Volume 83 - 2020 - Fasc.3 - Original articles
Long-term outcome after endoscopic ligation of acute esophageal variceal bleeding in patients with liver cirrhosis
Endoscopic variceal ligation (EVL) has been the standard treatment for acute variceal bleeding (AVB). However, reports of long-term prognosis after EVL are scarce. Therefore, the current work aimed to investigate the long-term outcome and prognostic modifiers of cirrhotic cases presented with acute esophageal variceal bleeding and managed with EVL.
The current prospective work comprised primarily 276 consecutive grown-up cirrhotic cases presenting with AVB and managed with EVL. Two-hundred patients who completed the study till death or 3-year follow-up were enrolled in final analysis. The primary outcome measure was occurrence of rebleeding and all-cause mortality.
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.
The association between cagL and cagA, vacAs-m, babA genes in patients with gastric cancer, duodenal ulcer, and non-ulcer dyspepsia related to Helicobacter pylori
Introduction : As a component of the cag T4SS, the cagL gene is involved in the translocation of CagA into host cells and is essential for the formation of cag PAI-associated pili between H. pylori and gastric epithelial cells.
Aim : We aimed to investigate the clinical association of the cagL gene with other virulence factors (VacA, CagA, EPIYA-C, and BabA protein) of H. pylori strains isolated from GC, duodenal ulcer (DU), and non-ulcer dyspepsia (NUD) cases.
Methods : The patient group (PG), including 47 patients (22 GC and 25 DU) and a 25 control group (CG= NUD) were included. Amplification of the H. pylori cagL, cagA, vacA, and babA2 genes and typing of EPIYA motifs were performed by PCR methods.
Results : Sixty-one (84.7%) H. pylori strains were detected with cagL (93.6% in SG, 68% in CG). We detected a significant difference between SG and CG for the presence of cagL (p=0.012) but no statistical comparison was done for (≥2) EPIYA-C repeats In the comparison of H. pylori strains with cagA/vacAs1m1 and cagA/ vacAs1m2 and babA2 for the presence of cagL, we could not detect a significant difference (p=1).
Not all pediatric intestinal polyps are alike
Background/Aims : In childhood, clinical presentation of intes- tinal polyps is variable. Painless rectal red blood loss is the most common presenting sign. Most polyps are sporadic, isolated and benign. However, it is important to correctly identify exceptions. Rare inherited polyposis syndromes need to be recognized because of their increased risk of intestinal and extra-intestinal malignancies. Furthermore, a correct diagnosis and treatment of rare gastro-intestinal malignancies is crucial.
Methods : Between 2016 and 2018 we encountered 4 different types of intestinal polyps. A database search was performed and patient files were checked for clinical manifestations and histo- pathology. Literature was searched to recapitulate red flags for these syndromes, probability of underlying genetic disorders and diagnostic criteria.
Results : Between 2016 and 2018, 28 patients presented at the Ghent University Hospital with 30 juvenile polyps. Furthermore, we diagnosed juvenile polyposis syndrome, Li Fraumeni syndrome and familial adenomatous polyposis (FAP) in 1 patient each, whilst 2 FAP patients were in follow-up. Each of these diagnoses has a different lifetime risk of (extra)-intestinal malignancy and requires a different approach and follow-up. Histopathology and genetic testing play an important role in identifying these syndromes in pediatric patients.
Conclusion : Although most intestinal polyps in childhood are benign juvenile polyps that require no follow-up, rare inherited syndromes should be considered and correctly diagnosed since adequate follow-up is necessary to reduce morbidity and mortality from both gastrointestinal and extraintestinal complications and malignancies. (Acta gastroenterol. belg., 2020, 83, 393-397).
