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Colonoscopy is commonly performed for diagnostic and therapeutic purposes and has a relatively low morbidity rate. Nevertheless, it is necessary for operators to be aware of the rare complications of colonoscopy due to a large number of procedures performed in daily practice. Acute appendicitis is an unusually rare occurrence after colonoscopy, with no clear association being found between the colonoscopy and acute appendicitis. A rapid diagnosis of this complication is possible by widespread awareness in surgeons regarding this condition. Acute appendicitis cannot be reliably resulted in as the cause of acute abdominal pain due to relatively subtle signs, symptoms, and studies performed for bowel perforation. The diagnosis of postcolonoscopy appendicitis is difficult, and strategies for its treatment show significant variation. This report presents a patient having undergone urgent laparotomy within 12 h after colonoscopy on having signs and symptoms of acute appendicitis-induced peritonitis.
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The aim is to compare high-dose rabeprazole and amoxicillin containing modified dual therapy (MDT) with bismuth subcitrate containing standard quadruple therapy (SQT) as the first-line Helicobacter pylori eradication treatment in terms of efficacy, safety, and adherence to treatment. A total of 200 consecutive patients diagnosed endoscopically with nonulcer dyspepsia with H. pylori infection were randomly assigned into 2 groups, 1 treated with amoxicillin 750 mg thrice daily plus rabeprazole 20 mg thrice daily (MDT group) or rabeprazole 20 mg b.i.d., bismuth subcitrate 120 mg q.i.d., tetracycline 500 mg q.i.d., metronidazole 500 mg t.i.d. (SQT group). Overall, 196 patients (98 in the MDT group and 98 in the SQT group) completed the study. H. pylori eradication was achieved in 84.7% of patients in the MDT group by intention to treat analysis and 84.9% by per-protocol analysis, which were comparable with SQT group (87.8% and 88.8%, respectively). Adverse events including nausea (P = 0.03), dysgeusia (P < 0.001), diarrhea (P = 0.001), black colored stool (P < 0.001), headache (P = 0.01), and abdominal pain (P = 0.05) were significantly higher in SQT group. The MDT is an efficient and safe treatment choice that could be recommended in the first-line eradication treatment of H. pylori.
Asunto(s)
Antibacterianos/uso terapéutico , Antiulcerosos/uso terapéutico , Erradicación de la Enfermedad/métodos , Dispepsia/tratamiento farmacológico , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori/efectos de los fármacos , Rabeprazol/uso terapéutico , Dolor Abdominal/inducido químicamente , Dolor Abdominal/epidemiología , Adulto , Amoxicilina/uso terapéutico , Antiulcerosos/farmacología , Diarrea/inducido químicamente , Diarrea/epidemiología , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Quimioterapia Combinada/métodos , Disgeusia/inducido químicamente , Disgeusia/epidemiología , Dispepsia/diagnóstico por imagen , Femenino , Gastroscopía , Cefalea/inducido químicamente , Cefalea/epidemiología , Infecciones por Helicobacter/diagnóstico por imagen , Humanos , Incidencia , Masculino , Metronidazol/uso terapéutico , Persona de Mediana Edad , Náusea/inducido químicamente , Náusea/epidemiología , Compuestos Organometálicos/uso terapéutico , Rabeprazol/farmacología , Tetraciclina/uso terapéutico , Resultado del TratamientoRESUMEN
Carbohydrate antigen 19.9 (CA 19.9) is a specific tumour marker of the biliary, pancreatic and gastrointestinal tracts. Autoimmune hepatitis is a chronic immune-mediated liver disorder characterised by female predominance. We report a case of approximately 30-fold increased serum CA 19.9 in a 57-year-old woman who was diagnosed with autoimmune hepatitis. She had no evidence of any malignant disease in pancreatobiliary or gastrointestinal tracts. CA 19.9 levels decreased to normal levels with immunosuppressive treatment. Markedly elevated serum CA 19.9 levels might be encountered with benign liver diseases such as autoimmune hepatitis.
