Evaluation of trefoil factor 3 as a non-invasive biomarker of gastric intestinal metaplasia and gastric cancer in a high-risk population.

BACKGROUND: Adenocarcinoma is preceded by chronic atrophic gastritis, gastric intestinal metaplasia and dysplasia. Trefoil factor 3 (TFF3) is a peptide secreted by goblet cells, which is abundantly present in intestinal metaplasia. AIM: To evaluate the utility of serum TFF3 as a non-invasive biomarker for the diagnosis of intestinal metaplasia and gastric cancer. METHODS: Single-center, cross-sectional study of 274 patients who consecutively underwent upper gastrointestinal endoscopy with gastric biopsies (updated Sydney system). TFF3 levels were measured in serum by a commercial ELISA kit. Patients with normal histology or chronic atrophic gastritis without intestinal metaplasia comprised the control group. In addition, 14 patients with invasive gastric cancer were included as a reference group. The association between TFF3 levels and intestinal metaplasia was assessed by logistic regression. RESULTS: Patients with intestinal metaplasia (n=110) had a higher median TFF3 level as compared to controls (n=164), 13.1 vs. 11.9ng/mL, respectively (p=0.024). Multivariable logistic regression showed a no significant association between TFF3 levels and intestinal metaplasia (OR=1.20; 95%CI: 0.87-1.65; p-trend=0.273). The gastric cancer group had a median TFF3 level of 20.5ng/mL, and a significant association was found (OR=3.26; 95%CI: 1.29-8.27; p-trend=0.013). CONCLUSION: Serum levels of TFF3 do not discriminate intestinal metaplasia in this high-risk Latin American population. Nevertheless, we confirmed an association between TFF3 levels and invasive gastric cancer.

Treatment with Melatonin Improves Cognitive Behavior and Motor Skills in a Rat Model of Liver Fibrosis.

INTRODUCTION AND AIM: Patients with liver cirrhosis (LC) and minimal hepatic encephalopaty have a higher accident rate. LC impairs the normal sleep-awake cycle and produces disturbances in behavior, cognition and motor skills. Abnormal melatonin (MT) levels have also been identified in LC. Administration of MT may regulate circadian rhythms and prevent the oxidative damage. We studied the effects of MT on spatial memory acquisition (SMA) and motor skills in a liver fibrosis model (LF)s. MATERIALS AND METHODS: Forty-five rats, divided into 4 groups. [G1: LF; G2: LF + MT; G3: MT; G4: Healthy control (HC)]. LF was induced by carbon tetrachloride intraperitoneal injection (0.2 mL/kg) for 5 months. MT was administered during 5 weeks (0.4 mg/kg/day). SMA was evaluated by using the Morris Water Maze protocol where the escape latency (EL) and mean speed were measured. Data were registered by SMART®. RESULTS: The EL measurement analyzed by two way ANOVA: cirrhosis presented a higher EL than controls or those treated with MT suggesting impaired memory acquisition which is rescued by MT treatment. The mean speed analysis revealed that LF presented higher speed than LF+MT or HC, suggesting that LF affects motor skills, which are improved by MT. To discard whether EL is affected by altered motor skills in LF treated with MT, we compared the average EL and speed between days 2 and 6 of the training protocol. Speed was not improved during the trials unlike EL, suggesting that memory acquisition is independent of motor skills. CONCLUSION: These findings suggest that MT improves cognition and motor skills in the LF model.

[Frequency of CagA-positive Helicobacter pylori strains in 160 patients subjected to endoscopy]. / Prevalencia de cepas cagA-positivo en la región de Coquimbo, determinada mediante nested-qPCR en muestras fecales.

