Midkine level may be used as a noninvasive biomarker in Crohn's disease

Background/aim: Crohn's disease (CD) is a kind of inflammatory bowel disease. Midkine (MDK) is an endogenous inflammatory marker. We aimed to investigate the relationship between MDK levels and inflammation and hence determine whether MDK can be used as a noninvasive biomarker in active CD. Materials and methods: Sixty-five consecutive patients over the age of 18 with CD and 36 healthy controls were included in this study. CD patients' venous blood samples were taken before treatment. Serum MDK levels were determined in human plasma samples by enzyme-linked immunosorbent assay (ELISA) method. Results: The mean age of the study patients was 44.8 ± 12.5 years, 35 patients were female, and 30 were male. Of these 65 patients, 37 had active CD and 28 were in the remission phase. MDK levels were significantly higher in active and remission CD than in healthy controls (P = 0.01, P = 0.038, respectively). Conclusion: e report that there is an association between MDK levels and CD activation, and therefore with enhanced inflammation. MDK levels were significantly correlated with inflammatory indices. In line with our findings, we suggest the theory that MDK inhibitors may be useful in treating Crohn's disease.

Evaluation of NAFLD fibrosis, FIB-4 and APRI score in diabetic patients receiving exenatide treatment for non-alcoholic fatty liver disease.

There is a closely relationship between the development and progression of nonalcoholic fatty liver disease (NAFLD) or metabolic associated fatty liver disease (MAFLD) and obesity and diabetes. NAFLD fibrosis scores should be routinely used to rule out patients with advanced fibrosis. High scores may help identify patients at higher risk of all causes andliverrelated morbidity and mortality. The aim of this study was to investigate the association between exenatide and fibrosis scores. The effect of exenatide treatment on fibrosis scores was evaluated in type 2 diabetes mellitus (DM) patients with MAFLD. Evaluation was made of 50 patients with type 2 DM and MAFLD. The NFS, FIB4 and APRI scores were calculated before and after 6 months of treatment. After 6 months of exenatide treatment, the NFS and APRI scores were determined to have decreased significantly. Exenatide was observed to control blood glucose, reduce body weight and improve fibrosis scores in MAFLD patients with type 2 diabetes.

Elevated adenosine deaminase levels in celiac disease.

Celiac disease (CD) is a genetically based chronic inflammatory disorder of the small bowel induced by the dietary gluten and possibly other environmental cofactors. The objective of this study was to investigate the relation of adenosine deaminase (ADA), a cytoplasmic enzyme involved in the catabolism of purine bases, as an index of altered immune response, with adult CD patients. ADA has been shown to increase in several inflammatory conditions, but there is no literature data indicating an alteration in CD. Serum levels of ADA were investigated in newly diagnosed 20 CD patients. ADA levels were compared in patients with CD and in healthy controls. Correlation analysis was also performed between ADA and other serum markers of CD (anti-gliadin and anti-endomysial antibodies) Mean serum ADA levels were significantly elevated in CD patients compared with control group. ROC curve analysis suggested that the optimum ADA level cut-off point for CD was 12.27 U/l. At a cut-off value of 12.27 U/l, the sensitivity was 80% and specificity was 100%. There was no statistically significant correlation between ADA and anti-gliadin and anti-endomisium antibodies. Serum ADA levels elevated significantly in CD patients, suggesting a partial role in activated T-cell response in the disease pathophysiology. ADA can be used as a supportive diagnostic marker in patients with CD.

Red cell distribution width for assessment of activity of inflammatory bowel disease.

