Nickel Sensitivity in Patients With Irritable Bowel Syndrome.

AIM: Nickel (Ni) is the most common contact allergen in the population. We aimed to investigate whether there is a relationship between Ni sensitivity and irritable bowel syndrome (IBS) in our study. MATERIALS AND METHODS: This study was conducted in 50 patients with IBS who were followed up between March 2018 and July 2018, and 40 healthy people as a control group in a single center with a dermatology department. European standard contact allergen series Ni preparate and corticosteroid pomace were applied to the back region of the study subjects. The evaluation was performed at 48, 72, and 96 hours according to the scheme proposed by the International Contact Dermatitis Research Group (ICDRG). Those who reacted at 72 hours were considered to have Ni allergy.  Results: The female/male ratio was 24/26 and 18/22 in the patient and control groups, respectively. The mean ages of the patient and control groups were 42.82 (±10.65) and 39.77 (±11.21) years, respectively. Ni sensitivity was present in 40% of the patient group and 17.5% of the control group (p=0.03). CONCLUSION: We believe that the presence of Ni sensitivity is important in the pathogenesis of IBS disease. In our study, Ni sensitivity was found to be quite high in IBS patients compared to the normal population.

A New Risk-Scoring System for Colorectal Cancer and Polyp Screening by Turkish Colorectal Cancer and Polyp Study Group.

BACKGROUND: Colorectal cancer is one of the most commonly diagnosed types of cancer worldwide. An early diagnosis and detection of colon cancer and polyp can reduce mortality and morbidity from colorectal cancer. Even though there are a variety of options in screen- ing tests, the question remains on which test is the most effective for the early detection of colorectal cancer. In this prospective study, we aimed to develop a simple, useful, effective, and reliable scoring system to detect colon polyp and colorectal cancer. METHODS: We enrolled 6508 subjects over the age of 18 from 16 centers, with colonoscopy screening. The age, smoking status, alcohol consumption, body mass index, polyp incidence, polyp size, number and localization, and pathologic findings were recorded. RESULTS: The age, male gender, obesity, smoking, and family history were found as independent risk factors for adenomatous polyp. We have developed a new scoring system which can be used for these factors. With a score of 4 or above, we found the following: sensitivity 81%, specificity 40%, positive predictive value 25.68%, and negative predictive value 89.84%, for adenomatous polyp detection; and sensitivity 96%, specificity 39%, positive predictive value 3.35%, negative predictive value 99.29%, for colorectal cancer detection. CONCLUSION: Even though the first colorectal cancer screening worldwide is generally performed for individuals over 50 years of age, we recommend that screening for colorectal cancer might begin for those under 50 years of age as well. Individuals with a score ≥ 4 must be included in the screening tests for colorectal cancer.

Gastric neuroendocrine neoplasms: A review.

Gastric neuroendocrine neoplasms (g-NENs) or neuroendocrine tumors are generally slow-growing tumors with increasing incidence. They arise from enterochromaffin like cells and are divided into four types according to clinical characteristic features. Type 1 and 2 are gastrin dependent, whereas type 3 and 4 are sporadic. The reason for hypergastrinemia is atrophic gastritis in type 1, and gastrin releasing tumor (gastrinoma) in type 2 g-NEN. The diagnosis of g-NENs needs histopathological investigation taken by upper gastrointestinal endoscopy. g-NENs are positively stained with chomogranin A and synaptophysin. Grading is made with mitotic index and ki-67 proliferation index on histopathological analysis. It is crucial to discriminate between types of g-NENs, because the management, treatment and prognosis differ significantly between subtypes. Treatment options for g-NENs include endoscopic resection, surgical resection with or without antrectomy, medical treatment with somatostatin analogues, netazepide or chemotherapy regimens. Follow-up without excision is another option in appropriate cases. The prognosis of type 1 and 2 g-NENs are good, whereas the prognosis of type 3 and 4 g-NENs are close to the prognosis of gastric adenocancer.

HBV flare associated with immunosuppressive treatments: it is still dangerous in the third-generation antivirals era.

