Medical Library

Changes of ghrelin following oral glucose tolerance test in obese children with insulin resistance.

AIM: To characterize changes in ghrelin levels in response to oral glucose tolerance test (OGTT) and to correlate changes in ghrelin levels with changes in insulin and glucose following OGTT in Chinese obese children of Tanner I and II stage with insulin resistance. METHODS: 22 obese children with insulin resistance state were divided into four groups according to their Tanner stage and gender: boys of Tanner I (BT-I), boys of Tanner II (BT-II), girls of Tanner I (GT-I), girls of Tanner II (GT-II). Ghrelin, insulin and glucose were measured at 0, 30, 60 and 120 min following OGTT. The control children with normal BMI were divided into control boys of Tanner I (CBT-I, n = 6), control boys of Tanner II (CBT-II, n = 5), control girls of Tanner I (CGT-I, n = 6), control girls of Tanner II (CGT-II, n = 5). Fasting serum ghrelin levels were analyzed. RESULTS: Ghrelin levels were lower in obese groups. Ghrelin levels of control group decreased in Tanner II stage (CGT-I vs CGT-II t = -4.703, P = 0.001; CBT-I vs CBT-II t = -4.794, P = 0.001). Basal ghrelin levels in BT-II decreased more significantly than that in BT-I group (t = 2.547, P = 0.029). Ghrelin levels expressed a downward trend after OGTT among obese children. The decrease in ghrelin levels at 60 min with respect to basal values was 56.9% in BT-I. Ghrelin concentrations at 0 min correlated directly with glucose level at 0 min in BT-I (r = 0.898, P = 0.015). There wasn\’t a significant correlation of ghrelin changes with glucose changes and insulin changes during OGTT in obese children with insulin resistance. CONCLUSION: In conclusion, in obese children with insulin resistance, ghrelin levels decreased with advancing pubertal stage. Ghrelin secretion suppression following OGTT was influenced by gender and pubertal stage. Baseline ghrelin levels and ghrelin suppression after OGTT did not significantly correlate with the degree of insulin resistance and insulin sensitivity.

Wang XM, Jiang YJ, Liang L, Du LZ.

Department of Endocrinology The Children\’s Hospital of Zhejiang University School of Medicine, 57 Zhugan Xiang, Hangzhou 310003, Zhejiang Province, China. wangxiumin1019@126.com.

Effect of H pylori infection and its eradication on hyperammo-nemia and hepatic encephalopathy in cirrhotic patients.

AIM: To investigate the relationship between H pylori infection, blood ammonia concentration and hepatic encephalopathy (HE), and the effect of H pylori eradication in cirrhotic patients. METHODS: From July 2003 to January 2005, 457 cirrhotic patients in five regions of Zhejiang Province were enrolled. Patients were evaluated for demographics, number connection test, H pylori infection, liver impairment, blood ammonia concentration and HE. Patients with H pylori infection were given 1 wk therapy with omeprazole plus clarithromycin and tinidazole. (14)C urea breath test was performed and mental symptoms and blood ammonia level were reassessed after bacterium eradication. RESULTS: Overall H pylori infection rate was 60.6%, and HE occurred in 47.5% of cirrhotic patients. Subclinical HE (SHE) was detected in 55 of 117 cirrhotic patients. Blood ammonia concentration in H pylori negative (n = 180) and positive (n = 277) cirrhotic patients was 53.8 +/- 51.4 and 78.4 +/- 63.6 mumol/L, respectively (P < 0.01), which was significantly reduced to 53.5 +/- 37.7 mumol/L after bacterium eradication (n = 126) (P < 0.01). Blood ammonia was 97.5 +/- 81.0 mumol/L in H pylori-positive cirrhotic patients, and this did not significantly change in those with persistent infection after H pylori eradication (n = 11). HE was more frequently observed in patients with H pylori infection than in those without (58.5% vs 30.6%, P < 0.01). HE rate significantly dropped to 34.1% after H pylori eradiation (P < 0.01). H pylori prevalence significantly differed among cirrhotic patients with HE (74.4%), SHE (69.1%), and those without HE (53.2%) (P < 0.05). Blood ammonia level was significantly different among cirrhotic patients with HE (94.5 +/- 75.6 mumol/L), SHE (59.9 +/- 49.2 mumol/L), and without HE (47.3 +/- 33.5 mumol/L) (P < 0.05). Logistic regression analysis showed that blood ammonia concentration, Child-Pugh stage, upper gastrointestinal bleeding, electrolyte disturbance, and urea nitrogen were risk factors for HE. CONCLUSION: H pylori infection is an important factor for inducing high blood ammonia concentration and HE in cirrhotic patients. H pylori eradication may be helpful for treatment and prevention of HE.

