Yilmaz Bilgic

The influence of vitamin D deficiency on eradication rates of Helicobacter pylori

BACKGROUND Helicobacter pylori eradication therapy improves the healing of various gastro-duodenal diseases such as chronic gastritis and peptic ulcer, and also reduces gastric cancer incidence. Several studies have reported on risk factors other than antibiotic resistance related to Helicobacter pylori eradication failure. OBJECTIVES In this study, we aimed to investigate whether or not the serum levels of 25-hydroxy-vitamin D (25(OH)D) influence eradication rates of H.pylori. MATERIAL AND METHODS 220 patients diagnosed with H.pylori gastritis using endoscopic biopsy had their 25-OH vitamin D levels measured via the electrochemiluminescence method before beginning eradication therapy of H.pylori. Gastric biopsies obtained at endoscopy were examined for H.pylori strains and histopathologic findings. All patients were treated with bismuth-containing quadruple therapy for 14 days. H.pylori eradication was determined via the 14C-urea breath test performed 4 weeks after the end of therapy. Based on the 25-OH vitamin D levels, the patients were divided into 2 groups: group 1 (deficient) had a vitamin D level of <10 ng/mL, while group 2 (sufficient) had a vitamin D level of ≥10 ng/ mL. RESULTS Eradication was successful in 170 (77.2%) patients and failed in 50 (22.7%) patients. The prevalence of 25(OH)D deficiency was 30.5%. Mean 25(OH)D levels were significantly lower in the eradication failure group compared to the successful treatment group (9.13 ±4.7 vs 19.03 ±8.13; p = 0.001). There were significantly more patients with deficient 25(OH)D levels in the failed treatment group compared to the successful treatment group (p = 0.001). CONCLUSIONS Our findings suggest that 25-OH vitamin D deficiency may be considered a risk factor related to eradication failure of H.pylori, which may lead to a need for supplementation of vitamin D before eradication of H.pylori.

Association of eNOS Gene Polymorphisms G894T and T-786C with Risk of Hepatorenal Syndrome

Background. There are no studies investigating the relationship between endothelial nitric oxide synthase (eNOS) gene polymorphisms and hepatorenal syndrome (HRS). Aim. The purpose of this study is to elucidate whether eNOS gene polymorphisms (G894T and T-786C) play a role in the development of type-2 HRS. Methods. This study was carried out in a group of 92 patients with cirrhosis (44 patients with type-2 HRS and 48 without HRS) and 50 healthy controls. Polymorphisms were determined by polymerase chain reaction (PCR) and melting curve analysis. Results. We did not find any significant difference in allele and genotype distributions of the eNOS -T-786C polymorphism among the groups (p = 0.440). However, the frequency of GT (40.9%) and TT (13.6%) genotypes and mutant allele T (34.1%) for the eNOS G894T polymorphism were significantly higher (p < 0.001 and p < 0.001, resp.) in the HRS group than in both the stable cirrhosis (14.6%, 4.2%, and 11.5%, resp.) and the control (22.0%, 2.0%, and 13.0%, resp.) groups. Conclusion. The occurrence of mutant genotypes (GT/TT) and mutant allele T in eNOS -G894T polymorphisms should be considered as a potential risk factor in cirrhotic patients with HRS.

Eosinophilic ascites, as a rare manifestation of eosinophilic gastroenteritis: a case report

Eosinophilic ascites (EA) can present as an unusual finding of eosinophilic gastroenteritis. We presented this case to remind eosinophilic acid in cases with unexplained etiology. A 29-years old man presented to an emergency department with abdominal swelling, progressively worsening nausea, and fatigue over one month. The patient had no history of allergic disease. There was moderate ascites in the physical examination. Percent eosinophil was 60% in peripheral blood smear while IgE level was increased in the serum. There was ascites on abdominal computed tomography (CT) scan. Serum ascites-albumin gradient (SAAG) was non-portal. Eosinophilic infiltration was detected biopsy samples obtained by upper GI tract endoscopy and in bone marrow aspiration and biopsy. The abdominal pain, ascites and all laboratory tests were completely recovered after 12 weeks of prednisolone therapy. Eosinophilic gastroenteritis should be considered in case of markedly increased eosinophilia in ascites fluid.

