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Volume 74 - 2011 - Fasc.2 - Original articles

Hepatitis C of Genotype 2 : The Role of Medical Invasive Exams

Background and Aim : Hepatitis C virus genotype 2 is the third in order of frequency in Belgium. The aim of this study was to better define the genotype 2 carriers' epidemiology characteristics. Methods : In a database comprising 1726 viremic hepatitis C virus patient from the south part of Belgium, the files of 98 genotype 2 carriers were reviewed. Results : There was a strong association between genotype 2 and the mode of transmission. The rate of contamination by invasive medical exams was very high (23%), and statistically different from the one of the others genotypes. Eligibility for antiviral ther- apies and the rate of sustained viral response were high. Conclusion : HCV genotype 2 was highly associated with trans- mission by invasive medical exams. (Acta gastroenterol. belg., 2011, 74, 277-280).


Are n-3 PUFA dietary recommendations met in in-hospital and school catering ?

Background : Literature provides compelling evidence for the health benefits of n-3 polyunsaturated fatty acids (PUFA) consumption and low n-6/n-3 ratiO. in particular, on inflammation and metabolic syndrome prevention and treatment. Consequently, recommendations were established for adequate n-3 PUFA supplies in the general population. The aim of our study was to evaluate the fatty acid (FA) profile in collective catering in relation to those recommendations. Methods : We obtained composition of lunches provided by the Township of Lille (France) to children and adults, and of "standard", "low-fat" and "for diabetic" menus from the catering service of St Luc university hospital (Brussels, Belgium). The average proportions of fish, meat, oils, and dairy were used to esti- mate total, saturated, monounsaturated and polyunsaturated (n-6 and n-3) FA contents. We used official tables of foodstuffs compo- sition provided by the French Agency for Food Safety, the project "Nutritional Composition of Aquatic Products", the French Institute for Nutrition, and the USDA National Nutrient Database for Standard Reference. French guidelines were taken as reference for daily recommended intakes. Results : n-3 PUFA content in lunches provided by municipal catering and in in-hospital menus were slightly below recommend- ed intakes. In the latter, n-3 PUFA enriched margarine contributed for 50% to daily intakes. Despite, the n-6/n-3 ratio was too high, especially in municipal catering (around 20), related to excessive n-6 PUFA supply. Conclusions: Our results highlight that meeting n-3 PUFA nutritional recommendation remains challenging for collective catering. A detailed analysis of provided menus represents a powerful tool to increase awareness and foster improvement in practice. (Acta gastroenterol. belg., 2011, 74, 281-288).


The influence of corticosterone on antizyme gene expression in early regenerating rat liver

Background and study aims : Antizyme 1, a specific inhibitor of Ornithine decarboxylase (ODC), plays a critical role in cell prolif- eration. Little is known about the impact of glucocorticoid on antizyme expression in the regenerating liver. In this paper, the effect of corticosterone on the gene expression of antizyme 1 in early regenerating rat liver induced by partial hepatectomy (PH) was investigated. Materials and methods : Bilateral adrenalectomies (ADX) were performed 3 days before PH. Corticosterone in sesame oil or sesame oil was injected sub-cutaneously to ADX rats. Antizyme 1 mRNA and protein levels as well as polyamine contents in the regenerating liver were determined by RT-PCR, Western blotting and HPLC, respectively. Results : Antizyme 1 protein content in the oil-treated ADX group decreased significantly at 5, 7 and 9 h after PH compared to control. Following corticosterone administration the content rose dose-dependently during the whole experiment. At 5 h post-PH, the protein levels in 10 and 40 mg/kg corticosterone-treated ADX rats increased by 66% and 148%, respectively, when compared with the control group. However, no significant changes in antizyme 1 mRNA levels were observed in oil-treated ADX rats or corticos- terone-treated groups compared to control. Polyamine contents in oil-treated ADX rats were the highest among all groups at 5 and 9 h. Corticosterone treatment resulted in a dramatic decrease of polyamine contents at most of the time points investigated when compared with those in control rats. Conclusions : Corticosterone treatment induces antizyme 1 pro- tein synthesis in early regenerating rat liver. However, it has little effect on antizyme 1 gene transcription. (Acta gastroenterol. belg., 2011, 74, 289-294).


