Protective effects of Acetobacter ghanensis against gliadin toxicity in intestinal epithelial cells with immunoregulatory and gluten-digestive properties.

PURPOSE: The aim of this study was to establish whether Acetobacter ghanensis, the probiotic characteristics of which were evaluated previously, attenuates gliadin-induced toxicity in intestinal epithelial cells with gluten-digestive and immunoregulatory properties. METHODS: A co-culture model of human intestinal epithelial cell (Caco-2) monolayers on top of peripheral blood mononuclear cells (PBMCs) obtained from patients with celiac disease (CD) was established. The gluten-digestive properties of A. ghanensis were determined by checking bacterial growth in a medium containing gluten as the main nitrogen source. The mRNA levels of genes encoding TJ-associated proteins were measured by quantitative real-time PCR (qRT-PCR). The concentrations of IL-6 and TNFα were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS: We found that PT-gliadin disrupted intestinal barrier integrity by modulating the expression of TJ-associated genes encoding zonulin (increased by ~ 60%), zonula occludens-1 (ZO-1) (decreased by ~ 22%), and occludin (decreased by ~ 28%) in Caco-2 cells. Furthermore, PT-gliadin treatment in Caco-2 cells was associated with increased concentrations of IL-6 (~ 1.6-fold) and TNFα (~ twofold) from PBMCs. These modulatory effects of PT-gliadin, however, were suppressed when Caco-2 cells were subjected to A. ghanensis in the presence of PT-gliadin. As a factor underlying these protective effects, we showed that A. ghanensis could digest gluten peptides. CONCLUSIONS: To our knowledge, the current study is the first to demonstrate that A. ghanensis improves intestinal barrier functions by attenuating the modulatory effects of PT-gliadin with immunoregulatory and gluten-digestive properties.

Effect of Direct-acting Oral Anticoagulants and Warfarin on Hospital Outcomes in Upper Gastrointestinal Bleeding.

OBJECTIVE: To evaluate the comparison of direct-acting oral anticoagulants (DOACs) and warfarin for their effects on major bleeding and hospital outcomes in patients with acute nonvariceal upper gastrointestinal bleeding (NVUGIB). STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Tekirdag Namik Kemal University Hospital, Hitit University Erol Olçok Education and Research Hospital, between January and December 2021. METHODOLOGY: Adult patients prescribed warfarin and DOACs were followed up for one year. Their length of hospital stay, need for intensive care unit admission, need for red blood cell transfusion, and major bleeding rates were compared. RESULTS: Thirty-two patients (61.5%) were user of DOACs (DOAC group), and 20 patients (38.5%) were users of warfarin (warfarin group). No statistically significant difference was determined between patients in warfarin group and DOAC group for the number of packed red blood cells transfused [median 3 (0-6) units, 3 (0-10) units, p=0.229, respectively], length of hospital stay [median 5 days (3-10), and 4.5 days (2-20), p=0.739, respectively], rate of intensive care unit admission [(n=9, 45%; and n=10 (31%), p=0.623, respectively] and the occurrence of major bleeding events (warfarin-70%; DOACs-78%; p=0.529). CONCLUSION: Major bleeding episodes and hospital outcomes of acute NVUGIB were similar between patients receiving warfarin and DOACs. KEY WORDS: Direct-acting oral anticoagulants, Warfarin, Gastrointestinal bleeding, Outcome, Mortality.

The Diagnostic Utility of Flow Cytometry in Celiac Disease Presented Isolated Iron Deficiency Anemia.

