Can Gönen

Comparison of High Resolution Magnifying Endoscopy and Standard Videoendoscopy for the Diagnosis of Helicobacter pylori Gastritis in Routine Clinical Practice: A Prospective Study

Background:  It has been shown that standard endoscopic features often labeled as gastritis has a poor correlation with histopathology. Recently, high resolution magnifying endoscopy has been reported to be an effective method to diagnose gastritis. The aim of the present study was to compare standard endoscopy with magnifying endoscopy for the diagnosis of Helicobacter pylori gastritis, and to determine whether gastritis can be diagnosed based on findings at magnification endoscopy.

Hodgkin’s Disease Presenting with Chylous Ascites and Cavernous Transformation of the Portal Vein

Chylous ascites is a rare form of ascites resulting from an accumulation of a milk-like peritoneal fluid rich in triglycerides, due to the presence of lymph in the abdominal cavity. It occurs as a result of disruption of the lymphatic system due to obstruction or traumatic injury [1, 2]. The reported incidence is approximately 1 per 20,000 hospital admissions and most investigators state that the incidence is increasing because of the prolonged survival of patients with cancer and

Re-determining the cut-off points of FIB-4 for patients monoinfected with chronic hepatitis B virus infection

Abstract Objective: This study aimed to determine significant liver fibrosis and cirrhosis with different FIB-4 cut-off points, and the need for liver biopsy (LB) by optimizing the initially established cut-off points of 1.45 and 3.25. Materials and methods: The study included 201 patients monoinfected with chronic HBV. METAVIR classification was used to determine the stage of fibrosis. ROC analysis and the Youden index were performed to define the optimum cut-off points. Results: A FIB-4 cut-off point of 1.45 and 1.62 generated Youden indexes of 0.51 and 0.55, the accuracy of 78.6% and 81.1% for significant liver fibrosis, respectively. The FIB-4 cut-off was set at 2.40 and 3.25 Youden indexes were 0.46 and 0.16, accuracies were 79.6% and 69.7% for significant liver fibrosis, respectively. A cut-off point of 1.45 and 1.62 for FIB-4 generated Youden indexes of 0.62 and 0.66, the accuracies of 81.6% and 84.1% for cirrhosis, while the FIB-4 cut-off point of 2.40 and 3.25 generated Youden indexes of 0.59 and 0.22, with the accuracies of 90% and 84.1% for cirrhosis, respectively. Conclusions: The FIB-4 cut-off points of 1.62 and 2.40 have higher accuracy and may decrease the need for LB 12% more than the initially established ones in HBV monoinfected patients.

Rapid identification of Helicobacter pylori and assessment of clarithromycin susceptibility from clinical specimens using FISH

Helicobacter pylori remains one of the most common bacterial infections worldwide. Clarithromycin resistance is the most important cause of H. pylori eradication failures. Effective antibiotic therapies in H. pylori infection must be rapidly adapted to local resistance patterns. We investigated the prevalence of clarithromycin resistance due to mutations in positions 2142 and 2143 of 23SrRNA gene of H. pylori by fluorescence in situ hybridisation (FISH), and compared with culture and antimicrobial susceptibility testing in 234 adult patients with dyspepsia who were enrolled. Antrum and corpus biopsy specimens were obtained for rapid urease test, histopathology and culture. Epsilometer test was used to assess clarithromycin susceptibility. H. pylori presence and clarithromycin susceptibility were determined by FISH in paraffin‐embedded biopsy specimens. We found that 164 (70.1%) patients were positive for H. pylori based on clinical criteria, 114 (69.5% CI 62.5–76.6%) were culture positive, and 137 (83.5% CI 77.8–89.2%) were FISH positive. Thus the sensitivity of FISH was significantly superior to that of culture. However specificity was not significantly different (91.4 versus 100.0%, respectively). The resistance rate to clarithromycin for both antrum and corpus was detected in H. pylori‐positive patients; 20.2% by FISH and 28.0% by E‐test.The concordance between E‐test and FISH was only 89.5% due to the presence of point mutations different from A2143G, A2142G or A2142C. We conclude that FISH is significantly more sensitive than culture and the E‐test for the detection of H. pylori and for rapid determinination of claritromycin susceptibility. The superior hybridisation efficiency of FISH is becoming an emerging molecular tool as a reliable, rapid and sensitive method for the detection and visualisation of H. pylori, especially when the management of H. pylori eradication therapy is necessary. This is particularly important for the treatment of patients with H. pylori eradication failure.