BACKGROUND: Helicobacter pylori is the most significant pathogen associated with gastric diseases, including gastric cancer. Infected patients with strains that are CagA-positive generally have worse outcomes than those infected with CagA-negative strains. Patients infected with CagA-positive strains have a higher risk for developing gastric cancer. AIM: To determine the prevalence of CagA-positive H. pylori strains in fecal samples of patients from the Coquimbo Region of Chile, using a non-invasive, nested-qPCR method. MATERIAL AND METHODS: We evaluated 160 patients with gastrointestinal symptoms subjected to an upper gastrointestinal endoscopy. DNA was extracted from fecal samples and tested for the presence of H. pylori using nested-qPCR for the ureC gene, and subsequently compared with the results of histology-Giemsa stain from the patients' endoscopic biopsies. When H. pylori was found, the presence of CagA-positive strains was determined via nested-qPCR. RESULTS: The histology-Giemsa stain was positive for H. pylori infection in 123 patients (76.9%), while the analysis of fecal samples detected H. pylori in 129 patients (80.6%). The sensitivity and specificity of nested-qPCR to detect the bacterium was 96.7 and 73.0% respectively. Among patients with the infection, 25% had CagA-positive strains. CONCLUSIONS: In this sample of patients, there is a low prevalence of CagA-positive H. pylori strains.

Non-invasive Diagnostic of Helicobacter pylori in Stools by Nested-qPCR.

The aim of this study was to develop a non-invasive diagnostic test for the detection of Helicobacter pylori in stool samples from digestive symptomatic patients, using a new protocol of nested-qPCR. A total of 143 patients were invited to participate in the study. A gastric biopsy of each patient was collected for Rapid Urease Testing (RUT) and histology by Giemsa stain. A fecal sample for nested-qPCR analysis was also obtained. DNA was extracted from the fecal samples, and conventional PCR followed by qPCR of the ureC gene of H. pylori was carried out. We evaluated the presence of H. pylori, in 103 females and 40 males, mean (± SD) age of 56.5 ± 14.18. The sensitivity of RUT to detect the infection was 67.0% (95% C.I.: 57.2 - 75.8) and specificity was 92.3% (95% C.I.: 76.5 - 99.1). Histology by Giemsa stain, commonly used as a reference for H. pylori detection, showed a sensitivity of 98.6% (95% C.I.: 92.5 - 100.0) and a specificity of 89.7% (95% C.I.: 72.7 - 97.8). In contrast, detection of H. pylori infection in stools by nested-qPCR showed a sensitivity of 100% (95% C.I.: 94.9 - 100.0) and a specificity of 83.9% (95% C.I.: 66.3 - 94.6). Our test, based in nested-qPCR is a better diagnostic alternative than conventional RUT, and is similar to histology by Giemsa stain in the detection of H. pylori, by which the test could be used for non-invasive diagnosis in clinical practice.

Prevalencia de cepas cagA-positivo en la región de Coquimbo, determinada mediante nested-qPCR en muestras fecales / Frequency of CagA-positive Helicobacter pylori strains in 160 patients subjected to endoscopy

Background: Helicobacter pylori is the most significant pathogen associated with gastric diseases, including gastric cancer. Infected patients with strains that are CagA-positive generally have worse outcomes than those infected with CagA-negative strains. Patients infected with CagA-positive strains have a higher risk for developing gastric cancer. Aim: To determine the prevalence of CagA-positive H. pylori strains in fecal samples of patients from the Coquimbo Region of Chile, using a non-invasive, nested-qPCR method. Material and Methods: We evaluated 160 patients with gastrointestinal symptoms subjected to an upper gastrointestinal endoscopy. DNA was extracted from fecal samples and tested for the presence of H. pylori using nested-qPCR for the ureC gene, and subsequently compared with the results of histology-Giemsa stain from the patients' endoscopic biopsies. When H. pylori was found, the presence of CagA-positive strains was determined via nested-qPCR. Results: The histology-Giemsa stain was positive for H. pylori infection in 123 patients (76.9%), while the analysis of fecal samples detected H. pylori in 129 patients (80.6%). The sensitivity and specificity of nested-qPCR to detect the bacterium was 96.7 and 73.0% respectively. Among patients with the infection, 25% had CagA-positive strains. Conclusions: In this sample of patients, there is a low prevalence of CagA-positive H. pylori strains.