BACKGROUND: Flow cytometric analysis of intestinal intraepithelial lymphocytes contributes to the diagnosis of celiac disease. Celiac disease may present with iron deficiency anemia alone which is considered as one of the forms of atypical celiac disease. In this study, we have aimed to investigate the diagnostic utility of flow cytometric analysis of intraepithelial lymphocytes in this atypical form. METHODS: Three groups were formed: the patients with unexplained iron deficiency (group 1), the patients with celiac disease (group 2), and the patients who underwent gastroduodenoscopy for other reasons (group 0). Duodenal biopsy samples were used for flow cytometric analysis of intraepithelial lymphocytes. T cell receptor gammadelta intraepithelial lymphocytes and CD3-/CD103+ intraepithelial lymphocytes were determined with relevant monoclonal antibodies. Sensitivity-specificity calculation was performed to evaluate the usability of flow cytometric variables as diagnostic tests. RESULTS: Group 1 had 22 patients, group 2 had 14 patients, and group 0 had 56 patients. In the comparison of the 3 groups, CD3+/ TCRγδ+ intraepithelial lymphocytes were found to be higher in celiac patients than other cases. CD3+/TCRγδ+ intraepithelial lymphocyte was evaluated for its usability as a diagnostic test. The cut-off value of CD3+/TCRγδ+ intraepithelial lymphocyte as 16.39% according to receiver operating characteristics curve analysis determined celiac disease in 14 of 22 patients in group 1 with 91.7% sensitivity and 80.4% specificity. CONCLUSIONS: Although celiac disease is diagnosed with serologic tests and histologic examination, successively, the increase in intestinal CD3+/TCRγδ+ intraepithelial lymphocytes may be used as a diagnostic test, and it may assist in revealing atypical forms of celiac disease.

Vagus nerve assessment via ultrasonography in irritable bowel syndrome. Are there any changes of dimension in the vagus nerve?

BACKGROUND/AIM: Irritable bowel syndrome (IBS) is the functional gastrointestinal disorder which has closely relationship with Central Nervous System (CNS). VN is the major connector between CNS and Enteric Nervous System (ENS). The aim of this study was to investigate the possible changes of dimension of Vagus Nerve (VN) with Vagus ultrasonography (VU) in IBS. MATERIAL AND METHODS: A total 119 patients which is consisted of 66 IBS patients appropriated with Rome IV criterias and 53 patients of control group were enrolled to the study. All patients were underwent to colonoscopy for role-out the organic pathologies, such as polyposis, inflammatory bowel syndromes, diverticulosis and colon cancer. Right Vagus (RV) and left Vagus (LV) nerve areas and diameters were calculated with VU. RESULTS: There were no statistical difference of RV (p=0.445) and LV (p=0.944) diameter between two groups. There were also no statistical difference of RV (p=0.549) and LV (p=0.874) areas between IBS and control groups. CONCLUSION: VU clearly depicted that there is no changes of dimension in VN areas and diameters in the IBS. This might show that VN is only a transporter of abnormal neuronal stimulations according to IBS pathophisiology.

Choroidal Thickness of Helicobacter-Positive Patients without Central Serous Chorioretinopathy.

PURPOSE: To evaluate the effect of Helicobacter pylori (H. pylori) infection on subfoveal choroidal thickness (SFCT) in patients without clinical central serous chorioretinopathy (CSC). MATERIALS AND METHODS: This prospective study included 50 patients with pathologically proven H. pylori infection (H. pylori (+)) and 50 patients without H. pylori infection (H. pylori (-)). All of the recruited patients were previously admitted to the Gastroenterology Department of the Namik Kemal University School of Medicine over the period of July 2014 to September 2015. All patients had 20/20 vision and underwent complete ophthalmological examination, macular optical coherence tomography (OCT), and enhanced depth imaging OCT. RESULTS: All patients had 20/20 vision and similar macular thicknesses. The mean SFCT of patients in the H. pylori (+) group was 309 ± 41.1 µm and 315 ± 18.2 µm in the H. pylori (-) group (p = 0.174). The right and left eyes of patients in the H. pylori (+) and (-) groups were not statistically significantly different (p = 0.852, p = 0.937). The age, sex, and choroidal thicknesses of patients in the H. pylori (+) and (-) groups were not correlated. CONCLUSION: H. pylori infection does not have an effect on choroidal thickness in patients without any ocular pathology.

The influence of vitamin D deficiency on eradication rates of Helicobacter pylori.