BACKGROUND: Impaired iron absorption or increased loss of iron was found to correlate with disease activity and markers of inflammation in inflammatory bowel disease (IBD). Red cell distribution width (RDW) could be a reliable index of anisocytosis with the highest sensitivity to iron deficiency. AIM: The importance of RDW in assessment of IBD disease activity is unknown. In this study, we aimed to determine if RDW could be useful in detecting active disease in patients with IBD. MATERIALS AND METHODS: A total of 74 patients with ulcerative colitis (UC) and 22 patients with Crohn's disease (CD) formed the study group with 20 age- and sex-matched healthy volunteers as the control group. CD activity index higher than 150 in patients with CD was considered to indicate active disease. Patients with moderate and severe disease according to the Truelove-Witts scale were accepted as having active UC. In addition to RDW, serum C-reactive protein (CRP) and fibrinogen levels, erythrocyte sedimentation rates (ESR), leukocyte, and platelet counts were measured. RESULTS: Fourteen (63.6%) of the patients with CD and 43 (58.1%) of the patients with UC had active disease. RDW, fibrinogen, CRP, ESR, and platelet counts were all significantly elevated in patients having active IBD compared with those without active disease and controls (P < 0.05). The study subjects were further classified into two subgroups: cases with active and inactive UC and those with active and inactive CD. A subgroup analysis indicated that for an RDW cutoff of 14, the sensitivity for detecting active UC was 88% and the specificity was 71% (area under curve [AUC] 0.81, P = 0.0001). RDW was the most sensitive and specific parameter indicating active UC. However, the same was not true for CD since CRP at a cutoff of 0.54 mg/dl showed a sensitivity of 92% and a specificity of 63% (AUC 0.92, P = 0.001), whereas RDW at a cutoff of 14.1 showed 78% sensitivity and 63% specificity to detect active CD. CONCLUSION: Among the laboratory tests investigated, including fibrinogen, CRP, ESR, and platelet counts, receiver operating characteristic (ROC) curve analysis indicated RDW to be the most significant indicator of active UC. For CD, CRP was an important marker of active disease.

Boceprevir-induced Herpes Zoster.

Herpes zoster is caused by reactivation of the varicella zoster virus (VZV), that attacks peripheral or cranial nerves and result in painful cutaneous inflammation. Boceprevir is a protease inhibitor which used as a new therapeutic agent for chronic hepatitis C infection. Boceprevir associated herpes zoster is extremely rare condition. We present herpes zoster infection assosiated Boceprevir in patint with chronic hepatitis C. How to cite this article: Babali A, Cakal B, Tanoglu A, Karaahmet F, Kekilli M. Boceprevir-induced Herpes Zoster. Euroasian J Hepatogastroenterol, 2018;8(2):161-162.

Liver fatty acid-binding protein is a diagnostic marker to detect liver injury due to chronic hepatitis C infection.

BACKGROUND AND AIMS: Liver fatty acid-binding protein (L-FABP) is a small molecule. The aim of this study was to examine L-FABP levels and to detect its diagnostic value in chronic hepatitis C (CHC). METHODS: We studied 22 patients with CHC and 20 healthy control subjects. Patients with persistently elevated serum aminotransferases and positive HCV RNA were included in the study. Patients with CHC underwent percutaneous liver biopsy. Serum level of L-FABP was determined by ELISA method. RESULTS: Patients with CHC had significantly increased levels of L-FABP compared to controls. A strong correlation between serum L-FABP concentrations and aspartate aminotransferases, alanine aminotransferases, HCV RNA levels and hepatic inflammation was found. When a cut-off value was 29,000 pg/mL for L-FABP, sensitivity and specificity were 75 and 100%, respectively. Positive and negative predictive values for L-FABP were 100 and 78%, respectively. CONCLUSIONS: Serum L-FABP is used as a new diagnostic marker to detect liver injury.

Effects of pegylated interferon α on fibrinolytic parameters in patients with chronic hepatitis C.

