Showing papers in "The Turkish journal of gastroenterology in 2010"

Efficacy of probiotics in Helicobacter pylori eradication therapy

Abstract: Background/aims Triple therapy with a proton pump inhibitor, amoxicillin and clarithromycin in Helicobacter pylori eradication is widely accepted, but this combination fails in a considerable number of cases. Our aim was to evaluate whether probiotic-containing yogurt affects the success of eradication. The second aim was to investigate the efficacy of probiotics in the prevention of the side effects related to eradication therapy. Methods A total of 76 histopathologically proven H. pylori-positive patients enrolled in this study were randomized into two groups. The following regimens were recommended: Group A: pantoprazole (40 mg, b.i.d.), amoxicillin (1000 mg b.i.d.), clarithromycin (500 mg b.i.d.), and 125 ml of probiotic-containing yogurt (Bifidobacterium DN-173 010-1010 cfu/g) before breakfast for 14 days; and Group B: pantoprazole (40 mg, b.i.d.), amoxicillin (1000 mg b.i.d.) and clarithromycin (500 mg b.i.d.) for 14 days. Subjects were asked to report any side effects of therapy during the treatment period. H. pylori status was rechecked four weeks after the completion of the eradication therapy by 13C-urea breath test. Results H. pylori eradication was achieved in 25 of the 38 patients in Group A (66%) and in 20 of the 38 patients (53%) in Group B. Although the success rate was higher in Group A than in Group B, the difference was not significant (p=0.350). The addition of probiotics to the triple therapy significantly lessened the frequency of stomatitis and constipation (p=0.037 and p=0.046, respectively). Conclusions The addition of probiotic-containing yogurt to the triple therapy did not increase the H. pylori eradication rates for the evaluated dosage and model; however, it decreased the frequency of stomatitis and constipation.

Assessment of anxiety levels in patients during elective upper gastrointestinal endoscopy and colonoscopy.

Abstract: Background/aims Upper gastrointestinal endoscopy and colonoscopy are frequently performed procedures that can cause anxiety related to disappointing expectations, embarrassment and fear of discomfort. The aim of this study was to examine the possible relationship between state anxiety and trait anxiety with upper gastrointestinal endoscopy and colonoscopy. Methods Ninety-eight consecutive outpatients (52 gastroscopy and 46 colonoscopy) undergoing upper gastrointestinal endoscopy and colonoscopy were interviewed to evaluate anxiety. Anxiety was rated at baseline and immediately prior to upper gastrointestinal endoscopy and colonoscopy using the Spielberger State- Trait Anxiety Inventory. Results A modest but significant increase was detected in state anxiety prior to upper gastrointestinal endoscopy and colonoscopy but no change was detected in trait anxiety in either group. Anxiety levels were not related with the type of endoscopic procedure. State anxiety scores increased from 36.9 (28.5 42.5) to 45.7 (27.5 48.0) (p=0.001) in patients undergoing upper gastrointestinal endoscopy and from 36.2 (26.5 38.5) to 44.8 (30.5 48.0) (p=0.001) in patients undergoing colonoscopy. Females had higher anxiety levels than males in both groups. Conclusions Diagnostic outpatient upper gastrointestinal endoscopy and colonoscopy were associated with remarkable anxiety in patients; however, anxiety levels were not related with the type of endoscopic procedure.

Prognostic significance of MUC1, MUC2 and MUC5AC expressions in gastric carcinoma.

Abstract: Background/aims The aim of this study was to investigate the expressions of some of the Mucus Core Proteins (MUC) MUC1, MUC2 and MUC5AC in gastric carcinomas, to assess their prognostic values and their relations with the clinicopathological characteristics. Methods MUC1, MUC2 and MUC5AC expressions were investigated immunohistochemically in 257 patients with gastric carcinomas. Results MUC1 was strongly expressed in normal gastric epithelium; however, the expression rate decreased with the loss of tumor differentiation (92.6% in well differentiated tumors, 83.7% in poorly differentiated tumors), with an increase in the number of metastatic lymph nodes (98.4% in tumors with no metastatic lymph nodes, 67.9% in tumors with lymph node metastasis-pN3), and with the progression in the tumor stage (100% in stage 1 tumors, 75.6% in stage 4 tumors). MUC1 expression was lower in distant metastatic tumors (83.3% in distant metastatic tumors and 90.8% in nonmetastatic tumors). There was no staining with MUC2 in normal gastric epithelium; however, de novo expressions appeared in tumoral tissues. In diffuse gastric carcinomas (mucinous and signet ring cell carcinomas), MUC2 expression was higher (97.5% in diffuse type and 89.4% in intestinal type). All of the mucinous carcinomas were MUC2-positive. The expression rate decreased with an increase in the number of metastatic lymph nodes and with the progression in the TNM stages of the cases. All of the tumors with intestinal metaplasia were MUC2-positive. MUC5AC was strongly expressed in normal gastric epithelium; however, the expression rate decreased with the loss of tumor differentiation, with an increase in the tumor invasion depth, and with an increase in the number of metastatic lymph nodes. MUC5AC expression was higher in intestinal type carcinoma (48.4%) than in the diffuse type (10%). The lowest expression rate was in the diffuse type according to the Borrmann's macroscopic classification. All of these results were statistically significant (p Conclusions When each of these three markers is evaluated, in the light of clinical and pathological parameters, MUC1 and MUC5AC may be accepted as significant prognostic parameters and may be useful in showing the progression of the tumors; MUC2 may be used in determining the mucinous carcinomas.

