Is there a correlation between helicobacter pylori and enterohepatic helicobacter species and gallstone cholecystitis?

Background: Cholecystitis is a common surgical condition. Recently, several authors have reported that DNA of bile tolerant Helicobacter spp. has been found in the human bile colonizing the biliary tract. The aim of this study was to evaluate the association between the presence of Helicobacter spp. and gallstone cholecystitis

Methods: In this case-control study, gallstones, bile, and gallbladder mucosa were collected from 25 patients without gallstone disease, 24 with acute cholecystitis, and 28 with chronic cholecystitis. The presence of Helicobacter pylori [H. pylori], Helicobacter bilis [H. bilis], Helicobacter hepaticus [H. hepaticus], and Helicobacter pullorum [H. pullorum] were investigated by polymerase chain reaction [PCR] using species-specific primers

Results: In this study, 77 subjects with acute and chronic cholecystitis and control groups with a mean age of 46.85 +/- 14.53 years, including 58 [67.25%] women and 19 [32.75%] men were included. DNA of 10 Helicobacter spp. was detected in the bile of the patients with cholecystitis including eight H. pylori and two H. bilis. However, we could not detect H. hepaticus and H. pullorum DNA in the samples. Moreover, there was an association between H. pylori and acute cholecystitis [p = 0.048], which was found to be stronger in 31-40-year-olds group [p = 0.003]

Conclusion: We found an association between the presence of H. pylori DNA and acute gallstone cholecystitis. There is not statistically significant correlation between three enterohepatic Helicobacter spp. [H. bilis, H. hepaticus, and H. pullorum] and cholelithiasis. Given the low sample size of the patients, more studies are required to clear the clinical role of Helicobacter spp. in the gallstone disease and cholecystitis

Upper gastrointestinal bleeding as the first manifestation of wegener's granulomatosis

Wegener's granulomatosis is an uncommon inflammatory disease that manifests as vasculitis, granulomatosis, and necrosis. It usually involves the upper and lower respiratory tracts and kidneys. Although it may essentially involve any organ, gastrointestinal [GI] involvement is notably uncommon. A 20-year-old male patient presented with epigastric pain, vomiting, hematemesis, and melena. On physical examination, he was pale. There was no abdominal tenderness or organomegaly. Upper GI endoscopy revealed dark blue-colored infiltrative lesions in prepyloric area. Evaluation of the biopsy sample showed mononuclear cell infiltration in the submucosal area, hyperplastic polyp, and chronic gastritis. High dose proton pump inhibitor and adjunctive supportive measures were given but no change in the follow-up endoscopy was detected. During hospital course, he developed intermittent fever and serum creatinine elevation. 12 days after admission, he developed dyspnea, tachypnea, and painful swelling of metacarpophalangeal joints, and maculopapular rash in extensor surface of the right forearm. Chest radiography showed pulmonary infiltration. Serum c-ANCA titer was strongly positive and skin biopsy revealed leukocytoclastic vasculitis. The patient received methylprednisolone pulse, which resulted in complete recovery of symptoms and gastric lesion. The present case indicates that GI bleeding may be the first manifestation of Wegener's granulomatosis. Moreover, it should be emphasized that gastric biopsy is not characteristic or diagnostic in such patients

Efficacy of double dose recombinant hepatitis b vaccination in chronic hepatitis c patients, compared to standard dose vaccination

Hepatitis B virus [HBV] vaccination is a well-known, safe and effective way for protection against HBV infection; however, non-responders remain susceptible to infection with HBV. This is so important in patients with any kind of chronic liver disease, especially chronic hepatitis C virus [HCV] patients in whom acute HBV infection may lead to decompensation of liver disease. Some of the studies have shown that immunogenicity of HBV vaccination is decreased in these patients. The aim of this study was to evaluate the efficacy and safety of double dose vaccination of HBV in these patients, compared with standard dose vaccination in similar patients and healthy adults. A total of64 patients with chronic HCV infection were randomized into 2 groups of 32. Group A received standard dose HBV vaccine, at 0, 1, 6 months, whereas group B received double dose HBV vaccine. Group C consisted of 32 healthy adults who also received standard dose vaccination. At 1 month after the end of vaccination, Hepatitis B surface antibody [HBsAb] titer was checked in all participants and the results were compared. There was no significant difference in age or sex among three groups. The response rate in groups B and C was 100% [all had HBsAb titer >10 mIU/mL], while in group A, 4 patients [12.5%] were non-responders [HBsAb titer < 10 mIU/mL]. The difference in response rate was statistically significant between Group A and the other two groups [P< 0.05]. The efficacy of standard dose HBV vaccination in patients with chronic HCV infection was suboptimal. Using double dose vaccination in these patients was an effective way to increase the antibody response

