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Yaras S, Demir M, Barutcu S, Yildirim AE, Gurel S, Ucbilek E, Kurtulmus IA, Kayhan MA, Vatansever S, Adanir H, Danis N, Duman S, Turan I, Ari D, Kose S, Alkim H, Harputluoglu MM, Dilber F, Akyildiz M, Cosar AM, Durak S, Sirin G, Kefeli A, Gokcan H, Avcioglu U, Ayyildiz T, Sezgin O, Akarsu M, Dincer D, Guzelbulut F, Gunsar F, Akarca US, Idilman R. The efficacy and tolerability of glecaprevir/pibrentasvir treatment in a real-world chronic hepatitis C patients cohort. Hepatol Forum 2023; 4:92-96. [PMID: 37822314 PMCID: PMC10564251 DOI: 10.14744/hf.2023.2023.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 10/13/2023]
Abstract
Background and Aim The aims of the present study were to evaluate the real-life efficacy and tolerability of glecaprevir (GLE)/pibrentasvir (PIB) in the treatment of patients with chronic hepatitis C (CHC). Materials and Methods Between May 2019 and May 2022, 686 patients with CHC, treated with GLE/PIB combination from 21 participating centers in Turkiye, were enrolled in the study. Results All patients were Caucasian, and their median age was 56 years. At the start of GLE/PIB treatment, the median serum Hepatitis C virus RNA and serum alanine amino transaminase (ALT) levels were 6.74 log10 IU/mL and 47 U/L, respectively. Fifty-three percent of the patients were infected with genotype 1b, followed by genotype 3 (17%). Diabetes was the more common concomitant disease. The sustained virological response (SVR12) was 91.4% with intent-to-treat analysis and 98.5% with per protocol analysis. The SVR12 rates were statistically significant differences between the patients who were i.v. drug users and non-user (88.0% vs. 98.8%, p=0.025). From the baseline to SVR12, the serum ALT levels and Model for End-Stage Liver Disease score were significantly improved (p<0.001 and p=0.014, respectively). No severe adverse effect was observed. Conclusion GLE/PIB is an effective and tolerable treatment in patients with CHC.
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Affiliation(s)
- Serkan Yaras
- Department of Gastroenterology, Mersin University, School of Medicine, Mersin, Turkiye
| | - Mehmet Demir
- Department of Gastroenterology, Mustafa Kemal University, School of Medicine, Hatay, Turkiye
| | - Sezgin Barutcu
- Department of Medical Sciences, Gaziantep University, School of Medicine, Gaziantep, Turkiye
| | | | - Selim Gurel
- Department of Internal Medicine, Uludag University, School of Medicine, Bursa, Turkiye
| | - Enver Ucbilek
- Department of Gastroenterology, Mersin University, School of Medicine, Mersin, Turkiye
| | | | - Meral Akdogan Kayhan
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Health Sciences, Ankara City Hospital, Ankara, Turkiye
| | - Sezgin Vatansever
- Department of Gastroenterology, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkiye
| | - Haydar Adanir
- Department of Internal Medicine, Akdeniz University, School of Medicine, Antalya, Turkiye
| | - Nilay Danis
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, USA
| | - Serkan Duman
- Department of Gastroenterology, Toros State Hospital, Mersin, Turkiye
| | - Ilker Turan
- Department of Gastroenterology, Ege University, School of Medicine, Izmir, Turkiye
| | - Derya Ari
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Health Sciences, Ankara City Hospital, Ankara, Turkiye
| | - Sukran Kose
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylul University, School of Medicine, Izmir, Turkiye
| | - Huseyin Alkim
- Department of Gastroenterology, Sisli Etfal Training and Research Hospital, Istanbul, Turkiye
| | | | - Feyza Dilber
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkiye
| | - Murat Akyildiz
- Department of Gastroenterology, Koc University, School of Medicine, Istanbul, Turkiye
| | - Arif Mansur Cosar
- Department of Gastroenterology, Karadeniz Technical University, School of Medicine, Trabzon, Turkiye
| | - Serdar Durak
- Department of Gastroenterology, Karadeniz Technical University, School of Medicine, Trabzon, Turkiye
| | - Goktug Sirin
- Department of Gastroenterology, Kocaeli University, School of Medicine, Kocaeli, Turkiye
| | - Ayse Kefeli
- Department of Gastroenterology, Tokat Gaziosmanpasa University, School of Medicine, Tokat, Turkiye
| | - Hale Gokcan
- Department of Gastroenterology, Ankara University, School of Medicine, Ankara, Turkiye
| | - Ufuk Avcioglu
- Department of Gastroenterology, Ondokuz Mayis University, School of Medicine, Samsun, Turkiye
| | - Talat Ayyildiz
- Department of Gastroenterology, Ondokuz Mayis University, School of Medicine, Samsun, Turkiye
| | - Orhan Sezgin
- Department of Gastroenterology, Mersin University, School of Medicine, Mersin, Turkiye
| | - Mesut Akarsu
- Department of Gastroenterology, Dokuz Eylul, School of Medicine, Izmir, Turkiye
| | - Dinc Dincer
- Department of Gastroenterology, Akdeniz University, School of Medicine, Antalya, Turkiye
| | - Fatih Guzelbulut
- Departments of Gastroenterology and Pathology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkiye
| | - Fulya Gunsar
- Department of Gastroenterology, Ege University, School of Medicine, Izmir, Turkiye
| | - Ulus Salih Akarca
- Department of Gastroenterology, Ege University, School of Medicine, Izmir, Turkiye
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University, School of Medicine, Ankara, Turkiye
