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    FONKSİYONEL DİSPEPSİLİ HASTALARDA HELICOBAKTER PYLORI ERADİKASYONUNUN EPİGASTRİK AĞRI SKORU İLE DEĞERLENDİRİLMES
    (2019) Karatay, Eylem; Utku, Özlem Gül
    Amaç: Dispepsi, erişkinlerin en sık görülen kronikhastalıklarından biridir. Dispepsi tedavisinin maliyeti gelişmişülkelerde sağlık harcamalarının büyük bir kısmını temsiletmektedir. Fonksiyonel dispepsi, multifaktöryel, etiyolojindeHelicobacter pylori’nin suçlandığı bir hastalıktır. Bu çalışmada,“Fonksiyonel dispepsi” alt grubu olan epigastrik ağrı sendromluhastalarda Helicobacter pylori’nin eradikasyonunun epigastrikağrı şiddeti üzerine etkilerini semptomatik skorlama yaparakdeğerlendirmeyi amaçladık.Gereç ve Yöntemler: Fonsiyonel dispepsi teşhisi konulan veendoskopik biyopsilerinde Helicobacter pylori pozitifliği tespitedilmiş 530 hasta çalışmaya dahil edildi. Hastalara dörtlüeradikasyon tedavisi verildikten sonra hastaların semptomskorları 2. ve 6. ayda tekrar sorgulandı.Bulgular: Çalışmaya 384 kadın (%73) ve 146 erkek (%27)hasta dahil edildi. Yaş ortalaması 39.8±10.6 /yıl idi. Tedavibaşlangıcından 2 ay sonra hastaların skorlarına bakıldığında 463(%88) hastada ağrı skorunda gerileme saptanırken, 67 (%12)hastanın ağrı skorunda değişiklik olmadı. Tedavi sonrası ağrıskorlarında anlamlı düzeyde azalma saptandı (p=0.001). İkincive 6. aydaki ağrı skorları karşılaştırıldığında; 6. ayda ki ağrıskoru, başlangıç ve 2. aydaki ağrı skoruna göre daha düşükbulundu.Sonuç: Hem iki hem de altıncı aydaki, semptom skorlarındakisaptadığımız azalma eradikasyon oranları ile ilişkili olabilir.Böylelikle gereksiz test yapılmasının önüne geçilerek sağlıkgiderleri azaltılabilir. Bu bilgileri teyit edecek daha büyüksayıda hasta grubu içeren ve randomize kontrollü çalışmalaraihtiyaç vardır.
  • Küçük Resim
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    Immediate unprepared polyethylene glycol-flush colonoscopy in elderly patients with severe lower gastrointestinal bleeding
    (WILEY, 2020) Utku, Ozlem Gul; Karatay, Eylem
    Aims Colon preparation is vital yet more difficult in elderly patients with severe lower gastrointestinal bleeding (LGIB). The aim of this study is to show the efficacy, safety and outcomes of unprepared polyethylene glycol (PEG)-flush retrograde colon cleansing in the diagnosis and treatment of elderly home care patients with LGIB. Methods A single-center study was performed between January 2014 and June 2018. Elderly home healthcare patients presenting with hematochezia were enrolled, and an unprepared retrograde bowel cleansing colonoscopy was performed within the first 8 h after admission to the emergency department. PEG solution (2 L) was added to the water jet tank, and jet pump injection was started from the left side of the colon to the right segment of the colon and ended up at the cecum. Results In total, 33 elderly patients presenting with hematochezia were evaluated. Mean inward and outward procedure times were 17.06 +/- 4.92 (8-33 min) and 28.66 +/- 6.88 (10-30 min), respectively. Most of the bleeding was localized in the right colon at 22 patients (66.3%). Endoscopic treatment was performed in 87.9% of patients. The average length of stay in hospital was 44.70 +/- 42.81 (range 18.00-240.00 h). Conclusions Immediate unprepared PEG-flush colonoscopy in elderly home care patients with acute LGIB is a safe and effective method, which detects bleeding sources and provides endoscopic therapy. With this procedure, the time of hospital stay is reduced. This approach may be used for the initial intervention in patients admitted to emergency departments or intensive care unit with severe acute LGIB.Geriatr Gerontol Int 2020; center dot center dot: center dot center dot-center dot center dot.
