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Akyüz F, Çavuş B, Pınarbaşı B, Bozacı M, Baran B, Akyuz U, Uyanıkoglu A, Demir K, Beşışık F, Özdil S, Boztaş G, Mungan Z, Badur S, Yenen S, Kaymakoglu S. Cryptogenic liver cirrhosis and hepatitis E virus (HEV): Are they related? Ann Hepatol 2020; 18:585-589. [PMID: 31130469 DOI: 10.1016/j.aohep.2019.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Hepatitis E virus (HEV) is one of the most common causes of acute hepatitis. In recent years, its role in the development of chronic hepatitis and cirrhosis especially in immunosuppressed patients and its wide range of extrahepatic involvement have increased the amount of research on HEV. In this study we aimed to investigate the presence of HEV infection in individuals with cryptogenic cirrhosis. MATERIALS AND METHODS HEV antibodies were analysed using the Anti HEV enzyme-linked immunosorbent assay (ELISA) kit (anti-HEV ELISA; Diapro Prodiagnostic Bioprobes, Milan, Italy). HEV RNA was isolated with using QIAMP Viral RNA mini kit (QIAGEN, Hilden, Germany). The HEV RNA titre was detected with the Rotor Gene 3000 real time polymerase chain reaction (PCR) system using GenoSen's HEV (Rotor Gene) Quantitative Real Time PCR Kit (Genome Diagnostics Private Limited, the Netherlands). RESULTS Our study included 21 healthy volunteers (12 males) and 35 cryptogenic cirrhosis patients (19 males). The ages of the patients and the controls were similar (46±12.1 vs. 37.5±9.7years). The mean Child-Pugh score was 8±2.5. The anti HEV immunoglobulin G(IgG) positivity rate was 9.5% and 25.7% in the control and patient groups respectively (p>0.05). HEV RNA positivity was not detected in the control group, but 3 cases (8.6%) in the patient group were positive (p>0.05). The HEV RNA, aspartate aminotransferase (AST) and alanine aminotransferase(ALT) levels for these 3 cases were 326.461copies/mL, 91IU/L and 67IU/L; 480copies/mL, 68IU/L and 36IU/L and 72copies/mL, 42IU/L and 24IU/L respectively. There were positive correlations between HEV RNA levels and AST and ALT levels (p<0.05). CONCLUSIONS Anti HEVIgG and HEV RNA positivity rates are high in cryptogenic cirrhosis although it is not statistically significant and there is a positive correlation between HEV RNA and aminotransferases.
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Affiliation(s)
- Filiz Akyüz
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
| | - Bilger Çavuş
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Binnur Pınarbaşı
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mürvet Bozacı
- Department of Virology and Microbiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Bülent Baran
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Umit Akyuz
- Department of Internal Medicine, Division of Gastroenterohepatology SağlıkBilimleri University, Fatih Sultan Mehmet Educational and Research Center, Istanbul, Turkey
| | - Ahmet Uyanıkoglu
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Kadir Demir
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Fatih Beşışık
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sadakat Özdil
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Güngör Boztaş
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Zeynel Mungan
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Selim Badur
- Department of Virology and Microbiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sadi Yenen
- Department of Virology and Microbiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sabahattin Kaymakoglu
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Attila T, Zeybel M, Yigit YE, Baran B, Ahishali E, Alper E, Aslan F, Ergonul O, Mungan Z. Upper socioeconomic status is associated with lower Helicobacter pylori infection rate among patients undergoing gastroscopy. J Infect Dev Ctries 2020; 14:298-303. [PMID: 32235091 DOI: 10.3855/jidc.11877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/22/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Socioeconomic factors play an important role in the prevalence of Helicobacter pylori (HP) infection. The aim of this study is to investigate HP prevalence among symptomatic patients in the upper socioeconomic segment of the population undergoing gastroscopy in an endemic urban region. METHODOLOGY Over a 12-month period, data were collected from the first consecutive 1000 patients (500 from university hospital, 500 from community hospital) who had gastroscopy and HP evaluation. RESULTS Overall, 211/1000 patients (21.1 %) were found to have HP in gastric biopsies. The specificity, sensitivity, positive predictive value, negative predictive value and diagnostic accuracy of rapid urease test were 87.5%, 99.7%, 99%, 96.5%, and 96.9% respectively. Atrophic gastritis, gastric and duodenal ulcers were significantly more common in HP positive patients. Age based distribution of HP prevalence: > 6 decades (15.5%), 3rd-5th decades (26.1%), < 3rd decades (10.4%). CONCLUSION In an HP endemic country, the prevalence of HP infection among symptomatic patients belonging to the upper socioeconomic segment of the population appears to be markedly lower. The lowest prevalence in young patients is expected to result in future decrease in HP prevalence.
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Affiliation(s)
- Tan Attila
- Division of Gastroenterology and Hepatology, Koc University School of Medicine, Istanbul, Turkey.
| | - Mujdat Zeybel
- Division of Gastroenterology and Hepatology, Koc University School of Medicine, Istanbul, Turkey.
| | - Yesim Esen Yigit
- School of Medicine, Rumelifeneri, Koc University, Istanbul, Turkey.
| | - Bulent Baran
- Division of Gastroenterology and Hepatology, Koc University School of Medicine, Istanbul, Turkey.
| | - Emel Ahishali
- Division of Gastroenterology and Hepatology, Koc University School of Medicine, Istanbul, Turkey.
| | - Emrah Alper
- Division of Gastroenterology and Hepatology, Koc University School of Medicine, Istanbul, Turkey.
| | - Fatih Aslan
- Division of Gastroenterology and Hepatology, Koc University School of Medicine, Istanbul, Turkey.
| | - Onder Ergonul
- Division of Infectious Diseases, Koc University, Istanbul, Turkey.
| | - Zeynel Mungan
- Division of Gastroenterology and Hepatology, American Hospital, Istanbul, Turkey.
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Mungan Z, Pınarbaşı Şimşek B. Gastroesophageal reflux disease and the relationship with Helicobacter pylori. Turk J Gastroenterol 2018; 28:S61-S67. [PMID: 29199171 DOI: 10.5152/tjg.2017.16] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
After Helicobacter pylori was identified, and its relationship with peptic ulcer disease was exactly shown, the relationship of this bacterium with gastroesophageal reflux disease (GERD) gained momentum and discussions continue to this day. We reviewed the literature for the relationship between H. pylori and GERD. According to the existing data, there is no relationship between GERD and H. pylori presence. Successful eradication therapy does not have an impact on the emergence or exacerbation of GERD. However Barrett's esophagus and esophageal adenocarcinoma are less frequent, especially in the presence of CagA positive H. pylori infections. Long-term use of proton pump inhibitor (PPI) may have an impact on the development of atrophy and/or intestinal metaplasia in H. pylori positive patients; therefore, H. pylori eradication is recommended in patients that should use long-term PPI. As a conclusion, H. pylori screening and the eradication decision should be independent of GERD, except for patients that will use long-term PPI.
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Affiliation(s)
- Zeynel Mungan
- Department of Gastroenterology, Koç University School of Medicine, İstanbul, Turkey
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Mungan Z, Pınarbaşı Şimşek B. Which drugs are risk factors for the development of gastroesophageal reflux disease? Turk J Gastroenterol 2018; 28:S38-S43. [PMID: 29199166 DOI: 10.5152/tjg.2017.11] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Gastroesophageal reflux disease (GERD), which is common in many communities, is associated with structural factors, eating habits, and the use of certain drugs. The use of such drugs can lead to the emergence of GERD and can also exacerbate existing reflux symptoms. These drugs can contribute to GERD by directly causing mucosal damage, by reducing lower esophageal sphincter pressure (LESP), or by affecting esophagogastric motility. In this article, we report our investigation of the relationships between GERD and medications within the scope of the "Turkish GERD Consensus Group." For the medication groups for which sufficient data were obtained (Figure 1), a systematic literature review in English was conducted using the keywords "gastroesophageal reflux" [MeSH Terms] and "anti-inflammatory agents, non-steroidal" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "acetylsalicylic acid" [MeSH Terms], "gastroesophageal reflux" [All Fields] and "estrogenic agents" [All Fields], "gastroesophageal reflux" [All Fields] and "progesterones" [All Fields], "gastroesophageal reflux" [All Fields] and "hormone replacement therapy" [All Fields], "gastroesophageal reflux" [MeSH Terms] and "diphosphonates" [MeSH Terms] OR "diphosphonates" [All Fields], "calcium channel blockers" [MeSH Terms] and "gastroesophageal reflux" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "nitrates" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "antidepressive agents" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "benzodiazepines" [MeSH Terms] and "hypnotic drugs" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "cholinergic antagonists" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "theophylline" [MeSH Terms], and "gastroesophageal reflux [MeSH Terms] AND "anti-asthmatic agents" [MeSH Terms]. The studies were analyzed and the results are presented here.
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Affiliation(s)
- Zeynel Mungan
- Department of Gastroenterology, Koç University School of Medicine, İstanbul, Turkey
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Attila T, Mungan Z. Fish Bone Penetrating into the Head of Pancreas in a Patient with Billroth II Gastrojejunostomy. GE Port J Gastroenterol 2018; 26:221-222. [PMID: 31192294 DOI: 10.1159/000489720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/27/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Tan Attila
- Division of Gastroenterology and Hepatology, Koc University School of Medicine, Istanbul, Turkey
| | - Zeynel Mungan
- Division of Gastroenterology and Hepatology, American Hospital, Istanbul, Turkey
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Mungan Z, Attila T, Ünal Kabaoğlu Z, Vural M. Vildagliptin-induced acute pancreatitis without enzyme elevation. Turk J Gastroenterol 2017; 28:514-517. [PMID: 29086719 DOI: 10.5152/tjg.2017.17308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We describe 2 patients with diabetes mellitus, presenting with upper abdominal pain. Although imaging findings were consistent with acute pancreatitis (AP), serum amylase and lipase levels were within normal limits. In both the cases, the only identifiable diagnostic culprit was vildagliptin. This is the first reported case of vildagliptin causing AP clinically and radiographically without elevated serum pancreatic enzymes. In conclusion, even when serum amylase and lipase levels are normal, AP should be kept in mind when making a differential diagnosis of patients with diabetes mellitus who present with abdominal pain and take dipeptidyl peptidase-4 (DPP-4) inhibitors.
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Affiliation(s)
- Zeynel Mungan
- Department of Gastroenterology, Koç University School of Medicine, İstanbul, Turkey; Department of Gastroenterology, VKV American Hospital, İstanbul, Turkey.
