Irfan Soykan

Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis.

Patients with gastroparesis frequently presentchallenging clinical, diagnostic, and therapeuticproblems. Data from 146 gastroparesis patients seen oversix years were analyzed. Patients were evaluated at the time of initial diagnosis and at themost recent follow-up in terms of gastric emptying andgastrointestinal symptomatology. The psychologicalstatus and physical and sexual abuse history in female idiopathic gastroparesis patients wereascertained and an association between those factors andgastrointestinal symptomatology was sought. Eightytwopercent of patients were females (mean age: 45 years old). The mean age for onset of gastroparesiswas 33.7 years. The etiologies in 146 patients are: 36%idiopathic, 29% diabetic, 13% postgastric surgery, 7.5%Parkinsons disease, 4.8% collagen vascular disorders, 4.1% intestinal pseudoobstruction,and 6% miscellaneous causes. Subgroups were identifiedwithin the idiopathic group: 12 patients (23%) had apresentation consistent with a viral etiology, 48% had very prominent abdominal pain. Othersubgroups were gastroesophageal reflux disease andnonulcer dyspepsia (19%), depression (23%), and onset ofsymptoms immediately after cholecystectomy (8%).Sixty-two percent of women with idiopathic gastroparesisreported a history of physical or sexual abuse, andphysical abuse was significantly associated withabdominal pain, somatization, depression, and lifetime surgeries. At the end of the follow-up period,74% required continuous prokinetic therapy, 22% wereable to stop prokinetics, 5% had undergone gastrectomy,6.2% went onto gastric electrical stimulation (pacing), and 7% had died. At some point 21%had required nutrition support with a feedingjejunostomy tube or periods of parenteral nutrition. Agood response to pharmacological agents can be expected in the viral and dyspeptic subgroups ofidiopathics, Parkinsons disease, and the majority ofdiabetics, whereas a poorer outcome to prokinetics canbe expected in postgastrectomy patients, those withconnective tissue disease, a subgroup of diabetics, andthe subset of idiopathic gastroparesis dominated byabdominal pain and history of physical and sexual abuse.Appreciation of the different etiologies andpsychological status of the patients may help predictresponse to prokinetic therapy.

Domperidone: review of pharmacology and clinical applications in gastroenterology.

Domperidone is a dopamine-2 receptor antagonist. It acts as an antiemetic and a prokinetic agent through its effects on the chemoreceptor trigger zone and motor function of the stomach and small intestine. Unlike metoclopramide, it does not cause any adverse neurological symptoms as it has minimal penetration through the blood-brain barrier. It thus provides an excellent safety profile for long-term administration orally in the recommended doses. Domperidone is widely used in many countries and can now be officially prescribed to patients in the United States by an investigational new drug application for the treatment of gastroparesis and any condition causing chronic nausea and vomiting. In view of this additional clinical exposure of domperidone to a new generation of gastroenterologists and other specialists, the purpose of this timely review is to revisit the pharmacology, clinical application, and safety profile of this beneficial medication.

Serum vitamin B12 and folate status in patients with inflammatory bowel diseases

BACKGROUND The aims of this study were to investigate the prevalence of serum vitamin B(12) and folate abnormalities in patients with inflammatory bowel diseases (IBD) and to identify risk factors associated with B12 and folate abnormalities in this entity. METHODS 138 patients with IBD (45 Crohns disease and 93 ulcerative colitis) and 53 healthy subjects were enrolled into the study. Fasting serum B12 and folic acid levels were measured and clinical data regarding inflammatory bowel diseases were gathered. RESULTS While the mean serum B(12) concentration in CD patients was 281+/-166pg/ml, the mean serum vitamin B12 concentration in UC patients was 348+/-218pg/ml (p=0.224). The number of patients with vitamin B12 deficiency in the CD group was greater than the number of patients with UC [n=10 (22%) vs. n=4 (7.5%), p=0.014]. The number of patients (n=10, 22%) with B12 deficiency in the CD group was also greater than controls (n=4, 7.5%) (p=0.039). With regard to folate levels, the median serum folate level was 7.7+/-5.3ng/ml in CD patients, 8.6+/-8.3ng/ml in UC patients and 9.9+/-3.3ng/ml in the control group (p=n.s.). Patients with a prior ileocolonic resection had an abnormal B12 concentration compared to patients without surgery (p=0.008). In CD patients, ileal involvement was the only independent risk factor for having a low folate level. CONCLUSION Serum vitamin B12 and folate deficiencies are common in patients with CD compared to UC patients and controls. In CD patients, prior small intestinal surgery is an independent risk factor for having a low serum vitamin B12 level.

