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Sarcopenia is one of the most significant contributors to morbidity in patients with chronic liver disease. Serum myokines are potential biomarkers for detecting early sarcopenia. We aimed to investigate the relationship between serum myokines and cirrhosis-related mortality in the early stages of the disease.In total, 262 patients and 50 healthy controls were enrolled in this study, which was designed as a multicenter cross-sectional study. At the beginning of the study, sarcopenia was defined by computed tomography scans using the third lumbar vertebra skeletal muscle index. Serum myostatin, irisin, and follistatin levels, nutritional status of the patients, and muscle strength as measured by the handgrip test were recorded. Cirrhosis-related mortality and overall survival were evaluated in the fourth year of the study as the second checkpoint of cross-sectional analysis.A total of 145 (55.3%) patients were diagnosed with sarcopenia. Multivariate analysis revealed that low BMI, high levels of myostatin, and decreased irisin levels were independent predictors of sarcopenia. While serum irisin level was the most predictive parameter in terms of 4th-year cirrhosis-related mortality in the CHILD A group, serum myostatin levels were found more indicative in the CHILD BC group regardless of sarcopenia status ( Plt; 0.001).Serum myostatin levels predict sarcopenia in all stages of cirrhosis. Serum irisin levels can also be used as a potential biomarker to predict both treatable sarcopenia and cirrhosis-related mortality in CHILD A patients.

Fibroblast growth factor 19 (FGF19) and small heterodimer partner (SHP) are molecules responsible for controlling serum bile acid levels. We designed this study for evaluating the effects of FGF 19 and SHP in intrahepatic cholestasis of pregnancy (ICP). Fifty-six pregnant women having ICP and 20 healthy pregnant women were included in the study. The patients were followed up until delivery in terms of pregnancy-related morbidity/mortality. Serum FGF 19 and SHP levels were determined by enzyme-linked immunosorbent assay (ELISA). Serum FGF 19 and SHP levels were significantly higher in the patient group compared to the control group (

BACKGROUND It has been demonstrated that there may be a relationship between liver fibrosis and serum biomarkers. The aim of this study was to investigate pre- and postoral antiviral therapy levels of these biomarkers and their relationship with other fibrotic parameters in hepatitis C virus (HCV) patients. METHODS The study group comprised HCV patients who were treated with oral antiviral regimens. Prior to, and 8 months after the treatment, serum biomarkers, including transforming growth factor-β (TGF-β), chitinase-3-like protein 1 (YKL-40), collagen type IV, matrix metalloproteinases (MMPs) and hyaluronic acid levels, were examined and fibrosis-4 (Fib-4) and aspartate aminotransferase to platelet ratio index (APRI) scores were calculated at the same times. RESULTS In total, 45 HCV patients (aged between 27 and 86 years) participated. Of these 20 (44.4%) were cirrhotic and 25 (55.6%) were noncirrhotic. The concentrations of YKL-40 (P = 0.01) and TGF-β (P = 0.032) after treatment were significantly higher than the pretreatment values, whereas hyaluronic acid concentrations decreased after treatment (P = 0.001). Noncirrhotic patients had significantly higher (P = 0.03) YKL-40 levels prior to therapy compared to cirrhotic patients. Median MMP-2 concentrations were higher in men than in women (P = 0.001). Prior to treatment, TGF-β, YKL-40 and collagen type IV levels were negatively correlated with Fib-4 scores, whereas only TGF-β and YKL-40 concentrations were negatively correlated with APRI scores. CONCLUSION YKL-40, TGF β and hyaluronic acid may be markers for fibrotic change during oral therapy for HCV. In particular, TGF β concentrations correlated with fibrotic indices. However, these results should be confirmed and validated by further research.

Pancreatic exocrine insufficiency (PEI) is found in 30-50% of diabetes mellitus (DM). Insulin resistance is triggering factor in both DM and nonalcoholic fatty liver disease (NAFLD). Therefore, we aimed to investigate frequency of PEI in NAFLD, and relationship of fecal pancreatic elastase (PE) levels with liver histology and pancreatic fat.Ninety-seven biopsy proven NAFLD patients and 50 controls were enrolled. Pancreas exocrine functions were measured by PE. Magnetic resonance imaging-estimated proton density fat fraction (MRI-PDFF) was used to quantify fat.NAFLD patients had significantly lower PE levels than controls (297 [204-517] vs. 500 [298-678] μg/g, p 0.01). PEI (PE 200 μg/g) ratio of NAFLD patients (22.7%, n = 22) was higher than PEI ratio of controls (6%, n = 3) (p = 0.011). Among diabetic (n = 35) NAFLD patients, 9 (25.7%) exhibited PEI, compared to 13 (21%) of non-diabetics. There was no significant difference in patients with and without DM in terms of PEI (p = 0.592). Among NASH (n = 68) patients 16 (23.5%) exhibited PEI, compared to (20.7%) of non-NASH (p = 0.76). Multiple analysis revealed NAFLD as a predictor of PEI independent of age, sex and DM (OR = 4.892, p = 0,021). Mean pancreas MRI-PDFF was significantly higher in diabetics (13.7% ± 3.6% vs. 8.7% ± 5.1%, p = 0.001). There was no significant pancreas MRI-PDFF difference between NASH and non-NASH (P = 0.95). Mean pancreas MRI-PDFF was significantly higher in patients with PEI (13.7% ± 3.4% vs. 8.9% ± 5.2%, P 0.01).This is the first study demonstrating the high frequency of PEI in NAFLD independent of DM. Moreover, increasing pancreatic steatosis appears to be associated with higher frequency of PEI in NAFLD.

