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Öğe Comparison of NERD patients with and without laryngopharyngeal reflux symptoms according to 24-hour ambulatory intraesophageal pH-impedance values(Wiley-Blackwell, 2016) Sakin, Yusuf Serdar; Vardar, Rukiye; Sezgin, Baha; Cetin, Zeynep Erdogan; Alev, Yasemin; Yildirim, Esra; Kirazli, Tayfun; Bor, SerhatÖğe COX-2 EXPRESSION IN NON ALCOHOLIC STEATOHEPATITIS WITH AND WITHOUT FIBROSIS(Wiley-Blackwell, 2011) Ulkuden, Burcu; Yapali, Suna; Yilmaz, Funda; Unal, Nalan G.; Gunsar, Fulya; Vardar, Rukiye; Ersoz, Galip; Karasu, Zeki; Akarca, Ulus S.Öğe The diagnostic value of 24-hour ambulatory intraesophageal pH-impedance in patients with laryngopharyngeal reflux symptoms comparable with typical symptoms(Sage Publications Inc, 2017) Sakin, Yusuf S.; Vardar, Rukiye; Sezgin, Baha; Cetin, Zeynep Erdogan; Alev, Yasemin; Yildirim, Esra; Kirazli, Tayfun; Bor, SerhatBackground: The diagnosis of laryngopharyngeal reflux is currently based on a combination of the patient history of multichannel intraluminal impedance and ambulatory pH (MII-pH); however, none of these findings alone is specific for the diagnosis of laryngopharyngeal reflux. We aimed to compare the baseline characteristics and esophageal baseline impedance values between patients with and without laryngopharyngeal reflux symptoms. Methods: We retrospectively analyzed data from two groups of patients with laryngopharyngeal reflux according to their reflux finding score (RFS) as scored by ENTs. Control patients were nonerosive reflux disease patients without laryngopharyngeal reflux. All MII-pH parameters and baseline impedance were analyzed from six levels and the proximal and distal baseline impedance and the ratio of the proximal to distal baseline impedance levels was calculated. Results: Altogether 123 patients with laryngopharyngeal reflux and 49 control patients were included. A total of 81 of 123 patients had RFS >= 7, and 42 of 123 patients had RFS > 7. Baseline impedance analysis showed that patients with laryngopharyngeal reflux symptoms had significantly lower proximal baseline impedance values (1997 +/- 51 vs 2245 +/- 109, p < 0.05) than the control group. Additionally, patients with laryngopharyngeal reflux symptoms had a significantly lower proximal-to-distal ratio (1.28 +/- 0.05 vs 1.53 +/- 0.09, p < 0.05). In the subgroup analysis, patients with RFS < 7 were found to have a significantly lower acid exposure time than either the patients with RFS >= 7 (3.85 +/- 0.65 vs 8.2 +/- 1.52, p < 0.05) or the control group (3.85 +/- 0.65 vs 6.1 +/- 0.81, p < 0.05). Additionally, patients with RFS7 had significantly lower proximal baseline impedance levels than the control group (1970 +/- 63 vs 2245 +/- 109, p < 0.05). Conclusions: Patients with pathologic laryngopharyngeal reflux symptom scores had lower proximal baseline impedance levels and lower proximal-to-distal ratios, which may reflect the proximal mucosal noxious effect of the refluxate. These results may indicate that laryngopharyngeal reflux symptoms may be due to chronic acid exposure in the proximal segments of the esophagus, and the proximal-to-distal ratio may be used as a new metric for diagnosis.Öğe Distribution and Phylogenetic Analysis of Subtypes and Alleles of Blastocystis sp. in the Stool Samples Collected from Patients with Gastrointestinal Complaints in Izmir, Turkey(Springer Int Publ Ag, 2023) Aykur, Mehmet; Kurt, Cansu Caliskan; Erdogan, Derya Dirim; Biray Avci, Cigir; Vardar, Rukiye; Aydemir, Sohret; Girginkardesler, NogayPurposeBlastocystis sp. is one of the most prevalent intestinal protozoa found in humans and many other animals. The present study aimed to examine the distribution and genetic diversity of Blastocystis sp. in stool samples from patients with gastrointestinal complaints in Izmir, Turkey.MethodsAll stool samples of 439 patients with gastrointestinal complaints were examined by native-Lugol and trichrome staining. To investigate the presence of Blastocystis sp. in stool samples, DNA was isolated, and PCR was performed with the barcode region in the SSU rRNA gene. PCR positive samples were sequenced to identify subtypes and alleles of Blastocystis sp.ResultsThe prevalence of Blastocystis sp. was found to be 16.6% (73/439) in patients with gastrointestinal complaints in Izmir, Turkey. Three different Blastocystis sp. subtypes were identified. ST3 (28/55; 51.0%) was the most common subtype followed by ST2 (19/55; 34.5%) and ST1 (8/55; 14.5%). Itching and diarrhea were the most prominent clinical symptoms in Blastocystis sp. positive patients. When clinical symptoms and subtypes were compared, diarrhea was found in 62.5%, 47.4%, and 46.4% of patients with ST1, ST2, and ST3 subtypes, respectively. In addition, itching was found in 37.5%, 32.1%, and 21.1% of patients with ST1, ST3, and ST2, respectively. Six distinct alleles were identified by allele analysis of Blastocystis 18S rRNA gene: allele 4 for ST1, alleles 9, 11, and 12 for ST2, and alleles 34 and 36 for ST3. In this study, Blastocystis sp. was detected in 16 of 21 districts, including the central and rural districts of Izmir. Although ST1 was detected in central districts, it was not found in rural districts.ConclusionThis study provides comprehensive data on the prevalence and molecular epidemiology of the genetic diversity at the level of subtypes and alleles of Blastocystis sp. in different districts of Izmir province in Turkey. To the best of our knowledge, this is the first study which evaluates the distribution of subtypes and alleles of Blastocystis sp. according to PCR and SSU rRNA gene sequencing in patients with gastrointestinal complaints in different districts of Izmir province in Turkey.