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Boga S, Yildirim AE, Ucbilek E, Koksal AR, Sisman ST, Durak I, Sen I, Dogu B, Serin E, Ucbilek AB, Yildirim MO, Erturk SM, Alkim H, Alkim C. The effect of sarcopenia and serum myokines on prognosis and survival in cirrhotic patients: a multicenter cross-sectional study. Eur J Gastroenterol Hepatol 2022; 34:1261-1268. [PMID: 36281901 DOI: 10.1097/meg.0000000000002461] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Sarcopenia is one of the most significant contributors to morbidity in patients with chronic liver disease. Serum myokines are potential biomarkers for detecting early sarcopenia. We aimed to investigate the relationship between serum myokines and cirrhosis-related mortality in the early stages of the disease. METHODS In total, 262 patients and 50 healthy controls were enrolled in this study, which was designed as a multicenter cross-sectional study. At the beginning of the study, sarcopenia was defined by computed tomography scans using the third lumbar vertebra skeletal muscle index. Serum myostatin, irisin, and follistatin levels, nutritional status of the patients, and muscle strength as measured by the handgrip test were recorded. Cirrhosis-related mortality and overall survival were evaluated in the fourth year of the study as the second checkpoint of cross-sectional analysis. RESULTS A total of 145 (55.3%) patients were diagnosed with sarcopenia. Multivariate analysis revealed that low BMI, high levels of myostatin, and decreased irisin levels were independent predictors of sarcopenia. While serum irisin level was the most predictive parameter in terms of 4th-year cirrhosis-related mortality in the CHILD A group, serum myostatin levels were found more indicative in the CHILD BC group regardless of sarcopenia status ( P < 0.001). CONCLUSION Serum myostatin levels predict sarcopenia in all stages of cirrhosis. Serum irisin levels can also be used as a potential biomarker to predict both treatable sarcopenia and cirrhosis-related mortality in CHILD A patients.
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Affiliation(s)
- Salih Boga
- Department of Gastroenterology, Memorial Bahcelievler Hospital, Istanbul
| | | | - Enver Ucbilek
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Turkey
| | - Ali Riza Koksal
- Department of Gastroenterology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | | | | | | | | - Erdinc Serin
- Biochemistry, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul
| | - Ayse Bolat Ucbilek
- Department of Radiology, University of Health Sciences Turkey, Adana Teaching and Research Hospital, Adana
| | | | - Sukru Mehmet Erturk
- Department of Radiology, Istanbul University, School of Medicine, Istanbul, Turkey
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Bayram M, Irak K, Cifci S, Koksal AR, Kazezoglu C, Acar Z, Ozarı HO, Alkim H. The effectiveness of small heterodimer partner and FGF 19 levels in prediction of perinatal morbidity in intrahepatic cholestasis of pregnancy. J OBSTET GYNAECOL 2022; 42:1174-1178. [DOI: 10.1080/01443615.2022.2028275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mehmet Bayram
- Department of Gastroenterology, Health Sciences University Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Kader Irak
- Department of Gastroenterology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Sami Cifci
- Department of Gastroenterology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ali Riza Koksal
- Department of Gastroenterology & Hepatology, Tulane University of Medicine, New Orleans, LA, USA
| | - Cemal Kazezoglu
- Department of Biochemistry, Health Sciences University Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Zuat Acar
- Department of Perinatology, Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Halil Onur Ozarı
- Department of Gastroenterology, Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Huseyin Alkim
- Department of Gastroenterology, Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Boga S, Alkim H, Alkim C, Koksal AR, Bayram M, Yilmaz Ozguven MB, Tekin Neijmann S. The Relationship of Serum Hemojuvelin and Hepcidin Levels with Iron Overload in Nonalcoholic Fatty Liver Disease. J Gastrointestin Liver Dis 2016; 24:293-300. [PMID: 26405701 DOI: 10.15403/jgld.2014.1121.243.hak] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Mild iron overload is frequently reported in patients with nonalcoholic fatty liver disease (NAFLD). Hepcidin is the master iron-regulatory peptide and hemojuvelin (HJV) is the key regulator of iron-dependent secretion of hepcidin. The aims of this study were to evaluate serum HJV and hepcidin levels in patients with biopsy-proven NAFLD with and without hepatic iron overload, and to identify potential associations of HJV and hepcidin with the clinical characteristics of the patients enrolled. METHODS Serum levels of HJV and hepcidin were measured in 66 NAFLD patients with (n=12) and without (n=54) iron overload, and controls (n=35) by enzyme-linked immunosorbent assay. Hemojuvelin and hepcidin levels were assessed in relation to clinical characteristics and liver histologic evaluation of the participants. RESULTS Significantly lower serum HJV (281.1 [239.2-353.6] vs. 584.8 [440.3-661] ng/ml, p<0.001) and similar serum hepcidin levels (60.5+/-31.1 vs. 55.8+/-11.9 ng/ml, p=0.285) were found in NAFLD patients when compared to controls. İron-overloaded NAFLD patients had significantly lower HJV (249.9 [187.6-296.3] vs. 292.9 [243-435] ng/ml, p=0.032) and significantly higher hepcidin (78.4+/-35.5 vs. 56.5+/-28.9ng/ml, p=0.027) levels than NAFLD patients without iron overload. Fibrosis stage was significantly higher in iron overloaded NAFLD group (p<0.001). Ferritin levels correlated significantly both with HOMA-IR (r=0.368, p=0.002) and fibrosis stage (r=0.571, p<0.001). CONCLUSIONS Our findings suggest that HJV levels are low in NAFLD and even lower in iron overloaded NAFLD, while hepcidin levels are higher in NAFLD with iron overload. The gradually decreased HJV and increased hepcidin concentrations in our patients most likely reflect the physiological response to iron accumulation in the liver.
