How does disease location affect acute phase reactants in ulcerative colitis?

Background: We aimed to evaluate erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell (WBC), platelet (PLT) counts and albumin levels according to disease location in ulcerative colitis.Methods: The ESR, CRP, WBC, PLT counts and albumin levels of 206 ulcerative colitis patients with endoscopic activity were retrospectively evaluated. Endoscopic activity had been assessed using Rachmilewitz endoscopic activity index. Patients were grouped according to the extent of disease by Montreal classification, and they were evaluated regarding the location and severity of disease according to the laboratory test results.Results: Among 206 patients, 88 (42.7%) had extensive colitis, 89 (43.2%) of them had left sided colitis and 29 (14%) patients had proctitis. According to the endoscopic activity index, 32.04% of the patients had mild activity, 39.32% moderate activity and 28.64% had severe activity. As the disease extent progressed from the distal to the proximal intestine, CRP, ESR, WBC and PLT counts showed a significant increase while albumin levels showed a significant decrease. In our study, the test that yielded the best results in the assessment of disease activity was CRP, which was found to be high in 80% of patients with extensive colitis, followed by ESR, PLT and WBC counts. As the involved intestine shortened, the rate of patients with abnormal laboratory tests significantly decreasedConclusion: CRP, ESR, WBC, PLT counts and albumin levels are of limited value in determining disease activity in ulcerative colitis patients, especially in those with proctiti

Evaluation of the Effectiveness of Endoscopic Retrograde Cholangiopancreatography in Patients with Perihilar Cholangiocarcinoma and Its Effect on Development of Cholangitis

Objective. We aimed to determine the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) in patients with inoperable perihilar cholangiocarcinoma and establish the incidence of cholangitis development following ERCP. Material and Method. This retrospective study enrolled patients diagnosed with inoperable perihilar cholangiocarcinoma who underwent endoscopic drainage (stenting) with ERCP. Patients were evaluated for development of cholangitis and the effectiveness of ERCP. The procedure was considered successful if bilirubin level fell more than 50% within 7 days after ERCP. Results. Post-ERCP cholangitis developed in 40.7% of patients. Cholangitis development was observed among 39.4% of patients with effective ERCP and in 60.6% of patients with ineffective ERCP. Development of cholangitis was significantly more common in the group with ineffective ERCP compared to the effective ERCP group (P=0.001). The average number of ERCP procedures was 2.33 ± 0.89 among patients developing cholangitis and 1.79 ± 0.97 in patients without cholangitis. The number of ERCP procedures was found to be significantly higher among patients developing cholangitis compared to those without cholangitis (P=0.012). Conclusion. ERCP may not provide adequate biliary drainage in some of the patients with perihilar cholangiocarcinoma and also it is a procedure associated an increased risk of cholangitis

An Evaluation of the Correlation between Hepcidin Serum Levels and Disease Activity in Inflammatory Bowel Disease

Aim. While there are many well-defined serological markers for inflammatory bowel disease (IBD), there is limited evidence that they positively affect clinical outcomes. This study aimed to evaluate the correlation between hepcidin serum levels and disease activity in IBD. Materials and Methods. Eighty-five consecutive IBD patients were enrolled in the study. Hepcidin serum levels were assessed using an enzyme-linked immunosorbent assay (ELISA) and were compared with disease activity as well as the interleukin-6 (IL-6) and C-reactive protein (CRP) levels. Results. The mean hepcidin serum levels in Crohn’s disease (CD) patients in remission and in the active phase were 3837±1436 and 3752±1274 pg/mL, respectively P=0.613. The mean hepcidin serum levels in ulcerative colitis (UC) patients in remission and in the active phase were 4285±8623 and 3727±1176 pg/mL, respectively P=0.241. Correlation analysis between inflammatory markers and hepcidin serum levels indicated that there was no correlation between hepcidin levels and IL-6 P=0.582 or CRP P=0.783. Conclusion. As an acute-phase protein, hepcidin seems to have a lower efficacy than other parameters in the detection of activation in IBD

In dialysis patients of statin therapy effects on renal anemia-inflammation and prohepcidin

