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Parkinson's disease patients may experiencevarious gastrointestinal symptoms; however, the exactpathophysiology of these symptoms is not fullyunderstood. Therefore, the aim of this study was toinvestigate the pattern of gastric myoelectrical activityin patients with Parkinson's disease. Eleven patientswith Parkinson's disease and 10 healthy subjectsparticipated in the study. Patients were stratified as “receiving dopaminergic therapy” (N= 5) and “off therapy” (N = 6). Gastricmyoelectrical activity was measured by means of surfaceelectrogastrography (EGG) for 30 min before and for 90 min after a standardized meal. The dominantfrequency, postprandial EGG power change, and thepercentage of normal 2-4 cycles/min (cpm) slow-waveactivity in the three groups were calculated andcompared. The mean postprandial EGG power increase in theuntreated patients was smaller than in the treatedpatients (–3.11 ± 1.01 and 1.17 ±1.96 dB; P = 0.072). Moreover, both of these values weresignificantly decreased when compared to the control group(untreated vs control: d–3.11 ± 1.01 vs8.01 ± 1.86 dB; P = 0.04 and treated vs control:1.17 ± 1.96 vs 8.01 ± 1.86 dB; P = 0.02).The percentage of normal 2-4 cpm slow waves in untreated patients wasnot different from the treated patients (82.6 ±6.6% vs 75.8 ± 13.6%, P = NS) or from the controlgroup (88.2 ± 5.4%, P = NS). The dominantfrequency after the meal was similar to that in thefasting state both in the untreated (3.3 ± 0.1 vs3.2 ± 0.2 cpm; P = NS) and treated patients (3.2± 0.1 vs 3.1 ± 0.1 cpm, P = NS), whereasthe dominant frequency significantly increasedpostprandially in the control group (2.88 ± 0.12vs 3.05 ± 0.16; P < 0.05). Abnormalities ingastric myoelectrical activity in untreated Parkinson'sdisease patients reflect direct involvement of thegastrointestinal tract by the primary disease process.EGG can be regarded as a useful diagnostic tool inevaluating gastrointestinal involvement inneurodegenerative diseases. [ABSTRACT FROM AUTHOR]

Patients with gastroparesis frequently present challenging clinical, diagnostic, and therapeutic problems. Data from 146 gastroparesis patients seen over six years were analyzed. Patients were evaluated at the time of initial diagnosis and at the most recent follow-up in terms of gastric emptying and gastrointestinal symptomatology. The psychological status and physical and sexual abuse history in female idiopathic gastroparesis patients were ascertained and an association between those factors and gastrointestinal symptomatology was sought. Eighty-two percent of patients were females (mean age: 45 years old). The mean age for onset of gastroparesis was 33.7 years. The etiologies in 146 patients are: 36% idiopathic, 29% diabetic, 13% postgastric surgery, 7.5% Parkinson's disease, 4.8% collagen vascular disorders, 4.1% intestinal pseudoobstruction, and 6% miscellaneous causes. Subgroups were identified within the idiopathic group: 12 patients (23%) had a presentation consistent with a viral etiology, 48% had very prominent abdominal pain. Other subgroups were gastroesophageal reflux disease and nonulcer dyspepsia (19%), depression (23%), and onset of symptoms immediately after cholecystectomy (8%). Sixty-two percent of women with idiopathic gastroparesis reported a history of physical or sexual abuse, and physical abuse was significantly associated with abdominal pain, somatization, depression, and lifetime surgeries. At the end of the follow-up period, 74% required continuous prokinetic therapy, 22% were able to stop prokinetics, 5% had undergone gastrectomy, 6.2% went onto gastric electrical stimulation (pacing), and 7% had died. At some point 21% had required nutrition support with a feeding jejunostomy tube or periods of parenteral nutrition. A good response to pharmacological agents can be expected in the viral and dyspeptic subgroups of idiopathics, Parkinson's disease, and the majority of diabetics, whereas a poorer outcome to prokinetics can be expected in postgastrectomy patients, those with connective tissue disease, a subgroup of diabetics, and the subset of idiopathic gastroparesis dominated by abdominal pain and history of physical and sexual abuse. Appreciation of the different etiologies and psychological status of the patients may help predict response to prokinetic therapy. [ABSTRACT FROM AUTHOR]

