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    Alerjik rinit ve irritabl bağırsak sendromu hastalarında probiyotik takviyesinin hastane yatış sıklığı ve inflamatuar belirteçler üzerine etkisi
    (DNT Ortadoğu Yayıncılık A.Ş., 2024) Haznedar, Berzan; Kozan, Günay; Ebik, Berat
    Amaç: Bu çalışma, tekrarlayan alerjik rinit (AR) ve irritabl bağırsak sendromu (IBS) olan hastalarda kısa süreli (3-6 ay) probiyotik kullanımının etkisini, özellikle inflamasyon indekslerindeki değişikliklere odaklanarak incelemeyi amaçlamıştır. Gereç ve Yöntemler: Bu retrospektif çalışmaya 2020-2021 yılları arasında IBS ve AR tanısı almış ve 3-6 ay süreyle probiyotik takviyesi kullanan hastalar dahil edildi. Demografik özellikler, sistemik inflamasyon indeksi (SII), nötrofil-lenfosit oranı (NLR) ve trombosit-lenfosit oranı (PLR) gibi klinik veriler ile probiyotik kullanımı öncesi ve sonrası hemogram sonuçları ve AR ile ilişkili başvuru sayıları toplandı. Probiyotik müdahalesi, probiyotik içermeyen standart IBS tedavisi alan kontrol grubu ile karşılaştırıldı. Bulgular: Değerlendirilen 135 hasta arasında, probiyotik tedavisi alan grupta kontrol grubuna kıyasla AR ile ilişkili hastane başvuru sıklığında anlamlı bir azalma gözlendi (p
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    BILIARY FASCIOLA GIGANTICA CASE REPORT FROM TURKEY
    (Southeast Asian Ministers Educ Organization, 2011) Goral, Vedat; Senturk, Senem; Mete, Omer; Cicek, Mutallib; Ebik, Berat; Kaya, Besir
    We present a case of Fasciola gigantica-induced biliary obstruction and cholestasis diagnosed and treated via endoscopy and trichlorobendazole treatment. This is the first case of Fasciola gigantica treated via endoscopic biliary extraction during ERCP and drug treatment reported from Turkey.
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    A Case of Biliary Fascioliasis by Fasciola gigantica in Turkey
    (Korean Soc Parasitology, Seoul Natl Univ Coll Medi, 2011) Goral, Vedat; Senturk, Senem; Mete, Omer; Cicek, Mutallib; Ebik, Berat; Kaya, Besir
    A case of Fasciola gigantica-induced biliary obstruction and cholestasis is reported in Turkey. The patient was a 37- year-old woman, and suffered from icterus, ascites, and pain in her right upper abdominal region. A total of 7 living adult flukes were recovered during endoscopic retrograde cholangiopancreatography (ERCP). A single dose of triclabendazole was administered to treat possible remaining worms. She was living in a village of southeast of Anatolia region and had sheeps and cows. She had the history of eating lettuce, mallow, dill, and parsley without washing. This is the first case of fascioliasis which was treated via endoscopic biliary extraction during ERCP in Turkey.
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    Comment on Cheilitis with hemorrhagic crusts of the vermilion lips
    (Wiley, 2020) Abdelmaksoud, Ayman; Goldust, Mohamad; Ebik, Berat
    [Abstract Not Available]
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    Development of hepatocellular carcinoma in patients with chronic hepatitis C who had sustained viral response following direct-acting antiviral therapy
    (Kare Publ, 2022) Ebik, Berat; Aygan, Mustafa; Tuncel, Elif Tugba; Kacmaz, Huseyin; Ekin, Nazim; Arpa, Medeni; Yalcin, Kendal
    Background and Aim: Several studies have suggested that treatment with direct-acting antivirals (DAAs) in patients with chronic hepatitis C virus (HCV) may be associated with an increased risk of developing hepatocellular carcinoma (HCC). We investigated the incidence and risk factors of HCC in HCV patients who achieved a sustained virologic response (SVR) following DAA therapies. Materials and Methods: The medical data of patients who were diagnosed with HCV and received DAA therapy in two tertiary centers in Turkey were retrospectively collected. Results: Among them, 75 patients (52.4%) were noncirrhotic and 68 patients (47.6%) were cirrhotic. The overall SVR rate was 97.2% (139/143). It was 100% in noncirrhotic and 94.1% in cirrhotic patients. HCC was developed in 5 (7.4%) patients, all of whom had baseline cirrhosis. The annual rate of HCC occurrence was 2.94%, and the 5-year cumulative incidence of HCC was 7.3%. The mean Child-Pugh score (CPS) and Model for End-Stage Liver Disease (MELD) score significantly decreased after DAA treatment (CPS 7.0 vs 5.9, p=0.001; MELD 10.8 vs 9.5, =-0.003). Conclusion: There was no significant increase in the rate of HCC in cirrhotic HCV patients treated with DAAs. This treatment led to a remarkably high SVR rate and lowered CPS and MELD scores in cirrhotic HCV patients.
