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Giriş ve Amaç: Kronik böbrek yetmezliği olan hastalarda üst gastrointestinal sistem bulguları oldukça sık görülmektedir. Bu çalışmada kronik böbrek yetmezliği olan hastalarda üst gastrointestinal sisteme ait endoskopik ve histolojik bulgularının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Hastanemizde Ocak 2013 ile Aralık 2018 tarihleri arasında kronik böbrek yetmezliği tanısı ile takip edilen ve herhangi bir nedenle endoskopi yapılan hastaların sonuçları retrospektif olarak değerlendirildi. Hastalar hemodiyalize alınanlar, sürekli ayaktan periton diyalizi yapılanlar ve diyalize girmeyenler olarak gruplandırıldı. Bulgular: Çalışmaya toplam 493 hasta dahil edildi (yaş ortalaması 57.02±16.3, %64.1 erkek). Hastaların 270’i hemodiyaliz, 34’ü sürekli ayaktan periton diyalizi ve 189 tanesi ise diyalize girmeyen gruptaydı. Hastaların %83’ünde anormal endoskopik bulgu saptandı. Gruplar arasında anormal endoskopik bulgu saptanma oranı benzerdi (hemodiyaliz; %83.7, periton diyalizi; %73.5, diyalize girmeyenler; %83.6, p:0.317). Her üç hasta grubunda en sık görülen endoskopik bulgu gastrit idi (%67.7). Histolojik değerlendirme yapılan 320 hastanın %24’ünde Helicobacter pylori pozitifliği, %26.6’sında intestinal metaplazi ve %0.9’unda mide kanseri tespit edildi. Sonuç: Kronik böbrek yetmezliği tanılı hastaların büyük çoğunluğunda üst gastrointestinal sisteme ait patolojiler görülmektedir. Bu hastalarda premalign gastrik lezyonlar sık görüldüğü için özellikle böbrek nakli planlanan hastalarda endoskopik değerlendirme kabul edilebilir bir prosedürdür.

Background/aims The aim of this study was to assess the clinical and sociodemographic risk factors of Helicobacter pylori infection and antibiotic resistance in the eastern Black Sea region of Turkey. Materials and methods In total, 344 patients with dyspeptic symptoms who completed an extended questionnaire were enrolled in the study. Diagnosis of H. pylori infection was made by rapid urease test, histopathological investigation, and culture. Susceptibility of H. pylori strains was assessed by agar dilution (amoxicillin, tetracycline, metronidazole, levofloxacin) and E-test (clarithromycin) methods. Results The H. pylori positivity rate was 40.4% (139/344). Logistic regression analysis indicated that age and the presence of duodenal ulcer were independent risk factors associated with H. pylori positivity (odds ratio (OR): 0.96, 95% CI: 0.93-0.99, p=0.013; OR: 5.42, 95% CI: 1.96-14.98, p=0.001, respectively). Of 104 H. pylori-positive cultures, 43 strains (41%) were susceptible to all antibiotics, whereas 61 (59%) were resistant to at least one antibiotic. H. pylori resistance rates were 34% for levofloxacin, 31.1% for metronidazole, 28.2% for clarithromycin, 2.9% for amoxicillin, and 1% for tetracycline. Logistic regression analysis indicated that previous use of clarithromycin was the only independent risk factor for H. pylori resistance (OR: 6.25, 95% CI: 1.59-24.52, p=0.009). Conclusion An understanding of the risk factors for H. pylori positivity and antibiotic resistance in an extended anamnesis may affect treatment choice and facilitate H. pylori eradication. In regions where antibiotic resistance rates are elevated, performing antibiotic susceptibility tests may lead to effective eradication treatment.

Introduction Adenomatous polyps in the gastrointestinal system rarely occur in childhood and are accompanied by syndromes such as Familial adenomatous polyposis, attenuated familial adenomatous polyposis, and MUTYH-associated polyposis, Gardner and Turcot syndrome, and also mismatch repair (MMR) gene defects. In this article, we want to present a rare patient who had adenomatous polyposis and in situ carcinoma and was detected biallelic MMR gene defect. Case A 16-year-old female patient admitted with painless rectal bleeding, chronic abdominal pain, and anorexia for 1 year. Her physical examination was notable for multiple cafe au lait spots. The colonoscopic and histopathologic examination revealed multiple adenomatous polyps that one of them contains low-high grade dysplasia and in situ carsinoma. Genetic analysis revealed a homozygous mutation in the PMS2 gene [c.1164delT (p.H388Qfs*10) (p.His388GInfsTer10)] and she was diagnosed with constitutional MMR gene defect syndrome. Polypectomy was performed 4 times in 2 years period. Then, the patient's last colonoscopic examination revealed a large broad polyp in the rectum and multiple polyps in the other colon segments, and she underwent colectomy because of high risk of colorectal cancer. Conclusions Adenomatous polyps are very important in childhood because of rarity. In particular, the presence of cafe au lait spots and a history of malignancy detected in relatives at an early age must be considered for CMMRD.

