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Introduction: Lesions in the gastroinestinal (GI) tract that are distal to the Treitz ligament are what cause the lower gastrointestinal bleeding (LGB) system. The purpose of this study was to investigate and compare the Charlson Comorbidity Index (CCI), mortality rates, length of hospital stays, need for intensive care, need for blood products, and surgical rates in patients with acute LGB. Material and Method: Retrospective research was done on patients who had lower GI bleeding and had been seen in our gastroenterology clinic between 2015 and 2021. We looked into the impact of CCI on patients' follow-up after LGB. Results: The mean age of the 210 patients who had lower GI bleeding was 67.70±13.67 years. For all of the patients, the median CCI value was 4.00. (2.00-5.00). While 16 study participants (group 1) passed away, 194 participants (group 2) were released from the hospital. The variance in the median CCI values between the two groups was statistically significant (p>0.001). The results of a multivariate logistic regression analysis revealed that CCI was a reliable predictor of mortality (p>0.001). Conclusion: It was found that CCI was an accurate predictor of mortality. CCI ought to be regarded as a crucial factor in the treatment of patients who are bleeding from their lower gastrointestinal tract.

Objectives: Diarrhea is a common health problem and may occur for many infectious and non-infectious causes. In this study, it was aimed to investigate the causes, methods used in diagnosis and the results obtained in patients who applied to the gastroenterology clinic with the complaint of diarrhea. Materials and methods: 187 patients who presented with diarrhea between 01.11.2019-01.11.2020 were included in this study. Results: Acute diarrhea was detected in 32 (17.1%) out of 187 patients, persistent in 34 (18.2%), and chronic diarrhea in 121 (64.7%). The cause of diarrhea was detected in 148 (79.1%) patients. Infectious cause in 66 (%44.6) patients; inflammatory bowel disease (IBD) in 41 (27.7%) patients; irritable bowel syndrome (IBS) in 22 (14.9%) patients and less frequently as other diagnose were listed. The cause of diarrhea was detected in 73.6% of patients with chronic complaints, and this rate was 87.5% in acute diarrhea; and 91.2% of those presenting with persistent diarrhea (p = 0.04). Lower C reactive protein levels were found in irritable bowel syndrome compared to other diarrheal causes (p

Inflammatory bowel disease (IBD), a multisystemic inflammatory disorder, has been associated with increased risk of cardiovascular problems, including complications such as conduction defects and arrhythmias. Therefore, the early assessment of the risk factors predisposing to ventricular arrhythmias is crucial, since it can improve clinical outcomes. The objective of the present study is to evaluate ventricular repolarization by using Tp‑e interval and Tp-e/QTc ratio as candidate markers of ventricular arrhythmias in patients with IBD.The presented study was designed as a single-center prospective cohort study. The study population consisted of 175 patients with IBD and 175 healthy volunteers. The Tp‑e interval, corrected QT (QTc), and Tp-e/QTc ratio were measured from the 12-lead electrocardiogram. These parameters were compared between groups.The groups were similar in terms of electrocardiographic findings such as heart rate, QRS interval, and QTc interval. However, Tp‑e interval (87.0 ms, interquartile range, IQR 81.0-105.0 ms vs. 84.0 ms, IQR 74.0-92.0 ms; p 0.001) and Tp-e/QTc ratio (0.21 ± 0.04 vs. 0.19 ± 0.05; p 0.001) were significantly increased in IBD patient group compared to control group. Notably, a positive correlation was demonstrated between Tp‑e interval, Tp-e/QTc ratio and disease duration (Spearman's Rho = 0.36, p 0.001 for Tp‑e; Spearman's Rho = 0.28, p 0.001 for Tp-e/QTc).This study demonstrated that IBD patients are at increased risk of disrupted ventricular repolarization (increased Tpe, Tpe/QTc ratio). In addition, a positive correlation was demonstrated between Tp‑e interval, Tp-e/QTc ratio, and disease duration. Therefore, IBD patients, especially those with long-standing diseases, should be more closely screened for ventricular arrhythmias.

BACKGROUND: There is limited data in the literature analyzing the efficacy of methotrexate in Crohn’s disease used after thiopurine analogs. We aimed in our study to show the efficacy of methotrexate in Crohn’s disease patients who failed to respond to thiopurine treatment. METHODS: The study included 29 azathioprine refractory patients with Crohn’s disease. Intramuscular methotrexate (25 mg/week) in the induction of remission and intramuscular methotrexate (15 mg/week) in 29 CD patients with a median follow-up time of 13 months was performed. In 15 (51.7%) patients, methotrexate was used in combination with anti-Tumour necrosis factor (TNF) (combination group), while it was used in 14 (48.3%) patients in monotherapy (monotherapy group). RESULTS: The mean Harvey–Bradshaw index score significantly decreased in the follow-up period (Wk0 = 7.6, last visit = 4.5, P < .001). Remission and response rates at week 12 were 75.9% and 79.3%, respectively. Maintenance of remission (77.8% vs 37.5%, respectively, P = .1) and response rates (77.8% vs 50%, respectively, P = .3) due to last visit examination were numerically higher in combination group but they were not statistically significant. The cumulative probability of remission maintenance in patients with methotrexate therapy was 72.7%, 33.1%, and 22.0% at 1, 2 ,and 4 years after starting methotrexate, respectively. CONCLUSION: Our results show that parenteral use of methotrexate is efficacious in inducing and maintaining remission as a step-up agent in azathioprine refractory Crohn’s disease patients.

Aim The aim of this study was to present one-year real-life data of our patients with CD who showed unresponsiveness and/or intolerance to biological agents and then received ustekinumab treatment through an early access program. Materials and methods The retrospective study reviewed the 52-week clinical data of 10 patients with moderate or severe CD who underwent ustekinumab therapy. Results The 10 patients comprised 7 (70%) men and 3 (30%) women with a mean age of 38 ± 11.3 years. Mean disease duration was 13.5 ± 8.5 years. Mean pretreatment CDAI score was 273.5 ± 92 and mean pretreatment HBI score was 11.6 ± 3.8. At the end of the 8-week intravenous induction treatment, 5 (55%) patients showed clinical remission according to the CDAI and HBI scores. Additionally, 62.5% of the patients were in clinical remission at the end of week 52 according to the CDAI and HBI scores. No drug-related side effects were observed in any patient throughout the treatment. Conclusion Ustekinumab appears to be effective and safe in the treatment of moderate and severe CD, particularly in cases of unresponsiveness and intolerance to biological agents such as anti-TNF, and in the achievement of clinical remission.

Giriş ve Amaç: Mallory-Weiss sendromu üst gastrointestinal sistem kanamalarının %1-4 kadarından sorumludur. Çoğu Mallory-Weiss sendromu spesifik endoskopik tedavi gerektirmeyen bir şekilde hafif kanama ile seyreder; bununla beraber bazı olgularda kanama abondan olabilir. Ülser kanamalarından farklı olarak Mallory-Weiss sendromunda endoskopik tedavi çok iyi standartize edilmemiştir. Biz bu çalışmamızda kendi olgularımızın demografik özelliklerini, uygulanılan endoskopik tedavileri ve hastaların klinik seyirlerini karşılaştırmayı hedefledik. Gereç ve Yöntem: Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Endoskopi ünitesinde 2010-2017 tarihleri arasında Mallory-Weiss sendromu tanısı almış hastalar retrospektif olarak incelendi. Bulgular: Çalışmaya toplam 37 hasta (erkek/kadın: 29/8, yaş ortalaması: 63,4±19,4) dahil edildi. Bu hastaların Mallory-Weiss laserasyonu endoskopi esnasında oluşan hasta sayısı 15 olup hastaların 27 tanesinde aktif kanama belirtisi vardı. Primer hemostaz 25 hastada %92,5 sıklıkta izlendi. Aktif kanama belirtisi olan hastalara uygulanılan endoskopik tedaviler adrenalin enjeksiyonu, klips uygulaması, heater prob idi. Mallory-Weiss sendromu oluşumuna göre hastalar iatrojenik Mallory-Weiss sendromu olan ve olmayan hastalar olarak iki gruba ayrıldı. Hastanede yatış varlığı, eritrosit süspansiyonu verilme ihtiyacı, aktif kanama belirtisi varlığı, hiatal herni varlığı ve uygulanılan endoskopik tedaviler karşılaştırıldığında bu parametreler açısından gruplar arasında fark yoktu. Toplam 27 hastaya klips uygulaması yapılmıştı; bu hastaların 19 tanesine sadece klips uygulanırken 8 tanesine ise klips ile beraber adrenalin uygulaması yapıldı. Hastalarımızda mortalite izlenmedi. Sonuç: Mallory-Weiss sendromlu çoğu hasta klinik olarak benign seyir gösterse de bu hastaların şiddetli kanama ile beraber olacakları akılda tutulmalıdır. Hemoklipsler tedavide etkin ve güvenli bir endoskopik tedavi yöntemidir.

Celiac disease is a chronic immune-mediated disease of the small intestine. It has been known that dilated cardiomyopathy and ischemic coronary artery disease have become more frequent in patients with celiac disease. The aim of the study was to assess Tp-e interval and Tp-e/QT ratio in patients with celiac disease.This study was conducted at a single center in collaboration with gastroenterology and cardiology clinics. Between January 2014 and June 2015, a total of 76 consecutive patients were enrolled (38 patients with celiac disease and 38 control subjects). Tp-e interval, Tp-e/QT and Tp-e/QTc ratio were measured from the 12-lead electrocardiogram.Tp-e interval (64.2±11.0 vs. 44.5±6.0; p0.001), Tp-e/QT ratio (0.18±0.02 vs. 0.13±0.02; p0.001) and Tp-e/QTc ratio (0.16±0.02 vs. 0.11±0.01; p0.001) were significantly higher in patients with celiac disease than control subjects. There was a significant positive correlation between Tp-e/QTc ratio and disease duration in patients with celiac disease (r=0.480, p=0.003) and also there was a significant positive correlation between Tp-e/QTc ratio and erythrocyte sedimentation rate (r=0.434, p0.001).Our study showed that Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were increased in patients with celiac disease. Whether these changes increase the risk of ventricular arrhythmia deserve further studies.

