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Objective: latrogenic colon perforation (ICP) is one of the most feared complications of colonoscopy and causes unwanted morbidity and mortality. In this study, we aimed to discuss the characteristics of the cases of ICP we encountered in our endoscopy clinic, its etiology, our treatment approaches, and results in the light of the current literature. Material and Methods: We retrospectively evaluated the cases of ICP among 9.709 lower gastrointestinal system endoscopy procedures (colonoscopy + rectosigmoidoscopy) performed for diagnostic purposes in our endoscopy clinic during 2002-2020. Results: A total of seven cases of ICP were detected. The diagnosis was made during the procedure in six patients and after eight hours in one patient, and their treatment was performed urgently. Whereas surgical procedures were performed in all patients, the type of the procedure varied; laparoscopic primary repair was performed in two patients and laparotomy in five patients. In the patients who underwent laparotomy, primary repair was performed in three patients, partial colon resection and end-to-end anastomosis in one patient, and loop colostomy in one patient. The patients were hospitalized for an average of 7.14 days. The patients who did not develop complications in the postoperative follow-up were discharged with full recovery. Conclusion: Prompt diagnosis and appropriate treatment of ICP is crucial to prevent morbidity and mortality.

Background: Cyclosporine is a rescue treatment alternative to avoid colectomy in corticosteroid refractory acute severe ulcerative colitis. In this study, we aimed to evaluate the long-term efficacy and safety of cyclosporine therapy in acute severe ulcerative colitis patients. Methods: Acute severe ulcerative colitis (basal Lichtiger score > 10) patients who did not respond to 40 mg intravenous methylprednisolone therapy after 3-5 days were included in the study. The presence of clinical response and remission was assessed at 1st week, 1st, 6th, and 12th month according to the Lichtiger index. Results: In this study, 40 patients, whose steroid refractory acute severe ulcerative colitis and basal Lichtiger score > 10 points were enrolled. The median disease duration was 49.3 months (2-204). All patients received cyclosporine for 132 +/- 78 days (7-270). Clinical response was obtained on seventh day in 82.5%. The clinical response rates of the first and sixth months were 72.5% and 62.5%, -respectively. A total of 17/40 (42.5%) patients underwent colectomy within 1 year. In the patients who underwent colectomy, the basal LS (14.2 +/- 1.9 vs 12.3 +/- 1.7) (P = .002) was higher and the basal hemoglobin value (11.8 +/- 2.3 vs 10.1 +/- 1.5) (P = .037) was lower than those who did not undergo colectomy. Conclusion: Our findings suggest that cyclosporine treatment may be successfully and safely used in steroid refractory acute severe ulcerative colitis patients. Cyclosporine is a drug that has recently started to come up again with the introduction of new maintenance treatments. Especially in patients who develop a loss of response to infliximab therapy, or where infliximab therapy is contraindicated, or who have azathioprine intolerance, or are unresponsive.

Peritoneal tuberculosis arises from hematogenous spread of pulmonary foci or from direct spread from an adjacent structure. Diagnosis of peritoneal tuberculosis can be challenging due to nonspecific symptoms, insidious onset, and variable imaging findings. Herein, we report a patient presenting with ascites who was eventually diagnosed with peritoneal tuberculosis.

