- 1 Ileal ulcers in a patient with Henoch-Scho¨nlein purpura
Henoch-Scho¨nlein purpura (HSP) is a systemic vasculitis characterized by a classic
tetrad of nonthrombocytopenic palpable purpura, arthritis, gastrointestinal, and renal involvement.
The most common gastrointestinal complaint is abdominal pain. The characteristic
endoscopic findings are ulcers seen in the second portion of the duodenum. We present the
case of a 45-year-old man suffering from abdominal pain. Erythematous purpura over bilateral
lower extremities and soreness of the joints developed 3 days before abdominal pain. An
abdominal computed tomography showed an edematous change of the intestinal wall and
the distal part of the ileum. A retrograde single balloon enteroscopy revealed several discrete
ulcers and hyperemic mucosa in the distal ileum. The middle, proximal, and terminal ileum
and ileocecal valve to the rectum were not affected. Under the impression of HSP, nonsteroidal
anti-inflammatory drugs and prednisolone were administered. We concluded that
balloon-assisted enteroscopy is helpful for differential diagnosis of small bowel lesions in adult
patients with HSP.
- 2 Analysis of ascitic fluid lactoferrin levels in the diagnosis of spontaneous bacterial peritonitis after systemic antibiotic treatment
Spontaneous bacterial peritonitis (SBP) is one of the most frequent complications
of liver cirrhosis. Ascitic fluid lactoferrin has been proved to be a good diagnostic tool
for SBP. However, lactoferrin in ascites may be checked after antibiotic treatment in these patients.
Our study aims to assess the utility of ascitic fluid lactoferrin levels for the diagnosis of
SBP after antibiotic treatment.
Materials and methods: Twenty-two ascites samples were collected from patients with
cirrhosis. Samples were examined for bacterial culture, lactoferrin concentration, and polymorphonuclear
leukocyte count. Clinical symptoms and indications for ascitic paracentesis
were obtained from medical records. The diagnosis of SBP was based on an elevated ascitic
fluid polymorphonuclear leukocyte count of 250 cells/mm3.
Results: Four (18.1%) samples fulfilled the diagnostic criteria for SBP. Three ascites samples
showed a positive result for bacterial culture. Patients who received antibiotics for treatment
of SBP constituted Group B (n Z 9), whereas those who did not receive any antibiotics
comprised Group A (n Z 9). Lactoferrin concentration was significantly elevated (mean:
261.69 145.5 ng/mL) in the three cases with a positive bacterial culture compared to those
without SBP, in both Group A (mean: 19.64 6.32 ng/mL, p Z 0.002) and Group B (mean:
23.64 9.53 ng/mL, p Z 0.001).
- 3 IL28B polymorphism and early anemia predict the rapid null response in genotype-1 chronic hepatitis C with dual therapy
Rapid null response (rNR), defined as less than one log
decline of Hepatitis C virus (HCV-RNA) at Week 4 of treatment with pegylated interferon-a
and ribavirin (PegIFN/RBV), is highly correlated with treatment failure in patients with chronic
hepatitis C (CHC), genotype-1 (GT-1). In this study, we investigate the possible predictors of
rNR.
Methods: We retrospectively analyzed a cohort of 199 GT-1 CHC naive patients who had been
treated with a dual therapy of PegIFN/RBV. Clinical parameters and genotypes of rs12979860,
the single nucleotide polymorphisms (SNPs) of interleukin-28B (IL28B) were analyzed for their
relationship with rNR.
Results: Of the patients analyzed, 41.7% did not exhibit a rapid virological response (RVR).
Only 13.1% of patients who experienced a rNR showed an RVR. The treatment failure rate
was 36.2%. High baseline viral load (OR: 5.74; p Z 0.028), nonrapid virological response
(non-RVR; OR: 4.32; p Z 0.004) and rNR (OR: 51.82; p < 0.001) were the predictors of treatment
failure. In addition, both the non-CC allele of rs12979860 (OR: 13.8; p < 0.001) and the
Hb (hemoglobin) decline to < 3 g/dL within
- 4 Barrett’s esophagus and risk of esophageal adenocarcinoma A retrospective analysis
Barrett’s esophagus (BE) is the most common cause or precursor
of esophageal adenocarcinoma (EAC), a condition with a poor prognosis. This study
aimed to investigate the clinical characteristics and risk of EAC in patients with BE.