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Affiliation(s)
- Salih Boga
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, 34371, Istanbul, Turkey.
| | - Huseyin Alkim
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, 34371, Istanbul, Turkey
| | - Canan Alkim
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, 34371, Istanbul, Turkey
| | - Ali Riza Koksal
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, 34371, Istanbul, Turkey
| | - Mehmet Bayram
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, 34371, Istanbul, Turkey
| | | | - Sebnem Tekin Neijmann
- Department of Biochemistry, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, 34147 Bakirkoy, Istanbul, Turkey
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Koksal AR, Boga S, Alkim H, Bayram M, Ergun M, Alkim C. Insulin Resistance as a Novel Risk Factor for Post-ERCP Pancreatitis: A Pilot Study. Dig Dis Sci 2016; 61:2397-2405. [PMID: 26995780 DOI: 10.1007/s10620-016-4127-0] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 03/07/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS The relationship between insulin resistance and post-ERCP pancreatitis (PEP) is not known. We aimed to determine the relation between pre-ERCP insulin resistance and risk of PEP, and to evaluate the relationship of insulin resistance with well-established risk factors for PEP. METHODS Consecutive patients who underwent ERCP with the diagnosis of choledocolithiasis between January and December 2013 were enrolled in this prospective study. Pre-procedural insulin resistance state and other risk factors were evaluated according to PEP development. RESULTS Pancreatitis developed in 16 (11.3 %) of 141 ERCP procedure. Homeostasis model assessment of insulin resistance (HOMA-IR) levels was found statistically significantly higher in patients who developed PEP than the ones who did not (3.37 ± 0.8 vs. 2.38 ± 1.4, p < 0.001). Common bile duct (CBD) diameter of the patients developing PEP was found significantly lower than the non-PEP group (10.1 ± 4 vs. 13.4 ± 4.5 mm, p = 0.01). Mean procedure time was 33.5 min in PEP group and 27.9 min in non-PEP group (p = 0.006). HOMA-IR (OR 2.39), procedure time (OR 1.15), and CBD diameter (OR 0.82) were independent predictors of PEP development. CONCLUSIONS The presence of insulin resistance is an important risk factor for PEP, and these data can be used as a considerable clue to predict the risk of PEP before ERCP and to decrease related morbidity.
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Affiliation(s)
- Ali Riza Koksal
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Halaskargazi Av. Etfal St. 34371 Sisli, Istanbul, Turkey.
