A very rare cause of markedly elevated CA 19.9: Autoimmune hepatitis

KISA, Ucler/0000-0002-8131-6810WOS: 000384674200012PubMed: 27098926Carbohydrate antigen 19.9 (CA 19.9) is a specific tumour marker of the biliary, pancreatic and gastrointestinal tracts. Autoimmune hepatitis is a chronic immune-mediated liver disorder characterised by female predominance. We report a case of approximately 30-fold increased serum CA 19.9 in a 57-year-old woman who was diagnosed with autoimmune hepatitis. She had no evidence of any malignant disease in pancreatobiliary or gastrointestinal tracts. CA 19.9 levels decreased to normal levels with immunosuppressive treatment. Markedly elevated serum CA 19.9 levels might be encountered with benign liver diseases such as autoimmune hepatitis

A patient with ileocecal Crohn's disease who has intermittent umbilical and left lower abdominal quadrant pain

WOS: 000366649600003PubMed: 26135322

Severe gastritis decreases success rate of Helicobacter pylori eradication

WOS: 000376607300004PubMed: 26637331In several studies, different risk factors other than antibiotic resistance have been documented with Helicobacter pylori eradication failure. We aimed in this study to investigate the relationship of gastric density of H. pylori, the occurrence/degree of gastric atrophy, and intestinal metaplasia (IM) with success rate of H. pylori eradication. Two hundred consecutive treatment naive patients who received bismuth containing standart quadruple treatment due to H. pylori infection documented by histopathological examination of two antral or two corpal biopsies entered this retrospective study. The updated Sydney system was used to grade the activity of gastritis, density of H. pylori colonization, atrophy, and IM. Stages III and IV of operative link for gastritis assessment (OLGA) or the operative link on gastric intestinal metaplasia assessment (OLGIM) stages was considered as severe gastritis. H. pylori eradication was determined via stool H. pylori antigen test performed 4 weeks after the end of therapy. The presence of gastric atrophy and IM was significantly higher in patients with eradication failure (p = 0.001 and 0.01, respectively). Severe gastritis (OLGA III-IV and OLGIM III-IV) rates were higher in eradication failure group. A multiple linear regression analysis showed that OLGA and OLGIM stages were to be independent risk factors for eradication failure (p = 0.03 and 0.01, respectively). Our results suggested that histopathologically severe gastritis may cause H. pylori eradication failure. In addition, we found that H. pylori density was not a risk factor for treatment failure in patients who receive quadruple treatment

The relationship between gastric preneoplastic findings and colon polyps

Giriş ve Amaç: Helicobacter pylori enfeksiyonu ile kolon polibi gelişimi arasındaki ilişkiye yönelik çalışmalarda çelişkili sonuçlar elde edilmiştir. Mide için preneoplastik olduğu bilinen atrofi ve intestinal metaplazi ile kolon polibi gelişimi arasındaki ilişki ise henüz yeterince irdelenmemiş- tir. İki merkezde yürütmüş olduğumuz çalışmada, gastrik preneoplas- tik bulgu varlığı ile kolon polibi arasındaki ilişkiyi araştırmayı amaçla- dık. Gereç ve Yöntem: Kırıkkale Üniversitesi Tıp Fakültesi ve Kırıkkale Yüksek İhtisas Hastanesi Gastroenteroloji polikliniklerine 01.01.2012 ile 01.09.2012 tarihleri arasında başvuraran hastalardan özofagogastrodu - odenoskopi yapılarak Helicobacter pylori için biyopsi örneği alınan ve eş zamanlı kolonoskopi işlemi yapılan olgular çalışmaya dahil edildi. Olgu - ların demografik özellikleri, polip saptanan olgularda polip karakteristik- leri (büyüklük, sayı, histoloji) ve özofagogastroduodenoskopik biyopsi sonucuna göre gastrik atrofi-intestinal metaplazi ve Helicobacter pylori pozitifliği Sydney klasifikasyonuna göre kaydedildi. Bulgular: Çalışma- ya yaş ortalaması 57,413,3 olan toplam 150 (93 erkek, %62,0) olgu dahil edildi. Olguların 51inde (%34,0) en az 1 kolon polibi mevcuttu. Kolon polibi ve adenoma varlığı için atrofi [(Sırasıyla; OR:3,1 (p0,01) ve OR:3,2 (p0,02)] bağımsız risk faktörü idi. Toplam adenomatöz po- lip çapı atrofinin derecesi (p0,04) ve intestinal metaplazinin derecesi (p0,01) ile, toplam adenom sayısı ise atrofinin derecesi (p0,01), intes- tinal metaplazinin derecesi (p0,001) ile korele idi. Sonuç: Çalışmamız- da; gastrik atrofi kolon polibi/adenom gelişimi için bağımsız risk faktörü olarak bulundu. Helicobacter pylori pozitifliğinin kolon polibi varlığı ile ilişkisi saptanmadı. Gastrik preneoplastik lezyonlar ile kolon neoplazisi arasındaki ilişkinin konfirme edilebilmesi için geniş ölçekli, popülasyon tabanlı çalışmalara ihtiyaç bulunmaktadır.Background and Aims: There are conflicting data regarding the rela- tionship of Helicobacter pylori infection and the development of colon polyp. Although it is known that gastric atrophy and intestinal metapla- sia are gastric preneoplastic findings, to date, the relationship between these findings and colonic polyp development has not been studied sufficiently. In our two-center study, we aimed to study the association between gastric preneoplastic lesions and the occurrence of colonic polyp. Materials and Methods: The patients who admitted to the Gastroenterology Outpatient Clinics of Kırıkkale University Faculty of Medicine and Kırıkkale Yüksek Ihtisas Hospital from January 1, 2012 to September 1, 2012 and underwent routine colonoscopy and had gastric biopsies taken for Helicobacter pylori infection on esophago - gastroduodenoscopy were enrolled in the study. Patient demographic data (gender and age), information on colon polyp characteristics (size, number of polyps, and histology), and the presence and density of Helicobacter pylori, gastric atrophy and intestinal metaplasia in gastric biopsies according to Sydney classification were recorded. Results: The study group included 150 patients (males: 93, 62,0%), and the mean age of the participants was 57,4±13,3 years. Fifty-one (34,0%) of the patients had at least one colon polyp. Gastric atrophy was an indepen - dent risk factor for the development of colon polyp and adenoma (odds ratio: 3,1 (p0,01) and odds ratio: 3,2 (p0,02), respectively). Total ad- enomatous polyp size and the density of gastric atrophy (p0,04) and of intestinal metaplasia were positively correlated (p0,01). The total number of colonic adenomas was positively correlated with the density of atrophy (p0,01) and of intestinal metaplasia (p<0,001). Conclu- sions: In our study, gastric atrophy was an independent risk factor for the development of colon polyp/adenoma. The presence of Helico - bacter pylori was not related with the development of colon polyp or adenoma. Large, population-based studies are required to confirm the relationship between gastric preneoplastic findings and the develop - ment of colon polyp