Öğe Efficacy of Fractionated Plasma Separation and Adsorption System (Prometheus) for Treatment of Liver Failure Due to Mushroom Poisoning(H G E Update Medical Publishing S A, 2010) Vardar, Rukiye; Gunsar, Fulya; Ersoz, Galip; Akarca, Ulus Salih; Karasu, ZekiBackground/Aims: Consuming wild mushrooms is an ordinary habit in late summer and autumn in our region. Every year, several cases of hepatic toxicity secondary to mushroom poisoning are observed because of poor identification of the mushrooms. Unfortunately some of them are fatal. Prometheus system is a newly developed extracorporeal liver support device for fractionated plasma separation and adsorption (FPSA) that enables removal of albumin-bound and water-soluble toxins. Therefore, it may be a promising treatment option for patients with liver failure due to mushroom poisoning. Methodology: We studied 8 patients with mushroom poisoning. All patients underwent 1 to 4 consecutive FPSA (Prometheus)-system in addition to medical and supportive treatment such as fluid replacement, Penicillin G, N-acetylcysteine (NAC) and silymarin. A variety of clinical and biochemical parameters were assessed. Results: We had improvement of the biochemical parameters after first treatment with FPSA-system. Seven of 8 patients survived and were discharged to resume an independent life. One patient who had grade III encephalopathy when admitted to hospital died. No major adverse events were observed during the application of this therapy modality. Conclusions: FPSA-system may be a safe and effective treatment option for patient with mushroom poisoning. Early hospitalization is essential in order to be successful. Controlled studies are needed to evaluate the efficacy of this new treatment choice on survival of patients with acute liver failure (ALF) due to mushroom poisoning.Öğe Endoskopik incelemede saptanan mide poliplerinin yerleşimi, histopatolojik tipleri ve tedavi yönetimi(2021) Ünal, Nalan Gülşen; Çelik, Ferit; Şenkaya, Ali; Aslanov, Seymur; Özütemiz, Ahmet Ömer; Doğanavşargil, Başak; Vardar, RukiyeGiriş ve Amaç: Gastrik polip lümene doğru çıkıntı oluşturan, mukoza veya submukozadan köken alan sesil ya da saplı lezyonlar olarak tanımlanır. Bu çalışmanın amacı, gastroskopi işlemi sırasında tespit edilen poliplerin görülme sıklığının, gastrik polip saptanan hastaların demografik özelliklerinin, poliplerin endoskopik ve histopatolojik özelliklerinin, eşlik eden diğer endoskopik bulguların ve tedavi şekillerinin değerlendirilmesidir. Gereç ve Yöntem: Bu çalışmaya, Haziran 2017 ile Haziran 2020 tarihleri arasında üniversite hastanemiz gastroenteroloji bölümü endoskopi ünitesinde yapılan 13280 gastroskopi işleminde, polip saptanan 80 hasta dahil edildi. Seksen hastada toplam 125 polip saptandı ve retrospektif olarak değerlendirildi. Hastaların yaşı ve cinsiyeti, gastroskopi yapılma nedeni, polip sayısı, poliplerin midedeki lokalizasyonu, polipektomi yöntemi, polip histopatolojisi, Helicobacter pylori pozitifliği, intestinal metaplazi varlığı, atrofik gastrit varlığı, polipektomi sonrası komplikasyon gelişip gelişmediği tarandı. Bulgular: Seksen (%0.6) hasta ve bu hastalarda saptanan toplam 125 polip sonucu değerlendirildi. Hastaların 54’ü (%67.5) kadın ve yaş ortalaması 57.5 ± 12.5 yıldı. Hastaların %51.2’sinde endoskopi yapılma nedeni, başka merkezlerden kliniğimize polipektomi amacıyla yönlendirilmeleriydi. Mide mukoza örneklemesinde hastaların %11.3’ünde Helicobacter pylori pozitifliği, %20’sinde intestinal metaplazi, %21.2’sinde atrofik gastrit mevcuttu. Poliplerin %65.6’sında polip boyutu 10 mm’nin altındaydı. Polipler sırasıyla; en sık korpusta (%54.4), antrumda (%22.4) ve fundusta (%20 .8) saptandı. Poliplerin histopatolojisi en sık fundik gland polip (%42.4), hiperplastik polip (%30.4) ve nöroendokrin tümördü (%20.8). En sık uygulanan polipektomi yöntemi poliplerin %51.2’sinde biyopsi forsepsi ile polipektomidir. Hastaların 5’inde (%4) polipektomi komplikasyonu olarak postpolipektomi interprosedürel kanama gelişti. Sonuç: Çalışmamızda mide polip saptanma oranı literatür ile uyumlu bulunmuştur. Endoskopik olarak bazen poliplerin birbirinden ayırt edilmesi zor olabildiğinden mümkün olan her polibe güvenli bir şekilde polipektomi yapılmalı ve komşu mide mukozasından örnekler alınmalıdırÖğe Fecal calprotectin as a factor that supports the pathogenicity of Dientamoeba fragilis(Academic Press Ltd- Elsevier Science Ltd, 2020) Aykur, Mehmet; Armagan, Guliz; Vardar, Rukiye; Dagci, HandeCalprotectin is a protein that is mostly released from neutrophils, monocytes, macrophages and submucosal epithelial cells. Fecal calprotectin (f-CP) is a marker of intestinal inflammation. There are some discussions about the pathogenicity of D. fragilis in the gastrointestinal tract. in this study, we investigated whether f-CP level is a factor supporting the pathogenicity of D. fragilis. the f-CP levels were evaluated in patients with only D. fragilis positive in comparison with healthy controls. Moreover, the levels of f-CP were investigated in fecal samples of D. fragilis negative patients with gastrointestinal complaints. the fecal samples were collected from three groups. Three groups of fecal samples were examined directly microscopy, trichrome staining, cultivation, enzyme immunoassay (EIA) and real-time PCR