Comparison of the efficacy of auricular vagus nerve stimulation and conventional low back rehabilitation in patients with chronic low back pain.

BACKGROUND: In recent years, human and animal studies have provided increasing evidence that vagus nerve stimulation (VNS) can produce analgesic effects as well as alleviating resistant epilepsy and depression. Our study was designed to compare the efficacy of transcutaneous auricular vagus nerve stimulation with conventional low back rehabilitation in patients with chronic low back pain (CLBP). METHODS: Sixty patients with LBP were randomly divided into two groups. Group 1 received conventional rehabilitation and home exercise, and Group 2 received transcutaneous auricular VNS and home exercise. Both groups received treatment five days a week for three weeks. Trunk mobility (Modified Schober test, fingertip-to-floor test), muscle strength (CSMI-Cybex Humac-Norm isokinetic dynamometer and Lafayette manual muscle strength measuring device), trunk endurance, balance tests, Visual Analog Scale, Beck Depression Scale, Pittsburgh Sleep Quality Index, Oswestry Disability Index were evaluated. RESULTS: At the end of three weeks, within-group assessment results showed positive effects on mobility, functional status, depression and sleep in all groups (p < 0.05). Pain level, endurance time and flexion trunk muscle strength results showed more improvement in Group 2 (p < 0.05). Some parameters of isokinetic lower extremity quadriceps muscle strength and fall risk scores showed a significant improvement in Group 1 (p < 0.05). DISCUSSION: VNS has been observed to be more effective on pain, trunk muscle strength and endurance duration and sleep status. Auricular VNS may be included in the treatment of patients with CLBP in whom conventional physical therapy is inadequate or not applicable.

Effects of a single session of noninvasive auricular vagus nerve stimulation on sports performance in elite athletes: an open-label randomized controlled trial.

OBJECTIVES: The purpose of this study was to investigate the efficacy of noninvasive auricular vagus nerve stimulation (AVNS) on sports performance. METHODS: The intervention group (n = 30) received a single session of AVNS, while the control group (n = 30) received a single session of sham AVNS. Pre- and post-treatment isometric quadriceps muscle strength, heart rate, lower extremity balance, and grip strength were measured. RESULTS: It was ascertained that the differences in heart rate (-0.73 pulse/min, p = 0.032) and modified Star Balance Test scores (anterior 2.72 cm, p = 0.000, posterolateral 3.65 cm, p = 0.000 and posteromedial 2.43 cm, p = 0.000) before and after AVNS were significant in subjects in the experimental group. The results of the one-way ANOVA analysis show that the differences obtained in all measurement parameters are not statistically significant (p > 0.05). Considering the partial eta squared (η2) obtained from the measurements, a small descriptive effect in favor of experimental group was obtained for the quadriceps strength (0.016) and anterior balance (0.054) measurements. CONCLUSION: This study demonstrates that a single AVNS session compared to sham AVNS shows a modest benefit though not statistically significant improvement in athletic performance. Single-use of AVNS seems not effective in improving athletic performance. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov identifier NCT05436821.

The effect of transcutaneous auricular vagus nerve stimulation on cycling ergometry and recovery in healthy young individuals.

BACKGROUND: It is aimed to examine the potential benefits and effects of the use of transcutaneous auricular vagus nerve stimulation (VNS) for sporting purposes on recovery, fatigue, and sportive performance level. METHODS: In this study, 90 people between the ages of 18-23 were participated. They were randomly divided into three groups as bilateral sham, unilateral left, and bilateral VNS. A 4-day protocol was applied to the participants. Cycling exercise was performed with maximum performance for 30 min under the same watt load. Pulse, systolic and diastolic blood pressure, distance, pain, fatigue, lactic acid level, and autonomic nervous system were evaluated. RESULTS: Within the groups, there was a statistically significant difference between the data (p < .05) except for the distance covered parameter. When we compare the groups, in addition to the distance traveled in all groups, there is no statistically significant difference in the 1st day 1st measurement and 2nd measurement data of all parameters (p > .05 When we compared the data according to days, there was a statistically significant difference between bilateral stimulation (BS) and unilateral stimulation, only pain and fatigue levels (p < .05). CONCLUSION: In our study, we saw that BS application gave positive results in reducing pain and fatigue due to cycling exercise compared to other applications. Similar results were obtained when we evaluated the data on a daily basis. We believe that VNS will be beneficial in reducing pain and fatigue, especially during and after the competition halftime.