| | - Salih Boga
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Halaskargazi Av. Etfal St. 34371 Sisli, Istanbul, Turkey
| | - Huseyin Alkim
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Halaskargazi Av. Etfal St. 34371 Sisli, Istanbul, Turkey
| | - Mehmet Bayram
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Halaskargazi Av. Etfal St. 34371 Sisli, Istanbul, Turkey
| | - Meltem Ergun
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Halaskargazi Av. Etfal St. 34371 Sisli, Istanbul, Turkey
| | - Canan Alkim
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Halaskargazi Av. Etfal St. 34371 Sisli, Istanbul, Turkey
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Boga S, Alkim H, Koksal AR, Ozagari AA, Bayram M, Tekin Neijmann S, Sen I, Alkim C. Serum ST2 in inflammatory bowel disease: a potential biomarker for disease activity. J Investig Med 2016; 64:1016-24. [PMID: 27001944 DOI: 10.1136/jim-2016-000062] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2016] [Indexed: 12/22/2022]
Abstract
ST2, a specific ligand of interleukin 33, was described as a biomarker protein of inflammatory processes and overexpression of ST2 in ulcerative colitis (UC) was shown previously. We aimed to investigate the potential relationship of serum ST2 levels with the clinical, endoscopic and histopathological activity scores in UC and Crohn's disease (CD). Serum ST2 levels were determined in 143 patients with inflammatory bowel disease (IBD) (83 UC and 60 CD), in 50 healthy controls (HC), and in 32 patients with irritable bowel syndrome (IBS). Serum ST2 levels were elevated in IBD (56.8 (41.9-87.2) pg/mL) compared to HC and IBS (30.7 (20.2-54.3), p<0.001 and 39.9 (25.9-68.7) pg/mL, p=0.002, respectively). No significant difference was found between UC (54.2 (41.3-93.0) pg/mL) and CD (63.8 (42.7-88.4) pg/mL) and between IBS and HC. Serum ST2 levels were significantly increased in active UC compared to inactive UC (72.5 (44.1-99.5) vs 40.0 (34.7-51.6) pg/mL, p<0.001) and in active CD in comparison with inactive CD (63.8 (42.7-88.4) vs 48.4 (29.6-56.9) pg/mL, p=0.036). Patients with CD showing fistulizing behavior had significantly higher ST2 levels compared to patients with inflammatory and stricturing CD (p<0.001). Clinical activity scores of patients with UC and CD were correlated with serum ST2 levels (r=0.692, p<0.001 and r=0.242, p=0.043, respectively). Serum ST2 levels showed stepwise increases with the increasing histopathological scores of patients with UC and CD (p<0.001 for both). The present study highlights significant associations between ST2 and IBD presence and activity and demonstrates elevated serum ST2 levels in patients with active CD as a novel finding.
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Affiliation(s)
- Salih Boga
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Huseyin Alkim
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Ali Riza Koksal
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Ayse Aysim Ozagari
- Department of Pathology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Bayram
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Sebnem Tekin Neijmann
- Department of Biochemistry, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Ilker Sen
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Canan Alkim
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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Alkim H, Koksal AR, Boga S, Sen I, Alkim C. Etiopathogenesis, Prevention, and Treatment of Thromboembolism in Inflammatory Bowel Disease. Clin Appl Thromb Hemost 2016; 23:501-510. [DOI: 10.1177/1076029616632906] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The close relationship between inflammation and thrombosis affects the progression and severity of inflammatory bowel disease (IBD). The prevalence of venous thromboembolism (VTE) varies between 1% and 7% among patients with IBD. The VTE risk in patients with IBD is at least 3 times higher than that in the normal general population. The absolute risk is very high during hospitalization, active disease, and surgery. The IBD-related VTE occurs at younger ages and recurs more frequently. The development of thrombosis in IBD is due to the interaction of many hereditary and acquired risk factors. Each patient diagnosed with IBD should be evaluated for a personal and family history of thrombosis and for prothrombotic drug use. Although procoagulant factors are increased during the natural course of inflammation, natural anticoagulants and fibrinolytic activity are decreased. Although IBD is accepted as a prothrombotic condition, there is no treatment that can remove this risk from daily practice. Patient training is required to control important factors, such as long-term immobilization and smoking. Oral contraceptives and hormone replacement therapy should be avoided. Inducing permanent disease remission must be the key approach for the prevention of thrombosis. Low-molecular-weight heparin (LMWH) is the basis of prophylactic treatment, which reduces the thrombosis risk by 50%. Prophylaxis with LMWH should be administered to all patients with IBD hospitalized due to disease attack or surgery. Long-term or even life-long anticoagulation therapy should be planned if there is insufficient disease control, recurrent VTE attacks, positive thrombophilia tests, or thrombosis in vital veins.
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Affiliation(s)
- Huseyin Alkim
- Department of Gastroenterology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ali Riza Koksal
- Department of Gastroenterology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Salih Boga
- Department of Gastroenterology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ilker Sen
- Department of Gastroenterology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Canan Alkim
- Department of Gastroenterology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Boga S, Koksal AR, Alkim H, Yilmaz Ozguven MB, Bayram M, Ergun M, Sisman G, Tekin Neijmann S, Alkim C. Plasma Pentraxin 3 Differentiates Nonalcoholic Steatohepatitis (NASH) from Non-NASH. Metab Syndr Relat Disord 2015; 13:393-9. [PMID: 26367098 DOI: 10.1089/met.2015.0046] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) includes a variety of histopathological findings ranging from simple steatosis to nonalcoholic steatohepatitis (NASH) which can only be differentiated by liver biopsy. There is yet no unique biomarker found to discriminate NASH from simple steatosis.We aimed to investigate the relationship of plasma pentraxin 3 (PTX3) and its main stimulant tumor necrosis factor alpha (TNF-α) with the degree of liver damage in NAFLD. METHODS Plasma PTX3 and TNF-α levels were measured in 70 patients with histologically verified NAFLD (56 with NASH, 14 with non-NASH) and 12 controls. RESULTS PTX3 and TNF-α levels were found significantly higher in the NAFLD group than in the control group (4.1 ± 2.3 vs. 1.3 ± 0.8 ng/mL, P < 0.001, and 7.6 ± 4.1 vs. 3.3 ± 1.3 pg/mL, P < 0.001 respectively) and in biopsy proven NASH subgroup than non-NASH subgroup (4.6 ± 2.2 vs. 2.2 ± 1.7 ng/mL, P = 0.001, and 8.3 ± 4.3 vs. 4.6 ± 1.6 pg/mL, P = 0.001 respectively). To discriminate NASH from non-NASH PTX3 had 91.1% sensitivity and 71.4% specificity at the cutoff value of 2.45 ng/mL. Plasma PTX3 levels showed correlation with NAFLD activity score, fibrosis stage and steatosis grade (r = 0.659, P < 0.001; r = 0.354, P < 0.01; and r = 0.455, P < 0.001, respectively). CONCLUSION This study demonstrated markedly higher PTX3 levels in NAFLD patients compared with controls, and in biopsy proven NASH patients compared with non-NASH ones. Thus, in this cohort we showed that plasma PTX3 may be a promising biomarker for the presence of NASH.
