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Gastroenterology and Hepatology From Bed to Bench Journal - Volume:11 Issue: 4, Autumn 2018

Gastroenterology and Hepatology From Bed to Bench Journal
Volume:11 Issue: 4, Autumn 2018

  • تاریخ انتشار: 1397/07/17
  • تعداد عناوین: 12
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  • John Ong, Michael F. Bath, Carla Swift, Yasseen Al, Naeeb Pages 277-283
    Aim
    The aim of this systematic review was to determine if the human colon, through the lower gut-liver axis, drives PSC activity by assessing the progression of the disease in patients with and without colectomy for colonic disease.
    Background
    The gut-liver axis is involved in the pathogenesis of liver disease. Abnormal immune-mediated responses to intestinal microbiome are implicated in primary sclerosing cholangitis (PSC) however the mechanisms remain poorly understood. Currently, no
    single animal model recapitulates all attributes of PSC in humans and this limits further studies of gut-liver interactions.
    Methods
    A systematic search of PubMed, Medline, and Scopus was performed for articles that contained the terms “colectomy” or
    “bowel resection” AND “primary sclerosing cholangitis” up to 15th April 2018. Articles were reviewed by 2 reviewers and raw data
    collated. A Forest plot was used to illustrate the effect of colectomy on subsequent liver transplantation for PSC. Linear regression was
    used to estimate mortality risk.
    Results
    Colectomy appeared to have no effect on PSC progression, although high-quality studies were lacking. Rates of liver
    transplantation or transjugular intrahepatic portosystemic shunt for PSC were not affected by colectomy (OR 0.59, 95% CI 0.14 - 2.53,
    p=0.48). Mortality risk following colectomy in patients with PSC is 2.11% per year (95% CI 0.03% - 4.18%, p=0.032, R2 = 0.722).
    Conclusion
    Current evidence is limited but suggests colectomy does not affect the progression of PSC in patients with colonic disease.
    Pathogenic micro-organisms or antigens that drive PSC may not be limited to the lower gut.
    Keywords: Primary sclerosing cholangitis, Inflammatory bowel disease, Colectomy, Procto-colectomy.
    (Please cite as: Ong J, Bath MF, Swift C, Al-Naeeb Y. Does colectomy affect the progression of primary sclerosing
    cholangitis? A systematic review and meta-analysis. Gastroenterol Hepatol Bed Bench 2018;11(4):277-283
    Keywords: Primary sclerosing cholangitis, inflammatory bowel disease, colectomy, procto-colectomy
  • Ahmad Javanmard, Sara Ashtari, Babak Sabet, Seyed Hossein Davoodi, Mohammad Rostami, Nejad, Mohammad Esmail Akbari, Azadeh Niaz, Amir Mohammad Mortazavian Pages 284-295
    Cancers of the gastrointestinal (GI) track are a serious global health problem. The human GI tract is home to trillions of
    microorganisms that known as gut microbiota and have established a symbiotic relationship with the host. The human intestinal
    microbiota plays an important role in the development of the gut immune system, metabolism, nutrition absorption, production of
    short-chain fatty acids and essential vitamins, resistance to pathogenic microorganisms, and modulates a normal immunological
    response. Microbiota imbalance has been involved in many disorders including inflammatory bowel disease, obesity, asthma,
    psychiatric illnesses, and cancers. Oral administration of probiotics seems to play a protective role against cancer development as a
    kind of functional foods. Moreover, clinical application of probiotics has shown that some probiotic strains can reduce the incidence
    of post-operative inflammation in cancer patients. In the present narrative review, we carried out update knowledge on probiotic
    effects and underlying mechanism to GI cancers. Currently, it is accept that most commercial probiotic products are generally safe
    and can used as a supplement for cancer prevention and treatment. Nevertheless, well-designed, randomized, double blind, placebocontrolled
    human studies are required to gain the acceptance of the potential probiotics as an alternative therapy for cancer control..
    Keywords: Probiotic, Prebiotics, Gastrointestinal cancer, Gut microbiota.