The effects of transcutaneous auricular vagus nerve stimulation on visual memory performance and fatigue.

Objectives: This study aims to investigate the effects of transcutaneous auricular vagus nerve stimulation (taVNS) on visual memory performance and fatigue in healthy individuals. Patients and methods: Between April 10, 2022 and May 25, 2022, a total of 60 physical therapy and rehabilitation students (27 males, 33 females; mean age: 20.6±1.6 years; range, 18 to 24 years) were included in the study. The individuals were divided into two groups as the experimental group (n=30) and the control group (n=30). The experimental group received taVNS, mobile device supported games, and low-medium intensity aerobic exercises, while the control group received mobile device supported games and aerobic exercises. The personal information form was applied to all participants. The level of fatigue was measured using a computer-based evaluation and Fatigue Severity Scale (FSS) to analyze the visual memory performance. Results: All parameters used to evaluate visual memory performance showed a significant difference, while the FSS scores showed no significant difference (p>0.05). Only one sub-parameter in the control group was significantly different, while none of the other sub-parameters or FSS scores were significantly different (p>0.05). There was a significant difference between the two groups in terms of two of the visual memory sub-parameters, although no significant difference was found for the results of one parameter and the FSS (p>0.05). Conclusion: Our study results show that taVNS can produce positive effects on visual memory performance, although it does not apparently affect fatigue.

The effect of auricular vagus nerve stimulation on electroencephalography and electromyography measurements in healthy persons.

Objectives: Auricular vagus nerve stimulation (VNS) is a non-invasive treatment modality. Opinions that it can be used in the treatment of various clinical problems have gained importance in recent years. In this study, it was aimed to lay the groundwork for the use of the auricular VNS in different ears. Methods: Healthy individuals (n = 90) were divided into three groups: unilateral left (n = 30), unilateral right (n = 30), and bilateral (n = 30) auricular VNS. Electroencephalography (EEG) and electromyography (EMG) measurements were performed before and after auricular VNS (10 Hz, 300 µs, 20 min) for a single session. Results: An increase in wrist extensor muscles activation was detected on the contralateral side of the auricular VNS application side. It has been observed that there is a general decrease in the power of high-frequency waves and an increase in the power of lower-medium frequency waves in various parts of the brain. Conclusion: Our findings suggest that the projection of the auricular VNS in the central nervous system may also affect the corticospinal tracts.

Acute Effect of Transcutaneous Auricular Vagus Nerve Stimulation on Hand Tremor in Parkinson's Disease: A Pilot Study of Case Series.

Objectives: The aim of this study is to investigate the effects of non-invasive vagus nerve stimulation (VNS) on tremor in Parkinson's disease (PD). Methods: This single-center, prospective, and implementation study with before-after design included five participants diagnosed with PD. Auricular VNS was applied to each participant 3 times on different days. VNS was applied to the participants as the right ear, left ear, and bilateral ear. The cardiovascular parameters of the participants were evaluated with Kubios HRV Standard and tremor with UPDRS tremor subscale and smartphone application before and after the intervention. Results: Significant decrease in diastolic blood pressure (p=0.043) was found in participants who underwent bilateral auricular VNS. Although there was no significant change in the UPDRS tremor subscale, decreases in the maximum tremor amplitude in the x (p=0.043) and y (0.014) planes were detected in the measurements made with the smartphone application. Conclusion: In this study, a decrease in the tremor amplitude measured in the 3D plane with auricular VNS was found in patients with PD.

Chiropractic Care and Quality of Life Among Office Workers With Nonspecific Pain: A Cross-Sectional Study.

