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May-June 2016
Volume 22 | Issue 3
Page Nos. 169-248
Online since Friday, May 13, 2016
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EDITORIALS
Is vitamin e or ursodeoxycholic acid a valid treatment option for nonalcoholic fatty liver disease in 2016?
p. 169
Melanie D Beaton, Bandar Al-Judaibi
DOI
:10.4103/1319-3767.182462
PMID
:27184632
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Contrast enhanced ultrasound for solid pancreatic lesions: Does timing after contrast injection also matter?
p. 171
Narendra S Choudhary, Rajesh Puri
DOI
:10.4103/1319-3767.182450
PMID
:27184633
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REVIEW ARTICLES
Management of hepatitis c genotype 4 in the liver transplant setting
p. 173
Waleed K Al-hamoudi
DOI
:10.4103/1319-3767.182453
PMID
:27184634
End-stage liver disease secondary to hepatitis C virus (HCV) infection is the major indication for orthotopic liver transplantation (OLT) worldwide. The percentage of HCV patients infected with genotype 4 (G4) among recipients of OLT varies depending on geographic location. In the Middle East, including Saudi Arabia, G4 infection is the most common genotype among transplant recipients. Due to the low prevalence of HCV-G4 in Europe and the United States, this genotype has not been adequately studied in prospective trials evaluating treatment outcomes and remains the least studied variant. The aim of this review is to summarize the natural history and treatment outcome of HCV-G4 following liver transplantation, with particular attention to new HCV therapies. This review incorporates all published studies and abstracts including HCV-G4 patients.
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Implementation of the simple endoscopic activity score in crohn's disease
p. 183
Efstratios Koutroumpakis, Konstantinos H Katsanos
DOI
:10.4103/1319-3767.182455
PMID
:27184635
Simple Endoscopic Score for Crohn's Disease (SES-CD) was developed as an attempt to simplify Crohn's Disease Endoscopic Index of Severity (CDEIS). Since it was constructed from CDEIS, SES-CD performs comparably but also carries similar limitations. Several studies have utilized SES-CD scoring to describe disease severity or response to therapy. Some of them used SES-CD score as a continuous variable while others utilized certain cutoff values to define severity grades. All SES-CD cutoff values reported in published clinical trials were empirically selected by experts. Although in most of the studies that used SEC-CD scoring to define disease severity, a score <3 reflected inactive disease, no study is using score 0 to predefine inactivity. Studies applying SES-CD to define response to treatment used score 0. There is no optimal SES-CD cut-off for endoscopic remission. The quantification of mucosal healing using SES-CD scoring has not been standardized yet. As the definition of mucosal healing by SES-CD is unset, the concept of deep remission is also still evolving. Serum and fecal biomarkers as well as new radiologic imaging techniques are complementary to SES-CD. Current practice as well as important changes in endoscopy should be taken into consideration when defining SES-CD cutoffs. The optimal timing of SES-CD scoring to assess mucosal healing is not defined yet. To conclude, SES-CD represents a valuable tool. However, a consensus agreement on its optimal use is required.
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ORIGINAL ARTICLES
An open-label randomized control study to compare the efficacy of vitamin e versus ursodeoxycholic acid in nondiabetic and noncirrhotic Indian NAFLD patients
p. 192
Pathik Parikh, Meghraj Ingle, Jatin Patel, Prasad Bhate, Vikas Pandey, Prabha Sawant
DOI
:10.4103/1319-3767.182451
PMID
:27184636
Background/Aim:
The study was carried out to compare the efficacy of Vitamin E versus Ursodeoxycholic acid (UDCA) in nondiabetic nonalcoholic fatty liver disease (NAFLD) patients.
Patients and Methods:
We randomized 250 non cirrhotic and non diabetic NAFLD patients diagnosed on ultrasound, with raised alanine aminotransferase (ALT) level. (>40 IU/L), to receive Vitamin E 400 mg twice a day (Group A) or UDCA 300 mg twice a day (Group B) for 52 weeks. Lifestyle modification to achieve at least 5% weight reduction and subsequent weight control and regular exercise was advised to both groups. The primary study endpoint was normalization of ALT. Secondary endpoints were the proportion of patients with reduction in ALT, relative reduction in the NAFLD Fibrosis score (NFS), symptomatic improvement and tolerability.