Can partially hydrolyzed guar gum be an alternative to lactulose in treatment of childhood constipation

Abstract: BACKGROUND/AIMS In the present study, we aimed to investigate if partially hydrolyzed guar gum (PHGG) can be used safely as a fiber source for treatment of constipation in children and to compare its success with the most commonly used osmotic laxative, lactulose. METHODS A randomized prospective controlled study on 61 patients (partially hydrolyzed guar gum group, n: 31; lactulose group, n: 30) was performed. Patients were given lactulose or partially hydrolyzed guar gum for four weeks. Using a standardized bowel diary, defecation frequency, stool consistency, and presence of flatulence and abdominal pain were recorded. Family questionnaires about the success, safety and side effect profile of both treatment arms were also obtained. RESULTS No significant differences were found in the baseline daily fiber (fruits and vegetables) intake between the two groups. Bowel movement frequency per week and stool consistency improved significantly in both treatment groups (p<0.05). The percent of children with abdominal pain and stool withholding also decreased eminently in both groups (p<0.05). Weekly defecation frequency increased from 4±0.7 to 6±1.06 and from 4±0.7 to 5±1.7 in the lactulose and partially hydrolyzed guar gum treated groups, respectively (p<0.05). According to the family questionnaire, the parents complained of bad taste, flatulence and necessity to ingest a high amount of drug in the lactulose treatment group. In the partially hydrolyzed guar gum treatment group, parents were satisfied with the defecation frequency of their children. CONCLUSIONS Treatment with partially hydrolyzed guar gum is as effective as lactulose treatment in relieving stool withholding and constipation-associated abdominal pain, and its use improves stool consistency. Lactulose seemed to have more side effects, including flatulence and sensation of bad taste.

Extraordinarily elevated serum levels of CA 19-9 and rapid decrease after successful therapy: a case report and review of literature

Abstract: Carbohydrate antigen 19-9 is most valuable as a serum marker for pancreatic and biliary cancer, but increased concentrations occur in several other gastrointestinal malignancies. A carbohydrate antigen 19-9 value of >1,000 U/ml usually indicates a digestive cancer and has been reported to have a specificity greater than 99% for pancreatic cancer; nevertheless, false-positive results owing to benign diseases such as pancreatitis or liver cirrhosis have been noted. We present a patient with cholelithiasis and choledocholithiasis with acute cholangitis who had very high serum levels of carbohydrate antigen 19-9 (9586 IU/ml). The rapid decrease in carbohydrate antigen 19-9 after successful treatment was as interesting as the pretreatment high serum level of carbohydrate antigen 19-9.

Anti-allergic effects of probiotic Dahi through modulation of the gut immune system.

Abstract: Background/aims The alarming increase in allergy in the last few decades demands the development of new anti-allergic prevention strategies, and consumption of functional foods (i.e. probiotic Dahi, which has already been proven to enhance immunity by modulation of the gut mucosal immune system) may be one of them. In the present study, we evaluated anti-allergic effects of a Dahi (yogurt) containing probiotic Lactobacillus acidophilus, L. casei and normal Dahi culture Lactococcus lactis biovar diacetylactis (named probiotic Dahi) on ovalbumin induced allergy in mice. Methods Allergy was induced by injecting (i.p.) ovalbumin at 0 and 14 days. Animals were fed with standard diet (control), milk, control Dahi or probiotic Dahi for 21 days. Total and ovalbumin-specific IgE, cytokines and lymphocyte proliferation index were examined after 7, 14 and 21 days. Results Feeding of probiotic Dahi completely suppressed the elevation of total and ovalbumin-specific IgE in the serum of ovalbumin-injected mice. Similarly, splenocytes collected from mice fed with probiotic Dahi entirely lost the total and ovalbumin-specific IgE production property during in-vitro culture. Production of T helper (Th)-1 cell-specific cytokines, i.e. interferon -γ and interleukin (IL)-2, increased, while Th2-specific cytokines, i.e. IL-4 and IL-6, decreased in the supernatant of cultured splenocytes collected from mice fed with probiotic Dahi compared to the other groups. Moreover, ovalbumin-stimulated lymphocyte proliferation was strongly suppressed by feeding of probiotic Dahi in comparison to milk and control Dahi. Conclusions Results of the present study indicate that probiotic Dahi suppressed ovalbumin-induced allergic consequences characterized by decreasing levels of total and ovalbumin-specific IgE and lymphocyte proliferation and skewed ovalbumin-induced Th2-specific immune response towards Th1-specific response.

Comparison of 7- and 14-day first-line therapies including levofloxacin in patients with Helicobacter pylori positive non-ulcer dyspepsia.

