Paediatric hepatitis C virus infection and its treatment: Present, past, and future Publication date: Available online 1 October 2019 Source: Arab Journal of Gastroenterology Author(s): Mortada El-Shabrawi, Fetouh Hassanin Abstract Hepatitis C virus (HCV) infection is a major cause of chronic liver disease in the world. It is a challenging medico-social problem in the paediatric population. High HCV infection rates are reported in low and middle incomes countries. From the health economic point of view treatment of hepatitis C virus (HCV) with subsequent virus eradication is very effective as it eliminates the long-term sequelae of untreated or maltreated HCV. In this review we summarize the updates and highlight the historical approach of treatment of chronic HCV infection in children in the new era of directly acting antiviral (DAA) agents.

Does rectal ketoprofen prevent post ERCP pancreatitis? Publication date: Available online 30 September 2019 Source: Arab Journal of Gastroenterology Author(s): Elias Makhoul, Joe El Mir, Marc Harb Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly used procedure in the management of pancreatic and biliary diseases. Acute pancreatitis is the most common complication following ERCP. Among many medications, nonsteroidal anti-inflammatory drugs (NSAIDs) were subject of numerous trials concerning post ERCP pancreatitis (PEP) prophylaxis. By inhibiting phospholipase A2, these drugs could intervene in the pathogenesis of the disease therefore limiting its occurrence. The use of some rectal NSAIDs agents was shown, to be advantageous in preventing this complication but there were not enough data on ketoprofen. The aim of this study was to assess the efficacy of rectal ketoprofen prophylactic administration in reducing the risk of PEP. Patients and methods The study was a non randomized retrospective single center study conducted between 2014 and 2018 on 242 patients divided into control and trial group receiving 100 mg of rectal Ketoprofen 30 mins before ERCP. PEP was defined as a new or exacerbated abdominal pain, in association with an elevation of serum lipase at least three times higher than the normal upper limit within and lasting more than 24 h after the procedure requiring a re-admission or a prolongation of the hospital stay. This endpoint was determined by comparing the number of patients presenting PEP in the NSAIDs group vs. the control group using Fisher exact test, with p < 0.05 representing a significant statistical value. Results Pancreatitis developed in 6% after ERCP, 5 of them being in the trial group and 9 in the control group. Additionally, statistical calculations showed a non significant difference between the two groups in the prevalence of PEP. Conclusion Rectal ketoprofen administration before ERCP does not have any effect in preventing pancreatitis post ERCP.

Highlights from Gastro Update Europe – Budapest June 26-27, 2019 Publication date: Available online 27 September 2019 Source: Arab Journal of Gastroenterology Author(s): Guido N.J. Tytgat

Egyptian recommendations for management of Helicobacter pylori infection: 2018 report Publication date: Available online 26 September 2019 Source: Arab Journal of Gastroenterology Author(s): Mohamed Alboraie, Walied Elhossary, Osama Aboelfotoh Aly, Bahaa Abbas, Lobna Abdelsalam, Doaa Ghaith, Zakarya Shady, Yasmine Gaber, Eman Adel, David Peura, David Armstrong, Gamal Esmat, Ahmed Gomaa, Ahmed El Ray, Ahmed Altonbary, Ahmad Soliman, Ahmed Zeid, Amgad Elzahaby, Assem Elfert, Hany Shehab

The value of mRNA expression of S100A8 and S100A9 as blood-based biomarkers of inflammatory bowel disease Publication date: Available online 25 September 2019 Source: Arab Journal of Gastroenterology Author(s): Tayebeh Azramezani Kopi, Azade Amini Kadijani, Hadi Parsian, Shabnam Shahrokh, Hamid Asadzadeh Aghdaei, Alireza Mirzaei, Hedieh Balaii, Mohammad Reza Zali Abstract Background and study aims Non-invasive biomarkers of inflammatory bowel diseases (IBD) are of critical importance. Here, we evaluated the S100A8 and S100A9 mRNA expression, as the heterodimers of calprotectin, in the blood leucocytes of IBD patients to find how their expression associates with the disease characteristics. Patients and methods In this cross-sectional study, 59 IBD patients and 30 healthy subjects were included. The flare and remission phases of disease were identified in 46 and 13 patients, respectively. Blood leucocytes were isolated, and the S100A8 and S100A9 mRNA expression were evaluated in the isolated leucocytes using relative quantification real-time PCR. Results The mean S100A8 and S100A9 mRNA expression were significantly higher in IBD patients than in the controls (p = 0.03 and p = 0.02, respectively). The mean S100A8 and S100A9 mRNA expression were significantly higher in the flare phase of the disease compared with the remission phase (p = 0.01 and p = 0.007, respectively). S100A8 distinguished IBD patients from controls with the sensitivity and specificity of 73% and 64%, and flare phase of disease from remission with the sensitivity and specificity of 67% and 62%. On the other hand, S100A9 distinguished IBD patients from controls with the sensitivity and specificity of 81% and 70%, and flare phase of disease from remission with the sensitivity and specificity of 68% and 64%. Conclusion The S100A8 and S100A9 mRNA are differentially expressed in blood leucocytes of IBD patients compared to healthy controls as well as active versus quiescent disease. Thus, they can be potentially used as a blood-based biomarker in the monitoring of IBD.