  • Küçük Resim
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    Do oral antiviral drugs used in the treatment of chronic hepatitis B cause erectile dysfunction?
    (Lippincott Williams and Wilkins, 2024) Üzel, Ali; Ebik, Berat; Bucaktepe, Gamze Erten; Yolaçan, Ramazan; Karabulut, Ümit; Uçmak, Feyzullah
    Objective The effect of antiviral drugs on the erectile dysfunction (ED) problem expressed by some patients using antiviral drugs due to chronic hepatitis B infection (HBV) was investigated. Methods A total of 102 male patients receiving antiviral therapy for HBVinfection without any known non-cirrhotic and comorbid disease that may cause ED and whodon't use any drugs with an ED formation potential were analyzed through the InternationalIndex of Erectile Function test. Results Among the patients admitted to the study, anxiety disorder was detected as 24.5% (n = 25) and depression as 46.1% (n = 47). 70.6% (n = 72) of the patients suffered ED. Severe ED was only detected in 3 (n = 2.9%) patients. ED was detected in 70.6% of the entecavir, 64.2% of tenofovir, and 80% of Tenofovir alafenamide users (P = 0.287). On the other hand, the logistics regression analysis revealed that the most important factors that increase the risk of ED are age (>55 age; RR: 2.66; P < 0.001), and anxiety disorder (RR: 2.30; P < 0.0001). The cumulative effect of antiviral drugs on ED was 5.7% (RR: 0.8; P = 0.156). Conclusion We could not find any mounting evidence relating to the effect ofcommonly used antiviral drugs for hepatitis B causing ED. The incidence rate of ED on ourpatients was at a similar rate with population studies in the literature based on society. It is notappropriate to terminate antiviral therapy in hepatitis B for this reason.
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    F-18-FDG PET/BT’de kolanjiosellüler kanseri taklit eden Fasciola hepatica vakası
    (2018) Kaya, Muhsin; Tuncel, Elif Tuğba; Ebik, Berat; Yalçın, Kendal; Kaçmaz, Hüseyin; Komek, Halil; Uçmak, Feyzullah
    İnsan fasioliazisi, Fasciola hepatica ve Fasciola gigantica’nın neden olduğu, dünya genelinde nadir görülen zoonotik bir hastalıktır. Genellikle çiftlik hayvanlarını etkileyen bir trematod olup insan rastlantısal ara konakçıdır. Spesifik olmayan semptom ve bulgularının birçok hepatobiliyer hastalıkta izlenebilmesi nedeniyle fasioliazisin tanı ve tedavisi gecikebilmektedir. Elli üç yaşında kadın hasta 18-Florodeoksi-glukoz pozitron emisyon bilgisaya-ralı tomo-grafi incelemesinde ekstrahepatik safra yollarında yüksek florode-oksi-glukoz tutulumu nedeniyle kliniğimize başvurdu. Hastada son 3 aydır süren karın ağrısı, kaşıntı ve halsizlik yakınmaları mevcuttu. Kolanjiyosellü-ler kanseri taklit eden ve serolojik olarak tanısı konan biliyer fasioliazisli bu vakayı sunacağız.