assay. in the first group (Group 1, n = 34), patient stool samples with gastrointestinal symptoms (without other pathogens) found only with D. fragilis were included. in the second group (Group 2, n = 31), there were patients' stool samples with gastrointestinal symptoms that D. fragilis was negative (but there may be other pathogenic agents). in the control group (Group 3, n = 23), we used fecal samples collected from healthy volunteers without any infection or gastrointestinal complaints. the collected fecal samples were stored at -20 degrees C until analysis. Levels of f-CP were determined by using human calprotectin ELISA kits. Total of 88 patients were enrolled in three different groups. We obtained f-CP levels as follows: 33.40 ng/mg protein in the group 1, 15.99 ng/mg protein in the group 2 and 1.54 ng/mg protein in the group 3. Statistically significant difference in f-CP levels of the group 1 and the group 2 were obtained when compared with healthy controls (p < 0.0001). However, the f-CP levels of the group 1 were not significantly different from the group 2 (p > 0.99). in conclusion, increased levels of f-CP are shown as a marker of an inflammatory disease of the lower gastrointestinal tract in infected humans. There is continues controversy about the pathogenicity of D. fragilis in symptomatic and asymptomatic patients. the findings of this study contribute to the ongoing debate about the pathogenicity of D. fragilis. in our study, the potential pathogenicity of D. fragilis is associated with increased f-CP concentrations with parasite detection in the fecal samples and therefore we assume that the parasite is not only a harmless commensal. in summary, higher levels of f-CP found in D. fragilis positive patients suggest the importance of researches that support the pathogenicity of indicated parasite.Öğe The frequency of gastrointestinal parasitosis and the effect of proton pump inhibitor use on gastrointestinal parasitosis and histopathological findings in patients with dyspepsia(2022) Almuradova, Elvina; Erdogan, Elvan; Ismayılov, Rashad; Ustun, Sebnem Oktem; Vardar, RukiyeAim: The main purpose of this study was to investigate the frequency of gastrointestinal parasites in patients with upper gastrointestinal system (GIS) complaints. The secondary aim was to evaluate the effect of proton pump inhibitors (PPI) on gastrointestinal parasite frequency and histopathological findings. Materials and Methods: Adult patients who underwent endoscopy for upper GIS symptoms were included in the study. Biopsy specimen for histopathological evaluation, gastric and duodenal aspiration fluid, and stool specimen for parasitological evaluation were also obtained from the patients. Results: A total of 40 patients (29 female and 11 male) were included in the study. The mean age of women was 54 ± 14.6 and men was 38.4 ± 18.7 years (p = 0.008). The patients were divided into two groups as not using PPI [14 patients (35%)] and using PPI [26 patients (65%)]. Parasites were detected in 3 patients (7.5%). Two of them were from the group using PPI, and one from the group not using PPI (p = 0.95). It was also observed that the effect of PPI on histopathological findings was not statistically significant. Helicobacter pylori positivity was associated with inflammation (p = 0.002) and intestinal metaplasia (p < 0.001). Conclusion: It was determined that dyspeptic complaints were more common in women. The effect of PPI on histopathological findings or the frequency of parasites were not statistically significant. Inflammation and intestinal metaplasia were found to be statistically higher in Helicobacter pylori positive cases than negatives.Öğe Gastroözofageal reflü hastalığı subgruplarında kortikal aktivitenin fonksiyonel magnetik rezonans görüntülemesi (FMRI) ile değerlendirilmesi(Ege Üniversitesi, 2014) Vardar, Rukiye; Bor, Serhat; Çallı, Mehmet CemBu çalışmada, GÖRH subtiplerinde ve fonksiyonel pirozisde serebral kortikal değişikliklerin visseral hipersensitivite ile ilişkili olabileceği hipotezinden yola çıkarak; reflü hastalığının farklı klinik sunumlarında, intraözofageal asit uyarısı ile oluşan serebral yanıtın fMRI ile karşılaştırılması; fonksiyonel pirozis ve hipersensitif özofagus gruplarında kortikal topografik değişikliklerin visseral hipersensitivite ile ilişkisinin araştırılması amaçlanmıştır. Ege Üniversitesi Tıp Fakültesi Hastanesi, Gastroenteroloji Bilim Dalı, Reflü Polikliniğine başvuran, klinik, endoskopik ve 24 saatlik intraözofageal impedans (MII) ölçümü ile GÖRH tanısı alarak, çalışmaya alınma kriterlerini karşılayan ve çalışmaya katılmaya gönüllü kişilerden seçilmiştir. Olgulara 24 saatlik impedans (MII) ölçümünün sonunda, impedans kateteri altında intraözofageal asit uyaranı (Bernstein testi) lmL/dk hızında 0,1N HCL verilerek EMRI görüntülemesi yapılmıştır. Çalışma hiçbir infüzyonun uygulanmadığı istirahat fazı, izotonik serum fızyolojik infüzyonu fazı, asit perfüzyonu ve tekrar izotonik serum fızyolojik infüzyonundan oluşan her biri 4 dakikalık çekimlerden oluşmuştur. Çalışmaya dâhil edilen 22 hastanın yarısı; tipik reflü semptomları ve patolojik MII bulguları olan ancak endoskopisi normal olan 11 olgunun (NERH), diğer yarısı tipik reflü semptomları ile birlikte endoskopik mukozal hasarı (özofajit, özofagusta ülser, vb.) olan ERH (n=11 hasta) olarak tanımlandı. Çalışmaya dahil edilen olgulardan erkeklerin çoğunlukla ERH olduğu kadınların ise NERH olduğu gözlemlenmiştir. NERH olgularında ağrı ve ağrıya duyarlılık ile ilgili kortikal alanlar ERH olgularından daha çok aktive olmuştur. Fakat NERH alt gruplarında aktivasyon farkı ortaya konamamıştır. NERH olgularında ağrı ve ağrıya duyarlılık ile ilgili alanlar daha çok aktive olmaktadır. Bulgular NERH olgularında persepsiyon eşiğinin azalması ile ilgili olabileceği düşünülmüştür. NERH alt grubunda 7 hasta gerçek NERH, 4 hasta Fonksiyonel pirozistir. NERH grubunda aktivasyon farkı cinsiyet farkına da bağlı olabilir.;Gastroesophageal reflux, fMRI, Bernstein test, nonerosive reflux disease, erosive reflux disease.;Gastroözofageal reflü, fMRI, Bernstein testi, noneroziv reflü hastalığı, eroziv reflü hastalığı.