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Background/Aims: To assess the utility of the DR-70 immunoassay in the diagnosis of gastric cancer. Materials and Methods: A total of 29 patients with histologically proven malignant gastric tumor and 29 healthy blood donors were enrolled in this study. DR-70 immunoassay was performed using an enzyme-linked immunosorbent assay kit to quantify the serum levels of fibrin degradation products. Results: The DR-70 values in patients with gastric cancer significantly differed from the values in controls (p

Aim: To analyze the risk factors of lamivudine treatment failure (LTF) for the long-term use in patients with low viral load (LVL). Material and Methods: In this multicenter study, 548 antiviral naïve noncirrhotic adult patients with LVL (for HBeAg+ patients HBV DNA 9 copies/ml and for HBeAg- patients HBV DNA 7 copies/ml) were enrolled. As a control group, 46 lamivudine-initiated patients with high viral load (HVL) were included. Primary outcome was switching to or adding on another antiviral drug as a consequence of primary nonresponse, partial response, viral breakthrough or adverse events. Secondary outcomes included LTF rates at 1, 2, 3, 4 and 5 years and LTF-related viral and host factors. Results: Among 594 patients, 294 had to change lamivudine at the follow-up. Primary nonresponse, partial response, viral breakthrough or adverse events frequencies were 6.8, 1.6, 64.5 and 0.1%, respectively. Five-year LTF rates were 61.3 and 84.2% in patients with LVL and HVL, respectively. Among patients with LVL, patients with Conclusion: Similar to patients with HVL, first-line lamivudine therapy is not efficient for long-term use in patients with LVL. LTF risk is so high even in the absence of worse predictive factors.

Summary Aim In addition to suppressing fibrinolysis, thrombin activatable fibrinolysis inhibitor (TAFI) was suggested to be involved in inflammation. To date, no study has been published that reports the role of TAFI in acute pancreatitis (AP). Therefore, the objective of the present study was to investigate the role of plasma TAFI as an indicator of inflammation in AP, and its association with disease severity. Methods Plasma TAFI antigen levels quantitatively determined by using ELISA kits in 21 AP patients at onset and remission and 17 healthy controls. Associations of TAFI with inflammatory markers to determine AP and disease severity were assessed. To predict the severity of AP, modified Glasgow prognostic score (mGPS) and computerized tomography severity index (CTSI) were used for each subject. Results Plasma TAFI levels was higher in AP patients at onset of the disease compared with healthy controls. The disease severity according to mGPS was significantly correlated with TAFI levels. Overall, accuracy of TAFI in determining AP was 83.3% with a sensitivity, specificity, NPV and PPV of 80.9%, 85.7%, 81.8%, and 85% respectively (AUC: 0.915). Conclusions The present study for the first time demonstrated that TAFI is elevated in AP. The appraisal of TAFI levels in patients with AP in conjunction with other markers of inflammation may provide additional information in estimating AP severity.

Summary Aim Cholangiocarcinoma (CCA) is a primary neoplastic tumor of the epithelial lining of the biliary tree which carries a poor prognosis despite combined therapeutic strategies. Although the exact etiology remains obscure, it has been suggested that locally produced Angiotensin II (Ang II) in intrahepatic CCA tissues plays a key role in the proliferation and activation of CCA. In the present study, we aimed to analyze the relationship between the levels of circulating angiotensin converting enzyme (ACE), an important molecule of the renin-angiotensin system (RAS), and biliary disorders. Patients and methods The study group comprised 19 extrahepatic cholangiocarcinoma (EHCC) (16 patients with hilar, three patients with distal CCA), and 15 choledocolithiasis (CL) patients, with 15 controls. Median age of EHCC, CL and healthy controls were 67 (48–82), 65 (29–87) and 56 (23–74) respectively. ACE was measured by monitoring the alteration in absorbance at 340 nm of the hydrolysis of furylacrylolylphenylalanylglycylglycine (FAPGG) to FAP and GG on an analyzer. The ACE activity in the sample was determined by comparing the sample reaction rate to that obtained with the ACE calibrator. Results Serum mean ACE levels were 56.6 ± 27.4 U/L, 32.9 ± 14.6 U/L and 28.6 ± 10.6 U/L for patients with EHCC, CL and healthy controls, respectively. Serum ACE levels were significantly higher in patients with EHCC compared to CL and control groups. No significant differences with respect to ACE levels were observed between CL and control groups. Conclusion Circulating ACE in the context of RAS might be associated with EHCC development by creating a local environment enriched with cytokines and other growth factors that may promote cholangiocyte turnover.

