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Biliary endoscopic sphincterotomy (EST) refers to the cutting of the biliary sphincter and intraduodenal segment of the common bile duct following selective cannulation, using a high frequency current applied with a special knife, sphincterotome, inserted into the papilla. EST is either used solely for the treatment of diseases of the papilla of Vater, such as sphincter of Oddi dysfunction or to facilitate subsequent therapeutic biliary interventions, such as stone extraction, stenting, etc. It is a prerequisite for biliary interventions, thus every practitioner who performs endoscopic retrograde cholangiopancreatography needs to know different techniques and the clinical and anatomic parameters related to the efficacy and safety of the procedure. In this manuscript, we will review the indications, contraindications and techniques of biliary EST and the management of its complications.

INTRODUCTION: HBV reactivation (HBVr) is a well-known complication in patients receiving immunosuppressive therapy and leads to significant morbidity and mortality. As the use of biological agents becomes more common in rheumatology practice, a growing number of HBVr cases are reported. The aim of this study was to evaluate the awareness of rheumatologists about the risk of HBVR, pre-treatment screening and prophylactic treatment in patients receiving immunosuppressive therapy. The aim of our study was to evaluate the awareness of rheumatologists about the risk of HBVR, pre-treatment screening and prophylactic treatment in patients receiving immunosuppressive therapy. METHODS: All rheumatyology specialist members of the Turkish Association of Rheumatology were invited to the study between April 1 and June 30, 2018. An e-mail was sent to the participants 3 times once in a month with an informative message, with a link to the questionnaire that allows the survey to be completed only once. Inclusion criteria were to be a member of Turkish Rheumatology Association and to be a rheumatology specialist as an active clinician in Turkey. The results of the survey were evaluated by the researchers. SONUÇLAR: A questionnaire was sent to 270 rheumatologists who met the criteria, 48 (%17,8) questionnaires were completed and included in the study. Participants had an average of 6.5 (1–25) years of professional experience. 93.8% (45/48) of the rheumatologists thought that all patients should be screened for HBV before immunosuppressive treatment and 6.2% thought that HBV screening should be performed only in high-risk patients. In patients with high-risk immunosuppressive therapy, such as Rituximab screening rate for HBV was %95,8 (46/48) but in patients with low risk such as less than 10 mg of prednisolone and their equivalent for more than 4 weeks screening rate was %35,4(17/48). When selecting an initial screening test; all of the rheumatologists (48/48) checked the HBsAg and %83,3 (40/48) would checked also HBcIgG and antiHBs. 44 (91.7%) rheumatologists stated that he or she had at least one patient with prophylaxis. Tenofovir (84.1%) was most commonly used drug in prophylaxis. 14 (29.2%) rheumatologists stated that HBVr was detected in at least one patient and 11of them stated that they had patients whose rheumatologic therapies were interrupted because of HBVr. TARTIŞMA VE SONUÇ: The results of our study show that the awareness of rheumatologists about HBV reactivation is relatively high but there is a need to further improvement.

INTRODUCTION: Current guidelines recommend the use of prophylactic nucleoside(t)ide analogs in the prevention of Hepatitis B virus(HBV) reactivation due to immunosuppressive(IS) treatments. There is no prospective randomized study evaluating the efficacy of tenofovir disoproxil fumarate(TDF) in this indication and the recommendations for its use are mainly based on the experiences in chronic HBV treatment. The aim of this study was to compare the efficacy of TDF and entecavir (ECV) in preventing HBV reactivation in patients receiving IS. METHODS: Between 2014 and 2017, patients who were documented as HBsAg and/or Anti-HBc IgG positive through the screening before IS treatment and prescribed prophylactic antiviral(AV) treatment indication according to the guidelines, were prospectively included in the study. Patients receiving medication for chronic HBV, with hepatitis C, D and HIV infection were excluded. Patients