Person: TUTAR, ENGİN
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TUTAR
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ENGİN
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Publication Open Access Reactive oxygen species and chemokines: Are they elevated in the esophageal mucosa of children with gastroesophageal reflux disease?(W J G PRESS, 2008) ÇELİKEL, ÇİĞDEM; Tutar, Engin; Ertem, Deniz; Unluguzel, Goksenin; Tanrikulu, Sevda; Haklar, Goncagul; Celikel, Cigdem; Ademoglu, Evin; Pehlivanoglu, EnderAIM: To determine the role of inflammatory cytokines and reactive oxygen species (ROS) in childhood reflux esophagitis. METHODS: A total of 59 subjects who had complaints suggesting GERD underwent esophagogastroduoden oscopy. Endoscopic and histopathologic diagnosis of reflux esophagitis was established by Savary-Miller and Vandenplas grading systems, respectively. Esophageal biopsy specimens were taken from the esophagus 20% proximal above the esophagogastric junction for conventional histopathological examination and the measurements of ROS and cytokine levels. ROS were measured by chemiluminescence, whereas IL-8 and MCP-1 levels were determined with quantitative immunometric ELISA on esophageal tissue. Esophageal tissue ROS, IL-8 and MCP-1 levels were compared among groups with and without endoscopic/histopathologic esophagitis. RESULTS: Of 59 patients 28 (47.5%) had normal esophagus whereas 31 (52.5%) had endoscopic esophagitis. In histopathological evaluation, almost 73% of the cases had mild and 6.8% had moderate degree of esophagitis. When ROS and chemokine levels were compared among groups with and without endoscopic esophagitis, statistical difference could not be found between patients with and without esophagitis. Although the levels of ROS, IL-8 and MCP-1 were found to be higher in the group with histopathological reflux esophagitis, this difference was not statistically significant. CONCLUSION: These results suggest that the grade of esophagitis is usually mild or moderate during childhood and factors apart from ROS, IL-8 and MCP-1 may be involved in the pathogenesis of reflux esophagitis in children. (C) 2008 The WJG Press. All rights reserved.Publication Open Access Korozif-kostik madde maruziyeti nedeniyle başvuran çocuklarda endoskopik bulguların değerlendirilmesi: Retrospektif araştırma(2023-03-01) ŞAHİN AKKELLE, BİLGE; KARAOĞLU, SALİH; TUTAR, ENGİN; ERTEM ŞAHİNOĞLU, DENİZ; ŞAHİN AKKELLE B., Volkan B., Dursun C., Korkmaz B., KARAOĞLU S., TUTAR E., ERTEM ŞAHİNOĞLU D.Objective: Accidental caustic ingestions cause damagecomplications in the gastrointestinal tract. In our study, the characteristics of children who underwent endoscopy due to caustic ingestions were evaluated. Material and Methods: The demographic, clinic, endoscopic data of symptomatic children who underwent endoscopy due to caustic ingestions between 2016-2021 were reviewed. According to Zargar classification, patients with normal or mild findings on endoscopy were defined as Group 1; those with moderate/severe findings on endoscopy were defined as Group 2. The data of the two groups were compared. Results: The mean age of 284 patients included in our study was 42±41 months, and 58.4% of them were male. The most frequently exposed caustic agents were household cleaning chemicals (87.3%). Most of the caustic agents exposed were alkaline (78.9%) and 64.3% were in granule form. Esophageal corrosive damage compatible with at least Grade 2a was found in 26.1% of the patients. Complaints of drooling, dysphagia were more frequent in Group 2 compared to Group 1 (p<0.05). There was a statistically significant difference between the groups in terms of the chemical properties of exposed agents. In the follow-up, esophageal stenosis was detected in 2.8% of the patients and pyloric stenosis was detected in 1 patient. Conclusion: The results of our study showed that drooling and dysphagia symptoms are important in predicting esophageal damage in caustic ingestions, but oropharyngeal examination findings may be misleading. Preventive medicine approaches, inspections