Girişve Amaç: Perkütan endoskopik gastrostomi uygulaması uzunyıllardır enteral nutrisyon için kullanılan bir yöntemdir. Perkütan endoskopikgastrostomi kateteri kendiliğinden çıktığı veya hasta tarafından çıkarıldığıdurumlarda aynı yol üzerinden uygulanan Foley kateter ile de enteralnutrisyonun devamı sağlanabilmektedir. Biz de perkütan endoskopik gastrostomi kateteriyerine Foley kateter kullanımını retrospektif olarak değerlendirmeyi hedefledik.Gereç ve Yöntem: 2016-2019 yıllarıarası İstanbul Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi Gastroenterolojiendoskopi ünitesinde perkütan endoskopik gastrostomi kateteri takılmış vesonrasında perkütan endoskopik gastrostomi kateteri istenmeden çıktığında Foleykateter takılan hastalar gelişen komplikasyonlar ve Foley kateterin kullanımsüresi açısından retrospektif olarak değerlendirildi. Bulgular: Çalışmaya verilerine ulaşılabilen 17 hasta dahil edildi.8 hastada Foley kateterde tıkanma, balonun sönmesi, migrasyona bağlı ileus ve ülserkanaması komplikasyonları gelişti. Komplikasyon gelişmeyen 9/17 hasta grubunda Foleykateter ile takip süresi medyan 6 hafta (1-74 hafta) olarak saptandı. Sonuç: Perkütan endoskopik gastrostomi kateteriyerine Foley kateter kullanımı özellikle yaşam beklentisi çok kısa, endoskopik işlem riski yüksek olan hastalardauygulanabilecek daha az invaziv, pratik ve ekonomik bir yöntemdir. Ancakhastalar komplikasyonlar açısından yakından takipedilmelidir., Backgroundand Aims: Percutaneous enteral gastrostomy has long been thepreferred method for providing enteralnutrition. In cases where the percutaneous enteralgastrostomy catheter is removed spontaneously or bythe patient, continuity of enteral nutrition can be maintained via thesame route using a Foley catheter. We aimed toretrospectively evaluate patient outcomes following the use of a Foley catheterinstead of a percutaneous enteral gastrostomy catheter.Material and Methods: Patientswho underwent percutaneous enteral gastrostomy catheter insertion at thegastroenterology endoscopy unit of İstanbul Kanuni Sultan Suleyman Training andResearch Hospital between 2016 and 2019, and patientswho had a Foley catheter inserted after the percutaneous enteral gastrostomycatheter was inadvertently removed were included inthis study. Patients were retrospectively evaluated for the complications andduration of the use of the Foley catheter. Results: A total of 17 patients,whose data could be retrieved, were included in thestudy. In eight patients, complications including occlusion of Foleycatheter, deflation of catheter balloon, ileus due to migration, and ulcerbleeding were reported. In patients without complications (9/17) the medianfollow up period with a Foley catheter was 6 weeks (range 1–74 weeks). Conclusion: Use of a Foley instead of percutaneousenteral gastrostomy catheter is a less invasive, practical, and economicalmethod, especially forpatients with low life expectancy and high endoscopic procedure risks. However,patients should be followed up closely for complications.

Background Cystatin C is a genuine marker for detecting minor reductions in estimated glomerular filtration rate (e-GFR). Study question We aimed to investigate the efficiency of cystatin C levels in predicting nephrotoxicity due to antiviral therapy in patients with chronic hepatitis B virus infection. Study design Seventy-six naive hepatitis B virus patients and 44 controls were enrolled in this prospective cohort study. Measures and outcomes Serum cystatin C, phosphate and creatinine levels, and urinary albumin/creatinine ratios of all patients were measured at baseline, 3rd, 12th, and 24th months. Nephrotoxicity was determined according to the amount of change in creatinine level at the fourth year of treatment compared with baseline ([INCREMENT]Cr0-4). Results Mean age was 36.1 ± 9.2 years and 40 (52.2%) of patients were women. There was no significant difference between baseline values of tenofovir disoproxil fumarate and entecavir groups. Although the creatinine level at the fourth year of treatment was statistically nonsignificant compared with baseline in the entecavir group, it was significantly higher in the fourth year of tenofovir treatment compared with baseline (0.95 ± 0.27 mg/dL vs. 0.76 ± 0.16 mg/dL, P = 0.002). While the increase in [INCREMENT]Cr0-4 was ≥0.2 mg/dL in 43.2% of patients in the tenofovir group, this rate was 18.8% in the entecavir group. Diagnostic accuracy in identifying decreased renal function as area under the curve (AUC) was high for baseline serum cystatin C level; furthermore, the highest AUC was calculated for cystatin C plus creatinine-based e-GFR equation (AUC: 0.81, P Conclusions Long-term tenofovir disoproxil fumarate nephrotoxicity can be predicted by serum cystatin C plus creatinine-based e-GFR measured before treatment.

Even though magnetic resonance imaging has been described as the most effective imaging method for the diagnosis of liver fibrosis, an accepted magnetic resonance ımaging (MRI) technique is yet to be defined. The aim of this study is to determine the efficiency of MRI in the staging of liver fibrosis.Patients with chronic hepatitis B infection and had upper abdominal MRI with hepatocyte specific contrast agent were evaluated. Twenty-nine patients that had undergone liver biopsy were included in the study. ADC, FA, and signal intensity values of liver parenchyma were measured by two observers and contrast enhancement index (CEI) was calculated as well. Patients were grouped as early (A) and late fibrosis(B) according to Ishak grading system and then the correlations between the stage and MRI findings were analysed. The intraclass correlation coefficient was used to analyze the inter-rater agreements. ADC, FA, and CEI were compared with Student t-test between early and late fibrosis groups. Pearson's correlation was used to assess the correlation between ADC and FA values. Spearman correlation was used to evaluate the relationship between pathologic fibrosis grade and MRI parameters that were measured.Twenty-two patients were staged as 1 and 2 (group A), seven patients were staged as 3 and above fibrosis(group B). Statistically, there was a strong, negative correlation between the FA values and the degree of fibrosis (r=-0.582, p=0.001). There was no correlation between the CEI and hepatocyte activity index (r=-0.88, p=0.655) and degree of fibrosis (r=0.0001, p=0.997). In terms of FA values, there was a statistically significant difference between two groups (group A=0.429 ± 0.06, group B=0.349 ± 0.06) (p=0.004).Correlation of FA values with fibrosis stage and significant difference in FA values between early-late stage fibrosis patients shows that diffusion tensor imaging can be a promising technique in the staging and follow-up of liver fibrosis.

