Sociodemographic characteristics and clinical risk factors of Helicobacter pylori infection and antibiotic resistance in the Eastern Black Sea region of Turkey.

BACKGROUND/AIMS: The aim of this study was to assess the clinical and sociodemographic risk factors of Helicobacter pylori infection and antibiotic resistance in the eastern Black Sea region of Turkey. MATERIALS AND METHODS: In total, 344 patients with dyspeptic symptoms who completed an extended questionnaire were enrolled in the study. Diagnosis of H. pylori infection was made by rapid urease test, histopathological investigation, and culture. Susceptibility of H. pylori strains was assessed by agar dilution (amoxicillin, tetracycline, metronidazole, levofloxacin) and E-test (clarithromycin) methods. RESULTS: The H. pylori positivity rate was 40.4% (139/344). Logistic regression analysis indicated that age and the presence of duodenal ulcer were independent risk factors associated with H. pylori positivity (odds ratio (OR): 0.96, 95% CI: 0.93-0.99, p=0.013; OR: 5.42, 95% CI: 1.96-14.98, p=0.001, respectively). Of 104 H. pylori-positive cultures, 43 strains (41%) were susceptible to all antibiotics, whereas 61 (59%) were resistant to at least one antibiotic. H. pylori resistance rates were 34% for levofloxacin, 31.1% for metronidazole, 28.2% for clarithromycin, 2.9% for amoxicillin, and 1% for tetracycline. Logistic regression analysis indicated that previous use of clarithromycin was the only independent risk factor for H. pylori resistance (OR: 6.25, 95% CI: 1.59-24.52, p=0.009). CONCLUSION: An understanding of the risk factors for H. pylori positivity and antibiotic resistance in an extended anamnesis may affect treatment choice and facilitate H. pylori eradication. In regions where antibiotic resistance rates are elevated, performing antibiotic susceptibility tests may lead to effective eradication treatment.

Inflammatory cytokine gene polymorphism profiles in Turkish patients with ulcerative colitis.

AIM: To investigate IL-1α, IL-1ß, IL-1R , IL-4RA, TGF-ß, TNF-α and IFN-γ, genes polymorphism in Turkish patients with ucerative colitis (UC). METHODS: An analysis was carried out at Trabzon Karadeniz Technical University Medicine Faculty Gastroenterology polyclinics between March 2005 and May 2011 on 51 patient with UC (cases) and 100 healthy individuals (controls). PCR-SSP and cytokine gene panel (Helderberg kits) based techniques for analysis of gene polymorphisms were used. RESULTS: Changes in allelic frequencies of each of the investigated eight cytokine genes polymorphisms in patient with ulcerative colitis were found. Among the allelic genes analyzed here, the highest statistically significant change was observed in the position TNF-α -308 G/A (339.7%). The following increases were observed in IL-IR mspa T/C variation (179.4%), IFN-γ 5644A/T variation (77.4%), and in IL-1ß -511T/C SNPs (35.9% ). In other analyzed genes, allelic changes were found to be decreasing for TGF- ß codon10C / T (-71.9%), IL4RA + 1902G / A (-47.3 %), and for IL- 1α -889T / C (-37.7%). The lowest negative change (-25.9%) was observed in the allele frequency in IL- 1ß 3962T / C (p les than 0.000). In addition, there were changes in genotypic frequencies investigated seven gene polymophic site and only one of cytokine gene IL-1ß 3962TT/TC/CC was not changed. CONCLUSION: Genes polymorphism is not itself the only determining factor for clinical diagnoses. However, it can be used in the clinical diagnosis of UC in order to determine the low level or high level variations in cytokine gene polymorphisms.

Esomeprazole in acute and maintenance treatment of reflux oesophagitis: a multicentre prospective study.

