Role of serological markers of activated eosinophils in inflammatory bowel diseases.
Eur J Gastroenterol Hepatol. 2012 Jan 29;
Authors: Dainese R, Galliani EA, De Lazzari F, D’Incà R, Mariné-Barjoan E, Vivinus-Nebot MH, Hébuterne X, Sturniolo GC, Piche T
Abstract
BACKGROUND: Activated eosinophils can infiltrate the intestinal mucosa in patients with inflammatory bowel disease (IBD), and eosinophils are also implicated in the histological damage seen in allergic diseases. AIM: To assess, in a group of patients with IBD in remission or with a mild disease activity, whether serological markers of eosinophil activation, eosinophil cationic protein (ECP) and eosinophil protein X (EPX), are related to evidence of IgE hypersensitivity and to the eosinophilia in gut mucosa. METHODS: Sixty-one patients with IBD (21 Crohn’s disease and 40 ulcerative colitis) in remission or with a mild disease activity were screened for IgE hypersensitivity and serological levels of ECP and EPX. Colonic biopsies were taken to assess mucosal eosinophilic infiltration. RESULTS: Skin prick test were positive in 31.1% of the patients with IBD, showing skin reactions to food allergens in 17.7%. Skin prick test findings were unrelated to ECP or EPX levels, or to clinical activity or eosinophil counts in the gut mucosa. A significant correlation was found between ECP and EPX levels (r=0.77; P<0.0001). CONCLUSION: Serological ECP and EPX findings did not correlate with IgE hypersensitivity findings or eosinophilic colonic infiltration in patients with IBD in remission or with mild disease activity. The role of eosinophils in IBD needs to be better characterized in the colonic mucosa, instead of relying on serological tests.
PMID: 22293328 [PubMed - as supplied by publisher]
Diagnosis and treatment strategies of tuberculous intestinal perforations: a case series.
Eur J Gastroenterol Hepatol. 2012 Jan 29;
Authors: Lee MJ, Cresswell FV, John L, Davidson RN
Abstract
Gastrointestinal tuberculosis (TB) may result in intestinal obstruction and perforation, even after antituberculous therapy has been initiated. Despite surgical intervention tuberculous perforation has a high complication and mortality rate, and it is difficult to predict the subgroup of patients with abdominal TB who progress to perforation. In this study, we retrospectively investigated the clinical features that may predict disease progression in patients in our institution who presented abdominal TB over a 5-year period between January 2006 and August 2011, as well as describe an unreported method of managing tuberculous intestinal perforations when resection with end-to-end anastomosis is unfeasible. Six out of 91 patients (6.6%) with abdominal TB developed perforations. Factors linked with increased complications and mortality were age, comorbidities, multiple perforations and length of time between onset of abdominal symptoms and perforation. Four patients (66.7%) had long histories of abdominal symptoms before perforation. Three patients were receiving or had completed antituberculous therapy before developing perforation. Five patients were managed surgically, two underwent laparostomy as both primary closure and end-to-end anastomosis were deemed too risky. Mortality following perforation was 17%. Patients with prolonged abdominal symptoms, even after antituberculous therapy, should raise suspicion for subacute intestinal obstruction. This should be recognized early and surgical intervention considered in order to prevent mortality secondary to perforation. Laparostomy may be an alternative when resection and end-to-end anastomosis is not possible.
PMID: 22293329 [PubMed - as supplied by publisher]
Hepatic Methionine-enkephalin may interfere with response to antiviral therapy in chronic hepatitis C.