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    Noninvasive assesment in differentiating benign and malign pancreatic lesions with endosonographic elastography score and strain ratio
    (2020) Utku, Özlem Gül; Ergül, Bilal; Karatay, Eylem; Efe, Cumali; Turhan, Nesrin; Oğuz, Dilek
    Background: We aimed to evaluate the diagnostic capability of endoscopic ultrasound elastography (EUS-EG) score and strain ratio (SR) for differentiating benign pancreatic lesions from the malign lesions Material and Method: We retrospectively evaluated well collected data of patients who undergone EUS-EG in a single center during the period of January 2016-June 2019. Patients who had pancreatic disorders were further evaluated for the study. The final diagnosis of solid pancreatic lesions (SPL) was made by histopathologic examination. Control group consisted of patients with chronic pancreatitis (CP) who diagnosed according to Rosemont criteria. Elastography was evaluated by a qualitative (elastography scores) and a quantitative method SR. Results: A total of 66 patients (42 (63.6%)female/24(63.6%)male) with mean age of 58.88±15.32 (19- 80) were included in the study. Thirty-eight patients had SLP, remain 28 patients were CP. In SPL group, 32 (84.2%) had adenocarcinomas and 6 (15.8%) had neuroendocrine tumors. Among 28 patients with benign pancreatic lesions, 23 (82.1%) had CP while five (17.9%) had autoimmune pancreatitis. Median SR values were significantly higher in patients with SPL than those with CP (44.0 (10.0-110.0) vs 7.0 (2.6- 14.6), p<0.001). Elasticity scores were also significantly different between patients with SLP and CP (p<0.001). Elasticity scores were significantly different between adenocarcinomas and CP (p<0.001). A 14 cut-off value of SR had 97% sensitive and 100% specificity for SPL and receiver-operating characteristic curves showed an area under the curve of 0.99.6. Likelihood Ratio test revealed that SR appears as the best parameter in discrimination of lesion type either as benign or malignant (X2 = 54.031, p<0.001). Conclusion: Our study suggested that EUS-elastography and SR scores are highly effective in differentiating malign-benign pancreatitis lesions.
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    The Performance of Nesfatin-1 in Distinguishing Irritable Bowel Syndrome Presenting Predominantly with Diarrhea from Celiac Disease
    (CLIN LAB PUBL, 2020) Karatay, Eylem; Gül-Utku, Özlem; Aksoy, Neval
    Background: We hypothesized that nesfatin-1, an anti-inflammatory peptide, could be used as a non-invasive diagnostic tool in the identification of celiac disease (CD) and irritable bowel syndrome presenting predominantly with diarrhea (IBS-D). Methods: Thirty-five patients with IBS-D who met the Rome III criteria, 28 patients with celiac disease who met the diagnostic criteria of the Marsh-Oberhuber classification, and 30 age- and gender-matched healthy controls were included in this cross-sectional study. All subjects responded to the IBS Severity Scoring System (IBS-SSS) questionnaire that was used to determine pain severity, pain frequency, bloating, dissatisfaction with bowel habits, and life interference. Results: Nesfatin-1 levels were significantly higher in the CD group compared to the IBS-D group and healthy controls. Nesfatin-1 was also higher in the IBS-D group compared to controls. Nesfatin-1 levels were correlated with IBS-SSS (r = 0.884, p < 0.001), severity of abdominal pain and discomfort (r = 0.644, p < 0.001), and C-reactive protein concentrations (r = 0.303, p = 0.004). ROC curve analysis demonstrated that a cutoff value of > 98.1 pg/mL for nesfatin-1 could discriminate subjects with CD from those with IBS-D and also healthy controls with a sensitivity of 82% and a specificity of 80%. Conclusions: The results of this study show that subjects with CD have higher nesfatin-1 levels compared to those with IBS-D or to the healthy controls. Moreover, nesfatin-1 can discriminate subjects with CD from those with IBS-D and also healthy controls, with high sensitivity and specificity. Further studies with histopathological evaluation are required to clearly address the role of nesfatin-1 in the diagnosis of CD.
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    The Role of Resolvin D1 in the Differential Diagnosis of the Cholangiocarcinoma and Benign Biliary Diseases
    (CLIN LAB PUBL, 2020) Gül-Utku, Özlem; Karatay, Eylem; Ergül, Bilal; Kısa, Üçler; Erdin, Züleyha; Oğuz, Dilek
    Background: The discrimination of malignant biliary strictures from benign biliary diseases (BBDs) is challenging and complicated. We aimed to investigate whether Resolvin D1 (RvD1) would aid in the discrimination of cholangiocarcinoma (CCA) from BBDs. Methods: Thirty-one patients with CCA, 27 patients with BBD, and 30 healthy controls were enrolled in this crosssectional study. The diagnosis of CCA was based on results obtained from abdominal USG, MRCP, abdominal CT, endosonography, and tumor markers, including CEA and CA 19-9. Histopathological evaluation was performed in the majority of patients, and the final diagnosis was based on surgery or biopsy results. RvD1, CEA, and CA 19-9 were analyzed in all patients with CCA and BBD. Results: RvD1 was significantly lower in those with CCA compared to patients with BBD and healthy controls. In addition, CEA and Ca 19-9 levels were significantly higher in the CCA group than the BBD group (p < 0.001). RvD1 concentration, CA 19-9 concentration, and total bilirubin level were found to be correlated with tumor stage (r = -0.702, 0.390, and 0.569, respectively). ROC curve analysis revealed that an RvD1 concentration of < 380 ng/mL (AUC: 0.783, 95% CI: 0673 - 0.893, p < 0.001) and CA 19-9 concentration of > 94.5 U/mL (AUC: 0.94, 95% CI: 0.898 - 0.998, p < 0.001) could be used to discriminate patients with CCA from those with BBD. Conclusions: Resolvin D1 and CA 19-9 levels might be used to effectively discriminate between BBD and CCA. Moreover, both RvD1 and CA 19-9 levels are associated with the stage of CCA, indicating that they may also be used in assessing disease progression.
