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Background Post-variceal band ligation bleeding ulcer is a severe complication with considerable mortality. We tried evaluating self-expandable metallic stent (SEMS) with concern to the ulcer morphology not well studied. Results We did a retrospective analysis of patients with bleeding post-band ulcers and treated by SEMS with concern to control bleeding and 6 weeks survival. Twenty-eight patients studied had their age (mean ± S.D.) 57.8 ± 8.6 years, and 85.7% were males. The Child-Pugh score range was 5–12]. Control of bleeding by SEMS was achieved in 23 (82.1%) patients, and overall, 6-week survival was 75%. Both post-band ulcer types B (oozing blood and type C (active spurted) were a risk for 6 weeks mortality (P = 0.04, OR 1.58, CI 95% 1.12–2.23). Conclusion SEMS is considered an excellent choice to control esophageal post-banding ulcer bleeding and a definite treatment bridge.

Background and aim: Non- invasive parameters of liver fibrosis are being widely incorporated and adopted in clinical practice, of them, 2 ratios APRI and FIB-4 were proposed and applied. The gamma-glutamyl transferase -to- platelet ratio (GPR) was developed and investigated as available test that is useful in predicting liver fibrosis stages in chronic HBV patients. We aimed to estimate the diagnostic performance of GPR compared to APRI in assessing different fibrosis stages estimated by ultrasound based Transient Elastography in chronic HCV Egyptian patients. Methods: This prospective study was conducted on 90 treatment-naive chronic HCV patients. Fibrosis stages were assessed by Transient Elastography. Serum aspartate transferase, alanine transferase, gamma-glutamyl transferase and platelets were estimated. APRI and GPR formulas were calculated. Results: GPR was significantly different with fibrosis stage (p value F3) from non-significant fibrosis (< F3) was significant with GPR AUC was 0.97 while APRI AUC was 0.86. GPR at cutoff point 0.31 has sensitivity 92 %, specificity 88%, PPV 86 % and NPV 91 %. While, APRI at cutoff 0.26 has sensitivity 81 % and specificity 78 %. Conclusion: The GPR represents a simple, non-invasive, inexpensive model for assessment of liver fibrosis. The GPR is a more accurate model than APRI to stage liver fibrosis in chronic HCV patients in Egypt.

Background Helicobacter pylori infection remains a major risk for gastroduodenal inflammation and ulceration with capability to disrupt the defensive autophagy pathway in the gastric mucosal cell thus producing resilient infection. A single-nucleotide mutation in the autophagy gene ATG16L1 which controls the host immune responses to viruses and bacteria was identified as a risk factor for increasing survival and persistence of many microbial infections. Aim To assess the association of ATG16L1 T300A gene mutation with the susceptibility to H. pylori infection in patients with chronic gastritis disease. Methods ATG16L1 T300A mutation was determined by TaqMan genotyping allele specific discrimination real-time PCR assay applying specific primers, (rs2241880 A/G) and probes for A and G allele. Result Patients with mutant homozygous GG genotype was associated with a 4.5 times increase in the risk of H. pylori infection relative to the wild homozygous AA and the heterozygous AG genotypes (p value = 0.009, OR = 4.472; 95% CI, 0.07–0.74). The carriage rate of the mutant G allele was significantly higher in H. pylori positive cases (64%) relative to (42%) in H. pylori negative cases (p value = 0.002, OR = 2.455, 95% CI, 0.3 (0.09–1.01), and this was associated with about a 2.5 times increase in the risk for H. pylori infection. Conclusion Genetic variant ATG16L1 T300A mutation increased the risk of H. pylori infection in Egyptian patients with chronic gastritis disease.

Background and aim Hepatocellular carcinoma (HCC) is a major health burden globally. Dysregulation of miRNA 148a-3p is engaged in carcinogenesis. TGF-β is a profibrogenic cytokine. This study assesses the expression level of miRNA 148a-3p and its relationship with serum TGF-β1 and fibrosis index based on four factors (FIB-4) in Egyptian patients with HCV-associated HCC. Subjects and Methods: The study included 72 HCC patients with HCV, 48 HCV cirrhotic patients, and 47 healthy controls. Serum TGF-β1 was assessed by ELISA and the expression of miRNA 148a-3p was measured by RT-PCR. Results Patients with HCC had lower plasma miRNA 148a-3p, higher serum TGF-β1, and higher FIB-4 levels than patients with cirrhosis and controls. miRNA 148a-3p discriminated HCC either from control (AUC: 0.997, 95.83% sensitivity, 85.11% specificity) or from cirrhosis (AUC: 0.943, 91.67% sensitivity, 81.25% specificity). Moreover, it distinguished metastatic from nonmetastatic patients (AUC: 0.800, 88.89% sensitivity, 60.0% specificity). The decreased miRNA 148a-3p and the increased TGF-β1 levels were related to distant metastasis, multinodular lesions, advanced TNM stage, and BCLC score (C). A negative correlation between miRNA 148a-3p and each of FIB-4 and TGF-β1 was detected. The decreased miRNA 148a-3p was associated with poor overall survival and poor progression-free survival. Conclusion An inverse relationship between miRNA 148a-3p and both TGF-β1 and FIB-4 was observed, which could be involved in HCC pathogenesis. Moreover, this miRNA is a potential diagnostic and prognostic biomarker for HCC., Highlights • Dysregulation of miRNA-148a expression has been associated with HCC carcinogenesis. • miRNA-148a-3p has a negative correlation with FIB4 and TGF-β1. • The decreased miRNA-148a-3p and the increased TGF-β1 were related to distant metastasis. • The decreased miR-148a-3p was associated with poor overall survival and progression-free survival.

