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Aim: The main purpose of this study was to investigate the frequency of gastrointestinal parasites in patients with upper gastrointestinal system (GIS) complaints. The secondary aim was to evaluate the effect of proton pump inhibitors (PPI) on gastrointestinal parasite frequency and histopathological findings. Materials and Methods: Adult patients who underwent endoscopy for upper GIS symptoms were included in the study. Biopsy specimen for histopathological evaluation, gastric and duodenal aspiration fluid, and stool specimen for parasitological evaluation were also obtained from the patients. Results: A total of 40 patients (29 female and 11 male) were included in the study. The mean age of women was 54 ± 14.6 and men was 38.4 ± 18.7 years (p = 0.008). The patients were divided into two groups as not using PPI [14 patients (35%)] and using PPI [26 patients (65%)]. Parasites were detected in 3 patients (7.5%). Two of them were from the group using PPI, and one from the group not using PPI (p = 0.95). It was also observed that the effect of PPI on histopathological findings was not statistically significant. Helicobacter pylori positivity was associated with inflammation (p = 0.002) and intestinal metaplasia (p < 0.001). Conclusion: It was determined that dyspeptic complaints were more common in women. The effect of PPI on histopathological findings or the frequency of parasites were not statistically significant. Inflammation and intestinal metaplasia were found to be statistically higher in Helicobacter pylori positive cases than negatives.

Amaç: Bu çalışmada mide kanserinin (MK) epidemiyolojik ve genel sağkalım (GSK) özelliklerinin araştırılması amaçlanmıştır. Gereç Yöntem: Ege Üniversitesi Kanserle Savaş Uygulama ve Araştırma Merkezine (EÜKAM) 1992- 2017 yıllarında kayıtlı Ege Üniversitesi Tıp Fakültesi Hastanesi kanser verileri retrospektif olarak taranmıştır. CAN-REG-4 bilgisayar programına kayıtlı veriler, Dünya Sağlık Örgütü ve Surveillance, Epidemiology, and End Results sistemlerinde gruplanarak analizler yapılmıştır. İstatistik analizlerde ki- kare, General Linear Model (GLM), Kaplan Meier sağkalım analizleri uygulanmıştır. Etik kurul onayı alınmıştır. Bulgular: EÜKAM veri tabanına kayıtlı toplam 117.139 kanserden 4.212’si (%3,6) MK’dir. Gastrointestinal sistem kanserler içinde kolorektal kanserlerden sonra ikinci sıklıkta MK (%21,6) yer almıştır. Olguların 2.692’si (%63,9) erkek, 1.520’si (%36,1) kadındır, arasındaki fark istatistiksel olarak anlamlıdır (p

Amaç: Bu çalışmada özofagus kanserlerinin (ÖK) epidemiyolojik ve genel sağkalım (GSK) özelliklerininaraştırılması amaçlanmıştır.Gereç Yöntem: Ege Üniversitesi Kanserle Savaş Uygulama ve Araştırma Merkezinin 1992-2017 yıllarıarasındaki verileri retrospektif olarak taranmıştır. CANREG-4 bilgisayar programına kayıtlı kanser verileri,Dünya Sağlık Örgütü ve Surveillance, Epidemiology, and End Results sisteminde gruplanmış veanalizleri yapılmıştır. İstatistik analizlerde ki-kare testi, General Linear Model ve Kaplan Meier sağkalımanalizleri uygulanmıştır.Bulgular: Toplam 117.139 kanserden 19.542’u gastrointestinal sistem (GİS) kanserleridir. GİSkanserlerinin 1.009’u (%5,2) ÖK olup, GİS kanserleri içinde 6. sıklıktadır. ÖK’de 25 yılda doğrusal artışizlenmemiştir. Medyan yaş 60 (15-90) yıldır. Olguların 573’ü (%56,8) erkektir. ÖK, erkeklerde en sık 60-69 yaşlarda (%31), kadınlarda 50-59 yaşlarda (%25,2) görülmektedir. En sık yerleşim torasiközofagustur (%79) ve yerleşim yeri açısından cinsiyetler arasında fark saptanmamıştır (p=0,33).Skuamöz hücreli karsinom (SHK) en sık rastlanan histolojik tiptir (%64,2). Servikal ve torasik özofagusdaSHK, abdominal özofagusta adenokarsinom daha fazladır. Vakaların yaklaşık yarısı tanıyı lokal ilerievrede almıştır. Medyan sağkalım 12 aydır. Bir, 5 ve 10-yıllık GSK oranları, sırasıyla %50,1, %17,7 ve%12’dir. Erkeklerde 5-yıllık GSK oranı %11,2 ve kadınlarda %25,8’dir, cinsiyetler arası fark anlamlıdır(p, Aim: The study aimed to investigate epidemiologic and overall survival (OS) characteristics ofesophageal cancers (EC).Materials and Methods: Data of Ege University Cancer Control and Research Center were screenedbetween 1992-2017 retrospectively. Data recorded in the computer program CAN REG-4 weregrouped and analyzed in the World Health Organisation and Surveillance, Epidemiology, and EndResults systems. Chi-square, Kaplan Meier, and General Linear Model tests were used for statisticalanalysis.Results: Of the total 117,139 cancers, 19,542 are gastrointestinal system (GIS) cancers. 1,009 (5.2%)of GIS cancers are EC and are 6th. There has not been any statistically significant increase in ECduring the 25 years. The median age was 60 (15-90) years. A total of 573 (56.8%) of patients weremale. EC was most commonly seen in men aged 60-69 (31%), in women aged 50-59 (25.2%) years.The most common localization was thoracic esophagus (79%). There wasn’t any statisticallysignificant difference between gender according to localization (p=0.33). Squamous cell carcinoma(SCC) was the most common histological type (64.2%). SCC was more common in cervical andthoracic, adenocarcinoma was more common in abdominal esophagus. Half of the patients werediagnosed at a locally advanced stage. Median survival was 12 months. The 1-, 5-, and 10-year OSrates were 50.1%, 17.7%, and 12% respectively. The 5-year OS was 11.2% for men and 25.8% forwomen, the difference was statistically significant (p