and sanctions for corrosive chemicals that are produced, sold, stored improperly are important in preventing these accidents.Publication Open Access Bowel Preparation for Colonoscopy in Children: 1 Day PEG-3350 with Bisacodyl versus 3 Day Sennosides(KARGER, 2019) ERTEM ŞAHİNOĞLU, DENİZ; Tutar, Engin; Bayrak, Nevzat Aykut; Volkan, Burcu; Ertem, DenizBackground and Objectives: Bowel preparation (BP) for colonoscopy is a challenging procedure in children and different regimens have been used for this purpose. Polyethylene glycol (PEG) is the most preferred agent in recent years. The primary aim of this study was to evaluate the efficacy of 1-day PEG-3350 with bisacodyl (PEG-B) and comparing it with 3-day sennosides A+B. Method: In this prospective, randomized, and single-blinded study, children aged 2-18 years were included in the PEG-B group for 1 day or in Senna group for 3 days. The effectiveness of BP was assessed according to the Ottawa and Boston BP scales, compliance and adverse effects were also recorded. Pre- and post-preparation biochemistry were obtained for investigation of safety of both regimens. Results: Successful BP was observed in 88.3% (n = 53/60) of PEG-B and 86% (n = 55/64) of Senna groups according to Boston scale, and it was 85% (n = 51/60) and 84.4% (n = 54/64), respectively, according to Ottawa scale. The cecal intubation rate was 96.7% (n = 58/60) in the PEG-B group and 93.8% (n = 60/64) in the Senna group. Ease of administration and disturbance in regular daily activities was better in the PEG-B group (p < 0.05). There was no major adverse event and biochemical abnormality in both groups. The correlation between Ottawa and Boston scales was found to be excellent (r(2) = -0.954, p < 0.01). Conclusions: The efficacy, safety, and adverse effect profile of 1-day BP with PEG-B regimen was found to be similar to 3-day sennosides regimen, however, the PEG-B regimen had advantages such as short duration, ease of administration, and better patient comfort. Also, high correlation rate between the Boston and Ottawa scales in pediatric patients was remarkable. (c) 2019 S. Karger AG, BaselPublication Open Access Broadly effective metabolic and immune recovery with C5 inhibition in CHAPLE disease(NATURE RESEARCH, 2021-02) ÖZEN, AHMET OĞUZHAN; Ozen, Ahmet; Kasap, Nurhan; Vujkovic-Cvijin, Ivan; Apps, Richard; Cheung, Foo; Karakoc-Aydiner, Elif; Akkelle, Bilge; Sari, Sinan; Tutar, Engin; Ozcay, Figen; Uygun, Dilara Kocacik; Islek, Ali; Akgun, Gamze; Selcuk, Merve; Sezer, Oya Balci; Zhang, Yu; Kutluk, Gunsel; Topal, Erdem; Sayar, Ersin; Celikel, Cigdem; Houwen, Roderick H. J.; Bingol, Aysen; Ogulur, Ismail; Eltan, Sevgi Bilgic; Snow, Andrew L.; Lake, Camille; Fantoni, Giovanna; Alba, Camille; Sellers, Brian; Chauvin, Samuel D.; Dalgard, Clifton L.; Harari, Olivier; Ni, Yan G.; Wang, Ming-Dauh; Devalaraja-Narashimha, Kishor; Subramanian, Poorani; Ergelen, Rabia; Artan, Reha; Guner, Sukru Nail; Dalgic, Buket; Tsang, John; Belkaid, Yasmine; Ertem, Deniz; Baris, Safa; Lenardo, Michael J.CHAPLE disease is a lethal syndrome caused by genetic loss of the complement regulatory protein CD55. Lenardo, Ozen and their colleagues report that blockade of C5 complement activation in a small cohort of pediatric patients with CHAPLE disease reduced gastrointestinal pathology and restored their immunity and growth. Complement hyperactivation, angiopathic thrombosis and protein-losing enteropathy (CHAPLE disease) is a lethal disease caused by genetic loss of the complement regulatory protein CD55, leading to overactivation of complement and innate immunity together with immunodeficiency due to immunoglobulin wasting in the intestine. We report in vivo human data accumulated using the complement C5 inhibitor eculizumab for the medical treatment of patients with CHAPLE disease. We observed cessation of gastrointestinal pathology together with restoration of normal immunity and metabolism. We found that patients rapidly renormalized immunoglobulin concentrations and other serum proteins as revealed by aptamer profiling, re-established a healthy gut microbiome, discontinued immunoglobulin replacement and other treatments and exhibited catch-up growth. Thus, we show that blockade of C5 by eculizumab effectively re-establishes regulation of the innate immune complement system to substantially reduce the pathophysiological manifestations of CD55 deficiency in humans.Publication Metadata only What is the diagnostic utility of endoscopic scoring systems in children?