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Objective: Inflammatory bowel disease (IBD) is a chronic, relapsing, and remittent inflammatory disease of the gastrointestinal tract. Nutritional deficiency may be instrumental in and attributable to this disease. We examined the effect of VitB12 supplementation on acetic acid (AA)-induced colitis in rats. Material and Methods: Five minutes after the application of acetic acid to the rats to create a colitis model, VitB12 was administered 1 mg/kg, i.p concentration, then the application continued for three consecutive days. Control groups were included for colitis and VitB12. After 4d, the rats were sacrificed, and colonic tissues were harvested for macroscopic and microscopic examination of colonic damage. TNF-α, IL-1β, IL-6, MDA, GSH and SOD values were measured biochemically. Results: There was statistically significant macroscopic improvement in damage to the colon tissues (p< 0.05). The severity of inflammation reduced in the VitB12 treated rat group compared with the control group, but was not significantly. The levels of TNF-α, IL-1β, MDA, and SOD did not differ between AA control and VitB12 treated AA colitis group. However, the levels of IL-6 and GSH were statistically significant different in rats with AA-induced colitis after VitB12 injection (p< 0.05). Conclusion: Nutritional deficiencies might contribute to the pathogenesis of IBD, and the efficacy of VitB12 supplementation has controversial effects on the intestinal mucosa.

With the ongoing COVID-19 pandemic, several previous studies from different countries showed that physical activity (PA) decreased during the COVID-19 outbreak. However, few studies have examined the recent tendency of PA in the adolescent population. Thus, we aimed to investigate the long-term trend of PA in Korean youth and the prevalence changes between before and during the COVID-19 pandemic.Data from Korea Youth Risk Behavior Web-Based Survey (KYRBS) was collected for consecutive years between 2009 and 2021. The period was separated into pre-pandemic (2009-2019), early-pandemic (2020), and mid-pandemic (2021). Self-reported amount of PA was categorized into four groups (insufficient, aerobic, muscle strengthening, and both physical activities) according to World Health Organization PA guidelines.A total of 840,488 adolescents aged 12-18 who fully responded to the survey were selected (response rate: 95.2%). The 13-year trends in the proportion of adolescents who reported aerobic and muscle-strengthening activities met or exceeded 2020 WHO exercise guidelines for adolescents plateaued (11.9% from 2009-2011, 14.2% from 2018-2019, 14.4% from 2020, and 14.0% from 2021); however, the slope decreased during the pandemic (βThrough a nationwide representative study, there was no significant difference with regard to the number of Korean adolescents who achieved the PA guidelines (pre-and-post-pandemic); however, the prevalence of recommended levels of PA needs to increase more based on the trend before the COVID-19 outbreak. The findings of this study suggest reinforcement of the importance of public health policies for Korean youths to be more physically active, especially during and after the pandemic. This article is protected by copyright. All rights reserved.

Background and aims Development of noninvasive liver fibrosis indexes has been research of interest due to the limitations of liver biopsy. Therefore, we aimed to develop and evaluate the diagnostic accuracy of a novel noninvasive index for predicting significant fibrosis, advanced fibrosis and cirrhosis in patients with chronic hepatitis B (CHB) infection based on age and routine clinical laboratory tests. Methods A total of 396 treatment naive liver biopsy performed patients were divided into training (n = 262) and validation cohorts (n = 134). Histological staging was assessed by Ishak fibrosis scoring system. Results In training cohort, we developed a novel fibrosis index, GAPI, using γ-glutamyl transpeptidase (GGT), age, platelet, and international normalized ratio (INR) results. The diagnostic accuracies of alanine aminotransferase ratio, age platelet index, aspartate aminotransferase to platelet ratio index, GGT to platelet ratio index, AST to lymphocyte ratio index, fibrosis index based on the four factors, Fibro Q, Goteborg University Cirrhosis Index, King's score, Pohl score, Wang I, fibrosis index, fibrosis cirrhosis index, cirrhosis discriminant score, Lok score, Doha score, Mehdi's model, GqHBsAg, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, RDW to lymphocyte ratio, RDW to platelet ratio, GGT/INR, GGT/albumin, white blood cell/platelet distribution width (PDW), mean platelet volume/PDW and platelet/PDW indexes were compared to GAPI index. For the prediction of significant fibrosis, advanced fibrosis and cirrhosis, the area under the receiver operating characteristic curves (AUROCs) of GAPI index were 0.776, 0.868, and 0.885 in training cohort, and 0.731, 0.883, and 0.919 in validation cohort, respectively. The AUROCs of the GAPI index were higher than those of the evaluated 27 noninvasive indexes to predict significant fibrosis, advanced fibrosis, and cirrhosis. Conclusion In resource limited settings, GAPI is a promising noninvasive liver fibrosis index for predicting significant fibrosis, advanced fibrosis and cirrhosis, and for decreasing the need for liver biopsy in patients with CHB infection using cutoff points of 2.00 and 3.50.

Background/aims To date, there is no standard tool to diagnose gastroesophageal reflux disease (GERD). Typically, GERD is a non-erosive reflux disease (NERD) that does not present endoscopic abnormalities. Confocal laser endomicroscopy (CLE) has been shown to be an effective tool to identify and diagnose GERD. We aimed to investigate the cellular and vascular changes in vivo and ex vivo through CLE in patients with GERD. Methods Patients with refractory GERD who underwent mucosectomy were recruited. The distal esophagus was observed in vivo using CLE. Mucosectomy tissue was stained with acriflavine and CLE image was obtained ex vivo. We compared cellular and vascular changes in CLE between erosive reflux disease (ERD), NERD, and a control group. Results Eleven patients who underwent anti-reflux mucosectomy and five control patients were enrolled in the study. Patients with ERD and NERD presented greater dilated intercellular space than patients in the control group on CLE image. The diameter, number, and cross-sectional area of the intra-papillary capillary loops (IPCLs) were significantly larger in the ERD group than in the NERD group. The irregular shape of the IPCLs were observed in both patients with ERD and NERD. Conclusions The irregular shape of the IPCLs were significantly correlated with a positive diagnosis of GERD. CLE may diagnose NERD with high sensitivity and accuracy.

