Esin Korkut

The prevalence of celiac disease in patients fulfilling Rome III criteria for irritable bowel syndrome

BACKGROUND AND AIMS Celiac disease shares several symptoms which constitute some of the ROME criteria used for the diagnosis of irritable bowel syndrome (IBS), and as such many patients with underlying Celiac disease may be mistakenly diagnosed as having IBS. The aim of the present study was to determine the prevalence of Celiac disease in patients with IBS fulfilling ROME III criteria. MATERIALS AND METHODS Patients who fulfilled ROME III criteria for irritable bowel syndrome were screened for Celiac disease using the Biocard(TM) Celiac Disease Stick test, and patients who tested positive had their serum samples analyzed for antigliadin IgA and IgG, and anti-tissue transglutaminase IgA antibodies. Patients with detectable antibody levels underwent endoscopic duodenal biopsy to confirm a diagnosis of Celiac disease. RESULTS Two of 100 patients who were diagnosed as having irritable bowel syndrome as per the Roma III criteria were found to have elevated levels of serum antigliadin IgA and IgG, and anti-tissue transglutaminase IgA antibodies, with histological evidence of Celiac disease on examination of duodenal biopsy. Both patients were started on a gluten-free diet, showing significant improvement in their symptoms on follow-up. CONCLUSIONS Celiac disease is a common finding among patients labeled as IBS. Celiac disease must be considered in differential diagnosis of IBS especially in the therapy refractory group.

A disease must be considered in the differential diagnosis of ascites: familial Mediterranean fever.

Five female patients were admitted to our clinic between 2002 and 2004 with ascites of unknown etiology. In all of the casDear Sir, Familial Mediterranean fever (FMF) is an autosomal recessive disease which most commonly occurs in Sephardic Jews, Armenians, Arabs and Turks. FMF is characterized by recurrent and self-limited attacks of fever accompanied by peritonitis, pleuritis, sinovitis or erysipelas-like erythema [1, 2] . Inflammation of all serosal membranes can be seen during attacks, such as pleuritis, sinovitis and pericarditis. Small amounts of peritoneal fluid are often seen at laparoscopy of FMF patients. This finding reflects a peritoneal reaction Published online: February 15, 2008

Manometric assessment of esophageal motor function in patients with primary biliary cirrhosis

INTRODUCTION/AIM Primary biliary cirrhosis is associated with other autoimmune diseases including Sjögrens syndrome, and scleroderma. Esophageal dysmotility is well known in scleroderma, and Sjögrens syndrome. The aim of this study is to investigate whether any esophageal motor dysfunction exists in patients with primary biliary cirrhosis. METHOD The study was performed in 37 patients (36 women, mean age: 56.29 ± 10.01 years) who met diagnostic criteria for primary biliary cirrhosis. Thirty-seven functional dyspepsia patients, were also included as a control group. Patients entering the study were asked to complete a symptom questionnaire. Distal esophageal contraction amplitude, and lower esophageal sphincter resting pressure were assessed. RESULTS Manometric findings in primary biliary cirrhosis patients vs. controls were as follows: Median lower esophageal sphincter resting pressure (mmHg): (24 vs 20, p=0.033); median esophageal contraction amplitude (mmHg): (71 vs 56, p=0.050); mean lower esophageal sphincter relaxation duration (sc, x ± SD): (6.10 ± 1.18 vs 8.29 ± 1.92, p<0.001); and median lower esophageal sphincter relaxation (%) (96 vs 98, p=0.019); respectively. No significant differences were evident in median peak velocity (sc) (3.20 vs 3.02, p=0.778) between patients with primary biliary cirrhosis and the functional dyspepsia patients. Esophageal dysmotility was found in 17 (45.9%) primary biliary cirrhosis patients (non-specific esophageal motor disorder in ten patients, hypomotility of esophagus in five patients, nutcracker esophagus in one patient and hypertensive lower esophageal sphincter in one patient). CONCLUSION Esophageal dysmotility was detected in 45.9% of patients. The study suggests that subclinic esophageal dysmotility is frequent in patients with primary biliary cirrhosis.

Mallory-Weiss sendromunun argon plazma koagülasyonu ile tedavisi

The endoscopic hemostatic method has been introduced as a safe and effective mechanical approach to hemostasis for upper gastrointestinal bleeding related to Mallory-Weiss syndrome. A 62-year-old male patient with chronic cough and a 27-year-old 10-week pregnant female were admitted to our clinic with gross hematemesis. Upper gastrointestinal endoscopy was performed and Mallory-Weiss syndrome was diagnosed. Coagulum and visible vessels were observed during the procedure. Argon plasma coagulation was applied. After argon plasma coagulation, complete hemostasis was achieved and rebleeding did not occur. In conclusion, argon plasma coagulation can be performed easily and with minimum risk of complications such as perforation or delayed hemorrhage in patients with actively bleeding non-fibrotic Mallory-Weiss syndrome.

Gastrointestinal sistemde argon plazma koagulasyon (APC)uygulaması: Klinik deneyimlerimiz

Background and Aims: The aim of this study was to retrospectively analyze use of argon plasma coagulation in lesions of the gastrointestinal tract. Materials and Methods: Data of 92 patients treated with an argon plasma coagulation system in the upper and lower gastrointestinal tract between May 2005 and November 2006, using a VIO argon plasma coagulation device (VIO 300 D with argon plasma coagulation 2; Erbe Elektromedizin, Tubingen, Germany; pulsed argon plasma coagulation, 20?120 W), were reviewed and analyzed. Results: Ninety-two patients were treated with argon plasma coagulation, and the mean age was 61.84 (3-91) years. Fifty of these patients were male (54.3%) and 42 (45.7%) were female. Ninety-two patients were treated in 155 sessions. The mean number of treatment sessions required was 1.68 (1?12). Indications were vascular lesions (24 patients), bleeding peptic ulcers or prevention of bleeding recurrence (19 patients), adjunctive therapy after piecemeal resection of colonic polyps (17 patients), palliative treatment of gastrointestinal tract cancers, treatment of bleeding after polypectomy or biopsy (11 patients), ablation of inlet patch (11 patients), ablation of Barrett?s esophagus (5 patients), radiation proctopathy (4 patients), and metallic stent cut (1 patient). There were no major complications observed. Minor complications were seen in only five patients (bleeding in 2, chest pain in 1, anal pain in 2 patients). Conclusions: Argon plasma coagulation system was an effective and safe method in various gastrointestinal pathologies.