    (Please cite as: Javanmard A, Ashtari S, Sabet B, Davoodi SH, Rostami-Nejad M, Akbari ME, et al. Probiotics and
    their role in gastrointestinal cancers prevention and treatment; an overview. Gastroenterol Hepatol Bed Bench
    2018;11(4):284-295).
    Keywords: probiotic, prebiotics, gastrointestinal cancer, gut microbiota
  • Muhammad Ali Khalid_Inamullah Khan Achakzai_Shoaib Ahmed Khan_Zain Majid_Farina M Hanif_Javed Iqbal_Syed Mudassir Laeeq_Nasir Hassan Luck Pages 301-305
    Aim
    Is Karnofsky Performance Status (KPS) a predictor of 3 month post discharge mortality in cirrhotic patients?
    Background
    Cirrhotic patients often experience an abrupt decline in their health, which often leads to frequent hospitalization and
    can cause morbidity and mortality. Various models are currently used to predict mortality in cirrhotics however these have their
    limitations. The Karnofsky Performance Status (KPS) being one of the oldest performance status scales, is a health care provider–
    administered assessment that has been validated to predict mortality across the elderly and in the chronic disease populations.
    Methods
    We used the KPS performance status scale to envisage short-term mortality in cirrhotic and HCC patients who survive to
    be discharged from hospital.
    Results
    Our study showed that KPS one week post-discharge, child pugh score, hospital stay, international normalized ratio, serum
    albumin, total bilirubin and serum creatinine showed statistical significance on univariate analysis. On multivariate analysis, KPS was
    found to be statistical significant predictor of 3-month mortality.
    Conclusion
    Hence KPS can be utilized to identify cirrhotic patients at risk of 3-month post discharge mortality.
    Keywords: Karnofsky Performance Status (KPS), Cirrhosis, 3 months mortality
    (Please cite as: Khalid MA, Achakzai IK, Ahmed Khan S, Majid Z, Hanif FM, Iqbal J, et al. The use of Karnofsky
    Performance Status (KPS) as a predictor of 3 month post discharge mortality in cirrhotic patients Gastroenterol
    Hepatol Bed Bench 2018;11(4):301-305).
    Introduction
    1 Hospitalization is a marker of poor outcomes
    including readmission and death. Patients with cirrhosis
    experience abrupt deterioration in their health that leads
    to repeated hospitalizations along with increased
    morbidity and mortality (1-3). Currently, the models
    used to predict mortality in cirrhotics are liver-specific
    and kidney-specific prognostic indicators such as the
    Model for End-Stage Liver Disease (MELD) score (4).
    However the MELD score has several limitations (5-7)
    one of them being its lack of ability to account for an
    individual’s performance status.
    It is now a well-known fact that performance status and
    the linked concept of infirmity are strong predictors of
    Keywords: Performance status, KPS, Mortality, Cirrhotics
  • Adnan Qureshi, Joanne Cunningham, Teresa William, Anil Hemandas Pages 306-312
    Aim
    The aim of this study was to compare general and stoma specific short term complications in patients having stoma surgery in
    either an emergency or elective setting during their index hospital stay. It also compares the complications specific to a stoma carried
    out by surgeons with or without a specialist interest in colorectal surgery.
    Background
    The stoma created in emergency surgery has a high short and long term complication rate. Emergency stomas where
    the site has not been marked preoperatively by a stoma therapist are more prone to complications. These complications may severely
    affect a patient’s quality of life.
    Methods
    We retrospectively analysed data for all non-urological stomas created over the last three years in our institute. This
    covered the period from January 2014 to January 2017. The stoma care department kept a full database record of all patients. Besides
    demography we analysed the type of stoma i.e. colostomy or ileostomy, indications for the stoma, most common operation, length of
    stay (LOS) and short term complications based on the Clavien-Dindo classification. We also analysed the perioperative stoma related
    complications within the emergency cohort.