Peroral endoscopic myotomy has been recognized as an effective treatment for patients with achalasia. Prior treatment may affect the outcome of subsequent treatment. We aimed to compare the safety and efficacy of POEM in treatment-naive patients vs. those with prior treatment failure. We retrospectively analyzed the data of achalasia patients who underwent POEM from November 2011 to January 2018. A comparative analysis was performed between De-Novo (DN) and Prior Treatment Failure (PTF) cases. Technical and clinical success, adverse events, operative time for POEM, hospital stay were compared between the two groups Overall, 209 patients with achalasia underwent POEM during the studied period, including 113 patients (54%) in the DN group and 96 patients (45%) in the PTF group. The baseline characteristics of the DN and PTF groups were not significantly different except for duration of disease. The PTF group had longer disease duration than the DN group. (7.92 ± 9.28 vs 4.45 ± 5.67 years, respectively, p = 0.005). Both groups were technically successful. Operative time was longer in the PTF group than that in the de-novo group, but the difference was not significant. The occurrence rates of complications were similar in both groups. Changes in the Eckardt score were comparable in the DN and PTF cases. IRP and LES pressure decreased after POEM. After 6 months, more patients suffered from reflux symptoms in the PTF group, but DeMeester score and endoscopic evaluation were not significantly different POEM is safe and equally effective for patients with prior treatment failure as well as de-novo patients up to 6 months post treatment.

AIM: It was to assess the diagnostic performance characteristics of a novel index, (ABA), which utilizes age, bilirubin and albumin to predict significant and severe fibrosis, and cirrhosis in patients with chronic hepatitis C infection. METHODS: A total of 114 patients were included in this study. The liver biopsies were graded using the Ishak scoring system. Diagnostic performance of the ABA index was compared to aspartate aminotransferase (AST) to alanine aminotransferase ratio, age platelet index, AST to platelet ratio index, γ-glutamyl transpeptidase (GGT) to platelet ratio index, FIB-4, FibroQ, Goteborg University Cirrhosis Index, King's score, GGT/international normalization ratio, platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, white blood cell to platelet distribution width ratio and mean platelet volume to platelet distribution width ratio (MPV/PDW) by receiver operating characteristics (ROC) curve analysis. RESULTS: The ABA index was formulated as 1.5 + (0.065 × age) + (1.85 × bilirubin) - (1.65 × albumin) according to the multivariate logistic regression analysis. According to the ROC curve analyses, the ABA index had the area under these ROC curves (AUROCs) of 0.805 [95% confidence interval (CI), 0.727-0.883] for significant fibrosis, 0.874 (95% CI, 0.804-0.943) for severe fibrosis and 0.895 (95% CI, 0.828-0.961) for cirrhosis. CONCLUSION: The ABA index was found to be superior to other evaluated noninvasive indexes of liver fibrosis by use of the cutoff point of 0 and 1. These findings should be confirmed by prospective and multicenter studies in patients with chronic hepatitis C infection.

ObjectiveThe adverse effects of proton pump inhibitors (PPIs) have been documented for pneumonia; however, there is no consensus regarding whether the use of PPIs might be harmful regarding the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this regard, we aimed to measure the potential associations of the current use of PPIs with the infection rates of COVID-19 among patients who underwent SARS-CoV-2 testing.DesignData were derived from a Korean nationwide cohort study with propensity score matching. We included 132 316 patients older than 18 years who tested for SARS-CoV-2 between 1 January and 15 May 2020. Endpoints were SARS-CoV-2 positivity (primary) and severe clinical outcomes of COVID-19 (secondary: admission to intensive care unit, administration of invasive ventilation or death).ResultsIn the entire cohort, there were 111 911 non-users, 14 163 current PPI users and 6242 past PPI users. After propensity score matching, the SARS-CoV-2 test positivity rate was not associated with the current or past use of PPIs. Among patients with confirmed COVID-19, the current use of PPIs conferred a 79% greater risk of severe clinical outcomes of COVID-19, while the relationship with the past use of PPIs remained insignificant. Current PPI use starting within the previous 30 days was associated with a 90% increased risk of severe clinical outcomes of COVID-19.ConclusionPatients taking PPIs are at increased risk for severe clinical outcomes of COVID-19 but not susceptible to SARS-CoV-2 infection. This suggests that physicians need to assess benefit–risk assessments in the management of acid-related diseases amid the COVID-19 pandemic.

We appreciate the comment and discussion from Dr Roulet1 on our original article.2 The author criticised that (1) our study did not consider the dose-dependent exposure to proton pump inhibitors (PPIs); (2) our study did not investigate the relationship of PPI use in hospitalised patients with COVID-19 during treatment for COVID-19 and (3) although our study accounted for protopathic bias by excluding new non-steroidal anti-inflammatory drug users, protopathic bias occurred in patients who responded to the early digestive symptoms of COVID-19. We acknowledge that plausible academic concerns have been raised, which might improve the original discussion and extend the insight into the association between PPI usage and COVID-19.1 We have performed a post-hoc analysis from the Korean nationwide cohort, addressing these concern. Data were obtained from the Korean nationwide cohort study, which includes patients (≥18 years) who underwent SARS-CoV-2 testing between 1 January and 15 May 2020.2–4 We performed propensity score matching between current PPI users (prehospitalisation PPI usage) and non-users among patients with laboratory-confirmed COVID-19 (n=4785), as previously described.2 Posthospitalisation PPI usage was defined as in-hospital PPI use in general wards, not intensive care units. The outcomes were a composite endpoint 1 (requirement of oxygen therapy, intensive care unit admission, administration of invasive ventilation or death) and a composite endpoint 2 …

