Combined multichannel intraluminal impedance and pH monitoring assists the diagnosis of sliding hiatal hernia in children with gastroesophageal reflux disease

Background

The role of combined multichannel intraluminal impedance and pH monitoring (MII-pH) in diagnosing sliding hiatal hernia in gastroesophageal reflux disease (GERD) children remains unclear. We aimed to explore the clinical efficacy of MII-pH as a supplement diagnostic method for sliding hiatal hernia.

Methods

A total of 104 symptomatic GERD children [mean ± standard deviation (SD) age = 4.5 ± 5.5 years] were recruited. All of them were diagnosed as GERD with and without sliding hiatal hernia by barium and/or esophagogastroduodenoscopy study. All subjects received 24 h MII-pH monitoring to test the efficacy of this new modality.

Results

Sixteen children were diagnosed to have sliding hiatal hernia, and nine (56.3 %) of them received fundoplication. None of non-hiatal hernia children were indicated for fundoplication [risk difference (RD) 0.56; P < 0.001]. Impedance probes detected more reflux episodes than pH-probe in the whole study population (mean ± SD = 62.1 ± 47.8 vs. 47.8 ± 48.1 episodes; P = 0.02, paired t test). Due to the presence of pH-only reflux, the reflux episodes detected by impedance probes is less than that by pH probe in sliding hiatal hernia children (mean ± SD = 49.2 ± 78.9 vs. 103.7 ± 60.4 episodes; P = 0.01, paired t test). Ratio of reflux episodes detected by pH-probe to that by impedance probes >1 was more frequently noted in sliding hiatal hernia children than non-sliding hiatal hernia children (Odds ratio 58.33, P < 0.001). The sensitivity and specificity of this diagnostic tool to predict sliding hiatal hernia in GERD children are 93.8 and 79.6 %, respectively.

Conclusions

Ratio of reflux episodes detected by pH-probe to that by impedance probes >1 demonstrated by MII-pH study is a good screening test of sliding hiatal hernia in GERD children.     

Lifestyle factors associated with gastroesophageal reflux disease in the Japanese population

Background

We aimed to clarify the lifestyle factors associated with erosive esophagitis and non-erosive reflux disease (NERD) in a Japanese population.

Methods

Among 886 subjects who underwent health screening, we selected, according to their scores on the FSSG (frequency scale for symptoms of gastroesophageal reflux disease; GERD) questionnaire and the findings of upper gastrointestinal endoscopy, 138 subjects with erosive esophagitis (EE), 148 subjects with NERD (absence of esophagitis, FSSG score ≥8, and acid reflux-related symptoms score ≥4), and 565 control subjects (absence of esophagitis and FSSG score ≤7). We compared clinical characteristics and various lifestyle factors in these three groups.

Results

The lifestyle factors significantly associated with NERD compared with findings in the control group were intake of egg (odds ratio [OR] 1.89, 95 % confidence interval [CI] 1.01–3.50), sleep shortage (OR 2.44, 95 % CI 1.54–3.88), and strong psychological stress (OR 1.77, 95 % CI 1.18–2.62). In male subjects, current smoking (OR 2.06, 95 % CI 1.13–3.74; OR 1.87, 95 % CI 1.09–3.20) was a significant risk factor for both NERD and EE. Moreover, alcohol >200 kcal/day (OR 3.99, 95 % CI 1.03–15.55) and intake of a large quantity of food at supper (OR 7.85, 95 % CI 1.66–37.05) were significant risk factors for EE in subjects with hiatal hernia. Intake of a large quantity of food at supper (OR 2.09, 95 % CI 1.06–4.13) was more common in the NERD group than in the EE group.

Conclusions

There were differences in the associated lifestyle factors between patients with NERD and those with EE, and there was also a gender-related difference between these groups.     

Risk factors for reflux esophagitis after eradication of Helicobacter pylori

Abstract

Objective: While there is an association between successful eradication of Helicobacter pylori (HP) and reflux esophagitis (RE), risk factors associated with RE remain obscure. The aim of this study is to determine risk factors associated with the development of RE after HP eradication.

Materials and methods: Among all patients treated with successful HP eradication from 2008 to 2016, we retrospectively analyzed those who were free from RE at initial esophagogastroduodenoscopy (EGD) and who were followed up with EGD after eradication. Patients were classified according to the presence or absence of RE at the follow-up EGD. RE was defined as mucosal breaks proximal to the squamous-columnar junction. Demographic data, underlying diseases, medications and endoscopic findings at the initial EGD were compared between patients with and without RE.