Öğe Gastroözofageal reflüye bağlı öksürük olgularında özofagus motilitesinin yüksek çözünülürlüklü özofageal manometri ile değerlendirilmesi(Ege Üniversitesi, 2013) Özçelik Ünal, Nalan Gülşen; Bor, Serhat; Vardar, RukiyeAmaç: Sigara öyküsü olmayan, ACEI kullanmayan, öksürük varyant astım ve üst hava yolu öksürük sendromu dışlanan, impedans pH monitörizasyonu ile gastroözofagiyal reflü hastalığı belirlenen kronik öksürük olgularında, bronkoalveolar lavajda (BAL) lipid yüklü makrofaj indeksi (LLMİ) ile mikroaspirasyon varlığını değerlendirmektir. METOD: GÖRH'e bağlı kronik öksürük ön tanısı alan 40 olguya YÇM ile özofagus manometrik incelemesi yapılmıştır. MII kateteri yerleştirilerek 24 saatlik monitarizasyonu yapılmış, sonuçlara göre olgular semptom ile ilişkili reflüsü olanlar ve olmayanlar olarak 2 gruba ayrılmıştır. Buiki grup arasındaki YÇM ile elde edilen veriler ile üst özofagus sfinkter basıncı, proksimal kontraksiyon uzunluğu süresi, transisyonel zon uzuluğu-süresi, distal kontaksiyon uzunluğu süresi, alt özofagus sfinkter basıncı açısından fark olup olmadığı araştırılmıştır. SONUÇLAR: GÖRH'e bağlı kronik öksürük olgularında muhtemelen birden fazla mekanizma bir arada rol oynamaktadır. Çalışmamız mikroaspirasyonun da bunlar arasında bir faktör olduğunu desteklemektedir. Ancak bu konuda yapılan çalışmaları yorumlamak zordur. Çünkü tanıda altın standart yöntemler olmadığı gibi, seçilen hasta populasyonları ve tercih edilen yöntemler çeşitlilik göstermektedir. Genel olarak olgu sayıları kısıtlıdır. Bu olgularda öksürük sensitivitesinde de artış olduğu öne sürülmüştür. Kimi yayınlara göre ön planda olan nörojenik inflamasyon, havayolu reflüsü ve buna bağlı öksürük hipersensitivite sendromudur. Gaz içeriği olan ve asidik olmayan reflülerin öksürük patogenezindeki rolü ya da fizyolojik sınırlardaki reflünün öksürük etyolojisindeki yeri gibi belirsizliğini koruyan noktalar mevcuttur. Reflünün değerlendirilmesinde yeni teknolojik yöntemlerin kullanıma girmesi, daha büyük olgu sayılı kontrollü çalışmaların düzenlenmesi ile daha sağlıklı bilgiler elde etmek mümkün olacaktır.;Gastroesophageal reflux, cough, high resolution manometry.;Gastroözofageal reflü, öksürük, yüksek çözünürlüklü manometri.Öğe Image-based assessment of esophageal stricture in experimental corrosive esophagitis in animals: An objective, adjunct diagnostic tool(Turkish Soc Gastroenterology, 2009) Vardar, Enver; Vardar, Rukiye; Yuekselen, Vahit; Makay, Oezer; Erkan, Nazif; Bayol, Uemit; Oezuetemiz, OemerBackground/aims: Many studies have reported image analysis techniques, such as nuclear morphometry, counting or calculating of mitotic figures or estimation of the ratio of positive-stained areas immunohistochemically. The esophagus is the most commonly involved organ during caustic ingestion, which leads to progressive and devastating results after caustic burn. The aim of this work was to compare the classical stenosis index method with a new objective method based on image analysis that was used to determine experimental stricture of the rat esophagus. Methods: We investigated this technique by randomly allocating 20 rats each to sham laparotomy and corrosive esophagus groups. The images of the sham laparotomy group and corrosive esophagus group were reviewed, analyzed and used in a mathematical operation on the computer. The numbers and the ratio of luminal area and total esophageal area were used to determine the esophageal stricture of the rat, and results were compared with stenosis index ratios. Results: The mean area of the lumen of the esophagus and the ratio of esophageal lumen/total esophageal area were 0.83 (0.51-1.28) mm(2) and 0.21 (0.08-0.37), respectively, in the corrosive esophagus group. In the sham toparotomy group, these values were 1.28 (0.47-3.03) mm(2) and 0.26 (0.13-0.92), respectively. The differences between the two groups in luminal area and ratio of esophageal lumen/total esophageal area were statistically significant (p<0.05). Conclusions: This new technique based on image analysis seems more objective and reproducible than the classical, manual method. It is concluded that the use of this new technique dramatically reduced the subjectivity of the measurement process.