Chen SJ, Wang LJ, Zhu Q, Cai JT, Chen T, Si JM.

Department of Gastroenterology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China. wanglj2001@tom.com.

Hemodynamic effects of propranolol with spironolactone in patients with variceal bleeds: A randomized controlled trial.

AIM: To study the hemodynamic effects of spironolactone with propranolol vs propranolol alone in the secondary prophylaxis of variceal bleeding. METHODS: Thirty-five cirrhotics with variceal bleeding randomly received propranolol (n = 17: Group A) or spironolactone plus propranolol (n = 18: Group B). Hemodynamic assessment was performed at baseline and on the eighth day. RESULTS: Spironolactone with propranolol caused a greater reduction in the hepatic venous pressure gradient than propranolol alone (26.94% vs 10.2%; P < 0.01). Fourteen out of eighteen patients on the combination treatment had a reduction in hepatic venous pressure gradient to <= 12 mmHg or a 20% reduction from baseline in contrast to only six out of seventeen (6/17) on propranolol alone (P < 0.05). CONCLUSION: Spironolactone with propranolol results in a better response with a greater reduction in hepatic venous pressure gradient in the secondary prophylaxis of variceal bleeding. A greater number of patients may be protected by this combination therapy than by propranolol alone. Hence, this combination may be recommended for secondary prophylaxis in patients with variceal bleeding.

De BK, Dutta D, Som R, Biswas PK, Pal SK, Biswas A.

Department of Medicine, Medical College, 64/4A/1A Dr. Suresh Chandra Banerjee Road, Calcutta 700010, India. binaykde@hotmail.com.

Importance of the surrounding colonic mucosa in distinguishing between hyperplastic and adenomatous polyps during acetic acid chromoendoscopy.

AIM: To examine the characteristics of colonic polyps, where it is difficult to distinguish adenomatous polyps from hyperplastic polyps, with the aid of acetic acid chromoendoscopy. METHODS: Acetic acid spray was applied to colonic polyps smaller than 10 mm before complete excision. Endoscopic images were taken before and 15-30 s after the acetic acid spray. Both pre- and post-sprayed images were shown to 16 examiners, who were asked to interpret the lesions as either hyperplastic or adenomatous polyps. Regression analysis was performed to determine which factors were most likely related to diagnostic accuracy. RESULTS: In 50 cases tested by the 16 examiners, the overall accuracy was 62.4% (499/800). Regression analysis demonstrated that surrounding colonic mucosa was the only factor that was significantly related to accuracy in discriminating adenomatous from hyperplastic polyps (P < 0.001). Accuracy was higher for polyps with linear surrounding colonic mucosa than for those with nodular surrounding colonic mucosa (P < 0.001), but was not related to the shape, location, or size of the polyp. CONCLUSION: The accuracy of predicting histology is significantly related to the pattern of colonic mucosa surrounding the polyp. Making a histological diagnosis of colon polyps merely by acetic acid spray is helpful for colon polyps with linear, regularly patterned surrounding colonic mucosa, and less so for those with nodular, irregularly patterned surrounding colonic mucosa.

Kim JH, Lee SY, Kim BK, Choe WH, Kwon SY, Sung IK, Park HS, Jin CJ.

Department of Internal Medicine, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, Korea. sunyoung@kuh.ac.kr.

Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients.

AIM: To evaluate portal hypertension parameters in liver cirrhosis patients with and without esophageal varices (EV). METHODS: A cohort of patients with biopsy confirmed liver cirrhosis was investigated endoscopically and with color Doppler ultrasonography as a possible non-invasive predictive tool. The relationship between portal hemodynamics and the presence and size of EV was evaluated using uni- and multivariate approaches. RESULTS: Eighty five consecutive cirrhotic patients (43 men and 42 women) were enrolled. Mean age (+/- SD) was 47.5 (+/- 15.9). Portal vein diameter (13.88 +/- 2.42 vs 12.00 +/- 1.69, P < 0.0005) and liver vascular index (8.31 +/- 2.72 vs 17.8 +/- 6.28, P < 0.0005) were found to be significantly higher in patients with EV irrespective of size and in patients with large varices (14.54 +/- 1.48 vs 13.24 +/- 2.55, P < 0.05 and 6.45 +/- 2.78 vs 10.96 +/- 5.05, P < 0.0005, respectively), while portal vein flow velocity (13.25 +/- 3.66 vs 20.25 +/- 5.05, P < 0.0005), congestion index (CI) (0.11 +/- 0.03 vs 0.06 +/- 0.03, P < 0.0005), portal hypertensive index (2.62 +/- 0.79 vs 1.33 +/- 0.53, P < 0.0005), and hepatic (0.73 +/- 0.07 vs 0.66 +/- 0.07, P < 0.001) and splenic artery resistance index (RI) (0.73 +/- 0.06 vs 0.62 +/- 0.08, P < 0.0005) were significantly lower. A logistic regression model confirmed spleen size (P = 0.002, AUC 0.72) and portal hypertensive index (P = 0.040, AUC 0.79) as independent predictors for the occurrence of large esophageal varices (LEV). CONCLUSION: Our data suggest two independent situations for beginning endoscopic evaluation of compensated cirrhotic patients: Portal hypertensive index > 2.08 and spleen size > 15.05 cm. These factors may help identifying patients with a low probability of LEV who may not need upper gastrointestinal endoscopy.

