Helicobacter pylori-derived outer membrane vesicles stimulate interleukin 8 secretion through nuclear factor kappa B activation.

BACKGROUND/AIMS: Bacteria-derived outer membrane vesicles (OMVs) are commonly associated with various biological activities and functions. Helicobacter pylori-derived OMVs are thought to contribute to pathogenesis. This study aimed to investigate the effects of H. pylori-derived OMVs. METHODS: H. pylori strains were isolated from patients with gastritis, gastric ulcer, or gastric cancer using endoscopic biopsy. The U-937, AGS, and MKN-45 cell lines were exposed to H. pylori and H. pylori-derived OMVs. The expression of interleukin 8 (IL-8) messenger RNA (mRNA) was assessed using reverse transcription-polymerase chain reaction (RT-PCR) and real-time RT-PCR, and IL-8 secretion was analyzed using enzyme-linked immunosorbent assay. Nuclear factor kappa B (NF-κB) activation was evaluated by Western blotting. RESULTS: H. pylori and H. pylori-derived OMVs induced the expression of IL-8 mRNA and protein. Importantly, the bacteria induced higher IL-8 mRNA and protein expression than the OMVs. IL-8 expression was induced to different levels in response to H. pylori-derived OMVs from hosts with different gastric diseases. Western blotting revealed the increased phosphorylation and reduced degradation of inhibitor of NF-κB alpha in cells exposed to OMVs. CONCLUSION: H. pylori-derived OMVs may aid the development of various gastric diseases by inducing IL-8 production and NF-κB activation.

The Fatty Liver Index: A Simple and Accurate Predictor of Colorectal Adenoma in an Average-Risk Population.

BACKGROUND: Nonalcoholic fatty liver disease, the hepatic manifestation of metabolic syndrome, is associated with increased risk of colorectal adenoma, a precursor of colorectal cancer. Because nonalcoholic fatty liver disease and colorectal adenoma share many common risk factors of metabolic syndrome, the association between these 2 pathological findings has been investigated in multiple studies, but the results have been conflicting. OBJECTIVE: The present study aimed to assess the relationship between the fatty liver index, a predictor of nonalcoholic fatty liver disease, and the prevalence of colorectal adenomas. DESIGN: This is a retrospective observational study. SETTINGS: This study was conducted at a single expert center. PATIENTS: A total of 2976 consecutive subjects over 40 years of age undergoing routine checkups including abdominal ultrasonography and colonoscopy at Chung-Ang University Hospital Health Care Center were included. MAIN OUTCOME MEASURES: The primary outcome measured was the prevalence of colorectal adenomas according to fatty liver index. RESULTS: Among these subjects, 932 (31.3%) had colorectal adenoma, 691 (23.2%) had metabolic syndrome, and 1512 (50.8%) had fatty liver on ultrasonography. In multivariate analysis, fatty liver index ≥30 was associated with an increased risk of colorectal adenoma (OR, 1.269; 95% CI, 1.06-1.49; p = 0.008). The fatty liver index-high group (fatty liver index ≥30) had more colorectal adenomas and more advanced colorectal adenomas than the fatty liver index-low group (fatty liver index <30) (p < 0.001 and p = 0.042). The prevalence of colorectal adenomas increased with increasing quartile of fatty liver index (p < 0.05). LIMITATIONS: The study was limited by a relatively healthy Asian population. CONCLUSION: The high fatty liver index may be a useful predictor of colorectal adenoma. See Video Abstract at http://links.lww.com/DCR/A478.

Abdominal Visceral to Subcutaneous Adipose Tissue Ratio Is Associated with Increased Risk of Erosive Esophagitis.

BACKGROUND: To investigate the association between abdominal fat distribution represented by the visceral fat area (VFA) to subcutaneous fat area (SFA) ratio, and erosive esophagitis (EE). METHODS: Seven hundred and twenty-eight participants aged >40 years underwent physical examination, blood tests, esophagogastroduodenoscopy, and abdominal computer tomography at Chung-Ang University Hospital from 2007 to 2012. RESULTS: Of 728 subjects, 65 (8.9%) had EE. The EE patients had higher body mass index, metabolic syndrome prevalence, triglyceride levels, and blood pressure (P < 0.05). The mean VFA/SFA ratio was higher in the EE group than in the non-EE group (1.30 vs. 0.92, P < 0.001). The predominance of EE in the group with higher VFA/SFA ratio was higher than in the group with lower VFA/SFA ratio (P < 0.001). A VFA/SFA ratio ≥1.165 had good accuracy to predict EE (area under the receiver-operating characteristic curve, 0.643). The VFA/SFA ratio and visceral fat volume were positively correlated with the severity of EE (P = 0.002), and a VFA/SFA ratio ≥1.165 was strongly correlated with the severity of EE (P < 0.001). CONCLUSION: The high VFA/SFA ratio can be a useful clinical predictor of EE.

Acute Gastric Injury Caused by Undissolved Sodium Picosulfate/Magnesium Citrate Powder.

Sodium picosulfate/magnesium citrate (SPMC) is a widely used oral bowel cleansing agent considered to be relatively safe. However, partially dissolved or undissolved SPMC powder may cause severe injuries of the esophagus and stomach. We report a very rare case of acute gastric injury without esophageal damage caused by the ingestion of undissolved SPMC powder. A 69-year-old man experienced epigastric pain after swallowing SPMC powder without dissolving it in water in preparation for a screening colonoscopy. He realized his mistake immediately and subsequently drank 2 L of water. The esophagogastroduodenoscopy conducted after 12 hours indicated an acute gastric ulceration without injury of the esophagus or duodenum. The endoscopy conducted after 6 weeks of oral proton pump inhibitor treatment showed healing of the gastric injury. This suggested that drinking large amounts of water after ingesting partially dissolved or undissolved SPMC powder can prevent serious esophageal injury, but offers no preventive benefit for acute gastric injury.

Adenocarcinoma developed from remnant cystic duct after cholecystectomy.

BACKGROUND: Cystic duct adenocarcinoma is a rare disease because the cystic duct has a short length and a narrow cavity. Cystic duct adenocarcinoma accounts for 8% of all gallbladder adenocarcinoma; of these, adenocarcinoma that develops from the remnant cystic duct after cholecystectomy is extremely rare. We report a case of incidentally detected adenocarcinoma that developed from the remnant cystic duct in a patient with history of cholecystectomy. CASE PRESENTATION: A 74-year-old Korean woman visited our hospital with abdominal pain. Her past medical history included cholecystectomy for acute cholecystitis with gallstones 10 years previously. Imaging of the abdomen demonstrated inflammation of the remnant cystic duct with multiple impacted stones. Complete removal of the remnant cystic duct with stones was performed. The pathologic report showed severe inflammation with abscess formation and an unexpected adenocarcinoma that appeared to invade the perimuscular connective tissue. The second operation (confirmation of the resection margin of the remnant cystic duct, wedge resection of the liver, and lymphadenectomy) was performed due to suspicion of pT2. There were no cancer cells in the resection margin of the remnant cystic duct, liver, or lymph nodes (0/6). The final histopathological diagnosis was pT2N0M0. She recovered without any complications. The patient is still living 1 year after surgery without recurrence or metastasis. CONCLUSIONS: We report a rare case of adenocarcinoma that developed from the remnant cystic duct in a patient who underwent cholecystectomy.