Öğe The impact of the speed of food intake on gastroesophageal reflux events in obese female patients(Wiley, 2017) Bor, Serhat; Erdogan, Askin; Bayrakci, Berna; Yildirim, Esra; Vardar, RukiyeObesity increases the risk of gastroesophageal reflux disease (GERD). The majority of the reflux attacks occur postprandially. The influence of the speed of food intake on gastroesophageal reflux events is unclear in obese patients. To determine the influence of the speed of food intake on intraesophageal reflux events in obese patients with and without GERD. A total of 26 obese female patients were recruited. The patients underwent esophageal manometry to evaluate the upper limit of the lower esophageal sphincter and subsequently placement of a Multichannel intraluminal impedance-pH (MII-pH) catheter. All patients were asked to eat the same standard meal (double cheeseburger, 1 banana, 100 g yogurt and 200 mL water; total energy value, 744 kcal; 37.6% carbohydrates, 21.2% proteins and 41.2% lipids) within 5 or 30 minutes under observation in a random order on two consecutive days. All reflux episodes over a 3-hour postprandial period were manually analyzed and compared. The mean age was 46 +/- 12 (18-66) years. The mean body mass index (BMI) was 39.9 +/- 8.4 kg/m(2). There was no difference between the fast- and slow-eating group in the number of refluxes within the 3-postprandial hours. The patients were divided into 2 groups according to the 24-hour MII-pH monitoring results, that is, 16 subjects with normal MII-pH monitoring and 10 patients with pathologic MII-pH monitoring. There was no effect of the speed of food intake in either the patients with or without GERD. In contrast to the general belief, this study suggested that the speed of food intake does not influence the number of refluxes in obese female patients with or without GERD.Öğe Indications of 24-h esophageal pH monitoring, capsule pH monitoring, combined pH monitoring with multichannel impedance, esophageal manometry, radiology and scintigraphy in gastroesophageal reflux disease?(Aves, 2017) Vardar, Rukiye; Keskin, MuharremAmbulatory esophageal pH monitoring is an essential method in patients exhibiting signs of non-erosive reflux disease (NERD) to make an objective diagnosis. Intra-esophageal pH monitoring is important in patients who are non-responsive to medications and in those with extraesophageal symptoms, particularly in NERD, before surgical interventions. With the help of the wireless capsule pH monitoring, measurements can be made under more physiological conditions as well as longer recordings can be performed because the investigation can be better tolerated by patients. Ambulatory esophageal pH monitoring can be detected within normal limits in 17%-31.4% of the patients with endoscopic esophagitis; therefore, normal pH monitoring cannot exclude the diagnosis of gastroesophageal reflux disease (GERD). Multi-channel intraluminal impedance pH (MII-pH) technology have been developed and currently the most sensitive tool to evaluate patients with both typical and atypical reflux symptoms. The sensitivity of a pH catheter test is 58% for the detection of acid reflux compared with MII-pH monitoring; further, its sensitivity is 28% for the detection of weak acid reflux compared with MII-pH monitoring. By adding impedance to pH catheter in patients with reflux symptoms, particularly in those receiving PPIs, it has been demonstrated that higher rates of diagnoses and symptom analyses can be obtained than those using only pH catheter. Esophageal manometry is used in the evaluation of patients with functional dysphagia and unexplained noncardiac chest pain and prior to antireflux surgery. The use of esophageal manometry is suitable for the detection of esophageal motor patterns and extreme motor abnormalities (e.g., achalasia and extreme hypomotility). Esophageal manometry and ambulatory pH monitoring are often used in assessments prior to laparoscopic antireflux surgery and in patients with reflux symptoms refractory to medical treatment. Although the esophageal motility is predominantly normal in patients with non-acid reflux, ineffective esophageal motility is often monitored in patients with acid reflux. In the literature, there are contradictory and an insufficient number of studies regarding radiological methods for the diagnosis of GERD. There are inconsistent values for sensitivity and specificity among the barium studies. There are inadequate studies in the literature involving scintigraphic examinations in the diagnosis of GERD, and a majority of existing studies have been conducted in the pediatric group. The results of a few studies do not provide sufficient contribution toward the implementation in clinical practice.Öğe Indications of 24-h esophageal pH monitoring, capsule pH monitoring, combined pH monitoring with multichannel impedance, esophageal manometry, radiology and scintigraphy in gastroesophageal reflux disease?(2017) Vardar, Rukiye; Keskin, MuharremAmbulatory esophageal pH monitoring is an essential method in patients exhibiting signs of non-erosive reflux disease (NERD) to make an objective diagnosis. Intra-esophageal pH monitoring is important in patients who are non-responsive to medications and in those with extraesophageal symptoms, particularly in NERD, before surgical interventions. With the help of the wireless capsule pH monitoring, measurements can be made under more physiological conditions as well as longer recordings can be performed because the investigation can be better tolerated by patients. Ambulatory esophageal pH monitoring can be detected within normal limits in 17%-31.4% of the patients with endoscopic esophagitis; therefore, normal pH monitoring cannot exclude the diagnosis of gastroesophageal reflux disease (GERD). Multi-channel intraluminal impedance pH (MII-pH) technology have been developed and currently the most sensitive tool to evaluate patients with both typical and atypical reflux symptoms. the sensitivity of a pH catheter test is 58% for the detection of acid reflux compared with MII-pH monitoring; further, its sensitivity is 28% for the detection of weak acid reflux compared with MII-pH