Gökhan Baysoy

Evaluation of lansoprazole as a probe for assessing cytochrome P450 2C19 activity and genotype-phenotype correlation in childhood.

PurposeLansoprazole, a cytochrome P450 2C19 (CYP2C19) substrate, has been widely used in children to manage acid-related diseases. CYP2C19 exhibits marked genetic polymorphisms, and distribution of these polymorphisms varies among different ethnic groups. There is limited data regarding the use of probe drugs for determining CYP2C19 activity in children. The aim of this study was to evaluate lansoprazole as an in vivo phenotyping probe for assessing CYP2C19 activity in children.MethodsThe CYP2C19*2, *3, and *17 variants were determined in 244 children. Three hours after a single oral dose of lansoprazole (n = 94) or omeprazole (n = 19), plasma lansoprazole and 5-hydroxy lansoprazole or omeprazole and 5-hydroxy omeprazole concentrations were analyzed by high-performance liquid chromatography.ResultsThe CYP2C19*17 was the most frequent variant allele (24.4%). The group of patients with CYP2C19*17*17 genotype had a 70% lower (p < 0.05) mean lansoprazole plasma concentration compared with the CYP2C19*1*1 genotype group, whereas the CYP2C19*2*2 group had 6.9-fold higher (p < 0.01) mean lansoprazole plasma concentration. Lansoprazole metabolic ratios (lansoprazole/5-hydroxy-lansoprazole) were found to be significantly lower in the *17*17 [mean ± standard deviation (SD); 2.8 ± 2.1] group and higher in the *2*2 group (63.5 ± 12.2) compared with that of the *1*1 genotype group (6.1 ± 4.5).ConclusionAccording to our results from a Turkish pediatric population, lansoprazole is a suitable probe drug for phenotyping CYP2C19. The CYP2C19*2 and *17 variants should be taken into consideration in predicting the clinical outcome of therapy with lansoprazole in the pediatric population.

Effects of Gluten-Free Diet on Quality of Life and Depression in Children With Celiac Disease.

Objectives: The aim of this study was to investigate the level of depression and quality of life in children with celiac disease (CD). In addition, it aimed to examine the relations of depression level and life quality with adherence to a gluten-free diet (GFD). Methods: Twenty-five children with CD and 25 healthy controls were included. The Depression Scale for Children and the General Purpose Health-Related Quality of Life Scale for Children were performed on patients before and after receiving recommendations to follow a GFD. Results: No significant differences were found in the depression scores between the patients and the control subjects (P > 0.05). In contrast, total scores and scores of the emotional well-being subscale of the measure of Quality of Life Scale for Children were significantly lower in patients with CD compared with the control group (P < 0.05). No significant improvements were observed in depression or life quality scores of the total subsample of celiac patients, all of whom received a recommendation to follow a GFD (P > 0.05). Significant decrease was observed in the depression scores, however, of celiac patients who were able to actually adhere to the GFD compared with nonadherent patients. Conclusions: CD negatively affected quality of life in children. Adherence to GFD was associated with reduction in depression symptoms. Improving the adherence of celiac patients to a GFD may have a favorable effect on their depression symptoms.

Differences in the prevalence of obesity in children with celiac disease.

o the Editor: We read with great interest the article writtenby Venkatasubramani et al entitled ‘‘Obesity in PediatricCeliac Disease’’ (1). In their retrospective study of 143 childrenwith celiac disease, 5% had a body mass index above the 95thpercentile at the time of diagnosis. As a result they concludethatobesityisnotararefindinginnewlydiagnosedceliacpatients.We previously reported 220 newly diagnosed celiac patients(7.2 4.3 years) in our center between 2000 and 2008 and foundthat only 1 patient (0.45%) hada body mass index above the 95thpercentile (2). It is well known that obesity is an epidemic in theUnited States because of the prevalence of fast-food nutrition (3).Therefore, the differences in the prevalence of obesity in celiacdisease in different cultures may be related to dietary habits andeconomic conditions.Necati Balamtekin, Go¨khan Baysoy, and Hu¨lya DemirHacettepe UniversityEtlik-Ankara, Turkey

Internal iliac vein thrombosis in pediatric Crohn's disease.

Thromboembolic events are one of the important extraintestinal manifestations of inflammatory bowel diseases that are associated with considerable morbidity and mortality. Iliac vein thrombosis is rarely reported in inflammatory bowel diseases. A 9.5 year-old girl was presented with joint pain, nausea, vomiting and weight loss. She was diagnosed with Crohns disease and right internal iliac vein thrombosis. With the implementation of immunosuppressive and anticoagulant therapies clinical picture has improved and thrombosis has resolved. Timely diagnosis and early treatment of extraintestinal complications of inflammatory bowel diseases might be lifesaving.

Safety of ribavirin in adolescent thalassemic patients with chronic hepatitis C virus infection

Hepatitis C virus (HCV) infection is still a common and imporant problem in thalassemic patients.1 There have been important mprovements in the treatment of chronic HCV infection especially n the last decade. Combination of pegylated interferon (peg-IFN) lfa-2 and ribavirin seems to improve the success of treatment esponse and currently is the recommended therapy for adults.2,3 owever, studies about the treatment of adolescents with thaassemia and HCV infection are limited and are concerned with the dverse effects of the treatment.1,4 We herein present two adoescents with -thalassemia major and chronic HCV infection who ere treated with peg-IFN and ribavirin and discuss the safety of he treatment.