Ali T. Ince

Oxidative Stress in Helicobacter pylori Infection: Does Supplementation with Vitamins C and E Increase the Eradication Rate?

Aim:  This study aims to assess the antioxidant property of vitamins E and C in Helicobacter pylori infection, and to determine if adding them to standard triple therapy plus bismuth subcitrate increases the H. pylori eradication rate.

Clinical presentation of abdominal tuberculosis in HIV seronegative adults.

BackgroundThe accurate diagnosis of abdominal tuberculosis usually takes a long time and requires a high index of suspicion in clinic practice. Eighty-eight immune-competent patients with abdominal tuberculosis were grouped according to symptoms at presentation and followed prospectively in order to investigate the effect of symptomatic presentation on clinical diagnosis and prognosis.MethodsBased upon the clinical presentation, the patients were divided into groups such as non-specific abdominal pain & less prominent in bowel habit, ascites, alteration in bowel habit, acute abdomen and others. Demographic, clinical and laboratory features, coexistence of pulmonary tuberculosis, diagnostic procedures, definitive diagnostic tests, need for surgical therapy, and response to treatment were assessed in each group.ResultsAccording to clinical presentation, five groups were constituted as non-specific abdominal pain (n = 24), ascites (n = 24), bowel habit alteration (n = 22), acute abdomen (n = 9) and others (n = 9). Patients presenting with acute abdomen had significantly higher white blood cell counts (p = 0.002) and abnormalities in abdominal plain radiographs (p = 0.014). Patients presenting with alteration in bowel habit were younger (p = 0.048). The frequency of colonoscopic abnormalities (7.5%), and need for therapeutic surgery (12.5%) were lower in patients with ascites, (p = 0.04) and (p = 0.001), respectively. There was no difference in gender, disease duration, diagnostic modalities, response to treatment, period to initial response, and mortality between groups (p > 0.05). Gastrointestinal tract alone was the most frequently involved part (38.5%), and this was associated with acid-fast bacteria in the sputum (p = 0.003).ConclusionGastrointestinal tract involvement is frequent in patients with active pulmonary tuberculosis. Although different clinical presentations of patients with abdominal tuberculosis determine diagnostic work up and need for therapeutic surgery, evidence based diagnosis and consequences of the disease does not change.

Administration of olive oil followed by a low volume of polyethylene glycol-electrolyte lavage solution improves patient satisfaction with right-side colonic cleansing over administration of the conventional volume of polyethylene glycol-electrolyte lavage solution for colonoscopy preparation

BACKGROUND Proper bowel cleansing before colonoscopy is essential for satisfactory evaluation of the colon. The required consumption of a large volume of salty-tasting liquid, 4 L of polyethylene glycol-electrolyte lavage solution (PEG-ELS), is the primary limitation to achieving this goal. OBJECTIVE To achieve better patient satisfaction with efficient bowel cleansing, we compared the effects of the conventional volume (4 L) of PEG-ELS with those of a low volume (2 L) in combination with pretreatment using different laxatives, such as magnesium hydroxide (milk of magnesia) and olive oil. DESIGN Randomized, controlled study. SETTING A single research hospital. PATIENTS Patients undergoing elective colonoscopy. INTERVENTIONS A total of 120 patients were randomized to 1 of 3 different preparation regimens: 39 patients were prepared with a conventional volume (4 L) of PEG-ELS (Preparation [Prep] 1), and the remaining patients were prepared with a lower volume (2 L) of PEG-ELS and pretreatment with a laxative, either 15 g of magnesium hydroxide (40 patients, Prep 2) or 60 mL of olive oil (41 patients, Prep 3) 3 hours before PEG-ELS administration. MAIN OUTCOME MEASUREMENTS The primary outcome was the efficacy of colonic cleansing on the left and right sides. Secondary outcomes were patient satisfaction and side effects. RESULTS The olive oil regimen (Prep 3) resulted in significantly more adequate bowel cleansing of the right colon than administration of the conventional volume of PEG-ELS (Prep 1) and the magnesium hydroxide (Prep 2) regimen (97.6% vs 74.5% and 72.5%, respectively, P = .007). However, this difference was not observed in the left colon (91.5%, 85.5%, and 91.8% for Preps 1, 2, and 3, respectively, P = .776). When asked, 38 patients (95%) taking Prep 2, 35 patients (85.3%) taking Prep 3, and only 11 patients (28.2%) taking Prep 1 preferred the same preparation regimen if they required a future colonoscopy (P =.006), based on ease of use and taste. The side effects were comparable in each group. LIMITATIONS The limitations of this study include the relatively small sample size, the single-center study design, and the use of a nonvalidated symptom scoring system. CONCLUSION Pretreatment with olive oil before administration of a low volume of PEG-ELS enhances both patient satisfaction and the quality of right-side colonic cleansing over the administration of the conventional volume of PEG-ELS for colonoscopy preparation. Although the magnesium hydroxide regimen (Prep 2) was the preferred regimen in this study, its colonic cleansing effectiveness was not as great as those of the other regimens. Based on our results, the olive oil regimen is recommended, especially for patients who are not able to consume large volumes of liquids, such as the elderly, and those who are suspected of having subtle right-side colonic lesions.