WOS:000433028600003 PubMed: 29593799 Introduction: Helicobacter pylori infection is a common infection worldwide. The most frequently recommended treatment for eradication of H. pylori remains triple therapy. In this study, we compared sequential and hybrid regimens for H. pylori eradication in a region of Turkey with high resistance to clarithromycin. Material and methods: Three hundred and forty H. pylori-positive patients were enrolled in the study. The subjects were randomly divided into two groups. The first group (170 patients) received rabeprazole (40 mg/b.i.d.) and amoxicillin (1000 mg/b.i.d.) for 2 weeks and metronidazole and clarithromycin (500 mg/b.i.d.) during the second week in the hybrid therapy group. The second group (170 patients) received rabeprazole (40 mg/b.i.d.) for 14 days, amoxicillin (1000 mg/b.i.d.) for the first 7 days, and metronidazole plus clarithromycin (each 500 mg/b.i.d.) during the next 7 days in the sequential therapy group. Results: In the per-protocol analysis, the eradication rate in the hybrid therapy group was 96.1% (147/153), and in the sequential therapy group it was 90.9% (140/154). There was no significant difference between the two groups (p = 0.06). Ninety-seven of those 340 patients reported minor adverse drug reactions. The percentages of patients with adverse reactions were 30.6% in the hybrid therapy group and 26.5% in the sequential therapy group (p = 0.74). Conclusions: Both therapies are highly effective for eradication of H. pylori, and could be recommended as a first-line therapy in regions with high antibiotic resistance.

The management of food impaction and foreign body ingestion in the upper gastrointestinal tract requires careful evaluation and timely intervention. This study was a retrospective evaluation of the management of adult patients with such a history.This study included adult patients admitted to a tertiary medical center with foreign body ingestion or food impaction between January 2012 and January 2018. The demographic and clinical data were recorded pro forma for statistical analysis.Of the 122 patients included in this study, 53.2% were male, and the mean age was 46.68+-18.64 years. In 84 of the patients (68.8%), the ingested object was food. Thirty patients were managed solely through laryngoscopy, while 61 patients (50%) underwent a flexible endoscopy. The patients with a foreign body ingestion were older than those with a food impaction (mean age: 51.3+-17.4 vs. 36.5+-17.4 years; p0.001) and a plain radiograph showed the ingested material more often in those patients (36.8% vs 10.7%; p0.001). Two patients underwent surgery due to perforations caused by the impacted material. No mortality was observed.The management of a foreign body ingestion or food impaction in an emergency setting requires a stepwise, algorithmic approach.

WOS:000396726500009 PubMed: 28337237 Introduction: Whether Helicobacter pylori triggers celiac disease (CD) or protects against CD is currently the subject of research. In the literature, there are epidemiologic studies that have reported conflicting results regarding the association between H. pylori and CD. Aim: To compare the prevalence of CD autoantibody positivity and the levels of CD autoantibodies between H. pylori-positive and H. pylori-negative subjects. Material and methods: This study was prospectively designed and included 240 dyspeptic patients who underwent upper gastrointestinal endoscopy with gastric and duodenal biopsies. The patients were divided into two groups according to presence of H. pylori infection. The serum levels of immunoglobulin (Ig) A, tissue transglutaminase antibodies (tTGA; IgA and IgG classes), and anti-endomysial antibodies (EMA; IgA and IgG classes) were measured for all participants by a blinded biochemistry expert. Results: There were no significant differences in the serum levels of CD autoantibodies or IgA between the two groups. There were also no significant differences in the percentages of subjects with positive CD serologies or subjects with IgA deficiencies between the groups. Conclusions: Helicobacter pylori remains one of the bacterial species that is most likely to trigger autoimmunity. However, studies have failed to reveal a relationship between H. pylori and CD; thus, additional basic work on the immunological aspects of the microbial-host interactions and longitudinal studies enrolling patients at very early stages of the disease may help us to address this issue.

Background/aim: To investigate whether focal high maximum standardized uptake value (SUVmax) determined by 18-fluorodeoxyglucose (FDG) positron emission tomography (PET)-computed tomography (CT) imaging is correlated with proliferation index in the colorectal region. Materials and methods: SUVmax values of 31 colorectal neoplasms that were incidentally detected during PET-CT examination were compared to dysplasia degree, histopathologic diagnosis, and immunohistochemical expression of the Ki-67 proliferation marker. Results: Statistically significant correlations were found between SUVmax and Ki-67 proliferation index, dysplasia degree, and histopathologic diagnosis. Median SUVmax value was found to be significantly higher in high-risk lesions than low-risk lesions. Conclusion: The Ki-67 proliferation index is an indicator of SUVmax in colorectal tract. SUVmax values can predict malignancy and prognosis in this region. Colonoscopy and biopsy should always be performed whenever a focal high FDG uptake is determined incidentally in a patient.

Background/aim: The incidence of acute cholecystitis (AC) increases with age, and aging is also one of the poor prognostic factors. Aging is related to altered physiology, so diseases may show different characteristics in elderly patients. We aimed to investigate the differences between the main characteristic features of AC in elderly and nonelderly patients. Materials and methods: In this retrospective study, patients who had a diagnosis of AC were included and divided into two groups of people aged

Background Helicobacter pylori (H.pylori) is associated with chronic gastritis, peptic ulcers, gastric adenocarcinomas and mucosa associated tissue lymphomas. Cytotoxin associated gene A (CagA) is one of the virulence factors of H.pylori. It is hypothesized that reactive oxygen species (ROS) play roles in H.pylori associated disease especially in development of gastric adenocarcinoma. Individuals infected with H.pylori bearing CagA produce more ROS than others. 8-hydroxydeoxyguanosine (8OHdG) is an in vitro marker of DNA damage and oxidative stress. The aim of this study was to investigate the relationship between 8OHdG level, H.pylori infection and CagA and alterations of serum 8OHdG level after H.pylori eradication. Materials and methods Patients admitted with dyspeptic complaints and upper gastrointestinal endoscopy were assessed. H.pylori was determined from histopathology of specimens. Serum 8OHdG levels of three groups (H.pylori negative, H. pylori positive CagA negative and H.pylori positive CagA positive) were compared. Patients with H.pylori infection received eradication therapy. Serum 8OHdG levels pretreatment and posttreatment were also compared. Results In total, 129 patients (M/F, 57/72) were enrolled in the study. Serum 8OHdG level of H.pylori negative, H. pylori positive CagA negative and H.pylori positive CagA positive groups were significantly different (5.77±1.35 ng/ml, 5.43±1.14 ng/ml and 7.57±1.25 ng/ml respectively, p=0.05). Furthermore, eradication therapy reduced serum 8OHdG level (6.10±1.54 ng/ml vs 5.55±1.23 ng/ml, p=0.05). Conclusions Individuals infected with H.pylori bearing CagA strains have the highest serum 8OHdG level and eradication therapy decreases the serum 8OHdG level. To the best of our knowledge this is the first study that evaluated the effect of CagA virulence factor on serum 8OHdG level and the effect of eradication therapy on serum 8OHdG levels together. Eradication of CagA bearing H.pylori may prevent gastric adenocarcinoma by decreasing ROS. 8OHdG level may thus be a good marker for prevention from gastric adenocarcinoma.