Background and Aims: Gastric polyps are sessile or pedunculated lesions originating from the mucosa or submucosa that protrude into the lumen. We sought to assess the occurrence of polyps discovered during gastroscopy, the demographic characteristics of patients with gastric polyps, the endoscopic and histopathological characteristics of polyps, other endoscopic observations, and treatment modalities. Materials and Methods: We included 80 patients who were found to have polyps during 13,280 gastroscopy procedures conducted in the endoscopy unit of the gastroenterology department of our university hospital between June 2017 and June 2020. After discovering 125 polyps, the 80 patients were examined retrospectively. We recorded the age and gender of the patients, reason for gastroscopy, number of polyps, localization of the polyps, polypectomy method, polyp histopathology, Helicobacter pylori positivity, presence of intestinal metaplasia, presence of atrophic gastritis, and presence or absence of complications after polypectomy. Results: We evaluated 80 out of 125 polyps (0.6%) found in these patients. Fifty-four (67.5%) patients were women and the mean age was 57.5 ± 12.5 years. Most patients (51.2%) were referred from other centers for polypectomy. According to the gastric mucosa sampling, 11.3% of the patients had positive Helicobacter pylori, 20% had intestinal metaplasia, and 21.2% had atrophic gastritis. The size of the polyp was less than 10 mm in 65.6% of the cases. Furthermore, polyps were most commonly found in the corpus (54.4%), antrum (22.4%), and fundus (20.8%). The most common histopathology of polyps were fundic gland polyps (42.4%), hyperplastic polyps (30.4%), and neuroendocrine tumors (20.8%). Polypectomy with biopsy forceps was the most common polypectomy method used (51.2%). Post polypectomy interprocedural bleeding occurred as a complication of polypectomy in 5 (4%) patients. Conclusion: The rate of gastric polyp discovery in our study was consistent with that in the literature. Because polyps can sometimes be difficult to distinguish endoscopically, polypectomy can be safely performed for any possible polyp and samples should be taken from the adjacent gastric mucosa., Giriş ve Amaç: Gastrik polip lümene doğru çıkıntı oluşturan, mukoza veya submukozadan köken alan sesil ya da saplı lezyonlar olarak tanımlanır. Bu çalışmanın amacı, gastroskopi işlemi sırasında tespit edilen poliplerin görülme sıklığının, gastrik polip saptanan hastaların demografik özelliklerinin, poliplerin endoskopik ve histopatolojik özelliklerinin, eşlik eden diğer endoskopik bulguların ve tedavi şekillerinin değerlendirilmesidir. Gereç ve Yöntem: Bu çalışmaya, Haziran 2017 ile Haziran 2020 tarihleri arasında üniversite hastanemiz gastroenteroloji bölümü endoskopi ünitesinde yapılan 13280 gastroskopi işleminde, polip saptanan 80 hasta dahil edildi. Seksen hastada toplam 125 polip saptandı ve retrospektif olarak değerlendirildi. Hastaların yaşı ve cinsiyeti, gastroskopi yapılma nedeni, polip sayısı, poliplerin midedeki lokalizasyonu, polipektomi yöntemi, polip histopatolojisi, Helicobacter pylori pozitifliği, intestinal metaplazi varlığı, atrofik gastrit varlığı, polipektomi sonrası komplikasyon gelişip gelişmediği tarandı. Bulgular: Seksen (%0.6) hasta ve bu hastalarda saptanan toplam 125 polip sonucu değerlendirildi. Hastaların 54’ü (%67.5) kadın ve yaş ortalaması 57.5 ± 12.5 yıldı. Hastaların %51.2’sinde endoskopi yapılma nedeni, başka merkezlerden kliniğimize polipektomi amacıyla yönlendirilmeleriydi. Mide mukoza örneklemesinde hastaların %11.3’ünde Helicobacter pylori pozitifliği, %20’sinde intestinal metaplazi, %21.2’sinde atrofik gastrit mevcuttu. Poliplerin %65.6’sında polip boyutu 10 mm’nin altındaydı. Polipler sırasıyla; en sık korpusta (%54.4), antrumda (%22.4) ve fundusta (%20.8) saptandı. Poliplerin histopatolojisi en sık fundik gland polip (%42.4), hiperplastik polip (%30.4) ve nöroendokrin tümördü (%20.8). En sık uygulanan polipektomi yöntemi poliplerin %51.2’sinde biyopsi forsepsi ile polipektomidir. Hastaların 5’inde (%4) polipektomi komplikasyonu olarak postpolipektomi interprosedürel kanama gelişti. Sonuç: Çalışmamızda mide polip saptanma oranı literatür ile uyumlu bulunmuştur. Endoskopik olarak bazen poliplerin birbirinden ayırt edilmesi zor olabildiğinden mümkün olan her polibe güvenli bir şekilde polipektomi yapılmalı ve komşu mide mukozasından örnekler alınmalıdır.

Dientamoeba fragilis is a protozoan parasite of the human gastrointestinal tract and still controversial in association with gastrointestinal symptoms. We present cross-sectional study of the prevalence of D. fragilis, and sociodemographic and clinical features in the patients with gastrointestinal symptoms. A total of 490 fecal specimens were collected from outpatients with gastrointestinal symptoms in the Department of Parasitology, Faculty of Medicine, Ege University and Celal Bayar University, Turkey. Fecal specimens were examined with microscopy and inoculated in Robinson medium. D. fragilis-positive samples were examined for the presence of other intestinal parasites using enzyme immunoassay. Real-time PCR analysis was performed on all samples. Of the 490 stool specimens examined by real-time PCR, 59 patients were positive for D. fragilis infection with prevalence rate of 12.04%. Forty-four of positive patients (74.5%) were found to be infected with only D. fragilis, while 23.7% were co-infected with Blastocystis and 1.7% were co-infected with Rotavirus. No statistically significant difference was found in all the examined patients in terms of D. fragilis positivity for all sociodemographic parameters. Loose stool consistency was associated with the presence of D. fragilis, with 18.3% (P = 0.001). When the clinical symptoms of all the patients participating in this study were examined, diarrhea was statistically more significant in patients with the presence of D. fragilis (16.3%; P = 0.001). The rate of diarrhea in D. fragilis-positive patients (84.09%; P = 0.0005) was higher than that of D. fragilis-negative patients and it was statistically significant. This study is important for assessing the prevalence of D. fragilis and its association with other factors in symptomatic patients in a large sample group in Turkey, as well as investigating the relationship of identified symptoms with the D. fragilis pathogenicity. It is suggested that D. fragilis in this case is not a commensal parasite but a pathogenic parasite and that the most common clinical symptom is diarrhea.