Results: Among 1575 patients, 142 (9.0%) had RE at the follow-up EGD. The time interval from HP eradication until EGD ranged from 4 to 24?months. The endoscopic grade of RE was higher in males than in females. Multivariate analysis revealed that male sex (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.04–2.24), body mass index ≥25?kg/m² (OR, 2.91; 95% CI, 2.00–4.22), use of calcium channel blockers (OR, 1.70; 95% CI, 1.12–2.55), and hiatal hernia (OR, 3.46; 95% CI, 2.41–5.00) were associated with the development of RE.

Conclusions: Calcium channel blocker use was found to be a risk factor for the development of RE after eradication of HP.     

Prevalence of Barrett’s Esophagus Remains Low in the Korean Population: Nationwide Cross-Sectional Prospective Multicenter Study

Purpose

In contrast to the Western population, the prevalence of Barrett’s esophagus (BE) is rare in the Korean population. However, the recent increase in prevalence of gastroesophageal reflux disease (GERD) may affect the prevalence of BE. The aim of this study was to survey the prevalence of BE and evaluate its risk factors.

Methods

Patients between 18 and 75 years of age who visited 11 Korean tertiary referral centers between April and July 2006 for routine upper endoscopic examination were surveyed using a symptom questionnaire. Biopsies were performed on the columnar lined epithelium (CLE) of the distal esophagus, and diagnosis was confirmed with detection of specialized intestinal metaplasia.

Results

The study comprised 2,048 patients (mean age 51.4 years, 965 males). The frequency of heartburn or acid regurgitation was 8.7% and 13.1%, respectively. Reflux esophagitis was diagnosed in 10.1% of patients (207 patients); however, most patients had mild reflux. CLE was found in 82 patients; however, only one patient had long-segment CLE. The prevalence of BE was 1% (21 patients). The risk factors for BE were age (P = 0.006), presence of heartburn [odds ratio (OR) 4.33, 95% confidence interval (CI) 1.66–11.34, P = 0.007], acid regurgitation (OR 3.37, 95% CI 1.35–8.42, P = 0.01), sliding hernia (OR 6.21, 95% CI 1.78–21.72, P = 0.001), and reflux esophagitis (OR 10.28, 95% CI 4.31–24.50, P < 0.0001) on univariate analysis. On multivariate analysis, presence of typical reflux symptoms (P = 0.02) and reflux esophagitis (P < 0.001) were significant.

Conclusions

Prevalence of Barrett’s esophagus remains low in Koreans; however, risk of developing BE has increased in patients with GERD symptoms and reflux esophagitis.     

Endoscopic and histological correlation of the findings of mucosa of the distal esophagus in nonerosive reflux disease

Background

Esophagogastroduodenoscopy (EGD) is frequently requested for patients with gastroesophageal reflux symptoms. When the distal esophagus mucosa shows no erosions, questions are posed: (1) Does the esophageal biopsy contribute to confirm reflux as the cause of the symptoms? (2) Do minimum endoscopic changes have correspondence with histology?

Methods

A total of 1901 patients were prospectively interviewed by a standard questionnaire to obtain a clinical diagnosis of gastroesophageal reflux disease (GERD); 150 patients (98 males; median age, 42 years) with clinical manifestations of GERD and an intact esophageal mucosa were assigned to nonerosive reflux disease (NERD) patients, and 49 patients (24 males; median age, 46 years) with no complaints of GERD were assigned to Controls. The EGD images were documented on tape. Four biopsies were performed at the distal esophagus. Experienced endoscopists and pathologists examined twice, at different times and separately, the respective endoscopic and histological examinations. For all comparisons, kappa (K) match, 95% confidence interval, and the P value were determined.

Results

In NERD patients, the match between endoscopic and histological findings as to the aspect of the mucosa of the esophagus was poor (K = 0.08). EGD showed 17.2% sensitivity and 90.2% specificity, whereas the esophagus histological study showed 39% sensitivity and 73% specificity. NERD patients presented a greater frequency of esophagitis than Controls (38.6% vs. 22.4%), but this value was nonsignificant (P = 0.023).

Conclusion

Agreement between patient symptoms or endoscopic findings and histological diagnosis is poor; therefore, histology of the esophageal mucosa as a diagnostic test of NERD demonstrates low sensitivity and does not justify routine use.     

Barrett’s Esophagus and Esophageal Adenocarcinoma Are Common After Treatment for Achalasia

Background

Achalasia is characterized by esophageal aperistalsis and impaired relaxation of the lower esophageal sphincter (LES). This contrasts with an insufficient LES, predisposing to gastro-esophageal reflux and Barrett’s esophagus. The co-incidence of achalasia and BE is rare. Pneumatic dilatation (PD) may lead to gastro-esophageal reflux, Barrett’s esophagus development, and esophageal adenocarcinoma.