Dysphagia aortica in a young patient with Behcet’s Disease: Case report Publication date: Available online 24 September 2019 Source: Arab Journal of Gastroenterology Author(s): Mahmoud K. Elsamman, Usama M. Abdelaal, Mohamed H. Omran, Mohamed H. Abdel Aziz, Hossam S. Saro, Mohsen S. Mohamed, Jorma Halttunen Abstract Dysphagia aortica is a rare aetiology of dysphagia resulting from an abnormality in thoracic aorta that causes extrinsic compression on the oesophagus. Dysphagia aortica includes aortic aneurysm, aortic dissection or even tortuous aorta and is seldom considered in the differential diagnosis of dysphagia. Herein, we report a 30-year-old man with Behcet’s disease who presented with rapid progressive dysphagia and diagnosed as dysphagia aortica caused by saccular aortic aneurysm complicated by large para-aortic haematoma compressing the oesophagus. The case reveals the importance of early and proper identification of the rare causes of dysphagia in young adults with complaint of dysphagia and history of recurrent oral and genital ulcers in absence of obvious cardiovascular diseases.

Up-regulation of TIMP-3 and RECK decrease the invasion and metastasis ability of colon cancer Publication date: Available online 23 September 2019 Source: Arab Journal of Gastroenterology Author(s): Jinmiao Wang, Yunshou Lin, Tao Jiang, Chao Gao, Duowei Wang, Xiaodong Wang, Ying Wei, Tong Liu, Liwei Zhu, Pengzhi Wang, Feng Qi Abstract Background and study aims Although the function of microRNA21 (miR-21) in the invasion and metastasis of colon cancer has been extensively studied, the mechanisms of invasion and migration related pathways between and its targets are still not elucidated. This study explored the mechanisms of the pathway between miR-21 and the target genes in vitro and in vivo. Materials and methods We transfected pmiRZip21 or Leti3 into colon cancer cells. The levels of miR-21 expression, mRNA transcription and protein of target genes were analysed by TaqMan microRNA assays, RT-PCR and western blot, respectively. Scratch migration and trans-well assays were used to evaluate metastasis and invasion. To build a subcutaneous tumour animal model, detect the level of miR-21 and the target genes and then identify the mechanisms in vivo. Results MiR-21 expression levels in colon cancer cells transfected with pmiRZip21 in vivo or in vitro were decreased (P < 0.05). The mRNA and protein levels of TIMP-3 and RECK were up-regulated after inhibiting miR-21 in vitro and in vivo (P < 0.05), but those of BMPR-II and PCDH17 were not. In pmiRZip21-transfected colon cancer cells, invasion and migration were significantly decreased both in vitro and vivo (P < 0.05). Conclusions Up-regulation of TIMP-3 and RECK, by inhibiting miR-21 expression can decrease tumour invasion and metastasis ability in vitro and in vivo, and has potential as a possible target site in anti-tumour therapy. More effects in vivo have to be investigated in further research.

Vitamin D, linoleic acid, arachidonic acid and COX-2 in colorectal cancer patients in relation to disease stage, tumour localisation and disease progression Publication date: Available online 1 July 2019 Source: Arab Journal of Gastroenterology Author(s): Berska Joanna, Bugajska Jolanta, Grabowska Agnieszka, Hodorowicz-Zaniewska Diana, Sztefko Krystyna Abstract Background and study aim Evidence shows that vitamin D and cyclooxygenase type 2 (COX-2) might play role in aetiology/progression of cancer. It is suggested that antitumour effect of vitamin D depends on vitamin D-receptor (VDR) expression. Aim of the study was to determine vitamin D and polyunsaturated fatty acids in colorectal cancer patients. Patients and methods A total of 39 patients with colorectal cancer (mean ± SD age: 65.5 ± 6.8 years) and 25 controls (mean ± SD age: 51.0 ± 6.9 years) were studied. 25-hydroxycholecalciferol - 25(OH)D3 in serum was quantitatively determined by high-performance liquid chromatography (HPLC). Levels of linoleic acid (LA) and arachidonic acid (AA) of serum phospholipids were measured by gas-chromatography (GC). Expression of VDR and COX-2 in normal colonic mucosa and tumour tissue was measured by real time polymerase chain reaction (RT-PCR). Results The mean value of 25(OH)D3 was significantly lower in the colorectal cancer patients with early stages of the disease and in patients with tumour confined to the rectum compared to control group (p < 0.02, p < 0.03, respectively). The higher concentration of AA (patients with early stages of the disease) and lower concentration of LA (patients with the advanced stages of the disease) was noticed compared to the control group. For the patients with the early stages of the disease the higher mean fold change of mRNA VDR and the lower mean fold change of mRNA COX-2 was noticed (p < 0.03, p < 0.02, respectively). Conclusion The assessment of vitamin D status in patients with colorectal cancer should include measurement of mRNA VDR expression in tumour tissue.