Eur J Gastroenterol Hepatol. 2012 Jan 29;
Authors: Floreani A, Antoniazzi S, Mescoli C, Bergasa NV
Abstract
BACKGROUND: The immunoreactivity of methionine-enkephalin (Met-enkephalin), one of the endogenous opioid peptides, is expressed in the liver in different types of chronic diseases. This finding suggests that the liver may be a source of endogenous opioids in disease state. In-vitro studies have shown that morphine, which exerts its effect by binding to opioid receptors, enhances hepatitis C virus replication and that it interferes with the antiviral effects of interferon. Thus, it was hypothesized that liver-derived endogenous opioids, which also bind to opioid receptors, may interfere with the response to antiviral therapy with interferon. AIM: To correlate the expression of Met-enkephalin immunoreactivity (MEIR) in the liver of patients with chronic hepatitis C with their response to treatment with pegylated interferon and ribavirin. METHODS: We sought to investigate the expression of the immunoreactivities of Met-enkephalin and of the δ-opioid receptor 1 (DOR1), to which Met-enkephalin binds, preferentially, in liver samples from 23 patients with chronic hepatitis C who had undergone antiviral therapy. Twelve patients obtained a sustained virological response, and 11 patients were relapsers after or nonresponders to treatment. Among the 12 patients with sustained virological response, one patient (8.3%) expressed MEIR and another one expressed DOR1 immunoreactivity (8.3%), whereas none of the patients expressed both immunoreactivities. Among the group of nonresponders/relapsers, one patient expressed MEIR (9%), two patients expressed DOR1 immunoreactivity (18.2%), and seven patients expressed both (63.6%). The difference between responders and nonresponders in the expression of both immunoreactivities was significantly different (P<0.001). CONCLUSION: Our data are in favor of the hypothesis that enhanced expression of MEIR and DOR1 immunoreactivity correlates with poor response to antiviral therapy that includes interferon. Thus, this study provides a rationale to study the effect of opiate antagonists in combination with antiviral therapy with interferon and ribavirin in patients who express MEIR in the liver and who have not responded to or who have relapsed after treatment with those antiviral medications.
PMID: 22293330 [PubMed - as supplied by publisher]
Low-dose heparin in the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis.
Eur J Gastroenterol Hepatol. 2012 Jan 29;
Authors: Li S, Cao G, Chen X, Wu T
Abstract
One of the most frequent and serious complications of endoscopic retrograde cholangiopancreatography (ERCP) is acute pancreatitis. The aim of this study was to evaluate the preventive effect of low-dose heparin (unfractionated or low-molecular-weight heparin) on post-ERCP pancreatitis (PEP) and its side-effects by a systematic review and meta-analysis of clinical trials. Searching PubMed and EMBASE, up to August 2011, two independent reviewers systematically identified prospective clinical trials detecting the effect of prophylactic low-dose heparin on the incidence of PEP, severe PEP, and post-ERCP hemorrhage complications. Four clinical trials fulfilled our selection criteria, with three prospective randomized and one nonrandomized. A meta-analysis of these clinical trials was then performed. A total of 1438 patients were included. Meta-analysis of these trials indicated that there was no significant association between the use of heparin and the reduction of PEP [relative risk (RR) 0.67, 95% confidence interval (CI): 0.44-1.03, P=0.07] and severe PEP (RR 0.62, 95% CI: 0.15-2.60, P=0.51). However, low-dose heparin did not increase the incidence of post-ERCP hemorrhage complications (RR 0.84, 95% CI: 0.34-2.03, P=0.69). This meta-analysis did not demonstrate a statistically significant benefit of prophylactic heparin use for the prevention of post-ERCP pancreatitis. More multicenter trials involving a larger number of patients are needed to show a possible prevention effect of PEP from heparin and its related compounds.
PMID: 22293331 [PubMed - as supplied by publisher]
Hepatectomy for hepatocellular carcinoma patients with macronodular cirrhosis.
Eur J Gastroenterol Hepatol. 2012 Jan 29;
Authors: Zeng QA, Qiu J, Hong J, Li Y, Li S, Zou R, Huang P, Li B, Zheng Y, Lao X, Yuan Y
Abstract
OBJECTIVE: Patients with hepatocellular carcinoma (HCC) presenting with nonmicronodular or micronodular cirrhosis are usually treated by hepatectomy. The value of resection for patients with hepatitis B virus-related macronodular cirrhosis, however, remains unknown because of potentially fatal complications of this procedure. METHODS: Clinicopathological data were analyzed for 85 resected HCC patients with hepatitis B virus-related macronodular cirrhosis. An additional 255 patients with nonmicronodular and micronodular cirrhosis were randomly selected during the same period as the control group. RESULTS: Compared with nonmicronodular and micronodular cirrhosis patients, macronodular cirrhotic patients exhibited elevated alanine aminotransferase, aspartate aminotransferase, and γ-glutamyltransferase levels, higher Child-Pugh classification, higher indocyanine green retention rate at 15 min (ICG R15), and more number of total complications. No significant differences were observed between the two groups with regard to major complications, mortality, overall survival, and recurrence-free survival. The morbidity rate was relatively low in patients exhibiting low ICG R15 (<10%). Cox analysis identified small tumors (≤5 cm) and radical resection as independent prognostic factors that could predict long-term overall survival. Radical resection can result in high recurrence-free survival in macronodular cirrhotic patients. CONCLUSION: Resection is safe for macronodular cirrhotic HCC patients, and radical resection provides a positive outcome. Small-sized patients are good candidates for hepatectomy. Macronodular cirrhosis should not rule out hepatectomy in patients with low ICG R15.