Aims

To determine the incidence of Barrett’s esophagus and esophageal adenocarcinoma in achalasia patients treated with PD.

Methods

We performed a single-center cohort follow-up study of 331 achalasia patients treated with PD. Mean follow-up was 8.9 years, consisting of regular esophageal manometry, timed barium esophagram, and endoscopy.

Results

Twenty-eight (8.4 %) patients were diagnosed with Barrett’s esophagus, one at baseline endoscopy. This corresponds with an annual incidence of Barrett’s esophagus of 1.00 % (95 % CI 0.62–1.37). Hiatal herniation was present in 74 patients and 21 developed Barrett’s esophagus compared to seven of 257 patients without a hiatal hernia. Statistical analysis revealed a hazard ratio of 8.04 to develop Barrett’s esophagus if a hiatal hernia was present. Post-treatment LES pressures were lower in patients with Barrett’s esophagus than in those without (13.9 vs. 17.4 mmHg; p = 0.03). Two (0.6 %) patients developed esophageal adenocarcinoma during follow-up.

Conclusions

Barrett’s esophagus is incidentally diagnosed in untreated achalasia patients despite high LES pressures, but is more common after successful treatment, especially in the presence of hiatal herniation. Patients treated for achalasia should be considered for GERD treatment and surveillance of development of Barrett’s esophagus, in particular, when they have low LES pressures and a hiatal herniation.     

Reflux gastro-œsophagien chez l’adulte jeune africain: cas des étudiants de l’Université du Burundi

Introduction

The Gastro-esophageal reflux disease (GERD) is an important public health issue, according to its high prevalence, its chronic evolution and the frequent solicitations of cares that it generates. Among students, it can constitute a cause of school absenteeism or failures. In particular, there has been no previous investigation of GERD in young adult in Burundi.

Goal

To estimate the prevalence of GERD among young adult, to describe the risk factors and the main clinical symptoms of GERD.

Methods

Cross-sectional study, curried out over July 2011 among students of University of Burundi, randomly recruited in literature department and in Science and Medicine faculties.

Results

400 students have been kept for the study, 279 males and 121 females (sex-ratio: 2.3). The mean age was 27years+/?4 years with extremes of 20 and 40 years. The GERD has been found among 111 students either a prevalence of 27.8%, CI95%=[23–32%]. According to GERD recurrence, 21% (84 among 400) either 75.6% of students with GERD had at least one episode per week (GERD recurrent). Among female students, the prevalence of GERD was 28.9%, CI95%=[21–38%] (35 students) while among males it was 27.3% CI95%=[22–33%] (76 students), p>0,05. The main symptoms of GERD were the heartburn alone in 81,1% CI95%=[72–88%], the heartburn associated to acid regurgitations in 16,2% CI95%=[10–25%] and the regurgitations alone in 2,7% CI95%=[1–8%]. The extra-digestive symptoms were described by 3% of students suffering from GERD.

Conclusion

The global prevalence of GERD is estimated to 27.8% and the recurrent GERD to 21% either 75.6% of students with GERD. The main risk factors described were the fat meals and the cooked banana. These rates seem to be among the highest.     

Association between metabolic syndrome and prevalence of gastroesophageal reflux disease in a health screening facility in Japan

Background

Abdominal fat accumulation, which induces high intra-abdominal pressure that causes increase in the gastroesophageal pressure gradient and hiatal hernia, as well as obesity, has been shown to increase the prevalence of gastroesophageal reflux disease (GERD). This study was performed to clarify the association between metabolic syndrome and the prevalence of GERD.

Methods

The study subjects were an adult population who visited a medical center for annual medical check-ups from April 2010 to March 2011. GERD was diagnosed by the presence of endoscopically proven reflux esophagitis, GERD symptoms (QUEST score ≥6), or current medical therapy for GERD. The presence of metabolic or pre-metabolic syndrome was diagnosed based on the Japanese criteria for metabolic syndrome.

Results

Six hundred four (16.0 %) of 3775 study subjects were positively diagnosed with GERD, with the number of those with metabolic and pre-metabolic syndrome being 477 (12.6 %) and 384 (10.2 %), respectively. Multiple logistic regression analysis showed that male gender, presence of hiatal hernia, and metabolic or pre-metabolic syndrome, as well as absence of gastric mucosal atrophy, were significant predictive factors for the prevalence of GERD, as were visceral fat accumulation and untreated dyslipidemia. Untreated hypertension and untreated hyperglycemia were also considered to be positive risk factors. Subjects undergoing treatment for hypertension showed an increased risk of GERD, while those undergoing treatment for dyslipidemia and diabetes mellitus showed a decreased risk.

