Background and Aims: We aimed to evaluate the efficiency of the standard triple therapy (clarithr... more Background and Aims: We aimed to evaluate the efficiency of the standard triple therapy (clarithromycin, amoxicillin, proton pump inhibitors) in Helicobacter pylori eradication over the period 2004 2008. Materials and Methods: 390 patients who were treated for Helicobacter pylori between 1999 and 2009 and assessed after treatment were examined retrospectively. 169 patients who were treated with standard triple therapy between 2004 and 2008 were also analyzed. Results: The mean age was 45.9±15 years, and 46.1% of patients were female. Eradication rates were 66.2%, 75.4%, 71.5%, 72%, and 73.4%, respectively, from 2004 to 2008. Eradication rates were not statistically different over time. The recent data were compared with the clinical studies made with triple therapy in our clinic before 2000, and it was determined that after 2000, eradication rates declined significantly and remained stable thereafter. Conclusions: Eradication rates significantly declined with the standard triple the...
Graft-versus-host hastal›¤› (GVHH), endoskopik bulgular Background and Aims: Acute graft-versus-h... more Graft-versus-host hastal›¤› (GVHH), endoskopik bulgular Background and Aims: Acute graft-versus-host disease occurs after allogeneic hematopoietic stem cell transplantation and is a reaction of donor immune cells against host tissues. Activated donor T cells damage host epithelial cells. About 35%-50% of hematopoietic stem cell transplant recipients will develop acute graft-versus-host disease. The endoscopic findings varied markedly and included mild mucosal edema with focal erythema, diffuse erythema, and diffuse polypoid indurations with multiple bleeding ulcerations. We investigated endoscopic findings in a graft-versus-host disease patient population. Materials and Methods: A retrospective review of endoscopic data was performed in 18 adult allogeneic bone marrow transplant recipients at our institution. Results: In this study, 18 allogeneic bone marrow transplant patients (mean age 33.9 years; 62% male) were evaluated. In 6 graftversus-host disease patients, the endoscopic appearances of the esophagus, stomach and duodenum varied from subtle mucosal erythema and edema to frank ulceration. Colonoscopy was performed with biopsies in 12 graft-versus-host disease patients. The colonoscopic findings varied markedly and ranged from mild mucosal edema with focal erythema to multiple bleeding ulcerations. Conclusions: The diagnostic accuracy of endoscopy was high in gastrointestinal graft-versus-host disease. Accurate diagnosis of gastrointestinal graft-versus-host disease might be obtained with mucosal biopsies from either the upper or lower gastrointestinal tract. Endoscopy may play a significant role in establishing early diagnosis and treatment for gastrointestinal graft-versus-host disease patients.
Oral sodium phosphate is an agent used commonly in our country for cleaning the intestines before... more 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. 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. 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. 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.
Amaç: Karaci¤er fibrozisinin biyopsi ile de¤erlendirilmesi invaziv bir yöntemdir ve örnekleme hat... more Amaç: Karaci¤er fibrozisinin biyopsi ile de¤erlendirilmesi invaziv bir yöntemdir ve örnekleme hatas›na yol açabilir. Fibrozis evresini öngören serum fibrozis belirteç algoritmalar› kronik hepatit C'de tan›mlanm›fl olmas›na ra¤men, kronik hepatit B'de benzer flekilde uygulanma-m›flt›r. Yöntem: Bu amaçla 9 serum fibrozis belirteci, karaci¤er biyokimyasal testleri ve ultrasonografik parametreleri, ard›fl›k olarak 109 yetiflkin kronik hepatit B ve D hastas›nda de¤erlendirdik. Tüm hastalar kompanse karaci¤er hastal›¤›na sahipti. METAV‹R skoru ile evre ≥2 fibrozis ve grade ≥2 inflamasyon varl›¤› ileri karaci¤er hastal›¤› olarak tan›mland›. Splenomegali ve/veya 150,000 alt›nda trombosit say›s›-n›n, histolojiden ba¤›ms›z olarak, ileri fibrozisin belirleyicisi oldu¤u hesaba kat›larak alt›n standart yap›lmaya çal›fl›ld›. Belirteçlerin ve bun-lar›n kombinasyonlar›n›n Odds oranlar›n›n de¤erlendirilmesinde ROC e¤risinin alt›nda kalan alan (AUROC) hesaplamas› kullan›ld›. Bulgular: ‹leri hastal›¤› olanlar daha ileri yafll›yd›, daha düflük albumin, daha yüksek gama glutamil transferaz ve daha düflük platelet sa-y›s›na sahipti. Dokuz fibrozis belirtecinin 6's›n›n seviyesi (metalloproteinazlar-1 doku inhibitörü, prokollagen tip III aminoterminal propeptide, matriks metalloproteinaz, laminin, hyaluronan and kollagen IV) ileri fibrozis ile korele idi. Bu alt› belirteç ayr›ca inflamasyonun tah
Clinics and research in hepatology and gastroenterology, 2012
Portal-enteric drainage of graft secretions is currently the preferred method of pancreatic trans... more Portal-enteric drainage of graft secretions is currently the preferred method of pancreatic transplantation and usually created between the donor duodenum and recipient jejunum; however, this anatomy does not allow for easy access to the donor pancreas. We report here the first case of a single balloon assisted-endoscopic retrograde pancreatography in a patient with progressively increasing amylase and lipase in portal-enteric-drained pancreas-kidney transplantation.
