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Gul Utku, Ozlem/0000-0003-1043-2627 WOS:000539973200006 PubMed: 32207216 Aims Colon preparation is vital yet more difficult in elderly patients with severe lower gastrointestinal bleeding (LGIB). The aim of this study is to show the efficacy, safety and outcomes of unprepared polyethylene glycol (PEG)-flush retrograde colon cleansing in the diagnosis and treatment of elderly home care patients with LGIB. Methods A single-center study was performed between January 2014 and June 2018. Elderly home healthcare patients presenting with hematochezia were enrolled, and an unprepared retrograde bowel cleansing colonoscopy was performed within the first 8 h after admission to the emergency department. PEG solution (2 L) was added to the water jet tank, and jet pump injection was started from the left side of the colon to the right segment of the colon and ended up at the cecum. Results In total, 33 elderly patients presenting with hematochezia were evaluated. Mean inward and outward procedure times were 17.06 +/- 4.92 (8-33 min) and 28.66 +/- 6.88 (10-30 min), respectively. Most of the bleeding was localized in the right colon at 22 patients (66.3%). Endoscopic treatment was performed in 87.9% of patients. The average length of stay in hospital was 44.70 +/- 42.81 (range 18.00-240.00 h). Conclusions Immediate unprepared PEG-flush colonoscopy in elderly home care patients with acute LGIB is a safe and effective method, which detects bleeding sources and provides endoscopic therapy. With this procedure, the time of hospital stay is reduced. This approach may be used for the initial intervention in patients admitted to emergency departments or intensive care unit with severe acute LGIB.Geriatr Gerontol Int 2020; center dot center dot: center dot center dot-center dot center dot.

Background: We aimed to evaluate the diagnostic capability of endoscopic ultrasound elastography (EUS-EG) and strain ratio (SR) for differentiating benign pancreatic lesions from the malign lesions Material and Method: We retrospectively evaluated well collected data of patients who undergone EUS-EG in a single centre during the period of January 2016-June 2019. Patients who had pancreatic disorders were further evaluated for the study. The final diagnosis of solid pancreatic lesions (SPL) was made by histopathologic examination. Control group consisted of patients with chronic pancreatitis (CP) who diagnosed according to Rosemont criteria. Elastography was evaluated by a qualitative (elastography scores) and a quantitative method SR. Results: A total of 66 patients (42 (63.6%)female/42 (63.6%)male) with mean age of 58.88±15.32 (19- 80) were included in the study. Thirty-eight patients had SLP, remain 28 patients were CP. In SPL group, 32 (84.2%) had adenocarcinomas and 6 (15.8%) had neuroendocrine tumors. Among 28 patients with benign pancreatic lessions, 23 (82.1%) had CP while five (17.9%) had autoimmune pancreatitis. Median SR values were significantly higher in patients with SPL than those with CP (44.0 (10.0-110.0) vs 7.0 (2.6-14.6), p, Amaç: Benign pankreas lezyonlarının malign lezyonlardan ayırt edilmesi için endoskopik ultrason elastografisi (EUS-EG) ve gerinim oranının (SR) tanısal yeteneğini değerlendirmeyi amaçladık.Gereç ve Yöntem: Ocak 2016-Haziran 2019 döneminde tek merkezde EUS-EG uygulanan hastaların iyi toplanmış verilerini retrospektif olarak değerlendirdik. Pankreas bozukluğu olan hastalar da çalışma için değerlendirildi. Katı pankreas lezyonlarının (SPL) kesin tanısı histopatolojik inceleme ile konuldu. Kontrol grubu, Rosemont kriterlerine göre teşhis edilen kronik pankreatitli (CP) hastalardan oluşmaktaydı. Elastografi kalitatif (elastografi skorları) ve kantitatif SR yöntemi ile değerlendirildi.Bulgular: Ortalama yaş 58,8±15,3 (19-80) olan toplam 66 hasta (42 (%63,6) kadın / 42 (%63,6) erkek) çalışmaya dahil edildi. Otuz sekiz hastada SLP; 28 hastada CP vardı. SPL grubunda 32'sinde (%84,2) adenokarsinom, 6'sında (%15,8) nöroendokrin tümör vardı. Benign pankreatik dersleri olan 28 hastanın 23'ünde (%82,1) CP, beşinde (%17,9) otoimmün pankreatit vardı. SPL'li hastalarda medyan SR değerleri CP'li hastalardan anlamlı olarak daha yüksekti (44,0 (10,0-110.0) ve 7,0 (2,6-14,6), p