Results:
One hundred and fifty patients received UDCA as compared to 100 patients receiving Vitamin E. The treatment groups were comparable at entry with regard to age (44.1 vs 42.4 years), gender (67% vs 63% female), risk factors for nonalcoholic steatohepatitis, hypochondriac pain, serum liver biochemistries, and NAFLD Fibrosis score. The primary endpoint was achieved in 21 (14%) and 19 (19%) of patients in Group A and Group B, respectively (
P
= 0.2). The proportion of patients with reduction in ALT (56% vs 63%,
P
= 0.2), symptomatic improvement (78% vs 67%,
P
= 0.058), reduction in the NFS (44% vs 47%,
P
= 0.69), and tolerability (98% vs 95%,
P
= 0.2) were similar between Group A and Group B, respectively.
Conclusion:
UDCA is an effective and safe alternative to Vitamin E in nondiabetic–noncirrhotic Indian NAFLD patients.
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Efficacy of contrast-enhanced harmonic endoscopic ultrasonography in the diagnosis of pancreatic ductal carcinoma
p. 198
Toshiyuki Uekitani, Seiji Kaino, Hirofumi Harima, Shigeyuki Suenaga, Manabu Sen-yo, Isao Sakaida
DOI
:10.4103/1319-3767.182457
PMID
:27184637
Background/Aims:
Distinguishing pancreatic ductal carcinoma (DC) from other pancreatic masses remains challenging. This study aims at evaluating the efficacy of contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) in the diagnosis of DC.
Patients and Methods:
Forty-nine patients with solid pancreatic mass lesions underwent CEH-EUS. EUS (B-mode) was used to evaluate the inner echoes, distributions, and borders of the masses. The vascular patterns of the masses were evaluated with CEH-EUS at 30–50 s (early phase) and 70–90 s (late phase) after the administration of Sonazoid
®
.
Results:
The final diagnoses included DCs (37), mass-forming pancreatitis (6), endocrine neoplasms (3), a solid pseudopapillary neoplasm (1), a metastatic carcinoma (1), and an acinar cell carcinoma (1). The sensitivity, specificity, and accuracy of the diagnoses of DC in hypoechoic masses using EUS (B-mode) were 89.2%, 16.7%, and 71.4%, respectively. The sensitivity, specificity, and accuracy for the diagnosis of DC in hypovascular masses using CEH-EUS were 73.0%, 91.7%, and 77.6% in the early phase and 83.8%, 91.7%, and 85.7% in the late phase, respectively.
Conclusions:
CEH-EUS for the diagnosis of DC is superior to EUS. CEH-EUS in the late phase was particularly efficacious in the diagnosis of DC.
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Outcome of acute upper gastrointestinal bleeding in patients with coronary artery disease: A matched case–control study
p. 203
Kessarin Thanapirom, Wiriyaporn Ridtitid, Rungsun Rerknimitr, Rattikorn Thungsuk, Phadet Noophun, Chatchawan Wongjitrat, Somchai Luangjaru, Padet Vedkijkul, Comson Lertkupinit, Swangphong Poonsab, Thawee Ratanachu-ek, Piyathida Hansomburana, Bubpha Pornthisarn, Thirada Thongbai, Varocha Mahachai, Sombat Treeprasertsuk
DOI
:10.4103/1319-3767.182452
PMID
:27184638
Background/Aim:
The risk of upper gastrointestinal bleeding (UGIB) increases in patients with coronary artery disease (CAD) due to the frequent use of antiplatelets. There is some data reporting on treatment outcomes in CAD patients presenting with UGIB. We aim to determine the clinical characteristics and outcomes of UGIB in patients with CAD, compared with non-CAD patients.
Patients and Methods:
We conducted a prospective multi-center cohort study (THAI UGIB-2010) that enrolled 981 consecutive hospitalized patients with acute UGIB. A matched case–control analysis using this database, which was collected from 11 tertiary referral hospitals in Thailand between January 2010 and September 2011, was performed.
