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The gastrointestinal (GI) system is one of the most commonly affected sites during a hematopoietic stem cell transplantation (HSCT)
due to toxicities of preparative regimens, the accompanying immunodeficiency, and organ damage caused by graft versus host disease.
In this review, we focus on early GI and liver complications following autologous (auto-) and allogeneic (allo-) HSCT and clarify both the
risk factors and therapeutic strategies. Early GI and liver complications associated with HSCT remain challenging issues. Despite the
improvements in this field during the last decade, treatments for these complications still place a significant burden on both patients
and the physicians treating these patients. GI and liver complications remain some of the causes of mortality associated with HSCT. For
practicing hematologists, oncologists, and gastroenterologists in this field, the awareness and early diagnosis of the GI complications
remain important factors to obtain optimal outcomes in this patient population.
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Jianping HUANG, Tao CHEN, Yi LIU, Liyuan LYU, Xiang LI, Wenjie YUE
Jianping HUANG, Tao CHEN, Yi LIU, Liyuan LYU, Xiang LI, Wenjie YUE
Background/Aims: To investigate how the serum 25-hydroxyvitamin D (25(OH)D) level change in patients with inflammatory bowel
disease (IBD) and investigate the intestinal mucosa vitamin D receptor (VDR) and vitamin D1-α hydroxylase (CYP27B1) expressions.
Materials and Methods: A total of 105 patients with IBD were enrolled in the present study, including 49 cases with ulcerative colitis (UC)
and 56 cases with Crohn’s disease (CD), compared with 45 healthy controls (CON) during the same period by testing the permeability of
the intestinal mucosa. The expressions of VDR and CYP27B1 in the intestinal mucosa were detected, so as the serum endotoxin, tumor
necrosis factor (TNF)-α, and 25(OH)D levels.
Results: The lactulose and mannitol absorption ratio (LMR) and serum endotoxin and TNF-α levels were significantly higher in the IBD
group than in the CON group (p<0.05). The levels of LMR, endotoxin, and TNF-α were higher in the UC group than in the CD group, but
25(OH)D was lower (p<0.05). VDR in the IBD and UC groups was down-regulated when compared with the CON group (p<0.05), but there
was no significance between them (p>0.05). CYP27B1 in the IBD and CD groups was significantly up-regulated compared with the CON
group (p<0.05), with no significant difference between them (p>0.05).
Conclusion: Patients with IBD exhibit vitamin D metabolism imbalance, lower serum 25(OH)D, and lower VDR expression, but higher
CYP27B1 expression in the colonic mucosa. However, VDR and CYP27B1 cannot be used to distinguish UC and CD.
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Background/Aims: Patients with ulcerative colitis (UC) are at increased risk of colorectal cancer (CRC). High-grade dysplasia (HGD) and
low-grade dysplasia (LGD) are premalignant conditions. The aim of this study is to evaluate the risk of CRC/dysplasia in patients with
UC, and the related risk factors.
Materials and Methods: Medical records of 1659 patients dating between 1993 and 2016 were scanned from an inflammatory bowel
disease database. A total of 801 patients with UC who underwent at least one colonoscopic procedure with at least 1-year follow-up
period were included in the study. Clinical, endoscopic, and histopathological data were assessed.
Results: The mean disease duration was 6.7±6.6 years. The total disease duration was 5334 person-years duration (pyd), and 34% of
patients had the disease for 8 years or longer. The prevalence of UC-associated CRC was 0.7%, and the prevalence of dysplasia was
0.85%. The overall incidence of CRC was determined to be 1.1/1000 pyd. The cumulative risk of CRC was 0.3% at 10 years, 1.3% at 20
years, and 5.9% at 30 years. The Cox regression analysis indicated that primary sclerosing cholangitis (HR:13.677, 95% CI:2.6-70.8,
p=0.012) was an independent risk factor for developing UC-associated CRC.