were randomized into two groups. TDF (245mg/day) was initiated by the first and ECV (0.5mg/day) was initiated by the second group before IS. AV treatments were continued for 6–18 months after the IS, according to the HBV reactivation risk profile. The patients were followed up in three-month intervals and the rate of HBV reactivation and side effects of the drugs were compared. RESULTS: The study included 120 patients (ECV:60, TDF:60 patients), mean age 58±12 years(23–85). There was no significant difference between the groups with respect to age and gender. HBsAg (ECV:51.7%, TDF:63.3%), Anti-HBcIgG (ECV:48.3%, TDF:36.7%), HBeAg (ECV:5%, TDF:3,3%), HBV DNA positivity (ECV:33.3%, TDF: 46.6%) and reactivation risk profiles (63.9% medium risk in both groups and 36.1% high risk) were similar. Whereas 41(68.3%) patients in the group EVC and 37(61.7%) patients in the group TDF completed their prophylactic AV treatments. Patients received immunosuppressive therapy for mean of 25.3 ± 17.4 (23.5 ± 16.3 in the ECV and 27.2 ± 18.4 in the TDF group) weeks. The duration of prophylactic AV treatment after IS treatment was 11.6 ± 2.8 months in the ECV and 11.2 ± 2.8 months in the TDF group (p = 0.47). The follow-up period after AV treatment was 12.8 ± 5.6 months in the ECV and 12.2 ± 4.4 months in the TDF group (p = 0.62). HBV reactivation was detected in neither of the groups during prophylactic treatment and after AV treatment was discontinued. In the group TDF, the treatment, during the fourth month, was discontinued due to severe itching and skin rashes in 1 patient. In the group ECV, 10 (16.7%) (mostly insomnia, headache and nausea in 2 patients), in the group TDF 14 (23.3%), (mostly insomnia in 4 patients, itching in 3 patients) drug-related side effects were observed in patients (p=0,31). DISCUSSION: ETC and TDF are effective drugs to prevent HBV reactivation in HBsAg and/or HBcIgG positive patients treated with IS, and there is no difference with respect to the risk of reactivation and side effects.

Primary biliary cirrhosis (PBC) is a chronic progressive cholestatic liver disease caused by diffuse inflammation, destruction and fibrosis of the intrahepatic bile ducts, ultimately leading to cirrhosis, portal hypertension and liver failure. The pathogenesis of PBC is incompletely understood, but current data suggest roles for genetic susceptibility and environmental factors. PBC is often thought of as an organ-specific autoimmune disease, which mainly targets the liver; however, lung tissue is also a site for autoimmune involvement of PBC. The pulmonary manifestations of PBC include abnormalities in gas transfer and pulmonary function, subclinical alveolitis, interstitial lung disease, granulomatous lung disease, airway disease, pulmonary hypertension, pulmonary hemorrhage and pleural effusion. (c) 2016 The Second Affiliated Hospital of Chongqing Medical University. Published by XIA & HE Publishing Inc. All rights reserved.

Cancer antigen 19-9 is a tumor marker present at high levels in the bileduct, colorectal, gastric, and hepatocellular cancer than esophagus orpancreas cancer. It is used to confirm the diagnosis of pancreas cancer,to assess the clinical response to the treatment, and to evaluate therecurrence of pancreatic cancer. High levels can also be seen in benignconditions, such as biliary tract obstruction, cholangitis, inflammatorybowel disease, acute or chronic pancreatitis, liver cirrhosis, cystic fibrosis,or thyroid diseases. Another rare condition which is associated withthe high level of cancer antigen 19-9 is the splenic cyst. Hence, weare submitting this case report of splenic cyst because of its rarenessand similarities to previously published cases with high levels of cancerantigen 19-9., CA 19-9 safra kanalı, kolon, mide, over, hepatosellüler, özofagus vepankreas kanserleri gibi malign durumlarda yüksek seviyelerde görülebilenbir tümör göstergesidir. Pankreas kanseri ayırıcı tanısı ve yinepankreas kanserinde tedaviye cevap ve nüksün değerlendirilmesindekullanılır. Yüksek seviyeler safra yolu obstrüksiyonu, kolanjit, inflamatuvarbarsak hastalığı, akut veya kronik pankreatit, karaciğer sirozu, kistikfibrozis ve tiroid hastalıkları gibi benign durumlarda da görülebilir. CA19- yüksekliği ile birlikte olan nadir bir durum da dalak kistleridir. Olgumuznadir olması ve CA 19-9‘un yayınlanılan benzer olgulardan yüksekseviyelerde olması sebebiyle sunulmuştur.

