Identification of underlying causes of chronic unspecific upper gastrointestinal-related symptoms in children, a pilot study

Upper gastrointestinal tract [GIT] symptoms are not disease specific and of limited value in the differentiation of GIT disorders. The present study aimed to determine the etiology of chronic unspecific symptoms in children and to test the need for upper endoscopy in diagnosis

This is a prospective study for 30 Egyptian children presented with chronic upper GIT symptoms for at least 2 months. History regarding severity and frequency of GIT symptoms were asked for. Children with known disorder that explains presenting symptoms were excluded. Upper GIT endoscopy was performed and 5 biopsies were obtained for pathological examination and for H pylori testing

The results showed that children age ranged between 2.5-18 years with mean +/- SD of 13.6 +/- 3.4 and 63.3% were females. The main complaints were epigastric pain in 43.3%, hematemesis in 30% and vomiting in 26.7%. Motility disorders were diagnosed in 66.7% children; in the form of GERD in 63.3% and achalasia in one. Complication of GERD in the form of erosive esophagitis was present in 15.8% children, while Barrett's esophagus was not observed. H. pylori infection was diagnosed in 80% histologically. Eosinophilic esophagitis was not detected

Detection of Helicobacter antigen in stool samples and its relation to H. Pylori positive cholecystitis in Egyptian patients with chronic calcular cholecystitis

Evidences supporting the association between H. pylori infection and chronic cholecystitis could be found by using direct culture or staining of H. pylori in gallbladder tissues as well as indirect techniques. Stool antigen test has been widely used due to its non-invasive nature. Various stool antigen tests were developed to detect H. pylori using an enzyme immunoassay [EIA] based on monoclonal or polyclonal antibodies This study evaluated the frequency of H. pylori antigen in stool samples of patients with chronic calcular cholecystitis as regard gall bladder histopathological changes. -Fifty patients were included presented with symptomatic cholecystolithiasis recruited from the outpatient clinic of National Hepatology and Tropical Medicine Research Institute during 2014-2015. Full history and clinical examination and abdominal ultrasonography were performed. Stool samples were collected, prepared and examined for detection of H. pylori antigen. Cholecystectomy was done for all patients; 45 patients [90%] by laparoscopic Cholecystectomy and 5 patients [10%] by open surgery and removed gallbladders were submitted to pathology department for detection of H. pylori in tissue under microscope using Giemsa stain. The results showed that [82%] were females with mean age [42.6+1years]. The mean BMI was [29+7.2] H. pylori-specific antigen in stool samples was detected in 40% of patients and38% were detected in patients; tissue, with significant correlation between H. pylori-specific antigen in stool and in tissue. Histopathological pictures infection in tissue were 68.4% mucosal erosions, 63.2% mucosal atrophy, 57.9% mucosal hyperplasia, 26.3% metaplasia, 42.1% musculosa hypertrophy, 26.3% fibrosis, but lymphoid aggregates were in 42.1% of cases

Detection of helicobacter pylori in hepatic tissue of patients with chronic hepatitis c and hepatocellular carcinoma: [immunohistochemical study]

Recent studies have suggested that bacterial coinfection with Helicobacter species in patients already infected with hepatitis C virus [HCV] could be involved in the development of cirrhosis and hepatocellular carcinoma [HCC]. A retrospective study was performed in order to explore the association between Helicobacter pylori and HCV in hepatic tissue of Egyptian patients with chronic hepatitis C and hepatocellular carcinoma. The presence of Helicobacter pylori was tested by immunohistochemistry on liver samples from two groups of patients; chronic hepatitis C [group I, n = 45] and hepatocellular carcinoma [group II, n = 15]. Group I [chronic hepatitis C] involved 31 males and 14 females [male/female, 2.2:1]. Their age ranged from 27 to 58 years with a mean of 45.8 +/- 7.0 years and HCC group involved 11 males and 4 females [male/female, 2.8:1]. Their age ranged from 48 to 78 years with a mean of 60.2 +/- 10.0 years. Immunostaining revealed H. pylori microorganisms in 33/45 biopsies [73.3%] of chronic hepatitis C group and 5/15 [33.3%] of HCC group [p = 0.005]. H. pylori organisms were present in liver tissues of HCV and HCC patients with significantly higher proportion in the former. Further studies are needed to ascertain its possible role, if ever, in the pathogenesis of cirrhosis and hepatic malignancy in Egyptian patients