Duodenal lymphocytosis in functional dyspepsia Publication date: June 2019 Source: Arab Journal of Gastroenterology, Volume 20, Issue 2 Author(s): Annalisa Capannolo, Stefano Necozione, Dolores Gabrieli, Fabiana Ciccone, Laura Sollima, Loredana Melchiorri, Angelo Viscido, Giuseppe Frieri Abstract Background and study aims Functional dyspepsia is an exclusion diagnosis requiring different tests, including endoscopy, often repeated over time. Duodenal biopsies are frequently resorted to, not rarely revealing duodenal microscopic inflammation. Aim of the study is to confirm a previously supposed role of antro-duodenal low-grade inflammation in functional dyspepsia, evaluating the frequency of duodenal lymphocytosis, H. pylori infection and their association in a group of patients with functional dyspepsia compared to asymptomatic control subjects. Patients and methods A cross-sectional, observational study has been conducted screening all the patients who underwent duodenal biopsies during upper endoscopy, in a 30 months period. All the patients without endoscopic lesions were analysed. The study group consisted of patients compatible with the diagnosis of functional dyspepsia (Rome III criteria). The control group consisted of healthy asymptomatic subjects in the population subjected to endoscopy. The presence of duodenal lymphocytosis and of H. pylori infection in the two groups was evaluated. Results 216 patients were enrolled: 161 in the functional dyspepsia group and 55 as asymptomatic control group. The frequency of duodenal lymphocytosis was similar between cases and control groups (25.47% vs 25.45%; p = 0.99), as well as H. pylori infection (26.71% vs 23.64%; p = 0.78). Duodenal lymphocytosis was significantly associated with functional dyspepsia only in H. pylori positive dyspeptic patients (p = 0.047). 94% of the subjects with both lymphocytosis and H. pylori infection suffer from dyspepsia. Duodenal intraepithelial lymphocytosis is significantly associated with bloating (p = 0.0082). Conclusions In our cohort of dyspeptic patients, duodenal lymphocytosis is significantly associated with bloating and the simultaneous presence of duodenal lymphocytosis and H. pylori infection is significantly more prevalent than in control subjects.

Endoscopic ultrasound-guided fine needle aspiration in diagnosis of cystic pancreatic lesions Publication date: June 2019 Source: Arab Journal of Gastroenterology, Volume 20, Issue 2 Author(s): Hussein Okasha, Mervat E. Behiry, Nagwa Ramadan, Reem Ezzat, Ahmed Yamany, Shaimaa El-Kholi, Ghada Ahmed Abstract Background and study aims pancreatic cysts are commonly found lesions and proper diagnosis is very important for planning further management. The study aims to evaluate the role of cyst fluid amylase and tumour markers as cancer antigen (CA 19-9) and carcinoembryonic antigen (CEA) in addition to mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign lesions. Patients and methods This prospective study was conducted on 184 patients diagnosed to have pancreatic cystic lesions from January 2013 to January 2018. Fluid analysis for CA 19-9, CEA, amylase, mucin stain and cytopathology were done. We compared these data with the final diagnosis based on histopathology after surgical resection, positive cytopathology and long period of follow up of the patients for at least 18 months. Results The highest AUC was that of cystic CEA with cut-off value of 160 ng/ml; it had a sensitivity of 60.4% and a specificity of 85%. The best cut-off value for cystic CA 19-9 was 1318 U/ml with a sensitivity of 64.1% and a specificity of 68.1%. The cut-off value of cyst amylase level was 5500 U/L, with 84.2% sensitivity and 37.1% specificity. The sensitivity of mucin stain in detecting mucinous cystic neoplasm was 85.45%, specificity was 86.05% with accuracy 85.87%. Conclusion Cyst fluid analysis by investigating amylase, mucin, CA 19-9, CEA and EUS examination improves the diagnosis of different pancreatic cysts.