The aims of this study were to investigate the diagnostic studies necessary to identify rumination syndrome and the long-term therapeutic outcomes of patients with rumination syndrome. Sixteen patients with rumination were evaluated between 1989 and 1995. Esophageal motility, gastric emptying, upper gastrointestinal motility, and electrogastrography of all patients were reviewed; follow-up information about their current status was available from 10 of the 16 patients. Duration of symptoms was 77.2 months and the mean age was 28.5 years at the time of diagnosis. Esophageal and upper gastrointestinal motility, gastric emptying, and electrogastrographic studies were all normal. Mean lower esophageal pressure was 12.7 mm Hg and three of the 16 patients had a decreased pressure of less than 6 mm Hg. Ten patients were followed for a mean duration of 31.2 months. Five of 10 patients used biofeedback and relaxation techniques and reported subjective improvement. Our results indicate that rumination syndrome is often confused with a gastric motility disorder and diagnosis is possible if one is aware of this condition. Although there is not a definitive management protocol for this condition, reassurance and education of the patient and the family are crucial first steps followed by behavioral and relaxation programs. [ABSTRACT FROM AUTHOR]

Autoimmune gastritis is an immune-mediated disease characterized by the destruction of parietal cells and atrophy of the oxyntic mucosa due to anti-parietal cell antibodies. It may lead to serious conditions including iron/vitamin B12 and micronutrient deficiencies, neurological disorders, and gastric malignancies. The exact mechanism of this disease is not exactly understood; however, dysregulated immunological mechanisms appear to be major contributors. Patients with this disease are often asymptomatic but may present with gastrointestinal symptoms and/or iron/vitamin B12 deficiencies. Although important serological markers are available and despite advanced endoscopic techniques, the definitive diagnosis relies on histopathological examination of gastric corporal biopsy specimens. Autoimmune gastritis is closely related with increased risk of gastric neuroendocrine tumors and gastric adenocarcinoma. Patients with autoimmune gastritis do not benefit from specific treatments, thus, management is directed to restore micronutrient deficiencies and to prevent occurrence of neoplastic transformation with appropriate endoscopic surveillance.

Background: Ultra-short coeliac disease (USCD) is defined as villous atrophy only present in the duodenal bulb (D1) with concurrent positive coeliac serology. We present the first, multicentre, international study of patients with USCD., Methods: Patients with USCD were identified from 10 tertiary hospitals (6 from Europe, 2 from Asia, 1 from North America and 1 from Australasia) and compared with age-matched and sex-matched patients with conventional coeliac disease., Findings: Patients with USCD (n=137, median age 27 years, IQR 21-43 years; 73% female) were younger than those with conventional coeliac disease (27 vs 38 years, respectively, p<0.001). Immunoglobulin A-tissue transglutaminase (IgA-tTG) titres at index gastroscopy were lower in patients with USCD versus conventional coeliac disease (1.8×upper limit of normal (ULN) (IQR 1.1-5.9) vs 12.6×ULN (IQR 3.3-18.3), p<0.001).Patients with USCD had the same number of symptoms overall (median 3 (IQR 2-4) vs 3 (IQR 1-4), p=0.875). Patients with USCD experienced less iron deficiency (41.8% vs 22.4%, p=0.006).Both USCD and conventional coeliac disease had the same intraepithelial lymphocytes immunophenotype staining pattern; positive for CD3 and CD8, but not CD4.At follow-up having commenced a gluten-free diet (GFD) (median of 1181 days IQR: 440-2160 days) both USCD and the age-matched and sex-matched controls experienced a similar reduction in IgA-tTG titres (0.5 ULN (IQR 0.2-1.4) vs 0.7 ULN (IQR 0.2-2.6), p=0.312). 95.7% of patients with USCD reported a clinical improvement in their symptoms., Interpretation: Patients with USCD are younger, have a similar symptomatic burden and benefit from a GFD. This study endorses the recommendation of D1 sampling as part of the endoscopic coeliac disease diagnostic workup., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Acute pancreatitis is an abrupt inflammatory disease of the exocrine pancreas and it can occur in different severities. It is becoming more common and more mortal in the gerontal population. The aim of our study was to explore the similarities and differences between young and gerontal patients with acute pancreatitis, with a special emphasis on patients over 80 years of age., Methods: Medical records of patients (n = 1150) with acute pancreatitis were analyzed retrospectively. Several scoring systems including Bedside index for severity in acute pancreatitis, Ranson's score, Harmless acute pancreatitis score, Acute Physiology and Chronic Health Evaluation, Balthazar Grade, Glasgow score, and Japanese severity score were applied at admission. Patients were divided into 3 groups; group I, young group (n = 706), if they were aged &lt;65 years; group II, older group (n = 338), if they were aged ≥65 years to &lt;80 years; group III, octogenarian group (n = 106), if they were aged ≥ 0 years., Results: In total, 1150 patients with acute pancreatitis were analyzed. Octogenarian group (n = 42, 39.6%) showed a more severe acute pancreatitis compared to patients in group I (n = 15, 2.1%) and II (n = 50, 14.8%, P &lt; .001). Complications were more common in patients in group III (P &lt; .001). Mortality rate was higher in patients in group III (n = 53, 50%) compared to group I (n = 8, 1.1%) and group II (n = 53, 15.7%) (P &lt; .001)., Conclusion: Gerontal patients with acute pancreatitis tend to have more severe disease and systemic and local complications. Mortality rates were higher in older patients compared to younger patients.

