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Polat G, Kani HT, Ergenc I, Ozen Alahdab Y, Temizel A, Atug O. Improving the Computer-Aided Estimation of Ulcerative Colitis Severity According to Mayo Endoscopic Score by Using Regression-Based Deep Learning. Inflamm Bowel Dis 2023; 29:1431-1439. [PMID: 36382800 DOI: 10.1093/ibd/izac226] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Assessment of endoscopic activity in ulcerative colitis (UC) is important for treatment decisions and monitoring disease progress. However, substantial inter- and intraobserver variability in grading impairs the assessment. Our aim was to develop a computer-aided diagnosis system using deep learning to reduce subjectivity and improve the reliability of the assessment. METHODS The cohort comprises 11 276 images from 564 patients who underwent colonoscopy for UC. We propose a regression-based deep learning approach for the endoscopic evaluation of UC according to the Mayo endoscopic score (MES). Five state-of-the-art convolutional neural network (CNN) architectures were used for the performance measurements and comparisons. Ten-fold cross-validation was used to train the models and objectively benchmark them. Model performances were assessed using quadratic weighted kappa and macro F1 scores for full Mayo score classification and kappa statistics and F1 score for remission classification. RESULTS Five classification-based CNNs used in the study were in excellent agreement with the expert annotations for all Mayo subscores and remission classification according to the kappa statistics. When the proposed regression-based approach was used, (1) the performance of most of the models statistically significantly increased and (2) the same model trained on different cross-validation folds produced more robust results on the test set in terms of deviation between different folds. CONCLUSIONS Comprehensive experimental evaluations show that commonly used classification-based CNN architectures have successful performance in evaluating endoscopic disease activity of UC. Integration of domain knowledge into these architectures further increases performance and robustness, accelerating their translation into clinical use.
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Affiliation(s)
- Gorkem Polat
- Graduate School of Informatics, Middle East Technical University, Ankara, Turkey
- Neuroscience and Neurotechnology Center of Excellence, Middle East Technical University, Ankara, Turkey
| | - Haluk Tarik Kani
- Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ilkay Ergenc
- Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Yesim Ozen Alahdab
- Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Alptekin Temizel
- Graduate School of Informatics, Middle East Technical University, Ankara, Turkey
- Neuroscience and Neurotechnology Center of Excellence, Middle East Technical University, Ankara, Turkey
| | - Ozlen Atug
- Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey
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Ergenç İ, Kani HT, Karabacak M, Cömert Özer E, Mehdiyev S, Jafarov F, Abacar KY, Kutluğ Ağaçkıran S, Sevik G, Aslan R, Alibaz Öner F, İnanç N, Atagündüz MP, Seçkin D, Özen Alahdab Y, Ergun T, Direskeneli H, Atuğ Ö, Atug O. RE: Risk of HBV Reactivation in HBsAg Negative and AntiHBc IgG Positive Patients Receiving Biologic Therapy. Turk J Gastroenterol 2023; 34:310. [PMID: 36919837 PMCID: PMC10152175 DOI: 10.5152/tjg.2023.237002] [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] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- İlkay Ergenç
- Department of Internal Medicine, Division of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Haluk Tarık Kani
- Department of Internal Medicine, Division of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Murat Karabacak
- Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Elif Cömert Özer
- Department of Dermatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Shahin Mehdiyev
- Department of Internal Medicine, Division of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Fuad Jafarov
- Department of Internal Medicine, Division of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Kerem Yiğit Abacar
- Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Seda Kutluğ Ağaçkıran
- Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Gizem Sevik
- Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Rahmi Aslan
- Department of Internal Medicine, Division of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Fatma Alibaz Öner
- Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Nevsun İnanç
- Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Mehmet Pamir Atagündüz
- Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Dilek Seçkin
- Department of Dermatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Yeşim Özen Alahdab
- Department of Internal Medicine, Division of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Tülin Ergun
- Department of Dermatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Haner Direskeneli
- Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Özlen Atuğ
- Department of Internal Medicine, Division of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
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Ergenç İ, Kani HT, Karabacak M, Cömert Özer E, Mehdiyev S, Jafarov F, Abacar KY, Kutluğ Ağaçkıran S, Sevik G, Aslan R, Alibaz Öner F, İnanç N, Atagündüz MP, Seçkin D, Özen Alahdab Y, Ergun T, Direskeneli H, Atuğ Ö, Atug O. Biologic Therapy Carries a Very Low Risk of Reactivation in Hepatitis B Surface Antigen-Negative Phase of Hepatitis B. Turk J Gastroenterol 2023; 34:156-160. [PMID: 36445058 PMCID: PMC10081030 DOI: 10.5152/tjg.2022.22196] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The risk of hepatitis B reactivation in hepatitis B surface antigen-negative phase of hepatitis B virus-infected patients exposed to biologic agents is not clear. We aimed to investigate the reactivation rate in hepatitis B surface antigen-negative phase of hepatitis B virus-infected patients after biologic therapy. METHODS Patients followed at gastroenterology, rheumatology, and dermatology clinics with a diagnosis of immune-mediated inflam matory diseases were screened. Immune-mediated inflammatory diseases patients exposed to biologic agents with a negative hepatitis B surface antigen and positive hepatitis B core immunoglobulin G antibody were included in the study. RESULTS We screened 8266 immune-mediated inflammatory disease patients, and 2484 patients were identified as exposed to biologic agents. Two hundred twenty-one patients were included in the study. The mean age was 54.08 ± 11.69 years, and 115 (52.0%) patients were female. The median number of different biologic subtype use was 1 (range: 1-6). The mean biologic agent exposure time was 55 (range: 2-179) months. One hundred and fifty-two (68.8%) patients used a concomitant immunomodulatory agent, and 84 (38.0%) patients were exposed to corticosteroids during biologic use. No hepatitis B reactivation with a reverse seroconversion of hepatitis B surface antigen positivity was seen. Antiviral prophylaxis for hepatitis B was applied to 48 (21.7%) patients. Hepatitis B virus-DNA was screened in 56 (25.3%) patients prior to the biologic exposure. Two patients without antiviral prophylaxis had hepatitis B virus-DNA reactivation with a negative hepatitis B surface antigen during exposure to the biologic agent. CONCLUSION We found 2 reactivations and no hepatitis B surface antigen seroconversion in our cohort. Antiviral prophylaxis for patients exposed to biologic agents may need to be discussed in more detail.