Tarzamni MK, Somi MH, Farhang S, Jalilvand M.

Liver and Gastrointestinal Diseases Research Center, Imam Hospital, University Ave, Tabriz, East Azerbaijan, Iran. sfarhang@yahoo.com.

KIT exon 11 codon 557/558 deletion/insertion mutations define a subset of gastrointestinal stromal tumors with malignant potential.

AIM: To study the association of the frequency and pattern of KIT and PDGFRA mutations and clinicopathological factors in a group of patients with gastrointestinal stromal tumors (GIST). METHODS: Thirty patients with GIST were examined. Exons 9, 11, 13, and 17 of the KIT and exons 12 and 18 of the PDGFRA gene were analyzed for the presence of mutations by PCR amplification and direct sequencing. RESULTS: KIT or PDGFRA mutations were detected in 21 of the 30 patients (70%). Sixteen patients had mutations within KIT exon 11, three within KIT exon 9, and two within PDGFRA exon 18. GISTs with KIT exon 9 mutations were predominantly located in the small intestine, showed a spindle cell phenotype, and were assessed as potentially malignant. GISTs with KIT exon 11 mutations were located in the stomach and intestine, showed mainly a spindle cell phenotype, and were scored as potentially malignant (P < 0.05). Tumors with KIT exon 11 codon 557/558 deletion/insertion mutations were found to be associated with a potentially malignant clinical behaviour (P < 0.003). GISTs with PDGFRA mutations located in stomach showed a mixed cell phenotype and were classified as of very low or low moderate malignant potential. CONCLUSION: Determination of KIT and PDGFRA mutations should be additional parameters for the better prediction of GISTs clinical behaviour. Tumors with deletion/insertion mutations affecting codons 557/558 of the KIT gene seem to represent a distinct subset of malignant GISTs.

Kontogianni-Katsarou K, Dimitriadis E, Lariou C, Kairi-Vassilatou E, Pandis N, Kondi-Paphiti A.

Department of Pathology, Areteion University Hospital, Athens, Greece. k.kontogianni@m2k.gr.

Effect of infliximab on small bowel stenoses in patients with Crohn\’s disease.

AIM: To assess prospectively small bowel stenoses in Crohn\’s disease (CD) patients treated with infliximab using Small Intestine Contrast Ultrasonography (SICUS). METHODS: Twenty patients (M 12, age, 42.7 +/- 11.8 years), 15 of whom showed obstructive symptoms indicating the presence of small bowel stenosis, and 5 without stenosis, were treated with infliximab (5 mg/kg at wk 0, 2, 6 and 5 mg/kg every 8 wk thereafter) for steroid refractoriness, fistulizing disease, or to avoid high-risk surgery. SICUS was performed at the induction phase and at regular time intervals during the follow-up period of 34.7 +/- 16.1 mo (range 7-58). Small bowel stenoses were detected by SICUS, endoscopy and MRI. RESULTS: In no case was progression of stenoses or the appearance of new ones seen. Of the 15 patients with stenosis, 5 stopped treatment after the induction phase (2 for no response, 3 for drug intolerance, one of whom showed complete regression of one stenosis). Among the remaining 10 patients, a complete regression of 8 stenoses (1 stenosis in 5 patients and 3 stenoses in one patient) was observed after 6-22 infliximab infusions. CONCLUSION: In patients with CD treated with infliximab we observed: (a) No progression of small bowel stenosis and no appearance of new ones, (b) Complete regression of 1/22 stenosis after the induction phase and of 8/15 (53.3%) stenosis after 6-22 infusions during maintenance therapy.

Pallotta N, Barberani F, Hassan NA, Guagnozzi D, Vincoli G, Corazziari E.

