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BACKGROUND: The aim of the study was to evaluate familial Mediterranean fever (FMF) mutation analysis in pediatric patients with inflammatory bowel disease (IBD). The relation between MEFV mutations and chronic inflammatory diseases has been reported previously. METHODS: Children with IBD (334 ulcerative colitis (UC), 224 Crohn’s disease (CD), 39 indeterminate colitis (IC)) were tested for FMF mutations in this multicenter study. The distribution of mutations according to disease type, histopathological findings, and disease activity indexes was determined. RESULTS: A total of 597 children (mean age: 10.8 ± 4.6 years, M/F: 1.05) with IBD were included in the study. In this study, 41.9% of the patients had FMF mutations. E148Q was the most common mutation in UC and CD, and M694V in IC (30.5%, 34.5%, 47.1%, respectively). There was a significant difference in terms of endoscopic and histopathological findings according to mutation types (homozygous/heterozygous) in patients with UC (P < .05). There was a statistically significant difference between colonoscopy findings in patients with or without mutations (P = .031, P = .045, respectively). The patients with UC who had mutations had lower Pediatric Ulcerative Colitis Activity Index (PUCAI) scores than the patients without mutations (P = .007). Conclusion: Although FMF mutations are unrelated to CD patients, but observed in UC patients with low PUCAI scores, it was established that mutations do not have a high impact on inflammatory response and clinical outcome of the disease.

BACKGROUND/OBJECTIVES: We analyzed the nationwide pediatric inflammatory bowel disease (PIBD) registry (1998-2016), to evaluate the nutritional status at the time of diagnosis. SUBJECTS/METHODS: Nine types of nutritional status by the combination of weight-for-length (2 years) and length/height-for-age with three categories (2 SD) were described. Malnutrition was defined by WHO criteria. Univariate and multivariate regression analysis was used to identify risk factors for malnutrition. RESULTS: In total, 824 IBD patients (498 Ulcerative colitis (UC); 289 Crohn's Disease (CD); 37 Indeterminate Colitis (IC); 412 male; the median age 12.5 years) were eligible. The prevalence of eutrophy, wasting/thinness, stunting, overweight, tall stature, concurrent wasting/thinness and stunting, tall stature with overweight, tall stature with wasting/thinness, and short stature with overweight were 67.4%, 14.9%, 6.6%, 3.1%, 3.2%, 3.3%, 1.1%, 0.4%, and 0.1%, respectively. The prevalence of malnutrition was 32.7%, indicating a higher prevalence in CD (p < 0.001). Incidence of overweight was less common in the CD than UC and IC (p < 0.001). Multivariate analysis revealed that age of onset (>10 years), prepubertal stage, severe disease activity, perianal involvement, and high C reactive protein level were independently associated with malnutrition in pediatric IBD. CONCLUSION: We showed the frequency of nutritional impairment in PIBD. The percentage of overweight subjects was lower than the other studies. The age of onset, disease activity, CRP level, perianal involvement, and pubertal stage were associated with a higher risk for developing malnutrition. Our results also confirmed that CD patients are particularly vulnerable to nutritional impairment., Society of Turkish Pediatric Gastroenterology, Hepatology, and Nutrition, This research was funded by The Society of Turkish Pediatric Gastroenterology, Hepatology, and Nutrition.

Objective: The presence of a foreign body in the esophagus represents one of the gastroenterological emergencies. In this study, we aimed to evaluate retrospectively foreign bodies attached to the esophagus. Materials and Methods: The files of pediatric patients admitted to the university hospital due to ingestion of foreign bodies between January 2018 and January 2019 were examined retrospectively, and those attached to the esophagus were evaluated. Results: A total of 215 pediatric patients were admitted with the complaint of foreign bodies ingestion, and 63 (29.3%) of them had foreign bodies impacted in the esophagus. The mean age of the 63 patients (55.6% males) was 4.8+-3.9 years. The mean age of 152 cases (58% males) was 5.3+-3.8 years. Of the cases with foreign bodies impacted in the esophagus, 10% were Syrian refugees. Most of the foreign bodies removed from the esophagus endoscopically were coins, which were frequently attached to the upper esophageal sphincter. In the remaining patients, the foreign bodies (mostly coins) pass through the gastrointestinal tract without any problems. Conclusion: Endoscopy is an important method in the treatment of esophageal foreign bodies. An early intervention is important in patients who ingested a button battery. However, adolescents who have food impacted in the esophagus should be evaluated earlier in terms of eosinophilic esophagitis.