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Affiliation(s)
- Salih Boga
- 1 Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital , Istanbul, Turkey
| | - Ali Riza Koksal
- 1 Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital , Istanbul, Turkey
| | - Huseyin Alkim
- 1 Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital , Istanbul, Turkey
| | | | - Mehmet Bayram
- 1 Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital , Istanbul, Turkey
| | - Meltem Ergun
- 1 Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital , Istanbul, Turkey
| | - Gurhan Sisman
- 3 Department of Gastroenterology, Istanbul Education and Research Hospital , Istanbul, Turkey
| | - Sebnem Tekin Neijmann
- 4 Department of Biochemistry, Bakirkoy Dr. Sadi Konuk Education and Research Hospital , Istanbul, Turkey
| | - Canan Alkim
- 1 Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital , Istanbul, Turkey
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Boga S, Koksal AR, Alkim H, Ergun M, Bayram M, Ozagari AA, Alkim C. Does anatomical distribution of colorectal polyps show a rightward shift? Analysis of 2,372 colorectal polyps in 1,558 patients from Turkey. J Gastrointestin Liver Dis 2015; 24:126-127. [PMID: 25822446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Salih Boga
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey.
| | - Ali Riza Koksal
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Huseyin Alkim
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Meltem Ergun
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Bayram
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Ayse Aysim Ozagari
- Department of Pathology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Canan Alkim
- Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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Koksal AR, Boga S, Alkim H, Ergun M, Bayram M, Sakiz D, Ozdogan O, Altinkaya E, Alkim C. How does a biopsy of endoscopically normal terminal ileum contribute to the diagnosis? Which patients should undergo biopsy? Libyan J Med 2014; 9:23441. [PMID: 24560378 PMCID: PMC3930941 DOI: 10.3402/ljm.v9.23441] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/10/2014] [Accepted: 01/11/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Terminal ileum endoscopy and biopsy are the diagnostic tools of diseases attacking the ileum. However, abnormal histological findings can be found in endoscopically normal terminal ileum. OBJECTIVE This study was performed to evaluate the histopathological results of biopsies from endoscopically normal terminal ileum in order to determine pre-procedure clinical and laboratory factors predicting abnormal histopathological results, if any. METHODS A total of 297 patients who underwent colonoscopy and terminal ileum biopsy and had normal terminal ileum or a few aphthous ulcers in the terminal ileum together with completely normal colon mucosa were included in the study. The patients were grouped into two arms as normal cases and cases with aphthous ulcers. Histopathological and pre-procedural laboratory results of patients were analyzed according to their indications. RESULTS The terminal ileum was endoscopically normal in 200 patients, and 97 patients had aphthous ulcers. Chronic ileitis rate was present in 5.5% of those with endoscopically normal terminal ileum and in 39.2% of the patients with aphthous ulcers. In both groups, the highest rate of chronic ileitis was detected in the patients with known inflammatory bowel disease (IBD) (15.4 and 50%, respectively), anemia (9.5 and 43.5%, respectively), and in the patients having chronic diarrhea together with abdominal pain (7.7 and 44.8%, respectively). We found that the sensitivity of mean platelet volume for predicting chronic ileitis was 87% and the specificity was 45% at a cut-off value lower than 9.35 fl. CONCLUSION In anemia indication or chronic diarrhea together with abdominal pain, the frequency of aphthous ulcers detected by ileoscopy and the frequency of chronic ileitis detected histopathologically despite a normal-appearing ileum were elevated.