Alginate-based formulations are frequently used as add-on proton pump inhibitor (PPI) therapy to help control of heartburn and regurgitation. There are limited data regarding the mechanisms and effects of alginate-based formulations. We aimed to evaluate the effects of the sodium alginate intake and its likely temporal relations on intraesophageal reflux events by MII-pH in patients with and without hiatal hernia (HH). Fifty GERD patients (18 with HH, 32 without HH) with heartburn or regurgitation once a week or more common were included. After combined multichannel intraluminal impedance and pH-metry (MII-pH) had been performed, all patients were asked to eat the same standard meal (double cheeseburger, 1 banana, 100 g regular yoghurt, and 200 mL water with total energy value of 744 kcal: 37.6% of carbohydrates, 21.2% of proteins, and 41.2% of lipids) during two consecutive days. On separate random two consecutive days, all patients took 10 mL of sodium alginate (GA; Gaviscon Advance; Reckitt Benckiser Healthcare, Hull, UK) or 10 mL of water, 30 minutes after the refluxogenic meal. After eating refluxogenic meal, patients were examined ½ hour for basal conditions, 1 hour in upright, and 1 hour in supine positions. Alginate significantly decreased acid reflux after intake at the first hour in comparison to water in patients with HH (6.1 vs. 13.7, P = 0.004) and without HH (3.5 vs. 5.5, P = 0.001). Weakly acid reflux were increased at the first hour in patients with HH (3.4 vs. 1.3, P = 0.019) and without HH (1.7 vs. 5, P = 0.02) compared to water. There was no distinctive effect of alginate on the height of proximal migration of reflux events in patients with HH and without HH. Alginate decreases acid reflux events within a limited time period, especially at the first hour both in patients with and without HH. Alginate has no effect on the height of reflux events along the esophagus both in patients with and without HH.

Background/Aims: Ledipasvir (LDV) and sofosbuvir (SOF) as single-tablet regimen (STR) has been approved for treatment of chronic HCV infection (CHC) for treatment-naive or experienced cirrhotic or non-cirrhotic patients. Our aim was to analyse the effectiveness and safety of 12-24 weeks treatment of LDV/SOF (90mg/400 mg)+/- ribavirin in a real-life setting in Turkey. Materials and Methods: Between May-Dec 2016, 104 treatment-naive or experienced adult patients with CHC and with or without cirrhosis (including decompensated cirrhosis) were included in this observational study. Patients were administered LDV/SOF STR +/- ribavirin once daily for 12-24 weeks. SVR12 rates and effects of the baseline characteristics on SVR12 rates were assessed. Results: Out of 104 enrolled patients (61.5% female, mean age 62.0 years); 60.6% were cirrhotic, 76.0% previously used peg-IFN, 94.2% had GT1. At the end of the treatment, 77.8% (77/99, no data for 21 patients) had undetectable HCV-RNA and 98.9% (94/95) had SVR12. in the baseline characteristics subgroups, the SVR12 rates varied between 94.4% and 100%, and none of the baseline characteristics had a significant effect on the SVR12 rates. During the study, 6 (5.8%) patients died and none of the deaths was suspected to be related to the LDV/SOF. No treatment-emergent adverse event was reported. Conclusion: in conclusion, LDV/SOF +/- ribavirin yielded very high SVR12 rates, without any safety or tolerability concern in Turkey. the effectiveness of the LDV/SOF treatment was not affected by the patient demographics or medical characteristics such as fibrosis level, cirrhosis status, previous treatment status, HCV-RNA level or HCV genotype., Gilead Sciences, TurkeyGilead Sciences, This study was supported by Gilead Sciences, Turkey for editorial support in the preparation of this manuscript.

Obesity is a serious chronic disease caused by genetic and environmental factors. One of the treatment options is intragastric balloon application. This study aimed to evaluate the results of patients who underwent intragastric balloon placement on the short- and long-term treatment of obesity. The data and long-term follow-up results of 34 patients who underwent intragastric balloon placement due to obesity between December 2011 and August 2013 were retrospectively evaluated. Age, sex, body mass index (BMI), presence of additional diseases, duration of intragastric balloon remaining in the stomach, patients weight, and BMI at intragastric balloon removal, weight measured in December 2019, bariatric surgery performed during the study period if any, and general health status during this period were obtained. The mean weight loss of the patients after intragastric balloon removal was 15.6 ± 9.6 kg (range, 045 kg). The mean decrease in BMI after intragastric balloon removal was 11.4 ± 6.4% (range, 0%26.5%). No patients developed any complications. The procedure was ineffective in the long-term in 76.4% of the patients. The most important disadvantage of intragastric balloon placement application in the treatment of obesity is that the weight lost in the early period is regained in the long-term after balloon removal. In patients scheduled to undergo bariatric surgery, intragastric balloon placement can be applied as a bridge therapy to facilitate preoperative weight loss to reduce complications. [Med-Science 2020; 9(4.000): 954-8]

Background/aims This study aimed to compare the causes of nonvariceal upper gastrointestinal bleeding (NVUGB), demographics, risk factors, and outcomes of patients during two periods between 1993 and 2016 in a tertiary health-care center in Turkey. Materials and methods We compared the causes of NVUGB and clinical outcomes in 421 patients hospitalized between January 1993 and December 1995 with those of 231 patients with NVUGB hospitalized between January 2015 and September 2016. We also compared epidemiological characteristics, risk factors, and the rates of endoscopic hemostatic procedures. Results We observed significant increases in patients' mean age, in the percentage of patients with comorbid conditions, and in the percentage of patients who received direct-acting oral anticoagulants before bleeding. We also observed a statistically nonsignificant increase in the diagnoses of gastric ulcer, along with a significant concordant decrease in diagnoses of duodenal ulcer as a cause of bleeding. The use of emergency surgical hemostasis decreased among cases of peptic ulcer bleeding. The overall rate of mortality from bleeding did not significantly change between the two periods. Conclusion Over the 23 years studied, the causes of NVUGB changed, probably because the population was increasingly elderly population and because of the use of anticoagulants and better therapeutic approaches to chronic duodenal ulcers. The use of emergency surgical hemostasis reduced, but mortality rate did not significantly change between the two specific periods.