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Affiliation(s)
- İlkay Ergenç
- Division of Gastroenterology, Department of Internal Medicine, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Haluk Tarık Kani
- Division of Gastroenterology, Department of Internal Medicine, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Murat Karabacak
- Division of Rheumatology, Department of Internal Medicine, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Elif Cömert Özer
- Department of Dermatology, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Shahin Mehdiyev
- Division of Gastroenterology, Department of Internal Medicine, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Fuad Jafarov
- Division of Gastroenterology, Department of Internal Medicine, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Kerem Yiğit Abacar
- Division of Rheumatology, Department of Internal Medicine, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Seda Kutluğ Ağaçkıran
- Division of Rheumatology, Department of Internal Medicine, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Gizem Sevik
- Division of Rheumatology, Department of Internal Medicine, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Rahmi Aslan
- Division of Gastroenterology, Department of Internal Medicine, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Fatma Alibaz Öner
- Division of Rheumatology, Department of Internal Medicine, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Nevsun İnanç
- Division of Rheumatology, Department of Internal Medicine, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Pamir Atagündüz
- Division of Rheumatology, Department of Internal Medicine, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Dilek Seçkin
- Department of Dermatology, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Yeşim Özen Alahdab
- Division of Gastroenterology, Department of Internal Medicine, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Tülin Ergun
- Department of Dermatology, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Haner Direskeneli
- Division of Rheumatology, Department of Internal Medicine, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Özlen Atuğ
- Division of Gastroenterology, Department of Internal Medicine, Marmara University Faculty of Medicine, İstanbul, Turkey
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Toruner M, Basaranoglu M, Atug O, Senturk O, Akyuz F, Cekic C, Over Hamzaoglu H, Tekin F, Sezgin O, Akpinar H, Celik AF, Tezel A, Gokturk HS, Kav T. Improvement of Work Productivity and Quality of Life with Anti-Tumor Necrosis Factor Treatment Used in Crohn's Disease in Routine Clinical Practice in Turkey. Turk J Gastroenterol 2022; 33:406-413. [PMID: 35678798 DOI: 10.5152/tjg.2022.21868] [Citation(s) in RCA: 1] [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: 06/15/2023]
Abstract
BACKGROUND Patients with Crohn's disease experience major deterioration in work productivity and quality of life. We aimed to provide the long-term effects of anti-tumor necrosis factor agents on work productivity and activity impairment and quality of life in patients with Crohn's disease using the Inflammatory Bowel Disease Questionnaire and the Short-Form Health Survey-36. METHODS Patients with Crohn's disease and initiated an anti-tumor necrosis factor treatment were included and followed up for 12 months in this observational study. RESULTS A total of 106 patients were included in this study, and 64.2% of the patients were males. Mean [± standard deviation] age was 36.8 [± 10.9] years. At baseline, mostly perianal fistulas [65.7%] were observed [n = 23]. Intestinal stenosis was detected in 34.9% of the patients [n = 37], and most of the stenosis was located in the ileum [70.6%] followed by the colon [20.6%]. Extraintestinal symp- toms were observed in 24 patients [22.6%]. Most frequent extraintestinal symptom was arthritis with 71.4% [n = 15]. Mean time from first symptom to initiation of anti-tumor necrosis factor treatment was 6.3 [± 5.0] years. Improvements in work productivity and activ- ity impairment scores throughout 12 months were -24.1% [P = .003] for work time missed, -18.0% [P = .006] for impairment at work, -8.5% [P = .160] for overall work impairment, and -17.0% [P < .001] for daily activity impairment. Similarly, significant improvements [P < .001] were detected in all components of the Inflammatory Bowel Disease Questionnaire when compared to baseline. Statistically sig- nificant improvements [P < .05] were detected for all components of Short-Form Health Survey-36 except for mental health [P = .095]. CONCLUSION Our study indicates the significant improvement in work productivity and activity impairment and quality of life of patients with Crohn's disease who receive long-term anti-tumor necrosis factor treatment.
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Affiliation(s)
- Murat Toruner
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ibn-i Sina Hospital, Ankara, Turkey
| | - Metin Basaranoglu
- Department of Gastroenterology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Ozlen Atug
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
| | - Omer Senturk
- Department of Gastroenterology, Kocaeli University Faculty of Medicine, Izmit, Turkey
| | - Filiz Akyuz
- Department of Gastroenterology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Cem Cekic
- Department of Gastroenterology, Izmir Katip Celebi University, Izmir, Turkey
| | | | - Fatih Tekin
- Department of Gastroenterology, Ege University Medical School, Izmir, Turkey
| | - Orhan Sezgin
- Department of Gastroenterology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Hale Akpinar
- Department of Gastroenterology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Aykut Ferhat Celik
- Department of Gastroenterology, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
| | - Ahmet Tezel
- Department of Gastroenterology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Huseyin Savas Gokturk
- Department of Gastroenterology, Baskent University Faculty of Medicine, Konya, Turkey
| | - Taylan Kav
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey
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Alibaz-Oner F, Ergelen R, Ergenc I, Seven G, Yazıcı A, Cefle A, Bes C, Atug O, Direskeneli H. Femoral Vein Wall Thickness Measurement May Be a Distinctive Diagnostic Tool to Differentiate Behçet's Disease with Intestinal Involvement and Crohn's Disease. Dig Dis Sci 2021; 66:2750-2755. [PMID: 32926263 DOI: 10.1007/s10620-020-06587-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/29/2020] [Accepted: 08/25/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUNDS Behçet's disease (BD) and Crohn's disease (CD) cannot be easily differentiated in young adults presenting with nonspecific gastrointestinal (GI) manifestations due to similar extraintestinal manifestations. We recently showed that increased common femoral vein (CFV) thickness is a distinctive feature of BD, rarely present in other inflammatory or vascular diseases with a specificity higher than 80% for the cutoff value of ≥ 0.5 mm. We suggest that CFV thickness measurement with ultrasonography (US) can be a diagnostic tool for BD. AIMS To assess the diagnostic performance of CFV thickness measurement in the differential diagnosis of BD and CD. METHODS Patients with BD (n = 69), CD (n = 38), and healthy controls (HC) (n = 38) were included in the study. Bilateral CFV thickness was measured with Doppler US. RESULTS Both right and left CFV thicknesses were significantly higher in BD compared to HC and CD (for right: 0.76 mm vs 0.33 mm, for left: 0.78 mm vs 0.35 mm, p < 0.001 for both). CFV thicknesses in CD were similar to HC (p > 0.05 for both). CFV thickness was also similar between BD patients with and without GI involvement (p = 0.367). The diagnostic cutoff values of ≥ 0.5 mm for CFV thickness performed well against to both CD and HCs for discrimination of BD. The sensitivity and specificity rates were > 85% for both HC and CD. Positive and negative predictive values in our tertiary clinical setting were > 90%. CONCLUSION We found significantly lower CFV thickness in CD compared to BD. Our results suggest that CFV wall thickness measurement is a distinctive diagnostic tool for the differentiation of BD and CD and can be helpful in daily practice for the differentiation of two diseases.