Interferon (IFN) interacts with endothelial cells and modulates the functions of these cells. In our study, we aimed to determine the effects of treatment with pegylated IFN-α (peg-IFN-α) on fibrinolytic parameters in patients with chronic hepatitis C. Fifteen patients with chronic hepatitis C were treated with peg-IFN-α once per week plus daily oral ribavirin. Euglobulin lysis time (ELT), plasma levels of D-dimer, tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor 1 (PAI-1), and thrombin activatable fibrinolysis inhibitor (TAFI) were determined before treatment, 2 weeks, 1 month, and 3 months after the initiation of the treatment. Plasma levels of t-PA increased significantly 1 month and 3 months after the treatment (P < .05). The PAI-1 and TAFI levels in 2 weeks, 1 month and 3 months after treatment were not statistically different as compared with pretreatment levels (P > .05) No significant difference in plasma D-dimer levels was observed during peg-IFN-α treatment (P > .05). There was a significant decrease in ELT 1 month and 3 months after the treatment (P < .05). Our results indicated that treatment with peg-IFN-α may be associated with enhanced fibrinolysis.

Serum iron parameters in cirrhosis and chronic hepatitis: detailed description.

BACKGROUND/AIMS: Serum iron parameters are affected by liver disorders. It is believed that the tests are unreliable in chronic liver disease, and systemic iron overload should be evaluated histologically in these patients. However, the effect of severity of chronic liver disease on serum iron parameters has not been evaluated. Similarly, differences between liver disease- and iron overload related iron parameter changes have not been clarified. We aimed to describe the effect of severity of chronic liver disease on serum iron tests and to elucidate the differences of liver disease- and iron overload-related iron parameter changes. METHODS: Commonly used serum iron parameters were studied in patients with cirrhosis, chronic viral hepatitis and in persons with confirmed hemochromatosis. Cirrhosis cases were categorized according to Child-Pugh classification. RESULTS: We found that cirrhotic persons of any Child-Pugh class had deviations from normal results. Patients with chronic hepatitis had normal serum iron parameters. Total iron binding capacity decreased as liver disease progressed from hepatitis toward Class C cirrhosis (r= -0.53, p<0.001). Changes in ferritin and transferrin saturation were essentially opposite to this trend (r=0.3, p=0.01 and r=0.47, p<0.001, respectively). Serum iron level was lower in cirrhosis compared to hepatitis. Increased transferrin saturation and ferritin levels resembling iron overload were limited to Class C cirrhotics. Patients with true iron overload could be easily differentiated from these cases by hyperferremia. CONCLUSION: Aberrant serum iron test results indicate cirrhotic stage in chronic liver disease. Cirrhosis and systemic iron overload cause characteristically different changes in serum iron parameters.

Natural anticoagulant protein levels in Turkish patients with inflammatory bowel disease.

Thromboembolism is an important cause of morbidity and mortality in patients with inflammatory bowel disease (IBD). The aim of this study was to investigate common thrombophilic markers in patients with IBD and to search for a relation between these predisposing factors and activity of disease. Seventy-four patients with ulcerative colitis, 22 patients with Crohn's disease and 20 healthy volunteers were enrolled into the study. Plasma levels of protein C, protein S, antithrombin III and activated protein C resistance were determined in patients with IBD and healthy controls. Mean values of protein C, protein S and antithrombin III were significantly lower in patients with ulcerative colitis and Crohn's disease compared with the healthy control group. Patients with active ulcerative colitis had lower protein C, protein S and antithrombin III level than patients in remission (P < 0.001, P < 0.001, P < 0.001). Levels of protein C, S and antithrombin III were also decreased in patients with active Crohn's disease compared with those in remission (P < 0.05, P < 0.001, P < 0.05). Differences in all natural anticoagulant levels between patients in remission and healthy individuals in both ulcerative colitis and Crohn's disease groups were not statistically significant (P > 0.05). No significant difference was observed in activated protein C resistance (APCR) between patients with active disease, those in remission and the control group (P > 0.05). Abnormalities in natural anticoagulants are common in patients with IBD during active disease.