WOS: 000391776700008, PubMed ID: 27605525, Background/Aims Gastroesophageal reflux disease (GERD) is one of the main causes of chronic cough. We evaluated the role of microaspiration in the pathogenesis of reflux-related cough by determining the amount of lipid-laden macrophages (LLMs) in bronchoalveolar lavage (BAL) specimens. Methods A total of 161 cases of chronic cough were evaluated, and 36 patients (average age 48.2 years) were recruited for this single center prospective study. Patients with a history of smoking, angiotensin converting enzyme inhibitor usage, any abnormality on pulmonary function tests, abnormal chest X-rays, occupational or environmental exposures, or upper airway cough syndrome were excluded. GERD was evaluated by 24-hour esophageal impedance-pH monitoring. BAL specimens for LLM determination were obtained from 34 patients by flexible bronchoscopy. Results Patients with pathological intra-esophageal reflux according to multichannel intraluminal impedance and pH monitoring had higher LLM positivity in BAL specimens than patients without pathological reflux (8/14 in reflux positive group vs 1/22 in reflux negative group; P = 0.004). The BAL cell distribution was not different between the 2 groups (P = 0.574 for macrophages, P = 0.348 for lymphocytes, P = 0.873 for neutrophils and P = 0.450 for eosinophils). Conclusions Our results confirm the role of the microaspiration of refluxate in the pathogenetic mechanism of chronic cough. While bronchoscopy is indicated in patients with chronic cough, in addition to the routine airway evaluation, BAL and LLM detection should be performed. LLM can be used to diagnose aspiration in reflux-related chronic cough. Future studies are needed to evaluate the response to antireflux medications or surgery in patients with LLM positivity.

Bor, Serhat/0000-0001-5766-9598, WOS: 000502088200006, PubMed: 31826051, Background & Aims: Pepsin in the gastric refluxate is a marker for a prior reflux event and rapid detection might be achieved using the Peptest (TM), an in vitro diagnostic medical device. the aim of this study was to validate the use of Peptest (TM) to reliably diagnose reflux in patients with gastro-esophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) disease diagnosed with multichannel intraluminal impedance/pHmetry (MII-pH). Methods: 20 reflux patients were recruited of whom 10 had classical GERD and 10 had LPR. All patients underwent MII-pH and provided expectorated saliva samples when a MII-pH reflux event was observed, or reflux symptoms were experienced, and all were tested for the presence of pepsin using the Peptest (TM). Results: Pepsin was detected in 31 out of 45 samples (68.9%). At least 1 positive pepsin result was seen in 16 patients (80%) and this was the same, irrespective of the GERD or LPR diagnosis. Peptest (TM) had a positive predictive value of 69% to detect MII-pH reflux events. Conclusions: Peptest (TM) is a good first-line diagnostic procedure to use in reflux sufferers to confirm the presence of reflux.

WOS:000417204500004, PubMed ID: 29199160, Empirical acid suppression tests that are performed with proton pump inhibitors (PPI) are used to detect both the presence of acid-related gastrointestinal symptoms and gastroesophageal reflux disease (GERD). In comparison to other diagnostic methods, it is non-invasive, easily applicable, and cost-effective in the diagnosis of GERD. In addition to typical reflux symptoms, it can also be used for diagnostic purposes in patients with non-cardiac chest pain (NCCP). If the symptom response is 50% and above when obtained using the PPI test in patients with NCCP, it can be considered as positive and the treatment should be continued sensitivity of the PPI test in patients with typical symptoms of GERD is 27%-89%, while its specificity is 35%-83%. Although there are differences related to the duration and dosage of the PPI test, a significant difference has not been found according to the type of PPI. When PPI test sensitivity and specificity were calculated by cumulatively evaluating the data regarding the PPI test in the literature, a sensitivity of 82.3% and specificity of 51.5% was obtained. It has been found that high doses of PPI were mostly used in studies, and the duration of the median test was 14 days. As a result, the sensitivity of PPI trial test is good, but the specificity is low in the diagnosis of GERD in patients with typical reflux symptoms

Calprotectin is a protein that is mostly released from neutrophils, monocytes, macrophages and submucosal epithelial cells. Fecal calprotectin (f-CP) is a marker of intestinal inflammation. There are some discussions about the pathogenicity of D. fragilis in the gastrointestinal tract. in this study, we investigated whether f-CP level is a factor supporting the pathogenicity of D. fragilis. the f-CP levels were evaluated in patients with only D. fragilis positive in comparison with healthy controls. Moreover, the levels of f-CP were investigated in fecal samples of D. fragilis negative patients with gastrointestinal complaints. the fecal samples were collected from three groups. Three groups of fecal samples were examined directly microscopy, trichrome staining, cultivation, enzyme immunoassay (EIA) and real-time PCR assay. in the first group (Group 1, n = 34), patient stool samples with gastrointestinal symptoms (without other pathogens) found only with D. fragilis were included. in the second group (Group 2, n = 31), there were patients' stool samples with gastrointestinal symptoms that D. fragilis was negative (but there may be other pathogenic agents). in the control group (Group 3, n = 23), we used fecal samples collected from healthy volunteers without any infection or gastrointestinal complaints. the collected fecal samples were stored at -20 degrees C until analysis. Levels of f-CP were determined by using human calprotectin ELISA kits. Total of 88 patients were enrolled in three different groups. We obtained f-CP levels as follows: 33.40 ng/mg protein in the group 1, 15.99 ng/mg protein in the group 2 and 1.54 ng/mg protein in the group 3. Statistically significant difference in f-CP levels of the group 1 and the group 2 were obtained when compared with healthy controls (p < 0.0001). However, the f-CP levels of the group 1 were not significantly different from the group 2 (p > 0.99). in conclusion, increased levels of f-CP are shown as a marker of an inflammatory disease of the lower gastrointestinal tract in infected humans. There is continues controversy about the pathogenicity of D. fragilis in symptomatic and asymptomatic patients. the findings of this study contribute to the ongoing debate about the pathogenicity of D. fragilis. in our study, the potential pathogenicity of D. fragilis is associated with increased f-CP concentrations with parasite detection in the fecal samples and therefore we assume that the parasite is not only a harmless commensal. in summary, higher levels of f-CP found in D. fragilis positive patients suggest the importance of researches that support the pathogenicity of indicated parasite., Scientific Research Projects Branch Directorate of Ege University, TurkeyEge University [13-TIP-092], This study was partly supported by the grant given by the Scientific Research Projects Branch Directorate of Ege University, Turkey (Grant number: 13-TIP-092).