Lamivudine prophylaxis for prevention of chemotherapy-induced hepatitis B virus reactivation in hepatitis B virus carriers with malignancies.

Summary.  Although hepatitis B virus (HBV) reactivation in HBV carriers undergoing immunosuppressive therapy is clearly documented, the role of antiviral prophylaxis in such individuals is still controversial. The aim of this study was to determine the efficacy of lamivudine prophylaxis in HBV carriers with haemato/oncological malignancies, who receive chemotherapy. Eighteen HBV carriers with malignancy, who were candidates for chemotherapy, were enrolled. Eight subjects (three with leukaemia, four with lymphoma and one with multiple myeloma) were enrolled for prophylactic lamivudine therapy. The remaining 10 patients (six with leukaemia, three with lymphoma and one with breast cancer) were not treated with lamivudine and were used as a control. Lamivudine was administered beginning on the same day as the chemotherapy and was maintained for a year after chemotherapy was discontinued. No HBV‐related mortality was observed in either group. In the lamivudine‐treated group, none of the subjects had clinical, biochemical or serological evidence of HBV reactivation during the time they were receiving chemotherapy and after their chemotherapy was discontinued. In contrast, five of the 10 HBV carriers not receiving lamivudine therapy experienced a reactivation of HBV infection. This reactivation of HBV was observed during the chemotherapy in four with one individual experiencing a HBV activation 12 months after chemotherapy was discontinued. No lamivudine‐related major adverse effects were observed. Hence prophylactic lamivudine treatment in HBV carriers with haemato/oncological malignancy receiving chemotherapy prevents chemotherapy‐induced HBV reactivation.

Clinical trial: insulin‐sensitizing agents may reduce consequences of insulin resistance in individuals with non‐alcoholic steatohepatitis

Background  Currently, although only a few therapies normalize the liver test abnormalities with/without improving the liver histology, no pharmacologic therapy has proved to be effective for the treatment of non‐alcoholic steatohepatitis.

Misoprostol in the treatment of chronic refractory constipation: results of a long-term open label trial

Misoprostol is known to be effective in stimulating intestinal transit both in healthy individuals and in patients with chronic constipation when evaluated in short‐term trials. The aim of this study was to determine the utility of misoprostol in the long‐term management of patients with chronic refractory constipation.

NOD2/CARD15, NOD1/CARD4, and ICAM-1 gene polymorphisms in Turkish patients with inflammatory bowel disease

PurposeThe genetic susceptibility of people with certain NOD2/CARD15, NOD1/CARD4, and ICAM-1 gene variants to inflammatory bowel disease is still under investigation. The aim of this study was to investigate polymorphisms in the NOD2/CARD15 (R702W, G908R, and 3020insC), NOD1/CARD4 (E266K, D372N), and ICAM-1 (G241R, K469E) genes, which are known to be associated with inflammation, in Turkish patients with inflammatory bowel disease and healthy control groups.MethodsThe genotypes of 70 patients with endoscopically and histopathologically diagnosed Crohns disease (38 men, 32 women; mean age, 38.8 ± 1.3), 120 patients with ulcerative colitis (67 men, 53 women; mean age, 41.7 ± 1.3) and 106 healthy control subjects (37 men, 69 women; mean age, 35.7 ± 1.4), who stated that they had never had any prior bowel disease history, were compared. A polymerase chain reaction-restriction fragment length polymorphism analysis was performed for two variants of the ICAM-1 gene, the three main variants of the NOD2/CARD15 gene, and the E266K variant of the NOD1/CARD4 gene, and DNA sequencing was used for the D372N polymorphism of the NOD1/CARD4 gene.ResultsIn this study, the three previously described Crohns disease-predisposing variants of the NOD2/CARD15 gene and the polymorphisms examined in the NOD1/CARD4 and ICAM-1 genes were not found to be associated with ulcerative colitis or Crohns disease.ConclusionsThese findings suggest that the polymorphisms observed in the NOD2/CARD15, NOD1/CARD4, and ICAM-1 genes are not genetic susceptibility factors for Crohns disease or ulcerative colitis in Turkey.

