Volume 83 - 2020 - Fasc.2 - Original articles
Logistic regression analysis of risk factors for upper gastrointestinal bleeding induced by PCI in combination with double antiplatelet therapy for STEMI patients
Objective : To analyze the risk factors for upper gastrointestinal bleeding (UGIB) in patients with ST-segment elevation myocardial infarction (STEMI) during double antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI).
Methods : A total of 388 patients treated from January 2015 to September 2017 due to STEMI were selected. Thirty-two cases of UGIB occurring during DAPT after PCI were included as a UGIB group, and another 356 cases without UGIB were set as a control group. Age, gender, body mass index, smoking, drinking, history of previous diseases (hypertension, diabetes and digestive tract diseases), infection of Helicobacter pylori (Hp), combined use of other drugs (statins, NSAIDs, β receptor blockers, PPI, H2RA and dabigatran etexilate), as well as serum levels of creatinine (Cr), alanine transaminase (ALT) and C-reactive protein (CRP) were compared. The risk factors for UGIB were subjected to univariate and logistic regression analyses.
Relation of cyclooxygenase-2 expression with premalignant gastric lesions
Introduction : We studied the relation between premalignant gastric lesions and cyclooxygenase-2 (COX-2) expression.
Methods : The study included 254 patients, who were histo- logically diagnosed with chronic active gastritis, atrophy, dys- plasia and metaplasia. Gastric biopsy specimens of the patients were histopathologically examined in terms of the presence of Helicobacter pylori (H. pylori) infection, atrophy The Operative Link for Gastritis Assessment ; (OLGA staging system), dysplasia (Vienna classification), and metaplasia (Sydney classification). COX-2 expression was investigated by immunohistochemical staining. COX-2 immunoreactivity score was calculated as the product of staining intensity and staining area. A score of >1 was defined as COX-2-positive expression.
Prognostic value and association of systemic inflammation for patients with stage IV gastric cancer
Objective : The present study is aimed at investigating the prognostic value and association of systemic inflammation (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and lymphocyte-to-monocytes ratio) for patients with stage IV gastric cancer.
Methods : In this retrospective study, patients with stage IV gastric cancer between January 2008 and December 2017 were included. A summary was performed on clinicopathological characteristics and a multivariate cox regression analysis was performed to identify the prognostic factors.
Results : 304 patients with stage IV gastric cancer were included in the study. On multivariate analysis, the systemic chemotherapy (p < .001), the jaundice (p = .004), the high neutrophil-to-lym- phocyte ratio (p = .005) and the high platelet-to-lymphocyte ratio (p = .041) were independent prognostic factors for patients with stage IV gastric cancer.
Conclusion : As systemic inflammation response markers, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are significantly associated with OS for stage IV gastric cancer patients. Systemic chemotherapy shows a clear overall survival benefit in patients with stage IV gastric cancer and Jaundice indicates poor overall survival. (Acta gastroenterol. belg., 2020, 83, 255-263).
The diagnostic yield of urgent colonoscopy in acute lower gastrointestinal bleeding
Background and aims : Lower Gastrointestinal Bleeding (LGIB) is one of the leading causes of ER visits. Colonoscopy is indicated in all patients with LGIB, yet the time frame for performing colonoscopy remains unclear. Whether or not urgent endoscopic evaluation improves outcomes of LGIB has been questioned. We therefore aimed to examine the success of urgent colonoscopy in identifying the source of LGIB.
Patients and methods : A retrospective study was conducted in which timing of colonoscopy was divided into urgent (performed within the first 24 hours of presentation) and delayed (performed following 24 hours of hospitalization). Data on clinical presentation, investigations and endoscopic findings was collected. Risk ratios were calculated and regression analysis was used to examine associations and identify predictors of endoscopic success.
Result : A total of 183 patients underwent colonoscopies. 55.4% of colonoscopies were performed within 24 hours of presentation. A source of LGIB was identified in 55.7% of first attempt colonoscopies. Endoscopic intervention was required in 10.9% of cases and rebleeding occurred in 24.6%, of which 6.5% required hospital re-admission. 2.7% required emergency colectomy and the calculated mortality rate was 1%. Risk ratios comparing urgent to delayed colonoscopy for source of LGIB identification, colectomy and mortality were 1.01, 4.8 and 1.2, respectively. Age and timing of colonoscopy appeared to be predictive of colectomy on regression analysis.
Conclusions : Urgent colonoscopy for LGIB did not improve the rate of identification of the source of bleeding, colectomy rate or mortality rate and was predictive of the need for emergency colectomy. (Acta gastroenterol. belg., 2020, 83, 265-270).
A 3’-untranslated region variant (rs2289046) of insulin receptor substrate 2 gene is associated with susceptibility to nonalcoholic fatty liver disease
Purpose: Nonalcoholic fatty liver disease (NAFLD) is an increasing global health concern defined by excessive hepatic fat content in the absence of excessive alcohol consumption. Regarding the key role of insulin and insulin resistance in NAFLD, we investigated whether insulin receptor substrate 1 (IRS1) and insulin receptor substrate 2 (IRS2) gene variants were associated with NAFLD risk.
Methods : In this case-control study, 305 subjects including 151 cases with biopsy-proven NAFLD and 154 controls were enrolled. All the subjects were genotyped for IRS1 (rs1801278) and IRS2 (rs2289046) gene variants using PCR-RFLP method.