teroscopy can be achieved without the need for laparotomy, usually with a bidirectional approach,... more teroscopy can be achieved without the need for laparotomy, usually with a bidirectional approach, and both tissue acquisition and therapy, including polypectomy, stricture dilation and cauterization, can be performed. 1 Complication rates are reportedly low, and learning curves appear to indicate rapid proficiency. 2,3 Pioneered in Japan and Europe, there are few North American studies of the utility and safety of DBE in the evaluation of small bowel disease. In this study, we present an overview of a five-year experience in DBE performed at a single North American center. The aim of the study was to determine the indications, diagnostic accuracy and complication rates of DBE in a tertiary/quaternary hospital setting. METHODS 1. Recruitment
Background: Small bowel strictures are an uncommon but difficult problem to evaluate and treat. T... more Background: Small bowel strictures are an uncommon but difficult problem to evaluate and treat. They can cause significant morbidity, and surgery has historically been the only definitive treatment option. We assessed outcomes of endoscopic dilation of benign small bowel strictures using double balloon enteroscopy (DBE). Methods: Retrospective study of 13 patients from January 2007 to December 2011 who underwent DBE and balloon dilation for benign small bowel strictures at a single tertiary referral center. Results: A total of 16 DBEs were performed in 13 patients (11 males, median age 60) for benign small bowel strictures using DBE. Final stricture etiology included Crohn's disease 4, nonsteroidal anti-inflammatory drugs 4, anastomotic stricture 3, radiation enteritis 1, and adhesions 1. Technical success was achieved in 12/13 (92%) and clinical success in 10/13 (77%) patients with a median follow-up of 46 months. Surgery was required in three patients: one technical failure to reach the stricture, one adverse event (perforation), and one recurrence. Conclusion: Balloon dilation of small bowel strictures using DBE is a reasonably safe and feasible alternative to surgery in selected cases. Larger prospective series would be required to confirm its benefit.
%20.9) (p=0.0001). Çok de¤iflkenli analizde özofajit geliflmesiyle yafl, erkek cinsiyet, duodenal... more %20.9) (p=0.0001). Çok de¤iflkenli analizde özofajit geliflmesiyle yafl, erkek cinsiyet, duodenal ülser hastal›¤›, pilor dar-l›¤›, hiatus hernisi, alt özofagus sfinkter gevflekli¤i, antral gastrit ve pangastrit iliflkili bulundu. Sonuç: Yaklafl›k 20 y›ll›k de¤erlendirmede endoskopik incelemeler s›ras›nda özofajit tespit edilme s›kl›¤› %16.1 bulunmufltur. 1990'l› y›llara göre 2000'li y›llarda özofajit görülme oran›nda art›fl mevcuttur. Olgu-lar›n %88.4'ünde hafif derecede (Grade I+II) özofajit vard›. Hiatus herni, alt özofagus sfinkter gevflekli¤i, pilor stenozu ve peptik ülser gibi durumlarda özofajit görülme riski daha yüksekti.
