Abstract

Objective.

Celiac disease (CD) has been linked to gastroesophageal reflux disease (GORD) and eosinophilic esophagitis (EoE), but population-based studies of the prevalence of CD in these conditions are lacking, that is, the aim of this study. Materials and methods. An endoscopic study was carried out in 1000 randomly selected adults from the general population. CD was defined on the basis of positive serology in parallel with mucosal abnormalities of the small intestine. Any eosinophil infiltration of the esophageal epithelium was defined as esophageal eosinophilia and EoE was defined as having at least 15 eosinophils/high-power field in biopsies from the distal esophagus. We used Fisher's exact test to compare the prevalence of GORD, esophageal eosinophilia, and EoE in subjects with CD versus controls.

Results.

Four hundred subjects (40%) had gastroesophageal reflux symptoms (GORS), 155 (15.5%) had erosive esophagitis, 16 (1.6%) had Barrett's esophagus, 48 (4.8%) had esophageal eosinophilia, and 11 (1.1%) had EoE. CD was diagnosed in 8/400 (2.0%) individuals with GORS (vs. controls: 10/600 (1.7%), p = 0.81), in 3/155 (1.9%) with erosive esophagitis (vs. 15/845 controls (1.8%), p = 0.75), and in 2/48 (4.2%) individuals with esophageal eosinophilia (controls: 16/952 (1.7%), p = 0.21), but in none of those 16 with Barrett's esophagus (vs. 18/984 controls (1.8%), p = 1.0) or of the 11 individuals with EoE (controls: 18/989 (1.8%), p = 1.0).

Conclusions.

This population-based study found no increased risk of CD among individuals with GORD, esophageal eosinophilia, or EoE. CD screening of individuals with GORD or EoE of individuals with CD cannot be recommended.

Abstract

Objective.

Endothelin-1 (ET-1) exerts vasoconstrictive effect on portal-systemic collateral vascular bed of portal hypertensive rats. Statins are lipid-lowering agents with nitric oxide (NO)-related vasodilatory effects. Considering NO-associated vascular hyporesponsiveness to vasoconstrictors and shunting formation in portal hypertension, this study investigated the effects of simvastatin on 1) the portal-systemic collateral vascular responsiveness to ET-1 and 2) the portal-systemic shunting degree. Materials/methods. Portal hypertension was induced by partial portal vein ligation (PVL) in Sprague-Dawley rats. Simvastatin (20 mg/kg/day) or distilled water (control) was randomly administered by oral gavage since 2 days prior to until 7 days after PVL. Systemic and portal hemodynamics were measured on the 8th day. In another series, collateral perfusion with Krebs solution at different flow rates was performed to get flow-pressure curves which serve as an index of shunting degree. To survey the direct vascular effect, PVL rats randomly underwent preincubation with 1) Krebs solution, that is, the control group; or Krebs solution plus 2) simvastatin; 3) simvastatin + N (ω)-nitro-l-arginine (NNA, a NO synthase inhibitor); 4) simvastatin + indomethacin (a cyclooxygenase inhibitor), followed by ET-1 to evaluate the collateral vascular responsiveness.

Results.

Chronic simvastatin treatment significantly reduced portal pressure. The flow-pressure curves were similar between two groups. Simvastatin preincubation reduced collateral perfusion pressure changes to ET-1 (p < 0.05), which were partially reversed by NNA (p < 0.05), but not by indomethacin.

Conclusions.

Chronic simvastatin treatment significantly improved portal hypertension. The effect was at least partially exerted by decreased portal-systemic collateral vascular resistance through NO-mediated vascular hyporesponsiveness. The severity of portal-systemic collaterals was not influenced by simvastatin.

Abstract

Background:

Air cholangiogram has been used in patients with malignant hilar obstruction to reduce cholangitis after endoscopic retrograde cholangiopancreatography (ERCP). However, it still remains unclear whether CO2 could be used as an alternative for air cholangiography in such patients.

Objective:

To investigate the effect of CO2 cholangiogram on post-ERCP complications.

Design:

Prospective, randomized controlled study.

Setting:

Tertiary care referral center.

Patients:

36 patients with Bismuth type II, III or IV were randomized into CO2 group or iodine contrast group (control group). Intervention: Cholangiography was performed by injection of either CO2 or iodine contrast through a sphincterotome. One or two metal stents were placed.