BACKGROUND The management of food impaction and foreign body ingestion in the upper gastrointestinal tract requires careful evaluation and timely intervention. This study was a retrospective evaluation of the management of adult patients with such a history. METHODS This study included adult patients admitted to a tertiary medical center with foreign body ingestion or food impaction between January 2012 and January 2018. The demographic and clinical data were recorded pro forma for statistical analysis. RESULTS Of the 122 patients included in this study, 53.2% were male, and the mean age was 46.68+-18.64 years. In 84 of the patients (68.8%), the ingested object was food. Thirty patients were managed solely through laryngoscopy, while 61 patients (50%) underwent a flexible endoscopy. The patients with a foreign body ingestion were older than those with a food impaction (mean age: 51.3+-17.4 vs. 36.5+-17.4 years; p

OBJECTIVE: Vitamin D deficiency has been related to diabetes, hypertension, hyperlipidemia and peripheral vascular disease. In this study, we aimed to investigate the role of vitamin D status in non-alcoholic fatty liver disease. METHODS: We included 211 consecutive subjects to examine the presence of non-alcoholic fatty liver disease. Of these subjects, 57 did not have non-alcoholic fatty liver disease and 154 had non-alcoholic fatty liver disease. RESULTS: The non-alcoholic fatty liver disease group had significantly higher fasting blood glucose (p = 0.005), uric acid (p = 0.001), aspartate aminotransferase (p

Functional dyspepsia (FD) can be described as the presence of symptoms such as bothersome postprandial fullness, early satiation, epigastric pain, and burning without any evidence of structural disease. The aim of this study was to evaluate the autonomic nervous system using heart rate variability (HRV) in patients with postprandial distress syndrome and epigastric pain syndrome.The study population included 64 consecutive patients with a diagnosis of FD and 62 age-matched and sex-matched healthy control individuals with no clinical evidence of gastrointestinal, systemic, or cardiovascular diseases. All patients underwent upper gastrointestinal endoscopy and 24 h Holter monitoring.There were 30 patients with postprandial distress syndrome and 34 with epigastric pain syndrome. Twenty-four hour square root of the mean squared differences of the successive normal to normal intervals (RMSSD) (30.5 ± 12.4, 35.8 ± 13.9; P=0.047), 24 h proportion derived by dividing the number of interval differences of successive normal to normal intervals greater than 50 ms (PNN50) (9.8 ± 3.9, 14.1 ± 7.3; P=0.017), daytime PNN50 (6.8 ± 1.6, 18.4 ± 13.8; P0.001), night SD of the normal to normal intervals (SDNN) (111.4 ± 39.9, 133.4 ± 29.8; P=0.001), and night RMSSD (31.7 ± 12.4, 38.2 ± 17.5; P=0.019) were significantly lower in patients with FD than controls. Other HRV parameters were not significantly different between the two groups. Changes in these parameters showed a decreased parasympathetic tone and discordance in sympathovagal activity in FD.Our study showed decreased parasympathetic activity in the patients with FD. Further studies are required to evaluate the significance of HRV parameters and to clarify the mechanism of decreased parasympathetic activity in patients with FD.

Objective: Ingested foreign bodies in gastrointestinal tract are a common event which can cause serious morbidity and mortality in the children and adult population. For this reason, early diagnosis and treatment are crucial for preventing these life threatening complications. In this study, we aimed to analyze the characteristics of the patients with upper gastrointestinal foreign bodies that were treated in our department. Methods: Patients diagnosed with upper gastrointestinal foreign bodies who were admitted to our hospital between February 2010 and August2013 were evaluated retrospectively. The data regarding their age, gender, clinical profile, type and localization of the esophageal foreign body, performed endoscopic procedure and initial symptoms of the patients were noted and analyzed statistically. Results: Thirty-eight patients with a diagnosis of gastrointestinal foreign body were included in this study. Of these patients, 21 were male and 17 were female. The youngest patient was 17 years old and the oldest patient was 79 years old. Most of the foreign bodies (%55.3) detected in the stomach. Food waste and metallic objects in 21 and 16 patients respectively. The most common complaint was dysphagia (%50). After endoscopic intervention three of the patients were directed to surgery. Conclusion: Early recognition and treatment of gastrointestinal foreign bodies is important as their complications are life threatening. The best method of removal of foreign bodies is controversial. Early management with upper gastrointestinal endoscopy is the most efficient and safe treatment method in current conditions., Amaç: Üst gastrointestinal sistem (GİS) yabancı cisimlerine özellikle çocuklarda sık karşılaşılır. Erişkin yaş grubunda daha seyrek görülmekte ancak daha yüksek oranda morbitide ve mortaliteye yol açabilmektedirler. Yabancı cisim yutulmasında tanı ve tedavide gecikme; perforasyon, obstrüksiyon gibi ciddi komplikasyonlara neden olabilen önemli bir sorundur. Bu makalede yabancı cisim yutulması nedeniyle kliniğimizde acil endoskopi işlemi uyguladığımız hastaların retrospektif değerlendirilmesini amaçladık. Yöntemler: Şubat 2010 ile Ağustos 2013 tarihleri arasında yabancı cisim yutulması ön tanısı ile acil endoskopi yapılan hastalar; yaş, cinsiyet, başvuru anında şikayeti, cisim tipi, yeri, uygulanan tedavi yönünden değerlendirildi. Bulgular: Çalışmaya dahil edilen 38 hastanın 21\'i erkek, 17\'i kadındı. En genç hasta 17 yaşındayken en yaşlı hasta ise 79 yaşındaydı. Hastaların 17\'sinde (%44,7) herhangi bir şikayet yok iken 19\'u (%50) disfaji, 2\'si (%5,3) kusma ile başvurmuştu. Yabancı cisimlerin 21\'i (%55,3) gıda ve 16\'sı (%42,1) metalik (10\'u toplu iğne, 2\'si para, 4\'ü diğer) cisimlerdi. 1 hasta ise yabancı cisim yuttuğunu ifade ettiği halde görülemediği için tanımlanamadı. Yabancı cisimlerin 11\'i özefagusta, 21\'i midede ve 1\'i duodenumda yerleşmişken 5\'i endoskopi ile görülemedi. 26 hastada yabancı cisim başarı ile çıkarılırken, ayakta direk grafisinde yabancı cisim treitz ligamanının distalinde tespit edilen 4 hasta ayaktan kontrol ile takibe alındı. 5 hastada yabancı cismin yeri tespit edilemedi (dolu mide, spontan distale ilerleme, spontan atılma, yanlış şüphe?). Endoskopik işlem ile yabancı cismi çıkarılamayan veya çıkarılması riskli olan 2(%5,2) hasta ve yabancı cisme bağlı intestinal obstrüksiyon gelişen 1(%3,3) hasta cerrahiye yönlendirildi. Sonuç: Yabancı cisim yutulmasında erken tanı ve tedavi hayatı tehdit edebilecek ciddi komplikasyonların önlenmesi açısından önemlidir. Yabancı cisimlerin çıkarılmasında en iyi tedavi yönteminin hangisi olduğu; hastanın yaşı, klinik durumu, yabancı cismin doğası, anatomik lokalizasyonu gibi birçok faktöre bağlıdır. Endoskopik tedavi ile başarı morbidite ve mortalitesi yüksek olabilecek cerrahi işlemden kurtarır.