Histopathological features of chronic hepatitis C in Egyptian patients

Chronic liver disease including that caused by the hepatitis C virus progresses in stages. It can range from inflammation, to fibrosis to end stage liver disease or liver cancer. This work aimed to study the histopathological features of chronic hepatitis C infected Egyptian patients followed-up at National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt. The study included 4267 liver biopsies from patients with serological and virological diagnosis of chronic HCV with no other identifiable cause for liver disease, signs of hepatic decomposition, or other significant non-hepatic disease. All biopsies were fixed in formalin, embedded in paraffin, and sectioned by microtome with a thickness of 5 micro m. Routine specimen processing involved staining slides with hematoxylin and eosin [5 levels] and Masson's trichrome stain [5 levels], for a total of 10 levels per specimen. All levels were screened by two pathologists to ensure the histological abnormalities. Ishak scoring system was applied for assessment of fibrosis and necroinflammatory injury. The percentage of hepatocytes involved by fatty changes was used to score the grade of steatosis. The relations between the histopathological findings, age and sex of the patients were carried out. The studied group [n = 4267] involved 3268 males and 999 female, with age ranging from 21 to 60 years and a mean of 41.7 +/- 9.7 years. Necroinflammatory activity of the virus was minimal in 17.88%, mild in 56.41%, moderate in 22.24% and severe in 3.47%. No fibrous tissue deposition was seen in 21 patients [0.49%], 27.32% of the patients had portal and periportal fibrous expansion, 27.91% had fibrous extensions with occasional thin fibrous tissue bridge, 36.28% had frequent broad fibrous tissue septa, while 7.99% of the studied group of patients had cirrhosis. Steatosis was absent in 52.45% of cases, mild in 39.75%, moderate in 7.19% and severe in 0.61% of patients. Non-specific granulomatous reaction was detected in 11 liver biopsies [9 males and 2 females]. Fibrosis and necroinflammation were more frequent in older patients. No significant difference between males and females regarding fibrosis, but females were more exposed to higher grades of necroinflammation [p < 0.001]. Chronic hepatitis C infection is a common and serious health problem that progresses to fibrosis, cirrhosis, liver failure and hepatocelluar carcinoma. Portal lymphoid infiltrate and minor hepatocellular necrosis were present in almost all cases. Necroinflammatory activity was mild in nearly half of the cases. Steatosis was detected in 47.55% of the patients. Fibrosis and necroinflammation were more frequent in older patients. Non-specific granulomas were rarely encountered in association with hepatitis C

Effect of garlic on tumor invasion and metastatic potential in induced colon carcinogenesis in rats: histopathological and immunohistochemical study

Preventive intervention of colorectal cancer has become essential as a major portion of the population may develop the disease at some points during their lives. Diet and nutrition play an important role during this multi-step colon carcinogenic process. Inhibitory activity of garlic was tested on Dimethylhydrasin [DMH] induced colon carcinogenesis in Sprague-Dawley rats. Experimental study was done to investigate the mechanism of garlic action on occurrence of colon neoplasia and liver metastasis as well as the expression of cyclooxygenase-2 [COX-2], matrix metalloproteinase [MMP-2] and CD34 was analyzed in the colonic mucosa. On histopathological examination of colon and liver of the investigated animals, the first [normal control] as well as the fourth group [receiving garlic only] revealed no pathological lesions. In the 2nd group [taking DMH only], colon neoplasia was detected in 21/21 [100%] of animals and liver metastasis in 10/21 [47.6%] while, in the 3rd group [receiving DMH and garlic], the tumor occurrence was detected in 16/32 [50%] of animals with no liver metastasis. Following treatment with garlic, significant suppression of COX-2, MMP-2 expressions [p<0.01] was detected with respect to the carcinogen group. As regards angiogenesis in DMH treated animals, CD34 expression was mostly of grades III and IV compared to grades 1 and II in combined DMH and garlic treated group. It could be concluded that the observed modulatory influences of garlic at the level of suppression of COX-2, MMP-2 and CD34 during DMH induced colon carcinogenesis suggest that the dietary intake of garlic has a chemopreventive and inhibitory effects through the multi-step carcinogenesis