BACKGROUND: There are limited data about the mortality and morbidity of patients with HBV flare related to immunosuppressive treatments (IST) in the third-generation antivirals era. Herein, we performed a multi-centric study in patients treated with entecavir (ETV) or tenofovir disoproxil fumarate (TDF) and evaluated their clinical course. METHODS: The study group included patients who were referred to gastroenterology or infectious disease specialists at eight different hospitals in Turkey. HBV flare was defined as at least a threefold elevation in alanine aminotransferase (ALT) levels above the upper limit of normal range. The demographic data, IST protocol, virological markers, liver tests, international normalized ratio (INR), HBV DNA, reactivation risk profile according to AGA guideline, MELD and MELD-Na scores were retrospectively evaluated. The primary aim of the study was to determine the liver-related mortality, including transplantation, at 12 weeks and factors predicting it. Secondary aims were to compare ETV and TDF with respect to mortality and time to ALT, bilirubin normalization and HBV DNA undetectability. RESULTS: The study group included 40 patients (29 males, mean age: 57 ±12 years). Twenty-five patients (62.5%) had a high risk of reactivation. Twenty-six patients received TDF and 14 patients received ETV treatment. Eight (20%) patients developed acute liver failure and one patient (2.5%) underwent living donor liver transplantation. Seven patients died due to liver-related complications, revealing a mortality rate of 17.5%. In multivariate analysis, total bilirubin levels at the onset, ALT levels and delta-MELD score at the first week were the independent risk factors for liver related mortality (HR: 1.222, 1.003, 1.253 and 95% CI: 1.096, 1.362; 1.001, 1.004 and 1.065, 1.470, respectively). There was no significant difference between the TDF and ETV groups with respect to time to normalize ALT and bilirubin levels, HBV DNA undetectability and mortality rates (16% and 21.4%, respectively). CONCLUSIONS: HBV flare associated with IST has a high mortality in the third-generation antivirals era. High total bilirubin at the onset and high ALT and delta-MELD score at the first week predict poor prognosis.

Nickel sensitivity in patients with gastroesophageal reflux disease.

OBJECTIVE: Various foods play important role in the pathogenesis of gastroesophageal reflux disease (GERD). These foods are shown to increase gastroesophageal reflux symptoms via various mechanisms and majority of these foods also contain nickel. The purpose of this study is to evaluate the relationship between Nickel sensitivity and GERD. MATERIAL AND METHODS: Fifty-four patients diagnosed with GERD and 50 healthy volunteers who were admitted to our gastroenterology outpatient clinic were took part in the study. European standard patch test series, nickel-containing test units and corticosteroids were applied to the patient body; upper back. Evaluation was performed according to the scheme of the International Contact Dermatitis Research Group (ICDRG). The positive and negative reactions were recorded at the hours of 48, 72 and 96. Following the test implementations, 7 days later, the tests were reevaluated for late reactions. Statistics package for Social Sciences (SPSS) 17 package program was used for statistical evaluation and results of tests were compared between groups with the Chi-squared test. p < 0.05 was considered statistically significant. RESULTS: Individuals in both groups were statistically similar in terms of age and gender. Nickel sensitivity was found to be positive in 48.2 and %22 of the GERD patients and control group, respectively. Difference between groups was statistically significant (p = 0.008). CONCLUSIONS: Nickel sensitivity was significantly higher in GERD patients compared to the control group. In addition to imbalance between defensive and aggressive forces of the esophagus, there seems to be an association between nickel sensitivity and GERD.

A lower serum gamma-glutamyltransferase level does not predict a sustained virological response in patients with chronic hepatitis C genotype 1.