Objective: Periampullary diverticulum (PAD) is an acquried luminal pathology that is located in the second segment of duodenum and Ampulla of Vater is located in or aside of it. We aimed to determine the frequency of periampullary diverticulum in endoscopic retrograde cholangiopancreatography (ERCP) and the effect of presence of periampullary diverticulum on ERCP success and complications. Material and Method: The ERCP procedures held in Gastroenterologic Endoscopy Unit of Sisli Hamidiye Etfal Training and Research Hospital between years 2011-2014 were retrospectively evaluated. Results: Periampullary diverticulum was found in 112 of (11.8%) 948 cases who underwent ERCP with various indications. A 1026 procedures were done to 836 patients without periampullary diverticulum and 136 procedures were done to 112 patients with periampullary diverticulum. No statistically significant difference was found in terms of number of ERCP procedure per patient between patients with and without periampullary diverticulum (1.21 vs. 1.23 p=0.838). Common bile duct cannulation failed in 8 (7%) of patients with periampullary diverticulum whereas this cannulation was unsuccessful in 54 (6.4%) of patients without periampullary diverticulum (p=0.859). The mean age of cases with periampullary diverticulum (72.7±12.2 years) was statistically significantly higher than the ones without periampullary diverticulum (56.8±16.4 years) (p

ST2, a specific ligand of interleukin 33, was described as a biomarker protein of inflammatory processes and overexpression of ST2 in ulcerative colitis (UC) was shown previously. We aimed to investigate the potential relationship of serum ST2 levels with the clinical, endoscopic and histopathological activity scores in UC and Crohn's disease (CD). Serum ST2 levels were determined in 143 patients with inflammatory bowel disease (IBD) (83 UC and 60 CD), in 50 healthy controls (HC), and in 32 patients with irritable bowel syndrome (IBS). Serum ST2 levels were elevated in IBD (56.8 (41.9–87.2) pg/mL) compared to HC and IBS (30.7 (20.2–54.3), p

Liver biopsy is the best method for detecting fibrosis grade of the liver in chronic hepatitis B. However, the invasiveness of liver biopsy complicates its routine use in follow-up of treatment. We planned to determine the usage of fibrosis predicting noninvasive scores in the follow-up of the treatment of patients with chronic hepatitis B treated with entecavir or tenofovir. Two hundred twenty-eight patients with hepatitis B with liver biopsy were included in the study. Fibrosis grade was determined by Ishak score. The laboratory data at months 0, 12, and 24 during treatment were collected and noninvasive fibrosis scores (aspartate aminotransferase to alanine aminotransferase ratio [AAR], aspartate aminotransferase to platelet ratio index [APRI], fibrosis index based on the 4 factors [FIB-4] and red cell distribution width to platelet ratio [RPR]) were calculated. Statistically significant increase in all scores and decrease in platelet count were observed as the fibrosis level increased. For differentiation of patients with fibrosis ≥grade 2, the highest sensitivity and specificity rates were shown by APRI score (sensitivity 67%, specificity 69%, and cutoff ≥0.5). FIB-4 was the most successful score for differentiation of patients with fibrosis ≥grade 3 (sensitivity 83%, specificity 74%, and cutoff ≥1.45). A significant decrease in all noninvasive fibrosis scores was observed at months 12 and 24 during treatment with both entecavir and tenofovir (P < 0.001). Among these, only the improvement in APRI score was found better in entecavir group with statistical significance (P < 0.05). APRI score was effective in demonstrating early-stage fibrosis. FIB-4, RPR, and platelet count were better in demonstrating advanced fibrosis. Although noninvasive scores cannot replace liver biopsy for diagnosis, they can be used for monitoring the response to treatment.

Background & Aims: Mild iron overload is frequently reported in patients with nonalcoholic fatty liver disease (NAFLD). Hepcidin is the master iron-regulatory peptide and hemojuvelin (HJV) is the key regulator of iron-dependent secretion of hepcidin. The aims of this study were to evaluate serum HJV and hepcidin levels in patients with biopsy-proven NAFLD with and without hepatic iron overload, and to identify potential associations of HJV and hepcidin with the clinical characteristics of the patients enrolled. Methods: Serum levels of HJV and hepcidin were measured in 66 NAFLD patients with (n=12) and without (n=54) iron overload, and controls (n=35) by enzyme-linked immunosorbent assay. Hemojuvelin and hepcidin levels were assessed in relation to clinical characteristics and liver histologic evaluation of the participants. Results: Significantly lower serum HJV (281.1 [239.2-353.6] vs. 584.8 [440.3-661] ng/ml, p

Background and Aims:Biopsy of the papilla taken during ERCP is widely used in the diagnosis of periampullary tumors. In this study, we aimed to evaluate the biopsy results taken from the papilla with the suspicion of tumor. and determine their predictive value after confirming the final the diagnosis. Materials and Methods:A total of 48 patients whom biopsies were taken from papilla during ERCP done between January 2013 and December 2014 in our clinic were taken to the study. ERCP and pathology reports, post-ERCP operative/EUS/or other guided biopsy results were collected retrospectively from computer database. According to these results final diagnosis of the patients were determined. Results:The mean age ot the patients was 69.4±13.3 years. Twenty-two of the cases wer male and 26 were female. According to the pathology reports in 12 (25%) of the patients malignancy were positive, in 7 (14.6%) of the patients adenomatous changes were present, in 23 (47.9%) of the patients malignancy were negative and in 6 of the patients the distinction between malign or benign changes could not be done. With these biopsy results 6 patients underwent to Whipple operation and ampullectomy was done in 1 patient. According to final diagnosis 19 (39.6%) of the patients were found malign, 5 (10.4%) of the patients were found to have adenomas and the remaining 24 (50%)patients were found negative for malignancy. The sensitivity of the biopsy of papilla for prediciting malignancy was found 66.6% and specificity was 100%, PPV was 100%, NPV 80% and diagnostic accuracy was 85%. In the malignancy positive group, pre-procedural ALP, ALT, AST, total bilirubin and CA 19-9 levels and number of the biopsies were found statistically significantly higher. In 3 patients with malignancy negative or indiscriminant biopsy results final diagnosis were obtained with second biopsy of the papilla. One of these patients were found to have adenocarcinoma. Conclusion:In patients with suspicion of ampullary region tumors the contribution of the biopsy of the papilla to the diagnosis was significant. Even if the first biopsy was negative, in the presence of clinical suspicion, the second biopsy may be helpful for definitive diagnosis. Papilla biopsy should be performed especially in patients with elevated AST, ALT, ALP, total bilirubin and CA 19-9 levels when there is clinical suspicion of malignancy., Giriş ve Amaç:Endoskopik retrograd koloanjiopankreatografi esnasında alınan papilla biyopsisi periampuller bölge tümörlerinin tanısında yaygın olarak kullanılmaktadır. Bu çalışmada, tümörden şüphelenilen olgularda alı-nan papilla biyopsi sonuçlarını değerlendirmeyi amaçladık. Gereç ve Yöntem:Çalışmaya kliniğimizde Ocak 2013 ile Aralık 2014 tarihleri arasında yapılan endoskopik retrograd kolanjiopankreatografi sırasında papilladan biyopsi alınan toplam 48 vaka alındı. Endoskopik retrograd kolanjiopankreatografi ve patoloji raporları, endoskopik retrograd kolanjiopankreatografi sonrası ameliyat/görüntüleme/endoskopik ultrasonografi eşliğinde biyopsi bulguları, bilgisayar veri tabanından retrospektif olarak toplandı. Bu sonuçlara göre hastaların nihai tanıları tespit edildi. Bulgular:Hastaların ortalama yaşı 69.4±13.3 yıl idi. Vakaların 22’si erkek, 26’si kadındı. Patoloji sonuçları-na göre hastaların 12’si (%25) malignite pozitifti, 7’sinde (%14.6) adenomatöz değişiklikler saptanmıştı, 23’ünde (%47.9) malignite negatifti ve 6’sında (%12.5) malign/benign ayrımı yapılamamıştı. Papilla biyopsisi sonuçlarına göre 1 hastaya ampullektomi ve 6 hastaya Whipple operasyonu uygulandı. Nihai tanılara göre hastaların 19’unun (%39.6) malign, 5’inin (%10.4) adenom, 24’ünün (%50) malignite negatif olduğuna karar verildi. Papilla biyopsisinin malignite tanısını öngörmede sensitivitesi %66.6, spesifitesi %100, pozitif prediktif değer %100, negatif prediktif değer %80 ve tanısal doğruluk oranı %85 olarak bulundu. İşlem öncesi alkalen fosfataz, aspartat aminotransferaz, alanin aminotransferaz, total bilirubin ve CA 19-9 düzeyleri ve işlem sırasında alınan parça sayısı malign grupta istatistiksel olarak anlamlı biçimde yüksekti. İlk biyopsileri negatif veya ayrım yapılamayan şeklinde rapor edilen ve papilla biyopsisi tekrarlanan 3 olguda da ikinci biyopsi ile nihai tanıya ulaşıldı. Bu olgulardan biri adenokarsinomdu. Sonuç:Ampüller bölge tümörü düşünülen olgularda papilla biyopsisinin tanıya katkısı yüksektir. İlk biyopsi negatif gelse de klinik bulgular varsa, ikinci biyopsinin yapılması yararlı olabilir. Özellikle aspartat aminotransferaz, alanin aminotransferaz, alkalen fosfataz, total bilirubin ve CA 19-9 değerleri yüksek olgularda klinik şüphe varlığında biyopsi yapılmalıdır.