Conclusion: This study underlined the low risk of CRC and dysplasia in patients with UC in a tertiary referral center in the western part of
Turkey. Primary sclerosing cholangitis was found to be the most important risk factor for the development of CRC in patients with UC.
Identification of risk factors is important to categorize patients into subgroups to know which patients will require frequent surveillance.
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Varun MEHTA, Rajesh KUMAR, Siddharth PARKASH, Sanjeev SINGLA, Arshdeep SİNGH, Jagdeep CHAUDHARY, Hardeep BAİNS
Varun MEHTA, Rajesh KUMAR, Siddharth PARKASH, Sanjeev SINGLA, Arshdeep SİNGH, Jagdeep CHAUDHARY,
... Devamını oku
Background/Aims: Necrotizing pancreatitis has morbidity and mortality rates exceeding most of the other acute medical emergencies
despite the best possible medical and surgical care. Early surgical intervention has a high operative risk.
Materials and Methods: This prospective open-label study was designed to evaluate the role of percutaneous catheter drainage (PCD)
of pancreatic necrosis as primary treatment of acute necrotizing pancreatitis. An ultrasound/computed tomography-guided drainage
was performed with 10 or 12 Fr catheters using a 0.35 mm guide wire, irrespective of whether necrosis was infected or not. Patients were
followed up for organ dysfunction, need for surgical intervention, and survival at week 8.
Results: A total of 20 (65% males) patients who had acute necrotizing pancreatitis with varied etiology were enrolled in the present
study. Of these patients, 9 (45%) did not need surgery after PCD. The remaining 11 (55%) patients showed significant reversal of organ
failure after PCD insertion (p<0.05 for improvement in serum creatinine, need for mechanical ventilation, and decline in C-reactive protein). Survival at week 8 was 95%. PCD was well tolerated with only two catheter-related complications being observed.
Conclusion: Percutaneous catheter drainage can be a primary treatment option for necrotizing pancreatitis. In addition, it helps to stabilize critically ill patients and delay the surgical procedure to beyond 4 weeks to improve the surgical outcomes.
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Heterotopic pancreas (HP) is localized pancreatic tissue that has no relation to orthotopic pancreas and has its own channel and vascular structures. Usually, the submucosa is located in the upper gastrointestinal tract; mesenteric placement is rarely reported. It is
frequently asymptomatic and is detected incidentally in imaging, laparotomies, or autopsies. Rarely, pancreatitis may be the cause of
small bowel obstruction, massive gastrointestinal bleeding, and malignant transformation. However, this has usually been reported in
localized submucosal HP cases. The imaging findings are typical, and the diagnosis can be verified without the need for a histopathological diagnosis. In this case report, we aimed to present the imaging findings of asymptomatic HP located in the proximal jejunum
mesentery of a 44-year-old woman. To avoid unnecessary surgical procedures, the characteristic imaging findings of HP are understood
and should be considered in the differential diagnosis of masses seen in the mesentery.
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Anna GASİNSKA, Beata BİESAGA, Anna Janecka WIDLA, Zbigniew DARASZ
Anna GASİNSKA, Beata BİESAGA, Anna Janecka WIDLA, Zbigniew DARASZ
Background/Aims: This is a retrospective analysis of 103 patients having locally advanced rectal cancer who received short-course
radiotherapy (SCRT). The objective of the study was to check whether a polymorphism in the RAD51 gene (135 G>C), Ku70 protein expression, and tumor microenvironment: proliferation rate measured by BrdUrdLI and Ki-67LI, hypoxia (glucose transporter-1 expression),
P53 protein expression, and DNA ploidy can influence DNA repair capacity, the factors contributing to patient overall survival (OS) and
the incidence of recurrences and metastases.
Materials and Methods: RAD51 (135 G>C) polymorphism was evaluated using restriction fragment length polymorphism polymerase
chain reaction, and proteins were identified using immunohistochemistry.
