Differential diagnosis of Crohn's disease using antibodies to glycoprotein 2 and Saccharomyces cerevisiae.

BACKGROUND/AIMS: Glycoprotein 2 (GP2), the major autoantigen of Crohn's disease (CD)-specific pancreatic autoantibodies, is reportedly correlated with several characteristics of CD. We investigated this serological marker in Turkish patients with CD and assessed its utility in combination with anti-Saccharomyces cerevisiae antibodies (ASCAs) for differential diagnosis of CD. MATERIALS AND METHODS: A total of 60 patients with CD, 62 patients with ulcerative colitis (UC), and 46 healthy controls with a definite diagnosis who were similar in age and sex were enrolled in the study conducted from November 2011 to October 2012. ASCA and anti-GP2 levels were measured using commercially available kits. RESULTS: Anti-GP2 IgA and IgG levels were higher in patients with CD (25%) than in those with UC (5%) and controls (2%). The seroprevalence of anti-GP2 IgA was markedly higher than that of IgG in patients with CD in contrast to previous studies. The specificity and positive predictive value of seropositivity for both ASCA and anti-GP2 were 100%. ASCA IgA seropositivity was correlated with a complicated disease course and a history of surgery. There was no correlation between anti-GP2 seropositivity and disease location, disease behavior, or a history of surgery. CONCLUSION: The combination of ASCA and anti-GP2 may enable differentiation of CD from UC. As ASCA seropositivity is associated with a more complicated disease course, patients seropositive for ASCA at the initial diagnosis should undergo more intense therapy.

Evaluation of platelet distribution width and mean platelet volume in patients with carotid artery stenosis.

Platelets contribute to the pathogenesis of atherosclerosis. Platelet activation has been linked with increased mean platelet volume (MPV) and platelet distribution width (PDW). We investigated the association between PDW, MPW, and the degree of carotid artery stenosis (CS). Patients (n = 229) were divided into 3 groups according to the North American Symptomatic Carotid Endarterectomy Trial criteria. Demographic and clinical features were collected retrospectively. Correlation analysis showed a positive association between PDW and the degree of CS. However, there was no significant correlation between CS and MPV. Moreover, we observed that PDW and low-density lipoprotein cholesterol were independent predictors of the degree of CS. This study showed that PDW, not MPV, is related to the degree of CS. Platelet distribution width could be a useful biomarker for CS. Whether targeting PDW will be of clinical benefit remains to be established.

Pantoprazole-induced thrombocytopenia in patients with upper gastrointestinal bleeding.

Proton pump inhibitors (PPIs) are highly effective drugs for patients suffering from peptic ulcer and gastro-esophageal reflux diseases, but recent studies have indicated possible risks with the long-term use of PPIs, such as osteoporosis, fractures, increased risk of pneumonia, diarrhea, iron and vitamin B12 deficiencies. There are publications written as a case study that indicate thrombocytopenia as side effects of PPIs, but there is no study on this subject. This study aimed to investigate the development of thrombocytopenia in patients with short-term use of PPI-infusion therapy. In this study, the records of the patients were evaluated retrospectively, for the period between January 2012 and January 2013. Thirty-five patients with upper gastrointestinal bleeding were enrolled. Platelet counts were analyzed before treatment, and on the first, second and third day of treatment, respectively. All patients were treated with intravenous pantoprazole. Hemogram values of patients were analyzed before and after PPI infusion treatment. Platelet counts were found to decrease from the first day to the third day of treatment (249 714.29/µl, 197 314.29/µl, 193 941.18/µl, 183 500/µl, respectively). The platelet count decrease was statistically significant (p < 0.001). After cessation of infusion therapy, platelet counts began to rise on the fourth day. Three patients had severe thrombocytopenia on the third day of the treatment. (69 000/µl, 97 000/µl and 49 000/µl respectively). Platelet counts recovered after discontinuation of treatment. In conclusion, this study demonstrates that PPIs may cause thrombocytopenia, and this result should not be ignored. In particular, patients with PPI infusion therapy should be monitored more closely.

Serum H-FABP levels in patients with hypothyroidism.