Background Fully covered self-expanding metal stents (FCSEMS), unlike partially covered SEMS (PCS... more Background Fully covered self-expanding metal stents (FCSEMS), unlike partially covered SEMS (PCSEMS), have been used to treat benign as well as malignant conditions. We aimed to evaluate the outcome of PCSEMS and FCSEMS in patients with both benign and malignant esophageal diseases. Methods Data were reviewed of all patients who underwent SEMS placement for malignant or benign conditions between January 1995 and January 2012. Patients with cancer were followed for at least 3 months, until death or surgery. Patients with benign conditions had stents removed between 4 and 12 weeks. Patient demographics, location and type of lesion, stent placement and removal, clinical success, and adverse events were analyzed. Results A total of 252 patients (mean ± standard deviation age 68.5 ± 14 years; 171 male) received 321 SEMS (209 PCSEMS, 112 FCSEMS) for malignant (78 %) and benign (22 %) conditions. Stent placement and removal was successful in 97.6 and 95.6 % procedures. Successful relief of malignant dysphagia was noted in 140 of 167 patients (83.8 %) and control of benign fistulas, leaks, and perforations was noted in 21 of 25 patients (84 %), but only 8 of 15 patients (53 %) with recalcitrant benign strictures had effective treatment. Fifty-six patients (22.2 %) experienced at least one stent-related adverse events. Migration was frequent, occurring in 61 of 321 stent placements (19 %), and more frequently with FCSEMS than PCSEMS (37.5 vs. 9.1 %, p \ 0.001). FCSEMS, benign conditions, and distal location were the variables independently associated with migration (p \ 0.001, p = 0.022, and p = 0.008). Patients with PCSEMS were more likely to have tissue in-or overgrowth than FCSEMS (53.4 vs. 29.1 %, p = 0.004). Conclusions Both PCSEMS and FCSEMS can be used in benign and malignant conditions; they are both effective for relieving malignant dysphagia and for closing leaks and perforations, but they seem less effective for relieving benign recalcitrant strictures. Stent migration is more common with FCSEMS, which may limit its use for the palliation of malignant dysphagia.
antegrade approach). The average age of these patients was 83.5 years (Range 80-94 years). Indica... more antegrade approach). The average age of these patients was 83.5 years (Range 80-94 years). Indications and findings are described in the Table. The most common DBE indication was occult gastrointestinal bleeding (66%). The most common finding was non-bleeding mucosal vascular ectasias (42.6%). A therapeutic intervention (other than diagnostic biopsies) was performed in 134 (60%) procedures. Of the 137 patient’s a total of 114 (83.2%) of these had a capsule endoscopy prior to DBE. Correlation between findings of capsule endoscopy and DBE occurred in 78.9% (see Table). The overall diagnostic (pertinent positive findings) yield of DBE was 89.2%. The diagnostic yield of DBE for gastrointestinal bleeding (occult and overt) was 90.2%. There were no immediate (less than 48 hours) post-procedural complications. Conclusion: Capsule endoscopy has a very high correlation with DBE, and furthermore, DBE can be performed safely in the octogenarian patient population. Given these findings, in an elderly patient with positive findings on CE, DBE should be considered as the next appropriate diagnostic and therapeutic test.
Background: Appearance of regulatory T cells (Treg) showing expression of FOXP3, a member of the ... more Background: Appearance of regulatory T cells (Treg) showing expression of FOXP3, a member of the forkhead/winged helix family of transcription factors and a master gene of Treg (FOXP3ϩTreg) in the duodenal papilla has been reported in patients with autoimmune pancreatitis (AIP). Aim: To investigate the usefulness of detection of FOXP3ϩTreg in the main duodenal papilla in the differential diagnosis between AIP and pancreatic cancer (Pca). Methods: First, we determined the cutoff value of FOXP3 expression in biopsies of the duodenal papilla obtained from patients with AIP (nϭ22) and chronic pancreatitis (nϭ21). Then, the data of 32 patients with AIP and 30 patients with Pca who had undergone endoscopic biopsy were studied. The numbers of FOXP3ϩ Treg and IgG4ϩ plasma cells per high-power field (HPF) were counted in all the histopathological specimens Results: The areas under the receiver-operating characteristic (AUROC) curves for FOXP3 and IgG4 expression were 0.934 and 0.953, respectively. The cutoff values calculated based on the AUROC data were 14cells/HPF for FOXP3 and 10cells/HPF for IgG4, respectively. Seropositivity for IgG4 was observed in 22 out of the 31 patients with AIP (sensitivity, 71.0%; specificity, 84.6%; accuracy, 75.0%). Significant infiltration of the major duodenal papilla by FOXP3ϩ lymphocytes (Ն14/HPF) was recognized in 18 of the 32 patients with AIP (sensitivity, 56.3%; specificity, 100%; accuracy, 77.4%). Significant infiltration of the major duodenal papilla by IgG4ϩ plasma cells (Ն10/HPF) was recognized in 27 of the 32 patients with AIP (sensitivity, 84.4%; specificity, 80.0%; accuracy, 82.3%). The observation of FOXP3 upregulation in the main duodenal papilla showed a reasonable degree of sensitivity, higher specificity and equuivalent accuracy to IgG4 upregulation in the main duodenal papilla for differential diagnosis between AIP and Pca. Conclusions: Observation of FOXP3ϩ cells in the main duodenal papilla may be useful in the differential diagnosis between AIP and Pca.