Results: There were 3 (2.9%) tumors with RAD51 CC, 75 (72.8%) with GG, and 25 (24.3%) with GC genotypes. The median follow-up
time was 63.1 months (range 2-120). Patients with CC genotype survived significantly longer than those with GG and GC genotypes and
did not develop any recurrences or distant metastases. Female patients with Ku70 expression (≤75.1) or RAD51CC genotype (impaired
DNA damage repair and radiosensitive) had significantly longer OS (p=0.013) than those with Ku70>75.1 % or RAD51GG,GC (radioresistant phenotype) and male patients in the log-rank test. In multivariate analysis, positive prognostic factors for OS in the male patients
were grade=1 and ≤17 days break in the treatment, whereas in the female subgroup, only radiosensitive phenotype (Ku70 ≤75.1% or
RAD51CC genotype).
Conclusion: To the best of our knowledge, this is the first study to provide evidence for the positive effect of CC genotype of RAD51 or
low Ku70 expression on OS in females with rectal cancer after SCRT.
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MEHMET KÖK , Yeşim ÇEKİN, Ayhan Hilmi ÇEKİN, Seyit UYAR, Ferda HARMANDAR, Yasin ŞAHİNTÜRK
MEHMET KÖK ,
Yeşim ÇEKİN, Ayhan Hilmi ÇEKİN, Seyit UYAR, Ferda HARMANDAR, Yasin ŞAHİNTÜRK
Background/Aims: Several studies have shown that a change in microbiota plays an important role in the pathogenesis of inflammatory
bowel disease (IBD). Furthermore, with the emergence in recent studies of differences according to the subtype of IBD and whether the
disease is active or in remission, there has started to be research into the relationship between IBD and several microorganisms. Blastocystis hominis is primary among these organisms. The aim of the present study was to determine the role of B. hominis in the acute
flare-up of ulcerative colitis (UC).
Materials and Methods: A total of 114 patients with UC were included in the study, with 52 in the active phase. The Mayo scoring system
was used for the activity index. Patients determined with a flare-up agent other than B. hominis were excluded from the study. Fecal
samples of the patients were examined by the polymerase chain reaction method for the presence of B. hominis.
Results: B. hominis positivity was determined in 37 (34%) patients with UC. Of the patients, 17 (32.6%) were in the acute flare-up phase,
and 20 (32.2%) were in remission (p=0.961). In 11 (64.7%) of the B. hominis positive patients, the disease severity was determined as
mild-moderate (p<0.001).
Conclusion: The results of the present study showed that while there was no difference between the active and remission phases in
respect of B. hominis presence, there was milder involvement in those determined with B. hominis.
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Asmaa ELZEFTAWY, Loai MANSOUR, Abdelrahman KOBTAN, Heba MOURAD, Ferial El KALLA
Asmaa ELZEFTAWY, Loai MANSOUR, Abdelrahman KOBTAN, Heba MOURAD, Ferial El KALLA
Background/Aims: The development of esophageal varices (EV) and resultant bleeding are the most critical complications of portal
hypertension. Upper gastrointestinal endoscopy is the gold standard for diagnosis of EV. To find a non-invasive method for diagnosis of
EV and to predict the bleeding risk is appealing and would decrease the cost and discomfort of upper endoscopy. The aim of our study
was to evaluate the blood ammonia level as a predictor of the presence of EV and of a high risk of bleeding.
Materials and Methods: In this cross-sectional study, a total of 359 patients with cirrhosis were examined for the presence of EV by upper endoscopy. Abdominal ultrasonography, calculation of the Child-Pugh score, and measurement of blood ammonia were performed
for each patient.
Results: The blood ammonia level was significantly higher in patients with EV than in those without it (p<0.001), and in patients with a
high risk of variceal bleeding than in those with a low risk (p=0.026).
Conclusion: An increased blood ammonia level and splenic vein diameter are predictors for the presence of EV and bleeding risk factors.
The blood ammonia level may be clinically useful as it correlates with and is an independent predictor for both the endoscopic risk signs
and risk factors of bleeding, and therefore, it could be used in patients with cirrhosis to decrease the number of screening endoscopies
they are subjected to.
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