Mete Akin

Kefir treatment ameliorates dextran sulfate sodium-induced colitis in rats

AIM To investigate the preventive effect of kefir on colitis induced with dextran sulfate sodium (DSS) in rats. METHODS Twenty-four male Wistar-albino rats were randomized into four groups: normal control, kefir-control, colitis, and kefir-colitis groups. Rats in the normal and kefir-control groups were administered tap water as drinking water for 14 d. Rats in the colitis and kefir-colitis groups were administered a 3% DSS solution as drinking water for 8-14 d to induce colitis. Rats in the kefir-control and kefir-colitis groups were administered 5 mL kefir once a day for 14 d while rats in the normal control and colitis group were administered an identical volume of the placebo (skim milk) using an orogastric feeding tube. Clinical colitis was evaluated with reference to the disease activity index (DAI), based on daily weight loss, stool consistency, and presence of bleeding in feces. Rats were sacrificed on the 15(th) day, blood specimens were collected, and colon tissues were rapidly removed. Levels of myeloperoxidase (MPO), tumor necrosis factor (TNF)-α, interleukin (IL)-10, malondialdehyde, and inducible nitric oxide synthase (iNOS) were measured in colon tissue. RESULTS The DAI was lower in the kefir-colitis group than in the colitis group (on the 3(rd) and 5(th) days of colitis induction; P < 0.01). The DAI was also significantly higher in the colitis group between days 2 and 6 of colitis induction when compared to the normal control and kefir-control groups. The DAI was statistically higher only on the 6(th) day in the kefir-colitis group when compared to that in the normal control groups. Increased colon weight and decreased colon length were observed in colitis-induced rats. Mean colon length in the colitis group was significantly shorter than that of the kefir-control group. Kefir treatment significantly decreased histologic colitis scores (P < 0.05). MPO activity in the colitis group was significantly higher than in the kefir-control group (P < 0.05). Kefir treatment significantly reduced the DSS colitis-induced TNF-α increase (P < 0.01). No statistically significant differences were observed among groups for IL-10 and MDA levels. Colon tissue iNOS levels in the colitis group were significantly higher than those in the control and kefir-colitis groups (P < 0.05). CONCLUSION Kefir reduces the clinical DAI and histologic colitis scores in a DSS-induced colitis model, possibly via reduction of MPO, TNF-α, and iNOS levels.

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.

Is gastroesophageal reflux contribute to the development chronic cough by triggering pulmonary fibrosis.

BACKGROUND/AIMS Previous studies have shown that the prevalence of abnormal acid reflux in fibrotic lung disease patients is high, and in particular, patients with secondary pulmonary fibrosis show higher esophageal acid exposure than normal controls. There are also some findings that, in patients with pathological reflux, pulmonary fibrosis may develop. The aim of this study is to investigate if pulmonary fibrosis is involved in the pathogenesis of chronic cough due to Gastroesophageal Reflux. MATERIALS AND METHODS A prospective study was performed in twenty-one patients with chronic cough due to gastroesophageal reflux who was diagnosed as reflux esophagitis by upper gastrointestinal endoscopy, histology, and in ten healthy controls without GER or any lung disease. All participitants underwent laryngoscopic examination and gastroesophageal scintigraphy with late lung imaging. Bronchoalveolar lavage fluid total and differential cell counts, T and B cell subsets, and the concentrations of IL- 1β and TNF-α were measured. RESULTS Reflux extending into the proximal esophagus was noted in 52.5%, and posterior laryngitis was present in 90.5% of the patients. No evidence of pulmonary aspiration was noted in the patients with reflux on scintigraphic examination. No significant difference was found between the GER and control groups in terms of cellular content, IL-1β and TNF-α levels or mean T cell subsets and B cell counts in bronchoalveolar lavage fluid. Forced expiratory volume in one second, forced vital capacity FEV1/FVC, total lung capacity, and carbon monoxide diffusion capacity values were within normal limits in the gastroesophageal reflux group. CONCLUSION Our findings do not support the hypothesis that gastroesophageal reflux leads to chronic cough by triggering alveolar epithelial injury and subsequent pulmonary fibrosis.

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.

Comparison of intravenous pantoprazole and ranitidine in patients with dyspepsia presented to the emergency department: a randomized, double blind, controlled trial

BACKGROUND This study aimed to compare pantoprazole, a proton-pomp inhibitors (PPIs), and ranitidine, a H2 receptor antagonists (H2RA), in ceasing dyspeptic symptoms in the emergency department (ED). METHODS This randomized, double-blinded study compared the effectiveness of 50 mg ranitidine (Ulcuran(®)) and 40 mg pantoprazole (Pantpas(®)), given in a 100 mL saline solution by an intravenous rapid infusion within 2-4 minutes in patients with dyspepsia presented to the ED. Pain intensity was measured at baseline, 30 and 60 minutes after the drug administration. RESULTS A total of 72 patients were eligible for the study. Of these patients, 2 were excluded from the study because the initial visual analogue scale (VAS) scores were under 20 mm and 4 were excluded from the statistical analysis because of being diagnosed as having other causes of epigastric pain despite being allocated to one of the study groups. Thirty-three patients in the pantoprazole group and 33 patients in the ranitidine group were analyzed ultimately. The mean age of the patients was 36.6±15 years, and 26 (39.4%) patients were male. Both of the groups reduced pain effectively at 30 [27.6±28 (18 to 37) vs. 28.3±23 (20 to 37), respectively] and 60 minutes [39.6±39 (26 to 53) vs. 42.3±25 (33 to 51), respectively]. There were 13 (39.4%) patients in the pantoprazole group and 8 (24.2%) patients in the ranitidine group who required additional drug at the end of the study (P=0.186). CONCLUSION Intravenous pantoprazole and ranitidine are not superior to each other in ceasing dyspeptic symptoms at 30 and 60 minutes in the ED.

A Different Pattern of Brunner Gland Adenoma on Endoscopic Ultrasonography

DOI: 10.4328/JCAM.1474 Received: 15.12.2012 Accepted: 02.01.2013 Publihed Online: 02.01.2013 Corresponding Author: Mete Akin, Burdur Devlet Hastanesi, Gastroenteroloji Klinigi, 15030 Yenimahalle, Burdur, Turkiye. T.: +9

Serial Changes in Alpha-Fetoprotein Levels During Therapy for Chronic Hepatitis C

1 Altuğ Şenol1, Mete Akın2, Yıldıran Songür3, Mehmet İşler4, M.Cem Koçkar1 1Süleyman Demirel University School of Medicine, Department of Gastroenterology, Isparta, 2Akdeniz University School of Medicine, Department of Gastroenterology, Antalya, 3Memorial Şişli Hospital, Department of Gastroenterology, İstanbul, 4Şifa Hospital, Department of Gastroenterology, Isparta, Turkey Alpha-Fetoprotein Levels in Chronic Hepatitis C Serial Changes in Alpha-Fetoprotein Levels During Therapy for Chronic Hepatitis C

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

Sigmoid özofaguslu bir olguda akalazya balon dilatasyonu

We report herein a method for pneumatic dilatation in a patient with achalasia complicated with sigmoid esophagus, since it could not be performed using the standard methods.