Giris ve Amac: Inflamatuvar barsak hastaliklari kronik inflamasyon ve aterosklerozda artisla karakterize hastaliklardir. Bircok calismada inflamatuvar barsak hastaliklarinda kardiyovaskuler hastaliklar icin potansiyel neden olabilecek lipid anormallikleri arastirilmistir. Biz bu calismamizda inflamatuvar barsak hastaliklarinda lipid parametreleri uzerinde etkisi olabilecek ilac tedavisi, operasyon ve hastalik suresi gibi degiskenleri inceledik. Gerec ve Yontem: Turkiye Yuksek Ihtisas Egitim ve Arastirma Hastanesi Inflamatuvar Barsak Hastaliklari Poliklinigi’nde Ocak 2016-Mart 2016 arasinda ardisik olarak takip ve tedavi edilen hastalar calismaya alindi. Bulgular: Calismaya toplam 138 hasta (ulseratif kolit: 71 hasta, Crohn: 67 hasta) alindi. Hastalarin yas ortalamasi 45 olup 47 kadin, 71 erkek hasta vardi. Total kolesterol ve dusuk yogunluklu lipoprotein seviyeleri ulseratif kolit hastalarinda Crohn hastaligina gore anlamli olarak fazlaydi (sirasiyla p=0,003 ve p=0,001). Ulseratif kolitte proktit, sol kolon tutulumlu ve ekstensif tutulumlu hastalar arasinda total kolesterol, trigliserid, yuksek yogunluklu lipoprotein ve dusuk yogunluklu lipoprotein seviyeleri arasinda fark yoktu. Crohn hastalarinda inflamatuvar, penetran ve strikturan fenotipler arasinda total kolesterol, trigliserid, yuksek yogunluklu lipoprotein ve dusuk yogunluklu lipoprotein arasinda fark yoktu. Azatiyopurin ve mesalazin alan ve almayan hastalar arasinda bakilan lipid parametreleri icin fark bulunmadi. Anti-tumor nekrozis faktor alan hastalarda ise total kolesterol ve dusuk yogunluklu lipoprotein kolesterol seviyeleri anti-tumor nekrozis faktor almayan hastalara kiyasla anlamli olarak daha dusuk izlendi (sirasiyla p=0,01 ve p=0,02). Hastalarin aldiklari ilac tedavi sureleri ile total kolesterol, trigliserid, dusuk yogunluklu lipoprotein ve yuksek yogunluklu lipoprotein seviyeleri arasinda korelasyon izlenmedi. Sonuc: Inflamatuvar barsak hastaliklarinda lipid anormallikleri uzerine etkili olabilecek ilac, operasyon, hastalik fenotipi ve hastalik tutulum yeri gibi faktorlerin bilinmesi, ateroskleroz gibi potansiyel komplikasyonlarin onlenebilmesine olanak taniyabilir.

The objective here is to examine the role of overall oxidative stress in the etiopathogenesis of gluten-sensitive enteropathy disease and its relationship with gluten free diet and autoantibodies.Eighty gluten-sensitive enteropathy patients and 80 control group participants were included in the study. As oxidative stress parameters, we researched total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), paraoxonase-1 and arylesterase parameters in the serum samples of gluten-sensitive enteropathy patients.In comparison to the control group, gluten-sensitive enteropathy patients had lower TAS, paraoxonase-1 and arylesterase levels and gluten-sensitive enteropathy patients had considerable TOS and OSI levels. In contrast, patients who agreed to the gluten free eating routine had a higher OSI proportion and patients who did not conform to the gluten free eating regimen had a lower paraoxonase-1 level. An affirming reciprocation was de tected amidst TOS and OSI proportion and gluten-sensitive enteropathy autoantibodies and C-reactive protein levels and a negative correlation was found between arylesterase level and gluten-sensitive enteropathy autoantibodies.We observed oxidative stress levels to be higher in gluten-sensitive enteropathy patients contrasted with the control group. Oxidative stress level showed differences in gluten-sensitive enteropathy patients depending on gluten diet content and autoantibody positivity. In point of fact, C-reactive protein and gluten-sensitive enteropathy autoantibodies are identified with oxidative anxiety parameters resulting in the possibility that oxidative stress might be successful in the gluten-sensitive enteropathy pathogenesis.Cilj je ovde bio da se ispita uloga ukupnog oksidativnog stresa u etiopatogenezi glutenske enteropatije i njegov odnos sa bezglutenskom ishranom i autoantitelima.Osamdeset pacijenata sa glutenskom enteropatijom i 80 članova kontrolne grupe je uključeno u studiju. Kao parametri oksidativnog stresa, istraživani su ukupni antioksidantni status (UAS), ukupni oksidantni status (UOS), indeks oksidativnog stresa (IOS), paraoksonaza 1 i arilesteraza u uzorcima seruma pacijenata sa glutenskom enteropatijom.U poređenju s kontrolnom grupom, pacijenti sa glutenskom enteropatijom imali su niže nivoe UAS-a, paraoksonaze-1 i arilesteraze a pacijenti sa glutenskom enteropatijom imali su znatne nivoe UOS-a i IOS-a. Za razliku od toga, pacijenti koji su pristali na bezglutenski režim ishrane imali su višu proporciju IOS-a a pacijenti koji nisu pristali na bezglutenski režim imali su niži nivo paraoksonaze 1. Afirmativan reciprocitet utvrđen je između UOS-a i proporcije IOS-a i autoantitela za glutensku enteropatiju i nivoa C-reaktivnog proteina, a negativna korelacija je pronađena između nivoa arilesteraze i auto antitela za glutensku enteropatiju.Uočili smo da je nivo oksidativnog stresa bio viši kod pacijenata sa glutenskom enteropatijom u poređenju s kontrolnom grupom. Nivo oksidativnog stresa pokazao je razlike među pacijentima s glutenskom enteropatijom zavisno od sadržaja glutena u ishrani i pozitivnih autoanti tela. Zapravo,C-reaktivni protein i autoantitela za glutensku entero patiju identifikuju se sa parametrima oksidativne anksioznosti, {to rezultira mogućnošću da oksidativni stres uspešno učestvuje u patogenezi glutenske enteropatije.

Background/aims We aimed to investigate the association of bezoar with endoscopic findings, risk factors for bezoar occurrence, and the success of endoscopic treatment in a tertiary center. Materials and methods This retrospective study was conducted between January 2012 and December 2015. Overall, 8200 endoscopy records were examined and 66 patients with bezoar were included in the study. Results We enrolled 29 (44%) female and 37 (56%) male patients in this study. The mean age of the patients was 63±9.4 years. The most frequent risk factors were history of gastrointestinal surgery (23%), diabetes mellitus (17%), trichophagia (9%), and anxiety disorder (6%). Gastric ulcer, duodenal ulcer, erosive gastritis, and reflux esophagitis were present in 27%, 11%, 20%, and 23% of the patients, respectively. While bezoars were most commonly observed in the stomach (70%), the majority of them were phytobezoars (91%). The mean number of interventions for each patient was 1.5 (range, 1-6). Endoscopy was successful in removing bezoars in 86.5% of the patients. Among those referred to surgery, seven patients underwent gastrostomy (10.5%); one (1.5%) patient underwent gastroenterostomy because of concomitant pyloric stenosis; and one (1.5%) patient underwent fistula repair surgery due to the development of duodenal fistula caused by bezoar. Conclusion The findings of this study indicated that bezoars are more common among subjects with history of gastrointestinal surgery, diabetes mellitus, or psychiatric disorders; bezoars are closely related to peptic ulcer and reflux esophagitis; and they can be successfully treated with endoscopy.

Giriş:Elektrokardiyografide (EKG) ventriküler repolarizasyon Tp-eintervali ve kalp hızına göre düzeltilmiş QT (QTc) aralığıkullanılarak değerlendirilir. Uzamış Tp-e/QTc oranı aritmiler vekardiyak mortalite riskinde artışla ilişkilidir. NASH(nonalkolik steatohepatit)’in ventriküler repolarizasyon üzerine etkileriyle ilgili az sayıdaçalışma olduğu için, NASHhastalarında Tp-einterval ölçümlerini ve Tp-e/QT oranını değerlendirmeyiamaçladık. Gereçve Yöntemler: Çalışmamıza toplam97 NASHhastası ile 77 kişilik kontrol grubu dahil edildi. Tp-e intervali,Tp-e/QT ve Tp-e/QTc oranları 12-lead elektrokardiyogram ileölçüldü.Bulgular:Kalp hızı her iki grupta da benzerdi (74.8± 10.1 vs.75.7± 11.7;p=0.598). QT interval (396.0± 34.2 vs.384.6± 30.7;p=0.023) ve QTc interval (403.6± 34.8 vs.399.9± 36.3;p=0.027), Tp-e interval (100.4± 13.6 vs.91.4± 13.4;p, Aim: Ventricular repolarization is assessed usingthe Tp-e interval and QT interval corrected by the heart rate (QTc) via anelectrocardiogram (ECG). Prolonged Tp-e/QTc is related with an increased riskof arrhythmias and cardiac mortality. As there have been few reports regardingthe effects of NAFLD on ventricular repolarization, we aimedto appraise the assessment of Tp-einterval and Tp-e/QT ratio in patients with NAFLD. Materialand Methods: Totally 97 patients with NAFLD and 77 control subjects were enrolled in our study. Tp-e interval, Tp-e/QT and Tp-e/QTcratios were measured from the 12-lead electrocardiogram. Results:Heart rate was similar between groups (74.8 ± 10.1 vs. 75.7 ± 11.7; p=0.598). QT interval(396.0 ± 34.2 vs.384.6 ± 30.7;p=0.023) and QTc interval (403.6 ± 34.8 vs. 399.9 ± 36.3; p=0.027), Tp-einterval (100.4 ± 13.6 vs.91.4 ± 13.4;p