Conclusion

Metabolic syndrome is a reliable predictive factor for the prevalence of GERD, and medical therapy for metabolic syndrome may modify the risk of GERD occurrence.     

The PSCA polymorphisms derived from genome-wide association study are associated with risk of gastric cancer: a meta-analysis

Purpose

Prostate stem cell antigen (PSCA) is a glycosylphosphatidylinositol-anchored 123-aa protein related to the cell-proliferation inhibition and/or cell-death induction activity. Many studies had reported the role of PSCA rs2294008 C?>?T and rs2976392 G?>?A polymorphisms on gastric cancer risk.

Methods

To investigate a more precise estimation of the relationships, we performed a meta-analysis on 9 case–control studies included 10,746 cases and 9,158 controls. Odds ratios (ORs) and 95?% confidence intervals (CIs) were used to assess the strength of the association.

Results

For PSCA rs2294008 C?>?T polymorphism, there was a significantly increased risk of gastric cancer in all genetic models (TT/TC vs. CC: OR?=?1.61, 95?% CI?=?1.35–1.91; TT vs. TC/CC: OR?=?1.33, 95?% CI?=?1.24–1.42). Similar results were also observed for PSCA rs2976392 G?>?A polymorphism (AA/AG vs. GG: OR?=?1.69, 95?% CI?=?1.24–2.31; AA vs. AG/GG: OR?=?1.36, 95?% CI?=?1.24–1.50). In the stratified analysis by ethnicity of rs2294008, an increased gastric cancer risk was found in both Asians (TT vs. TC/CC: OR?=?1.31, 95?% CI?=?1.22–1.42) and Europeans (TT/TC vs. CC: OR?=?1.42, 95?% CI?=?1.18–1.71). Furthermore, when stratified by clinicopathologic characteristics of tumor location and histology, a higher risk on non-cardia compared with cardia gastric cancer (TT vs. TC/CC: OR?=?1.43, 95?% CI?=?1.12–1.83) as same as diffused compared with intestinal gastric cancer (TT vs. TC/CC: OR?=?1.29, 95?% CI?=?1.13–1.49) was observed.

Conclusion

These findings supported that PSCA rs2294008 C?>?T and rs2976392 G?>?A polymorphisms may contribute to the susceptibility to gastric cancer, particular in non-cardia or diffused gastric cancer.     

Prognostic value of a single HVPG measurement and Doppler-ultrasound evaluation in patients with cirrhosis and portal hypertension

Background

In patients with cirrhosis the onset of clinically significant portal hypertension (CSPH; i.e., hepatic venous pressure gradient (HVPG) ???10?mmHg) is associated with an increased risk of complications. However, most cirrhotic patients already have CSPH at presentation, and limited information is available on further risk stratification in this population. This study assessed the prognostic value of a single HVPG measurement and Doppler-ultrasound (US) evaluation in patients with cirrhosis and CSPH.

Methods

Eighty-six consecutive patients with cirrhosis (73% compensated) and untreated CSPH (mean HVPG 17.8?±?5.1?mmHg) were included. All were studied by paired HVPG and US, and followed up for a minimum of 12?months (mean 28?±?20?months).

Results

Sixteen (25.3%) patients developed a first decompensation, and 11.6% died on follow-up. HVPG (per 1?mmHg increase OR 1.22, 95% CI 1.05?C1.40, p?=?0.007) and bilirubin (per 1?mg/ml increase OR 2.42, 95% CI 0.93?C6.26, p?=?0.06) independently predicted first decompensation, and Model for End-Stage Liver Disease (MELD) score (per 1 point increase OR 1.24, 95% CI 1.03?C1.51, p?=?0.03) and HVPG (per 1?mmHg increase OR 1.08, 95% CI 1.01?C1.26, p?=?0.05) independently predicted mortality. The best HVPG cutoff predicting these events was 16?mmHg. Ultrasonographic parameters lacked independent predictive value. The ultrasonographic detection of abdominal collaterals had a high positive likelihood ratio (7.03, 95% CI 2.23?C22.16) for the prediction of HVPG ???16?mmHg, implying an increase of the probability of belonging to this higher-risk population from 58 to 91%.

Conclusions

HVPG holds an independent predictive value for first decompensation and death in patients with CSPH. The ultrasonographic detection of collaterals allows the non-invasive identification of patients with HVPG ???16?mmHg, who are at higher risk.     