BACKGROUND: Helicobacter pylori eradication therapy improves the healing of various gastro-duodenal diseases such as chronic gastritis and peptic ulcer, and also reduces gastric cancer incidence. Several studies have reported on risk factors other than antibiotic resistance related to Helicobacter pylori eradication failure. OBJECTIVES: In this study, we aimed to investigate whether or not the serum levels of 25-hydroxy-vitamin D (25(OH)D) influence eradication rates of H.pylori. MATERIAL AND METHODS: 220 patients diagnosed with H.pylori gastritis using endoscopic biopsy had their 25-OH vitamin D levels measured via the electrochemiluminescence method before beginning eradication therapy of H.pylori. Gastric biopsies obtained at endoscopy were examined for H.pylori strains and histopathologic findings. All patients were treated with bismuth-containing quadruple therapy for 14 days. H.pylori eradication was determined via the 14C-urea breath test performed 4 weeks after the end of therapy. Based on the 25-OH vitamin D levels, the patients were divided into 2 groups: group 1 (deficient) had a vitamin D level of <10 ng/mL, while group 2 (sufficient) had a vitamin D level of ≥10 ng/ mL. RESULTS: Eradication was successful in 170 (77.2%) patients and failed in 50 (22.7%) patients. The prevalence of 25(OH)D deficiency was 30.5%. Mean 25(OH)D levels were significantly lower in the eradication failure group compared to the successful treatment group (9.13 ±4.7 vs 19.03 ±8.13; p = 0.001). There were significantly more patients with deficient 25(OH)D levels in the failed treatment group compared to the successful treatment group (p = 0.001). CONCLUSIONS: Our findings suggest that 25-OH vitamin D deficiency may be considered a risk factor related to eradication failure of H.pylori, which may lead to a need for supplementation of vitamin D before eradication of H.pylori.

Protective effects of onion (Allium cepa) extract against doxorubicin-induced hepatotoxicity in rats.

BACKGROUND/AIM: Doxorubicin (DOX) is a widely used and potent chemotherapeutic agent. However, serious dose-limiting toxicity through generation of free oxygen radicals is a commonly encountered clinical problem. The aim of the current study was to assess the protective role of onion (Allium cepa) extract (ACE) against DOX-induced hepatotoxicity in rats. METHOD: A total of 24 rats were randomly divided into 3 equal experimental groups: (1) DOX; (2) ACE + DOX; and (3) control groups. ACE was given orally as 1 mL of fresh ACE juice for 14 consecutive days followed by DOX injection. DOX was injected intraperitoneally in a single dose of 30 mg/kg body weight to induce hepatotoxicity, and the rats were killed after 48 h from injection. Control group was given saline only. RESULTS: In the ACE pretreated group (ACE + DOX), serum aspartate transaminase, alanine transaminase, and tissue malondialdehyde and glutathione levels were significantly lower, while superoxide dismutase and glutathione peroxidase were higher compared with the DOX group. The histopathological examination of liver specimens revealed parenchymal necrosis, proliferation of biliary duct in DOX group; while ACE pretreatment provided marked reduction in these changes. CONCLUSION: Our study indicates that pretreatment with ACE protects against DOX-induced hepatotoxicity due to the antioxidant properties of ACE. Further studies on efficacy of antioxidant treatment by ACE in DOX-mediated toxicity and underlying mechanisms would provide a better explanation.

Relationship among MIF, MCP-1, viral loads, and HBs Ag levels in chronic hepatitis B patients.

BACKGROUND/AIM: To determine whether macrophage migration inhibitory factor (MIF) and monocyte chemoattractant protein-1 (MCP-1) levels in patients with hepatitis B (HB) are different than in normal individuals and whether the HB surface antigen (HBs Ag) level and viral load are correlated with each other and with the two aforementioned parameters. MATERIALS AND METHODS: Sera were obtained from 52 chronic active HB (CAHB) patients and 33 healthy controls, and their MIF and MCP-1 levels were measured. Statistical analyses were performed. A value of P < 0.05 was considered statistically significant. RESULTS: The MIF and MCP-1 values of the control group were increased compared to those of the CAHB group. The MIF and MCP-1 levels were negatively correlated with HBs Ag levels and viral loads. The MIF and MCP-1 levels were positively correlated. The HBs Ag levels and the log10 of the viral loads were positively correlated. CONCLUSION: We conclude that the negative correlation of MIF and MCP-1 with viral load and HBs Ag levels may be due to T-cell deficiency, antinuclear antibody seropositivity, and/or inhibition of chemokine ligand 2 receptors by viral antigens. More studies with a greater number of subjects are needed to evaluate the potential role of MIF and MCP in CAHB.