PMID: 22293332 [PubMed - as supplied by publisher]
Epidermal growth factor gene polymorphism 61A/G in patients with chronic liver disease for early detection of hepatocellular carcinoma: a pilot study.
Eur J Gastroenterol Hepatol. 2012 Jan 29;
Authors: Abbas E, Shaker O, El Aziz GA, Ramadan H, Esmat G
Abstract
BACKGROUND: Overexpression of epidermal growth factor (EGF) in the liver induces transformation into hepatocellular carcinoma (HCC) in animal models. Polymorphisms in the EGF gene modulate EGF levels. OBJECTIVES: To evaluate the effect of EGF gene single nucleotide polymorphism and to assess its correlation with the risk of HCC in patients with chronic liver diseases. PATIENTS AND METHODS: The present study included 80 participants divided into four groups: group 1 included 20 asymptomatic healthy control volunteers, group 2 included 20 patients with chronic hepatitis C viral (HCV) infection, group 3 included 20 patients with liver cirrhosis, and group 4 included 20 patients with HCC. For all participants, the following investigations were performed: routine laboratory investigations including complete blood count, liver function tests, sero markers of hepatitis viruses HBsAg, HCV-RNA by quantitative polymerase chain reaction, and α-fetoprotein. DNA was extracted from whole blood for detection of single nucleotide polymorphism of the EGF by polymerase chain reaction, followed by restriction fragment length polymorphism. RESULTS: We found a significant difference between both patients with HCC and HCV versus controls in terms of the G carrier (GG and GA; 80 vs. 40%, P<0.05). In addition, the cirrhotic and chronic hepatitis C patients with GG had three-fold and 2.3-fold odds ratio for developing HCC, respectively. CONCLUSION: The EGF 61GG genotype might be associated with a high risk for the development of HCC in Egyptian patients with chronic liver disease.
PMID: 22293333 [PubMed - as supplied by publisher]
Hepatocellular carcinoma in a low-endemic area: rising incidence and improved survival.
Eur J Gastroenterol Hepatol. 2012 Jan 23;
Authors: Witjes CD, Karim-Kos HE, Visser O, van den Akker SA, de Vries E, Ijzermans JN, de Man RA, Coebergh JW, Verhoef C
Abstract
OBJECTIVE: To examine recent trends in incidence and outcome among patients with hepatocellular carcinoma (HCC) in an unselected population in Western Europe. METHODS: Data from the nationwide Netherlands Cancer Registry were used to estimate trends in incidence for all 6514 patients newly diagnosed with primary liver cancer between 1989 and 2009. Trends in incidence, treatment, and relative survival according to sex and age were estimated in 5143 patients with HCC, also using the European Standardized Rates (ESR). RESULTS: The ESR for all primary liver cancers combined increased significantly between 1989 and 2009 as did the ESR for HCC among men (estimated annual percentage change: 2.2%, 95% confidence interval: 1.6-2.7) and for women aged below 60 years, suggesting etiological influences in these groups. Especially, the nonhistologically confirmed HCC incidence increased. More patients underwent surgery for HCC, from 9% in 1989-1994 to 23% in 2005-2009, as well as chemotherapy and/or irradiation, from 6 to 11% in the same period. At the end of the study period, only 66% of patients received noncancer-related HCC therapy, that is, best supportive care, compared with 85% in 1989-1994. The 1 and 5-year relative survival for patients with HCC increased significantly (P<0.001 and P<0.001). CONCLUSION: In as much as the modest increase in the incidence of HCC was a matter of better detection, due to improved imaging techniques, which may have affected the overall relative survival for HCC patients, the increasing trend in survival is likely to be, in the absence of other explanations, due to better treatment of the underlying liver cirrhosis.
