Relationship between long-term use of proton pump inhibitor (PPI) and hypomagnesemia in patients with gastroesophageal reflux disease.

BACKGROUND: The aim of this study was to evaluate the relationship between the long-term use of PPI and hypomagnesemia in patients with gastroesophageal reflux disease. METHODS: This case control study was conducted on GERD patients with long-term use of proton pump inhibitor and patients with no history of gastroesophageal reflux and proton pump inhibitor referring to gastrointestinal clinic in 2019. Then concentration of serum magnesium (Mg) and potassium (K) were measured using atomic absorption spectrophotometer according to protocol. Other data were extracted from medical records. Statistical tests such as t-test, chi-square test and ONE WAY ANOVA were used for analysis of data. RESULTS: In the current study, 263 patients were classified into two groups (case: 132, control: 131). The mean level of potassium in case and control groups was 3.92±0.64 and 4.20±0.43, respectively (P=0.001). Moreover, the mean level of Mg in two groups was 2.03±0.36 and 2.09±0.52, respectively (P=0.24). In addition, significant difference was seen between serum level of K, regarding the type of proton pump inhibitor and duration of medication use (p<0.01). However, no significant difference was seen between serum levels of Mg, regarding the type of proton pump inhibitor such as omeprazole, pantoprazole and other drugs (p>0.05). CONCLUSION: Based on these results, long-term use of proton pump inhibitors is not associated with hypomagnesemia in GERD patients. However, long-term use of PPIs may reduce serum potassium levels in these patients. Therefore, periodic evaluation of serum Mg level in PPI-treated patients seems to be unnecessary.

Selective immunoglobulin M deficiency in a patient with celiac disease and recurrent pneumonia.

SIgMD is a rare immune disorder that occurs in a primary or secondary condition. Patients with recurrent infectious, cancers, and autoimmune disorders should be investigated to determine SIgMD.

Comparing the Efficacy of Sequential and Standard Quadruple Therapy for Eradication of H. Pylori Infection.

BACKGROUND: The aim of this study was comparison the effectiveness of sequential and standard quadruple therapy on eradication of H. pylori infection. METHODS: This clinical trial study was conducted on 160 patients with dyspepsia or gastroduodenal ulcer. Patients were randomly divided into two groups. Group A (standard regimen) received omeprazole, amoxicillin, clarithromycin and bismuth subcitrate for 2 weeks. Group B (sequential regimen) received omeprazole and amoxicillin in 5 days and omeprazole, tinidazole and levofloxacin in 5 days. After the end of treatment regimens, 20 mg omeprazole was administered twice daily for 3 weeks. H. pylori eradication was assessed 2 months after antibiotic treatment via fecal antigen. RESULTS: Frequency of H. pylori eradication in group A and B was observed in 55 (68.8%) and 63 patients (78.8%), respectively. No significant difference was seen between two groups, regarding H. pylori eradication (p = 0.15). The most common side effects in group A, B were bitterness of mouth (63.8%) and nausea (16.2%), respectively (p H. pylori infection, higher rate of H. pylori eradication was seen in group B than group A. Thus, sequential regimen was a more appropriate regimen with fewer complications.

The Comparison of Levofloxacin- and Clarithromycin-Based Bismuth Quadruple Therapy Regimens in Helicobacter pylori Eradication.

OBJECTIVE: The aim of the current study was to compare the efficacy of quadruple therapy including levofloxacin and clarithromycin for Helicobacter pylori eradication. METHODS: This clinical trial study was conducted on 189 patients with H. pylori infection who underwent gastroscopy and stomach biopsy in Shahid Beheshti Hospital, Kashan, Iran. After classification of patients, one group was treated with bismuth subcitrate (120 mg, 2 tablet/12 h), omeprazole (20 mg/12 h), amoxicillin (1 g/12 h), and clarithromycin (500 mg/12 h) and other group with bismuth subcitrate (120 mg, 2 tablet/12 h), omeprazole (20 mg/12h), amoxicillin (1 g/12 h), and levofloxacin (500 mg/12 h) for 2 weeks. After the end of the antibiotic treatment, omeprazole therapy was continued for 4 weeks. Two weeks after discontinuation of omeprazole, fecal antigen test was performed for both the groups to confirm the eradication of H. pylori infection. FINDINGS: The success of H. pylori eradication in the levofloxacin and clarithromycin groups was observed in 78 (89.7%) and 71 (69.6%) patients, respectively (P < 0.01). A significant difference was also seen between the two groups in terms of side effects and its incidence (P < 0.01), so that the incidence of side effect types in the clarithromycin group was more than the levofloxacin group except muscular pain and fatigue (P < 0.01). CONCLUSION: Levofloxacin-based quadruple regimen therapy was superior to clarithromycin-based quadruple regimens regarding H. pylori eradication and side effects. Therefore, the levofloxacin-based regimen can be considered as an effective treatment for the first-line anti-H. pylori therapy.