Abstract: Background/aims Because of the increasing resistance to clarithromycin and metronidazole, the most frequently used antibiotics in the first-line therapy of Helicobacter pylori eradication, new therapeutic alternatives are needed. The aim of this study was to compare the efficacy of 7- and 14-day triple therapy including lansoprazole, levofloxacin and amoxicillin for Helicobacter pylori eradication as a first-line therapy. Methods Ninety-one non-ulcer dyspeptic patients infected with Helicobacter pylori as diagnosed by both histology and a rapid urease test were included in this study. Patients were randomized to receive either 7- (Group 1; 51 patients) or 14-day (Group 2; 40 patients) therapy with lansoprazole (30 mg b.i.d.), plus levofloxacin (500 mg o.i.d.) and amoxicillin (1000 mg b.i.d.) and they were followed for six weeks. Eradication was assessed by 14C-urea breath test four weeks after completing the treatment protocols. Results In Group 1, 41 patients completed the treatment and the eradication rate was 34.15%. In group 2, 36 patients completed the treatment and the eradication rate was 72.2% (p= 0.001 vs group 1). Conclusions Triple therapy with lansoprazole, levofloxacin and amoxicillin for 14 days was effective for Helicobacter pylori eradication, but 7-day therapy with the same protocol had a lower and unacceptable cure rate and should not be used.

The efficiency of sucralfate in corrosive esophagitis: a randomized, prospective study.

Abstract: Background/aims Ingestion of a chemical agent is a serious problem, and several treatment protocols to prevent stricture formation have been proposed. We conducted a randomized prospective study to evaluate the effectiveness of oral intensive sucralfate plus conventional therapy compared to conventional therapy alone. Methods Fifteen patients with stage 2b and 3 corrosive esophagitis admitted to our gastroenterology, general surgery and intensive care units between 2004 and 2007 were included. Patients were divided into two groups. The patients in the first group (n=8) received intensive sucralfate therapy plus conventional therapy, while the other group (n=7) received only conventional therapy. We performed upper endoscopic procedures on days: 0, 21, 45, 90 and 180 to identify the emergent complications. Results In the first group, only one patient had stricture formation, allowing passage of a 9.2 mm endoscope and causing no dysphagia, on day 45. There was no progression in the stricture on follow-ups at the 3rd and 6th months. In the second group, 6 patients had stricture formation causing narrowing and dysphagia. Conclusions Intensive sucralfate therapy may decrease the frequency of stricture formation in patients with advanced corrosive esophagitis. Further studies with large groups of patients are required to confirm our findings.

Intragastric balloon treatment of obesity must be combined with bariatric surgery: a pilot study in Turkey.

Abstract: Background/aims The treatment of morbid obesity by intragastric balloon (BioEnterics) placement is a safe and effective procedure. Cultural, social and economical factors are known to have an impact on the outcome of therapeutic interventions. This study aimed to evaluate the effect of this method on weight loss and long-term outcome following balloon removal in a cohort of Turkish patients. Methods Twenty-five patients (11 male, 14 female) who selected BioEnterics intragastric balloon method for weight loss over surgery were included in the study. Their mean age was 35.2±13.4 and mean body mass index was 43.5±8.7 kg/m2. Patients who had any contraindication for endoscopic BioEnterics intragastric balloon placement were excluded. BioEnterics intragastric balloon was performed under deep sedation with propofol, and all patients were placed on a 1000 kcal/day diet for six months. Patients were reevaluated six months following balloon removal. Excess weight loss of greater than 25% was considered as end of treatment success. Maintenance of excess weight loss greater than 25% at the end of a six-month follow-up period was considered as long-term success. Results were reported as mean body mass index and mean %excess weight loss±SD. Statistical analysis was done using SPSS computer program. Results One patient was excluded from the study because of psychological intolerance (1/25) prompting early balloon removal. Twenty-four patients completed both the initial phase and the follow-up period. At the end of the initial six months, the mean body mass index was 35.7±4.6 kg/m2 and mean excess weight loss was 46.9±11.3%. Although 22 out of 24 patients (91.6%) had achieved end of treatment success, the mean body mass index was back to 41.9±7.7 kg/m2 at the end of the follow-up period. Only two patients were able to maintain excess weight loss of 25% at the completion of the study, resulting in a long-term success rate of 8.3%. Conclusions BioEnterics intragastric balloon is a safe and effective but temporary therapeutic modality for obesity treatment. After BioEnterics intragastric balloon removal, almost all patients had returned to their initial weights. Therefore, BioEnterics intragastric balloon must only be offered for patients who accept to undergo bariatric surgery after BioEnterics intragastric balloon removal. Losing weight by BioEnterics intragastric balloon before bariatric surgery will improve the morbidity and mortality rates of this modality.

Gallstones associated with nonalcoholic steatohepatitis (NASH) and metabolic syndrome.