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Ermis F, Uyanikoglu A, Akyuz F, Yonal O, Keskin F, Ciftci S, Mungan Z. Melatonin may have a role in the pathogenesis of functional dyspepsia in males. Eur Rev Med Pharmacol Sci 2015; 19:4675-4678. [PMID: 26698268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Pathogenesis of functional dyspepsia (FD) is complex. Melatonin is synthesized in enterochromaffin cells (EC) of the digestive system. It may influence gut function. The aim of this study is to evaluate the serum melatonin levels in FD patients. PATIENTS AND METHODS A total of 57 FD patients, and 12 healthy controls were enrolled in this study between 2008-2010 years. Diagnosis of FD was established based on the Rome III Criteria. Blood samples were taken at 10 a.m. and serum samples were stored in -85°C. Serum melatonin levels were determined by an enzyme-linked immunosorbent assay (ELISA) kit. (polyclonal Kennaway G280 anti-melatonin antibody, Bühlmann Laboratories AG, Schönenbuch, Switzerland). RESULTS Twenty-three (40.3%) patients were male, and, mean age was 44.3 ± 12.1 years. Mean age of control group was 38.5 ± 11.8 years, and 7 of them were male. The mean serum concentration of melatonin in patients and control group were 31.19 ± 43.4 pg/ml and 14.8 ± 20.9 pg/ml, respectively (p < 0.05). Melatonin levels were significantly higher in male patients (38.6 ± 55 pg/ml vs 12.8 ± 22 pg/ml, p < 0.05). However, melatonin levels were similar in females (p > 0.05). CONCLUSIONS The serum melatonin levels were significantly higher in male patients with functional dyspepsia. High nocturnal melatonin secretion may play a role in the pathogenesis of functional dyspepsia, especially in males.
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Affiliation(s)
- F Ermis
- Department of Gastroenterology, Duzce Medical Faculty, Duzce University, Duzce, Turkey.
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Bonora E, Bianco F, Cordeddu L, Bamshad M, Francescatto L, Dowless D, Stanghellini V, Cogliandro RF, Lindberg G, Mungan Z, Cefle K, Ozcelik T, Palanduz S, Ozturk S, Gedikbasi A, Gori A, Pippucci T, Graziano C, Volta U, Caio G, Barbara G, D'Amato M, Seri M, Katsanis N, Romeo G, De Giorgio R. Mutations in RAD21 disrupt regulation of APOB in patients with chronic intestinal pseudo-obstruction. Gastroenterology 2015; 148:771-782.e11. [PMID: 25575569 PMCID: PMC4375026 DOI: 10.1053/j.gastro.2014.12.034] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 12/03/2014] [Accepted: 12/23/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Chronic intestinal pseudo-obstruction (CIPO) is characterized by severe intestinal dysmotility that mimics a mechanical subocclusion with no evidence of gut obstruction. We searched for genetic variants associated with CIPO to increase our understanding of its pathogenesis and to identify potential biomarkers. METHODS We performed whole-exome sequencing of genomic DNA from patients with familial CIPO syndrome. Blood and lymphoblastoid cells were collected from patients and controls (individuals without CIPO); levels of messenger RNA (mRNA) and proteins were analyzed by quantitative reverse-transcription polymerase chain reaction, immunoblot, and mobility shift assays. Complementary DNAs were transfected into HEK293 cells. Expression of rad21 was suppressed in zebrafish embryos using a splice-blocking morpholino (rad21a). Gut tissues were collected and analyzed. RESULTS We identified a homozygous mutation (p.622, encodes Ala>Thr) in RAD21 in patients from a consanguineous family with CIPO. Expression of RUNX1, a target of RAD21, was reduced in cells from patients with CIPO compared with controls. In zebrafish, suppression of rad21a reduced expression of runx1; this phenotype was corrected by injection of human RAD21 mRNA, but not with the mRNA from the mutated p.622 allele. rad21a Morpholino zebrafish had delayed intestinal transit and greatly reduced numbers of enteric neurons, similar to patients with CIPO. This defect was greater in zebrafish with suppressed expression of ret and rad21, indicating their interaction in the regulation of gut neurogenesis. The promoter region of APOB bound RAD21 but not RAD21 p.622 Ala>Thr; expression of wild-type RAD21 in HEK293 cells repressed expression of APOB, compared with control vector. The gut-specific isoform of APOB (APOB48) is overexpressed in sera from patients with CIPO who carry the RAD21 mutation. APOB48 also is overexpressed in sporadic CIPO in sera and gut biopsy specimens. CONCLUSIONS Some patients with CIPO carry mutations in RAD21 that disrupt the ability of its product to regulate genes such as RUNX1 and APOB. Reduced expression of rad21 in zebrafish, and dysregulation of these target genes, disrupts intestinal transit and the development of enteric neurons.
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Affiliation(s)
- Elena Bonora
- Department of Medical and Surgical Sciences, University of Bologna, and St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesca Bianco
- Department of Medical and Surgical Sciences, University of Bologna, and St. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Michael Bamshad
- University of Washington Center for Mendelian Genomics, Seattle, USA
| | | | - Dustin Dowless
- Center for Human Disease Modeling Duke University, Durham, USA
| | - Vincenzo Stanghellini
- Department of Medical and Surgical Sciences, University of Bologna, and St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Rosanna F. Cogliandro
- Department of Medical and Surgical Sciences, University of Bologna, and St. Orsola-Malpighi Hospital, Bologna, Italy
| | | | | | - Kivanc Cefle
- Istanbul Medical Faculty, Dept. of Internal Medicine, Division of Medical Genetics
| | | | - Sukru Palanduz
- Istanbul Medical Faculty, Dept. of Internal Medicine, Division of Medical Genetics
| | - Sukru Ozturk
- Istanbul Medical Faculty, Dept. of Internal Medicine, Division of Medical Genetics
| | - Asuman Gedikbasi
- Istanbul Medical Faculty, Dept. of Internal Medicine, Division of Medical Genetics
| | - Alessandra Gori
- Department of Medical and Surgical Sciences, University of Bologna, and St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Tommaso Pippucci
- Department of Medical and Surgical Sciences, University of Bologna, and St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Claudio Graziano
- Department of Medical and Surgical Sciences, University of Bologna, and St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Umberto Volta
- Department of Medical and Surgical Sciences, University of Bologna, and St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giacomo Caio
- Department of Medical and Surgical Sciences, University of Bologna, and St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, and St. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Marco Seri
- Department of Medical and Surgical Sciences, University of Bologna, and St. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Giovanni Romeo
- Department of Medical and Surgical Sciences, University of Bologna, and St. Orsola-Malpighi Hospital, Bologna, Italy.
| | - Roberto De Giorgio
- Department of Medical and Surgical Sciences, University of Bologna, and St. Orsola-Malpighi Hospital, Bologna, Italy; Centro Unificato di Ricerca Biomedica Applicata, Bologna, Italy.
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Abstract
Eosinophilic gastroenteritis is an uncommon disease characterized by eosinophilic infiltration of the gastrointestinal tract. The clinical manifestations are related to the layer(s) and extent of the bowel involved. In this paper, we present a case of intractable abdominal pain caused by jejunal submucosal eosinophilic infiltration without mucosal involvement, diagnosed by deep endoscopic biopsies. The patient was successfully treated with steroids without need for surgery for diagnosis or therapy.
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Affiliation(s)
- Zeynel Mungan
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Turkey ; Department of Gastroenterology, American Hospital, Istanbul, Turkey
| | - Tan Attila
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Turkey ; Department of Gastroenterology, American Hospital, Istanbul, Turkey
| | - Yersu Kapran
- Department of Pathology, American Hospital, Istanbul, Turkey
| | | | - Zeynep Unal
- Department of Diagnostic Radiology, American Hospital, Istanbul, Turkey
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Abstract
Columnar epithelium in the distal part of the esophagus is generally related to Barrett's esophagus. Barrett's esophagus is a well-known premalignant lesion for adenocarcinoma of the esophagus. Therefore, its diagnosis and surveillance are important. Columnar epithelium in the esophagus other than Barrett's esophagus can be gastric heterotopia, which generally takes place in the upper part of the esophagus and is named inlet patch. The presence of gastric metaplasia in the distal part of the esophagus is rare and can cause misdiagnosis. Therefore, its differentiation from Barrett's esophagus is important. Here we present a case of gastric heterotopia located in the distal part of the esophagus that caused reflux-like symptoms and needed differentiation from Barrett's esophagus.
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Mungan Z. An observational European study on clinical outcomes associated with current management strategies for non-variceal upper gastrointestinal bleeding (ENERGIB-Turkey). Turk J Gastroenterol 2013. [PMID: 23161291 DOI: 10.4318/tig.2012.0402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND/AIMS This observational, retrospective cohort study assessed outcomes of the current management strategies for nonvariceal upper gastrointestinal bleeding in several European countries (Belgium, Greece, Italy, Norway, Portugal, Spain, and Turkey) (NCT00797641; ENERGIB). MATERIALS AND METHODS Turkey contributed 23 sites to this study. Adult patients (≥18 years old) consecutively admitted to hospital and who underwent endoscopy for overt non-variceal upper gastrointestinal bleeding (hematemesis, melena or hematochezia, with other clinical/laboratory evidence of acute upper GI blood loss) were included in the study. Data were collected from patient medical records regarding bleeding continuation, re-bleeding, pharmacological treatment, surgery, and mortality during a 30-day follow-up period. RESULTS A total of 423 patients (67.4% men; mean age: 57.8 ± 18.9 years) were enrolled in the Turkish study centers, of whom 96.2% were admitted to hospital with acute non-variceal upper gastrointestinal bleeding. At admission, the most common symptom was melena (76.1%); 28.6% of patients were taking aspirin, 19.9% were on non-steroidal anti-inflammatory drugs, and 7.3% were on proton pump inhibitors. The most common diagnoses were duodenal (45.2%) and gastric (27.7%) ulcers and gastritis/gastric erosions (26.2%). Patients were most often managed in general medical wards (45.4%). A gastrointestinal team was in charge of treatment in 64.8% of cases. Therapeutic procedures were performed in 32.4% of patients during endoscopy. After the endoscopy, most patients (94.6%) received proton pump inhibitors. Mean (SD) hospital stay was 5.36 ± 4.91 days. The cumulative proportions of continued bleeding/re-bleeding, complications and mortality within 30 days of the non-variceal upper gastrointestinal bleeding episode were 9.0%, 5.7% and 2.8%, respectively. In the Turkish sub-group of patients, the significant risk factors for bleeding continuation or re-bleeding were age >65 years, presentation with hematemesis or shock/syncope, and the diagnosis of duodenal ulcer. The risk of clinical complications after non-variceal upper gastrointestinal bleeding was higher in female patients older than 65 years, in patients with comorbidities, and in patients presenting with shock/syncope, and also according to time to endoscopy. The use of aspirin, non-steroidal anti-inflammatory drugs or warfarin at baseline was negatively associated with the development of bleeding or clinical complications. The risk of death within 30 days after non-variceal upper gastrointestinal bleeding was significantly higher in patients older than 65 years and in those receiving transfusions other than intravenous fluid or red blood cells within 12 hours of presentation. CONCLUSIONS According to the survey results, non-variceal upper gastrointestinal bleeding in Turkey varies from that in other European countries in a number of aspects. These differences could be associated with a younger population and Helicobacter pylori incidence. Despite the diminishing need for surgical intervention and mortality rates for non-variceal upper gastrointestinal bleeding, as is the case in other European countries, non-variceal upper gastrointestinal bleeding remains a serious problem.
