Volume 72 - 2009 - Fasc.2 - Original articles
Tumor necrosis factor-alpha gene promoter polymorphisms in Chinese patients with nonalcoholic fatty liver diseases
Background : Nonalcoholic Fatty Liver Disease (NAFLD) encompasses a histopathological spectrum of clinical conditions such as simple fatty liver (steatosis), nonalcoholic steatohepatitis (NASH), and a variant that has degrees of fibrosis. Tumor Necrosis Factor-alpha (TNF-a) is considered essential for NAFLD. Therefore, we investigated the correlation between TNF-a gene promoter polymorphism and NAFLD in this human study.
Patients and methods : The TNF-a gene polymorphisms at posi- tion -238 and -308 were analyzed in 189 Chinese patients with NAFLD and 138 healthy controls by using polymerase chain reac- tion and restriction fragment length polymorphism assay. The serum levels of TNF-a in both patient and control groups were measured by ELISA. The associations of TNF-a polymorphism and serum TNF-a, and/or insulin resistance, and/or clinical features were analyzed.
Results : The carrier frequencies of TNF-a gene polymorphism with G/A mutation at -238 were significantly higher in the patients with NAFLD than those in the control subjects (p < 0.05). However, there were no significant differences between the NAFLD patients and control subjects in the polymorphisms at -308 (p > 0.05). In addition, the serum level of TNF-a was markedly higher in the patients with NAFLD than in the control subjects (p < 0.05). There were significant associations between TNF-a gene polymorphism in the -238 A allele and increased serum TNF-a, insulin resistance, as well as increased body mass index in the NAFLD patients.
Conclusions : The results indicate that the TNF-a gene polymor- phism at position -238 is associated with susceptibility of nonalco- holic Fatty Liver Disease in a Chinese population. (Acta gastro- enterol. belg., 2009, 72, 215-221).
Effect of addition of vitamin C to clarithromycin-amoxicillin-omeprazol triple regimen on Helicobacter pylori eradication
Background : The use of vitamin C as a supplement with the common regimen for eradication of Helicobacter pylori infection is the subject of ongoing controversy. We conducted a prospective controlled study with the aim of testing whether the vitamin C supplement to the therapy includes lower dosage of clarithromycin could have an acceptable influence on Helicobacter pylori eradica- tion in comparison with routine anti-Helicobacter pylori regimen.
Materials and methods : Two hundred and fourteen consecutive patients with the verification of Helicobacter pylori infection via positive Rapid Urease Test (RUT) and histology results were included and divided into two therapy groups : 1) a group without vitamin C (n = 100) that were administered 20 mg omeprazol, 1 g amoxicillin, and 500 mg clarithromycin twice daily for 2 weeks and 2) a triple-plus-vitamin C group (n = 114) that was administered 20mg omeprazol, 1g amoxicillin, 250mg clarithromycin plus 250 mg vitamin C twice daily for 2 weeks. Four weeks after the completion of therapy, each patient was scheduled for urea breath test to assess the success of Helicobacter pylori eradication.
Results : Similar eradication of Helicobacter pylori was found between the triple-only group with 500 mg of clarithromycin and the triple with 250 mg of clarithromycin-plus vitamin C group (89% versus 86.8%, P = 0.623).
Conclusions : Adding vitamin C might reduce the needed dosage of clarithromycin for eradication of Helicobacter pylori. (Acta gastroenterol. belg., 2009, 72, 222-224).
Quantitative endoscopic and histologic activity assessment of ulcerative colitis
Background : Correct assessment of the severity and activity of ulcerative colitis (UC) is necessary for determining effective treat- ment and predicting prognosis. The correlation between histologic activity and endoscopic activity, however, has not yet been deter- mined by using a quantitative scoring system.
Study aims : To compare the endoscopic activity index (EAI), detected during colonoscopy, with the histologic activity index (HAI) detected in biopsy samples taken from the same colon segments of UC patients in order to determine the degree of agreement between both assessments.
Patients and methods : Ninety-six UC patients participated in this prospective study. EAIs and HAIs were obtained by summing the scores given for each mucosal/histological change to produce a total score between 1 and 12. The correlation between EAI and HAI was calculated.
Results : There was a positive correlation between HAI and EAI (r = 0.78 ; p < 0.001). There was no statistical inconsistency between the EAI and HAI results (p = 0.625, using the McNemar test). The whole group kappa coefficient was 0.607 (p < 0.001).
Conclusion: Endoscopic and histologic activity of mucosal disease in patients with UC are generally consistent. Measuring both histologic and endoscopic activity with a quantitative scoring system during patient follow-up would be a more accurate method for monitoring UC patients. (Acta gastroenterol. belg., 2009, 72, 225-229).
Clinical characteristics of Iranian pediatric patients with inflammatory bowel disease
Background : Inflammatory bowel disease (IBD) is a group of disorders, including Crohn's disease (CD), ulcerative colitis (UC) and indeterminate colitis (IC). Small intestine and colon are prima- rily affected in this group of disorders.
Purpose : This single center study was performed to define demographic features and clinical characteristics of Iranian pediatric patients with IBD.
Method : Fifty nine patients with IBD, who have been referred to Children's Medical Center Hospital during a 10-year period, were investigated in this study. The data was gathered by interviewing the patients and their families, as well as reviewing their medical records.
Results : Among 59 patients with IBD, 23 cases had UC and 19 cases had CD, while the remaining 17 cases had IC. Patients with UC were significantly younger at the time of diagnosis in com- parison with patients with CD. The most common symptoms were abdominal pain, diarrhea, fever and growth failure. Hepatobiliary abnormalities and arthritis were common extra intestinal manifes- tations. The median Pediatric Crohn's Disease Activity Index was 42.5 (range 20-60), whereas the median Pediatric Ulcerative Colitis Activity Index was 40 (range 20-70). Seven of 23 UC (30.4%) had proctatis, while 16 (69.6%) had extensive colitis. In CD, 11 of 19 (57.9%) had involvement of terminal ileum and colon, while inflammation was limited to the colon in 8 cases (42.1%). The colonoscopic findings in the IC group were heterogeneous.
Conclusion : This study provides epidemiological data on pedi- atric patients with IBD, which could be useful for health care workers in prompt diagnosis and appropriate treatment of early onset IBD. (Acta gastroenterol. belg., 2009, 72, 230-234