Background: Many rheumatic diseases may cause gastrointestinal manifestations. The goal of this study was to analyze the prevalence and predictors of gastrointestinal involvement in patients with rheumatic disorders., Methods: A retrospective chart review was performed for patients with systemic lupus erythematosus, rheumatoid arthritis, and sys- temic sclerosis who have consulted due to gastrointestinal symptoms. The relationship between clinical symptoms, gastroscopic/colo- noscopic findings, and histopathological results with current drugs and disease duration was evaluated., Results: A total of 364 patients with rheumatic disorders and 740 people as control group were included in the study. Abdominal bloating followed by abdominal pain, regurgitation, and heartburn were reported as the main complaints by more than half of the patients. Most of the patients had gastric mucosal changes expressed as Lanza score, and the presence of major polypharmacy was the most important factor affecting Lanza score (odds ratio: 10, 95% CI: 1.882-54.111, P < .007) followed by disease duration (odds ratio: 1.559, 95% CI: 1.369-1.775, P < .001) and age (odds ratio: 1.069, 95% CI: 1.030-1.109, P < .001). In general, approximately 30% of the patients were posi- tive for Helicobacter pylori infection and 35% showed intestinal metaplasia in histopathological examination. Most of the colonoscopic findings were associated with colonic polyps (n = 81). In multivariate analysis, disease duration was the only factor that affected the pres- ence of colonic lesions (Area Under the Receiver Operating Characteristic (ROC) Curve (AUROC): 0.871, 95% CI: 0.824-0.918, P < .001)., Conclusion: Patients with rheumatologic diseases frequently have gastrointestinal manifestations. The most encountered gastrointes- tinal symptom was abdominal bloating, followed by abdominal pain. Being aware of gastrointestinal manifestations and their determi- nants may help physicians manage and follow patients with rheumatologic disorders.