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Affiliation(s)
- Ali Riza Koksal
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey;
| | - Salih Boga
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Huseyin Alkim
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Meltem Ergun
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Bayram
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Damlanur Sakiz
- Department of Pathology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Osman Ozdogan
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Engin Altinkaya
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Canan Alkim
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
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11
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Köksal AR, Alkim H, Ergun M, Boga S, Bayram M, Alkim C, Eryilmaz OT. First case of T-cell/histiocyte-rich-large B-cell lymphoma presenting with duodenal obstruction. Libyan J Med 2013; 8:22955. [PMID: 24345670 PMCID: PMC3866841 DOI: 10.3402/ljm.v8i0.22955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
MESH Headings
- Abdominal Pain/etiology
- Adult
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/administration & dosage
- Disease-Free Survival
- Doxorubicin/administration & dosage
- Duodenal Obstruction/complications
- Duodenal Obstruction/etiology
- Gastroscopy
- Histiocytes/pathology
- Humans
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Nausea/etiology
- Positron-Emission Tomography
- Prednisone/administration & dosage
- Remission Induction
- Rituximab
- T-Lymphocytes/pathology
- Treatment Outcome
- Vincristine/administration & dosage
- Vomiting/etiology
- Weight Loss
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Affiliation(s)
- Ali Riza Köksal
- Department of Gastroenterology Sisli Etfal Education and Research Hospital Istanbul, Turkey;
| | - Huseyin Alkim
- Department of Gastroenterology Sisli Etfal Education and Research Hospital Istanbul, Turkey
| | - Meltem Ergun
- Department of Gastroenterology Sisli Etfal Education and Research Hospital Istanbul, Turkey
| | - Salih Boga
- Department of Gastroenterology Sisli Etfal Education and Research Hospital Istanbul, Turkey
| | - Mehmet Bayram
- Department of Gastroenterology Sisli Etfal Education and Research Hospital Istanbul, Turkey
| | - Canan Alkim
- Department of Gastroenterology Sisli Etfal Education and Research Hospital Istanbul, Turkey
| | - Ozlem Ton Eryilmaz
- Department of Gastroenterology Sisli Etfal Education and Research Hospital Istanbul, Turkey
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12
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Alkim C, Sakiz D, Alkim H, Livaoglu A, Kendir T, Demirsoy H, Erdem L, Akbayir N, Sokmen M. Thrombospondin-1 and VEGF in inflammatory bowel disease. Libyan J Med 2012; 7:LJM-7-8942. [PMID: 22299021 PMCID: PMC3269884 DOI: 10.3402/ljm.v7i0.8942] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 12/20/2011] [Accepted: 12/29/2011] [Indexed: 12/17/2022] Open
Abstract
Background and aim Angiogenesis is an important process in the pathogenesis of chronic inflammation. We aimed to study the angiogeneic balance in inflammatory bowel disease (IBD) by evaluating the expression of vascular endothelial growth factor (VEGF) and thrombospondin-1 (TSP-1) on colonic epithelial cells, together with the expression of inducible nitric oxide synthase (iNOS). Methods Twenty-one ulcerative colitis (UC), 14 Crohn's disease (CD), 11 colorectal cancer patients, and 11 healthy controls colonic biopsy samples were evaluated immunohistochemically. Results The expressions of TSP-1, VEGF, and iNOS in UC and CD groups were higher than expression in healthy control group, all with statistical significance. However, in colorectal cancer group, VEGF and iNOS expressions were increased importantly, but TSP-1 expression was not statistically different from healthy control group's expression. Both TSP-1 and VEGF expressions were correlated with iNOS expression distinctly but did not correlate with each other. Conclusions Both pro-angiogeneic VEGF and antiangiogeneic TSP-1 expressions were found increased in our IBD groups, but in colorectal cancer group, only VEGF expression was increased. TSP-1 increases in IBD patients as a response to inflammatory condition, but this increase was not enough to suppress pathologic angiogenesis and inflammation in IBD.
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Affiliation(s)
- Canan Alkim
- Department of Gastroenterology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
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13
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Alkim H, Iscan M. Desloratadine Induced Pill Esophagitis. Gastroenterology Res 2012; 5:37-38. [PMID: 27785177 PMCID: PMC5051040 DOI: 10.4021/gr398w] [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: 02/08/2012] [Indexed: 11/21/2022] Open
Abstract
Pill induced esophagitis is a rare complication mostly seen in patients using tetracycline and its derivatives or non-steroidal anti-inflammatory drugs. Here we present a 37 years old female patient experiencing pill esophagitis after taking desloratadine without liquid immediately before going to bed. This was the first pill esophagitis case related with desloratadine reported in the literature. Pill esophagitis is a preventable complication that consists of giving simple advice of how and when to take medication.
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Affiliation(s)
- Huseyin Alkim
- Gastroenterology Specialist, Alman Hospital, Gastroenterology Department, Istanbul, Turkey
- Corresponding author: Huseyin Alkim, Nisantasi Ihlamur Yolu No: 51-1, Unsal Karahan Sitesi, C Blok, D: 49, 34363 Tesvikiye, Sisli, Istanbul, Turkey.