The loss of the best communication port after total laryngectomy surgery makes speech rehabilitation an important goal. Our aim was to improve the quality of esophageal speech (ES) using online esophageal multichannel intra-luminal impedance (MII) as a new biofeedback method. Twenty-six total laryngectomized patients were included. Before ES therapy, an esophageal motility test was carried out. MII catheters were placed in all subjects who were then randomized into two groups. Group 1 included 13 cases, who were retrained according to the classical method. Group 2 included 13 cases, who were retrained according to the simplified animation of air movements within the esophagus and upper stomach resulting from the modifications of intra-esophageal air kinetics gained by MII. The level of speech proficiency was evaluated relative to pretraining levels using perceptual scales in the third and sixth months. Acoustic voice was analyzed. The number of syllables read per minute and the intelligibility of monosyllabic and dissyllabic words were calculated. In this study, MII was used for the first time in alaryngeal speech rehabilitation as a biofeedback method; an overall sufficient speech level was achieved by 68.4% at the end of therapy, whereas attendance was 90%. A statistically significant improvement was found in both groups in terms of ES level compared with the pretraining period although there was no significant difference between groups. Although we did not observe the expected difference between groups suggested by our hypothesis, MII may be used as an objective tool to show patients how to swallow and regurgitate air during training, and may thus expedite ES therapy both for the speech therapist and the patient in the future.

WOS: 000347777400005, PubMed ID: 25452843, Background: The role of sexual activity on gastroesophageal reflux disease (GERD) is an under-recognized concern of patients, and one rarely assessed by physicians. Objective: The objective of this article is to determine the influence of sexual activity on the intraesophageal acid exposure and acid reflux events in GERD patients. Methods: Twenty-one patients with the diagnosis of GERD were prospectively enrolled. Intraesophageal pH monitoring was recorded for 48 hours with a Bravo capsule. All patients were instructed to have sexual intercourse or abstain in a random order two hours after the same refluxogenic dinner within two consecutive nights. Patients were requested to have sex in the standard "missionary position" and women were warned to avoid abdominal compression. The patients completed a diary reporting the time of the sexual intercourse and GERD symptoms. The percentage of reflux time and acid reflux events were compared in two ways: within 30 and 60 minutes prior to and after sexual intercourse on the day of sexual intercourse and in the same time frame of the day without sexual intercourse. Results: Fifteen of 21 GERD patients were analyzed. The percentage of reflux time and number of acid reflux events did not show a significant difference within the 30- and 60-minute periods prior to and after sexual intercourse on the day of sexual intercourse and on the day without sexual intercourse, as well. Conclusion: Sexual activity does not predispose to increased intraesophageal acid exposure and acid reflux events. Larger studies are needed to confirm our findings in patients who define reflux symptoms during sexual intercourse.

High-resolution esophageal manometry (HRM) is a recent development used in the evaluation of esophageal function. Our aim was to assess the inter-observer agreement for diagnosis of esophageal motility disorders using this technology. Practitioners registered on the HRM Working Group website were invited to review and classify (i) 147 individual water swallows and (ii) 40 diagnostic studies comprising 10 swallows using a drop-down menu that followed the Chicago Classification system. Data were presented using a standardized format with pressure contours without a summary of HRM metrics. The sequence of swallows was fixed for each user but randomized between users to avoid sequence bias. Participants were blinded to other entries. (i) Individual swallows were assessed by 18 practitioners (13 institutions). Consensus agreement (≤ 2/18 dissenters) was present for most cases of normal peristalsis and achalasia but not for cases of peristaltic dysmotility. (ii) Diagnostic studies were assessed by 36 practitioners (28 institutions). Overall inter-observer agreement was 'moderate' (kappa 0.51) being 'substantial' (kappa > 0.7) for achalasia type I/II and no lower than 'fair-moderate' (kappa >0.34) for any diagnosis. Overall agreement was somewhat higher among those that had performed >400 studies (n = 9; kappa 0.55) and 'substantial' among experts involved in development of the Chicago Classification system (n = 4; kappa 0.66). This prospective, randomized, and blinded study reports an acceptable level of inter-observer agreement for HRM diagnoses across the full spectrum of esophageal motility disorders for a large group of clinicians working in a range of medical institutions. Suboptimal agreement for diagnosis of peristaltic motility disorders highlights contribution of objective HRM metrics.

Background It is claimed that gastroesophageal reflux disease (GERD) increases in patients with obstructive sleep apnea syndrome (OSAS). We aimed to evaluate the prevalence of GERD in patients with OSAS and primary snoring and identify OSAS-related risk factors associated with GERD. Methods In this prospective, cross-sectional, multicenter study, in total 1,104 patients were recruited for polysomnography: 147 subjects were in non-OSAS (primary snoring) and 957 patients were in OSAS group. All patients completed a validated GERD questionnaire. Demographic, anthropometric characteristics, and medical history were recorded. Results The prevalence of GERD was similar in OSAS (38.9 %) and non-OSAS (32.0 %) groups (p=0.064). There was no difference in terms of major gastroesophageal reflux (GER) symptoms (heartburn/acid regurgitation) between nonOSAS and mild, moderate, and severe OSAS groups. The prevalence of GERD was increased in female OSAS patients (46.6 %) compared to males (35.7 %) (p=0.002). In OSAS patients with GERD, body mass index was greater (34.0±7.0 vs. 33.1±6.8, p=0.049), waist (115.5±13.9 vs. 113.1±13.4, p=0.007) and hip (117.9±13.7 vs. 114.2±12.8, p

One method of speech rehabilitation following total laryngectomy surgery is esophageal speech therapy (EST). In this method, which has witnessed relatively low success rates at the end of therapy, identification of patients who can benefit from EST beforehand will be important for determining the appropriate method for alaryngeal speech rehabilitation and might be cost-effective, saving time and labor. To this end, this study conducted research on the feasibility of manometric data measured prior to therapy using an esophageal motility test (EMT) in order to determine the candidates most suitable for esophageal speech (ES) beforehand. A total of 51 total laryngectomy male patients who had never been subject to any kind of speech rehabilitation and had always been articulate were included in the study. Data were collected from 44 patients who completed EST, lasting for 6 months in total and consisting of 11 sessions. Manometric measures were obtained through EMT using a water-perfusion system with a Dent sleeve catheter on the patients prior to the therapy. Wepman's scale was used in order to evaluate ES proficiency. Following the therapy, in accordance with this scale, while patients whose scores was 1, 2, or 3 were considered as adequate, those whose scores were 4, 5, 6, or 7 were considered inadequate and were divided into two groups. Manometric correlations were analyzed between 17 patients (group I) who were able to perform ES at an adequate level and 27 patients (group II) who could not. No statistically significant difference between the groups could be observed in terms of average pressure generated within the upper and lower esophageal sphincters obtained through EMT, peak amplitude of esophageal body contraction pressure, contraction duration time, onset velocity, or peak velocity values. EMT conducted prior to application of EST to total laryngectomized patients did not have any value in determining the level of ES that a patient could reach. Our results also suggest that sphincter pressures or esophageal motility patterns do not have any predictive value and should not be performed.