  • Küçük Resim
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    Serum resolvin D1 levels as a marker of inflammation in constipation dominant irritable bowel syndrome
    (Aves, 2020) Karatay, Eylem; Utku, Ozlem Gul
    Background/Aims: The objective of this study is to determine the role of circulating resolvin D1 (RvD1) in patients with constipation subtype of irritable bowel syndrome (IBS-C) and evaluate the relationship between abdominal pain severity and RvD1 levels. Materials and Methods: This research included 55 patients with IBS-C and 36 healthy controls. Controls were selected from patients who applied to our department with similar complaints as IBS but were not diagnosed with any type of pathology after further investigations. All participants underwent complete blood count, C-reactive protein (CRP), and RvD1 levels measurements. We also recorded abdominal pain severity and the number of bowel movements. Patients with IBS-C were compared with respect to the demographic features and laboratory measurements. Results: The median CRP concentration in patients with IBS-C was significantly higher than that of controls (p=0.003). However, the median RvD1 concentration was significantly lower in the IBS group than that of the control group (p<0.001). The receiver operating characteristic curve analyses revealed that RvD1 concentration lower than 0.47 ng/mL and CRP concentration higher than 3.40 mg/L may identify patients with IBS-C with a high specificity. In the IBS group, there was a strong negative correlation between abdominal pain severity and RvD1 concentration (r=-0.766, p=0.001). Conclusion: This research demonstrates that patients with IBS-C have higher CRP and lower RvD1 concentrations than healthy controls. Both RvD1 and CRP concentrations predict the presence of IBS-C. Additionally, RvD1 concentrations decreased with the increase in abdominal pain severity. Further research works are needed for investigating the role of the RvD1 analogs in the treatment of IBS.
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    TNBS ile Oluşturulmuş Deneysel Rat Kolit Modelinde Tedavide Karışım Probiyotikler Etkin midir?
    (2020) Utku, Özlem Gül; Karatay, Eylem; Ergül, Bilal; Yılmaz, Canan; Ekinci, Özgür; Arhan, Mehmet
    Amaç: Enflamatuvar barsak hastalıkları (EBH) kronik idiyopatik hastalıklardır. EBH patogenezinin en kabul edilen hipotezi, genetik, çevresel faktörler ve konakçı bağışıklık sistemi arasındaki karmaşık etkileşimlerin, anormal immün yanıtlara ve kronik intestinal enflamasyona yol açmasıdır. Disbiyozis barsak mikrobiyota bileşiminde ve işlevinde değişiklikler olarak tanımlanmıştır. Klinik ve deneysel çalışmalar disbiyozisin EBH etiyopatogenezinde önemli rol oynadığını desteklemektedir. Bu çalışmada, deneysel kolit modelinde Enterococcus Faecium, Lactobacillus Acidophilus, Lactobacillus Rhamnosus, Bifidobacterium Bifidum, Bifidobacterium Longum bakterilerinin anti-enflamatuvar ve anti-oksidan etkinlikleri ve steroide göre probiyotiklerin tedavi başarısının değerlendirilmesi amaçlandı. Yöntem: Bu çalışmada toplam 24 adet 200-250 gram ağırlığında Wistar-Albino dişi rat grubu kullanıldı. Her grupta 6 rat olacak şekilde 4 farklı grup oluşturuldu. Sağlıklı kontrol (sham: grup A), trinitrobenzensülfonik asit (TNBS) koliti (grup B), (TNBS + metilprednizolon: grup C) ve probiyotik (TNBS + P: grup D). Sıçanlar 8. günde sakrifiye edildi. Makroskopik ve mikroskopik skorları değerlendirildi, doku miyeloperoksidaz (MPO), malondialdehit (MDA) ve süperoksitdismutaz (SOD) düzeyleri ölçüldü. Bulgular: Makroskopik ve mikroskopik skor düzeyleri değerlendirildiğinde A grubunun makroskopik skoru B, C ve D gruplarından düşüktü ve istatiksel anlamlı farklılık mevcuttu. C grubunun makroskopik ve mikroskobik skoru B grubuna göre düşüktü ve istatiksel anlamlı farklılık bulundu. Gruplar arasında ortanca MPO düzeyleri açısından anlamlı fark (p<0,001) tespit edilmedi. MDA ve SOD değerleri değerlendirildiğinde medyan MDA düzeyleri arasında anlamlı farklılık tespit edildi (p<0,001). Sonuç: Çalışmamız probiyotiklerin anti-oksidan ve oksidan sistemler arasındaki dengeyi düzenlediğini göstermektedir. Eğer klinik çalışmalar ile desteklenirse probiyotikler EBH’de destek tedavisi olarak kullanılabilir.