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Affiliation(s)
- Zeynel Mungan
- İstanbul Medical Faculty, İstanbul University, Department of Gastroenterohepatology, İstanbul, Turkey.
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Mungan Z. An observational European study on clinical outcomes associated with current management strategies for non-variceal upper gastrointestinal bleeding (ENERGIB-Turkey). Turk J Gastroenterol 2013; 23:463-77. [PMID: 23161291 DOI: 10.4318/tjg.2012.0402] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND/AIMS This observational, retrospective cohort study assessed outcomes of the current management strategies for nonvariceal upper gastrointestinal bleeding in several European countries (Belgium, Greece, Italy, Norway, Portugal, Spain, and Turkey) (NCT00797641; ENERGIB). MATERIALS AND METHODS Turkey contributed 23 sites to this study. Adult patients (≥18 years old) consecutively admitted to hospital and who underwent endoscopy for overt non-variceal upper gastrointestinal bleeding (hematemesis, melena or hematochezia, with other clinical/laboratory evidence of acute upper GI blood loss) were included in the study. Data were collected from patient medical records regarding bleeding continuation, re-bleeding, pharmacological treatment, surgery, and mortality during a 30-day follow-up period. RESULTS A total of 423 patients (67.4% men; mean age: 57.8 ± 18.9 years) were enrolled in the Turkish study centers, of whom 96.2% were admitted to hospital with acute non-variceal upper gastrointestinal bleeding. At admission, the most common symptom was melena (76.1%); 28.6% of patients were taking aspirin, 19.9% were on non-steroidal anti-inflammatory drugs, and 7.3% were on proton pump inhibitors. The most common diagnoses were duodenal (45.2%) and gastric (27.7%) ulcers and gastritis/gastric erosions (26.2%). Patients were most often managed in general medical wards (45.4%). A gastrointestinal team was in charge of treatment in 64.8% of cases. Therapeutic procedures were performed in 32.4% of patients during endoscopy. After the endoscopy, most patients (94.6%) received proton pump inhibitors. Mean (SD) hospital stay was 5.36 ± 4.91 days. The cumulative proportions of continued bleeding/re-bleeding, complications and mortality within 30 days of the non-variceal upper gastrointestinal bleeding episode were 9.0%, 5.7% and 2.8%, respectively. In the Turkish sub-group of patients, the significant risk factors for bleeding continuation or re-bleeding were age >65 years, presentation with hematemesis or shock/syncope, and the diagnosis of duodenal ulcer. The risk of clinical complications after non-variceal upper gastrointestinal bleeding was higher in female patients older than 65 years, in patients with comorbidities, and in patients presenting with shock/syncope, and also according to time to endoscopy. The use of aspirin, non-steroidal anti-inflammatory drugs or warfarin at baseline was negatively associated with the development of bleeding or clinical complications. The risk of death within 30 days after non-variceal upper gastrointestinal bleeding was significantly higher in patients older than 65 years and in those receiving transfusions other than intravenous fluid or red blood cells within 12 hours of presentation. CONCLUSIONS According to the survey results, non-variceal upper gastrointestinal bleeding in Turkey varies from that in other European countries in a number of aspects. These differences could be associated with a younger population and Helicobacter pylori incidence. Despite the diminishing need for surgical intervention and mortality rates for non-variceal upper gastrointestinal bleeding, as is the case in other European countries, non-variceal upper gastrointestinal bleeding remains a serious problem.
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Affiliation(s)
- Zeynel Mungan
- İstanbul Medical Faculty, İstanbul University, Department of Gastroenterohepatology, İstanbul, Turkey.
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Uyanikoğlu A, Danalioğlu A, Akyüz F, Ermış F, Güllüoğlu M, Kapran Y, Demır K, Ozdıl S, Beşişik F, Boztaş G, Mungan Z, Kaymakoğlu S. Etiological factors of duodenal and gastric ulcers. Turk J Gastroenterol 2012; 23:99-103. [PMID: 22706736 DOI: 10.4318/tjg.2012.0435] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND/AIMS We aimed to determine the etiology of patients with duodenal and gastric ulcers. METHODS 140 patients diagnosed with peptic ulcer between April 2002-2009 were enrolled in this prospective study. Two biopsy specimens were collected from the antrum and corpus for histology and one for rapid urease testing, and stool samples were analyzed for Helicobacter pylori antigen. Serum calcium and gastrin levels were also analyzed. RESULTS 82 (58%) patients were male, with a median age of 47.70±15.03 years (range: 16-92). The ulcer was located in the duodenum in 96 patients, stomach in 40, and both duodenum and stomach in 4. The rates of patients positive for Helicobacter pylori antigen in stool, positive in urease testing and positive for Helicobacter pylori presence in antral and corpus samples were 48%, 52%, 67%, and 60%, respectively. 107 (76%) patients were positive for Helicobacter pylori in one of the test methods. 64 (46%) patients had a history of nonsteroidal antiinflammatory drug use within the last month. Mean levels of calcium and gastrin were 9.29±0.40 (7.90-10.20) and 73.96±89.88 (12.86-562.50), respectively. Gastrin level was correlated to inflammatory activity (p<0.05). 19 (13.6%) of the patients were negative for Helicobacter pylori, nonsteroidal anti- inflammatory drug use and hypersecretory illness, and were classified as idiopathic. CONCLUSIONS The most common cause of duodenal and gastric ulcer was Helicobacter pylori, and it was responsible for three-fourths of the cases. About half of the patients had a history of nonsteroidal antiinflammatory drug use, and nonsteroidal antiinflammatory drug and Helicobacter pylori were both responsible for the ulcer in three-fourths of these patients. In about one-tenth of the patients, nonsteroidal antiinflammatory drug use was the cause of ulcer alone, and about one-tenth of the ulcers were classified as idiopathic.
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Affiliation(s)
- Ahmet Uyanikoğlu
- Istanbul University, Faculty of Medicine, Department of Gastroenterohepatology, İstanbul, Turkey.
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Uyanikoglu A, Akyuz F, Ermis F, Arici S, Bas G, Cakirca M, Baran B, Mungan Z. Does Cholecystectomy Increase the Esophageal Alkaline Reflux? Evaluation by Impedance-pH Technique. J Neurogastroenterol Motil 2012; 18:187-93. [PMID: 22523728 PMCID: PMC3325304 DOI: 10.5056/jnm.2012.18.2.187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 01/24/2012] [Accepted: 02/01/2012] [Indexed: 11/23/2022] Open
Abstract
Background/Aims The aim of this study is to investigate the reflux patterns in patients with galbladder stone and the change of reflux patterns after cholecystectomy in such patients. Methods Fourteen patients with cholecystolithiasis and a control group including 10 healthy control subjects were enrolled in this prospective study. Demographical findings, reflux symptom score scale and 24-hour impedance pH values of the 14 cholecystolithiasis cases and the control group were evaluated. The impedance pH study was repeated 3 months after cholecystectomy. Results Age, gender, and BMI were not different between the two groups. Total and supine weakly alkaline reflux time (%) (1.0 vs 22.5, P = 0.028; 201.85 vs 9.65, P = 0.012), the longest episodes of total, upright and supine weakly alkaline reflux mediums (11 vs 2, P = 0.025; 8.5 vs 1.0, P = 0.035; 3 vs 0, P = 0.027), total and supine weakly alkaline reflux time in minutes (287.35 vs 75.10, P = 0.022; 62.5 vs 1.4, P = 0.017), the number of alkaline reflux episodes (162.5 vs 72.5, P = 0.022) were decreased with statistical significance. No statistically significant difference was found in the comparison of symptoms between the subjects in the control group and the patients with cholecystolithiasis, in preoperative, postoperative and postcholecystectomy status. Conclusions Significant reflux symptoms did not occur after cholecystectomy. Post cholecystectomy weakly alkaline reflux was decreased, but it was determined that acid reflux increased after cholecystectomy by impedance pH-metry in the study group.
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Affiliation(s)
- Ahmet Uyanikoglu
- Department of Gastroenterology, Harran University Faculty of Medicine, Sanliurfa, Turkey
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Sen F, Pinarbaşi B, Işsever H, Akyüz F, Mungan Z, Kaymakoğlu S. Postprandial platelet-poor plasma 5-hydroxytryptamine concentrations during diarrhea and constipation periods of alternatingtype irritable bowel syndrome patients. Turk J Gastroenterol 2011; 22:270-8. [PMID: 21805417 DOI: 10.4318/tjg.2011.0212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND/AIMS Our aim was to measure concentrations of platelet-poor plasma 5-hydroxytryptamine and to assess any relationship with gastrointestinal symptomatology under fasting and fed conditions in alternating-type irritable bowel syndrome during both constipation and diarrhea periods separately. Results of the two periods were compared with each other as well as with the results of the controls. METHODS Nine patients with alternating diarrhea and constipation symptoms and 9 controls were enrolled. Serial plasma 5-hydroxytryptamine was measured for 1 hour under fasting and for 3 hour after a standard carbohydrate meal. Patients underwent the same measurements during constipation and diarrhea periods separately. Serum 5-hydroxytryptamine concentrations were determined by high-performance liquid chromatography. Symptomatology was assessed throughout the study. RESULTS Patients exhibited higher concentrations of platelet-poor plasma 5-hydroxytryptamine under fed conditions during diarrhea, especially at postprandial 30 minutes (p<0.05) compared with concentrations during constipation. Increases in postprandial plasma 5-hydroxytryptamine concentrations relative to fasting concentrations were also significantly higher during the diarrhea period than during constipation and in controls (p<0.05). Although there was no significant correlation between plasma 5-hydroxytryptamine concentrations and symptom scores, patients had worse postprandial symptomatology during diarrhea compared with controls (p<0.05). CONCLUSIONS Platelet-poor plasma 5-hydroxytryptamine concentrations after meal ingestion differ between constipation and diarrhea periods in alternating-type irritable bowel syndrome. Postprandial symptomatology is also more prominent during diarrhea. These results suggest that differences in plasma levels of serotonin between diarrhea and constipation may underlie the pathogenesis of alternating-type irritable bowel syndrome and could be involved in some aspects of symptomatology.
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Affiliation(s)
- Fatma Sen
- Department of Internal Medicine, İstanbul University Faculty of Medicine, İstanbul, Turkey.