Girişve Amaç: Etat mamillone endoskopikolarak gözlenen ve Helicobacter pylori pozitifolan hastalarda mukozal nodüler tutulum ile karakterizekolaylıkla tanınabilen karakteristik bir bulgudur. Bizbu çalışmada etat mamillone görüntüsü nedeniyle endoskopik biyopsi alınanhastalarda bu görüntünün histopatolojik tanıya göre doğruluğunu araştırdık. Gereç ve Yöntem: Bu çalışma Ocak2016-Aralık 2017 tarihleri arasında hastanemiz gastroenteroloji kliniğindeçeşitli sebeplerle endoskopi yapılan hastaların hasta kayıtları incelenerekretrospektif olarak yapılmıştır. Toplamda 5200 endoskopi kaydı incelenmiş, etatmamillion veya etat mamillone tabiri geçen 53 hasta çalışmaya dahil edilmiştir.Bulgular: Araştırma popülasyonu 41kadın (%77) ve 12 erkek (%23) erkekhasta olmak üzere 53 kişiden oluştu. Hastaların ortalama yaşı 29±11.2 (18-56)yıldı. Hastaların endoskopik biyopsi sonuçlarına bakıldığında 4 (%8) hastadaatrofik gastrit mevcut iken 49 (%92) hastada atrofi yoktu. Hastaların biyopsiörnekleri incelendiğinde 53 hastanın 45’inde Helicobacter pylori pozitifsaptandığı görüldü (%85). Bu hastaların Sydney sınıflamasına göre 12’sinde 1+ Helicobacterpylori (%23),17’sinde 2+ Helicobacter pylori (%32) ve 16’sında 3+ Helicobacter pylori (%30) saptanmıştır. Endoskopik etat mamillonegörüntüsü ile biyopsi sonuçları arasında %85 oranında korelasyon olduğu görülmüştür.Sonuç:Endoskopikolarak tanımlanan etat mamillone görünümü Helicobacter pylori gastrititanısı için kullanılabilecek non-invaziv ve yüksek doğruluk oranına sahip biryöntemdir., Background and Aims: Etat mamilloneis an endoscopic appearance characterized by mucosal nodular involvement inpatients with Helicobacter pylorigastritis. In the present study, we investigated the accuracy of this appearanceon the basis of histopathological diagnosis in patients who underwentendoscopic biopsy for etat mamillone. Materialand Methods: The present study was performed retrospectively betweenJanuary 2016 and December 2017 in the gastroenterology clinic of our hospital.A total of 5200 endoscopy records were examined, and 53 patients with etatmamillion or etat mamillone were included in the study. Results: The study population consisted of 53 patients, 41 of whomwere female (77%) and 12 male (23%). The mean age of the patients was 29±11.2years (range: 18–56 years). Atrophic gastritis was observed in four patients (8%),while 49 patients (92%) had no atrophy. Upon biopsy, 45 of the 53 patients(85%) were found to be Helicobacter pylori positive.According to the Sydney classification, 12 patients had 1+ Helicobacterpylori (23%),17 had 2+ Helicobacter pylori (32%),and 16 had 3+ Helicobacter pylori (30%).There was 85% correlation between the endoscopic etat mamillone appearance andbiopsy results. Conclusion: Endoscopic etat mamillone appearance is anon-invasive and highly accurate method for diagnosis of Helicobacterpylori gastritis.

Background Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD), and the overall burden is increasing at the global level. Differences in perceptions of UC-related burden may highlight dramatic degree insufficient patient-physician communication. ICONIC is a prospective, non-interventional, observational study assessing disease burden in adults with UC using Pictorial Representation of Illness and Self Measure (PRISM). The local results of ICONIC study for Turkey are presented. Methods Patients aged ≥18 years with early UC (diagnosed ≤36 months) were enrolled. At baseline and every 6 months, patient and physician reported outcomes were collected using PRISM, the Simple Clinical Colitis Activity Index (SCCAI and P-SCCAI), The Rating Form of IBD Patients’ Concerns (RFIPC), the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and the Patient Health Questionnaire-9 (PHQ-9). Correlations between the patient assessed PRISM and other measurement tools were evaluated with Pearson correlation coefficient. Results One hundred and twenty patients were included (77 [64.2%] female; mean age 35.2 years). Physician-assessed disease severity was: severe 23 [19.2%], moderate 42 [35.0%], mild 40 [33.3%], in remission 15 [12.5%]. The mean ± SD physician- and patient-assessed PRISM scores were 4.8 ± 2.3 cm (range: 0.0–9.0) and 4.1 ± 2.6 cm (range: 0.0–8.5) at baseline and increased to 6.1 ± 2.3 cm (range: 0.1–8.5) and 5.5 ± 2.7 cm (range: 0.0–9.3) at the final visit, respectively, indicating an improvement in the perceived disease burden. The mean values of physician-SCCAI and P-SCCAI were 3.8 ± 3.5 and 5.5 ± 4.3 at baseline and decreased to 1.4 ± 2.5 and 2.7 ± 3.2 at the final visit, respectively, showing a decrease in disease activity. At baseline, the RFIPC and PHQ-9 values were 2.7 ± 1.7 and 8.0 ± 5.5 and decreased to 2.2 ± 2.0 and 5.2 ± 4.5 at the final visit, respectively. Patient-assessed SIBDQ was 43.8 ± 14.5 at baseline and increased to 54.0 ± 13.0 at the final visit. The strongest correlation of patient-assessed PRISM was with the physician-assessed PRISM (Spearman rho = 0.69, p Conclusion In the Turkish ICONIC sub-study, majority of patients on treatment showed improved outcomes during the follow-up period. A moderate correlation between patient-assessed PRISM and other measurement instruments represents that PRISM may be used as surrogate marker for patient suffering.

Background The American Society for Gastrointestinal Endoscopy (ASGE) has recently published a guideline for suspected CBDS with the intention of reducing unnecessary ERCP and thereby complications. The aim of this study was to assess the diagnostic efficacy of the ASGE guideline. Methods Data of patients who underwent ERCP with suspected CBDS were analyzed retrospectively. Patients were classified into high, intermediate and low risk groups based on predictors that have been suggested by the ASGE. Very strong predictors of the presence of ductal stones included: CBDS on transabdominal ultrasonography (US), clinical ascending cholangitis or total bilirubin (TBIL) >4 mg/dL). Strong predictors included dilated CBD >6 mm on US with gallbladder in situ and TBIL level of 1.8–4.0 mg/dL whereas moderate predictor included abnormal liver biochemical test other than bilirubin, age more than 55 years and clinical findings of biliary pancreatitis. Results Of 888 enrolled patients, 704 had CBDS demonstrated by ERCP and the remainder did not. All very strong and strong predictors were found to be significantly higher among patients who had CBDS. Detection of CBDS by ultrasonography and a dilated common biliary duct were observed to be independent risk factors associated with the existence of CBDS. The high risk group had a high (86.7%) positive predictive value (PPV), however, sensitivity and specificity were observed to be moderate (67.8% and 60.3% respectively). PPV was 67.9% in the intermediate risk group and the sensitivity and specificity were very low (31.9% and 42.3%). Discussion The probability of CBDS was observed to be high in the intermediate and high risk groups. However due to low sensitivity and specificity values, the ASGE guideline needs additional or different predictors.

Giris ve Amac: Normal populasyona gore inflamatuvar barsak hastaliginin tromboz riskinde artisla beraber oldugu iyi bilinir. Biz burada ulseratif kolit ve Crohn hastaligi olan hastalarimizda tromboz sikligini, tromboz saptanan hastalarin klinik seyirlerini ve trombozlarin ozelliklerini belirlemeyi amacladik. Gerec ve Yontem: Turkiye Yuksek Ihtisas Egitim ve Arastirma Hastanesi Inflamatuvar Barsak Hastaliklari polikliniginde takip edilen 3128 hasta tromboz yonunden retrospektif olarak incelendi. Bulgular: Calismamiza toplam 20 hasta alindi. Hastalarin yas ortalamasi 40,45 (22-70) olup 16 hasta erkek, 4 hasta kadindi. Hastalarimizin 10 tanesinde tromboz bacak derin venlerinde iken 4 hastada bacak derin venleriyle beraber pulmoner emboli seklinde goruldu. 2 hastada tromboflebit, 1 hastada serebral ven trombozu, 1 hastada mezenterik ven trombozu ve 2 hastada da portal ve hepatik ven trombozu olarak goruldu. Ilk inflamatuvar barsak hastaligi tanisi ile ilk tromboz tanisi arasi gecen sure ortanca 16 ay (2-240)’di. Trombozlar 15 hastada aktif hastalik esnasinda olusmustu. 20 hastanin 13 tanesinde tromboz tanisi sonrasi aldiklari medikal tedavilerde bir ust basamaga gecis goruldu. Sonuc: Inflamatuvar barsak hastaligi tromboza zemin hazirlayan bir hastaliktir. Tromboz gelisen hastalarin erken tani ve tedavisi morbidite ve hatta mortalitede azalmaya neden olacaktir. Tromboz ciddi seyredecek inflamatuvar barsak hastaliginin habercisi olabilir. Aktif hastalik ozellikle pretomboti bir durum olarak degerlendirilmeli ve gerekli antikoagulasyon baslanmalidir.