Introduction/aim: Primary biliary cirrhosis is associated with other autoimmune diseases includin... more Introduction/aim: Primary biliary cirrhosis is associated with other autoimmune diseases including Sjögren's syndrome, and scleroderma. Esophageal dysmotility is well known in scleroderma, and Sjögren's syndrome. The aim of this study is to investigate whether any esophageal motor dysfunction exists in patients with primary biliary cirrhosis. Method: The study was performed in 37 patients (36 women, mean age: 56.29 ± 10.01 years) who met diagnostic criteria for primary biliary cirrhosis. Thirty-seven functional dyspepsia patients, were also included as a control group. Patients entering the study were asked to complete a symptom questionnaire. Distal esophageal contraction amplitude, and lower esophageal sphincter resting pressure were assessed. Results: Manometric findings in primary biliary cirrhosis patients vs. controls were as follows: Median lower esophageal sphincter resting pressure (mm Hg): (24 vs 20, p = 0.033); median esophageal contraction amplitude (mm Hg): (71 vs 56, p = 0.050); mean lower esophageal sphincter relaxation duration (sc, x ± SD): (6.10 ± 1.18 vs 8.29 ± 1.92, p b 0.001); and median lower esophageal sphincter relaxation (%) (96 vs 98, p =0.019); respectively. No significant differences were evident in median peak velocity (sc) (3.20 vs 3.02, p =0.778) between patients with primary biliary cirrhosis and the functional dyspepsia patients. Esophageal dysmotility was found in 17 (45.9%) primary biliary cirrhosis patients (non-specific esophageal motor disorder in ten patients, hypomotility of esophagus in five patients, nutcracker esophagus in one patient and hypertensive lower esophageal sphincter in one patient). Conclusion: Esophageal dysmotility was detected in 45.9% of patients. The study suggests that subclinic esophageal dysmotility is frequent in patients with primary biliary cirrhosis.
Background. Hepatitis D virus (HDV) requires hepatitis B surface antigen (HBsAg) to propagate inf... more Background. Hepatitis D virus (HDV) requires hepatitis B surface antigen (HBsAg) to propagate infection and cause disease. Entecavir is a nucleoside analog with potent antiviral efficacy, and in the woodchuck animal model it also decreased hepatitis B virus (HBV) cccDNA and woodchuck surface antigen. The aim of this study was to investigate the efficacy of entecavir in chronic hepatitis D (CHD). Methods. This single-center study was conducted in patients with compensated liver disease. All patients had to have detectable hepatitis HDV RNA and elevated levels of alanine aminotransferase (ALT). Entecavir was given at a dosage of 1 mg/d for 1 year. The primary end point was achievement of undetectable HDV RNA at the end of treatment. Results. Thirteen consecutive patients were assessed. All patients had detectable HDV RNA, and 8 had detectable HBV DNA at baseline. At the end of treatment, HBV DNA became undetectable in all patients (P = .001). No significant decline in HDV RNA, ALT, or quantitative HBsAg levels was observed. The primary end point of undetectable HDV RNA at the end of treatment was achieved in 3 patients who had significantly lower baseline HDV RNA levels than nonresponders (2.99 log 10 copies/mL ± .70 vs 4.68 ± .97; P = .0185). In all 3 patients, ALT levels were also normal at the end of treatment. Conclusions. One year of entecavir treatment is ineffective in CHD. Any generalized beneficial effect of nucleoside/nucleotide analog treatment may necessitate prolonged treatment. Patients with CHD with HBV dominance, which is likely to occur in the later phases of CHD, may be a reasonable patient cohort in which to target nucleoside/nucleotide analog therapy.
years of age (55.5% male) underwent a total of 223 DBE procedures (123 antegrade approach). The a... more years of age (55.5% male) underwent a total of 223 DBE procedures (123 antegrade approach). The average age of these patients was 83.5 years (Range 80-94 years). Indications and findings are described in the The most common DBE indication was occult gastrointestinal bleeding (66%). The most common finding was non-bleeding mucosal vascular ectasias (42.6%). A therapeutic intervention (other than diagnostic biopsies) was performed in 134 (60%) procedures. Of the 137 patient's a total of 114 (83.2%) of these had a capsule endoscopy prior to DBE. Correlation between findings of capsule endoscopy and DBE occurred in 78.9% (see . The overall diagnostic (pertinent positive findings) yield of DBE was 89.2%. The diagnostic yield of DBE for gastrointestinal bleeding (occult and overt) was 90.2%. There were no immediate (less than 48 hours) post-procedural complications. Conclusion: Capsule endoscopy has a very high correlation with DBE, and furthermore, DBE can be performed safely in the octogenarian patient population. Given these findings, in an elderly patient with positive findings on CE, DBE should be considered as the next appropriate diagnostic and therapeutic test.