Background: Gastric adenocarcinoma is an extremely rare tumor with a poor prognosis in childhood. Patients are usually diagnosed late, as they present with non-specific symptoms and therefore, patients have low survival rates after diagnosis.

Dear Editor,We have read with great interest the publication entitled “The Relationship between Blood Groups and patients with COVID-19 (1).” In the study, the author points out that the frequencies of blood groups in patientswith COVID-19 and recommends that “people with blood type A behave more sensitively in terms of following the protection measures.” In this study, there is not a control group that represents the population. Theblood group variable is compared within the patient group. The author cited Cekdemir’s study (2) for reference, but no statistical comparison was made between the two studies. Moreover, we see that the distributionof blood groups are varied within the regions in Turkey (2). Without a proper control group, evaluating theblood groups cannot give us a view or risk ratio for the entire population. We know there are some studiesfrom different countries regarding the ABO blood groups and COVID-19. A recent meta-analysis suggeststhat blood type A may be more susceptible to infect COVID-19, while blood type O may be less susceptibleto infect COVID-19 (3). A recent study from Turkey (4) that has an own reference group which is comparedstatistically also shows similar results. On the other hand, Dzik et al. (5) pointed that selecting a proper controlgroup is crucial for these studies. Simple blood bank donors may not be a suitable reference group becauseblood donors are known to be selected in favor of blood group O persons who preferred as donors. ABOblood group also varies by ethnicity, and this may influence the observed ABO distribution when comparingpatients versus uninfected group. Without a proper reference population comparison within this framework,this study cannot directly show a risk towards a specific blood group in COVID-19. Additionally, the authorconcluded that “a statistically significant difference was found concerning the symptom of cough accordingto the blood groups of the patients.” However, in the last paragraph, the author concluded that “there wasno difference between the symptom states according to blood groups.” If there were a difference, it would bebetter to show in which groups.

Background: Gastrointestinal duplication cysts are rare congenital anomalies that are most often localized in the ileum. The condition is usually diagnosed within the first year of life. Case Report: Here, we report an infantile case presented with severe anemia and melena accompanied by a gastric duplication cyst. Conclusion: Duplication cysts should be kept in mind in the differential diagnosis of melena.