Giris ve Amac: Calismamizda klinigimizde Dieulafoy Lezyonu tanisi konulan hastalari, yapilan endoskopik tedavileri ve bu tedavilerin basari oranlarini ortaya koymayi hedefledik. Gerec ve Yontem: Klinigimizde 2008-2016 tarihleri arasinda endoskopileri yapilan hastalar ‘Dieulafoy Lezyonu’ tanisi icin retrospektif olarak tarandi. Endoskopik tanisi Dieulafoy lezyonu olan hastalarin servis yatislari, laboratuvar degerleri, kac gun yattiklari, hastaliklarinin nihai sonucu tespit edildi. Bulgular: 18 hasta calismaya alindi. En sik basvuru sikayeti melenaydi. Hastalarin yedi tanesinde mortalite gerceklesti. Klips, tek basina veya kombine olmak uzere en sik basvurulan endoskopik tedavi yontemiydi. Klipsin tek basina uygulandigi hastalarla, klipsle beraber veya klips olmadan kombine tedavi uygulanan hastalar arasinda mortalite acisindan fark yoktu (p=0,9). Adrenalinle beraber heater yapilan olgular dislanarak yapilan subgrup analizinde klips uygulanan hastalarla klipsle beraber diger yontemlerin yapildigi hastalar arasinda mortalite karsilastirildi. Iki grup arasinda yine mortalite acisindan bir fark yoktu (p=0,6). Sonuc: Calismamiz klips tedavisine eklenecek adrenalin ve/veya heater koagu- lasyon gibi yontemlerle yapilan kombine tedavinin mortaliteyi azaltmada klips monoterapisine kiyasla herhangi bir ustunluklerinin olmadigini gostermistir.

Objective There is no precise consensus at present on age to define elderly patients with inflammatory bowel disease (IBD), but recently, age of more than 60 years has been widely accepted. Characteristics of IBD in the elderly are somewhat different from what is seen in younger patients. The elderly have milder disease activity, and therapeutic options are fewer because of their age and features such as comorbidities, drug interactions, and loss of organ function. There are few reports on Crohn's disease in the elderly. Herein, first report on this topic with respect to population of this country is presented. Methods Characteristics of 95 patients with Crohn's disease, who were over age 60 from 3125 patients with IBD treated in our clinic between 1996 and 2015 were analyzed. Research was performed using patient files, and outpatient clinic visits, when possible. Results Median age of the group was 66 years, and male:female ratio was 1.6. Of the total, 48.4% of the patients had colonic disease, 37.9% had ileocolonic disease, and 13.7% had small bowel disease. Data indicated that 23.1% of patients had undergone surgical procedures, which were primarily right hemicolectomy and ileotransversostomy. Disease was most often managed with mesalazine or azathioprine. It was also determined that 12.6% patients had 2 or more comorbidities, and findings indicated coronary heart disease and hypertension were most prevalent. Conclusion Analysis revealed similar features in characteristics of disease compared with recent knowledge reported in the literature. This is the first report from our country to describe Crohn's disease in the elderly population, and the number of patients is sufficient to provide general information about this group.

We aimed to determine the levels of total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI) and paraoxonase1/arylesterase levels in inflammatory bowel disease (IBD), and the relation be - tween these molecules and the activity index of the disease.Eighty IBD patients (ulcerative colitis (UC)/Crohn disease (CD) 40/40) and 80 control group participants were included in the study. Oxidative stress parameters were measured using the colorimetric method. As disease activity indexes, the endoscopic activity index (EAI) was used for UC and the CD activity index (CDAI) was used for CD.In IBD patients, mean TAS (1.3±0.2 vs 1.9±0.2, respectively; p0.001) and arylesterase (963.9±232.2 vs 1252.9±275, respectively; p0.001) levels were found to be lower and TOS level (5.6±1.6 vs 4.0±1.0, respectively; p0.001) and OSI rate (4.5±1.6 vs 2.2±0.8, respectively; p0.001) were found to be higher compared to the control group. A strong positive correlation was found between EAI and TOS levels (r=0.948, p0.001) and OSI rate (r=0.894, p0.001) for UC patients. A very strong positive correlation was found between EAI and TOS levels (r=0.964, p0.001) and OSI rate (r=0.917, p0.001) for CD patients. It was found in a stepwise regression model that C-reactive protein, OSI and arylesterase risk factors were predictors of IBD compared to the control group. Conclusion: Increased oxidative stress level in IBD patients and the detection of OSI rate as an independent predictor for disease activity indexes lead to the idea that oxidative stress might be related to the pathogenesis of IBD.Na{ cilj bio je da odredimo nivoe ukupnog antioksidativnog statusa (TAS), ukupnog oksidativnog statusa (TOS), indeks oksidativnog stresa (OSI) i nivoe paraoksonaze 1/arilesteraze u zapaljenskoj bolesti creva (IBD), kao i odnos između ovih molekula i indeksa aktivnosti bolesti.U studiju je uključeno 80 pacijenata sa IBD (ulcerozni kolitis (UC) / Kronova bolest (CD) 40/40) i 80 subjekata kao kontrolna grupa. Parametri oksidativnog stresa mereni su kolorimetrijskom metodom. Kao indeksi aktivnosti bolesti, indeks endoskopske aktivnosti (EAI) koriščen je za UC, dok je za CD korišćen indeks aktivnosti CD (CDAI).Kod obolelih od IBD, nađeno je da su srednji TAS (1,3±0,2 vs 1,9±0,2; p0,001) i nivoi arilesteraze (963,9±232,2 vs 1252,9±275; p0,001) bili niži, a nivo TOS (5,6±1,6 vs 4,0±1,0; p0,001) i stopa OSI 4,5±1,6 vs 2,2±0,8; p0,001) viši u poređenju s kontrolnom grupom. Otkrivena je snažna pozitivna korelacija između nivoa EAI i TOS (r=0,948, p0,001) i stope OSI (r=0,894, p0,001) za obolele od UC. Veoma jaka pozitivna korelacija nađena je između nivoa EAI i TOS (r=0,964, p0,001) i stope OSI (r=0,917, p0,001) za obolele od CD. U modelu stepwise regresije uočeno je da su C-reaktivni protein, OSI i faktori rizika za arilesterazu bili prediktori za IBD u poređenju s kontrolnom grupom.Povišen nivo oksidativnog stresa kod pacijenata sa IBD i detekcija stope OSI kao nezavisnog prediktora za indekse aktivnosti bolesti navode na ideju da oksidativni stres može biti povezan sa patogenezom IBD.

Background Double Balloon Enteroscopy (DBE) provides the opportunity not only to investigate but also apply endoscopic therapeutic interventions for small intestinal disturbances. The aim of this study is to assess the indications, diagnosis, therapeutic interventions, complications and safety in clinical practise of DBE procedures that have been performed in our clinic. Material-methods The data of patients who had undergone DBE procedure in our clinic between October 2007 and December 2014 were retrospectively investigated. All features including indications, findings, histopathological results, applied interventions and complications due to procedure were noted. Results A total of 297 patients, 160 (53,9%) male and 137 (46,1%) female were enrolled in the study. Total number of procedures for these 297 patients were 372 [256 (68,8%) oral and 116 (31,2%) anal]. Mean age of the patients was 46,9 (14–94) years. The most common indications were; obscure gastrointestinal (GI) bleeding (28,3%), iron deficiency anaemia (17,5% ) and abnormal findings in a prior imaging study (13,8%), respectively. The rate of new diagnosis with DBE was 11.8%, where the rate for confirmation of a possible diagnosis was 16.2%, rate of endoscopic treatment with definite diagnosis was 11%, rate for ruling out possible diagnosis or showing normal findings was 34.7% and rate for insufficient or unsuccessful procedures was 26.3%. Ulcers, inflammation and erosions (13%), polyposis syndromes (9.8%) and vascular pathologies (7.4%) were the most common endoscopic findings. Conclusion Our study shows that DBE has high efficacy for diagnosis and ability to perform treatment of small intestinal disturbances with safety.

Background and Aim: We aimed to identify ischemia-modified albumin (IMA) levels in inflammatory bowel disease (IBD) and IBD subgroups, and to examine its relation with disease activity index. Methods: Sixty-eight patients with IBD (35 ulcerative colitis [UC] and 33 crohn disease [CD]) and 65 healthy volunteers were included in the study. Rachmilewitz scoring system (endoscopic activity index [EAI]) was used to determine UC activity, and as for CD activity, CD activity index (CDAI) scoring was used. IMA measurement was performed with ELISA kit. Results: Ischemia-modified albumin levels in IBD, UC, and CD groups were comparably higher than the control group (37.7 ng/mL vs 42.4 ng/mL vs 36.4 ng/mL vs 21.8 ng/mL, respectively; P

Giris ve Amac: Akut pankreatitin %1-5 nedeni hipertrigliseridemidir. Insulin infuzyonu, heparin infuzyonu ve plazmaferez hipertrigliseridemiye bagli Akut pankreatitin tedavisinde yer almaktadir. Biz bu calismamizda hipertrigliseridemiye bagli olusan Akut pankreatitli hastalarimizin demografik ozelliklerini, pankreatitlerinin seyrini, uygulanan tedavi yontemlerini ve plazmaferezin etkinligini arastirdik. Gerec ve Yontem: Turkiye Yuksek Ihtisas Hastanesi Gastroenteroloji Klinigi’nde 2012-2016 yillari arasinda akut pankreatit tanisi konulan hastalar retrospektif olarak tarandi. Ilk basvuruda trigliserid degeri 900 mg/dl ve uzeri olan hastalar, diger etiyolojik nedenlerin yoklugunda hipertrigliseridemiye bagli Akut pankreatit olarak kabul edildi. Hastalarin medikal bilgilerine hasta dosyalari ve hastane otomasyon bilgi sisteminden ulasildi. Bulgular: Toplam 10 hasta (E/K: 4/6, yas ortalamasi 41,4 (26-51) calismaya alindi. Hastalarimizda akut pankreatit atak sikligi 1,4 (1-3) olarak bulundu. Akut pankreatit siddetini belirlemede BISAP skorlamasi kullanildi. BISAP skoru yuksek olan hastalara plasmaferez uygulandi (4 hasta). Bu hastalarin 3 tanesinde psodokist ve walled-off nekroz olustugu goruldu. Walled-off nekroz olusan bir hastaya perkutan drenaj yapildi. Toplamda hicbir hastada mortalite izlenmedi. Sonuc: Hipertrigliseridemi, diger nedenlere kiyasla akut pankreatite nadiren yol acar. Bu hastalarin erken taninmasi ve uygun tedavisi hastalik iliskili morbidite ve mortalitenin azalmasina yol acar. Plazmaferez ozellikle ciddi seyreden hastalarda etkili bir tedavi yontemidir.