Abstract: Background/aims We aimed to evaluate the prevalence of non-alcoholic steatohepatitis and metabolic syndrome in patients with symptomatic gallstones undergoing laparoscopic or open cholecystectomy. Methods A study of 95 patients was performed. Simultaneous liver biopsies were taken during cholecystectomy between 2006 and 2007. There were no postoperative complications. Patients with significant alcohol intake, hepatitis B or C (virus-positive), autoimmune diseases, and Wilson's disease were excluded. Demographics, liver function tests, lipid profile, and ultrasound findings of patients with and without non-alcoholic steatohepatitis were compared. Results A total of 95 patients completed the study. The mean age was 52.15 years, and 29 patients were male and 66 female. Fifty-two patients (55%) had biopsies compatible with non-alcoholic steatohepatitis. Conclusions Fifty-five percent of patients with gallbladder stones had associated non-alcoholic steatohepatitis. Awareness of this association may result in an earlier diagnosis. The high prevalence of non-alcoholic steatohepatitis in patients with gallbladder stone may justify routine liver biopsy during cholecystectomy to establish the diagnosis and stage and possibly direct therapy.

Influence of CYP2C19 functional polymorphism on Helicobacter pylori eradication.

Abstract: Background/aims Proton pump inhibitors are mainly metabolized by cytochrome P450 2C19 in the liver. Recently, some studies have shown that the acid suppressing effect of proton pump inhibitors are influenced by a functional polymorphism of cytochrome P450 2C19. The aim of the present study was to investigate the effect of cytochrome P450 2C19 polymorphism on Helicobacter pylori eradication in patients who received proton pump inhibitors based triple therapy. Methods We determined the incidence of cytochrome P450 2C19 genotypes and the effect of cytochrome P450 2C19 genotypes on Helicobacter pylori eradication rates in 105 patients with Helicobacter pylori-positive chronic gastritis. Upper endoscopic procedure and gastric biopsies were performed in all patients. Helicobacter pylori was demonstrated histologically. Lansoprazole, amoxicillin and clarithromycin twice a day for 14 days were prescribed for those found to be infected with Helicobacter pylori. More than one month after the medication, a 13C urea breath test was conducted to examine the success or failure of the eradication treatment. Cytochrome P450 2C19 polymorphism was analyzed by the polymerase chain reaction-restriction fragment length polymorphism method. Results The genotypes of cytochrome P450 2C19 were classified into the three groups, as rapid extensive metabolizer, intermediate metabolizer and poor metabolizer. In our patient population, the frequencies of rapid extensive metabolizer, intermediate metabolizer and poor metabolizer were 72%, 23% and 5%, respectively. The eradication rate was 70.0% for rapid extensive metabolizer, 92% for intermediate metabolizer and 80% for poor metabolizer. The eradication rate was highest in intermediate metabolizer patients. Conclusions The present study confirmed the low eradication rate for rapid extensive metabolizer. Our findings provide evidence that the cytochrome P450 2C19 genotype is useful to predict the success of treatment. For the rapid extensive metabolizer group, alternative regimens can be tried to increase the Helicobacter pylori eradication rates.

Molecular detection of Mycobacterium tuberculosis in formalin-fixed, paraffin-embedded tissues and biopsies of gastrointestinal specimens using real-time polymerase chain reaction system.

Abstract: Background/aims We aimed to perform the molecular detection of Mycobacterium tuberculosis in formalin-fixed, paraffin-embedded tissues and biopsies of gastrointestinal specimens using real-time polymerase chain reaction system. Methods The study included three groups: (A) control (n=24), with no previous signs of M. tuberculosis complex (MTBC), (B) patients (n=28) with known TB origin and (C) patients (n=50) with clinical and histopathological signs of TB but who were culture- and acid-fast bacilli (AFB)-negative. The samples were obtained from the Medical and Surgical Gastroenterology Departments of Bhopal Memorial Hospital and Research Centre. We extracted DNA using DNeasy Blood & Tissue kit (QIAGEN, Germany) and performed realtime assay using Roche LightCycler 2.0 with fluorescence resonance energy transfer (FRET) hybridization probes obtained from Roche Molecular Diagnostics (USA) for the specific amplification of the 159 bp region of the mycobacterium genome. Results All the samples (n=24) of Group A were found to be negative, while in Group B, 27 out of the 28 cases studied were found to be positive by LightCycler real-time polymerase chain reaction (LC PCR). In Group C, 18 out of the 50 cases studied were found to be positive, showing a positivity of 36%. The overall positive and negative predictive values of the test for clinical TB (Group C) were 100% and 96.9%, respectively. Conclusions Results of our investigation demonstrated that the real-time detection technology using FRET probes has much higher sensitivity for the detection of MTBC DNA in tissue biopsy samples and formalin-fixed paraffin-embedded surgically resected tissues of the gastrointestinal tract.

Endothelial nitric oxide synthase gene polymorphism in gastric cancer.

Abstract: BACKGROUND/AIMS: Nitric oxide, a labile compound synthesized by nitric oxide synthase, is a major regulator not only of physiological vascular tonus but also of the abnormal vascularity associated with tumors Endothelial production of nitric oxide regulates blood flow and angiogenesis and reduces tumor cell adhesion to the endothelium A high concentration of nitric oxide and its metabolites causes DNA damage during nitration, nitrosation and deamination Both positive and negative effects on carcinogenesis and tumor growth, apoptosis, and cytotoxic mechanisms may be explained by differential susceptibility of tumor cells to nitric oxide-mediated reactions METHODS: In this study, three major polymorphisms (786T>C, the 27 base pair variable number of tandem repeats in intron 4, and 894G>T) of the endothelial nitric oxide synthase gene were investigated in gastric cancer and normal tissues of 50 patients with gastric cancer and in the peripheral blood of 98 healthy subjects RESULTS: We found no significant differences in intron 4a/b and 894G>T (Glu298Asp) allele and genotype frequencies between control and patient specimens Nevertheless, the genotype and allele frequencies of 786T>C polymorphism were found to be significantly different between the healthy controls and tumor tissues CONCLUSIONS: The results suggest that endothelial nitric oxide synthase 786T>C polymorphism may play a role in the development of gastric cancer

Effects of hypertension and ovariectomy on rat hepatocytes. Are amlodipine and lacidipine protective? (A stereological and histological study).