PMID: 22273986 [PubMed - as supplied by publisher]
Quantification of hepatitis B surface antigen can help predict spontaneous hepatitis B surface antigen seroclearance.
Eur J Gastroenterol Hepatol. 2012 Jan 23;
Authors: Arai M, Togo S, Kanda T, Fujiwara K, Imazeki F, Yokosuka O
Abstract
BACKGROUND AND AIM: The clinical outcomes of hepatitis B virus (HBV) carriers are favorable following hepatitis B surface antigen (HBsAg) seroclearance. The aim of this study was to investigate the clinical course of spontaneous HBsAg seroclearance and the factors predicting it. METHODS: A total of 423 patients who tested positive for HBsAg and were referred to Chiba University Hospital between January 1985 and April 2008 were included in the study and the following characteristics were analyzed: age, sex, status of hepatitis B e antigen, alanine aminotransferase level, HBV DNA level, number of platelets, HBV genotype, past treatment with interferon, and HBsAg level. When a nucleotide analog was used for treatment, we stopped follow-up. Measurement of HBsAg was performed using the chemiluminescent enzyme immunoassay method and less than 0.03 IU/ml of HBsAg was designated as HBsAg seroclearance. RESULTS: The study group included 239 men and 184 women and their average age was 40.5±13.8 years. Twenty-five patients achieved HBsAg seroclearance during the follow-up period with an incidence rate of 0.97% per year. Multivariate analysis revealed that HBsAg titer (compared with patients with a low HBsAg level: odds ratio=0.45, 95% confidence interval: 0.29-0.70) at baseline was the only predictive factor for HBsAg seroclearance. CONCLUSION: HBsAg seroclearance occurred at a frequency of 0.97% per year without the use of a nucleotide analog. HBsAg titer at baseline was the only predictive factor for HBsAg seroclearance.
PMID: 22273987 [PubMed - as supplied by publisher]
Increased TLR2 expression on blood monocytes in irritable bowel syndrome patients.
Eur J Gastroenterol Hepatol. 2012 Jan 23;
Authors: Ohman L, Lindmark AC, Isaksson S, Posserud I, Strid H, Sjövall H, Simrén M
Abstract
OBJECTIVES: The understanding of the mechanisms for increased immune activation in subgroups of patients with irritable bowel syndrome (IBS) is incomplete. We hypothesized that monocytes are more activated in patients with IBS than in the healthy population. We therefore examined activation phenotype and cytokine secretion of blood monocytes. METHODS: Blood samples from 74 patients with IBS and 30 controls were obtained. The activation phenotype of CD11cCD14 monocytes and cytokine secretion in serum and in peripheral blood mononuclear cells cultured with or without lipopolysaccharide was determined. Gastrointestinal and psychological symptom severity and quality of life were assessed using validated questionnaires. RESULTS: Monocytes from patients demonstrated an increased expression of toll-like receptor (TLR) 2, whereas the expression on monocytes of TLR4, HLA-DR, CD40, CD80 and CD86 was comparable in patients and controls. The expression of activation markers on monocytes did not correlate with gastrointestinal or extracolonic symptom severity, but the expressions of TLR2, HLA-DR and CD86 were associated with less severe psychological symptoms and better social and physical well-being. Cytokine secretion in serum and peripheral blood mononuclear cell cultures was comparable in patients and controls. A subgroup of patients (15%) who had TLR2 and HLA-DR expression intensity above the level seen in controls reported less severe psychosocial symptoms. CONCLUSION: Patients with IBS have increased expression of TLR2 on monocytes and the activation level on monocytes correlates with less severe psychological symptoms and better quality of life. Thus, our data implicate less importance of psychosocial factors and increased importance of immunological parameters for symptom generation in a subgroup of patients with IBS.
PMID: 22273988 [PubMed - as supplied by publisher]
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