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BACKGROUND AND AIM: The aim of this study was to evaluate the efficacy of bismuth-based quadruple regiment as a first-line treatment for Helicobacter pylori (H. pylori) eradication in patients with unexplained iron deficiency anemia (IDA). The serum hepcidin-25, iron, ferritin levels and total iron-binding capacity were evaluated at baseline and after H. pylori eradication in order to assess whether H. pylori eradication plays a role in IDA related to H. pylori infection. METHODS: The study included 80 patients with unexplained IDA and H. pylori infection. All patients received pantoprazole (40 mg b.i.d.), bismuth subcitrate (120 mg q.i.d.), tetracycline (500 mg q.i.d.) and metronidazole (500 mg t.i.d.) over 14 days as H. pylori eradication regimen. In all patients, blood samples were drawn at baseline and 1 month after eradication therapy. In all patients, serum hepcidin-25 levels were determined by using commercially available enzyme-linked immunosorbent assay kits. RESULTS: There was an improvement in hemoglobin, iron, total iron-binding capacity and ferritin values after H. pylori eradication in all subjects. Serum hepcidin-25 levels significantly decreased after H. pylori eradication (p < 0.001). CONCLUSION: Gastric H. pylori infection is a common cause of IDA of unknown origin in adult patients. Our results provide evidence indicating that hepcidin level decreases after successful H. pylori eradication with improvement in IDA.
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Anemia Ferropénica/epidemiología , Anemia Ferropénica/prevención & control , Carga Bacteriana/estadística & datos numéricos , Infecciones por Helicobacter/tratamiento farmacológico , Infecciones por Helicobacter/epidemiología , Hepcidinas/sangre , Adulto , Anemia Ferropénica/diagnóstico , Antibacterianos/uso terapéutico , Biomarcadores/sangre , Comorbilidad , Femenino , Infecciones por Helicobacter/diagnóstico , Helicobacter pylori/efectos de los fármacos , Helicobacter pylori/aislamiento & purificación , Humanos , Hierro/sangre , Masculino , Persona de Mediana Edad , Prevalencia , Pronóstico , Factores de Riesgo , Resultado del Tratamiento , Turquía/epidemiologíaRESUMEN
BACKGROUND: In several studies, different risk factors other than antibiotic resistance have been documented with Helicobacter pylori eradication failure. We aimed in this study to investigate the relationship of gastric density of H. pylori, the occurrence/degree of gastric atrophy, and intestinal metaplasia (IM) with success rate of H. pylori eradication. METHODS: Two hundred consecutive treatment naive patients who received bismuth containing standart quadruple treatment due to H. pylori infection documented by histopathological examination of two antral or two corpal biopsies entered this retrospective study. The updated Sydney system was used to grade the activity of gastritis, density of H. pylori colonization, atrophy, and IM. Stages III and IV of operative link for gastritis assessment (OLGA) or the operative link on gastric intestinal metaplasia assessment (OLGIM) stages was considered as severe gastritis. H. pylori eradication was determined via stool H. pylori antigen test performed 4 weeks after the end of therapy. RESULTS: The presence of gastric atrophy and IM was significantly higher in patients with eradication failure (p = 0.001 and 0.01, respectively). Severe gastritis (OLGA III-IV and OLGIM III-IV) rates were higher in eradication failure group. A multiple linear regression analysis showed that OLGA and OLGIM stages were to be independent risk factors for eradication failure (p = 0.03 and 0.01, respectively). CONCLUSION: Our results suggested that histopathologically severe gastritis may cause H. pylori eradication failure. In addition, we found that H. pylori density was not a risk factor for treatment failure in patients who receive quadruple treatment.