Diagnosis of non-coeliac gluten sensitivity (NCGS) remains still problematic due to the subjectiveness and lack of a specific biomarker. We aimed to compare NCGS duodenal mucosae with healthy individuals and Marsh type 1 coeliac disease (CD), to determine whether NCGS has characteristic histological features. A total of 44 healthy controls, 42 NCGS, and 44 type 1 CD patients were selected according to clinical, serological, and laboratory data. Duodenal biopsies were evaluated on H&E, CD, and CD117 for villus/crypt ratio, IEL counts/100 enterocytes, uneven distribution pattern with clusters of IELs in the villous epithelium, linear distribution of T lymphocytes in the basal lamina propria, and eosinophils and mast cells in the lamina propria. IEL counts were within normal range in controls (13 ± 7.65), normal or mildly increased in NCGS (24.7 ± 10.46), and increased in CD (58.79 ± 14.97) on CD3. The presence of uneven distribution pattern of IELs in the villous epithelium was significantly higher in NCGS (90.5%), in contrast to controls (27.3%) and CD (34.1%). The presence of linear distribution of T lymphocytes in the basal lamina propria (68.2%, 76.2%, 78.1%), eosinophil counts (6.85 ± 3.42, 6.21 ± 2.8, 7.62 ± 3.89), and mast cell counts (25.1 ± 5.1, 26 ± 2.9, 30.3 ± 4.4) was similar in controls, NCGS, and CD, respectively. In conclusion, duodenal mucosae in NCGS are characterized by preserved villous architecture, normal or mildly increased IELs with clusters, and eosinophils and mast cells within normal limits. We believe uneven distribution of IELs with clusters in the villous epithelium can be used as a supportive histopathological tool for NCGS in the right clinical setting., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The clinical spectrum of autoimmune gastritis is silent in the early stages of the disease and no specific symptom is related to this entity. Although gastroscopic findings of this entity are well defined, data regarding colonoscopic findings are limited. The aims of this study were to determine the prevalence of colonoscopic findings and to explore factors that might affect these findings. This is a retrospective chart review of patients with autoimmune gastritis (n=240). Data regarding colonoscopic findings, serum gastrin and chromogranin A (CgA) levels and gastric histopathological results were extracted and compared with 550 patients positive for Helicobacter pylori and gastric atrophy. Control subjects had colonoscopy and gastroscopy with biopsies. Colorectal lesions were observed in 64 (26.6%) of patients with autoimmune gastritis and 36 (6.6%) patients had colorectal lesions in the control group (p<0.001). Serum gastrin (OR: 8.59, 95% CI 1.72 to 25.07, p<0.001) and CgA levels (OR: 6.79, 95% CI 0.41 to 27.26, p<0.001) were found as factors affecting the presence of colorectal carcinoma. Serum gastrin and CgA levels were also found as predictors for the presence of colorectal adenomas. There is a higher prevalence of colorectal neoplastic lesions in patients with autoimmune gastritis. Serum gastrin and CgA levels were found to be determinants of colorectal neoplastic lesions observed in patients. In the workup of these patients, serum gastrin and CgA levels may guide physicians for the demonstration of colorectal neoplastic lesions., Competing Interests: Competing interests: None declared., (© American Federation for Medical Research 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Aim: This study aimed to determine the presence of concomitant extrahepatic autoimmune disease (EAD) in patients with autoimmune liver disease (ALD) and the efficacy of the treatment response of ALD with the presence of any EAD., Materials and Methods: Between January 2001 and November 2017, 241 patients with ALD were included in the study., Results: Of the 241 patients, 88, 134, and 19 had autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and overlap syndrome (OS), respectively. Thirty-one patients had cirrhosis: 77% and 23% had compensated and decompensated disease, respectively. The presence of at least one EAD was defined in 38.6% of the patients with ALD (n=93), and 12% of them had ≥1 EAD. EAD was most commonly seen in patients with OS and PBC compared with those with AIH (p=0.036). Autoimmune thyroid disease was the most common association (20%), followed by Sjogren syndrome (12.0%). At the end of the follow-up period, 165 patients (72%) had biochemical response. The presence of EAD did not affect the biochemical response., Conclusion: EAD is most frequently seen in patients with ALD. The presence of EAD is not associated with the treatment response., Competing Interests: Conflict of Interest: The authors have no conflict of interest to declare., (© Copyright 2021 by Hepatology Forum - Available online at www.hepatologyforum.org.)

Background and Goals: The aims of the present study were to investigate the natural history of cirrhosis and to determine trends in the etiology of cirrhosis., Methods: Between January 2001 and January 2018, a total of 1,341 patients had been diagnosed with cirrhosis and were included., Results: A total of 898 cirrhotic patients, who were followed up for at least 6 months were included into the analysis. The median age was 54 years. The median Child-Pugh and MELD scores were 7.5 and 11, respectively. Ascites (51%) was the most common causes of decompensation. Chronic viral hepatitis was the most frequent cause of cirrhosis (58%). Hepatitis B virus (HBV) infection was the main etiology (34%), followed by hepatitis C virus (HCV) infection (18%). Among 129 patients with cryptogenic cirrhosis (CC), 60 had metabolic abnormalities. If these 60 patients with CC were considered to have nonalcoholic fatty liver disease (NAFLD)-related cirrhosis, the proportion of NAFLD-related cirrhosis increased from 1.8 to 8.0%. At admission, 74 patients (8%) had been diagnosed with hepatocellular carcinoma (HCC). A new HCC developed in 80 patients during the follow-up period. The probability of developing HCC was 3.9% at 12 months. Logistic regression analysis showed that the development of HCC was significantly associated with older age (p < 0.001), male gender (p < 0.001), viral etiology (p = 0.026), and baseline high aspartate aminotransferase level (p = 0.01). Overall, 104 cirrhotic patients died., Conclusion: HBV and HCV remain the leading causes of etiology in cirrhosis and HCC. However, NAFLD-related cirrhosis is recognized as a growing burden., (© 2020 S. Karger AG, Basel.)

