Belching in Irritable Bowel Syndrome: An Impedance Study

BACKGROUND/AIMS: There are limited data about the relation between belching and irritable bowel syndrome (IBS). We aim to evaluate belching in patients with IBS. METHODS: Twenty-five patients with IBS and 12 healthy volunteers were enrolled in the study. IBS was diagnosed in accordance with the Rome III criteria. All patients were questioned about the presence of symptoms for belching, gastroesophageal reflux disease, and dyspepsia. Esophageal manometry and 24-hour pH-impedance were performed in all patients and healthy volunteers. Each of the patients with IBS underwent gastroscopy and colonoscopy. RESULTS: Demographic features were similar in both groups (P > 0.05). The belching rate was 32% in patients with IBS. The mean DeMeester score was significantly higher in IBS patients (13.80 ± 14.40 vs 6.04 ± 5.60, P = 0.027) and 24% of patients had pathologic acid reflux (DeMeester score > 14). Gastroscopy was normal in all patients. Symptom association probability positivity was detected in 24% of patients in the impedance study. The rate of weak acid reflux was also significantly higher in patients with IBS (97.00 ± 56.20 vs 58.20 ± 29.30, P = 0.025). The number of supine gas reflux (7.50 ± 6.40 vs 2.42 ± 2.80, P = 0.001) and supragastric belches was significantly higher in patients with IBS (51.20 ± 41.20 vs 25.08 ± 15.20, P = 0.035). Although the number of gastric belching was higher in controls, the difference did not reach statistical significance (12.10 ± 17.60 vs 4.90 ± 3.80, P = 0.575). We did not find any correlation between belching and any symptoms of IBS. CONCLUSIONS: Belching is frequent in patients with IBS. Non-erosive reflux disease is frequent in IBS, which may be related to supragastric belching.

Role of several cytokines and adhesion molecules in the diagnosis and prediction of survival of hepatocellular carcinoma

Background and study aims: There is still need for accurate markers for early diagnosis of hepatocellular carcinoma [HCC] and assessment of prognosis. The aim of this study is to investigate interleukin [IL]-32, IL-1 beta, IL-18, vascular cell adhesion molecule [VCAM]-1, and epithelial cell adhesion molecule [EpCAM] in the diagnosis and assessment of prognosis of HCC

Patients and methods: Fifty patients with HCC and 15 healthy volunteers were enroled into this prospective study. Serum samples were obtained at the first admission before any treatment was given. Serum IL-32, IL-1 beta, IL-18, VCAM-1, and EpCAM levels were determined using ELISA kits

Results: The mean age of the patient group and controls was 60 +/- 9 years and 56 +/- 8 years, respectively. The mean serum level of IL-32 was higher in patients with HCC than in the control subjects [65.1 vs. 14.1 pg/mL; p < 0.001]. IL-18 levels were significantly higher in the HCC group [546.5 vs. 157.8 pg/mL; p < 0.001]. EpCAM [20.3 vs. 1.5 pg/mL; p < 0.001] and VCAM [6.5 vs. 1.8 micro g/mL; p < 0.001] levels were also higher in patients with HCC. The mean level of IL-1 beta in the HCC group was similar to that in the control subjects [1.9 vs. 1.9 pg/mL; p = 0.97]. Fifty-eight per cent of the patients with HCC died at 7.3 months [median]. Cytokine levels except EpCAM did not correlate with survival [p > 0.05]. Alpha-foetoprotein, IL-32, IL-18, EpCAM, and VCAM had valuable cutoff levels to differentiate between patients with HCC and control group [p < 0.001]

Conclusions: Although cytokines can be a diagnostic marker for HCC, they did not have any significant prognostic value in patients with HCC. Only EpCAM may be used to determine the prognosis of HCC, thereby assisting with treatment management

Value of neutrophil/lymphocyte ratio in the differential diagnosis of sarcoidosis and tuberculosis

The differential diagnosis of sarcoidosis creates a challange due to tuberculosis also having lung and lymph node involvement. Because both diseases show granulomatous inflammation, it may not be possible to distinguish tuberculosis and sarcoidosis in pathological specimens. As a result of the complexity in the differential diagnosis of sarcoidosis and tuberculosis, new markers for differentiation are being investigated. The aim of our study is to investigate the value of neutrophil/lymphocyte ratio [NLR] as a possible marker in differentiating sarcoidosis and tuberculosis. In our study, 51 acid-fast bacilli [AFB] positive and/or culture-positive patients with pulmonary tuberculosis, 40 patients with biopsy-proven sarcoidosis and a control group consisting of 43 patients were included. In our study, information was collected retrospectively based on hospital records. Leukocyte and neutrophil counts, NLR, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] were significantly higher, and albumin was significantly lower in the tuberculosis group compared with sarcoidosis [for all parameters P < 0.001]. The most appropriate cut-off value of NLR to distinguish tuberculosis from sarcoidosis was determined as 2.55. For this cut-off value of NLR there was 79% sensitivity, 69% specificity, 73% positive predictive value [PPV], 75% negative predictive value [NPV], and area under the curve [AUC] was 0.788. For differentiation of sarcoidosis from tuberculosis, accuracy of the NLR test according to this cut-off value was found as 76%. NLR as a little known marker in respiratory medicine was found to be supportive in differentiation of tuberculosis and sarcoidosis. More studies on this issue is needed