    Results
    A total of 199 patients had new ostomies created during the three-year period. Four patients died during the inpatient stay
    and were excluded from the analysis. The total number of stomas created in the emergency cohort was 60 and 135 stomas were
    elective procedures. The male to female ratio was 1:1.01. The average age for the emergency cohort was 6 years older than for the
    elective cohort. There was a statistically significant difference in length of stay between the two cohorts (T Test P Value =.02). There
    was a higher number of elective patients discharged in the first week compared to the emergency surgery patients. The rate of grade 3
    or 4 complications was higher in the emergency cohort of patients. The rate of grade 3 or 4 complications was also much higher in
    patients operated by surgeons who did not have a specialist interest in colorectal surgery. The majority of grade 3 complications seen
    in the emergency surgery cohort and operated on by non-colorectal specialists (NCS) were stoma related, i.e retraction, necrosis and
    prolapse.
    Conclusion
    Emergency surgery procedures are frequently bowel related. Emergency stoma surgery should not be taken as trivial
    procedure, non-colorectal surgeons should take advice and assistance from specialist colorectal surgeons for bowel related cases,
    particularly when a stoma is involved
    Keywords: Stoma, Colorectal surgery, complications
  • Pantea Tajik, Amir Hossein Goudarzian, Mahdi Shadnoush, Bahador Bagheri Pages 313-318
    Aim
    The present study is aimed to investigate the effect of red sugar on functional constipation in children compared to figs syrup.
    Background
    Treatment of constipation in childhood improves gastrointestinal function in the future and regular bowel habit. Red
    sugar is an effective ingredient in the treatment of constipation. Figs syrup is the other common natural substance used to treat
    constipation in children. Conducted studies on these two substances and similar herbal substances have shown their beneficial effects,
    but in a conducted study, it is reported that the effect of fig syrup is less than the chemical material.
    Methods
    This Randomized Controlled Trial (RCT) Study was done in 2016. First, by performing an examination and filling out the
    identifying form of the patient's health status, mothers respond to the designed questionnaire. 30 children with constipation were
    treated with the usual drug, fig syrup, and 30 other children received red sugar. After a 4-week treatment period, the examination was
    conducted again and the questionnaire was filled out again. The changes following the intervention were measured and the status
    before and after treatment were compared as well. The analyses were performed using SPSS 20 (SPSS for Windows, SPSS Inc.,
    Chicago, IL, USA).
    Results
    In this study, there was no significant difference between effects of red sugar and fig syrup in terms of the frequency of fecal
    excretion, and pain at the time of excretion (p = 0.264). However, the fig syrup was more effective in reducing the anorexia (p <
    0.001) and abdominal pain compared with fig syrup (p < 0.001). Also fig syrup was more effective in inducing diarrhea (p = 0.019).
    Conclusion
    In general, treatment by red sugar has been effective in improving the functional characteristics of constipation in
    children; and did not show any complication and toxic effects. It is easily accessible at affordable prices to resolve childhood
    constipation
    Keywords: Constipation, Children, Traditional medicine, Iran
  • Mehri Hajalikhani, Mohammad Hassan Emami, Mahsa Khodadoostan, Ahmad Shavakhi, Moeen Rezaei, Reza Soluki Pages 319-324
     
    Aim
    To investigate whether aggressive hydration can increase the efficacy of prophylactic non-steroid anti-inflammatory drugs
    (NSAIDs) in prevention of post-ERCP pancreatitis.
    Background
    NSAIDs are recommended for the prevention of PEP; however, whether aggressive hydration can have additional
    benefits in this regard is not known.
    Methods
    Patients candidate for ERCP received either pre-procedural rectal diclofenac (100 mg) alone (n = 112) or in combination
    with aggressive hydration by lactate ringer’s (n = 107) as prophylactic method. PEP was defined based on increase in serum levels of
    pancreatic enzymes (from baseline to 24 hours following the procedure) accompanied with symptoms.