Aim Polyp is called formations protruding into the lumen in the gastrointestinal tract. In this study, we aimed to determine frequency, anatomic distribution within the large bowel and pathologic types of colon polyps based on the colonoscopy results. Materials and methods The colonoscopy reports between 2010 and 2011 were analyzed retrospectively. Complaint of the patients on admission, the presence of polyps, anatomic distribution of polyps, polyp type and polyp size were evaluated. Result A total of 4000 colonoscopy reports were examined. The largest proportion of polyps occurred in the left colon (74.4%), followed by the ascending colon (11.5%). Eighty-five were adenomatous polyps, 71 were hyperplastic polyps, 12 were inflammatory polyps, 12 were serrated adenoma, 3 were adenocarcinoma, and 8 were tubulovillous adenomas. Discussion In light of like this study, the development of screening and follow-up programs in Turkey will be useful to reduce the incidence and mortality of colorectal cancer. How to cite this article: Kefeli A, Basyigit S, Yeniova AO, Nazligul Y, Kucukazman M, Aktas B. General Properties of Colon Polyps in Central Anatolia. Euroasian J Hepato-Gastroenterol 2014;4(1):7-10.

Helicobacter pylori is one of the common infection of humans. It is associated with chronic gastritis, peptic ulcer, mucosa related tissue lymphoma and gastric cancer. Whether H. pylori gastritis is a local inflammation or contributes to systemic inflammation remains unclear. Mean platelet volume is an indicator of systemic inflammation that can be determined from routine hemogram analyses. The present study was aimed to evaluate the relationship between mean platelet volume and H. pylori gastritis. Two hundred and eighty three (283) patients admitted with dyspeptic symptoms, and to whom endoscopy was performed, were enrolled in the study. Mean platelet volume levels of patients with and without H. pylori gastritis were compared and also, mean platelet volume levels according to parameters of Sydney Score System were compared. There was no significant difference between patients with and without H. pylori gastritis in the mean of mean platelet volume (p>0.05). Also, mean platelet volume levels did not differ between groups with regards to H. pylori intensity (p>0.05). There was also no significant association between mean platelet volume levels and H. pylori gastritis intensity. Chronic and acute infection, atrophy and intestinal metaplasia also did not have relationship with mean platelet volume. It can be concluded therefore, that mean platelet volume cannot be used as an indicator of systemic inflammation for H. pylori gastritis. Key words: Mean platelet volume, Helicobacter pylori, inflammation.

Background and aim: Helicobacter pylori (H. pylori) infection can cause chronic gastritis, peptic ulcer disease, gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma. For this reason, eradication of H. pylori has become an important issue. In recent years, failure of eradication therapy with standard eradication regimes had directed toward new therapeutic alternatives. The present study aimed to show the efficacy of bismuth-containing quadruple regimen for the first-line treatment of H. pylori infection. Materials and methods: H. pylori positive patients received a quadruple therapy consisted of esomeprazole 20 mg bid, colloidal bismuth subcitrate 600 mg bid, tetracycline 500 mg qid and metronidazole 500 mg tid for 7 days. The diagnosis of H. pylori infection was performed by the histopathological assessment of gastric biopsies. Six weeks after completion of therapy, H. pylori status was rechecked by C14 urea-breath test. Results: A total of 115 patients have completed the protocols (upper gastrointestinal endoscopy, treatment, urea-breath test). H. pylori eradication rate was found to be 87%. This eradication rate is significantly higher than those of classic triple therapies in the literature. Conclusion: The bismuth-containing quadruple regimen achieved an acceptable and very higher eradication rate than those of classic triple therapies in the literature. It can recommend as a first-line therapy for Helicobacter pylori infection. Abbreviations: HP: Helicobacter pylori; MALT: Mucosaassociated lymphoid tissue lymphoma; PPI: Proton pump inhibitor; CPM: Count per minute; SD: Standard deviation.

