Person: DUMAN, DENİZ
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DUMAN
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DENİZ
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Publication Open Access Acid suppression therapy, gastrointestinal bleeding and infection in acute pancreatitis - An international cohort study(ELSEVIER, 2020-10) DUMAN, DENİZ; Demcsak, Alexandra; Soos, Alexandra; Kincses, Lilla; Capunge, Ines; Minkov, Georgi; Kovacheva-Slavova, Mila; Nakov, Radislav; Wu, Dong; Huang, Wei; Xia, Qing; Deng, Lihui; Hollenbach, Marcus; Schneider, Alexander; Hirth, Michael; Ioannidis, Orestis; Vincze, Aron; Bajor, Judit; Sarlos, Patricia; Czako, Laszlo; Illes, Dora; Izbeki, Ferenc; Gajdan, Laszlo; Papp, Maria; Hamvas, Jozsef; Varga, Marta; Kanizsai, Peter; Bona, Erno; Miko, Alexandra; Vancsa, Szilard; Juhasz, Mark Felix; Ocskay, Klementina; Darvasi, Erika; Miklos, Emoke; Eross, Balint; Szentesi, Andrea; Parniczky, Andrea; Casadei, Riccardo; Ricci, Claudio; Ingaldi, Carlo; Mastrangelo, Laura; Jovine, Elio; Cennamo, Vincenzo; Marino, Marco V.; Barauskas, Giedrius; Ignatavicius, Povilas; Pelaez-Luna, Mario; Rios, Andrea Soriano; Turcan, Svetlana; Tcaciuc, Eugen; Malecka-Panas, Ewa; Zatorski, Hubert; Nunes, Vitor; Gomes, Antonio; Goncalves, Tiago Curdia; Freitas, Marta; Constantino, Julio; Sa, Milene; Pereira, Jorge; Mateescu, Bogdan; Constantinescu, Gabriel; Sandru, Vasile; Negoi, Ionut; Ciubotaru, Cezar; Negoita, Valentina; Bunduc, Stefania; Gheorghe, Cristian; Barbu, Sorin; Tantau, Alina; Tantau, Marcel; Dumitru, Eugen; Suceveanu, Andra Iulia; Tocia, Cristina; Gherbon, Adriana; Litvin, Andrey; Shirinskaya, Natalia; Rabotyagova, Yliya; Bezmarevic, Mihailo; Hegyi, Peter Jeno; Han, Jimin; Rodriguez-Oballe, Juan Armando; Salas, Isabel Miguel; Comas, Eva Pijoan; de la Iglesia Garcia, Daniel; Cuadrado, Andrea Jardi; Castineira, Adriano Quiroga; Chang, Yu-Ting; Chang, Ming-Chu; Kchaou, Ali; Tlili, Ahmed; Kacar, Sabite; Gokbulut, Volkan; Duman, Deniz; Kani, Haluk Tarik; Altintas, Engin; Chooklin, Serge; Chuklin, Serhii; Gougol, Amir; Papachristou, George; Hegyi, PeterBackground: Acid suppressing drugs (ASD) are generally used in acute pancreatitis (AP); however, large cohorts are not available to understand their efficiency and safety. Therefore, our aims were to evaluate the association between the administration of ASDs, the outcome of AP, the frequency of gastrointestinal (GI) bleeding and GI infection in patients with AP. Methods: We initiated an international survey and performed retrospective data analysis on AP patients hospitalized between January 2013 and December 2018. Results: Data of 17,422 adult patients with AP were collected from 59 centers of 23 countries. We found that 23.3% of patients received ASDs before and 86.6% during the course of AP. ASDs were prescribed to 57.6% of patients at discharge. ASD administration was associated with more severe AP and higher mortality. GI bleeding was reported in 4.7% of patients, and it was associated with pancreatitis severity, mortality and ASD therapy. Stool culture test was performed in 6.3% of the patients with 28.4% positive results. Clostridium difficile was the cause of GI infection in 60.5% of cases. Among the patients with GI infections, 28.9% received ASDs, whereas 24.1% were without any acid suppression treatment. GI infection was associated with more severe pancreatitis and higher mortality. Conclusions: Although ASD therapy is widely used, it is unlikely to have beneficial effects either on the outcome of AP or on the prevention of GI bleeding during AP. Therefore, ASD therapy should be substantially decreased in the therapeutic management of AP. (C) 2020 IAP and EPC. Published by Elsevier B.V.Publication Open Access Myeloperoxidase and calprotectin; Any role as non-invasive markers for the prediction of inflammation and fibrosis in non-alcoholic steatohepatitis?