Objectives: Evidence suggests that lysosomal acid lipase deficiency (LAL-D) is often underdiagnosed because symptoms may be nonspecific. We aimed to investigate the prevalence of LAL-D in children with unexplained liver disease and to identify demographic and clinical features with a prospective, multicenter, cross-sectional study., Methods: Patients (aged 3 months-18 years) who had unexplained transaminase elevation, unexplained hepatomegaly or hepatosplenomegaly, obesity-unrelated liver steatosis, biopsy-proven cryptogenic fibrosis and cirrhosis, or liver transplantation for cryptogenic cirrhosis were enrolled. A Web-based electronic data collection system was used. LAL activity (nmol/punch/h) was measured using the dried blood spot method and classified as LAL-D(0.37). Asecond dried blood spot sample was obtained from patients with intermediate LAL activity for confirmation of the result., Results: A total of 810 children (median age 5.6 years) from 795 families were enrolled. The reasons for enrollment were unexplained transaminase elevation (62%), unexplained organomegaly (45%), obesity-unrelated liver steatosis (26%), cryptogenic fibrosis and cirrhosis (6%), and liver transplantation for cryptogenic cirrhosis (, Conclusions: Overall, the frequency of LAL-D patients in this study (0.1%) suggests that LAL-D seems to be rare even in the selected high-risk population., C1 [Kuloglu, Zarife; Kansu, Aydan; Selbuz, Suna] Ankara Univ, Sch Med, Dept Pediat Gastroenterol Hepatol & Nutr, Ankara, Turkey., [Kalayci, Ayhan G.] Ondokuz Mayis Univ, Sch Med, Dept Pediat Gastroenterol Hepatol & Nutr, Samsun, Turkey., [Sahin, Gulseren] Dr Sami Ulus Childrens Hosp, Dept Pediat Gastroenterol Hepatol & Nutr, Ankara, Turkey., [Kirsaclioglu, Ceyda Tuna] Haematol Oncol Training & Res Hosp, Ankara Child Hlth Dis, Turkish Republ Hlth Minist, Dept Pediat Gastroenterol Hepatol & Nutr, Ankara, Turkey., [Demiroren, Kaan] Yuzuncu Yil Univ, Fac Med, Dept Pediat Gastroenterol Hepatol & Nutr, Van, Turkey., [Dalgic, Buket] Gazi Univ Univ, Dept Pediat Gastroenterol Hepatol & Nutr, Ankara, Turkey., [Kasirga, Erhun] Celal Bayar Univ, Fac Med, Dept Pediat Gastroenterol Hepatol & Nutr, Manisa, Turkey., [Onal, Zerrin] Univ Med Sci, Bakirkoy Dr Sadi Konuk Res & Training Ctr, Dept Pediat Gastroenterol Hepatol & Nutr, Istanbul, Turkey., [Islek, Ali] Ataturk Univ, Fac Med, Dept Pediat Gastroenterol Hepatol & Nutr, Erzurum, Turkey., [Eren, Esra] Ondokuz Mayis Univ, Sch Med, Samsun, Turkey., [Hosnut, Ferda Ozbay] Dr Sami Ulus Childrens Hosp, Ankara, Turkey., [Urganci, Nafiye; Usta, Ayse Merve] Sisli Etfal Training & Res Hosp, Istanbul, Turkey., [Yaman, Aytac] Haematol Oncol Training & Res Hosp, Ankara Child Hlth Dis, Turkish Republ Hlth Minist, Ankara, Turkey., [Ozkan, Tanju] Uludag Univ, Fac Med, Bursa, Turkey., [Bozbulut, Eksi] Gazi Univ, Fac Med, Ankara, Turkey., [Dogan, Guzide] Celal Bayar Univ, Fac Med, Manisa, Turkey., [Arslan, Duran] Erciyes Univ, Fac Med, Kayseri, Turkey., [Akcam, Mustafa] Suleyman Demirel Univ, Sch Med, Isparta, Turkey., [Isik, Ishak Abdurrahman] Antalya Training & Res Hosp, Antalya, Turkey., [Ecevit, Cigdem Omur; Erdemir, Gulin] Dr Behcet Uz Children Dis & Surg Training & Res H, Izmir, Turkey., [Usta, Yusuf] Mersin Univ, Fac Med, Mersin, Turkey., [Ozgur, Taner] Uludag Univ, Fac Med, Bursa, Turkey., [Ozcay, Figen; Gulsan, Meltem] Baskent Univ, Fac Med, Ankara, Turkey., [Balamtekin, Necati] Guhane Training & Res Hosp, Ankara, Turkey., [Ozturk, Yesim] Dokuz Eylul Univ, Fac Med, Izmir, Turkey., [Cantez, Serdar] Istanbul Univ, Istanbul Fac Med, Istanbul, Turkey., [Gulerman, Fulya; Guven, Burcu] Kirikkale Univ, Fac Med, Kirikkale, Turkey., [Ustundag, Gonca Handan] Bulent Ecevit Uni, Fac Med, Zonguldak, Turkey., [Emiroglu, Halil Haldun] Selcuk Univ, Fac Med, Konya, Turkey., [Karacabey, Neslihan] Erciyes Univ, Fac Med, Kayseri, Turkey., [Comba, Atakan] Hitit Univ, Fac Med, Corum, Turkey., [Aydogan, Aysen Uncuoglu] Kocaeli Univ, Sch Med, Kocaeli, Turkey., [Gokce, Selim] Bezmialem Univ, Fac Med, Istanbul, Turkey., [Kuyum, Pinar] Dokuz Eylul Univ, Fac Med, Izmir, Turkey., [Tosun, Mahya Sultan] Denizli State Hosp, Denizli, Turkey., [Tokgoz, Yavuz] Adnan Menderes Univ, Fac Med, Adnan, Turkey., [Yuksekkaya, Hasan] Necmenttin Erbakan Univ, Fac Med, Ankara, Turkey., [Tumgor, Gokhan; Agin, Mehmet] Cukurova Univ, Fac Med, Ankara, Turkey., [Eren, Makbule] Eskisehir Osmangazi Univ, Fac Med, Eskisehir, Turkey., [Baran, Masallah] Izmir Tepec Training & Res Hosp, Izmir, Turkey., [Gumus, Meltem] Konya Egitim Konya Training & Res Hosp, Konya, Turkey., [Canan, Oguz] Adana Baskent Univ, Adana, Turkey., [Kocamaz, Halil] Pamukkale Univ, Fac Med, Denizli, Turkey., [Cakir, Murat] Karadeniz Tech Univ, Fac Med, Trabzon, Turkey., [Hizli, Samil; Balci Sezer, Oya] Kecioren Training & Res Hosp, Ankara, Turkey., [Dogan, Yasar; Deveci, Ugur] Firat Univ, Fac Med, Elazig, Turkey., [Celtik, Coskun] Sifa Univ, Izmir, Turkey.