The quality of colon cleansing and the tolerance of patients to the procedure are two major determinants of the quality of a colonoscopy. Many bowel-cleansing regimens are known, but there is no ideal regimen. Alverine citrate (Relaxyl, Spasmonal) is a spasmolytic agent that has been shown to affect responses of mechanoreceptors of the intestine to both mechanical and chemical stimuli. Patients who underwent colonoscopies at four centers were randomly assigned two different bowel-cleansing procedures. The bowel-cleansing methods were oral sodium phosphate (NaP) (Group I) and oral NaP plus alverine citrate (Group II). Patients were randomized into one of these regimens. The quality of colon cleansing was assessed by an endoscopist with an empirical, clinically meaningful 3-point scale. Both groups were similar with respect to age, gender, and pre- and postcolonoscopic diagnosis. In Group I, 76 patients (47 women and 29 men; aged 39.53 ± 7.87 years) and in Group II, 71 patients (41 women and 30 men; aged 39.78 ± 8.27 years) were included in the study. In Groups I and II, 37 (48.7%) and 41 (57.7%) patients had perfect bowel cleansing, respectively. The overall colon cleansing in the group with NaP plus alverine citrate was comparable with that in the NaP group. The tolerability of patients to the colonoscopy in the two groups was also similar. Based on the present data, adding oral alverine citrate to NaP does not increase either the quality of bowel cleansing or the tolerance of patients to the procedure.

OBJECTIVE: To investigate the diagnostic value of a terminal ileum biopsy in chronic non-bloody diarrhea with normal endoscopic appearance. METHODS: Patients who had a terminal ileum biopsy performed between January 2007 and January 2010 during a colonoscopy despite normal endoscopic appearance were reviewed. They were divided into two groups according to the indication for the colonoscopy: non-bloody diarrhea and non-diarrhea; and their histopathological findings were compared. RESULTS: By screening the colonoscopy records, 473 patients were found to have had a terminal ileum biopsy. Of these patients, 178 were excluded for various reasons. Finally, 295 patients were suitable for analysis. The non-bloody diarrhea group consisted of 135 patients, while the remaining 160 patients constituted the non-diarrhea group. A histopathological examination of the terminal ileum biopsy specimens in the non-bloody diarrhea group revealed an abnormal histology in eight patients (5.9%), compared with five patients (3.1%) in the non-diarrhea group. No statistically significant difference was found between the two groups (P = 0.26). CONCLUSION: Although performing a biopsy of the terminal ileum despite a macroscopically normal appearance may offer some additional benefit to the diagnosis of chronic non-bloody diarrhea, prospective trials are needed for assessing the diagnostic value of a terminal ileum biopsy in patients with chronic diarrhea.

Hepatoportal sclerosis (HPS) is a clinicopathologic condition that is clinically characterized by portal hypertension (varices and portosystemic collateral vessels), splenomegaly and pancytopenia, in the absence of cirrhosis. Although the etiology is obscure, a number of theories such as immunologic and vascular endothelial cellular abnormalities have been put forward to explain the underlying pathophysiology. Angiotensin-converting enzyme (ACE), an important molecule of the renin–angiotensin system (RAS), is also known as a regulatory molecule in systemic and portal circulation in distinct disorders. The aim of the present study was to investigate the possible role of the ACE in the context of RAS in HPS pathogenesis. The study was conducted on 30 HPS patients (16 men, 14 women; median age 36 years, range 18–63) and 20 healthy controls. The clinical features of HPS patients including demographics, laboratory, and ultrasonography findings were summarized. Serum ACE levels were measured by using commercially available kits. Serum median ACE levels were 36 (8–174) U/l and 16 (8–43) U/l for the HPS patients and controls, respectively. Serum ACE levels were significantly higher in patients with HPS compared to the control group (P