Objectives: The malign lesions of stomach may be ulcerative. Today, the follow-up periods for patients with gastric ulcer (GU) has not been clearly defined. The aim of this study was to assess the significance of ulcer size and location in differential diagnosis of GUs at endoscopy.Materials and methods: Data were retrospectively collected from the records of gastrointestinal endoscopy unit and pathology laboratory of our hospital between August 2008 and October 2010. We evaluated the demographic, endoscopic and histopathological features of the patients with GU. ROC curve analysis was performed for determining cut-off diameter differing malign ulcer from benign ulcer during gastroscopy.Results: A total of 161 patients (81 males, 80 females) with gastric ulcer were included. Twenty-seven patients had malign ulcer and 134 had benign ulcer. Mean ages of groups of malign and benign ulcer were 66.4 ± 13.8 and 56.7 ± 17 years, respectively (p

Objectives: Standard triple therapy composed of a proton pump inhibitor, clarithromycin and amoxicillin has been widely preferred for H. pylori eradication in Turkey and World. Alternative therapies are currently under investiga­tion because of an increase in clarithromycin resistance. The aim of this study was to evaluate the efficacy of a levoflox-acin-containing triple therapy. Materials and methods: The study was carried out in 81 H. pylori-infected patients (52 female, 29 male) with nonul-cer dyspepsia. The mean age was found 46.3 ± 13.9. Treatment was indicated with lansoprazol 30 mg b.d., amoxicil-lin 1 g b.d., and levofloxacin 500 mg daily for 7 days. H. pylori status was rechecked by (14)C urea breath test 6-8 weeks after the end of therapy. Results: Totally 81 patients could complete the treat­ment and follow-up protocol. Effectiveness was 68%. The distrib-tions of age, gender and smoking were similar be­tween eradicated and non-eradicated groups (p > 0.05). Conclusion: Seven-day levofloxacin based triple therapy is not very effective in the first-line treatment of H. pylori in-fection. The new treatment modalities should be inves­tigated., Amaç: İlk basamak H.pilori eradikasyonunda Türkiye\'de ve Dünya\'da en çok tercih edilen tedavi protokolü pro­ton pompa inhibitörü, klaritromisin ve amoksisilin içeren standart tedavi rejimidir. Ancak artan klaritromisin direnci sebe-biyle alternatif tedavi rejimleri araştırılmaktadır. Ça­lışmamızda standart üçlü tedavi rejimindeki klaritromisin yerine le-vofloksasin getirilmesiyle oluşturulan kombinas­yonun etkinliğini araştırdık. Gereç ve yöntem: Çalışma, H.pilori ile enfekte 52 kadın, 29 erkek, toplam 81 nonülser dispepsi hastasında tamam-landı (yaş ortalaması 46,3 ± 13,9). Tedavide “lansoprazol 30mg 2x1, levofloksasin 500 mg 1x1, amoksisilin 1 gr 2x1” 7 gün verildi. Tedavi bitiminden 6-8 hafta sonra C14 üre-nefes testiyle tedavinin etkinliği kontrol edildi. Bulgular: Hastaların % 68\'inde H.pilori negatifliği sağlan­dı. Eradikasyon sağlanan ve sağlanmayan hasta grupları yaş, sigara ve cinsiyet dağılımı yönünden benzer bulundu (p > 0,05). Sonuç: İlk basamak H.pilori eradikasyonunda 7 gün sü­reyle verilen levofloksasin temelli üçlü tedavi yeterince etkin değildir. Yeni tedavi protokollerine ihtiyaç duyulmak­tadır.

Objectives: CagA positive H. pylori strains are considered to be more virulent than other strains. In this study, we aimed to investigate the rate of CagA positivity in duodenal ulcer (DU) and functional dyspepsia (FD), and its effect on H. pylori eradication response.Materials and methods: The study was performed on H. pylori positive 60 patients with DU and 50 patients with FD, who underwent upper gastrointestinal endoscopy. H. pylori infection was identified by histology. All patients received a quadriple therapy consisted of esomeprazole 20 mg b.i.d., colloidal bismuth subcitrate 600 mg b.i.d., tetracycline 500 mg q.i.d. and metronidazole 500 mg t.i.d. for 7 days. H.pylori status was rechecked using C14-urea breath test 6 weeks after the end of treatment to confirm cure. Specific IgG antibodies for CagA status were determined by enzyme linked immunosorbent assay.Results: CagA positivities in the patients with DU and FD were calculated respectivily 70% and 68% (P>0.05). H. pylori was eradicated in 85.5% of the patients infected with CagA (+) strains, in 50% of those infected with CagA (-) strains (P=0.001). The eradication rates were 95.2% and 55.6% in CagA positive and negative DU subgroups (P=0.001), and 73.5% and 43.8% in CagA positive and negative FD subgroups (P=0.04).Conclusion: CagA positivities were not different in duodenal ulcer and functional dyspepsia. CagA (+) strains was susceptible to the eradication treatment. The titres of serum anti-CagA antibodies may be used in the prediction of eradication outcome, and the modification of eradication therapy.

Aim: To date, the main diagnostic tool for assessing the liver fibrosis stage has been liver biopsy. Despite the advantages in patient prognosis prediction and disease management, the application of liver biopsy is hampered by its limitations. The limitations of liver biopsy have led to a need for the development of a non- invasive scoring system that is simple to use, reliable, and cheap. The aim of this study was to evaluate the accuracy of APRI (AST to Platelet Ratio Index) and FIB-4 (Fibrosis-4) scores in the prediction of liver fibrosis in Chronic Hepatitis B patients.Material and Methods: A retrospective assessment was made of the electronic medical records to identify patients who underwent liver biopsy for evaluation of fibrosis related to CHB (Chronic Hepatitis B). A total of 352 patients were included in the study. Laboratory parameters that were measured within 7 days of the liver biopsy day were considered suitable for the calculation of the formulae. The APRI and FIB-4 scores was calculated. Liver biopsy reports, which were eligible for inclusion in the study, were assessed retrospectively. The fibrosis stage and histological acitvity index were used as previously described by Ishak. Analyses were performed using SPSS 22 (IBM SPSS Statistics 22, SPSS inc., an IBM Co., Somers, NY).Results: APRI was well correlated with fibrosis and HAI score (r=0.280, p0.05; r=0.22, p0.05) respectively. The FIB-4 correlation between fibrosis and HAI was significant (r=0.433, p0.05; r=0.34, p0.05) respectively.Conclusion: Inexpensive, non-invasive, and reliable fibrosis assessement models for CHC should be applied in clinical practice.Keywords: Chronic hepatitis B; liver fibrosis; APRI, FIB-4.

