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

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

Effect of a probiotic and metformin on liver aminotransferases in non-alcoholic steatohepatitis: a double blind randomized clinical trial

Non-alcoholic steatohepatitis [NASH] is a clinicopathological entity that is being recognized more frequently in recent years. This study aimed to evaluate the effects of Metformin, with and without a probiotic supplement on liver aminotransferases in patients with NASH. Sixty four patients 18-75 years with NASH confirmed by biopsy and histological assessment were enrolled to study. Patients were randomized to one of the following treatments for 6 months: Group I, probiotic [Protexin two tablets per day] plus Metformin 500 mg two tablets per day [Met/Pro], or group II, Metformin 500 mg two tablets per day plus two placebo tablet [Met/P]. After 6 month alanine aminotransferase [ALT], aspartate aminotransferase, and ultrasound grading of NASH were assessed. In group I, serum alanine aminotransferase [ALT: 133.7 +/- 70 vs. 45.2 +/- 32.5; P < 0.00], and aspartate aminotransferase activity [AST: 123.1 +/- 72 vs. 44.2 +/- 33.9; P < 0.001], and ultrasound grading of NASH [P < 0.001] all decreased significantly by the end of the treatment period. In group II, while serum alanine aminotransferase [ALT] was not significantly reduced [118.4 +/- 67.9 vs. 112.5 +/- 68.7; P < 0.064], aspartate aminotransferase activity [AST: 125.3 +/- 71 vs. 113.4 +/- 71; P < 0.001], and ultrasound grading of NASH did fall significantly [P < 0.01]. Body mass index [BMI], fasting blood sugar [FBS], cholesterol, and triglyceride fell significantly in both groups. Probiotic combination with Metformin improves liver aminotransferases better than metformin alone in patients with NASH

Hepatic steatosis in Iranian patients with chronic hepatitis C

To evaluate the frequency and severity of fibrosis, and also the association of various viral and host factors of steatosis in Iranian patients with hepatitis C [CHC]. Eighty treatment-na‹ve CHC patients, age 37.6 +/- 11.77 years, were studied. Percutaneous liver biopsy was performed for all patients. Based on pathology reports, patients were divided into two groups: with and without significant steatosis. Hepatitis C virus RNA [HCV-RNA], various viral and host factors, and biochemical findings and genotyping of HCV were compared in the two groups. Of the 80 patients, 42 [52.5%] had pathologic evidence of significant steatosis. The mean serum level of cholesterol, triglyceride, glucose, and Gamma-glutamyl transpeptidase as well as the mean body mass index, viral load, stage of fibrosis and frequency of genotype 3 were significantly higher in the patients with than those without steatosis [p < 0.05]. In multivariate analysis, only genotype 3 and viral load had significant association with steatosis. In patients with genotype 3 infection, the mean viral load in those with and without steatosis was 1,623,357 +/- 833,543.46 and 821,262.1 +/- 924,480 copies/ml, respectively, and the difference was statistically significant [p = 0.009]. The mean viral load in patients with genotype 1 infection was not significantly different between the two groups. The mean stage of fibrosis was higher in the group that had significant steatosis [p < 0.05]. Steatosis is a common finding in Iranian patients with CHC. Infection with HCV genotype 3 and high viral load in these patients are associated with significant steatosis

Efficacy of triple therapy with interferon alpha-2b, ribavirin and amantadine in the treatment of naive patients with chronic hepatitis C

There is controversy about the efficacy of amantadine in the treatment of chronic hepatitis C. In this study, we evaluated the efficacy of triple therapy with interferon-alpha, ribavirin and amantadine in the treatment of naive patients with chronic hepatitis C. Forty-eight patients with genotype 3 chronic hepatitis C received a three-drug regimen: interferon alpha-2b, 3 million units, three times a week, ribavirin 1000-1200 mg based on body weight, daily, in divided doses, and amantadine 100 mg twice daily, for six months. End of treatment response [ETR], sustained virologic response [SVR], biochemical response and histologic improvement were evaluated. Forty-eight patients, 41 male and 7 female, with a mean age of 37.42 +/- 16.2 years, were enrolled in the study. During treatment, four patients were excluded from the study due to severe thrombocytopenia, major depression and incompliance. End of treatment response was seen in 38 [86.36%] patients. Among these patients, 34 [77.27%] had sustained virologic response 6 months after the end of treatment and 40 [91%] had improvement in serum level of liver enzyme. Among patients who had response to treatment, liver biopsy was performed for 33 at the end of treatment and 31 patients had histologic improvement. Five non-responsive patients underwent liver biopsy at the end of treatment, and 2 of them had histologic improvement. No major side effects due to amantadine occurred in our patients. Triple therapy with interferon-alpha-2b, ribavirin and amantadine is a safe and effective regimen in the treatment of chronic hepatitis C