Serological Markers for Inflammatory Bowel Disease in AIDS Patients with Evidence of Microbial Translocation

Background: Breakdown of the gut mucosal barrier during chronic HIV infection allows translocation of bacterial products such as lipopolysaccharides (LPS) from the gut into the circulation. Microbial translocation also occurs in inflammatory bowel disease (IBD). IBD serological markers are useful in the diagnosis of IBD and to differentiate between Crohn's disease (CD) and ulcerative colitis (UC). Here, we evaluate detection of IBD serological markers in HIV-infected patients with advanced disease and their relationship to HIV disease markers.Methods IBD serological markers (ASCA, pANCA, anti-OmpC, and anti-CBir1) were measured by ELISA in plasma from AIDS patients (n = 26) with low CD4 counts (<300 cells/$\mu$l) and high plasma LPS levels, and results correlated with clinical data. For meta-analysis, relevant data were abstracted from 20 articles. Results: IBD serological markers were detected in approximately 65% of AIDS patients with evidence of microbial translocation. An antibody pattern consistent with IBD was detected in 46%; of these, 75% had a CD-like pattern. Meta-analysis of data from 20 published studies on IBD serological markers in CD, UC, and non-IBD control subjects indicated that IBD serological markers are detected more frequently in AIDS patients than in non-IBD disease controls and healthy controls, but less frequently than in CD patients. There was no association between IBD serological markers and HIV disease markers (plasma viral load and CD4 counts) in the study cohort. Conclusions: IBD serological markers may provide a non-invasive approach to monitor HIV-related inflammatory gut disease. Further studies to investigate their clinical significance in HIV-infected individuals are warranted

Open-label study of a regimen consisting of 1 week of lansoprazole, clarithromycin, and amoxicillin followed by 3 weeks of lansoprazole in healing peptic ulcer and eradicating Helicobacter pylori

Objective: The aim of the study was to assess the efficacy of a regimen consisting of 1 week of low-dose triple therapy with lansoprazole, amoxicillin, and clarithromycin followed by lansoprazole alone for an additional 3 weeks in the eradication of Helicobacter pylori and the healing of peptic ulcer. Methods: Patients aged ≥16 years with active peptic ulcer diagnosed by endoscopy and H pylori infection were eligible for this prospective, open-label, 3-center study. A triple-drug regimen was used that consisted of lansoprazole 30 mg once daily, amoxicillin 1 g BID, and clarithromycin 250 mg BID for 7 days. Ulcer healing and H pylori eradication were assessed endoscopically 8 to 9 weeks after the start of treatment. H pylori was determined to be eradicated if both histologic examination and rapid urease testing (4 biopsy samples, antrum [2] and body [2]) were negative. Results: Fifty-five patients who tested positive for H pylori, 49 with duodenal ulcer (DU) and 6 with gastric ulcer (GU), aged 16 to 78 years, were enrolled in the study. Ten patients were lost to follow-up and 1 withdrew from the study because of side effects; 44 patients were included in the per-protocol analyses. H pylori was eradicated in 34 patients, 62% (95% CI, 0.477-0.746) and 77% (95% CI, 0.662-0.885) in the intent-to-treat and per protocol analyses, respectively. Ulcers were healed in a total of 38 patients (34 DU, 4 GU), 69% in the intent-to-treat population (95% CI, 0.552-0.809) and 86% in the per-protocol population (95% CI, 0.727-0.948). In patients with DU, the rate of healing was 69% in the intent-to-treat analysis (95% CI, 0.546-0.817) and 89% in the per-protocol analysis (95% CI, 0.752-0.971). Conclusions: One week of therapy with lansoprazole 30 mg once daily, amoxicillin 1 g BID, and clarithromycin 250 mg BID, followed by 3 weeks of treatment with lansoprazole 30 mg once daily, effectively healed peptic ulcer but was only moderately effective in eradicating H pylori

Effective colonoscopy training techniques: Strategies to improve patient outcomes