Magnifying Endoscopic Features of Granulomatous Gastritis

To the Editor, We read with interest the case presentation published in a recent issue of Digestive Diseases and Sciences, focusing on granulomatous gastritis and its association with Helicobacter pylori (H. pylori) infection [1]. To date, wide variety of endoscopic features have been reported in granulomatous gastritis cases. These include multiple, single, flat or raised erosions; aphthoid ulcerative lesions; patchy or linear erythema; active or healing ulcers; punctate hemorrhages; irregular folds with nodularity, friability or bleeding; and even normal-appearing mucosa [2–4]. To the best of our knowledge, there have been no reports describing the high-resolution magnifying endoscopic features of granulomatous gastritis. We have encountered a patient with granulomatous gastritis during our studies with high-resolution magnifying endoscopy. The endoscopy protocol has been explained in detail elsewhere [5]. A 23-year-old woman with dyspepsia was referred to our center for upper gastrointestinal endoscopy. She had dyspepsia for the last 3 months with no history or clinical symptoms of sarcoidosis, inflammatory bowel disease, granulomatous infection or previous abdominal surgery. Physical examination was remarkable only for mild epigastric tenderness. The hematological examination was normal. During upper endoscopy, antral erythema was the only abnormality under standard mode. High-resolution magnifying examination of antral mucosa revealed intersecting clefts of white amorphous material between antral ridges causing a diamond-shaped mucosal architecture (Fig. 1). Histopathologic examination demonstrated epithelioid granulomas and chronic gastritis (Fig. 2). Glandular atrophy and intestinal metaplasia were absent. H. pylori was detected by rapid urease test and by histologic examination of specimens from antrum. There was no evidence of malignancy or vasculitis. Development of high-resolution magnifying endoscopes introduced a new era in which visualization of gastrointestinal mucosal microstructure became a reality. Under magnification, normal antral mucosa resembled a plowed field with a regularly arranged ridge pattern [5]. The normal subepithelial capillaries form a coil-shaped network, while collecting venules are rarely seen (Fig. 3). This finding was termed ‘‘well-defined ridge pattern’’ [6]. In contrast, patients with H. pylori-induced antral gastritis had irregular and unclear ridges with a white amorphous appearance, and the minute points on the center of each ridge could not be observed distinctly (Fig. 4). Although the antral erythema was the only finding under standard mode in our patient, high-resolution examination revealed differences both from normal antral mucosa and typical H. pylori-induced changes. Antral ridges were separated by intersecting longitudinal and transverse knifelike clefts of white amorphous material, giving a diamond-shaped or cobblestone appearance. There were fairly uniform islands of antral ridges between clefts (Fig. 1). Although granulomatous gastritis is a rare disease, it will be useful and probably more definitional if these lesions could be C. Gonen H. Akpinar Department of Gastroenterology, School of Medicine, Dokuz Eylul University, Izmir, Turkey e-mail: hale.akpinar@deu.edu.tr

High treatment modification rates with lamivudine therapy in HBV‐infected patients with low baseline viremia and early virological response: A multicenter study

Low baseline viremia and an early treatment response predict the best outcomes in hepatitis B virus (HBV)‐infected patients treated with nucleoside analogues with low barriers to resistance. The aim of this study was to assess the long‐term results and effectiveness of lamivudine in patients with low baseline viremia and early virological treatment response.

P238 Diagnostic value of serum adenosine deaminase levels in patients with inflammatory bowel diseases

variants of colonoscopy, and 9 variants of CTE were significant different between ITB and ileocolic CD. But no parameters of biopsy was found significant different between two groups. 3. Multivariate analysis showed that 8 variants were independent factors for the differential diagnosis between ITB and ileocolic CD, including PLT, TSPOT positive, transverse ulcer, patulous ileocecal valve, involvement of sigmoid colon, involvement of small intestine, comb sign, and perianal lesion (Table 1). 4. Predicted model was constructed by multivariate analysis as follows, Logit P = 2.703 + 0.012·PLT 4.264·(TSPOT positive) 4.253·(transverse ulcer) 3.569·(patulous ileocecal valve) + 1.507·(involvement of sigmoid colon) + 1.869·(involvement of small intestine) + 1.885·(comb sign) + 1.797·(perianal lesion). The best diagnostic cut-off point (P= 0.4979) are obtained by ROC analysis (Figure 1). The sensitivity and specificity of the model to identify ITB patients were 88.57% and 100% respectively, and the AUC was 0.9798.

Inflamatuvar barsak hastalıklarının aktivite tayininde endoskopik aktivite indeksleri ile laboratuvar parametreleri arasındaki ilişki

Inflamatuvar barsak hastaliklari genetik olarak yatkin kisilerde, nedeni ve mekanizmasi tam olarak bilinmeyen, kronik seyirli, remisyon ve alevlenme donemleriyle karakterize inflamatuvar bir hastalik grubudur. Ulseratif kolit ve Crohn hastaligi olmak uzere iki onemli hastaligi icermektedir. Bu hastalarda; hastalik aktivitesinin degerlendirilmesi, tedavinin sekillendirilmesi icin bircok klinik aktivite gostergeci ve non invaziv belirtec kullanilmis, fakat hicbiri inflamatuvar aktivitenin saptanmasinda histopatolojik ve endoskopik incelemeler kadar kesin bulgu vermemistir. Inflamatuvar barsak hastaliklarinda aktivitenin belirlenmesi amaci ile ulseratif kolit icin yaygin kullanim bulan klinik indeksler; Truelove-Witts ve Rachmilewitz klinik aktivite indeksidir. Crohn hastaliginda ise tum dunyada kabul edilen klinik indeks Crohn hastaligi aktivite indeksidir. Endoskopik indeksler icerisinde; ulseratif kolit icin endoskopik Mayo Skoru ve Crohn hastaligi icin basit endoskopik skor yaygin kullanim alani bulmus indekslerdir. Biz bu calismada yaygin kullanilan bu aktive indeksleriyle gunluk pratigimizde sik kullandigimiz laboratuvar parametrelerini karsi-lastirdik. Bu amacla inflamatuvar barsak hastaliklari klinik ve endoskopik takibinde bu parametrelerin degerini arastirdik.