Volume 59, Number 19, March 06, 1942

WOS:000417204500005PubMed ID: 29199161Ambulatory esophageal pH monitoring is an essential method in patients exhibiting signs of non-erosive reflux disease (NERD) to make an objective diagnosis. Intra-esophageal pH monitoring is important in patients who are non-responsive to medications and in those with extraesophageal symptoms, particularly in NERD, before surgical interventions. With the help of the wireless capsule pH monitoring, measurements can be made under more physiological conditions as well as longer recordings can be performed because the investigation can be better tolerated by patients. Ambulatory esophageal pH monitoring can be detected within normal limits in 17%-31.4% of the patients with endoscopic esophagitis; therefore, normal pH monitoring cannot exclude the diagnosis of gastroesophageal reflux disease (GERD). Multi-channel intraluminal impedance pH (MII-pH) technology have been developed and currently the most sensitive tool to evaluate patients with both typical and atypical reflux symptoms. The sensitivity of a pH catheter test is 58% for the detection of acid reflux compared with MII-pH monitoring; further, its sensitivity is 28% for the detection of weak acid reflux compared with MII-pH monitoring. By adding impedance to pH catheter in patients with reflux symptoms, particularly in those receiving PPIs, it has been demonstrated that higher rates of diagnoses and symptom analyses can be obtained than those using only pH catheter. Esophageal manometry is used in the evaluation of patients with functional dysphagia and unexplained noncardiac chest pain and prior to antireflux surgery. The use of esophageal manometry is suitable for the detection of esophageal motor patterns and extreme motor abnormalities (e.g., achalasia and extreme hypomotility). Esophageal manometry and ambulatory pH monitoring are often used in assessments prior to laparoscopic antireflux surgery and in patients with reflux symptoms refractory to medical treatment. Although the esophageal motility is predominantly normal in patients with non-acid reflux, ineffective esophageal motility is often monitored in patients with acid reflux. In the literature, there are contradictory and an insufficient number of studies regarding radiological methods for the diagnosis of GERD. There are inconsistent values for sensitivity and specificity among the barium studies. There are inadequate studies in the literature involving scintigraphic examinations in the diagnosis of GERD, and a majority of existing studies have been conducted in the pediatric group. The results of a few studies do not provide sufficient contribution toward the implementation in clinical practic

Methylphenidate use and school performance among primary school children:a descriptive study

Background: There is no conclusive evidence that stimulants have beneficial effects on major associated outcome parameters, particularly school performance. We assessed the differences in school performance among children using methylphenidate at the end of primary school in relation to various parameters of methylphenidate use. Methods: We linked children from a pharmacy prescription database with standardized achievement test results at the end of primary school. We explored differences in test scores between current methylphenidate users versus never users and methylphenidate users who stopped treatment at least 6 months before the test, early versus late starters, different dosage of methylphenidate, and concurrent antipsychotic or asthma treatment. Results: Out of the 7736 children, 377 (4.9%) children were treated with methylphenidate at the time of the test. After adjusting for confounders the methylphenidate users (532.58 +/- .48) performed significantly lower on the test than never users (534.72 +/- .11). Compared with late starters of methylphenidate treatment (536.94 +/- 1.51) we found significantly lower test scores for the early starters (532.33 +/- .50). Conclusion: Our study indicates that children using methylphenidate still perform less at school compared to their peers. Our study also suggests that earlier start of methylphenidate treatment is associated with a lower school performance compared to children starting later with the treatment. This result could either indicate a limited effect of long term treatment or a more strongly affected group of early starters

Is the prevalence of intestinal metaplasia at the squamocolumnar junction different in patients with progressive sytemic sclerosis?

WOS: 000283606300009PubMed ID: 20931428Background/aims: Gastroesophageal reflux disease is seen frequently in patients with progressive systemic sclerosis. The aim of the present study was to determine the prevalence of intestinal metaplasia-squamocolumnar junction in patients with progressive systemic sclerosis and to investigate the association with gastroesophageal reflux disease. Methods: Thirty-one patients with progressive systemic sclerosis (Group A), 58 patients with gastroesophageal reflux disease -without progressive systemic sclerosis (Group B) and 36 patients without progressive systemic sclerosis or gastroesophageal reflux disease (Group C) were prospectively enrolled into this study. Biopsies were taken from the antrum, body, squamocolumnar junction (Z-line), and from the esophagus (3 cm above the Z-line). All biopsies were independently evaluated by two pathologists who were unaware of the diagnosis. Results: We found that grade C-D esophagitis, esophageal stricture and Barrett's esophagus were statistically significantly higher in Group A (p0.05), and prevalence of Helicobacter pylori was 61%, 67% and 38% in Groups A, B and C, respectively. Prevalence of Helicobacter pylori was similar in Group B and Group A, and significantly higher in Group B than Group C. Within each group, no significant relationship was detected between intestinal metaplasia at squamocolumnar junction and gender, age, smoking, alcohol consumption, body mass index, gastric atrophy, and prevalence of Helicobacter pylori. Conclusions: Patients with progressive systemic sclerosis have a higher tendency to the more severe forms and complications of gastroesophageal reflux disease including Barrett's esophagus than in those without progressive systemic sclerosis. However, there was no difference in the prevalence of intestinal metaplasia at squamocolumnar junction between groups, and it can he pointed out that intestinal metaplasia at squamocolumnar junction might not be related with gastroesophageal reflux disease

What is the place of empirical proton pump inhibitor testing in the diagnosis of gastroesophageal reflux disease? (Description, duration, and dosage)