Background/Aims: This study aims to show the predictive value of noninvasive serum markers on the hepatic fibrosis level. Materials and Methods: This cross sectional study involves 120 patients with chronic hepatitis C. The noninvasive markers used were as follows: age-platelet index (AP index), cirrhosis discriminant score (CDS), aspartate aminotransferase (AST)-alanine aminotransferase (ALT) ratio (AAR), fibrosis-4 (FIB-4) index, AST-platelet ratio index (APRI), Goteborg University Cirrhosis Index (GUCI), FibroQ, King’s score, platelet count. Concurrent liver biopsies were evaluated using the modified Ishak and Knodell scoring systems. In accordance with the Knodell scores, F3-F4 scores were defined as “severe fibrosis,” and the modified Ishak scores stage of ≥3 (F3–F6) were defined as “clinically significant fibrosis.” Receiver Operating Characteristic (ROC) curve analyses were carried out to compare the noninvasive markers with hepatic fibrosis level. Results: Mean age of the patients was 51.7±11.6. A total of 10 patients (8.3%) with Knodell scores and 24 patients (20%) with modified Ishak scores were evaluated to have ≥F3 hepatic fibrosis. ROC analyses with the Knodell and modified Ishak scores were as follows: AP index=0.61–0.57, CDS=0.66–0.55, AAR=0.60–0.49, FIB-4=0.70–0.68, APRI=0.67–0.72, GUCI=0.66–0.72, FibroQ=0.64–0.54, King’s score=0.68–0.54, platelet count=0.61–0.55. Conclusion: We found that APRI, FIB-4, King’s score, and GUCI can be used to determination patients with mild fibrosis with a high negative predictive value and in the differentiation of severe/significant fibrosis from mild to moderate fibrosis.

We aimed to identify the levels of soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) and interleukin 17A (IL-17A) in inflammatory bowel disease (IBD) and to examine their relationship with disease activity.A total of 92 patients with IBD, in which 54 patients were diagnosed with ulcerative colitis and 38 patients with Crohn's disease (CD), and 104 healthy controls were included in the study. The Rachmilewitz endoscopic activity index was calculated in ulcerative colitis, and the CD activity index was calculated in CD.sTWEAK (P0.001) and IL-17A (P = 0.006) levels were higher in the IBD group than in the control group. Both in the IBD group and ulcerative colitis and CD subgroups, in active patients, sTWEAK and IL-17A levels were found to be higher than in inactive and control groups. In the IBD group, a positive correlation was determined between sTWEAK and IL-17A, and C-reactive protein, endoscopic activity index, and CD activity index. In multivariable regression analysis, C-reactive protein and sTWEAK levels were determined to be an independent risk factor for both endoscopic activity index and CD activity index. In receiver operating curve analysis, the sTWEAK level was determined to predict IBD with high sensitivity and specificity with a value of588.34 pg/mL and activity with a value of669.28 pg/mL.Based on these results, we ascertain that sTWEAK has a role in etiopathogenesis of IBD. In addition, we believe that sTWEAK could be used as a marker for both disease activity criteria and treatment monitoring.

Background/aim: We aimed to examine the effect of plastic biliary stenting in the treatment of common bile duct (CBD) stones. Materials and methods: The data of 13,034 patients in our unit who had endoscopic retrograde cholangiopancreatography (ERCP) between 2008 and 2015 were scanned retrospectively. Results: A biliary stent was placed in 61 of 74 patients. While the plastic biliary stent was placed in patients, the mean stone size after the 1st ERCP was 20 mm and the bile duct size was 13 mm. At the time of the 2nd ERCP conducted approximately 73.9 days later, the mean stone size was found to be 15 mm and the bile duct size was 12 mm. With recurrent ERCPs, the CBD stone was successfully removed in 53 patients but could not be removed in 8 patients. Among the 53 successful cases, 29 removals were successful in the 2nd ERCP session, 16 were successful in the 3rd session, 2 were successful in the 4th session, 1 was successful in the 5th session, 4 were successful in the 6th session, and 1 was successful in the 7th session. Conclusion: For CBD stones that cannot be removed by standard methods, temporary plastic stenting is an alternative method.

Giriş ve Amaç: Periampuller bölge tümörleri tüm gastrointestinal malignensilerinyaklaşık %0,5-2’sini oluşturmaktadır. Bu tümörler arasında en sıkolarak pankreas başı ve ampulla vateri kanseri görülmektedir. Bu tümörlerinerken tanısı ve benign lezyonlardan ayırımı tedavi şeklinin belirlenmesindeönem taşımaktadır. Çalışmamızın amacı, papiller forseps biyopsinin pankreastümürü ve ampulla vateri tümörü tanısında etkinliğinin değerlendirilmesive iki tümöre ait özelliklerin karşılaştırılmasıdır. Gereç ve Yöntem: ÇalışmaTürkiye Yüksek İhtisas Hastanesi endoskopik retrograd kolanjiopankreatografiünitesinde 7 yıllık periyotta endoskopik retrograd kolanjiopankreatografiyapılan ve papiller forseps biyopsisi alınan hastalar geriye yönelik tarandı.Bulgular: Çalışmaya toplam 135 hasta dahil edildi. Toplam 58 (%50) hastadamalignite tespit edildi. En sık saptanan malign tümörler ampulla vaterikanseri ve pankreas başı kanseri idi [sırası ile hastaların %28.4 (n=33) ve%12.1 (n=14)]. Papiller forseps biyopsinin periampuller bölge tümörü tanısındaspesifitesi %96.7 ve sensitivitesi %72.4 ölçüldü. Papilin endoskopikgörünümüne göre endoskopistin yorumunun periampuller bölge tümörü tanısındasensitivitesi %64.3 olarak ölçüldü. Pankreas başı kanseri ile ampullavateri kanseri arasında hastaların verileri iki kanser grubu arasında karşılaş-tırıldığında sadece CA-19.9 değerleri iki grup arasında farklıydı (sırası ile365 U/ml ve 78 U/ml; p=0.01). Sonuç: Periampuller bölge tümörleri’ninayırıcı tanısında duedonoskop eşliğinde gerçekleştirilen papiller forseps biyopsisioldukça yararlı bir yöntemdir. Ek olarak malign hastaların ayırımındapapilin endoskopi görünümünün değerlendirilmesi ve tümör markırlarınınkullanımı ile bu yöntemin etkinliği daha da arttırılabilir., Background and Aims: Periampullary area tumors account for about 0.5-2% of all gastrointestinal malignancies. Malignant tumors of pancreatic headand ampulla vater are the most seen tumors of this region. The early diagnosisof these tumors and separation from benign lesions are importantin choosing a treatment modality. The aim of our study is to evaluate theactivity of papillary forceps biopsy in the diagnosis of pancreatic and ampullavater tumors, and to compare the two tumors’ properties. Materials andMethods: Patients in whom papillary forceps biopsy was performed werescreened retrospectively in the endoscopic retrograde cholangiopancreatographyunit of Türkiye Yüksek İhtisas Hospital within 7-year period. Results:A total of 135 patients were included in the study. Malignancy was detectedin 50% of patients (n=58). The most frequent malignant tumors wereampulla vater cancer and pancreatic cancer [28.4% of patients (n=33); and12.1% (n=14), respectively]. The specificity of papillary forceps biopsy in thediagnosis of periampullary area tumors was found to be 96.7%, and sensitivitywas 72.4%. When the endoscopist view was evaluated according to thepapillary endoscopic appearance, sensitivity was measured as 64.3%. OnlyCA-19-9 levels were statistically different between pancreatic head cancerand ampulla vater cancer groups (365 U/ml and 78 U/mL, respectively; p =0.01). Conclusion: Papillary forceps biopsy performed with duodonoscopyis a useful method in the differential diagnosis of periampullary tumors. Thismethod can be further improved by the evaluation of endoscopic apparanceof papillae and additionally by using tumor markers.

Aim Drug-induced liver injury (DILI) is becoming a worldwide problem with its still unexplained properties. Methods The data of patients who were diagnosed with DILI between January 2008 and December 2013 were assessed. Results Five patients had been diagnosed with intrinsic and 82 patients with idiosyncratic DILI. The most common causative agents were antimicrobial drugs. The most common injury pattern was hepatocellular. When patients with bilirubin levels of more than 5 mg/dL were divided into two groups according to receiving steroid therapy (n = 11) or not (n = 40), there was not any significant difference according to their clinical results (P > 0.05). Five of the idiosyncratic DILI patients were diagnosed with drug-induced autoimmune hepatitis (DI-AIH). In histopathological examination, hepatic rosette formation and emperipolesis were observed to be more common among patients with DI-AIH when compared with ones without (P

An aberrant right posterior hepatic duct is present in 4.8-8.4% of the population. It is one of the causes of bile duct injury during laparascopic cholecystectomy. Herein we present a patient with complete transection of the common hepatic duct during laparascopic cholecystectomy (Stewart-Way class 3). Interestingly, the patient had an intact aberrant right posterior duct draining into the common hepatic duct distal to the obstruction site that prevented early diagnosis of the biliary injury because of drainage of the liver sufficient to prevent the development of jaundice.

