Nihat Akbayir

Heterotopic gastric mucosa in the cervical esophagus (inlet patch): Endoscopic prevalence, histological and clinical characteristics

Background and Aim:  Heterotopic gastric mucosal patch, which has a 0.1–10% frequency, is encountered when the cervical esophagus is examined carefully during endoscopy. In this study, we aimed to determine the prevalence of the patch in the cervical esophagus, to identify its macroscopic and histological characteristics and to evaluate demographic and clinical features.

Sensorineural Hearing Loss in Patients with Inflammatory Bowel Disease: A Subclinical Extraintestinal Manifestation

Isolated case reports in which symptomatic hearing loss develops suddenly during the course of inflammatory bowel disease (IBD) have been reported, but the presence of subclinical sensorineural hearing loss (SNHL) associated with IBD has been investigated in only two preliminary studies.In order to research this further, we aimed to investigate the presence of subclinical SNHL in IBD by comparison with a control group and to examine possible relations between the bowel disease parameters and hearing loss.Otoscopy, tympanometry, and pure tone audiometry were carried out in 39 patients with IBD (21 Crohns disease [CD], 18 ulcerative colitis [UC]) and 25 healthy age- and sex-matched controls. All patients and control subjects had normal otoscopy findings and tympanometry was unremarkable, excluding middle ear disease and conductive hearing loss. Analysis of each frequency examined showed that the average hearing thresholds were increased significantly in the study group compared to those of the control group at higher frequencies (2, 4, and 8 kHz). When these parameters were compared with the control group according to subgroups of IBD, a significant difference was determined for the UC group at frequencies of 2, 4, and 8 kHz and for the CD group only at the frequency of 4 kHz. Although there was a trend of increment in SNHL as the age of the patient and duration and extent of UC increased, no significant correlation was observed between SNHL and these parameters or sex, activity, involvement site, medication history of IBD, and coexistence of other extraintestinal manifestations. In conclusion, it was demonstrated that a subclinical SNHL may be associated with UC and somewhat with CD, affecting mainly the high frequencies. In light of this finding, it may be advisable to investigate labyrinth functions as well as other extraintestinal manifestations in patients with IBD.

Investigation of Helicobacter pylori colonization in laryngeal neoplasia

Helicobacter pylori has been investigated in several other organ systems and localizations such as the oral cavity, but has not been investigated extensively in squamous cell carcinoma of the larynx, a region that could be directly exposed to the bacterium by the oral route or gastro-esophageal reflux. Only serological studies are available regarding the relation between H. pylori and laryngeal cancer, yielding conflicting results. To our knowledge, there is no study investigating the presence of H. pylori in laryngeal squamous cell carcinoma tissue. The purpose of this study was to investigate the presence of H. pylori in laryngeal squamous cell carcinoma tissue and to investigate the possible role of this organism in the etiopathogenesis of laryngeal cancer. Specimens from 50 patients with laryngeal cancer who underwent total or partial laryngectomy between March 1999 and December 2002 were examined by histopathological and immunohistochemical methods to detect H. pylori. The presence of H. pylori was also investigated histopathologically in 50 benign laryngeal biopsy specimens. In our study, we demonstrated that H. pylori was not present in laryngeal squamous cell carcinoma tissue or in the benign lesions. We could not find any evidence indicating that H. pylori played a role at the tissue level in the pathogenesis of laryngeal carcinoma.

Clinical presentation of abdominal tuberculosis in HIV seronegative adults.

BackgroundThe accurate diagnosis of abdominal tuberculosis usually takes a long time and requires a high index of suspicion in clinic practice. Eighty-eight immune-competent patients with abdominal tuberculosis were grouped according to symptoms at presentation and followed prospectively in order to investigate the effect of symptomatic presentation on clinical diagnosis and prognosis.MethodsBased upon the clinical presentation, the patients were divided into groups such as non-specific abdominal pain & less prominent in bowel habit, ascites, alteration in bowel habit, acute abdomen and others. Demographic, clinical and laboratory features, coexistence of pulmonary tuberculosis, diagnostic procedures, definitive diagnostic tests, need for surgical therapy, and response to treatment were assessed in each group.ResultsAccording to clinical presentation, five groups were constituted as non-specific abdominal pain (n = 24), ascites (n = 24), bowel habit alteration (n = 22), acute abdomen (n = 9) and others (n = 9). Patients presenting with acute abdomen had significantly higher white blood cell counts (p = 0.002) and abnormalities in abdominal plain radiographs (p = 0.014). Patients presenting with alteration in bowel habit were younger (p = 0.048). The frequency of colonoscopic abnormalities (7.5%), and need for therapeutic surgery (12.5%) were lower in patients with ascites, (p = 0.04) and (p = 0.001), respectively. There was no difference in gender, disease duration, diagnostic modalities, response to treatment, period to initial response, and mortality between groups (p > 0.05). Gastrointestinal tract alone was the most frequently involved part (38.5%), and this was associated with acid-fast bacteria in the sputum (p = 0.003).ConclusionGastrointestinal tract involvement is frequent in patients with active pulmonary tuberculosis. Although different clinical presentations of patients with abdominal tuberculosis determine diagnostic work up and need for therapeutic surgery, evidence based diagnosis and consequences of the disease does not change.

