prevalence of celiac disease in patients fulfilling Rome III criteria for irritable bowel syndrome

Background and study aims: the clinical presentation of coeliac disease can vary from a classical malabsorption syndrome to more subtle atypical gastrointestinal manifestations similar to irritable bowel syndrome [IBS]. The aim of this study was to investigate the prevalence of coeliac disease in Egyptian patients with clinically diagnosed diarrhoea-predominant IBS [according to Rome III criteria]

Patients and methods: this study was conducted on 100 patients with clinically diagnosed diarrhoea-predominant IBS [fulfilling Rome III criteria]. They were subjected to complete clinical evaluation, routine laboratory investigations, abdominal ultrasonography and serum anti-tissue transglutaminase antibody [anti-tTG] test as a predictor marker for coeliac disease. All patients who tested positive for serum anti-tTG underwent upper gastrointestinal endoscopy with four to eight biopsy sample collected from the second part of the duodenum

Results: all of the studied 100 patients presented with abdominal pain or discomfort, flatulence and diarrhoea. Eight patients [8%] exhibited high levels of serum anti-tTG, and their duodenal biopsy samples satisfied the histopathological criteria of coeliac disease. The studied patients were divided into two group: Group I comprising 92 patients with IBS and negative anti-tTG results and Group II comprising eight patients with IBS and positive anti-tTG results. A non-significant difference was noted between the two groups in age, gender and duration of abdominal pain [p>0.05]. The haemoglobin level was found to be significantly reduced in anti-tTG-positive patients [p<0.01], as was the Na level in anti-tTG-negative patients [p<0.05]. A highly statistically significant inverse correlation was noted between anti-tTG and both serum total protien and serum albumin

Conclusion: some symptoms overlap between coeliac disease and IBS. A lack of awareness may lead to a diagnostic delay in these patients

Molecular detection of circulating thyroid specific transcripts [TSHR/Tg-mRNAs] in thyroid cancer patients: their diagnostic significance

Thyroid cancer is the most prevalent endocrine malignancy. The preoperative diagnosis of differentiated thyroid cancer [DTC] that relies solely on fine-needle aspiration [FNAC] biopsy, sometimes possesses conflicting results. New molecular markers for thyroid cancer have been investigated with most of them based on the detection in thyroid nodules or tumor tissue specimens. Recently, it was possible to detect thyroid cancer cells in the circulation by measuring the mRNA of thyroid specific genes. Among these, thyroglobulin and more recently thyroid stimulating hormone receptor mRNAs, TSHR/Tg-mRNAs in peripheral blood might serve as cancer-specific markers. These have become promising new circulating markers for thyroid cancer. The purpose of this study is to assess TSHR/Tg-mRNAs as diagnostic molecular markers for thyroid cancer and if they can be used preoperatively in synergy with FNAC. This study was performed on 60 subjects; 20 healthy volunteers and 40 patients; including 16 patients with benign thyroid diseases, 24 patients with thyroid cancer; 18 patients with newly diagnosed [DTC] and 6 patients with recurrent thyroid cancer. Diagnosis of cancer was based on FNAC and histopathology of surgical specimens. All subjects had TSHR/Tg-mRNAs in peripheral blood measured by reverse transcriptase [RT]-PCR. Based on cytology/pathology; 18 patients had newly diagnosed DTC and 11 had benign thyroid disease. Preoperative FNAC was performed on 29 of 40 patients; FNAC was diagnostic in 11/18 of malignant lesions [61.1%], in 8/11 of benign lesions [72.7%], while 10/29 [34.5%] were indeterminate. TSHR/Tg-mRNAs correctly diagnosed DTC in 20/24 and 19/24 [sensitivity 83.3% and 79.1%] and benign disease in 14/16 and 13/16 [specificity 87.5% and 81.3%], respectively. With indeterminate FNA, TSHR/Tg-mRNAs correctly diagnosed DTC [follicular type] in 5/7 and benign disease in 2/3 [combined sensitivity 71.4%; specificity 66.7%]. There was high concordance between RT-PCR results for TSHR-mRNA and Tg-mRNA. Of the controls 19/20 [95%] and 16/20 [80%] were negative for both TSHR- and Tg-mRNAs. With the use of a carefully selected primer pair and qualitative RT-PCR; our results indicate that TSHR/Tg-mRNAs in peripheral blood are both equally sensitive and specific markers for detection of thyroid cancer cells. Combining TSHR/Tg-mRNAs and FNAC and ultrasound enhances the preoperative detection of cancer in patients with thyroid nodules, reducing unnecessary surgeries and correctly classified most follicular cancers and could have spared surgery in patients with benign disease

Salivary PCR detection of Helicobacter pylori DNA in Egyptian patients with dyspepsia

Several methods are available for detecting Helicobacter pylori infection: [1] invasive methods based on gastric biopsies, [2] non invasive methods like Urea Breath Test [UBT], serology and stool antigen tests. Importance of salivary PCR in detection of H. pylori is still questionable. To evaluate the role of salivary PCR technique in detecting H. pylori gastric affection in Egyptian patients with dyspepsia and in differentiating between functional dyspepsia and acid-ulcer syndrome. This study included 60 patients with dyspepsia classified into three groups: [Group 1] patients with gastric H. pylori and ulcers or erosions [n = 20], [Group 2] patients with gastric H. pylori and no ulcers or erosions and had functional dyspepsia [n = 20], [Group 3] patients without H. pylori and had functional dyspepsia [n = 20]. All underwent upper gastrointestinal endoscopy with biopsies, rapid urease test and salivary samples for H. pylori PCR. Significant difference between the three groups regarding salivary PCR values. No significant difference between Group 1 and Group 2 but both had significant difference with Group 3, significant difference between gastric H. pylori positive patients [n = 40] and negative ones [n = 20]. Salivary PCR test had sensitivity of 85%, specificity of 70% in diagnosing H. pylori. PCR value of 534000 Iu/ml had best sensitivity [75%] and specificity [100%] for diagnosing H. pylori, highly significant positive correlation between H. pylori gastric affection and salivary PCR values. No significant difference between patients with acid ulcer syndrome [n = 20] and those with functional dyspepsia [n = 40] as regard salivary PCR mean values. Salivary PCR test showed sensitivity of 100%, specificity of 50% in differentiating between patients with acid ulcer syndrome and those with functional dyspepsia. PCR value of 440000 Iu/ml had best sensitivity [100%] and specificity [55%] in differentiating acid ulcer syndrome from functional dyspepsia with non significant. H. pylori salivary PCR may be of value in diagnosing H. pylori gastric affection and is strongly correlated with it but it is of limited value in differentiating between acid ulcer syndrome and functional dyspepsia