Objective: The aim of this study was to evaluate the quality of life by a self-administered World Health Organization Quality of Life short version survey (WHOQoL-BREF) among office workers with nonspecific pain receiving chiropractic care in Istanbul, Turkey. Methods: This cross-sectional study included 77 office workers (age interval, 18-65) with nonspecific neck, thoracic, back and/or extremity pain who underwent chiropractic care. Two weeks later, the quality of life was evaluated by a self-administered WHOQoL-BREF. The Numeric Pain Scale to evaluate the perceived pain was administered to all of the participants in the beginning and at the end of the study. Group-level changes on WHOQoL-BREF total score and subdimensions were compared according to descriptive data of office workers. The significance level was set at P ≤ .05. Results: WHOQoL-BREF scale scores after chiropractic care (mean ± standard deviation) were 71.21% ± 7.91% (total score), 81.49% ± 14.43% (general health), 80.38% ± 10.49% (physical health), 73.16% ± 11.68% (psychological), 70.41% ± 12.43% (social), and 65.58% ± 10.91% (environment). Numeric Pain Scale scores decreased in a statistically significant way when compared with baseline (P ≤ .05). The descriptive statistical analysis of WHOQoL-BREF dimensions revealed that women had significantly higher scores than men, the 18-to-35 age group had higher scores compared with the 50-to-65 age group, and those married had significantly higher scores than those who were not married (P ≤ .05). Conclusion: The findings of our study suggest that chiropractic care had positive effects on the quality of life of office workers.

The Impact of Auricular Vagus Nerve Stimulation on Pain and Life Quality in Patients with Fibromyalgia Syndrome.

The purpose of this study is to evaluate the impact of auricular vagus nerve stimulation, applied in conjunction with an exercise treatment program, on pain and life quality in patients with fibromyalgia syndrome (FMS). To achieve the study objectives, 60 female patients between the ages 18 and 50, with diagnosed FMS according to the American College of Rheumatology (ACR) 2010 diagnostic criteria, were randomly divided into 2 groups of 30. The first group was assigned 20 sessions of a home-based exercise program, while the second group was assigned 20 sessions of auricular vagus nerve stimulation and 20 sessions of a home-based exercise program. Patients were assessed before and after the treatments using the Visual Analog Scale (VAS) for pain, Beck Depression Scale for depression, Beck Anxiety Scale for anxiety, Fibromyalgia Impact Questionnaire (FIQ) for functional evaluation, and Short Form-36 (SF-36) for life quality. In this randomized controlled trial, comparisons within the groups revealed that both groups had statistically significant improvements in pain, depression, anxiety, functionality, and life quality scores (p < 0.05), while comparisons across the groups revealed that the group experiencing the vagus nerve stimulation had no statistically significant differences between the baseline scores, except for those of SF-36's subparameters of physical function, social functionality, and pain. In fact, comparisons across the groups after the interventions revealed that the group experiencing the vagus nerve stimulation had better scores but not statistically significant. From analysis of this data, we observed that vagus nerve stimulation in FMS treatment did not give additional benefit together with exercise, except for three subparameters of SF-36. It was identified that further studies which separately investigate the effects of vagus nerve stimulation and exercise on FMS with longer follow-up periods and an increased number of patients are needed.

Efficacy of dry needling in patients with myofascial temporomandibular disorders related to the masseter muscle.

OBJECTIVE: This randomized, single-center clinical trial aimed to compare the efficacy of superficial dry needling (SDN) and deep dry needling (DDN) in patients with myofascial temporomandibular disorder (MTMD) related to the masseter muscle.Methods: Forty patients showing MTMD with trigger points in the masseter muscle were randomly assigned to groups. Dry needling of the masseter muscle was performed once per week for three weeks. Pressure pain threshold (PPT) measurements, visual analog scale scores, and maximal jaw opening were assessed.Results: Both patient groups showed significant pain reduction, but the SDN group showed significantly better pain reduction. The PPT measurements obtained in the follow-up examinations at three and six weeks were significantly better than the values in SDN and DDN groups.Discussion: SDN showed better pain-reduction efficacy in patients with MTMD. Further research with a larger size sample and a longer follow-up period will help elucidate the benefits of SDN.

Evaluation of the Sympathetic Skin Response to the Dry Needling Treatment in Female Myofascial Pain Syndrome Patients.