WOS: 000518828400005 PubMed: 32141819 Background/Aims: The objective of this study is to determine the role of circulating resolvin D1 (RvD1) in patients with constipation subtype of irritable bowel syndrome (IBS-C) and evaluate the relationship between abdominal pain severity and RvD1 levels. Materials and Methods: This research included 55 patients with IBS-C and 36 healthy controls. Controls were selected from patients who applied to our department with similar complaints as IBS but were not diagnosed with any type of pathology after further investigations. All participants underwent complete blood count, C-reactive protein (CRP), and RvD1 levels measurements. We also recorded abdominal pain severity and the number of bowel movements. Patients with IBS-C were compared with respect to the demographic features and laboratory measurements. Results: The median CRP concentration in patients with IBS-C was significantly higher than that of controls (p=0.003). However, the median RvD1 concentration was significantly lower in the IBS group than that of the control group (p

Background and Aim: Gastrointestinal problems are reportedly more frequent in patients with diabetes mellitus (DM) compared to the general population and are a cause of reduced quality of life (QOL). Even though studies have suggested that parameters such as glycemic control and disease duration are responsible for upper gastrointestinal (GI) symptoms in DM, there is little compelling evidence to show a direct relationship given the fact that various other studies report no relationship. These conflicts may be caused by the lack of standardization of patient populations, evaluation methods and other causes. Our aim was to determine and compare the frequency of GI symptoms and GI-related QOL in recently diagnosed DM patients and healthy controls in order to evaluate this relationship with minimization of confounding factors.Material and methods: A total of 59 patients newly diagnosed with DM and 92 age- and sex-matched controls were included in this study. Demographic characteristics, chronic diseases, GI symptoms (as measured by 8-MGSI score) and GI-related QOL (irritable bowel syndrome quality of life, IBS-QOL) scores were evaluated. Linear regression analysis was performed to determine factors that independently influenced IBS-QOL.Results: The patient and control groups were similar with regard to all characteristics except for chronic diseases. The scores for 8-MGSI and IBS-QOL were significantly worse in patients with DM. Regression analyses showed that IBS, DM and dyspepsia were independent factors that influences IBS-QOL scores.Conclusion:The results of our study show that the effect of DM on GI symptoms is not a function of disease duration or glycemic control; DM presence itself seems to have adverse effects on the GI system through mechanisms that are yet unknown. The explanation of these mechanisms rely on experimental research and prospective studies with rigid patient inclusion criteria.

Insan gastrointestinal sisteminde bulunan bakterilerin cesitli hastaliklarin patogenezinde ve tedavisinde rol aldigi son yillarda ortaya cikmis . Vucudumuzda yasayan mikroorganizmalarin tamamina mikrobiyota, insanlarla kommensal olarak yasayan mikroorganizlarin tasidiklari genoma mikrobiyom adi verilmektedir. Insan vucudunun saglikli bir yasam surdurebilmesi icin saglikli bir gastrointestinal sisteme sahip olmasi gerekmektedir. Bunun saglanmasi da intestinal mikroflora ile olmaktadir. Bagirsagin yararli mikroflorasini guclendirmek icin probiyotik, prebiyotik ve sinbiyotikler gibi gida katki maddeleri kullanilmaktadir.Mikrobiyotaki bakteriler belirli bir oranda yararli ve zararli bakterileri icerir. Yararli /zararli bakteri orani azaldiginda “mikrobiyal disbiyozis” adini verdigimiz patolojik bir surec baslar. Mikrobiyal disbiyozis sureci ile gastrointestinal hastalilardan enflamatuvar bagirsak hastaligi, kolon - gastrik kanser colyak hastaligi ile iliskilendirilirken ,extraintestinal hastalilardan da alerji ,obezite, Parkinson hastaligi, diyabet ve kardiyovaskuler hastaliklar gibi bircok hastalik da iliskilidir. Mikrobiyota manipulasyona dayanan mudahaleler, sindirim sistemi icinde ve disinda bircok kronik durum icin kullanimi giderek yayginlasmakta ve gelecek icin umut vercidir.