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Carga Bacteriana/estadística & datos numéricos , Gastritis/tratamiento farmacológico , Gastritis/epidemiología , Infecciones por Helicobacter/tratamiento farmacológico , Infecciones por Helicobacter/epidemiología , Helicobacter pylori/aislamiento & purificación , Adulto , Femenino , Infecciones por Helicobacter/microbiología , Helicobacter pylori/efectos de los fármacos , Humanos , Incidencia , Masculino , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Turquía/epidemiologíaAsunto(s)
Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Colitis/diagnóstico , Enfermedad de Crohn/diagnóstico , Anomalías del Sistema Digestivo/diagnóstico , Ileítis/diagnóstico , Vólvulo Intestinal/diagnóstico , Adulto , Colitis/complicaciones , Enfermedad de Crohn/complicaciones , Diagnóstico Diferencial , Anomalías del Sistema Digestivo/complicaciones , Femenino , Humanos , Ileítis/complicaciones , Vólvulo Intestinal/complicacionesRESUMEN
OBJECTIVE: We aimed to compare the plasma pantoprazole level (PPL) between patients with type 2 diabetes mellitus and non-diabetic patients during Helicobacter pylori (H. pylori) eradication treatment and to explore the role of PPL in predicting the treatment success rates. METHODS: This study included 40 diabetic and 40 non-diabetic treatment-naive H. pylori-infected patients. Bismuth-based standard quadruple treatment for H. pylori eradication was used for 14 days in both groups. PPL was measured using the square-wave voltammetry method. RESULTS: H. pylori eradication rate (60.0% vs 87.5%, P = 0.005) and PPL (0.25 ± 0.03 µg/mL vs 0.34 ± 0.03 µg/mL, P < 0.001) was significantly lower in the diabetic group compared with the controls. Patients with treatment failure had lower PPL than those with successful treatment (P < 0.001). The receiver operating characteristics curve demonstrated that PPL had a significant predictive value for the outcome of H. pylori eradication. CONCLUSION: Type 2 diabetic patients had lower PPL than the non-diabetic controls, which led to their lower H. pylori eradication rates.
Asunto(s)
2-Piridinilmetilsulfinilbencimidazoles/sangre , Diabetes Mellitus Tipo 2/complicaciones , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Inhibidores de la Bomba de Protones/sangre , 2-Piridinilmetilsulfinilbencimidazoles/uso terapéutico , Adulto , Antibacterianos/uso terapéutico , Antiulcerosos/uso terapéutico , Quimioterapia Combinada , Femenino , Infecciones por Helicobacter/complicaciones , Humanos , Masculino , Metronidazol/uso terapéutico , Persona de Mediana Edad , Compuestos Organometálicos/uso terapéutico , Pantoprazol , Valor Predictivo de las Pruebas , Inhibidores de la Bomba de Protones/uso terapéutico , Curva ROC , Tetraciclina/uso terapéutico , Insuficiencia del TratamientoAsunto(s)
Anticuerpos Antivirales/inmunología , Hepatitis Viral Humana/diagnóstico , Insectos Vectores/virología , Fiebre por Flebótomos/diagnóstico , Phlebovirus/inmunología , Psychodidae/virología , Enfermedad Aguda , Adulto , Animales , Diagnóstico Diferencial , Femenino , Hepatitis Viral Humana/virología , Humanos , Fiebre por Flebótomos/virología , Phlebovirus/aislamiento & purificación , Transaminasas/metabolismo , TurquíaRESUMEN
BACKGROUND & AIM: This study aimed to compare the efficacy and safety of bismuth-included standard regimen and modified sequential treatments in Turkey, where the success rate of standard triple therapy is very low. METHODS: One-hundred and sixty patients with dyspeptic complaints and naïve Helicobacter pylori infection were randomized into four groups: 41 patients received standard 14-day quadruple treatment (STD) (Rabeprazole 20mg-bid, bismuth subcitrate (120 mg-qid), Tetracycline 500 mg-qid, Metronidazole 500 mg-tid) for 2 weeks. The modified sequential therapy groups received 20 mg rabeprazole and 1g amoxicillin, twice daily for the first 5 days, followed by Rabeprazole 20mg-bid, bismuth subcitrate (120 mg-qid), Tetracycline 500 mg-qid, Metronidazole 500 mg-tid for the remaining 5 (10 day sequential therapy group-10S) (42 patients), 7 (12 day sequential therapy group-12S) (42 patients) and 9 (14 day sequential therapy group-14S) (41 patients) days. RESULTS: The overall compliance and H. pylori eradication rate among the 160 patients who completed the H. pylori eradication regimens were 86.9% (139/160) and 78.1% (125/160), respectively. The results were not statistically different between groups in the eradication rates. Per-protocol eradication rates were 76.5% in STD, 71.4% in 10S, 82.4% in 12S and 83.3% in 14S groups (p=0.7). Intention-to-treatment rates were 77.5% in STD, 72.5% in 10S, 82.5% in 12S and 80.0% in 14S groups (p=0.5). CONCLUSION: The eradication rates of standard 14-day and different sequential quadruple treatment regimens are comparable and much more higher than with standard 14-day triple H. pylori eradication treatment that has been reported previously in Turkey.
