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The outcome of H. pylori infection is closely related with bacteria's virulence factors and host immune response. The association between T cells and H. pylori infection has been identified, but the effects of the nine major H. pylori specific virulence factors; cagA, vacA, oipA, babA, hpaA, napA, dupA, ureA, ureB on T cell response in H. pylori infected patients have not been fully elucidated. We developed a multiplex- PCR assay to detect nine H. pylori virulence genes with in a three PCR reactions. Also, the expression levels of Th1, Th17 and Treg cell specific cytokines and transcription factors were detected by using qRT-PCR assays. Furthermore, a novel expert derived model is developed to identify set of factors and rules that can distinguish the ulcer patients from gastritis patients. Within all virulence factors that we tested, we identified a correlation between the presence of napA virulence gene and ulcer disease as a first data. Additionally, a positive correlation between the H. pylori dupA virulence factor and IFN-γ, and H. pylori babA virulence factor and IL-17 was detected in gastritis and ulcer patients respectively. By using computer-based models, clinical outcomes of a patients infected with H. pylori can be predicted by screening the patient's H. pylori vacA m1/m2, ureA and cagA status and IFN-γ (Th1), IL-17 (Th17), and FOXP3 (Treg) expression levels. Herein, we report, for the first time, the relationship between H. pylori virulence factors and host immune responses for diagnostic prediction of gastric diseases using computer—based models. [ABSTRACT FROM AUTHOR]

In previous studies of proton pump inhibitors may have effects on systems other than the stomach has not been investigated sufficiently. Especially in patients treated in intensive care conditions and the resulting use of the mucosal immune system may be very important complication of a defect or failure might be the result does not have any work was done. Therefore, in our study, the mucosal immune system, which is one of the components of the cells on primarily paneth, proton pump inhibitors was to investigate the possible effects. For this purpose, 42 Wistar Albino rats, separated into six different groups. In addition, each H2 receptor blocker and proton pump inhibitor groups, with antibiotics given; the existence of bacteria in the environment and between paneth cells release antimicrobial agent relationship has been planned to be exposed. As a result of the histological examination with light microscope, pantoprazol to be effective on the small bowel paneth cells and thus a component of the mucosal immune system, antibiotic peptides that block degranulation was found. This effect, the close enteroendocrine cells, mast cells and leukocytes of lamina propria of ileum also directly or indirectly affect. Our findings generally common knowledge, pantoprazol outside gastric parietal cell proton pump containing cells was also thought to influence. In conclusion our study results show that paneth cell secretion activities in both groups were not needed are corroborative with the fact that mucosal immunity potential can only be induced by microbial environment. [ABSTRACT FROM AUTHOR]

Background and Aim: This study aims to investigate the effects of chronic coffee consumption (>5 years) and type of coffee in non-alcoholic steatohepatitis (NASH), non-alcoholic fatty liver (NAFLD) and patients who have regular alcohol consumption., Materials and Methods: In this study, 158 healthy individuals and 101 patients with histologically proven NASH were enrolled. The daily amount of coffee intake, amount of alcohol use and type of coffee were calculated for all patients. The degree of steatosis and fibrosis was analyzed by transient elastography and liver ultrasound in non-NASH and by liver biopsy in NASH patients., Results: Patients with a history of coffee consumption (n=132) had lower liver enzyme levels compared to the non-coffee group (n=127) (p=0.001). Serum ALT level was significantly lower [ALT: 21.2±11.7 U/L vs. 56.4±15.6 U/L (p=0.004)], and the liver histopathology was significantly better for patients with a coffee consumption of daily for >5years (p=0.045 for fibrosis score for NASH, p=0.036 for LSM and p=0.015 for CAP measurements for the non-NASH patient)., Conclusion: Coffee seems to have a positive protective effect on liver histology and liver enzyme levels in healthy individuals, in patients with chronic alcohol consumption, NAFLD and NASH. These results are more prominent in patients who drink coffee on a regular daily base for more than five years., Competing Interests: The authors does mot have any conflict of interest., (© Copyright 2020 by Hepatology Forum.)

