Volume 84 - 2021 - Fasc.4 - Original articles
The prevalence of disorders of the gut-brain axis in type 2 diabetes mellitus patients with metabolic dysfunction-associated fatty liver disease: an observational study
Background and study aim: Disorders of the gut-brain axis
(DGBI) and metabolic dysfunction-associated liver disease
(MAFLD) are frequently diagnosed and exhibit pathophysiological
similarities. This study aimed to estimate the prevalence of DGBI in
type 2 diabetes mellitus (T2DM) patients with MAFLD.
Patients and methods: In this single center, observational study,
in adults with T2DM demographics, diabetes-related parameters
and liver tests were recorded. MAFLD was defined by the presence
of hepatic steatosis on imaging. Functional dyspepsia (FD) and
irritable bowel syndrome (IBS) were diagnosed based on Rome IV
criteria. Quality of life (QOL), anxiety levels and depression levels
were documented by validated questionnaires.
Results: We included 77 patients, 44 with and 33 without
steatosis. There were no significant differences in age, body mass
index (BMI), waist circumference, HbA1c levels or metformin
use between groups. IBS was significantly more prevalent in the
liver steatosis group (9/44 vs. 2/33, p = .037), while a similar trend
was observed for FD (9/35 vs. 2/31, p = .103). No differences were
found in anxiety, depression and overall QOL. However, QOL
subscales for health worry, food avoidance and social reaction were
significantly higher in the liver steatosis group.
Conclusions: In otherwise comparable T2DM patients, DGBI,
and especially IBS, are more prevalent in the presence of MAFLD.
This difference could not be attributed to increased levels of
anxiety or depression. Future research should target the underlying
pathophysiological mechanisms.
Portal venous pressure in non-cirrhotic bilharzial patients undergoing elective splenectomy, can it affect mortality? A prospective study
Background and study aims: To evaluate the impact of intraoperatively
measured portal vein pressure (PVP) on mortality in
non-cirrhotic bilharzial patients undergoing splenectomy.
Methods: The present study is a prospective study that was
conducted in Egypt from April 2014 to April 2018. Adult patients
with non-cirrhotic bilharziasis who were scheduled to undergo
splenectomy were included. Studied cases were divided into a
survival cohort and a non-survival cohort. The main objective
was the correlation between the incidence of mortality and
intraoperative PVP.
Results: The present work comprised 130 cases with a mean
age of 51.8 ± 6.4 years old. The in-hospital mortality rate was
22.3%, with sepsis as a major cause of death (37.9%). In term
of the association between preoperative variables and mortality,
survivors had statistically significant lower portal vein diameter
(13.6 ± 1.8 versus 15.2 ± 1.8mm; p<0.001) and higher portal vein
velocity (14.2 ± 1.8 versus 10.4 ± 2.3 cm/sec; p<0.001) than nonsurvivors.
The survived patients had significantly lower PVP
(13.9 ± 1.1 versus 17.7 ± 2.7; p <0.001). A cut-off value of ≥14.5
mmHg, the PVP yielded a sensitivity of 86.2% and a specificity
of 69% for the prediction of mortality. The association analysis
showed a statistically significant association between mortality and
postoperative liver function parameters.
Conclusions: High intraoperative PVP is linked to early
postoperative death in non-cirrhotic cases undergoing splenectomy.
Our study showed that PVP > 14.5mmHg was an independent
predictor of death and showed good diagnostic performance for
the detection of early postoperative mortality.
A pilot randomized trial to study the success rate of early precut fistulotomy and its effect on radiation dose in patients with difficult biliary cannulation
Background: Role of precut fistulotomy in reducing fluoroscopy
time and the radiation dose in difficult selective biliary cannulation
is unknown.
