A lower serum gamma-glutamyltransferase level does not predict a sustained virological response in patients with chronic hepatitis C genotype 1.

BACKGROUND/AIMS: Low gamma-glutamyltransferase (GGT) level was shown to be an independent predictor of a sustained virological response (SVR) in chronic hepatitis C. We aimed to determine factors associated with high GGT level, and to evaluate whether low GGT level is an independent predictor of a SVR in chronic hepatitis C genotype 1. METHODS: We retrospectively reviewed our data of patients with chronic hepatitis C genotype 1 treated with pegylated interferon-α and ribavirin. Baseline features were compared between patients with normal and high GGT levels. Factors associated with high GGT level and those associated with a SVR were determined by univariate and multivariate analysis. RESULTS: This study included 57 patients. Mean age was 52.28±9.35 years. GGT levels was elevated in 27 patients (47.4%). GGT levels were normal in 63.3% of the patients who achieved a SVR and in 40.7% of those who did not achieve a SVR (p>0.05). By multivariate logistic regression analysis, the presence of cirrhosis (odds ratio [OR], 9.41; 95% confidence interval [CI], 1.08 to 102.61) and female gender (OR, 6.77; 95% CI, 1.23 to 37.20) were significantly associated with high GGT level, and only rapid virological response was associated with a SVR (OR, 8.369; 95% CI, 1.82 to 38.48). CONCLUSIONS: Low GGT level does not predict a SVR; however, it may be a predictor of high fibrosis scores.

Effects of alpha tocopherol and ascorbic acid on Helicobacter pylori colonization and the severity of gastric inflammation.

BACKGROUND AND AIM: We aimed to evaluate the changes in histopathologic features, concentrations of vitamins C and E in gastric mucosa, and total antioxidant capacity of the body after ingestion of ascorbic acid and alpha tocopherol in patients with Helicobacter pylori. MATERIAL AND METHOD: Patients with H. pylori-positive nonulcer dyspepsia were included in this study. Tissue samples were taken from the lesser and greater curvature in both prepyloric antrum and corpus for histopathologic examination and measurement of vitamins C and E concentrations. Blood samples were obtained for measurement of the total antioxidant capacity of the body. The patients were given vitamin C 500 mg BID and vitamin E 200 IU BID for 4 weeks orally. At the end of the 4th week, the initial procedures were repeated. Histopathologic examination of the tissue samples were carried out by two pathologists. RESULTS: The mean vitamins C and E concentrations in gastric mucosa at the 4th week were higher than those at the beginning (p = .000 and p = .006, respectively). Mean total antioxidant capacity of the body at the beginning and that at the 4th week were similar (p = .689). H. pylori intensity in the antrum at the beginning was higher than that at the 4th week for both pathologists (p = .007 and p = .039). Neutrophilic activity in the antrum at the beginning was higher than that at the 4th week for both pathologists (p = .000 and p = .025). Neutrophilic activity in the corpus at the beginning was higher than that at the 4th week for pathologist 1 (p = .033), and they were similar for pathologist 2 (p = .763). CONCLUSION: The findings that H. pylori intensity and neutrophilic activity decrease through increasing gastric ascorbic acid and alpha tocopherol concentrations suggest that supplementation with vitamins C and E increases the eradication rates via impairing the microenvironment created by the bacteria and facilitating the diffusion of antibiotics into gastric mucosa.

Efficacy of the Combination of Tetracycline, Amoxicillin, and Lansoprazole in the Eradication of Helicobacter pylori in Treatment-Naïve Patients and in Patients Who Are Not Responsive to Clarithromycin-Based Regimens: A Pilot Study.

BACKGROUND/AIMS: The aim of this study was to evaluate the eradication rate of a triple therapy regimen that included a proton pump inhibitor, amoxicillin, and tetracycline instead of clarithromycin in treatment-Naïve patients and in patients who did not respond to standard triple therapy. METHODS: This study included 110 patients infected with Helicobacter pylori. Patients in groups A and B were treatment-Naïve, and those in group C were not responsive to previous standard triple therapy. Patients in group A (n=40) received lansoprazole 30 mg b.i.d., amoxicillin 1,000 mg b.i.d., and clarithromycin 500 mg b.i.d. for 14 days. Patients in groups B (n=40) and C (n=30) received lansoprazole 30 mg b.i.d., amoxicillin 1,000 mg b.i.d., and tetracycline 500 mg q.i.d. for 14 days. RESULTS: In group A, eradication was achieved in 18 (45%) of the 40 patients included in the intention-to-treat (ITT) analysis and in 18 (47.4%) of the 38 patients included in the per-protocol (PP) analysis. In group B, eradication was achieved in 15 (37.5%) of the 40 patients included in the ITT analysis and in 15 (39.3%) of the 38 patients included in the PP analysis. In group C, eradication was achieved in 14 (46.6%) of the 30 patients included in the ITT analysis and in 14 (43.8%) of the 29 patients included in the PP analysis. There was no statistically significant difference among the 3 groups with regard to eradication rates (p>0.05). CONCLUSIONS: Despite the low rate of resistance to tetracycline, the combination of lansoprazole, amoxicillin, and tetracycline instead of clarithromycin is not a good option for the eradication of H. pylori.

