Impact of Serological and Histological Factors on Neurological Manifestations in Children and Adults with Celiac Disease / 대한소아소화기영양학회지

Purpose@#Celiac disease (CD) is a common autoimmune disease with extra-intestinal manifestations, including neurological disorders. There are few reports to assess various factors in increasing the chances of developing neurological disorders in CD, so we designed this study. @*Methods@#All patients with CD at any age who had been referred to the Celiac Clinic were evaluated for neurological problems. CD was defined as IgA anti-transglutaminase antibodies (anti-tTG) of 18 IU/mL or higher in serology and Marsh type I or more severe in histopathological evaluation. Logistic regression analysis was used to evaluate the impact of various independent variables on the neurological manifestations. @*Results@#A total of 540 patients enrolled in this study. A 360 (66.7%) of patients were children. A 64.8% and 35.2% were female and male, respectively. Overall, 34.1% of patients had neurological manifestation, including headache, neuropathy, epilepsy, and ataxia. The odds of developing neurological manifestations in children were significantly lower than in adults (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.45–0.96; p=0.03) and in patients with gastrointestinal (GI) symptoms significantly higher than in the group without GI manifestations (OR, 1.77; 95% CI, 1.18–2.63; p=0.005). Other variables, including Marsh classification (OR, 0.44; 95% CI, 0.18– 1.11; p=0.08) and anti-tTG levels (OR, 1.00; 95% CI, 0.999–1.001; p=0.59) did not significantly increase the chances of developing neurological disorders. @*Conclusion@#Our study showed that increasing age and the presence of GI symptoms, but not serological and histological findings, could increase the chances of developing neurological diseases in CD patients.

Impact of Serological and Histological Factors on Neurological Manifestations in Children and Adults with Celiac Disease / 대한소아소화기영양학회지

Purpose@#Celiac disease (CD) is a common autoimmune disease with extra-intestinal manifestations, including neurological disorders. There are few reports to assess various factors in increasing the chances of developing neurological disorders in CD, so we designed this study. @*Methods@#All patients with CD at any age who had been referred to the Celiac Clinic were evaluated for neurological problems. CD was defined as IgA anti-transglutaminase antibodies (anti-tTG) of 18 IU/mL or higher in serology and Marsh type I or more severe in histopathological evaluation. Logistic regression analysis was used to evaluate the impact of various independent variables on the neurological manifestations. @*Results@#A total of 540 patients enrolled in this study. A 360 (66.7%) of patients were children. A 64.8% and 35.2% were female and male, respectively. Overall, 34.1% of patients had neurological manifestation, including headache, neuropathy, epilepsy, and ataxia. The odds of developing neurological manifestations in children were significantly lower than in adults (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.45–0.96; p=0.03) and in patients with gastrointestinal (GI) symptoms significantly higher than in the group without GI manifestations (OR, 1.77; 95% CI, 1.18–2.63; p=0.005). Other variables, including Marsh classification (OR, 0.44; 95% CI, 0.18– 1.11; p=0.08) and anti-tTG levels (OR, 1.00; 95% CI, 0.999–1.001; p=0.59) did not significantly increase the chances of developing neurological disorders. @*Conclusion@#Our study showed that increasing age and the presence of GI symptoms, but not serological and histological findings, could increase the chances of developing neurological diseases in CD patients.

Susceptibility testing of Helicobacter pylori: Comparison of E-test and Disk Diffusion for Metronidazole and Mutations in rdxA gene sequences of Helicobacter pylori strains