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Ermis F, Akyuz F, Arici S, Uyanikoglu A, Yakar F, Pinarbasi B, Demir K, Özdil S, Besisik F, Kaymakoglu S, Boztas G, Cuhadaroglu C, Mungan Z. Effect of Proton Pump Inhibitor (PPI) Treatment in Obstructive Sleep Apnea Syndrome: An Esophageal Impedance-pHmetry Study. ACTA ACUST UNITED AC 2011; 58:1566-73. [DOI: 10.5754/hge10465] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Akyüz F, Cakaloğlu Y, Pinarbaşi B, Demir K, Akyüz U, Ozdil S, Beşişik F, Boztaş G, Mungan Z, Kaymakoğlu S. Anticoagulant therapy and Budd-Chiari syndrome: is it successful? Hepatogastroenterology 2011; 58:900-903. [PMID: 21830413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND/AIMS Anticoagulant therapy is an accepted treatment for Budd-Chiari syndrome (BCS). However, the natural course of untreated patients is unclear. We aimed to evaluate the efficacy of anticoagulant therapy on survival in BCS. METHODOLOGY Between 1995 and 2007, 45 patients diagnosed with BCS based on the clinical, biochemical, radiological and histological findings were retrospectively evaluated with respect to underlying disease, therapeutic interventions, complications and overall outcome. Complications and survival during the follow-up period were compared in between anticoagulant treated and untreated cases. RESULTS Mean patient age was 34.4 +/- 11.8 years and 46.7% (21) of them were male. Median followup time was 24 months (6-132); 8.9% of patients were diagnosed as acute, 31.1% as subacute and 60% as chronic BCS according to disease duration. Centrilobular necrosis was found in 16 of 36 biopsy performed patients. Etiological factors were detected in 60% of patients and 40% of them were cryptogenic. Twenty four of them received anticoagulant therapy, the remaining 21 were followed-up with supportive medical therapy. Five patients who had shunt operation were excluded for survival analyses. Complications were similar between treated and untreated cases (p>0.05). There was a positive correlation between survival and centrilobular necrosis (r=0.376, p=0.037). The mean survival periods were 95.5 months (%95 CI 73-117 months) and 72.5 months (%95 CI 42-103 months) in anticoagulant treated and untreated patients, respectively (p>0.246). CONCLUSION Most patients with BCS are admitted to hospital at the chronic stage and more than half of them have underlying thrombotic risk factor. In our study, no beneficial effects of anticoagulant therapy were observed on the survival and complications of liver disease.
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Affiliation(s)
- Filiz Akyüz
- Department of Gastroenterohepatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Akyuz F, Pinarbasi B, Ermis F, Uyanikoglu A, Demir K, Ozdil S, Besisik F, Kaymakoglu S, Boztas G, Mungan Z. Is portal hypertensive enteropathy an important additional cause of blood loss in portal hypertensive patients? Scand J Gastroenterol 2010; 45:1497-502. [PMID: 20695721 DOI: 10.3109/00365521.2010.510568] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Recently, mucosal changes of small bowel were defined by developing new imaging techniques including capsule endoscopy (CE) in portal hypertensive patients. However, the clinical impact of these changes is unknown. In this study, we aimed to determine the additional cause of blood loss in portal hypertensive patients. MATERIAL AND METHODS A total of 444 portal hypertensive patients, hospitalized in our clinic between 2005 and 2007, were evaluated. Patients with obscure bleeding were enrolled to this prospective case-control study. CE was performed in 21 patients who met inclusion criteria. Gastroscopy, colonoscopy and computerized tomography/small bowel enema were performed in all patients. RESULTS Fourteen cirrhotic and seven noncirrhotic portal hypertensive patients were enrolled to this study. Mean age of patients was 47.9±15.6 years, and 13 of 21 were male. Small bowel varices were found in 7 patients (1 active bleeding) and other mucosal abnormalities in 10 patients (vascular ectasia, erosion and edema, 1 active bleeding). Although two of them were normal, jejunal malignant mass was found in two patients (1 active bleeding). Of 21 patients, 19 (90.5%) patients had portal hypertensive abnormalities (including varices). However, ileal varices rate was 57.1% (4 patients) in noncirrhotic portal hypertensive patients and 21.4% (3 patients) in cirrhotics. CONCLUSION Ninety percent of patients had portal hypertensive abnormalities in small bowel and one-third of them had small bowel varices. Small bowel varices and vascular ectasia were the main causes of obscure bleeding in portal hypertensive patients.
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Affiliation(s)
- Filiz Akyuz
- Istanbul Medical Faculty, Department of Gastroenterology, Capa-Istanbul, Turkey.
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Akyüz F, Arici S, Ermiş F, Mungan Z. Utility of esophageal manometry and pH-metry in gastroesophageal reflux disease before surgery. Turk J Gastroenterol 2010; 20:261-5. [PMID: 20084569 DOI: 10.4318/tjg.2009.0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND/AIMS The necessity of manometric evaluation before fundoplication in patients with gastroesophageal reflux disease is still a matter of debate. However, misdiagnosis can be responsible for postoperative problems. We aimed to evaluate the necessities of manometry and pH-metry before fundoplication in order to prevent possible complications after surgery. METHODS Between 1997 and 2004, 259 consecutive patients who referred to our laboratory with a diagnosis of gastroesophageal reflux disease and request for manometric test before surgery were evaluated retrospectively. Manometric analysis was performed in all patients and 24-hour ambulatory pH-metry in 91 of them. RESULTS The mean age of the patients was 42.6+/-13 years and 51% were female. While 102 (39.4%) of the patients had normal esophageal motility, 122 (47.1%) had gastroesophageal reflux-related dysmotility (22% with ineffective esophageal motility, 25.1% with hypotensive lower esophageal sphincter). Primary esophageal motility disorders were detected in 29 (11.2%) patients (4 achalasia, 24 uncoordinated contractions and 1 nutcracker esophagus). Six patients had secondary dysmotility caused by scleroderma. Pathologic reflux was detected in 54 (59.3%) patients in whom pH-metry was performed. CONCLUSIONS Our results support that manometry and pH-metry must be performed before surgery in gastroesophageal reflux disease.
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Affiliation(s)
- Filiz Akyüz
- Department of Gastroenterohepatology, Istanbul University, Istanbul School of Medicine, Istanbul
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Ahishali E, Demir K, Ahishali B, Akyuz F, Pinarbasi B, Poturoglu S, Ibrisim D, Gulluoglu M, Ozdil S, Besisik F, Kaymakoglu S, Boztas G, Cakaloglu Y, Mungan Z, Canberk Y, Okten A. Electron microscopic findings in non-alcoholic fatty liver disease: is there a difference between hepatosteatosis and steatohepatitis? J Gastroenterol Hepatol 2010; 25:619-26. [PMID: 20370732 DOI: 10.1111/j.1440-1746.2009.06142.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS Non-alcoholic fatty liver disease has long been accepted as benign; however, recent evidence suggests that the disease may progress to cirrhosis and hepatocellular carcinoma, although the natural course of the disease is still unclear. This study was designed to comparatively evaluate electron microscopic features of non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH). METHODS Quantitative and semi-quantitative ultrastructural evaluations were performed on liver biopsies from 23 patients, 10 with NAFL and 13 with NASH. RESULTS No statistically significant difference was noted between NAFL and NASH patients in ultrastructural features of hepatocytes including megamitochondria, intramitochondrial crystalline inclusions, mitochondrial matrix granules, foamy cytoplasmic appearance, electron-lucent and glycogen-containing nuclear regions, lipofuscin granules, or an increased frequency of vesicles containing electron-dense material in peribiliary Golgi zone; however, the mitochondrial diameter was significantly higher in the NASH patients. Intercellular distance and microvilli between hepatocytes, collagen and electron-dense material accumulation in the space of Disse, electron-dense material accumulation and microvillus density in bile canaliculi did not differ significantly between the groups. CONCLUSIONS Our data show that, although NAFL and NASH can be distinguished by their distinct light microscopic features, ultrastructural characteristics are similar, which suggests that NAFL may also have the potential to progress to fibrosis and cirrhosis like NASH.
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Affiliation(s)
- Emel Ahishali
- Department of Gastroenterohepatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Poturoglu S, Kaymakoglu S, Gurel Polat N, Ibrisim D, Ahishali E, Akyuz F, Badur S, Demir K, Mungan Z. A new agent for tumour necrosis factor-alpha inhibition: In vitro effects of dipyridamole in Crohn's disease. Scand J Clin Lab Invest 2009; 69:696-702. [PMID: 19452347 DOI: 10.3109/00365510902989075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Tumour necrosis factor-alpha (TNF-alpha) plays a central role in inflammatory cascade in Crohn's disease (CD). Our study aims to investigate the in vitro effects of dipyridamole (DP) on the TNF-alpha and interleukin-10 (IL-10) production in the intestinal mononuclear cells of CD patients. MATERIAL AND METHODS Thirteen patients with CD and in 17 healthy individuals underwent colonoscopy and biopsy samples were taken. Cultured mononuclear cells were preincubated with DP1 (0.7 microg/ml), DP2 (1.25 microg/ml), methotrexate (MTX)1 (0.5 nmol/L) and MTX2 (1.5 nmol/L). These cells were then stimulated with lipopolysaccaride (LPS) and phytohemagglutinin (PHA). The levels of TNF-alpha and IL-10 in supernatants were measured with standard immunoassay monoclonal antibody method. RESULTS An appropriate cell culture could be obtained in 10 patients with CD and 12 healthy individuals. In LPS stimulated cells, MTX1 and MTX2 were superior to DP1 and DP2 in suppressing TNF-alpha in both groups. In PHA stimulated cells, while MTX1 was superior to DP1, MTX2 and DP2 had an equivalent effect in CD patients (p<0.05, p>0.05, respectively). In LPS-stimulated cells DP2 was significantly superior to MTX2 in increasing IL-10 levels in both groups (p<0.05). In PHA stimulated cells, DP1 and DP2 caused a higher increase in IL-10 levels compared with MTX1 and MTX2 in CD group (p<0.05). CONCLUSIONS Dipyridamole suppresses TNF-alpha similar with MTX. It seems to be superior to MTX in increasing IL-10 levels. Addition of DP to anti-TNF medications may create a synergy in cytokine modulation.
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Affiliation(s)
- Sule Poturoglu
- Department of Internal Medicine, Division of Gastroenterohepatology Istanbul University, Istanbul, Turkey.
