Volume 80 - 2017 - Fasc.1 - Original articles
Serum concentrations of Cyclophilin A in patients with Nonalcoholic Fatty Liver Disease
Aim : Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease and its incidence is rising worldwide. Cyclophilin A (CyPA) is a protein, which is secreted under the presence of oxidative stress and hyperglycemia, and it plays role in proinflammatory signal reduction. In this study we investigated serum levels of CyPA in patients with biopsy proven NAFLD and examined their association with clinical and histological phenotypes.
Methods : In this study, we identified serum levels of CyPA in patients with NAFLD (n=52) and healthy controls without evi- dence of any liver disease (n=44). The levels of CyPA were mea- sured by enzyme-linked immunosorbent assay and were compared between two study groups. Furthermore, serum levels of CyPA were assessed in relation to the clinical characteristics of the study participants.
Results : Serum levels of CyPA were significantly higher in patients with NAFLD (3,8±2,6 µg/ml, P=0.03) compared to healthy controls (2,8±1,8 µg/ml). Moreover, concentrations of CyPA were 2,8±1,8, 3,4±2,3, and 4,2±2,9 µg/ml in control group, non-diabetic and diabetic NAFLD patients, respectively. The difference between the groups was statistically significant (P=0.04). There was signifi- cant correlation between the serum concentrations of CyPA and glucose levels (P=0.01), but there was no significant correlation with other clinical and histologic parameters.
Conclusion : Our data suggest that CyPA levels are elevated in patients with NAFLD, especially in patients with diabetes. (Acta gastroenterol. belg., 2017, 80, 3-7).
Observation of combined-optimized therapy of Lamivudine and Adefovir Dipivoxyl for hepatitis B-induced decompensated cirrhosis with baseline HBV DNA>1,000 IU-mL
Objective : This study aimed to observe and compare the efficacy and safety of the combined therapy and two different optimized therapies of lamivudine (LAM) and adefovir dipivoxil (ADV), as well as entecavir (ETV) monotherapy in patients with hepatitis B-induced decompensated cirrhosis.
Method : A total of 127 patients with decompensated cirrhosis were divided into four groups, and each group received different doses of regimens: initial combination of LAM and ADV, ADV add- on therapies with previous 12-week LAM, ADV add-on therapies with previous 24-week LAM, and ETV monotherapy.
Results : At the end of the treatment, the level of alanine amino- transferase (ALT), albumin (ALB) and total bilirubin (TBIL) in the combination therapy group and 12-week optimized therapy group were significantly improved. For the 24-week optimized therapy group, only ALT levels revealed a significant improvement. There were no obvious differences in the normalization rate of ALT, negative conversion rate of HBV DNA and HBeAg, as well as improvement in Child-Pugh scores among the combination therapy group, 12-week optimized therapy group, and ETV monotherapy group. However, the difference among these three groups and the 24-week optimized therapy group were significant. Differences were not observed in the HBeAg seroconversion between each group. Differences in blood urea nitrogen, serum creatinine, creatine kinase, or other serious adverse effects were not observed in each group at the end of the 96-week treatment.
Conclusion : Combination therapy and early ADV addition were the preferred approaches in the antiviral strategy for the treatment of hepatitis B-induced decompensated cirrhosis. (Acta gastroenterol. belg., 2017, 80, 9-13).
Nodular Regenerative Hyperplasia in HIV-positive patients : a case series and review of the literature
Nodular regenerative hyperplasia (NRH) is a well-described condition that leads to non-cirrhotic portal hypertension and is histologically characterised by a nodular transformation of the liver without fibrosis. It seems to be a consequence of obliterative portal venopathy of small hepatic veins. Its precise aetiology remains to be clearly determined. NRH was reported to occur in HIV-positive patients ten years ago. In this article, three consecutive clinical cases of HIV-related NRH were identified in a high volume reference centre of HIV positive patients and are presented. Clinical, diagnostic aspects and strategies for management of this under-diagnosed medical condition in the HIV population are also developed. (Acta gastroenterol. belg., 2017, 80, 15-19).
The role of insulin - like growth factor - 1 on steatohepatitis
Purpose : Recent studies have revealed that growth hormone and STAT5 were related to hepatosteatosis in mice. Loss of signal transducer and activator of transcription factor-5 leads to hepatosteatosis and impaired liver regeneration. We aimed to investigate the role of IGF-1 in steatosis with normal (SNLFT) and disturbed liver function tests (SDLFT) in humans.
Method : We included 272 NAFLD patients and 110 age, sex and body mass index (BMI)-matched healty controls. We measured routine blood biochemistry and complete blood count, IGF- 1, insulin, c-peptide, ferritin, hsCRP, ESR and HOMA-IR. We subdivided NAFLD patients into SNLFT and SDLFT subgroups.
Results : Age, sex and BMI were similar between NAFLD and controls. IGF-1 levels were significantly lower in NAFLD patients (120,6±48,2) than controls (148,9±53,8), (p<0,0001). IGF-1 levels were also lower in SDLFT subgroup (93,4±27,8) than SNLFT subgroup (123,1±49,0), (p:0,032). Waist circumference, fasting blood glucose, HbA1c, uric acid, hsCRP, AST, ALT, GGT, WBC, hemoglobin, hematocrit, ferritin, insulin, c-peptid and HOMA- IR measurements were significantly higher in NAFLD patients than controls (for all values: p<0,0001).Cholesterol (p:0,026), triglycerides (p<0,0001), ESR (p:0,006) were significantly higher in NAFLD patients than controls. HDL-chelesterol levels were significantly lower (p:0,002) in NAFLD patients than controls.
