Bülent Yildirim

Differential changes in Substance P, VIP as well as neprilysin levels in patients with gastritis or ulcer

The protective effect of capsaicin-sensitive sensory nerve (CSSN) activation was recently demonstrated in human gastric mucosa. We here examined changes in neuropeptides, specifically Substance P (SP), calcitonin-gene related peptide (CGRP) and vasoactive intestinal peptide (VIP) in patients with chronic gastritis or ulcer. Furthermore changes in neprilysin levels, which hydrolyse these neuropeptides, were determined. Gastric biopsies were obtained from both lesion- and normal-appearing mucosa of 57 patients. The presence of H. pylori infection was verified with rapid urease assay. Neuronal and non-neuronal levels of SP, VIP, CGRP and neprilysin activity were determined in freshly frozen biopsies. Immunohistochemical localization of neprilysin was performed in 30 paraffin embedded specimens. We here found that neuronal SP levels decreased significantly in normally appearing mucosa of patients with gastritis while levels of non-neuronal SP increased in diseased areas of gastritis and ulcer. The presence of H. pylori led to further decreases of SP levels. The content of VIP in both disease-involved and uninvolved mucosa, and expression of neprilysin, markedly decreased in patients with gastritis or ulcer. Since VIP, as well as SP fragments, formed following hydrolysis with neprilysin is recognized to have gastroprotective effects, decreased levels of VIP, SP and neprilysin may predispose to cellular damage.

Gastric collision tumor: Case report of a rare adenocarcinoma and a typical carcinoid tumor

We report a case with features of gastric adenocarcinoma colliding with a typical carcinoid component. A 51-year-old female was admitted to the Department of Internal Medicine with complaints of epigastric pain. On physical examination of the patient there was significant epigastric tenderness and the CA19-9 level was higher than the normal titer value. An upper gastrointestinal endoscopy showed an ulcerated polypoid mass located on the cardiac region of the stomach. Pathological and immunohistochemical findings diagnosed as a collision tumor comprising both adenocarcinoma and carcinoid tumor. Metastasis of adenocarcinoma was found in 7 perigastric lymph nodes, while metastasis of the carcinoid was not detected. The admixture of neoplastic endocrine and nonendocrine cells, have been found infrequently in gastric tumors. The mixed tumors can be further classified into composite tumors that show an admixture of two histological components with histological transitions and collision tumors where the two components are not intermixed In general it is not easy to morphologically distinguish a collision tumor, from composite tumor. Microscopically, hematoxylin and eosin-stained tissue sections from two different areas of the mass revealed two different types of tumor; an intestinal type adenocarcinoma and a carcinoid tumor. We report a case with features of adenocarcinoma colliding with a typical carcinoid component, along with a review of the literature.

Evaluation of increased subclinical atherosclerosis risk with carotid intima-media thickness and pulse wave velocity in inflamatory bowel disease

BACKGROUND/AIMS A significant increase in accelerated atherosclerosis risk have determined in chronic inflammatory diseases. Recent studies have suggested a pathophysiological link between inflamatory bowel disease (IBD) and atherosclerosis; for which carotid intima-media thickness (CIMT) and pulse wave velocity (PWV) has been considered as an early marker. The aim of this study was to determine the presence of early atherosclerosis in IBD patients without clinically diagnosed cardiovascular disease and any coincident risk factors for atherosclerosis. MATERIALS AND METHODS 40 IBD patients who are in remission and without known atherosclerosis and also without any risk factors for atherosclerosis (17 Crohns disease and 23 ulcerative colitis ) and 40 healthy subjects for control group involved in the study. The measurement of bilateral CIMT and carotis-femoral PWV have done in patients and control groups. RESULTS Significant differences existed between control subjects and patients with IBD in the values of PWV (5.97±0.54 vs. 7.17±0.92 m/sn; p<0.001), maximum CIMT (0.76±0.06 vs. 0.86±0.11 mm; p<0.001) and mean CIMT (0.66±0.06 vs 0.74±0.09 mm; p<0.001). In the correlation analysis, a positive correlation has determined between PWV and maximum CIMT and mean CIMT ( p<0.001, r=0.75 / p<0.001, r=0.74 respectively ). CONCLUSION IBD patients have an increased risk of subclinical atherosclerosis than healty controls as showed by greater values of CIMT and PWV.