  • Küçük Resim
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    Güneydoğu Anadolu Bölgesindeki üçüncü basamak gastroenteroloji kliniğinin toksik hepatit deneyimi
    (Dicle Üniversitesi Tıp Fakültesi, 2018) Uçmak, Feyzullah; Tuncel, Elif Tuğba; Kaçmaz, Hüseyin; Ebik, Berat; Kaya, Muhsin
    Amaç: Toksik hepatit birçok ilaç ve bitkisel ürünün alınmasıyla ortaya çıkan klinik tablodur. Çok sayıda ilaç değişik mekanizmalarla toksik hepatite neden olmaktadır. Hastalığın görülme sıklığı ve sebepleri bölgesel farklılıklar gösterebilmektedir. Çalışmadaki amacımız kliniğimize başvuran toksik hepatitli olguların demografik, klinik ve laboratuar özelliklerini sunmaktır. Yöntemler: Ağustos 2014-Haziran 2016 tarihleri arasında kliniğimize anormal karaciğer fonksiyon testleri nedeniyle yatırılan, klinik ve laboratuar değerlendirme sonrası TH tanısı konulan hastalar alındı. Hastaların demografik özellikleri, toksik hepatitin muhtemel etiyolojisi, klinik özellikleri, biyokimya ve tam kan değerleri, klinik seyirleri kaydedildi. Bulgular: Çalışmaya yaş ortalaması 41.4±16.8 olan 56 (34 kadın) hasta alındı. Hastaların 31 (%55.6)’inde ilaçlar, 11 (%20.4)’inde bitkisel maddeler, 6 (%9,3)’ında narkotik madde ve 8 (%14,8)’inde bitkisel madde, ilaç ve narkotik kullanımına bağlı toksik hepatit geliştiği saptandı. İlaçlar içinde en çok antibiyotik (birinci sırada amoksisilin+ klavulanik asit) ve non-steroid anti inflamatuvar ilaç (birinci sırada diklofenak sodyum) kullanımı hikayesi saptandı. Bitkisel madde kullanımı olan hastalarda en sık meryem otu, lavanta çayı ve atom çayı kullanım hikayesi mevcuttu. Narkotik madde olarak en sık ekstazi (5 hasta) kullanımı saptandı. Otuz yaş altı (RR:1.545, p<0.001) ve erkek cinsiyet (RR:11.0, p=0.013) narkotik madde kullanımı için risk faktörü olarak saptandı. Sonuç: Bölgemizde ilaç ve bitkisel madde kullanımına bağlı gelişen TH anormal karaciğer fonksiyon testlerinin önemli bir sebebi olarak dikkate alınmalıdır. Özellikle genç erkeklerde narkotik kullanımı toksik hepatit etiyolojisinde önemli yer tutmaktadır.
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    Kronik böbrek yetmezlikli nadir bir olgu: Laurence moon bardet biedl sendromu
    (Türk Nefroloji Derneği, 2012) Yılmaz, Zülfükar; Ebik, Berat; Yıldırım, Yaşar; Kayabaşı, Hasan; İleri, Serdar; Yılmaz, Fatma; Kadiroğlu, Ali Kemal; Yılmaz, Mehmet Emin
    Laurence Moon Bardet Biedl Sendromu (LMBBS); otozomal resesif geçişli, obezite, mental retardasyon, polidaktili, hipogonadizm ve retinitis pigmentoza ile karakterize nadir görülen bir bozukluktur. Hastalığın tanı kriterleri arasında yer almasa da bu hastalarda, böbreklerde yapısal anomali ve fonksiyon bozukluğu, diabetes mellitus, insülin direnci, hipertansiyon ve karaciğerde fibrozis de görülebilmektedir. Renal fonksiyonlarda progresif bozulma sonucu gelişen son dönem böbrek yetersizliği en sık ölüm nedenidir. Bu olgu sunumunda, boyun apsesi, üre, kreatinin değerlerinde yükseklik ve metabolik asidozla başvuran 17 yaşında bir Laurence Moon Bardet Biedl sendromu olgusunun paylaşması amaçlandı.