WOS: 000530895000009 Objective: Inflammatory bowel disease (IBD) is an idiopathic disease associated with changes in the immune system and in the intestinal microbiota. The most accepted hypothesis of IBD pathogenesis is thought to be the abnormal immunological response and chronic intestinal inflammation, which is caused by the complex interactions between genetic, environmental factors and the host immune system. Microbial flora is important in the maturation of the immune system. Dysbiosis is defined as changes in intestinal microbiota composition and function. Clinical and experimental studies support that dysbiosis plays a significant role in the etiopathogenesis of IBD. Probiotics are useful live microorganisms that provide the intestinal balance in the host. In this study, we aimed to evaluate the anti-inflammatory and anti-oxidant activities of Enterococcus faecium, Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium bifidum and Bifidobacterium longum bacteria in the experimental colitis model. Methods: Twenty-four female Wistar-Albino rats and 30 mg 0.5 mL trinitrobenzenesulfonic acid (TNBS) dissolved in 50% ethanol which induced colitis by intrarectal installation. Rats were divided into four groups; healthy control (sham: group A), TNBS colitis (group B), (TNBS + methylprednisolone: group C) and probiotic (TNBS + P: group D). The rats were sacrificed on the 8th day. Macroscopic and microscopic scores, tissue myeloperoxidase (MPO), malondialdehyde (MDA) and superoxide dismutase (SOD) levels were measured. Results: Macroscopic and microscopic scores levels in group A were significantly lower than in group B, C and D. Macroscopic and microscopic scores levels in group C were significantly lower than in group B. Macroscopic scores were statistically similar between group C and D. There was a statistically significant difference between the groups in terms of median MDA levels and median SOD levels (p

WOS:000545456000025 PubMed: 32390401 Background: The discrimination of malignant biliary strictures from benign biliary diseases (BBDs) is challenging and complicated. We aimed to investigate whether Resolvin D1 (RvD1) would aid in the discrimination of cholangiocarcinoma (CCA) from BBDs. Methods: Thirty-one patients with CCA, 27 patients with BBD, and 30 healthy controls were enrolled in this crosssectional study. The diagnosis of CCA was based on results obtained from abdominal USG, MRCP, abdominal CT, endosonography, and tumor markers, including CEA and CA 19-9. Histopathological evaluation was performed in the majority of patients, and the final diagnosis was based on surgery or biopsy results. RvD1, CEA, and CA 19-9 were analyzed in all patients with CCA and BBD. Results: RvD1 was significantly lower in those with CCA compared to patients with BBD and healthy controls. In addition, CEA and Ca 19-9 levels were significantly higher in the CCA group than the BBD group (p < 0.001). RvD1 concentration, CA 19-9 concentration, and total bilirubin level were found to be correlated with tumor stage (r = -0.702, 0.390, and 0.569, respectively). ROC curve analysis revealed that an RvD1 concentration of < 380 ng/mL (AUC: 0.783, 95% CI: 0673 - 0.893, p < 0.001) and CA 19-9 concentration of > 94.5 U/mL (AUC: 0.94, 95% CI: 0.898 - 0.998, p < 0.001) could be used to discriminate patients with CCA from those with BBD. Conclusions: Resolvin D1 and CA 19-9 levels might be used to effectively discriminate between BBD and CCA. Moreover, both RvD1 and CA 19-9 levels are associated with the stage of CCA, indicating that they may also be used in assessing disease progression.