No association between gallstones and gastroesophageal reflux disease

OBJECTIVES: Gallstones and hiatal hernia reportedly have been linked to similar dietary factors prevalent in western countries, and patients with cholelithiasis or previous cholecystectomy have been reported to have more duodenogastric reflux than healthy controls. Nonetheless, the contribution of duodenogastric reflux to the development of gastroesophageal reflux disease (GERD) remains controversial. The present study was aimed to assess the association between gallstone disease and GERD. METHODS: Outpatients from general medical clinics who underwent upper GI endoscopy and abdominal ultrasonography were recruited into a case-control study. A case population of 790 patients with various grades of GERD was compared to a control population of 407 patients without GERD. In a multivariate logistic regression, the presence of GERD served as the outcome variable, whereas the presence of gallstones, hiatal hernia, social habits, and demographic characteristics served as predictor variables. RESULTS: No associations were found between the presence of cholelithiasis or previous cholecystectomy and GERD or between the presence of cholelithiasis or previous cholecystectomy and hiatal hernia. The severity of GERD also remained unaffected by the presence of gallstones. The occurrence of GERD was influenced only by hiatal hernia (odds ratio [OR] = 3.15, 95% CI = 2.44-4.08), alcohol consumption (OR = 1.47, CI = 1.08-1.99), and not by cholelithiasis (OR = 1.02, CI = 0.68-1.51), or cholecystectomy (OR = 0.90, CI = 0.64-1.28). The frequency of GERD among hiatus hernia patients with gallstones (437/592 = 74%) was similar to the frequency of GERD among hiatus hernia patients without gallstones (168/220 = 76%, p = 0.516). CONCLUSIONS: Neither cholelithiasis nor cholecystectomy poses a risk for the occurrence of GERD or hiatal hernia. Gallstone disease does not seem to influence the integrity of the esophageal mucosa through GERD.     

Clinically Significant Endoscopic Findings in a Multi-Ethnic Population With Uninvestigated Dyspepsia

Introduction

The proportion of clinically significant endoscopic findings (CSEF) in dyspepsia affects the initial management of this condition. With the changing epidemiology of organic upper gastrointestinal diseases in Asia, current data on CSEF remains uncertain.

Methods

A cross-sectional study of consecutive adult patients attending an open access endoscopy list for the primary indication of dyspepsia was conducted. Independent epidemiological and clinical factors for CSEF were determined prospectively.

Results

Data for 1167/1208 (96.6?%) adults (mean age 49.7?±?15.9?years, 42.4?% males, ethnic distribution: 30.5?% Malays, 36.9?% Chinese and 30.8?% Indians) were analysed between January 2007 and August 2008. Three-hundred and eight (26.4?%) patients were found to have CSEF, most often those with age ??45?years (30.3 vs 19?%, P?<?0.0001), male gender (34.1 vs 20.7?% female, P?<?0.0001), lower education levels (i.e. primary or no education), smoking (36.7 vs 24.9?%, P?=?0.003), H. pylori infection (40.6 vs 21.8?%, P?<?0.0001), and duration of dyspepsia ??5?months (32.8 vs 24.4?%, P?=?0.006). Age????45?years (OR 1.82, 95?% CI?=?1.38?C2.48), male gender (OR 1.84, 95?% CI?=?1.53?C2.59), H. pylori infection (OR 2.36, 95?% CI?=?1.83?C3.26), and duration of dyspepsia ??5?months (OR 1.44, 95?% CI?=?1.13?C2.03) were subsequently identified as independent risk factors for CSEF.

Conclusion

CSEF are found in 26.4?% of Asian adults with uninvestigated dyspepsia. Duration of symptoms <5?months, among other recognised factors, is predictive of CSEF.     

Reflux gastro-œsophagien dans la population consultant à Bujumbura

Introduction

Gastro-esophageal reflux disease (GERD), its risk factors, the severity of endoscopic lesions and the role that helicobacter pylori (H pylori) may play are not well known in Burundi. No study had been made among consulting populations.

Aim

The aim of the study was to establish the prevalence of GERD in consulting populations and to evaluate its risk factors, the esophageal lesions linked to GERD and a probable impact of H pylori infection.

Patients and methods

A cross sectional and prospective study, was carried out over seven months (from March to September 2011) in a cohort of consecutive patients who came to general medicine or gastroenterology clinics at CEMADIF.