BACKGROUND/AIMS: Low gamma-glutamyltransferase (GGT) level was shown to be an independent predictor of a sustained virological response (SVR) in chronic hepatitis C. We aimed to determine factors associated with high GGT level, and to evaluate whether low GGT level is an independent predictor of a SVR in chronic hepatitis C genotype 1. METHODS: We retrospectively reviewed our data of patients with chronic hepatitis C genotype 1 treated with pegylated interferon-α and ribavirin. Baseline features were compared between patients with normal and high GGT levels. Factors associated with high GGT level and those associated with a SVR were determined by univariate and multivariate analysis. RESULTS: This study included 57 patients. Mean age was 52.28±9.35 years. GGT levels was elevated in 27 patients (47.4%). GGT levels were normal in 63.3% of the patients who achieved a SVR and in 40.7% of those who did not achieve a SVR (p>0.05). By multivariate logistic regression analysis, the presence of cirrhosis (odds ratio [OR], 9.41; 95% confidence interval [CI], 1.08 to 102.61) and female gender (OR, 6.77; 95% CI, 1.23 to 37.20) were significantly associated with high GGT level, and only rapid virological response was associated with a SVR (OR, 8.369; 95% CI, 1.82 to 38.48). CONCLUSIONS: Low GGT level does not predict a SVR; however, it may be a predictor of high fibrosis scores.

AST-platelet ratio index in the prediction of significant fibrosis and cirrhosis in patients with chronic hepatitis B.

BACKGROUND/AIMS: We aimed to evaluate the diagnostic accuracy of AST-platelet ratio index in the prediction of significant fibrosis and cirrhosis in chronic hepatitis B patients by comparison with liver biopsy. MATERIALS AND METHODS: We retrospectively reviewed our computerized data of chronic hepatitis B patients who attended the Gastroenterology Clinic from 2004-2009. Treatment-naive chronic hepatitis B patients who had undergone liver biopsy were included in this study. The degree of fibrosis was scored according to the Ishak staging system. Significant fibrosis was defined as F3-6 and cirrhosis as F5-6. AST-platelet ratio index was calculated based on the original studies. Tests results were compared between the groups F0-2 versus F3-6 and F0-4 versus F5-6. RESULTS: Two hundred and fifty consecutive patients with chronic hepatitis B were included in this study. The area under the ROC curves of AST-platelet ratio index to predict significant fibrosis and cirrhosis were 0.779 and 0.781, respectively. Using cut-off values ≤0.5 and >1.5, significant fibrosis was excluded with a negative predictive value of 91.30% and sensitivity of 87.69% and predicted with a positive predictive value of 59.52% and specificity of 90.81% in 53.60% of patients. Using cut-off values ≤1 and >2, cirrhosis was excluded with a negative predictive value of 92.09% and sensitivity of 64.10% and predicted with a positive predictive value of 33.33% and specificity of 91.47% in 81.60% of patients. CONCLUSIONS: AST-platelet ratio index may be a useful noninvasive marker in the exclusion of both significant fibrosis and cirrhosis in patients with chronic hepatitis B. However, it is not accurate in the prediction of either significant fibrosis or cirrhosis.

Effects of alpha tocopherol and ascorbic acid on Helicobacter pylori colonization and the severity of gastric inflammation.

BACKGROUND AND AIM: We aimed to evaluate the changes in histopathologic features, concentrations of vitamins C and E in gastric mucosa, and total antioxidant capacity of the body after ingestion of ascorbic acid and alpha tocopherol in patients with Helicobacter pylori. MATERIAL AND METHOD: Patients with H. pylori-positive nonulcer dyspepsia were included in this study. Tissue samples were taken from the lesser and greater curvature in both prepyloric antrum and corpus for histopathologic examination and measurement of vitamins C and E concentrations. Blood samples were obtained for measurement of the total antioxidant capacity of the body. The patients were given vitamin C 500 mg BID and vitamin E 200 IU BID for 4 weeks orally. At the end of the 4th week, the initial procedures were repeated. Histopathologic examination of the tissue samples were carried out by two pathologists. RESULTS: The mean vitamins C and E concentrations in gastric mucosa at the 4th week were higher than those at the beginning (p = .000 and p = .006, respectively). Mean total antioxidant capacity of the body at the beginning and that at the 4th week were similar (p = .689). H. pylori intensity in the antrum at the beginning was higher than that at the 4th week for both pathologists (p = .007 and p = .039). Neutrophilic activity in the antrum at the beginning was higher than that at the 4th week for both pathologists (p = .000 and p = .025). Neutrophilic activity in the corpus at the beginning was higher than that at the 4th week for pathologist 1 (p = .033), and they were similar for pathologist 2 (p = .763). CONCLUSION: The findings that H. pylori intensity and neutrophilic activity decrease through increasing gastric ascorbic acid and alpha tocopherol concentrations suggest that supplementation with vitamins C and E increases the eradication rates via impairing the microenvironment created by the bacteria and facilitating the diffusion of antibiotics into gastric mucosa.