Heterotopic gastric mucosa in the cervical esophagus: could this play a role in the pathogenesis of laryngopharyngeal reflux in a subgroup of patients with posterior laryngitis?

Objective. Acid secretion produced by a heterotopic gastric mucosal patch (HGMP) in the proximal esophagus, instead of gastric acid, may be responsible for laryngopharyngeal reflux (LPR), passing the upper esophageal sphincter. The aim of this study was to investigate the prevalence of HGMP in the proximal esophagus in patients with posterior laryngitis indicating the presence of LPR in comparison with a control group and to elucidate the possible role of this lesion in the pathogenesis of LPR. Material and methods. A total of 36 consecutive patients with posterior laryngitis diagnosed on laryngoscopic examination were enrolled in the study. Esophagoscopy and ambulatory 24-h intra-esophageal dual-probe pH monitoring were performed in all patients. During endoscopy, special attention was paid to the proximal part of the esophagus, and the proximal electrode for pH monitoring was placed in this region under endoscopic view. The control group comprised 660 consecutive patients who had undergone upper gastrointestinal endoscopy for the usual indications. When HGMP was found, biopsies were taken for histological confirmation. Results. HGMP was detected in 5 out of 36 patients. One out of five patients with patches was excluded from the study because the histopathology of this patients patch revealed antral-type mucosa, which is not capable of acid secretion. Thus a total of 35 patients were included in the study, yielding a HGMP prevalence of 11.4% (4/35). Compared with the prevalence of the control group (1.6%), a significant difference was observed (p<0.005). pH monitoring showed that 45.4% of the patients had abnormal proximal acid reflux. All of four HGMP (+) patients with posterior laryngitis revealed significantly higher abnormal proximal reflux compared to the patients without patches (p<0.05). Conclusions. This first preliminary study may suggest that HGMP in the cervical esophagus could play a role in the pathogenesis of LPR, at least in a minor group of patients with posterior laryngitis, depending on its capability to produce acid in situ, although isolated proximal reflux could not be demonstrated. This finding may need to be supported by further studies with larger patient populations and using acid stimulation tests.

Association of Gluten Enteropathy and Irritable Bowel Syndrome in Adult Turkish Population

Purpose Irritable bowel syndrome is generally diagnosed according to the symptoms of the patient, and gluten enteropathy can also be presented with similar symptoms (diarrhea and/or constipation) of irritable bowel syndrome. Aimed to assess the association and the frequency of gluten enteropathy in a group of Turkish patients diagnosed as irritable bowel syndrome. Results Found anti-gliadin IgA positivity only in four patients among patients with irritable bowel syndrome. However, none of these four patients had anti-endomycium positivity or any histopathological findings specific for gluten enteropathy. All these four patients had normal histology in their small bowel biopsies. Conclusion Irritable bowel syndrome is a common problem in the population, but gluten enteropathy is not associated with the vast majority of subjects with irritable bowel syndrome as expected. The need for screening gluten enteropathy among these patients is still unclear, and screening with serology only without small bowel biopsy may lead to false positive results.

Is there any relationship between Hepatitis C virus and vitiligo

Goals and Background Hepatitis C virus (HCV) is a hepatotropic and lymphotropic virus. This agent can promote development of a panel of autoimmune diseases. The relationship between HCV infection and vitiligo, in which autoimmune mechanisms are believed to play a role is not yet elucidated. In this study we investigated HCV seropositivity in vitiligo patients and compared this with non-vitiligo population. Study A total of 102 consecutive patients with vitiligo were included in the study (47 male, 55 female, mean age: 36.8 ± 16.9 years, range: 5–75). Control population was 670 age and sex matched healthy blood donors (406 male, 264 female, mean age: 32.8 ± 11.3 years, range: 20–58). Third generation enzyme immunoassay was used for serum anti-HCV determination. When positive, qualitative confirmation was performed by HCV-RNA determination using RT-PCR. Results Anti-HCV antibody was detected only in 1 patient and confirmed by RT-PCR test. This patient was a 6-year-old girl with a non-segmental form of vitiligo, which is more frequently associated with autoimmune disorders, hence the incidence of HCV seropositivity found as 0.98%. There was no statistically significant difference between this figure and 0.6% prevalence in healthy blood donors. Conclusion Seroprevalence of HCV in vitiligo patients is not different from that of a control group in Turkey, and HCV infection may not be involved in the pathogenesis of vitiligo despite case reports showing co-existence of these 2 diseases.