Intraepithelial lymphocytosis (IELosis) with or without villous abnormality is a characteristic feature of gluten sensitivity (GS) including celiac disease (CD) and non-celiac-GS, although various conditions may also be associated with IELosis. In order to distinguish GS from the other causes of IELosis, a threshold for IEL counts is necessary. We aimed to determine a cut-off value for IELs and monitor its value in the spectrum of GS in a large cohort. For this purpose, the duodenal biopsies from four groups of individuals including Types 1 (n = 88) and 3 (n = 92) CD, non-CD IELosis (n = 112), and control (n = 82) cases, all strictly defined by their clinical, laboratory, and serologic features, were evaluated. The number of IELs/100 enterocytes and their distribution pattern on H&E- and CD3-immunostained sections were assessed for each group. Kruskal-Wallis test and ROC curve analysis for discriminant value were employed for statistics. The IEL counts showed an increasing trend through the spectrum of mucosal pathology including controls (12.06; 21.40), non-CD IELosis (28.62; 39.46), Type 1 CD (49.27; 60.15), and Type 3 CD (58.53; 71.74) both on H&E- and CD3-immunostained sections, respectively (p < 0.001). ROC analysis revealed 20.5 on H&E and 28.5 on CD3 as the IEL cut-off values with a sensitivity of 95.9 and 87.7% and a specificity of 98.8% and 93.9%, respectively, for controls. IELs showed a diffuse distribution pattern per biopsy piece and per villus (90.9%, 100%, respectively) in nearly all of Type 1 CD cases (p < 0.001). An IEL cut-off value of 20.5 on H&E together with a diffuse distribution pattern seem to be the most discriminant features for the diagnosis of CD, even for the milder forms of the disease.

Background: Gastric emptying (GE) of solids is delayed and autonomic dysfunction is detected in autoimmune gastritis (AIG). The goals of this study were to: (1) compare serum levels of ghrelin and motilin in subjects with delayed and normal GE and (2) investigate whether circulating antimyenteric antibodies (CAA), serum ghrelin levels and motilin levels have any effect on autonomic function., Materials and Methods: Noninvasive cardiovascular reflex tests were used in order to evaluate the autonomic function. GE was evaluated by a standard 2-hour scintigraphic test. Serum ghrelin and motilin levels were tested by enzyme-linked immunosorbent assay and CAA were tested by immunofluorescence., Results: The serum ghrelin and motilin levels in the patients with delayed GE (n = 22) were significantly decreased compared to the normal GE patients (n = 19), (67.55 ± 8.81 versus 126.79 ± 25.81pg/mL, P < 0.001 and 279.59 ± 111.12 versus 500.42 ± 155.95pg/mL, respectively, P < 0.001). Whereas, the serum ghrelin and motilin levels in the patients with deranged autonomic function (n = 26) were significantly decreased compared to the patients with normal autonomic function (n = 15), (80.73 ± 28.46 versus 127.79 ± 28.06pg/mL, P < 0.001 and 316.92 ± 160.47 versus 490.20 ± 141.02pg/mL, P < 0.001, respectively).  None of the patients were positive for CAA., Conclusions: Ghrelin and motilin levels in AIG subjects with delayed GE and deranged autonomic function were significantly decreased. The decrease in serum ghrelin and plasma motilin levels in AIG suggest their potential role in the delayed GE observed in these subjects., (Copyright © 2018 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