(AVES, 2013) ÇELİKEL, ÇİĞDEM; Tutar, Engin; Kutluk, Gunsel; Bayrak, Nevzat Aykut; Celikel, Cigdem Ataizi; Pehlivanoglu, Ender; Ertem, DenizBackground/aims: The aim of this study was to evaluate the consistency of the Savary-Miller, the Hetzel-Dent and the Los Angeles endoscopic classification systems and to compare them with the esophageal histopathology in children. Material and Methods: Children between the ages of 5-17 years who underwent esophagogastroduodenoscopy were included in the study. The endoscopic reports and the still images of the esophagus were reclassified by the same gastroenterologist according to the Savary-Miller, Hetzel-Dent and Los Angeles scoring systems. The esophageal biopsies were also reevaluated by the same pathologist and the consistency between endoscopic and histopathologic esophagitis was evaluated. Results: A total of 113 out of 192 pediatric patients were included in the study. Seventy-three patients (64.6%) had esophagitis according to the Hetzel-Dent classification, whereas only 20 (17.7%) patients were defined as having esophagitis according to the other two classification systems. The consistency between the Savary-Miller and Los Angeles classifications was excellent (kappa: 0.92) but the agreement between the Hetzel-Dent and Savary-Miller and between the Hetzel-Dent and Los Angeles classifications were poor. A total of 82 patients (72.6%) had histopathological esophagitis, and there was a weak consistency between all 3 endoscopic scoring systems and the histopathology. Conclusions: Since pediatric patients have milder esophagitis than in adults, the use of endoscopic scoring systems developed for adults seems to be inapplicable for children. The inclusion of minimal endoscopic changes in endoscopic scoring systems by using more sensitive and novel endoscopic techniques would increase the sensitivity of these scoring systems in children.Publication Open Access Çocukluk çağı çölyak hastalığında tanısal faktörlerin değerlendirilmesi: tanımlayıcı retrospektif araştırma(2022-10-01) ŞAHİN AKKELLE, BİLGE; TUTAR, ENGİN; ERTEM ŞAHİNOĞLU, DENİZ; Şahin Akkelle B., Volkan B., Tutar E., Ertem Şahinoğlu D.ÖZET Amaç: Son yıllarda artan farkındalık ve tanı olanaklarıyla çölyak hastalığı (ÇH) tanısı alan hasta sayısının arttığı düşünülmektedir. Çalışmamızda yıllara göre ÇH tanı sıklığının ve tanıya katkıda bulunan faktörlerin değerlendirilmesi hedeflenmiştir. Gereç ve Yöntemler: Çalışmamızda, 2010-2015 ve 2016-2021 yılları arasında ÇH tanısı alan çocuk hastalar sırasıyla Grup 1 ve Grup 2 olarak tanımlandı. Hastalar demografik özellikleri, semptomları, komorbiditeleri, refere edildikleri merkezler açısından değerlendirildi ve veriler gruplar arasında karşılaştırıldı. Bulgular: Çalışmaya dâhil edilen 257 hastanın %37,4’ü (n=96) Grup 1’i oluşturmaktaydı. Tipik/atipik semptomların sıklığı gruplar arasında benzerdi (p>0.05). Tarama sonucu tanı alan asemptomatik hasta oranı Grup 1’de %14,6, Grup 2’de %31,1’di ve gruplar arasındaki fark anlamlıydı (p<0,05). Taramayla tanı alan hastaların çoğunluğu Tip 1 diabetes mellitus tanılı hastalardan (%57,6) oluşmaktaydı. Grup 1’deki hastaların %41,7’sinde, Grup 2’deki hastaların %35,2’sinde ilk başvuru çocuk gastroenteroloji polikliniğine yapılmıştı. Genel pediatri polikliniklerinden refere edilen hasta oranları her iki grupta benzerken, diğer yan dal polikliniklerinden refere edilen hasta oranında son 6 yıllık dönemde artış saptandı. Sonuç: Çalışmamızın sonuçlarına göre son yıllarda ÇH tanısı alan olgu sayısı artmıştır. ÇH ilişkili atipik semptomlar konusunda 1.basamak sağlık hizmetleri veren hekimlerde farkındalığın artması ve tarama programları, yeni vakaların teşhisi için en önemli kaynaklardır.