Ewa Klimacka-Nawrot

Transforming growth factor-β1 and its receptors in patients with ulcerative colitis

Transforming growth factor-beta1 (TGF-beta1) plays a role in the pathogenesis of ulcerative colitis (UC) by activating its specific receptors (T beta RI-T beta RIII). We investigated the expression of genes encoding for TGF-beta1 and T beta RI-III using RT-QPCR in patients with active and inactive UC and non-IBD controls. The localization and level of TGF-beta1 protein in intestinal tissue was estimated by immunohistochemistry, and serum TGF-beta1 concentrations were determined using ELISA. We found a significant increase in TGF-beta1 gene expression and increase in the expression of genes encoding receptor T beta RI in patients with active UC when compared with controls. The expression of genes encoding T beta RII was found to be higher in patients with both active and inactive UC when compared to controls. Specific staining for TGF-beta1 in fibroblasts was significantly greater in both active and inactive UC as compared to controls. The serum concentration of TGF-beta1 was significantly higher in patients with active UC when compared with controls as well as in UC patients with left side/total colonic extension when compared with those with disease limited to rectum/rectosigmoid area. However, no correlation between TGF-beta1 serum concentrations and UC activity index was found. Increases in TGF-beta1 gene expression and its protein level, associated with altered TGF-beta1 receptor profile indicate a functional role for TGF-beta1 in intestinal inflammatory/repair processes in UC. Increases in TGF-beta1 serum concentrations correlate with extension of disease.

Expression, localization and systemic concentration of vascular endothelial growth factor (VEGF) and its receptors in patients with ulcerative colitis.

Vascular endothelial grow factor (VEGF) promotes angiogenesis by activating the specific receptors KDR and Flt-1. We investigate the expression of genes encoding VEGF and its receptors KDR and Flt- 1 by RT-QPCR reaction using Quanti Tect SYBR Green RT-PCR in patients with active and inactive ulcerative colitis (UC) and control subjects. The localization and level of VEGF protein and its receptors protein in intestinal tissue were estimated by immunohistochemistry. VEGF concentration in serum and plasma was determined by ELISA. We found a significant increase of VEGF gene expression and increase expression of genes encoding receptor Flt-1 in patients with active UC when compared with controls, but KDR was present in trace amount. VEGF and Flt-1 proteins were colocalized in enterocytes as well as in endothelium and muscularis layer of the intestine. The specific staining reaction for VEGF protein as well as for Flt-1 protein was significantly higher in active UC compared with controls. Serum level of VEGF was significantly higher in active UC patients as compared with inactive UC patients as well as with controls. The plasma VEGF level was found to be significantly higher in active UC patients as compared with controls. The increase of gene expression as well as protein level for VEGF and its receptor in UC - inflamed colon, and VEGF action via Flt-1 receptor may have a functional role in UC. Increased VEGF levels in both serum and plasma in active UC patients may reflect VEGF overexpression in intestinal inflammatory tissue.

Taste and appetite disorders of chronic hepatitis C patients.

Objective Decreased appetite is one of the main factors that influences quality of life of patients with chronic liver diseases. The reason for appetite disorders remains unclear but taste perturbations are one of the postulated causes. The potential role of taste alterations and, connected to these, appetite disorders in chronic hepatitis C (CHC) patients are poorly investigated. The aim of this study was to evaluate potential taste alterations (dysgeusia) including all five tastes (sweet, salty, bitter, sour and umami) in CHC patients. Methods Forty CHC patients (16 men and 24 women) infected with genotype 1 hepatitis C virus participated in this study. All the patients had a compensated liver disease and were being treated with any agents. One hundred and ten healthy volunteers were matched to the patients by age and sex. The study included gustatory tests (taste recognition threshold, taste intensity with hedonic perception) and analysis of the pleasure derived from eating. Results In CHC patients, the recognition threshold of umami taste was increased (P<0.01) and the intensity of sweet taste perception was higher (P<0.05). The hedonic response did not differ between the groups. A significant increase in declared pleasure derived from eating (P<0.001 to P<0.05) was also observed. Some differences in case of the patients with more advanced disease were also found. Conclusion Alterations in taste, especially umami and sweet taste disorders, may alter real food perception and lead to a reduction in food intake in some CHC patients.

High-resolution Manometry in Patients with Gastroesophageal Reflux Disease Before and After Fundoplication.