PubMed: 32162872 Background: We hypothesized that nesfatin-1, an anti-inflammatory peptide, could be used as a non-invasive diagnostic tool in the identification of celiac disease (CD) and irritable bowel syndrome presenting predominantly with diarrhea (IBS-D). Methods: Thirty-five patients with IBS-D who met the Rome III criteria, 28 patients with celiac disease who met the diagnostic criteria of the Marsh-Oberhuber classification, and 30 age- and gender-matched healthy controls were included in this cross-sectional study. All subjects responded to the IBS Severity Scoring System (IBS-SSS) questionnaire that was used to determine pain severity, pain frequency, bloating, dissatisfaction with bowel habits, and life interference. Results: Nesfatin-1 levels were significantly higher in the CD group compared to the IBS-D group and healthy controls. Nesfatin-1 was also higher in the IBS-D group compared to controls. Nesfatin-1 levels were correlated with IBS-SSS (r = 0.884, p < 0.001), severity of abdominal pain and discomfort (r = 0.644, p < 0.001), and C-reactive protein concentrations (r = 0.303, p = 0.004). ROC curve analysis demonstrated that a cutoff value of > 98.1 pg/mL for nesfatin-1 could discriminate subjects with CD from those with IBS-D and also healthy controls with a sensitivity of 82% and a specificity of 80%. Conclusions: The results of this study show that subjects with CD have higher nesfatin-1 levels compared to those with IBS-D or to the healthy controls. Moreover, nesfatin-1 can discriminate subjects with CD from those with IBS-D and also healthy controls, with high sensitivity and specificity. Further studies with histopathological evaluation are required to clearly address the role of nesfatin-1 in the diagnosis of CD. © 2020 Verlag Klinisches Labor GmbH. All rights reserved.

Background/aim: This study was designed to identify the effect of pentoxifylline on trinitrobenzene sulfonic acid (TNBS)-induced colitis in rats. Materials and methods: Forty-two female Wistar rats were randomly divided into 7 groups: group A, TNBS + intraperitoneal (IP) pentoxifylline; group B, TNBS + IP saline; group C, TNBS + intrarectal (IR) pentoxifylline; group D, TNBS + IR saline; group E, IP pentoxifylline + TNBS; group F, IP saline + TNBS; group G, IR saline. Pentoxifylline was given daily for 3 days before or 6 days after the induction of colitis. Rats were killed after 6 days. Results: IP and IR pentoxifylline similarly and significantly reduced damage and histopathological scores. Pentoxifylline attenuated the accumulation of malonyldialdehyde and transforming growth factor β1 and the activities of myeloperoxidase, matrix metalloproteinase-3, and tissue inhibitor of metalloproteinases-1, and it also restored superoxide dismutase activity. The IP route was more effective than the IR route in this regard. Administration of IP pentoxifylline before or after induction did not influence all parameters. Conclusions: Pentoxifylline showed a therapeutic effect in this experimental colitis model. IP administration seemed to be better. This effect may occur as a result of inhibition of oxidative stress and metalloproteinase activity.

Background /Aims : We aimed in our study to determine serum amphiregulin level, which is an indicator of a malignancy, and to foresee pancreatic carcinoma in chronic pancreatitis.Materials and Methods: 42 patients who applied to Department of Gastroenterology and were diagnosed with chronic pancreatitis and 43 healthy patients as the control group were enrolled in the study. Serum amphiregulin levels were studied with an Amphiregulin Human ELISA Kit ab99975 (Abcam, Cambridge, UK) by ELISA(Enzyme-Linked Immunosorbent Assay) method. Results: Patients with chronic pancreatitis compared to healthy control group (p : 0.007) and the group complicated with pseudocyst among chronic pancreatitis patient group, serum amphiregulin level (p : 0.006) and Ca 19-9 (p : 0.03) level are high. We also found that the relationship between the long diameter of the pseudocyst and serum amphiregulin level is statistically significant (p : 0.01) in the complicated chronic pancreatitis group. Conclusion: Patients with chronic pancreatitis and the group complicated with pseudocyst among chronic pancreatitis patient group must be monitored more closely in terms of pancreatic cancer since serum amphiregulin level and Ca 19-9 level are high and the relationship between the long diameter of the pseudocyst and serum amphiregulin level is statistically significant in such patient groups.