Objectives: Patients with autoimmune gastritis may have symptoms suggestive of delayed gastric emptying. The aim of this study was to explore the predictive value of two scoring systems in the differentiation of delayed gastric emptying in patients with autoimmune gastritis., Methods: About 154 patients (106 women) with autoimmune gastritis whose gastric emptying test were available, were analyzed using two laboratory-based scoring systems: 'global score' (hemoglobin, mean corpuscular volume, gastrin, vitamin B 12 , and chromogranin A) and 'simple score' (hemoglobin, mean corpuscular volume, and gastrin) in order to discriminate delayed and normal gastric emptying., Results: The mean 'simple score' was 4.82 ± 0.94 for autoimmune gastritis patients with delayed gastric emptying and 0.72 ± 0.60 for patients with normal gastric emptying (p < 0.001). The mean 'global score' was 7.42 ± 0.81 for autoimmune gastritis patients with delayed gastric emptying and 1.176 ± 0.98 (p < 0.001) for patients with normal gastric emptying. There was also a positive correlation between severity of symptoms of patients with autoimmune gastritis and global (r = 0.83, p < 0.001) and simple scores (r = 0.81, p < 0.001)., Conclusion: This model may help physicians, while evaluating autoimmune gastritis patients and deciding which patients need gastric emptying test. Gastric emptying study should be ordered in patients who are fulfilling the criteria proposed by these scoring systems.

Background/aims: Autoimmune gastritis patients may have autonomic nerve dysfunction. The goal of our study was to explore the predictive value of two scoring systems in the differentiation of altered autonomic nerve function in autoimmune gastritis patients., Materials and Methods: Seventy-five patients with autoimmune gastritis were evaluated by using cardiovascular reflex tests in order to delineate autonomic nerve function. Data were analyzed by using two laboratory-based scoring systems: "global score" (hemoglobin, mean corpuscular volume, gastrin, vitamin B12, and chromogranin A) and "simple score" (hemoglobin, mean corpuscular volume, gastrin) in order to discriminate deranged and normal autonomic nerve function., Results: Mean "simple" and "global" scores were significantly higher in subjects with altered autonomic dysfunction than in subjects with normal autonomic function (3.55±1.88 vs. 0.908±0.409, p<0.001 and 5.95±2.07 vs 2.46±1.28, p<0.001, respectively). Receiver operatör characteristic (ROC) analysis revealed that the optimum "simple score" cutoff point was 0.75 with a sensitivity of 86.7% and specificity of 92.3% for discriminating autoimmune gastritis patients with autonomic nerve dysfunction from patients with normal autonomic nerve function [area under the curve (AUC): 88.3, positive predictive value (PPV): 97.5% and negative predictive value (NPV): 66.6%; 95% confidence interval (CI), 88.4-99.7]., Conclusion: Simple score and global score have a high predictive value in the assessment of autoimmune gastritis patients with autonomic nerve dysfunction. These scoring systems may help physicians while evaluating autoimmune gastritis patients for the existence of autonomic nerve dysfunction instead of complex cardiovascular reflex tests.

Aim: Celiac disease is an autoimmune enteropathy with variable clinical symptoms. Elderly patients can have different manifestations from those of young patients. The aims of the present study were to investigate whether any differences or similarities exist between older and young patients with celiac disease with a special emphasis on concurrent autoimmune diseases., Methods: Celiac disease patients were stratified as older and younger patients. These two groups were then compared by means of clinical symptoms, laboratory parameters and concurrent autoimmune diseases. Factors associated with the presence of an autoimmune disease were identified by univariate and multivariate analysis., Results: There were 66 older patients (mean age 67.7 ± 3.2 years, 50 women), and 277 younger patients (mean age 35.9 ± 11.7 years, 207 women). Of the 66 older patients, eight patients had gastrointestinal symptoms and 58 patients had extradigestive symptoms. In the younger group, the number of patients referred due to gastrointestinal symptoms was higher (8 [12.2%] vs 200 (72.2%), P < 0.001) compared with the older group. Whereas 10 (15.1%) older patients showed polyautoimmunity, 55 (19.8%) younger patients had polyautoimmunity. Multiple autoimmune syndrome was more common in older patients compared with young patients (31 [47%] vs 12 [4%], P < 0.001, respectively)., Conclusions: The presentation of celiac disease clinically, histologically and by means of laboratory parameters is different in older and young patients. Polyautoimmunity and multiple autoimmune syndrome are more common in older patients compared with younger patients. A biopsy score of Marsh score type, antinuclear antibody positivity, high serum anti-tissue transglutaminase immunoglobulin A level and low hemoglobin level were risk factors for having an autoimmune disease. Geriatr Gerontol Int 2017; 17: 2060-2067., (© 2017 Japan Geriatrics Society.)