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    Mikroskobik kolitli hastalarda çölyak hastalığı görülme oranı
    (Dicle Üniversitesi, Tıp Fakültesi, 2012) Ebik, Berat; Kaya, Muhsin; Yılmaz, Mehmet Emin
    Giriş: Mikroskobik kolit karın ağrısı ve ishal ile karakterize olan, endoskopik incelemede mukozanın hemen her zaman normal olarak saptandığı ancak alınan biyopsi örnekleri ile tanı konan klinik tablodur. İshal ve kronik karın ağrısı ile başvuran bir hastada şüphe edilmeyip biyopsi alınmadığında bu hastalara irritabl barsak sendromu (İBS) tanısı konabilir. Bu da hastaya yaklaşımı olumsuz yönde etkiler. Çölyak Hastalığı (ÇH) buğday, arpa, yulaf ve çavdar gibi tahıllarda bulunan glutene intolerans sonucu gelişen, ince barsaklarda inflamasyon ve villus atrofisi şeklinde karakteristik histopatolojik bulgular ile seyreden, glutensiz diyet ile düzelen, kalıtsal bir hastalıktır. Hastalığın etyolojisi tam olarak bilinmemektedir. Çölyak hastalığı asemptomatik olabileceği gibi şiddetli malabsorbsiyon kliniği ile de kendini gösterebilmektedir.Amaç:Kolonoskopik biyopsi ile tanısı konulan Mikroskopik kolitli hastalarda çölyak hastalığı görülme oranını araştırmaktır.Hastalar ve yöntem: Çalışmaya Roma III kriterlerine göre irrıtabl barsak sendromu tanısı olan toplam 98 hastanın; yapılan kolonoskopik biyopsileri sonucunda mikroskobik kolit tanısı alan toplam 20 hasta alınmıştır. Bu hastaların 12' si erkek 8' i kadındır. Mikroskobik kolitli 20 hastanın hepsi lenfositik kolitti. Olguların hiçbirinde kollagenöz kolit mevcut değildi. Bu hastalarda çölyak hastalığını araştırmak amacıyla anti-gliadin IgA (AGA), anti-gliadin IgG, anti-endomysium (EMA) IgA, anti-endomysium IgG, IgA anti-tissue transglutaminase (tTG) antikorlarının varlığı araştırıldı. Ayrıca bu hastalara endoskopik duodenum biyopsisi yapılarak histolojik açıdan çölyak hastalığının varlığına bakıldı.Bulgular: Çalışmaya aldığımız 20 mikroskobik kolitli hastanın hiç birinde çölyak hastalığını destekler serolojik bulguya rastlanılmadı. Hastaların yapılan endoskopik biyopsilerinde de çölyak hastalığına ait histolojik değişikliklere rastlanılmadı. Mikroskopik kolitli hastalarda çölyak hastalığının daha fazla görüldüğüne dair bir bulgu saptanmadı.Sonuç: Çalışmaya alınan hasta sayısı az olmakla beraber mikroskobik kolitle çölyak hastalığı arasında herhangi bir ilişkiye rastlanmadı.
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    Oxidative stress and the importance of H. pylori eradication in patients with functional dyspepsia
    (Wolters Kluwer Medknow Publications, 2022) Ebik, Berat; Aslan, Nihat; Ekin, Nazım; Bacaksız, Ferhat; Arpa, Medeni; Neşelioǧlu, Salim; Erel, Özcan; Uçmak, Feyzullah
    Background: To investigage the thiol and disulphide levels in Helicobacter pylori-positive patients with non-ulcer dyspepsia and investigate the change in these levels with eradication therapy. Methods: This is a prospective observational study. A total of 320 patients diagnosed with dyspepsia according to Rome IV criteria were included in the study. First, blood samples were drawn from patients to determine their serum thiol and disulphide levels. Endoscopic biopsy was performed on all patients and the biopsy specimens obtained were examined pathologically. Patients positive for H. pylori were administered eradication therapy. Blood samples were drawn from these patients for the second time, and their serum thiol and disulphide levels were measured. The thiol-disulfide levels of the patients who were successful in H. pylori eradication treatment, with those who were not, were compared before and after the treatment. Results: The mean plasma disulphide level decreased significantly from 14.0 ± 6.6 to 10.9 ± 5.9 μmol/L in H. pylori-positive patients that responded to the H. pylori eradication treatment (P = 0.033). On the other hand, there was an insignificant increase in the mean serum thiol level (341.4 ± 30.5 vs. 342.6 ± 29.8 μmol/L; P = 0.273) and an insignificant decrease in the mean serum disulphide level (15.2 ± 2.5 vs. 14.8 ± 2.3 μmol/L; P = 0.163) in H. pylori-positive patients that did not respond to the H. pylori eradication treatment. Conclusion: The inflammation caused by H. pylori shifted the thiol-disulphide equilibrium in the cell redox system towards the direction of disulphide. The study findings suggest that the restoration of the said hemostatic balance with eradication therapy relieved the organism from oxidative stress.