Protective effect of dexpanthenol against cisplatin‑induced hepatotoxicity

The aim of the present study was to investigate the protective effect of dexpanthenol (Dexp) against cisplatin (Cis)-induced hepatotoxicity. Thirty-two Sprague Dawley rats were divided into four groups: Control group (n=8), Dexp group (n=8, 500 mg/kg/ip/daily single dose/3 days Dexp), Cis group (n=8, 7 mg/kg/ip/single dose Cis) and Cis+Dexp group (n=8, 500 mg/kg/ip/daily single dose/3 days Dexp +7 mg/kg/ip/single dose Cis). MDA, CAT, GSH, GSH-Px, TOS, TAS, OSI, Total Nitrit, IL-1β, IL-6 and TNF-α levels were analyzed in liver tissue samples. After paraffinization of liver tissue samples, histopathological (congestion, loss of glycogen, number of Kupffer cells) and immunohistochemical (caspase-3 expression) parameters were assessed on the paraffinized liver sections. GSH, TAS, TOS, OSI, Tot Nit, L-Arginine, ADMA and SDMA levels were measured in the serum samples. Statistically significant differences were found between the groups in terms of all liver tissue biochemical parameters, with the exception of IL-1β and TNF-α levels. GSH, CAT, GSH-Px, TAS and Tot Nit levels were significantly higher in the Cis+Dexp group compared to the Cis group, whereas MDA, TOS, OSI and IL-6 levels were higher in the Cis group. Similarly, serum GSH, TAS, Tot Nit levels were higher in the Cis+Dexp group whereas TOS, L-Arginine, ADMA and SDMA levels were higher in Cis group. There were statistically significant differences between Control and Cis groups in terms of congestion increase, increase of glycogen loss, increase of Kupffer cell number and increase of caspase-3 expression (P<0.001). There was a statistically significant difference between the Cis and the Cis+Dexp groups in terms of histopathologic parameters, with the exception of congestion (P<0.001). To conclude, histopathological, immunohistochemical, and biochemical results of this study demonstrated that Dexp has a protective effect against Cis-induced hepatotoxicity.

An evaluation of the indications, complications and results of patients with percutaneous endoscopic gastrostomy

Aim of this study is to evaluate the indications, complications and results of patients undergoing percutaneus endoscopic gastrostomy. In our study, we evaluated the outpatients or hospitalized patients applying to Turgut A–zal Medical Center between April 2008-November 2010. 247 patients who would be unable to perform oral feeding for at least 4 weeks and underwent for PEG procedure were evaluated retrospectively. PEG procedure was performed 296 times on 247 cases. The most common indication for PEG has been neurological diseases (39.2%), other indications follow up in order with respiratory failure (10.5%), multiple trauma (10.1%), hypoxic encephalopahty (8.6%) and the other diseases (6.5%). Complications associated with PEG were wound infection (5.6%), tube blockage (3.2%), tube fracture (2.4%), tube leakage (2.4%), breakage (2.4%), and buried bumper syndrom (3.2%). Overall minor complication rate was %13,7, and overall major complication rate (buried bumpersyndrome) was 3.2%. The most common complication was wound infection. During follow-up, 102 patients died of primary disease. 30 days (early) and 1 year mortality rates were 14.3% and 39.5%. Overall mortality rate was 41,3% and mean survival was 17.34 ± 0.7 months. PEG tube was removed in 10 cases because of a adequate oral intake. The mean duration of a PEG tube stay was 16 ± 1.2 months. PEG is a procedure requiring no general anesthesia with low morbidity and mortality rates. It is also an effective, safe method which can be performed at the bedside. It should be one of methods prefered for patients who need long-term enteral nutrition.