Analysis of four different methods for the detection of helicobacter pylori infection in patients with dyspepsia

Helicobacter pylori [H.pylori] is a major causative agent of chronic gastritis and peptic ulcer disease. Furthermore, H.pylori plays an important role in the pathogenesis of gastric cancer and gastric mucosa-associated lymphoid tissue [MALT] lymphoma. So the accurate diagnosis of the H.pylori infection is of clinical importance to compare the accuracy of four tests, including culture, histopathology, rapid urease test and serology for the diagnosis of H.pylori infection in patients with dyspepsia. National Hepatology and Tropical Medicine Research Institute. Prospective study. Sixty patients complaining of dyspepsia and undergoing upper endoscopy were included in the study, three antrum biopsy specimens were taken from each patient for rapid urease test, histopathological examination and culture. Blood samples were taken after endoscopic examination and sera were separated by centrifugation and stored at -70C until analyzed. A total of 60 patients were included in this study, 24 males and 36 females. Their age ranged from 23-65 years, histopathology was positive in 45 patients [75%]. Rapid urease test was positive in 36 patients [60%]. Culture was positive in 24 patients [40%] and Serology was positive in 45 patients [75%]. We found that If endoscopy was to be performed, a biopsy urease test was recommended as the test of first choice, with histology recommended only in negative cases. Culture is recommended in treatment-resistant cases to allow testing for antibiotic susceptibility. If endoscopy is not to be performed, serology is also an accurate test, but coupling it with testing of virulence strains is preferred to avoid unnecessary treatment

Ameliorative efficacy of a triple antioxidant combination of silymarin, selenium and vitamin E on thioacetamide induced liver cirrhosis in rats

This study was carried out to investigate the curative and protective efficacy of the triple antioxidant combination of silymarin, selenium [Se] and vitamin E [Vit.E] in thioacetamide-induced liver cirrhotic rats. Thioactamide [TAA] at a dose of 200 mg/kg, twice weekly, produced liver cirrhosis in rats as manifested by the significant [P<0.05] levation of hepatic marker enzymes and disturbances in antioxidant defense when compared with normal rats. Also, histopathologic evaluation of liver samples-demonstrated cirrhotic changes in TAA treated group. Oral administration of silymarin [20 mg/kg body weight], Se [10 micro mol/kg body weight] and vit. E in diet [1 g/kg diet] for 14 consecutive days, pre and post cirrhosis induction, significantly [P<0.05] decreased alanine and aspartate aminotransferase [ALT and AST, respectively], gamma-glutamyl transferase [GGT] and malondialdehyde [MDA] inthioacetamide treated rats. These ameliorative effects were more apparent in the post-treated group. The triple antioxidant also improved the activities of free radical detoxifying enzymes by increasing the activities of glutathione peroxidase [GSH-Px], glucose 6 phosphate dehydrogenase [G6P-DH], erythrocyte copper, zinc-superoxide dismutase [Cu, Zn-SOD] and the levels of reduced glutathione [GSH], plasma ceruloplasmin [Cp] and total protein in thioacetamide treated rats. A conclusion was made that the triple antioxidant induced marked improvement of biochemical and histopathological liver changes caused by thioactamide induction. Also, the results indicated that the potential therapeutic action of the triple antioxidant against TAA induction was more effective than its curative action