BACKGROUND: The aim of this study was to evaluate sympathetic nervous system (SNS) activity following dry needling (DN) treatment, by using the sympathetic skin response (SSR) method in female patients diagnosed with myofascial pain syndrome (MPS). METHODS: Twenty-nine MPS patients with trapezius muscle pain and 31 healthy subjects were included in this study. During a single treatment session, DN treatment was applied into trigger points, for a duration of 10 minutes. Healthy patients were subjected to SSR in weeks 1 and 4; whereas the patient group was subjected to SSR 1 week prior to their treatment and in the first, second, third and fourth weeks following the completion of their treatment. RESULTS: We found diminished latency on both sides. A significantly high algometer measurement (P < 0.05) was observed in the control group. DN treatment was effective in diminishing the visual analog scale (VAS) (P < 0.001), pressure pain threshold (PPT) (P < 0.01), and SSR (P < 0.001). No SSR change was detected in the healthy group after the follow-up period (P > 0.05). CONCLUSION: DN is an effective treatment in MPS and trigger point (TP). This original study is the first to deal with the SSR in MPS and weekly SSR trailing, requiring further investigation to solidy findings.

Yields of dual therapy containing high-dose proton pump inhibitor in eradication of H. pylori positive dyspeptic patients.

UNLABELLED: BACKGROUND/AIMs: H. pylori eradication has been recommended for dyspeptic patients in high prevalance regions. Triple therapies are still prescribed mostly because culture and antibiotic susceptibility tests aren't widely available in the world. Dual therapy with high-dose proton pump inhibitors reported to have higher eradication rates. Our objective was to determine eradication success and cost-effectivity of dual therapy in dyspeptic patients. METHODOLOGY: Patients were treated orally with either dual (n:74,omeprazole 20mg q.i.d and amoxicillin 1g b.i.d) or triple therapy (n:116,omeprazole 20mg b.i.d and amoxicillin 1g b.i.d and clarithromycin 500mg b.i.d) for 14 days. HpSA was requested 3 months later. The results were evaluated statistically, p values ˂0,05 were considered significant. RESULTS: Patients (n:190) were included the study((80 female,110 male, mean age: 35.6±11year(p<0.001)). Alcohol/smoking, endoscopic findings and H. pylori rates with pathological examinations were not significantly different between groups whereas there was a significant difference in HpFast tests(p<0.01). When examined with HpSA tests 3 months after the treatment, eradication rate was 81.1% in the dual therapy group versus 63.8% in the triple therapy group (p:0.011). Dual therapy was economic than triple therapy (144USDvs.107USD,p<0.001). CONCLUSIONS: Dual therapy seems more successful, cost-effective and is less risky in terms of side effects compared to standard triple therapy in patients with dyspepsia.

[Production of a recombinant CagA protein for the detection of Helicobacter pylori CagA antibodies]. / Helicobacter pylori CagA antikorlarinin saptanmasi için rekombinant bir CagA proteininin üretilmesi.

At present, Helicobacter pylori infections affect approximately 50% of the world population. It is known that H.pylori is related with several gastric diseases including chronic atrophic gastritis, peptic and gastric ulcers as well as gastric carcinomas. CagA (Cytotoxin-associated gene A) protein which is one of the most important virulence factors of H.pylori, is thought to be responsible for the development of gastric cancer. CagA is a 128 kDa hydrophilic protein which binds to the epitelial stomach cells and is known to be phosphorylated on its EPIYA regions. The EPIYA regions are highly variable and carry a higher risk of developing gastric cancer than CagA negative strains. The aim of this study was to construct a prokaryotic expression system expressing a recombinant CagA protein, which can be used for the detection of anti-CagA antibodies. For the isolation of H.pylori genomic DNA, a total of 112 gastric biopsy samples obtained from patients who were previously found positive for rapid urease (CLO) test, were used. H.pylori DNAs were amplified from 57 of those samples by polymerase chain reaction (PCR) and of them 35 were found positive in terms of cagA gene. Different EPIYA motifs were detected in 25 out of 35 cagA positive samples, and one of those samples that contained the highest number of EPIYA motif, was chosen for the cloning procedure. Molecular cloning and expression of the recombinant fragment were performed with Champion Pet151/D expression vector (Invitrogen, USA), the expression of which was induced by the addition of IPTG (Isopropyl-beta-D-thiogalactopyranoside) into the E.coli culture medium. Expression was observed with anti-histidin HRP (Horse Radish Peroxidase) antibodies by SDS-PAGE and Western Blot (WB) analysis. In our study, two clones possessing different fragments from the same H.pylori strain with three different EPIYA motifs were succesfully expressed. Since CagA antigen plays a signicant role in the pathogenesis of H.pylori infections, the detection of anti-CagA antibodies done by non-invasive commercial ELISA or WB methods, is important in diagnosis. Recombinant CagA protein produced in this study could easily be used in the ELISA tests to be developed for screening anti-CagA antibodies in the patients' sera. However, since an ELISA method using this antigen has not been developed yet, its diagnostic performance could not be evaluated in this study. In conclusion, the construction of such a system for recombinant CagA antigen expression may be a pilot study for the development of our own ELISA tests in Turkey, and also will help the clinicians for the prediction of disease outcome and decision of the appropriate antimicrobial treatment by the help of anti-CagA antibody detection.