Kronik pankreatit ve pankreas kanseri benzer klinik ve laboratuar bulguları ile zaman zaman birbirinden ayrımı oldukça zor olabilen ikiayrı pankreas patolojisidir. Ultrasonografi (USG), Bilgisayarlı Tomografi (BT), Manyetik Rezonans Görüntümele (MRI) gibi klasik radyolojikyöntemlerin yetersiz kaldığı durumlarda Fuorodeoksiglukoz-Pozitron Emisyon Tomografisi (FDG-PET), Endoskopik Ultrasonografi (EUS)ve EUS eşliğinde İnce İğne Aspirasyon Biyopsisi ayırıcı tanıda yararlı olabilmektedir. Bu yazıda pankreas başında inflamasyona sekondergenişleme ile karakterize, pankreas kanseri ile karışan bir fokal pankreatit olgusunu sunmaktayız.( Sakarya Tıp Dergisi 2016, 6(4):235-239 ), Chronic pancreatitis and pancreatic cancer are two separate pancreatic pathology, which can be quite difficult at time to distinguishfrom each other, with similar clinical and laboratory findings. When conventional radiological methods such as Ultrasonography (USG),Computed Tomography (CT), Magnetic Resonance Imaging (MRI) are insufficent, fluorodeoxyglucose-positron emission tomography(FDG-PET), Endoscopic Ultrasonography (EUS) and EUS guided fine needle aspiration biopsy may be useful in the differential diagnosis.In this paper, we report a case, characterized by enlargement of the head of the pancreas secondary to inflammation, a focal pancreatitisinvolved with pancreatic cancer.( Sakarya Med J 2016, 6(4):235-239 ).

Upper esophageal strictures occur in approximately 3-4% of patients who receive radiotherapy for head and neck cancers. The standart initial treatment is dilation by using bougie or through-the-scope balloon dilators. Endoscopic treatment requires the passage of a guidewire through the stricture which cannot be accomplished in some of the patients with complex strictures. Retrograde dilation of esophageal strictures through a mature percutaneous gastrostomy tract have been reported in a limited number of cases and small case series up to date and can be considered as a rescue treatment before considering surgery in such patients. Herein we report retrograde dilatation of a radiation-induced complex esophageal stricture through the percutaneous gastrostomy tract in a patient with operated larynx cancer.

Background/aim: In this study we aimed to investigate the short-term effect of Helicobacter pylori eradication on symptoms in patients with non-ulcer dyspepsia. Materials and methods: The study group included 63 H. pylori-positive patients (47 female, 16 male, mean age: 42±11 years) with non-ulcer dyspepsia. The diagnosis of non-ulcer dyspepsia was based on exclusion of other etiologies by blood tests, upper gastrointestinal endoscopy, abdominal ultrasonography, and Rome II criteria. Before starting eradication treatment, patients completed a form for symptom scoring in which the severity of 10 symptoms was scored from 0 to 3. Patients received omeprazole (2X20mg), amoxicillin (2x1000mg) and clarithromycin (2x500mg) triple eradication therapy for 10 days. The success of eradication was assessed with either endoscopic biopsy or 13Curea breath test at least 30 days after the treatment. The symptom scores of patients in whom Helicobacter pylori was eradicated or remained positive were compared before and after the treatment. Results: Among the 63 patients enrolled into the study, Helicobacter pylori was eradicated in 49 patients (77.8%) and remained positive in 14. In patients with successful eradication treatment, the mean total symptom score decreased significantly after the treatment (5.3±4.6) compared to pre-treatment levels (7.8±4.9). In patients who failed treatment, we also observed a significant decrease in the mean total symptom score after the treatment (5.5±3.7) compared to pre-treatment levels (9.5±5.1). There was no significant difference between the decreases in the mean total symptom score of patients in whom Helicobacter pylori was eradicated (2.4±3.5) and those in whom it remained positive (4±3.5). When groups were compared, we observed that there was no significant difference between the mean total symptom scores of groups before and after the treatment. Conclusion: We think that the significant decrease in the symptom scores of patients with non-ulcer dyspepsia after the eradication treatment is due to the treatment and/or placebo effect and that eradication of Helicobacter pylori contributes no further., Giriş ve amaç: Bu çalışmada Helikobakter pilori eradikasyonunun nonülser dispepsili hastalarda