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Affiliation(s)
- Fatma Alibaz-Oner
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Fevzi Çakmak Mahallesi, Ust-Kaynarca, Pendik, Istanbul, Turkey.
| | - Rabia Ergelen
- Department of Radiology, School of Medicine, Marmara University, Fevzi Çakmak Mahallesi, Ust-Kaynarca, Pendik, Istanbul, Turkey
| | - Ilkay Ergenc
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Marmara University, Fevzi Çakmak Mahallesi, Ust-Kaynarca, Pendik, Istanbul, Turkey
| | - Gizem Seven
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Fevzi Çakmak Mahallesi, Ust-Kaynarca, Pendik, Istanbul, Turkey
| | - Ayten Yazıcı
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ayse Cefle
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Cemal Bes
- Division of Rheumatology, Health Science University, Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Ozlen Atug
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Marmara University, Fevzi Çakmak Mahallesi, Ust-Kaynarca, Pendik, Istanbul, Turkey
| | - Haner Direskeneli
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Fevzi Çakmak Mahallesi, Ust-Kaynarca, Pendik, Istanbul, Turkey
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Zibandeh N, Genc D, Duran Y, Banzragch M, Sokwala S, Goker K, Atug O, Akkoç T. Human dental follicle mesenchymal stem cells alleviate T cell response in inflamed tissue of Crohn's patients. Turk J Gastroenterol 2020; 31:400-409. [PMID: 32519960 DOI: 10.5152/tjg.2020.19358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIMS Crohn's Disease (CD) is a chronic inflammatory condition characterized by various abnormalities that lead to overly aggressive T-cell responses. Our in vitro experiments aimed to investigate the potential use of Dental Follicle Mesenchymal Stem Cells (DF-MSCs) to suppress the exaggerated immune response in inflamed and non-inflamed tissue of Crohn's Disease (CD). MATERIAL AND METHODS Dental follicle tissues were obtained from extracted third molar teeth of 3 healthy volunteers who have no abscess or inflammatory diseases. Eleven patients included the experiment who had been diagnosed with CD and not received steroid maintenance therapy for more than 1 month. Mononuclear Cells (MNCs) were isolated from inflamed and non-inflamed tissue of CD. Isolated cells were stimulated with anti-CD3/anti-CD28 monoclonal antibodies in the presence and absence of DF-MSCs and analyzed for lymphocytes proliferation capacity and viability, T lymphocyte subsets, CD4+IL22BP and CD4+CD25+Foxp3+ regulatory T cell (Tregs) frequencies and cytokine levels. RESULTS A significant downregulation of lymphocyte proliferation and CD4+IL22BP T cell ratio were found in inflamed cultures with DF-MSCs (p<0,005). Also, the frequency of Tregs increased with DF-MSCs (p<0,05). Pro-inflammatory cytokine levels (TNF-α and IL-6) were decreased (p<0,05) and IL-10 levels were increased (p<0,05) in the supernatant of inflamed cultures. CONCLUSION DF-MSCs reduced the inflammatory immune response, induced Tregs and downregulated CD4+IL22BP T cell ratio in inflamed samples of CD patients, which may be exploited for significant therapeutic use.
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Affiliation(s)
- Noushin Zibandeh
- Division of Pediatric Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
| | - Deniz Genc
- Division of Pediatric Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yazgul Duran
- Division of Pediatric Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
| | - Munhtsetseg Banzragch
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
| | - Sakina Sokwala
- Division of Pediatric Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
| | - Kamil Goker
- Department of Oral and Maxillofacial Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Ozlen Atug
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
| | - Tunç Akkoç
- Division of Pediatric Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
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Alahdab YO, Demirtas CO, Kani HT, Tuney D, Seker L, Tolu T, Atug O. Clinical significance of isolated abnormal intestinal findings in magnetic resonance enterography in patients with suspected small bowel disease. Abdom Radiol (NY) 2020; 45:1036-1043. [PMID: 31686178 DOI: 10.1007/s00261-019-02297-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Magnetic resonance imaging (MRE) is a well-established adjunct diagnostic tool for the diagnosis of Crohn's Disease (CD), as ileocolonoscopy can sometimes be falsely reassuring when CD skips distal terminal ileum. We aimed to determine the frequency and clinical significance of isolated abnormal small bowel findings in MRE with normal ileal view in ileoscopy. METHODS We retrospectively reviewed findings from 1611 MRE studies that were conducted between 2012 and 2018 to detect patients bearing abnormal intestinal findings and having full ileocolonoscopy. After exclusion of normal or repetitive MRE scans and previously known CD, 147 patients with abnormal MRE detected. MRE scans were categorized as suspicious of CD and non-specific findings. RESULTS Out of 147 patients with abnormal MRE, 122 (83%) had terminal ileum involvement in MRE consistent with ileoscopy findings. Twenty-five (17%) patients were found to have solitarily abnormal intestinal findings in MRE with normal ileoscopy. Only 3 (12%) were diagnosed with CD initially, and all had MRE findings suspicious of CD. The remainder 40% (n = 10) were diagnosed with non-Crohn's small bowel disease after further investigation, while in the other 48% (n = 12) abnormal MRE findings could not be explained with any organic disease in the follow-up. CONCLUSION The present study demonstrated that only a small portion of patients with isolated abnormal intestinal findings in MRE is CD, and more than that are non-crohn's small bowel diseases. These findings, even if they carry the suspicion of CD, do not transform to CD in the long-term follow-up.
