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    An Adolescent Girl with an Extraordinary Crohn Disease
    (Springer, 2019) Gulerman, Fulya; Guven, Burcu; Celik, Cansu; Onaran, Zafer; Celikel, Banu Acar
    Inflammatory bowel disease (IBD) is a comprehensive term used to describe diseases of the gastrointestinal tract resulting from chronic inflammatory processes. Patients with Crohn`s disease, a type of IBD, also may have extraintestinal findings. Joint symptoms and mucocutaneous involvement are the most common manifestations. Therefore, the presence of symptoms such as swollen, painful joints, aphthous stomatitis, erythema nodosum, uveitis, and pericarditis should not be avoided. A 15-year-old girl was admitted to our outpatient clinic with complaints of severe abdominal pain, nausea, vomiting and bleeding in one eye. The patient was diagnosed with acute pancreatitis and uveitis at the first evaluation, followed by bloody diarrhea and arthritis. In endoscopy, antrum, bulbus and second segment of duodenum were seen as hyperemic, nodular and edematous. In the colonoscopy, mucosa of the terminal ileum was granular and edematous. The cecum, the ascending colon, hepatic flexure, descending colon, sigmoid colon, and rectum mucosa were hyperemic, granular in appearance (cobblestone view) and lymphoid hyperplasic in appearance. The patient was diagnosed as multisystemic Crohn`s disease. The patient was followed up with prednisolone and mesalazine treatment. At the end of one-year follow-up, the symptoms of pancreatitis improved totally, but there were no response to the treatment for uveitis and arthritis, and patient developed pericarditis and bloody diarrhea continued occasionally. Infliximab, a biological agent (tumour necrotising factor alpha, TNFa blocker), was the second choice of treatment. The expected result could not be obtained and after 6 cure treatments medication was switched to adalimumab. After 6 cycles of treatment, the patient`s symptoms were completely regressed. In conclusion, it should be kept in mind that extraintestinal manifestations of IBD can occur in pediatric patients before the original signs of the disease occur. The management of these findings with new treatment modalities may result in more positive outcomes in the future.
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    Amylase/creatinine clearance ratio in diabetic ketoacidosis: a case report
    (Walter De Gruyter Gmbh, 2014) Boybeyi, Ozlem; Ergur, Ayca Torel; Dursun, Zarife Esra; Gulerman, Fulya
    Diabetic ketoacidosis (DKA) accompanies any other intra-abdominal pathology. Serum amylase/lipase levels are commonly used in order to rule out acute pancreatitis in patients having abdominal pain in DKA. A more specific and noninvasive diagnostic tool - amylase/creatinine clearance ratio (ACCR) - can be used to rule out pancreatitis in patients with DKA. A 14-year-old girl was admitted with abdominal pain and nausea. She had been followed up for type 1 diabetes mellitus for the last 5 years. The serum amylase levels were increased up to 687 U/L (normal: 28-120 U/L) on the third day of hospitalization. Simultaneous serum and urinary amylase concentrations were measured, and ACCR was calculated (1.2%). The diagnosis of pancreatitis was ruled out. The serum amylase levels decreased in the following days, and she was discharged. ACCR determination is a simple and specific test to diagnose pancreatitis, especially in patients with DKA.
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    Congenital Microvillus Inclusion Disease in the Differential Diagnosis of Intractable Metabolic Acidosis
    (Elsevier Taiwan, 2017) Guzoglu, Nilufer; Aliefendioglu, Didem; Gulerman, Fulya; Gucer, Safak; Kaymaz, Figen
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    Emotional dysregulation in adolescents with functional gastrointestinal disorders
    (ELSEVIER, 2020) Guven, Burcu; Gulerman, Fulya; Akyuz, Ebubekir; Aydin, Gozde
    Background and Study Aims: In various gastrointestinal system diseases, emotional dysregulation has been shown to reduce pain tolerance and increase the severity of the disease. Increased emotional dysregulation during the adolescence period causes gastrointestinal symptoms to be more frequent and severe. In this study, Child Depression Inventory (CDI) scores were investigated in patients admitted to our clinic with functional gastrointestinal disorders. Patients and Methods: According to Rome IV criteria, 200 patients with functional abdominal pain and dyspepsia aged 12-17 years were included in this study. 100 patients without a chronic disease were taken as control group. Patients completed the self-report questionnaires about symptoms, school performance, nutrition and sports habits. We used Child Depression Inventory (CDI) to assess the patients' depression. Results: The mean age of study group was 15.29 +/- 1.48 years (12-17 years), median 16 years; 80% (160/200) were girls. The mean age of control group was 14.96 +/- 1.66 years (12-17 years), median 15 years; 70% (70/100) were girls. There is no difference between the two groups for age and gender. Median depression score was 12.5 (range, 0-53) in the study group and 10.0 (range, 0-41) in the control group and a significant difference was found between the two groups (p = 0.014). School performance was revealed as 'very good' in 112 (56%) children in the study group and in 24 (24%) children in the control group and a significant difference was found between the two groups (p < 0.001). A negative correlation was found between school performance and depressive symptoms. Conclusion: It is not clear that emotional dysregulation induces FGIDs or FGIDs cause emotional dysregulation. But it is known that these diseases are common in the adolescent age group. Incorporating social and physical activities into the educational processes of adolescents will have favorable effects on their academic performance as well as emotional regulation. (C) 2020 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.
