scores at baseline between patients testing (+) and (-) on food allergen testing, mainly for diarrhoea (p=0.001), abdominal pain (p=0.001) and indigestion p=<0.001)
Conclusions : FH is present in 4 % of patients with a functional gastrointestinal disorder. (Acta gastroenterol. belg., 2018, 81, 253- 256).
Can we better protect patients with inflammatory bowel disease against infections - patient attitude and personal immunization knowledge
Background and Study Aims : Inflammatory bowel disease (IBD) predisposes patients to a severe course of infections yet adherence to vaccination guidelines is low. Little is known about IBD patient attitude towards immunizations. We aimed to investigate patient attitude towards vaccinations and its influence on personal immunization coverage.
Patients and Methods : A self-completed survey was completed by 195 IBD patients. The author-designed questionnaire comprised: demographic data, IBD medical history, vaccination history, reasons of influenza vaccine refusal, and the most reliable source of information about immunizations. Moreover, patients were asked if they agree with the statement that immunizations are beneficial for a person with IBD.
Results : 99 patients (50%) claimed that prevention of infectious diseases is beneficial for a person with IBD but this opinion had no influence on recommended vaccination uptake. There was suboptimal vaccination coverage : hepatitis B (55%); diphteria, pertussis, tetanus (12%); hepatitis A (7%); annual influenza (6%); varicella-zoster (3%), and pneumococcal vaccine (2%). Top reasons for nonvaccination were: lack of information from a physician (47,5%), unawareness (35%), perceived lack of benefit (33%) and concerns about adverse events (26%). The most reliable source of information concerning immunizations was a gastroenterologist for the majority of IBD patients (58%) while more than 35% chose their general practitioner.
Conclusions : Active promotion and information regarding beneficial role of immunizations among IBD patients and other chronically ill individuals significantly improves the quality of care. It is important to explain misconceptions about vaccines by the most reliable sources. We propose implementing an uniformed "immunization chart" for every chronically ill individual. (Acta gastroenterol. belg., 2018, 81, 257-261).
Evaluation of the cost and length of hospital stays related to the management of an intestinal Clostridium difficile infection
Introduction : Intestinal Clostridium difficile Infection (CDI) treated in hospitals may concern patients whose reason for admission is CDI (primary diagnosis) or who have acquired CDI during their stay (secondary diagnosis).
Objectives : The objective of this study is to evaluate the cost for social security and hospitals and the length of hospital stays related to CDIs as the main reason for admission.
Method : This study was carried out in 2012 in 13 Belgian hospitals. Cases were selected by using diagnosis recorded in minimum discharge summaries. Pediatric stays are not part of the inclusion criteria (n= 86).
Results : The average length of stay (standard deviation) was 13.53 days (11.95). The average cost (standard deviation) covered by social security/hospitals was €5,019.51 / €6,286.39 (9,638.42/ 6,368.45). 7% of patients were admitted to the Intensive Care Unit during hospitalization, for an average duration (standard deviation) of 8.18 days (2.93). The mortality rate was 8.1%. 19.8% of patients used vancomycin during the stay, 43% were treated with metronidazole only, 12.8% used vancomycin and metronidazole and 24.4% do not received vancomycin or metronidazole. No patients received fidaxomycin.
Conclusion : This study made it possible to approach the cost of CDI as the main reason for admission. Such data should allow contributing to optimally assess both the pharmacoeconomic impact of the implementation of prevention strategies and also therapeutic management making use of more expensive medicinal products but associated with decreased risk of recurrence. (Acta gastroenterol. belg., 2018, 81, 263-268).
Economic evaluation of S. boulardii CNCM I-745 for prevention of antibiotic- associated diarrhoea in hospitalized patients
Interest in administration of probiotics to prevent antibiotic-associated diarrhoea (AAD) in hospitalized patients is increasing. We determined the cost of antibiotic-associated diarrhoea in hospital settings for non-complicated and Clostridium difficile (C.diff) complicated AAD, and performed a health-economic analysis of AAD prevention with S. boulardii CNCM I-745 (S. boulardii) from data collected in 1 university and 3 regional hospitals in Flanders. Using a decision tree analytic model, costs and effects of S. boulardii for AAD prevention are calculated. Incremental costs due to AAD, including increased length of hospitalization, were calculated using bottom-up and top-down costing approaches from a hospital, healthcare payer (HCP) and societal perspective. Model robustness was tested using sensitivity analyses. Additional costs per hospitalized patient range from € 277.4 (hospital) to € 2,150.3 (societal) for non-complicated and from € 588.8 (hospital) to € 2,239.1 (societal) for C. diff. complicated AAD. Using S. boulardii as AAD prevention results in cost savings between € 50.3 (bottom-up) and € 28.1 (top- down) per patient treated with antibiotics from the HCP perspective; and € 95.2 and € 14.7 per patient from the societal and hospital perspectives. Our analysis shows the potential for using S. boulardii as AAD prophylactic treatment in hospitalized patients. Based on 831,655 hospitalizations with antibiotic administration in 2014 and € 50.3 cost saving per patient on antibiotics, generalized use of S. boulardii could result in total annual savings up to € 41.8 million for the Belgian HCP. (Acta gastroenterol. belg., 2018, 81, 269-276).