Kronik hastalık anemisi kronik infeksiyonlarda, kanserlerde, travmada veinflamatuar hastalıklarda sıklıkla gözlenir. Son zamanlara kadar patogenezihakkında çok az sey biliniyordu. Son bir kaç yıldır, kronik hastalık anemisipatogenezinde bir inflamatuar sitokin olan IL-6'nın uyardıgı hepcidin ön planaçıkmıstır. Hepcidin demir düzenleyicisi olmakla birlikte kronik hastalıkanemisinden de sorumlu tutulmaktadır.Hepcidin bir antimikrobiyal peptid olup esas olarak karacigerdesentezlenir. Hepcidinin dietten demir emilimini ve makrofajlardan vekaracigerdeki demir depolarından demirin mobilizasyonunu düzenledigi önesürülmektedir. İnflamasyon kronik hastalık anemisinin güçlü mediatörü olanhepcidinin üretimini artırır.Kronik böbrek yetmezliginde (KBY) anemi esas olarak eritropoetin (EPO)eksikliği yüzündendir. Fakat bu hastalarda sıklıkla kronik inflamatuar bir durumsözkonusudur. Kronik inflamasyonun altında üremik ortam, artmısproinflamatuar sitokinler, infeksiyonlar, aterosklerozis vs. gibi birçok nedenbulunmaktadır. Diyaliz hastalarında artmıs hepcidin seviyeleri fonksiyonel demireksikliginden ve anemiden sorumlu olabilir. Diyaliz hastalarında sıklıkla düsükdüzeyde bir inflamasyon ve aynı zamanda düzeyi artmıs hepcidin mevcuttur.Son zamanlarda öne sürülen hipoteze göre; KBY'de hepcidin ile anemi,inflamasyon ve karaciger fonksiyonları arasında bir iliski olabilir.Biz çalısmamızda diyaliz hastalarında anemi, inflamasyon parametreleriile hepcidin iliskisini göstermeyi ve statinlerin anemi, inflamasyon ve hepcidinparametrelerine etkisini arastırmayı amaçladık. Statinlerin anti-inflamatuaretkisinden yararlanarak kronik inflamasyon-anemi döngüsünü kırıp anemiyekatkıda bulunmayı hedefledik. Biz çalısmaya 40 hasta (hemodiyaliz: 21, peritondiyaliz: 19) aldık. Hastaları hs-CRP6 (Grup B: 14, hemodiyaliz: 7, periton diyaliz: 7)degerlerine göre grupladık. Hastaların 22 tanesi tedavi grubu, 18 tanesi kontrolgrubu idi. Prohepcidinin EPO dozlarından, demir parametrelerinden, kronikinflamasyondan ne ölçüde etkilendigini ortaya koymaya çalıstık.ilk kez, düsük seviyede inflamasyona sahip diyalize giren hasta grubundastatin tedavisinin inflamasyon ve anemi belirteci olan prohepcidini anlamlıbiçimde azalttıgını (p 6; Grup B) of dialysis patients and we showed prohepcidin levels how to be affected from using EPO doses, iron status parameters, chronic inflammation. In conclusion, we displayed first time the statin therapy significantly decreased prohepcidin that marker of anemia and inflammation in dialysis patients with low grade inflammation (Grup A-therapy)

Relation of Asymmetric Dimethylarginine Levels to Macrovascular Disease and Inflammation Markers in Type 2 Diabetic Patients

Aim. We aimed to determine the relation of asymmetric dimethyl arginine (ADMA) levels to atherosclerotic vascular disease and inflammation markers in type 2 diabetes. Methods. We recruited 50 type 2 diabetic patients with atherosclerosis, 50 type 2 diabetic patients without atherosclerosis, and 31 healthy control patients into our study. We obtained fasting serum and plasma samples and measured HbA1c, fasting blood glucose, C-peptide, creatinine, total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, hsCRP, fibrinogen, erythrocyte sedimentation rate, total homocysteine, and ADMA levels. In addition, all of the patients were evaluated for carotid artery intima media thickness by ultrasound. We evaluated ADMA levels in healthy controls, diabetic patients with macrovascular complications, and diabetic patients without macrovascular complications and evaluated the relationship between ADMA levels and total homocysteine, inflammation markers, and macrovascular disease. Results. Mean ADMA values in non-MVD and control groups were significantly lower than in MVD group (0.39±0.16, 0.32±0.13, 0.52±0.23, P<0.05, resp.). These three variables (carotid intima-media thickness, inflammatory markers, and ADMA levels) were significantly higher in diabetes group than control (P<0.05). Conclusion. There is a relationship between ADMA and macrovascular disease in type 2 diabetes, but further studies are needed to understand whether increased ADMA levels are a cause of macrovascular disease or a result of macrovascular disease