Aim: Coagulation disorders may develop in association with severe acute pancreatitis (AP). Plasma thrombin-antithrombin III complex (TAT) levels are one of the principal markers of coagulation disorder. The purpose of this study was to evaluate TAT and other hemostatic parameters in patients with AP and to examine whether or not these parameters indicate the severity of AP. Method: Forty-six patients with AP (14 severe, 32 non-severe) and a 30-member healthy control group were recruited. The severity of AP was determined using the revised Atlanta classification. ELISA was used to measure patients’ plasma TAT levels. Results: The TAT levels of AP patients at presentation were higher than those of the control group (p = 0.005). The plasma TAT levels of patients with severe AP were also significantly higher than those of patients with non-severe AP (p = 0.05) and of the control group (p < 0.001). The general accuracy, sensitivity and specificity of TAT levels in predicting the severity of AP were 77.4, 77.8, and 77.3% respectively. Conclusion: The coagulation cascade was activated in the AP patients in our study, and this was shown to become more pronounced as severity of the disease increased. Plasma TAT levels at the time of presentation in patients with AP can be used as a marker for predicting the severity of the disease.

Background: Reactivation of the hepatitis B virus (HBV) either during or after chemotherapy may cause serious and sometimes fatal hepatitis. All patients undergoing chemotherapy should therefore be screened in terms of HBV before chemotherapy. The purpose of this research was to identify HBV screening rates in patients with solid cancer undergoing parenteral chemotherapy and to determine the outcomes of patients undergoing HBV screening. Methods: Data for patients undergoing parenteral chemotherapy for solid cancer from January 1, 2012 to December 30, 2018 were retrieved from our electronic health record patient files in this retrospective study. Screening was defined as hepatitis B surface antigen (HBsAg) and/or hepatitis B core antibody (HBcAb) tests carried out within six months prior the first chemotherapy session. Results: Four thousand fifty-eight (63%) of the 6440 patients who underwent parenteral chemotherapy were screened for HBsAg and/or HBcAb. The proportions of patients screened for HBsAg and HBcAb improved from 38.8% (2012) to 76.3% (2018), and from 0.2% (2012) to 43% (2018), respectively (PConclusion: Although HBV screening rates before chemotherapy are increasing among solid cancer patients, the rate of initiation of antiviral prophylaxis is still low. It is therefore important to raise awareness regarding HBV reactivation during/after chemotherapy.

Objective: To investigate the frequency of sarcopenia in cirrhotic patients, the correlation of sarcopenia with conventional prognostic scores and its relationship with mortality by measuring the psoas muscle area at the level of mid-3rd lumbar (L3) vertebra on computed tomography (CT) scan. Materials and Methods: We included 229 cirrhotic patients who had undergone abdominal CT scan for hepatocellular carcinoma screening. A control group was formed in 204 healthy individuals who had undergone abdominal computed tomography examination due to trauma. 1- and 3-year follow-up results were recorded. Cross-sectional areas of the right and left psoas muscles were calculated in axial sections passing through the level of the mid-L3 in CT images. The cases with two standard deviations under the mean of the total psoas muscle area in control group were evaluated as sarcopenic. Results: Sarcopenia was detected in 39.7% of 229 cirrhotic patients. While a statistically significant difference was detected in the Child-Pugh prognostic score between cirrhotic patients with and without sarcopenia, there was a modest difference in the MELD score. The percentage of cirrhotic patients with sarcopenia who passed during 1- and 3- year follow-ups (28.6% and 40.7%, respectively) were significantly higher than non-sarcopenic patients (9.4% and 24.6%, respectively). Conclusion: The findings obtained in this study suggest that psoas muscle atrophy shown by CT scan image at the level of the mid-L3 vertebra has predictive value for mortality in cirrhotic patients.

Polysplenia syndrome is a rare congenital anomaly frequently associated with various visceral anomalies. The most frequent manifestations of this syndrome, in addition to polysplenia are malrotation, congenital heart diseases and gastrointestinal, genitourinary and vascular abnormalities. In this report, we present an adult case of ascites due to prehepatic portal hypertension associated with portal cavernous transformation. The patient had a left-sided liver, right-sided multiple splenules and stomach, interrupted inferior vena cava with azygos continuation and extensive ascites. The portal vein was not observed and collateral vascular structures of cavernous transformation were identified in the hepatic hilus. Portal cavernous transformation with various congenital abnormalities has been reported in the literature; however, there are no cases of polysplenia syndrome presenting with ascites associated with portal cavernous transformation.