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Despite extensive investigation, the pathophysiology of human inflammatory bowel disease (IBD) remains incompletely understood. We examined the existence of oxidative and nitrosative stress and also alterations in epidermal growth factor (EGF) secretion in saliva of IBD patients. Saliva samples were obtained from 30 nonsmoking IBD patients including 16 Crohn's disease (CD) patients and 16 ulcerative colitis (UC) patients and 16 age- and sex-matched controls. Samples were analyzed for thiobarbituric reactive substances (TBARS) as a marker of lipid peroxidation, ferric reducing ability (antioxidant power), and EGF and nitric oxide (NO) levels. Saliva TBARS levels increased significantly (P < 0.01) in CD patients but not in UC patients. Analysis of antioxidant power revealed that saliva of CD patients has lower antioxidant power (P < 0.01) than saliva of the healthy control population. The concentration of EGF was found to be increased (P < 0.01) in saliva of CD patients in comparison to that of healthy subjects. NO levels increased in saliva of both CD and UC patients in comparison to that of healthy subjects. It is concluded that excessive NO production is present in saliva of both CD and UC patients but only saliva of CD patients is oxidatively stressed. EGF secretion is normal in UC patients, although CD patients show a significant increase in salivary EGF levels.

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Development of PSC in patients with UC might have a positive effect on colonic disease. Further investigations to evaluate the basis of this improvement are warranted.

BackgroundQuality of life (QOL) is an important measure in the management of Irritable Bowel Syndrome (IBS). Controversy exists in the findings of studies evaluating QOL in IBS subtypes, and little is known about this issue in Iranian patients. Determination of the factors affecting QOL in IBS patients may influence treatment outcomes. The aims of this study are to: 1) compare QOL between subtypes in a sample of Iranian IBS patients, 2) determine the factors associated with QOL in IBS.MethodsThis cross sectional study included two hundred and fifty IBS patients with the mean age (± standard deviation) of 31.62 (± 11.93) years that were referred to outpatient gastroenterology clinic. IBS patients were diagnosed based on Rome-3 criteria by a gastroenterologist, and then they were categorized into three subtypes according to the predominant type of bowel habit. The "QOL specific for IBS", "Stait-trait anxiety inventory", and "Beck depression inventory-2" questioners were used to evaluate QOL, anxiety, and depression symptoms, respectively.ResultsThe mean QOL scores in IBS mixed subtype (71.7 ± 25.57), constipation predominant subtype (80.28 ± 25.57), and diarrhea predominant subtype (76.43 ± 19.13) were not different. (P value: 0.05) In multivariate linear regression analysis, anxiety symptom scores were inversely correlated with QOL scores. [Standardized beta: -0.43, (95% confidence interval: -0.70, -0.39), P value: < 0.01]ConclusionIt seems reasonable to manage anxiety symptoms properly in IBS patients since this might increase their QOL.

Growth factors and nitric oxide (NO) play a major role in dysregulated immune response in ulcerative colitis (UC). Recent evidence has shown increased levels of transforming growth factor-beta(1) (TGF-beta(1)) in UC and suggested an anti-inflammatory effect for this factor. Based on our recent study, dysfunctional immunoregulation is present in saliva of UC patients, we hypothesized that salivary level of NO and TGF-beta(1) may differ by severity of UC and be useful to determine the activity of the disease. Thirty-seven UC patients and 15 healthy controls were enrolled and saliva samples were obtained. Truelove-Witts severity index and modified Truelove-Witts severity index were used to determine the severity of the disease. NO and TGF-beta(1) levels were detected in saliva of all patients and control subjects using enzyme-linked immunosorbent assay. A total of 21 patients had mild disease while 8 had moderate and 8 had severe colitis. Adjusted for baseline characteristics, the levels of NO and TGF-beta(1) in different groups were compared. Salivary NO and TGF-beta(1) levels were higher in UC patients comparing to controls (P < 0.00005 and P = 0.005, respectively). The levels of NO and TGF-beta(1) showed no significant differences among the severity groups (P = 0.46 and P = 0.23, respectively). NO levels linearly increased by age (Coeff = 1.5, r = 0.38, P = 0.02). Gender, extension of disease, and medical treatment did not affect NO and TGF-beta(1) levels. Although UC patients have abnormal amounts of NO and TGF-beta(1) in their saliva, their disease activity cannot be predicted by these factors, which may indicate a pathophysiologic role rather than being nonspecific inflammatory markers for TGF-beta(1) and NO.