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Poturoglu S, Kaymakoglu S, Gurel Polat N, Ibrisim D, Ahishali E, Akyuz F, Badur S, Demir K, Mungan Z. A new agent for tumour necrosis factor-alpha inhibition: In vitro effects of dipyridamole in Crohn's disease. Scand J of Clinical & Lab Investigation 2009. [DOI: 10.1080/00365510902989075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Akyuz F, Mungan Z. Diagnostic Capability of Capsule Endoscopy in Small Bowel Diseases. Gastroenterology Res 2009; 2:81-85. [PMID: 27956958 PMCID: PMC5139822 DOI: 10.4021/gr2009.03.1281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2009] [Indexed: 11/03/2022] Open
Abstract
Capsule Endoscopy (CE) is a recently developed noninvasive technique for imaging of small bowel pathologies. It is a swallowable wireless mini-camera for getting images of the gastrointestinal (GI) mucosa. General indications of CE are obscure bleeding, iron deficiency anemia, Crohn disease, abdominal pain, polyposis coli, celiac disease and small bowel tumors. Obstruction must be excluded with small bowel radiography before using CE. Bowel preparation can be recommended for good visualization. The main indication is obscure GI bleeding. Even though useful for the other indications in selected cases, large polypoid lesions may be missed. Diagnostic capability of CE and double balloon enteroscopy (DBE) are similar and CE is a good complemantary method for DBE.
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Affiliation(s)
- Filiz Akyuz
- Department of Gastroenterohepatology, Istanbul Medical Faculty, Istanbul University, Turkey
| | - Zeynel Mungan
- Department of Gastroenterohepatology, Istanbul Medical Faculty, Istanbul University, Turkey
- Corresponding author: Istanbul Medical Faculty, Internal Medicine, Endoscopy unit, Capa 34093, Istanbul, Turkey. E-mail:
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Ahishali E, Boztas G, Akyuz F, Ibrisim D, Poturoglu S, Pinarbasi B, Ozdil S, Mungan Z. Response to hepatitis B vaccination in patients with celiac disease. Dig Dis Sci 2008; 53:2156-9. [PMID: 18157638 DOI: 10.1007/s10620-007-0128-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Accepted: 11/09/2007] [Indexed: 12/14/2022]
Abstract
Abnormal immune response to gliadin, genetic, and environmental factors play a role in the pathogenesis of celiac disease (CD). Non-responsiveness to hepatitis B virus (HBV) vaccination is related to genetic features. Certain human leukocyte antigen (HLA) genotypes are more prevalent among non-responders to HBV vaccination. There is also a strong relationship between CD and these HLA genotypes. This study investigates the relationship between CD and non-responsiveness to HBV vaccination, with an emphasis on genotypic co-incidence. No statistically significant difference was noted between the ages and gender of CD patients and control subjects. Baseline serum IgA, IgM, and IgG levels of all CD patients were normal. Responsiveness to HBV vaccination was observed in 17 (68%) CD patients and all (100%) control subjects (P = 0.006). In conclusion, CD should also be sought in unresponders to HBV vaccine who are not immunosuppressed.
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Affiliation(s)
- Emel Ahishali
- Department of Gastroenterohepatology, Istanbul Faculty of Medicine, Istanbul University, Capa, Istanbul, Turkey.
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Pinarbaşi B, Poturoğlu S, Yanar H, Güven K, Akyüz F, Dizdaroğlu F, Güllüoğlu M, Taviloğlu K, Kaymakoğlu S, Mungan Z. A rare cause of hemosuccus pancreaticus: primary splenic artery aneurysm ruptured into pancreatic serous cystadenoma. Turk J Gastroenterol 2008; 19:57-63. [PMID: 18386243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Hemosuccus pancreaticus is a rare clinical condition defined as bleeding into the pancreatic duct from a peripancreatic artery. We present here a 57-year-old woman admitted to our clinic with abdominal pain, tar-colored stool and confusion. Further investigations were done because of severe anemia. Abdominal computerized tomography revealed intraabdominal hematoma. Laparotomy was performed, which confirmed that intraabdominal haemorrhagia had occurred with the rupture of a splenic artery aneurysm into a pancreatic serous cystadenoma, which ruptured into the abdomen because of high pressure. This is an interesting case diagnosed with multidisciplinary approaches.
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MESH Headings
- Aneurysm, Ruptured/complications
- Aneurysm, Ruptured/diagnosis
- Aneurysm, Ruptured/surgery
- Angiography
- Celiac Artery/diagnostic imaging
- Cystadenoma, Serous/diagnosis
- Cystadenoma, Serous/etiology
- Cystadenoma, Serous/surgery
- Female
- Gastrointestinal Hemorrhage/diagnosis
- Gastrointestinal Hemorrhage/etiology
- Gastrointestinal Hemorrhage/surgery
- Humans
- Laparotomy
- Middle Aged
- Pancreatic Cyst/diagnosis
- Pancreatic Cyst/etiology
- Pancreatic Cyst/surgery
- Pancreatic Ducts/diagnostic imaging
- Pancreatic Ducts/pathology
- Pancreatic Ducts/surgery
- Rare Diseases
- Rupture, Spontaneous/complications
- Rupture, Spontaneous/diagnosis
- Rupture, Spontaneous/surgery
- Splenectomy
- Splenic Artery/diagnostic imaging
- Splenic Artery/pathology
- Splenic Artery/surgery
- Tomography, X-Ray Computed
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Affiliation(s)
- Binnur Pinarbaşi
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Abstract
Contrary to the widely known view of the insidious, slowly progressive pattern of hepatitis C, a rapidly progressive cirrhotic form can develop in immunodeficient conditions. Hepatitis C leads to cirrhosis in immunocompetent hosts after 20 years of infection however in hypogammaglobulinemic patients disease progresses faster, leading to cirrhosis and death within 10 years of diagnosis and frequently earlier. Here we present a 57-year-old woman with common variable immunodeficiency infected with hepatitis C after antral and duodenal resection and gastrojejunostomy operation in another hospital for lymphoma mimicking duodenal nodular hyperplasia which then rapidly progressed to decompensated cirrhosis in less than two years.
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Affiliation(s)
- Fatih Ermis
- Department of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine.
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Yönal O, Hatirnaz O, Akyüz F, Ozbek U, Demir K, Kaymakoglu S, Okten A, Mungan Z. HFE gene mutation, chronic liver disease, and iron overload In Turkey. Dig Dis Sci 2007; 52:3298-302. [PMID: 17410459 DOI: 10.1007/s10620-006-9683-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 11/16/2006] [Indexed: 12/09/2022]
Abstract
We aimed to determine the relationships between iron overload and HFE gene mutation in chronic liver disease in Turkey. One hundred thirteen chronic liver disease patients and 138 healthy controls were evaluated regarding their clinical, biochemical, and genetic parameters. Each group was divided into two subgroups according to transferrin saturation (TS) (45% and >45%). HFE gene mutation was analyzed by the PCR-RFLP method. C282Y homozygote, heterozygote, and wild-type mutation rates were 1.7%, 0%, and 98.3% in patients and 0%, 1.4%, and 98.6% in controls, respectively. H63D homozygote, heterozygote, and wild-type mutation rates were 1.8%, 24.7%, and 73.5% in patients and 1.4%, 24%, and 74.6% in controls, respectively. Mutation rates were not statistically different in patients with high and normal TS. Iron overload was positively correlated with biochemical activity and Child-Pugh score (P < 0.05). In multivariate analysis, H63D homozygotic mutation was an independent factor for the development of hepatocellular carcinoma (P = 0.004). We conclude that C282Y mutation is very rare in Turkey. Iron overload is not related to H63D mutation but is positively correlated with biochemical activity and Child-Pugh score in chronic liver diseases.
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Affiliation(s)
- Oya Yönal
- Department of Gastroenterohepatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Akyüz F, Demir K, Ozdil S, Aksoy N, Poturoğlu S, Ibrişim D, Kaymakoğlu S, Beşişik F, Boztaş G, Cakaloğlu Y, Mungan Z, Cevikbaş U, Okten A. The effects of rosiglitazone, metformin, and diet with exercise in nonalcoholic fatty liver disease. Dig Dis Sci 2007; 52:2359-67. [PMID: 17429734 DOI: 10.1007/s10620-006-9145-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Accepted: 11/10/2005] [Indexed: 12/12/2022]
Abstract
Our aim was to evaluate effects of metformin, rosiglitazone, and diet with exercise in nonalcoholic fatty liver disease. Forty-seven patients (mean age, 44+/-10 years; 17 female) whose ALT levels had been high for at least 6 months and with hepatosteatosis detected by liver biopsy and/or USG were enrolled in this study. Of these, 12 were treated with 850 mg/day metformin (group 1), 11 with 4 mg/day rosiglitazone (group 2), and 24 with diet and exercise (group 3) for 1 year. ALT normalization at months 6 and 12 was accepted as treatment response. Liver biopsy was performed in all patients in groups 1 and 2 before treatment and 12 patients (4 in group 1, 8 in group 2) after treatment; but in group 3 it was performed only in patients who approved this procedure (12 patients). Body mass index did not change in groups 1 and 2, but it decreased significantly in group 3 (30+/-3 to 28+/-2 kg/m(2)) at month 12. Treatment response rate was 33.3, 54.5, and 54.2% in groups 1, 2, and 3, respectively, at month 6. This rate was 22.2, 37.5, and 41.2 in groups 1, 2, and 3, respectively, at month 12. Rate of steatosis and stage of fibrosis did not change after treatment. Diet with exercise seems to be superior to metformin and rosiglitazone. Decreasing treatment response at month 12 compared to month 6 may be due to fluctuations of ALT levels. Treatment response should be evaluated histologically.
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Affiliation(s)
- Filiz Akyüz
- Department of Gastroenterohepatology Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Ahishali E, Pinarbasi B, Akyuz F, Ibrisim D, Kaymakoglu S, Mungan Z. A case of Aeromonas hydrophila enteritis in the course of ulcerative colitis. Eur J Intern Med 2007; 18:430-1. [PMID: 17693233 DOI: 10.1016/j.ejim.2006.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Revised: 10/15/2006] [Accepted: 12/15/2006] [Indexed: 11/27/2022]
Abstract
A 24-year-old man with a previous diagnosis of ulcerative pancolitis presented with severe malabsorption with watery diarrhea, malaise, and weight loss. Physical examination revealed paleness, hypotension, tachycardia, edema, ascites, and left-sided pleural effusion. Laboratory analysis revealed hypoalbuminemia and hypocalcemia. Further examination revealed that malabsorption was related to Aeromanas hydrophila infection. Clinical improvement was observed upon oral ciprofloxacin treatment. No clinical or laboratory activation of ulcerative colitis was detected during this infection.