semptomlar üzerine kısa dönemdeki etkisini araştırmayı amaçladık. Gereç ve yöntem: Çalışmaya Helikobakter pilori pozitif non-ülser dispepsili 63 hasta (47 kadın, 16 erkek, ortalama yaş: 42±11 yıl) alındı. Non-ülser dispepsi tanısı kan tetkikleri, üst gastrointestinal sistem endoskopisi, abdomen ultrasonografi ve Roma II kriterleri ile diğer nedenlerin ekarte edilmesi ile konuldu. Hastalar eradikasyon tedavisine başlamadan önce 10 semptomun şiddetinin 0-3 puan üzerinden skorlandığı bir semptom skor skalası formu doldurdular. Eradikasyon için 10 günlük omeprazol (2x20mg), amoksisilin (2x1000mg) ve klaritromisin (2x500mg) üçlü tedavisi verildi. Eradikasyon tedavisinin başarısı ilaçların bitiminden en az 30 gün sonra biyopsi veya 13C üre solunum testi ile değerlendirildi. Helikobakter pilori negatifleşen ve pozitif kalan grupların tedavi öncesi ve sonrası semptom skorları karşılaştırıldı. Bulgular: Çalışmaya alınan 63 hastanın 49'unda Helikobakter pilori eradike edilirken (%77,8) 14'ünde pozitif kaldı. Tedavinin başarılı olduğu hastalarda tedavi sonrası ortalama toplam semptom skoru (5,3±4,6) tedavi öncesine göre (7,8±4,9) anlamlı ölçüde azaldı. Tedavinin başarısız olduğu hastalarda da tedavi sonrası ortalama toplam semptom skorunda (5,5±3,7) tedavi öncesine göre (9,5±5,1) anlamlı azalma görüldü. Helikobakter pilorinin eradike edildiği gruptaki ortalama toplam semptom skorundaki azalma (2,4±3,5) ile pozitif kaldığı gruptaki azalma (4±3,5) arasında anlamlı fark bulunmadı. Gruplar kendi aralarında karşılaştırıldığında tedavi öncesi ve sonrası dönemdeki ortalama toplam semptom skorları arasında anlamlı fark olmadığı görüldü. Sonuç: Nonülser dispepsili hastalarda eradikasyon tedavisi ile semptom skorunda kısa dönemde anlamlı ölçülerde azalma görülmesinin tedavinin kendisine ve/veya plasebo etkisine bağlı olduğu, Helikobakter pilori'nin eradike edilmesinin ek katkı sağlamadığı düşünülmüştür.

Background/aim: There is no consensus regarding the application of conscious sedation in endoscopic procedures. In this prospective study we aimed to determine the necessity of applying sedation in diagnostic endoscopic ultrasonography. Materials and methods: Eighty patients who underwent endoscopic ultrasonography in Türkiye Yüksek İhtisas Hospital Gastroenterology Clinic were included in the study. Patients were separated into three groups depending on the region examined: esophagus (11 patients), stomach-duodenum (16 patients), and pancreasbiliary system (49 patients). Groups were randomized to receive either midazolam (42 patients) or placebo (34 patients) in a double-blind fashion. Midazolam and isotonic saline were administered intravenously at doses of 0.07 mg/kg and 0.07 ml/kg, respectively. The education period, previous endoscopy history, anxiety score, basal pulse and oxygen saturation, sedation score, and difficulty of procedure were determined separately by endoscopist. The patient, cooperation of the patient, willingness to undergo the same procedure again, pain level, intubation time, total procedure time, and the changes in the oxygenation and cardiac rhythm were compared. Results: The mean anxiety score, education period, basal pulse and oxygen saturation, and the ratio of a previous endoscopy history of the patients receiving midazolam and placebo were similar in all three groups. Sedation score was higher in patients receiving midazolam compared to those receiving isotonic saline, and the difference was statistically significant in the third group (p=0.03). Difficulty of the procedure, cooperation of the patient and willingness of the patient to undergo the same procedure again were in favor of midazolam in all three groups. Hypoxia and the need for oxygen were significantly higher in the third group of patients receiving midazolam (p=0.04). There was no significant difference between the pain level, intubation time, and total procedure time of the groups. Conclusion: Based on the insignificant differences between the patients receiving placebo and midazolam, we think that endosonography of the esophagus, stomach, and pancreas- biliary system can be performed without sedation., Giriş ve amaç: Endoskopik işlemlerde bilinçli sedasyon uygulanması konusunda henüz bir görüş birliğine varılamamıştır. Bu prospektif çalışmada tanısal endoskopik ultrasonografi yapılan hastalarda sedasyon gereksinimini belirlemeyi amaçladık. Gereç ve yöntem: Çalışmaya Türkiye Yüksek İhtisas Hastanesi Gastroenteroloji Kliniği'nde