Nadir Bir Enfeksiyonun Çok Nadir Bir Klinik Prezentasyonu: Parankimal Fasciola hepatica

Fascioliazis düz, kahverengi bir karaciğer paraziti olan Fasciola hepaticaun sebep olduğu, öncelikle sığır, koyun gibi çiftlik hayvanlarında görülen bir enfeksiyon hastalığıdır. Enfeksiyonun tanısı hastalıktan şüphe etmekle mümkündür. Radyolojik bulgular oldukça spesifiktir. Genellikle Bilgisayarlı Tomografi (BT) ve diğer görüntüleme yöntemleri karaciğerde hipodens, hareketli lezyonlar göstermektedir. Parankimal F. hepatica çok nadir izlenmektedir. Biz burada F. Hepaticanın çok nadir bir klinik prezentasyonu olan parankimal F. hepaticalı bir vakayı sunmayı amaçladık. (Turkiye Parazitol Derg 2013; 37: 305-6)Fascioliasis is primarily an infection of livestock such as cattle and sheep, caused by the flat, brown liver fluke Fasciola hepatica. Humans are accidental hosts. The diagnosis of infection depends on suspicion. Radiologic findings are specific. Usually, Computed Tomography (CT) and other imaging studies show hypodense migratory lesions of the liver. The development of a chronic liver abscess appears to be extremely rare. Here we present our case with hepatic abscess due to F. hepatica, which is a rare clinical presentation. (Turkiye Parazitol Derg 2013; 37: 305-6

Ischemic proctitis in a diabetic patient

WOS: 000341380900017PubMed: 24261036

A rare cause of ischemic colitis: Buerger's disease

Buerger's hastalığı ya da diğer adıyla tromboanjitis obliterans etkilenen da- marlarda tromboz ve rekanalizasyonlarla giden bir hastalık olup, arter ve süperfisyal venlerde segmental okluzif ve multipl inflamatuvar lezyonlarla karakterizedir. Kolonik etkilenme çok nadir görülmektedir. Burada daha önce Buerger's hastalığı tanısı ile takip edilmekte olan hastada gelişen iske- mik kolit tablosunu tartışmayı amaçladık.Buerger's disease, or thromboangiitis obliterans, is characterized by occlusive segmental and often multiple inflammatory lesions of arteries and superficial veins with thrombosis and recanalization of the affected vessels. Involvement of the colon is extremely rare. Herein, we present a case of colon ischemia in a patient diagnosed previously as Buerger's disease

Comparison of Helicobacter pylori eradication rates of standard 14-day quadruple treatment and novel modified 10-day, 12-day and 14-day sequential treatments

WOS: 000333109300011PubMed: 24268371Background & aim: This study aimed to compare the efficacy and safety of bismuth-included standard regimen and modified sequential treatments in Turkey, where the success rate of standard triple therapy is very low. Methods: One-hundred and sixty patients with dyspeptic complaints and naive Helicobacter pylori infection were randomized into four groups: 41 patients received standard 14-day quadruple treatment (STD) (Rabeprazole 20 mg-bid, bismuth subcitrate (120 mg-qid), Tetracycline 500 mg-qid, Metronidazole 500 mg-tid) for 2 weeks. The modified sequential therapy groups received 20 mg rabeprazole and 1 g amoxicillin, twice daily for the first 5 days, followed by Rabeprazole 20 mg-bid, bismuth subcitrate (120 mg-qid), Tetracycline 500 mg-qid, Metronidazole 500 mg-tid for the remaining 5 (10 day sequential therapy group-10S) (42 patients), 7 (12 day sequential therapy group-12S) (42 patients) and 9 (14 day sequential therapy group-14S) (41 patients) days. Results: The overall compliance and H. pylori eradication rate among the 160 patients who completed the H. pylori eradication regimens were 86.9% (139/160) and 78.1% (125/160), respectively. The results were not statistically different between groups in the eradication rates. Per-protocol eradication rates were 76.5% in STD, 71.4% in 10S, 82.4% in 12S and 83.3% in 14S groups (p = 0.7). Intention-to-treatment rates were 77.5% in STD, 72.5% in 10S, 82.5% in 12S and 80.0% in 14S groups (p = 0.5). Conclusion: The eradication rates of standard 14-day and different sequential quadruple treatment regimens are comparable and much more higher than with standard 14-day triple H. pylori eradication treatment that has been reported previously in Turkey. (C) 2013 European Federation of Internal Medicine. Published by Elsevier B. V. All rights reserved