Increased Numbers of Eosinophils, Rather than Only Etiology, Predict Histologic Changes in Patients with Esophageal Eosinophilia.
Clin Gastroenterol Hepatol. 2012 Jan 27;
Authors: Sridhara S, Ravi K, Smyrk TC, Kita H, Kephart GM, Weiler C, Katzka DA
Abstract
BACKGROUND & AIMS: It can be a challenge to differentiate individuals with eosinophilic esophagitis (EoE) from those with gastroesophageal reflux disease (GERD). We investigated differences in histologic and eosinophil patterns and numbers of mast cells between patients with these disorders. METHODS: We performed histologic analyses and immunohistochemical assays for eosinophil-derived neurotoxin (EDN), major basic protein (MBP), and tryptase, using biopsy samples from 10 patients with GERD (positive results from a pH study and response to proton-pump inhibitors), Barrett’s esophagus, or EoE (negative results from a pH study and positive response to budesonide). Patients were matched for degree of eosinophilia. RESULTS: Samples from patients with EoE, GERD, or Barrett’s esophagus had similar increases in concentrations of eosinophils. Patients with GERD or EoE did not differ in amount of basal zone hyperplasia, microabscesses, spongiosis, eosinophil distribution, maximum eosinophils/high-power field (HPF) or composite histologic scores. Samples from all 3 groups had high levels of EDN and MBP; the levels of eosinophil products correlated (ρ=0.93). Extracellular staining for EDN was greater than intracellular staining (2.67/3 vs 1.86/3); levels tended to be greater in samples from patients with EoE than GERD (P=.05) or Barrett’s esophagus (P=.06). Detection of EDN correlated with peak numbers of eosinophils/HPF (ρ= 0.6 for intracellular and extracellular staining). Peak numbers of tryptase-positive mast cells/HPF were significantly greater in samples from patients with EoE than GERD or Barrett’s esophagus (P=.01 and .005, respectively). The Spearman correlation between eosinophil and mast cell density was ρ=0.2. CONCLUSIONS: Biopsy samples from patients with GERD and EoE, matched for esophageal eosinophilia, have similar changes in histology and levels of EDN and MBP, whereas mast cells from patients with EoE have higher levels of these products. The presence of esophageal eosinophils, rather than etiology, could be the most important determinant of epithelial response.
PMID: 22289868 [PubMed - as supplied by publisher]
Risk of Colorectal Cancer in Patients with Ulcerative Colitis: a Meta-Analysis of Population-Based Cohort Studies.
Clin Gastroenterol Hepatol. 2012 Jan 27;
Authors: Jess T, Rungoe C, Peyrin-Biroulet L
Abstract
BACKGROUND & AIMS: Patients with ulcerative colitis (UC) have an increased risk of developing colorectal cancer (CRC). Studies examining the magnitude of this association have yielded conflicting results. We performed a meta-analysis of population-based cohort studies to determine the risk of CRC in patients with UC. METHODS: We used Medline, Embase, Cochrane, and Cinahl to perform a systematic literature search. We included 8 studies in the meta-analysis, based on strict inclusion and exclusion criteria. We calculated pooled standardized incidence ratios (SIRs) with 95% confidence intervals (CI) for risk of CRC in patients with UC and performed meta-regression analyses of the effect of cohort size, calendar period, observation time, percentage with proctitis, and rates of colectomy on the risk of CRC. RESULTS: An average of 1.6% of patients with UC were diagnosed with CRC during 14 years of follow up. SIRs ranged from 1.05 to 3.1, with a pooled SIR of 2.4 (95% CI, 2.1-2.7). Men with UC had a greater risk of CRC (SIR, 2.6; 95% CI, 2.2-3.0) than women (SIR, 1.9; 95% CI, 1.5-2.3). Young age was a risk factor for CRC (SIR, 8.6; 95% CI, 3.8-19.5; although this might have resulted from small numbers), as was extensive colitis (SIR, 4.8; 95% CI, 3.9-5.9). In meta-regression analyses, only cohort size was associated with risk of CRC. CONCLUSIONS: In population-based cohorts, UC increases the risk of CRC 2.4-fold. Male sex, young age at diagnosis with UC, and extensive colitis increase the risk.
PMID: 22289873 [PubMed - as supplied by publisher]
Efficacy and Safety of Anticoagulation on Patients with Cirrhosis and Portal Vein Thrombosis.