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Affiliation(s)
- Yesim Ozen Alahdab
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Coskun Ozer Demirtas
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey.
| | - Haluk Tarik Kani
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Davut Tuney
- Department of Radiology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Lamia Seker
- Department of Internal Medicine, Marmara University, School of Medicine, Istanbul, Turkey
| | - Tugba Tolu
- Department of Internal Medicine, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ozlen Atug
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
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Kani HT, Sakalli Kani A, Dural U, Basgoze E, Aksu C, Kahraman MM, Ozen Alahdab Y, Atug O, Kuscu K, Imeryuz N. The Effect of Dream Anxiety on Sleep Quality in Inflammatory Bowel Diseases. Dig Dis 2019; 38:380-389. [PMID: 31821999 DOI: 10.1159/000504748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/13/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Declining sleep quality is a well-known issue in inflammatory bowel disease (IBD), but dream characteristics of patients with IBD and their role in sleep quality are unknown. In this study, we aimed to examine whether and how patients with ulcerative colitis (UC) and Crohn's disease (CD) differ on sleep quality, sleepiness level, and dream anxiety (DA) level compared to healthy controls (HC), controlling for their depressive and anxious tendencies. METHODS Patients and HCs were enrolled prospectively into the study. The Van DA Scale, Pittsburg Sleep Quality Index, Epworth Sleepiness Scale, Beck Depression Index, and State-Trait Anxiety Inventories were used to assess DA, sleep quality, sleepiness, depression, and anxiety, respectively. RESULTS Patients with IBD had significantly lower depression (p = 0.004), state anxiety (p = 0.0001), trait anxiety (p = 0.004), and DA (p = 0.0001) than HCs. Although no statistically significant difference in sleep quality was found (p = 0.99), daytime sleepiness was more common in HCs than in IBD patients (p = 0.0001). No statistically significant difference was seen in depression, state anxiety, trait anxiety, DA, sleep quality, and daytime sleepiness between patients with CD and those with UC. No correlation was found between disease activity indices and psychological parameters. CONCLUSION In contrast to previous studies, this study found lower anxiety and depression levels in patients with IBD than in HCs. Moreover, DA score was higher in HCs. For the first time, we revealed that DA may be one of the factors leading to sleep disturbance in patients with IBD.
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Affiliation(s)
- Haluk Tarik Kani
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey,
| | - Ayse Sakalli Kani
- Department of Psychiatry, Marmara University, School of Medicine, Istanbul, Turkey
| | - Uzay Dural
- Department of Psychology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Emre Basgoze
- Department of Internal Medicine, Marmara University, School of Medicine, Istanbul, Turkey
| | - Cagri Aksu
- Marmara University, School of Medicine, Istanbul, Turkey
| | | | - Yesim Ozen Alahdab
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ozlen Atug
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Kemal Kuscu
- Department of Psychiatry, Marmara University, School of Medicine, Istanbul, Turkey
| | - Nese Imeryuz
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
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Kani HT, Dural U, Sakalli Kani A, Yanartas O, Kiziltas S, Yilmaz Enc F, Atug O, Deyneli O, Kuscu K, Imeryuz N. Evaluation of depression, anxiety, alexithymia, attachment, social support and somatization in functional dyspepsia. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1480081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Haluk Tarik Kani
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
| | - Uzay Dural
- Department of Psychology, Istanbul Medipol University, Istanbul, Turkey
| | - Ayse Sakalli Kani
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| | - Omer Yanartas
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| | - Safak Kiziltas
- Department of Gastroenterology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Feruze Yilmaz Enc
- Department of Gastroenterology, Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Ozlen Atug
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
| | - Oguzhan Deyneli
- Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey
| | - Kemal Kuscu
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| | - Nese Imeryuz
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
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Yanartas O, Kani HT, Bicakci E, Kilic I, Banzragch M, Acikel C, Atug O, Kuscu K, Imeryuz N, Akin H. The effects of psychiatric treatment on depression, anxiety, quality of life, and sexual dysfunction in patients with inflammatory bowel disease. Neuropsychiatr Dis Treat 2016; 12:673-83. [PMID: 27069364 PMCID: PMC4818049 DOI: 10.2147/ndt.s106039] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Depression and anxiety are common disorders in inflammatory bowel disease (IBD). Our aim is to prospectively determine the effect of psychiatric treatment on scores for depression, anxiety, quality of life (QoL), and sexual dysfunction in an outpatient population diagnosed with IBD and also anxiety and/or depression disorder. PATIENTS AND METHODS Patients who scored higher than the cutoff point on the Hospital Anxiety Depression Scale were referred for further structured psychiatric evaluation and determination of the need for psychiatric drug treatment. Patients who underwent drug therapy completed Short Form-36 (SF-36) and the Arizona Sexual Experience Scale at baseline and after 6 months of follow-up. RESULTS Major depressive disorder and generalized anxiety disorder were the most common diagnoses. After 6 months, 47 patients had completely adhered to drug treatment (group A), whereas 20 were nonadherent (group B). In group A, all domains of SF-36, Arizona Sexual Experience Scale, depression/anxiety scores, and Crohn's disease activity index were statistically improved after treatment when compared with the baseline. In group B, the three domains of SF-36, platelet count, and mean corpuscular volume were worse between baseline and at 6 months. CONCLUSION In IBD patients having any psychiatric disorder, 6 months of antidepressant drug treatment is associated with an improvement in depression, anxiety, QoL, and sexual functioning scores, as well as an improvement in Crohn's disease activity index. On the other hand, insufficient psychiatric treatment seems to be related to a poor QoL.
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Affiliation(s)
- O Yanartas
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| | - H T Kani
- Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - E Bicakci
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
| | - I Kilic
- Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - M Banzragch
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
| | - C Acikel
- Department of Public Health, Gulhane Military Medical Academy, Ankara, Turkey
| | - O Atug
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
| | - K Kuscu
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| | - N Imeryuz
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
| | - H Akin
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
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11
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Eren F, Kurt R, Ermis F, Atug O, Imeryuz N, Yilmaz Y. Preliminary evidence of a reduced serum level of fibroblast growth factor 19 in patients with biopsy-proven nonalcoholic fatty liver disease. Clin Biochem 2012; 45:655-8. [PMID: 22465275 DOI: 10.1016/j.clinbiochem.2012.03.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 01/25/2012] [Accepted: 03/10/2012] [Indexed: 12/28/2022]
Abstract
OBJECTIVES We sought to determine whether serum concentrations of fibroblast growth factor 19 (FGF19) - an ileum-derived enterokine which plays a role in the control of glucose and lipid homeostasis - are altered in patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD). DESIGN AND METHODS Serum levels of FGF19 were measured using enzyme-linked immunosorbent assay in 91 patients with biopsy-proven NAFLD and 74 controls. RESULTS FGF19 levels were significantly lower in patients with biopsy-proven NAFLD (median: 130pg/mL) than in controls (median: 210pg/mL, P<0.001). Serum FGF19 levels were significantly but modestly associated with hepatocyte ballooning scores in univariate analysis (r=-0.25, P<0.05) but not after adjustment for potential confounders (β=-0.18; t=1.78, P=0.08). CONCLUSIONS This pilot study suggests that serum FGF19 levels are decreased in patients with NAFLD but are not independently associated with liver histology findings.