Efficacy of the Combination of Tetracycline, Amoxicillin, and Lansoprazole in the Eradication of Helicobacter pylori in Treatment-Naïve Patients and in Patients Who Are Not Responsive to Clarithromycin-Based Regimens: A Pilot Study.

BACKGROUND/AIMS: The aim of this study was to evaluate the eradication rate of a triple therapy regimen that included a proton pump inhibitor, amoxicillin, and tetracycline instead of clarithromycin in treatment-Naïve patients and in patients who did not respond to standard triple therapy. METHODS: This study included 110 patients infected with Helicobacter pylori. Patients in groups A and B were treatment-Naïve, and those in group C were not responsive to previous standard triple therapy. Patients in group A (n=40) received lansoprazole 30 mg b.i.d., amoxicillin 1,000 mg b.i.d., and clarithromycin 500 mg b.i.d. for 14 days. Patients in groups B (n=40) and C (n=30) received lansoprazole 30 mg b.i.d., amoxicillin 1,000 mg b.i.d., and tetracycline 500 mg q.i.d. for 14 days. RESULTS: In group A, eradication was achieved in 18 (45%) of the 40 patients included in the intention-to-treat (ITT) analysis and in 18 (47.4%) of the 38 patients included in the per-protocol (PP) analysis. In group B, eradication was achieved in 15 (37.5%) of the 40 patients included in the ITT analysis and in 15 (39.3%) of the 38 patients included in the PP analysis. In group C, eradication was achieved in 14 (46.6%) of the 30 patients included in the ITT analysis and in 14 (43.8%) of the 29 patients included in the PP analysis. There was no statistically significant difference among the 3 groups with regard to eradication rates (p>0.05). CONCLUSIONS: Despite the low rate of resistance to tetracycline, the combination of lansoprazole, amoxicillin, and tetracycline instead of clarithromycin is not a good option for the eradication of H. pylori.

Comparison of the efficacy of entecavir and tenofovir in chronic hepatitis B.

BACKGROUND/AIMS: This study aimed to compare the efficacy of entecavir and tenofovir in nucleos(t)ide-naive chronic hepatitis B patients after 48 weeks of therapy. METHODOLOGY: We retrospectively reviewed our data of chronic hepatitis B patients. Nucleos(t)ide-naive patients who had received entecavir or tenofovir for at least 48 weeks were included. We compared entecavir and tenofovir after 48 weeks of therapy with respect to virological, biochemical, serological and histological responses. RESULTS: Of the 44 patients, 24 received entecavir and 20 received tenofovir. Pretreatment characteristics of the patients were similar. After 48 weeks, serum HBV DNA levels decreased by 6.93±1.54log copy/ mL in the entecavir group and 6.89±1.22log copy/mL in the tenofovir group (p=0.65). A similar proportion of patients in entecavir and tenofovir groups achieved undetectable serum HBV DNA (87.5% vs. 95%, p=0.39) and serum ALT normalization (79.2% vs. 85%, p=0.62). The mean histological activity index score improved by 3.83±3.51 points in the entecavir group and 2.20±1.91 points in the tenofovir group (p=0.07), and the mean fibrosis scores improved by 0.38±1.61 points in the entecavir group and 0.70±1.17 points in the tenofovir group after 48 weeks (p=0.44). CONCLUSIONS: Entecavir and tenofovir are similarly effective in nucleos(t)ide-naive chronic hepatitis B patients with high viral load and/or high fibrosis scores after 48 weeks of therapy.