OBJECTIVE: Hypothyroidism (HT) has an increased risk for cardiovascular mortality and morbidity due to increased atherosclerosis. Heart-type fatty acid binding protein (H-FABP) is abundant in the cytosol of cardiomyocytes, and transports fatty acids into these cells. Although H-FABP has been shown to increase in several atherosclerotic and inflammatory conditions, there is no literature data indicating an alteration in other atherosclerotic processes such as HT. MATERIAL AND METHODS: A total of 39 patients with subclinical hypothyroidism (SCH), 26 patients with overt hypothyroidism (OH), and 29 healthy subjects were enrolled in this study. Carotid artery intima media thickness (CIMT) was measured by high resolution B mode ultrasonography. H-FABP levels, thyroid function test, and biochemical tests of all subjects were measured. The associations between H-FABP and thyroid test and CIMT were examined with correlation and regression analysis. RESULTS: OH patients had higher H-FABP levels (mean, 6.18 ± 3.08 ng/mL) than both the SCH (mean, 3.81 ± 2.16 ng/mL) and the controls (mean, 2.12 ± 1.27 ng/mL) (P < 0.01 and < 0.001, respectively). SCH patients had increased serum H-FABP levels compared with control subjects (P < 0.01). CIMT of both OH and SCH patients was also significantly greater compared with control subjects (both of p < 0.01). H-FABP was significantly and positively correlated with age, systolic blood pressure, thyroid stimulating hormone (TSH) levels, and CIMT, and negatively correlated with fT4 levels. The H-FABP levels retained an independent and positive association with systolic blood pressure, and a negative association with fT4 levels. CONCLUSION: Serum H-FABP levels progressively increased from the control group to the OH group. This suggests that H-FABP may be an indicator of low-level myocardial damage in HT, especially when used together with CIMT. Decreasing serum fT4 levels seem also to have an effect on H-FABP levels.

Evaluation of epicardial fat tissue thickness in patients with primary hyperparathyroidism.

OBJECTIVE: Primary hyperparathyroidism (pHPT) affects the cardiovascular system, and epicardial fat tissue (EFT) thickness is closely associated with cardiovascular diseases and atherosclerosis. Despite this, the association between EFT thickness and pHPT has not been studied in a clinical setting. This study aimed to assess EFT thickness in patients with pHPT. METHODS: The study included 38 patients with pHPT and 40 healthy controls. EFT thickness, carotid intima-media thickness (CIMT), serum levels of parathormone (PTH) and calcium, and blood chemistry profiles were determined in all subjects. Correlation and regression analyses were performed with EFT thickness and CIMT as dependent variables and age; systolic and diastolic blood pressure; body mass index (BMI); presence of diabetes mellitus; and free plasma glucose (FPG), PTH, and serum calcium (Ca) levels as independent variables. RESULTS: Both the mean EFT thickness and the mean CIMT were significantly greater in the pHPT group than the control group (P < .001 for both). Correlation analysis showed that EFT thickness was significantly correlated with CIMT, age, systolic blood pressure, and PTH and serum Ca levels. Furthermore, the regression analysis revealed that EFT thickness retained its independent and positive association with FPG and serum Ca levels. CONCLUSIONS: The results of this study indicate that EFT thickness may be a useful marker of early atherosclerosis in patients with pHPT. Furthermore, the increase in EFT thickness appears to be due to hypercalcemia.

Decrease in TSH levels after lactose restriction in Hashimoto's thyroiditis patients with lactose intolerance.

We aimed to evaluate the prevalence of lactose intolerance (LI) in patients with Hashimoto's thyroiditis(HT) and the effects of lactose restriction on thyroid function in these patients. Eighty-three HT patients taking L-thyroxine (LT4) were enrolled, and lactose tolerance tests were performed on all patients. Lactose intolerance was diagnosed in 75.9 % of the patients with HT. Thirty-eight patients with LI were started on a lactose-restricted diet for 8 weeks. Thirty-eight patients with LI (30 euthyroid and 8 with subclinical hypothyroidism), and 12 patients without LI were included in the final analysis. The level of TSH significantly decreased in the euthyroid and subclinical hypothyroid patients with LI [from 2.06 ± 1.02 to 1.51 ±1.1 IU/mL and from 5.45 ± 0.74 to 2.25 ± 1.88 IU/mL,respectively (both P<0.05)]. However, the level of TSH in patients without LI did not change significantly over the 8 weeks (P>0.05). Lactose intolerance occurs at a high frequency in HT patients. Lactose restriction leads to decreased levels of TSH, and LI should be considered in hypothyroid patients who require increasing LT4 doses,have irregular TSH levels and are resistant to LT4 treatment.