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Affiliation(s)
- Fatih Eren
- Institute of Gastroenterology, Marmara University, Maltepe, 34840, Istanbul, Turkey
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12
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Alahdab YO, Eren F, Giral A, Gunduz F, Kedrah AE, Atug O, Yilmaz Y, Kalayci O, Kalayci C. Preliminary evidence of an association between the functional c-kit rs6554199 polymorphism and achalasia in a Turkish population. Neurogastroenterol Motil 2012; 24:27-30. [PMID: 21951831 DOI: 10.1111/j.1365-2982.2011.01793.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND C-kit-positive interstitial cells of Cajal (ICC) of the lower esophageal sphincter are reduced in achalasia. Two functional gene polymorphisms (rs2237025 and rs6554199) within the c-kit gene may affect its transcriptional activity. In this pilot study, we hypothesized that these polymorphisms would be associated with achalasia. METHODS Genomic DNA was extracted and real-time PCR reactions were used to determine the rs2237025 and rs6554199 c-kit polymorphisms in 88 Turkish patients with achalasia and 101 healthy controls. KEY RESULTS The frequency of the T allele of rs6554199 was significantly higher in patients with achalasia [odds ratio (OR): 1.55; 95% confidence interval (CI), 1.03-2.34; P = 0.038] compared with the G allele. Under a dominant model of inheritance, the carriage of at least one T allele was significantly more frequent in patients with achalasia (80.7%) than in controls (65.3%; OR: 2.21; 95% CI, 1.13-4.33; P = 0.022). No association of the c-kit rs2237025 polymorphism with achalasia was detected. CONCLUSIONS & INFERENCES Despite the small sample size and the possibility of a false positive finding, our preliminary data support the hypothesis that the T allele of the c-kit rs6554199 polymorphism may be associated with achalasia in the Turkish population. These findings need to be replicated in other racial-ethnically diverse populations.
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Affiliation(s)
- Y O Alahdab
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
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13
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Yilmaz Y, Yonal O, Eren F, Atug O, Hamzaoglu HO. Serum levels of soluble receptor for advanced glycation endproducts (sRAGE) are higher in ulcerative colitis and correlate with disease activity. J Crohns Colitis 2011; 5:402-6. [PMID: 21939913 DOI: 10.1016/j.crohns.2011.03.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [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: 12/15/2010] [Revised: 03/17/2011] [Accepted: 03/18/2011] [Indexed: 02/08/2023]
Abstract
UNLABELLED Interaction of the receptor for advanced glycation endproducts (RAGE) with its ligands results in expression of inflammatory mediators, activation of NF-κB, and induction of oxidative stress, all of which have been implicated in the pathogenesis of inflammatory bowel diseases (IBD). Soluble receptor for advanced glycation endproducts (sRAGE) has recently emerged as a reliable biomarker of inflammation in numerous RAGE-mediated disorders. OBJECTIVE To assess sRAGE levels in adult patients with IBD. METHOD Serum was collected from adult patients with Crohn's disease (CD, 56 patients), ulcerative colitis (UC, 60 patients), and healthy controls (HC, 113 subjects). Levels of sRAGE were determined by enzyme-linked immunosorbent assay. RESULTS Serum sRAGE levels were elevated in IBD compared to HC and were higher in UC patients compared to CD and HC. Levels of sRAGE were significantly higher in the serum of UC patients with active disease compared to patients with inactive disease, but no association with the Montreal Classification was evident. Serum sRAGE was lower in CD patients with biological therapies. CONCLUSIONS These findings suggest that serum levels of sRAGE are altered in patients with intestinal inflammation and may reflect distinct immunoinflammatory pathogenesis of UC and CD.
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Affiliation(s)
- Y Yilmaz
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul 34899, Turkey.
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14
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Yilmaz Y, Ones T, Purnak T, Ozguven S, Kurt R, Atug O, Turoglu HT, Imeryuz N. Association between the presence of brown adipose tissue and non-alcoholic fatty liver disease in adult humans. Aliment Pharmacol Ther 2011; 34:318-23. [PMID: 21631560 DOI: 10.1111/j.1365-2036.2011.04723.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The presence of active brown adipose tissue (BAT) has been associated with a reduced risk of obesity in adult humans. AIM To examine whether the presence and activity of BAT in patients undergoing PET-CT examinations is related to the presence of fatty liver. METHOD We retrospectively analysed 3666 consecutive PET-CT whole-body scans performed on a total of 1832 patients who were referred for suspected malignancies. BAT-positive subjects (BAT+) were defined as subjects who showed substantial amounts of brown adipose tissue on PET-CT scans. In areas where uptake of [(18)F]FDG was identified by CT for BAT, the maximal standardised uptake values (SUVmax), defined as the maximum activity per millilitre within the region of interest divided by the injected dose in megabecquerels per gram of body weight, were determined. A ratio of mean liver attenuation to spleen attenuation <0.8 on CT scans was considered to indicate NAFLD. RESULTS Thirty patients of the 1832 screened individuals (2%) demonstrated brown fat uptake (BAT+ subjects). Ninety matched individuals without evidence of BAT on PET scans (BAT- subjects) were enrolled for comparison purposes. After adjustment for potential confounders, the odds ratio for having NAFLD was significantly higher for BAT- subjects (3.12, 95% confidence interval = 1.03-9.88, P < 0.05). The SUVmax for brown fat tissue was significantly correlated with the ratio of mean liver attenuation to spleen attenuation (P < 0.05). CONCLUSION The presence of brown adipose tissue in adulthood is independently associated with a lower likelihood of NAFLD diagnosed by CT findings.
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Affiliation(s)
- Y Yilmaz
- Department of Gastroenterology, Marmara University, School of Medicine, Pendik, Istanbul, Turkey.