tanısal endoskopik ultrasonografi yapılan 80 hasta alındı. Hastalar incelenen bölgelere göre özofagus (11 hasta), mide-duodenum (16 hasta) ve pankreatobiliyer sistem (49 hasta) olmak üzere üç gruba ayrıldı. Gruplar midazolam (42 hasta) veya plasebo (34 hasta) almak üzere çift kör randomize edildiler. Midazolam ve serum fizyolojik intravenöz yoldan 0.07mg/kg ve 0.07 ml/kg dozlarında verildi. Hastaların eğitim süreleri, daha önce endoskopi yaptırıp yaptırmadıkları, anksiyete skoru, nabız ve oksijen satürasyonu, sedasyon skoru, hasta ve endoskopist tarafından belirlenen işlem zorluğu, hasta kooperasyonu, işlemi tekrar yaptırma eğilimi, ağrı düzeyi, endoskopu yutma ve toplam işlem süresi ile oksijenasyon ve kalp ritmindeki değişiklikleri karşılaştırıldı. Bulgular: Her üç grupta plasebo ve midazolam alan hastaların ortalama anksiyete skorları, eğitim süreleri, bazal nabız ve oksijen satürasyonları ile önceden endoskopi yaptırma oranları benzerdi. Sedasyon skoru midazolam alan hastalarda plasebo grubuna göre daha yüksek olup aradaki fark üçüncü grupta istatistiksel anlamlılık boyutuna ulaşıyordu (p=0.03). İşlem zorluğu, hasta kooperasyonu ve hastanın işlemi tekrar yaptırma eğilimi her üç grupta da midazolam lehine idi. Hipoksi ve oksijen ihtiyacı üçüncü grupta midazolam verilen hastalarda istatistiksel olarak anlamlı düzeyde daha fazla idi (p=0.04). Grupları n ağrı düzeyi, endoskopu yutma ve toplam işlem süreleri arasında anlamlı farklılık bulunmadı. Sonuç: Plasebo ve midazolam alan hastalar arasındaki farklılıkların anlamlı olmamasına dayanarak özofagus, mide ve pankreas-biliyer sistem için yapılan endosonografi işlemlerinin sedasyon uygulanmadan da gerçekleştirilebileceğini düşünmekteyiz.

Background and Aim: Dyspepsia is a common compliant among people in the general population as well as individuals attending to health care centers. This study was conducted to determine the frequency and epidemiologic features of dyspepsia in patients admitting to primary care centers in Turkey. Material and Method: The study was carried out by applying questionnaire in a population of 7520 patients who were randomly selected among those admitted to primary care centers in 32 different cities of Turkey. The questionnaire was applied by doctors working in the primary care centers. Patients were categorized into two groups (gastrointestinal system or not) depending on the main symptoms on admission. The prevalence of dyspepsia was investigated by applying questionnaire to a total of 2203 randomly selected patients from both of the groups. The diagnosis of dyspepsia was based on the Rome-II criteria. Results: Among the 7520 patients participating in the study, 2157 (31.5%) were admitted with gastrointestinal system symptoms and 5363 (41%) with non-gastrointestinal system symptoms. Out of 2157 patients with gastrointestinal system symptoms, questionnaire was performed in randomly selected 1461 patients and a diagnosis of dyspepsia was reached in 760 (52%). Out of 5363 patients with nongastrointestinal system symptoms, questionnaire was performed in randomly selected 742 patients and a diagnosis of dyspepsia was reached in 210 (28.3%). The prevalence of dyspepsia was 44% in the whole group. Most of the patients were female (68.1%) and the mean age was 45?14 years. The most frequent symptoms were bloating (75.7%), fullness (61.2%), epigastric discomfort (57%), epigastric pain (50%), nausea (34.8%), early satiety (26.5%) and vomitting (13.2%). Symptoms were precipitated by meals in 27.7% of the patients. Spices was the leading food precipitating symptoms. There was a statistically significant relationship between dyspepsia and smoking (p=0.001) and tea consumption (p=0.0001). Six percent of the patients had a family history of gastric cancer. Antiacids were the most common (56.7%) medications used for treatment. Conclusion: Dyspeptic patients constitute a considerable part of patients admitting to primary health care centers in Turkey. The most frequent symptoms are bloating and fullness., Giriş ve Amaç: Dispepsi toplumda ve sağlık kuruluşlarına başvuran hastalarda sık rastlanan bir şikâyettir. Bu çalışma Türkiye'de birinci basamak sağlık kuruluşlarına başvuran hastalarda dispepsi sıklığını saptamak ve epidemiyolojik özelliklerini belirlemek için yapılmıştır. Gereç ve Yöntem: Çalışma Türkiye'nin 32 farklı ilindeki birinci basamak sağlık kuruluşuna başvuran olgular arasından rasgele seçilen 7520 olguda anket yapılarak