Abstract: BACKGROUND/AIMS Calcium channel blockers are increasingly used for the treatment of hypertension. Menopause and hypertension are both important risk factors for liver damage and several other circulatory abnormalities. The aim of this study was to determine the effects of amlodipine and lacidipine in an ovariectomy-induced postmenopausal period model and a deoxycorticosterone acetate-salt-induced hypertensive model in rats. METHODS In this study, animals were divided into six groups as follows: control (Group 1), hypertension (Group 2), ovariectomy (Group 3), ovariectomy and hypertension (Group 4), ovariectomy, hypertension and amlodipine-treated (Group 5), and ovariectomy, hypertension and lacidipine-treated (Group 6). At the end of the experiment, the livers were removed and tissue samples were histologically and stereologically examined. RESULTS The numerical densities of the hepatocytes according to group were 0.000422, 0.00329, 0.000272, 0.00259, 0.00374 and 0.000346 μm3, respectively. Significant differences were found between values of all groups (p<0.01, Mann-Whitney U test). According to histopathological investigation, Group 3 and particularly Group 4 showed some microscopic abnormalities such as dilatation in sinusoids central veins and branches of portal vein, irregularities of the hepatocyte columns, significant mononuclear cell infiltrations, and unstained vacuoles in the cytoplasm of the hepatocytes. Histological structure was protected from the destructive effects of ovariectomy and hypertension in Groups 5 and 6. CONCLUSIONS Our experimental results show that both hypertension and the postmenopausal period have negative effects on the number of hepatocytes and histological structure of the liver. Both amlodipine and lacidipine appear to ameliorate the hypertension and/or postmenopausal period-related decrease in hepatocyte number. We thus suggest that lacidipine and particularly amlodipine have important protective and recovering effects on the liver.

Inflammatory pseudotumor of the liver diagnosed by needle biopsy: report of three cases (one with neuroendocrine tumor of the rectum and lung).

Abstract: Inflammatory pseudotumor of the liver is a rare disorder that can histologically and radiologically resemble malignant neoplasms. The prognosis of the patients with hepatic inflammatory pseudotumor is usually good with conservative therapy. Most of the reported cases are diagnosed in the surgical resection specimens; only very few reported cases have been diagnosed by needle biopsy. We report three additional cases of inflammatory pseudotumor of the liver diagnosed by liver biopsy. Two of these cases were treated successfully with antibiotics. The other case, who was resistant to medical treatment, had coexisting neuroendocrine neoplasms of the rectum and the lung. Since her general condition did not allow an extensive surgery, the mass of the liver could not be resected and she died approximately five months after she was voluntarily discharged from the hospital. Many of the inflammatory pseudotumor of the liver are found to be associated with variable neoplasms, but to our knowledge, the latter case is the first case of inflammatory pseudotumor associated with a neuroendocrine tumor.

Sequential therapy for Helicobacter pylori eradication.

Abstract: Background and aims The success of Helicobacter pylori eradication using triple eradication therapy declines over time. In this prospective study, we have compared a group of naive H. pylori-positive patients receiving sequential therapy with our previously published naive H. pylori-positive control group who received ranitidine bismuth citrate-clarithromycin-amoxicillin eradication treatment. Moreover, the eradication success of these two treatment protocols was compared with that of recent standard triple eradication treatment results for the naive patients in our country and western communities. Methods We performed invasive tests for H. pylori in naive patients who underwent gastroduodenoscopy in the Endoscopy Unit, Ankara University, Faculty of Medicine, and patients who were diagnosed as H. pylori-positive by these tests were rechecked by the same invasive tests one month after the completion of eradication treatment. The group receiving sequential therapy was given pantoprazole + amoxicillin during the first seven days and pantoprazole + metronidazole + tetracycline during the second seven days. These patients were compared with the H. pylori-positive naive control group patients, who were given ranitidine bismuth citrate + clarithromycin + amoxicillin. The patients in whom eradication was achieved in the 4th week with sequential therapy were reevaluated one year later regarding the success of eradication with the H. pylori stool antigen test. Results The average age of the 108 patients who received the sequential therapy was 45.2±12.5 years. The average age of the 75 patients who received ranitidine bismuth citrate treatment was 41.2±12.6 years. Six (5%) patients in the consecutive treatment group developed deterioration in taste in the mouth and 10 (9%) developed diarrhea. However, no side effects severe enough to require discontinuation of the treatments were observed in either treatment group. The results of the invasive tests were evaluated by the end of the first month, and revealed an eradication rate of 88% in the sequential treatment group versus 95% in the ranitidine bismuth citrate treatment group. Sixty-eight of 94 patients in whom eradication was achieved by sequential therapy were reevaluated with H. pylori stool antigen test in one year, and eradication was found to persist in 52 (77%) of these 68 patients. Conclusions High rates of eradication were achieved in both groups in the 4th week evaluation. It was observed at the follow-up performed one year later that the eradication achieved with sequential therapy persisted in 77% of the patients treated.