Background/aim: The aim of this study was to investigate the efficacy of a through- the-scope sodium phosphate solution with completion colonoscopy on the same day as a salvage option for inadequate bowel preparation Materials and methods: All participants were instructed to eat a low residual diet for 3 days before the scheduled colonoscopy and a clear liquid diet 18 h before the colonoscopy. The patients were asked to take split doses of an oral sennoside solution at 1800 and 2200 in the evening before the colonoscopy. In cases of inadequate bowel preparation detected during routine colonoscopy, a sodium phosphate solution was administered through the scope on the day of the colonoscopy procedure. The degree of bowel cleansing was assessed by the Boston Bowel Preparation Scale (BPS: 0?9). Results: Almost excellent bowel cleansing was obtained with a statistically significant difference between the degree of bowel cleansing before and after the application of the sodium phosphate (Boston BPS: 5.48 < 1.01 vs. 8.88 ± 0.33 respectively, P < 0.001). Conclusion: Through-the-scope sodium phosphate with completion colonoscopy on the same day was shown to be an efficacious and acceptable method for inadequate bowel preparation.

Soliter rektal ulser sendromu (SRUS), siklikla genc-eriskin yas grubunda gorulen etiyolojisi tam olarak bilinmeyen kronik bir hastaliktir. Tani semptomlar, endoskopik bulgular ve histopatolojik incelemelerin kombinasyonu ile mumkundur. Bu yazida maligniteyi taklit eden soliter rektal ulser olgusu sunulmustur .

Esophageal variceal bleeding is a serious complication of portal hypertension in cirrhotic patients. Current treatment approach consists of band ligation and sclerotherapy. More than 10% of variceal bleedings are refractory to standard treatments and have a higher mortality rate. In this study, we aimed to share our experiences regarding covered self-expanding metal stent (SEMS) as a bridging therapy to permanent treatments, which decrease portal blood pressure, such as TIPS and surgery in two refractory variceal bleeding patients who were referred to our hospital with a past history of multiple band ligations to esophageal varies.

BACKGROUND/AIMS The Wnt/s-catenin pathway plays a prominent role in hepatocellular carcinoma (HCC). The Dickkopf (DKK) proteins (DKK1-4) are known Wnt antagonists; the overexpression of DKK1 has been demonstrated in HCC, and increased DKK3 methylation in the HCC tissue is associated with worse prognosis. Thus, the aim of our study was to demonstrate the diagnostic accuracy of serum DKK1 and DKK3 in HCC in comparison with that of serum alpha-fetoprotein (AFP). MATERIALS AND METHODS We included consecutive 40 HCC patients, 54 cirrhosis patients, and 39 healthy controls. Serum DKK1 and DKK3 levels were measured by an enzyme-linked immunosorbent assay, and serum AFP levels were measured by a chemiluminescence assay. RESULTS The AFP levels differed in each group and could help differentiate between groups (p < 0.001). The DKK1 levels could help differentiate the HCC group from cirrhosis and control groups (p < 0.001), and the DKK3 levels could help differentiate HCC and cirrhosis groups from the control group (p < 0.001). Combined usage of DKK1 and AFP increased the diagnostic yield, with a sensitivity, specificity, positive predictive value, and negative predictive value of 87.5%, 92.3%, 92.1%, and 87.8%, respectively. CONCLUSION Although AFP is superior to DKK1 and DKK3 in the diagnosis of HCC, the combination of DKK1 and AFP showed a better diagnostic yield than AFP alone.