Noradrenalin versus the combination of midodrine and octreotide in patients with hepatorenal syndrome: randomized clinical trial

Hepatorenal syndrome [HRS] is known as development of acute renal failure in a patient who usually has advanced liver disease. The aim of the present study was to determine the safety and the efficacy of noradrenalin in comparison with midodrine-octreotide in patients with HRS. This study was registered to the Iranian Registry of Clinical trials [IRCT]. This study was a single-center, randomized, clinical trial that performed in Alzahra hospital, Isfahan, Iran. Since March 2011 to January 2012, twenty-three patients were enrolled in the study. Eligible patients were allocated in 2 groups. In the first group, patients received infusion of NA with the dose of 0.1-0.7 micro g/kg/min, and in the other groups, patients received octreotide 100-200 micro g subcutaneously 3 times daily and midodrine 5-15 mg orally 3 times daily. In both study groups, patient received albumin infusion in addition to noradrenalin or midodrine-octreotide. Complete response of HRS was observed in 8 of the 11 patients [73%] treated with noradrenalin and in 9 of the 12 patients [75%] treated with midodrine-octreotide [P > 0.05]. HRS recurred after treatment withdrawal in 2 of 11 in NA and 3 of 12 in MO group. That shows no significant difference between 2 groups [P > 0.05]. We deduce that NA has the same efficacy and safety with MO and can induce a complete response in high percentage of the patients. Moreover, we observed no significant differences in the recurrence rate and outcomes after 3 months among the patients in both study groups; this result could support the use of NA in HRS management

Linguistic validation of the irritable bowel syndrome-quality of life questionnaire for Iranian patients

There is a growing interest of clinical and epidemiological researches in the field of functional gastrointestinal disorders in our society. Accordingly, validated and culturally adapted instruments are required for appropriate measurement of variables specially the quality of life. The aim of our study was the linguistic validation of the Irritable Bowel Syndrome-Quality of Life questionnaire [IBS-QOL] for Iranian IBS patients with Persian language. Following the standard forward-backward translation method, the IBSQOL was translated into the Persian language and completed by 141 IBS patients. Patients also completed the IBS Symptom Severity Scale [IBS-SSS] and Hospital Anxiety and Depression Scale [HADS]. One-week retest was performed on 30 randomly selected patients. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and intraclass correlation coefficient [ICC], respectively. To analyze the discriminant validity, the IBS-QOL scores was correlated to the IBS-SSS and HADS scores. According to the results, reliability analyses were acceptable for all of the IBS-QOL domains [Cronbach's alpha=0.68 to 0.90 and ICCs=0.77 to 0.91]. Discriminant validity was supported by the presence of correlations of the IBS-QOL scores with disease severity [r=-0.628], depression [r=-0.692], and anxiety [r=-0.711] scores; P<0.001. These results indicate that the Persian version of the IBS-QOL is a reliable instrument with sufficient psychometric requirements to assess quality of life in Iranian IBS patients with Persian language

40 years old woman with monolobar Caroli's syndrome treated by left hepatic lobectomy

Caroli's disease [CD] is a rare congenital abnormality characterized by dilatation of intra hepatic bile ducts, which causes stone formation, recurrent cholangitis and higher risk for biliary malignancy. Association of this anomaly with congenital hepatic fibrosis is named Caroli's syndrome [CS]. The monolobar involvement of CS is a very rare condition, curable by partial hepatectomy. We report a 40-year-old woman with recurrent epigastric pain without icterus with normal AST, ALT and alkaline phosphates for 5 years due to left lobe Caroli syndrome which was diagnosed by CT scan and MRCP. Then, the patient underwent successful operation [left hepatic resection]. After 8 months follow up, she was symptom free. Because the presentation of unilobar CS may be as late as middle age, this congenital anomaly should be considered in differential diagnosis of patients with recurrent epigastric pain without icterus in this age group and MRCP is a useful diagnostic tool