BACKGROUND: Cyclosporine is a rescue treatment alternative to avoid colectomy in corticosteroid refractory acute severe ulcerative ­colitis. In this study, we aimed to evaluate the long-term efficacy and safety of cyclosporine therapy in acute severe ulcerative colitis patients. METHODS: Acute severe ulcerative colitis (basal Lichtiger score > 10) patients who did not respond to 40 mg intravenous methylprednisolone therapy after 3-5 days were included in the study. The presence of clinical response and remission was assessed at 1st week, 1st, 6th, and 12th month according to the Lichtiger index. RESULTS: In this study, 40 patients, whose steroid refractory acute severe ulcerative colitis and basal Lichtiger score > 10 points were enrolled. The median disease duration was 49.3 months (2-204). All patients received cyclosporine for 132 ± 78 days (7-270). Clinical response was obtained on seventh day in 82.5%. The clinical response rates of the first and sixth months were 72.5% and 62.5%, ­respectively. A total of 17/40 (42.5%) patients underwent colectomy within 1 year. In the patients who underwent colectomy, the basal LS (14.2 ± 1.9 vs 12.3 ± 1.7) (P = .002) was higher and the basal hemoglobin value (11.8 ± 2.3 vs 10.1 ± 1.5) (P = .037) was lower than those who did not undergo colectomy. CONCLUSION: Our findings suggest that cyclosporine treatment may be successfully and safely used in steroid refractory acute severe ulcerative colitis patients. Cyclosporine is a drug that has recently started to come up again with the introduction of new maintenance treatments. Especially in patients who develop a loss of response to infliximab therapy, or where infliximab therapy is contraindicated, or who have azathioprine intolerance, or are unresponsive.

Objective: In our study, we aimed to evaluate the prevalence of Helicobacter pylori (H. Pylori) and the characteristics of antrum pathologies in patients with portal hypertensive gastropathy. Materials and Methods: Antrum pathologies and the presence of H. Pylori evaluated with Giemsa stain in gastroscopies of 203 patients with portal hypertensive gastropathy. Results: A total of 203 patients, 119 male, 84 female, with portal hypertensive gastropathy was included in our study. In patients with portal hypertension, the rate of H. Pylori positivity was 15.3%. This rate was determined as 18.5% under 65 years old and 8.8% over 65 years old. On the basis of gender, H. Pylori positivity rates were 21.8% in male patients and 6% in female patients. The most common antrum pathologies in the patients, in order of frequency, were reactive gastropathy with a rate of 41.4%, active gastritis with a rate of 23.6%, and edema with a rate of 22.2%. The rate of intestinal metaplasia was found to be 9.9%. Conclusion: In the patients with portal hypertension included in our study, the H. Pylori positivity rate was found to be 15.3%. This rate was found to be below the H. Pylori positivity rate in our country. The most common antrum pathology in the patients was reactive gastropathy with a rate of 41.4%, while the rate of intestinal metaplasia was found to be 9.9%., Amaç: Çalışmamızda portal hipertansif gastropatisi (PHG) olan hastalarda Helicobacter pylori sıklığını ve antrum patolojilerinin özelliklerini değerlendirmeyi amaçladık. Gereç ve Yöntem: Portal hipertansiyonu olan 203 hastanın endoskopi ünitemizde yapılmış olan gastroskopilerinde portal hipertansif gastropati saptanan hastaların antrum patolojileri ve Giemsa boyası ile değerlendirilen H. Pylori varlığı retrospektif olarak araştırılmıştır. Bulgular: Çalışmaya, portal hipertansif gastropatisi olan, 119’u erkek, 84’ü kadın, toplam 203 hasta dahil edilmiştir. Portal hipertansif gastropatisi olan hastalarda, H. Pylori pozitiflik oranı %15,3 olarak saptandı. Bu oran 65 yaş altında %18,5, 65 yaş üzerinde ise %8,8 olarak saptanmıştır. Cinsiyet bazında, H. Pylori pozitiflik oranları erkek hastalarda %21,8, kadın hastalarda %6 olarak tespit edildi. Hastalarda en sık görülen antrum patolojileri sıklık sırasına göre: %41,4 oranı ile reaktif gastropati, %23,6 aktif gastrit ve %22,2’lik oran ile ödem olarak saptandı. İntestinal metaplazi oranı ise %9,9 olarak saptandı. Sonuç: Çalışmamıza dahil ettiğimiz PHG’i olan hastalarda, H. Pylori pozitiflik oranı %15,3 olarak saptandı. Bu oranın ülkemiz genelindeki H. Pylori pozitiflik oranının altında olduğu görülmüştür. Hastalarda en sık görülen antrum patolojisi %41,4 oranı ile reaktif gastropati iken, intestinal metaplazi oranı %9,9 olarak saptandı.