Relationship of increased serum brain natriuretic peptide levels with hepatic failure, portal hypertension and treatment in patients with cirrhosis.

Abstract: Background/aims Brain natriuretic peptide is a cardiac neurohormone secreted from ventricles in response to end diastolic pressure and increased volume. It has diuretic, natriuretic and vasodilator effects. In cirrhosis, a hyperdynamic circulation occurs because of hemodynamic and hemostatic alterations. The increase in brain natriuretic peptide concentration shows parallelism with the stage of cirrhosis. The aim of this study is to investigate the relation of increased brain natriuretic peptide level with the pathophysiologic components of cirrhosis and treatment. Methods Ninety-five cirrhotic patients in different stages (Child-A: 33; Child-B: 25; Child-C:37) and age and sex matched 86 healthy individuals were recruited for the study. Brain natriuretic peptide concentration was measured with brain natriuretic peptide-Triage test device using fluoresan immune assay method. Results Brain natriuretic peptide levels of patients with hepatic cirrhosis were significantly higher compared to control group (288.5±329.2/60.2±29.5/p=0.000, respectively). Serum brain natriuretic peptide levels were positively correlated with Child score (Child A-B-C; 201.2±266/258.7±233.6/386.5±407.7, respectively). A negative correlation was observed between brain natriuretic peptide and albumin levels (p=0.002). Brain natriuretic peptide concentration was significantly correlated with the grade of esophagus varices, and presence of ascites and collateral circulation (p=0.006; p=0.001; p=0.002; respectively). Patients receiving with beta-blocker and diuretic treatments had significantly higher brain natriuretic peptide levels. Conclusions High brain natriuretic peptide levels in patients with cirrhosis may be due to hepatocellular insufficiency or portal hypertension, but a cardiomyopathy developing insiduously should not be regarded.

Colonic malignant melanoma, primary or metastatic? Case report.

Abstract: Gastrointestinal malignant melanomas, either primary or metastatic, are rare and overlooked tumors There is also controversy regarding the actual existence of primary melanoma in the gastrointestinal tract apart from the esophagus and anorectal regions, where melanocytes normally exist A case of malignant melanoma in the cecum is presented The patient was a 30- year-old male who presented to the hospital for abdominal pain and diarrhea The tumor was located mainly in the submucosa and measured 14x11x45 cm The cut surface was solid, gray-white and fleshy Histologically, tumor cells were arranged in compact nests or wide cords surrounded by fibrous stroma The tumor cells had pleomorphic nuclei and quite rich cytoplasm; multinucleated, giant tumor cells were intermingled Although no tumor cells contained apparent brown pigment, most were found to be positive for S-100 protein, HMB-45, Melan-A, and vimentin The possibility of a metastatic lesion was considered While the patient had a history of a pathologically examined dorsal nevus excision two years before, there was no evidence of either cutaneous or ocular primary melanoma at the time of diagnosis Moreover, a thorough postoperative investigation did not reveal any other lesion in any other site favoring a metastatic spread There was also no evidence of recurrent disease or metastasis one year after the surgery This case is presented in view of its rare occurrence in the cecum The difficulties in the diagnostic course are discussed, together with a literature review on distinguishing a primary mucosal melanoma from a metastatic one from an unknown or regressed cutaneous primary tumor

The efficacy and safety of colonoscopy preparation with oral sodium phosphate in elderly patients.

Abstract: Background/aims Oral sodium phosphate is an agent used commonly in our country for cleaning the intestines before colonoscopy. Our aim was to compare the safety, tolerability and efficiency of oral sodium phosphate solution used in colonoscopy preparation in patients over 70 years of age. Methods This study was carried out in Ankara University School of Medicine Cebeci Hospital Endoscopy Center between August 2008 and March 2009. The extent of colon cleanliness was scored in the colonoscopy procedure. The data from the two groups were compared. Results In our study, 55 patients were divided into two groups according to their age, as over 70 years (n: 25) and under 70 years (n: 30). The average age of the group under 70 years was 49.4±9.8 and of the group over 70 years was 71.4±1.2 (p=0.04). Among the patients included in this study, 59.1% were female (n: 28) and 50.9% were male (n: 27). In the over 70 years group, the intestinal cleanliness was poor-fair in 2 patients, acceptable in 7 patients and excellent in 16 patients. In the below 70 years group, the intestinal cleanliness was poor in 2 patients, acceptable in 9 patients, good in 13 patients, and excellent in 6 patients. In the statistical evaluation, it was determined that there was no statistical difference between the over- and below 70 years of age groups regarding good-excellent intestinal cleanliness and poor-medium intestinal cleanliness (p=0.109). There was no statistical difference between the groups with regard to the adverse effects. The sodium, potassium and creatinine levels were assessed on the procedure day in 5 patients with clinical side effects (abdominal pain, nausea, vomiting, dizziness, hypotension) in the elderly group. No electrolyte imbalance or renal function impairment was observed in these patients. Conclusions In the group of patients over 70 years old, a special patient group without comorbid diseases, oral sodium phosphate solution used for colon preparation was effective and well-tolerated with a low adverse effect rate. In spite of this safe profile, since serum creatinine levels and electrolyte imbalance were assessed in only a limited number of patients, the relationship reported in the literature between oral sodium phosphate and electrolyte imbalance and renal function impairment should be kept in mind.