Results

2500 patients agreed to participate in the survey. 1374 were female and 1126 males (sex-ratio of 1.2). The mean age was 43 years. There were 869 patients with GERD, either a prevalence of 34.7%, CI95%=[33–37%]. Among females patients, the prevalence of GERD was 40.3%, CI95%=[37–43%] and among males patients it was 28%, CI95%=[25–31%], p<0.001.Theprevalence was 33.8% among <30 years old patients, 39% between 30–49 years old patients and 27.3% among ≥ 50 years old patients. 51.4% had at least an episode daily, 34.3% an episode weekly and 14.3% an episode monthly. 164 patients with GERD underwent upper digestive endoscopy to assess esophageal mucosa lesions. 79.9%, CI95%=[82–93%] had a normal mucosa, 7.9%, CI95%=[4–13%] had esophagitis grade I or II according to Los Angeles classification and 3.7%, CI95%=[1–8%] had esophagitis grade III or IV. 8.5%, CI95%=[5–14%] had an hiatal hernia or an open cardia. The H pylori infection didn’t seem to be a risk factor of GERD.

Conclusion

GERD is estimated to 34.7% among populations consulting in Bujumbura. It is responsible of esophageal lesions in 11.6%. The female gender would be a risk factor whereas H pylori infection doesn’t seem to have an impact on GERD.     

Association of low serum adiponectin levels with erosive esophagitis in men: an analysis of 2405 subjects undergoing physical check-ups

Background

Obesity is a risk factor for gastro-esophageal reflux disease (GERD). It is generally considered that intra-abdominal pressure in obese subjects is involved in the pathogenesis of GERD through acid exposure to the esophagus. Recently, visceral fat has been recognized as an endocrine organ that secretes various adipocytokines including adiponectin. The aim of this study was to elucidate the relation between adiponectin and erosive esophagitis.

Methods

This was a cross-sectional retrospective observational study: 2405 consecutive subjects who underwent screening esophago-gastro-duodenoscopy with serum adiponectin measurement as part of their physical check-up programs were analyzed. Clinical factors were compared between subjects with and without erosive esophagitis. The association between adiponectin and erosive esophagitis was assessed using a bootstrapping re-sampling method after adjustment for factors that tended to be different in univariate analysis.

Results

Serum adiponectin levels were significantly lower in those with erosive esophagitis (8.17???g/ml) than in those without (10.1). The erosive esophagitis group had a greater body mass index (BMI) and waist circumference (WC) and a higher prevalence of hiatal hernia. Using the bootstrap method, with a lower adiponectin cut-off value of 3?C7???g/ml, the lower limit of the 95% confidence interval of the adjusted odds ratio consistently exceeded 1 after adjustment for BMI and hiatal hernia in men. When adjusting for WC instead of BMI, the effect of adiponectin was reduced but remained significant at a lower cut-off value (3?C3.5???g/ml).

Conclusions

Low serum adiponectin levels may be associated with an increased risk for erosive esophagitis in men.     

Staphylococcus aureus infections after liver transplantation

Background

More data on the risk factors and outcomes after Staphylococcus aureus infections in liver transplantation are needed.

Methods

Liver recipients with S. aureus infections (cases) were retrospectively identified and compared to gender-, age-, and transplant type-matched (1:2) non-S. aureus-infected controls. Risk factors associated with S. aureus infections were identified by conditional logistic regression analysis.

Results

We evaluated 51 patients (median age 52?years). First S. aureus infections developed at a median time of 29?days after transplantation, with 52.94% of them in the first month; 88.24% were nosocomial, 41.18% were polymicrobial, and 47.06% were caused by methicillin-resistant S. aureus (MRSA). Surgical site infections represented 58.82% and bacteremia 23.53%. By univariate analysis, patients with S. aureus infections were intubated more frequently (odds ratio [OR] 26.92, 95% confidence interval [CI] 3.23?C3,504.15, p?=?0.0006), had a central line (OR 11.69, 95% CI 1.42?C95.9, p?=?0.02), or recent surgery (OR 26.92, 95% CI 3.23?C3,504.15, p?=?0.0006) compared with controls. By multivariate analysis, subjects who underwent surgery within 2?weeks prior to infection had a 26.9 times higher risk of developing S. aureus infection (95% CI 3.23?C3,504.15, p?=?0.0006); these results were adjusted for matched criteria. S. aureus infections did not affect graft or patient survival, but the study was not powered for such outcomes.

Conclusion

Only recent surgical procedure was found to be a significant independent risk factor for S. aureus infections after liver transplantation.     

Meta-analysis of functional MBL polymorphisms

Objective

The aim of this study was to determine whether functional mannose-binding lectin gene (MBL) polymorphisms are associated with the susceptibility to rheumatoid arthritis (RA) or primary Sjögren’s syndrome (pSS).