Background and Aims:Common bile duct stones were successfully extracted in 85-90% of cases using endoscopic retrograde cholangiopancreatography procedures with balloons and basket catheters. However, endoscopic stone removal becomes challenging and sometimes impossible in the presence of a large, angled or multiple stones. The mechanical lithotripsy method is a procedure used to crush difficult to treat common bile duct stones. We retrospectively analyzed efficacy and safety of mechanical lithotripsy at our single center. Materials and Methods:Between August 2011 and August 2014, mechanical lithotripsy procedures were performed in 18 cases in the Sisli Etfal Education and Training Hospital Gastroenterology Department. Demographic features, laboratory tests, clinical course, procedure type and complications were retrospectively analyzed. Results:Mechanical lithotripsy was performed in 18 patients (Age: 22-68; 11 females, 7 males). In 16 patients, an endoscopic sphincterotomy was performed and the common bile duct was swept with a balloon catheter. While stone fragmentation was being performed with a basket catheter, the entrapped stone was impacted within the mid- common bile duct. A mechanical lithotripteur was used to crush the stone. In two patients with large stones, mechanical lithotripteur was performed after sphincterotomy. Mechanical lithotripsy was successful in 15 (83%) patients; however, in two patients the wire of the mechanical lithotriptor snapped. Unfortunately, an esophageal perforation occurred in one patient. A metallic esophageal stent was placed and the patient recovered in one month. There were no mortalities in our mechanical lithotripsy cases. Conclusion:Mechanical lithotripsy is useful to crush difficult common bile duct stones in routine endoscopic retrograde cholangiopancreatography exams and also as a rescue procedure. It is a difficult procedure that requires considerable technical expertise. The success rate was 70-80% for cases performed by those with experience; it is widely available in many parts of the world. The success rate was 81% in our series, despite some complications., Giriş ve Amaç:Endoskopik sfinkterotomi, balon ve basket kateterler yardımıyla koledok taşlarının %85-90’ı temizlenebilmektedir. Büyük taşlarda, impakte taşlarda, çok sayıda taşı olan hastalarda standart tedavi ile başarı güçtür. Zor taşlar için kullanılan metodlardan biri de mekanik litotripsi yöntemidir. Biz de kliniğimizde mekanik litotripsi yönteminin etkinliği ve güvenilirliğini retrospektif olarak incelemeyi amaçladık. Gereç ve Yöntem: Çalışmaya Ağustos 2011 ile Ağustos 2014 arasında Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi Gastroenteroloji Endoskopi ünitesinde mekanik litotripsi yapılmış olan 18 hasta alındı. Hastaların demografik özellikleri, laboratuvar değerleri, hastalara yapılan işlemler, işlem sonrası klinik seyir ve işlem komplikasyonları retrospektif olarak değerlendirildi. Bulgular:Mekanik litoripsi işlemi 22-68 yaş arası 18 hastaya (11’i kadın) uygulanmıştır. Hastaların 16’sında endoskopik sfinkterotomi yapılmış, balonla koledok temizlenmiş, basket kateterle taş parçalanmaya çalışılırken basket kateter koledokta sıkışmış ve mekanik litotripsi işlemine geçilmiştir. 2 hastada ise köşeli ve büyük taşlar bilindiğinden direkt olarak through the scope mekanik litotriptör ile taşlar kırılmıştır. Skop dışından mekanik litotripsi yapılan hastaların 15’ünde (%83) litotripsi işlemi başarıyla gerçekleştirilirken, 2 hastada baskette kırılma meydana gelmiştir. Bir hastada ise mekanik litotripsiyi takiben özofagus alt uçta perforasyon saptanmıştır. Endoskopik retrograd kolanjiopankreatikografi işlemi, mekanik litotripsi ve anesteziye bağlı mortalite görülmemiştir. Sonuç:Mekanik litotripsi, papilladan çıkmayacak kadar büyük taşların kırılarak küçültülmesi amacıyla planlı veya basketle koledok taşlarının temizlenmesi esnasında, basketin koledok içinde sıkışması nedeniyle plansız ve zorunlu olarak taşı kırmak maksadıyla kullanılır. Zor, deneyim gerektiren, literatürde başarı oranı %70-80 olarak bildirilen bir iş-lemdir. Bizim olgularımızda da %83 tedavi başarısı etkin bir metod olduğunu göstermekte ancak riskleri de beraberinde getirmektedir.