Evaluation of paraoxonase and arylesterase activities in patients with irritable bowel syndrome.

The aims of the present study were to evaluate oxidative status, by investigating the serum Paraoxonase/Arylesterase (PON/ARE) activities along with conjugated dienes in patients with IBS and controls and to confirm the link between oxidative stress and IBS. Thirty IBS patient and 30 healthy subjects were recruited. Total serum cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), PON and ARE activities and conjugated dienes levels were measured. Mean serum PON1 activity was lower in IBS group compared to that of the control group whereas there was no significant difference in ARE activity between IBS and control groups (p < 0.000, p < 0.716, respectively). Serum conjugated diene levels of the IBS group was significantly higher than that of the control group (p < 0.01). The drop in PON activity accompanied with an increase in conjugated diene levels indicate the presence of oxidative stress, a disturbance in prooxidant - antioxidant balance and increased inflammation in IBS patients.

Analysis of cases with tuberculous peritonitis: a single-center experience.

BACKGROUND/AIMS: Tuberculous peritonitis (TP) is a rare form of tuberculosis and is caused by peritoneal involvement with Mycobacterium tuberculosis. A distinctive correlation exists between socioeconomic state and disease prevalence. We aimed to evaluate the clinical, laboratory, and radiological findings of patients with TP. MATERIALS AND METHODS: We conducted a retrospective study in patients with peritoneal tuberculosis from January 2004 to October 2008 at Yuzuncu Yil University Medical School Education and Research Hospital. During this time, the data of 21 patients (17 females) with TP were reviewed. RESULTS: Fever, abdominal pain, and anorexia were the most common symptoms. An analysis of ascites showed lymphocyte predominance and low albumin gradient in all patients. Patients with TP had a median ascites adenosine deaminase (ADA) level of 139 U/L (range, 25 to 303U/L). Peritoneal involvement (wet peritonitis) was seen in all the cases. Following 6-month administration of combined anti-TBC treatment, mean serum CA-125 levels were within the normal range among patients who had previously higher serum CA-125 level. Mortality rate in the total cases was 4.6%. CONCLUSION: Peritoneal tuberculosis should be considered in the differential diagnosis of exudative ascites in eastern Turkey. A high level of suspicion is required, especially in high-risk populations living in rural areas. ADA seems to be a sufficient, safe, and inexpensive method to perform the diagnosis of peritoneal tuberculosis. Serum CA-125 levels may play a key role to support the diagnosis as well as disease management of TP.

Melatonin attenuates oxidative stress, liver damage and hepatocyte apoptosis after bile-duct ligation in rats.

The goal of this study was to evaluate the possible protective effects of melatonin against cholestatic oxidative stress, liver damage and hepatocyte apoptosis in the common rats with bile duct ligation (BDL). A total of 24 male Wistar albino rats were divided into three groups: control, BDL and BDL + received melatonin; each group contains eight animals. Melatonin-treated BDL rats received daily melatonin 100 mg/kg/day via intraperitoneal injection. The application of BDL clearly increased the malondialdehyde (MDA) levels and decreased the superoxide dismutase (SOD) and glutathione (GSH) activities. Melatonin treatment significantly decreased the elevated tissue MDA levels and increased the reduced SOD and GSH enzyme levels in the tissues. The changes demonstrate that the bile duct proliferation and fibrosis in expanded portal tracts include the extension of proliferated bile ducts into lobules, mononuclear cells and neutrophil infiltration into the widened portal areas as observed in the BDL group. The data indicate that melatonin attenuates BDL-induced cholestatic liver injury, bile duct proliferation and fibrosis. The α-smooth muscle actin (α-SMA) and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL)-positive cells in the BDL were observed to be reduced with the melatonin treatment. These results suggest that administration of melatonin is a potentially beneficial agent to reduce liver damage in BDL by decreasing oxidative stress.

Investigation of serum macrophage migration inhibitor factor and monocyte chemotactic protein-1 levels in irritable bowel syndrome.