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15
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Ulukaya E, Yilmaz Y, Moshkovskii S, Karpova M, Pyatnitskiy M, Atug O, Dolar E. Proteomic analysis of serum in patients with non-alcoholic steatohepatitis using matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Scand J Gastroenterol 2010; 44:1471-6. [PMID: 19883279 DOI: 10.3109/00365520903353379] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE We sought to investigate whether serum proteomic pattern analysis obtained using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI TOF-MS) may help to diagnose non-alcoholic steatohepatitis (NASH) in the setting of non-alcoholic fatty liver disease (NAFLD). MATERIAL AND METHODS We enrolled 80 patients with biopsy-proven NAFLD and 19 healthy comparison subjects. Patients with NAFLD were classified according to their liver histology as having definite NASH (n = 48), borderline NASH (n = 22) or simple steatosis (n = 10). Liver ultrasound scanning was performed to assess the degree of steatosis. Mass spectra of serum samples were obtained using a Ultraflex II mass spectrometer. RESULTS The highest accuracy for NASH diagnostics was reached using 15 peaks. Corresponding sensitivity and specificity values were 73.95% +/- 3.38% and 88.71% +/- 1.39%, respectively. However, mass spectra did not allow us to distinguish NASH from simple steatosis. CONCLUSIONS We conclude that proteomic analyses of serum samples from NAFLD patients by MALDI TOF-MS do not seem to have a major clinical value for diagnosing NASH. However, the identification of 15 peaks in our study may help to further elucidate the pathophysiology of NASH and merits further investigation.
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Affiliation(s)
- Engin Ulukaya
- Department of Biochemistry, Uludag University Medical School, Bursa, Turkey
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Atug O, Akin H, Alahdab YO, Ceyhan B, Tozun N, Ozdogan O. Interstitial pneumonitis associated with pegylated interferon-alpha 2a and ribavirin for chronic hepatitis C infection: a case report. Cases Journal 2009. [PMID: 20181162 PMCID: PMC2827138 DOI: 10.1186/1757-1626-2-6464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Interstitial pneumonitis is a rare but potentially fatal side effect occurring from 2 weeks to 16 weeks after the initiation of treatment with pegylated interferon alpha and ribavirin for chronic hepatitis C. Herein, we present a 68-year-old man with chronic hepatitis C virus infection who developed interstitial pneumonitis association with pegylated interferon after 36 weeks initiation of pegylated interferon-alpha and ribavirin therapy. He did not recover after discontinuation of pegylated interferon/ribavirin and improved by steroid therapy.
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Tiftikci A, Atug O, Yilmaz Y, Eren F, Ozdemir FT, Yapali S, Ozdogan O, Celikel CA, Imeryuz N, Tozun N. Serum levels of adipokines in patients with chronic HCV infection: relationship with steatosis and fibrosis. Arch Med Res 2009; 40:294-8. [PMID: 19608019 DOI: 10.1016/j.arcmed.2009.04.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 04/14/2009] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Hepatic steatosis and fibrosis are common histological findings in patients with chronic hepatitis C virus (HCV) infection. In this study we sought to determine whether serum levels of three adipokines (leptin, adiponectin and resistin) show any biochemical correlation with hepatic steatosis and fibrosis in patients with chronic HCV infection. METHODS We examined a total of 51 patients with chronic HCV infection (22 males and 29 females, mean BMI: 27.4+/-5kg/m(2)) and 24 healthy control subjects (10 males and 14 females, mean BMI: 23.2+/-3kg/m(2)). Liver steatosis and fibrosis were scored on biopsies. Serum levels of leptin, adiponectin and resistin were determined by ELISA. RESULTS HCV genotypes were 1b in 41 patients (80.4%), 3a in three patients (5.9%), 2a in two patients (3.9%), 1a in two patients (3.9%), 1c in one patient (2%), and 2b in one patient (2%). Serum levels of leptin, resistin, and the leptin-to-adiponectin ratio were significantly higher in patients with chronic HCV infection than in controls. Steatosis and fibrosis were detected in 33.3% and 70.5% of chronic HCV patients, respectively. No significant association with serum adipokine levels and degree of steatosis was evident. Low serum levels of resistin were associated with the presence of fibrosis independently of potential confounders. CONCLUSIONS Patients with chronic HCV infection display elevated levels of adipokines in their sera. Reduced concentrations of resistin may be a biochemical marker of fibrosis in this patient group.
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Affiliation(s)
- Arzu Tiftikci
- Department of Gastroenterology, Acibadem University School of Medicine, Istanbul, Turkey
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Abstract
AIM/BACKGROUND Lye (NaOH) ingestion in humans often results in alkaline damage to the esophagus, but knowledge about this process is limited. Here, we explore the effects of lye on esophageal epithelial structure and function using rabbit esophageal epithelium as a model of lye ingestion. METHODS Rabbit esophageal epithelium was mounted in Ussing chambers so that the electrical potential difference (PD), short-circuit current (I (sc)), and transepithelial resistance (R (T)) could be monitored before, during, and after mucosal exposure to lye (NaOH) at pHs ranging from 7.4 to 12.1. Histopathology and dextran fluxes were also performed and correlated with the electrical data. RESULTS Mucosal exposure to lye at pHs <11.5 had no damaging effects on the esophagus. However, at pHs >or=11.5, damage was both time- and pH-dependent, as noted by increases in PD and I (sc), and declines in R (T). Further, the electrical changes were paralleled morphologically by epithelial liquefaction necrosis and increases in dextran flux. Also, by pretreating tissues with ouabain, the early lye-induced rise in PD and I (sc) was shown to result from a combination of increased active (sodium) transport and passive (sodium) diffusion which indicates that, even early on, the damaging effects of lye include changes in both apical cell membranes and tight junctions of this epithelium. CONCLUSION Lye (NaOH) injury to the esophageal epithelium is both pH- and time-dependent, but requires a minimum pH of 11.5. At pHs >or=11.5, lye produces liquefaction necrosis, an injury that involves both cellular and junctional barriers, and which markedly increases epithelial permeability to ions and uncharged molecules. Based on these results, non-industrial cleaning products in the home are likely to be safer if they have a concentration of lye below pH 11.5.
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Affiliation(s)
- Ozlen Atug
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey.
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19
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Tahan V, Atug O, Akin H, Eren F, Tahan G, Tarcin O, Uzun H, Ozdogan O, Tarcin O, Imeryuz N, Ozguner F, Celikel C, Avsar E, Tozun N. Melatonin ameliorates methionine- and choline-deficient diet-induced nonalcoholic steatohepatitis in rats. J Pineal Res 2009; 46:401-7. [PMID: 19552763 DOI: 10.1111/j.1600-079x.2009.00676.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [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: 12/14/2022]
Abstract
Nonalcoholic steatohepatitis (NASH) may progress to advanced fibrosis and cirrhosis. Mainly, oxidative stress and excessive hepatocyte apoptosis are implicated in the pathogenesis of progressive NASH. Melatonin is not only a powerful antioxidant but also an anti-inflammatory and anti-apoptotic agent. We aimed to evaluate the effects of melatonin on methionine- and choline-deficient diet (MCDD)-induced NASH in rats. Thirty-two male Wistar rats were divided into four groups. Two groups were fed with MCDD while the other two groups were fed a control diet, pair-fed. One of the MCDD groups and one of the control diet groups were administered melatonin 50 mg/kg/day intraperitoneally, and the controls were given a vehicle. After 1 month the liver tissue oxidative stress markers, proinflammatory cytokines and hepatocyte apoptosis were studied by commercially available kits. For grading and staging histological lesions, Brunt et al.'s system was used. Melatonin decreased oxidative stress, proinflammatory cytokines and hepatocyte apoptosis. The drug ameliorated the grade of NASH. The present study suggests that melatonin functions as a potent antioxidant, anti-inflammatory and antiapoptotic agent in NASH and may be a therapeutic option.