Background: The aim of this study was to evaluate the prevalence and features of the major cutaneous manifestations (erythema nodosum [EN] and pyoderma gangrenosum [PG]) and to determine the associations between cutaneous manifestations and other extraintestinal manifestations in patients with inflammatory bowel disease (IBD). Methods: The mucocutaneous manifestations of patients with IBD were studied between December 2002 and June 2007. All patients underwent a detailed whole body examination by a gastroenterologist and dermatologist. Results: In all, 352 patients were included in this study; 34 patients (9.3%) presented with at least 1 major cutaneous manifestation. The prevalence of EN (26 patients) and PG (8 patients) in IBD was 7.4% and 2.3%, respectively. EN was more common in Crohn's disease (16/118) than ulcerative colitis (10/234) (P = 0.002). EN was found to be related to disease activity of the bowel (P = 0.026). The prevalence of arthritis was significantly higher in the IBD patients with EN (11/26) than in IBD patients without EN (53/326) (P = 0.006). Arthritis was more common in IBD patients with PG (7/8) than in IBD patients without PG (57/344) (P = 0.00). IBD patients with PG were significantly more likely to have uveitis (1/8) compared with IBD patients without PG (5/344) (P = 0.017). Conclusions: We found the prevalence of 2 important cutaneous manifestations to be 9.3% in IBD in Turkish patients. EN was found to be more common in Crohn's disease and is associated with an active episode of bowel disease and peripheral arthritis. In addition, PG was connected with uveitis and peripheral arthritis. (Inflamm Bowel Dis 2009)

Background: Cancer antigen 125 (CA‐125) is a tumor marker used for the diagnosis and monitoring of ovarian carcinoma. It can also be elevated in endometriosis, inflammations, and in nongynecological malignancies. Up to date, serum CA‐125 levels in inflammatory bowel diseases (IBD) have not been studied before. Aim: To assess the levels of CA‐125 in patients with ulcerative colitis (UC) and Crohn's disease (CD). Methods: Serum levels of CA‐125 were investigated in 68 cases with UC (male/female: 47/21), 32 CD (male/female: 21/11), and 31 healthy controls (male/female: 16/15). Levels of CA‐125 were also compared among UC patients according to lesion location, severity, and activity of CD. Results: Serum CA‐125 levels were 17.29±24.50 U/ml, 15.56±20.74 U/ml, and 8.85±2.62 U/ml in patients with UC, CD, and healthy controls, respectively. Serum CA‐125 levels were significantly higher in UC compared to control group (P=0.001). Serum CA‐125 levels were higher in CD patients compared to control group but there was no significance (P=0.087). Serum CA‐125 levels were higher in pancolitis compared to distal type and left‐sided UC. Conclusions: Our data suggest that serum CA‐125 levels may be increased in patients with IBDs. J. Clin. Lab. Anal. 23:244–248, 2009. © 2009 Wiley‐Liss, Inc.

Objetivos:Inflamacao ocular e uma manifestacao extra-intestinal comum de doenca inflamatoria do intestino (IBD) e pode ser paralela a atividade da doenca. Neste estudo, investigamos se a espessura da coroideia pode ser util para avaliar a atividade da IBD.Metodo:Um total de 62 olhos de 31 pacientes com IBD [10 com doenca de Crohn (CD) e 21 colite ulcerosa (UC)] alem de 104 olhos de 52 doadores de sangue saudaveis foram incluidos neste estudo. A espessura da coroide foi medida utilizando-se imagens de tomografia de coerencia optica com profundidade aprimorada. O indice de atividade da doenca Crohn (CDAI) e o indice de Truelove Witts modificado foram usados para avaliar atividade da doenca em CD e UC, respectivamente.Resultados:Nao houve diferenca significativa entre os pacientes com IBD e controles saudaveis em termos de medicoes da espessura da coroide subfoveal media em regiao 3000 μm nasal e 3000 μm temporal (p>0,05). Com base na analise univariada; idade, tabagismo, local do envolvimento em CD (ileal ou ileo-cecal), CDAI, atividade CD e indice de atividade endoscopica da UC foram significativamente correlacionados com a espessura da coroide (p

We read the article by Zissimopoulos et al. with great interest [1]. They aimed to assess the role of Chromogranin A (CgA) in evaluating the disease activity and responsiveness to medical treatment...