    Results
    PEP was occurred in 3 patients in the diclofenac only group and in 1 patient in the diclofenac + hydration group with no
    significant difference (2.7% vs. 0.9%, P = 0.622). Serum amylase levels decreased over time in the diclofenac + hydration group but
    not in the diclofenac only group. Also, serum lipase levels decreased more rapidly over time in the diclofenac + hydration group
    compared to the diclofenac only group.
    Conclusion
    Combination prophylactic therapy with NSAIDs plus aggressive hydration does not seem to have additional clinically
    important benefits in preventing PEP. Studies with larger sample of patients are required in this regard.
    Keywords: Pancreatitis, Endoscopic retrograde cholangiopancreatography, Prevention, Inflammation, Diclofenac, Aggressive
    hydration.
    (Please cite as: Hajalikhani M, Emami MH, Khodadoostan M, Shavakhi A, Rezaei M, Soluki R. Combination of
    diclofenac and aggressive hydration for the prevention of post-ERCP pancreatitis. Gastroenterol Hepatol Bed
    Bench 2018;11(4):319-324
    Keywords: pancreatitis, endoscopic retrograde cholangiopancreatography, prevention, inflammation, diclofenac, aggressive hydration
  • Roman Maslennikov, Anastasia Driga, Konstantine Ivashkin, Vladimir Ivashkin Pages 325-332
    Aim
    To assess NT-proBNP as a biomarker for hyperdynamic circulation in decompensated cirrhosis.
    Background
    Hyperdynamic circulation is common in decompensated cirrhosis. The previous studies reveal that N-terminal-proBNP
    (NT-proBNP) is elevated in cirrhosis.
    Methods
    A prospective study involved 47 patients with decompensated cirrhosis. All of them underwent echocardiography with
    simultaneous measurement of blood pressure and heart rate. Cardiac output and systemic vascular resistance were calculated. The
    concentration of NT-proBNP in blood was measured with enzyme-linked immunosorbent assay.
    Results
    In patients with decompensated cirrhosis, the concentration of NT-proBNP in blood directly correlated with end-diastolic
    volume (r=0.482; p<0.001), stroke volume (r= 0.566; p<0.001), cardiac output (r=0.556; p<0.001), volume of the left atrium
    (r=0.292; p=0.047), and inversely correlated with systemic vascular resistance (r=-0.538; p<0.001). There was no significant
    correlation between NT-proBNP and ejection fraction (p=0.083). Patients with hyperdynamic circulation have higher concentration of
    NT-proBNP (152÷476 pg/ml vs. 31÷133 pg/ml, p<0.001) regardless of the presence of diastolic dysfunction (p=0.222). According to
    ROC analysis, the best cut-off values for detection of hyperdynamic circulation in decompensated cirrhosis are considered to be 170.0
    pg/ml of blood NT-proBNP, showing sensitivity and specificity of 72.0 and 86.4%, respectively. The positive and negative predictive
    value are 86.4% and 73.1%, AUC = 0.829 (0.709-0.949).
    Conclusion
    NT-proBNP may serve as a non-invasive biomarker for hyperdynamic circulation in decompensated cirrhosis
    Keywords: Blood Circulation, Liver Cirrhosis, Biomarkers, Natriuretic Peptide, Brain
  • Farideh Kamarehei, Alireza Khabiri, Massoud Saidijam, Meysam Soleimani, Mohammad Yousef Alikhani Pages 333-342
     
    Aim
    In this research, we designed a direct Enzyme Linked Immunoassay method to detect Helicobacter pylori antigens in stool
    specimens.
    Background
    Helicobacter pylori infection as the worldwide problem is related to many gastrointestinal disorders such as gastritis,
    gastric cancer, non-ulcer disease, peptic ulcer disease and duodenal ulcer.
    Methods
    We produced and purified recombinant CagA and NapA antigens in Escherichia coli and extracted their antibodies from a
    panel of positive sera specimens. We designed a novel enzyme linked immunoassay direct method in combination with the whole cell
    for the qualitative and quantitative detection of Helicobacter pylori antigens in human stool. Assay performance was evaluated by
    histopathology staining and urease activity.