Profound loss of neprilysin accompanied by decreased levels of neuropeptides and increased CRP in ulcerative colitis

Neprilysin (NEP, CD10) acts to limit excessive inflammation partly by hydrolyzing neuropeptides. Although deletion of NEP exacerbates intestinal inflammation in animal models, its role in ulcerative colitis (UC) is not well explored. Herein, we aimed to demonstrate changes in NEP and associated neuropeptides at the same time in colonic tissue. 72 patients with UC and 27 control patients were included. Patients’ demographic data and laboratory findings, five biopsy samples from active colitis sites and five samples from uninvolved mucosa were collected. Substance P (SP), calcitonin gene related peptide (CGRP) and vasoactive intestinal peptide (VIP) were extracted from freshly frozen tissues and measured using ELISA. Levels of NEP expression were determined using immunohistochemistry and immunoreactivity scores were calculated. GEBOES grading system was also used. We demonstrated a profound loss (69.4%) of NEP expression in UC, whereas all healthy controls had NEP expression. Patients with UC had lower neuronal SP; however non-neuronal SP remained similar. UC patients had also lower neuronal and non-neuronal VIP levels. CGRP were low in general and no significant changes were observed. Additionally, CRP positive patients with UC had higher rates of NEP loss (80% vs 51.9%) and lower SP levels when compared with CRP negative patients with UC. Concurrent decreases in SP and VIP with profound loss of NEP expression observed in UC is likely to be one of the factors in pathogenesis. Further studies are required to define the role of neuropeptides and NEP in UC.

Comparison of heater probe coagulation and argon plasma coagulation in the management of Mallory–Weiss tears and high-risk ulcer bleeding

BACKGROUND AND STUDY AIMS Upper gastrointestinal (GI) bleeding is a common medical emergency. Endoscopic treatments often lead to better therapeutic outcomes than conventional conservative treatments. This study aimed to investigate and compare the use of heater probe coagulation (HPC) and argon plasma coagulation (APC) together with epinephrine injection for the treatment of Mallory-Weiss tears and high-risk ulcer bleeding. PATIENTS AND METHODS A total of 97 patients (54 in the HPC group and 43 in the APC group) who were diagnosed with upper GI bleeding secondary to a Mallory-Weiss tear or high-risk gastric or duodenal ulcers were included in the study. Lesions were classified according to the Forrest classification. The HPC and APC groups were compared in terms of initial haemostasis, re-bleeding in the early period, need for surgery, average need for transfusion, and duration of hospital stay. RESULTS There were no significant differences between the HPC and APC groups in terms of ensuring initial haemostasis (98% vs. 97.5%, p>0.05), re-bleeding rates (17% vs. 19%, p>0.05), need for surgery (2% vs. 9%, p>0.05), average need for transfusion (3.7±2.11 vs. 3.4±2.95 units, p>0.05), and average duration of hospital stay (4.6±2.24vs. 5.3±3.23days, p>0.05). CONCLUSION There was no difference between HPC and APC when used together with epinephrine injection for the treatment of Mallory-Weiss tear and high-risk ulcer bleeding.

A Cause of Mortal Massive Upper Gastrointestinal Bleeding: Aortoesophageal Fistula

Introduction: Aortoesophageal fistula is an uncommon but mortal cause of massive upper gastrointestinal bleeding. The most common causes are thoracic aortic aneurisym, foreign body reaction, malignancy and postoperative complication. It can be seen in different pattern on upper gastrointestinal endoscopy. There are surgical, endoscopic and interventional radiological treatment options, however, definitive treatment is surgical intervention. Diagnosis and treatment desicion should be made quickly because of rapid and mortal course. Case report: In this article, a case of aortoesophageal fistula was presented that resulted in mortality as a result of massive bleeding.

Effectiveness and safety of sofosbuvir/ledipasvir ± ribavirin treatment in liver and/or renal transplant patients with chronic hepatitis C: A single-center experience:

Objective: Successful treatment is possible with novel direct-acting oral antiviral agents in solid organ transplant patients with hepatitis C. In this study, the effectiveness and safety of sofosbuvir/ledipasvir ± ribavirin treatment in liver and/or renal transplant patients with chronic hepatitis C were evaluated. Materials and methods: A total of 23 liver and/or renal transplant patients who received sofosbuvir/ledipasvir ± ribavirin for chronic hepatitis C over 12 or 24 weeks were enrolled in the study. The treatment response, clinical and laboratory adverse effects, and effect on immunosuppressive drug levels were assessed. Results: A total of 12 patients had undergone renal transplantation and 11 had undergone liver transplantation. All of the renal transplant patients and 91% of liver transplant patients had genotype 1. In total, 10 renal transplant patients and 4 liver transplant patients had treatment experience. Two renal transplant patients and one liver transplant patient had compensated cirrhosis. Nine renal transplant patients were on tacrolimus, and two were on cyclosporine; all of the liver transplant patients were on tacrolimus-based immunosuppressive therapy. While hepatitis C RNA was negative in 75% of renal transplant patients and 91% of liver transplant patients at week 4, it was negative in all of the patients at the end of treatment and 12 weeks after treatment. Significantly reduced hemoglobin levels were observed in patients administered ribavirin during treatment (p = 0.01). There were no significant differences between the baseline and treatment period values of mean creatinine, estimated glomerular filtration rate, bilirubin, and tacrolimus levels. There were no adverse effects leading to treatment discontinuation. Conclusion: Sofosbuvir/ledipasvir ± ribavirin is quite safe and effective in hepatitis C treatment after liver and/or renal transplantation.