[Assessment of the fulfillment of paracentesis in cirrotic patients admited in two services of internal medicine in hospitals of median complexity]. / Evaluación de la realización de paracentesis en pacientes cirróticos ingresados a dos servicios de medicina interna de hospitales mediana complejidad.

UNLABELLED: The Spontaneous Bacterial Peritonitis (SBP) is a severe complication of cirrhosis. The prognosis depends on the time of initiation of therapy that is required for early diagnosis. OBJECTIVE: To evaluate the performance of diagnostic paracentesis (DP) in cirrhotic patients with ascites during hospitalization. MATERIALS AND METHODS: An observational, analytical, prospective, study conducted during October 2009 to June 2010. RESULTS: There were 92 income, average age was 60.3 years (SD 11.7), corresponding to 57.6% men, the most common etiology of CH was alcohol (48.9%). There were 40 PD (43.5%), of which 35% positive SBP. Of the DP, 47.5% were performed on admission and / or submission of warning signs. The average period of hospitalization was higher in those who underwent late DP. The MELD score both at admission and discharge was significantlyhigher in patients on admission punctured. CONCLUSION: DP was done in less than half of hospitalized cirrhotic, and its timely completion only 1 in 5 of revenues. The DP perform at the right time reduces hospital days.

Increased expression of P2RY2, CD248 and EphB1 in gastric cancers from Chilean patients.

BACKGROUND: Gastric cancer (GC) ranks as one of the major causes of mortality due to cancer worldwide. In Chile, it is currently the leading cause of cancer death. Identification of novel molecular markers that may help to improve disease diagnosis at early stages is imperative. MATERIALS AND METHODS: Using whole-genome DNA microarrays we determined differential mRNA levels in fresh human GC samples compared to adjacent healthy mucosa from the same patients. Genes significantly overexpressed in GC were validated by RT-PCR in a group of 14 GC cases. RESULTS: The genes CD248, NSD1, RAB17, ABCG8, Ephb1 and P2RY2 were detected as the top overexpressed in GC biopsies. P2RY2, Ephb1 and CD248 showed the best sensitivity for GC detection with values of 92.9%, 85.7% and 64.3% (p<0.05), respectively. Specificity was 85.7%, 71.4% and 71.4% (p<0.05), for each respectively.

Evaluación de la realización de paracentesis en pacientes cirróticos ingresados a dos servicios de medicina interna de hospitales mediana complejidad / Assessment of the fulfillment of paracentesis in cirrotic patients admited in two services of internal medicine in hospitals of median complexity

La peritonitis bacteriana espontánea (PBE) es una complicación severa de la cirrosis hepática (CH). Su pronóstico depende del momento de inicio de la terapia para lo que se requiere un diagnóstico oportuno. Objetivo: Evaluar la realización de paracentesis diagnóstica (PD) en cirróticos con ascitis durante su hospitalización. Materiales y métodos: Estudio observacional, analítico y prospectivo, realizado en un período de 11 meses consecutivos. Resultados: Se registraron 92 ingresos, el promedio de edad fue de 60,3 años (DE 11,7), correspondiendo un 57,6% a hombres, la etiología de CH más frecuente fue alcohólica (48,9%). Se realizaron 40 PD (43,5%), de ellas 35% con PBE positiva. Del total de PD, un 47,5% se efectuaron al ingreso y/o al presentar signos de alarma. El promedio de días de hospitalización fue mayor en aquellos en que se realizó la PD tardíamente. El MELD (Model for the End stage Liver Disease) tanto al ingreso como egreso es significativamente mayor en los pacientes puncionados al ingreso. Conclusión: Se realiza PD en menos de la mitad de los cirróticos hospitalizados, siendo su realización oportuna solo en 1 de cada 5 de los ingresos. El realizar PD en el momento adecuado disminuye los días de hospitalización y morbimortalidad.