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    Gastroesophageal reflux disease in children: How much we know?
    (Bilimsel Tip Yayinevi, 2015) Gungor, Hatice Eke; Gulerman, Fulya; Ozmen, Serap
    Objective: Gastroesophageal reflux disease (GERD) can manifest with various clinical presentations and accompany to several diseases. This study aimed to assess presenting complaints, clinical characteristics and comorbid disorder in cases with GERD. Materials and Methods: We retrospectively reviewed age, gender, presenting complaints, findings of physical examination secondary causes of reflux, and comorbid disorders in 219 cases aged 1 month-15 years were diagnosed as GERD in Department of Pediatric Gastroenterology, between September, 2003 and December, 2005. Results: Of 291 cases, 114 (52.1%) were boys. Number of cases aged >= 1 years 168 (76.7%) was higher than those aged aged < 1 year. As presenting complaint, gastrointestinal (GIS) complaints (18 cases; 35.2%) were more common among cases aged < 1 year, whereas association of GIS and respiratory complaints (74 cases; 44%) were more frequently observed among cases aged >= 1 year. Recurrent vomiting, excessive crying, irritability, and feeding difficulty were more commonly observed among cases aged < 1 year. Cough, abdominal pain, chest pain and/or heartburn, changes in voice and nausea were found more common among cases aged >= 1 year. There was malnutrition in 15 cases (6.8%), short stature in 19 cases (8.6%) according to body weight and height Z scores assessed during physical examination. Growth retardation was more common among cases aged < 1 year when compared to those aged >= 1 year, indicating significant difference (p< 0.01). The most common secondary cause was neurological diseases observed in 6 cases aged < 1 year (46.1%) and 12 cases aged >= 1 year (41.3%). When comorbid diseases were considered, asthma was observed in 31 cases whereas Helicobacter pylori gastritis in 28 cases, indicating significant difference between cases aged < 1 and >= 1 year (p=0.009). Conclusion: Cases with suspected GERD should be investigated for extra-gastrointestinal findings. To improve quality of life in such patients, these problems, which tend to be chronic, should be recognized and treated early.
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    Helicobacter pylori resistance to clarithromycin and fluoroquinolones in a pediatric population in Turkey: A cross-sectional study
    (Wiley, 2019) Guven, Burcu; Gulerman, Fulya; Kacmaz, Birgul
    BackgroundHelicobacter pylori antimicrobial resistance is gradually increasing around the world. However, there are a limited number of studies reporting on this issue in the pediatric population. In this study, we aimed to determine Hpylori resistance to clarithromycin and fluoroquinolones in the pediatric patients living in Krkkale province that were detected with Hpylori in gastric biopsies. Moreover, we also aimed to investigate the concordance between the histopathologic and molecular methods used in the diagnosis of Hpylori infection. Materials and MethodsPatients aged 2-18years who had a history of epigastric pain and/or nausea persisting for longer than 1month underwent upper gastrointestinal endoscopy. Biopsies were taken from the gastric antral mucosa. In the samples detected with Hpylori in the histopathologic examination, the presence of Hpylori and Hpylori resistance to clarithromycin and fluoroquinolones was investigated using the GenoType HelicoDR test which allows the detection of wild-type and mutant genes. The strains detected with more than one mutant gene are defined as hetero-resistant strains. ResultsThe 93 patients that underwent DNA extraction and amplification included 68 (73.1%) girls and 25 (26.9%) boys with a median age of 152.62 (range 6-17) years. The overall concordance for the diagnosis of Hpylori infection between histopathology and PCR was 94%, and Hpylori resistance to clarithromycin and fluoroquinolones was 27% and 15%, respectively. ConclusionsThe high Hpylori resistance to clarithromycin and fluoroquinolones among the pediatric patients in our region implicates that the antibiotic sensitivity of strains should be studied prior to administration in accordance with the recommendations provided in the guidelines. Moreover, the presence of hetero-resistant strains in our patients may be a reason for treatment failure.