    Results
    The sensitivity and specificity of assay was determined as 91.7 [95% confidence interval: 89.3–95.6%] and 93.1% [95% CI:91.2–96.4%], respectively. Novel ELISA exhibits enhanced sensitivity and specificity of Helicobacter pylori detection in comparison
    with another commercially available kit.
    Conclusion
    Combination of the recombinant antigens and whole cell of Helicobacter pylori in immunoassay designing is a new
    approach about early diagnosis, treatment and fallowing up of the Helicobacter pylori infected patients, especially in peptic cancer
    cases
    Keywords: Helicobacter pylori, Cytotoxin-associated gene A, Neutrophil activating protein A, Enzyme-linked immunosorbent assay
  • Vahid Mansouri, sina rezaei tavirani, Mohammad Mehdi Zadeh, Esmaeel, Mohammad Rostami, Nejad, Mostafa Rezaei –Tavirani Pages 343-351
    Aim
    In this study the significant differentially expressed genes (DEGs) related to gastric cancer (GC) and chronic gastritis were
    screened to introduce common and distinctive genes between the two diseases.
    Background
    Diagnosis of gastric cancer as a mortal disease and chronic gastritis the stomach disorder which can be considered as
    risk factor of GCs required safe and effective molecular biomarkers.
    Methods
    Microarray profiles were downloaded from Gene Expression Omnibus (GEO) and analyzed via GEO2R. The candidate
    DEGs plus relevant genes from STRING database were interacted by Cytoscape software version 3.6.0 the central nodes were
    determined and analyzed.
    Results
    JUN, GAPDH, FOS, TP53, PRDM10, VEGFA, and CREB1 as central nodes and TFF1 and ERG1 as the top changed
    expressed genes were determined as critical nodes related to gastric cancer. GAPDH, PRDM10, TP53, JUN, AKT1, EGFR, MAPK1,
    EGF, DECR1, and MYC were identified as common remarkable genes between GC and chronic gastritis.
    Conclusion
    Identification of distinctive and common genes between GC and chronic gastritis can be useful in the early stage
    detection of disease and reducing risk of GCs
    Keywords: Gastric Cancer, Chronic Gastritis, Biomarkers
  • Ehsan Javanmard, Hamed Mirjalali, Maryam Niyyati, Meysam Sharifdini, Esfandiar Jalilzadeh, Seyed Javad Seyed Tabaei, Hamid Asadzadeh Aghdaei, Roghieh Rostami, Ehsan Nazemalhosseini, Mojarad, Ali Haghighi, Mohammad Reza Zali Pages 352-358
    Aim
    The aim of the present study was to simultaneously investigate parasitic contamination of treated wastewater and downstream
    vegetable farms that are irrigated with treated sewage, during a year.
    Background
    (Oo) Cysts and eggs of parasites are resistant to most of routine wastewater treatment process. Irrigation of vegetables
    farms with either treated wastewater or illegally use of raw wastewaters enhances the risk of contamination with enteric pathogens.
    Methods
    The treated wastewater samples were taken after chlorination from a wastewater treatment plant located at the south of
    Tehran. In addition, 60 vegetable samples (5 samples from each farm) were collected from the selected downstream farms that
    routinely used treated wastewater for irrigation of crops. Parasitological tests were performed using Ziehl–Neelsen, conventional
    lugol’s iodine staining and direct microscopical examination.
    Results
    Parasites including free living larvae, eggs of Toxoascaris leonina, egg of Toxocara sp. Trichuris sp, Trichostrongylus sp
    and amoeboid trophozoite were seen in 5/12 (41.7%) of vegetable samples gathered during a year. There was no statistically
    significant correlation between the season and parasitic contamination of the vegetables (P= 1). Furthermore, parasitic contamination
    was observed in 7/12 (53.8%) of treated wastewater samples. The correlation between season and parasitic contamination of treated
    wastewater was evaluated that the results showed a higher contamination of treated wastewater in spring and autumn (P<0.05).
    Fisher’s exact test also showed that there was no significant correlation between parasitic contaminations of vegetable samples and
    treated wastewater according to seasonal change.