Background and Objectives: Glutamine is a nonessential amino acid which improves intestinal mucosal regeneration and absorption. Glutathione is a vital molecule for antioxidant reactions and is synthesized from cystine. The first aim of the study is to measure the plasma glutamine and cystine in children with celiac disease (CD) and compare them with controls. The second aim of this study is to investigate whether these amino acids are correlated with endomysial antibody (EMA) or not. Methods and Study Design: Fifty children with CD were compared to 50 healthy, age, and sex matched normal children as control. Plasma glutamine and cystine levels of the children were measured by using tandem mass spectrometry. Results: Plasma glutamine (808 vs 870 mu mol/L) and cystine (19 vs 48.5 mu mol/L) were significantly lower in the celiac group than the controls (p0.05). Serum EMA was negatively correlated with plasma cystine (r=-0,321, p=0.023), glutamine (r=-0.413, p=0.003). Conclusions: Our study indicated that plasma glutamine and cystine were significantly lower in the celiac children than the controls. Also, these amino acids were negatively correlated with EMA.

Background & aim: plasma amino acid levels may show differences in regard to physiological changes, diet and diseases. The aim of the study is to measure the amino acid levels in children with celiac disease and compare them with the controls. Material and methods: sixty-two children with classic celiac disease and 62 age and sex matched healthy control were enrolled in this study. Plasma amino acid levels of the children were measured by using tandem mass spectrometry. Results: celiac children had significant lower plasma levels of citrülline, glutamine and cystine than control (p0.05). Conclusions: this study indicated that plasma amino acid levels can be variable in the celiac disease. Further studies with a large number size are needed whether plasma amino acids assays help to reflect of the intestinal mucosal damage and for following compatibility of gluten free diet in the celiac patients. Antecedentes y objetivo: los niveles de aminoácidos en plasma pueden mostrar diferencias en lo que se refiere a los cambios fisiológicos, la dieta y las enfermedades. El objetivo del estudio es medir los niveles de aminoácidos en los niños con enfermedad celíaca y compararlos con los controles. Materiales y metodos: en este estudio se inscribieron 62 niños con enfermedad celíaca clásica emparejados por edad y sexo con 62 controles sanos. Los niveles de aminoácidos en plasma de los niños se midieron utilizando la espectrometría de masas. Resultados: los niños celíacos tenían niveles significativamente inferiores plasmáticos de citrulina, glutamina y cistina que el grupo control (p < 0,05). Alanina, asparagina, ácido glutámico, hidroxiprolina, isoleucina, leucina, fenilalanina, prolina, serina, treonina y valina fueron significativamente mayores en los niños celíacos que en los controles (p < 0,05). Por otro lado, no hubo ninguna diferencia significativa en los niveles de arginina, argininosuccinato, ácido aspártico, glicina, homocisteína, lisina, hidroxilisina, metionina, ornitina, triptófano, tirosina, histidina entre los niños celíacos y los controles sanos (p > 0,05). Conclusiones: este estudio mostró que los niveles de aminoácidos en plasma pueden ser variables en la enfermedad celíaca. Se necesitan estudios con un tamaño mayor para conocer si los ensayos de aminoácidos en plasma ayudan a reflejar la lesión de la mucosa intestinal y para el seguimiento de la compatibilidad de la dieta libre de gluten en los pacientes celíacos.

Background & aim: plasma amino acid levels may show differences in regard to physiological changes, diet and diseases. The aim of the study is to measure the amino acid levels in children with celiac disease and compare them with the controls.