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Affiliation(s)
- Veysel Tahan
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey.
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Yilmaz Y, Atug O, Yonal O, Duman D, Ozdogan O, Imeryuz N, Kalayci C. Dipeptidyl peptidase IV inhibitors: therapeutic potential in nonalcoholic fatty liver disease. Med Sci Monit 2009; 15:HY1-HY5. [PMID: 19333209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Nonalcoholic fatty liver disease is the most common chronic liver disease in industrialized countries and is considered the hepatic manifestation of metabolic syndrome. Apart from correction of underlying metabolic abnormalities, restriction of caloric intake, and physical exercise, no drugs have been licensed for the treatment of nonalcoholic fatty liver disease. Of note, reduced caloric intake and exercise with resultant weight loss may lead to a reduction in liver fat content, but no studies have shown long-term benefits of this. Dipeptidyl peptidase IV inhibitors are promising new oral drugs for the treatment of type 2 diabetes. Here, we hypothesize that dipeptidyl peptidase IV inhibitors can reduce fat infiltration in the liver and thus be a potential treatment for nonalcoholic fatty liver disease. There are 3 lines of evidence supporting this hypothesis. First, dipeptidyl peptidase IV inhibitors are known to improve insulin resistance, a key metabolic abnormality encountered by patients with nonalcoholic fatty liver disease. Second, patients with nonalcoholic steatohepatitis have increased dipeptidyl peptidase IV activity, which has been found to correlate positively with the histopathologic grade and degree of liver steatosis. Finally, data from experimental studies suggest that dipeptidyl peptidase IV inhibitors can reduce liver inflammation and steatosis. In light of these findings, we propose that pharmacologic inhibition of dipeptidyl peptidase IV may provide a new therapeutic option for slowing the progression of nonalcoholic fatty liver disease. Future research is expected to support the efficacy and tolerability of dipeptidyl peptidase IV modulation in early liver steatosis.<br />
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Affiliation(s)
- Yusuf Yilmaz
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey.
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21
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Atug O, Akin H, Alahdab YO, Ceyhan B, Tozun N, Ozdogan O. Interstitial pneumonitis associated with pegylated interferon-alpha 2a and ribavirin for chronic hepatitis C infection: a case report. Cases J 2009; 2:6464. [PMID: 20181162 DOI: 10.1186/1757-1626-0002-0000006464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Accepted: 02/09/2009] [Indexed: 11/10/2022]
Abstract
Interstitial pneumonitis is a rare but potentially fatal side effect occurring from 2 weeks to 16 weeks after the initiation of treatment with pegylated interferon alpha and ribavirin for chronic hepatitis C.Herein, we present a 68-year-old man with chronic hepatitis C virus infection who developed interstitial pneumonitis association with pegylated interferon after 36 weeks initiation of pegylated interferon-alpha and ribavirin therapy. He did not recover after discontinuation of pegylated interferon/ribavirin and improved by steroid therapy.
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Affiliation(s)
- Ozlen Atug
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey.
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22
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Yilmaz Y, Ulukaya E, Gul OO, Arabul M, Gul CB, Atug O, Oral AY, Aker S, Dolar E. Decreased plasma levels of soluble receptor for advanced glycation endproducts (sRAGE) in patients with nonalcoholic fatty liver disease. Clin Biochem 2009; 42:802-7. [PMID: 19217891 DOI: 10.1016/j.clinbiochem.2009.02.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Revised: 01/27/2009] [Accepted: 02/03/2009] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Levels of soluble receptor for advanced glycation endproducts (sRAGE) have been linked to several components of the metabolic syndrome. We tested the hypothesis that plasma levels of sRAGE may be associated with non-alcoholic fatty liver disease. DESIGN AND METHODS We enrolled subjects with definite nonalcoholic steatohepatitis (NASH, n=40), borderline NASH (n=8), simple fatty liver (n=9) and healthy controls (n=14). Plasma levels of sRAGE were measured by ELISA. RESULTS Concentrations of sRAGE were significantly lower in patients with definite NASH (1080+/-392 pg/mL, P<0.01) and borderline NASH (1050+/-278 pg/mL, P<0.05) compared to controls (1480+/-387 pg/mL). Levels of sRAGE were significantly and inversely correlated with ALT (r=-0.30, P<0.05) and AST (r=-0.23, P<0.05). CONCLUSION Plasma levels of sRAGE are significantly reduced in definite and borderline NASH.
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Affiliation(s)
- Yusuf Yilmaz
- Department of Gastroenterology, Marmara University, School of Medicine, 34662, Altunizade, Istanbul, Turkey.
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Atug O, Akin H, Alahdab Y, Ceyhan B, Tozun N, Ozdogan O. Interstitial pneumonitis associated with pegylated interferon-alpha 2a and ribavirin for chronic hepatitis C infection: a case report. Cases J 2009. [DOI: 10.1186/1757-1627-2-6464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Atug O, Tahan V, Eren F, Tiftikci A, Imeryuz N, Hamzaoglu HO, Tozun N. Pro12Ala polymorphism in the peroxisome proliferator-activated receptor-gamma (PPARgamma) gene in inflammatory bowel disease. J Gastrointestin Liver Dis 2008; 17:433-437. [PMID: 19104705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND & AIMS Peroxisome proliferator-activated receptor-gamma (PPAR-gamma) has recently been implicated as an endogenous regulator of cellular proliferation and inflammation. Impaired expression of PPAR-gamma in colonic epithelial cells in ulcerative colitis (UC) and increased expression in hypertrophic mesenteric adipose tissue in Crohn's disease (CD) have been reported. Furthermore, PPAR-gamma ligands have been shown to inhibit tissue injury associated with immune activation in UC. Any mutation in PPAR-gamma gene may be responsible for the increase in inflammatory mediators and hence the perpetuation of inflammation in inflammatory bowel disease (IBD) patients. One common polymorphism in PPAR-gamma gene is proline to alanine substitution (Pro12Ala) which results from a CCA to GCA missense substitution in codon 12 of exon 2 of the PPAR-gamma gene. In this study, we aimed to explore Pro12Ala polymorphism in PPAR-gamma gene in IBD in Turkish patients. METHODS 69 patients with CD, 45 with UC and 100 controls of similar age and sex were studied. Genomic DNA was isolated from peripheral blood leucocytes and mutagenically separated-polymerase chain reaction (PCR) analyses were performed to determine the Pro12Ala polymorphism of the PPAR-gamma gene. RESULTS We observed no significant differences in the frequency of the Pro12Ala polymorphism in the PPAR-gamma gene among subjects with CD, UC and controls (15.9%, 15.5% and 13%, respectively, p>0.05). CONCLUSION These results suggest that Pro12Ala polymorphism in the PPAR-gamma gene relates neither to the risk of the development of inflammatory bowel disease nor to the clinical subtypes of CD in the Turkish population.