Serum α-fetoprotein levels in liver steatosis.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a common disorder and becoming a leading cause of cirrhosis in the western world. The monitoring of the disease is challenging and the prognostic importance of α-fetoprotein (AFP) level elevation in NAFLD remains uncertain. METHODS: Eighty-four patients were evaluated in the study. Patients with evidence of fatty liver in an abdominal ultrasonography performed for any reason were enrolled in the study. Degree of liver steatosis was graded into three groups. As a control group, patients without fatty liver or other liver diseases were included. All patients and controls were asked about prior hepatic diseases, consumption of alcohol, smoking, drug use, and a physical examination, biochemical analyses including liver function tests, different components of the metabolic syndrome, and the homeostasis model assessment-estimated insulin resistance (HOMA-IR) score were also performed. RESULTS: Body mass index, aspartate aminotransferase, alanine aminotransferase, glucose, insulin, and HOMA-IR in patients with NAFLD were higher than in control group. Triglyceride, total cholesterol, low-density lipoprotein, and high-density lipoprotein cholesterol levels were higher in NAFLD group than in control group. A statistically significant increase in AFP levels was noted in patients with NAFLD (4.09 ± 1.68) when compared with healthy controls (2.95 ± 0.41) (P < 0.05). A statistically significant increase in AFP levels was noted in patients with grade 3 NAFLD (5.43 ± 1.51) when compared with grade 1 (2.92 ± 1.06) and grade 2 NAFLD groups (3.97 ± 1.45). Also, AFP was significantly higher in grade 2 NAFLD group than in grade 1 NAFLD group. AFP was correlated with NAFLD grade, but neither ALT nor AST showed correlation. According to multivariate analysis, correlation between NAFLD grade and serum AFP levels was independent from the other factors. CONCLUSION: Patients with NAFLD have higher AFP levels than those without fatty liver changes. AFP levels rise as grade of liver steatosis increases. NAFLD should be among the differential diagnosis of elevated serum AFP levels.

Plasma transforming growth factor-beta1 level in inflammatory bowel disease.

BACKGROUND/AIMS: The aim of this study was to evaluate plasma transforming growth factor-B1 concentration in patients with inflammatory bowel disease at different stages of disease activation and to compare these values with those of healthy controls. METHODS: A total of 70 patients (31 women) evaluated in the Inflammatory Bowel Disease Clinics of TUrkiye YUksek Ihtisas Hospital, Gastroenterology Department, and 20 healthy controls (10 women) were enrolled in the study. Serum samples were obtained from 40 patients with ulcerative colitis (female/male: 18/22, mean age: 41.5+/-12), 30 patients with Crohn's disease (female/male: 17/13, mean age: 36.9+/-1.9) and 20 healthy controls (female/ male: 10/10, mean age: 32.1+/-1.7). The control group included normal blood donors without gastrointestinal complaints or a familial history of inflammatory bowel disease. Clinical activity in Chron's disease was measured by Crohn disease activity index and in ulcerative colitis patients by Rachmilewitz endoscopic index. Chron's disease patients with a Chron's disease activity index >150 and ulcerative colitis patients with a Rachmilewitz index > or =4 were accepted to have active disease. Determination of transforming growth factor-B1 level was performed with the enzyme- linked immunosorbent assay. RESULTS: Serum transforming growth factor-B1 levels were measured as: Chron's disease 1133.3+/-766.5 pg/ml, ulcerative colitis 1362.5+/-880.6 pg/ml and control group 1230.0+/-572.7 pg/ml. There were no significant differences between the three groups. In patients with active disease in ulcerative colitis, transforming growth factor-B1 level was measured as 1952.5+/-543.7, while this value was 772.5+/-750.5 in patientsin remission in ulcerative colitis. There was a significant difference between patients with active ulcerative colitis and remission ulcerative colitis. CONCLUSIONS: In inflammatory bowel disease, transforming growth factor-B1 can be used as a marker for differential diagnosis of active ulcerative colitis patients and remission ulcerative colitis patients. Nevertheless, more studies with larger patient groups are necessary.

Do scattered white spots in the duodenum mark a specific gastrointestinal pathology?