The predictive value of colon transit time and anorectal manometry in the approach of faecal continence in children with spina bifida
Purpose : The aim of this study is to analyse colon transit time (CTT) and anorectal manometry (ARM) in children with spina bifida (SB) as a predictor for achieving spontaneous faecal continence.
Methods : SB patients (2.5-7 years old) followed at the SB Reference Centre Ghent University Hospital underwent CTT and/or ARM before starting bowel management. A standardized questionnaire about the presence of constipation and faecal incontinence was completed. CTT was measured using a 6-day pellet abdominal X-ray method. ARM was performed in non- sedated children using a latex-free catheter.
Results : Twenty-two patients were studied, with a median age of 4.57 years. They all underwent a CTT study, 17 (77%) also agreed to ARM. 10/22 patients (45.5%) were constipated. 5/22 patients (22.7%) became spontaneously continent, 10/22 (45.5%) became pseudo- continent with bowel management, the others remained incontinent. SB patients had a significant prolonged CTT compared to healthy controls. In the group with an abnormal CTT study (12 patients), none of the patients developed faecal continence spontaneously, irrespective of the ARM result. In case of a normal CTT study (10 patients), 7 agreed to ARM. All children with normal resting pressure (4 patients) gained continence spontaneously. The 3 children with abnormal low resting pressure remained incontinent.
Conclusions : This prospective study confirms the predictive value of normal CTT and normal resting pressure, in the evolution towards spontaneous faecal continence. If CTT is abnormal, irrespective of the ARM, bowel management will be necessary to obtain pseudo-continence. In these cases, ARM is not a designated examination. (Acta gastroenterol. belg., 2018, 81, 277-282).
Endoscopic treatment of biliary complications after living donor liver transplantation in a high volume transplant center in Turkey; a single-center experience
Background and aim : Biliary complications are an important cause of mortality and morbidity after living donor liver transplantation (LDLT). We present our endoscopic treatment results after LDLT as a single center with high volume.
Methods : Patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) after LDLT between 2005 and 2015 were included. Clinical data included patient demographics, ERCP indications (stricture or leak), and treatment outcomes, including need for percutaneous and surgical interventions.
Results : ERCP was performed in 446 (39.2%) patients with duct-to-duct anastomosis of 1136 LDLT patients. The most common biliary complication was stricture ± stone (70.6%, 315/446). Stricture and leak occurred in 60 (13.4%) patients. Only biliary leak was found in 40 (8.9%) patients. Our endoscopic treatment success rate in patients with biliary stricture after LDLT was 65.1%. Overall endoscopic success rates in our patients were 55.0% in patients with both leak and stricture, and only leak. In all, our percutaneous transhepatic biliary interventions (PTBI) and ERCP success rate was 90.6% in patients with biliary complications after LDLT.
Conclusions : Endoscopic treatments are highly effective for biliary complications after LDLT. Effective use of percutaneous interventions in collaboration with endoscopic treatments significantly reduces the need for surgical treatment. (Acta gastroenterol. belg., 2018, 81, 283-287).
Bioinformatic analysis of differentially expressed genes involved in the hepatitis B virus-associated acute liver failure
Background : The rarity of acute liver failure, along with its severity and heterogeneity, has resulted in a very limited evidence to understand of the molecular mechanism. To analyze the differentially expressed genes (DEGs) in the Hepatitis B Virus -Associated Acute Liver Failure and elucidate the biological significance of the DEGs.
Methods : Firstly, differentially expressed genes (DEGs) between seventeen HBV-associated acute liver failure liver samples and ten control normal liver samples were identified by R package. Then, the enriched GO terms and KEGG pathways of those DEGs were obtained using the Database for Annotation, Visualization and Integrated Discovery (DAVID). Finally, protein-protein interactions (PPI) network of those DEGs were constructed using STRING database and visualized by Cytoscape software.
Results : A total of 328 DEGs were identified in Hepatitis B Virus-Associated Acute Liver Failure group compared with the control group. Several novel biomarkers that might play important roles in HBV-associated acute liver failure were identified through the analysis of gene microarray in GEO. Furthermore, DEGs with high connectivity degrees, such as KNG1, PLG, F2 and pathways such as complement and coagulation cascades were noticed.
Conclusion : DEGs with high connectivity degrees, such as KNG1, PLG and their relative pathway complement and coagu- lation cascades may be important for further understanding of the molecular mechanism of HBV-associated acute liver failure. (Acta gastroenterol. belg., 2018, 81, 288-294).