The Spontaneous Bacterial Peritonitis (SBP) is a severe complication of cirrhosis. The prognosis depends on the time of initiation of therapy that is required for early diagnosis. Objective: To evaluate the performance of diagnostic paracentesis (DP) in cirrhotic patients with ascites during hospitalization. Materials and methods: An observational, analytical, prospective, study conducted during October 2009 to June 2010. Results: There were 92 income, average age was 60.3 years (SD 11.7), corresponding to 57.6% men, the most common etiology of CH was alcohol (48.9%). There were 40 PD (43.5%), of which 35% positive SBP. Of the DP, 47.5% were performed on admission and / or submission of warning signs. The average period of hospitalization was higher in those who underwent late DP. The MELD score both at admission and discharge was significantly higher in patients on admission punctured. Conclusion: DP was done in less than half of hospitalized cirrhotic, and its timely completion only 1 in 5 of revenues. The DP perform at the right time reduces hospital days.

[A screening program for colorectal cancer in Chilean subjects aged fifty years or more]. / Programa de detección de neoplasias colorrectales en población mayor de 50 años.

BACKGROUND: Mortality from colorectal cancer (CCR) in Chile has nearly doubled over the past 15 years. International studies have shown that CCR screening programs based on fecal occult blood test (FOBT) reduce CCR mortality. AIM: To analyze the results from a CCR screening model in people over 50 years. MATERIAL AND METHODS: Between 2007 and 2009, a prospective multicenter study was performed in seven major Chilean cities. FOBT using an immunological method, was measured in asymptomatic subjects aged 50 years or more, without risk factors. In patients with a positive FOBT, with symptoms or with family risk factors, a colonoscopy was indicated. RESULTS: A total of 6348 subjects were assessed, FOBT was performed in 4938 of them, with a compliance of 77%. The result was positive in 9.6%. A total of 2359 colonoscopies were ordered, with an overall compliance of 50.1%. Of the 1184 colonoscopies performed, adenomas and high risk adenomas were found in 304 (26%) and 75 (6%) patients, respectively. Thirteen patients were diagnosed with stage I and IICCR. Three of these lesions were excised endoscopically and 10 surgically. The detection rate of polyps, high risk adenomas and cancer was 75, 12 and 2 per 1000 screened individuals, respectively. CONCLUSIONS: This program allowed the early detection of an important number of high risk colon lesions, and all patients with CCR were diagnosed at early stages.

Programa de detección de neoplasias colorrectales en población mayor de 50 años / A screening program for colorectal cancer in Chilean subjects aged fifty years or more

Background: Mortality from colorectal cancer (CCR) in Chile has nearly doubled over the past 15 years. International studies have shown that CCR screening programs based on fecal occult blood test (FOBT) reduce CCR mortality. Aim: To analyze the results from a CCR screening model in people over 50 years. Material and Methods: Between 2007 and 2009, a prospective multicenter study was performed in seven major Chilean cities. FOBT using an immunological method, was measured in asymptomatic subjects aged 50 years or more, without risk factors. In patients with a positive FOBT, with symptoms or with family risk factors, a colonoscopy was indicated. Results: A total of 6348 subjects were assessed, FOBT was performed in 4938 of them, with a compliance of 77%. The result was positive in 9.6%. A total of 2359 colonoscopies were ordered, with an overall compliance of 50.1%. Of the 1184 colonoscopies performed, adenomas and high risk adenomas were found in 304 (26%) and 75 (6%) patients, respectively. Thirteen patients were diagnosed with stage I and IICCR. Three of these lesions were excised endoscopically and 10 surgically. The detection rate of polyps, high risk adenomas and cancer was 75, 12 and 2 per 1000 screened individuals, respectively. Conclusions: This program allowed the early detection of an important number of high risk colon lesions, and all patients with CCR were diagnosed at early stages.