Prevalence of Eosinophilic Esophagitis in Adult Patients with Upper Gastrointestinal Symptoms in a Locality in Upper Egypt

BACKGROUND/AIMS: Eosinophilic esophagitis (EoE) is gaining importance in the diagnosis of upper gastrointestinal (UGI) symptoms. Diagnosis is based on the clinical presentation of esophageal dysfunction and pathological findings in the absence of other causes of tissue eosinophilia. Our study was designed to evaluate EoE prevalence in patients with UGI symptoms in our locality (El-Minia, Egypt). METHODS: This single-center, cross-sectional study recruited all patients with UGI symptoms who agreed for endoscopic evaluation. Esophageal biopsy samples were obtained and histological evaluation for the presence of eosinophils was performed for every patient. EoE was defined when at least 15 eosinophils were present in a single high-power field, in the absence of other causes of esophageal eosinophilia. RESULTS: Between 2013 and 2015, 218 of 476 adult patients with UGI symptoms underwent upper endoscopy after giving consent. Among the 218 patients, only 4 (1.87%) had the diagnosis of EoE based on the presence of eosinophils in esophageal biopsies and exclusion of other causes of esophageal eosinophilia. Three patients with EoE presented mainly with dysphagia (75%) and/or other UGI symptoms, such as heartburn. CONCLUSIONS: We observed a low prevalence of EoE in our locality. The diagnosis of EoE should be considered in patients with dysphagia and/or heartburn.

Expression of SSX-1 and SSX-5 genes in the peripheral blood of patients with hepatocellular carcinoma

Liver cancer is the fifth most common cancer in men and the seventh in women. Hepatocellular carcinoma [HCC] is responsible for significant morbidity and mortality in patients with liver cirrhosis and accounts for 90% of primary liver cancer. Synovial sarcoma X chromosome [SSX] genes belong to cancer testis antigens [CTA] family; expressed only in germ cell tumors. There have been some studies about the SSX genes expression in the HCC. To the best of our knowledge no reports included these genes expression in the Egyptian patients with HCC. This study aims to evaluate the SSX-1 and SSX-5 mRNA expression in tumor cells circulating in the peripheral blood [PB] of a cohort of Egyptian patients with HCC and to find out any possible associations between these genes expression and different clinical/laboratory parameters. This study included 100 subjects; 52 HCC cases, 25 with post viral hepatitis liver cirrhosis and 23 apparently healthy controls. Expression of SSX-1 and SSX-5 mRNA in PB was tested by reverse transcription polymerase chain reaction [RT-PCR] SSX-1 and SSX-5 mRNA were expressed in 40.4% and 36.5% of the HCC patients, respectively. SSX-1 and/or SSX-5 were not detected in healthy controls or cirrhotic patients. Neither SSX-1 nor SSX-5 expression showed an association with Alfa-Fetoprotein [AFP] levels, tumor size, tumor differentiation, hepatitis B infection and Bilharziasis [P > 0.05]. SSX-1 and SSX-5 mRNA are specifically expressed in tumor cells circulating in PB of HCC patients and thus could be used as easy access, simple method molecular markers for early diagnosis of HCC patients in Egypt

Vascular endothelial growth factor level in chronic liver diseases

Ninety individuals [76 males and 14 females] were classified into four groups. G1 [control group] included 20 healthy individuals, G2 [chronic hepatitis group] included 20 patients, G3 [liver cirrhosis group] included 30 patients and G4 included 20 patients with HCC. All groups were subjected to clinical examination, abdominal ultrasonography, complete blood picture, HCV antibodies, HRs Ag and function tests [total and direct bilirubin, total plasma proteins and albumin, prothrombin time and concentration and liver enzymes AST, ALT and ALP]. Patients of G3 and G4 were classified according to Child Pugh classification into A, B and C. Upper endoscopic examination was done for 36/50 patients with chronic hepatitis or HCC. Circulating VEGF levels were determined by ELISA. There was statistically higher significant levels of circulating VEGF in G1, G2 and G3 than in the controls. There was a statistically significant higher level of circulating VEGF in G4 than in G3 and G4 and a statistically negative significant correlation between VEGF levels and platelet count in G2. There were no significant correlation between VEGF and the grade of esophageal varices in G3 and G4 and no significant correlation between VEGF and upper GIT bleeding or spider naevi [vascular skin changes] in G2. A statistically significant correlation was found between VEGF and degree of hepatic dysfunction