Oral nitrate reductase activity is not associated with development of non-alcoholic fatty liver disease [NAFLD] and non-alcoholic steatohepatitis [NASH]: a pilot study

NAFLD/NASH is a manifestation of metabolic syndrome and is associated with obesity/overweight. Not all obese/overweight individuals develop NASH. Gastro-esophageal reflux disease [GERD] is considered a gastrointestinal manifestation of the metabolic syndrome and is associated with obesity/ overweight. Again not all obese/overweight individuals develop GERD. Recent data show association of dietary nitrate content and oral nitrate reductase activity [NRA] with GERD. Nitrates need to be converted to nitrite [done in human beings by nitrate reductase of oral bacteria exclusively] to be active in metabolic pathways. To assess the relation between NASH/NAFLD and oral NRA. Oral NRA was measured in individuals with NASH [compatible abdominal ultrasound and two elevated ALT/AST levels over six months] and was compared with that of those without NASH. Oral NRA was measured according to a previously reported protocol. Eleven NASH patients and twelve controls were enrolled. Mean oral NRA activity were 2.82 vs. 3.51 microg nitrite-N formed per person per minute for cases and controls respectively [p=0.46]. According to our data, oral nitrite production is not different between individuals with and without NASH.

Treatment of gastro-esophageal reflux disease may improve surgical outcomes for chronic otitis media

This study has been designed to investigate the clinical association between gastro esophageal reflux disease [GERD] and chronic otitis media [COM] in adults and also the role of GERD treatment on the outcome of COM surgery. In a randomized clinical trial, 58 patients with COM who were candidates for surgery were evaluated for GERD and divided in two groups; GERD positive [case] and GERD negative [control] patients. The GERD positive patients were randomized to either receiving medical treatment for GERD or not prior to surgery. The surgical outcomes were assessed at 3 and 6 months after COM surgery in the three groups. Fifty-eight [26 males] patients were enrolled. Forty-two [72.4%] of these had GERD according to a validated questionnaire. Three months after surgery auditory recovery in GERD negative patients was significantly higher [16[100%]] than those suffering from GERD [28 out of 42 [66.7%]], p=0.008. The figures remained similar at six months follow up as well [100% vs. 72.5% in GERD negative and positive patients respectively, p=0.002]. In the GERD-positive group, 8 of 18 [44.4%] patients who did not receive GERD treatment before tympanomastoidectomy recovered after three months whereas, while 20 of 24 [83.3%] patients who received GERD treatment recovered during this time [p<0.001]. At six months 44.4% of non-treated GERD patients had auditory recovery as compared to 95.5% of those treated for GERD [p<0.01]. Our data show that the effect of GERD on the outcome of COM surgery may be considerable. On the other hand, treating COM patients for GERD medically for two months before tympanoplasty improves the surgical outcomes. Therefore, we suggest that COM patients be evaluated for GERD before undergoing tympanoplasty and if GERD is present, they be treated medically for a couple of months before undergoing surgery.