Prevalence of Celiac disease in Turkish children with type 1 diabetes mellitus and their non-diabetic first-degree relatives.

Abstract: BACKGROUND/AIMS The objective of this study was to determine the prevalence of Celiac disease in Turkish children with type 1 Diabetes Mellitus and their non-diabetic first-degree relatives. METHODS Forty-eight children with type 1 Diabetes Mellitus (18 males, 30 females; age range: 3.5 to 23 years; mean age: 12.09 +/- 4.78 years), 29 non-diabetic siblings, 40 non-diabetic parents, and 103 healthy children were screened for celiac disease using the IgA and IgG anti-tissue transglutaminase antibody and total serum IgA. Small intestinal biopsy was offered to all antibody-positive patients. RESULTS Eight of 48 diabetic patients had positive anti-tissue transglutaminase IgA. Selective IgA deficiency was detected in 2 diabetic children and both were positive to anti-tissue transglutaminase IgG. Intestinal biopsy was accepted by 8 of 10 (80%) diabetic children with positive celiac serology. Pathologic examination showed total villous atrophy in 3 (6.3%) diabetic children. Positive anti-tissue transglutaminase IgA was found in 1/29 siblings and 2/40 parents. Celiac disease was confirmed by biopsy in the sibling. Two parents refused the biopsy. The frequency of biopsy-proven celiac disease was found as 1.4 in relatives of diabetic children. None of the serum samples of healthy children comprising the control group showed selective IgA deficiency or positivity for anti-tissue transglutaminase IgA antibody. CONCLUSIONS These findings indicate that the prevalence of celiac disease in Turkish children with type 1 diabetes mellitus is higher than in healthy controls. The 1.4% frequency of Celiac disease in relatives of diabetic children is close to that of controls.

Fasciola hepatica-induced acute pancreatitis: report of two cases and review of the literature.

Abstract: Fasciola hepatica is a zoonotic liver fluke that can cause disease in humans. F. hepatica is known to cause bile duct inflammation and biliary obstruction, but is rarely reported as responsible for producing acute pancreatitis. We report two patients complaining of acute pancreatitis. Endoscopic retrograde cholangiopancreatography showed distinct features, and sphincterotomy allowed extraction of multiple parasites. A high index of suspicion, specific ultrasonographic findings and eosinophilia are very helpful in the diagnosis of the disease.

Protective role of Urtica dioica L. (Urticaceae) extract on hepatocytes morphometric changes in STZ diabetic Wistar rats.

Abstract: BACKGROUND/AIMS The present investigation was carried out to evaluate the protective effect of the hydroalcoholic extract of Urtica dioica leaves on the quantitative morphometric changes in the liver of streptozotocin-induced diabetic rats. METHODS Thirty male Wistar rats were divided into control (G1), diabetic (G2), diabetic + Urtica dioica (G3) groups. The control group received only sham injections of intraperitoneal saline; the diabetic group received intraperitoneal saline for 5 days followed by streptozotocin (80 mg/kg) on the 6th day; and the diabetic + Urtica dioica group received 100 mg/kg Urtica dioica intraperitoneal (7) injections for 5 days and streptozotocin injection on the 6th day. After five weeks, the animals were sacrificed and whole livers removed. Liver specimens were used for quantitative morphometric analysis after hematoxylin and eosin staining. All data were statistically analyzed by one-way ANOVA and expressed as the mean with standard error of means. RESULTS In the G3 (diabetic + Urtica diocia) group, the mean surface area of hepatocytes in the periportal zone (Z1) was greater than in G2 (diabetic) and G1 (control) groups, but this difference was not significant. No alteration was observed in the surface area of hepatocytes in the perivenous zone (Z3) in the diabetic + Urtica dioica (G3) group compared to the diabetic (G2) group. The mean nuclear area of hepatocytes of the rats in the diabetic + Urtica dioica (G3) group was higher in Z1 and lower in Z3 than that of rats in the diabetic (G2) group. The mean diameter of hepatocyte nuclei in the diabetic + Urtica dioica (G3) group was lower than that of diabetic (G2) and control (G1) groups in both Z1 and Z3. CONCLUSIONS This study revealed that the administration of extract of Urtica dioica leaves before induction of diabetic with streptozotocin has a protective effect on the morphometric alterations of hepatocytes in the periportal and perivenous zones of the liver lobule in rats.