The close relationship between inflammation and thrombosis affects the progression and severity of inflammatory bowel disease (IBD). The prevalence of venous thromboembolism (VTE) varies between 1% and 7% among patients with IBD. The VTE risk in patients with IBD is at least 3 times higher than that in the normal general population. The absolute risk is very high during hospitalization, active disease, and surgery. The IBD-related VTE occurs at younger ages and recurs more frequently. The development of thrombosis in IBD is due to the interaction of many hereditary and acquired risk factors. Each patient diagnosed with IBD should be evaluated for a personal and family history of thrombosis and for prothrombotic drug use. Although procoagulant factors are increased during the natural course of inflammation, natural anticoagulants and fibrinolytic activity are decreased. Although IBD is accepted as a prothrombotic condition, there is no treatment that can remove this risk from daily practice. Patient training is required to control important factors, such as long-term immobilization and smoking. Oral contraceptives and hormone replacement therapy should be avoided. Inducing permanent disease remission must be the key approach for the prevention of thrombosis. Low-molecular-weight heparin (LMWH) is the basis of prophylactic treatment, which reduces the thrombosis risk by 50%. Prophylaxis with LMWH should be administered to all patients with IBD hospitalized due to disease attack or surgery. Long-term or even life-long anticoagulation therapy should be planned if there is insufficient disease control, recurrent VTE attacks, positive thrombophilia tests, or thrombosis in vital veins.

Individuals with increased visceral adiposity are considered to be more sensitive and more prone to severe acute pancreatitis because of the inflammatory microenvironment they have. We hypothesized that insulin resistance, adipokines, and proinflammatory cytokines that markedly affect the course of pancreatitis can contribute toward development of postendoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis (PEP) and aimed to investigate the association between PEP risk and preprocedural serum vaspin, chemerin, tumor necrosis factor α, interleukin-6 (IL-6) levels, and homeostasis model assessment of insulin resistance.Eighty-two patients with a diagnosis of choledocholithiasis and 30 controls were enrolled. Preprocedural chemerin, vaspin, IL-6, and well-known PEP risk factors were compared between PEP and non-PEP groups.The mean age of the patients was 56.3±14.4 years; 52 patients were women. Adipocytokine levels, BMIs, and waist circumferences of the patient group were found to be higher than those of the controls. Total cannulation success and the mean procedure time were 82.9% and 28.7±8.8 min, respectively. PEP developed in 12 (14.6%) patients. Chemerin levels in the PEP group were higher than those in the non-PEP group (580.2±172.5 vs. 392.2±168.2 ng/ml, P0.01). Insulin resistance was higher in the PEP group than the non-PEP group (P=0.001), but there was no significant difference between PEP and non-PEP groups in terms of preprocedural vaspin, tumor necrosis factor α, IL-6, and C-reactive protein levels. According to logistic regression analysis, increased chemerin levels, homeostasis model assessment of insulin resistance 2.5 or greater, and pancreatic duct cannulation were found to be independent risk factors for PEP [odds ratio (OR)=1.006, P=0.006; OR=4.57, P=0.05; OR=6.54, P=0.02].Elevated serum chemerin levels and insulin resistance are independent risk factors of PEP development.

In order to investigate the relationship between hemostatic abnormalities and portal vein thrombosis (PVT) in hepatocellular carcinoma (HCC), platelets, prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time, fibrinogen, d-dimer, fibrinogen degradation products (FDPs), protein C, protein S, antithrombin, plasminogen, antiplasmin, coagulation factors (CFs) V, VII, VIII, IX, XI, and XIII, von Willebrand factor (vWF), prothrombin fragment 1 + 2 (PF 1 + 2), tissue-type plasminogen activator (tPA), and plasminogen activator inhibitor 1 (PAI-1) were studied in patients with HCC, cholangiocarcinoma, and metastatic liver tumors and in cirrhosis patients with or without PVT. Platelet, antithrombin, protein C, plasminogen, and CFs V, VII, IX, XI, and XIII levels of HCC group were found lower and PT, aPTT, thrombin time, vWF, FDPs, PF 1 + 2, tPA, and PAI-1 levels were higher than the control group. Our findings suggested that the abnormalities of coagulation and fibrinolysis systems have some role in provoking thrombosis of portal veins in HCC, in addition to the invasion of portal veins by hepatoma cells.

This study was planned for searching possible changes of the total coagulation and fibrinolysis system in inflammatory bowel disease (IBD) in order to obtain some clues for explaining the relation between IBD and hypercoagulability. A total of 24 patients with ulcerative colitis, 12 patients with Crohn disease, and 20 healthy controls were studied. Platelets; prothrombin time (PT); partial thromboplastin time (PTT); fibrinogen; d-dimer; fibrinogen degradation products; protein C; protein S; antithrombin; thrombin time; von Willebrand factor; coagulation factors V, VII, VIII, IX, XI, and XIII; plasminogen; antiplasmin; tissue plasminogen activator; plasminogen activator inhibitor 1; and prothrombin fragments 1 + 2 were studied. Most of the procoagulants (platelets, fibrinogen, von Willebrand factor, coagulation factor IX, and plasminogen activator inhibitor 1) were found increased together with decreases in some anticoagulants (protein S and antithrombin) in IBD. Also the activation markers of coagulation (d-dimer, fibrinogen degradation products, and prothrombin fragments 1 + 2) were all increased. The parameters of the total coagulation–fibrinolysis system were increased in IBD, regardless of the form and the activity of the disease.

The relationship between insulin resistance and post-ERCP pancreatitis (PEP) is not known. We aimed to determine the relation between pre-ERCP insulin resistance and risk of PEP, and to evaluate the relationship of insulin resistance with well-established risk factors for PEP. Consecutive patients who underwent ERCP with the diagnosis of choledocolithiasis between January and December 2013 were enrolled in this prospective study. Pre-procedural insulin resistance state and other risk factors were evaluated according to PEP development. Pancreatitis developed in 16 (11.3 %) of 141 ERCP procedure. Homeostasis model assessment of insulin resistance (HOMA-IR) levels was found statistically significantly higher in patients who developed PEP than the ones who did not (3.37 ± 0.8 vs. 2.38 ± 1.4, p