| | - Mustafa Iscan
- Gastroenterology Specialist, Alman Hospital, Gastroenterology Department, Istanbul, Turkey
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14
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Alkim H, Ayaz S, Sasmaz N, Oguz P, Sahin B. Hemostatic Abnormalities in Cirrhosis and Tumor-Related Portal Vein Thrombosis. Clin Appl Thromb Hemost 2011; 18:409-15. [DOI: 10.1177/1076029611427900] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Huseyin Alkim
- Gastroenterology Department, Bakırkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Selime Ayaz
- Hematology Department, Turkey High Specialty Hospital, Ankara, Turkey
| | - Nurgul Sasmaz
- Gastroenterology Department, Turkey High Specialty Hospital, Ankara, Turkey
| | - Perihan Oguz
- Gastroenterology Department, Turkey High Specialty Hospital, Ankara, Turkey
| | - Burhan Sahin
- Gastroenterology Department, Turkey High Specialty Hospital, Ankara, Turkey
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15
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Alkim H, Iscan M, Oz F. Effectiveness of ranitidine bismuth citrate and proton pump inhibitor based triple therapies of Helicobacter pylori in Turkey. Libyan J Med 2011; 6:LJM-6-8412. [PMID: 21912572 PMCID: PMC3171195 DOI: 10.3402/ljm.v6i0.8412] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 08/09/2011] [Indexed: 12/15/2022] Open
Abstract
Background Helicobacter pylori infection is the main cause of gastritis, gastroduodenal ulcer disease, MALT lymphoma, and adenocarcinoma of the stomach. The reported prevalence of H. pylori in the adult population in Turkey is 67.6%–81.3%. A national meta-analysis showed that the average H. pylori eradication rate with proton pump inhibitor-based triple regimens in Turkey had decreased from 84% in 1997 to 55.3% in 2004, suggesting a need to evaluate alternative regimens. Materials and methods The study was a prospective, single-center trial with a parallel group design. After the selection procedure, consecutive out-patients were assigned to one of six study groups using random sampling numbers. All patients received amoxicillin 1,000 mg b.i.d. and clarithromycin 500 mg b.i.d. along with ranitidine bismuth citrate 400 mg b.i.d., or omeprazole 20 mg b.i.d., or lansoprazole 30 mg b.i.d., or rabeprazole 20 mg b.i.d., or pantoprazole 40 mg b.i.d., or esomeprazole 40 mg b.i.d. for 14 days. Results When we look at the eradication rates of the treatment groups, only two groups (ranitidine bismuth citrate and rabeprazole groups) had eradication rates greater than 80%, both at intention to treat and per protocol analyses. The other four groups (omeprazole, lansoprazole, pantoprazole, and esomeprazole groups) showed statistically significant lower eradication rates both at intention to treat (between 57.6 and 66.7%) and per protocol (between 60.3 and 72.1%) analyses when compared with ranitidine bismuth citrate and rabeprazole groups (p<.05). Conclusion Ranitidine bismuth citrate and/or rabeprazole based triple therapies must be preferred for the first-line treatment of H. pylori infection.
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Affiliation(s)
- Huseyin Alkim
- Department of Gastroenterology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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16
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Alkim H, Ayaz S, Alkim C, Ulker A, Sahin B. Continuous active state of coagulation system in patients with nonthrombotic inflammatory bowel disease. Clin Appl Thromb Hemost 2011; 17:600-4. [PMID: 21593018 DOI: 10.1177/1076029611405034] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This study was planned for searching possible changes of the total coagulation and fibrinolysis system in inflammatory bowel disease (IBD) in order to obtain some clues for explaining the relation between IBD and hypercoagulability. A total of 24 patients with ulcerative colitis, 12 patients with Crohn disease, and 20 healthy controls were studied. Platelets; prothrombin time (PT); partial thromboplastin time (PTT); fibrinogen; D-dimer; fibrinogen degradation products; protein C; protein S; antithrombin; thrombin time; von Willebrand factor; coagulation factors V, VII, VIII, IX, XI, and XIII; plasminogen; antiplasmin; tissue plasminogen activator; plasminogen activator inhibitor 1; and prothrombin fragments 1 + 2 were studied. Most of the procoagulants (platelets, fibrinogen, von Willebrand factor, coagulation factor IX, and plasminogen activator inhibitor 1) were found increased together with decreases in some anticoagulants (protein S and antithrombin) in IBD. Also the activation markers of coagulation (D-dimer, fibrinogen degradation products, and prothrombin fragments 1 + 2) were all increased. The parameters of the total coagulation-fibrinolysis system were increased in IBD, regardless of the form and the activity of the disease.
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Affiliation(s)
- Huseyin Alkim
- Bakırkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
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17
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Alkim C, Savas B, Ensari A, Alkim H, Dagli U, Parlak E, Ulker A, Sahin B. Expression of p53, VEGF, microvessel density, and cyclin-D1 in noncancerous tissue of inflammatory bowel disease. Dig Dis Sci 2009; 54:1979-84. [PMID: 19034659 DOI: 10.1007/s10620-008-0554-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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: 03/19/2008] [Accepted: 09/26/2008] [Indexed: 12/13/2022]
Abstract
We aimed to evaluate the carcinogenesis risk in inflammatory bowel disease via p53 mutation and its relation with hyperproliferation (cyclin-D1) and angiogenesis (with vascular endothelial growth factor [VEGF] and microvessel density) and whether these events play important roles in pathogenesis of inflammatory bowel disease. Colonic tissue samples of 26 ulcerative colitis, 6 Crohn's disease, and 8 amoebic colitis patients as well as samples of 10 healthy controls were stained with p53, cyclin-D1, CD34, and VEGF monoclonal antibodies by immunohistochemistry and evaluated semiquantitatively. Expression of p53 was higher in ulcerative colitis than in the healthy control and amoebic colitis groups (4.15 +/- 2.07, 1.4 +/- 1.5, 1.3 +/- 1.5; P < 0.001). The Crohn's disease group had the highest p53 expression (4.6 +/- 1.6). The Crohn's disease, ulcerative colitis, and amoebic colitis groups all had higher VEGF expression than did the healthy controls (respectively, 4.3 +/- 1.2, 2.92 +/- 2.0, 2.3 +/- 1.5, 0.6 +/- 0.97; P < 0.001). Also, microvessel density was statistically higher in all three colitis groups than in healthy controls. Cyclin-D1 expression in all four groups was similar. The study showed that p53 mutation was present in nonneoplastic mucosa of inflammatory bowel disease patients. Detecting strong p53 overexpression with VEGF overexpression may help in differentiating inflammatory bowel disease from other colitis.