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    Ten cases of aquagenic syringeal acrokeratoderma revealed during the COVID-19 outbreak
    (Wiley, 2021) Erhan, Ayhan; Yıldırım, Cihat; Aksoy, Mustafa; Ebik, Berat; Öztürk, Murat; Akelma, Hakan
    Aquagenic syringeal acrokeratoderma (ASA) is a rare, acquired disease affecting predominantly young women. It is characterised by the development of hypopigmented, translucent, flat‐topped, oedematous papules and plaques that form hyperwrinkling or keratoderma.1 It occurs after 3‐5 minutes of contact with water and resolves when the hand dries.1 Although its aetiology is not known exactly, it has been suggested that the disease may develop due to genetic predisposition or diseases such as cystic fibrosis, focal hyperhidrosis and Raynaud's phenomenon.2, 3 However, increased personal hygiene measures such as wearing personal protective equipment, excessive hand washing and disinfection in the COVID‐19 epidemic may play a role in the aetiology of ASA.5 Here we present ten cases with a very short history of ASA where lesions were first seen after the COVID‐19 outbreak.
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    Three Patients with Neuroleptic Malignant Syndrome: Differential Diagnosis and the Causes of Predisposition
    (Aves, 2011) Kadiroglu, Ali Kemal; Ebik, Berat; Kaya, Omer; Yildirim, Serdar; Bez, Yasin
    Neuroleptic malignant syndrome (NMS) is a life-threatening idiosyncratic reaction that occurs after the administration of neuroleptic drugs. It usually appears within the first two weeks of neuroleptic treatment. The tetrad of NMS seen in 50% of patients includes fever, muscle rigidity, altered mental status and evidence of autonomic instability. NMS may be overlooked or its diagnosis may be difficult due to its similarities with some organic and psychiatric disorders. Due to its heterogeneous character, differential diagnosis and supportive treatment are very important when managing these patients. We aimed to present the differential diagnosis and the causes of predisposition in three patients, two with a diagnosis of schizophrenia and one with psychomotor impairment, who were admitted to the medical intensive care unit with a diagnosis of an NMS-like condition related to antipsychotic (olanzapine) treatment.
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    What does quantitative HBsAg level mean in chronic hepatitis D infection?
    (Lippincott Williams & Wilkins, 2023) Ebik, Berat; Cangul, M. Sadik; Yalcin, Kendal
    ObjectiveIn hepatitis delta virus (HDV) infection, which is an important etiological cause of chronic liver disease, the relationship between serum quantitative HBsAg level and fibrosis and histological activity was investigated. MethodsBetween 2014 and 2020, 98 patients with chronic HDV infection (53 noncirrhotic, 45 cirrhotic) participated in this prospectively designed study. Quantitative HBsAg levels of the patients were measured and their relationship with the stage of chronic liver disease was compared with histological activity index (HAI), fibrosis score and HDV RNA, model for end-stage liver disease score and other biochemical parameters. ResultsAll patients were infected with genotype 1 (100%). HBeAg was positive in 8 (8.1%) of the patients. A correlation was found between quantitative HBsAg level and HDV RNA level in patients with both cirrhotic (r = 0.568; P < 0.001) and noncirrhotic (r = 0.644; P < 0.001) HDV infection. Alanine transaminase (P = 0.001; r = 0.495) and aspartate transaminase (P = 0.001; r = 0.511) levels correlated with quantitative HBsAg levels, more prominently in noncirrhotic patients. There was a correlation between quantitative HBsAg level and histological activity index (HAI) in patients with noncirrhotic HDV infection (P < 0.001; r = 0.664). In receiver operating characteristic analysis, both quantitative HBsAg (for cutoff: 1000; sensitivity 76%; specificity 17%; P = 0.335) and HDV RNA (for cutoff: 100000; sensitivity 2%; specificity 98%; P = 0.096) were not predictive markers for cirrhosis. ConclusionQuantitative HBsAg level can be evaluated as an indicator of viral replication and histological activity in patients with chronic delta hepatitis without cirrhosis. We think that quantitative HBsAg level will be useful in the management of chronic HDV infection, especially in noncirrhotic patients.