(AVES, 2020-10-30) ÇELİKEL, ÇİĞDEM; Bicakci, Ercan; Demirtas, Coskun Ozer; Celikel, Cigdem; Haklar, Goncagul; Duman, Deniz GuneyBackground/Aims: Specific serum markers reflecting hepatic inflammation and fibrosis are required to tailor the treatment strategies in non-alcoholic steatohepatitis (NASH). We aimed to investigate the roles of myeloperoxidase (MPO) and calprotectin in predicting the hepatic inflammation status and disease severity in NASH. Materials and Methods: A total of 48 patients with biopsy-proven NASH and 25 healthy volunteers with normal weight were prospectively enroiled Serum MPO and calprotectin levels were compared between the NASH and control groups. Hepatic MPO and calprotectin expressions were compared in terms of histologic non-alcoholic fatty liver disease activity scores (NAS) (low NAS [<= 4] vs. high NAS [>5]) and fibrosis stage (insignificant [F0-1]/significant [F2-4]). Results: Serum MPO and calprotectin levels were not significantly different between the NASH and control groups. In the subgroup analysis, hepatic MPG expression was significantly increased in patients with NASH with significant fibrosis than in those with insignificant fibrosis (F2-4: 7.04 +/- 3.61 vs. F0-1: 4.83 +/- 2.42, p=0.01). We found no difference between the groups with low and high NAS with regard to serum MPG and calprotectin levels and hepatic MPG and calprotectin expressions. Conclusion: This study demonstrated that hepatic MPG expression can reflect advanced fibrosis in NASH. However, when serum MPO and calprotectin levels were evaluated as potential serum markers, both did not associate with hepatic inflammation status and fibrosis stage in NASH. Therefore, our study results preclude their use as serum markers for hepatic inflammation in NASH.Publication Open Access Advanced endoscopic ultrasound management techniques for preneoplastic pancreatic cystic lesions(BMJ PUBLISHING GROUP, 2017-01) DUMAN, DENİZ; Arshad, Hafiz Muhammad Sharjeel; Bharmal, Sheila; Duman, Deniz Guney; Liangpunsakul, Suthat; Turner, Brian G.Pancreatic cystic lesions can be benign, premalignant or malignant. The recent increase in detection and tremendous clinical variability of pancreatic cysts has presented a significant therapeutic challenge to physicians. Mucinous cystic neoplasms are of particular interest given their known malignant potential. This review article provides a brief but comprehensive review of premalignant pancreatic cystic lesions with advanced endoscopic ultrasound (EUS) management approaches. A comprehensive literature search was performed using PubMed, Cochrane, OVID and EMBASE databases. Preneoplastic pancreatic cystic lesions include mucinous cystadenoma and intraductal papillary mucinous neoplasm. The 2012 International Sendai Guidelines guide physicians in their management of pancreatic cystic lesions. Some of the advanced EUS management techniques include ethanol ablation, chemotherapeutic (paclitaxel) ablation, radiofrequency ablation and cryotherapy. In future, EUS-guided injections of drug-eluting beads and neodymium:yttrium aluminum agent laser ablation is predicted to be an integral part of EUS-guided management techniques. In summary, International Sendai Consensus Guidelines should be used to make a decision regarding management of pancreatic cystic lesions. Advanced EUS techniques are proving extremely beneficial in management, especially in those patients who are at high surgical risk.Publication Open Access Turkish Gastroenterology Association, Pancreas Study Group, Chronic Pancreatitis Committee Consensus Report(AVES, 2020-11-12) DUMAN, DENİZ; Soyturk, Mujde; Bengi, Goksel; Oguz, Dilek; Kalkan, Ismail Hakki; Yalniz, Mehmet; Tahtaci, Mustafa; Demir, Kadir; Kasap, Elmas; Oruc, Nevin; Unal, Nalan Gulsen; Sezgin, Orhan; Ozdogan, Osman; Altintas, Engin; Yaras, Serkan; Parlak, Erkan; Koksal, Aydin Seref; Saruc, Murat; Unal, Hakan; Unsal, Belkis; Gunay, Suleyman; Duman, Deniz; Yurci, Alper; Kacar, Sabite; Filik, LeventPublication Open Access European Guideline on IgG4-related digestive disease - UEG and SGF evidence-based recommendations(SAGE PUBLICATIONS INC, 2020-07) DUMAN, DENİZ; Lohr, J-Matthias; Beuers, Ulrich; Vujasinovic, Miroslav; Alvaro, Domenico; Frokjaer, Jens Brondum; Buttgereit, Frank; Capurso, Gabriele; Culver, Emma