Result:
Of 981 hospitalized patients with UGIB, there were 61 CAD patients and 244 gender-matched non-CAD patients (ratio 1:4). UGIB patients with CAD were significantly older, and had more frequently used antiplatelets and warfarin than in non-CAD patients. Compared with non-CAD, the CAD patients had significantly higher Glasgow–Blatchford score, full and pre-endoscopic Rockall score and full. Peptic ulcer in CAD patients was identified more often than in non-CAD patients. UGIB patients with CAD and non-CAD had similar outcomes with regard to mortality rate, re-bleeding, surgery, embolization, and packed erythrocyte transfusion. However, CAD patients had longer duration of hospital stays than non-CAD patients. Two CAD patients died from cardiac arrest after endoscopy, whereas three non-CAD patients died from pneumonia and acute renal failure during their hospitalization.
Conclusion:
In Thailand, patients presenting with UGIB, concomitant CAD did not affect clinical outcome of treatment, compared with non-CAD patients, except for longer hospital stay.
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Are serum quantitative hepatitis b surface antigen levels, liver histopathology and viral loads related in chronic hepatitis b-infected patients?
p. 208
Ayhan Balkan, Mustafa Namiduru, Yasemin Balkan, Ayse Ozlem Mete, Ilkay Karaoglan, Vuslat Kecik Bosnak
DOI
:10.4103/1319-3767.182454
PMID
:27184639
Background/Aims:
Fluctuations in hepatitis B virus (HBV) DNA and alanine transaminase (ALT) levels complicate assessment of the phases of chronic hepatitis B (CHB) infection and correct identification of the inactive HBV carrier state. In this study, we aimed to examine the role of HBsAg quantification (qHBsAg) in the identification of the phases of HBV and to evaluate its association with liver histopathology.
Patients and Methods:
Inactive HBV carriers (IC) (n = 104) and CHB patients (n = 100) were enrolled in the study. Demographic characteristics of patients were evaluated; biochemical parameters and serum qHBsAg levels were studied, and liver biopsy and histopathology were assessed.
Results:
Serum qHBsAg levels were found to be significantly low in IC (5150.78 ± 8473.16 IU/mL) compared with the HBeAg-negative CHB (7503.21 ± 8101.41 IU/mL) (
P
= 0.001) patients. The diagnostic accuracy of qHBsAg to differentiate HBeAg-negative CHB from IC was found to be moderate (c-statistic: 0.695) and the cutoff level for qHBsAg in diagnosis was found as 1625 IU/mL (specificity: 80%; sensitivity: 49%). No correlation was noted between serum qHBsAg level and ALT, histologic activity index (HAI), and fibrosis in IC and CHB. A moderate and positive correlation was observed between the serum qHBsAg level and HBV-DNA in HBeAg-positive CHB patients.
Conclusions:
Serum qHBsAg levels may prove to be useful in the differentiation between IC and HBeAg-negative CHB when used in conjunction with HBV DNA. Furthermore, patients diagnosed solely on the basis of HBV DNA and ALT may present with higher grade and stage of liver histopathology than expected.
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Hepatitis b virus expression and replication in ovum and the influencing factors
p. 215
Ying Kong, Feng Ye, Yan Jin, Juanzi Shi, Hongtao Qiu, Shumei Lin
DOI
:10.4103/1319-3767.182456
PMID
:27184640
Background/Aim:
The aim of this study was to investigate the factors that influence hepatitis B virus (HBV) expression and replication in the ovum.
Materials and Methods:
Immunohistochemistry and
in situ
hybridization techniques were used to assay the distributions of HBcAg, HBV DNA, and HBV mRNA in ovarian tissues and the ovum in 50 patients with chronic HBV infection. HBeAg and HBV DNA in the serum were also detected. Comparisons of categorical data were performed using McNemar test.
