Person: ERTEM ŞAHİNOĞLU, DENİZ
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ERTEM ŞAHİNOĞLU
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DENİZ
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Publication Open Access Phenotypic pattern of early versus later-onset pediatric inflammatory bowel disease in a eurasian country(2022-10-01) ERTEM ŞAHİNOĞLU, DENİZ; Akkelle B. S., Ertem D., Volkan B., Tutar E.Objectives: It is not clear whether the characteristics of pediatric inflammatory bowel disease (IBD) differ between Eastern and Western countries. The aim of this study was to analyze the characteristics of PIBD in Turkey, according to the age at diagnosis. Methods: The data of 176 children with IBD who were followed in our center were analyzed. Patients were divided into early (EO-IBD, onset at 2 to <10 years) and later-onset (LO-IBD, 10 to <= 17 years) IBD according to the age at diagnosis. Patients\" data with ulcerative colitis (UC) and Crohn\"s disease (CD) were compared. Results: Of 176 patients, 47 (26.7%) were diagnosed with EO-IBD. Patients with early-onset ulcerative colitis (EO-UC) had the highest rate of family history of IBD (17.6%). Pancolitis was the most common form of UC regardless of the age at onset. The rate of moderate-severe disease activity in later-onset UC (62.5%) was higher than in EO-UC (37.5%). A higher rate of extraintestinal manifestations was observed in EO-IBD patients, particularly in EO-UC (38.2%) than in LO-IBD patients. Patients with early-onset CD (EO-CD) had predominantly colonic involvement and nonstricturing, nonpenetrating disease behavior. The rate of perianal disease in patients with later-onset CD (LO-CD) (64.5%) was noticeably higher than those with EO-CD (23%). Conclusions: Our results suggest that patients with EO-UC represented a distinct phenotype with a mild disease activity, high rate of extraintestinal symptoms, and a high proportion of family history. The analysis of our IBD cohort also demonstrated remarkably high rate of perianal disease, particularly in patients with LO-CD.Publication Open Access Evaluation of mucosal status in the follow-up of pediatric patients with celiac disease: the role of serology(2022-09-01) AY, NADİYE PINAR; ERTEM ŞAHİNOĞLU, DENİZ; ÇELİKEL, ÇİĞDEM; Sengul O. K., Akkelle B. S., Ay P., Volkan B., Tutar E., Celikel Ç., Ertem D.Recent guidelines suggest non-biopsy serology-based approach for the diagnosis of celiac disease; however, there is no evidence-based data regarding noninvasive follow-up of mucosal healing. The aim of this study is to investigate the efficacy of serology in reflecting mucosal status in the follow-up of pediatric patients with celiac disease. This is a validation study conducted at a university hospital. Patients who had biopsy proven celiac disease (Marsh III) at diagnosis, and had been followed-up for at least 12 months, were prospectively evaluated with duodenal biopsies. tTG-IgA and EMA tests were performed on the day of endoscopy. One hundred four patients with a mean age of 7.4 +/- 4.02 years were included in the study. The sensitivity and specificity of tTG-IgA were 85.2% and 61% respectively, with a high negative predictive value (NPV) of 92.2% but a very low positive predictive value (PPV) of 43.4%. We found that a cutoff value of 68.5 U/mL for tTG-IgA had a sensitivity, specificity of 85.2% and 85.7% respectively. The AUC was 0.891. The sensitivity and specificity of EMA was 77.8% and 87% respectively, with a high NPV of 91.8% but low PPV of 67.7%.Publication Open Access A rare and often unrecognized cause of hematochezia and tenesmus in childhood: Solitary rectal ulcer syndrome(AMER ACAD PEDIATRICS, 2002-12-01) ERTEM ŞAHİNOĞLU, DENİZ; Ertem, D; Acar, Y; Karaa, EK; Pehlivanoglu, ESolitary rectal ulcer syndrome (SRUS) is an unusual disorder of childhood, which usually presents with rectal bleeding, mucous discharge, prolonged straining, tenesmus, and localized pain in the perineal area. After the first description by Cruveilhier, Madigan and Morson further detailed the clinical and pathologic features of SRUS in 1969. The pathogenesis of the syndrome is not well-understood. The postulated mechanism responsible for rectal prolapse in most cases seems to be excessive straining efforts during which high intra-abdominal pressure forces the anterior rectal mucosa firmly into the contracting puborectalis muscle. The anterior rectal mucosa is frequently forced into the anal canal and as a consequence becomes strangulated, causing congestion, edema, and ulceration. Histologically, the presence of fibromuscular obliteration of the lamina propria with disorientation of muscle fibers is characteristic, which could be secondary to chronic mechanical and ischemic trauma and inflammation by hard stools, and intussusception of the rectal mucosa. Although the syndrome is well-recognized in adults, the pediatric experience with this condition is limited and often remains unrecognized or misdiagnosed. A misdiagnosis has been reported in one fourth of adult cases, and the correct diagnosis usually delayed approximately 5 to 7 years. There are few pediatric case reports in English literature. Here, we describe 2 children with SRUS, aged 11 and 14 years, whose SRUS was diagnosed 2 and 6 years, respectively, after the onset of the first signs and symptoms.Publication Metadata only Low Titer Tissue Transglutaminase Antibodies: A Link to Helicobacter pylori Infection?