INTRODUCTION: The aim of this study was to assess the efficacy and safety of esomeprazole 40 mg once daily (q.d.) in healing reflux oesophagitis at 4 and 8 weeks, and the efficacy of esomeprazole 20 mg q.d. for 12 weeks in the maintenance of remission. METHODS: A total of 235 patients with endoscopically proven reflux oesophagitis were enrolled in this study, which consisted of two phases (healing and maintenance therapy). Patients who showed complete endoscopic and symptomatic healing at the end of 4 or 8 weeks were switched to maintenance treatment with esomeprazole 20 mg q.d. for 12 weeks. The primary efficacy endpoint was healing of reflux oesophagitis at week 8. Secondary assessments included the proportion of patients with symptomatic relapse in the maintenance phase. RESULTS: At the end of week 8, 88% (95% life-table confidence intervals [CI]: 84%, 92%) of patients were healed endoscopically and 90.6% of the patients were asymptomatic. Patient age, gender and Helicobacter pylori status had no effect on the efficacy of treatment. During the 12-week maintenance treatment phase, symptomatic relapse ratios were 0.5%, 2.2%, and 0%, for the first, second, and third 4-week periods, respectively. The proportions of patients satisfied with treatment were 95% and 99.4% at the end of acute and maintenance treatment, respectively. The most common adverse effects were headache, upper respiratory tract infection and abdominal pain. CONCLUSIONS: Esomeprazole is effective in the healing of reflux oesophagitis, the resolution of heartburn, and in maintaining symptomatic remission. The effectiveness of esomeprazole in patients with gastroesophageal reflux disease is not affected by the presence of H. pylori.

Hepatoid adenocarcinoma of the stomach: report of five cases and review of the literature.

We report on a rare hepatoid adenocarcinoma of the stomach producing alpha-fetoprotein (AFP) in five cases. Definitive features included an aggressive, invasive, and rapidly progressing neoplasm showing areas morphologically comparable to those of hepatocellular carcinomas. All patients had multiple metastases to lymph nodes and/or liver. The serum AFP level of the patients was between 83-87.900 ng/ml. Two subtotal and one palliative gastrectomy was performed. A short duration of chemotherapy was administered only in two patients. The length of survival averaged 4.7 months. Our experience together with what has been reported in literature suggest that the course of hepatoid adenocarcinoma of the stomach is more aggressive than an ordinary adenocarcinoma and that from a diagnostic point of view distinction from an adenocarcinoma may be accomplished histochemically and by measuring serum AFP levels.

Evaluation of a new rapid lateral flow chromatography test for the diagnosis of Helicobacter pylori.

OBJECTIVE: The rapid, simple and non-invasive diagnosis of Helicobacter pylori (H. pylori) infection is important in implementing chemotherapy in appropriate manner, and in assessing persistent H. pylori infection after eradication therapy. The ImmunoCard STAT! HpSA kit (Meridian Bioscience, Europe) is a lateral flow chromatography test which utilizes a monoclonal anti-H. pylori antibody. In this study, we investigated the usefulness of the ImmunoCard STAT! HpSA test before and after eradication therapy on patients referred to undergo upper gastrointestinal endoscopy. METHODS: Sixty-five consecutive patients who were referred to undergo upper gastrointestinal endoscopy at the Department of Gastroenterology, Karadeniz Technical University Medical School, Turkey between February and August 2005 were included in this study. The ImmunoCard STAT! HpSA was compared with 4 invasive tests (histology, gram staining, rapid urease test, and culture). The reference method was defined as positive when 2 of the 4 invasive tests were positive. A negative H. pylori status was considered when all 4 tests present concordant negative results. RESULTS: Overall, the ImmunoCard STAT! HpSA test had 77.8% sensitivity, 79.3% specificity, 82.4% positive predictive value (PPV) and 74.2% negative predictive value (NPV) in all patients. With regard to pre-treatment values, the sensitivity was 70.6%, specificity 70.6%, PPV 100% and NPV 100% while on post-treatment group the sensitivity was 84.2%, specificity 64.7%, PPV 72.7% and NPV 78.6%. CONCLUSION: Our results indicate that the ImmunoCard STAT! HpSA test is a rapid, simple, and helpful procedure not only to determine H. pylori infection but also to assess the success of eradication therapy.

Induction of apoptosis and inhibition of growth of human hepatoma HepG2 cells by heparin.