AIM: Irritable bowel syndrome (IBS), a functional disorder of the bowel, has been thought to result from immune activation. The aim of this study was to evaluate macrophage migration inhibitory factor (MMIF) and monocyte chemotactic protein-1 (MCP-1) levels in IBS patients. MATERIALS AND METHODS: We enrolled 30 IBS patients and 30 healthy controls. The MMIF and MCP-1 levels of all patients and controls were detected using commercial enzyme-linked immunosorbent assay kits. RESULTS: Serum MMIF and MCP-1 levels were markedly higher in IBS patients than in controls. White blood cell, neutrophil, lymphocyte, monocyte, eosinophil, and basophil counts did not differ significantly between groups. CONCLUSION: These results show that alterations in MMIF and MCP-1 affect the proinflammatory process. They also suggest that MMIF and MCP-1 may play a substantial role in IBS.

The role of oxidants and reactive nitrogen species in irritable bowel syndrome: a potential etiological explanation.

BACKGROUND: The aim of this study was to evaluate the plasma concentrations of malondialdehyde (MDA) and nitric oxide (NO) and the plasma activities of oxidant and antioxidant enzymes in patients with IBS. MATERIAL/METHODS: A total of 36 patients with IBS were included in the study. Thirty-five healthy subjects were selected to form the control group. Superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), xanthine oxidase (XO), adenosine deaminase (AD) activities, and malondialdehyde (MDA) and nitric oxide (NO) concentrations were studied in the serum samples of all patients and controls. RESULTS: Plasma XO and AD activities, and MDA and NO concentrations were significantly higher in IBS patients than in controls. The SOD, CAT, and GSH-Px activities in the serum of patients with IBS were significantly lower than that of controls. CONCLUSIONS: These results suggest that lipid peroxidation and alterations in the oxidant-antioxidant enzymatic system may play a role in the pathogenesis of IBS. Increased lipid peroxidation in IBS may be related to an increase in NO level and XO activity and a decrease in antioxidant enzymes activities. In addition, increased AD activity may have a role in immunological changes of IBS patients.

Effects of the ischemic preconditioning on anastomotic healing in laparoscopic colon operations.

BACKGROUND: Previous experimental studies have repeatedly demonstrated the potential protective effect of remote ischemic preconditioning (IPC) on colon anastomosis. The purpose of this experimental study was to investigate the possible positive effects of IPC by interval insufflations in laparoscopic colon operations. METHODS: Thirty Wistar-albino rats were randomized into 3 groups. Colonic transsection and anastomosis were performed in the control group. In the laparoscopic colon operation without IPC group, the intra-abdominal pressure was raised to 14 mm Hg for 60 minutes, and then laparotomy and colonic anastomosis were performed. In the IPC group, the intra-abdominal pressure was raised to 14 mm Hg for 5 minutes, followed by desufflation. Laparotomy and colonic anastomosis were performed exactly as in the non-IPC group. On the seventh postoperative day, all animals were killed, and blood and tissue samples were obtained. Anastomotic healing and inflammatory responses were determined by histopathologic examination and by measuring the anastomotic bursting pressure, tissue hydroxyproline level, and tissue and serum nitric oxide, malondialdehyde (MDA), and catalase activity levels. Differences with P-values of <0.05 were considered to be statistically significant. RESULTS: Although the best anastomotic healing was detected in the control group, anastomotic healing was better in the IPC group than that in the non-IPC group. In terms of anastomotic bursting pressure, plasma MDA, serum catalase activity, and tissue nitric oxide levels, the IPC group was superior to the non-IPC group. No significant differences were found between the control and IPC groups, except in the plasma MDA levels. CONCLUSIONS: Use of IPC with colon anastomosis had positive effects on wound healing and may serve as a safe method to reduce the adverse effects of ischemia and wound healing in laparoscopic colon operations.

The prevalence of hereditary hemochromatosis in some men from the Eastern part of Turkey and the effects of H63D mutations on iron studies.

