Aykut Ferhat Celik

Revalidation of description of constipation in terms of recall bias and visual scale analog questionnaire

Background and Aim:  The present study was designed to identify a cut‐off value to define subjective and relatively objective criteria of constipation using the visual scale analog questionnaire (VSAQ) in healthy subjects. In addition, the importance of recall bias when evaluating constipation was investigated by repeating the questionnaire and ensuring the subjects maintained diaries.

Hyperhomocysteinemia in inflammatory bowel disease patients without past intestinal resections: correlations with cobalamin, pyridoxine, folate concentrations, acute phase reactants, disease activity, and prior thromboembolic complications.

Objective Homocysteine is a sulfur-containing amino acid formed during the demethylation of methionine and high levels of this amino acid is a known risk factor for both arterial and also venous thromboembolic complications. Deficiencies of cobalamin, folate, and pyridoxine may predispose subjects to hyperhomocysteinemia, a common phenomenon in inflammatory bowel disease (IBD) patients. The aim of this study was to identify the prevalence, risk factors of hyperhomocysteinemia and its correlation with prior thromboembolic events in an IBD cohort without past intestinal resections. Methods In this prospective study, we studied the concentrations of homocysteine, cobalamin, folate, and pyridoxine in 105 consecutive patients with IBD, of whom 11 had a prior history of thromboembolic complications. Data regarding smoking habits, medication use, disease location, and severity were gathered and patients with past intestinal resections were excluded. Age-matched and sex-matched 85 healthy volunteers served as controls and multivariate regression analysis was performed to find out independent predictors of hyperhomocysteinemia. Results The mean age (±SD) in the IBD cohort was 38.69±12.13 years, and 51% were male. The mean age in the control group was 37.61±10.05 years, and 52% were male. Homocysteine concentrations in patients were higher [16.35 μmol/L (range 6.82 to 48.15) vs. 9.60 μmol/L (range 4.97 to 17.39), P=0.000] and hyperhomocysteinemia had a higher prevalence in patients than in the controls (56.2% vs. 4.7%, χ2=56.179, P=0.000), thus IBD significantly increased the risk of hyperhomocysteinemia [odds ratio=25.973 (95% confidence interval: 8.861-76.128)]. Homocysteine concentrations in patients with a history of thrombosis were not higher than those without a history of thrombosis [16.29 μmol/L (range 8.45 to 34.75) vs. 16.36 μmol/L (range 6.82 to 48.15), not significant]. Hyperhomocysteinemia was found in 54.5% of patients with thrombosis and 56.4% of patients without thrombosis (not significant). On stepwise regression analysis, plasma cobalamin level, albumin concentration, erythrocyte sedimentation rate, and platelet count were found to be independent predictors of elevated homocysteine levels. Conclusions IBD patients have a higher prevalence of hyperhomocysteinemia than do healthy controls and elevated homocysteine levels are independently associated with lower serum cobalamin, albumin levels and elevated erythrocyte sedimentation rate, and platelet count. There is no correlation between hyperhomocysteinemia and a history of prior thromboembolic events.

Serum YKL-40 as a marker of disease activity and stricture formation in patients with Crohn's disease.

Background and Aim:  YKL‐40 is secreted by macrophages and neutrophils and is a growth factor for vascular endothelial cells and fibroblasts. Elevated serum levels of YKL‐40 have been reported in patients with various inflammatory conditions and ongoing fibrosis. The aim of this study was to investigate the relationship between serum concentrations of YKL‐40 and disease activity, acute phase reactants, and the presence of strictures in patients with Crohns disease (CD).

Incidence of gallstones in chronic renal failure patients undergoing hemodialysis: experience of a center in Turkey.