Conclusion : This study supported previous findings of experi- mental studies in that, IGF-1 levels were lower in SNLFT and SDLFT. Growth hormone-IGF-1 system may be involved in the pathogenesis of NAFLD. (Acta gastroenterol. belg., 2017, 80, 21-24).
Very low rates of Helicobacter pylori infection in organ transplant recipients presenting with peptic ulcer disease
Background : Leading causative factors of peptic ulcer disease (PUD) in the general population are infection with Helicobacter pylori (HP) and exposure to non-steroidal anti-inflammatory drugs (NSAID). We hypothesized that this may be different in transplant recipients given increased exposure of immunosuppres- sive and anti-microbial drugs.
Methods : We performed a retrospective single center analysis of all patients presenting with PUD to the endoscopy unit at a tertiary care and transplant center in Germany between 2006 and 2013. PUD was diagnosed by upper endoscopy. HP was identified by biopsy and histology. Organ transplant recipients were compared to non-transplant recipients (control group).
Results : 366 patients with PUD were identified in the study period. 12% (44/366) had previously received an organ transplant. 7% (3/44) of transplant recipients were found to be positive for HP compared to 25% (81/322) in the control group (p=0.007). Even when excluding patients taking proton-pump-inhibitors (PPI) from the analysis rates were similar with 30% (65/214) of the ulcers being HP positive in the control group compared to 14% (1/7) in transplant recipients (p=0.006). Furthermore, in the trans- plant recipient group rates of being in intensive care, concurrent PPI and concurrent antibiotic medication were significantly higher than in the control group.
Conclusions : Organ transplant recipients with PUD have lower rates of Helicobacter pylori positivity compared to the general population. (Acta gastroenterol. belg., 2017, 80, 25-30).
Immunohistochemical expression of CDX2, CK7, HER2 and HER4 in periam- pullary adenocarcinoma : implications for clinicopathology and patient outcomes
Background : Periampullary carcinomas originate from the pancreatic head, the ampulla, the distal bile duct, or the duodenum. The expression of CK7 and CDX2 has been used in the classification of periampullary carcinomas. There is prognostic value of human epidermal growth factor receptor (HER) 2 and HER 4, which have been linked to poor prognosis in several types of tumors, such as breast and gastric carcinomas. We aimed to evaluate the expression and prognostic value of CDX2, CK7, HER 2, and HER 4 in periampullary adenocarcinoma.
Patients and Methods : We retrospectively selected 98 patients who had undergone pancreatoduodenectomy for periampullary adenocarcinoma at our pathology department. The tumor location, pathological subtype, involvement of vessels and lymph nodes, perineural invasion, clinical follow-up, and tumorstage were noted. Immunohistochemistry was performed for CK7, CDX2, HER2, and HER4.
Results : CDX2 staining was predictive of perineural invasion. Additionally, there was a significant association between the overexpression of HER2 and HER4 and the presence of perineural invasion. HER4 was significantly positive in patients with the pancreatobiliary subtype compared with patients with the intestinal subtype. Patients with the pancreatobiliary subtype, lymph node involvement, and advanced pT and UICC stages had significantly lower median survival.
Conclusion : Our findings suggest that only pancreatobiliary subtype, lymph node involvement and advanced pT and UICC stages were independent predictors of short survival, but the ampulla tumor location predicted a significantly better survival time. The immunohistochemical expression of CDX2, CK7, HER4, and HER2, vessel involvement, and perineural invasion were not associated with the survival of patients with periampullary adenocarcinoma. (Acta gastroenterol. belg., 2017, 80, 31-37).
The efficiency of Levofloxacin Containing Sequential Therapy with or without Bismuth, in Helicobacter Pylori Eradication, in Non-ulcer Dyspepsia
Introduction : The aim of this study is to determine the efficiency of levofloxacin containing sequential therapy with or without bismuth in Helicobacter pylori (Hp) eradication in nonulcer dyspepsia.
Materials and Methods: One hundred and ninety Hp-positive patients with the pre-diagnosis of nonulcer dyspepsia were included in this study. Patients were randomized into 2 groups and 95 individuals were included in each group. The first group was administered levofloxacin containing sequential therapy with bismuth, whereas the second group was administered only levofloxacin containing sequential therapy. Rates of therapy discontinuation and eradication success were compared between the 2 groups. Furthermore, symptomatic healing rates were com- pared between patients in whom Hp eradication was achieved and in whom it was not achieved.
Results : Ninety-one patients from each group applied for follow- up after treatment. It was found that 7/91(7.6%) patients from the first group and 5/91(5.4%) patients from the second group did not complete the therapy (p >0.05). In patients who completed therapy, Hp eradication was achieved in 72 out of the 84 patients (85.2%) from the first group and 71 out of 86 patients (82.6%) from the second group (p > 0.05). In addition, symptomatic healing occurred in 125 out of 143 patients (87.4%) in whom Hp was eradicated and 12 out of 27 (44.4%) patients in whom Hp was not eradicated (p < 0.001).
Discussion: Levofloxacin containing sequential therapy for 14 days is quite effective and well-tolerated choice for Hp eradication. However, adding bismuth to sequential therapy does not significantly improve Hp eradication success rates. Therefore, Hp eradication is beneficial and necessary in patients with nonulcer dyspepsia. (Acta gastroenterol. belg., 2017, 80, 39-42).