Methods

A meta-analysis was conducted to investigate the potential association of RA or pSS with MBL polymorphisms, including the codon 54 (allele B), codon 57 (allele C), and codon 52 (allele D) variants of exon 1, and the ??550 (allele L) and ??221 (allele X) promoter variants.

Results

A total of 12 comparative studies, including eight RA (1623 patients and 1671 controls) and four pSS (280 patients and 516 controls) studies, were included in the meta-analysis. The meta-analysis revealed no association between the MBL B allele and RA in the overall study population (odds ratio [OR] 0.991, 95?% confidence interval [CI] 0.726–1.355, p?=?0.957). However, the meta-analysis showed significant associations between the MBL D, H, and X alleles and RA in the overall population (OR 1.708, 95?% CI 1.077–2.707, p?=?0.023; OR 1.936, 95?% CI 1.218–3.078, p?=?0.005; OR 1.582, 95?% CI 1.216–2.057, p?=?0.001, respectively). An association was found between the MBL B allele and pSS in the overall study population (OR 0.691, 95?% CI 0.541–0.917, p?=?0.010). Stratification by ethnicity indicated a trend toward an association between the B allele and pSS in European populations, but no association in Asian populations (OR 0.689, 95?% CI 0.465–1.021, p?=?0.063; OR 0.896, 95?% CI 0.311–2.562, p?=?0.838, respectively).

Conclusion

This meta-analysis demonstrated an association between the MBL D, L, and X alleles and the risk of RA. It also demonstrated an association between the MBL B allele and the susceptibility to pSS, suggesting a protective role of the MBL B allele against the development of pSS.     

Nonalcoholic Fatty Liver Disease Increases Risk for Gastroesophageal Reflux Symptoms

Background

Nonalcoholic fatty liver disease (NAFLD) is now recognized as a leading cause of liver dysfunction. Gastroesophageal reflux disease (GERD) is a common disorder causing symptoms that often impair patients’ quality of life. In recent years, the prevalence of both these diseases has increased, partially overlapping the rise of metabolic disorders.

Aims

We investigated whether a relation does exist between NAFLD and GERD symptoms.

Methods

Cross-sectional study among 206 outpatients diagnosed with NAFLD and 183 controls. We collected clinical and laboratory data, assessed severity and frequency of GERD symptoms and the esophageal endoscopic pattern.

Results

The prevalence of GERD symptoms was higher in NAFLD patients than controls (61.2 vs. 27.9 %, p < 0.001). We found a positive association between NAFLD and the experiencing of heartburn, regurgitation and belching. GERD symptoms were related to body mass index (BMI) and metabolic syndrome (MetS); a strong association persisted after adjustment for all the covariates (adjusted OR 3.49, 95 CI % 2.24–5.44, p < 0.001).

Conclusions

Our data show that the prevalence of GERD typical symptoms is higher in patients with NAFLD. GERD was associated with higher BMI and MetS, but not with age and diabetes type 2. NAFLD remained strongly associated with GERD, independently of a coexisting MetS status. Consistent with these findings, MetS can be considered a shared background, but cannot completely explain this correlation. We suggest NAFLD as an independent risk factor for GERD symptoms.     

Variants of ADRA2A are associated with fasting glucose, blood pressure, body mass index and type 2 diabetes risk: meta-analysis of four prospective studies

Aims/hypothesis

We quantified the effect of ADRA2A (encoding ??-2 adrenergic receptor) variants on metabolic traits and type 2 diabetes risk, as reported in four studies.

Methods

Genotype data for ADRA2A single nucleotide polymorphisms (SNPs) rs553668 and rs10885122 were analysed in >17,000 individuals (1,307 type 2 diabetes cases) with regard to metabolic traits and type 2 diabetes risk. Two studies (n?=?9,437), genotyped using the Human Cardiovascular Disease BeadChip, provided 12 additional ADRA2A SNPs.

Results

Rs553668 was associated with per allele effects on fasting glucose (0.03?mmol/l, p?=?0.016) and type 2 diabetes risk (OR 1.17, 95% CI 1.04?C1.31; p?=?0.01). No significant association was observed with rs10885122. Of the 12 SNPs, several showed associations with metabolic traits. Overall, after variable selection, rs553668 was associated with type 2 diabetes risk (OR 1.38, 95% CI 1.09?C1.73; p?=?0.007). rs553668 (per allele difference 0.036?mmol/l, 95% CI 0.008?C0.065) and rs17186196 (per allele difference 0.066?mmol/l, 95% CI 0.017?C0.115) were independently associated with fasting glucose, and rs17186196 with fasting insulin and HOMA of insulin resistance (4.3%, 95% CI 0.6?C8.1 and 4.9%, 95% CI 1.0?C9.0, respectively, per allele). Per-allele effects of rs491589 on systolic and diastolic blood pressure were 1.19?mmHg (95% CI 0.43?C1.95) and 0.61?mmHg (95% CI 0.11?C1.10), respectively, and those of rs36022820 on BMI 0.58?kg/m² (95% CI 0.15?C1.02).