AST-platelet ratio index, Forns index and FIB-4 in the prediction of significant fibrosis and cirrhosis in patients with chronic hepatitis C.

BACKGROUND/AIMS: The aim of this study was to evaluate the diagnostic accuracy of aspartate aminotransferase-platelet ratio index, the Forns index and FIB-4 for the assessment of hepatic fibrosis in chronic hepatitis C patients by comparison with liver biopsy. METHODS: We retrospectively reviewed our computerized data of chronic hepatitis C patients who admitted to the Gastroenterology Clinic between 2004 and 2008. Treatment-naive chronic hepatitis C patients who had undergone liver biopsy and had laboratory test results allowing the calculation of aspartate aminotransferase-platelet ratio index, the Forns index and FIB-4 were included in this study. The degree of fibrosis was scored according to the METAVIR staging system. Significant fibrosis was defined as F2-4 and cirrhosis as F4. Aspartate aminotransferase-platelet ratio index, the Forns index and FIB-4 were calculated based on the original studies. Tests results were compared between groups F0-1 (no or mild fibrosis) versus F2-4 (significant fibrosis) and F03 (no cirrhosis) versus F4 (cirrhosis). RESULTS: One hundred and fifty patients with chronic hepatitis C were included in this study. The areas under the ROC curves of the Forns index, aspartate aminotransferase-platelet ratio index and FIB-4 to predict significant fibrosis were 0.795, 0.774 and 0.764, respectively. The area under the ROC curves of the Forns index, aspartate aminotransferase-platelet ratio index and FIB-4 to predict cirrhosis were 0.879, 0.839 and 0.874, respectively. CONCLUSIONS: The Forns index, aspartate aminotransferase-platelet ratio index and FIB-4 were accurate noninvasive blood tests to predict the presence or absence of significant fibrosis and cirrhosis in half of the chronic hepatitis C patients. The Forns index was slightly better than the aspartate aminotransferase-platelet ratio index and FIB-4 in the prediction of significant fibrosis and cirrhosis.

Efficacy of vitamins supplementation to therapy on Helicobacter pylori eradication in patients with low antioxidant capacity.

BACKGROUND AND OBJECTIVES: It was shown that supplementation of vitamins C and E to therapy increased Helicobacter pylori eradication rate. In the present study, we aimed to evaluate whether supplementation of antioxidant vitamins to therapy increases H. pylori eradication rates in patients with chronic stress and low antioxidant capacity. METHODS: This study included 120 patients who presented to gastroenterology outpatient clinic with H. pylori-positive nonulcer dyspepsia and low total antioxidant capacity. Patients in group A (n=80) were given lansoprazole (30 mg, BID), amoxicillin (1000 mg, BID), and clarithromycin (500 mg, BID) for 14 days, as well as vitamin C (500 mg, BID) and vitamin E (200 IU, BID) for 30 days. Patients in group B (n=40) were given lansoprazole (30 mg, BID), amoxicillin (1000 mg, BID), and clarithromycin (500 mg, BID) for 14 days. RESULTS: Total antioxidant capacity were lower than normal levels in all patients. One hundred and fifteen patients (77 in group A, 38 in group B) were analyzed with per protocol analysis. In group A, H. pylori eradication was achieved in 63.8% of the patients included in the intention to treat analysis and in 66.2% of the patients included in the per protocol analysis. In group B, H. pylori eradication was achieved in 42.5% of the patients included in the intention to treat analysis and in 44.7% of the patients included in the per protocol analysis. Eradication rates were significantly higher in group A than in group B (P<0.005). CONCLUSIONS: Supplementation with vitamins C and E increased H. pylori eradication rate of standard triple therapy.

The Relationship between Quiescent Inflammatory Bowel Disease and Peripheral Polyneuropathy.

BACKGROUND/AIMS: Inflammatory bowel disease is a chronic, recurrent disorder that involves multiple organ systems. Polyneuropathy is the most common neurological manifestation. The aim of the present study was to investigate the relationship between polyneuropathy and inflammatory bowel disease. METHODS: The study included 40 patients with infl ammatory bowel disease (20 with ulcerative colitis and 20 with Crohn's disease) and 24 healthy controls. The patients had no clinical signs or symptoms of polyneuropathy. Nerve conduction studies were performed using an electroneuromyography apparatus. RESULTS: Mean distal motor latencies, conduction velocities, and F wave minimum latencies of the right median nerve were signifi cantly abnormal in the patient group, compared to the healthy controls (p<0.05). CONCLUSIONS: Some electrophysiological alterations were observed in chronic inflammatory bowel disease patients who showed no clinical signs. While investigating extra-intestinal manifestations in inflammatory bowel disease patients, nerve conduction studies must be performed to identify electrophysiological changes and subclinical peripheral polyneuropathy, which can subsequently develop.

Serum levels of prostate specific antigen are elevated after colonoscopy.