Pankreas kitlelerinin endosonografi ile örneklemesinde 19 gauge iğne aspirasyon ve 19 gauge tru-cut biyopsi benzer etkinlik ve güvenilirliktedir

Background and Aims: In this study, we aimed to compare the reliability and efficiency of 19 gauge fine needle aspiration and 19 gauge Tru Cut needle biopsy in the sampling of pancreatic body mass with endosonography, in those conditions when diagnosis cannot be made by on-site pathological evaluation. Materials and Methods: Forty-eight patients seen at Izmir Ataturk Training and Research Hospital, Department of Gastroenterology, in whom pancreatic body mass sampling was performed with endosonography were enrolled in this study. 19 gauge endosonography with fine needle aspiration was performed in one group (n=26) and 19 gauge Tru-Cut needle biopsy sampling in the other (n=22). Results: An adequate sampling rate was achieved regardless of the number of sessions, with 92.3% with 19 gauge fine needle aspiration and 90.9% with 19 gauge Tru-Cut needle biopsy. Adequacy of cellularity ratio in the first session was 69.2% with fine needle aspiration and 72.7% with Tru-Cut needle biopsy (p;gt;0.05). While the ratio of obtaining cell block from fine needle aspiration was 23%, this ratio was 45% with Tru-Cut needle biopsy (p;lt;0.005). There was no difference in terms of procedure-related complications. Conclusions: 19 gauge endosonography - fine needle aspiration and 19 gauge endosonography -Tru-Cut needle biopsy were similarly effective and reliable in terms of cellular adequacy, but the ratio of obtaining cell block was significantly higher in the Tru-Cut needle biopsy group than the fine needle aspiration group.Giriş ve Amaç: Bu çalışmada yerinde sitopatolojik inceleme yapılamayan ortamda pankreas gövde kesimde yerleşik fokal pankreatik kitlelerden örnek alınmasında 19-gauge endoskopik ultrason - ince iğne aspirasyon biyopsisi ile 19 gauge endoskopik ultrason tru-cut biyopsinin örneklemedeki hücresel yeterliliğini ve güvenilirliğini karşılaştırmayı amaçladık. Gereç ve Yöntem: İzmir Atatürk Eğitim ve Araştırma Hastanesi Gastroenteroloji kliniğinde endosonografi kullanılarak doku örneklemesi yapılan 48 hasta çalışmaya dahil edildi. Bir gruba (n=26) 19 gauge endoskopik ultrason ince iğne aspirasyon ile, diğer gruba (n=22) 19 gauge tru-cut biopsi ile pankreas kitle örneklemesi yapıldı. Bulgular: işlem tekrar sayısına bakılmaksızın, yeterli örnekleme yapılma oranı 19- gauge ince iğne aspirasyon biyopside %92.3 ve 19 gauge tru-cut biyopside %90.9, ince iğne aspirasyon biyopsisi grubunda 1. seansta hücresel yeterlilik oranı %69.2, tru-cut biyopsi grubunda 1. seansta hücresel yeterlilik oranı %72.7 idi (p>0 ,05). ‹nce iğne aspirasyon biyopsiside hücre bloğu elde edilme oranı %23 iken, tru-cut biyopsi’de %45 idi (P0,005). işleme bağlı komplikasyonlar açısından fark saptanmadı. Sonuç: 19-gauge endoskopik ultrason - ince iğne aspirasyon biyopsisi ile 19 gauge endoskopik ultrason tru-cut biyopsinin hücresel yeterlilik açısından benzer derecede etkin ve güvenilir ancak hücre bloğu elde etme oranının endoskopik ultrason tru-cut biyopsi grubunda belirgin daha yüksek olduğunu saptadık