WOS: 000209200300006, PubMed ID: 24917982, Background: There is a general belief that gastro-oesophageal reflux increases after meals and especially following a rapid intake. Objective: To evaluate the impact of rapid vs. slow food intake on gastro-oesophageal reflux disease (GORD) patients. Materials and methods: Forty-six GORD patients with heartburn and / or acid regurgitation once a week or more often common were included in this study. Participants were asked to eat the same standard meal within either 5 or 30 minutes under observation in a random order on 2 consecutive days. A total of 28 hours of recording were obtained by intraoesophageal impedance pH and number of liquid and mixed reflux episodes within 3 hours of the slow- and fast-eating postprandial periods were calculated. Results: While all patients defined GORD symptoms, 10 (21.7%) had pathological 24-h intraoesophageal impedance measurement, 15 (32.6%) had pathological DeMeester and 21.7% had erosive oesophagitis. No difference has been shown according to the eating speed when all reflux episodes were taken together (754 vs. 733). Speed of food intake also did not have an impact on patients with normal vs. pathological 24-h intraoesophageal impedance or erosive vs. non-erosive. During the first postprandial hour, approximately half of the reflux events were non-acid, compared to 34.2% during the second hour and 26.8% during the third hour (p < 0.001). The number of acid reflux episodes was significantly higher than non-acid reflux especially during the second and third hours and in total for 3 hours. Conclusions: This first study addressing the effect of eating speed on reflux episodes in GORD patients did not support the general belief that reflux increases following fast eating. Acid and non-acid reflux were similar at the first postprandial hour, then acid reflux episodes were predominantly higher, which implicate the importance of acid pockets., Ege reflux study group [08.12.2009/09-5.1/3], This study was supported by Ege reflux study group, grant number: 08.12.2009/09-5.1/3.

WOS:000417204500005, PubMed ID: 29199161, Ambulatory esophageal pH monitoring is an essential method in patients exhibiting signs of non-erosive reflux disease (NERD) to make an objective diagnosis. Intra-esophageal pH monitoring is important in patients who are non-responsive to medications and in those with extraesophageal symptoms, particularly in NERD, before surgical interventions. With the help of the wireless capsule pH monitoring, measurements can be made under more physiological conditions as well as longer recordings can be performed because the investigation can be better tolerated by patients. Ambulatory esophageal pH monitoring can be detected within normal limits in 17%-31.4% of the patients with endoscopic esophagitis; therefore, normal pH monitoring cannot exclude the diagnosis of gastroesophageal reflux disease (GERD). Multi-channel intraluminal impedance pH (MII-pH) technology have been developed and currently the most sensitive tool to evaluate patients with both typical and atypical reflux symptoms. The sensitivity of a pH catheter test is 58% for the detection of acid reflux compared with MII-pH monitoring; further, its sensitivity is 28% for the detection of weak acid reflux compared with MII-pH monitoring. By adding impedance to pH catheter in patients with reflux symptoms, particularly in those receiving PPIs, it has been demonstrated that higher rates of diagnoses and symptom analyses can be obtained than those using only pH catheter. Esophageal manometry is used in the evaluation of patients with functional dysphagia and unexplained noncardiac chest pain and prior to antireflux surgery. The use of esophageal manometry is suitable for the detection of esophageal motor patterns and extreme motor abnormalities (e.g., achalasia and extreme hypomotility). Esophageal manometry and ambulatory pH monitoring are often used in assessments prior to laparoscopic antireflux surgery and in patients with reflux symptoms refractory to medical treatment. Although the esophageal motility is predominantly normal in patients with non-acid reflux, ineffective esophageal motility is often monitored in patients with acid reflux. In the literature, there are contradictory and an insufficient number of studies regarding radiological methods for the diagnosis of GERD. There are inconsistent values for sensitivity and specificity among the barium studies. There are inadequate studies in the literature involving scintigraphic examinations in the diagnosis of GERD, and a majority of existing studies have been conducted in the pediatric group. The results of a few studies do not provide sufficient contribution toward the implementation in clinical practice.

WOS: 000405291100003, PubMed ID: 28815026, Background: The diagnosis of laryngopharyngeal reflux is currently based on a combination of the patient history of multichannel intraluminal impedance and ambulatory pH (MII-pH); however, none of these findings alone is specific for the diagnosis of laryngopharyngeal reflux. We aimed to compare the baseline characteristics and esophageal baseline impedance values between patients with and without laryngopharyngeal reflux symptoms. Methods: We retrospectively analyzed data from two groups of patients with laryngopharyngeal reflux according to their reflux finding score (RFS) as scored by ENTs. Control patients were nonerosive reflux disease patients without laryngopharyngeal reflux. All MII-pH parameters and baseline impedance were analyzed from six levels and the proximal and distal baseline impedance and the ratio of the proximal to distal baseline impedance levels was calculated. Results: Altogether 123 patients with laryngopharyngeal reflux and 49 control patients were included. A total of 81 of 123 patients had RFS >= 7, and 42 of 123 patients had RFS > 7. Baseline impedance analysis showed that patients with laryngopharyngeal reflux symptoms had significantly lower proximal baseline impedance values (1997 +/- 51 vs 2245 +/- 109, p < 0.05) than the control group. Additionally, patients with laryngopharyngeal reflux symptoms had a significantly lower proximal-to-distal ratio (1.28 +/- 0.05 vs 1.53 +/- 0.09, p < 0.05). In the subgroup analysis, patients with RFS < 7 were found to have a significantly lower acid exposure time than either the patients with RFS >= 7 (3.85 +/- 0.65 vs 8.2 +/- 1.52, p < 0.05) or the control group (3.85 +/- 0.65 vs 6.1 +/- 0.81, p < 0.05). Additionally, patients with RFS7 had significantly lower proximal baseline impedance levels than the control group (1970 +/- 63 vs 2245 +/- 109, p < 0.05). Conclusions: Patients with pathologic laryngopharyngeal reflux symptom scores had lower proximal baseline impedance levels and lower proximal-to-distal ratios, which may reflect the proximal mucosal noxious effect of the refluxate. These results may indicate that laryngopharyngeal reflux symptoms may be due to chronic acid exposure in the proximal segments of the esophagus, and the proximal-to-distal ratio may be used as a new metric for diagnosis.