monitoring. By adding impedance to pH catheter in patients with reflux symptoms, particularly in those receiving PPIs, it has been demonstrated that higher rates of diagnoses and symptom analyses can be obtained than those using only pH catheter. Esophageal manometry is used in the evaluation of patients with functional dysphagia and unexplained noncardiac chest pain and prior to antireflux surgery. the use of esophageal manometry is suitable for the detection of esophageal motor patterns and extreme motor abnormalities (e.g., achalasia and extreme hypomotility). Esophageal manometry and ambulatory pH monitoring are often used in assessments prior to laparoscopic antireflux surgery and in patients with reflux symptoms refractory to medical treatment. Although the esophageal motility is predominantly normal in patients with non-acid reflux, ineffective esophageal motility is often monitored in patients with acid reflux. in the literature, there are contradictory and an insufficient number of studies regarding radiological methods for the diagnosis of GERD. There are inconsistent values for sensitivity and specificity among the barium studies. There are inadequate studies in the literature involving scintigraphic examinations in the diagnosis of GERD, and a majority of existing studies have been conducted in the pediatric group. the results of a few studies do not provide sufficient contribution toward the implementation in clinical practiceÖğe The influence of the speed of food intake on multichannel impedance in patients with gastro-oesophageal reflux disease(Sage Publications Inc, 2013) Bor, Serhat; Bayrakci, Berna; Erdogan, Askin; Yildirim, Esra; Vardar, RukiyeBackground: There is a general belief that gastro-oesophageal reflux increases after meals and especially following a rapid intake. Objective: To evaluate the impact of rapid vs. slow food intake on gastro-oesophageal reflux disease (GORD) patients. Materials and methods: Forty-six GORD patients with heartburn and / or acid regurgitation once a week or more often common were included in this study. Participants were asked to eat the same standard meal within either 5 or 30 minutes under observation in a random order on 2 consecutive days. A total of 28 hours of recording were obtained by intraoesophageal impedance pH and number of liquid and mixed reflux episodes within 3 hours of the slow- and fast-eating postprandial periods were calculated. Results: While all patients defined GORD symptoms, 10 (21.7%) had pathological 24-h intraoesophageal impedance measurement, 15 (32.6%) had pathological DeMeester and 21.7% had erosive oesophagitis. No difference has been shown according to the eating speed when all reflux episodes were taken together (754 vs. 733). Speed of food intake also did not have an impact on patients with normal vs. pathological 24-h intraoesophageal impedance or erosive vs. non-erosive. During the first postprandial hour, approximately half of the reflux events were non-acid, compared to 34.2% during the second hour and 26.8% during the third hour (p < 0.001). The number of acid reflux episodes was significantly higher than non-acid reflux especially during the second and third hours and in total for 3 hours. Conclusions: This first study addressing the effect of eating speed on reflux episodes in GORD patients did not support the general belief that reflux increases following fast eating. Acid and non-acid reflux were similar at the first postprandial hour, then acid reflux episodes were predominantly higher, which implicate the importance of acid pockets.Öğe Investigation of Dientamoeba fragilis Prevalence and Evaluation of Sociodemographic and Clinical Features in Patients with Gastrointestinal Symptoms(Springer International Publishing Ag, 2019) Aykur, Mehmet; Kurt, Cansu Caliskan; Erdogan, Derya Dirim; Avci, Cigir Biray; Vardar, Rukiye; Aydemir, Sohret; Girginkardesler, Nogay; Gunduz, Cumhur; Dagci, HandeBackgroundDientamoeba fragilis is a protozoan parasite of the human gastrointestinal tract and still controversial in association with gastrointestinal symptoms.PurposeWe present cross-sectional study of the prevalence of D. fragilis, and sociodemographic and clinical features in the patients with gastrointestinal symptoms.MethodsA total of 490 fecal specimens were collected from outpatients with gastrointestinal symptoms in the Department of Parasitology, Faculty of Medicine, Ege University and Celal Bayar University, Turkey. Fecal specimens were examined with microscopy and inoculated in Robinson medium. D. fragilis-positive samples were examined for the presence of other intestinal parasites using enzyme immunoassay. Real-time PCR analysis was performed on all samples.ResultsOf the 490 stool specimens examined by real-time PCR, 59 patients were positive for D. fragilis infection with prevalence rate of 12.04%. Forty-four of positive patients (74.5%) were found to be infected with only D. fragilis, while 23.7% were co-infected with Blastocystis and 1.7% were co-infected with Rotavirus. No statistically significant difference was found in all the examined patients in terms of D. fragilis positivity for all sociodemographic parameters. Loose stool consistency was associated with the presence of D. fragilis, with 18.3% (P=0.001). When the clinical symptoms of all the patients participating in this study were examined, diarrhea was statistically more significant in patients with the presence of D. fragilis (16.3%; P=0.001). The rate of diarrhea in D. fragilis-positive patients (84.09%; P=0.0005) was higher than that of D. fragilis-negative patients and it was statistically significant.ConclusionThis study is important for assessing the prevalence of D. fragilis and its association with other factors in symptomatic patients in a large sample group in Turkey, as well as investigating the relationship of identified symptoms with the D. fragilis pathogenicity. It is suggested that D. fragilis in this case is not a commensal parasite but a pathogenic parasite and that the most common clinical symptom is diarrhea.