Thrombospondin-1 and VEGF in inflammatory bowel disease

Background and aim Angiogenesis is an important process in the pathogenesis of chronic inflammation. We aimed to study the angiogeneic balance in inflammatory bowel disease (IBD) by evaluating the expression of vascular endothelial growth factor (VEGF) and thrombospondin-1 (TSP-1) on colonic epithelial cells, together with the expression of inducible nitric oxide synthase (iNOS). Methods Twenty-one ulcerative colitis (UC), 14 Crohns disease (CD), 11 colorectal cancer patients, and 11 healthy controls colonic biopsy samples were evaluated immunohistochemically. Results The expressions of TSP-1, VEGF, and iNOS in UC and CD groups were higher than expression in healthy control group, all with statistical significance. However, in colorectal cancer group, VEGF and iNOS expressions were increased importantly, but TSP-1 expression was not statistically different from healthy control groups expression. Both TSP-1 and VEGF expressions were correlated with iNOS expression distinctly but did not correlate with each other. Conclusions Both pro-angiogeneic VEGF and antiangiogeneic TSP-1 expressions were found increased in our IBD groups, but in colorectal cancer group, only VEGF expression was increased. TSP-1 increases in IBD patients as a response to inflammatory condition, but this increase was not enough to suppress pathologic angiogenesis and inflammation in IBD.

The Effectiveness of Lamivudine Treatment in Cirrhotic Patients with HBV Precore Mutations: A Prospective, Open-Label Study

In this study, the effect of lamivudine therapy on viral suppression, Child-Pugh score, and survival was assessed in patients with decompensated cirrhosis due to precore mutant hepatitis B virus and the results were compared with those for nonreplicative cirrhotic patients. Twenty-three replicative patients who received lamivudine and 15 nonreplicative patients were included and followed up for an average of 23.7 ± 13.4 months. At baseline, there were no significant differences between the groups with regard to clinical and biochemical parameters or Child-Pugh scores, except for serum alanine aminotransferase levels (P < 0.05) and quantitative hepatitis B virus DNA measurements (P < 0.001). Compared to baseline, there was no significant difference in Child-Pugh score in the lamivudine group at the last visit (P = 0.202), whereas a marked increase was observed in nonreplicative patients (P = 0.002). Mortality rates in the lamivudine and nonreplicative groups were 17.43% and 13.3%, respectively (P = 0.556), and there was no difference in survival analysis (P = 0.809). Lamivudine therapy stabilizing clinical situation in decompensated cirrhotics with precore mutation makes the natural history of the disease equal with nonreplicative decompensated cirrhotics or even provides some advantages over them.

Diffüz antral gastrit ve multifokal atrofik gastritli hastalarda mide sıvısı askorbik asit düzeyleri ve epitel hücre proliferasyonlarının karşılaştırılması

Background/aim: Diffuse antral gastritis (DAG) is a duodenal ulcer phenotype of chronic Helicobacter pylori gastritis, while multifocal atrophic gastritis (MAG) is a gastric cancer phenotype. The aim of this study was to investigate ascorbic acid (vitamin C) levels in the gastric juice in patients with DAG and MAG, to compare the gastric epithelial cell proliferation rates between the groups and also to examine any correlation between ascorbic acid levels in gastric juice and the cell proliferation rates. Materials and methods: Thirty-seven patients with chronic H. pylori gastritis (27 MAG, 10 DAG) were included in the study (male/female: 15/22, range: 19-74, mean age: 43.6 yrs). Ascorbic acid concentrations in fasting plasma and gastric juice samples of the patients were measured. Loss of maturation in foveolar epithelium due to cell proliferation was shown immunohistochemically using cytokeratin-20 antibody in antral and corporal regions of both patient groups. Results: There was no significant difference in plasma ascorbic acid levels between the two groups. No statistically significant difference could be demonstrated in gastric juice ascorbic acid concentrations between patients with DAG and MAG (0.93±0.97 mg/dl and 0.96±1.12 mg/dl, respectively; p>0.05). Immunohistochemical examination revealed that staining for cytokeratin- 20 was significantly less in MAG patients than in those with DAG (74.7% vs 90.9%, respectively; p