OBJECTIVES Isoniazid (INH) prophylaxis is recommended for the prevention of tuberculosis (TB) reactivation before or/and during initiation of treatment with tumour necrosis factor antagonists (anti-TNF agents). Nonetheless, the long-term effectiveness of chemoprophylaxis is not clear. In this study, we aimed to evaluate the characteristics of patients who developed TB reactivation in spite of INH prophylaxis associated with anti-TNF treatment. PATIENTS AND METHODS In this retrospective study, medical records of 1263 patients with inflammatory bowel disease were reviewed. Baseline TB screening tests (purified protein derivative test and/or QuantiFERON-TB Gold test) were performed on all patients before initiation of anti-TNF therapy. Patients with purified protein derivative of more than 5 mm and/or a positive result of the QuantiFERON-TB Gold test received INH prophylaxis for 9 months. We analysed the data of patients diagnosed with TB reactivation during the anti-TNF treatment despite INH chemoprophylaxis. RESULTS Overall, 175 patients underwent anti-TNF treatment. Sixty of these 175 patients had pretreatment testing showing latent TB infection and therefore were treated concomitantly with INH for 9 months in addition to their anti-TNF treatment. TB reactivation occurred in four of these 60 co-INH/anti-TNF treated patients. Active TB was diagnosed after 37.5±27 (range: 18-84) months of anti-TNF treatment. In two of the four patients that active TB was diagnosed, was also detected other Mycobacterium spp.: M. bovis in one patient and M. genavense in the other one. CONCLUSION INH chemoprophylaxis may not prevent the reactivation of TB during anti-TNF therapy in the long-term. Patients should be carefully and periodically screened for TB reactivation during anti-TNF therapy.

The aims of the present study were to evaluate the efficacy and tolerability of ledipasvir/sofosbuvir (LDV/SOF) with or without ribavirin in the treatment of chronic hepatitis C (CHC) in patients with advanced liver disease and to analyse whether the use of LDV/SOF treatment is associated with a new occurrence of hepatocellular carcinoma (HCC) during and after LDV/SOF treatment. The Turkish Early Access Program provided LDV/SOF treatment to a total of 200 eligible CHC patients with advanced liver disease. The median follow-up period was 22 months. All patients were Caucasian, 84% were infected with genotype 1b, and 24% had a liver transplantation before treatment. The sustained virological response (SVR12) was 86.0% with ITT analysis. SVR12 was similar among patients with Child-Pugh classes A, B and C disease and transplant recipients. From baseline to SVR12, serum ALT level and MELD score were significantly improved (P < 0.001). LDV/SOF treatment was generally well tolerated. Only one patient developed a new diagnosed HCC. Seventeen of the 35 patients, who had a history of previous HCC, developed HCC recurrence during the LDV/SOF treatment or by a median follow-up of 6 months after treatment. HCC recurrence was less commonly observed in patients who received curative treatment for HCC compared with those patients who received noncurative treatment (P = 0.007). In conclusion, LDV/SOF with or without ribavirin is an effective and tolerable treatment in CHC patients with advanced liver disease. Eradication is associated with improvements in liver function and a reduced risk of developing a new occurrence of HCC.

Objective We aimed to determine the frequency, morphological features, differential diagnosis, possible adverse events of inverted colonic diverticulum (ICD), which may be misdiagnosed as polyps. Methods In all, 810 patients who underwent a colonoscopy between April 2016 and November 2019 were included in the study, and their data were evaluated retrospectively. Colonoscopic procedures were performed at a single center by the same endoscopist. Results Among all the 810 patients, the prevalence of diverticulum was 29.58% (121/409) in men and 25.19% (n = 101/401) in women, respectively. ICD was observed in 1.73% (n = 14) of all patients, including 11 (78.57%) men (aged 63.2 ± 12.95 years [range 47-90 years]) and three women (60.3 ± 4.04 years [range 58-65 years]). Most (63.16% [12/19]) ICD lesions were localized in the sigmoid colon. And the diagnosis was confirmed by eversion using biopsy forceps in 78.95% of them. One patient developed perforation after polypectomy with hot biopsy forceps and was treated by surgical operation. Conclusions ICD is a common lesion that may lead to serious adverse events if misdiagnosed as polyps. Differential diagnosis of ICD is crucial during the colonoscopy.