Background and Aims: We aimed to evaluate the efficiency of the standard triple therapy (clarithr... more Background and Aims: We aimed to evaluate the efficiency of the standard triple therapy (clarithromycin, amoxicillin, proton pump inhibitors) in Helicobacter pylori eradication over the period 2004 2008. Materials and Methods: 390 patients who were treated for Helicobacter pylori between 1999 and 2009 and assessed after treatment were examined retrospectively. 169 patients who were treated with standard triple therapy between 2004 and 2008 were also analyzed. Results: The mean age was 45.9±15 years, and 46.1% of patients were female. Eradication rates were 66.2%, 75.4%, 71.5%, 72%, and 73.4%, respectively, from 2004 to 2008. Eradication rates were not statistically different over time. The recent data were compared with the clinical studies made with triple therapy in our clinic before 2000, and it was determined that after 2000, eradication rates declined significantly and remained stable thereafter. Conclusions: Eradication rates significantly declined with the standard triple the...
Graft-versus-host hastal›¤› (GVHH), endoskopik bulgular Background and Aims: Acute graft-versus-h... more Graft-versus-host hastal›¤› (GVHH), endoskopik bulgular Background and Aims: Acute graft-versus-host disease occurs after allogeneic hematopoietic stem cell transplantation and is a reaction of donor immune cells against host tissues. Activated donor T cells damage host epithelial cells. About 35%-50% of hematopoietic stem cell transplant recipients will develop acute graft-versus-host disease. The endoscopic findings varied markedly and included mild mucosal edema with focal erythema, diffuse erythema, and diffuse polypoid indurations with multiple bleeding ulcerations. We investigated endoscopic findings in a graft-versus-host disease patient population. Materials and Methods: A retrospective review of endoscopic data was performed in 18 adult allogeneic bone marrow transplant recipients at our institution. Results: In this study, 18 allogeneic bone marrow transplant patients (mean age 33.9 years; 62% male) were evaluated. In 6 graftversus-host disease patients, the endoscopic appearances of the esophagus, stomach and duodenum varied from subtle mucosal erythema and edema to frank ulceration. Colonoscopy was performed with biopsies in 12 graft-versus-host disease patients. The colonoscopic findings varied markedly and ranged from mild mucosal edema with focal erythema to multiple bleeding ulcerations. Conclusions: The diagnostic accuracy of endoscopy was high in gastrointestinal graft-versus-host disease. Accurate diagnosis of gastrointestinal graft-versus-host disease might be obtained with mucosal biopsies from either the upper or lower gastrointestinal tract. Endoscopy may play a significant role in establishing early diagnosis and treatment for gastrointestinal graft-versus-host disease patients.
Oral sodium phosphate is an agent used commonly in our country for cleaning the intestines before... more 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. 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. 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. 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.
Amaç: Karaci¤er fibrozisinin biyopsi ile de¤erlendirilmesi invaziv bir yöntemdir ve örnekleme hat... more Amaç: Karaci¤er fibrozisinin biyopsi ile de¤erlendirilmesi invaziv bir yöntemdir ve örnekleme hatas›na yol açabilir. Fibrozis evresini öngören serum fibrozis belirteç algoritmalar› kronik hepatit C'de tan›mlanm›fl olmas›na ra¤men, kronik hepatit B'de benzer flekilde uygulanma-m›flt›r. Yöntem: Bu amaçla 9 serum fibrozis belirteci, karaci¤er biyokimyasal testleri ve ultrasonografik parametreleri, ard›fl›k olarak 109 yetiflkin kronik hepatit B ve D hastas›nda de¤erlendirdik. Tüm hastalar kompanse karaci¤er hastal›¤›na sahipti. METAV‹R skoru ile evre ≥2 fibrozis ve grade ≥2 inflamasyon varl›¤› ileri karaci¤er hastal›¤› olarak tan›mland›. Splenomegali ve/veya 150,000 alt›nda trombosit say›s›-n›n, histolojiden ba¤›ms›z olarak, ileri fibrozisin belirleyicisi oldu¤u hesaba kat›larak alt›n standart yap›lmaya çal›fl›ld›. Belirteçlerin ve bun-lar›n kombinasyonlar›n›n Odds oranlar›n›n de¤erlendirilmesinde ROC e¤risinin alt›nda kalan alan (AUROC) hesaplamas› kullan›ld›. Bulgular: ‹leri hastal›¤› olanlar daha ileri yafll›yd›, daha düflük albumin, daha yüksek gama glutamil transferaz ve daha düflük platelet sa-y›s›na sahipti. Dokuz fibrozis belirtecinin 6's›n›n seviyesi (metalloproteinazlar-1 doku inhibitörü, prokollagen tip III aminoterminal propeptide, matriks metalloproteinaz, laminin, hyaluronan and kollagen IV) ileri fibrozis ile korele idi. Bu alt› belirteç ayr›ca inflamasyonun tah
Clinics and research in hepatology and gastroenterology, 2012
Portal-enteric drainage of graft secretions is currently the preferred method of pancreatic trans... more Portal-enteric drainage of graft secretions is currently the preferred method of pancreatic transplantation and usually created between the donor duodenum and recipient jejunum; however, this anatomy does not allow for easy access to the donor pancreas. We report here the first case of a single balloon assisted-endoscopic retrograde pancreatography in a patient with progressively increasing amylase and lipase in portal-enteric-drained pancreas-kidney transplantation.