Girişve Amaç: Shatzki halkası özofagus alt kısmında lümeni halkaveya yüzük şeklinde daraltan yapılardır. Bu çalışmada Shatzki halkasının endoskopikbulgular ve diğer hastalıklar ile ilişkisini araştırmayı amaçladık. Gereç ve Yöntem: Bu çalışma Ocak2014-Aralık 2015 tarihleri arasında endoskopi yapılan hastaların kayıtlarıincelenerek retrospektif olarak yapılmıştır. Toplamda 5.000 endoskopi kaydıincelenmiş ve Shatzki halkası tespit edilen 104 hasta çalışmaya dahiledilmiştir. Bulgular: Araştırma popülasyonu 46 kadın (%44,2) ve 58 erkek (%55,8) erkek hasta olmak üzere 104 kişiden oluştu.Hastaların ortalama yaşı 60,8±14,1 yıldı. Hastaların en sık başvuruendikasyonları disfaji (%26), dispepsi (%38,5) ve karın ağrısı (%28,8) idi.Endoskopi bulguları incelendiğinde hastaların %53,8’inde reflü özofajit,%50’sinde hiatal herni tespit edildi. Özofageal divertikül %4,8, başka web %1,özofageal ülser %5.7, özofageal polip %0,9, özofagus varisleri %1,9, özofagusmotilite bozuklukluğu (hipertrofik alt özofagus sfinkteri) %1,9 ve Barrettözofagus %3,8 hastada tespit edildi. Hastaların %58’inde Helicobacter pylori, %19’unda demir eksikliği anemisi ve %5,7’sinde vitamin B12 eksikliği saptandı. Sonuç:Shatzkihalkası aralıklı disfajinin önemli sebeplerinden biri olup reflü özofajit,hiatal herni ve demir eksikliği anemisi ile birliktelik göstermektedir., Background and aim: The Schatzki ring is a ring-shaped luminalconstriction in the lower part of the esophagus. In this study, we aimed toinvestigate the relationship of the Schatzki ring with endoscopic findings and otherdiseases. Material and Methods: Thisstudy was retrospectively conducted by examining the records of patients whounderwent endoscopy between January 2014 and December 2015. A total of 5.000endoscopic recordings were examined, and 104 patients with Schatzki ring were included in the study. Results: The study population consistedof 104 patients, 46 (44.2%)female and 58 (55.8%)male. The mean patient age was 60.8±14.1 years. The most frequent admission indications were dysphagia(26%), dyspepsia (38.5%), and abdominal pain (28.8%). When endoscopic findings were examined,53.8% of patients had reflux esophagitis and 50% had hiatal hernia. Esophageal diverticulum waspresent in 4.8%; other esophageal web, in 1%; esophageal ulcer, in 5.7%; esophageal polyp, in 0.9%; esophageal varices, in 1.9%; esophagus motility disorder(hypertrophic lower esophageal sphincter), in 1.9%; and Barret’s esophagus, in 3.8%. Helicobacterpylori was diagnosed in 58% of patients; iron deficiency anemia, in 19%; and B12 deficiency, in 5.7%. Conclusion:The Schatzki ring is one of the important causes ofintermittent dysphagia and is associated with reflux esophagitis, hiatalhernia, and iron deficiency anemia.

Giriş ve Amaç: Crohn hastalığı için üstgastrointestinal sistem tutulumu sıklığı %0,5-4 arasında değişir. Bu hastalarıntedavi ve takipleri ileokolonik hastalıktan farklılık gösterir. Biz buçalışmada kliniğimizde Crohn hastalığının üst gastrointestinal sistemietkilediği hastalarımızı sunduk.Gereç ve Yöntem: Hastanemiz Gastroenteroloji Kliniğinde takip edilen ve üst gastrointestinalsistem tutulumu olan Crohn hastaları çalışmaya alındı. Bulgular: On hastada üst gastrointestinalsistem tutulumu izlendi. Hastaların yaş ortancası 40,5 (31-53) olup 6 hasta(%60) erkek 4 hasta (%40) ise kadındı. Ortanca takip süresi 29 (1-228) ay oluphastaların 4 tanesinde (%40) izole üst gastrointestinal sistem tutulumu varkengeri kalan 6 hastanın (%60) beraberinde ileal veya ileokolonik hastalığı vardı.Organ tutulumlarına bakıldığında 1 hastada (%10) özofagus, 2 hastada mide (%20)ve 7 hastada (%70) duodenum tutulumu izlendi. Endoskopik görünümler hastadanhastaya değişmekle beraber Crohn hastalığı için tipik sayılan kaldırım taşıgörünümü 2 hastada, ülserler 7 hastada ve nodülarite ise 4 hastada endoskopikolarak tanımlandı. Biyopsilerde granülom 3 hastada izlendi (%30)Sonuç: Crohn hastalığı tanısıolan bir bireyde gelişen epigastrik ağrı, bulantı-kusma ve disfaji gibişikayetler üst gastrointestinal sisteminendoskopik incelenmesini zorunlu hale getirmektedir. Erken tanı ve uygun tedavigelişebilecek komplikasyonların önüne geçebilir., Background and Aim: The frequency of upper gastrointestinal system involvement in Crohn’s disease is 0.5%–4%. Treatment and follow-up strategies of these patients differ from those of ileocolonic disease. Here we present our patients who had Crohn’s disease with upper gastrointestinal system involvement. Materials and Methods: We retrospectively investigated our patients who had Crohn’s disease with upper gastrointestinal system involvement. Results: Upper gastrointestinal system involvement was detected in 10 patients. The median age of patients was 40.5 years (31-53 years); 6 patients were male and 4 patients were female. The median follow-up period after diagnosis was 29 (1-228) months. Four patients had isolated upper gastrointestinal system involvement, while 6 patients had ileocolonic disease. The frequency of organ involvement was 10% (1 patient) for the esophagus, 20% (2 patients) for the stomach, and 70% (7 patient) for the duodenum. Endoscopic appearances varies among patients; cobble stone appearances were detected in 2 patients, ulcers were detected in 7 patients and nodulariy were detected in 4 patients. Granulomas were detected histopathologically in 3 patients (30%). Conclusion: Complaints like epigastric pain, nausea and vomiting, and/or dysphagia must warrant clinicians to investigate the upper gastrointestinal system in Crohn’s disease. Early diagnosis and appropriate treatment are necessary to prevent complications.

We investigated the sensitivity of neutrophil to lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as well as a combination of NLR and PLR to predict endoscopic disease severity based on mucosal assessment in ulcerative colitis (UC).The study group consisted 104 patients with active UC, 104 patients in remission, and 105 healthy individuals. Disease activity was described with Rachmilewitz endoscopic activity index (EAI). Curve analysis was used to determine the optimal cutoff values of NLR and PLR for obtaining remission. The patients with both PLR and NLR values higher than the cutoff values were coded as »high risk,« those with one parameter higher were coded as »moderate risk«, those with both parameters lower than the cutoff values were coded as »low-risk« patients.The mean NLR and PLR values in the endoscopically active disease group were higher than the others, with higher values in the endoscopic remission group compared with the control group (p0.001). Rachmilewitz EAI in high-risk patients was significantly higher than that in others (p0.001). In Cox regression analyses, moderate and high risk, high erythrocyte sedimentation rate and high EAI were found as independent predictors of endoscopic active disease.This is the first study that investigated the use of NLR and PLR combination to assess endoscopic disease severity in UC. Either high NLR or PLR levels can predict active endoscopic disease. However, the use of these parameters in combination is more accurate in evaluating mucosal disease and inflammation in UC.Izučavana je osetljivost odnosa neutrofili prema limfocitima (NLR) i trombociti prema limfocitima (PLR), kao i kombinacija NLR i PLR za predviđanje težine endoskopskog oboljenja na osnovu procene oštećenja mukoze u ulcerativnom kolitisu (UC).Izučavanje je obuhvatilo 104 pacijenta sa aktivnin UC, 104 pacijenta u remisiji i 105 zdravih osoba. Težina oboljenja opisivana je sa Rachmilewitz-ovim endoskopskim indeksom aktivnosti (EAI). Određene su optimalne »cutoff« vrednosti NLR i PLR za dobijenu remisiju. Pacijenti sa obe vrednosti PLR i NLR više od predviđenih »cuoff« vrednosti označene su kao »visoki rizik«, one sa jednim višim parametrom označene su kao »umereni ritzik«, a one sa oba niža paramatera od »cutoff« vrednosti kao pacijenti sa »niskim rizikom«.Srednje vrednosti NLR i PLR u grupi endoskopski aktivih oboljenja bile su više nego kod drugih sa višim vrednostima u grupi sa endskopskom remisijom u poređenju sa kontrolnom grupom (p0,001). Rachmilewitz EAI u pacijenata sa visokimm rizikom bile su značajno više nego kod drugih pacijenata (p0,001). Primenom Cox regresione analize, umereni i visoki rizik, visoka sedimentacija eritrocita i visoki EAI su nađeni kao nezavisni prediktori endoskopski aktivnog oboljenja.Ovo je prvo izučavanje koje je koristilo NLR i PLR kombinaciju za procenu težine endoskopskog oboljenja u UC, kao i da li visoki nivoi NLR i PLR mogu da predvide aktivno endoskopsko oboljenje. Međutim, primena ovih parametara u kombinaciji mnogo je korisnija za priocenu mukoznog oboljenja i inflamacije u UC.

Objective: Autoimmune hepatitis (AIH) is a liver disorder that affects both children and adults. It is characterized by inflammatory liver histology, elevated transaminase level, circulating nonorgan-specific autoantibodies, and increased level of immunoglobulin G in the absence of known etiology. Ventricular repolarization has been evaluated using T wave and QT interval measurements in patients with hepatic cirrhosis. Ventricular repolarization may be defined using QT interval, QT dispersion, and T wave measurements. Recently, it has been demonstrated that peak and end of the T wave (Tp-e) interval, Tp-e/QT, and Tp-e/corrected QT interval (QTc) ratios can be novel indicators for prediction of ventricular arrhythmias and mortality. In this study, an investigation of ventricular repolarization using Tp-e interval and Tp-e/QT ratio in patients with AIH was performed. Methods: Total of 31 patients with AIH and 31 controls were enrolled in the present study. Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were measured on 12-lead electrocardiogram. Results: QT interval (378.9+-41.4 vs. 350.0+-22.7; p=0.001), QTc interval (396.8+-46.7 vs. 367.3+-34.9; p=0.039), Tp-e interval (68.2+-12.3 vs. 42.5+-6.8; p