(KARGER) ÇELİKEL, ÇİĞDEM; Akkelle, Bilge S.; Sengul, Ozlem K.; Tutar, Engin; Volkan, Burcu; Celikel, Cigdem; Ertem, DenizIntroduction: Low serum titer of anti-tissue transglutaminase (tTG) has been described in various conditions without any evidence of celiac disease (CD). Infectious agents have been suggested to trigger autoimmunity and promote the production of anti-tTG. The aim of this study was to investigate if there is a link between a positive celiac serology and concomitant Helicobacter pylori infection in children. Methods: The data of 178 pediatric patients who underwent upper gastrointestinal endoscopy due to positive celiac serology were compiled. The patients whose histopathologic findings were not consistent with CD were followed on gluten-containing diet. The changes in the serum level of anti-tTG IgA on the follow-up were compared between H. pylori-infected and noninfected patients after the eradication of H. pylori. Results: Of 155 patients who met the inclusion criteria, 119 (group 1) were diagnosed as CD, and duodenal histopathology of the remaining 36 children (group 2) was not compatible with CD. In group 2, 11 out of 36 (30.5%) patients were infected with H. pylori. After the eradication of H. pylori, anti-tTG IgA level either decreased or dropped below cutoff value in 9/11 (81%) patients while it was 20% in those who were not infected with H. pylori in the 6th month of the follow-up (p = 0.001). Conclusion: Our results suggest that H. pylori infection may be the cause of false or transient positive celiac serology. Thus, a positive celiac serology should be carefully interpreted in the presence of H. pylori infection before confirming the diagnosis of this life-long disease.Publication Metadata only Outcomes of Pediatric Fistulising Perianal Crohn's Disease(AVES, 2021) ERTEM ŞAHİNOĞLU, DENİZ; Akkelle, Bilge S.; Sengul, Ozlem K.; Volkan, Burcu; Tutar, Engin; Ergelen, Rabia; Yardimci, Samet; Ertem, DenizBackground: Perianal disease is reported more widely in pediatric Crohn patients than in the past, and hos been stated as an independent modifier of the disease behavior. In this study, we aimed to analyze the clinical characteristics and outcomes of fistulising perianal Crohn's disease (fpCD) in the pediatric age group. Methods: A total number of 149 children with an established diagnosis of inflammatory bowel disease who have been diagnosed before 18 years of age and followed in our tertiary center were revised. Clinical, endoscopic, laboratory, and radiologic data of 50 patients with CD, who had at least 18 months follow-up data, were compiled. Results: Of 50 patients, 26 (52%) were diagnosed as fpCD (38% at onset). More than half of the patients without any notable external orifices around the perianal area were diagnosed as fpCD by an magnetic resonance imaging (MRI). Pediatric fpCD patients hod a higher disease activity score and platelet count, lower serum albumin level, and a higher rate of granuloma in the biopsy samples, compared with non-fistulising patients. A considerably high rate of surgical interventions (i.e., seton placement 46% and abscess drainage 15%) was performed in combination with infiiximab. Conclusion: Fistulising perianal Crohn's disease seems to be more common than previously reported in the pediatric age group. A severe course of the disease might serve as a warning for the development of fpCD. A careful physical examination and use of perianal MRI with a high index of suspicion may increase the likelihood of fistula detection, hence may change the treatment strategy.Publication Metadata only An uncommon and often overlooked cause of failure to thrive: Diencephalic syndrome(LIPPINCOTT WILLIAMS & WILKINS, 2000) ERTEM ŞAHİNOĞLU, DENİZ; Ertem, D; Acar, Y; Alper, G; Kotiloglu, F; Pehlivanoglu, EPublication Metadata only The Interaction Between Helicobacter pylori and Atopy: Does Inverse Association Really Exist?(WILEY, 2009) ERTEM ŞAHİNOĞLU, DENİZ; Cam, Sebahat; Ertem, Deniz; Bahceciler, Nerin; Akkoc, Tunc; Barlan, Isil; Pehlivanoglu, EnderTo date, cross-sectional and case-control studies suggest an inverse association between Helicobacter pylori infection and atopic diseases, whereas the immunologic basis has not been studied yet. In this study we investigated T helper (Th) cell function in H. pylori-infected children and compared cytokine responses in atopic and non-atopic groups. The study groups was recruited from a cohort of 327 healthy children evaluated and followed-up for 6 years to assess the natural history of H. pylori infection. Seventy-four of 136 healthy children who underwent C-13 urea breath test were eligible and accepted to participate. All participants were evaluated by a questionnaire, and skin-prick testing. According to the results, children were divided into four groups with respect to the presence or absence of H. pylori and atopy. Peripheral blood mononuclear cells isolated from 34 of 74 children were cultured with H. pylori, Der p 1, and phytohemagglutinin (PHA). Interferon-gamma (IFN-gamma), interleukin (IL)-4 and IL-10, transforming growth factor-beta (TGF-beta) levels were measured in supernatants. The frequency of atopy was lower in H. pylori-infected group (31.9% vs. 48.1, p = .22), while atopic symptoms were similar between infected and non-infected children. While PHA and H. pylori induced IFN-gamma levels were significantly higher in H. pylori-infected children, concomitant presence of both atopy and H. pylori decreased the level of PHA and H. pylori induced IFN-gamma production. PHA and Der p 1-induced IL-4 levels were higher in atopic children, and IL-4 production was suppressed when they were concomitantly infected with H. pylori. The production of TGF-beta was found to be suppressed in atopic children irrespective of the presence of H. pylori infection. The results of the current study demonstrated a counteractive Th1 and Th2 cytokine interaction between H. pylori infection and atopy. However, this counteractive immunologic balance did not protect against atopy.