Jari Koskenpato

Fecal calprotectin and S100A12 have low utility in prediction of small bowel Crohn's disease detected by wireless capsule endoscopy

Abstract Objective. Data on fecal calprotectin and S100A12 in predicting wireless capsule endoscopy (WCE) findings in suspicion of Crohns disease (CD) are scarce. Our aim was to study the role of calprotectin and S100A12 in predicting inflammatory lesions of small bowel in patients undergoing WCE. Material and methods. 84 patients undergoing WCE (77 for suspicion of CD and 7 CD patients for evaluation of disease extent) were prospectively recruited. WCE findings were scored. Patients provided a stool sample for measurements of biomarkers. Patients underwent an esophagogastroduodenoscopy and ileocolonoscopy before WCE. Results. WCE was abnormal in 35 (42%) of 84 patients: 14 patients with CD, 8 with NSAID enteropathies, 8 with angioectasias, 4 with polyps or tumors, and 1 with ischemic stricture. Median calprotectin concentration in the study population was 22 μg/g (range 2–342) and S100A12 concentration 0.048 μg/g (range 0.003–1.215). Fecal calprotectin was significantly higher in CD patients (median 91, range 2–312) compared with those with normal WCE or other abnormalities (p = 0.008), whereas fecal S100A12 (0.087 μg/g, range 0.008–0.896) did not differ between the groups (p = 0.166). In detecting inflammatory small bowel lesions, sensitivity, specificity, positive predictive value, and negative predictive value for fecal calprotectin (cutoff 50 μg/g) were 59%, 71%, 42%, and 83%, and for S100A12 (cutoff 0.06 μg/g) these were 59%, 66%, 38%, and 82%. Conclusions. In predicting small bowel inflammatory changes, fecal biomarkers calprotectin and S100A12 have moderate specificity, but low sensitivity. Neither fecal calprotectin nor S100A12 can be used for screening or excluding small bowel CD.

Role of Gastric Emptying in Functional Dyspepsia: A Scintigraphic Study of 94 Subjects

Many physiological factors can alter gastricemptying, and the role of gastric emptying in functionaldyspepsia is controversial. The aim of this study was toassess the effects of different factors (age, sex, the degree of dyspeptic and irritablebowel symptoms, lactase deficiency, smoking habits, theuse of antiinflammatory drugs, and H. pylori gastritis)on gastric emptying in patients with functional dyspepsia. The study population consisted of 83patients with functional dyspepsia and 11 controlsubjects who underwent a standardized scintigraphicexamination to study gastric emptying. This studydetected no difference in gastric emptying betweendifferent subgroups with functional dyspepsia. Therewas, however, a slight tendency for delayed gastricemptying among patients with functional dyspepsiacompared to controls. Intragastric distribution of thesolid content was more distally located in smokers, andthe solid lagtime was prolonged among antiinflammatorydrug users. The gastric emptying of liquids was delayed among older patients. The subgroupingof dyspeptic symptoms is of minor importance withrespect to gastric emptying. Habitual smoking and theuse of antiinflammatory drugs are potent factors able to alter the gastric emptying of solids, butthe role of H. pylori seems to be lessimportant.

Randomised clinical trial: low‐FODMAP rye bread vs. regular rye bread to relieve the symptoms of irritable bowel syndrome

Grains are high in FODMAPs (Fermentable Oligo‐, Di‐, Monosaccharides And Polyols) and often considered as triggers of IBS symptoms.

Capsule endoscopy in pediatric patients: Technique and results in our first 100 consecutive children

Abstract Objective. Capsule endoscopy (CE) offers noninvasive methods to assess small bowel pathology but only limited data are available on the feasibility, safety, and findings in children. In this study, we report our results of 100 consecutive CE in children. Material and methods. Single center retrospective study. All pediatric patients (mean age 119 months, range from 8 to 188 months) undergoing CE were included until 100 investigations were completed. The indications for CE were: suspicion or evaluation of Crohns disease (n = 35) or ulcerative colitis (n = 24), gastrointestinal bleeding (n = 18), and miscellaneous (n = 23). Results. The youngest patients able to swallow the capsule were 84 months old. When the patient was unable to swallow the capsule (n = 51), it was guided into the duodenum with endoscope. In two patients, the capsule remained in the stomach during the 8 h of recording and in 23 cases the capsule failed to reach the cecum. The capsule was expelled naturally in all except one patient. In 39% of the patients, CE revealed a significant finding (multiple ulcers, bleeding, tumors, strictures). In patients examined for bleeding or for a suspicion of Crohns disease, the respective proportions were 50% and 60%. Conclusions. This study shows that CE is a feasible diagnostic method to study the small intestine in pediatric patients and that CE can be done in children as young as 8 months old. The diagnostic yield is highest in cases with bleeding or a high suspicion of Crohns disease.

Measuring gastric emptying: comparison of 13C-octanoic acid breath test and scintigraphy.