Clin Gastroenterol Hepatol. 2012 Jan 27;
Authors: Delgado MG, Seijo S, Yepes I, Achécar L, Catalina MV, García-Criado A, Abraldes JG, de la Peña J, Bañares R, Albillos A, Bosch J, García-Pagán JC
Abstract
BACKGROUND & AIMS: Portal vein thrombosis (PVT) is a frequent event in patients with cirrhosis; it can be treated with anticoagulants, but there is limited data regarding safety and efficacy of this approach. We evaluated this therapy in a large series of patients with cirrhosis and non-neoplastic PVT. METHODS: We analyzed data from 55 patients with cirrhosis and PVT, diagnosed from June 2003 to September 2010, who received anticoagulant therapy for acute or subacute thrombosis (n=31) or progression of previously known PVT (n=24). Patients with cavernomatous transformation were excluded. Thrombosis was diagnosed and recanalization was evaluated using Doppler ultrasound, angio-computed tomography, and/or angio-magnetic resonance imaging analyses. RESULTS: Partial or complete recanalization was achieved in 33 patients (60%; complete in 25). Early initiation of anticoagulation was the only factor significantly associated with recanalization. Rethrombosis after complete recanalization occurred in 38.5% of patients after anticoagulation therapy was stopped. Despite similar baseline characteristics, patients who achieved recanalization developed, during the follow-up period, less-frequent liver-related events (portal hypertension-related bleeding, ascites, or hepatic encephalopathy), but this difference was not statistically significant (P=.1). Five patients developed bleeding complications that were probably related to anticoagulation. A platelet count <50×109/L was the only factor significantly associated with higher risk for experiencing a bleeding complication. There were no deaths related to anticoagulation therapy. CONCLUSIONS: Anticoagulation is a relatively safe treatment that leads to partial or complete recanalization of the portal venous axis in 60% of patients with cirrhosis and PVT; it should be maintained indefinitely to prevent rethrombosis.
PMID: 22289875 [PubMed - as supplied by publisher]
Levels of Alanine Aminotransferase Confound Use of Transient Elastography to Diagnose Fibrosis in Patients with Chronic HCV Infection.
Clin Gastroenterol Hepatol. 2012 Jan 27;
Authors: Tapper EB, Cohen EB, Patel K, Bacon B, Gordon S, Lawitz E, Nelson D, Nasser IA, Challies T, Afdhal N
Abstract
BACKGROUND & AIMS: Hepatic elastography (HE) is a non-invasive technique that measures liver stiffness and is used to diagnose hepatic fibrosis. It can help patients thought to have early-stage disease avoid a staging liver biopsy, but only when confounding variables that increase liver stiffness are excluded. Chronic inflammation from hepatitis C virus (HCV) infection is not considered to be one of these variables. METHODS: We identified 684 patients with HCV and METAVIR fibrosis scores of 0-2 from a prospective, multi-institutional study of liver stiffness in 2880 patients with chronic liver disease. Patients were 49.6±9.0 years old, 64.3% male, and had an average body mass index of 26.7±4.1. RESULTS: In a multivariate analysis, inflammation (based on histologic analysis) and level of alanine aminotransferase (ALT) were associated with liver stiffness. The chances of a patient having a level of stiffness that indicates cirrhosis increased with grade of inflammation and level of ALT. Using a conservative, 14.5 kPa cutoff for the diagnosis of cirrhosis, grade 3 inflammation had an odds ratio (OR) of 9.10 (95% confidence interval [CI], 2.49-33.4). Likewise, levels of ALT greater than 80 IU/L and 120 IU/L had ORs of 3.84 (95% CI, 2.10-7.00) and 4.10% (95% CI, 2.18-7.69), respectively. The effect of the level of ALT persisted when analysis was restricted to patients with fibrosis scores of F0 to F1. CONCLUSION: In patients with HCV infection and early-stage fibrosis, increased levels of ALT correlate with liver stiffness among patients in the lowest strata of fibrosis (METAVIR scores 0-2). Patients without fibrosis but high levels of ALT could have liver stiffness within the range for cirrhosis. Inflammation should be considered a confounding variable in analysis of liver stiffness.
PMID: 22289876 [PubMed - as supplied by publisher]
Factors Associated with Persistant and Non-Persistant Chronic Constipation, Over 20 Years.
Clin Gastroenterol Hepatol. 2012 Jan 27;
Authors: Choung RS, Locke GR, Rey E, Schleck CD, Baum C, Zinsmeister AR, Talley NJ
Abstract
BACKGROUND & AIMS: The prevalence of chronic constipation (CC) has been reported to be as high as 20% in the general population, but little is known about its natural history. We estimated the natural history of CC and characterized features of persistent CC and non-persistent CC, compared to individuals without constipation. METHODS: In a prospective cohort study, we analyzed data collected from multiple, validated surveys (minimum of 2) of 2853 randomly selected subjects, over a 20-year period (median, 11.6 years). Based on responses, subjects were characterized as having persistent CC, non-persistent CC, or no constipation. We assessed the association between constipation status and potential risk factors using logistic regression models, adjusting for age and sex. RESULTS: Of the respondents, 84 had persistent CC (3%), 605 had non-persistent CC (21%), and 2164 had no symptoms of constipation (76%). High scores from the somatic symptom checklist (odds ratio [OR] =2.1; 95% confidence interval [CI], 1.3-3.4) and frequent doctor visits (OR=2.0; 95% CI, 1.0-3.8) were significantly associated with persistent CC, compared to subjects with no constipation symptoms. The only factor that differed was increased use of laxatives or fiber among subjects with persistent CC (OR=3.0; 95% CI, 1.9-4.9). CONCLUSION: The prevalence of constipation might be exaggerated-the proportion of the population with persistent CC is low (3%). Patients with persistent and non-persistent CC have similar clinical characteristics, although individuals with persistent CC use more laxatives or fiber. CC therefore appears and disappears among certain patients, but we do not have enough information to identify these individuals in advance.
PMID: 22289877 [PubMed - as supplied by publisher]
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