Isolated CA 19-9 Elevation as Preceding Finding of Colorectal Carcinoma -

Rectal bleeding, change in bowel habits, abdominal pain are cardinal symptoms of colorectal carcinoma. Otherwise, weight loss, fatigue and weakness do not suggest colorectal carcinoma. Carbohydrate antigen (CA) 19-9 level is higher in several malignancies, especially gastrointestinal malignancies, and some benign conditions. Herein, we present a patient who is referred to our clinic with the complaint of fatigue and significant CA 19-9 elevation, diagnosed as metastatic colorectal carcinoma. Presenting case highlights that CA 19-9 elevation might be the only finding of colorectal carcinoma in even patients with nonspecific complaints.

Portal hypertension and cholestasis due to Echinococcus alveolaris: a case report -

Alveolar ecchinococcosis (AE) is a rare but potentially life-threatening serious parasitic disease. The parasit may involve liver and, most importantly, expand vessels and biliary tract. We present here a case of esophageal variceal bleeding due to portal hypertension and cholestasis secondary to AE. We present the case of a 30-year-old female patient who was admitted to emergency service with hematemesis, melena and icter. Upper gastrointestinal endoscopy revealed gastroesophageal varices and portal gastropathy. Contrasted computerized tomography examination showed a solid calcific lesion (cross dimension 6x11 and 5x9 cm.) of biliary tracts causing dilatation. An USG guided biopsy from the mass was performed and histological examination revealed AE. We also review here the literature on portal hypertension and cholestasis due to Echinococcus alveolaris. AE is rare a disease and may cause severe complications. Endoscopic and percutaneous drainage for biliary obstruction caused by hepatic AE has a palliative effect even in the late stages. Liver transplantation was recommended but this operation was not performed for living donor shortage. Liver transplantation should be considered in the management of advanced liver alveolar echinococcosis.

Ascites and hepatic involvement: a rare and atypical presentation of Burkitt Lymphoma /Burkitt lenfomanin asit ve karaciger tutulumunun oldugu, nadir gorulen atipik prezentasyonu

Burkitt lymphoma (BL) is an uncommon form of lymphoma in adults. In this disease, extensive involvement of the omentum and the peritoneum is rare. We present this case with ascites because it is such a rare and overlooked clinical presentation of BL. A previously healthy 20-year-old man was admitted to our hospital with abdominal pain, distension, and night sweats. Physical examination revealed massive ascites. Computerized tomography showed liver metastasis and ascites, but no pathologic thoracal or abdominal lympadenopathy was reported. Atypical lymphocytic cells with cytoplasmic vacuoles were determined on cytologic examination of ascites. We detected starry sky view on the bone marrow examination. On immunophenotyping, cells were CD20 positive, but negative for CD30, CD79a/Tdt. Patient was diagnosed as BL. Burkitt lymphoma should be considered in young patients presenting with ascites and hepatic mass even without lymphadenopathy or focal gastrointestinal masses.

Lighter Ingestion as an Uncommon Cause of Severe Vomiting in a Schizophrenia Patient.

Background. Foreign bodies in the gastrointestinal tract are important morbid and mortal clinical conditions. Particularly, emergency treatment is required for cutting and drilling bodies. The majority of ingested foreign bodies (80–90%) leave gastrointestinal tract without creating problems. In 10–20% of cases, intervention is absolutely required. Less than 1% of cases need surgery. In this paper, we present a schizophrenia patient who swallowed multiple lighters. Case. A 21-year-old male schizophrenic patient who uses psychotic drugs presented to the emergency department with the complaints of abdominal pain, severe vomiting, and inability to swallow for a week. His physical examination revealed epigastric tenderness. A plain radiograph of the abdomen revealed multiple tiny metallic densities. Gastroscopy was performed. The lighters were not allowing the passage, and some of them had penetrated the gastric mucosa, and bezoars were observed. One lighter was extracted with the help of the polypectomy snare. Other lighters as a bezoar were removed by surgery. Conclusion. Excessive vomiting of swallowed foreign bodies in the etiology of psychotic patients should be kept in mind. Endoscopic therapy can be performed in the early stages in these patients, but in the late stage surgery is inevitable.