[Melanocytosis of the oesophagus: case report]. / Özofagial Melanozis: Olgu Sunumu.

Esophageal melanocytosis is a benign clinicopathologic entity characterized by melanocytic proliferation in esophageal squamous epithelium and melanin deposition in the mucosa. Little is known about the etiology and natural course of this condition, although it has been suggested to be a precursor of primary esophageal melanoma by some authors. Following a search of the databases regarding esophageal melanocytosis and melanosis, thirty-four cases of isolated esophageal melanocytosis were found. The histopathologic features of esophageal melanocytosis are reviewed and its differential diagnosis with other pigmented esophageal lesions is discussed.

Lymphoproliferative disorders in individuals with chronic hepatitis B and C in the Turkish population.

The aims of this cohort study were to evaluate the association of malignant lymphoproliferative disorders in patients with chronic viral hepatitis and to compare the results with those in individuals with non-alcoholic fatty liver disease. A total of 3,873 patients with chronic liver disease who were seen consecutively in the Liver Disease Outpatient Clinic between January 2001 and July 2007 were assessed retrospectively. The frequency of malignant lymphoproliferative disorders including non-Hodgkin's lymphoma, Hodgkin's lymphoma, and chronic lymphocytic leukemia in these patients was investigated. Of the total, 1,999 patients had chronic hepatitis B infection (male/female: 1,226/773, mean age: 45.1 ± 13.2 years), 978 had chronic hepatitis C infection (male/female: 437/541, mean age: 53.8 ± 13.7 years), and the remaining 896 had non-alcoholic fatty liver disease (male/female: 450/446, mean age: 50.8 ± 11.2 years). A malignant lymphoproliferative disorder was identified in 13 patients (male/female: 9/4, mean age: 52.8 ± 16.8 years) with chronic viral hepatitis, while no case of malignant lymphoproliferative disorder was identified in individuals with non-alcoholic fatty liver disease (P = 0.048). Among the patients with malignant lymphoproliferative disorders, seven had chronic hepatitis B infection and six had chronic hepatitis C infection; 11 had non-Hodgkin's lymphoma and two had chronic lymphocytic leukemia. All non-Hodgkin's lymphoma cases were B-cell lymphoma. Based on the data obtained in this investigation, the association with malignant lymphoproliferative disorders in chronic viral hepatitis seems to be high as compared to that occurring in individuals with non-alcoholic fatty liver disease.

Assessment of Helicobacter pylori eradication rate of triple combination therapy containing levofloxacin.