Öğe Is the prevalence of intestinal metaplasia at the squamocolumnar junction different in patients with progressive sytemic sclerosis?(Turkish Soc Gastroenterology, 2010) Vardar, Rukiye; Vardar, Enver; Bor, SerhatBackground/aims: Gastroesophageal reflux disease is seen frequently in patients with progressive systemic sclerosis. The aim of the present study was to determine the prevalence of intestinal metaplasia-squamocolumnar junction in patients with progressive systemic sclerosis and to investigate the association with gastroesophageal reflux disease. Methods: Thirty-one patients with progressive systemic sclerosis (Group A), 58 patients with gastroesophageal reflux disease -without progressive systemic sclerosis (Group B) and 36 patients without progressive systemic sclerosis or gastroesophageal reflux disease (Group C) were prospectively enrolled into this study. Biopsies were taken from the antrum, body, squamocolumnar junction (Z-line), and from the esophagus (3 cm above the Z-line). All biopsies were independently evaluated by two pathologists who were unaware of the diagnosis. Results: We found that grade C-D esophagitis, esophageal stricture and Barrett's esophagus were statistically significantly higher in Group A (p<0.05). Intestinal metaplasia at squamocolumnar junction was detected in 31% of Group A, in 32% of Group B and in 29% of Group C patients (p>0.05), and prevalence of Helicobacter pylori was 61%, 67% and 38% in Groups A, B and C, respectively. Prevalence of Helicobacter pylori was similar in Group B and Group A, and significantly higher in Group B than Group C. Within each group, no significant relationship was detected between intestinal metaplasia at squamocolumnar junction and gender, age, smoking, alcohol consumption, body mass index, gastric atrophy, and prevalence of Helicobacter pylori. Conclusions: Patients with progressive systemic sclerosis have a higher tendency to the more severe forms and complications of gastroesophageal reflux disease including Barrett's esophagus than in those without progressive systemic sclerosis. However, there was no difference in the prevalence of intestinal metaplasia at squamocolumnar junction between groups, and it can he pointed out that intestinal metaplasia at squamocolumnar junction might not be related with gastroesophageal reflux disease.Öğe Is There any Non-Invasive Marker Replace the Needle Liver Biopsy Predictive for Liver Fibrosis, in Patients with Chronic Hepatitis?(H G E Update Medical Publishing S A, 2009) Vardar, Rukiye; Vardar, Enver; Demir, Sibel; Sayhan, S. Emil; Bayol, Uemit; Yildiz, Coskun; Postaci, HakanBackground/Aims: Non-invasive serum markers are being used to determine fibrosis score as an alternative to liver biopsy. The aim of the present study was to evaluate the accuracy and predictive value of the non-invasive markers in identifying the presence or absence of significant fibrosis in patients with chronic viral hepatitis. Methodology: A total of 557 patients (401 chronic hepatitis B (CHB), 156 chronic hepatitis C (CHC) were-enrolled into the study retrospectively. Liver biopsies were evaluated histopathologically according to the Knodell scoring system. Laboratory values such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), Y-glutamyltranspeptidase (GGT) and platelet count (PLT) was tested on the same day of liver biopsy. Using these laboratory values, AST/ALT ratio (AAR), age-platelet index (API) and AST/PLT ratio index (APRI), GGT/ PLT ratio index (GAPI) and AST to GGT ratio (AGR) were calculated. Results: Advanced liver fibrosis including stage 3-4 was observed in 197 (49%) of patients with CHB, 84 (54%) of patients with CHC. Mean age and GGT were higher and PLT was lower in patients with advanced liver fibrosis (stage 3-4) than those in patients with absence of significant fibrosis (stage 0-1) (p < 0.001). But, there was no statistically significant relationship for mean value of AST and ALT between patients with stage 0-1 and stage 3-4. The API and GAPI were found to be significantly associated with the fibrosis score and correlation co-efficient (r) were 0.35 and 0.23, respectively (p < 0.001), while the APRI, AAR and AGR values were not associated with the fibrosis score in all of the patients (p > 0.05). But, APRI has showed correlation with liver fibrosis in patients with CH C contrary to patients with CHB. Conclusion: Age, GGT, PLT, API and GAPI are significantly associated with the extent of fibrosis. But these non-invasive markers can not replace liver biopsy.Öğe Is There any Non-Invasive Marker Replace the Needle Liver Biopsy Predictive for Liver Fibrosis, in Patients with Chronic Hepatitis?