OBJECTIVE: To discover whether scattered white spots (SWS) in the duodenum are related to a specific kind of disease. We also scrutinized other upper endoscopic findings which might be associated with SWS. METHODS: Among the patients who were admitted for upper gastrointestinal system endoscopy, those having the endoscopic appearance of SWS in duodenum were enrolled in this study. In total 107 patients [70 women, 37 men, mean age: 51.6 +/- 16.88 years (range: 17-82 years)] were included. At least three duodenal biopsies were taken from each patient and histopathological examinations were done by experienced pathologists. RESULTS: The histopathological examination revealed that 39 (36.4%) patients had intestinal lymphangiectasia (IL), 15 (14%) patients had giardiasis (G) and 30 (28.1%) patients had chronic non-specific duodenitis (CD). Two patients with IL were also found to have G. Twenty patients had both IL and CD. One had both G and CD. G was the least common etiology for SWS in the duodenum. The most common reasons for SWS in the duodenum in this study group were IL and CD, in order of decreasing frequency. There was no significant relationship with the other upper endoscopic findings in all these patients. CONCLUSION: Histopathological examinations should be provided for each patient with SWS in the duodenum to assess the etiology.

Clinical features of ulcerative colitis and Crohn's disease in Turkey.

BACKGROUND AND AIMS: This study is aimed at determining the clinical and socio-demographic characteristics of Turkish patients with inflammatory bowel disease who have been treated in a tertiary referral center. PATIENTS AND METHODS: The study was conducted between 1993 and 2007 at Ankara Yuksek Ihtisas Hospital, Inflammatory Bowel Disease Clinics. The clinical and epidemiologic data from this clinic were gathered and analysed. RESULTS: During the study period, 702 patients were identified as having inflammatory bowel disease; among these, 507 with ulcerative colitis (72.2%) and 195 with Crohn's disease (27.8%). The mean age at diagnosis was 46.2 years in ulcerative colitis and 40 years in Crohn's disease (p < 0.001). The male to female ratio was 1.2 for ulcerative colitis and 1.6 for Crohn's disease (p = 0.12). Of the patients who were primarily diagnosed with ulcerative colitis 16.8% had their diagnoses changed to Crohn's disease after the follow-up period. CONCLUSIONS: Peak age of onset for both Crohn's disease and ulcerative colitis were similar to other countries. A slight male predominance of Crohn's disease and ulcerative colitis were found for Turkish patients. Though it takes longer to diagnose, Crohn's disease may have a milder course in Turkish patients.

Preoperative detection of insulinomas: two case reports.

BACKGROUND: Insulinoma is the most common endocrine tumor of the pancreas. Accurate preoperative detection and localization of insulinomas is essential for the appropriate selection of candidates for surgery. We present two cases with benign pancreatic insulinoma. CASE PRESENTATION: Preoperative evaluation for patients with suspected insulinomas has been controversial. Endoscopic ultrasonography (EUS) has a sensitivity of 95% in well skilled operators and well tolerated preoperative imaging method. CONCLUSION: We have detected the insulinomas with EUS before surgery in our patients but other imaging modalities did not help us for localization of them. Patients have been asymptomatic postoperatively with no hypoglycemia on repeat fasting. We reviewed here the different modalities for preoperative localization of insulinoma.

Moxifloxacine plus amoxicillin and ranitidine bismuth citrate or esomeprazole triple therapies for Helicobacter pylori infection.