BACKGROUND/AIMS: Owing to its high efficacy, ease of use, perfect adaptation and low complication profile, it is suggested that the triple therapy combination consisting of levofloxacin, amoxicillin and proton pump inhibitor may be an alternative for the first-line and second-line treatment of Helicobacter pylori. The aim of this study is to evaluate the efficacy of the triple therapy regimen containing two different doses of levofloxacin in the first-line eradication treatment. MATERIAL AND METHODS: 110 naïve patients with anti Helicobacter pylori treatment indications according to Maastricht III Consensus Report were included to the study. Patients were randomized into two groups as the patients treated with a levofloxacin (500 mg o.i.d), amoxicillin (1 g b.i.d) and proton pump inhibitor (b.i.d) combination for 10 days (Group 1, n=60) and patients treated with a levofloxacin (500 mg b.i.d), amoxicillin (1 g b.i.d) and proton pump inhibitor (b.i.d) combination for 10 days (Group 2, n=50). Eradication rate was assessed at the 6th week of therapy just subsequent to termination of treatment. RESULTS: 110 treatment-naïve patients (60 female, mean age: 44.1±14.7 years) were randomized and all patients completed the study. Helicobacter pylori eradication of the Group 1 was 60% and in Group 2 was 72.7%. The difference between the two groups was not statistically significant (p=0.427). None of patients experienced severe complication that would lead to discontinuation of therapy. CONCLUSION: It is observed that the efficacy of the triple therapy combination containing levofloxacin is not within acceptable limits for the first-line Helicobacter pylori eradication.

Peripheral facial nerve paralysis after upper third molar extraction.

Peripheral facial nerve paralysis (PFNP) after mandibular interventions has been reported in the literature. In most cases, paralysis begins immediately after the injection of the mandibular anesthesia, and duration of facial weakness is less than 12 hours. However, there are few documented cases of PFNP after maxillary dental or surgical procedures. A variety of mechanisms have been associated to PFNP, including viral reactivation, demyelination, edema, vasospasm, and trauma. The purpose of this presentation was to report a rare case of facial paralysis that occurred after an upper third molar extraction. The cause of the PFNP and the importance of the multidisciplinary approach in the management are emphasized.

Sequential therapy for Helicobacter pylori eradication.

BACKGROUND AND AIMS: The success of Helicobacter pylori eradication using triple eradication therapy declines over time. In this prospective study, we have compared a group of naive H. pylori-positive patients receiving sequential therapy with our previously published naive H. pylori-positive control group who received ranitidine bismuth citrate-clarithromycin-amoxicillin eradication treatment. Moreover, the eradication success of these two treatment protocols was compared with that of recent standard triple eradication treatment results for the naive patients in our country and western communities. METHODS: We performed invasive tests for H. pylori in naive patients who underwent gastroduodenoscopy in the Endoscopy Unit, Ankara University, Faculty of Medicine, and patients who were diagnosed as H. pylori-positive by these tests were rechecked by the same invasive tests one month after the completion of eradication treatment. The group receiving sequential therapy was given pantoprazole + amoxicillin during the first seven days and pantoprazole + metronidazole + tetracycline during the second seven days. These patients were compared with the H. pylori-positive naive control group patients, who were given ranitidine bismuth citrate + clarithromycin + amoxicillin. The patients in whom eradication was achieved in the 4th week with sequential therapy were reevaluated one year later regarding the success of eradication with the H. pylori stool antigen test. RESULTS: The average age of the 108 patients who received the sequential therapy was 45.2±12.5 years. The average age of the 75 patients who received ranitidine bismuth citrate treatment was 41.2±12.6 years. Six (5%) patients in the consecutive treatment group developed deterioration in taste in the mouth and 10 (9%) developed diarrhea. However, no side effects severe enough to require discontinuation of the treatments were observed in either treatment group. The results of the invasive tests were evaluated by the end of the first month, and revealed an eradication rate of 88% in the sequential treatment group versus 95% in the ranitidine bismuth citrate treatment group. Sixty-eight of 94 patients in whom eradication was achieved by sequential therapy were reevaluated with H. pylori stool antigen test in one year, and eradication was found to persist in 52 (77%) of these 68 patients. CONCLUSIONS: High rates of eradication were achieved in both groups in the 4th week evaluation. It was observed at the follow-up performed one year later that the eradication achieved with sequential therapy persisted in 77% of the patients treated.

Effectiveness of different treatment regimens in helicobacter pylori eradication: ten-year experience of a single institution.