L.; De-Madaria, Enrique; Della-Torre, Emanuel; Detlefsen, Sonke; Dominguez-Munoz, Enrique; Czubkowski, Piotr; Ewald, Nils; Frulloni, Luca; Gubergrits, Natalya; Duman, Deniz Guney; Hackert, Thilo; Iglesias-Garcia, Julio; Kartalis, Nikolaos; Laghi, Andrea; Lammert, Frank; Lindgren, Fredrik; Okhlobystin, Alexey; Oracz, Grzegorz; Parniczky, Andrea; Mucelli, Raffaella Maria Pozzi; Rebours, Vinciane; Rosendahl, Jonas; Schleinitz, Nicolas; Schneider, Alexander; van Bommel, Eric F. H.; Verbeke, Caroline Sophie; Vullierme, Marie Pierre; Witt, Heiko; Besselink, Marc G.; Bruno, Marco J.; Czako, Laszlo; del Chiaro, Marco; Filippova, Oleksandra; Fukuda, Akihisa; Gaujoux, Sebastien; Hart, Phil A.; Hegyi, Peter; Jonas, Eduard; Kahraman, Alisan; Kleger, Alexander; Kuryata, Olexander; Laukkarinen, Johanna; Lerch, Markus M.; Marchegiani, Giovanni; Marschal, Hanns-Ulrich; Matos, Celso; Molad, Yair; Oguz, Dilek; Pukitis, Aldis; Satoi, Sohei; Stone, John H.; Verheij, Joanne; de Vries, NiekThe overall objective of these guidelines is to provide evidence-based recommendations for the diagnosis and management of immunoglobulin G4 (IgG4)-related digestive disease in adults and children. IgG4-related digestive disease can be diagnosed only with a comprehensive work-up that includes histology, organ morphology at imaging, serology, search for other organ involvement, and response to glucocorticoid treatment. Indications for treatment are symptomatic patients with obstructive jaundice, abdominal pain, posterior pancreatic pain, and involvement of extra-pancreatic digestive organs, including IgG4-related cholangitis. Treatment with glucocorticoids should be weight-based and initiated at a dose of 0.6-0.8 mg/kg body weight/day orally (typical starting dose 30-40 mg/day prednisone equivalent) for 1 month to induce remission and then be tapered within two additional months. Response to initial treatment should be assessed at week 2-4 with clinical, biochemical and morphological markers. Maintenance treatment with glucocorticoids should be considered in multi-organ disease or history of relapse. If there is no change in disease activity and burden within 3 months, the diagnosis should be reconsidered. If the disease relapsed during the 3 months of treatment, immunosuppressive drugs should be added.Publication Open Access Microbial Preparations (Probiotics) for the Prevention of Clostridium difficile Infection in Adults and Children: An Individual Patient Data Meta-analysis of 6,851 Participants(CAMBRIDGE UNIV PRESS, 2018-07) DUMAN, DENİZ; Johnston, Bradley C.; Lytvyn, Lyubov; Lo, Calvin Ka-Fung; Allen, Stephen J.; Wang, Duolao; Szajewska, Hania; Miller, Mark; Ehrhardt, Stephan; Sampalis, John; Duman, Deniz G.; Pozzoni, Pietro; Colli, Agostino; Lonnermark, Elisabet; Selinger, Christian P.; Wong, Samford; Plummer, Susan; Hickson, Mary; Pancheva, Ruzha; Hirsch, Sandra; Klarin, Bengt; Goldenberg, Joshua Z.; Wang, Li; Mbuagbaw, Lawrence; Foster, Gary; Maw, Anna; Sadeghirad, Behnam; Thabane, Lehana; Mertz, DominikOBJECTIVE. To determine whether probiotic prophylaxes reduce the odds of Clostridium difficile infection (CDI) in adults and children. DESIGN. Individual participant data (IPD) meta-analysis of randomized controlled trials (RCTs), adjusting for risk factors. METHODS. We searched 6 databases and 11 grey literature sources from inception to April 2016. We identified 32 RCTs (n=8,713); among them, 18 RCTs provided IPD (n=6,851 participants) comparing probiotic prophylaxis to placebo or no treatment (standard care). One reviewer prepared the IPD, and 2 reviewers extracted data, rated study quality, and graded evidence quality. RESULTS. Probiotics reduced CDI odds in the unadjusted model (n=6,645; odds ratio [OR] 0.37; 95% confidence interval [CI], 0.25-0.55) and the adjusted model (n=5,074; OR, 0.35; 95% CI, 0.23-0.55). Using 2 or more antibiotics increased the odds of CDI (OR, 2.20; 95% CI, 1.11-4.37), whereas age, sex, hospitalization status, and high-risk antibiotic exposure did not. Adjusted subgroup analyses suggested that, compared to no probiotics, multispecies probiotics were more beneficial than single-species probiotics, as