Haluk Tarik Kani

The effects of psychiatric treatment on depression, anxiety, quality of life, and sexual dysfunction in patients with inflammatory bowel disease

Objective Depression and anxiety are common disorders in inflammatory bowel disease (IBD). Our aim is to prospectively determine the effect of psychiatric treatment on scores for depression, anxiety, quality of life (QoL), and sexual dysfunction in an outpatient population diagnosed with IBD and also anxiety and/or depression disorder. Patients and methods Patients who scored higher than the cutoff point on the Hospital Anxiety Depression Scale were referred for further structured psychiatric evaluation and determination of the need for psychiatric drug treatment. Patients who underwent drug therapy completed Short Form-36 (SF-36) and the Arizona Sexual Experience Scale at baseline and after 6 months of follow-up. Results Major depressive disorder and generalized anxiety disorder were the most common diagnoses. After 6 months, 47 patients had completely adhered to drug treatment (group A), whereas 20 were nonadherent (group B). In group A, all domains of SF-36, Arizona Sexual Experience Scale, depression/anxiety scores, and Crohn’s disease activity index were statistically improved after treatment when compared with the baseline. In group B, the three domains of SF-36, platelet count, and mean corpuscular volume were worse between baseline and at 6 months. Conclusion In IBD patients having any psychiatric disorder, 6 months of antidepressant drug treatment is associated with an improvement in depression, anxiety, QoL, and sexual functioning scores, as well as an improvement in Crohn’s disease activity index. On the other hand, insufficient psychiatric treatment seems to be related to a poor QoL.

Male issues of the ileal pouch

Abstract:Restorative proctocolectomy with ileal pouch–anal anastomosis is the standard surgical treatment modality for patients with ulcerative colitis who require colectomy. There are special issues related to male gender. We performed systemic literature review on the topic, incorporating the experience in our specialized Center for Ileal Pouch Disorders, and provide recommendations for the identification and management for the gender-specific issues in male patients with ileal pouches. Chronic pouchitis, particularly ischemic pouchitis, anastomotic leak, and presacral sinus are more common in male patients than their female counterparts. Sexual dysfunction can occur after pouch surgery, particularly in those with pouch failure. Diagnosis and management of benign and malignant prostate diseases can be challenging due to the altered pelvic anatomy from the surgery. Digital rectal examination for prostate cancer screening is not reliable. Transpouch biopsy of prostate may lead to pouch fistula or abscess. Pelvic radiation therapy may have an adverse impact on the pouch function. In conclusion, sexual dysfunction and enlarged prostate can occur in patients with the ileal pouch. The measurement of serum prostate-specific antigen is a preferred method for the screening of prostate cancer. If biopsy of the prostate is needed, the perineal route is recommended. The risk for pouch dysfunction and the benefit for oncologic survival of pelvic radiation for prostate cancer should be carefully balanced.

Levofloxacin for the treatment of severe refractory BK virus‑associated hemorrhagic cystitis in hematopoietic stem cell transplantation recipients: A report of three cases

BK-virus (BKV) is an important etiological agent for late-onset hemorrhagic cystitis (HC) in patients undergoing hematopoietic stem cell transplantation. Late-onset HC causes significant morbidity among these patients. Therapeutic approaches remain predominantly symptomatic. Several treatment options have been used with variable success rates. Cidofovir has the highest specificity against BKV; however, its lack of availability in the majority of countries, high costs and potential nephrotoxic effects limit its use. The present study reports three cases of severe and prolonged BKV-associated HC (BKHC). HC was resolved in all three of the patients using oral levofloxacin. Thus, levofloxacin may be an effective treatment modality for achieving complete clinical and molecular response in patients with refractory, severe BKHC.

Should we use proton pump inhibitors as an add-on treatment in hereditary hemochromatosis?

Hereditary hemochromatosis (HH) is a rare disorder related to mutations in the HFE gene (1). These mutations cause increased iron absorption from intestine and accumulation in several organs, impairing organ functions (2). Increased iron accumulation causes liver fibrosis, elevation in liver enzymes, cirrhosis, hepatocellular carcinoma, hearth failure, arthritis, and diabetes mellitus (3-5). To avoid complications, the iron overload is decreased; phlebotomy is the cornerstone in treatment (6).

Evaluation of depression, anxiety, alexithymia, attachment, social support and somatization in functional dyspepsia

ABSTRACT AIM: The psychiatric and psychosocial aetiology of Functional dyspepsia is not well known. In the present study, our aim is to determine the relative contributions of psychiatric predictors – i.e. depression, anxiety, somatization, alexithymia – in relation with socio-psychological factors, specifically their personal characteristics (i.e. emotional attachment) and perceived social support, in distinguishing FD from organic dyspepsia and healthy samples. MATERIAL AND METHODS: An estimated 30 functional dyspepsia, 29 organic dyspepsia patients who were admitted to our gastroenterology outpatient clinic and 27 healthy controls were enrolled to our study. Beck Depression Inventory, Toronto Alexithymia Scale, Adult Attachment Scale, State-Trait Anxiety Inventory, Multidimensional Scale of Perceived Social Support and somatization sub-scale of Symptom Checklist-90 were provided to all patients and healthy controls. All participants were examined by a gastroenterologist and a psychiatrist. RESULTS: Healthy controls were younger than organic dyspepsia group and women/men rate was lower in organic dyspepsia than other two groups. Depression score was higher in functional dyspepsia group than in healthy controls and functional dyspepsia group’s attachment syle was more secure than that of the healthy control group. Somatization rate was seen higher in functional dyspepsia group with psychiatric examination. There was no significant difference seen in anxiety, alexithymia and social support between the three groups. DISCUSSION: Anxious-avoidant attachment profile as well as the higher propensity to have depressive and anxiety symptoms might be critical psychiatric and psychosocial factors underlying FD’s aetiology. A multidisciplinary approach is needed in the follow up of functional dyspepsia patients. Psychological evaluation and treatment would increase the life quality of dyspepsia patients.

P137 Sexual dysfunction in inflammatory bowel disease patients

whose SES-CD was 3 whereas it was 88% in patients whose SES-CD was 2 (p < 0.01). This tendency was observed both in patients who were treated with/without biologics. Cox regression analysis after adjustment of possible confounding factors revealed that SES-CD 2 was found to be independent determinants of non-relapse (HR 0.17; 95%CI 0.06 0.48). Conclusions: The present study demonstrated that endoscopic remission (SES-CD 2) predicted long-term prognosis even in patients with clinical remission.