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Antiinfecciosos/administración & dosificación , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Metronidazol/administración & dosificación , Compuestos Organometálicos/administración & dosificación , Inhibidores de la Bomba de Protones/administración & dosificación , Rabeprazol/administración & dosificación , Tetraciclina/administración & dosificación , Adulto , Esquema de Medicación , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Inducción de Remisión , Factores de Tiempo , TurquíaAsunto(s)
Colecistitis Aguda/complicaciones , Infecciones Intraabdominales/complicaciones , Imagen por Resonancia Magnética , Flebitis/diagnóstico , Flebitis/etiología , Colecistitis Aguda/diagnóstico por imagen , Humanos , Infecciones Intraabdominales/patología , Masculino , Persona de Mediana Edad , Flebitis/patología , UltrasonografíaRESUMEN
BACKGROUND/AIMS: Proton-pump inhibitor and ranitidine bismuth citrate-based triple regimens are the two recommended first line treatments for the eradication of Helicobacter pylori. We aimed to compare the effectiveness and tolerability of these two treatments in a prospective, multicentric, randomized study. MATERIALS AND METHODS: Patients with dyspeptic complaints were recruited from 15 study centers. Presence of Helicobacter pylori was investigated by both histology and rapid urease test. The patients were randomized to either ranitidine bismuth citrate 400 mg bid plus amoxicillin 1 g bid plus clarithromycin 500 mg bid (n=149) or lansoprazole 30 mg bid plus amoxicillin 1 g bid plus clarithromycin 500 mg bid (n=130) treatment arm for 14 days. Adverse events have been recorded during the treatment phase. A 13 C urea breath test was performed 6 weeks after termination of treatment to assess the efficacy of the therapy. Eradication rate was calculated by intention-to-treat and per-protocol analysis. RESULTS: Two hundred seventy-nine patients (123 male, 156 female) were eligible for randomization. In per-protocol analysis (n=247), Helicobacter pylori was eradicated with ranitidine bismuth citrate- and lansoprazole-based regimens in 74,6% and 69,2% of cases, respectively (p>0,05). Intention-to-treat analysis (n=279) revealed that eradication rates were 65,1% and 63,6% in ranitidine bismuth citrate and in lansoprazole-based regimens, respectively (p>0,05). Both regimes were well-tolerated, and no serious adverse event was observed during the study. CONCLUSION: Ranitidine bismuth citrate-based regimen is at least as effective and tolerable as the classical proton-pump inhibitor-based regimen, but none of the therapies could achieve the recommendable eradication rate.