ADAM proteases involved in inflammation are differentially altered in patients with gastritis or ulcer

ADAM metallopeptidase domain (ADAM)9, 10 and 17 have α-secretase activity that regulates ectodomain shedding of factors involved in inflammation, cell proliferation, angiogenesis, and wound healing. The secretase activity of ADAM proteins is known to induce an inflammatory response. However, under certain conditions, a lack of secretase activity may induce inflammation suggesting differential roles of ADAM proteins with secretase activity. To the best of our knowledge, the present study evaluated the changes in α-secretase activity and expression of associated ADAM proteases (ADAM9, 10 and 17) in the gastric mucosa of patients with gastritis and ulcers, for the first time. Gastroduedonal mucosal samples from 42 patients were snap-frozen to determine changes in α-secretase activity. Twenty-four of these patients had gastritis, 9 patients had duedonal ulcers and 9 patients did not have any pathological changes. Paraffin-embedded gastric specimens (n=32) were used for immunohistochemical detection of ADAM9, ADAM10 and ADAM17. α-secretase activity of the gastric mucosa of healthy subjects was significantly higher compared with the uninvolved mucosa of patients with gastritis or ulcer. These results were associated with the immunohistochemical staining results, which demonstrated that ADAM10 expression markedly decreased in glandular epithelial cells and ADAM9 expression was lost in foveolar epithelial cells of gastric mucosa adjacent to ulcer. However, ADAM17 expression was increased in the normal gastric mucosa of patients with bleeding peptic ulcers and in the gastric mucosa adjacent to the ulcer suggesting a counteracting role of ADAM17. Decreased ADAM9 and 10 expression, and an associated decrease in α-secretase activity may predispose to chronic gastritis and ulcer. Further studies are required to determine the possible etiological role of increased ADAM17 expression.

Association of Mean Platelet Volume And Severity of Bleeding In Patients With Non-Variceal Upper Gastrointestinal Bleeding

Objective: Upper gastrointestinal (GI) bleeding is a common medical condition that might require surgery and can result in mortality in high risk lesions. The present study aimed to investigate the association with severity of bleeding and mean platelet volume (MPV) as an indicator of platelet function and activation, in patients with upper GI bleeding.. Material and Methods: A total of 97 patients diagnosed with upper GI bleeding secondary to Mallory-Weiss tear and high-risk gastric or duodenal ulcer and who underwent endoscopic treatment with epinephrine injection plus heater prob coagulation or argon plasma coagulation were analyzed retrospectively. Patients were compared according the median MPV levels, in terms of initial hemostasis, mean transfusion count and duration of hospital stay, recurrent bleeding rates and need for surgery. results: Median MPV level was 8.3 fL in enrolled patients. MPV was lower than the median level in 52 (53%) patients and higher in 45 (47%) patients. There were no statistically significant differences between the two groups in terms of initial hemostasis (100% vs. 96%, p>0.05), average transfusion count (3.5 ± 2.25 and 3.66 ± 2.77 units, p>0.05). average duration of hospital stay (5.1 ± 3.05 and 4.89 ± 2.33 days, p>0.05). recurrent bleeding rates (15% vs. 20%, p>0.05) and need for surgical treatment (6% vs. 4%, p>0.05). conclusion: MPV was not found to related with the severity of bleeding in patients with upper GI bleeding secondary to Mallory-Weiss tear or high-risk of gastric or duodenal ulcer. key Words: Upper gastrointestinal bleeding, Mean platelet volume, Peptic ulcer, Mallory-Weiss tear Mete AKIN1, Erhan ALKAN2, Yaşar TUNA1, Tolga YALÇINKAYA1, Bülent YILDIRIM1 Varis Dışı Üst Gastrointestinal Sistem Kanamalarında Ortalama Trombosit Hacminin Kanama Ciddiyeti İle İlişkisi Association of Mean Platelet Volume And Severity of Bleeding In Patients With Non-Variceal Upper Gastrointestinal Bleeding 1Akdeniz Üniversitesi, İç Hastalıkları, Gastroenteroloji Bilim Dalı, Antalya, Türkiye 2Burdur Devlet Hastanesi, Gastroenteroloji Bölümü, Burdur, Türkiye