The Correlation between the Numerical Status of Th22 Cells and Serum Level of IL-22 with Severity of Ulcerative Colitis.

Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease, yet its etiology as well as pathogenesis remain poorly understood. There is increasing evidence that aberrant expression of CD4+T lymphocytes plays an essential role in the progression of different pathologies such as UC. This study aimed to evaluate the circulatory frequency of T-helper 22 (Th22), a subset of CD4+ T cells, and serum level of its signature cytokine, IL-22, in patients with UC. Blood samples from 30 patients with UC and 30 controls (n=30) were tested for IL-22 level and circulatory Th22-cell count by ELISA and Flow cytometric analysis, respectively. Our results revealed higher serum level of IL-22 as well as circulatory frequency of Th22 cells in patients with UC compared to those in healthy controls. Notably, effective factors on severity of the disease were age, Th22, IL-22, ESR and CRP. We conclude that elevated circulating Th22 cells and their signature cytokine, IL-22, may be implicated in the pathogenesis of UC. These findings may provide preliminary experimental clues for the development of new therapies for UC and its severity judgment.

Comparison of gastric juice soluble triggering receptor expressed on myeloid cells and C-reactive protein for detection of Helicobacter pylori infection.

BACKGROUND AND AIM: Triggering receptor expressed on myeloid cells (TREM-1) is a receptor on phagocytes that is triggered by infectious agents. The soluble form of it (sTREM-1) can be elevated in gastric juice by Helicobacter pylori (H. pylori) infection of gastric mucosa. The aim of this study was to compare the diagnostic values of sTREM-1 and C-reactive protein (CRP) for detection of H. pylori infection in gastric mucosa. METHODS: In this diagnostic accuracy study on cases who underwent endoscopy from March 2015 to July 2016 in Shahid Beheshti Hospital, Kashan, Iran, gastric juice sTREM-1 and CRP concentrations were measured by enzyme-linked immunosorbent assays (ELISA) and their diagnostic values were compared to detect H. pylori infection. Gold standard test was histopathology. Data were entered into SPSS software version 16. Statistical analysis was made by Kolmogorov-Smirnov, Chi-square, Independent-samples t-test, Kruskal-Wallis, Mann-Whitney U, Pearson product-moment correlation, Receiver operating characteristic curve (ROC), Brier score, Nagelkerke R square and scaled reliability test. RESULTS: Of a total of 160 cases, 81 (50.6%) were H. pylori-positive based on pathology. The level of sTREM-1 in H. pylori-positive patients was significantly higher than H. pylori-negative patients (p=0.000), but no significant difference between CRP concentrations was shown between groups (p=0.7). Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and accuracy of sTREM-1 were 82%, 75%, 3.3, 0.25, 78% and for CRP were 62%, 40%, 1.02, 0.98, 51% respectively for diagnosis of H. pylori infection. True positive and negative rates were 66 (81.5%) and 59 (74.7%) for sTREM-1 and 50 (61.7%) and 31 (39.2%) for CRP. The levels of sTREM-1 and CRP were not significantly different between endoscopic finding groups (p=0.97, p=0.2 respectively). CONCLUSION: Despite CRP, sTREM-1 was a relatively acceptable indicator of H. pylori infection of gastric mucosa.

Comparison of the serum and salivary antibodies to detect gastric Helicobacter pylori infection in Kashan (Iran).

BACKGROUND AND AIM: Helicobacter pylori (H. pylori) is an important and common contagious human pathogen which may cause peptic ulcer and also gastric cancer. The definite diagnosis of it is made through invasive tests. Recently, non-invasive tests including serologic tests of serum and saliva have been conducted for diagnosis of H. pylori infection. In this research, the diagnostic values of serum and salivary serology were compared together to use salivary anti-H. pylori test as an alternative method in the future. METHODS: During this prospective case-control study on patients who were candidates for endoscopy and gastric biopsy from March 2015 to April 2016 in Shahid Beheshti hospital, Kashan, Iran, serum and salivary samples were obtained for measurement of Immunoglobulin G (IgG) antibody levels against H. pylori by enzyme-linked immunosorbent assay (ELISA). Histopathology was the gold standard test. Statistical analysis was performed by SPSS software version 16. Statistical tests included Kolmogorov-Smirnov, independent-samples t-test, Chi-square, Mann-Whitney U, Kruskal-Wallis, McNemar and correlation. RESULTS: Of 123 patients, sixty-one patients (49.6%) were H. pylori-positive according to histology. The median levels of anti-H. pylori antibodies in serum (p<0.001) and saliva (p<0.001) of H. pylori-positive cases were significantly higher than H. pylori-negative cases. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and accuracy of serologic tests in serum were 75%, 79%, 3.5, 0.3, 77% and for saliva were 85%, 82%, 4.7, 0.18, 84% respectively. CONCLUSION: Diagnostic values of salivary ELISA are comparable to serum ELISA and can be used as an alternative modality for diagnosis of H. pylori infection.