Thyroid Disorders in Patients with Inflammatory Bowel Diseases

Background: The rate of thyroid disorders is reported to be increased in patients with Ulcerative Colitis (UC) and Crohn’s disease (CD) than the normal population. The purpose of this study is to evaluate the prevalance of Thyroid disorders in a group of patients with inflammatory bowel diseases (IBD). Material and Methods: 146 IBD patients (113 UC and 33 CD patients) and 66 healthy control subjects were enrolled into the study. Serum free T4 (FT4), free T3 (FT3), TSH and anti TPO levels of the patients were analyzed retrospectively and and compared with a control group. These cases were also investigated with thyroid ultrasound and nuclear (scintigraphy) imaging. Results: The mean age of IBD patients (76 women) was 42.9 ± 12.4 years. Among the control group 42 were female and their mean age was 40.9 ± 12.1 years. Thyroid gland disease was found in 14 (9.5%, 8 female, 6 male) of 146 IBD patients. The frequency of thyroid disorders has been found to be higher than the control group in patients with control group (14/146 vs. 1/66, p = 0.042). No statistically significant difference has been observed at the thyroid disorder rates between the UC and CD patients (11/113 vs. 3/33, p = 0.912). Hashimoto thyroiditis has been found at 4 (2.7%) of the IBD patients. Conclusion: In accordance with several works published in literature, we have found a higher rate of thyroid disease apperance at IBD patients.

Effect of endogenous hypergastrinemia on gallbladder volume and ejection fraction in patients with autoimmune gastritis

BACKGROUND: Gastrin has a cholecystokinetic action on gallbladder motility, and cholecystokinin and gastrin act directly on the smooth muscle of the gallbladder. The aim of this study was to investigate the effect of endogenous hypergastrinemia on gallbladder motility in patients with autoimmune gastritis. METHODS: Forty-one patients (29 females, 12 males; mean age, 46 years) with autoimmune gastritis and 29 healthy subjects (17 females, 12 males; mean age, 44.8 years) were enrolled in the study. Fasting and postprandial gallbladder volumes were measured ultrasonographically with the ellipsoid technique and the ejection fraction of the gallbladder was calculated from fasting and postprandial volumes. All subjects were investigated after 12 hours of fasting and 30 minutes after a standard test meal. RESULTS: The gallbladder ejection fraction (%) of the patients with autoimmune gastritis was lower than that of the control group (46.06±18.28% vs 55.03±14.67%, P=0.032). There was no difference between patients with autoimmune gastritis and the control group in terms of the mean fasting gallbladder volume (30.38±12.85 vs 29.27±9.91 cm 3 , P=0.189) and the mean postprandial gallbladder volume (15.67±8.32 vs 13.44±7.69 cm 3 , P=0.258). Logistic regression analysis of baseline parameters revealed that 'abdominal bloating' was a risk factor for the low gallbladder ejection fraction in autoimmune gastritis patients (P=0.045, F=4.40). In addition, logistic regression analysis of baseline parameters revealed that smoking (n=5, P=0.025, F=5.44) is a predictor of low gallbladder ejection fraction in patients with autoimmune gastritis.CONCLUSIONS: Patients with endogenous hypergastrinemia have a low gallbladder ejection fraction compared with healthy controls. This study shows that at least part of upper gastrointestinal symptoms observed in this patient population may be due to altered gallbladder motility.

Hepatitis B Reactivation in Patients with Hematological and Solid Malignancies: A Retrospective Analysis of Single Center’s Experience

Background: Hepatitis B reactivation might occur in patients with hematological and solid organ malignancies due to immunosuppressive effect of chemotherapy. Methods: Fourteen patients were evaluated retrospectively from their files to discuss the clinical manifestations, management, and avoiding of Hepatitis B reactivation within patients who receive immunosuppressive treatment. Results: These 14 HbsAg positive patients were being followed up and treated via oncological immunosuppressive chemotherapy. The ages of the patients were between 25 and 72. Seven of the patients were male, and the average follow up period for the patients was between 10 and 74 months. TV 0, 5 mg was started for seven of the patients before the chemotherapy and TFV 245 mg to one of the patients. LAM 100 was started for three patients whose basal HBV DNA was low. It has been analyzed that HBV DNA was negative in further observations. In follow up controls, we noticed HBV reactivation at two patients, LAM was given one of them and TFV was given the other one. One patient was applied allogeneic transplantation whose basal liver tests were normal and Hbsag was negative. Hepatitis B reactivation was detected after the first week of therapy. Conclusions: We offer testing in all patients undergoing cancer therapy for hepatitis B, HBsAg, core antibody (anti-HBc total), and anti-HBs before to start cancer therapy. Patients with higher risk of HBV reactivation require antiviral prophylaxis.

The Prevalence of Celiac Disease in Patients with Diabetes Mellitus

AIM: To determine the prevalence of celiac disease related autoantibodies in patients with type 1 and 2 diabetes mellitus (DM), and to compare these results with the general population. METHODS: In total, 137 consecutive patients with type 1 DM, 172 with type 2 DM and 113 age-sex matched control subjects were included into the study. Antigliadin-autoantibodies (AGA) IgG and IgA, and endomysial-antibodies(EMA) IgG and IgA antibodies were determined. Patients who were positive for one or more were offered a gastroduodenoscopic examination. RESULTS: AGA IgG positivity was detected in 38.7% (53/137) patients with type 1 DM in 26.2% (45/172) patients with type 2 DM and in 16.8% (19/113) control subjects (significant differences). AGA IgA positivity was detected in 24.8% (34/137) patients with type 1 DM, in 9.3% (16/172) patients with type 2 DM and in 3.5% (4/113) control subjects (significant differences). EMA IgG positivity was detected in 10.2% (14/137) patients with type 1 DM in 0.6% (1/176) patients with type 2 DM and 0.9% (1/113) control subjects (significant differences). EMA IgA positivity was detected in 11.7% (16/137) patients with type 1 DM in 0.6% (1/172) patients with type 2 DM and in none of control subjects. EMA IgA positivity was sig- nificantly higher in patients with type 1 DM as compared with patients with type 2 DM and controls. CONCLUSION: High prevalence of celiac disease at the diagnosis of type 1 DM is observed. Serological markers are useful for identifying celiac disease patients with type 1 DM.

The Relationship between Hyperhomocysteinemia,Haemostatic Factors and Acute Coronary Syndrome in Southeastern Turkey:A Prospective,Comparative Study

Aim: We investigated the relationship between hyperhomocysteinemia, coagulation factors and acute coronary syndrome. Materials and method: The study was conducted at cardiology and hematology department of Dicle University Medical School between January 1st 2003 and May 31st 2009. The study included 96 patients with acute coronary syn-drome and 96 controls. Results: Baseline characteristics of patients (63 males, 33 females, mean age 56.4 years) and controls (58 males and 38 females, mean age: 51.1 years) were similar. There was a statistically significant difference between two groups according to homocysteine levels (13.4 ±8.0 micromole/L vs. 12.8 ± 7.1 micromole/L p = 0.042). In this study, we found that hyperhomocysteinemia, smoking, elevated levels of CRP, low levels of HDL, positive family history, presence of hypertension, BMI > 27, low levels of protein C and protein S were associated with high risk for acute coronary syndrome. Fibrinogen level, factor V level, factor VIII level, factor IX level ,factor X level ,and factor V leiden (p = 0.128) are not risk factors for acute coronary syndrome. Conclusion: Hyperhomocysteine is a significant risk factor for acute coronary syndrome There is not relationship between coagulation factors and acute coronary syn-drome except low levels of protein C and protein S.