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 Open Access Can gastro-oesophageal reflux be predicted while advancing the endoscope through the laryngeal area? [7](2005-06-01) ERTEM ŞAHİNOĞLU, DENİZ; Ugras M., Ertem D., Cam S., Tutar E., Pehlivanoglu E.[No abstract available]Publication Open Access Pediatrik çölyak hastalarında glutensiz diyet tedavisine uyumu etkileyen faktörlerin değerlendirilmesi(2022-08-01) ŞAHİN AKKELLE, BİLGE; TUTAR, ENGİN; ERTEM ŞAHİNOĞLU, DENİZ; Şahin Akkelle B., Tutar E., Ertem Şahinoğlu D.Amaç: Çölyak hastalığının günümüzde bilinen tek tedavi şekli ömür boyu glutensiz diyet tedavisidir ve hastalığın yönetimindeki en önemli sorun diyete uyumsuzluktur. Bu çalışmada, çocukluk çağında tanı almış çölyak hastalarında diyet tedavisini etkileyen faktörlerin değerlendirilmesi amaçlanmıştır. Bireyler ve Yöntem: Bu çalışmada, çölyak hastalığı tanısı almış ve en az bir yıldır takipli olan 8-18 yaş arasındaki rastgele seçilmiş 92 hasta kesitsel olarak değerlendirilmiştir. Hastaların demografik ve klinik özellikleri, ailelerinin sosyal yapısı ve glutensiz diyet hakkındaki bilgileri incelenmiştir. Hastaların diyete uyumu güncel serum anti-tTG IgA düzeylerine bakılarak değerlendirilmiştir. Seroloji sonucuna göre hastalar, diyete uyumlu ve uyumsuz olarak 2 gruba ayrılmış ve veriler karşılaştırılmıştır. Bulgular: Çalışmaya dahil edilen 92 hastanın güncel yaş ortalaması 13.1±3.5 yıl’dır. Anti-tTG IgA düzeyi normal olan hasta oranı %55.4 olarak saptanmıştır. Diyete uymayan hastalarda yaş ortalamasının daha yüksek (13.8±3.4 yıl; p<0.05) olduğu bulunmuştur. Takip süresi iki yıldan az olan hastaların (%34.8) diyete uyum oranının en yüksek (%68) olduğu bulunmuştur. Kardeş sayısının fazla olması ve kalabalık ev ortamı diyet uyumunu olumsuz etkileyen faktörler olarak tespit edilmiştir. Cinsiyet, tanı yaşı, başvuru semptomları, komorbidite varlığı ve annenin eğitim düzeyi ile diyete uyum arasında ilişki saptanmamıştır. Ebeveynlerin %55.4’ünün çapraz bulaşma konusunda bilgi sahibi olmadıkları tespit edilmiştir. Sonuç: Çalışmanın sonuçlarına göre çocukluk döneminde çölyak hastalarında diyete uyumsuzluk oranı oldukça yüksektir. Çalışmada, tanıdan sonra geçen süre ile diyet uyumu arasında ters ilişki saptanmıştır. Diyetin yaşam şekli olarak benimsenmesi ve istikrarlı bir şekilde uygulanması ile hastalığa ait morbidite ile mortalitenin önlenmesi mümkündür.Publication Open Access Gastrointestinal Manifestations in Children with Primary Immunodeficiencies: Single Center: 12 Years Experience(KARGER, 2019) ÖZEN, AHMET OĞUZHAN; Akkelle, Bilge S.; Tutar, Engin; Volkan, Burcu; Sengul, Ozlem K.; Ozen, Ahmet; Celikel, Cigdem A.; Ertem, DenizBackground: It has been reported that 5-50% of patients with primary immune deficiencies (PID) may present with or develop gastrointestinal (GI) manifestations. Objective: This study was aimed at analyzing GI and related endoscopic, histopathological findings in children with PID. Methods: Children with PID who were evaluated by endoscopy between 2005 and 2016 were enrolled in this study. Demographic data, growth parameters, signs and symptoms at diagnosis were obtained. Results: Of 425 children with PID, 195 had GI manifestations. Forty-seven of 195 children required endoscopic investigation, 30 (63.8%) were male, and the mean age was 7.7 +/- 5 years. The rate of consanguinity was 61.7%, and the most common symptom was chronic diarrhea (57.4%). Seventy-two percent of the patients were malnourished. Giardia intestinalis was detected in 4, and Helicobacter pylori was confirmed in 8/45 (17.7%) patients. Non-celiac villous flatting was discovered in 15.5% of patients. Twelve patients were diagnosed as having immunodeficiency associated inflammatory bowel disease (IBD)-like colitis. Conclusions: PID may present with GI manifestations or develop during the course of the disease. Investigating immunodeficiency in patients with atypical GI symptoms can provide an appropriate therapeutic option, and an improved quality of life, particularly in populations with a high rate of consanguinity.