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Affiliation(s)
- Emel Ahishali
- Istanbul Medical Faculty, Department of Gastroenterohepatology, Turkey
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Demir K, Akyuz F, Ozdil S, Aksoy N, Kaymakoglu S, Poturoglu S, Akyüz U, Besisik F, Boztas G, Mungan Z, Cevikbas U, Cakaloglu Y, Okten A. What is the reason of elevated alanine aminotransferase level in HBeAg negative patients with low viremia: NAFLD or chronic hepatitis? Ann Hepatol 2007; 6:92-6. [PMID: 17519831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND STUDY AIMS Increased alanine aminotransferase (ALT) levels with negative hepatitis B virus (HBV) DNA by hybridization is a common problem in Turkey where is a mild endemic region. We aimed to evaluate the causes of elevated ALT levels in patients who are negative for hepatitis B e antigen (HBeAg) and HBV DNA (by hybridization) for at least 6 months. PATIENTS-METHODS Forty-nine patients were enrolled in this study. Histological changes [histological activity index (HAI), and the extent of fibrosis] were assessed according to the Knodell scoring system and steatosis were graded by Brunt's classification for NAFLD in all patients. RESULTS A mean age of the patients was 34.9 +/- 12.1 years (16-70). 43 (87.8%) of them were male. Mean ALT level was 95 +/- 39.7 IU/L (50- 258). Hyperglycemia (>100 mg/dL) and hyperlipidemia were found in 12 and 24 patients, respectively. Hepatic steatosis (7 patients grade 1; 5 patients grade 2; and 7 patients grade 3), ground-glass hepatocyte, chronic hepatitis, and Wilson disease were found in liver biopsy in 38.8%, 32.6%, 26.6%, 2%, respectively. Mean HAI was 6.5 +/- 3.6 (4-12) in chronic hepatitis. Seven patients (53.9%) were in stage 1 and 2 while 6 patients (46.1%) were in stage 3 and 4. CONCLUSIONS Nonalcoholic fatty liver disease is the most common cause of elevated ALT levels in HBeAg negative/HBV DNA negative patients. Chronic hepatitis B was found in 26.6% of these patients.
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Affiliation(s)
- Kadir Demir
- Department of Gastroenterohepatology, Istanbul University, Turkey.
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Mungan Z, Pinarbaşi B, Kaymakoğlu S. Eosinophilic esophagitis: case report. Turk J Gastroenterol 2007; 18:100-2. [PMID: 17602357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Eosinophilic esophagitis is an inflammatory condition of the esophagus characterized by eosinophilic infiltration. It is a condition mainly affecting children; the adult form has only recently gained recognition as a distinct entity. The major symptom among adults with eosinophilic esophagitis is dysphagia. It is often misdiagnosed as gastroesophageal reflux disease because of the similarity in symptoms. An endoscopic biopsy is required to distinguish between the conditions. The cause of eosinophilic esophagitis is poorly understood, but food allergy has been implicated. Topical steroids are the most effective and convenient method for the treatment of eosinophilic esophagitis in adults. The long-term prognosis of eosinophilic esophagitis is uncertain; however, data suggests a benign course. We herein present two eosinophilic esophagitis cases that were the first to be diagnosed in our clinic.
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Affiliation(s)
- Zeynel Mungan
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Medical Faculty, Istanbul.
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Deglincerti A, De Giorgio R, Cefle K, Devoto M, Pippucci T, Castegnaro G, Panza E, Barbara G, Cogliandro RF, Mungan Z, Palanduz S, Corinaldesi R, Romeo G, Seri M, Stanghellini V. A novel locus for syndromic chronic idiopathic intestinal pseudo-obstruction maps to chromosome 8q23-q24. Eur J Hum Genet 2007; 15:889-97. [PMID: 17487221 DOI: 10.1038/sj.ejhg.5201844] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Chronic idiopathic intestinal pseudo-obstruction (CIIP) is a rare and severe clinical syndrome characterized by symptoms and signs of intestinal occlusion, in the absence of any mechanical obstruction of the gut lumen. In the attempt to identify the genetic basis of CIIP, we analyzed a Turkish pedigree with a high degree of consanguinity in which three siblings presented with a syndromic form of CIIP. All affected family members were characterized by recurrent, self-limiting subocclusive episodes, long-segment Barrett esophagus, and a variety of minor cardiac valve or septal defects. In some patients full-thickness intestinal biopsy samples were obtained and tissues were processed for immunohistochemistry using antibodies to different markers of the intestinal neuromuscular tract. Full-thickness biopsies of the gut wall showed abnormalities of both the neural and muscular components suggesting an underlying intestinal neuro-myopathy. Blood samples were collected for DNA extraction from each available family member and DNAs were genotyped using 382 microsatellites spanning the entire genome with the aim to take advantage of the homozygosity mapping approach. Linkage analysis identified a new syndromic locus on chromosome 8q23-q24 (multipoint LOD score=5.01). Our data strongly support the presence of a new genetic locus associated with CIIP, long-segment Barrett esophagus, and cardiac involvement on chromosome 8.
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Affiliation(s)
- Alessia Deglincerti
- Laboratory of Medical Genetics, Department of Internal Medicine, Cardioangiology and Hepatology, University of Bologna, Bologna, Italy
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Yönal O, Hatirnaz O, Akyüz F, Köroğlu G, Ozbek U, Cefle K, Mungan Z. Definition of C282Y mutation in a hereditary hemochromatosis family from Turkey. Turk J Gastroenterol 2007; 18:53-7. [PMID: 17450498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Hereditary hemochromatosis is an autosomal recessive disorder associated with the mutation of the HFE gene. C282Y and H63D mutations in this gene have been described. Hereditary hemochromatosis is primarily associated with the C282Y mutation; the importance of H63D is not well known. In previously reported studies, the C282Y mutation was not detected in Turkey. We herein present a family in which the C282Y mutation was detected. A consanguineous marriage produced 10 children. A 33-year-old man (index case) was diagnosed with hemochromatosis (transferrin saturation rate 80%, ferritin 514 ng/ml, liver biopsy showed +3 iron accumulation, liver involvement in MRI), and genetic analysis showed homozygous C282Y mutation. With family screening, another brother was also diagnosed with hemochromatosis. Transferrin saturation rate was high (>45%) in seven healthy brothers and the father. Genetic analysis revealed two cases with C282Y homozygous mutations, three with C282Y/H63D compound heterozygous mutations, one C282Y heterozygous and three H63D heterozygous among the family members. This is the first family in Turkey in which the C282Y mutation has been detected.
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Affiliation(s)
- Oya Yönal
- Department of Gastroenterohepatology, Istanbul Medical Faculty, Istanbul
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Ibrisim D, Cakaloglu Y, Akyuz F, Karadag A, Ozdil S, Besisik F, Mungan Z, Okten A. Treatment of hepatic hydrothorax with terlipressin in a cirrhotic patient. Scand J Gastroenterol 2006; 41:862-5. [PMID: 16785202 DOI: 10.1080/00365520500527441] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hepatic hydrothorax is a complication of cirrhosis that is uncommon and difficult to treat. Diuretic therapy, thoracentesis, transjugular intrahepatic portosystemic shunt and liver transplantation are the main therapeutic options. Here, we report on a 47-year-old man with decompensated liver cirrhosis related to hepatitis B and D virus infections and who had complications of hepatic hydrothorax and hepatorenal syndrome. In this case, the hepatic hydrothorax, which was refractory to thoracic tube drainage and octreotide treatment, could be controlled with 5 days of terlipressin therapy associated with albumin. Terlipressin administration resulted in both improvement in renal function and successful resolution of hepatic hydrothorax. Splanchnic vasoconstrictor agents that reduce splanchnic blood flow, increase both central volume and effective renal blood flow. Thus they improve renal function. In our case, terlipressin, known to be beneficial in hepatorenal syndrome, was also effective in the treatment of hepatic hydrothorax probably by similar mechanisms. This is the first case in the literature.
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Affiliation(s)
- Duygu Ibrisim
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Medical Faculty, Capa, TR-34390 Istanbul, Turkey
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Akyüz F, Ibrişim D, Balik E, Yonal O, Kaymakoğlu S, Buğra D, Mungan Z. Evaluation of malignancy risk and endoscopic follow up in achalasia: case report. Turk J Gastroenterol 2006; 17:46-9. [PMID: 16830277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Achalasia is an esophageal motility disorder that is accepted as a risk factor for the development of cancer. Especially in megaesophagus, chronic irritation of foods and bacterial overgrowth may contribute to the formation of high-grade dysplasia and squamous cell carcinoma. We present a case of advanced stage achalasia with high-grade dysplasia detected three years after a cardiomyotomy operation. Cancer risk continues after surgical operation in achalasia, like in this case. In conclusion, endoscopic follow up is necessary for these patients even after surgical treatment.
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Affiliation(s)
- Filiz Akyüz
- Department of Gastroenterohepatology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
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Akbayir N, Sökmen HM, Caliş AB, Bölükbaş C, Erdem L, Alkim C, Sakiz D, Mungan Z. Heterotopic gastric mucosa in the cervical esophagus: could this play a role in the pathogenesis of laryngopharyngeal reflux in a subgroup of patients with posterior laryngitis? Scand J Gastroenterol 2005; 40:1149-56. [PMID: 16265772 DOI: 10.1080/00365520510023468] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Acid secretion produced by a heterotopic gastric mucosal patch (HGMP) in the proximal esophagus, instead of gastric acid, may be responsible for laryngopharyngeal reflux (LPR), passing the upper esophageal sphincter. The aim of this study was to investigate the prevalence of HGMP in the proximal esophagus in patients with posterior laryngitis indicating the presence of LPR in comparison with a control group and to elucidate the possible role of this lesion in the pathogenesis of LPR. MATERIAL AND METHODS A total of 36 consecutive patients with posterior laryngitis diagnosed on laryngoscopic examination were enrolled in the study. Esophagoscopy and ambulatory 24-h intra-esophageal dual-probe pH monitoring were performed in all patients. During endoscopy, special attention was paid to the proximal part of the esophagus, and the proximal electrode for pH monitoring was placed in this region under endoscopic view. The control group comprised 660 consecutive patients who had undergone upper gastrointestinal endoscopy for the usual indications. When HGMP was found, biopsies were taken for histological confirmation. RESULTS HGMP was detected in 5 out of 36 patients. One out of five patients with patches was excluded from the study because the histopathology of this patient's patch revealed antral-type mucosa, which is not capable of acid secretion. Thus a total of 35 patients were included in the study, yielding a HGMP prevalence of 11.4% (4/35). Compared with the prevalence of the control group (1.6%), a significant difference was observed (p<0.005). pH monitoring showed that 45.4% of the patients had abnormal proximal acid reflux. All of four HGMP (+) patients with posterior laryngitis revealed significantly higher abnormal proximal reflux compared to the patients without patches (p<0.05). CONCLUSIONS This first preliminary study may suggest that HGMP in the cervical esophagus could play a role in the pathogenesis of LPR, at least in a minor group of patients with posterior laryngitis, depending on its capability to produce acid in situ, although isolated proximal reflux could not be demonstrated. This finding may need to be supported by further studies with larger patient populations and using acid stimulation tests.
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Affiliation(s)
- Nihat Akbayir
- Department of Gastroenterology, Sişli Etfal Training and Research Hospital, Istanbul, Turkey.