Metronidazole is a main stay of modern multidrug therapies for Helicobacter pylori [H. pylori] infection. Metronidazole resistance reduces the effectiveness of these combination therapies. Various methods have been used for the determination of the sensitivity of H. pylori to metronidazole, that have shown conflicting results. The aims of this study are: 1] Comaring E-Test and disk diffusion methods for determining the susceptibility of H. pylori to metronidazole; and 2] As metronidazole resistance in H. pylori has been found to be associated with mutations in rdxA, the role of this gene in metronidazole resistance in H. pylori has been examined in this study. A total of 46 H. pylori strains from 223 consecutive patients were examined. The E-Test was performed according to the manufacturer's guidelines, and the disk diffusion test, according to standard procedure, using 5 micro g metronidazole disks. Extraction of DNA was done from all H. pylori isolates by boiling and the use of phenol-chloroform methods, and afterwards Polymerase Chain Reaction [PCR] was performed. Metronidazole resistance as determined by E-test and disk diffusion methods, was 64.3% and 47.6% respectively. None of the resistant or sensitive samples possessed rdxA gene deletion. Disk diffusion method is not reliable in determining metronidazole resistance in H. pylori. An intact rdxA gene has also been reported in metronidazole-resistant H. pylori, suggesting that additional metronidazole resistance mechanisms exist in H. pylori and even molecular methods are not reliable for the detection of this resistance

Three living fasciola hepatica in the biliary tract of a woman

Fasciola hepatica [F. hepaticd] as a foodborne trematode can occasionally cause hepatobiliary diseases. We report a 67-year-old woman who was referred to our center because of the diagnosis of cholangitis. She was a resident of mountainous area with the history of unsafe water and contaminated vegetables. Endoscopic retrograde cholangiopancreatography [ERCP] was performed as a diagnostic and therapeutic modality for her. Three living R hepatica was removed from biliary tract with a basket via ERCP. Clinical and laboratory condition of the patient improved after therapy of antibiotics and triclabendazole

Management of gastroesophageal reflux disease in adults

Gastroesophageal reflux disease [GERD] is a very common disease. GERD is defined as the reflux of stomach content which causes troublesome symptoms and/or complications. The management of GERD is step by step. Dietary and lifestyle modifications are the first steps. Twice-daily H2RAs at standard doses for a minimum duration of two weeks can be considered in patients with GERD who fail to respond to lifestyle and dietary modifications. If symptoms of GERD persist, once-daily Proton Pump Inhibitors [PPIs] can be recommended. Patients with an unsatisfactory response to once-daily PPIs dosing can be considered to have refractory GERD. Twice-daily PPI therapy can be recommended in patients who fail to respond to once-daily PPI therapy. The add-on treatment with H2RAs, baclofen, or visceral pain modulators can be considered in selective subjects with GERD who fail to respond to twice daily PPI. Anti-reflux surgery may be taken into account in selected patients. This review focuses on the initial and maintenance therapy of GERD and also reviews different management of recurrent and refractory GERD

Incidental diagnosis of appendiceal abscess by colonoscopy; a case report and review of the literature

Although complicated acute appendicitis is occasionally observed in general practice, the diagnosis of appendiceal abscess by colonoscopy is unusual. We report a case of appendiceal abscess with spontaneous drainage into the lumen of colon diagnosed during colonoscopy and resolved by the time of surgery

Acute cholangitis due to anomaly of right hepatic artery

Acute cholangitis [AC] is commonly observed in general practice with different causes. We report a case of recurrent AC caused by anomaly of the right hepatic artery, as a rare underlying condition

An incidentally swallowed toothbrush

Although foreign body [FB] ingestion is relatively common,ingestion of a toothbrush is rare. We are reporting on a 26-year old female who had accidentally swallowed a toothbrush which was successfully removed via endoscopy using a polypectomy snare

Diffuse melanoma of the stomach and duodenum: a case report

Gastrointestinal melanoma [GIM] is occasionally observed in general practice. We report a case of melanoma dispersed diffusely in the stomach and duodenum with no skin involvement

Hemobilia due to rupture of hepatic artery pseudoaneurysm

Although gastrointestinal bleeding is common, hemobilia due to the rupture of hepatic artery pseudoaneurysm is uncommon. We report a case of hemobilia which was successfully treated via angiography