Aim: Elderly patients with autoimmune gastritis might have different symptoms than those of young patients. The aim of the present study was to compare presented symptoms and laboratory parameters associated with autoimmune gastritis in both old and young age groups., Methods: A total of 355 patients with autoimmune gastritis were stratified into two groups: 65 years or older (n = 119, mean age 69.47 ± 5.027 years), and under 65 years (n = 236, mean age 45.79 ± 10.51 years). These two groups were then evaluated and compared by means of clinical symptoms, concurrent autoimmune diseases, serum gastrin, vitamin B 12 and chromogranin A levels, and the presence of enterochromograffin-like cell hyperplasia., Results: Among 119 older patients, 35 had dyspeptic symptoms, and 84 patients were referred for vitamin B 12 and/or iron deficiency. In the younger group (n = 236), there were more patients who had dyspeptic symptoms (36 vs 200, P < 0.001). Serum gastrin (726.68 ± 266.183 vs 214.36 ± 104.62 pg/mL, P < 0.001) and chromogranin A (301.26 ± 172.95 vs 106.59 ± 67.66 ng/mL, P < 0.001) levels were significantly higher, and the presence of enterochromograffin-like cell hyperplasia was more frequent (113 vs 31, P < 0.001) in older patients than younger patients. Polyautoimmunity (66.3% vs 24.5%) and multiple autoimmune syndrome (17.6% vs 5.5%) were more common in older patients (P < 0.001)., Conclusions: There are differences in the clinical characteristics and the laboratory parameters between patients with autoimmune gastritis that are older and younger than 65 years-of-age. Elderly patients with autoimmune gastritis were investigated more commonly for vitamin B 12 and/or iron deficiency. Polyautoimmunity and multiple autoimmune syndrome were more common, and serum gastrin and chromogranin A levels were significantly higher in older patients. Geriatr Gerontol Int 2017; 17: 1090-1095., (© 2016 Japan Geriatrics Society.)

Aim: Acute gastrointestinal bleeding is a potentially life-threatening condition that requires rapid assessment and dynamic management. Several scoring systems are used to predict mortality and rebleeding in such cases. The aim of the present study was to compare three scoring systems for predicting short-term mortality, rebleeding, duration of hospitalization and the need for blood transfusion in elderly patients with upper gastrointestinal bleeding., Methods: The present study included 335 elderly patients with upper gastrointestinal bleeding. Pre- and post-endoscopic Rockall, Glasgow-Blatchford and AIMS65 scores were calculated. The ability of these scores to predict rebleeding, mortality, duration of hospitalization and the need for blood transfusion was determined., Results: Pre- (4.5) and post-endoscopic (7.5) Rockall scores were superior to the Glasgow-Blatchford (12.5) score for predicting mortality (P = 0.006 and P = 0.015). Likewise, pre- (4.5) and post-endoscopic Rockall scores were superior to the respective Glasgow-Blatchford scores for predicting rebleeding (P = 0.013 and P = 0.03). There was an association between duration of hospitalization and mortality; as the duration of hospitalization increased the mortality rate increased. In all, 94% of patients hospitalized for a mean of 5 days were alive versus 56.1% of those hospitalized for 20 days, and 20.2% of those hospitalized for 40 days., Conclusions: In elderly patients with upper gastrointestinal bleeding, the Rockall score is clinically more useful for predicting mortality and rebleeding than the Glasgow-Blatchford and AIMS65 scores; however, for predicting duration of hospitalization and the need for blood transfusion, the Glasgow-Blatchford score is superior to the Rockall and AIMS65 scores. Geriatr Gerontol Int 2017; 17: 575-583., (© 2016 Japan Geriatrics Society.)