Up to 20% of patients, or even more, will fail to obtain eradication after a standard triple therapy. The aim of this study is to evaluate the efficacy of moxifloxacine-containing regimens in the first-line treatment of Helicobacter pylori. One hundred and twenty H. pylori-positive patients were randomized into four groups to receive one of the following 14-day treatments: ranitidine bismuth citrate (RBC) 400 mg b.d. plus amoxicillin 1 g b.d. and clarithromycin 500 mg b.d. (RAC group, n = 30); RBC 400 mg b.d. plus moxifloxacine 400 mg o.d. and amoxicillin 1,000 mg b.d. (RAM group, n = 30); esomeprazole 40 mg b.d. plus amoxicillin 1,000 mg b.d. plus clarithromycin 500 mg b.d. (EAC group, n = 30); and esomeprazole 40 mg b.d. plus amoxicillin 1,000 mg b.d. plus moxifloxacine 400 mg o.d. (EAM group, n = 30). Eradication was assessed by (13)C urea breath test 8 weeks after therapy. Per-protocol and intention-to-treat eradication was achieved in 23 out of 30 patients (76.7%, 95% confidence interval [CI]: 61-92) in the RAC group, in 20 patients (66.7%, 95% CI: 49-84) in the RAM group, in 16 patients in the EAM group (53.3%, 95% CI: 34-71), and in 19 patients in the EAC group (63.3%, 95% CI: 54-72). Mild or moderate side-effects were significantly more common in the EAM group (70%) compared to the RAC (36.6%), RAM (43.3%), and EAC (56.6%) groups (P = 0.03). From our results, we conclude that moxifloxacine-containing triple therapies have neither eradication nor compliance advantages over standard triple therapies. Further studies with new antibiotic associations are needed for the better eradication of H. pylori in developing regions of the world.

Chronic constipation as a causative factor for development of varicocele in men: a prospective ultrasonographic study.

OBJECTIVE: The purpose of this study was to determine the role of chronic constipation in the etiopathogenesis of varicocele in men. METHODS: In this prospective study, group 1 included 25 male patients who had symptoms of chronic constipation for a mean duration +/- SD of 17.0 +/- 20.3 months (range, 3-96 months), and group 2 included 26 male subjects without any symptoms associated with constipation. All subjects were evaluated by both physical examination and scrotal ultrasonography. For the plexus pampiniformis (PP) veins, a mean diameter exceeding 2 mm and reflux for more than 1 second were accepted as suggestive findings for varicocele, as described previously. RESULTS: Left varicocele was detected in 13 (52%) of the 25 patients in group 1 and in 5 (19%) of the 26 subjects in group 2 (P = .02). The mean diameters of the left PP veins were 2.58 +/- 0.97 mm (range, 1.2-4.3 mm) in group 1 and 1.71 +/- 0.53 mm (range, 1.0-3.0 mm) in group 2 (P < .001). A significant difference was detected between the two groups for varicocele prevalence and the mean diameter of the left PP veins. CONCLUSIONS: Chronic constipation is a significant causative factor for the development of left varicocele, which may be attributable to the accompanying distention of the sigmoid colon and distal part of the descending colon, with resultant compression of the left testicular vein in the retroperitoneum. Therefore, we propose routine ultrasonographic examinations for the possible development of varicocele in men with chronic constipation.

Homocysteine and fibrinogen changes with L-thyroxine in subclinical hypothyroid patients.

The aim of the present study was to evaluate plasma total homocysteine (Hcys) and serum fibrinogen concentrations in subclinical hypothyroid (SH) and overt hypothyroid patients before and after L-thyroxine (LT4) replacement and to compare them in euthyroid subjects. Fifteen SH and 20 hypothyroid premenopausal women were recruited in the study. We measured fasting plasma levels of Hcys and serum levels of free thyroxine (fT4), free triiodothyronine (fT3), thyrotropin (TSH), folate, vitamin B12, fibrinogen, renal functions, and lipid profiles in patients with SH and overt hypothyroid patients before and after LT4 treatment. Eleven healthy women were included in the study as a control group. Pretreatment Hcys levels were similar in SH and control subjects, whereas mean fibrinogen level of SH patients was higher than that of control subjects (p<0.05). Baseline Hcys (p<0.01) and fibrinogen (p<0.001) levels of the overt hypothyroid patients were significantly higher than those of the healthy subjects, and the pretreatment Hcys levels decreased with LT4 treatment (p<0.001). In conclusion, our data support that SH is not associated with hyperhomocysteinemia and Hcys does not appear to contribute to the increased risk for atherosclerotic disease in patients with SH.