AIM: We aimed to report the outcomes of different H. pylori eradication regimens used in our institution over the last 10 years. METHOD: Retrospectively, H. pylori-positive patients who were referred for upper gastrointestinal endoscopy with dyspeptic symptoms and who started eradication treatment and returned for a follow-up visit were included in the study. Subjects were allocated into six groups according to their treatment regimens as follows: Group 1) Proton pump inhibitor, clarithromycin and amoxicillin for 2 weeks; Group 2) Colloidal bismuth subcitrate, metronidazole and tetracycline for 2 weeks; Group 3) ranitidine bismuth citrate, clarithromycin and amoxicillin for 2 weeks; Group 4) Proton pump inhibitor, colloidal bismuth subcitrate, clarithromycin and amoxicillin for 2 weeks; Group 5) Proton pump inhibitor, tetracycline and amoxicillin for 2 weeks; and Group 6) Proton pump inhibitor and amoxicillin for 5 days, followed consecutively by Proton pump inhibitor, clarithromycin and metronidazole for 5 days. A follow-up visit to determine eradication was scheduled a minimum of 6 weeks after completion of the treatment. RESULTS: In this study, 400 patients were included. Eradication rates were 74.7%, 92.3%, 81.2%, 81.5%, 70.5%, and 66.6% in Groups 1-6, respectively. CONCLUSION: In Group 1, the eradication rate was lower than 80%. In Groups 34, the eradication rate increased to over 80%. The colloidal bismuth subcitrate, metronidazole and tetracycline regimen (Group 2) was the most successful, with a rate of 92.3%. The eradication rate in the consecutive regimen group (Group 6) did not reach the recommended level (higher than 80-85%).

MR angiography of esophageal mural veins in portal hypertension: a correlation with endoscopic grades of esophageal varices.

BACKGROUND/AIMS: The esophageal mural veins are important for providing blood to the esophageal submucosal varices. The purpose of this study was to investigate any correlation between the diameters of esophageal mural veins as observed on routine contrast-enhanced magnetic resonance angiography and the endoscopic grades of esophageal varices in patients with portal hypertension. METHODS: The images of 57 patients with portal hypertension in whom magnetic resonance portography was performed were evaluated retrospectively. The correlation between the diameter of the esophageal mural veins and the endoscopic grade of the esophageal varices was investigated with Spearman's correlation test. This test was also used to assess the correlation between the grade of esophageal varices and the diameters of the paraesophageal veins. A p value less than 0.05 was considered to be statistically significant. RESULTS: A positive correlation was determined between the diameter of mural veins and the endoscopic grade of the esophageal varices (p=0.022; r=0.363). There was no correlation, however, between the endoscopic grade of the esophageal varices and the diameter of the paraesophageal veins. CONCLUSIONS: A correlation exists between the diameters of the esophageal mural veins and the endoscopic grades of the esophageal varices. Magnetic resonance angiography may give information about the status of the esophageal varices in portal hypertensive patients.

The prevalence of celiac disease in patients fulfilling Rome III criteria for irritable bowel syndrome.

BACKGROUND AND AIMS: Celiac disease shares several symptoms which constitute some of the ROME criteria used for the diagnosis of irritable bowel syndrome (IBS), and as such many patients with underlying Celiac disease may be mistakenly diagnosed as having IBS. The aim of the present study was to determine the prevalence of Celiac disease in patients with IBS fulfilling ROME III criteria. MATERIALS AND METHODS: Patients who fulfilled ROME III criteria for irritable bowel syndrome were screened for Celiac disease using the Biocard(TM) Celiac Disease Stick test, and patients who tested positive had their serum samples analyzed for antigliadin IgA and IgG, and anti-tissue transglutaminase IgA antibodies. Patients with detectable antibody levels underwent endoscopic duodenal biopsy to confirm a diagnosis of Celiac disease. RESULTS: Two of 100 patients who were diagnosed as having irritable bowel syndrome as per the Roma III criteria were found to have elevated levels of serum antigliadin IgA and IgG, and anti-tissue transglutaminase IgA antibodies, with histological evidence of Celiac disease on examination of duodenal biopsy. Both patients were started on a gluten-free diet, showing significant improvement in their symptoms on follow-up. CONCLUSIONS: Celiac disease is a common finding among patients labeled as IBS. Celiac disease must be considered in differential diagnosis of IBS especially in the therapy refractory group.