An Evaluation of the Correlation between Hepcidin Serum Levels and Disease Activity in Inflammatory Bowel Disease

Aim. While there are many well-defined serological markers for inflammatory bowel disease (IBD), there is limited evidence that they positively affect clinical outcomes. This study aimed to evaluate the correlation between hepcidin serum levels and disease activity in IBD. Materials and Methods. Eighty-five consecutive IBD patients were enrolled in the study. Hepcidin serum levels were assessed using an enzyme-linked immunosorbent assay (ELISA) and were compared with disease activity as well as the interleukin-6 (IL-6) and C-reactive protein (CRP) levels. Results. The mean hepcidin serum levels in Crohn&apos;s disease (CD) patients in remission and in the active phase were 3837 ± 1436 and 3752 ± 1274 pg/mL, respectively ( = 0.613). The mean hepcidin serum levels in ulcerative colitis (UC) patients in remission and in the active phase were 4285 ± 8623 and 3727 ± 1176 pg/mL, respectively ( = 0.241). Correlation analysis between inflammatory markers and hepcidin serum levels indicated that there was no correlation between hepcidin levels and IL-6 ( = 0.582) or CRP ( = 0.783). Conclusion. As an acute-phase protein, hepcidin seems to have a lower efficacy than other parameters in the detection of activation in IBD

The Effect of Intravenous Iron Treatment on Quality of Life in Inflammatory Bowel Disease Patients with Nonanemic Iron Deficiency

Background. Iron deficiency is the prevalent complication of inflammatory bowel disease (IBD). Herein, we investigated the effect of intravenous iron treatment on quality of life (QoL) in nonanemic and iron deficient IBD patients. Methods. Eighty-five IBD patients were recruited for this study. The patients were intravenously administered 500 mg iron sucrose in the first week of the study. Hematologic parameters and QoL were evaluated before to iron treatment and during the 12th week of treatment. The Inflammatory Bowel Disease Questionnaire (IBDQ) and the Short Form-36 (SF-36) Health Survey were used to assess QoL. Results. Prior to intravenous iron administration, the IBDQ, SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were 152.3±30.6, 46.7±7.3, and 45.7±9.8, respectively. In the 12th week of iron administration, those scores were 162.3±25.5 (P<0.001), 49.3±6.4 (P<0.001), and 47.6±8.9 (P=0.024), respectively, which were all significantly different from the scores prior to iron administration. The mean changes in the IBDQ scores for ulcerative colitis and Crohn’s disease were 8.7% and 3.0% (P=0.029), were 6.4% and 4.7% (P=0.562) for the SF-36 PCS, and were 4.6% and 3.2% (P=0.482) for the SF-36 MCS, respectively. Conclusion. Intravenous iron treatment may improve QoL in nonanemic, but iron deficient, IBD patients

Clinical Study Serum Syndecan-1 Levels and Its Relationship to Disease Activity in Patients with Crohn&apos;s Disease

Background. Syndecan-1 (SDC-1), a member of the family of heparan sulfate proteoglycans, plays an important role in the resolution of inflammation. This study aimed to investigate the relationship between SDC-1 and disease activity in Crohn&apos;s disease (CD). Methods. Serum samples of 54 patients with CD and 30 healthy controls were obtained. First, SDC-1 levels of the CD patients were compared to the control group. Subsequently, SDC-1 levels were analyzed in patients with CD in active and remission periods. Finally, SDC-1 efficacy in predicting disease activity was evaluated by performing correlation analysis between SDC-1 and C-reactive protein (CRP) and Crohn&apos;s disease activity index (CDAI). Results. SDC-1 level was higher in the CD group (61.9 ± 42.6 ng/mL) compared with the control group (34.1 ± 8.0 ng/mL) ( = 0.03). SDC-1 levels were higher in active CD patients (97.1 ± 40.3 ng/mL) compared with those in remission (33.7 ± 13.5 ng/mL) ( &lt; 0.001). A significant positive correlation was found between SDC-1 and CRP ( = 0.687, &lt; 0.001) and between SDC-1 and CDAI ( = 0.747, &lt; 0.001). Conclusion. Serum levels of SDC-1 are higher in CD compared to the normal population and can be an effective marker of disease severity