Surveillance recommendations for patients with Lynch syndrome and FAP : a monocentric study
Background and study aims : The most important causes of hereditary colorectal cancer are Lynch syndrome (LS) and the adenomatous polyposis syndromes (familial adenomatous poly- posis syndrome or FAP, attenuated FAP or AFAP and MUTYH associated polyposis syndrome or MAP). The aim of this study was to investigate whether all patients with a hereditary syndrome within one center receive uniform advice regarding surveillance and treatment.
Patients and methods : A retrospective analysis was performed of all electronic patient health records of patients with LS, FAP, AFAP and MAP who received genetic counselling or were followed by a health care specialist at the University Hospital in Ghent.
Results : Data from 122 patients were collected. For all patients, recommendations from the medical genetics department were highly consistent. Adherence to their recommendations was good within the center for the management of colon polyps. There was a lack of consistency in the screening and surveillance advice for other tumors in departments other than gastroenterology. Only 33 patients had systematic follow-up consultations to check results and organize surveillance.
Conclusion : Previously, small studies have suggested that patients with hereditary gastrointestinal cancer syndromes infrequently have surveillance as specified in the guidelines. This study shows almost uniform recommendations and good adherence for surveillance of the colon, but incomplete or contradictory advice for surveillance of other organs. The need for an integrated approach from a multidisciplinary team will only increase in the future, because more families with hereditary cancer are likely to be found due to the increased use of next generation sequencing in cancer diagnostics. (Acta gastroenterol. belg., 2020, 83, 399-405).
The easy way of evaluating exocrine pancreatic insufficiency in type 2 diabetes : listen to the patients’ complaints and look in their eyes!
Background and Study Aims : The objective of this study is to determine the prevalence of exocrine pancreatic insufficiency (EPI) in diabetic patients, and to investigate whether there is a relationship between EPI and diabetes period, gastrointestinal complaints and other diabetic microvascular complications.
Patients and Methods : A total of 93 participants, consisting of 57 type 2 diabetes patients and 36 healthy volunteers have been included in our cross-sectional study. Participants were questioned for abdominal complaints and weight loss. Fecal elastase-1 (FE-1) was determined in fecal spot samples received from participants. The relationship between EPI and blood glucose, HbA1c, and duration and complications of diabetes were investigated.
Results : FE-1 levels were significantly lower in diabetic group compared to control group (p=0.007). The number of patients with FE-1 levels of <200μg/g were significantly higher in diabetic group (p=0.002). A statistically significant negative correlation was determined between FE-1 levels and the duration of diabetes (r= -0.453 p<0.001). FE-1 levels were significantly lower in patients with retinopathy (p= 0.014). In the post-hoc analysis, this difference was due to patients in the proliferative retinopathy group. A significant negative correlation was determined between the presence of retinopathy and FE-1 levels (r=-0.32, p=0.02). Abdominal pain and distension complaints were independent predictive factors that estimate EPI.
Conclusions : An important part of type 2 diabetes patients has EPI and it should be considered in diabetes patients upon abdominal pain and distension. Determination of proliferative retinopathy in the eye examination may also suggest an idea on the possible presence of EPI. (Acta gastroenterol. belg., 2020, 83, 407- 412).
Evaluation of the clinical course and prognostic indices of acute pancreatitis in elderly patients : a prospective study
Background and aim : Acute pancreatitis (AP) is a life- threatening condition across all age groups. In this study, it was aimed to investigate the severity of the disease and associated mortality in the geriatric population.
Methodology : This single-center, prospective study elderly (≥65 years of age) and younger (18-65 years of age) total 147 patients with AP are enrolled To diagnose and asses the severity of AP Atlanta classification was used. Baseline and 12-months follow-up data included Ranson, Imrie, BISAP, APACHE-II, SOFA, Modified Marshall, Balthazar, and Computed Tomography Severity Index (CTSI) as prognostic tools.