Obesity increases the risk of gastroesophageal reflux disease (GERD). The majority of the reflux attacks occur postprandially. The influence of the speed of food intake on gastroesophageal reflux events is unclear in obese patients. To determine the influence of the speed of food intake on intraesophageal reflux events in obese patients with and without GERD. A total of 26 obese female patients were recruited. The patients underwent esophageal manometry to evaluate the upper limit of the lower esophageal sphincter and subsequently placement of a Multichannel intraluminal impedance-pH (MII-pH) catheter. All patients were asked to eat the same standard meal (double cheeseburger, 1 banana, 100 g yogurt and 200 mL water; total energy value, 744 kcal; 37.6% carbohydrates, 21.2% proteins and 41.2% lipids) within 5 or 30 minutes under observation in a random order on two consecutive days. All reflux episodes over a 3-hour postprandial period were manually analyzed and compared. The mean age was 46 ± 12 (18-66) years. The mean body mass index (BMI) was 39.9 ± 8.4 kg/m2. There was no difference between the fast- and slow-eating group in the number of refluxes within the 3-postprandial hours. The patients were divided into 2 groups according to the 24-hour MII-pH monitoring results, that is, 16 subjects with normal MII-pH monitoring and 10 patients with pathologic MII-pH monitoring. There was no effect of the speed of food intake in either the patients with or without GERD. In contrast to the general belief, this study suggested that the speed of food intake does not influence the number of refluxes in obese female patients with or without GERD.

Summary Obesity increases the risk of gastroesophageal reflux disease (GERD). The majority of the reflux attacks occur postprandially. The influence of the speed of food intake on gastroesophageal reflux events is unclear in obese patients. To determine the influence of the speed of food intake on intraesophageal reflux events in obese patients with and without GERD. A total of 26 obese female patients were recruited. The patients underwent esophageal manometry to evaluate the upper limit of the lower esophageal sphincter and subsequently placement of a Multichannel intraluminal impedance-pH (MII-pH) catheter. All patients were asked to eat the same standard meal (double cheeseburger, 1 banana, 100 g yogurt and 200 mL water; total energy value, 744 kcal; 37.6% carbohydrates, 21.2% proteins and 41.2% lipids) within 5 or 30 minutes under observation in a random order on two consecutive days. All reflux episodes over a 3-hour postprandial period were manually analyzed and compared. The mean age was 46 ± 12 (18–66) years. The mean body mass index (BMI) was 39.9 ± 8.4 kg/m2. There was no difference between the fast- and slow-eating group in the number of refluxes within the 3-postprandial hours. The patients were divided into 2 groups according to the 24-hour MII-pH monitoring results, that is, 16 subjects with normal MII-pH monitoring and 10 patients with pathologic MII-pH monitoring. There was no effect of the speed of food intake in either the patients with or without GERD. In contrast to the general belief, this study suggested that the speed of food intake does not influence the number of refluxes in obese female patients with or without GERD.

The pathophysiology of chronic cough and its association with dsymotility and laryngopharyngeal reflux remains unclear. This study applied high-resolution manometry (HRM) to obtain a detailed evaluation of pharyngeal and esophageal motility in chronic cough patients with and without a positive reflux-cough symptom association probability (SAP). Retrospective analysis of 66 consecutive patients referred for investigation of chronic cough was performed. Thirty-four (52%) were eligible for inclusion (age 55 [19-77], 62% female). HRM (ManoScan 360, Given/Sierra Scientific Instruments, Mountain View, CA) with 10 water swallows was performed followed by a 24-hour ambulatory pH monitoring. Of this group, 21 (62%) patients had negative reflux-cough SAP (group A) and 13 (38%) had positive SAP (group B). Results from 23 healthy controls were available for comparison (group C). Detailed analysis revealed considerable heterogeneity. A small number of patients had pathological upper esophageal sphincter (UES) function (n=9) or esophageal dysmotility (n=1). The overall baseline UES pressure was similar, but average UES residual pressure was higher in groups A and B than in control group C (-0.2 and -0.8mmHg vs. -5.4mmHg; P

Background: Irritable bowel disease is a chronic disease which characterized by abdominal pain and discomfort along with changes in bowel habits. As in other chronic diseases, there is also a need for a scale that can be used by the members of the medical team to determine the quality of life of the patient, help them to have a better quality of life, enable the patients to cope with the disease and provide symptom control. This study is planned as a determiner of validity and reliability in order to apply the Irritable Bowel Disease Quality of Life Scale. Methods: 200 cases whose colonoscopy results were normal were brought into the scope of the study. A psycholinguistic and psychometric analysis of the scale was made. For language validity, the back-translation method has been used. The structural validity of scale is analyzed with the simultaneous/similar scales method. Results: From the analysis of the content-scope validity of the scale it is deduced that the Turkish language form of the scale is an appropriate means of measurement, while the internal consistency reliability of Cronbach Alpha Coefficient, which is used to calculate the general reliability of the scale, is estimated as 0.97. Accordingly, it is determined that reliability is high. The Weighted Kappa values of scale vary between 0.81 and 0.94, this value is confirmed to be “very good” and statistically significant. Conclusion: The Irritable Bowel Disease Quality of Life Scale has quite high indicators of validity and reliability, and it can be used in Turkish society.

Limited data exist regarding the psychosocial aspects of gastroesophageal reflux disease (GERD). Some GERD subgroups, such as functional heartburn and hypersensitive esophagus, might show different psychiatric comorbidities than others. We aimed to evaluate the psychiatric comorbidities of GERD subgroups using a cross-sectional design. A group of GERD patients at a tertiary outpatient clinic were evaluated via upper GIS (gastrointestinal system) endoscopy, esophageal manometry, and 24-h impedance–pH monitoring. Thirty-nine patients diagnosed with erosive reflux disease, 44 with non-erosive reflux disease, 20 with functional heartburn, 11 with hypersensitive esophagus, and 44 healthy controls participated. Psychiatric diagnoses were made using the Structured Clinical Interview for Diagnostics and Statistical Manual of Mental Disorders IV. Psychometric measurements of the patients were performed using the Somatosensory Amplification Scale, Beck Depression Inventory, State-Trait Anxiety Inventory, and Short-Form 36. Healthy controls were evaluated with the same psychometric scales except for the Short-Form 36. All of the GERD subgroups were significantly more depressed than the control group. Depressive disorders were significantly more prevalent in the functional heartburn group than in the non-erosive reflux disease and erosive reflux disease groups. The trait anxiety level of the functional heartburn group was significantly higher than those of the control and non-erosive reflux disease groups. The quality of life scores of the GERD subgroups were significantly lower than the population standards. Depressive disorders were frequently comorbid in the GERD subgroups studied (30–65 %). It is essential to consider the high prevalence rates of comorbid depression when managing GERD.