Background/Aims The study aimed to determine pre- and post-fundoplication esophagogastric junction (EGJ) pressure and esophageal peristalsis by high-resolution manometry (HRM) in patients with gastroesophageal reflux disease (GERD). Methods Pre-operative and post-operative HRM data from 25 patients with GERD were analyzed using ManoView version 2.0.1. with updated software for Chicago classification and pressure topography. The study involved swallowing water boluses of 10 mL in the upright position. Results Significant increase of mean basal EGJ pressure and minimal basal EGJ pressure was found in post-operative as compared with preoperative patients (P < 0.05 and P < 0.001, respectively). Integrated relaxation pressure (IRP) reached higher values in post-operative patients than in pre-operative patients (P < 0.001). Intra-bolus pressure (IBP) was significantly higher (P < 0.05) and contractile front velocity (CFV) was slower (P < 0.01) in post-operative patients than in pre-operative patients. Moreover significant increase of distal contractile integral (DCI) was found in post-operative patients (P < 0.05). Hiatal hernia was detected by HRM in 11 pre-operative patients. Fifteen out of 25 post-operative patients complained of dysphagia. Conclusions Fundoplication restores the antireflux barrier by reinforcing EGJ basal pressures, repairing hiatal hernias, and enhances peristaltic function of the esophagus by increasing DCI. However slight IRP elevation found in post-fundoplication patients may result in bolus pressurization and motility disorders.

Alterations in taste perception as a result of hyperbaric oxygen therapy.

The present study evaluates the effect of hyperbaric oxygen therapy on taste sensitivity, hedonic perception of taste, and food preferences. The studied groups included 197 people in total (79 in the study group; 118 in the control group). All patients from the study group were treated with hyperbaric oxygen therapy due to chronic non-healing wounds. The control group consisted of healthy people, who did not receive hyperbaric oxygen therapy. The taste intensity, recognition thresholds, and hedonic perception were examined using gustatory tests. The aqueous solutions of sucrose for sweet, sodium chloride for salty, citric acid for sour, quinine hydrochloride for bitter, and monosodium glutamate for umami taste were used. The participants fulfilled the questionnaire to examine pleasure derived from eating certain types of dishes. Gustatory tests and analyses of the pleasure derived from eating in the study group were carried out before the first exposure to hyperbaric oxygen and then at the end of therapy, after at least 25 sessions of treatment. In the control group, examination of perception of taste sensations was conducted only once. The results of comparing patients with non-healing wounds with healthy people are characterized by reduced taste sensitivity. After participation in hyperbaric oxygen therapy, the improvement in perception of taste sensations and changes in hedonic evaluation have occurred among patients with non-healing wounds. In terms of food preference, a decreased desire for eating sweet desserts, chocolate, and crisps was observed in those patients who received hyperbaric oxygen therapy.

PTU-151 High Resolution Manometry Profile of Hiatal Hernia in Patients before and after Fundoplication

Introduction Current data relating to esophageal motility evaluated by high resolution manometry(HRM) in presence of hiatal hernia(HH) is equivocal. This study was aimed to compare HRM variables in patients with HH before and after fundoplication and to evaluate diagnostic performance of HRM in detecting sliding HH. Methods Sensitivity and specificity of HRM were assessed in 31 patients(20 females; mean age 48.2) with gastroesophageal reflux disease who were qualified for Nissen fundoplication and underwent preoperative HRM. Intraoperative diagnosis of HH was the gold standard. Area under curve(AUC) of receiver operating characteristic(ROC) reflecting diagnostic accuracy of HRM was also computed. Eleven patients(5 females; mean age 52.1) out of 31 were selected who underwent both: HRM before fundoplication(preoperative group) and at least 3 months after surgery(postoperative group). Manometric protocol included 10 consecutive swallows of 10 ml of water. Variables from pre and postoperative group were compared using paired Wilcoxon test. Results 29 patients out of 31 were found to have HH during surgery while 14 patients had manometric criteria for HH(mean HH size was 2.44 cm). Sensitivity and specificity of HRM in detecting HH were 48% and 100% respectively. AUC under ROC curve for HRM was 0.74 indicating limited usefulness of this method; regarding threshold value of 0.8 for clinical practise. HRM profile of HH in preoperative group is characterised by significantly lower minimal basal esophagogastric junction(EGJ) pressure as well as integrated relaxation pressure(IRP) comparing to postoperative group without HH. IRP values were within normal range in both examined groups( < 15 mmHg). Although mean basal EGJ pressure was lower in preoperative than in postoperative group, the difference between groups didn’t reach statistical significance. Neither DCI nor IBP was affected by fundoplication. Data is shown in table. Abstract PTU-151 Table Preoperative median (IQR*) Postoperative median (IQR*) Hiatal hernia by HRM and intraoperative diagnosis (n) 11 0 Mean Basal EGJ pressure (mmHg) 8.3 (2.6, 11.2) 15.8 (9.9,22.8) Minimal Basal EGJ pressure (mmHg) 0.5 (–2.8, 4.1) 6.5 (4.6, 14.8)† IRP (mmHg) 1.5 (–0.7, 3.7) 5.2 (2.1, 11.8)†† IBP (mmHg) 14.1 (9.6, 18.7) 13.9 (7.1, 24.6) DCI (mmHgxsxcm) 1324 (711.6, 2207.7) 1381.7 (648, 2699.7) * interquartile range; † p < 0.01; ††p < 0.001 Conclusion HRM is not reliable tool to diagnose HH. Due to poor sensitivity of HRM in detecting HH, manometric profile of patients with HH versus those without should be evaluated with caution. Surgical correction of HH contributes to higher EGJ relaxation pressure and improvement of antireflux barrier however neither bolus pressurisation nor DCI is affected by fundoplication. Disclosure of Interest None Declared