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Amoxicilina/administración & dosificación , Bismuto/administración & dosificación , Dispepsia/tratamiento farmacológico , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori/efectos de los fármacos , Lansoprazol/administración & dosificación , Ranitidina/análogos & derivados , Adolescente , Adulto , Anciano , Amoxicilina/efectos adversos , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Bismuto/efectos adversos , Claritromicina/administración & dosificación , Claritromicina/efectos adversos , Esquema de Medicación , Quimioterapia Combinada , Dispepsia/microbiología , Endoscopía del Sistema Digestivo , Femenino , Infecciones por Helicobacter/diagnóstico , Antagonistas de los Receptores H2 de la Histamina/administración & dosificación , Antagonistas de los Receptores H2 de la Histamina/efectos adversos , Humanos , Lansoprazol/efectos adversos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Inhibidores de la Bomba de Protones/administración & dosificación , Inhibidores de la Bomba de Protones/efectos adversos , Ranitidina/administración & dosificación , Ranitidina/efectos adversos , Resultado del Tratamiento , Adulto JovenAsunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Isquemia/etiología , Proctitis/etiología , Recto/irrigación sanguínea , Biopsia , Colonoscopía , Diagnóstico Diferencial , Femenino , Humanos , Isquemia/diagnóstico , Persona de Mediana Edad , Proctitis/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
Fascioliasis is primarily an infection of livestock such as cattle and sheep, caused by the flat, brown liver fluke Fasciola hepatica. Humans are accidental hosts. The diagnosis of infection depends on suspicion. Radiologic findings are specific. Usually, Computed Tomography (CT) and other imaging studies show hypodense migratory lesions of the liver. The development of a chronic liver abscess appears to be extremely rare. Here we present our case with hepatic abscess due to F. hepatica, which is a rare clinical presentation.
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Fascioliasis/diagnóstico , Parasitología de Alimentos , Nasturtium/parasitología , Adulto , Animales , Antihelmínticos/uso terapéutico , Bencimidazoles/uso terapéutico , Diagnóstico Diferencial , Fasciola hepatica/aislamiento & purificación , Fascioliasis/diagnóstico por imagen , Fascioliasis/tratamiento farmacológico , Femenino , Pruebas de Hemaglutinación , Humanos , Hígado/diagnóstico por imagen , Hígado/parasitología , Hígado/patología , Tomografía Computarizada por Rayos X , TriclabendazolRESUMEN
Post-traumatic diaphragmatic hernia complicated by gastric volvulus may manifest immediately or several years after the incident. Delayed presentation of traumatic diaphragmatic hernia with gastric volvulus is relatively unusual. We report a 28-year-old male patient who admitted with gastric volvulus due to traumatic diaphragmatic hernia after sustaining a knife wound to the left lower chest one year before presentation. The patient has been followed without any symptom for two years since the diaphragmatic hernia was repaired by primary suture plication.
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Hernia Diafragmática Traumática/diagnóstico por imagen , Hernia Diafragmática Traumática/cirugía , Vólvulo Gástrico/diagnóstico por imagen , Adulto , Hernia Diafragmática Traumática/etiología , Humanos , Masculino , Náusea/etiología , Radiografía Torácica , Vólvulo Gástrico/cirugía , Resultado del Tratamiento , Vómitos/etiología , Pérdida de PesoRESUMEN
Inflammatory bowel diseases are associated with increased risk for thrombotic complications, In patients with ulcerative colitis (UC) cerebral sinus venous thrombosis (CSVT) is an extremely rare complication. We report a patient with active UC and CSVT. The patient was heterozygous for Factor V Leiden and G20210A prothrombin gene mutations without other identifiable precipitating factors. This patient highlights the need for investigating the patients with UC with thrombotic complications for other thrombophilic states.