The aim of this study was to compare scintigraphy, the standard method, and the 13C-octanoic acid breath test (OBT) for measuring gastric emptying. Patients with functional dyspepsia (N = 21, 8 men and 13 women; ages, 40–75) underwent standardized dynamic scintigraphy and OBT. Scintigraphic images were obtained for 90 min and breath samples for 4 hr. The gastric half-emptying time for solids (T1/2) was calculated by two previously described mathematical models for the OBT samples: the nonlinear least-squares method and the geometrical method. T1/2 was significantly longer measured by OBT than by scintigraphy (167 ± 50 min for the nonlinear least-squares method (P < 0.05) and 185± 52 min for the geometrical method (P < 0.005) vs. 109 ± 74 min for scintigraphy). No correlation appeared between T1/2 measured by scintigraphy and T1/2 measured by OBT (r = 0.26) for nonlinear least-squares method and (r = −0.13) for geometrical method). Furthermore, the correlation between the two mathematical models appeared to be low (r = 0.15). Although OBT is simple and safe, its correlation with scintigraphy appears to be weak. The usefulness of this test for measuring gastric emptying thus requires further validation.

First-line eradication therapy for Helicobacter pylori in primary health care based on antibiotic resistance: results of three eradication regimens.

Aim:  To determine the efficacy of three Helicobacter pylori eradication regimens and factors affecting the eradication results in Finland.

Incidence and complications of peptic ulcer disease requiring hospitalisation have markedly decreased in Finland.

The characteristics of peptic ulcer disease (PUD) are changing.

Does oral α-galactosidase relieve irritable bowel symptoms?

Abstract Objective. Abdominal bloating is reported by a majority of irritable bowel syndrome (IBS) patients. Excess colonic fermentation may cause gaseous symptoms. Several foodstuffs contain oligosaccharides with an α-galactosidic linkage that is resistant to mammalian hydrolases. Assisted hydrolysis by exogenous α-galactosidase enzyme (AG) could offer a way of controlling IBS symptoms by reducing colonic fermentation and gas production. The aim of this study was to assess the effect of AG on symptom severity and quality of life in IBS patients with abdominal bloating or flatulence. Methods. A total of 125 subjects with IBS received AG or placebo at meals for 12 weeks. IBS-Symptom Severity Score (IBS-SSS) and quality of life (QoL) were assessed at baseline, during the treatment and at 4-week follow-up. Results. AG showed a trend toward a more prominent decrease in IBS-SSS. The responder rate at week 16 was higher for the AG group. No difference was detected in QoL between AG and placebo groups. A total of 25 patients (18 in AG group and 7 in placebo group, p = 0.016) withdrew from the study. Abdominal pain and diarrhea were more often reported as reason for withdrawal in AG group. Conclusions. We found no evidence to support the use of AG routinely in IBS patients. Improvement of clinical response at 4-week follow-up may suggest a long-term effect of unknown mechanism, but could also be attributed to non-responder drop out. Gastrointestinal (GI) side effects may be a coincidence in this study, but irritation of GI tract by AG administration cannot be excluded.

Pilot Study: Comparison of Sourdough Wheat Bread and Yeast-Fermented Wheat Bread in Individuals with Wheat Sensitivity and Irritable Bowel Syndrome

Many patients suspect wheat as being a major trigger of their irritable bowel syndrome (IBS) symptoms. Our aim was to evaluate whether sourdough wheat bread baked without baking improvers and using a long dough fermentation time (>12 h), would result in lower quantities of alpha-amylase/trypsin inhibitors (ATIs) and Fermentable, Oligo-, Di-, Mono-saccharides and Polyols (FODMAPs), and would be better tolerated than yeast-fermented wheat bread for subjects with IBS who have a poor subjective tolerance to wheat. The study was conducted as a randomised double-blind controlled 7-day study (n = 26). Tetrameric ATI structures were unravelled in both breads vs. baking flour, but the overall reduction in ATIs to their monomeric form was higher in the sourdough bread group. Sourdough bread was also lower in FODMAPs. However, no significant differences in gastrointestinal symptoms and markers of low-grade inflammation were found between the study breads. There were significantly more feelings of tiredness, joint symptoms, and decreased alertness when the participants ate the sourdough bread (p ≤ 0.03), but these results should be interpreted with caution. Our novel finding was that sourdough baking reduces the quantities of both ATIs and FODMAPs found in wheat. Nonetheless, the sourdough bread was not tolerated better than the yeast-fermented bread.

Diminished salivary epidermal growth factor secretion: a link between Sjogren's syndrome and autoimmune gastritis?

Objectives: Healthy human labial salivary glands produce epidermal growth factor (EGF). In Sjögren’s syndrome (SS), EGF staining is diminished. SS is also associated with chronic autoimmune corpus gastritis. We therefore hypothesized that EGF secretion would be diminished in SS and that this could affect gastric target cells. Methods: Salivary EGF secretion in SS was compared to that in healthy controls using an enzyme-linked immunosorbent assay (ELISA). EGF receptor (EGFR) immunoreactive cells in the gastric corpus of healthy human subjects were analysed using immunostaining. Results: Salivary secretion of EGF was diminished in SS patients (232.4, range 52.6–618.4, vs. 756.6, range 105.3–1631.6 pg/min, p = 0.002). Proton-pump positive parietal cells were mostly EGFR immunoreactive whereas very few pepsinogen I (PGI)-positive cells were EGFR positive. Conclusions: As EGF is relatively acid resistant, salivary gland-derived EGF might participate in an exo/endocrine mode of parietal cell maintenance in the gastric corpus. Deficiency of salivary gland-derived EGF in SS patients may cause impairment of gastric parietal cells resulting in exposure of immunogenic cryptic antigens and loss of immunological self-tolerance.