was using probiotics in clinical settings where the CDI risk is 5%. Of 18 studies, 14 reported adverse events. In 11 of these 14 studies, the adverse events were retained in the adjusted model. Odds for serious adverse events were similar for both groups in the unadjusted analyses (n=4,990; OR, 1.06; 95% CI, 0.89-1.26) and adjusted analyses (n=4,718; OR, 1.06; 95% CI, 0.89-1.28). Missing outcome data for CDI ranged from 0% to 25.8%. Our analyses were robust to a sensitivity analysis for missingness. CONCLUSIONS. Moderate quality (ie, certainty) evidence suggests that probiotic prophylaxis may be a useful and safe CDI prevention strategy, particularly among participants taking 2 or more antibiotics and in hospital settings where the risk of CDI is >= 5%.Publication Open Access Small EUS-suspected gastrointestinal stromal tumors of the stomach: An overview for the current state of management(MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2016) DUMAN, DENİZ; Yegin, Ender Gunes; Duman, Deniz GuneyGastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors found in the gastrointestinal (GI) tract, with the stomach being the most common site. They represent a distinct group of GI tumors originating from the interstitial cells of Cajal and are characterized by gain-of-function mutations of KIT. KIT oncoprotein serves as both diagnostic and therapeutic targets. Prognosis is related to size, mitotic activity, and site of the tumor. Asymptomatic, small endoscopic ultrasonography (EUS)-suspected GISTs are increasingly encountered with the wide availability of endoscopic/endosonographic examination. The majority of small GISTs are biologically indolent, albeit possibly harboring c-KIT gene mutations. An ongoing controversy exists regarding the management and surveillance policy for small gastric GISTs. A number of reports on the management of GISTs have been published, not confidently addressing the issue of gastric GISTs of small size. This work provides an overview on the current state of management considerations, specifically focusing on small EUS-suspected gastric GISTs, which are increasingly encountered by clinicians.Publication Open Access A large Turkish pedigree with multiple endocrine neoplasia type 1 syndrome carrying a rare mutation: c.1680_1683 del TGAG(AVES, 2020-08-28) ÇETİN, ALİ; Demirtas, Coskun Ozer; Ata, Pinar; Cetin, Ali; Turkyilmaz, Ayberk; Duman, Deniz GuneyBackground/Aims: Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant syndrome characterized by tumors arising from endocrine glands with no specific genotype-phenotype correlation. Here, we report the largest Turkish kindred with MEN1 syndrome which inherited a scarce MEN1 mutation gene. Materials and Methods: A 64-year-old man, referred to our gastroenterology outpatient clinic for evaluation of a pancreatic mass lesion, was diagnosed with MEN1 syndrome after endoscopic ultrasound-guided sampling of the mass revealed pancreatic neuroendocrine tumor (pNET) and accompanying primary hyperparathyroidism (PHPT) and pituitary tumor. Genetic analysis by whole gene Sanger sequencing of the MEN1 gene identified a frame-shift mutation in exon 10 (c.1680_1683delTGAG). All the relatives of the index case were proposed for clinical and genetic evaluation for MEN1 syndrome. Results: Of the 25 relatives of the index case, 17 were diagnosed with the MEN1 syndrome. Eighteen members among all relatives consented to genetic analysis, and 11 had the same mutation as the index case. All the mutation positive members had MEN1, while none of mutation-negative subjects had any sign of MEN1 syndrome. The frequencies of PHPT, pNET, and pituitary tumors in this kindred were 94.1% (16/17), 29.4% (5/17), and 29.4% (5/17) respectively. Conclusion: We report a rare MEN1 gene mutation which has been descibed in a single sporadic patient earlier. It was inherited by at least three generations of a large family, proving the strong dominant effect of the MEN1 phenotype. Further research may be conducted to clarify potential candidacy of this mutation as a hotspot for MEN1 patients, especially in the Turkish population.