The aim of this study was to investigate the changes in serum lipid profiles in biliary obstruction associated with benign and malignant conditions and to find whether they can be used as adjunctive biochemical tumor markers in the differential diagnosis.One hundred and twenty patients (60 malignant, 60 benign) who underwent endoscopic retrograde cholangiopancreatography with the clinical picture of intrahepatic and extrahepatic cholestasis were reviewed in the period from January to July 2008.In the malignant group, significantly higher cholesterol (P0.001), low-density lipoprotein (P0.001), and triglycerides (P0.001) were observed, whereas high-density lipoprotein (P0.001) levels were lower. The receiver operating characteristic analysis showed that high-density lipoprotein 19.5 mg/dl or less [sensitivity: 88.3%, specificity: 83.3%, area under the curve: 0.906 (0.851-0.961), P0.001] and total to -high-density lipoprotein cholesterol ratio at least 17.7 [sensitivity: 80.0%, specificity: 93.1%, area under the curve: 0.921 (0.871-0.971)] were strong predictors of malignant biliary obstruction.Serum lipid profile may be used as an adjunctive marker to identify malignant causes of the obstructive jaundice.

WOS: 000313112900020, PubMed ID: 23063679, BACKGROUND & AIMS: Data are limited on the efficacy and safety of tenofovir and entecavir when given for more than 1 year to patients with hepatitis B-related cirrhosis. We investigated the long-term safety and efficacy of these antiviral drugs in patients with chronic hepatitis B virus (HBV) infection, with compensated or decompensated cirrhosis, and compared results with those from lamivudine. METHODS: We performed a retrospective analysis of data from 227 adult patients with chronic HBV infection who were diagnosed with cirrhosis, beginning in 2005, at 18 centers throughout Turkey. There were 104 patients who had decompensated cirrhosis, and 197 patients were treatment naive before. Seventy-two patients received tenofovir (followed up for 21.4 +/- 9.7 mo), 77 patients received entecavir (followed up for 24.0 +/- 13.3 mo), and 74 patients received lamivudine (followed up for 36.5 +/- 24.1 mo). We collected data on patient demographics and baseline characteristics. Laboratory test results, clinical outcomes, and drug-related adverse events were compared among groups. RESULTS: Levels of HBV DNA less than 400 copies/mL were achieved in 91.5%, 92.5%, and 77% of patients receiving tenofovir, entecavir, or lamivudine, respectively. Levels of alanine aminotransferase normalized in 86.8%, 92.1%, and 71.8% of patients who received tenofovir, entecavir, and lamivudine, respectively. Child-Turcotte-Pugh scores increased among 8.5% of patients who received tenofovir, 15.6% who received entecavir, and 27.4% who received lamivudine. Frequencies of complications from cirrhosis, including hepatic encephalopathy, variceal bleeding, hepatocellular carcinoma, and mortality, were similar among groups. Lamivudine had to be changed to another drug for 32.4% of the patients. CONCLUSIONS: Tenofovir and entecavir are effective and safe for long-term use in patients with compensated or decompensated cirrhosis from HBV infection.

Acute pancreatitis (AP) constitutes a systemic inflammatory process which is often accompanied by thrombosis and bleeding disorders. The role of platelets in the pathophysiology of the disease has not been elucidated yet. Mean platelet volume (MPV) is an index of platelet activation and reported to be influenced by inflammation. The objective of the present study is to assess whether platelet volume would be useful in predicting disease severity in AP. Additionally possible relationship of MPV with clinical and radiologic parameters in conjunction with other inflammatory markers during AP was also investigated.A total of 144 AP patients (male/female: 87/57), and 40 healthy subjects (male/female: 23/17) were enrolled in this study. Mean platelet volume and inflammatory parameters were measured for all study participants. Modified Glasgow Prognostic Score (mGPS) and the computerized tomography severity index (CTSI) were used as to predict the disease severity in AP patients.A statistically significant decrease in MPV levels was observed in AP patients (8.06 ± 0.71 fL) compared with healthy controls (8.63 ± 0.62 fL) (P0.001). According to the mGPS, overall accuracy of MPV in determining severe AP was 72.7% with a sensitivity, specificity, NPV and PPV of 70.6%, 73.9%, 81.9%, and 60 respectively (AUC: 0.762). Overall accuracy of MPV in predicting disease severity according to CTSI was not superior compared with other inflammation markers.The present study demonstrated that MPV is decreased in AP. Assessment of MPV with other inflammatory markers may provide additional information about disease severity in AP.

