Budd-chiari syndrome and renal arterial neurysms due to behcet disease: a rare association

Behcet’s disease is a multisystemic vasculitis of unknown etiology with a chronic relapsing course. Vasculitis in Behcet’s disease with predominant vascular involvement is the only vasculitis that affects both arteries and veins of any size. Involvement of the renal artery and inferior vena cava is rare among the arteries and veins, respectively. When disease affect the veins, it is in the form of thrombosis. Arterial complications include  aneurysms, stenosis and occlusions. Both rupture of arterial aneurysm and occlusion of suprahepatic veins,  causing Budd-Chiari syndrome, are associated with a high mortality rate. Vascular involvement is more common in male patients than in female patients. Men and patients with a younger age of onset present with a more severe prognosis. In this case report, we describe a very rare cause of intrarenal arterial aneurysm’s rupture with  previous Budd-Chiari syndrome due to Behcet’s disease and successful angiographic embolization of actively bleeding aneurysm

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

PubMedID: 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

Frequency of reflux esophagitis in celiac disease [Çölyak hastaliginda reflü ösefajit sikligi]

Gastrointestinal motor abnormalities, such as decrease in lower eosophageal sphincter pressure, have been defined in patients with celiac disease. Hence, these patients have risk for reflux esophagitis. In this study, we evaluate the frequency of reflux esophagitis and reflux symptoms in pediatric patients with newly diagnosed celiac disease. The study consisted of 71 patients with celiac disease and 292 children who underwent upper gastrointestinal endoscopy due to chronic abdominal pain, vomiting or gastrointestinal bleeding at the time of the study. Nineteen celiac patients (26.7%) and 34 patients (11.6%) in the control group had reflux esophagitis in the histopathological examination of distal esophageal biopsies (p<0.001). Symptoms such as vomiting, nausea, and dysphagia were more common in celiac patients with reflux oesophagitis (p<0.05 for nausea). No significant difference was found in terms of histopathological grade in celiac patients with and without reflux esophagitis. Patients with reflux esophagitis had lower ferritin levels than the others (4.6±3.5 µg/dl, 10.1 ± 12.9 µg/dl; p<0.05). Iron deficiency anemia was more common in patients with reflux esophagitis, but the difference was not significant. Symptoms related with reflux improved after gluten-free diet within six months in all cases. In this study, we revealed that the frequency of reflux esophagitis is increased in patients with celiac disease. We conclude that further immunohistochemical and morphometric studies will clarify the pathogenesis of esophageal damage in patients with celiac disease