PTU-152 High Resolution Manometry Pattern of Esophagogastric Junction and Esophageal Motility in Patients before and after Fundoplication

Introduction Until now it has been limited knowledge related to the application of high resolution manometry(HRM) for the evaluation of fundoplication results. The aim of this study is to assess prospectively esophagogastric junction(EGJ) relaxation and resting pressures and esophageal motility by HRM in patients with gastroesophageal reflux disease(GERD) before and after laparoscopic Nissen fundoplication. Methods 25 patients with GERD(15 females; mean age 46.8 ) underwent HRM before(preoperative group) and at least 3 months after surgery(postoperative group). Manometric protocol included 10 consecutive swallows of 10 ml of water. Variables from pre and postoperative group were compared using Wilcoxon test for paired samples and also McNemar’s test was done to evaluate if surgery had influenced values normalisation. Abstract PTU-152 Table Preoperative median (IQR*) Postoperative median (IQR*) p value Mean Basal EGJ pressure (mmHg) 10.0 (5.7 – 15.6) 15.8 (15.2 – 23.7) p < 0.05 Minimal Basal EGJ pressure (mmHg) 1.8 (–1.1 – 6.5) 7.3 (4.6 – 13.9) p < 0.001 IRP (mmHg) 2.0 (0 – 3.3) 6.0 (2.9 –11.4) p < 0.001 Hiatal hernia (n, %) 11 (45%) 0 IBP (mmHg) 10.2 (6.2 – 14.1) 13.9 (11.7 – 20. 8) p < 0.05 DCI (mmHgxsxcm) 859 (430 – 1574) 1008 (725 – 1968) p < 0.05 CFV (cm/s) 4.3 (3.1 – 5.4) 2.9 (2.0 – 4.0) p < 0.01 Double-peaked waves (%) (0 – 22) (0 – 78) p < 0.01 * interquartile range Results In postoperative group mean basal EGJ pressure as well as minimal basal EGJ pressure were significantly higher than in preoperative group. Integrated relaxation pressure(IRP) was also significantly higher in postoperative group as compared with preoperative group. IRP values were within the normal range in both examined groups(<15 mmHg) except one patient in postoperative group. Before fundoplication 11 patients had hiatal hernia, but none after surgery. Significant increase of intrabolus pressure(IBP) and decrease of contractile front velocity(CFV) were found in postoperative group as compared with preoperative group. Distal contractile integral(DCI) was significantly higher in postoperative group, however based on DCI threshold(450mmHgxsxcm) only trend from ineffective to effective esophageal motility was observed(p = 0.07). Also double-peaked waves were more frequent in postoperative than in preoperative group. Early dysphagia was observed in 8 of 25 patients after fundoplication. Data is shown in table. Conclusion HRM is valuable tool for EGJ characteristics in GERD patients before and after fundoplication. Fundoplication establishes antireflux barrier by increasing EGJ resting pressures and correcting hiatal hernia. Even moderate increased of IRP may contribute to motility disorders and bolus pressurisation in some patients after fundoplication. Disclosure of Interest None Declared