The application of SpyScope® technology in evaluation of pre and post liver transplant biliary problems

Abstract: Amac: Peroral kolanjiyoskopinin uygulanmas›n›n s›n›rl› olma- s› SpyScope teknolojisinin geliflmesine sebep olmufltur. Bu ret- rospektif cal›flman›n amac› SpyScope'un etkinlii ve Trans- plant Kliniimizde uygulama alanlar›n›n belirlenmesidir. Yontem ve Gerec: Hastalar›n kay›tlar› retrospektif olarak de- ¤erlendirilmifltir. Endikasyonlar nakil oncesi (Grup I) ve nakil sonras› (Grup II) safra yolu darl›klar›n›n deerlendirilmesi fleklindedir. Gerektiinde SpyBite biyopsi forsepsi ile direk go- rufl alt›nda biyopsi al›nm›flt›r. Demografik ozellikler, SpyScope endikasyonlar›n›n deerlendirilmesi, sonuclar ve histopatolojik

Evaluation of the presence of Helicobacter species in the biliary system of Turkish patients with cholelithiasis.

Abstract: BACKGROUND/AIMS Helicobacter genus and bile-resistant Helicobacter pylori are suggested to have a role in gallstone formation and epithelial cell proliferation in the gallbladder. The aim of this study was to evaluate the presence of Helicobacter species in the gallbladder tissue, bile and gallstones of Turkish patients with cholelithiasis. METHODS Forty-seven patients with calculous cholecystitis and 3 controls were evaluated for the presence of Helicobacter spp. by culture, polymerase chain reaction, and histological and immunohistochemistry methods. RESULTS Escherichia coli (10.6%), Enterobacter amnigenus (6.3%), Klebsiella planticola (2.1%), and Klebsiella ozaenae (2.1%) were isolated from the sample cultures of 8 patients. No other microorganisms, including H. pylori and other Helicobacter spp., were detected. Polymerase chain reaction was negative for Helicobacter spp. and H. pylori. No microorganisms resembling Helicobacter spp. were seen on the histological sections. The association between the presence of bacteria and epithelial cell proliferation index was not statistically significant (p=0.48). CONCLUSIONS There was no association between the presence of Helicobacter spp. and development of cholelithiasis in our study group. The microorganisms found in the samples did not reveal any significant association with the underlying disease.

Pure naratriptan-induced ischemic colitis: a case report.

Abstract: A 60-year-old female with sudden onset of abdominal pain and hematochezia was diagnosed with histology-proven ischemic colitis. She used naratriptan on a regular basis for migraine. By exclusion of other causes for colonic ischemia and the absence of cardiovascular risk factors, naratriptan was considered the causal agent. Discontinuation resulted in a complete clinical recovery. With the increasing use of triptans, health care providers should be aware of the possible serious ischemic events associated with these drugs.

Why is isolated spleen metastasis a rare entity

Abstract: Primary and metastatic tumors of the spleen are uncommon, excluding involvement by lymphoma Isolated spleen metastasis from other organs is a rare incident Herein, we report the case of a 59-year-old man who developed isolated splenic metastasis from ascending colon cancer The patient underwent right hemicolectomy for T3N1M0 tumor of the ascending colon During the postoperative follow-up, increasing serum level of carcinoembryonic antigen was observed Furthermore, abdominal computed tomography scan showed a splenic tumor measuring 4 cm Curative splenectomy was performed Pathologic investigation confirmed the adenocarcinoma metastasis The interesting point of our report is that the spleen metastasis arose from the ascending colon This report is the third described case in the literature of isolated spleen metastasis from a right colon carcinoma

β-Catenin and its relation to VEGF and cyclin D1 expression in pT3 rectosigmoid cancers.

Abstract: Background/aims β-Catenin is a critical component of the Wnt signaling pathway that regulates cell proliferation and differentiation. Wnt signaling leads to the stabilization of cytosolic β-catenin and to translocation to the nucleus, where it binds with T-cell factor and promotes the transcription and changes in target gene expression, including vascular endothelial growth factor and cyclin D1. The aim of this study was to assess the expression of cyclin D1 and vascular endothelial growth factor and to correlate them with β-catenin expression and some clinicopathologic parameters. Methods In this study, we analyzed paraffin-embedded specimens from 42 patients with pT3 rectosigmoid cancer for β-catenin, vascular endothelial growth factor and cyclin D1 expression using immunohistochemistry. Results Thirty-six (85.7%) and 24 (57.1%) tumors expressed vascular endothelial growth factor and cyclin D1, respectively. Nuclear expression of β-catenin was detected in only 26.1% of tumors. It was revealed that cytoplasmic β-catenin expression was significantly related to vascular endothelial growth factor expression (p=0.011). No association was found between nuclear or cytoplasmic β-catenin and cyclin D1 expression. No significant association was seen between β-catenin, vascular endothelial growth factor or cyclin D1 expression and some investigated clinicopathologic features. Conclusions Our results may contribute to knowledge regarding the functional interaction between β-catenin and vascular endothelial growth factor. We suggest that the overexpression of cyclin D1 in rectosigmoid cancers may be more complicated than purely upregulation by β-catenin. Further larger studies on Wnt/β-catenin and target gene activity and protein expression are necessary to better understand and define their roles in the pathogenesis of colorectal carcinoma.