The treatment of caustic esophageal strictures is a challenging topic. Although traditional therapies have limited efficacy, most of these patients eventually require surgery. Biodegradable (BD) stents are newly designed stents for benign conditions. This is a retrospective case series of seven patients with caustic esophageal stricture. BD esophageal stents were inserted for palliation of dysphagia. The position of the stent was checked at 1, 4, 8, 12 16, 20, and 24 weeks and at the end of follow-up period. The follow-up period was 60 ± 23 (36-102) weeks. Complete dissolution of the stent occurred at 16 ± 4 (12-20) weeks. Three patients had partial/complete relief of dysphagia. The remaining four patients experienced tissue hyperplasia at the edges of the stent and required serial dilations. At the end of follow-up, all patients had partial or complete relief of dysphagia. Although BD stents have some efficiency, tissue hyperplasia is the main limiting factor. Further randomized trials are needed to determine efficiency of BD stents for caustic damage.

To evaluate the neuroprotective effects of adalimumab in an experimental spinal cord injury model and compare them with those of the widely-used methylprednisolone.Forty male Wistar rats were divided into 5 as the sham, trauma, adalimumab, methylprednisolone, and adalimumab+methylprednisolone groups. Only laminectomy was performed in the sham group. Laminectomy and trauma was performed to the trauma group but no treatment was given. A single dose of 40 mg/kg subcutaneous adalimumab was administered after the laminectomy and trauma to group 3. A single dose of intravenous 30 mg/kg methylprednisolone was administered right after laminectomy and trauma to group 4. Single doses of 40 mg/kg adalimumab and 30 mg/kg methylprednisolone were administered together after laminectomy and trauma to group 5. Serum malondialdehyde (MDA), TNF-α, IL-1β and IL-6 levels were measured and sections were obtained for histopathological study at the end of the 7supth/supday.MDA, TNF-α, IL-1β and IL-6 levels in serum were significantly decreased in the adalimumab group with clinical and histopathological improvement not less than the methylprednisolone group. The serum MDA levels were similar when the two drugs were given together or separately but there was a statistically quite significant decrease in TNF-α, IL-1β and IL-6 levels with concurrent use. Statistically significantly better results were obtained on histopathological evaluation with the use of both drugs together.This study revealed that adalimumab is as effective as methylprednisolone in compressive spinal cord injury in rats.

Objective: This study was designed to identify the effect of rivaroxaban, a direct factor Xa inhibitor, on trinitrobenzene sulfonic acid (TNBS)-induced colitis in rats. Materials and Methods: Twenty-four female Wistar rats were divided into 4 groups of 6 each. Group 1 received TNBS + rivaroxaban, group 2 received TNBS + methylprednisolone, group 3 received TNBS and group 4 received a saline enema. Colitis was induced in the rats by the intracolonic administration of TNBS. Rivaroxaban and methylprednisolone were given by oral gavage daily for 7 days. The rats were killed 7 days after the induction of colitis. Results: Rivaroxaban and methylprednisolone significantly reduced gross damage and histopathological scores. Rivaroxaban was more effective than methylprednisolone in terms of microscopic mucosal healing. Rivaroxaban attenuated the accumulation of malonyldialdehyde (MDA) and transforming growth-factor β1 (TGF-β1) and the activites of myeloperoxidase (MPO), matrix metalloproteinase-3 and tissue inhibitor of metalloproteinases-1. Methylprednisolone reduced only the activity of MPO and the accumulation of MDA and TGF-β1. Superoxide dismutase activity showed a restoration to normal levels after rivaroxaban and methylprednisolone administration. Conclusions: Rivaroxaban showed a therapeutic effect in the TNBS model of experimental colitis, and it seemed to be at least as effective as methylprednisolone. This effect may be brought about by the inhibition of oxidative stress and metalloproteinase activity associated with tissue injury and remodeling.