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    Results of Multichannel Intraluminal Impedance pH Metry in Symptomathic Children with Normal pH Metry Findings
    (Georg Thieme Verlag Kg, 2014) Soyer, Tutku; Gulerman, Fulya; Boybeyi, Ozlem; Aslan, Mustafa; Gunal, Yasemin
    AimA retrospective study was performed to evaluate the results of multichannel intraluminal impedance (MII) pH metry in symptomatic children with normal pH monitoring (PM) findings. Patients and MethodsChildren who have reflux index (RI) less than 4% in PM and recurrent symptoms were included. All children underwent MII. Children who received antireflux treatment with normal PM findings were excluded from the study. MII results were evaluated for RI, content of reflux (acid, weak acid, and alkaline) number and type of impedance events, esophageal bolus clearance time and proximal extent of reflux (PER). ResultsEight patients (age range: 5-13 years) were included to the study. The male female ratio was 5:3. The recurrent symptoms were related with gastrointestinal (n=5) and upper respiratory system (n=3). One of the patients was operated for esophageal atresia and one was followed for corrosive esophageal disease. Four of the patients had RI higher than 4% in MII. Patients with normal RI in MII, had weak acid reflux (n: 1), alkaline reflux (n=1) and no reflux (n=2). When number of impedance events evaluated, four patients had abnormal reflux episodes (70 or more reflux episodes). Impedance event recordings were correlated in 75% of PM findings. The content of impedance events were mixed and gas in nature. Prolonged esophageal clearance time and PER were detected in patients with chest pain and operated esophageal atresia. ConclusionMII can be considered as a superior diagnostic tool to detect weak acid and alkaline reflux in patients who had recurrent symptoms with normal PM studies. MII also provides information about bolus clearance time and extent of reflux.
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    Stress induced gastrointestinal bleeding in a pediatric intensive care unit: which risk factors should necessitate prophilaxis?
    (Edizioni Minerva Medica, 2016) Sahin, Sanliay; Ayar, Ganime; Yazici, Mutlu U.; Koksal, Tulin; Akman, Alkin O.; Gunduz, Razin C.; Gulerman, Fulya
    BACKGROUND: The aim of this study was to determine the frequency and the risk factors of stress induced gastrointestinal bleeding (GIB) in critically ill children, and to investigate the effect of prophilaxis. The setting was a 14-beded, tertiary care PICU. METHODS: Records of 182 children admitted consecutively from December 2012 to May 2013 were retrospectively reviewed. 136 patients were eligible. The age ranged from 40 days to 18 years. Diagnosis, demographic data, risk factors, administration of prophilaxis, drugs used in medication, prescence and degree of GIB and complications were recorded. RESULTS: The male-female ratio was 1.3. Mean age was 5.9. Mean PRISM III score was 12.2 and 49.3% had PRISM Score >= 10. Most frequent diagnosis was infectious diseases. Sixtyone (44.9%) children received prophylaxis in which antacids was used in 28 (45.9%), sucralfate in 18 (29.5%), proton pomp inhibitors (PPIs) in 51 (83.6%) and 5 (8.2%) received H2 reseptor antagonist. The incidence of GIB was 15.4% (N.=21), in which 66.7% (N.=14) were mild, 23.8% (N.=5) were moderate, 4.8% (N.=1) was significant and 4.8% (N.=1) was massive. In children who received prophylaxis 17 (27.9%) cases developed GIB. Mechanical ventilation was found to be the only risk factor significantly associated with stress induced GIB. Also; mechanical ventilation and trauma was strongly significant (P<0.001) and coagulopathy/thrombocytopenia, PRISM III >= 10, renal and hepatic failure, hypotension, and heart failure/arrhythmia was found to be associated with the development of GIB in critically ill children (P<0.05). CONCLUSION: GIB is a serious concern for PICU clinicians and intensivists are confused about the conflicting evidence supporting prophilaxis. We believe that prophylaxis could be beneficial for mechanically ventilated children. Also trauma, coagulopathy/thrombocytopenia, PRISM III >= 10, renal and hepatic failure, hypotension, and heart failure/arrhythmia must be kept in mind as risk factors requiring attention in PICU setting.