Materials and methods: From January 2001 to December 2012, a total of 425 patients with
histologically proven BE were identified and analyzed retrospectively. Patients’ personal data
(smoking, alcohol consumption), underlying systemic disease data (diabetes mellitus and hypertension),
endoscopic findings (hiatal hernia, peptic ulcer, endoscopically suspected
esophageal metaplasia, severity of reflux esophagitis, rapid urease test), and pathological
findings (degree of dysplasia, Helicobacter pylori infection) were collected for further
analysis.
Results: In this retrospective study, 15 patients were diagnosed with EAC. Only one patient
was found to have EAC during endoscopic surveillance for BE. The majority of patients
(14/15 patients) suffered alarm symptoms and were diagnosed to have BE and EAC concurrently.
Meanwhile, EAC is already relatively at an advanced stage. The mean age for diagnosis
of EAC in a patient with BE was 67.67 9.92 years old. All patients were male. From a total
of 15 patients, 33.3% (5 patients) demonstrated erosive esophagitis under endoscopy and 60%
(3 of 5 patients) of these were classified as Los Angeles grade C or D disease.
- 5 Severe diarrhea caused by cytomegalovirus in an elderly man
Gastrointestinal (GI) cytomegalovirus (CMV) disease is
common in patients who are immunocompromised but is
rare in immunocompetent hosts. Regardless of the host
factor, CMV colitis accounts for the majority of cases of GI
CMV disease [1]. CMV enteritis is quite exceptional,
particularly in an immunocompetent host. The endoscopic
findings and clinical features have not well been
recognized.
We report a case of CMV enteritis with an unusual
endoscopic finding of diffuse suppurative inflammation in
the small intestine. To the best of our knowledge, this is the
first report in the English literature of CMV enteritis in an
immunocompetent patient with this atypical endoscopic
finding.
- 6 Barrett’s esophagus and esophageal adenocarcinoma East versus West
Based on the American College of Gastroenterology guidelines,
Barrett’s esophago (BE) is defined as a change in the
distal esophageal epithelium that can be recognized as
columnar type mucosa at endoscopy and is histologically
confirmed to have intestinal metaplasia. The development
of BE has also been associated with gastroesophageal reflux
disease (GERD). Other risk factors related to BE include
smoking, age, male gender, etc. Helicobacter pylori
infection has been reported to be negatively associated
with BE [1]. As a consequence of the clinical and epidemiological
evidence supporting the association between BE
and esophageal adenocarcinoma (EAC), BE is considered a
precancerous lesion of EAC. Based on that definition, the
prevalence of BE in Asia ranges from 0.06% to 6.2% [1]. The
reported prevalence of BE in Western countries has varied
from 0.9% to 4.5% in the general population and from 6.3%
to 13.6% in patients with GERD [2].
- 7 Advances in Digestive Medicine Reviewer Acknowledgments
Consistent high-quality of papers published in Advances in Digestive Medicine (AIDM) can only be maintained with the cooperation
and dedication of a number of expert referees. The Editors would like to thank all those who have donated the hours necessary
to review, evaluate and comment on manuscripts; their conscientious efforts have enabled the journal to maintain its tradition of
excellence. We are grateful to the following reviewers for their contributions during 2015.
Chang, Chi-Yang
Chang, Chun-Chao
Chang, Yu-Hung
Chen, Chien-Hua
Chen, Chien-Lin
Chen, Peng-Jen
Chen, Ping-Hsien
Cheng, Tsun-I
Chiu, Han-Mo
Chou, Jen-Wei
Hou, Ming-Chih
Hsieh, Tsai-Yuan
Hsu, Ping-I
Lee, Chia-Long
Liao, Wei-Chih
Lin, Chun-Che
Lin, Chun-Jung
Liou, Jyh-Ming
Liu, Chun-Jen
Lo, Gin-Ho
Lotus Shyu, Yea-Ing
Lu, Ching-Liang
Luo, Jiing-Chyuan
Peng, Cheng-Yuan
Perng, Chin-Lin
Su, Ming-Yao