OBJECTIVES:In this case–control study, we sought to determine whether the incidence of gallbladder stones (GBS) was increased in chronic renal failure (CRF) patients on a hemodialysis (HD) program. We also evaluated factors, such as lipid profiles and gallbladder motility, that could affect the formation of GBS. In addition, we reviewed other available studies on this subject and compared the factors that might have some influence on the development of GBS.METHODS:A total of 182 CRF patients (135 male, 47 female, mean age 32.1 yr) undergoing chronic HD and who were referred to our transplantation center in the last 10 yr and 194 healthy controls (137 male, 57 female, mean age 33.3 yr) were included in the study. Abdominal ultrasound was performed on all patients, and ALT, AST, and lipid profiles were determined. In addition, 19 patients with CRF (12 male, 7 female, mean age 33.5 yr) and 22 controls (14 male, 8 female, mean age 33.2 yr) who were age and sex matched were randomly chosen for gallbladder emptying, monitored by ultrasound at 30-min intervals for 2 h after a mixed meal. Fasting volume, minimal residual volume, and ejection fraction of the gallbladder were assessed. For statistical analysis, χ2, t test, and logistic regression analysis were used.RESULTS:GBS were detected in seven patients with CRF (3.85%, 5 male, 2 female) and three controls (1.55%, one male, two female) (p > 0.05). The mean follow-up time of CRF patients after diagnosis was 39.3 months (range: 2–168), the mean duration of HD was 21.8 months (range: 1–120). The analysis of seven stones in the CRF group revealed that five were cholesterol-rich stones, and two were mixed (cholesterol and bilirubin) stones. Cholesterol levels were higher in the control group, and triglycerides were higher in the CRF group, but these findings were nonsignificant (p > 0.05). Other biochemical values were not significantly different between the groups. CRF patients with and without GBS were similar in their duration of CRF and HD, age, and other biochemical parameters (p > 0.05). When gallbladder emptying was considered, there was no difference between the two groups in fasting volume, residual volume, and ejection fraction (CRF: 89.7%; controls: 92.3%) of the gallbladders (p > 0.05).CONCLUSIONS:We detected similar incidences of GBS in CRF patients undergoing HD and healthy controls, and this was comparable to the results of most of the previous studies. Young male CRF patients had a nonsignificantly higher incidence of GBS than control males. Although cholesterol-rich GBS were predominant, we could not find any significant difference between the groups when factors that could affect GBS formation, such as lipid profiles and gallbladder motility, were taken into account.

Ornidazole-induced liver damage: report of three cases and review of the literature.

Abstract: Metronidazole and ornidazole, synthetic nitroimidazole derivatives, are used in the treatment of infections caused by anaerobic bacteria and protozoa. The drugs are well tolerated and serious side effects are very rarely encountered. Hepatotoxicity is a rare side effect and hitherto only six cases have been reported. We describe three patients who developed hepatitis after ornidazole use and review the previously reported cases. All three cases used ornidazole in conventional doses and developed hepatitis and associated cholestasis. They improved 1–2 months after discontinuation. We concluded that nitroimidazole derivatives may cause hepatotoxic damage resembling acute cholestatic hepatitis. Early recognition and withdrawal of the drug may prevent further damage.

DoesHelicobacter pylori-induced gastritis enhance food-stimulated insulin release?

The fact thatH. pylori gastritis results in an increased secretion of basal and meal-stimulated gastrin, which is also a physiologic amplifier of insulin release directed us to investigate whetherH. pylori gastritis may lead to an enhancement of nutrient-stimulated insulin secretion. For this purpose, we have investigated the insulin responses to both oral glucose and a mixed meal in 15 patients withH. pylori gastritis before and one month after the eradication therapy and also in 15H. pylori-negative control subjects. The areas under the curve (AUC) for serum insulin following both oral glucose and a mixed meal in the patients withH. pylori gastritis before the eradication were significantly (P<0.05) higher than those in theH. pylori-negative controls. After the eradication ofH. pylori, the AUC for serum insulin following oral glucose and mixed meal decreased by 9.4% and 13.1%, respectively (P<0.001 in both), and serum basal and meal-stimulated gastrin levels decreased significantly (P<0.001). These results suggest thatH. pylori gastritis enhances glucose and meal-stimulated insulin release probably by increasing gastrin secretion.