Background and Aim: Rebleeding has remained the most important determinant of poor prognosis in peptic ulcer bleeding. Gastric acid plays an important role in the pathogenesis of rebleeding. We aimed to compare the efficiency of intermittent and continuous pantoprazole infusion treatment on peptic ulcer rebleeding after endoscopic therapy. Materials and Method: In this prospective study, patients with active peptic ulcer bleeding or non-bleeding visible vessel were treated initially with endoscopic therapy. They were randomized to receive intermittent or continuous intravenous pantoprazole treatment. Rebleeding rate, duration of hospital stay, need for total blood transfusion and need for urgent surgery were compared among both groups. Results: Rebleeding rate (6.1 vs. 8.3%), duration of hospital stay (4.17 vs. 4.41), need for total blood transfusion (2.18 vs. 2.59) and need for urgent surgery (4.1 vs. 4.2%) were similar in intermittent and continuous pantoprazole infusion therapy groups, respectively. There was no bleeding-related death in either group. Conclusion: In patients with peptic ulcer bleeding, intermittent and continuous pantoprazole infusion after successful endoscopic therapy have comparable outcomes in reducing rebleeding. Both have similar effects on hospital stay, need for blood transfusion and urgent surgery. Intermittent administration has application and cost advantages over continuous infusion.

Autosomal-dominant polycystic kidney disease is an inherited disorder characterized by multiple cysts in kidneys and other organs. A 63-year-old man was evaluated for the etiology of recurrent pancreatitis and chronic renal failure. Multiple cysts of kidneys, liver, and pancreas and pancreas divisum was diagnosed. Pancreatitis should be included in the differential diagnosis of abdominal pain in patients with ADPKD. Pancreas divisum may be a predisposing factor for acute pancreatitis in these patients.

Endoscopic retrograde cholangiography (ERCP) has a greater potential for procedure-related complications than other endoscopic procedures in the upper gastrointestinal tract (1). Extraluminal hemorrhagic complications after ERCP are relatively rare but potentially life threatening and, thus, should be identified and treated rapidly (2). In this report, we describe a very rare complication—subcapsular hepatic hematoma—resulting from a guide wire–associated injury that developed 2 days after ERCP. A 41-year-old man was admitted to our hospital with the complaints of new-onset (few hours) right upper quadrant pain. He was known to have hilar cholangiocarcinoma for the last 8 months and his last biliary stent had been replaced 2 days before as an out-patient in our ERCP unit. Physical examination revealed left upper quadrant tenderness and subfebrile fever (37.8◦C). Laboratory data were as follows: hemoglobin 12.1 g/dL, hematocrit 38%, MCV 93 fL, white blood cell count 13.5 × 109/L, platelet count 437 × 109/L. Serum biochemical tests were within normal limits other than alkaline phosphatase 2140 U/L (38–155 IU/L); γ -glutamyltransferase, 508 U/L (15–60 U/L); total bilirubin, 6.16 mg/dL (0.1– 2.0 mg/dL); and direct bilirubin, 4.74 mg/dL (0.1–0.8 mg/dL). Abdominal sonography revealed a 78× 41mm in diameter collection in the anterior part of the liver (Figure 1). There were 3 stents in the common bile duct and intrahepatic biliary ducts. Computerized tomography demonstrated the subcapsular hematoma. He was hospitalized and followed with palliative measurements including intravenous fluid replacement, antibiotics

To the Editor: Ischemic colitis is the most common form of intestinal ischemia. Although frequent in the elderly, younger patients may also be affected (1). Very few cases have been reported following endoscopic examinations thus far (2,3). Here we present a case of ischemic colitis following colonoscopy in a young patient with no risk factor.