Results : 6 (15%) patiens in elderly and 5 (6,7%) patients in non elderly group had modarete-severe AP . Patients were followed up 1 year and during this time no systemic complications were seen , 8 (20%) patients in elderly group and 10 (13,6%) patients in younger group had local complications. 1 patients in elderly and 2 patients in non elderly group had acute necrotic collection whereas 1 patient developed walled of necrosis in non elderly group. The elderly patients with any of the following index characteristics would not be expected to have a mild disease course: Imrie score ≥ 3, BISAP score ≥ 3, APACHE-II ≥ 11, CRP ≥ 195 mg/dl
Conclusions : AP caused a prolonged hospitalization in the elderly compared to younger patients but its severity and clinical outcomes were not different in the two groups. (Acta gastroenterol. belg., 2020, 83, 413-417).
Evaluation of the diagnostic validity of noninvasive tests for predicting liver fibrosis stage in chronic hepatitis B patients
Background and study aim : The aim of this study was to evaluate the effectiveness of noninvasive tests in predicting liver fibrosis levels in chronic hepatitis B (CHB) patients.
Patients and methods : A total of 539 treatment naive patients aged 18 years and older with CHB who underwent liver biopsy were included. Patients with coinfections and comorbidities were excluded. Data were obtained retrospectively from patient’ follow- up files. Liver biopsy was evaluated according to the Ishak scoring system. SPSS 22.0 program was used for statistical analysis. Diagnostic sensitivity of APRI, FIB-4, NLR, GPR, AAR, RPR, API, King’s score, Fibro Q and MPV was determined for predicting ≥F2, ≥F3, ≥F4, ≥F5 groups.
Results : The median age of the CHB patients was 41 ±11.57 / year and 49.2% of the patients were female. The distribution of fibrosis stages was : F0, 16.5% ; F1, 26.4% ; F2, 39.7% ; F3, 10.4% ; F4, 4.1% ; F5, 2.4% ; F6 0.4%. Age, AST, ALT, GGT, ALP, RDW, HBV DNA levels were significantly higher, platelet and albumin levels were significantly lower in the ≥F3 group. All noninvasive tests except NLR and AAR predicted ≥F3 adequately (AUROC >0.5). King’s score for predicting ≥F2, ≥F5, and GPR for predicting ≥F3 had the highest diagnostic power. The tests predicted the fibrosis stage better, as the fibrosis stage progressed.
Conclusion : As a result; most of the noninvasive tests we evaluated could predict significant fibrosis and cirrhosis with significant accuracy. The rate of unnecessary biopsies can be reduced with the help of these noninvasive tests. (Acta gastroenterol. belg., 2020, 83, 419-425).
Hepatitis B Reactivation in HBsAg-negative Anti-HBc-positive patients receiving cytotoxic chemotherapy for solid tumors
Purpose : The prevalence of hepatitis B virus (HBV) reacti- vation in HBsAg-negative/anti-HBc-positive patients receiving chemotherapy for solid tumors is not fully known. The aim of this study was to investigate the incidence and outcomes of HBV reactivation in these patients.
Methods : Data among 645 HBsAg-negative/ anti-HBc-posi- tive patients who underwent intravenous chemotherapy were retrospectively analyzed. Patients were categorized into two groups, based on received antiviral prophylaxis (n = 43) or not (n = 602). HBV reactivation was defined as the presence of detectable serum HBV DNA or HBsAg seroconversion from negative to positive, with or without increased liver enzymes.
Results : HBV reactivation was detected in 3 patients (0.49%) among non-antiviral prophylaxis group and in none of those with antiviral prophylaxis. Two of the HBV reactivation detected patients were successfully treated with rescue therapy, while the third died due to liver failure.
Conclusions : HBV reactivation is rare in HBsAg-negative and anti-HBc-positive patients receiving chemotherapy for solid tumors. However, considering the fatal outcomes patients must be closely monitored in terms of HBV-DNA positivity and/or HBsAg seroreversion and pre-emptive antiviral therapy must be initiated as soon as HBV reactivation occurs. (Acta gastroenterol. belg., 2020, 83, 426-431).