    Conclusion
    The results showed parasites in both treated wastewater plant and downstream crops farms that suggests the public
    health importance of the quality of water resources that routinely used for irrigation of vegetable farms
    Keywords: Treated wastewaters, vegetable farms, Irrigation, Parasitic contamination, Iran
  • Amir sadeghi, Mohammad Amin Shahrbaf, Hamid Asadzadeh Aghdaei, Mohammad Reza Zali, Komeil Esmaeilinejad Pages 359-362
    Simple renal cysts are one of the most common lesions in elderly. These cysts are usually asymptomatic but when the size of these
    cysts increase, we would see symptoms such as hypertension, hematuria, flank pain or urinary obstruction. In this study, we explore a
    case of small bowel obstruction that presented with nausea, repeated vomiting that causes hematemesis, and a submucosal obstructive
    lesion that was seen in Esophagogastroduodenoscopy (EGD). After endoscopic ultrasound (EUS) evaluation, we detected a large
    simple renal cyst and approved our diagnosis with CT scan. We planned a medical treatment for this patient that consist consuming
    small size meals, 5 to 6 times a day, and high calorie liquids in small volumes. We conclude that simple renal cyst can be one of the
    cause of extrinsic intestinal obstruction and EUS is affective for differentiation of intrinsic submucosal lesion from extrinsic
    compressio
    Keywords: Intestinal obstruction_Renal cyst_Endoscopic ultrasound.(Please cite as: Sadeghi A_Shahrbaf MA_Asadzadeh Aghdaei H_Esmaeilinejad K_Zali MR. A rare presentation ofsimple renal cyst: gastrointestinal obstruction. Gastroenterol Hepatol Bed Bench 2018_11(4):359-362
  • Beata Polewiczowska, David Al, Dulaimi Pages 363-365
    Aim
    To assess NT-proBNP as a biomarker for hyperdynamic circulation in decompensated cirrhosis.
    Background
    Hyperdynamic circulation is common in decompensated cirrhosis. The previous studies reveal that N-terminal-proBNP
    (NT-proBNP) is elevated in cirrhosis.
    Methods
    A prospective study involved 47 patients with decompensated cirrhosis. All of them underwent echocardiography with
    simultaneous measurement of blood pressure and heart rate. Cardiac output and systemic vascular resistance were calculated. The
    concentration of NT-proBNP in blood was measured with enzyme-linked immunosorbent assay.
    Results
    In patients with decompensated cirrhosis, the concentration of NT-proBNP in blood directly correlated with end-diastolic
    volume (r=0.482; p<0.001), stroke volume (r= 0.566; p<0.001), cardiac output (r=0.556; p<0.001), volume of the left atrium
    (r=0.292; p=0.047), and inversely correlated with systemic vascular resistance (r=-0.538; p<0.001). There was no significant
    correlation between NT-proBNP and ejection fraction (p=0.083). Patients with hyperdynamic circulation have higher concentration of
    NT-proBNP (152÷476 pg/ml vs. 31÷133 pg/ml, p<0.001) regardless of the presence of diastolic dysfunction (p=0.222). According to
    ROC analysis, the best cut-off values for detection of hyperdynamic circulation in decompensated cirrhosis are considered to be 170.0
    pg/ml of blood NT-proBNP, showing sensitivity and specificity of 72.0 and 86.4%, respectively. The positive and negative predictive
    value are 86.4% and 73.1%, AUC = 0.829 (0.709-0.949).
    Conclusion
    NT-proBNP may serve as a non-invasive biomarker for hyperdynamic circulation in decompensated cirrhosis.
    Keywords: Blood circulation, Liver cirrhosis, Biomarkers, Natriuretic peptide, Brain.
    (Please cite as: Maslennikov R, Driga A, Ivashkin K, Ivashkin V. NT-proBNP as a biomarker for hyperdynamic
    circulation in decompensated cirrhosis. Gastroenterol Hepatol Bed Bench 2018;11(4):325-332).