Methods: We performed a randomized trial where patients with
difficult biliary cannulation were randomized into 2 groups: early
precut fistulotomy (precut five minutes after failed standard biliary
cannulation) or late precut fistulotomy (precut fifteen minutes after
failed standard biliary cannulation). We compared the success
rates of selective biliary cannulation, fluoroscopy time, radiation
dose, complication rates, need for repeat endoscopic retrograde
cholangiography (ERC) and need for other interventions
Results: Of the 130 eligible patients screened, 40 patients were
randomized. The technical success was comparable between
early and late group. The fluoroscopy time and radiation dose
were significantly less in the early group [4 minutes (3, 6) vs 15
minutes (8, 28), p=0.001] and [1.35 mGy (0.90, 1.63) vs 2.40
mGy (1.58, 3.25), p=0.010] respectively. In the late group, 60%
required need for rescue precut fistulotomy. One patient from late
group developed post ERC pancreatitis while 1 from early group
developed perforation. Three needed other interventions due to
failed second attempt.
Conclusion: Early precut fistulotomy has comparable technical
success and reduces the radiation dose as compared to late precut
fistulotomy for difficult biliary cannulation.
Is Cholecystectomy a cause of difficult biliary cannulation in endoscopic retrograde cholangiopancreatography?
Background and study aim: In European Society of
Gastrointestinal Endoscopy guidelines, biliary cannulation of
naive papillae is defined as difficult in the presence of more than
5 papilla contacts, more than 5min cannulation time or more than
one unintended pancreatic duct cannulation or opacification.
It is not known whether cholecystectomy is a cause of difficult
biliary cannulation. This study aimed to investigate whether
cholecystectomy (CCY) is a cause of difficult biliary cannulation
in patients who have undergone Endoscopic Retrograde
Cholangiopancreatography (ERCP) for choledocholithiasis.
Patients and methods: Adult patients with naive papillae
and those who underwent ERCP for common bile duct stones
and/or sludge were included in this retrospective study. Patient
demographics, clinical presentation (acute cholangitis, biliary
pancreatitis or biliary colic), periprocedural data including
laboratory and radiological findings and ERCP results were
compared between no-CCY and post-CCY groups.
Results: 438 patients were included in the present study and
347 of these patients were in the no-CCY group and 91 patients
were in post-CCY group. A statistically significant difference was
found in the number of patients with difficult cannulation in the
post-CCY group (n=30, 33.0%) patients compared to the no-
CCY group (n=67, 19.3%) (p=0.011). According the multivariate
analyses results, presence of history of cholecystectomy was found
an independent risk factor of difficult cannulation (Odds ratio:
2.014; 95 % Cl 1.205-3.366; p=0.008).
Conclusions: The results showed that biliary cannulation was
significantly more difficult in patients with cholecystectomy who
underwent ERCP for common bile duct stones.
The role of the BISAP score in predicting acute pancreatitis severity according to the revised Atlanta classification: a single tertiary care unit experience from Turkey
Background/Aims: In this study, we examine the utility of
Bedside Index of Severity in Acute Pancreatitis (BISAP), which is
an increasingly more commonly used simple and practical novel
scoring system for predicting the prognosis and severity of the
disease at presentation.
Materials and methods: Consecutive patients diagnosed with
AP between January 2013 and December 2020 were evaluated
retrospectively. The AP severity was assessed using the revised
Atlanta classification (RAC). BISAP score, demographic
characteristics, pancreatitis etiology, pancreatitis history, duration
of hospital stay, and mortality rates of the patients were recorded.
Results: A total of 1000 adult patients were included, of whom
589 (58.9%) were female and 411 (41.1%) were male. The mean
age in female and male patients was 62.15 ± 17.79 and 58.1 ± 16.33
years, respectively (p >0.05). The most common etiological factor
was biliary AP (55.8%), followed by idiopathic AP (23%). Based
on RAC, 389 (38.9%), 418 (41.8%), and 193 (19.3%) patients had
mild, moderate, and severe AP. Of the 1000 patients, 42 (4.2%) died.
Significant predictors of mortality included advanced age (>65
y) (p=0.003), hypertension (p=0.007), and ischemic heart disease
(p=0.001). A BISAP score of ≥3 had a sensitivity, specificity, positive
predictive value, and negative predictive value (NPV) of 79.79%,
91.57%, 69.37%, and 94.99%, respectively, for determining SAP
patients according to RAC.
Conclusion: BISAP is an effective scoring system with a high
NPV in predicting the severity of AP in the early course of the
disease in a Turkish population.