Objective: This study aimed to examine the value of Ki67 expression along with other potential prognostic factors for predicting overall survival and disease-free survival in patients with gastrointestinal stromal tumors who underwent curative resection., Patients and Methods: Sixty-eight histologically confirmed and operated patients with gastrointestinal stromal tumors were included. Clinical and follow-up data were retrieved from medical records and patients were contacted at the end of the study. The effects of certain clinical and histopathological parameters on survival outcomes were examined., Results: Sixty-eight patients were followed for a mean duration of follow-up of 2923.3 patient-months. Twelve deaths (17.6%), seven metastasis (10.3%), and two local recurrences (2.9%) occurred. Overall survival was 102.5 months [95% confidence interval (CI), 88.3-116.8] and disease-free survival was 91.8 months (95% CI, 76.5-107.2). Multivariate analyses identified a high Ki67 index (≥ 10%) as an independent predictor of both poor overall survival (hazard ratio, 4.8; 95% CI 1.2-19.2; P=0.027) and poor disease-free survival (hazard ratio, 15.3; 95% CI, 4.7-50.2)., Conclusion: A high Ki67 expression seems to be a useful prognostic factor that would aid in predicting disease course in gastrointestinal stromal tumors. These findings deserve further investigation in larger studies.

"Groove" pancreatitis is a rare segmental form of chronic pancreatitis that involves the area located between the common bile duct, head of the pancreas and duodenum. It is more common in middle-aged males who have a history of alcohol abuse. The differential diagnosis varies from anatomic variants to malignancies. The most relevant differential diagnosis of groove pancreatitis is adenocarcinoma of the head of the pancreas. Most of the cases were diagnosed after pancreatic resection. Thus, the correct diagnosis of this rarely seen disease is very important to avoid unnecessary tests or procedures and to determine the definitive treatment.

Background/aims: Thrombocytopenia and platelet function abnormalities are problems commonly found in patients with chronic liver disease (CLD). Despite lack of widespread recognition as to the clinical significance of Soluble P-selectin (sP-selectin), in that increased levels of sP-selectin have been described in patients with CLD, it has been proposed as a marker of in-vivo platelet activation. The study's aim was to determine whether levels of sP-selectin in patients with CLD increase in accordance with the degree of liver failure, the likelihood of CLD patients with high sP-selectin levels being more prone to thrombosis, as well as investigating the coagulation and fibrinolytic parameters related to the sP-selectin., Methodology: This study was comprised of two groups: 40 patients with cirrhosis and portal hypertension (28 males and 12 females); and a control group of 10 healthy volunteers (6 males and 4 females). In both groups, biochemical parameters, sP-selectin, coagulation and fibrinolytic activity levels were measured and a Doppler ultrasound was performed., Results: Plasma sP-selectin levels were found to be higher in the patients compared to those of the control group (p < 0.01), while at the same time significant differences were observed with respect to the stage of disease. Patients with low platelet counts were found to have higher sP-selectin levels than those with normal platelet counts (p < 0.01). Seven patients (17.5%) were seen to have portal vein thrombosis upon doppler ultrasound examination, while sP-selectin levels were significantly lower in those patients with thrombosis than those without (p < 0.05). It was our finding that sP-selectin levels inversely correlated with anti thrombin III., Conclusions: In conclusion, sP-selectin levels related to the degree of liver disease and thrombosis are seen together with low platelet and sP-selectin levels in patients with cirrhosis.

Acquired toxoplasmosis is more frequently an unrecognized disease. Immunocompetent adults and adolescents with primary infection are generally asymptomatic, or symptoms observed may include malaise, fever, and lymphadenopathy. In contrast, immunocompromised patients may experience severe manifestation including encephalitis and multi system organ failure. We report a case of toxoplasmic hepatitis presenting with hepatomegaly in an immunocompetent patient.

Objective: To describe an unusual case of acute liver failure due to Hodgkin's lymphoma., Case Presentation and Intervention: A 37-year-old man was admitted with jaundice and abdominal distension. Physical examination showed tender hepatosplenomegaly, ascites, grade I encephalopathy, left cervical (2 x 1 cm) and axillary (1 x 1 cm) lymph nodes. The laboratory data revealed elevated serum bilirubin, transaminases, lactate dehydrogenase, and coagulation defects. Initially, primary liver disease was considered, but a liver biopsy revealed infiltration of the liver by Hodgkin's lymphoma that was confirmed by lymph node biopsy. Hodgkin's lymphoma was of lymphocyte depletion type., Conclusion: This case demonstrates that in the presence of lymphadenopathy involving acute liver failure, hematological malignancies should be taken into consideration. Liver and lymph node biopsies should be performed as early as possible.