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    What does the procalcitonin level tell us in patients with acute pancreatitis?
    (College of Physicians and Surgeons Pakistan, 2022) Ebik, Berat; Kaçmaz, Hüseyin; Tuncel, Elif Tuğba; Arpa, Medeni; Uçmak, Feyzullah; Kaya, Muhsin
    Objective: To determine the factors affecting the procalcitonin level, and its association with the severity of pancreatitis in patients with acute pancreatitis (AP). Study Design: Cross-sectional analytical study. Place and Duration of Study: Division of Gastroenterology, University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital and Department of Gastroenterology, Dicle University School of Medicine, Diyarbakır, Turkey, between April 2017 and June 2021. Methodology: The study included 214 patients diagnosed with AP according to Atlanta criteria. By checking the PCT and CRP values of the patients in the first 12 hours, the relationship with these scales that predict the severity of pancreatitis was statistically examined. Results: Hundred and fifty-two patients (71.0%) had mild, while 62 patients (29.0%) had severe pancreatitis. According to the Atlanta criteria, the mean PCT level of patients with mild pancreatitis was 1.4±0.7 ng/mL, while the mean PCT level of patients with severe pancreatitis was 9.0±12.3 ng/mL (p<0.001). The diagnostic performance of PCT was better for predicting severe AP. For the 0.94 ng/mL cut-off, PCT had 86.9% sensitivity and 50.7% specificity. (AUC=0.731[95% CI: 0.669-0.811]; p<0.001; LR: 1.7). In patients with severe pancreatitis, the PCT level was 4.7±18.5 ng/mL in patients without concomitant infection and 15.8±8.1 ng/mL in patients with concomitant infection (p<0.001). Conclusion: High PCT value measured at the time of the first admission to the hospital may predict severe pancreatitis. In addition, a high PCT value at the time of admission to the hospital in patients with pancreatitis may indicate another concomitant infection.
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    What is the incidence of celiac disease in patients with microscopic colitis? Why are these two diseases related?
    (Termedia Publishing House Ltd, 2024) Ebik, Berat; Ekin, Nazim; Bacaksiz, Ferhat; Uzel, Ali; Akkuzu, Mustafa Zanyar; Ucmak, Feyzullah; Kaya, Muhsin
    Introduction: Although there are studies in the literature showing that celiac disease (CD) is more common in patients with microscopic colitis (MC), there are publications to the contrary. The pathophysiologies of both diseases are different from each other. Aim: To investigate the frequency of CD in MC patients, the different features of these 2 diseases, and the relationship between them. Material and methods: In our prospective and cross-sectional analytical study, the presence of CD was investigated in 90 patients diagnosed with MC by colonoscopy and biopsy due to chronic diarrhoea between September 2011 and December 2021. Results: We detected MC in 102 (9.3%) of 1096 patients investigated for chronic diarrhoea. We detected CD in 1 (1.1%) of 90 patients with MC who participated in the study. Only 10% of the patients were positive for AGA IgA, 3.3% for EMA IgA, and 2.2% for Anti-TG2 IgA. There was no difference in autoantibody titre in treatment-responsive and treatment-resistant MC patients. HLA DQ2 was positive in 32.2% (n = 29) of the MC patients, and HLA DQ8 was found in 5.5% (n = 5). Intraepithelial lymphocyte increase was remarkable in the duodenal biopsies of MC patients who did not respond to treatment (40% vs. 11.4%; p = 0.007). Conclusions: We did not reach the conclusion that CD is more common in MC patients. An increase in IEL may also occur in the small intestine in patients with MC who do not respond to treatment.