The Rumination Syndrome (Clinical and Manometric Profile, Therapy, and Long-Term Outcome)

The aims of this study were to investigate thediagnostic studies necessary to identify ruminationsyndrome and the long-term therapeutic outcomes ofpatients with rumination syndrome. Sixteen patients with rumination were evaluated between 1989 and1995. Esophageal motility, gastric emptying, uppergastrointestinal motility, and electrogastrography ofall patients were reviewed; follow-up information about their current status was available from10 of the 16 patients. Duration of symptoms was 77.2months and the mean age was 28.5 years at the time ofdiagnosis. Esophageal and upper gastrointestinal motility, gastric emptying, andelectrogastrographic studies were all normal. Mean loweresophageal pressure was 12.7 mm Hg and three of the 16patients had a decreased pressure of less than 6 mm Hg.Ten patients were followed for a mean duration of31.2 months. Five of 10 patients used biofeedback andrelaxation techniques and reported subjectiveimprovement. Our results indicate that ruminationsyndrome is often confused with a gastric motilitydisorder and diagnosis is possible if one is aware ofthis condition. Although there is not a definitivemanagement protocol for this condition, reassurance and education of the patient and the family arecrucial first steps followed by behavioral andrelaxation programs.

A new percutaneous approach for the treatment of hydatid cysts of the liver

OBJECTIVES: The aims of this study were to investigate the efficacy of a new percutaneous treatment modality of hydatid disease of the liver and to present the results of long term follow-up. METHODS: Eighty-seven patients (55 female, mean age 43.5 yr) with 98 hydatid cysts (73 type I, 15 type II, and 10 type III) in the liver underwent percutaneous treatment. All patients were examined by ultrasonography and some of them were examined by CT. They were all positive by indirect hemagglutination test. Sonographic guidance was used in all patients. The procedure included the puncture and free drainage of the cyst fluid. After free drainage was stopped, absolute alcohol and polidocanol 1% were used as sclerosing agents. The patients were followed-up with periodic ultrasonographic examinations. RESULTS: The mean follow-up time was 33 months. The mean diameter of the cysts decreased from 77.0+/-2.7 mm to 63.0+/-2.5 mm (p < 0.001). The entire cyst cavity filled with a solid echo pattern in 32 cysts, two-thirds of the cyst cavity showed a pseudotumor echo pattern in 34 cysts, and one-third of the cyst cavity showed a pseudotumor pattern in 23 cysts, whereas no pseudotumor appearence was observed in eight cysts. Apart from an anaphylactoid reaction observed in one patient, no major complication occurred during the follow-up period. CONCLUSIONS: Long term results indicate that this new percutaneous treatment modality of the hydatid disease of the liver is an effective and safe method without causing major complications. Percutaneous treatment of hydatid cysts of the liver offers good results and should be the first choice, especially for patients who are contraindicated to surgery.

Barrett's esophagus: Prevalence and its relationship with dyspeptic symptoms

Background and Aim:  Barretts metaplasia is a premalign condition which plays a pivotal role in the development of esophageal adenocarcinoma. It is considered a complication of chronic gastroesophageal reflux disease. Although esophageal adenocarcinoma is an uncommon cancer, its incidence is rapidly increasing. The aims of the present study were to determine the prevalence of Barretts metaplasia in outpatients referred for gastroscopy for upper gastrointestinal symptoms, and to clarify the relationship between Barretts metaplasia and upper gastrointestinal symptoms.