Behçet’s Disease: Gastrointestinal Involvement

Reports indicate that the prevalence of gastrointestinal involvement of Behcet’s disease (BD) shows geographic variation. Since no true population surveys are available, at least some of this variation could be due to selection bias. The usually reported prevalence is less than 1% among patients from the Western countries and the Middle East while this frequency becomes 10% or higher in the Far East with reports of around 25% from Japan. As in Crohn’s disease (CD), gastrointestinal Behcet’s disease (GIBD) is seen most commonly in the ileocecal area. Lesions in the esophagus and stomach are distinctly rare. It is quite difficult to differentiate GIBD from CD disease unless other stigmata of either condition are present. The rarity of rectal involvement and the absence of granulomas in GIBD can on occasion be helpful. On the other hand, the presence of these two features in CD (∼10% for rectal disease and 10–15% for granuloma formation) is not frequent either, reducing their usefulness in differential diagnosis. Thus far, outcome perforation is more common in GIBD (25–50%) than in Crohn’s (∼2%). Management of GIBD is very similar to what we do in CD. Surgical treatment is reserved for complications like perforation, bleeding, obstruction, and stubborn fistula formation. Since relapses are frequent even under medical treatment, surgical resection should be conservative.

A case of fibrosing mediastinitis with obstruction of superior vena cava and downhill esophageal varices: a rare cause of upper gastrointestinal hemorrhage.

Fibrosing mediastinitis (FM) is an excessive fibrotic reaction that occurs in the mediastinum and may lead to compression of mediastinal structures (especially vascular or bronchial). In the present study we describe the first case report of FM, in a patient who developed downhill esophageal varices and bleeding, which was secondary to superior vena cava obstruction.

Bone marrow transplantation for Behçet’s disease: a case report and systematic review of the literature

OBJECTIVES Behçets disease (BD) can be life threatening and may be refractory to corticosteroids and immunosuppressives. There has been some experience with haematopoietic stem cell transplantation (HSCT) in BD either for severe, refractory disease or for a haematological condition. The objectives of this study were to describe a BD patient undergoing HSCT and to evaluate the outcomes of BD patients who underwent HSCT. METHODS We report a BD patient with refractory gastrointestinal (GI) involvement who had HSCT for concomitant myelodysplastic syndrome (MDS). We also performed a systematic literature search regarding HSCT for either refractory disease or concomitant haematological conditions in BD patients. RESULTS A 30-year-old woman with refractory GI BD involvement with trisomy 8 MDS underwent a successful myeloablative allogeneic HSCT resulting in complete resolution of both BD and MDS. Additionally we identified 14 manuscripts providing data on 19 patients with BD who had HSCT. Among these 20 patients, including ours, refractory disease was the indication of transplantation in 9, while 11 patients were transplanted because of accompanying haematological conditions. Transplant indications for the nine patients (four male, five female) with refractory BD were neurological involvement in five, pulmonary artery aneurysm in two, GI disease in one and not reported in one patient. Three patients with neurological disease, both patients with pulmonary artery aneurysm and the patient with intestinal involvement achieved complete remission of their disease. Six patients transplanted for haematological conditions, including the presented case, also had GI involvement of BD. All of these patients achieved complete remission of GI findings after HSCT. CONCLUSION When considering HSCT, the potential adverse events and complications, which can be fatal, need to be kept in mind.

Herpes simplex virus esophagitis in an immunocompetent host with sepsis

cured of an accompanying irritable bowel syndrome. Gustafssonet al. (7) state that in 31 patients “clinically, most enema-treated patients recovered within days and had no relapses within 18 months.” Tvede and Rask-Madsen (6) cured one of two patients, albeit using two low volume fecal enemas. The true situation is that far from having a “marginal” effectiveness, fecal bacteriotherapy is overwhelmingly successful. Famularoet al. next suggest that bacterial composition of the fecal enema should have been reported. Unfortunately, reliable methods for obtaining such a composition are not generally available, and such a report would have contributed little to the case report. More to the point, the donor stools were found to be free of pathogens, and after all, the treated patient did remain well for