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Affiliation(s)
- Ozlen Atug
- Marmara University School of Medicine, Department of Gastroenterology, Istambul, Turkey.
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Atug O, Giral A, Kalayci C, Dolar E, Isitan F, Oguz D, Ovunc O, Ozgur O, Soykan I, Simsek I, Unal S, Yenice N. Esomeprazole in acute and maintenance treatment of reflux oesophagitis: a multicentre prospective study. Adv Ther 2008; 25:552-66. [PMID: 18568450 DOI: 10.1007/s12325-008-0071-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The aim of this study was to assess the efficacy and safety of esomeprazole 40 mg once daily (q.d.) in healing reflux oesophagitis at 4 and 8 weeks, and the efficacy of esomeprazole 20 mg q.d. for 12 weeks in the maintenance of remission. METHODS A total of 235 patients with endoscopically proven reflux oesophagitis were enrolled in this study, which consisted of two phases (healing and maintenance therapy). Patients who showed complete endoscopic and symptomatic healing at the end of 4 or 8 weeks were switched to maintenance treatment with esomeprazole 20 mg q.d. for 12 weeks. The primary efficacy endpoint was healing of reflux oesophagitis at week 8. Secondary assessments included the proportion of patients with symptomatic relapse in the maintenance phase. RESULTS At the end of week 8, 88% (95% life-table confidence intervals [CI]: 84%, 92%) of patients were healed endoscopically and 90.6% of the patients were asymptomatic. Patient age, gender and Helicobacter pylori status had no effect on the efficacy of treatment. During the 12-week maintenance treatment phase, symptomatic relapse ratios were 0.5%, 2.2%, and 0%, for the first, second, and third 4-week periods, respectively. The proportions of patients satisfied with treatment were 95% and 99.4% at the end of acute and maintenance treatment, respectively. The most common adverse effects were headache, upper respiratory tract infection and abdominal pain. CONCLUSIONS Esomeprazole is effective in the healing of reflux oesophagitis, the resolution of heartburn, and in maintaining symptomatic remission. The effectiveness of esomeprazole in patients with gastroesophageal reflux disease is not affected by the presence of H. pylori.
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Affiliation(s)
- Ozlen Atug
- School of Medicine, Department of Gastroenterology, Marmara University, Istanbul, Turkey
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Atug O, Hamzaoglu H, Tahan V, Alican I, Kurtkaya O, Elbuken E, Ozdogan O, Tozun N. Hyperbaric oxygen therapy is as effective as dexamethasone in the treatment of TNBS-E-induced experimental colitis. Dig Dis Sci 2008; 53:481-5. [PMID: 17934837 DOI: 10.1007/s10620-007-9956-4] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2007] [Accepted: 08/01/2007] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Hyperbaric oxygen (HBO) has been demonstrated to be useful as an adjunctive therapy for Crohn's disease. In the present study, HBO was tested as a treatment for trinitrobenzenesulfonic acid-ethanol (TNBS-E)-induced distal colitis, and its effects were compared with dexamethasone therapy. METHODS A total of 48 Sprague-Dawley rats were separated into six groups: the control, and those treated with vehicle, TNBS-E, HBO, dexamethasone, or combined HBO + dexamethasone. The HBO treatment group was exposed to 100% HBO at 2 ATM for 75 min twice daily at 6-h intervals in a HBO chamber, both on the day of colitis induction and 3 days thereafter. Treatment with intraperitoneal dexamethasone twice daily was started 1 h before the induction of colitis and was continued for 7 days in the dexamethasone group. The rats were decapitated 8 days after the induction of colitis, and the colonic tissue wet weight, macroscopic and microscopic lesion score, and tissue myeloperoxidase (MPO) activity were determined. RESULTS HBO therapy decreased the activity of experimental colitis measured by the tissue wet weight, macroscopic score, microscopic score, and MPO activity. The dexamethasone treatment significantly reduced the colitis activity as determined by the tissue MPO activity and wet weight. There were also decreases in the macroscopic and microscopic activity scores with the dexamethasone therapy; however, these changes were not statistically significant. The combined therapy with HBO and dexamethasone provided no additional benefit over HBO therapy alone. CONCLUSION HBO therapy can be a valuable therapeutic option in treatment of patients with inflammatory bowel disease. HBO therapy in the refractory patients deserves further, larger clinical studies.
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Affiliation(s)
- Ozlen Atug
- Department of Gastroenterology, Marmara University School of Medicine, Altunizade, Uskudar, Istanbul 34662, Turkey
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Atug O, Dobrucali AM, Tobey NA, Orlando RC. 280 EFFECT OF LYE (NaOH) EXPOSURE ON THE PERMEABILITY OF RABBIT ESOPHAGEAL EPITHELIUM. J Investig Med 2005. [DOI: 10.2310/6650.2005.00006.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tobey NA, Argote CM, Kav T, Vanegas X, Atug O, Semprun-Prieto L, Barlow W, Orlando RC. 120 CONTRIBUTORS TO ANION TRANSPORT IN HUMAN ESOPHAGEAL STRATIFIED SQUAMOUS EPITHELIUM AND BARRETT'S ESOPHAGUS. J Investig Med 2005. [DOI: 10.2310/6650.2005.00006.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tobey NA, Vanegas X, Atug O, Sempruin-Prieto L, Orlando RC. 121 THE CALCIUM-INDEPENDENT COMPONENT OF THE SHUNT PATHWAY IN RABBIT ESOPHAGEAL EPITHELIUM. J Investig Med 2005. [DOI: 10.2310/6650.2005.00006.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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