gerçekleştirilmiştir. Anket birinci basamakta çalışan hekimler tarafından yapılmıştır. Hastalar başvurudaki ana yakınmalarına göre gastrointestinal sistem ve gastrointestinal sistem dışı olmak üzere iki guruba ayrıldıktan sonra, her iki gurup içinden rasgele seçilen 2203 olguya anket yapılarak birinci basamaktaki dispepsi prevalansı araştırılmıştır. Dispepsi tanısı Roma-II kriterlerine göre konulmuştur. Bulgular: Çalışmaya katılan 7520 hastanın 2157'si (%31,5) GİS semptomları ile doktora başvururken, 5363'ü (%68,5) Gastrointestinal Sistem dışı yakınmalar ile doktora başvurmuştur. Gastrointestinal Sistem yakınmaları ile başvuran 2157 hasta arasından rasgele seçilerek anket yapılan 1461 olgunun 760'ında (%52), Gastrointestinal Sistem dışı yakınmalar ile başvuran 5363 olgu arasından rasgele anket yapılan 742 olgunun 210'unda (%28,3) dispepsi tanısı konulmuştur. Dispepsi prevalansı %44 olarak bulunmuştur. Hastaların çoğu kadın olup ( %68,1), yaş ortalaması 45±14 yıldır. En sık semptomlar şişkinlik (%75,7), midede dolgunluk (%61,2), midede rahatsızlık hissi (%57), mide ağrısı (%50), bulantı (%34,8), erken doyma (%26,5) ve kusmadır (%13,2). Hastaların %27,7'si yakınmaların yemek ile arttığını bildirmişlerdir. Baharat şikâyetleri artıran yiyeceklerin başında gelmektedir. Çay (p=0.0001) ve sigara içme (p=0.001) ile dispepsi arasında istatistiksel olarak anlamlı bir ilişki bulunmuştur. Hastaların %6'sında ailede mide kanseri hikâyesi tespit edilmiştir. Tedavi için en sık (%56,7) antiasitlerin kullanılmakta olduğu görülmüştür. Sonuç: Türkiye'de birinci basamak sağlık kuruluşuna başvuran hastaların önemli bir bölümünü dispepsi hastaları oluşturmaktadır. En önemli semptomlar ise şişkinlik ve dolgunluktur.

Background/aim: The present study was done in order to determine the frequency of irritable bowel syndrome (IBS) in primary care centers of Turkey. Materials and methods: The study was carried out by applying questionnaire in a study population of 7520 patients who were randomly selected among those admitted to primary care centers in 32 different cities of Turkey in the year 2005. The questionnaire was applied by doctors working in the primary care centers. Patients were categorized in to two groups (gastrointestinal system (GIS) or non-GIS) depending on the main symptoms on admission. The prevalence of IBS in primary care centers was investigated by applying questionnaire to 2203 randomly selected patients from both of the groups. The diagnosis of IBS was based on the Rome- II criteria. Results: Among the 7520 patients participating in the study, 2157 (31.5%) were admitted with GIS symptoms and 5363 (41%) with non-GIS symptoms. Out of 2157 patients with GIS symptoms, questionnaire was performed in randomly selected 1461 patients and a diagnosis of İBS was reached in 598 (41%). Out of 5363 patients with non-GIS symptoms, questionnaire was performed in randomly selected 742 patients and a diagnosis of İBS was reached in 141 (19%). Conclusion: This study shows that functional GIS disorders are commonly seen in our country and the patients frequently admit to doctors in the primary care centers because of the persistence of their symptoms, Giriş ve amaç: Bu çalışma Türkiye'de birinci basamak sağlık kurumları nda irritabl barsak sendromu (İBS) sıklığını saptamak için yapılmıştır. Gereç ve yöntem: Çalışma 2005 yılında Türkiye'nin 32 farklı ilindeki birinci basamak sağlık kuruluşuna başvuran olgular arasından rastgele seçilen 7520 olguda anket yapılarak gerçekleştirilmiştir. Anket birinci basamakta çalışan hekimler tarafından yapılmıştır. Hastalar başvurudaki ana yakınmalarına göre gastrointestinal sistem (GİS) ve GİS dışı olmak üzere iki guruba ayrıldıktan sonra, her iki gurup içinden rastgele seçilen 2203 olguya anket yapılarak birinci basamakta İBS prevalansı araştırılmı ştır. İBS tanısı Roma-II kriterlerine göre konulmuştur. Bulgular: Çalı şmaya katılan 7520 hastanın 2157'si (%31,5) GİS semptomları ile doktora başvururken, 5363'ü (%68,5) GİS dışı yakınmalar ile doktora başvurmuştur. GİS yakınmaları ile başvuran 2157 hasta arasından rastgele seçilerek anket yapılan 1461 olgunun 598'inde (%41), GİS dışı yakınmalar ile başvuran 5363 olgu arasından rastgele anket yapılan 742 olgunun 141'inde (%19) İBS tanısı konulmuştur. Sonuç: Bu çalışma ülkemizde fonksiyonel gastrointestinal hastalıkların sık görüldüğünü ve hastaları n yakınmalarının devamı nedeni ile birinci basamak hekimlerine sık başvurduklarını ortaya koymaktadır.