The risks of prostate cancer and colorectal carcinoma increase with age. So, colonoscopy and measurement of serum prostate specific antigen (PSA) may be performed during a short term in a given patient. We aimed to evaluate whether colonoscopy affects serum PSA levels and to evaluate the relationship between prostate volume and elevation in serum PSA levels after colonoscopy. This study included 44 consecutive male patients, who underwent colonoscopy. The mean age of the patients was 56.05±9.27 years. The mean time required for colonoscopy was 30 min. Serum PSA levels were measured 48-72 hours before colonoscopy, immediately after performing laxative enema, and at 24-48th hour, the 7th day, and the 14th day after colonoscopy in each patient. The serum PSA level was elevated after enema and at 24-48th hour and 7th day after colonoscopy from the baseline (p<0.05), and declined to the baseline by 14th day. When the cut off value of 20 cm3 for normal prostate volume was taken into account, the serum PSA levels were significantly higher at the 24-48th hour and the 7th day in patients with larger prostate volume (>20 cm3) than those with normal prostate volume (p=0.013 and p=0.009). These results suggest that PSA is easily released by manipulations from the larger prostate. In conclusion, serum PSA levels were elevated during 7 days after colonoscopy. Before performing invasive procedures, patients with high serum PSA levels should be asked whether colonoscopy was performed prior to the measurement.

Does reflux have an effect on nasal mucociliary transport?

CONCLUSION: Gastroesophageal and laryngopharyngeal reflux were found to have no effect on nasal mucociliary transport. OBJECTIVE: Gastroesophageal and laryngopharyngeal reflux have been recognized as causative factors for chronic rhinosinusitis but no definite mechanism has been described yet. We aimed to determine whether gastroesophageal and laryngopharyngeal reflux impair nasal mucociliary transport. METHODS: This was a prospective cohort study in a tertiary referral center. Fifty patients with both laryngopharyngeal and gastroesophageal reflux comprised the study group. Reflux syndrome index and reflux finding score were calculated for each patient before and after treatment. Antireflux medication was given for 12 weeks. The control group consisted of 30 healthy volunteers. Nasal mucociliary transport was assessed by means of the saccharine test. It was performed before and after the treatment. Statistical analysis was performed using the saccharine test results of the study and control groups. RESULTS: No statistical difference was found between the saccharine test results of the study group and control group before treatment. The differences between the pretreatment and post-treatment reflux symptom index and reflux finding scores were statistically significant. The difference between the post-treatment saccharine test results of the patients in whom reflux scores returned to normal and those with remaining high scores was not statistically significant.

Oxidative stress in Helicobacter pylori infection: does supplementation with vitamins C and E increase the eradication rate?

AIM: This study aims to assess the antioxidant property of vitamins E and C in Helicobacter pylori infection, and to determine if adding them to standard triple therapy plus bismuth subcitrate increases the H. pylori eradication rate. METHODS: This study included 160 patients infected with H. pylori, who were randomized into one of two groups. Patients in group A (n = 80) received lansoprazole (30 mg, b.i.d.), amoxicillin (1000 mg, b.i.d.), clarithromycin (500 mg, b.i.d.), and bismuth subcitrate (300 mg, q.i.d.) for 14 days, while patients in group B (n = 80) received vitamin C (500 mg, b.i.d.) and vitamin E (200 IU, b.i.d.) for 30 days, in addition to lansoprazole (30 mg, b.i.d.), amoxicillin (1000 mg, b.i.d.), clarithromycin (500 mg, b.i.d.), and bismuth subcitrate (300 mg, q.i.d.) for 14 days. Total antioxidant capacity (TAC) was evaluated with a Randox kit. Success rate was calculated using both intention-to-treat (ITT) and per-protocol (PP) analyses. RESULTS: One hundred and sixty patients were analyzed using ITT analysis. One hundred and fifty-three patients completed the study. In group A, H. pylori eradication was achieved in 48 (60%) of the 80 patients included in the ITT analysis, and in 48 (64%) of the 75 patients included in the PP analysis. In group B, H. pylori eradication was achieved in 73 (91.25%) of the 80 included in the ITT analysis and in 73 (93.5%) of the 78 patients included in the PP analysis. The eradication rate was significantly higher in group B than in group A (p < .005). TAC was at the lower limit of normal in both groups and the difference between them was not statistically significant (p > .05). CONCLUSION: In group B, H. pylori eradication rate was 91.25%, which is higher than the ideal 80% eradication rate. The results of the present study show that adding the prescribed doses of vitamins E and C to antimicrobial therapy is effective in eradicating H. pylori infection.

Glutaraldehyde-induced colitis: three case reports.

Glutaraldehyde (2% solution) is an effective and widely used disinfecting solution for cold sterilization of endoscopic instruments. Direct contact of glutaraldehyde solution with colonic mucosa can cause self-limited colitis. As it rarely occurs as a complication of colonoscopy, glutaraldehyde-induced colitis is generally reported only as case reports in the literature. We report three cases of glutaraldehyde-induced colitis after colonoscopy. All lesions resolved with supportive treatment. We stress the need for thorough rinsing of the surface and channels of the endoscope with water to avoid the occurrence of this complication.