BackgroundDiet is an important modulator of inflammation, which is associated with inflammatory bowel disease (IBD). In this study, we examined whether the inflammatory properties of diets are associated with disease activity in patients with IBD.MethodsA cross-sectional study was conducted on 143 IBD patients, including 32 patients with Crohn’s disease (CD) and 111 patients with ulcerative colitis (UC). Dietary intakes were assessed by a valid 168-item food frequency questionnaire (FFQ). The inflammatory potential of the diet was assessed by calculating the two scores of Dietary Inflammatory Index (DII®), and the Empirical Dietary Inflammatory Pattern (EDIP), and CD and UC disease activity were determined by the Crohn’s disease activity index (CDAI) and the Mayo score, respectively. Associations of the inflammatory indices as median and as tertiles with disease activity were analyzed using logistic regression in a univariate model and after adjusting for total energy intake (continuous), type of disease (CD and UC) and drug consumption (no drugs, single drug, and multiple drugs).ResultsSixty-four IBD patients (44.8%) in this study had active disease.The DII® score and the EDIP did not differ significantly between active and inactive patients (− 1.45 ± 1.04 vs.− 1.20 ± 1.24; 0.56 ± 0.22 vs. 0.53 ± 0.28, respectively). After adjusting for energy intake, drug use, and IBD type, the odds (95%CIs) of active disease among patients in tertile 3 compared to those in tertile 1 were 0.84 (0.32–2.17) for DII and 1.50 (0.61–3.72) for EDIP; neither of which were statistically significantly different from the rates in tertile 1.ConclusionsAlthough point estimates were in the expected direction of increased risk, the inflammatory potential of diet, assessed using DII or EDIP, was not associated with severity of disease in IBD patients. Whether diet-related inflammation affects disease activity in patients with IBD deserves further investigations.

Immunogenicity of recombinant hepatitis B virus vaccine in patients with and without chronic hepatitis C virus infection:A case-control study. World J Gastroenterol 2007; 13(2): 294-298http://www.wjgnet.com/1007-9327/13/294.asp INTRODUCTIONOne major transmission route for both hepatitis C virus (HCV) and hepatitis B virus (HBV) is the parenteral route, and the sources of infection include administration of blood or blood products [1,2] , intravenous drug use [3,4] and needle-stick accidents [5,6] . According to the analysis of the Third National Health and Nutrition Survey, more than 25% of HCV-positive patients in the United States had hepatitis B markers, a proportion nearly six times that in the HCV-negative group [3] . However, the actual prevalence of HBV infection in patients with HCV infection is probably underestimated [7,8] . Although it has been shown that superinfection of either HBV or HCV may suppress the other's replicative levels, coinfection with both viruses has synergistic effects with regard to histological lesions, progression to cirrhosis and cancer development [9][10][11][12][13] . As such it has been recommended by the National Institutes of Health (NIH) that individuals with HCV be vaccinated against HBV infection to prevent such an outcome [14] . HBV vaccination at standard doses (20 µg for adults at mo 0, 1, and 6) results in an effective antibody response in 90% to 98% of healthy individuals [15,16] . However, reduced immunog enicity of the vaccine has been established in persons with chronic liver disease, patients receiving hemodialysis, patients with HIV infection and those awaiting transplantation [17][18][19][20][21] . To the best of our knowledge, only a few studies, with inconsistent results, have compared the immunogenicity of standard HBV vaccination in chronic hepatitis C patients with that in healthy individuals through a case-control study [22][23][24] . Therefore, we found it valuable to compare the response of standard HBV vaccination between patients with chronic HCV infection and healthy individuals in a prospective case-control study. METHODS: This is a prospective case-control study. A total of 38 patients with chronic HCV infection and 40 healthy controls were included. Vaccination was performed by injection of 20 µg recombinant HBsAg into the deltoid muscle at mo 0, 1 and 6. Anti-HBs concentration was determined 3 mo after the last dose and compared between the two groups. The response pattern was characterized as (1) high-response when the anti-HBs antibody titer was > 100 IU/L, (2) low-response when the titer was 10-100 IU/L and (3) no-response when the titer was < 10 IU/L. MATERIALS AND METHODS Subjects RESULTS:In the patient group, there were 10/38 (26.3%) non-responders, 8/38 (21.1%) low-responders and 20/38 (52.6%) high-responders. The corresponding va l u e s i n t h e c o n t r o l g r o u p w e r e 2 / 4 0 ( 5 . 0 % ) , 7/40 (17.5%) and 31/40 (77.5%), respectively. The response pattern was statistically different between the two groups. In multivar...