Efficacy of combination of biofeedback therapy and pelvic floor muscle training in dyssynergic defecation
Background: It is now known that with appropriate exercises,
the functions of the muscles in the body ameliorate and increase
in strength. We applied pelvic floor muscle relaxation training
and exercises that strengthen the abdominal and pelvic muscles
in combination with biofeedback therapy (BFT) to patients with
dyssynergic defecation (DD).
Methods: Patients who met the criteria for DD and had
no underlying organic cause were included in this study. The
electromyography (EMG) technique was used for BFT therapy.
Patients had received at least six sessions of BFT. BFT was
considered successful in patients when the DD pattern in anorectal
manometry (ARM) disappeared and/or adequate anal relaxation
was obtained following BFT and in patients who had full clinical
recovery.
Results: Data of 104 patients (58 females [55.8%] and 46
males [44.2%]) was evaluated. Abdominal and rectal symptoms
disappeared in 71 (68.26%) patients. Of the patients who achieved
symptomatic improvement, 58 (55.76%) saw a disappearance of
the dyssynergic defecation pattern.
When the differences between anal sphincter pressures before
and after treatment were compared in patients who responded to
BFT and those who did not, no significant differences were observed,
but significant changes were found in anal squeezing pressures. It
was found that those who had high squeezing pressures before BFT,
those who increased their squeezing pressures after BFT, and those
who decreased their resting pressure responded better to BFT.
Conclusions: In this study, BFT was found to be more effective
in those with a high squeezing pressure and those that increased
squeezing pressure after BFT. These findings will influence the
treatment of patients with dyssynergic defecation who do not
respond to treatment. A combination of abdominal and pelvic
floor muscle exercises and BFT increases patient response.
Clinical assessment and cytokines level in constipation-predominant irritable bowel syndrome participants treated with Lactobacillus-containing cultured milk drink
Background: Gut dysbiosis is linked with the pathophysiology
of irritable bowel syndrome (IBS). Manipulation of intestinal
microbiota using cultured milk drinks may stimulate the immune
system, hence providing beneficial support in IBS treatment.
This study aimed to investigate the effects of cultured milk drink
on clinical symptoms, intestinal transit time (ITT), fecal pH and
cytokines in constipation-predominant IBS (IBS-C) as compared to
non-IBS participants.
Methods: Each recruited participant was given three bottles
of 125 ml cultured milk drink containing 109 cfu Lactobacillus
acidophilus LA-5 and Lactobacillus paracasei L. CASEI-01
consumed daily for 30 days. At pre- and post-30-day consumption,
fecal pH, ITT, clinical symptoms, IL-6, IL-8 and TNF-α levels were
assessed. Seventy-seven IBS-C and 88 non-IBS were enrolled.
Results: Post-consumption, 97.4% of IBS-C experienced improvements
in constipation-related symptoms supported by the
significant reduction of ITT and decreased fecal pH (p<0.05). All
pro-inflammatory cytokines were significantly lower in post as
compared to pre-consumption of cultured milk drinks in IBS-C
(p<0.05). There was significant reduction in the IL-8 and TNF-α
levels in post- as compared to pre-consumption for the non-IBS (p
< 0.05).
Conclusion: Cultured milk drink taken daily improved clinical
symptoms and reduced cytokines, hence should be considered as
an adjunctive treatment in IBS-C individuals.
Feasibility of a low FODMAPs diet without initial dietician intervention in the management of patients with irritable bowel syndrome: a prospective study
Background and aims: Efficiency of a low FODMAPs diet (LFD)
to relieve symptoms in patients with irritable bowel syndrome (IBS)
has been proved in several studies. Our study aimed to evaluate
the management of IBS-patients when explanations about LFD are
given by the physician without dietician intervention.
Patients and methods: Patients with IBS were evaluated prospectively
after explanations about the LFD were given with the
help of a leaflet. A first questionnaire evaluating trigger foods
and diet acceptability was submitted to the patient after the
consultation. Six weeks later, a second questionnaire evaluated
patient’s understanding and adherence to the diet, the evolution of
symptoms, and the need for a specific dietetic support.