Purpose: We aimed to conduct an updated systematic review and network meta-analysis (NMA) to estimate the efficacy of Helicobacter pylori (H. pylori) treatment strategies in Arab countries. Methods: We systematically searched PubMed, Scopus, Web of Science (WOS), EBSCO, and EMBASE from inception to July 18, 2020, using boolean operators. Retrieved articles were screened, and relevant data were extracted. We used R programming software to analyze extracted data. Results: Fifty-four articles (n= 7829 patients) were included in the NMA. Pooled overall analysis demonstrated that adjuvant therapy (standard triple or sequential therapy plus another adjuvant drug) was the best treatment with higher odds of eradication rate [OR= 6.42, 95% CI (1.37: 30.05), P-score= 0.21]. Moreover, Seqential therapy (SQT) and Quinolone based therapy (QBT) were associated with higher eradication rate compared to other regimens [OR= 4.83, 95% CI (1.49: 15.64), P-score= 0.30] and [OR= 4.32, 95% CI (1.15: 16.16), P-score= 0.36], respectively. In adults, the efficacy of QBT was higher than other stratigies in terms of H. pylori eradication [OR= 2.00, 95% CI (1.09, 3.69), P score= 0.19]. In naïve population, QBT and SQT were associated with substantial eradication rate [OR= 1.94, 95% CI (1.19: 3.16), P score=0.19] and [OR= 1.66, 95% CI (1.10: 2.50), P score=0.33], respectively. Conclusion: Our findings suggest that standard triple or sequential therapy plus another adjuvant drug, QBT and SQT therapies were the most effective regimens for eradicating H.pylori in Arab countries.

Background Duodenoscope-emerging infection especially drug-resistant bacteria is considered a major concern nowadays. Different approaches were attempted to overcome this problem, like double high-level disinfection procedure. We performed a systematic review and meta-analysis to evaluate risk difference for positive cultures from duodenoscopes between double high-level disinfection (dHLD) and single (standard) high-level disinfection (sHLD). Main body A thorough literature search (in October and November 2019) for studies comparing dHLD and sHLD for duodenoscopes was performed by 3 researchers in the Web of Science, Scopus, PubMed, and Cochran databases. The search terms were “duodenoscope,” “ERCP endoscope,” “disinfection,” “sterilization,” and “reprocessing,” and only randomized clinical trials with the English language were accepted. Four trials were identified studying dHLD, and only 2 clinical trials comparing dHLD with standard sHLD were found reporting 6193 duodenoscope cultures. Overall sHLD cultures were 2972, and dHLD cultures were 3221; overall positive cultures were 140 in sHLD and 161 in dHLD. The results of a meta-analysis using the random-effect model showed no significant risk difference (RD) between the 2 procedures for duodenoscope positive cultures (p = 0.53, RD 0.003, 95% CI “− 0.007–0.013”). Conclusions Double HLD offered no significant difference over single HLD for duodenoscope disinfection. An alternative strategy to overcome duodenoscope-transmitted infection is a big issue to be resolved.