Department of Scienze Cliniche, Universita Sapienza, Policlinico Umberto I, Viale del Policlinico, Rome 00161, Italy. enrico.corazziari@uniroma1.it.

Factors influencing a low rate of hepatitis C viral RNA clearance in heroin users from Southern China.

AIM: To study the virological and host factors influencing hepatitis C infection outcomes in heroin users in southern China. METHODS: HCV RNA and associated factors were analyzed among 347 heroin users from Guangxi Zhuang Autonomous Region, southern China who were hepatitis C virus (HCV) EIA positive for two or more consecutive visits. RESULTS: Using the COBAS AMPLICOR HCV TEST, a remarkably low HCV RNA negative rate of 8.6% was detected. After multivariate logistic regression analysis, HCV RNA clearance was significantly associated with the presence of HBsAg (OR = 8.436, P < 0.0001), the lack of HIV-1 infection (OR = 0.256, P = 0.038) and age younger than 25 (OR = 0.400, P = 0.029). CONCLUSION: Our study suggests HCV infection among Chinese heroin users results in high levels of viral persistence even amidst factors previously found to enhance viral clearance. Prospective studies of a possible genetic component within the Chinese population and the pathogenicity of non-genotype 1 HCV infections are needed.

Garten RJ, Lai SH, Zhang JB, Liu W, Chen J, Yu XF.

Department of Molecular Microbiology and Immunology, The Johns Hopkins University Bloomberg School of Public Health, Room E5148, 615 N. Wolfe St, Baltimore, MD 21205, United States. xfyu@jhsph.edu.

Cost-effectiveness analysis of early veno-venous hemofiltration for severe acute pancreatitis in China.

AIM: To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis (SAP) in China. METHODS: We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were: continuous or long-term veno-venous hemofiltration (CVVH/LVVH), short-term veno-venous hemofiltration (SVVH), SVVH plus peritoneal dialysis (PD), and non-hemofiltration control group. The effectiveness of the technique was determined by survival rate, complications prevention and surgery preservation. The total cost of hospitalization was also assessed. RESULTS: The SVVH only technique was the least costly modality, $5809 (44449 RMB), and was selected as the baseline treatment modality. SVVH only arm achieved the lowest C/E ratio in terms of overall survival, complications prevention and surgery preservation. In incremental cost-effectiveness analysis, the CVVH/LVVH only and the control arms were inferior to other techniques. Sensitivity analysis showed SVVH only and SVVH plus PD arms overlapped in C/survival ratio. CONCLUSION: The role of early veno-venous hemofiltration as an alternative therapy for SAP remains controversial. However, we propose that early use of short-term high-volume veno-venous hemofiltration would have a beneficial impact on the management of SAP.

Jiang K, Chen XZ, Xia Q, Tang WF, Wang L.

Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Guo Xue Xiang No. 37, Chengdu 610041, Sichuan Province, China. xiaqing@medmail.com.cn.

Clinical and endoscopic features of Chinese reflux esophagitis patients.

AIM: To analyze the clinical and endoscopic features of Chinese patients with reflux esophagitis (RE). METHODS: A total of 1405 RE patients were analyzed retrospectively. Data on gender, age, presence/absence of H pylori infection and associated esophageal hiatal hernia were collected. Esophagitis was divided into different grades according to Los Angeles Classification. RESULTS: Of 18823 patients, 1405 were diagnosed as RE. The ratio of male to female patients was 1.75:1 (P < 0.01). The mean age of male and female patients was significantly different (P = 0.01). The peak age at onset of the disease was 40-60 years. According to Los Angeles Classification, there were significant differences in the age of patients with grades A and B compared to patients with grades C and D (P < 0.01). Two hundred and seventy-seven patients were infected with H pylori, the infection rate was low (P < 0.01). Complication of esophageal hiatal hernia was found to be significantly associated with the severity of esophagitis and age in 195 patients (P < 0.01). Esophageal mucosa damages were mainly located at the right esophageal wall. CONCLUSION: The peak age of onset of RE is 40-60 years and higher in males than in females. The mean age of onset of RE is lower in males than in females. The infection rate of H pylori is significantly decreased in patients with esophagitis. Old age and esophageal hiatal hernia are associated with more severe esophagitis. Right esophageal mucosal damage can occur more often in RE patients.

Li W, Zhang ST, Yu ZL.

Department of Gastroenterology, Beijing Friendship Hospital Affiliated to Capital Medical University; Faculty of Gastroenterology, Capital Medical University; Beijing Digestive Disease Center, Beijing 100050, China. stingvip@tom.com.