Results: Thirty-five patients were included (69% female; mean
age 45±15). Seventy-four percent of the patients thought that their
symptoms were related to food ingestion, and 97% were ready to go
on a diet to improve their symptoms. During the second visit, 91%
of the patients reported understanding correctly the explanations,
52% followed LFD regularly, 28% sometimes and 20% did not
follow LFD at all or barely. Multiple non-adherence factors were
reported. All symptoms, except constipation, decreased significantly
six weeks after starting LFD. Finally, 77% of the patients reported
satisfaction with care and 69% were willing to be supported by a
dietician.
Conclusions: Most IBS patients understood explanations given
by GI physicians, but low compliance to the diet and a wish for
dietician support was highlighted, suggesting that a dietician intervention
should be scheduled when LFD is implemented.
Is belching increasing after bariatric bypass surgery in the long term period?
Background and aims: Gastric bypass surgery effectively treats
obesity; however, its association with belching, which occurs in
other bariatric surgeries, remains unclear. Hence, we aimed to
evaluate belching occurrence after gastric bypass surgery.
Methods: We enrolled 12 healthy volunteers and 17 patients (12
and 5 underwent Roux-en-Y gastric bypass and mini-gastric bypass
surgeries 24 (18–54) months prior, respectively). Gastrointestinal
symptoms were assessed. Gastroscopy was performed, followed by
the 24-hour pH-impedance analysis.
Results: Age and sex were not statistically different between
the two groups (P > 0.05). Patients had a significantly higher mean
DeMeester score than the healthy controls (9.11 ± 19.40 vs. 6.04 ±
5.60, P = 0.048), but the pathologic acid reflux (DeMeester score >
14) rate was similar in both groups (11.8% vs. 8.3%). Regarding the
impedance, symptom-association probability was positive in 11.8%
of patients. The patients also had higher alkaline reflux rates (6%
vs. 0%); additionally, 50% of them experienced belching based on
the questionnaire, and 25% had esophagitis based on gastroscopy.
Furthermore, patients had a significantly higher number of gas
reflux (123.24 ± 80 vs. 37.2 ± 21.5, P = 0.001) and supragastric/
gastric belches (182 ± 64/228 ± 66.69 vs. 25.08 ± 15.20/12.17 ±
17.65, P = 0.001). Supragastric belching was more frequent than
gastric belching in the controls, whereas gastric belching was more
frequent in the patients.
Conclusion: Belching increases after gastric bypass surgery
in a long-term period. Gastric belching was more frequent than
supragastric belching in these patients.
Relationship of prognostic factors in stomach cancer with helicobacter pylori: a retrospective study
Background and study aims: The prognostic value of H. pylori,
which infects more than half of the human population living
in the world and plays a role in gastric cancer pathogenesis, is
controversial. Our aim is to investigate the relationship between H.
pylori and prognostic factors in gastric cancer.
Patients and methods: The data of 110 patients (38 females and
72 males) that underwent surgeries due to gastric cancer between
2014 and 2017 were retrospectively analyzed. The relationships
between survival (disease-free and overall) and factors such as p53,
HER2/neu, Ki-67, neutrophil and platelet lymphocyte ratio (NLR
/ PLR), histopathological and demographic characteristics were
examined. In addition, the results of H. pylori positive and negative
groups were compared.
Results: Sixty-one (55%) patients were H. pylori negative and 49
(45%) were positive. In multivariate analysis, TNM stage, lymph
node capsule invasion and NLR were determined as independent
prognostic factors in both disease-free and overall survival. Age>62
and PLR>14.3 were determined as independent predictive factors
of poor prognosis in overall survival. In univariate analysis, tumor
diameter of >4.3 cm, lymphovascular and perineural invasion, and
diffuse p53 expression were determined as predictive factors of poor
prognosis in disease-free and overall survival. The effectiveness of
these markers in prognosis was not different between H. pylori
negative and positive groups.
Conclusion: While age, tumor diameter, TNM stage, lymph
node capsule invasion, perineural and lymphovascular invasion,
diffuse p53, PLR, and NLR were determined as prognostic factors
in gastric cancer, these factors were not affected by the presence of
H. pylori.