Background Liver transplantation is considered the main treatment for end stage liver disease and the early stages of hepatocellular carcinoma. Long-term metabolic outcomes after liver transplantation affect morbidity and mortality, and the genetic rule has not been well studied for such complications. The patatin-like phospholipase domain-containing 3 (PNPLA3) gene L148M (rs738409) polymorphism has been associated with a wide spectrum of metabolic affection, but mainly fatty liver, in the general population. Here, we demonstrate the impact of the PNPLA3 polymorphism on living related donor liver transplantation (LRDLT) recipients' new onset diabetes mellitus and obesity. Methods Genotyping of PNPLA3 rs738409 variants was analyzed using an allele discrimination assay with real-time PCR in 158 LRDLT donors and their recipients, who had no history of diabetes mellitus or fatty liver disease before transplantation and survived >1 year after transplantation. The LRDLT recipients were assessed for the development of new onset diabetes and the risk of obesity 1 year after transplantation. Results Recipients' PNPLA3 genotypes were associated with the development of new onset diabetes mellitus after liver transplantation (CC genotype 18.8%, CG genotype 39.1%, GG genotype 42.2%, P = 0.000; GG genotype: odds ratio 24, (95% CI 8.1–70.5). Logistic regression for the predictors of new onset diabetes showed significant risk for recipients with the PNPLA3 CG genotype (P = 0.000, OR 5.5, 95% CI 2.4–12.7) and the GG genotype (P = 0.000, OR 32, 95% CI 9–116.7). In recipients, the GG genotype enhanced the incidence of obesity, with an odds ratio of 3.8 (95% CI 1.6–8.9). The PNPLA3 gene of variants of donors did not show any significant variations with different parameters. Conclusion The PNPLA3 L148M (rs738409) polymorphism of recipients, not donors carries a risk for new onset diabetes and obesity in LRDLT recipients post-transplant. That means there is a peripheral effect, rather than a central effect, of genotype.

The chitinase 3-like 1 (CHI3L1) gene encodes the YKL-40 protein. Serum YKL-40 levels are controlled by polymorphisms in the CHI3L1 gene. We aimed to examine the association of the rs880633 (T/C) polymorphism in the CHI3L1 gene with serum YKL-40 levels and to evaluate the role of this polymorphism as a risk factor for HCC and its effect on patient survival. A total of 225 subjects were categorized into two groups: group I included 120 patients with HCC, and group II involved 105 age and gender-matched healthy volunteers. Genotypes of the rs880633 (T/C) polymorphism in the CHI3L1 gene were analyzed using an allele discrimination assay with real-time PCR, and serum YKL-40 levels were determined using an ELISA technique. A significant difference in the genotype frequency of the T/C polymorphism in the CHI3L1 gene was observed between the two groups, with an increase in the frequency of the CC genotype observed among patients with HCC. Regarding the allelic distribution, the C allele was significantly predominant in patients, with HCC presenting with an increased HCC risk compared to the T allele. Subjects with the CC genotype had the highest serum YKL-40 levels, followed by those with the TC genotype, while subjects with the TT genotype had the lowest serum YKL-40 levels. An analysis of the overall survival of HCC patients revealed that patients with both the CC and CT genotypes displayed a significantly shorter survival rate than patients carrying the TT genotype. Conclusions The rs880633 polymorphism in the CHI3L1 gene may be a risk element for HCC. Patients with the CC genotype displayed the highest serum YKL-40 levels, which were linked to poor prognosis.

Background Chitinase 3-like 1 (CHI3L1) gene codes for the YKL-40 protein. Serum YKL-40 levels are controlled by polymorphisms in the proximal promoter region of CHI3L1 gene. Aim: We aimed to investigate the association of rs880633 (T/C) polymorphism at CHI3L1 gene with serum YKL-40 production and to evaluate the role of this polymorphism as a risk for HCC and its impact on patient’s survival. Methods 225 subjects were classified into two groups, group I: included 120 HCC patients and group II: included 105 age & gender matched healthy volunteers. Genotyping of (T/C) polymorphism rs880633 at CHI3L1 gene was analyzed using allelic discrimination assay by Real-Time PCR technique and serum YKL-40 level was determined by ELISA. Results There was a significant statistical difference as regards genotype frequency of CHI3L1 gene T/C polymorphism between the two studied groups, with increased frequency of CC genotype among HCC patients and increased frequency of TT genotype among the control group. As regards allelic distribution, C allele was significantly more dominant in HCC patients that have increased HCC risk with odds ratio (CI = 95%) of 2.05(1.40 – 2.99) comparing to T allele. Subjects carrying CC genotype had the highest levels serum YKL40 followed by those with TC genotype, while subjects with TT genotype were found to have the lowest serum YKL40. HCC Patient with TT genotype had significantly longer survival rate than those had TC, CC genotypes, Overall survival of HCC patients revealed that both CC and CT genotypes had significantly shorter survival rate than those had TT genotype (P value Conclusions CHI3L1 gene variants rs880633 might be a candidate risk factor for HCC. Carriers of CC genotype have highest serum YKL40 levels, are associated with criteria of bad prognosis. So, genotyping of (T/C) polymorphism rs880633 at CHI3L1 gene could predict the patient outcome. Legal entity responsible for the study Menoufia University. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.