Results:
The positive rates of HBcAg, HBV DNA, and HBV mRNA in ovum and ovarian tissues of high replication group were significantly higher than low replication group (
χ
2
= 15.04,
P
< 0.05;
χ
2
= 12.96,
P
<0.05;
χ
2
= 19.36,
P
< 0.05; respectively). High positive rates of HBcAg, HBV DNA, and HBV mRNA in ovum and ovarian tissues were found in women with HBeAg-positive than HBeAg-negative (
χ
2
= 113.14,
P
< 0.05;
χ
2
= 11.13,
P
< 0.05;
χ
2
= 17.39,
P
< 0.05; respectively).
Conclusion:
HBV can infect and replicate in the ovary and ovum. Maternal HBeAg status and HBV DNA levels are important influencing factors.
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No mortality difference following treatment with terlipressin or somatostatin in cirrhotic patients with gastric variceal hemorrhage
p. 220
Tsung-Hsing Hung, Chen-Chi Tsai, guo-Chih TsenK, Yu-Hsi Hsieh, Chih-Wei Tseng
DOI
:10.4103/1319-3767.182458
PMID
:27184641
Background/Aims:
The aim of this study was to compare the efficacy of terlipressin versus somatostatin as adjuvants to endoscopic treatment in cirrhotic patients with gastric variceal bleeding.
Patients and Methods:
The National Health Insurance Database, derived from the Taiwan National Health Insurance Program, was used to enroll patients who were discharged with International Classification of Diseases, 9
th
Revision, Clinical Modification diagnoses of cirrhosis and who underwent gastric variceal sclerotherapy for gastric variceal bleeding between January 1, 2007, and December 31, 2007. We observed treatment outcomes and identified clinical factors associated with mortality.
Results:
In total, we enrolled 311 cirrhosis patients who underwent sclerotherapy for active gastric variceal bleeding. Among them, 218 patients received terlipressin, and 93 patients received somatostatin. The overall 30 day mortality rate was 13.2% (41/311). A total of 78 (25.1%) patients underwent second-look endoscopy, but only 12 (7%) needed a second course of gastric variceal sclerotherapy. The overall 30-day mortality rates for patients treated with terlipressin and somatostatin were 13.3% and 12.9%, respectively, showing no statistically significant differences between outcomes in the two treatment groups (
P
= 0.672). The risk of 30-day mortality was significantly higher in patients with hepatocellular carcinoma (HR: 3.257, 95% CI: 1.640-6.469,
P
= 0.001), acute renal failure (HR: 6.261, 95% CI: 2.376-16.499,
P
< 0.001), or hepatic encephalopathy (HR: 3.091, 95% CI: 1.430-6.680,
P
= 0.004).
Conclusions:
Mortality rates did not differ significantly between cirrhosis patients with acute gastric variceal bleeding who received somatostatin or terlipressin as adjuvants to endoscopy.
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Protective effect of the methanolic extract of
malva parviflora
l. leaves on acetic acid-induced ulcerative colitis in rats
p. 226
Aisha Dugani, Bushra Dakhil, Soad Treesh
DOI
:10.4103/1319-3767.182459
PMID
:27184642
Background/Aims:
Inflammatory bowel disease (IBD) is a general term describing chronic, idiopathic relapsing, inflammatory conditions of the gastrointestinal tract of unknown etiology. Previous studies have indicated that
Malva parviflora
leaf extract possesses anti-inflammatory, antioxidant, and antiulcerogenic activity. activity. This work aimed to investigatee the anti-inflammatory effect of the methanolic (MEMP) and aqueous (AEMP) extracts of
M. parviflora
leaves on acetic acid-induced colitis in rats.
Materials and Methods:
42 male Wistar albino rats were divided into seven groups (
n
= 6). Group I: Normal saline control group with no colitis; Group II: Acetic acid colitis group; Group III: 100 mg/kg/5 d MEMP; Group IV: 200 mg/kg/5 d.MEMP; Group V: 100 mg/kg/5 d AEMP; Group VI: 200 mg/kg/5 d AEMP; Group VII: Prednisolone group (2 mg/kg/5 d). Treatments were followed by induction of colitis using intrarectal instillation of 2 mL of 4% acetic acid. Colon damage was evaluated macroscopically (spleen weight/body weight, colon weight/length ratio) and the histological changes were also recorded.