Unlabelled: Hepatitis C and B virus(HCV, HBV) dual infection may occur and even persist in the same patient. Different results have been found in clinical and laboratory studies of dually infected patients., Aim: In our study, we aimed to investigate the effect of previous or present hepatitis B virus infection to clinical course and antiviral therapy in patients with chronic hepatitis C., Method: Hundredthirty consecutive patients with hepatitis C, who were referred to our gastroenterology unit, were studied retrospectively. Patients who were exposed to HBV infection were named as group 1, and patients who had pure hepatitis C infection were named as group 2. Fifty patients in group 1 were compared with 80 patients in group 2. HBs Ag was positive in 12, and HBV antibodies were positive in the other 38 patients of group 1., Results: Age, sex, follow-up duration, transaminase levels, liver synthesis functions, histopathological findings, Child-Pugh stages and presence of complications were not statistically different in groups 1 and 2. HBV-DNA by PCR assay was negative in all 12 HBs Ag positive patients. Hepatocelluler carcinoma(HCC) was found totally in 8 cases, 2 in group 1 and 6 in group 2, while none in HBs Ag positive patients. Antiviral therapy was administired to 39 patients, 15 in group 1 and 24 in group 2. There was no difference in regard to treatment duration and response to treatment between both groups., Conclusion: In our study, we have found previous or present HBV infections were observed frequently in chronic hepatitis C patients, although it's effect to clinical course and antiviral therapy is not significant.

Inflammatory bowel disease (IBD) has been associated with an increased generation of nitric oxide (NO). Different authors have shown that NO in IBD can be either harmful or protective. The aim of this study was to investigate the efficiency of intrarectal (i.r.) and intraperitoneal (i.p.) application of N(G)-nitro-L-arginine methyl ester (L-NAME), a non-specific nitric oxide synthase inhibitor, in experimental acute colitis in the rats. Acute colitis was induced in rats by 2,4,6-trinitrobenzenesulfonic acid (TNBS) and ethanol. Twenty-eight rats were divided into four groups. L-NAME (50 mg/kg/day) was administered i.p. (Group 1) and i.r. (Group 2) for 7 days following the day when colitis was induced. Group 3 rats were not given any treatment after induction of colitis. Control group rats were given saline solution i.r. instead of TNBS. The presence of hyperemia, inflammation and ulcer was evaluated to score of macroscopic morphologic damage. The severity of colitis was assessed by microscopic criteria including ulceration, mucus cell depletion, crypt abscesses, inflammatory cysts, mucosal atrophy, edema, inflammatory cell infiltration, and vascular dilatation. Rectal tissue myeloperoxidase (MPO) activity and serum-rectal tissue nitrite levels were measured. Serum and rectal tissue nitrite levels increased in Group 3 rats. Both i.p. and i.r. L-NAME treatment significantly reduced serum and rectal tissue nitrite levels, but no effect on MPO activity and histologic damage score was observed. Under the present conditions we concluded i.r. and i.p. L-NAME treatment, applied at the dosage of 50 mg/kg/day, does not have any protective effect on the colonic injury.

A 67 year-old female with a 10-year history of cirrhosis due to hepatitis C virus who developed a gastric carcinoid tumor of the corpus is described. Carcinoid tumor was identified during her last routine gastroscopic evaluation for portal hypertension. In the case, serum parietal cell antibodies, hypergastrinemia and atrophic gastritis were also found. Chronic hepatitis C virus infection is known to induce clinical and laboratory signs of autoimmunity. But the question of whether hepatitis C virus plays a pathogenic role in the development of gastric carcinoid tumor is unknown. As far as we know, this is the first report describing gastric carcinoid tumor in hepatitis C virus induced chronic liver disease. We suggest that the possibility of the development of autoimmune atrophic gastritis and carcinoid tumors should be considered in patients with chronic hepatitis C that coexists with autoimmune diseases and has positive parietal cell antibodies.