13 research outputs found
Helicobacter pylori (H pylori) infection in Greece: the changing prevalence during a ten-year period and its antigenic profile
BACKGROUND: To evaluate changes in H pylori infection prevalence in Greece during a ten-year period, and to examine its antigenic profile. METHODS: Three groups of patients were studied. Group O-87: Banked serum samples of 200 consecutive adult outpatients, from the Hepato-Gastroenterology clinic of a teaching hospital at Athens, collected in 1987. Group O-97: Serum samples of 201 similarly selected outpatients from the same Unit, collected in 1997. Group BD-97: Serum samples of 120 consecutive blood donors from the same hospital, collected in 1997. H pylori IgG antibody seroprevalence was studied by a quantitative ELISA. Antigenic profile was studied by western-blot IgG assay, in 62 IgG positive patients of O-97 and BD-97. Results were analyzed by conventional statistics and multivariate regression analysis. RESULTS: The H pylori seroprevalence increased with age in the three tested groups. In O-97, seroprevalence did not differ from that, in BD-97. On the contrary, there was a significant decrease in seropositivity between O-87 and O-97 (59.5% vs 49.2%, p = 0.039). Multiple regression analysis showed that age over 35 years (OR:3.45, 95% CI:1.59–7.49, p = 0.002) and year of patients' selection – that is 1987 or 1997 – (OR:1.73, 95% CI:1.14–2.65 for 1987, p = 0.010), were independent risk factors of H pylori infection. The seroprevalence of CagA+ and VacA+ strains was 77.4% and 58.5%, respectively, and type I(CagA+/VacA+) strains were significantly more common than type II(CagA-/VacA-) strains (59.7% vs 22.6%, p < 0.001). CONCLUSIONS: During a ten-year period, we found a significant decrease of H pylori infection in Greece and our data support the birth cohort phenomenon as an explanation for the age-dependent increase of H pylori infection. The prevalence of CagA and/or VacA positive strains is relatively high, in a country with low incidence of gastric cancer
Severe gastrointestinal involvement in systemic sclerosis
Gastrointestinal tract (GIT) is the most common organ system involved in
systemic sclerosis (SSc). GIT involvement is mainly attributed to GIT
dismobility and wide mouth diverticular. GIT involvement in SSc can be
also severely debilitating and even life threatening. To our knowledge,
the presence of gastrointestinal bleeding due to the presence of
multiple peptic ulcers in scleroderma patients is not well described. In
this case report, we describe a scleroderma patient with recurrent
gastrointestinal bleeding due to multiple peptic ulcers, in which
vagotomy, pyloroplasty, and cholocystectomy were performed and
subcutaneous somatostatin was administered to discontinue the recurrent
bleeding and stabilize her clinical condition
The liver in brucellosis
Background & Aims: Brucellosis involves the liver in varying ways,
ranging from benign subclinical increases in serum aminotransferase
levels to ominous chronic suppurative disease. Data on histopathology of
the liver in brucellosis are scarce and contradictory. We sought to
determine the liver histologic patterns present in a series of
brucellosis patients and review the existing knowledge about liver
involvement in this worldwide, prevalent zoonotic infection. Methods:
Fourteen patients from 2 referral centers were retrospectively studied.
They had brucellosis caused by Brucella melitensis and had undergone
liver biopsy at the time of diagnosis. Results: All patients exhibited
granuloma formation in the liver parenchyma and in the majority in
portal spaces. Varying degrees of cellular infiltration of parenchymal
tissue and portal spaces, giant cells in granulomas, parenchymal
necroses, and Kupffer’s cell hyperplasia were also noted. No significant
epidemiological or clinical correlations with liver involvement were
exhibited. Thus, liver involvement was not increased in men vs women,
young vs old patients, or complicated vs uncomplicated disease.
Conclusions: The liver is involved in Brucella melitensis infection
contrary to past beliefs. Different histologic patterns can be observed
in liver involvement in brucellosis, the most common being granuloma
formation. The pathogenetic role of brucellosis in development of liver
fibrosis and cirrhosis remains limited and understudied
Acute Liver Failure: From Textbook to Emergency Room and Intensive Care Unit With Concomitant Established and Modern Novel Therapies.
Acute liver failure is a rare hepatic emergent situation that affects primarily young people and has often a catastrophic or even fatal outcome. Definition of acute liver failure has not reached a universal consensus and the interval between the appearance of jaundice and hepatic encephalopathy for the establishment of the acute failure is a matter of debate. Among the wide variety of causes, acetaminophen intoxication in western societies and viral hepatitis in the developing countries rank at the top of the etiology list. Identification of the clinical appearance and initial management for the stabilization of the patient are of vital significance. Further advanced therapies, that require intensive care unit, should be offered. The hallmark of treatment for selected patients can be orthotopic liver transplantation. Apart from well-established treatments, novel therapies like hepatocyte or stem cell transplantation, additional new therapeutic strategies targeting acetaminophen intoxication and/or hepatic encephalopathy are mainly experimental, and some of them do not belong, yet, to clinical practice. For clinicians, it is substantial to have the alertness to timely identify the patient and transfer them to a specialized center, where more treatment opportunities are available
Capsule endoscopy in the investigation of patients with portal hypertension and anemia
INTRODUCTION: Data on small bowel abnormalities in patients with portal hypertension (PHT) are limited. Bleeding from the gastrointestinal tract and anemia are common complications in these patients. Capsule endoscopy (CE) was used to evaluate small bowel (SB) pathology in patients with PHT and anemia, and possible associations with various parameters were examined
A perspective on risk factors for esophageal adenocarcinoma: emphasis on Helicobacter pylori infection.
Gastroesophageal reflux disease (GERD) and the increasing rate of its associated complications, including esophageal adenocarcinoma (EAC), has stimulated a plethora of studies attempting to evaluate provocative and protective factors. Helicobacter pylori (Hp) infection (Hp-I) was initially considered as a beneficial condition in GERD management based on rather limited data. Large-scale regional studies revealed an alternative approach, by suggesting a positive relationship between Hp-I and EAC development. Regarding pathophysiology, Hp-I induces gastric microbiota disturbances through hypochlorhydria and chronic inflammation, with a subsequent possible effect on the GERD-Barrett's esophagus (BE)-EAC cascade. Additionally, both direct effects on esophageal mucosa and indirect effects on known mechanisms of GERD, such as acid pocket and transient lower esophageal sphincter relaxation, remain to be elucidated. Hp contribution to carcinogenesis is related to oncogenic gastrin, cyclooxygenase-2, and prostaglandins; Ki-67 is also expressed and represents an index of BE-related malignancy. Moreover, Hp-I is vigorously suggested as a risk factor for metabolic syndrome, which may be the link between Hp-I and EAC. Although further studies are necessary to establish a pathophysiologic risk between Hp-I and the GERD-BE-EAC sequence, the theory of Hp protection against GERD seems outdated