Conclusions/interpretation

Multiple ADRA2A SNPs are associated with metabolic traits, blood pressure and type 2 diabetes risk. The ??-2 adrenergic receptor should be revisited as a therapeutic target for reduction of the adverse consequences of metabolic trait disorders and type 2 diabetes.     

Investigation of pretreatment prediction of proton pump inhibitor (PPI)-resistant patients with gastroesophageal reflux disease and the dose escalation challenge of PPIs��TORNADO study: a multicenter prospective study by the Acid-Related Symptom Research Group in Japan

Backgrounds

Some non-erosive reflux disease (NERD) and reflux esophagitis (RE) patients are unresponsive to a proton pump inhibitor (PPI) at standard dose. We investigated the predictive marker of the efficacy of PPI for GERD patients including NERD and RE treated with standard and increased doses of a PPI.

Methods

Patients with symptomatic gastroesophageal reflux disease (GERD) (NERD and RE) were treated with rabeprazole (RPZ) 10?mg once daily for 4?weeks. The RPZ dosage was increased to 10?mg twice daily for an additional 2?weeks and again to 20?mg twice daily for another 2?weeks if heartburn was not relieved. Baseline characteristics and efficacy of RPZ were assessed on the basis of a heartburn diary and frequency scale for symptoms of GERD (FSSG).

Results

Complete heartburn relief rates after 4?weeks were 42.5% (31/73) and 67.9% (19/28) in NERD and RE groups, respectively, which rose to 68.9 and 91.7% after dose escalation. Multivariate analysis revealed that parameters associated with resistance to RPZ 10?mg once daily were female, non-smoking, frequent heartburn, low score for question 4 (Q4) of the FSSG (subconsciously rubbing the chest), and high scores for Q3 (heavy stomach after meal) and Q7 (unusual sensation in the throat). Frequent heartburn and a high score for Q7 were associated with resistance to RPZ 20?mg twice daily. FSSG scores of patients resistant to RPZ were significantly higher in comparison with responders before and during treatment.

Conclusions

FSSG could predict response to a PPI for symptomatic GERD. Increase of RPZ dose is useful for treatment of GERD refractory to the standard dose of RPZ.     

Racial/Ethnic Differences in Spontaneous HCV Clearance in HIV Infected and Uninfected Women

Background/Aims

Among individuals without human immunodeficiency virus (HIV), African Americans have lower spontaneous clearance of hepatitis C virus (HCV) than Caucasians, and women have higher clearance than men. Few studies report racial/ethnic differences in acute HCV in HIV infected, or Hispanic women. We examined racial/ethnic differences in spontaneous HCV clearance in a population of HCV mono- and co-infected women.

Methods

We conducted a cross sectional study of HCV seropositive women (897 HIV infected and 168 HIV uninfected) followed in the US multicenter, NIH-funded Women’s Interagency HIV Study (WIHS), to determine the association of race/ethnicity with spontaneous HCV clearance, as defined by undetectable HCV RNA at study entry.

Results

Among HIV and HCV seropositive women, 18.7 % were HCV RNA negative, 60.9 % were African American, 19.3 % Hispanic and 17.7 % Caucasian. HIV infected African American women were less likely to spontaneously clear HCV than Hispanic (OR 0.59, 95 % CI 0.38–0.93, p = 0.022) or Caucasian women (OR 0.57, 95 % CI 0.36–0.93, p = 0.023). Among HIV uninfected women, African Americans had less HCV clearance than Hispanics (OR 0.18, 95 % CI 0.07–0.48, p = 0.001) or Caucasians (OR 0.26, 95 % CI 0.09–0.79, p = 0.017). There were no significant differences in HCV clearance between Hispanics and Caucasians, among either HIV infected (OR 0.97, 95 % CI 0.57–1.66, p = 0.91) or uninfected (OR 1.45, 95 % CI 0.56–3.8, p = 0.45) women.

Conclusions

African Americans were less likely to spontaneously clear HCV than Hispanics or Caucasians, regardless of HIV status. No significant differences in spontaneous HCV clearance were observed between Caucasian and Hispanic women. Future studies incorporating IL28B genotype may further explain these observed racial/ethnic differences in spontaneous HCV clearance.