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Boztas G, Mungan Z, Ozdil S, Akyüz F, Karaca C, Demir K, Kaymakoglu S, Besisik F, Cakaloglu Y, Okten A. Pneumatic balloon dilatation in primary achalasia: the long-term follow-up results. Hepatogastroenterology 2005; 52:475-80. [PMID: 15816461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND/AIMS Pneumatic dilatation is a safe and most effective treatment for achalasia. We analyzed the long-term results of pneumatic dilatation in primary achalasia by objective and subjective findings. METHODOLOGY Pneumatic dilatation was performed in patients that were diagnosed with primary achalasia in our manometry laboratory between 1993-1999 years. We evaluated patients with clinical, radiologic, endoscopic and manometric results before treatment. Mean esophageal diameters on the level of the lower esophageal sphincter and middle esophagus were measured by barium esophagograms. The patients were clinically reevaluated after one week and barium esophagograms were repeated one month later after dilatation. Clinical examination, endoscopy and manometry were done at 1, 3, 6 and 12 months and repeated yearly for follow-up period. A statistical comparison of pre- and posttreatment on the frequency of dysphagia, radiological diameter of the esophagus and manometric data was performed using unpaired t tests and chi2 tests. RESULTS Pneumatic dilatation was performed on 50 adult patients with a mean age 41.42+/-18.07 years. A single dilatation was successful in forty patients (80%) and two to three dilatations were performed in ten (20%) patients. The median number of dilatations was 1.26. In the postdilatation period, mean short-term (< 1 year) and long-term (2-7 years) clinical improvement was 82.8% and 66.85% respectively. The mean diameter of the esophagus was regressed to 26.51+/-7.69 mm from 36.66+/-11.23 mm (p<0.001) and the mean diameter of the lower esophageal sphincter was increased to 8.38+/-3.12 mm from 2.58+/-1.13 mm (p<0.001) with pneumatic dilatation. The mean pretreatment pressure of lower esophageal sphincter was 41.14+/-11.34 mmHg and these values were 18.79+/-7.85 mmHg (p<0.001), 13.18+/-9.53 mmHg (p<0.001) in the 1st, and 5th years of the posttreatment period, respectively. The mean pressure of the lower esophageal sphincter was 31.78+/-8.91 mmHg in nonresponder patients during the posttreatment period; there was no significant difference prior to pneumatic dilatation (p>0.1). Surgical operation was performed on 5 patients (10%), who had no benefit from pneumatic dilatation. CONCLUSIONS Pneumatic dilatation is an effective procedure in the treatment of primary achalasia during the short- and long-term period. Treatment evaluation can possibly be made objectively with radiographic and manometric alterations of esophagus that occurred after pneumatic dilatation.
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Affiliation(s)
- Güngör Boztas
- Department of Internal Medicine, Gastroenterology Division, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
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Poturoğlu S, Mungan Z, Boztaş G, Kaymakoglu S, Ozdil S, Akyüz F, Aksoy N, Kamalí S, Pinarbasí B, Cevikbaş U, Okten A. Peritoneal amyloidosis caused by Familial Mediterranean Fever. J Gastroenterol Hepatol 2005; 20:325-6. [PMID: 15683444 DOI: 10.1111/j.1440-1746.2005.03718.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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40
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Akbayir N, Alkim C, Erdem L, Sökmen HM, Sungun A, Başak T, Turgut S, Mungan Z. Heterotopic gastric mucosa in the cervical esophagus (inlet patch): endoscopic prevalence, histological and clinical characteristics. J Gastroenterol Hepatol 2004; 19:891-6. [PMID: 15242492 DOI: 10.1111/j.1440-1746.2004.03474.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Heterotopic gastric mucosal patch, which has a 0.1-10% frequency, is encountered when the cervical esophagus is examined carefully during endoscopy. In this study, we aimed to determine the prevalence of the patch in the cervical esophagus, to identify its macroscopic and histological characteristics and to evaluate demographic and clinical features. METHODS Six hundred and sixty patients (317 male, 343 female; mean age 50.28 years, range 14-90) with upper gastrointestinal symptoms had elective esophagogastroduodenoscopy and the cervical esophagus was examined for the patch during withdrawal of the endoscope. Biopsies were obtained from the antrum and the patch. Helicobacter pylori was assessed using an immunohistochemical method. RESULTS The patch was found in 11 patients of 660, with a prevalence of 1.67%. Patch size ranged between 5 and 30 mm, appeared as a single patch in nine patients and as twin patches in two patients. Mean age and male : female ratio were not significantly different from the patient population without patches, but the female sex was predominant (three men, eight women; mean age 43.6 years, range 32-64). In five of 11 patients, the upper esophageal and laryngopharyngeal symptoms were remarkable. Eight patients in whom histological confirmation was carried out showed three fundic and five antral-type mucosa. Two of five patients with antral H. pylori also had the bacteria in the patch. H. pylori prevalence in the patch was 25%. CONCLUSION Heterotopic gastric mucosal patches in the proximal esophagus should not be overlooked during endoscopy because they may lead to important complications in relation to their acid secretion, which may vary according to their parietal cell mass.
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Affiliation(s)
- Nihat Akbayir
- Department of Gastroenterology, Sisli Etfal Teaching and Research Hospital, Istanbul 81041, Turkey.
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Ozdil S, Akyüz F, Pinarbasi B, Demir K, Karaca C, Boztas G, Kaymakoglu S, Mungan Z, Besisik F, Cakaloglu Y, Okten A. Ulcerative colitis: analyses of 116 cases (do extraintestinal manifestations effect the time to catch remission?). Hepatogastroenterology 2004; 51:768-70. [PMID: 15143912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND/AIMS Evaluation of clinical, demographic and epidemiologic features of ulcerative colitis and therapy response of these patients. METHODOLOGY Retrospectively, 116 patients (64.7% female) were enrolled in this study. Mean age and mean follow-up period were 36+/-16, 5+/-2 years, respectively. RESULTS The most common anatomic involvement was pancolitis (60.3%) and the others were as follows: left side 25%, rectum 13.8% and ileum (backwash ileitis) 0.9%. Extraintestinal manifestations were observed in 42.2% of patients (sacroiliitis 12%, primary sclerosing cholangitis 7.6%, pyoderma gangrenosum 2.4%, peripheral arthropathy 1.6%, autoimmune hepatitis 1.6%, steatosis 12.9%, gallstone 0.8%, perianal fistulas 0.8%, sagittal sinus thrombosis 0.8%, psoriasis 0.8%). Multiple extraintestinal manifestations were observed (primary sclerosing cholangitis + pyoderma gangrenosum) in 2 patients. Colonic perforation due to toxic megacolon was observed in only one patient during follow-up period. The mean period for remission was 3.7 months in 72% of patients with pancolitis by the treatment of 5-aminosalicylic acid (5-ASA) (2-3 gr/day) + methylprednisolone (1 mg/kg/day) +/- (for maintenance of remission) azathioprine (AZT) (1.5-2 mg/kg/day); 3.7 months in 72% of left-sided colitis by 5-ASA +/- corticosteroid enemas +/- methylprednisolone (1 mg/kg/day) +/- (for maintenance of remission) AZT (1.5-2 mg/kg/day) and 3.7 months in 62.5% of patients with distal colitis by 5-ASA (p.o. +/- enema) +/- corticosteroid enemas. Colectomy was performed on 7 patients refractory to these treatments. Six patients (4 of them had pancolitis) were treated with cyclosporine (Cys) (4 mg/kg/day, p.o.). Only one patient, a non-responder to Cys therapy, had colectomy. The mean remission time was 4.7 months in 80.6% of patients with extraintestinal involvement and 3.2 months in 71.2% of patients without extraintestinal involvement (P=0.002). CONCLUSIONS Medical therapy was generally enough for the treatment. Cys and/or surgery can be another choice for the patients that do not respond to the medical therapy. Extraintestinal manifestations do not change the remission rate, but prolong the time to catch remission.
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Affiliation(s)
- Sadakat Ozdil
- Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology, Turkey
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Karaca C, Pinarbaşi B, Danalioğlu A, Akyüz F, Kaymakoğlu S, Ozdil S, Boztaş G, Mungan Z. Liver abscess as a rare complication of Crohn's disease: a case report. Turk J Gastroenterol 2004; 15:45-8. [PMID: 15264121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Pyogenic liver abscess is a rarely seen extraintestinal complication of Crohn's disease. It has different features from other liver abscesses. Its clinical and laboratory findings are not specific and mimic the reactivation of Crohn's disease and diagnosis can be delayed. The radiological methods are very useful in diagnosis and treatment of liver abscess. In this paper, we present a patient with pyogenic liver abscess which developed in the course of Crohn's disease.
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Affiliation(s)
- Cetin Karaca
- Department of Gastroenterohepatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
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43
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Danalioglu A, Cakaloglu Y, Karaca C, Aksoy N, Akyuz F, Ozdil S, Demir K, Besisik F, Boztas G, Mungan Z, Kaymakoglu S, Okten A. Terlipressin and albumin combination treatment in hepatorenal syndrome. Hepatogastroenterology 2003; 50 Suppl 2:ccciii-cccv. [PMID: 15244209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVES Hepatorenal syndrome (HRS) is a severe complication of cirrhosis, leading to death in nearly all of cases in the absence of liver transplantation. Several treatments have been attempted as a bridge to liver transplantation. Promising results have been shown with terlipressin and albumin treatment. The aim of this retrospective study was to evaluate our patients with HRS and the effects of combined therapy of terlipressin and albumin on survival. PATIENTS AND METHODS Twenty two patients (15 with type 1 HRS and 7 with type 2 HRS) who were admitted to our clinic between 1996 and 2001, were enrolled. All 7 pts with type 1 HRS were given terlipressin 2-4 mg/day and albumin 2 x 20 g/day for 6 days (range: 3-14). RESULTS Rate of mortality in hospital was 64% in total group, 80% in type 1 and 29% in type 2. Additionally rate of death was 57% in type 1 patients that received terlipressin+albumin and 100% in unreceived ones (p<0.05). CONCLUSION In this retrospective study, survival following improvement in renal function was noted in nearly half (43%) of type 1 patients that received terlipressin+albumin. Parameters associated with response to terlipressin+albumin and increased survival should be defined better in a large cohort of cirrhotic patients with HRS.
