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Volume 74 - 2011 - Fasc.1 - Original articles

High prevalence of advanced fibrosis in association with the metabolic syndrome in a Belgian prospective cohort of NAFLD patients with elevated ALT. Results of the Belgian NAFLD registry

Introduction : Non-alcoholic Fatty Liver Disease (NAFLD) is increasingly recognised as a source of liver related morbidity and mortality. Hard data on epidemiology and natural history are scarce. Aim : To study demographic and metabolic characteristics of the NAFLD patients seen by Belgian hepatologists. Methods : Belgian hepatologists filled in a questionnaire for every newly diagnosed NAFLD patient between January 1st and December 31st 2004. Liver biopsy was advised if ALT > 1.5 × ULN and if 3/5 of the criteria for the metabolic syndrome (MS) (ATPI- II) were present, but was not mandatory. Biopsy was scored using the Brunt classification. Results : 230 patients were prospectively included in 9 centres ; 54% were males ; mean age was 49.4 ± 13.9 y ; mean BMI was 30.6 ± 4.6 kg/m2. The MS was present in 53%. In 16% formerly undiag- nosed diabetes was discovered. 51% had a liver biopsy : 25% met the criteria, 26% did not. Grading did not differ between patients with or without MS. Staging was significantly more severe in patients with MS (2.43 ± 1.25 vs. 1.73 ± 1.18, p < 0.001). A sub- group of patients with GGT > 5 × ULN were significantly older (55.9 vs. 47.64 y, p = 0.02), more frequently diabetic (53% vs. 23%, p = 0.01) and had more advanced fibrosis (3.42 vs. 1.08, p = 0.008). ALT levels were variable. Conclusions : The MS is highly prevalent in Belgian NAFLD patients and is associated with more severe disease. Mild to moder- ate fibrosis is frequent, and the proposed criteria for liver biopsy are not accurate in selecting these patients. Patients with elevated GGT constitute a subgroup with more advanced disease. (Acta gastroenterol. belg., 2011, 74, 9-16).


Fate and ultra-structural features of chicken skin mucosa around juvenile polyps

Objective : Chicken skin mucosa (CSM) is a common finding around juvenile polyps in children. Its ultrastructural features and fate after polypectomy are not yet clear. The aim was to study ultra-structural features and outcome of this CSM compared to that of the polyps and distant endoscopically normal mucosa. Material and Methods : From 240 children with juvenile polyps, 45 needed a second colonoscopy. Thirty six patients showing CSM represented the cohort of this study. One polyp only was studied in each patient. The histologic features of the CSM were compared to normal and polyp mucosa. The fate of CSM was evaluated in the second colonoscopy. Results : The mean numbers of intraepithelial lymphocytes, as well as lamina propria inflammatory cellular infiltrates were significantly higher in polyp mucosa than in CSM. Goblet cells were significantly higher in CSM compared to normal mucosa with marked depletion in the polyp mucosa. The muscularis mucosae thickness was significantly higher in CSM compared to polyps (p<0.0001) and both showed higher values than the normal mucosa. The CSM almost disappeared within a month period following polypectomy. Conclusions : The polyp showed the most intense mucosal inflammatory reaction. CSM with the unique thickening of muscu- laris mucosae especially around larger polyps almost disappeared after polypectomy. So these results suggest that CSM is a benign compensatory reaction induced by the mechanical effect of the polyp. (Acta gastroenterol. belg., 2011, 74, 17-21).


Trace element levels in ischemia-reperfusion injury after left colonic anastomosis in rats and effects of papaverine and pentoxiphylline on vascular endothelial growth factor in anastomosis healing

Background and study aims : Due to their high morbidity and mortality, anastomotic leakage and disruption are still serious problems in colonic surgery. Bowel clamps applied during anasto- mosis in order to prevent abdominal contamination with colonic contents, may cause microcirculation and perfusion problems and subsequent ischemia-reperfusion injury. Papaverine, a myorelax- ant and vasodilatator, and pentoxiphylline, a hemorrheologic agent are used for microcirculation disorders and vascular endothelial growth factor (VEGF) is a stimulator of angiogenesis. With this experimental study, we aimed to measure trace element [copper (Cu) and zinc (Zn)] levels in ischemia-reperfusion injury due to clamps after left colonic anastomosis in rats and show the effects of papaverine and pentoxiphylline on VEGF that stimulates angio- genesis in anastomotic healing.


Delayed gastric emptying is related to cardiovascular autonomic neuropathy in Chinese patients with type 2 diabetes

Background and study aims : Delayed gastric emptying (DGE) is the commonest gastrointestinal (GI) complication in type 2 diabetes. We aimed to evaluate the association between DGE and cardiovascular autonomic neuropathy (CAN) in type 2 diabetes. Patients and methods : A total of 71 Chinese patients (39 men and 32women, aged 60-90 years) and 30 controls (12 men and 18 women, aged 50-79 years) were studied in Nanjing, China. The gastric emptying was assessed by 13C-octanoic acid breath test (OBT) and gastric emptying ultrasonography (GEU). Cardiovascular autonomic neuropathy (CAN) was assessed by a scoring system being validated before. Results : The diabetic patients, except for a higher plasma glu- cose level, had similar characteristics compared to the non-diabet- ic controls. Diabetic patients had higher incidence of DGE and CAN than controls (48.5% vs. 10.7%, p = 0.001). Among diabetic patients with DGE (n = 27), 18 (66.7%) had CAN and 9 (33.3%) did not. Corresponding figures for those without DGE (n = 39) were 14 (35.9%) and 25 (64.1%), respectively (p = 0.014). Diabetes was independently associated with the risk of DGE with odd ratio (95% CI) of 15.6 (1.92, 127.06) (p = 0.010). The presence of dia- betes or CAN was independently associated with the half gastric emptying time after adjusting for age, gender, plasma glucose and blood pressure. Conclusions : We found a much prolonged gastric emptying time in Chinese patients with type 2 diabetes as compared to non-dia- betic controls. There was a high rate of CAN in diabetic patients, and it was associated with gastric emptying. (Acta gastroenterol. belg., 2011, 74, 28-33).