Aim Acute pancreatitis (AP) is an inflammatory disorder, the incidence of which has been increasing over recent years. Mean platelet volume (MPV) is an index of platelet activation and influenced by inflammation. The objective of the present study is to assess whether MPV would be convenient parameters for predictor factor of patients with AP. Materials and methods A total of 140 AP patients (male/female: 63/77) and 70 healthy subjects (male/female: 23/47) were enrolled in this study. The following data were extracted from the hospital medical records, including age, sex, platelet count, MPV, were recorded at the time of admission and as well as at the 1st day of remission of the disease. Results Mean platelet volume levels at onset and remission of AP were 7.8 ± 1.6 and 7.7 ± 0.9 respectively, and there was no statistically significant difference between these groups. Platelet count at onset and remission of AP and control subjects was 203 ± 74 × 103/μl, 234 ± 76 × 103/μl and 251 ± 87 × 103/μl, respectively, and there was statistically significant difference between these groups. Platelet count at onset and remission of AP was statistically lower than control subjects. Conclusion Some studies in literature suggest that MPV might be a useful parameter to be used as an indicator for AP and a prognostic factor for AP, but, in this study, it was revealed that MPV values do not change at AP compared with controls. Therefore, further prospective studies investigating the factors affecting the platelet size are required to determine whether MPV has a clinical implication and for predictor value of patients with AP. How to cite this article: Kefeli A, Basyigit S, Yeniova AÖ, Küçükazman M, Nazligul Y, Aktas B. Platelet Number and Indexes during Acute Pancreatitis. Euroasian J Hepato-Gastroenterol 2014;4(2):67-69.

Objectives: Helicobacter pylori (H.pylori) infection is major etiologic factor of chronic active gastritis and peptic ulcer disease. Functional dyspepsia (FD) is defined as “persistent or recurrent abdominal pain or discomfort centered in the upper abdomen in patient who has no definite structural or biochemical explanation of their symptoms. It is uncertain whether treatment of H.pylori infection relieves symptoms in patients with FD. We searched short term effects of H.pylori eradication for symptoms in patients with FD.Material and method: We enrolled patients with dyspeptic symptoms which were diagnosed FD and satisfied en-rollment criteria of trial. Endoscopic biopsy was taken from each patient during upper gastrointestinal endoscopy. H.pylori infected patients were assigned to seven days of treatment with 30 mgr of lansoprozole twice daily, 1000 mg of amoksisilin twice daily, and 500 mg levofloxacin once daily. Patients were assessed whether treatment was suc-cessful or not by 14C urea breathe test after 6-8 week. Also pretreatment and post treatment symptom scores were questioned.Results: There were 99 female and 68 male patients. After treatment 114 patients (68%) was negative for H. pylori, 53 patients (32%) remained positive. Mean of age and proportion of sex was similar in H.pylori (+) and (-) groups. While 111 (97.4%) of H.pylori (-) patients’ symptom scores decreased, 38 (71.7%) of H.pylori (+) patients’ scores de-creased. There was significant differences between two groups (p=0.001).Conclusion: Eradication of H.pylori relieves the symptoms of functional dyspepsia. New trials for long term effect of H.pylori eradication on symptoms must be conducted in future.

Objective: It is important to examine the epidemiology of liver cirrhosis (LC) because of it is a preventable disease. In this single-center study, we aimed to determine the epidemiological characteristics and etiology of LC in Central Anatolian region of Turkey.Methods: We reviewed data of patients with liver cirrhosis who presented to outpatient and inpatient clinics of our medical center between January 1, 2011 and September 31, 2014Results: Overall, 135 patients were included to the study: 91 men (67.4%) and 44 women (33%) with a mean age of 63±14,3 years (range: 15–87years). The primary causes of cirrhosis were chronic hepatitis B (CHB) (n: 52, 38.5%) and cryptogenic cirrhosis (n: 33, 24.4%). CHB was the main etiology of cirrhosis in men (49.5%) and cryptogenic LC was predominant in women (40.9%). Patients with alcoholic cirrhosis were solely male. Percentage of patients with autoimmune hepatitis was significantly higher among women (70%). The percentage of patients with HBV was similar between patients aged50 years (31.6% and 39.7%, respectively), but percentage of patients with hepatitis C virus was lower (5.3%) in patients aged50 years (14.7%). There was no cirrhotic patients under 50 years of age due to a genetic disorderConclusion: Despite national vaccination program, effective treatment regimens and intensive screening methods against hepatitis B virus, it remains to be the most common cause of LC in our country.Key words: Viral hepatitis, alcohol induced liver disease, autoimmune hepatitis, cryptogenic liver cirrhosis, non-alcoholic fatty liver disease, Amaç: Karaciğer sirozu sebepleri yönünden önlenebilir bir hastalık olduğu için epidemiyolojisinin araştırılması önemlidir. Biz bu tek merkezli çalışmada, Türkiye’nin Orta Anadolu bölgesinde, karaciğer sirozunun etyolojik nedenlerini ve epidemiyolojik özelliklerini belirlemeyi amaçladık.Yöntemler: 1 Ocak 2011 ve 31 Eylül 2014 tarihleri arasında sağlık merkezimizdeki yataklı ve ayaktan kliniklere başvurmuş olan karaciğer sirozu tanılı hastalar kaydedildi. Bulgular: Toplam 135 hasta çalışmaya dahil edildi: ortalama yaşı 63±14.3 (minimum:15 ve maksimum:87 yaş) olan 91 erkek hasta (%67,4) ve 44 kadın hasta (%33). Sirozun temel nedenleri: Kronik hepatit B (KHB), (n:52, %38,5) ve kriptojenik, (n:33, %24,4) idi. Sirozun en sık nedeni erkeklerde KHB (%49,5) ve kadınlarda kriptojenik karaciğer sirozuydu (%40,9). Alkolik sirozu olan hastaların tamamı erkekti. Otoimmün hepatiti olan hastaların oranı kadınlarda anlamlı olarak yüksekti (%70). 50 yaş altındaki ve üstündeki sirotik hastalar arasında KHB’li hastaların oranı benzerdi (sırasıyla;%31,6 ve %39,7), ancak 50 yaş altındakilerde hepatit C virüsü olan hastaların oranı, 50 yaş üstündekilere göre anlamlı olarak daha azdı (%5,3 ve %14,7). 50 yaş altında genetik bozukluğa bağlı sirotik hasta yoktu.Sonuç: Hepatit B virüsüne karşı Ulusal aşılama programı, etkin tedavi önlemleri ve artırılmış tarama tetkiklerine rağmen, KHB halen ülkemizde en sık siroz nedenidir