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Affiliation(s)
- Ahmet Danalioglu
- Istanbul University, Istanbul Medical Faculty, Gastroenterohepatology Department, Turkey
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Danalioglu A, Kaymakoglu S, Mungan Z, Karaca C, Demir K, Durakoglu Z, Besisik F, Boztas G, Cakaloglu Y, Okyen A. Cyclosporin for severe ulcerative colitis attacks. Hepatogastroenterology 2003; 50 Suppl 2:ccxcviii-ccc. [PMID: 15244207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND/AIMS Cyclosporin-A is used as alternative medical therapy in steroid refractory ulcerative colitis with severe activity. In spite of known effectivity, the long term results of cyclosporin-A therapy is not clear for today. METHODS The results of 13 steroid refractory patients that treated with cyclosporin-A were retrospectively assessed. Cyclosporin-A was started as orally, 8 mg/kg/day in 4 patients and intravenously, 4 mg/kg/day in 9 patients. Intravenous therapy changed to oral therapy one week after beginning. Patients also received 5-ASA and azathioprine. Steroid was tapered. RESULTS Ten patients responded to treatment in a mean of 9 days (range: 2-30 days). Three unresponded patients underwent total colectomy on 7, 11 and 19th day of therapy. Ten initially responded patients received the drug for average 4.9 months. Of these, four relapsed during and one relapsed soon after therapy. Four of 5 relapser patients underwent colectomy. One patient that not accepted surgical intervention is still receiving medical therapy. Remaining 5 patients, 38% of total group; 50% of patients that initially responded, maintain the remission at the end of average 17 months of follow up period. CONCLUSION Cyclosporin-A therapy in severe ulcerative colitis that is refractory to steroids, provides initial remission in 80% of patients and allows 40% to retain their colon for 1 year.
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Affiliation(s)
- Ahmet Danalioglu
- Istanbul University, Istanbul School of Medicine, Gastroenterohepatology Department, Turkey
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45
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Ozdil S, Demir K, Boztas G, Danalioglu A, Karaca C, Akyüz F, Aksoy N, Kaymakoglu S, Mungan Z, Besisik F, Cakaloglu Y, Okten A. Crohn's disease; analysis of 105 patients. Hepatogastroenterology 2003; 50 Suppl 2:cclxxxvii-ccxci. [PMID: 15244204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
In this paper, 105 patients with Crohn's disease, (47 M, 58 F), mean age 37.4 +/- 42 years were evaluated clinically, demographically and epidemiologically. Mean age of patients at the time of diagnosis was 26.5 +/- 10.9 years. Follow-up period was 2.7 +/- 2.1 years on average. On admission, symptoms or signs were as follows: right lower quadrant pain 90.5%, abdominal mass 18.1%, enterocutaneous fistula 11.4% and subileus 9.5%. Diagnosis of Crohn's disease was established during appendectomy in 14 patients (13.3%). Family history of inflammatory bowel disease was determined only in six patients (5.7%). Intestinal localization were as follows: ileo colonic 52%, ileal 38%, colonic 10%. Clinical forms were inflammatory (68%), fistulous (23%) and obstructive (9%). Sacroiliitis (7.6%), ankylosing spondylitis (4.7%), erythema nodosum (2.9%), pyoderma gangrenosum (1%) were detected as extraintestinal manifestations. Of the patients, 12.4% underwent surgical intervention due to abscess drainage in 6.6%, fistulectomy in 3.8%, stricture resection in 1.9%. Medical therapy alone was sufficient in 75.3% of patients. As a result, our cases mentioned in this paper reflect the general characteristics of Crohn's disease and prominence of regular visits and treatment.
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Affiliation(s)
- S Ozdil
- Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology, Turkey
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Mungan Z, Akyüz F, Bugra Z, Yönall O, Oztürk S, Acar A, Cevikbas U. Familial visceral myopathy with pseudo-obstruction, megaduodenum, Barrett's esophagus, and cardiac abnormalities. Am J Gastroenterol 2003; 98:2556-60. [PMID: 14638363 DOI: 10.1111/j.1572-0241.2003.08707.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This report describes a new subgroup of familial visceral myopathy. Three patients from within this family were admitted to the hospital with pseudo-obstruction. Barium x-ray, abdominal plain film, esophageal manometry, colonoscopy, gastroscopy, and echocardiography were performed in all siblings for diagnostic evaluation. Two of our patients had surgery because of suspicion of acute abdomen. In one of them, full-thickness biopsy, which was performed during laparotomy, revealed findings that were compatible with familial visceral myopathy. Three siblings from this family with visceral myopathy, in which the parents were consanguineous, had megaduodenum, long-segment Barrett's esophagus, and different cardiac abnormalities.
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Affiliation(s)
- Zeynel Mungan
- Division of Gastroenterology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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47
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Kaymakoglu S, Kahraman T, Kudat H, Demir K, Cakaloglu Y, Adalet I, Dincer D, Besisik F, Boztas G, Sözen AB, Mungan Z, Okten A. Hepatopulmonary syndrome in noncirrhotic portal hypertensive patients. Dig Dis Sci 2003; 48:556-60. [PMID: 12757170 DOI: 10.1023/a:1022549018807] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatopulmonary syndrome has yet not been sufficiently assessed in noncirrhotic portal hypertension. The prevalence of hepatopulmonary syndrome was determined in 31 consecutive patients with noncirrhotic portal hypertension (19 idiopathic portal hypertension, 7 portal vein thrombosis, 5 congenital hepatic fibrosis) and 46 patients with liver cirrhosis. Contrast echocardiography was carried out in all patients. Macroaggregated albumin lung perfusion scans were performed in patients with positive contrast echocardiogram. Hepatopulmonary syndrome was detected in 5 (10.8%) cirrhotic and 3 (9.7%) noncirrhotic portal hypertensive patients (2 idiopathic portal hypertension, 1 portal vein thrombosis). All patients with hepatopulmonary syndrome had an increased shunt fraction (13-62%) and a decreased diffusion capacity of carbon monoxide (40-79%), and 7 of them were hypoxemic (PaO2, 31.6-69.8 mm Hg). These findings show that hepatopulmonary syndrome may occur in both liver cirrhosis and noncirrhotic portal hypertension and that portal hypertension is the predominant etiopathogenic factor related to hepatopulmonary syndrome.
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Affiliation(s)
- Sabahattin Kaymakoglu
- Division of Gastroenterology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Durakoğlu Z, Boztaş G, Sezgil A, Kaymakoğlu S, Dinçer D, Ozdil S, Beşişik F, Mungan Z, Okten A. Alverine induced toxic hepatitis: a case report. Turk J Gastroenterol 2002; 13:226-8. [PMID: 16378311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Drug-induced hepatotoxicity is an important cause of hepatocellular injury. Hepatic necrosis may range from asymptomatic elevations in transaminases to fulminant hepatic failure and death. Alverine is an antispasmodic drug which is especially used in patients with irritable bowel syndrome. Only a few cases of alverine associated hepatotoxicity have been reported previously. We present the case of a patient with alverine induced hepatotoxicity and cholestasis, which has only seldomly been reported in the literature.
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Affiliation(s)
- Ziyaettin Durakoğlu
- Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology, Capa.
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Danalioğlu A, Kaymakoğlu S, Mungan Z, Karaca C, Demir K, Durakoğlu Z, Beşişik F, Boztaş G, Cakaloğlu Y, Okten A. Efficacy of cyclosporin in severe ulcerative colitis attack. Turk J Gastroenterol 2002; 13:130-3. [PMID: 16378293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND/AIMS Cyclosporin-A is used as a alternative medical therapy in steroid resistant ulcerative colitis with severe activity. In spite of its known efficacy, the long term effects of are not entirely clear. METHODS The records of 13 steroid resistant patients treated with cyclosporin-A were retrospectively assessed. Cyclosporin-A had been prescribed orally at a dose of 8 mg/kg/day in four patients and intravenously, 4mg/kg/day in nine patients. Intravenous therapy was changed to oral therapy after one week and patients also received 5-ASA and azathioprine. Steroid treatment was tapered. RESULTS Ten patients responded to treatment in a mean of nine days (range: 2-30 days). Three patients who did not respond underwent total colectomy on day seven, 11 and 19 of therapy. The 10 patients who initially responded received the drug for an average of 4.9 months; four of these relapsed during and one relapsed soon after discontinuation of therapy. Four of the five patients who relapsed underwent colectomy and the one patient who did not accept surgical intervention continued medical therapy. The remaining five patients (38% of the total group; 50% of the patients who initially responded) remained in remission at the end of an average 17 month follow up period. CONCLUSIONS Cyclosporin-A therapy in severe ulcerative colitis that is resistant to steroids, provides initial remission in 80% of patients and allows 40% to retain their colon for one year.
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Affiliation(s)
- Ahmet Danalioğlu
- Istanbul Medical School, Department of Gastroenterology and Hepatology.
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Dinçer D, Besisik F, Sahin E, Demir K, Tuncer I, Cevikbas U, Mungan Z, Kaymakoglu S, Boztas G, Ozdil S, Cakaloglu Y, Okten A. Intestinal metaplasia of the gastric cardia: a study from Turkey. Hepatogastroenterology 2002; 49:1153-6. [PMID: 12143225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND/AIMS We aimed to investigate the prevalence of intestinal metaplasia in the cardia of a patient group with high incidence of Helicobacter pylori infection presenting for elective upper endoscopy. We also re-evaluated the relation between intestinal metaplasia in the cardia and gastroesophageal reflux disease, smoking, alcohol history, H. pylori infection, Barrett's esophagus and intestinal metaplasia elsewhere in the stomach. METHODOLOGY Sixty patients presenting for elective upper endoscopy were included in this study. Prior to undergoing endoscopy each patient was questioned with regard to the clinical indication and symptoms including heartburn, regurgitation, and dysphagia. In addition, a smoking and alcohol history were recorded. Endoscopic biopsies: 1) one from the midantrum on the lesser curvature, 2) one from the incisura angularis, 3) one from the mid-corpus on the lesser curvature, 4) one from the columnar side of the squamocolumnar junction, 5) one from the squamous side of the squamocolumnar junction, 6) one from 2 cm distal to the esophagogastric junction, 7) one from across the squamocolumnar junction. Slides were stained using a combination of hematoxylin-eosin with Alcian blue at pH 2.5 for intestinal metaplasia. Each specimen was examined for the presence of H. pylori. RESULTS The prevalence of H. pylori infection was 63%. Prevalence of the H. pylori infection was significantly lower in the patients with intestinal metaplasia of the cardia than in the patients without intestinal metaplasia of the cardia (P = 0.025). There was a positive correlation between the age of the patients and having intestinal metaplasia of the cardia (r = 0.286, P = 0.008). There was no relationship between intestinal metaplasia of the cardia and pyrozis, regurgitation, dysphagia, history of alcohol and smoking esophagitis determined by endoscopy or histopathology, sex, intestinal metaplasia elsewhere in the stomach (P > 0.05). CONCLUSIONS The incidence of the intestinal metaplasia of the gastric cardia in Turkey is less than that of western countries. Intestinal metaplasia of the gastric cardia negatively correlates with H. pylori infection. And there was no relationship between gastric cardia intestinal metaplasia and reflux disease. Further investigations are needed for determining the premalign lesion and etiologic factors for cancer of the gastric cardia.
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Affiliation(s)
- Dinc Dinçer
- Department of Gastroenterohepatology, Istanbul Medical Faculty, Istanbul, Turkey.
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