Isolated Small Bowel Transplantation in Turkey: A Single Center Experience Running Title: Isolated Small Bowel Transplantation in Turkey

Background SBTx has become a feasible therapeutic option for patients with irreversible intestinal failure. Increase in the number and in the improvement of the patient and graft survival in SBTx has a slow course when compared to other solid organ transplantation. Aim The aim of this study is to analyze 25 isolated SBTx performed since 2003 at a single center. It also aims to compare the patient and graft survivals rate during the early (before 2010) and late (after 2010) period. Materials and Methods Medical charts of 24 patients were analyzed retrospectively. To compare the center’s experience during a twelve year period, the results were divided into two groups (before (n:7) and after 2010 (n:18)). At the appropriate time, data were reported as mean± standard deviation, median, and range. Kaplan Meier method was used for the survival analysis of the graft and the patients. Results Median age of the patients was 39 (min 6 months, max: 56 yr). Six of them were in the pediatric age group. Compared to before 2010, graft survival rates increased from 28.1% to 53.8% in 3 months, from 28.6% to 35.9% in 6 months, and from 14.3% to 29.9% in one year after 2010. At the same period, patient survival rate increased from 57.1% to 72.2% in 3 months, from 28.6% to 38.9% in 6 months, and from 14.3% to 33.3% in one year. In the pediatric age group, patient and graft survival rates were 85.7% in 3 months, 71.4% in 6 months, and 71.4 % in 1 year. Conclusion SBTx is an effective treatment choice for selected patients with intestinal failure. Although patient and graft survival rates were improved after 2010 in our center, it was inferior. Patient and graft survival rates in pediatric SBTx are favourable and promising

Application of endoscopic hemoclips for nonvariceal upper gastrointestinal bleeding in children

WOS: 000339310300005PubMed ID: 25003673Background/Aims: Data about the efficiency and outcome of therapeutic endoscopic techniques in children with nonvariceal upper gastrointestinal bleeding (UGB) are scarce. We aimed to analyze our experience with endoscopic hemoclip application in children with non-variceal UGB. Materials and Methods: During a 3-year period, a total of 1715 endoscopies were performed in our pediatric endoscopy unit; 182 (10.6%) of them were performed for UGB to 158 patients. Fifty-six of them had emergent endoscopy. Among them, 15 cases with nonvariceal UGB were only given endoscopic hemoclips. Demographic, clinical, and laboratory findings at initial admission; endoscopic appearance of bleeding lesions; and outcome of hemoclip application were recorded from the hospital files and endoscopy records. Results: Ten patients (66.6%) had gastric ulcer, 3 (20%) had duodenal ulcer, 1 (6.7%) had Dieulafoy lesion, and 1 (6.7%) had bleeding at the post-polypectomy site. Initial homeostasis after hemoclip application was achieved in all patients (100%). Rebleeding was seen in only one patient (6.5%) with a Dieulafoy lesion, who needed hemoclip application for a second time, and the bleeding was controlled successfully. Permanent hemostasis was 100%. The median number of hemoclips used per case and per application was 3.4 and 3.2, respectively. None of the patients experienced any complication related to hemoclip application. Median duration of hospitalization was 6 days. On follow-up, none of the patients received surgical therapy, and 30-d mortality related to bleeding was 0%. Conclusion: The use of hemoclips for nonvariceal UGB in children is an effective modality to control bleeding without any complications in children

Mass Image in Stomach: A Case of Splenic Artery Aneurysm

WOS: 000436869700019PubMed ID: 2994172

Comparison of standard and standard plus vitamin E therapy for Helicobacter pylori eradications in children

WOS: 000353553700019PubMed ID: 25910378Background/Aims: Although various drugs can be used in adults for Helicobacter pylori eradication in adults, treatment options are limited in children. The aim of this study was to compare the effects of the standard lansoprazole, amoxicillin, and clarithromycin (LAC) protocol to those of LAC + vitamin E (LACE) combination for H. pylori eradication. Materials and Methods: The study included 90 children (age range: 10-17 years) who were admitted to four pediatric gastroenterology centers between March 2011 and November 2012 with dyspeptic symptoms and who had tested positive for H. pylori by 14C-urea breath tests. The patients were randomized into two groups. The LAC group [45 patients (pts)] was treated with a standard regimen consisting of lansoprazole (1 mg/kg/day), amoxicillin (50 mg/kg/day), and clarithromycin (14 mg/kg/day), each of which was given in two equally divided doses every 12 h for 14 days; the LACE group (45 pts) was given the standard regimen and vitamin E at 200 IU/day for 14 days. H. pylori eradication was assessed using the 14C-UBT in the 6th week after the cessation of treatment. Results: H. pylori was eradicated in 21 (46.6%) pts in the LAC group, while it was eradicated in 29 (64.4%) pts in the LACE group. There was no statistical difference between the two groups (p=0.13). Conclusion: The eradication rate of H. pylori in children while using the LAC regimen has decreased in the last years. The LACE regimen has been associated with an increased eradication rate but can reach to statistically significance. Further studies with larger cohorts are needed to examine the success of the LACE regimen for H. pylori eradication

Liver Involvement in Children with Alpha-1 Antitrypsin Deficiency: A Multicenter Study