Otoimmün kolanjiyopati veya immünglobulin G4 ilişkili sklerozan kolanjitimmün sistem ilişkili bir kolanjit tipidir. Otoimmün pankreatit sıklıklabu duruma eşlik eder; bununla beraber hastaların çok az bir yüzdesindeotoimmün kolanjiyopati tek başına da görülebilir. 69 yaşında kadın hastakliniğimize halsizlik, kaşıntı ve sarılıkla başvurdu. Endoskopik retrogradkolanjiopankreatografi de intrahepatik safra yollarında çok sayıdadarlık ve dilatasyonlarla beraber ana koledok distalde darlığa rastlandı.Sklerozan kolanjitin diğer nedenlerini ekarte edebilmek için hastadanimmünglobulin G4 çalışıldı ve sonuç 1.200 mg/dl olarak geldi. Bu sonuçlaotoimmün kolanjiyopati tanısı kondu. Otoimmün kolanjiyopatiintrahepatik ve/veya extrahepatik safra yollarında darlık olan hastalardaayırıcı tanıda mutlaka akılda tutulmalıdır. Şüphe edilen hastalardaimmünglobulin G4 tarama amaçlı kullanılabilir. Otoimmün kolanjiyopatinintanı ve tedavisi hastaları ilerleyen zamanda siroz veya gereksizcerrahiden koruyacaktır., Autoimmune cholangiopathy or IgG4-related sclerosan cholangitis isan immune- mediated type of cholangitis. Autoimmune pancreatitis isfrequently associated with this condition. However, in a minority ofpatients, autoimmune cholangiopathy exist alone. A 69- year-old femalepatient was admitted to our hospital with fatigue, pruritus, andjaundice. There were multiple strictures and dilations in the intrahepaticbiliary tree with stricture in the distal part of the common bile duct. Toexclude other causes of sclerosan cholangitis, IgG4 was studied. TheIgG4 titer was 1200 mg/dl; therefore, the diagnosis was autoimmunecholangiopathy. Autoimmune cholangiopathy must be investigated inpatients with biliary strictures in either the intrahepatic or extrahepaticbile ducts. IgG4 can be used to screen for autoimmune cholangitis. Diagnosisand treatment of this condition prevents patients from cirrhosisand unnecessary surgery.

Backgrounds and Aim: After the colonoscopic polypectomy, patients were followed-up according to international guidelines. In this study, we aimed to determine whether there was compliance with follow-up intervals as specified by the guidelines. Also, we researched whether there is any beneficial effect of reduced follow-up intervals for detecting AAP and/or colon carcinoma. Material and Methods: Patients who had a colonoscopy between January 2008 and December 2015 in Türkiye Yüksek İhtisas Training and Research Hospital, Gastroenterology Department, Endoscopy Unit were enrolled in the study. Patients who had detected adenoma on their first colonoscopy were divided into two groups: Group A and Group B. In Group A, colonoscopic surveillance was performed earlier according to the current guideline, and in Group B, colonoscopic surveillance was performed properly according to the current guideline. Between the two groups, the detection rate of AAP and/or colon carcinoma were compared. Results: Overall, 270 patients (mean age: 56.8 years) were included in the study. At their first colonoscopies, 759 polyps, 528 adenomas, and 95 AAPs were detected. In our clinical practice, the interval between the first and second colonoscopy was 21 months. Group A had 228 patients (84.1%), and Group B had 42 patients (15.9%). Between the two groups, the detection rates of AAP and cancer could be compared. Between the two groups, the presence of AAP (6.6% vs. 11.9%; p = 0.2) and colon carcinoma (0.4% vs. 0%; p = 1.0) was not different. Conclusion: Compared with current guidelines, reduced follow-up intervals between the first and second colonoscopies are not associated with conferring additional beneficial effects to patients., Giriş ve Amaç: Kolonoskopikpolipektomi yapıldıktan sonra hastalar uluslararası kılavuzlarca önerilen takiparalıklarına göre izlenir. Bu çalışmada klinik pratikte, kılavuzlarcabelirlenmiş olan takip aralıklarına uyulup uyulmadığı ve takip aralığınıkısaltmanın advanced adenomatöz polip (AAP) ve/veya kolon kanseri saptanmasıüzerine önleyici etkisi olup olmadığının araştırılması amaçlanmıştır.Gereç ve Yöntem:Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi Gastroenteroloji KliniğiEndoskopi Ünitesinde Ocak 2008-Aralık 2015 tarihleri arasında kolonoskopiyapılan 2178 hastanın verileri retrospektif olarak incelendi. İlk kolonoskopideadenomsaptanan olgular, kılavuzların belirttiğinden daha erken takip kolonoskopisiyapılan (Grup A) ve kılavuzların önerdiği sürede takip kolonoskopisi yapılanlar(Grup B) şeklinde 2 gruba ayrılarak AAP ve kanser varlığı açısından karşılaştırıldı.Bulgular: Çalışmaya başlangıç kolonoskopi esnasında yaşortalaması 56,8 olan 270 olgu dahil edildi. Bu hastaların ilk kolonoskopisinde759 polip, 582 adenom ve 95 AAP tespit edildi. Klinik uygulamamızda ilkkolonoskopi ile ikinci kolonoskopi arası ortanca süre 21 aydı. Olguların 228(%84,1)’i Grup A, 42 (%15,9)’si ise Grup B’de idi. İki grup arasında takipkolonoskopi esnasında AAP (%6,6 vs. %11,9, p=0,2) veya kanser (%0,4 vs. %0 p=1.0) varlığı açısındananlamlı bir fark bulunmadı.Sonuç:İlkkolonoskopide polip saptanan hastalara kılavuzlara göre belirtilen süreden dahakısa aralıklarda takip kolonoskopi yapmanın anlamlı düzeyde ek bir faydasıgösterilememiştir.

Tuberculosis is an important health care problem in developing countries. Extrapulmonary tuberculosis can affect many organs. However gastrointestinal tuberculosis is a rare condition with 3-5% frequency. Tuberculosis enteritis and tuberculosis peritonitis are the major clinical manifestations of gastrointestinal tuberculosis. Differential diagnosis between Crohn’s disease and tuberculosis enteritis is important. Immunsupresive treatments including anti-tumour necrosis factors are the leading treatment modalities in Crohn’s disease. Therefore distinction between these conditions is crucial.

We aimed to investigate the prognostic importance of platelet-lymphocyte ratio (PLR) and neutro - phil-lymphocyte ratio(NLR) combination for patients diagnosed with acute pancreatitis and its relationship with mortality.This retrospective study was included 142 patients diagnosed with acute pancreatitis. Ranson, Atlanta and BISAP 0h, 24h and 48h scores of the patients were calculated by examining their patient files. The patients were divided into three groups as low-risk, medium-risk and high-risk patients according to their PLR and NLR levels.The number of patients with acute pancreatitis complications such as necrotizing pancreatitis, acute renal failure, sepsis and cholangitis was significantly higher in the high-risk group compared to other groups. Mortality rate was found to be 90% in the high-risk group, 16% in the medium-risk group, and 1.9% in the low-risk group. The number of patients with a Ranson score of 5 and 6, a severe Atlanta score, a BISAP 0h score of 3 and 4, a BISAP 24h and 48h score of 4 and 5 was higher in the high-risk group compared to other groups. PLR-NLR combination, Atlanta and Ranson scores, and C-reactive protein level were determined to be independent risk factors predicting mortality in stepwise regression model. PLR-NLR combination had the highest area under curve value in terms of predicting acute claspancreatitis prognosis and had a similar diagnostic discrimination with other scoring systems.In our study it was found that PLR-NLR combination had a similar prognostic importance with other scoring systems used to determine acute pancreatitis prognosis.Svrha ovog istraživanja je da se utvrdi značajnost kombinacije trombocitno-limfocitnog odnosa (PLR) i neutrofilnolimfocitnog odnosa (NLR) za dijagnostikovanje aktunog pankreatitisa kao i u odnosu na mortalitet.Retrospektivno izučavanje obuhvatilo je 142 pacijenta sa dijagnozom akutnog pankreatitisa. Ranson, Atlanta i BISAP 0h, 24h i 48h skorovi kod pacijenata računati su uvidom u istorije bolesti pacijenata. Pacijenti su podeljeni u tri grupe i to niskog, srednjeg i visokog rizika prema nivoima njihovih PLR i NLR.Broj pacijenata sa akutnim pankreasnim komplikacijama kao što su nekrotizirajuči pankreatitis, akutni renalni poremečaj, sepsa i holangitis bili su znaćajno viši u grupi sa visokim rizikom u odnosu na druge grupe. Nađeno je da je kod visoko rizićne grupe mortalitet iznosio 90%, 16% kod grupe sa srednjim rizikom i 1,9% kod grupe niskog rizika. Broj pacijenata sa Ranson skorom 5 i 6, teškim Atlanta skorom, i BISAP 0h skorom 3 i 4, i BISAP 24h i 48h skorom 4 i 5 je bio viši u grupi sa visokim rizikom u odnosu na druge grupe. Utvrđeno je da su PLR-NLR kombinacija, Atlanta i Ranson skorovi, i nivo C-reaktivnog proteina bili nezavisni faktori rizika u predviđanju mortalitea u regresionom modelu. PLR-NLR kombinacija je imala največu površinu ispod vrednosti krive u predviđanju prognoze akutnog pankreatitisa i slićnu dijagnostićku diskriminaciju sa drugim skor sistemima.U našem izučavanju nađeno je da PLR-NLR kombinacija ima sličan prognostički značaj sa drugim skor sistemima koji se koriste za utvrđivanje prognoze akutnog pankreatitisa.

Objective:We established an expectation that ischemia-modified albumin (IMA) levels are higher in the celiac disease since it is an autoimmune/chronic inflammatory disease. In this study, we determined the level of IMA and its relation to autoimmunity/chronic inflammation in celiac disease.Material and methods:The level of IMA of 65 patients diagnosed with celiac disease and 65 healthy volunteers, was measured with the serum ELISA kit. C-reactive protein (CRP), anti-gliadin antibodies immunoglobulin A (AGA-lgA), anti-gliadin antibodies immunoglobulin G (AGA-lgG), anti-tissue transglutaminase immunoglobulin A antibodies (Anti-t-TGA), anti-tissue transglutaminase immunoglobulin G antibodies (Anti-t-TGG) levels were studied.Results:IMA (30.8 ng/mL vs. 20.1 ng/mL, p=0.006; respectively) levels in celiac patients were higher than the control group. In celiac patients who were antibody positive, IMA level was found to be higher compared to antibody negative patients. A positive correlation was determined between IMA level and AGA-IgA (r=0.504, pConclusion:Chronic inflammation and autoimmunity were found to be associated with high levels of IMA. To use IMA as a diagnosis and follow-up criterion in celiac disease, IMA levels must be compared before and after treatment of active celiac disease.