(H G E Update Medical Publishing S A, 2009) Vardar, Rukiye; Vardar, Enver; Demir, Sibel; Sayhan, S. Emil; Bayol, Uemit; Yildiz, Coskun; Postaci, HakanBackground/Aims: Non-invasive serum markers are being used to determine fibrosis score as an alternative to liver biopsy. The aim of the present study was to evaluate the accuracy and predictive value of the non-invasive markers in identifying the presence or absence of significant fibrosis in patients with chronic viral hepatitis. Methodology: A total of 557 patients (401 chronic hepatitis B (CHB), 156 chronic hepatitis C (CHC) were-enrolled into the study retrospectively. Liver biopsies were evaluated histopathologically according to the Knodell scoring system. Laboratory values such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), Y-glutamyltranspeptidase (GGT) and platelet count (PLT) was tested on the same day of liver biopsy. Using these laboratory values, AST/ALT ratio (AAR), age-platelet index (API) and AST/PLT ratio index (APRI), GGT/ PLT ratio index (GAPI) and AST to GGT ratio (AGR) were calculated. Results: Advanced liver fibrosis including stage 3-4 was observed in 197 (49%) of patients with CHB, 84 (54%) of patients with CHC. Mean age and GGT were higher and PLT was lower in patients with advanced liver fibrosis (stage 3-4) than those in patients with absence of significant fibrosis (stage 0-1) (p < 0.001). But, there was no statistically significant relationship for mean value of AST and ALT between patients with stage 0-1 and stage 3-4. The API and GAPI were found to be significantly associated with the fibrosis score and correlation co-efficient (r) were 0.35 and 0.23, respectively (p < 0.001), while the APRI, AAR and AGR values were not associated with the fibrosis score in all of the patients (p > 0.05). But, APRI has showed correlation with liver fibrosis in patients with CH C contrary to patients with CHB. Conclusion: Age, GGT, PLT, API and GAPI are significantly associated with the extent of fibrosis. But these non-invasive markers can not replace liver biopsy.Öğe Obezite ve intestinal akalen fosfataz ilişkisi(Ege Üniversitesi, 2019) Vardar, Rukiye; Uysal, Alper; Armağan, Güliz; Şimşir, Ilgın YıldırımAmaç: İntestinal mikrobitanın lipid emilimi, immun sistem defansı ve enerji metabolizmasında büyük önemi olduğu bilinmektedir. Kesin metabolizması bilinmemekle birlikte, intestinal mikrobiatanın obezite gelişiminde rolü olduğu, modifikasyonunun enerji üretimini artırabildiği, düşük dereceli inflamasyonu tetiklediği, insülin direncini arttırdığı ve yağ asidi doku kompozisyonunu etkilediği gösterilmiştir. İntestinal mikrobiatadaki değişimin intestinal kaynaklı inflamasyona neden olarak obeziteye yol açtığı düşünülmektedir. İntestinal alkalen fosfatın, intestinal mikrobiatanın düzenlenmesinde rolü olduğu birçok çalışma ile gösterilmiştir. Çalışmamızda intestinal mikrobiatanın önemli düzenleyici faktörlerinden olan intestinal alkalen fosfataz ile obezite arasındaki ilişkiyi araştırmayı amaçladık. Gereç ve Yöntem: 2017 Aralık-2018 Mayıs tarihlerinde Ege Üniversitesi Tıp Fakültesi Hastanesi Gastroenteroloji Endoskopi Ünitesi'ne refere edilmiş, BKİ < 25 kg/m2 olan 18 hasta, BKİ 26 ve 30 kg/m2 arası olan 18 hasta ve BKİ > 30 kg/m2 olan 18 hasta çalışmaya dahil edildi. NCEP ATP III kriterlerinden en az 3 tanesini karşılayanlar Metabolik Sendrom tanısı aldı ve hastalar Metabolik Sendroma göre de gruplandırıldı. Hastalardan alınan serum ve doku örneklerinde intestinal alkalen fosfataz enzimi ELİSA ile çalışıldı. Ayrıca enzimin dokudaki varlığını sübjektif değerlendirmek için Western Blot testi çalışıldı ve BKİ'ye göre ayrılmış 3 grup arasında doku ve serum intestinal alkalen fosfataz seviyeleri karşılaştırıldı. Bulgular: Hastaların % 65.4'ü kadın, % 34.6'sı erkekti. Yaş ortalaması 52, 94 ± 14.93'idi. BKİ ortalaması 29.36 ± 6.7 kg/m2 ve bel çevresi ortalaması ise 101 ± 16, 55 cm olarak saptandı. Sigara kullanım oranı %25 olarak görüldü. Alkol kullanım oranı ise %11.5'ti. Hastalar MeS tanısına göre gruplandırıldığında %34.6 hasta MeS tanısı alırken %65.4 hasta MeS tanısı almadı. Hastaların sİALP ortalaması ise 187.414 ± 76.532 ng/ml ve dİALP ortalaması ise 207, 77 ± 122, 68 ng/ml olarak saptandı. Kadınlarda sİALP düzey ortalaması 190, 68 ± 82.30 ng/ml görülürken, erkeklerde sİALP ortalaması 66.041 ng/ml olarak bulundu. Cinsiyet ve ortalama sİALP arasında istatiksel anlamlı fark görülmedi. Obez, fazla kilolu ve normal kilolu grup ile sİALP düzeyleri karşılaştırıldığında en yüksek ortalamanın (x=247.910 ng/ml) normal kilolu grupta olduğu, bunu fazla kilolu grubun (x=208.622 ng/ml) ve obez grubun (x=112.433 ng/ml) izlediği görüldü. Gruplar ile dİALP düzeyleri karşılaştırıldığında da yine en yüksek ortalamanın (x=306, 638 ng/ml) normal kilolu grupta olduğu bunu fazla kilolu grubun (x=232.236 ng/ml) ve obez grubun (x=95.445 ng/ml) izlediği görülmüştür. sİALP ve dİALP BKİ grupları ile değişiminin istatiksel olarak anlamlı olduğu saptandı(sİALP için p=0.00, dİALP için p=0.00) dİALP düzeyleri ile MeS tanıları karşılaştırıldığında ise MeS tanısı alan grupta dİALP düzeyi 161.076 ± 106.532 ng/ml bulunurken, MeS tanısı olmayan grupta dİALP düzeyi 232.503 ± 124.87 ng/ml olarak saptandı. İki grup arasında ortalama dİALP açısndan karşılaştırıldığında MeS tanısı grupta ortalama dİALP düzeyi istatiksel olarak anlamlı düşük bulundu (p=0.045). Sonuç: İALP'nin dokudaki ve serumdaki komponentlerinin obez hastalarda fazla kilolu ve normal kilolu gruba göre daha düşük düzeyde olduğu gösterilmiştir. Ayrıca İALP doku komponentinin, MeS olan olgularda anlamlı düşük olduğu saptanmıştır.;Obezite, Alkalen Fosfataz, İstestinal Alkalen Fosfataz, Vücut Ağırlığı, Bel Çevresi, Metabolik Sendrom.;Obesity, Alkaline Phosphatase, Istestinal Alkaline Phosphatase, Body Weight, Waist Circumference, Metabolic Syndrome.