Main outcome measures:

Post-ERCP complications, length of hospital stay after ERCP, 1-month and 1-year mortality. Result: There was no significant difference in age, gender, symptoms, liver function tests, type of tumor origin and Bismuth type between patients in CO2 and contrast groups (p > 0.05). Compared with one-stent placement, more volume of CO2 and longer operation time were observed when performing two-stent placement (both p < 0.05). The rate of cholangitis in CO2 group was significantly lower than that in control group (5.6% vs. 33.3%, p = 0.04). After ERCP, mean hospital stay time was shorter in CO2 group compared with control (p < 0.05). The difference of 1-month and 1-year mortality between two groups was not significant (both p > 0.05).

Conclusion:

CO2 cholangiogram could be a safe method to visualize intrahepatic bile duct with low incidence of post-ERCP cholangitis, which could be considered for the patients with malignant hilar obstruction.

Abstract

Purpose.

Owing to inconsistent observations in the literature of an association between HLA-DP polymorphisms (rs3077 and rs9277535) and hepatitis B virus (HBV) infection and spontaneous clearance, there is an urgent need for a comprehensive and reliable understanding of this subject. This meta-analysis was performed to quantitatively summarise the evidence for the relevance of these HLA-DP polymorphisms to HBV infection and spontaneous clearance. Methods. A meta-analysis was conducted with the data from eight relevant papers published from April 2009 to March 2012, following strict selection. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for alleles, co-dominant, dominant and recessive genotype models of the rs3077 and rs9277535 loci.

Results.

Our analysis indicated a significant association of rs3077 and rs9277535 in HLA-DP with HBV infection, suggesting that these HLA-DP polymorphisms act beneficially against HBV infection (for rs3077, AG vs. GG: OR = 0.522, 95% CI = 0.485-0.561; AA vs. GG: OR = 0.350, 95% CI = 0.311-0.393; for rs9277535, AG vs. GG: OR = 0.542, 95% CI = 0.506-0.579; AA vs. GG: OR = 0.371, 95% CI = 0.336-0.409). Additionally, these HLA-DP polymorphisms served as protective factors in the spontaneous clearance of HBV (for rs3077, AG vs. GG: OR = 0.600, 95% CI = 0.464-0.775; AA vs. GG: OR = 0.420, 95% CI = 0.299-0.590; for rs9277535, AG vs. GG: OR = 0.623, 95% CI = 0.570-0.681 and AA vs. GG: OR = 0.464, 95% CI = 0.386-0.556) with similar results for both dominant and recessive genotype models.

Conclusions.

Our results demonstrated that the rs3077 and rs9277535 HLA-DP polymorphisms reduced HBV infection and increased the likelihood of spontaneous viral clearance in some Asian populations.

Abstract

Background.

Short-chain fatty acids (SCFAs), particularly propionic and butyric acids, have been shown to have many positive health effects. The amount and type of SCFAs formed from dietary fibre by the colonic microbiota depends on the substrate available and is reflected in blood. The total intake and type of dietary fibre in people with gastrointestinal diseases differs considerably from healthy subjects.

Objective.

To compare fasting SCFA concentrations in subjects with microscopic colitis (MC), celiac disease and controls without these diseases. SCFAs were also analysed over 6.5 h in young healthy subjects, who had eaten a fibre-rich breakfast, to identify a possible peak concentration of SCFAs after a meal. Methods. SCFAs in serum were pre-concentrated using hollow fibre-supported liquid membrane extraction and gas chromatography.

Results.

The MC group had a higher concentration of valeric acid than the control group (p < 0.01). No significant differences in other SCFA concentrations were seen between groups, but the control group tended to have higher concentration of acetic acid (p = 0.1). Furthermore, males had higher concentrations of SCFAs (with the exception of valeric acid) than females (p < 0.05), which were independent of groups. The peaks for acetic, propionic and butyric acids came approximately 5 h, 6.5 h and 2-3 h, respectively, after breakfast.

Conclusion.

The fasting concentrations of SCFAs were quite similar, although the fibre intake had probably been quite different for a long time. The results might have been different if SCFAs had been recorded over a longer period.

Abstract

Objectives.

Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is widely performed for pancreatic masses. The 25-gauge needle (25G) might be easier to be manipulated and expected to be associated with fewer complications since it is thinner and more flexible than the 22-gauge needle (22G) although obtaining adequate specimens is questioned. In this randomized trial, the authors tried to compare prospectively 25G and 22G in diagnostic accuracy, manipulability from the operator's viewpoint and procedure-related complications. Material and methods. A total of 188 consecutive patients undergoing EUS-FNA for solid or cystic pancreatic masses were consecutively enrolled and 94 patients were randomized to either 25G or 22G group, respectively.

Results.

Baseline characteristics were similar except that more masses of 25G group were located in the head or uncinate process of pancreas than those from 22G group. Although there was no difference in diagnostic accuracy (89.4% vs. 88.3% with p = 0.82), 25G was easier to be manipulated (p = 0.004) and related with fewer procedure-related complications (10.6% vs. 3.2% with p = 0.004).

Conclusions.

25G can be chosen in preference to 22G when performing pancreatic EUS-FNA because 25G was significantly superior to 22G in terms of manipulability and complications although both were effective for accurate diagnosis.

Abstract

Objective.

The first objective of the present study was to identify opportunities of improvement for clinical practice, assessed by local quality indicators, then to analyze possible reasons why we did not reach defined treatment quality measures. The second objective was to characterize patients, considered unresectable according to present criteria, for future arrangement of interventional studies with improved patient selection. Material and methods. Prospective observational cohort study from October 2008 to December 2010 of patients referred to the authors' institution with suspected pancreatic or periampullary neoplasm.

Results.

Of 330 patients, 135 underwent surgery, 195 did not, 129 due to unresectable malignancies. The rest had benign lesions. Perioperative morbidity rate was 32.6%, mortality 0.7%. Radical resection (R0) was obtained in 23 (41.8%) of 55 patients operated for pancreatic adenocarcinoma and 6.3% underwent reconstructive vascular surgery. Diagnostic failure/delay resulted in unresectable carcinoma, primarily misconceived as serous cystic adenoma in two patients. One resected lesion turned out to be focal autoimmune pancreatitis. One case with misdiagnosed cancer was revised to be a pseudoaneurysm. Palliative treatment was offered to 144 patients with malignant tumors, 62 due to locally advanced disease and all pancreatic adenocarcinomas.

Conclusions.

Quality improvement opportunities were identified for patient selection and surgical technique: Too few patients underwent reconstructive vascular surgery. The most important quality indicators are those securing resectional, radical (R0) surgery. Altogether 143 patients (57.9%) of those with malignant tumors were found unresectable, most of these patients are eligible for inclusion in future interventional studies with curative and/or palliative intention.

Abstract

Objective.

The presence of mural nodules is a strong predictor of malignancy in patients with branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs). Endoscopic ultrasound (EUS) is the most sensitive imaging for the detection of mural nodules. The aim was to evaluate whether initial EUS evaluation is necessary to detect mural nodules in all patients with BD-IPMNs. Material and methods. We reviewed retrospectively the medical records of all 104 patients with BD-IPMNs diagnosed by EUS from January 2008 to December 2011. Of the 104 patients, 13 (12.5%) had mural nodules (MN-positive group) and 91 (87.5%) did not (MN-negative group).

Results.

Patients in the MN-positive group were significantly older (69 years vs. 61 years, p = 0.013), had larger-sized cysts on EUS (24.1 ± 8.3 mm vs. 16.2 ± 8.0 mm, p = 0.001), a higher rate of main pancreatic duct dilatation (30.8% vs. 3.3%, p = 0.004), and higher serum CA 19-9 concentrations (67.8 ± 109.4 U/mL vs. 17.5 ± 27.0 U/mL, p = 0.012), than patients in the MN-negative group. Cyst sizes measured by EUS, CT, and MRCP did not differ significantly. Multivariate logistic regression analysis showed that cysts ≥16 mm in size on CT (odds ratio [OR], 9.84; 95% confidential interval [CI], 1.08-89.93; p = 0.043) and main pancreatic duct dilatation (OR, 12.65; 95% CI, 1.62-98.99; p = 0.016) were independent predictors of mural nodules.

Conclusions.

Patients with BD-IPMNs, cyst size ≥16 mm, and main pancreatic duct dilatation should be further evaluated by EUS for the presence of mural nodules.