Giriş ve Amaç: Primer biliyer kolanjit çoğunlukla orta yaş kadınların etkilendiği, kronik kolestatik bir karaciğer hastalığıdır. Persistan kolestatik karaciğer enzim yüksekliği, normal biliyer görüntüleme ve antimitokondrial antikor varlığı primer biliyer kolanjit teşhisi için gereklidir. Ursodeoksikolik asit tedavisi altındaki bazı hasta gruplarında hastalığın ilerlediği gösterilmiştir. Biz kliniğimizde primer biliyer kolanjit tanısı ile izlenen hastaların tedavi sonuçlarını vermeyi ve Paris-I ve Paris-II, Toronto ve Barselona kriterlerine göre ursodeoksikolik asit yanıtını ön görmede testlerin doğruluk oranlarını göstermeyi amaçladık Gereç ve Yöntem: Yüksek İhtisas Hastanesi Hepatoloji Bölümü’nde 2000-2010 yılları arasında primer biliyer kolanjit tanısı alan 82 hasta retrospektif olarak incelendi. Primer biliyer kolanjit tanısı antimitokondrial antikor pozitifiliği, alkalen fosfataz enzim yüksekliği ve/veya biyopsi ile konuldu. En az 2 yıl boyunca ursodeoksikolik asit 13-15 mg/kg/g dozunda alan hastalar çalışmaya alındı Bulgular: Hastalar 3. ay, 6 ay, 1. yıl, 2. yıl, 3. yıl, 4. yıl ve 5. yıl biyokimyasal yanıt açısından Barselona, Paris I-II ve Toronto kriterleri açısından değerlendirildi. Tedaviye yanıtı ön görmede en başarılı test doğruluk oranına göre Paris I (%71.7) olarak hesaplandı. Hastalarımızda tedavi başarısını ön görmekte en başarılı diğer testler sırası ile Toronto (%54.6), Barselona (%50.6) ve Paris-II (%47.4) olarak saptandı. Tedavi yanıtını ön görmedeki başarı tüm testlerde 2 yıldı ve sonrasında başarı oranları artmakta idi. Sonuç: Ursodeoksikolik asit tedavisi başlanan hastalarda 3. ayda karaciğer biyokimya testlerinde iyileşme görülmesine rağmen, ursodeoksikolik asit tedavi yanıtını ön görmede kullanılan testlerin doğruluk oranları 2. yılda artmakta idi. Çalışmamızda tanı testlerinin doğruluk oranı düşük idi. Bu nedenle daha geniş hasta gruplu çalışmalar yapılıp sonuçlarımızın doğrulanması gerekmektedir., Background and Aims: Primary biliary cholangitis is a chronic cholestatic liver disease mainly affecting middle- aged women. Persistently elevated cholestatic liver enzymes, normal biliary imaging, and the presence of antimitochondrial antibodies are key elements of the diagnosis. It was demonstrated that the disease can progress under ursodeoxycholic acid treatment. Our aim is to demonstrate the response to treatment of primary biliary cholangitis patients. We also aim to determine the accuracy rate of the Paris-I, Paris-II, Toronto, and Barcelona criteria for predicting ursodeoxycholic acid treatment in primary biliary cholangitis. Materials and Methods: Eighty-two primary biliary cholangitis patients diagnosed between 2000 and 2010 were investigated retrospectively. Only patients who were treated with ursodeoxycholic acid with a daily 13–15 mg/kg dose for at least 2 years were included in the study. The diagnosis of primary biliary cholangitis was made by two of the following criteria: presence of antimitochondrial antibody, elevated cholestatic liver enzymes, and biopsy. Results: Patients’ biochemical parameters at 3, 6, 12, 24, 36, 48, and 60 months using the Paris-I, Paris-II, Toronto, and Barcelona criteria were compared. Paris-I was found to be the best test to predict treatment response (71.7%). Other tests are less successful at predicting treatment response (Toronto: 54.6%, Barcelona: 50.6%, and Paris-II: 47.4%). Beyond the second year of the treatment, the success ratios of tests to predict response to treatment were increased. Conclusion: Although liver biochemical tests are improving in the third month of ursodeoxycholic acid treatment, the accuracy rate of the Paris-I, Paris-II, Toronto, and Barcelona criteria increases after the second year of the treatment. We found low accuracy rates for these tests.

Elli altı yaşında erkek hasta karaciğer nakli sonrası anastomoz darlığı ve kolanjit tanısı ile kliniğimize başvurdu. Hastaya perkütan transhepatik kolanjiografi (PTK) yapıldı. Kolanjit tanısı ile imipenem başlandı. Ancak ateş ve beyaz küre değerinde yükseklik olması üzerine imipenem tedavisinin 10. gününde teikoplanin eklendi. İlaç başlandıktan bir gün sonra tonik klonik epileptik nöbetleri oldu. Kranial bilgisayarlı tomografi (BT), elektroensefalografi (EEG) ve kranial magnetik rezonans görüntüleme (MRG) çekildi. Sadece MRG’de kronik iskemik değişiklikler saptandı. Laboratuvar analizinde kan sodyum 124 mEq/L saptanan hastaya replasman tedavisi yapıldı. Hastaya levetiracetam başlandı. Epileptik atakları tekrarlayan hastada metabolik asidoz gelişti ve entübe edildi. Teikoplanin verilmesinden hemen sonra başlaması ve diğer etiyolojik faktörlerin dışlanması nedeniyle nöbetlerin teikoplanine bağlı olabileceği düşünüldü ve hastanın ilacı kesildi. İlaç kesilmesi sonrası nöbetler kesildi. Ancak ventilatöre bağlı pnömoni gelişen hasta exitus oldu. Enfekte ve teikoplanin alan bir hastada nöbet varlığında ilaca bağlı nöbet akılda tutulmalıdır.

Background Serum C-reactive protein (CRP) increases and albumin decreases in patients with inflammation and infection. However, their role in patients with acute pancreatitis is not clear. The present study was to investigate the predictive significance of the CRP/albumin ratio for the prognosis and mortality in acute pancreatitis patients. Methods This study was performed retrospectively with 192 acute pancreatitis patients between January 2002 and June 2015. Ranson scores, Atlanta classification and CRP/albumin ratios of the patients were calculated. Results The CRP/albumin ratio was higher in deceased patients compared to survivors. The CRP/albumin ratio was positively correlated with Ranson score and Atlanta classification in particular and with important prognostic markers such as hospitalization time, CRP and erythrocyte sedimentation rate. In addition to the CRP/albumin ratio, necrotizing pancreatitis type, moderately severe and severe Atlanta classification, and total Ranson score were independent risk factors of mortality. It was found that an increase of 1 unit in the CRP/albumin ratio resulted in an increase of 1.52 times in mortality risk. A prediction value about CRP/albumin ratio >16.28 was found to be a significant marker in predicting mortality with 92.1% sensitivity and 58.0% specificity. It was seen that Ranson and Atlanta classification were higher in patients with CRP/albumin ratio >16.28 compared with those with CRP/albumin ratio ≤16.28. Patients with CRP/albumin ratio >16.28 had a 19.3 times higher chance of death. Conclusion The CRP/albumin ratio is a novel but promising, easy-to-measure, repeatable, non-invasive inflammation-based prognostic score in acute pancreatitis.

Background/aim We aimed to present the endoscopic ultrasound (EUS) features of gastric lesions suggesting gastric ectopic pancreas during upper gastrointestinal endoscopy that were diagnosed in our gastroenterology unit, which is a tertiary center for endoscopic procedures in Turkey. Materials and methods The data of patients who underwent upper gastrointestinal EUS in our center between April 2012 and July 2014 were retrospectively analyzed. Results All of the lesions suggesting gastric ectopic pancreas were localized in the gastric antrum. Thirty-six of 44 lesions (81.1%) showed central dimpling. Lesion borders were shown to be definite in 10 (22.7%) lesions, whereas the borders of 34 lesions (77.3%) were indefinite. Thirty-nine lesions (88.6%) had heterogeneous and 5 lesions (11.4%) had homogeneous echo patterns; whereas 29 lesions (65.9%) were hypoechoic, 9 lesions (20.5%) were hyperechoic and 6 lesions (13.6%) had mixed echogenicity. Forty-two lesions (95.5%) were shown to affect only a single sonographic layer of the gastric wall. Conclusion EUS features of lesions that strongly suggest gastric ectopic pancreas endoscopically, without any histopathological evidence and without either endoscopic or surgical resection, are as follows: indefinite border appearance, minimal heterogeneous hypoisoechoic echo pattern, existence of anechoic duct-like structures inside the lesion, common localization in the submucosal layer, and existence of umbilication.

Background/Aims: The American Society for Gastrointestinal Endoscopy (ASGE) endoscopic retrograde cholangiopancreatography (ERCP) grading system was proposed but has not been fully evaluated with prospective clinical studies. In this study, we aimed to evaluate the effectiveness of the ERCP difficulty grading system for predicting success and adverse event rates related to the procedure. Materials and Methods: A total of 1057 ERCP procedures performed on 752 patients were included in the present study. The complexity grades of the procedures were recorded according to the ASGE grading system. Specific complications of ERCP (pancreatitis, cholangitis, bleeding, and perforation) were also defined and graded. Results: The procedure difficulty was determined as 1 st degree in 153 patients (14.4%), 2 nd degree in 498 patients (47.1%), 3 rd degree in 271 (25.6%), and 4 th degree in 135 patients (12.7%). The success rate for the entire procedures was 88.4%. The success rate for 1 st -degree procedures was 99.3%, 97.2% for 2 nd -degree procedures, 86.7% for 3 rd -degree procedures, and 46.7% for 4 th -degree procedures (p