teroscopy can be achieved without the need for laparotomy, usually with a bidirectional approach,... more teroscopy can be achieved without the need for laparotomy, usually with a bidirectional approach, and both tissue acquisition and therapy, including polypectomy, stricture dilation and cauterization, can be performed. 1 Complication rates are reportedly low, and learning curves appear to indicate rapid proficiency. 2,3 Pioneered in Japan and Europe, there are few North American studies of the utility and safety of DBE in the evaluation of small bowel disease. In this study, we present an overview of a five-year experience in DBE performed at a single North American center. The aim of the study was to determine the indications, diagnostic accuracy and complication rates of DBE in a tertiary/quaternary hospital setting. METHODS 1. Recruitment
Background: Small bowel strictures are an uncommon but difficult problem to evaluate and treat. T... more Background: Small bowel strictures are an uncommon but difficult problem to evaluate and treat. They can cause significant morbidity, and surgery has historically been the only definitive treatment option. We assessed outcomes of endoscopic dilation of benign small bowel strictures using double balloon enteroscopy (DBE). Methods: Retrospective study of 13 patients from January 2007 to December 2011 who underwent DBE and balloon dilation for benign small bowel strictures at a single tertiary referral center. Results: A total of 16 DBEs were performed in 13 patients (11 males, median age 60) for benign small bowel strictures using DBE. Final stricture etiology included Crohn's disease 4, nonsteroidal anti-inflammatory drugs 4, anastomotic stricture 3, radiation enteritis 1, and adhesions 1. Technical success was achieved in 12/13 (92%) and clinical success in 10/13 (77%) patients with a median follow-up of 46 months. Surgery was required in three patients: one technical failure to reach the stricture, one adverse event (perforation), and one recurrence. Conclusion: Balloon dilation of small bowel strictures using DBE is a reasonably safe and feasible alternative to surgery in selected cases. Larger prospective series would be required to confirm its benefit.
%20.9) (p=0.0001). Çok de¤iflkenli analizde özofajit geliflmesiyle yafl, erkek cinsiyet, duodenal... more %20.9) (p=0.0001). Çok de¤iflkenli analizde özofajit geliflmesiyle yafl, erkek cinsiyet, duodenal ülser hastal›¤›, pilor dar-l›¤›, hiatus hernisi, alt özofagus sfinkter gevflekli¤i, antral gastrit ve pangastrit iliflkili bulundu. Sonuç: Yaklafl›k 20 y›ll›k de¤erlendirmede endoskopik incelemeler s›ras›nda özofajit tespit edilme s›kl›¤› %16.1 bulunmufltur. 1990'l› y›llara göre 2000'li y›llarda özofajit görülme oran›nda art›fl mevcuttur. Olgu-lar›n %88.4'ünde hafif derecede (Grade I+II) özofajit vard›. Hiatus herni, alt özofagus sfinkter gevflekli¤i, pilor stenozu ve peptik ülser gibi durumlarda özofajit görülme riski daha yüksekti.