BACKGROUND/AIMS: Apoptotic and anti-proliferative effects of heparin on a number of cancers have been described. There have been no studies analyzing the effect of heparin on human hepatoma cells. The aim of this study was to investigate the effect of heparin on human hepatoma cell line, HepG2. METHODOLOGY: HepG2 cell line was cultured with different concentrations of heparin. Colony count, viability assay, percentage of the apoptosis and proliferative index were assessed at the end of the 7th day. Trypan blue was used to assess viability. Apoptosis and proliferative indexes were assessed by flow-cytometry. RESULTS: Hepatoma cells were arrested at the G0/G1 phase with heparin incubation and proliferative indexes decreased significantly in 20, 40 and 80 U/mL of heparin concentrations in comparison with the control (36 +/- 1%, 30 +/- 5% and 29 +/- 8% vs. 44 +/- 1%, p < 0.01). Flow cytometry revealed a statistically significant increase in apoptosis in groups incubated with 40 and 80 U/mL of heparin in comparison with the control (39 +/- 26% and 58 +/- 18% vs. 0.83 +/- 1.3%, p < 0.01). Colony counts per well and viable cells per microL decreased significantly in 80 U/mL of heparin. CONCLUSIONS: Heparin leads to a significant anti-proliferative and an apoptotic effect on human hepatoma cells in vitro.

Nimesulide-induced fulminant hepatitis.

An 18-year-old boy was brought to the hospital with jaundice, confusion, abdominal discomfort and distension. He had a history of oral intake of nimesulide for three days. Clinical and laboratory findings were compatible with fulminant hepatitis. Exclusion of other causes of liver injury strongly favored drug-induced toxicity. All of the signs, symptoms and laboratory abnormalities returned to normal after cessation of the nimesulide and supportive treatment, and he was discharged on the 15th day after admission. This case differs from the other cases in the literature regarding the time of onset, and indicates that nimesulide may induce fulminant hepatitis in the first few days of administration. Therefore, patients receiving nimesulide should be frequently monitored with serial serum transaminases, beginning from the first week of intake.

Early medical treatment is life saving in acute Budd-Chiari due to polycythemia vera.

Here we describe two women with polycythemia vera presented with fulminant hepatic failure due to acute Budd-Chiari syndrome. Both had a history of severe abdominal pain and distention of short duration. Clinical and laboratory findings showed fulminant hepatic failure due to acute Budd-Chiari syndrome. Diagnosis was confirmed with abdominal ultrasonography and Doppler ultrasonography showing ascites, hepatomegaly, portal hypertension and total occlusion of hepatic veins. Complete blood count and other clinical findings were compatible with polycythemia vera in both patients. Patients were treated successfully with early administration of continuous heparin infusion, repeated phlebotomies and hydroxyurea. We emphasize here early diagnosis and effective treatment in such fulminant cases may be life saving.

Effects of losartan, somatostatin and losartan plus somatostatin on portal hemodynamics and renal functions in cirrhosis.

BACKGROUND/AIMS: Several drugs have been used to reduce portal hypertension. Losartan constitutes arteriolar and venous vasodilation by inhibiting the effects of the increased angiotensin II in cirrhotic patients. In this study, we analyzed the effects of losartan, when used alone and when combined with somatostatin, on portal and renal hemodynamics. METHODOLOGY: Seventeen patients with cirrhosis were enrolled. During the study, the patients were administered 250 micrograms of somatostatin i.v. bolus and subsequent infusion at a rate of 250 micrograms/hr for 2 hours on the second day; 25 mg losartan orally on the fourth day; and losartan and somatostatin together, in the same doses as the second and the fourth day, were given on the sixth day. RESULTS: The portal flow volume and the velocity that were measured after the administration of somatostatin, losartan and the combination of each drug, were found to be increased when compared with the initial values (P < 0.001). Additionally, the creatinine clearances were increased and statistically significant with somatostatin. CONCLUSIONS: Considering its low cost, easy usability, long lasting effect, we suggest that losartan can be used as an alternative treatment in the clinical conditions where portal pressure should be reduced and can be combined with somatostatin without any significant adverse effects.