Background and Aims: Gastroesophageal reflux disease is a common gastrointestinal disorder and its prevalence differs depending on the population studied. There are few data on the epidemiology of gastroesophageal reflux disease in Turkey. The aim of the study was to determine the frequency and epidemiologic features of gastroesophageal reflux disease in patients admitting to primary health care centers in Turkey. Materials and Methods: The study was carried out in a population of 7520 patients randomly selected among those admitted to primary health care centers in 32 different cities in Turkey. Patients were categorized into two groups [gastrointestinal system or non- gastrointestinal system] depending on the main symptoms on admission. The prevalence and epidemiologic features of gastroesophageal reflux disease were investigated via face-to-face questionnaire to a total of 2203 randomly selected patients from both of the groups. The diagnosis of gastroesophageal reflux disease was based on the Rome-II criteria. Results: Among the 7520 patients participating in the study, 2157 (31.5%) were admitted with gastrointestinal system symptoms and 5363 (41%) with non- gastrointestinal system symptoms. Of the 2157 patients with gastrointestinal system symptoms, the questionnaire was administered in a randomly selected 1461 patients and a diagnosis of gastroesophageal reflux disease was reached in 560 (38.3%). Of the 5363 patients with non- gastrointestinal system symptoms, a questionnaire was administered in a randomly selected 742 patients and a diagnosis of dyspepsia was reached in 189 (25.4%). The prevalence of dyspepsia was 33.9% in the whole group. Most of the patients were female (69.3%) and the mean age was 44 ± 14 years. Heartburn (60.1%), regurgitation (59.1%), retrosternal pain (35.5%) and cough (27.6%) were the most frequent symptoms. Sixteen percent of the patients experienced heartburn once a month, 30% once a week, 39.5% more than once a week, and 13.9% daily. There were no significant associations between gastroesophageal reflux disease and marital status, smoking, or tea, alcohol and coffee consumption. Economic status (p, Giriş ve Amaç: Gastroözofageal reflü hastalığı, gastrointestinal sistemin sık görülen hastalıklarından birisi olup, prevalansı çalışmanın yapıldığı topluma göre değişmektedir. Türkiye'de gastroözofageal reflü hastalığı epidemiyolojisi hakkında sınırlı bilgi vardır. Bu çalışma da Türkiye'de birinci basamak sağlık kuruluşlarına başvuran hastalarda gastroözofageal reflü hastalığı sıklığını saptamak ve epidemiyolojik özelliklerini belirlemek amaçlanmıştır. Gereç ve Yöntem: Çalışma Türkiye'nin 32 farklı ilindeki birinci basamak sağlık kuruluşlarına başvuran olgular arasından rasgele seçilen 7520 olguda gerçekleştirilmiştir. Hastalar başvurudaki ana yakınmalarına göre gastrointestinal sistem ve gastrointestinal sistem dışı semptomlarla başvuranlar olmak üzere iki guruba ayrıldıktan sonra, her iki gurup içinden rastgele seçilen 2203 olguya yüz yüze görüşülerek anket yapılmış ve gastroözofageal reflü hastalığı prevalansı ve epidemiyolojik özellikleri araştırılmıştır. Gastroözofageal reflü hastalığı tanısı Roma-II kriterlerine göre konulmuştur. Bulgular: Çalışmaya katılan 7520 hastanın 2157'si (%31.5) gastrointestinal sistem semptomları ile doktora başvururken, 5363'ü (%68.5) gastrointestinal sistem dışı yakınmalar ile başvurmuştur. Gastrointestinal sistem yakınmaları ile başvuran 2157 hasta arasından rasgele anket yapılan 1461 olgunun 560'ında (%38.3), gastrointestinal sistem dışı yakınmalar ile başvuran 5363 olgu arasından rasgele anket yapılan 742 olgunun 189'unda (%25.4) gastroözofageal reflü hastalığı tanısı konulmuştur. Gastroözofageal reflü hastalı ğı prevalansı %33.9 olarak bulunmuştur. Hastaların çoğunluğu kadın olup (%69.3), yaş ortalaması 44±14 yıldır. Retrosternal yanma (%60.1), regürjitasyon (%59.1), retrosternal ağrı (%35.5) ve öksürük (%27.6) en sık görülen yakınmalardır. Hastaların %16.6'sı retrosternal yanmayı ayda bir, %30'u haftada bir, %39.5'i haftada birden fazla, %13.9'u her gün yaşadığını ifade etmektedir. Medeni durum, çay, sigara, kahve ve alkol kullanımı ile gastroözofageal reflü hastalığı arasında istatistiksel anlamlı bir ilişki bulunmamıştır. Ekonomik durum (p < 0,01) ve eğitim düzeyi (p < 0,01) ile gastroözofageal reflü hastalığı arasında anlamlı pozitif bir korelasyon vardır. Sonuç: Sonuç olarak, ülkemizde gastroözofageal reflü hastalığı batılı ülkelerde rastlanan sıklığa yakın oranlarda görülmekte olup retrosternal yanma ve regürjitasyon başvuruda en sık rastlanan şikayetler olarak ortaya çıkmaktadır.