Hepatocellular carcinoma (HCC) is an increasing problem worldwide. Determining a prognosis is important for the management of HCC.We aimed to investigate the impact of interleukin (IL)-29, galectin-3, leptin, fibronectin and protease-activated receptor-1 on the prognosis and diagnosis of patients with HCC.60 HCC patients (75% male) and 20 healthy volunteers (70% male) were enrolled in this prospective study. Serum samples were obtained during the first admission before any adjuvant or metastatic treatments were administered. Serum biomarkers were determined using ELISA kits.All patients had cirrhosis, and the Child - Pugh stages were as follows: 61.5% Child - Pugh A, 35.9% Child - Pugh B and 2.6% Child - Pugh C (61.7% hepatitis B virus, 11.7% hepatitis C virus, 6.7% hepatitis B virus + hepatitis C virus, 11.7% alcoholic and 8.3% cryptogenic). Fifty-three percent of the HCC patients died within a median of 7.5 months. The mean serum level of IL-29 in patients with HCC was higher than that in the control group (32.55 pg/ml vs 11.46 pg/ml, p 0.015). Galectin-3 levels were significantly higher in the HCC group (6.7 ng/ml vs 1.38 ng/ml, p 0.001). Fibronectin levels were higher in the control group than in the HCC group (260 635 ng/ml vs 257 353 ng/ml). However, the mean protease-activated receptor-1 and leptin levels were similar between the two groups (p 0.05). The biomarkers were divided into two groups according to their median level. In the log rank analysis, biomarkers had no effect on survival (p 0.05).IL-29 and galectin-3 levels were significantly higher in HCC patients. Although IL-29 and galectin-3 can be used as diagnostic markers for HCC, they had no prognostic value in HCC patients.

Background Regarding the incidence of colorectal malignancy and polyps in patients with acromegaly, studies reported different results in different populations. For this reason, the aim of this study was to determine the frequency of possible colonic pathologies, such as diverticula, polyps, and malignancies in Turkish patients with active acromegaly and factors affecting them. Methods A total of 134 patients with acromegaly and 134 patients with irritable bowel syndrome/dyspeptic symptoms as a control group were included in the study. None of these patients had a previous or family history of colonic neoplasms. Colonoscopies of patients with acromegaly were performed before definitive surgery in a single center by experienced endoscopists. Results The acromegaly and control groups were similar in terms of age and sex. The incidence of all colonic polyps was significantly higher in the acromegaly group (p= 0.012). The frequency of hyperplastic polyps was also increased in the acromegaly group (p= 0.004); however, the frequencies of adenoR. Iliaz, M.D. () Biruni Faculty of Medicine, Department of Gastroenterology, Biruni University, 34295 Istanbul, Turkey raimiliaz@gmail.com S. C. Dogansen · S. Tanrikulu · G. Y. Yalin · S. Yarman Istanbul Faculty of Medicine, Department of Endocrinology and Metabolism, Istanbul University, Istanbul, Turkey B. Cavus · F. Akyuz Istanbul Faculty of Medicine, Department of Gastroenterology, Istanbul University, Istanbul, Turkey M. Gulluoglu Istanbul Faculty of Medicine, Department of Pathology, Istanbul University, Istanbul, Turkey matous polyps and colonic diverticula were similar in both groups. In the comparison of patients with acromegaly for the presence of polyps, those with polyps were older, had higher levels of insulin-like growth factor (IGF-1), were of male sex, and skin tags were more common (p= 0.016, p= 0.034, p= 0.006 and p= 0.001, respectively). There were no colorectal malignancies in the patients with active acromegaly. Conclusion The frequency of hyperplastic polyps was increased, whereas colonic malignancy was not observed in Turkish patients with active acromegaly.