WOS:000369625200009 PubMed: 26773183 Treatments with bismuth-containing quadruple therapy (QT), sequential therapy (ST), or concomitant therapy (CT) have been proposed as empirical first-line regimens for Helicobacter pylori. We compared the efficacy and tolerability of 10 days bismuth-containing quadruple QT, 10 days ST, and 10 days CT with as first-line treatments for H. pylori in a randomized crossover study. The subjects were randomly divided into three groups. The first 130 patients were treated with rabeprazole, bismuth potassium citrate, metronidazole, and tetracycline for 10 days. The second 130 patients in the sequential group were treated with rabeprazole and amoxicillin for 5 days, and then rabeprazole, clarithromycin, and metronidazole for an additional 5 days. The last 130 patients in the concomitant group were treated with rabeprazole, amoxicillin, clarithromycin, and metronidazole for 10 days. H. pylori eradication was confirmed by urea breath test at 6 weeks. The primary outcome was eradication rates of first-line treatment by intention to treat and per protocol (PP) analyzes. There was no difference between the average ages and the male/female ratio of the groups. The PP analysis was performed on 121, 119, and 118 patients in the QT, ST, and CT groups, respectively. In the PP analysis, the successful eradication 94.2% (114/121), 95.0% (113/119), and 95.8% (113/118) the QT, ST, and CT groups, respectively. There was no significant difference among the three groups (p = 0.86). 10 days QT, ST, and CT are highly effective as empirical first-line therapies for H. pylori in the region with high clarithromycin resistance.

The success of the current anti-Helicobacter pylori (H. pylori) treatment protocols is reported to decrease by years, and research is needed to strengthen the H. pylori eradication treatment. Sequential treatment (ST), one of the treatment modalities for H. pylori eradication, includes amoxicillin 1 gr b.i.d and proton pump inhibitor b.i.d for first 5 days and then includes clarithromycin 500 mg b.i.d, metronidazole 500 mg b.i.d and a proton pump inhibitor b.i.d for remaining 5 days. In this study, we investigated efficacy and tolerability of bismuth addition in to ST. We included patients that underwent upper gastrointestinal endoscopy in which H. pylori infection was diagnosed by histological examination of antral and corporal gastric mucosa biopsy. Participants were randomly administered ST or bismuth containing ST (BST) protocols for the first-line H. pylori eradication therapy. Participants have been tested by urea breath test for eradication success 6 weeks after the completion of treatment. One hundred and fifty patients (93 female, 57 male) were enrolled. There were no significant differences in eradication rates for both intention to treat population (70.2%, 95% confidence interval [CI]: 66.3-74.1% vs. 71.8%, 95% CI: 61.8-81.7%, for ST and BST, respectively, p > 0.05) and per protocol population (74.6%, 95% CI: 63.2-85.8% vs. 73.7%, 95% CI: 63.9-83.5% for ST and BST, respectively, p > 0.05). Despite the undeniable effect of bismuth, there may be several possible reasons of unsatisfactory eradication success. Drug administration time, coadministration of other drugs, possible H. pylori resistance to bismuth may affect the eradication success. The addition of bismuth subcitrate to ST regimen does not provide significant increase in eradication rates.

Background: Diabetes mellitus is closely related to pancreas cancer. In this study we aimed to investigate the effect of hyperglycemia on tumor and inflammation markers, as well as pancreatic exocrine functions. Methods: A total of 98 consecutive diabetic patients with poor glycemic control, and 50 healthy controls were included in the study. We measured hsCRP, erythrocyte sedimentation rate (ESR), CA19-9, CEA, amylase and lipase in addition to routine biochemistry tests, before and after euglycemia was achieved. Results: Fasting blood glucose, HbA1c, CA19-9,CEA, hsCRP, ESR, triglycerides, AST, ALT, GGT, ALP, total cholesterol and LDL-C levels decreased significantly with the regulation of glycemic control. Amylase and lipase levels increased with the regulation of glycemic control. After glycemic control, CA19-9 and CEA levels were still higher, whereas amylase and lipase levels were still lower in the diabetic group compared with the control group. Basal HbA1c showed significant correlation with CA19-9, CEA, amylaseand lipase. Conclusions: We propose to repeat observations of tumor markers after hyperglycemia is resolved, in order to avoid unnecessary invasive tests. Our data also suggest that pancreatic exocrine function was improved with lowering blood glucose in a short period of time.

H. pyloriis related to various gastrointestinal diseases.β2Microglobulin (β2M) is an intrinsic element of major histocompatibility complex (MHC I). Serumβ2M level may increase in inflammatory states. The aim of current study is to evaluate the relationship betweenβ2M andH. pyloribearing CagA strains.Methods.H. pyloristatus was determined by histopathology of samples taken from stomach. CagA status andβ2M level were measured from blood samples of patients. Eradication therapy was administered to the patients withH. pyloriinfection.β2Microglobulin levels were measured before and after treatment.Results. 35 (29.2%)H. pylori(−) patients and 85 (70.8%)H. pylori(+) patients were included in the study. There were 52 (43.3%) patients with CagA negative and 33 (27.5%) patients with CagA positiveH. pyloriinfection. The mean serumβ2M level was 1.83 mg/L inH. pylori(−) group, 1.76 mg/L inH. pylori(+) CagA (−) group, and 1.93 mg/L inH. pyloriand CagA (+) group (P>0.05). Serumβ2M levels (1.82 versus 1.64 mg/LP<0.05) were decreased after eradication.Conclusion.H. pyloriand CagA status did not affectβ2M level. Relationship between low grade systematic inflammation andH. pylorishould be investigated to find out new predictors for diseases associated with inflammation.