AST-platelet ratio index, Forns index and FIB-4 in the prediction of significant fibrosis and cirrhosis in patients with chronic hepatitis C.

BACKGROUND/AIMS: The aim of this study was to evaluate the diagnostic accuracy of aspartate aminotransferase-platelet ratio index, the Forns index and FIB-4 for the assessment of hepatic fibrosis in chronic hepatitis C patients by comparison with liver biopsy. METHODS: We retrospectively reviewed our computerized data of chronic hepatitis C patients who admitted to the Gastroenterology Clinic between 2004 and 2008. Treatment-naive chronic hepatitis C patients who had undergone liver biopsy and had laboratory test results allowing the calculation of aspartate aminotransferase-platelet ratio index, the Forns index and FIB-4 were included in this study. The degree of fibrosis was scored according to the METAVIR staging system. Significant fibrosis was defined as F2-4 and cirrhosis as F4. Aspartate aminotransferase-platelet ratio index, the Forns index and FIB-4 were calculated based on the original studies. Tests results were compared between groups F0-1 (no or mild fibrosis) versus F2-4 (significant fibrosis) and F03 (no cirrhosis) versus F4 (cirrhosis). RESULTS: One hundred and fifty patients with chronic hepatitis C were included in this study. The areas under the ROC curves of the Forns index, aspartate aminotransferase-platelet ratio index and FIB-4 to predict significant fibrosis were 0.795, 0.774 and 0.764, respectively. The area under the ROC curves of the Forns index, aspartate aminotransferase-platelet ratio index and FIB-4 to predict cirrhosis were 0.879, 0.839 and 0.874, respectively. CONCLUSIONS: The Forns index, aspartate aminotransferase-platelet ratio index and FIB-4 were accurate noninvasive blood tests to predict the presence or absence of significant fibrosis and cirrhosis in half of the chronic hepatitis C patients. The Forns index was slightly better than the aspartate aminotransferase-platelet ratio index and FIB-4 in the prediction of significant fibrosis and cirrhosis.

Efficacy of vitamins supplementation to therapy on Helicobacter pylori eradication in patients with low antioxidant capacity.

BACKGROUND AND OBJECTIVES: It was shown that supplementation of vitamins C and E to therapy increased Helicobacter pylori eradication rate. In the present study, we aimed to evaluate whether supplementation of antioxidant vitamins to therapy increases H. pylori eradication rates in patients with chronic stress and low antioxidant capacity. METHODS: This study included 120 patients who presented to gastroenterology outpatient clinic with H. pylori-positive nonulcer dyspepsia and low total antioxidant capacity. Patients in group A (n=80) were given lansoprazole (30 mg, BID), amoxicillin (1000 mg, BID), and clarithromycin (500 mg, BID) for 14 days, as well as vitamin C (500 mg, BID) and vitamin E (200 IU, BID) for 30 days. Patients in group B (n=40) were given lansoprazole (30 mg, BID), amoxicillin (1000 mg, BID), and clarithromycin (500 mg, BID) for 14 days. RESULTS: Total antioxidant capacity were lower than normal levels in all patients. One hundred and fifteen patients (77 in group A, 38 in group B) were analyzed with per protocol analysis. In group A, H. pylori eradication was achieved in 63.8% of the patients included in the intention to treat analysis and in 66.2% of the patients included in the per protocol analysis. In group B, H. pylori eradication was achieved in 42.5% of the patients included in the intention to treat analysis and in 44.7% of the patients included in the per protocol analysis. Eradication rates were significantly higher in group A than in group B (P<0.005). CONCLUSIONS: Supplementation with vitamins C and E increased H. pylori eradication rate of standard triple therapy.

The Relationship between Quiescent Inflammatory Bowel Disease and Peripheral Polyneuropathy.