Abstract Background: Hereditary hemochromatosis (HH) is characterized by an increased intestinal absorption of iron due to mutations in iron-related genes. The C282Y and H63D mutations of the HFE gene are principally responsible for HFE-related hemochromatosis. The majority of HH cases are reported in Western countries where HFE-related mutations are common. The prevalence of HFE-related mutations is not yet clear in eastern Turkey. We aim to clarify the frequency of HFE gene mutations in men who live in eastern Turkey and also assess the biochemical effects of the H63D mutation. Methods: Using the reverse hybridization Hemochromatosis Strip Assay A (ViennaLab, Profiblot T-48, Tecan), DNA extracted from the blood samples of 159 healthy men was analyzed for different mutations in the HFE gene. Results: The H63D mutation was found with an overall carrier frequency of 5.6% (7% heterozygous and 2% homozygous). We also noted that the C282Y gene mutation was not detected in the study. In subjects with the H63D mutation, there were significantly elevated levels both of serum iron and transferrin saturation (p<0.05). Other hematologic and biochemical tests were in the normal ranges in H63D-positive subjects. Conclusions: A lack of C282Y mutations has been reported as a basic finding for non-Western countries and Turkey. H63D mutations in the HFE gene may cause higher levels of serum iron and transferrin saturation. Both may be useful as simple screening tools for HH.

A familial outbreak of fascioliasis in Eastern Anatolia: a report with review of literature.

AIM: To present the results of a cross-sectional epidemiological analysis of a familial outbreak of fascioliasis in Eastern Anatolia and to discuss the clinical, diagnostic and therapeutic properties of the patients. MATERIALS AND METHODS: A screening group consisting of 92 individuals from the same family with a history of watercress ingestion and a control group consisting of 30 individuals from neighboring families were included in the study. In both groups, full blood count, erythrocyte sedimentation rate, liver function tests and total IgE levels were assessed. Stool analysis was performed on three consecutive days with native, lugol and sedimentation methods. The diagnosis was based on the detection of parasite ova in the stool or alternatively based on consistent clinical, laboratory, and radiological findings or positive clinical findings in combination with a positive ELISA test. Abdominal ultrasonography and computerized tomography scans were performed on all patients. RESULTS: 24 patients (21 women and 3 men) were diagnosed with fascioliasis. The mean age was 24.5±18.6 years (range, 5-64 years). All cases had a history of watercress ingestion, malaise, fatigue, lack of appetite, and abdominal pain. Clinical features included: weight loss was present in 18 cases (75%), dyspepsia in 12 (50%), headache in 11 (45.8%), sweating in 10 (41.7%), fever and dyspnea each in 8 (33.3%), nausea and vomiting in 6 (25%), and itching in 4 (16.75). The most common laboratory abnormalities were total IgE elevation in 19 cases (79.2%) and eosinophilia in 17 (70.8%). The eosinophilia was >20% in 14 cases (58.3%) and the total IgE was >500IU/ml in 15 cases (62.5%). Stool examination for ova was positive in 11 cases. 10 patients had positive clinical, laboratory and radiological findings. A further three patients were diagnosed based on their clinical findings and their ELISA results. All cases had positive ELISA results. All patients, except one pregnant woman, were treated with 10mg/kg triclabendazole. Two patients required a second treatment course of triclabendazole 20mg/kg in two divided doses due to persistence of ova in the stool. One patient who developed acute urticaria as a side effect of the drug was given three additional courses of 10mg/kg triclabendazole in combination with prednisolone and antihistamines. The pregnant woman initially received four courses of 25mg/kg praziquantel treatment for 1 week. As ova were still detected in her stool following delivery, she was subsequently treated with triclabendazole. CONCLUSIONS: One case of fascioliasis may indicate a familial outbreak. In the acute stage radiological investigations can assist in confirming the diagnosis. ELISA testing is a reliable and sensitive method for the diagnosis of fascioliasis during any stage of the disease and may also be useful during follow-up.

A rare case of ascariasis in the gallbladder, choledochus and pancreatic duct.

Due to the anatomical characteristics of the biliary tract, Ascaris lumbricoides rarely settles in the gallbladder, which makes biliary ascariasis a rare clinical condition. Ultrasonography plays a significant and practical role in the diagnosis and follow-up of suspected cases of biliary ascariasis. The 15-year-old case presented herein had been complaining of abdominal pain and dyspepsia for three months, and the clinical and laboratory findings for the patient indicated acute abdomen. Abdominal ultrasonography showed worms consistent with Ascaris inside a normal-sized gallbladder, dilated choledochus and the pancreatic duct. We started antiparasitic treatment in the patient, with cholangitis and pancreatitis diagnoses. Post-treatment follow-up ultrasonography showed a normal gallbladder, choledochus and pancreatic duct.