Endoscopic submucosal dissection for colorectal laterally spreading tumors.

BACKGROUND/AIMS: Colorectal laterally spreading tumors are superficial tumors classified into two groups as granular (G-laterally spreading tumor) and non-granular (non-granular-laterally spreading tumor) types. In this study, we aimed to investigate the efficacy and feasibility of endoscopic submucosal dissection in the treatment of laterally spreading tumors. MATERIALS AND METHODS: Forty-four laterally spreading tumors in 40 patients were treated with endoscopic submucosal dissection at a tertiary referral hospital. Patient data were collected retrospectively. In this study, we evaluated tumor size, macroscopic type, lesion location, histology, curative resection, and complications. RESULTS: Of the 44 laterally spreading tumors excised by endoscopic submucosal dissection, 29 (65.9%) were G-laterally spreading tumor and 15 (34.1%) were non-granular-laterally spreading tumor. Most of the non-granular-laterally spreading tumors were localized in the right colon, while most G-laterally spreading tumors were localized in the left colon (p<0.001). There was also no difference between G-laterally spreading tumors (6/29) and non-granular-laterally spreading tumors (2/15) with regard to exhibiting malignant features (p=0.69). Although median size (40 mm vs. 27.5 mm) and procedure time (115 minutes vs. 60 minutes) for G-laterally spreading tumors were bigger and longer respectively, procedure time per cm2 was not different (8.9 minutes vs. 8.2 minutes) between the two groups. Curative resection rates for laterally spreading tumors were quite high (95.5%), while en bloc resection rates were low (77.3%). The rates of endoscopic submucosal dissection-related complications such as perforation, major and minor bleeding were low (4.5%, 2.3%, 6.8%, respectively). CONCLUSION: Endoscopic submucosal dissection is an effective and safe therapeutic option with high curative rates for early-stage malignant and pre-malignant laterally spreading tumors not having an absolute indication for surgery, regardless of the lesion type and size.

Endoscopic submucosal dissection for premalignant lesions and noninvasive early gastrointestinal cancers.

AIM: To investigate the indication, feasibility, safety, and clinical utility of endoscopic submucosal dissection (ESD) in the management of various gastrointestinal pathologies. METHODS: The medical records of 60 consecutive patients (34 female, 26 male) who underwent ESD at the gastroenterology department of Kocaeli University from 2006-2010 were examined. Patients selected for ESD had premalignant lesions or non-invasive early cancers of the gastrointestinal tract and had endoscopic and histological diagnoses. Early cancers were considered to be confined to the submucosa, with no lymph node involvement by means of computed tomography and endosonography. RESULTS: Sixty ESD procedures were performed. The indications were epithelial lesions (n = 39) (33/39 adenoma with high grade dysplasia, 6/39 adenoma with low grade dysplasia), neuroendocrine tumor (n = 7), cancer (n = 7) (5/7 early colorectal cancer, 2/7 early gastric cancer), granular cell tumor (n = 3), gastrointestinal stromal tumor (n = 2), and leiomyoma (n = 2). En bloc and piecemeal resection rates were 91.6% (55/60) and 8.3% (5/60), respectively. Complete and incomplete resection rates were 96.6% (58/60) and 3.3% (2/60), respectively. Complications were major bleeding [n = 3 (5%)] and perforations [n = 5 (8.3%)] (4 colon, 1 stomach). Two patients with colonic perforations and two patients with submucosal lymphatic and microvasculature invasion (1 gastric carcinoid tumor, 1 colonic adenocarcinoma) were referred to surgery. During a mean follow-up of 12 mo, 1 patient with adenoma with high grade dysplasia underwent a second ESD procedure to resect a local recurrence. CONCLUSION: ESD is a feasible and safe method for treatment of premalignant lesions and early malignant gastrointestinal epithelial and subepithelial lesions. Successful en bloc and complete resection of lesions yield high cure rates with low recurrence.