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In HIV-infected patients, manifestations of the disease are common in the gastrointestinal tract. The objective of our study was to evaluate the diagnostic yield of the Given Video Capsule System (Given Imaging, Yoqneam, Israel) in these patients.
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After exclusion of GI-tract stenosis by anamnestic exploration, 49 patients were included into the study. Stratification: Group A (n = 19): HIV-positive, CD4 cell count
Between March 2002 and December 2004, 49 patients were included in our study prospectively and were divided into three groups. Group A consisted of HIV-positive patients with a CD4 cell count of
The procedure was well tolerated and there were no complications. All capsules were recovered after 12 to 96 h in the stool. In group A [CD4 cell count
Finally, in group C [healthy volunteers] we found antrum gastritis (3), brunneromas (2), bulbitis (1), hypertensive gastropathy (1), ileitis (1), jejunal lipoma (1), jejunal polyp (1), pseudodiverticulum (1), suspected jejunal angiodysplasias (1), villous atrophy (1). Sporadic lymphangiectatic villi were seen in five patients. In group C there were a total of 13 pathological results, 5 of these distal to the ligament of Treitz and 3 with therapeutic relevance (suspected jejunal angiodysplasia (1), jejunal polyp (1), ileitis (1). In one case the capsule did not reach the coecum during the examination.
Opportunistic infections and tumors of the gastrointestinal tract play an important role in clinical management of AIDS patients. The data presented in this study show that capsule endoscopy reveals a substantial variety of manifestations in the small bowel in HIV-positive patients with advanced immunosuppression. There were significantly more pathological findings distal of the ligament of Treitz in the group presenting with gastrointestinal symptoms (group A) than in the group B without gastrointestinal symptoms, in particular more severe findings like Kaposi sarcoma, ulcerative jejunitis due to CMV-infection, aphthous jejunal lesions, jejunal mycobacteriosis, Strongyloides stercoralis infection and jejunitis. This was valid especially for patients with CD4 cell count less than 100/μl. Accordingly, therapeutic implications were more frequent in group A compared to group B patients. The number of pathological findings proximal of the ligament of Treitz and the total amount of findings are nearly identical in both HIV positive groups.
Despite limited size of study population, we could show that wireless capsule endoscopy of the small intestine provides additional information, and influences therapeutic planning in HIV-positive patients with a CD4 cell count of less than 200/μl and GI-symptoms. This had therapeutic consequences in approximately 20% of the patients, when gastrointestinal symptoms were present. Thus, capsule endoscopy should be further evaluated in regard of its use for the management of HIV-infected patients with immunosuppression.
Gastro-Esophageal Reflux Disease (GERD) defined as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Many drugs are used for the treatment of GERD such as omeprazole (a proton pump inhibitor) which is a widely used antiulcer drug demonstrated to protect against esophageal mucosal injury. Melatonin has been found to protect the gastrointestinal mucosa from oxidative damage caused by reactive oxygen species in different experimental ulcer models. The aim of this study is to evaluate the role of exogenous melatonin in the treatment of reflux disease in humans either alone or in combination with omeprazole therapy.
Even though over 50 years have passed since the discovery of melatonin, the knowledge on its physiological function is still not complete. The results of the researches have provided the evidence that melatonin is synthesized not only in the pineal gland, but also in different organs. A special attention has been directed to the digestive tract where total quantity of melatonin is considerably greater than in the pineal gland [3]. It was calculated that the gastrointestinal tract contains at least 400 times melatonin than the pineal gland [4]. Although pineal melatonin acts prevalently in an endocrine capacity, extra-pineal melatonin may act as an autocrine or a paracrine hormone [5]. It protects gastric mucosa against destructive activity of free radicals in stress-induced ulcers and due to non-steroidal anti-inflammatory drugs and other gastrotoxic agents [6]. Furthermore, Kato et al. [7] demonstrated the inhibitory action of melatonin on secretion of HCL and pepsin. Only a few studies on gastrointestinal role of melatonin have been carried out on humans.
All individuals were subjected to thorough history taking including: history of drug intake, epigastric pain, upper gastrointestinal bleeding (hematemesis and/or melena), dyspeptic manifestations and heartburn. They were also subjected to clinical examination with special stress on: (a) General examination: pulse, blood pressure and temperature. (b) Chest and heart examination. (c) Local abdominal examination for the state of the liver, spleen and the presence or absence of ascites. They also underwent laboratory investigations: Complete blood picture, Urine and stool analysis and Liver function tests including serum albumin, bilirubin, alanine transaminase enzyme (ALT), aspartate transaminase enzyme (AST). The patients excluded from our study were; patients with cardiac disease, patients with renal affection, and patients with liver diseases (drug induced, autoimmune disease and viral hepatitis). In addition, patients on the drugs known to affect the GIT motility (phenothiazines, anticholinergics, nitrates or calcium channel blockers) excluded during the time of conduction of the study or the preceding two weeks. After exclusion, 45 subjects were selected for evaluation by: a) Endoscopic Investigation: subjects were subjected to upper gastrointestinal endoscopy for visualization of the mucosa of esophagus and stomach for the presence of mucosal ulceration. b) Record of esophageal motility by Smart graph analysis software lab motility system Sandhill 8 - channels esophageal manometry. Manometric recording systems rely on computers for data acquisition display and analysis. This manometric recording was done by using station pull through technique at 5 minutes intervals. The most important aspect of Lower Esophageal Sphincter (LES) pressure measurement is that of LES relaxation. Subjects with duodenal, gastric ulcers or functional dyspepsia were excluded and finally 27 subjects with GERD were selected to complete the study compared with nine healthy volunteers who matched with age and sex as controls or reference.
After admission the following was done: (a) blood samples for measuring serum melatonin levels taken at 10.00 p.m., 2.00 a.m. and 6.00 a.m. After collecting the sample, the blood centrifuged and serum thus was obtained and frozen at the temperature of minus 80C. Melatonin concentration was measured with ELISA method using the Lab system Multiscan and antibodies of the Immuno-Biological Laboratories (catalogue RE 54021) [8]. (b)An ambulatory digitrapper was used to perform 24 hours pH-metry measurement by UP S2020 Orion MMS Holland pH-metry. The pH probe was positioned 5 cm above the position of the LES. The data were collected using De-meester (DM) score; gastroesophageal reflux considered as a drop in esophageal PH below "4" and the percentage reflux in 24 hours calculated for each patient [9].
Melatonin, a close derivative of serotonin (5-hydroxytryptamine, 5-HT) [13], is a hormone initiating sleep in humans [14] and a powerful scavenger of free radicals. It is more effective than several well-known vitamins [15]. The pineal gland is the major source of melatonin in the peripheral circulation, producing melatonin in a distinct circadian fashion, with peak levels occurring during the night [13]. Melatonin has been also detected in entero-endocrine (EE) cells of gastro-intestinal tract (GIT) wall, where this indole may act via endocrine, paracrine and/or luminal pathway through G-protein coupled receptors [16]. Following pinealectomy, the light/dark cycle of plasma melatonin levels disappears, while its daytime blood concentrations are attenuated but sustained mainly due to its release from the GIT, and therefore, a part of blood melatonin has a source in the digestive system, especially during daytime [17]. 041b061a72