Risk factors associated with gallstone and biliary sludge formation during pregnancy

Aim:  To define the risk factors in gallstone and sludge formation, and to investigate the incidence of gallstone and biliary sludge formation during pregnancy in a group of healthy pregnant women.

A New Modified Concomitant Therapy for Helicobacter pylori Eradication in Turkey

Background:  Helicobacter pylori eradication rates have tended to decrease recently, mostly due to antibiotic resistance. In the present study, our aim was to determine Hp eradication rate with the LAC plus tid metronidazole regimen and the secondary objective of this study was to identify an effective regimen for our population.

Peritoneal tuberculosis and granulomatous hepatitis secondary to treatment of bladder cancer with Bacillus Calmette-Guérin.

Intravesical administration of Bacillus Calmette-Guérin is used as a treatment method in superficial bladder cancer. While it is generally well tolerated, serious side effects may develop. Granulomatous hepatitis cases have been previously reported; however, only one case with tuberculous peritonitis exists in the current literature. We hereby present two cases, one of which is the second tubercular peritonitis case following Bacillus Calmette-Guérin treatment to be reported, and the other a case with granulomatous hepatitis. Complete cure was achieved in both cases with specific therapy. In the patient who developed peritonitis, intravesical Bacillus Calmette-Guérin therapy was recommenced after antituberculosis treatment, and completed without further complications.

Pathophysiology, classification and available guidelines of acute pancreatitis

Acute pancreatitis (AP) constitutes the majority of cases requiring hospital admission in gastroenterology. We are yet to know many things about its pathophysiology which is a certain drawback for the progress in its treatment. Prediction of severity is necessary for the plan of the management. The existing scoring systems are yet to be satisfactory. However our progress in the field was significant in the recent decade and a leap forward is expected in this cumbersome-to-manage condition which has many unmet needs. In this review, we are going to summarize the hitherto data in pathogenesis and would weigh the usefulnes and weaknes of each of existing scoring systems in the management of AP.

Endoscopic stapling in comparison to laparoscopic fundoplication for the treatment of gastroesophageal reflux disease

The SRSTM Endoscopic Stapling System (Medigus Ltd, Omer, Israel) is a novel method for the treatment of gastroesophageal reflux disease (GERD). The present study assessed the safety and efficacy of SRS compared with laparoscopic anti‐reflux surgery (LARS).

The Effectiveness of Lamivudine Treatment in Cirrhotic Patients with HBV Precore Mutations: A Prospective, Open-Label Study

In this study, the effect of lamivudine therapy on viral suppression, Child-Pugh score, and survival was assessed in patients with decompensated cirrhosis due to precore mutant hepatitis B virus and the results were compared with those for nonreplicative cirrhotic patients. Twenty-three replicative patients who received lamivudine and 15 nonreplicative patients were included and followed up for an average of 23.7 ± 13.4 months. At baseline, there were no significant differences between the groups with regard to clinical and biochemical parameters or Child-Pugh scores, except for serum alanine aminotransferase levels (P < 0.05) and quantitative hepatitis B virus DNA measurements (P < 0.001). Compared to baseline, there was no significant difference in Child-Pugh score in the lamivudine group at the last visit (P = 0.202), whereas a marked increase was observed in nonreplicative patients (P = 0.002). Mortality rates in the lamivudine and nonreplicative groups were 17.43% and 13.3%, respectively (P = 0.556), and there was no difference in survival analysis (P = 0.809). Lamivudine therapy stabilizing clinical situation in decompensated cirrhotics with precore mutation makes the natural history of the disease equal with nonreplicative decompensated cirrhotics or even provides some advantages over them.

Olanzapine-induced acute pancreatitis

A 44-year-old man with schizophrenia was started on olanzapine 1 year ago. After 6 weeks, olanzapine was changed to amisulpride 400 mg/day because of abdominal pain. However, the etiology of abdominal pain was not investigated. After 10 months, olanzapine was readministered at 10 mg/day because of an increase in obsessive symptoms. During the third week of treatment, the patient developed severe abdominal pain radiating back, with nausea and vomiting. His family history was unremarkable. He did not consume alcohol or drugs and was a non-smoker. Physical examination revealed tachycardia and tachypnea, with a blood pressure of 110/70 mmHg and oxygen saturation of 95%. The patient had a fever of 38.2°C. Abdominal examination revealed mild distension with tenderness. Blood test revealed the following: glucose: 181 mg/dL, amylase: 1552 U/L, lipase: 2138 U/L, CRP: 3.2 mg/dL, WBC: 15,550 mm3, hematocrit: 36%, and platelets: 366,000 mm3. Computed tomography examination revealed diffuse enlargement of the pancreatic parenchyma with peripancreatic fluid collection. There was no biliary abnormality. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography revealed there was no biliary tract abnormality. Olanzapine was discontinued and intravenous fluids and analgesics were administered. After 1 week, the patient was discharged with complete resolution of symptoms.