Baran, Masallah/0000-0003-3827-2039WOS: 000520045600004PubMed: 32206627Purpose: Alpha-1 antitrypsin deficiency (A1ATD) in one of the most common genetic causes of liver disease in children. We aimed to analyze the clinical characteristics and outcomes of patients with A1ATD. Methods: This study included patients with A1ATD from five pediatric hepatology units. Demographics, clinical findings, genetics, and outcome of the patients were recorded (n=25). Results: Eight patients (32.0%) had homozygous PiZZ genotype while 17 (68.0%) had heterozygous genotype. Patients with PiZZ genotype had lower alpha-1 antitrypsin levels than patients with PiMZ genotype (37.6 +/- 7.7 mg/dL vs. 66.5 +/- 22.7 mg/dL, p=0.0001). Patients with PiZZ genotype were diagnosed earlier than patients with PiMZ genotype, but this was not significant (13 +/- 6.8 months vs. 23.7 +/- 30.1 months, p=0.192). Follow-up revealed the death of one patient (12.5%) with a homozygous mutation, and revealed that one patient had child A cirrhosis, five patients (62.5%) had chronic hepatitis, and one patient (12.5%) was asymptomatic. Nine of the 17 patients with a heterozygous mutation had chronic hepatitis (52.9%), two (11.7%) had child A cirrhosis, and six (35.2%) were asymptomatic. Overall, 18 (72%) of the 25 children had liver pathology in the long-term. Conclusion: Although prevalence is rare, patients with liver disorders should be checked for alpha-1 antitrypsin levels. Moreover, long-term follow-up is essential because most patients have a liver pathology

Infants with extrahepatic biliary atresia: Effect of follow-up on the survival rate at Ege University Medical School transplantation center

WOS: 000406275100011PubMed ID: 28699603Background/Aims: Biliary atresia (BA) is the main cause of neonatal cholestasis and the primary reason for infant liver transplants worldwide. It is an obliterative cholangiopathy observed only in children and caused by progressive inflammation and fibrosis of the bile duct. We collaborated with a liver transplantation center to investigate the effects of follow-up in patients with BA. Materials and Methods: Medical records of 99 patients who were diagnosed with BA and monitored at our center from 1990 to 2002 (27 patients) and from 2003 to 2015 (72 patients) were analyzed retrospectively. Patients were evaluated for birth weight; age at jaundice onset; age at alcoholic stool detection; age at the time of Kasai portoenterostomy (KPE), if performed; age at admission to our center; age at liver transplantation; duration between KPE and transplantation; pediatric end-stage liver disease (PELD) scores during transplantation; and growth and developmental status. The periods 1990-2002 and 2003-2015 were defined as phases I and II, respectively. Results: The median age of the patients at presentation to our hospital was 149 (range: 20-730) days during phase I and 61 (range: 28-720) days during phase II. The median age at jaundice onset was 7 days, and the median age at alcoholic stool detection was 15 days. There was no significant difference between phases I and II in terms of age at jaundice onset, age at alcoholic stool detection, or birth weight. Twenty-five (92.5%) of the 27 patients in the phase I group were admitted to our center after undergoing KPE. Forty-four (61.1%) of the 72 patients in the phase II group (median age at the time of KPE: 47 days) were operated at our center. Median ages of the patients at the time of KPE at our center were 67.5 (range: 25-220) and 47 (range: 28-139) days during phases I and II, respectively. The median age of the 28 patients who were transferred from another center was 70 (range: 45-105) days during phase II. Liver transplantation was performed in 55 of 99 patients (55.5%). Significant differences were observed in the age at transplantation, duration between KPE and transplantation, and PELD scores between patients with BA who underwent KPE at our center and who underwent KPE at other institutes from other institutes. Conclusion: These findings demonstrate the importance of a timely diagnosis of BA and undergoing KPE before malnutrition and/or cirrhosis deteriorate the patient's health. Furthermore, follow-up of patients with BA at a liver transplantation center increased the success of KPE and improved survival rates

Rectal Bleeding and Hypertensive Colopathy in May-Thurner Syndrome

WOS: 000319559800002PubMed ID: 2271100

The Place of Cow Milk Allergy in Gastroenterology Practice

WOS: 000219056100004Aim: Cow milk allergy (CMA) prevalence is between 2-7.5%; this prevalence decreases towards adolescence. In this study, children with cow milk allergy were evaluated retrospectively in terms of clinical findings at referral and responses to the treatment. Materials and Methods: In this study, 36 children (Female/Male: 13/23) diagnosed with CMA were assessed in terms of diarrhea type, other accompanying system findings, laboratory values, serological tests, endoscopic findings, histopathological findings and treatment. Results: Cow milk specific IgE (Fx2) was positive only in 11 cases (30%). The most common symptom was discomfort 63.9% (n=23); frequency of gastrointestinal system findings were as follows: vomiting 52.8% (n=19), diarrhea 50% (n=18), bloody diarrhea 22.2% (n=8). Also, atopic skin findings 44% (n=16), chronic cough 38.8% (n=14) and reactive airway disease were observed in 22.2% (n=8) cases. Eosinophilic inflammation colitis was detected in patients undergoing colonoscopy. Of the 5 cases undergoing gastroduodenoscopy, results were compatible with eosinophilic esophagitis in 3 and with eosinophilic gastroenteritis in 2. We determined that 33 of the cases (92%) gave full response to elimination diet while in 2 cases symptoms persisted although their intensity decreased. Conclusion: In children with CMA, most frequent complaints were discomfort, vomiting and diarrhea. In 47% of cases, more than one organ was involved. Eosinophilic infiltration was detected in all patients undergoing endoscopy

Successful treatment of a child having generalized Kaposi's sarcoma after living donor liver transplantation with conversion to sirolimus

WOS: 000264891700020PubMed ID: 18452496SRL is a new and potent immunosuppressive agent that has been successfully introduced in organ transplantation. In contrast to other immunosuppressive agents, SRL has a potent antitumor activity both in vitro and in vivo. Herein, we report a child with Kaposi's sarcoma that was diagnosed 30 months after LDLT and treated successfully with only conversion to SRL monotherapy. KS regressed completely at the end of the first month and remained in remission during 28 months follow-up