Colonoscopy has substantially evolved during the last 20 years and many different training techniques have been developed in order to improve the performance of endoscopists. The most known are mechanical simulators, virtual reality simulators, computer-simulating endoscopy, magnetic endoscopic imaging, and composite and explanted animal organ simula-tors. Current literature generally indicates that the use of simulators improves performance of endoscopists and enhances safety of patients, especially during the initial phase of training. Moreover, newer endoscopes and imaging techniques such as high-definition colonoscopes, chromocolonoscopy with dyes spraying, and third-eye retroscope have been incorporated in everyday practice, offering better visualization of the colon and detection of polyps. Despite the abundance of these different technological features, training devices are not widely used and no official guideline or specified training algorithm or technique for lower gastrointestinal endoscopy has been evolved. In this review, we present the most important training methods currently available and evaluate these using existing literature. We also try to propose a training algorithm for novice endoscopists. © 2016 Papanikolaou et al

Effective colonoscopy training techniques: strategies to improve patient outcomes

Ioannis S Papanikolaou,1 Pantelis S Karatzas,2 Lazaros T Varytimiadis,2 Athanasios Tsigaridas,2 Michail Galanopoulos,2 Nikos Viazis,2 Dimitrios G Karamanolis21Hepato-gastroenterology Unit, 2nd Department of Internal Medicine, Attikon University General Hospital, University of Athens, 2Gastroenterology Department, Evangelismos Hospital, Athens, GreeceAbstract: Colonoscopy has substantially evolved during the last 20 years and many different training techniques have been developed in order to improve the performance of endoscopists. The most known are mechanical simulators, virtual reality simulators, computer-simulating endoscopy, magnetic endoscopic imaging, and composite and explanted animal organ simulators. Current literature generally indicates that the use of simulators improves performance of endoscopists and enhances safety of patients, especially during the initial phase of training. Moreover, newer endoscopes and imaging techniques such as high-definition colonoscopes, chromocolonoscopy with dyes spraying, and third-eye retroscope have been incorporated in everyday practice, offering better visualization of the colon and detection of polyps. Despite the abundance of these different technological features, training devices are not widely used and no official guideline or specified training algorithm or technique for lower gastrointestinal endoscopy has been evolved. In this review, we present the most important training methods currently available and evaluate these using existing literature. We also try to propose a training algorithm for novice endoscopists.Keywords: endoscopy, colonoscopy, teaching techniques, simulator, endoscopists, colon, polyp

Effects of endoscopic variceal treatment on oesophageal function: a prospective, randomized study

Aim Endoscopic methods are currently the most widely used techniques for the treatment of bleeding oesophageal varices (BOV). However, a number of complications may limit their usefulness. We conducted a prospective, randomized comparison of variceal ligation versus sclerotherapy in cirrhotics; after the control of variceal haemorrhage to study the relative short-term risks of these two procedures with respect to oesophageal motility and gastro-oesophageal reflux. Methods Seventy-three patients with established cirrhosis and an episode of variceal bleeding controlled by one session of endoscopic therapy were randomized to treatment with sclerotherapy or ligation until variceal eradication. In 60 of these patients, oesophageal manometry and 24-h intra-oesophageal pH monitoring were performed at inclusion and I month after variceal eradication. Results After variceal eradication with sclerotherapy, peristaltic wave amplitude decreased from 76.2 +/- 14.7 mmHg to 61.6 +/- 17.7 mmHg (P= 0.0001), simultaneous contractions increased from 0% to 37.9% (P = 0.0008), and the percentage of time with pH &lt; 4 increased from 1.60 +/- 0.25 to 4.91 +/- 1.16% in channel 1 (P= 0.0002) and from 1.82 +/- 0.27 to 5.69 +/- 1.37% in channel 2 (P= 0.0006). In contrast, the above parameters were not disturbed with ligation. Conclusion Our data define the advantages of ligation over sclerotherapy with respect to post-treatment oesophageal dysmotility and associated gastrooesophageal reflux