Background Fully covered self-expanding metal stents (FCSEMS), unlike partially covered SEMS (PCS... more Background Fully covered self-expanding metal stents (FCSEMS), unlike partially covered SEMS (PCSEMS), have been used to treat benign as well as malignant conditions. We aimed to evaluate the outcome of PCSEMS and FCSEMS in patients with both benign and malignant esophageal diseases. Methods Data were reviewed of all patients who underwent SEMS placement for malignant or benign conditions between January 1995 and January 2012. Patients with cancer were followed for at least 3 months, until death or surgery. Patients with benign conditions had stents removed between 4 and 12 weeks. Patient demographics, location and type of lesion, stent placement and removal, clinical success, and adverse events were analyzed. Results A total of 252 patients (mean ± standard deviation age 68.5 ± 14 years; 171 male) received 321 SEMS (209 PCSEMS, 112 FCSEMS) for malignant (78 %) and benign (22 %) conditions. Stent placement and removal was successful in 97.6 and 95.6 % procedures. Successful relief of malignant dysphagia was noted in 140 of 167 patients (83.8 %) and control of benign fistulas, leaks, and perforations was noted in 21 of 25 patients (84 %), but only 8 of 15 patients (53 %) with recalcitrant benign strictures had effective treatment. Fifty-six patients (22.2 %) experienced at least one stent-related adverse events. Migration was frequent, occurring in 61 of 321 stent placements (19 %), and more frequently with FCSEMS than PCSEMS (37.5 vs. 9.1 %, p \ 0.001). FCSEMS, benign conditions, and distal location were the variables independently associated with migration (p \ 0.001, p = 0.022, and p = 0.008). Patients with PCSEMS were more likely to have tissue in-or overgrowth than FCSEMS (53.4 vs. 29.1 %, p = 0.004). Conclusions Both PCSEMS and FCSEMS can be used in benign and malignant conditions; they are both effective for relieving malignant dysphagia and for closing leaks and perforations, but they seem less effective for relieving benign recalcitrant strictures. Stent migration is more common with FCSEMS, which may limit its use for the palliation of malignant dysphagia.
antegrade approach). The average age of these patients was 83.5 years (Range 80-94 years). Indica... more antegrade approach). The average age of these patients was 83.5 years (Range 80-94 years). Indications and findings are described in the Table. The most common DBE indication was occult gastrointestinal bleeding (66%). The most common finding was non-bleeding mucosal vascular ectasias (42.6%). A therapeutic intervention (other than diagnostic biopsies) was performed in 134 (60%) procedures. Of the 137 patient’s a total of 114 (83.2%) of these had a capsule endoscopy prior to DBE. Correlation between findings of capsule endoscopy and DBE occurred in 78.9% (see Table). The overall diagnostic (pertinent positive findings) yield of DBE was 89.2%. The diagnostic yield of DBE for gastrointestinal bleeding (occult and overt) was 90.2%. There were no immediate (less than 48 hours) post-procedural complications. Conclusion: Capsule endoscopy has a very high correlation with DBE, and furthermore, DBE can be performed safely in the octogenarian patient population. Given these findings, in an elderly patient with positive findings on CE, DBE should be considered as the next appropriate diagnostic and therapeutic test.
Background: Appearance of regulatory T cells (Treg) showing expression of FOXP3, a member of the ... more Background: Appearance of regulatory T cells (Treg) showing expression of FOXP3, a member of the forkhead/winged helix family of transcription factors and a master gene of Treg (FOXP3ϩTreg) in the duodenal papilla has been reported in patients with autoimmune pancreatitis (AIP). Aim: To investigate the usefulness of detection of FOXP3ϩTreg in the main duodenal papilla in the differential diagnosis between AIP and pancreatic cancer (Pca). Methods: First, we determined the cutoff value of FOXP3 expression in biopsies of the duodenal papilla obtained from patients with AIP (nϭ22) and chronic pancreatitis (nϭ21). Then, the data of 32 patients with AIP and 30 patients with Pca who had undergone endoscopic biopsy were studied. The numbers of FOXP3ϩ Treg and IgG4ϩ plasma cells per high-power field (HPF) were counted in all the histopathological specimens Results: The areas under the receiver-operating characteristic (AUROC) curves for FOXP3 and IgG4 expression were 0.934 and 0.953, respectively. The cutoff values calculated based on the AUROC data were 14cells/HPF for FOXP3 and 10cells/HPF for IgG4, respectively. Seropositivity for IgG4 was observed in 22 out of the 31 patients with AIP (sensitivity, 71.0%; specificity, 84.6%; accuracy, 75.0%). Significant infiltration of the major duodenal papilla by FOXP3ϩ lymphocytes (Ն14/HPF) was recognized in 18 of the 32 patients with AIP (sensitivity, 56.3%; specificity, 100%; accuracy, 77.4%). Significant infiltration of the major duodenal papilla by IgG4ϩ plasma cells (Ն10/HPF) was recognized in 27 of the 32 patients with AIP (sensitivity, 84.4%; specificity, 80.0%; accuracy, 82.3%). The observation of FOXP3 upregulation in the main duodenal papilla showed a reasonable degree of sensitivity, higher specificity and equuivalent accuracy to IgG4 upregulation in the main duodenal papilla for differential diagnosis between AIP and Pca. Conclusions: Observation of FOXP3ϩ cells in the main duodenal papilla may be useful in the differential diagnosis between AIP and Pca.