Results:
The results of this study showed that acetic acid caused severe inflammation of the colon and a significant increase in spleen weight/body weight, and an increase in colon weight/length ratio compared with normal control group. Pretreatment with MEMP and AEMP for 5 days followed by induction of colitis resulted in a significant attenuation of spleen weight and colon weight/length ratio compared with acetic acid control group. Methanolic extract provided better anticolitic effect than aqueous extract; the effect was prominent at the dose of 200 mg/kg. Histopathological findings confirmed the protective effect of the MEMP.
Conclusion:
In conclusion, MEMP could ameliorate mucosal damage in experimentally induced colitis when given orally.
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Expression of serotonin receptors in the colonic tissue of chronic diarrhea rats
p. 234
Tong Zhu, Juanjuan Qiu, Jiajia Wan, Fengyun Wang, Xudong Tang, Huishu Guo
DOI
:10.4103/1319-3767.182460
PMID
:27184643
Background/Aims:
This study aimed to investigate the difference among the expression of serotonin receptors (5-HT
3
, 5-HT
4
, and 5-HT
7
receptors) in colonic tissue of chronic diarrhea rats.
Materials and Methods:
A rat model of chronic diarrhea was established by lactose diet. The expression of 5-HT
3
, 5-HT
4
, and 5-HT
7
receptors in the colonic tissue was detected using immunohistochemistry, real-time PCR and Western blotting techniques.
Results:
There is no significant difference on the protein expression of 5-HT
3
receptor between the normal group and the chronic diarrhea model group. The mRNA expression of 5-HT
3
receptor in the chronic diarrhea model group was significantly lower than that in the normal group (n = 10;
P
< 0.01). The protein and mRNA expression of 5-HT
4
receptor in the chronic diarrhea model group were significantly higher than those in the normal group (n = 10;
P
< 0.05,
P
< 0.01). On the contrary, the protein and mRNA expressions of 5-HT
7
receptor in the chronic diarrhea model group were significantly decreased compared with the normal group (n = 10;
P
< 0.01,
P
< 0.01).
Conclusions:
The results suggested the receptors of 5-HT
4
and 5-HT
7
may be involved in inducing diarrhea by lactose diet.
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Hepatitis c virus genotype 4 replication in the hepatocellular carcinoma cell line HepG2/C3A
p. 240
Medhat K Shier, Mohammad S El-Wetidy, Hebatallah H Ali, Mohammad M Al-Qattan
DOI
:10.4103/1319-3767.182461
PMID
:27184644
Background/Aims:
The lack of a reliable cell culture system allowing persistent
in vitro
hepatitis C virus (HCV) propagation is still restraining the search for novel antiviral strategies. HepG2 cells transfection with HCV allows for viral replication. However, the replication is weak presumably because of HepG2 lack of miRNA-122, which is essential for viral replication. Other agents such as polyethylene glycol (PEG) and dimethyl sulfoxide (DMSO) have been shown to increase the efficiency of infection with other viruses. This study included comparison of HCV genotype 4 5′UTR and core RNA levels and HCV core protein expression at different time intervals in the absence or presence of PEG and/or DMSO postinfection.
Materials and Methods:
We used serum with native HCV particles in infecting HepG2 cells
in vitro
. HCV replication was assessed by reverse transcriptase polymerase chain reaction for detection of HCV RNA and immunofluorescence and flow cytometry for detection of HCV core protein.
Results:
HCV 5′UTR and core RNA expression was evident at different time intervals after viral infection, especially after cells were treated with PEG. HCV core protein was also evident at different time intervals using both immunofluorescence and flow cytometry. PEG, not DMSO, has increased the HCV core protein expression in the treated cells, similar to its effect on viral RNA expression.
Conclusions:
These expression profiles suggest that the current model of cultured HepG2 cells allows the study of HCV genotype 4 replication and different stages of the viral life cycle.
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© Saudi Journal of Gastroenterology (Official journal of The Saudi Gastroenterology Association) | Published by Wolters Kluwer -
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Online since 15
th
October, 2006