Background and Aim Cardiovascular disease (CVD) is the most frequent cause of death in nonalcoholic fatty liver disease (NAFLD). Insulin resistance, hepatic dysfunction, and chronic inflammation are factors interacting in explaining the increased CVD incidence in NAFLD. We aimed to evaluate the effects of insulin resistance and inflammatory biomarkers on asymmetric dimethylarginine (ADMA) levels, a predictor of CVD. We also investigated relationship between these markers and histological findings in patients with NAFLD. Patients and Methods Plasma ADMA, high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and homeostasis model assessment of insulin resistance (HOMA-IR) were measured in 70 patients with histologically verified NAFLD (53 with nonalcoholic steatohepatitis [NASH], 17 with non-NASH) and 12 controls. Results The HOMA-IR (5.3 [3.9] vs 1.9 [1], P < 0.001), hs-CRP (5.6 [4.2] vs 2.2 [2.3] mg/L, P < 0.001), ADMA (0.81 [0.25] vs 0.48 [0.24] μmol/L, P = 0.005), and IL-6 (4.1 [1.2] vs 1.0 [0.4] pg/mL, P < 0.001) levels were all found higher in the NAFLD group than the control group. The ADMA levels were significantly higher in patients with NAFLD independent from HOMA-IR and body composition ( P = 0.02). The IL-6 and HOMA-IR levels of the NASH group were found significantly higher than those of the non-NASH group. The only determinant significantly correlated to ADMA was HOMA-IR. Conclusions Our data suggested that although ADMA levels are independently higher in NAFLD, the only determinant correlated to ADMA is HOMA-IR and not inflammatory biomarkers (hs-CRP, IL-6) or presence/absence of NASH.

Background and Aims: Oesophagogastroduodenoscopy (gastroscopy) andcolonoscopy are examinations required for the evaluation of the etiology ofanemia. We aimed to retrospectively evaluate results of gastroscopic andcolonoscopic examinations done in our endoscopy unit for the investigationof anemia. Materials and Methods: Retrospective data from 545 gastroscopyand 398 colonoscopy examinations done in the Endoscopy Unit ofŞişli Hamidiye Etfal Training and Research Hospital Gastroenterology Departmentbetween January 2012 and December 2013 with an indication ofanemia were obtained from our computer database. Results: Gastroscopywas performed on 545 patients because of anemia, of whom 214 (39%)were male and 331 (61%) were female. The average age of the patients was53.8±17.2 years. In 27.2% of these patients, diseases such as oesophagealvarices, gastric cancer, gastroduodenal ulcer, angiodisplasia and previousgastric surgery that could explain anemia were detected. This ratio was 20%in female patients, 39% in male patients, 19% in patients younger than 50years and 34% in patients 50 years and over. Colonoscopy was done in 398patients because of anemia, of whom 171 (43%) were male and 227 (57%)were female. The average patient age was 56.9±15.7 years. In 40.5% of patientsundergoing colonoscopy, a pathology that may cause anemia was detected.This ratio was 33.5% in female patients, 49.7% in male patients, 22%in patients younger than 50 years and 49.1% in patients 50 years or over.While malignancy was detected in 1.8% of patients undergoing gastroscopydue to anemia, 3.3 % malignancy and 21.6 % polyp were detected in patientsundergoing colonoscopy. Conclusion: In the upper and lower gastrointestinalsystem, endoscopic examinations done for the investigation of irondeficiency anemia etioogy and the detection rate of a pathology that couldexplain anemia was higher in patients 50 years or older and in male patients., Giriş ve Amaç: Anemi etiyolojisini araştırmada özofagogastroduodenoskopi(gastroskopi) ve kolonoskopi yapılması gerekli olan tetkiklerdir. Endoskopiünitemizde anemi nedeniyle yapılan gastroskopi ve kolonoskopi işlemlerininsonuçlarını retrospektif olarak değerlendirmeyi amaçladık. Gereç ve Yöntem:Ocak 2012-Aralık 2013 tarihleri arasında Şişli Hamidiye Etfal Eğitimve Araştırma Hastanesi Gastroenteroloji Kliniği endoskopi ünitesinde anemiendikasyonu ile yapılmış olan 545 gastroskopi ve 398 kolonoskopi işlemininsonuçları retrospektif olarak bilgisayar veri tabanından elde edildi. Bulgular:Anemi nedeniyle gastroskopi istenen 545 hastanın 214’ü (%39) erkek ve331’i (%61) kadındı. Hastaların ortalama yaşı 53.8±17.2 yıl olarak bulundu.Bu hastaların toplam %27.2’sinde özofagus varisi, mide kanseri, gastroduodenalülser, angiodisplazi ve geçirilmiş mide ameliyatı gibi anemiyi açıklayabilecekpatoloji saptandı. Bu oran kadın hastalarda %20, erkek hastalarda%39 olarak; 50 yaş altı hastalarda %19, 50 yaş üstü hastalarda %34 olarakbulundu. Anemi nedeniyle kolonoskopi yapılan 398 hastanın 171’i (%43)erkek ve 227’si (%57) kadındı. Hastaların ortalama yaşı 56.9±15.7 yıl idi.Kolonoskopi yapılan hastaların %40.5’inde anemiye sebep olabilecek patolojisaptandı. Bu oran kadın hastalarda %33.5, erkek hastalarda %49.7 olarak;50 yaş altı hastalarda %22, 50 yaş üstü hastalarda %49.1 olarak bulundu.Anemi nedeniyle gastroskopi yapılan hastaların %1.8’inde malignite saptanırken,kolonoskopi yapılan hastaların ise %3.3’ünde malignite, %21.6’sındapolip saptandı. Sonuç: Demir eksikliği anemisi etiyolojisi araştırmak içinyapılan alt ve üst gastrointestinal sistem endoskopik incelemeleri ile 50 yaşüstü ve erkek hasta grubunda anemiyi açıklayacak patoloji saptama oranıdaha yüksektir.

Background and Aims: Nasobiliary drainage is an established mode of treatment for acute suppurative cholangitis, bile leakage and biliary fistula. We retrospectively analyzed the safety and efficacy of nasobiliary drainage placement for biliary drainage in patients with acute cholangitis. Materials and Methods: Between January 2011 and December 2012, nasobiliary drainage was performed in 22 patients at Sisli Etfal Training and Education Hospital. The clinical characteristics, laboratory results, clinical outcomes, and complications were analyzed retrospectively. Results:Nasobiliary drainage was performed in 22 patients (11 female), and the mean age was 54,3±24,4 years (range, 12-84). Acute suppurative cholangitis (n=11), hydatid cyst with biliary communication (n=4), postoperative biliary leak (n=3), external biliary leakage (n=2), and hemobilia (n=2) were the main indications of nasobiliary drainage. The catheter was removed in 8,4±6,2 days, and time elapsed to normalization of total serum bilirubin levels was 4±0,6 days. There were no endoscopic retrograde cholangiopancreatography -related complications. Although it is not a comfortable treatment modality, there were no instances of displacement or kinking of the nasobiliary drainage.Conclusions: Biliary drainage by nasobiliary drainage is a safe and effective treatment in patients with severe cholangitis, postoperative bile leakage and bile fistula.