Background Neurologic and liver involvement in Wilson's disease (WD) is well-documented, however, few reports demonstrated cardiac involvement. Tpe and Tpe/QT are new measures of ventricular repolarization which were recently suggested as predictor of arrythmogenesis. We aimed to evaluate ventricular depolarization and repolarization parameters including QT, QTc, Tpe intervals, Tpe/QT, Tpe/QTc ratios, and QT dispersion (QTd) in patients with WD. Materials and methods Thirty-five patients with WD and 30 healthy controls were included in the study. Patients were evaluated by a neurologist in addition to MR imaging. Twenty-one of 35 patients were diagnosed as neuroWilson (NW), whereas 14 patients as non-NW. ECG recordings were obtained using a 12-lead commercial device (Cardiac Science, Burdick s500,USA). All patients underwent standard echocardiographic evaluation. These two groups of patients and healthy controls were compared. Results There were no difference between patients with WD and healthy controls in terms of age sex, BMI, liver, and kidney functions where as patients with WD were anemic and thrombocytopenic. Left atrial, ventricular dimensions, left ventricular systolic, and diastolic functions were similar between patients and healthy control. QT interval was prolonged in patient group, however, QTc, Tpe intervals, Tpe/QT, and Tpe/QTc ratios and QTd did not differ between groups. When patients with NW and non-NW were compared, both QT and QTc intervals were significantly longer in patients with NW, however, Tpe interval, Tpe/QT and Tpe/QTc ratios, and QTd did not differ. Conclusion QT and QTc intervals are prolonged in patients with Wilson's disease and neurologic involvement.

Introduction and aim Over the years, there has been a change in the profile of patients with chronic hepatitis C (CHC). In recent years, more patients with CHC have presented to the clinics at the cirrhotic stage, with decompensated liver disease, and with hepatocellular carcinoma. The aim of this study was to investigate the changing epidemiological, clinical, and virological characteristics of CHC patients. Patients and methods A total of 313 CHC patients were included in this study. The patients were classified into group 1 (1996–2001) and group 2 (2011–2016). Epidemiological, clinical, and virological differences were investigated between two periods. Results Overall, 44.7% (n=140) of the patients were in group 1. The sex distribution between the two groups was similar. The patients in group 2 was older than those in group 1 (54±15 vs. 45±12 years, retrospectively, P

Backgrounds and Aims In autoimmune hepatitis, there are uncertainties about whether to discontinue the treatment, when the treatment should be discontinued, and the risks of relapse in the cases where remission is achieved with immunosuppressive therapy. In this study, patients with AIH, whose immunosuppressive treatments were discontinued, were evaluated for the rates of remission and the risk of relapse. Materials and Methods A total of 119 patients, who were diagnosed with AIH based on the AIHG scoring systems between 1990 and 2015, were evaluated. Patients were receiving standard azathioprine and steroid therapy. The treatment was discontinued in patients, who had been receiving treatment for at least 2 years, who had no clinical complaints, and whose aminotransferases were normal and when an increase occurred in AST values more than two times the normal after the treatment was interrupted, the case was considered as a relapse. Results Among the patients, 83%( n = 99) were women. When the patients were diagnosed with AIH, their mean age was 36 ± 16(8–79) years; 70.6%( n = 84) were type 1, 3.4%( n = 4) type 2, and 26%( n = 31) were autoantibody-negative AIH. At the time of discontinuation, liver biopsy was performed in 8 of the patients and minimal-mild abnormalities were detected. Patients whose treatment was discontinued received treatment for an average of 101 ± 75(range: 24–280, median: 68.5) months; and, they were followed up for an average of 19 (1–110) months during the period without medication. Relapse occurred in 67%( n = 12) of the patients with drug withdrawal. Relapse occurred within the first 12 months in 67% of these patients ( n = 8) and developed with an acute hepatitis attack in 42%. None of the clinical, laboratory, and histological data were found to be effective on relapse. Conclusion In patients with AIH, relapse occurs in two-thirds of patients within an average of 19 month after the discontinuation of the medication. Most relapses occur at the early period and they are accompanied by an acute hepatitis attack.