BACKGROUND/AIMS: Inflammatory bowel disease is a chronic, recurrent disorder that involves multiple organ systems. Polyneuropathy is the most common neurological manifestation. The aim of the present study was to investigate the relationship between polyneuropathy and inflammatory bowel disease. METHODS: The study included 40 patients with infl ammatory bowel disease (20 with ulcerative colitis and 20 with Crohn's disease) and 24 healthy controls. The patients had no clinical signs or symptoms of polyneuropathy. Nerve conduction studies were performed using an electroneuromyography apparatus. RESULTS: Mean distal motor latencies, conduction velocities, and F wave minimum latencies of the right median nerve were signifi cantly abnormal in the patient group, compared to the healthy controls (p<0.05). CONCLUSIONS: Some electrophysiological alterations were observed in chronic inflammatory bowel disease patients who showed no clinical signs. While investigating extra-intestinal manifestations in inflammatory bowel disease patients, nerve conduction studies must be performed to identify electrophysiological changes and subclinical peripheral polyneuropathy, which can subsequently develop.

Can an immunohistochemistry method differentiate intestinal tuberculosis from Crohn's disease in biopsy specimens?

BACKGROUND: It is sometimes difficult to diagnose whether a patient has intestinal tuberculosis or Crohn's disease because both have similar clinical, pathologic, and endoscopic features. However, their therapies are completely different and a mistake in diagnosis can result with deterioration. Many laboratory methods for the diagnosis of tuberculosis require considerable time to receive a diagnostic result. We wanted to evaluate whether an immunohistochemical tuberculosis staining method can be helpful for faster differentiation of biopsy materials. METHODS: We used formalin-fixed paraffin-embedded histologically diagnosed small intestine (n=1), colon (n=7), skin (n=8), lung (n=5), lymph node (n=24) tuberculosis and Crohn's disease (n = 28) biopsy materials only with granulomas. Demographic characteristics like age and gender were also obtained. Pathology specimens were stained immunohistochemically with an antibody to VP-M660, targeting the 38-kDa antigen of Mycobacterium tuberculosis. RESULTS: In the M. tuberculosis group, 33/45 of patients have positive immunohistochemistry (IHC) staining (73% sensitivity, 93% specificity), whereas only two of 28 patients have positive staining in the Crohn's group (p<0.001). The positive staining with IHC was detected as 85.7, 75, 75, and 60% in colon, lymph node, skin, and lung granulomas, respectively, in M. tuberculosis patients. CONCLUSIONS: Immunohistochemical staining of biopsy specimens with anti-VP-M660 seems to be a simple and fast technique with 73% sensitivity and 93% specificity for establishing an earlier differentiation of M. tuberculosis from Crohn's disease.

Serum levels of prostate specific antigen are elevated after colonoscopy.

The risks of prostate cancer and colorectal carcinoma increase with age. So, colonoscopy and measurement of serum prostate specific antigen (PSA) may be performed during a short term in a given patient. We aimed to evaluate whether colonoscopy affects serum PSA levels and to evaluate the relationship between prostate volume and elevation in serum PSA levels after colonoscopy. This study included 44 consecutive male patients, who underwent colonoscopy. The mean age of the patients was 56.05±9.27 years. The mean time required for colonoscopy was 30 min. Serum PSA levels were measured 48-72 hours before colonoscopy, immediately after performing laxative enema, and at 24-48th hour, the 7th day, and the 14th day after colonoscopy in each patient. The serum PSA level was elevated after enema and at 24-48th hour and 7th day after colonoscopy from the baseline (p<0.05), and declined to the baseline by 14th day. When the cut off value of 20 cm3 for normal prostate volume was taken into account, the serum PSA levels were significantly higher at the 24-48th hour and the 7th day in patients with larger prostate volume (>20 cm3) than those with normal prostate volume (p=0.013 and p=0.009). These results suggest that PSA is easily released by manipulations from the larger prostate. In conclusion, serum PSA levels were elevated during 7 days after colonoscopy. Before performing invasive procedures, patients with high serum PSA levels should be asked whether colonoscopy was performed prior to the measurement.