An increase in the prevalence of colorectal polyps and cancer is reported in patients with acromegaly. This trial is designed to determine whether there is an increase in the prevalence of colorectal polyps/cancer in Turkish acromegaly patients. Sixty-six patients, who were under follow-up with the diagnosis of acromegaly and underwent total colonoscopic examination, were enrolled in the study. Sixty-five age- and gender-matched patients with nonspecific complaints were selected as control. The mean age of acromegalic patients was 51.5±12.8 years of whom 27 (40.9%) were females. In 20 (30.3%) of the patients with acromegaly a total of 65 colorectal polyps were detected. Forty-seven (72.3%) of the polyps were detected at the rectosigmoid region. In 8 (12.3%) of the 65 control patients a total of 17 polyps were found. There was a statistically significant difference between the groups (P=0.018). At the logistic regression analysis we found that the risk for colon polyps increased 3.2-fold in the presence of acromegaly, irrespective of age and gender (OR: 3.191, 95% CI: 1.25–8.13). In conclusion, patients who were followed up with the diagnosis of acromegaly should be taken to the colonoscopic surveillance program and all polyps detected should be excised in order to protect them from colorectal cancer.

Background: Terminal ileum endoscopy and biopsy are the diagnostic tools of diseases attacking the ileum. However, abnormal histological findings can be found in endoscopically normal terminal ileum. Objective: This study was performed to evaluate the histopathological results of biopsies from endoscopically normal terminal ileum in order to determine pre-procedure clinical and laboratory factors predicting abnormal histopathological results, if any. Methods: A total of 297 patients who underwent colonoscopy and terminal ileum biopsy and had normal terminal ileum or a few aphthous ulcers in the terminal ileum together with completely normal colon mucosa were included in the study. The patients were grouped into two arms as normal cases and cases with aphthous ulcers. Histopathological and pre-procedural laboratory results of patients were analyzed according to their indications. Results : The terminal ileum was endoscopically normal in 200 patients, and 97 patients had aphthous ulcers. Chronic ileitis rate was present in 5.5% of those with endoscopically normal terminal ileum and in 39.2% of the patients with aphthous ulcers. In both groups, the highest rate of chronic ileitis was detected in the patients with known inflammatory bowel disease (IBD) (15.4 and 50%, respectively), anemia (9.5 and 43.5%, respectively), and in the patients having chronic diarrhea together with abdominal pain (7.7 and 44.8%, respectively). We found that the sensitivity of mean platelet volume for predicting chronic ileitis was 87% and the specificity was 45% at a cut-off value lower than 9.35 fl. Conclusion: In anemia indication or chronic diarrhea together with abdominal pain, the frequency of aphthous ulcers detected by ileoscopy and the frequency of chronic ileitis detected histopathologically despite a normal-appearing ileum were elevated. Keywords: Terminal ileum; ileoscopy; chronic ileitis; inflammatory bowel disease (Published: 19 February 2014) Citation: Libyan J Med 2014, 9 : 23441 - http://dx.doi.org/10.3402/ljm.v9.23441

Gastrointestinal tract is the most common site of extranodal non-Hodgkin’s lymphoma. Small bowel involvement accounts for 2030% of all gastrointestinal lymphomas. Among all intestinal lymphomas, the ileum is the most common involved area, with duodenal involvement only accounting for a small proportion. The most frequent histological type is diffuse large B-cell lymphoma (DLBCL). T-cell/ histiocyte-rich-large B-cell lymphoma (TCHRBCL) is an uncommon morphologic variant of B-cell lymphoma. Duodenal involvement of TCHRBCL has not been reported previously. We hereby report this first case of TCHRBCL of the duodenum. (Published: 16 December 2013) Citation: Libyan J Med 2013, 8 : 22955 - http://dx.doi.org/10.3402/ljm.v8i0.22955

A 25-year-old female patient with Crohn's disease had been using azathioprine and metronidazole for an extended period because of recurrent perianal and rectovaginal fistulae. Infliximab was added to the treatment regimen following postoperative recurrence of a rectovaginal fistula. Upon the development of severe neutropenia and thrombocytopenia after the third dose of infliximab, azathioprine and infliximab were stopped. Neutropenia work-up did not reveal any other cause. Neutropenia was ameliorated with use of granulocyte colony-stimulating factor. Treatment was restarted with infliximab alone upon leakage from the rectovaginal fistula with no hematologic toxicity. This case was considered as a serious adverse effect of infliximab and azathioprine combination therapy.

Background: Helicobacter pylori infection is the main cause of gastritis, gastroduodenal ulcer disease, MALT lymphoma, and adenocarcinoma of the stomach. The reported prevalence of H. pylori in the adult population in Turkey is 67.6%-81.3%. A national meta-analysis showed that the average H. pylori eradication rate with proton pump inhibitor-based triple regimens in Turkey had decreased from 84% in 1997 to 55.3% in 2004, suggesting a need to evaluate alternative regimens. Materials and methods: The study was a prospective, single-center trial with a parallel group design. After the selection procedure, consecutive out-patients were assigned to one of six study groups using random sampling numbers. All patients received amoxicillin 1,000 mg b.i.d. and clarithromycin 500 mg b.i.d. along with ranitidine bismuth citrate 400 mg b.i.d., or omeprazole 20 mg b.i.d., or lansoprazole 30 mg b.i.d., or rabeprazole 20 mg b.i.d., or pantoprazole 40 mg b.i.d., or esomeprazole 40 mg b.i.d. for 14 days. Results: When we look at the eradication rates of the treatment groups, only two groups (ranitidine bismuth citrate and rabeprazole groups) had eradication rates greater than 80%, both at intention to treat and per protocol analyses. The other four groups (omeprazole, lansoprazole, pantoprazole, and esomeprazole groups) showed statistically significant lower eradication rates both at intention to treat (between 57.6 and 66.7%) and per protocol (between 60.3 and 72.1%) analyses when compared with ranitidine bismuth citrate and rabeprazole groups ( p

BACKGROUND/AIMS It is known that ulcerative proctitis might show extension, but in practice, patients with proctitis are not considered as important with regard to regular follow-up and treatment. The aim of this study was to evaluate the extension of ulcerative colitis cases limited to the rectum and compare them with the patients with rectosigmoid and left colonic ulcerative colitis for their features, risk factors influencing the extension and natural course of the disease. METHODS The study involved 193 (62 rectal, 49 rectosigmoid and 82 left-sided) ulcerative colitis patients. RESULTS Fourteen percent of the patients showed extension to at least one proximal segment in 3.9±2.9 (range: 0.8-12) years. The extension was found as 16.1% in proctitis, 12.2% in rectosigmoiditis and 13.4% in left-sided colitis groups. Extension was found 2.79-fold (95% confidence interval: 1.1-7.1) higher in patients with chronic active disease. Further, the patients with amoebic attacks, those under steroid treatment and those without treatment showed higher risk for extension. CONCLUSIONS Patients with proctitis, like the patients presenting with more extensive colitis, should be offered regular treatment and follow-up.

