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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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    Comparison of clinical outcomes and FOXP3, IL-17A responses in Helicobacter pylori infection in children versus adults
    (Wiley, 2021) Yorguc, Eda; Gulerman, Hacer Fulya; Kalkan, Ismail Hakki; Guven, Burcu; Balci, Mahi; Yorguc, Mustafa caglar
    Background The purpose of this study was to compare the clinical symptoms and pathological consequences of Helicobacter pylori (H. pylori) infection between children and adults and determine the levels of expression of FOX3P and IL-17A to examine the Th17/Treg balance. Methods Forty pediatric and 40 adult patients who were followed up at the Pediatric Gastroenterology and Internal Medicine Gastroenterology Departments were enrolled in the study. In our case-control study, gastric tissue specimens were evaluated using the updated Sydney system, and the number of cells expressing FOXP3/IL-17A (T-reg and Th17 cell markers) was analyzed immunohistochemically. In addition, each case was evaluated using a clinical follow-up questionnaire. Results Clinical signs and symptoms of children and adults were similar. IL-17A and FOXP3 levels were significantly higher in children and adults with H. pylori (+) than in those without H. pylori (-) (p < .001). In patients with H. pylori (+), the mean FOXP3 level was significantly higher, whereas the mean IL-17A level was significantly lower in children than in adults (p < 0001 for both groups). In children with H. pylori (+), bacterial density was negatively correlated with IL-17A level and positively correlated with FOXP3 level. In adults with H. pylori (+), there was a statistically significant, highly positive correlation between bacterial density and levels of IL-17A and FOXP3. Conclusions T-reg cells are suggested to more predominant in children than in adults, IL-17A levels decrease as H. pylori bacterial density increases. In conclusion, immune responses incline toward T-reg, which increases the susceptibility to persistent infections.
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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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    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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    Importance of Delta Over Baseline Values in Predicting the Severity of Helicobacter pylori Infection in Children
    (Bursa Uludag Univ, 2021) Guven, Burcu; Gulerman, Hacer Fulya; Kacmaz, Birgul
    Introduction:Although severe forms of the disease are seen in adults, the Helicobacter pylori (H. pylori) infection is usually acquired during childhood. Therefore, prompt diagnosis of H. pylori infection in childhood is of prime importance. In the present study, we aimed to identify the sensitivity and specificity of 13C urea breath test (UBT) in the diagnosis of H. pylori infection and to assess the severity of the disease with delta over baseline (DOB) values. Materials and Methods: UBT was administered to 200 children who presented with epigastric pain and/or nausea. Esophagogastroduodenoscopy (EGD) was performed in patients. UBT results were compared with histopathological findings. In the Area Under the ROC Curve analysis, a cutoff DOB value was found for the severity of H. pylori infection. Results: 193 children with a mean age of 13.50 +/- 2.98 years were included in the analysis. Of these, 71 (36.8%) patients had a positive UBT and 122 (63.2%) had a negative UBT. EGD was performed in 60 out of 71 patients with positive UBT and in 30 out of 122 patients with negative UBT. The sensitivity and specificity of UBT were 85.1% and 100%. DOB was found to be a significant predictor of moderate/marked H. pylori density at a cutoff value of 6%. Conclusions: The positive correlation detected between the level of DOB values and the density of H. pylori and inflammatory activity can be an advantage for detecting the severity of disease