Introduction/aim: Primary biliary cirrhosis is associated with other autoimmune diseases includin... more Introduction/aim: Primary biliary cirrhosis is associated with other autoimmune diseases including Sjögren's syndrome, and scleroderma. Esophageal dysmotility is well known in scleroderma, and Sjögren's syndrome. The aim of this study is to investigate whether any esophageal motor dysfunction exists in patients with primary biliary cirrhosis. Method: The study was performed in 37 patients (36 women, mean age: 56.29 ± 10.01 years) who met diagnostic criteria for primary biliary cirrhosis. Thirty-seven functional dyspepsia patients, were also included as a control group. Patients entering the study were asked to complete a symptom questionnaire. Distal esophageal contraction amplitude, and lower esophageal sphincter resting pressure were assessed. Results: Manometric findings in primary biliary cirrhosis patients vs. controls were as follows: Median lower esophageal sphincter resting pressure (mm Hg): (24 vs 20, p = 0.033); median esophageal contraction amplitude (mm Hg): (71 vs 56, p = 0.050); mean lower esophageal sphincter relaxation duration (sc, x ± SD): (6.10 ± 1.18 vs 8.29 ± 1.92, p b 0.001); and median lower esophageal sphincter relaxation (%) (96 vs 98, p =0.019); respectively. No significant differences were evident in median peak velocity (sc) (3.20 vs 3.02, p =0.778) between patients with primary biliary cirrhosis and the functional dyspepsia patients. Esophageal dysmotility was found in 17 (45.9%) primary biliary cirrhosis patients (non-specific esophageal motor disorder in ten patients, hypomotility of esophagus in five patients, nutcracker esophagus in one patient and hypertensive lower esophageal sphincter in one patient). Conclusion: Esophageal dysmotility was detected in 45.9% of patients. The study suggests that subclinic esophageal dysmotility is frequent in patients with primary biliary cirrhosis.
Background. Hepatitis D virus (HDV) requires hepatitis B surface antigen (HBsAg) to propagate inf... more Background. Hepatitis D virus (HDV) requires hepatitis B surface antigen (HBsAg) to propagate infection and cause disease. Entecavir is a nucleoside analog with potent antiviral efficacy, and in the woodchuck animal model it also decreased hepatitis B virus (HBV) cccDNA and woodchuck surface antigen. The aim of this study was to investigate the efficacy of entecavir in chronic hepatitis D (CHD). Methods. This single-center study was conducted in patients with compensated liver disease. All patients had to have detectable hepatitis HDV RNA and elevated levels of alanine aminotransferase (ALT). Entecavir was given at a dosage of 1 mg/d for 1 year. The primary end point was achievement of undetectable HDV RNA at the end of treatment. Results. Thirteen consecutive patients were assessed. All patients had detectable HDV RNA, and 8 had detectable HBV DNA at baseline. At the end of treatment, HBV DNA became undetectable in all patients (P = .001). No significant decline in HDV RNA, ALT, or quantitative HBsAg levels was observed. The primary end point of undetectable HDV RNA at the end of treatment was achieved in 3 patients who had significantly lower baseline HDV RNA levels than nonresponders (2.99 log 10 copies/mL ± .70 vs 4.68 ± .97; P = .0185). In all 3 patients, ALT levels were also normal at the end of treatment. Conclusions. One year of entecavir treatment is ineffective in CHD. Any generalized beneficial effect of nucleoside/nucleotide analog treatment may necessitate prolonged treatment. Patients with CHD with HBV dominance, which is likely to occur in the later phases of CHD, may be a reasonable patient cohort in which to target nucleoside/nucleotide analog therapy.
years of age (55.5% male) underwent a total of 223 DBE procedures (123 antegrade approach). The a... more years of age (55.5% male) underwent a total of 223 DBE procedures (123 antegrade approach). The average age of these patients was 83.5 years (Range 80-94 years). Indications and findings are described in the The most common DBE indication was occult gastrointestinal bleeding (66%). The most common finding was non-bleeding mucosal vascular ectasias (42.6%). A therapeutic intervention (other than diagnostic biopsies) was performed in 134 (60%) procedures. Of the 137 patient's a total of 114 (83.2%) of these had a capsule endoscopy prior to DBE. Correlation between findings of capsule endoscopy and DBE occurred in 78.9% (see . The overall diagnostic (pertinent positive findings) yield of DBE was 89.2%. The diagnostic yield of DBE for gastrointestinal bleeding (occult and overt) was 90.2%. There were no immediate (less than 48 hours) post-procedural complications. Conclusion: Capsule endoscopy has a very high correlation with DBE, and furthermore, DBE can be performed safely in the octogenarian patient population. Given these findings, in an elderly patient with positive findings on CE, DBE should be considered as the next appropriate diagnostic and therapeutic test.
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