Background/objectives: Percutaneous endoscopic gastrostomy is a method of providing enteral feeding to patients who cannot take adequate oral nutrition. The aims of this study were to determine the performance of malnutrition and mortality scoring systems for predicting short and long-term mortality in elderly patients who had undergone gastrostomy procedure due to non-malignant conditions., Design: Retrospective cohort study., Setting: University hospital in Turkey., Participants: 155 individuals aged 65 and older principally hospitalized for non-malignant diseases and require percutaneous endoscopic gastrostomy., Measurements: "Geriatric Nutritional Risk Index", "Malnutrition Universal Screening Tool" (MUST) and "Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity" (P-POSSUM) scores were calculated. The ability of these scores to predict mortality was determined., Results: The mean survival period was 9.59±6.0 months and mortality rate was 80.6%. The performance of "Geriatric Nutritional Risk Index" was superior to MUST and P-POSSUM in predicting long-term survival of gastrostomy patients; 94.1% of patients were alive with a cut-off value of 90 for "Geriatric Nutritional Risk Index" (sensitivity: 92% CI 85.9-95.6 and specificity: 90% CI 74.3-96.5). Survival analysis showed that patients (n=7) with a "Geriatric Nutritional Risk Index" score of > 98 before the gastrostomy had the longest survival time, while patients (n=102) with a "Geriatric Nutritional Risk Index" score of < 82 had the worst outcome., Conclusions: A scoring system such as "Geriatric Nutritional Risk Index" should be considered as a risk scoring system for predicting early and late mortality at gastrostomy and also assist in making decisions such as timing of gastrostomy procedure., Competing Interests: The authors declare that they have no conflict of interest.

The spectrum of mucosal pathology in coeliac disease (CD), initially defined by Marsh in 1992 has been subjected to several modifications in the following years by Oberhuber, then by Corazza and Villanaci, and finally by Ensari. The present study, aimed to end the ongoing confusion regarding the classification of mucosal pathology in CD by applying all the classifications proposed so far on a large series of cases. A total of 270 duodenal biopsies taken from the distal duodenum of patients with a diagnosis of CD were included in the study. All biopsies were classified according to Marsh, Oberhuber, Corazza Villanaci, and Ensari classification schemes. For statistical analyses cases were divided into three groups: Group 1 included type 1 lesions in Marsh, Ensari, and Oberhuber and grade A in Corazza Villanaci classifications. Group 2 comprised of type 2 lesions in Marsh and Ensari classifications together with type2, type 3a and 3b lesions in Oberhuber classification and grade B1 lesions in Corazza Villanaci classification. Group 3 included type 3 lesions in Marsh and Ensari classifications, and type 3c lesions in Oberhuber, and grade B2 lesions in Corazza Villanaci classifications. The kappa value was 1.00 (excellent) for group 1, 0.53 (fair) for group 2 and 0.78 (excellent) for group 3 (p<0.0001). These results suggest that any of the above classification system would serve similar purposes in the diagnosis of CD. Therefore, it is advisable that the pathologist should use the simplest reliable scheme., (Copyright © 2016 Elsevier GmbH. All rights reserved.)

Background/aims: Chromogranin A is an important tool in the diagnosis of neuroendocrine tumors. Autoimmune gastritis is an autoimmune disorder marked by hypergastrinemia, which stimulates enterochromaffin-like cell proliferation. Chromogranin A is also elevated in autoimmune gastritis patients with a different level of increase in each patient. The goal of this study is to explore constituents that influence serum chromogranin A levels in autoimmune gastritis patients., Materials and Methods: One hundred and eighty-eight autoimmune gastritis patients and 20 patients with type I gastric carcinoid tumors were analyzed retrospectively and compared to 110 functional dyspepsia patients in terms of factors that might affect serum chromogranin A levels., Results: The mean serum chromogranin A level was 171.17±67.3 ng/mL in autoimmune gastritis patients (n=62) without enterochromaffin-like cell hyperplasia, and 303.3±102.82 ng/mL in patients (n=126) with enterochromaffin-like cell hyperplasia (p<0.001). The presence of corpus atrophy (p=0.026, OR: 5.03, CI 95%: 1.21-20.88, β=1.61) and presence of enterochromaffin-like cell hyperplasia (p=0.017, OR: 6.59, CI 95%: 1.4-31.08, β=1.88) were found as risk factors associated with serum chromogranin A level., Conclusion: Factors influencing raised serum chromogranin A levels in autoimmune gastritis were the presence of ECL cell hyperplasia and serum gastrin levels. Serum chromogranin A levels maybe helpful in distinguishing autoimmune gastritis patients and gastric carcinoid type I from the control group, but not useful in the differentiation of individuals with autoimmune gastritis from patients with gastric carcinoids.