Aim. We aimed to identify and describe characteristic and diagnostic ultrasonographic features of arterioportal fistula cases. Patients. In this case series we describe 3 patients with arterioportal fistula. By depending on shared sonographic features of these patients we describe a “sonographic pattern” for the sonographic diagnosis of arterioportal fistula. Conclusion. In summary; both of the artery and vein related with fistula were wider than normal and seen as adjacent anechoic circles, there was an aneurismatic dilation on vein which has turbulent flow within it, the communication between the artery and aneurism can be seen sonographically, both of the vessels have arterial flow, filling of the vein was retrograde and other branches of the artery and vein unrelated with aneurism were all normal in dimension.

We aimed to evaluate the carcinogenesis risk in inflammatory bowel disease via p53 mutation and its relation with hyperproliferation (cyclin-D1) and angiogenesis (with vascular endothelial growth factor [VEGF] and microvessel density) and whether these events play important roles in pathogenesis of inflammatory bowel disease. Colonic tissue samples of 26 ulcerative colitis, 6 Crohn's disease, and 8 amoebic colitis patients as well as samples of 10 healthy controls were stained with p53, cyclin-D1, CD34, and VEGF monoclonal antibodies by immunohistochemistry and evaluated semiquantitatively. Expression of p53 was higher in ulcerative colitis than in the healthy control and amoebic colitis groups (4.15 +/- A 2.07, 1.4 +/- A 1.5, 1.3 +/- A 1.5; P < 0.001). The Crohn's disease group had the highest p53 expression (4.6 +/- A 1.6). The Crohn's disease, ulcerative colitis, and amoebic colitis groups all had higher VEGF expression than did the healthy controls (respectively, 4.3 +/- A 1.2, 2.92 +/- A 2.0, 2.3 +/- A 1.5, 0.6 +/- A 0.97; P < 0.001). Also, microvessel density was statistically higher in all three colitis groups than in healthy controls. Cyclin-D1 expression in all four groups was similar. The study showed that p53 mutation was present in nonneoplastic mucosa of inflammatory bowel disease patients. Detecting strong p53 overexpression with VEGF overexpression may help in differentiating inflammatory bowel disease from other colitis.

This study was designed to determine the possible effects of omeprazole on human natural killer cells. Peripheral venous blood samples were taken from 20 peptic ulcer patients before and at the 14th and the 28th days of omeprazole treatment. Mononuclear cells were removed from blood and their capability of making conjugation with K562 target cells and lysing K562 target cells was evaluated. A significant decrease was found (P < 0.001) in the 14th and the 28th days compared with the basal value of the capability of the mononuclear cells to conjugate with the K562 target cells and to lyse them. This study demonstrated that omeprazole significantly reduces natural killer cell functions. This finding suggests that omeprazole may also have some effects on the other systems in addition to parietal cell acid secretion.

Pill induced esophagitis is a rare complication mostly seen in patients using tetracycline and its derivatives or non-steroidal anti-inflammatory drugs. Here we present a 37 years old female patient experiencing pill esophagitis after taking desloratadine without liquid immediately before going to bed. This was the first pill esophagitis case related with desloratadine reported in the literature. Pill esophagitis is a preventable complication that consists of giving simple advice of how and when to take medication.

Lipomas of the gastrointestinal tract are uncommon tumors. Almost all gastrointestinal lipomas are submucosal or subserosal, and most are asymptomatic, although they may cause abdominal pain, bowel obstruction, and gastrointestinal bleeding. The diagnosis of gastrointestinal lipoma is usually not made before surgery. We present a case of colonic intussusception caused by a lipoma that was located in the muscular layer of the colon and was diagnosed preoperatively by sonography. The descending colon appeared edematous and thick. There was layering within the lumen of the descending colon, mimicking the target sign. At the distal end of the intussusception, there was a 4.7-cm, hyperechoic, rounded lesion with a smooth margin. Surgery revealed a polypoid mass originating from the splenic flexure and causing intussusception of the colon, and pathologic analysis confirmed the diagnosis of lipoma of the muscular layer of the colon.

Behcet's disease is a chronic, recurrent, systemic disease characterized by orogenital ulcers and oculocutaneous inflammatory lesions. Cardiovascular, pulmonary, neurological, articular, and GI involvement are common features, but pancreatic involvement is very rare. We present a case of Behcet's disease with both chronic pancreatitis and abdominal aorta pseudoaneurysm.

Background and aim: Angiogenesis is an important process in the pathogenesis of chronic inflammation. We aimed to study the angiogeneic balance in inflammatory bowel disease (IBD) by evaluating the expression of vascular endothelial growth factor (VEGF) and thrombospondin-1 (TSP-1) on colonic epithelial cells, together with the expression of inducible nitric oxide synthase (iNOS). Methods: Twenty-one ulcerative colitis (UC), 14 Crohn’s disease (CD), 11 colorectal cancer patients, and 11 healthy controls colonic biopsy samples were evaluated immunohistochemically. Results: The expressions of TSP-1, VEGF, and iNOS in UC and CD groups were higher than expression in healthy control group, all with statistical significance. However, in colorectal cancer group, VEGF and iNOS expressions were increased importantly, but TSP-1 expression was not statistically different from healthy control group’s expression. Both TSP-1 and VEGF expressions were correlated with iNOS expression distinctly but did not correlate with each other. Conclusions: Both pro-angiogeneic VEGF and antiangiogeneic TSP-1 expressions were found increased in our IBD groups, but in colorectal cancer group, only VEGF expression was increased. TSP-1 increases in IBD patients as a response to inflammatory condition, but this increase was not enough to suppress pathologic angiogenesis and inflammation in IBD. Keywords: inflammatory bowel disease; thrombospondin-1; VEGF; iNOS; colon cancer (Published: 30 January 2012) Citation: Libyan J Med 2012, 7 : 8942 - DOI: 10.3402/ljm.v7i0.8942