Results: Our findings showed that the IRS2 rs2289046 “GG+AG” genotype compared with “AA” genotype to be a marker of decreased NAFLD susceptibility and the difference remained significant even after adjustment for confounding factors including age, BMI, sex, smoking status, systolic blood pressure, and diastolic blood pressure (P=0.014; OR=0.50, 95%CI= 0.29-0.87). Furthermore, the IRS2 “G” allele was significantly underrepresented in the cases with NAFLD than controls (P=0.026 ; OR=0.62, 95%CI=0.41-0.94). However, no significant difference was found for IRS1 rs1801278 gene variant.
Conclusions : This study suggests, for the first time, that the IRS2 gene rs2289046 variant may play a role in NAFLD susceptibility. Nevertheless, this observation warrants further investigations in other populations. (Acta gastroenterol. belg., 2020, 83, 271-276).
Diagnostic utility of oxidative and non-oxidative markers for spontaneous bacterial peritonitis in non-malign ascites
Objective : In this study, we aimed to investigate the diagnostic availability of oxidant and antioxidant parameters in ascites for spontaneous bacterial peritonitis (SBP).
Material and methods : This study was carried out between July and October 2018 with 25 patients with SBP and 24 patients without SBP. Patients with acute infection, those taking vitamin supplements and antioxidant medication, smoking and drinking alcohol, and patients without ascites culture were excluded from the study.
Results : In patients with SBP compared those without SBP median paraoxonase (3.1 vs 15.6 ; p <0.001), median stimulated paraoxonase (12.6 vs 53.1 ; p <0.001), median arylesterase (769,9 vs 857,5 ; p = 0,003) and median catalase (10 vs 22,2 ; p = 0,003) were found to be lower and median myeloperoxidase (8.1 vs 1.1 ; p <0.001) were found to be higher. There was a positive correlation between paraoxonase levels and stimulated paraoxonase levels, arylesterase levels and catalase levels, there was a negative correlation between paraoxonase levels and myeloperoxidase levels. Paraoxonase levels 3.7 and lower, stimulated paraoxonase levels 25.8 and lower, arylesterase levels 853.4 and lower, catalase levels 11.8 and lower and myeloperoxidase levels 2.7 and more predicted the the presence of SBP with high specificity and high sensitivity. Paraoxonase and stimulated paraoxo-nase levels were found to have superior performance in predicting the presence of SBP compared to arylesterase levels (p <0.05).
Conclusion : In this study it was shown that paraoxonase, stimulated paraoxonase, arylesterase, catalase and myeloperoxidase activities can be used for the diagnosis and severity of SBP. (Acta gastroenterol. belg., 2020, 83, 279-284).
Benefits of abdominal paracentesis drainage performed ahead of percutaneous catheter drainage as a modification of the step-up approach in acute pancreatitis with fluid collections
Aim : The aim of the study is to evaluate the role of abdominal paracentesis drainage (APD) ahead of percutaneous catheter drainage (PCD), as a modification of the step-up approach, when treating acute pancreatitis (AP) with peritoneal ascitic fluid (PAF).
Patients and methods : This is a prospective cohort study including 118 participants with AP in which the indicative factors for upgrading from APD to PCD were investigated in patients with PAF. Ninety six patients with a sufficient volume of PAF initially underwent ultrasound-guided APD and were separated into two groups : group A (the patients who did not undergo PCD after APD) and B (the patients who underwent PCD after APD). Participants with AP who underwent PCD but lacked enough PAF for APD before PCD were followed up in a separate group (group C). Primary outcome was conversion rate to more aggressive procedure (percutaneous treatment modalities to surgery or death).
Results : Of the 96 patients who underwent APD, 42 were managed with APD alone and 54 received PCD after APD (14 required necrosectomy after initial PCD). APD led to a large decrease in levels of the initial severity scores and laboratory variables in both groups of patients with PAF. The reduction in levels of all evaluated predictive severity scores and laboratory variables was similar (P>0.05) after APD.
Conclusion : Application of APD ahead of PCD is safe and beneficial in the management of AP with abdominal or pelvic fluid collections. There are no relevant predictors that suggest whether APD is indicated or not. (Acta gastroenterol. belg., 2020, 83, 285- 293).
Serum level of CCL2 predicts outcome of patients with pancreatic cancer
Background : Pancreatic cancer is one of the most deadly cancers worldwide with a five-year survival rate of less than 5%. Chronic pancreatitis showed increased risk to develop pancreatic cancer, in which chronic inflammation of the pancreas may play a critical role. Cytokines play an indispensable role in inflammatory reaction and tumorigenesis. The purpose of this study was to determine whether cytokines were associated with survival and poor prognosis of pancreatic cancer.
Methods : In this study, we examined levels of some important cytokines in the serum of 68 patients with pancreatic cancer, including CCL2, CCL17, CXCL-1, CXCL-5, G-CSF, GM-CSF, TGF-β and IFN-γ.
Results : We found that high level of serum CCL2 was strongly associated with poor survival and prognosis, but no significant association with other clinicopathological features, including gender, age, location and TNM staging. For other cytokines, no significant correlation with poor survival and prognosis was found.
Conclusion : Our results suggest that serum level of CCL2 may serve as a potential marker for predicting the outcome of patients with pancreatic cancer. (Acta gastroenterol. belg., 2020, 83, 295-299).