Background/aim: Hypobetalipoproteinemia (HBL) is a congenital lipid metabolism disorder. The prognosis and treatment of fatty liver in this disease are not clearly known. Herein we report a prospective pilot study we conducted in order to determine the efficacy of ursodeoxycholic acid treatment in patients with non-alcoholic steatohepatitis (NASH) due to familial HBL (FHBL). Materials and methods: The study included three patients with NASH due to FHBL. The diagnosis of NASH was based on abnormal serum transaminases for more than six months; a liver biopsy showing the presence of steatosis, ballooning degeneration, and necroinflammation with or without Mallory bodies, fibrosis, or cirrhosis; and appropriate exclusion of other liver diseases. The diagnosis of FHBL was based on < 5th percentile plasma levels of total cholesterol or LDL cholesterol, or total apolipoprotein B (apoB), demonstration of low levels of LDL or apoB in one of the first-degree relatives, and exclusion of secondary causes. Patients received ursodeoxycholic acid (15mg/kg/day) for 12 months. Serum transaminases were followed every three months. Results: The study group included one female (44 years old) and two male (22 and 38 years old) patients. All patients were asymptomatic. Liver biopsy revealed mild inflammation and fibrosis in all patients. None of the patients had ALT normalization at the end of one year of treatment with ursodeoxycholic acid. Conclusion: Ursodeoxycholic acid is not an effective drug in the treatment of NASH due to FHBL., Giriş ve amaç: Hipobetalipoproteinemi (HBL) kalıtsal bir lipid metabolizma hastalığı olup bu hastalarda görülebilen karaciğer yağlanmasının prognoz ve tedavisi henüz net olarak bilinmemektedir. Bu çalışmada ailevi hipobetalipoproteinemiye bağlı non-alkolik steatohepatitli (NASH) hastalarda ursodeoksikolik asit tedavisinin etkinliğini araştırılması amacı ile prospektif pilot bir çalışma yürütülmüştür. Gereç ve yöntem: Çalı şmaya ailevi hipobetalipoproteinemiye bağlı NASH tanısı konulan 3 hasta alındı. NASH tanısı 6 aydan uzun süredir serum transaminazlarında yükselme, karaciğer biyopsisinde steatoz, balon dejenerasyon ve nekroinflamasyona eşlik edebilen Mallory cisimcikleri, fibrozis veya siroz varlığı ve diğer karaciğer hastalıklarının ekarte edilmesi ile konuldu. Ailevi hipobetalipoproteinemi tanısı hastanın total kolesterol veya LDL veya total apolipoprotein B (apoB) düzeylerinin 5 persentilin altına inmesi, birinci dereceden yakınlarından birinde LDL veya apoB düşüklüğünün gösterilmesi ve sekonder nedenlerin ekarte edilmesi ile konuldu. Hastalara 12 ay süre ile 15mg/kg/gün dozunda ursodeoksikolik asit tedavisi verildi. Üç ayda bir serum transaminaz düzeyleri takip edildi. Bulgular: Çalışmaya alınan 3 hastanın 2'si 23 ve 38 yaşlarında erkek, 1'i 44 yaşında kadındı. Hepsi asemptomatikti. Karaciğer biyopsisinde tüm hastalarda hafif düzeyde inflamasyon ve fibrozis mevcuttu. Hastaları n hiçbirinde bir yıllık ursodeoksikolik asit tedavisi sonunda serum ALT değerlerinde normalleşme görülmedi. Sonuç: Ursodeoksikolik asit ailevi hipobetalipoproteinemiye bağlı NASH'ın tedavisinde etkin bir tedavi değildir.