Development and psychometric evaluation of a dutch questionnaire for the assessment of anorectal and lower urinary tract symptoms

Background and study aims : Epidemiological studies have shown a frequent coexistence of symptoms and diseases affecting the anorectum and lower urinary tract. To further investigate com- bined symptoms and pathology of both pelvic viscera we developed a self-reported questionnaire, in Dutch, which extensively evaluates habits, complaints and symptoms of both viscera. We describe the construction and the psychometric properties of this questionnaire. Patients and methods : This prospective study was conducted in 56 patients with anorectal symptoms, 41 patients with lower urinary tract symptoms and in a control group of 91 people. The following psychometric properties of the questionnaire were evaluated : content validity, construct validity, criterion validity, test-retest reliability and internal consistency. Results : The questionnaire covered all important domains, was well interpreted and showed good acceptability (content validity). The questionnaire clearly differentiated the patient populations (construct validity). The criterion validity of the questionnaire was excellent. The test-retest reliability of the questionnaire was accept- able in all three the study populations (overall median kappa : 0.64 ; Inter Quartile Range : 0.56-0.75 ; mean agreement : 88%). The internal consistency of both anorectal and lower urinary tract symptom questions was high (Crohnbach's alpha of 0.78 and 0.80 respectively). Conclusions: This questionnaire is a valid and reliable instrument for the assessment of anorectal and lower urinary tract symptoms. It can provide further insights into the epidemiology of concomitant bowel and bladder disorders and, accordingly, can contribute to a more efficient diagnostic and therapeutic approach in patients with such disorders. (Acta gastroenterol. belg., 2011, 74, 295-303).


The use of colonoscopy to follow the inflammatory time course of TNBS colitis in rats

Background and study aims : Animal models of colitis are widely used to study the pathogenesis of inflammatory bowel diseases (IBD) and irritable bowel syndrome (IBS). However techniques allowing sequential assessment of colonic inflammation over time, without the need to sacrifice the animal, are required. This study evaluated in vivo colonoscopy to follow the evolution of colitis in rats in comparison with the more commonly used post-mortem macroscopic, microscopic and biochemical assays of inflammation. Methods : Colitis was induced in rats by a single intrarectal instillation of trinitrobenzene sulphonic acid (TNBS). Using a baby upper gastrointestinal endoscope, the severity of colitis was moni- tored at days 3, 10, 28 and 56 after the induction of colitis. Inflammation was scored by colonoscopy based on the degree of ulceration, extent of inflammation, mucosal bleeding, oedema and stenosis. During follow-up, rats were randomly selected for post- mortem macroscopic and microscopic histology and myeloperoxi- dase (MPO) assessment of the colon. Results : Colonoscopy showed signs of severe mucosal inflamma- tion in the distal colon 3 days after induction of TNBS colitis. Subsequently, colitis subsided at days 10 and 28 with complete endoscopic remission at day 56. During the acute phase of inflam- mation, endoscopic findings were consistent with the post-mortem inflammatory parameters (macroscopic and microscopic histopathology, MPO colonic activity). A strong correlation between endoscopy and macroscopy remained even during the chronic phase of inflammation. Conclusions : Our findings suggest that routine endoscopy is a reliable method for monitoring the development and follow-up of the degree of TNBS colitis in rats. (Acta gastroenterol. belg., 2011, 74, 304-311).


Buried Bumper Syndrome : Low incidence and safe endoscopic management

Aims : Buried bumper syndrome (BBS) is a rare long-term complication of percutaneous endoscopic gastrostomy (PEG) and consists of a progressive impaction of the inner bumper of the tube in the mucosa of gastric wall. The aim of our study was to report our own experience with BBS, focusing on its incidence and endoscopic management. Patients and methods : Medical records of a large group of 879 patients having undergone PEG insertion (2002-2009) were retrospectively reviewed. All PEG's were followed by our special Nutrition Support Team. Patients presenting with BBS during their follow-up were included in the study. Results: Only eight patients (8/879; 0.9%) developed BBS, which was confirmed during gastroscopy. Median time between PEG insertion and BBS diagnosis was 22.0 ± 22.28 months. Five patients underwent successful treatment with : 1) flexible guide wire insertion through the internal orifice of the PEG to define its anatomical settings, 2) cruciform incisions of the gastric mucosa with a needle-knife starting at the center of the mucosal dome covering the internal bumper, and reaching its edges, 3) extrusion and complete extraction of the inner bumper through the gastric tract. No complications were observed. Median hospital stay related to BBS lasted 4.0 ± 3.67 days. In two patients with peri- stomal abscess and deeply migrated bumper surgery was needed. Conclusions : Cruciform mucosal incisions with needle-knife is a safe endoscopic technique to treat the BBS that could avoid surgery in most of the cases. Preventive measures applied after PEG inser- tion and continued during the follow-up may result in a distinctly lower prevalence of BBS. (Acta gastroenterol. belg., 2011, 74, 312- 316).