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Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/genética , Factor V/genética , Mutación/genética , Protrombina/genética , Trombosis de los Senos Intracraneales/etiología , Antiinflamatorios/uso terapéutico , Femenino , Humanos , Angiografía por Resonancia Magnética/métodos , Prednisona/uso terapéutico , Trombosis de los Senos Intracraneales/tratamiento farmacológico , Adulto JovenRESUMEN
BACKGROUND/AIMS: Anemia, especially due to iron deficiency, is a frequent feature in celiac disease. In this study, we aimed to define the prevalence of celiac disease in Turkish patients with iron deficiency anemia of obscure origin. METHODS: One thousand four hundred and eighty-six consecutive patients with iron deficiency anemia were evaluated for etiology. Of those, 77 patients were found to have iron deficiency anemia of obscure origin. Sera from 77 patients with iron deficiency anemia of obscure origin and 119 healthy controls were tested for IgA and IgG tissue transglutaminase (tTG) antibodies by ELISA. Endoscopic mucosal biopsies were taken from the second part of the duodenum in these patients. Histopathologic examination results of patients were stratified according to Marsh classification. RESULTS: IgA and IgG class anti-tTG antibodies were found positive in 6 (7.8%) and 3 (3.9%) patients with iron deficiency anemia of obscure origin, respectively. Three patients had only IgA anti-tTG and 3 had both IgA and IgG anti-tTG antibodies. In the control group, 1 subject was positive for both IgA and IgG anti-tTG antibodies (0.7%). Six patients (7.8%) and 1 control subject (0.8%) had histopathologic findings of celiac disease (p=0.02). CONCLUSIONS: Patients with iron deficiency anemia of obscure origin had increased prevalence of celiac disease. Our study results suggest that serological screening may be recommended for early detection of celiac disease in patients with iron deficiency anemia of obscure origin.
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Anemia Ferropénica/epidemiología , Anemia Ferropénica/etiología , Enfermedad Celíaca/epidemiología , Adolescente , Adulto , Anciano , Autoanticuerpos/sangre , Biopsia , Enfermedad Celíaca/inmunología , Enfermedad Celíaca/patología , Femenino , Proteínas de Unión al GTP/inmunología , Humanos , Inmunoglobulina A/sangre , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Prevalencia , Proteína Glutamina Gamma Glutamiltransferasa 2 , Estudios Seroepidemiológicos , Transglutaminasas/inmunología , Turquía/epidemiología , Adulto JovenRESUMEN
Familial Mediterranean Fever (FMF) is an autosomal recessive genetic disorder characterised by recurrent and self-limited abdominal pain, synovitis and pleuritis. MEFV gene mutations are responsible from the disease and its protein product, pyrin or marenostrin, plays an essential role in the regulation of the inflammatory reactions. MEFV gene contains 10 exons and most of the mutations have been found on the last exon. Up to date, 152 mutations and polymorpisms have been reported inwhere V726A, M694V, M694I, M680I and E148Q are the most common mutations. In this study, MEFV allele frequencies of 136 individuals (60 from Pediatry, 76 from Internal Medicine) have been evaluated, and compared with each other. Asymptomatic individuals with FMF family history (4 from Pediatry, 6 from Internal Medicine) were excluded from the analysis. The prominent mutations indicated in the Pediatry group are V726A, M694V and M680I (G/C) and with the allele frequency of 0.06, 0.05 and 0.04 respectively while they were E148Q, M694V, M680I (G/C) in the Internal Medicine group with the allele frequency of 0.12, 0.08 and 0.04. The E148Q mutation is significantly overrepresented in the adult referrals (P = 0.02). Mutation on both alleles was observed in only 12% of cases. Overall mutation frequency was low, seen in 26.2% (66/252). However, when only diagnosed patients were analyzed it is 72.7% (16/22). It is also interesting that 63% of individuals are female that there may be sex influence on FMF phenotype.
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Fiebre Mediterránea Familiar/metabolismo , Adolescente , Adulto , Alelos , Niño , Preescolar , Fiebre Mediterránea Familiar/genética , Genotipo , Humanos , Persona de Mediana Edad , Mutación/genética , Turquía , UniversidadesRESUMEN
Diffuse plane xanthomas are characterized by the presence of yellowish plaques on the eyelids, neck, upper trunk, buttocks, and flexural folds. Histology shows foamy histiocytes in the dermis. Approximately half of the cases are associated with lymphoproliferative disorders. Budd-Chiari syndrome is an uncommon condition induced by thrombotic or nonthrombotic obstruction of hepatic venous outflow. We present a case of diffuse plane xanthoma in a 62-year-old man who developed normolipemic plane xanthomas coinciding with Budd-Chiari syndrome and monoclonal gammopathy. We review the English-language literature regarding the rare association of xanthomas and Budd-Chiari syndrome.