WOS: 000417204500004PubMed ID: 29199160Empirical acid suppression tests that are performed with proton pump inhibitors (PPI) are used to detect both the presence of acid-related gastrointestinal symptoms and gastroesophageal reflux disease (GERD). In comparison to other diagnostic methods, it is non-invasive, easily applicable, and cost-effective in the diagnosis of GERD. In addition to typical reflux symptoms, it can also be used for diagnostic purposes in patients with non-cardiac chest pain (NCCP). If the symptom response is 50% and above when obtained using the PPI test in patients with NCCP, it can be considered as positive and the treatment should be continued sensitivity of the PPI test in patients with typical symptoms of GERD is 27%-89%, while its specificity is 35%-83%. Although there are differences related to the duration and dosage of the PPI test, a significant difference has not been found according to the type of PPI. When PPI test sensitivity and specificity were calculated by cumulatively evaluating the data regarding the PPI test in the literature, a sensitivity of 82.3% and specificity of 51.5% was obtained. It has been found that high doses of PPI were mostly used in studies, and the duration of the median test was 14 days. As a result, the sensitivity of PPI trial test is good, but the specificity is low in the diagnosis of GERD in patients with typical reflux symptoms

Primary Gastric Invasive Micropapillary Carcinoma: A Case Report

İnvaziv mikropapiller karsinom yeni tanımlanan bir tümördür. Progressif kilo kaybı ve bulantı nedeniyle hastaneye yatırılan 77 yaşındaki kadın hastanın endoskopik biyopsisinde antral/prepilorik yerleşimli, orta derecede diferansiye adenokarsinom saptandı. Sonrasında subtotal gastrektomi ve lenf düğümü rezeksiyonu yapıldı. Tümör, orta derecede diferansiye hücrelerin oluşturduğu mikropapiller ve az sayıda glandüler yapılardan oluşmaktaydı. İmmunohistokimyasal olarak mikropapiller ve glandüler alanlarda pansitokeratin, sitokeratin 7 ve epitelyal membran antijen pozitifti. mikropapiller alanlarda, hücre kümelerinin çevresinde periferal lokalizasyonda epitelyal membran antijen ile invazive mikropapiller karsinom için karakteristik membranöz, sitoplazmik pozitiflik saptandı. Literatürde mide yerleşimli invazive mikropapiller karsinom oldukça nadirdir.Invasive micropapillary carcinoma is a recently identified neoplasm. A 77-year-old-female was admitted to the hospital due to progressive loss of weight and nausea. Endoscopic biopsy of the antral/prepyloric located mass was diagnosed as moderately differentiated adenocarcinoma. Subtotal gastrectomy and regional lymph node resection were performed. The tumor was composed of moderately differentiated cells arranged in micropapillary structures with only a few poorly formed glandular foci in lamina propria. Immunohistochemically, neoplastic cells of micropapillary and focal conventional adenocarcinoma areas were diffusely positive for pancytokeratin, cytokeratin 7 and epithelial membrane antigen. In micropapillary areas, membranous and peripheral cytoplasmic positivity with epithelial membrane antigen in outside of the cell clusters called “inside-out polarity” pattern that is characteristic for invasive micropapillary carcinoma were seen. Invasive micropapillary carcinoma is very rare in the stomach in the English literature

Fecal calprotectin as a factor that supports the pathogenicity of Dientamoeba fragilis

ARMAGAN, GULIZ/0000-0001-6466-2263WOS: 000514245100013PubMed: 31730996Calprotectin is a protein that is mostly released from neutrophils, monocytes, macrophages and submucosal epithelial cells. Fecal calprotectin (f-CP) is a marker of intestinal inflammation. There are some discussions about the pathogenicity of D. fragilis in the gastrointestinal tract. in this study, we investigated whether f-CP level is a factor supporting the pathogenicity of D. fragilis. the f-CP levels were evaluated in patients with only D. fragilis positive in comparison with healthy controls. Moreover, the levels of f-CP were investigated in fecal samples of D. fragilis negative patients with gastrointestinal complaints. the fecal samples were collected from three groups. Three groups of fecal samples were examined directly microscopy, trichrome staining, cultivation, enzyme immunoassay (EIA) and real-time PCR assay. in the first group (Group 1, n = 34), patient stool samples with gastrointestinal symptoms (without other pathogens) found only with D. fragilis were included. in the second group (Group 2, n = 31), there were patients' stool samples with gastrointestinal symptoms that D. fragilis was negative (but there may be other pathogenic agents). in the control group (Group 3, n = 23), we used fecal samples collected from healthy volunteers without any infection or gastrointestinal complaints. the collected fecal samples were stored at -20 degrees C until analysis. Levels of f-CP were determined by using human calprotectin ELISA kits. Total of 88 patients were enrolled in three different groups. We obtained f-CP levels as follows: 33.40 ng/mg protein in the group 1, 15.99 ng/mg protein in the group 2 and 1.54 ng/mg protein in the group 3. Statistically significant difference in f-CP levels of the group 1 and the group 2 were obtained when compared with healthy controls (p 0.99). in conclusion, increased levels of f-CP are shown as a marker of an inflammatory disease of the lower gastrointestinal tract in infected humans. There is continues controversy about the pathogenicity of D. fragilis in symptomatic and asymptomatic patients. the findings of this study contribute to the ongoing debate about the pathogenicity of D. fragilis. in our study, the potential pathogenicity of D. fragilis is associated with increased f-CP concentrations with parasite detection in the fecal samples and therefore we assume that the parasite is not only a harmless commensal. in summary, higher levels of f-CP found in D. fragilis positive patients suggest the importance of researches that support the pathogenicity of indicated parasite.Scientific Research Projects Branch Directorate of Ege University, TurkeyEge University [13-TIP-092]This study was partly supported by the grant given by the Scientific Research Projects Branch Directorate of Ege University, Turkey (Grant number: 13-TIP-092)