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Affiliation(s)
- Canan Alkim
- Gastroenterology Department, Sisli Etfal Research and Training Hospital, Istanbul, Turkey.
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18
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Abstract
This study was designed to determine the possible effects of omeprazole on human natural killer cells. Peripheral venous blood samples were taken from 20 peptic ulcer patients before and at the 14th and the 28th days of omeprazole treatment. Mononuclear cells were removed from blood and their capability of making conjugation with K562 target cells and lysing K562 target cells was evaluated. A significant decrease was found (P < 0.001) in the 14th and the 28th days compared with the basal value of the capability of the mononuclear cells to conjugate with the K562 target cells and to lyse them. This study demonstrated that omeprazole significantly reduces natural killer cell functions. This finding suggests that omeprazole may also have some effects on the other systems in addition to parietal cell acid secretion.
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Affiliation(s)
- Huseyin Alkim
- Department of Gastroenterology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Affiliation(s)
- M Akdoğan
- Department of Gastroenterology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey
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20
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Alkim C, Saşmaz N, Alkim H, Cağlikülekçi M, Turhan N. Sonographic findings in intussusception caused by a lipoma in the muscular layer of the colon. J Clin Ultrasound 2001; 29:298-301. [PMID: 11486326 DOI: 10.1002/jcu.1038] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Lipomas of the gastrointestinal tract are uncommon tumors. Almost all gastrointestinal lipomas are submucosal or subserosal, and most are asymptomatic, although they may cause abdominal pain, bowel obstruction, and gastrointestinal bleeding. The diagnosis of gastrointestinal lipoma is usually not made before surgery. We present a case of colonic intussusception caused by a lipoma that was located in the muscular layer of the colon and was diagnosed preoperatively by sonography. The descending colon appeared edematous and thick. There was layering within the lumen of the descending colon, mimicking the target sign. At the distal end of the intussusception, there was a 4.7-cm, hyperechoic, rounded lesion with a smooth margin. Surgery revealed a polypoid mass originating from the splenic flexure and causing intussusception of the colon, and pathologic analysis confirmed the diagnosis of lipoma of the muscular layer of the colon.
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Affiliation(s)
- C Alkim
- Department of Gastroenterology, Türkiye Yüksek Ihtisas Hospital, Sihhiye Street, Sihhiye, 06100 Ankara, Turkey
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Abstract
Behçet's disease is a chronic, recurrent, systemic disease characterized by orogenital ulcers and oculocutaneous inflammatory lesions. Cardiovascular, pulmonary, neurological, articular, and GI involvement are common features, but pancreatic involvement is very rare. We present a case of Behçet's disease with both chronic pancreatitis and abdominal aorta pseudoaneurysm.
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Affiliation(s)
- H Alkim
- Türkiye Yüsek Ihtisas Hospital, Ankara, Turkey
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Abstract
OBJECTIVE To report a case of propylthiouracil-induced hepatic damage. CASE SUMMARY A 64-year-old white woman with hyperthyroidism received propylthiouracil 250 mg/d for 1 year. She developed hepatitis after 1 year of therapy. Alcohol and drug abuse were ruled out and all serologic tests for hepatitis A, B, and C were negative. Cytomegalovirus and Epstein-Barr virus infection were also ruled out. Antinuclear antibody, antimitochondrial antibody, and antismooth muscle antibody were negative. The clinical picture was similar to that of viral hepatitis characterized by nausea, vomiting, and jaundice. Histologic examination of a liver biopsy specimen showed chronic active hepatitis. The patient developed cirrhosis during follow-up. DISCUSSION Propylthiouracil is widely used in the treatment of hyperthyroidism. Despite its widespread use, there have been only a few reported cases of propylthiouracil-induced hepatotoxicity. The precise mechanism of the injury is unknown, although immunologic factors are suggested. CONCLUSIONS Hepatic damage induced by propylthiouracil is a rare complication. However, the danger of permanent hepatic damage should be kept in mind. The best way of preventing propylthiouracil hepatotoxicity is careful screening of patients considered for treatment.
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Affiliation(s)
- S Ozenírler
- Department of Medicine, University of Gazi, Ankara, Turkey
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