Objectives: Very few studies demonstrated that β-2 adrenergic agonists reduce "Lower Esophageal Sphincter”pressure in healthy volunteers and asthma patients, but their effects have not been studied at rescue dosage for asthma patients. We aimed to investigate potential effects of salbutamol on esophageal mechanics. Methods: Phase 4, prospective clinical trial. Seventeen asthma patients with frequent GERD symptoms underwent HRM with 36 solid-state pressure sensors( MMS,The Netherlands ). After exclusion two of them due to hiatal-hernia, LES-relaxation(IRP),esophagus-length(EL),contractile-front-velocity(CFV),distal-latency(DL),upper&lower sphincter pressures(UESP&LESP) metrics were measured at rest, after 10x5 ml water intake, following multiple rapid swallow. Measurements were taken after different respiratory maneuvers before/after inhalation of salbutamol 400 mcg for once. Results: Most of patients were female(n=14,93%),mean age was 51±4.8(38-65).Mean IRP,CFV,DL values were measured as 914±571mmHg.sn.cm, 4.4±3cm/sn and 7.1±1 respectively. There were no statistically significant differences among UESP,LESP,EL during respiratory maneuvers before and after salbutamol inhalation. A significant decrease was observed in UESP with salbutamol after deep inspirium (94±61vs62±42 respectively)(p=0.04) Conclusions: Decrease in UESP might be related with direct topical effect of the inhaler. Tendency to fall, but not a significant decrease in LESP might be interpretedas;salbutamol, at least at this rescue-low dosage, might not responsible from a refluxogenic effect as suggested previously by the literature.

The aim of this study was to evaluate the effect of laparoscopic antireflux surgery (LARS) on the laryngeal symptoms, physical findings and voice parameters of gastroesophageal reflux disease (GERD) patients with or without laryngopharyngeal reflux (LPR). Forty-one GERD patients predominantly with LPR symptoms (Group I) and twenty-six GERD patients without LPR symptoms (Group II) who had LARS were prospectively analysed before and 2 years after the surgery. Upper gastrointestinal endoscopy, 24-h ambulatory pH or MII-pH monitoring was performed in all cases. A reflux study group including specialists from five departments in a university hospital decided surgical indications. Patients were asked to fill out a validated LPR and voice quality questionnaire (Reflux Symptom Index and Voice Handicap Index-10). Laryngeal findings were evaluated and scored using a laryngoscopic grading scale [Reflux Finding Score (RFS)], by four blinded ENT specialists. GRBAS scale was done by a blinded otolaryngologist. Voice parameters were measured objectively via the Multi Dimensional Voice Programme (MDVP). The mean age was 45.8 ± 8.5 for Group I (24 men) and 48.9 ± 12.3 for Group II (16 men). The mean follow-up after LARS was 24.5 ± 1.3 months for Group I and 25.2 ± 1.1 months for Group II. The preoperative mean score of RSI was 22.8 ± 7.4 vs. 11.2 ± 6.6; RFS was 10.6 ± 2.3 vs. 5.7 ± 2.5 and VHI was 18.07 ± 4.4 vs. 10.86 ± 3.3 for Group I and II, respectively. The postoperative mean score of RSI was 12.9 ± 6.4 vs. 8.4 ± 4.5; RFS was 6.9 ± 2.0 vs. 4.5 ± 2.3 and VHI was 9.59 ± 4.4 vs. 7.95 ± 3.5 for Group I and II, respectively. Group I had significantly lower RSI and RFS scores following LARS compared to the preoperative scores. LARS successfully improved RFS, RSI and VHI in carefully selected patients with GERD, especially the signs and symptoms related to the larynx and voice. Although the indications for LARS are limited in patients with LPR symptoms, these results favor the decision-making period of LARS.

The purpose of this study was to evaluate the air kinetics of well- and poor-speaking patients and their upper (UES) and lower (LES) esophageal sphincter pressures . The esophageal speech capability of 23 total laryngectomy patients was assessed with the Wepman scale. LES and UES points and pressures were measured, and air kinetics were compared. All patients were male, with an average age of 58 years. Both the LES and UES pressures were not statistically different between good-speaking and poor-speaking patients (p > 0.05). The ability to speak was estimated only by looking at tracings. Good speakers are able to retain air successfully and on a long-term basis between the upper and lower esophageal sphincters. During short and/or rapid speech, these patients are able to rapidly suck and then expel the air from their upper esophagus. During long speeches, after sucking the air into their distal esophagus, they used the air in the upper part of the esophagus during the speech, only later seeming to fill the lower esophagus with the air as a possible reserve in the stomach. It has been shown that the basic requirement for speaking is the capacity to suck and store the air within the esophagus. For successful speech, the air should be stored inside the esophagus. MII technology contributes to our understanding of speech kinetics and occupies an important place in patient training as a biofeedback technique.

Background/Aims: In this study, we aimed to provide the usage of the Rome III criteria for irritable bowel syndrome (IBS) in the healthcare field by conducting validity and reliability studies in Turkey and to facilitate diagnosis of these patients. Materials and Methods: Item analysis of the Rome III criteria was performed, and the test was applied to 79 patients after their consistency had been validated with expert opinion. After the first application, the retest was applied to 77 cases, and the consistency between the two applications was examined by kappa analysis. IBS was diagnosed by expert opinion, which was accepted as ’the gold standard’. Results: Cronbach’s alpha of the Rome III criteria was calculated as 0.90. When the compliance between expert assessment and IBS Rome III diagnostic criteria was compared, the diagnostic criteria’s sensitivity was determined as 78.6%, and their specificity was 82.9%. When the Rome III criteria test-retest agreement was analysed, the sensitivity, specificity and negative and positive predictive values of the Rome III diagnostic criteria were determined as 97.4%. Conclusion: In this study, the internal consistency of the Rome III criteria for diagnosis of patients with IBS in our country was found to be an important criterion because of the fact that the Rome III criteria have high internal consistency and validation, they are a reliable measurement tool, they are able to distinguish IBS-positive and -negative cases with the same rate as a specialist and their application is very easy.

Background/Aims: In this study, we aimed to provide the usage of the Rome III criteria for irritable bowel syndrome (IBS) in the healthcare field by conducting validity and reliability studies in Turkey and to facilitate diagnosis of these patients.Materials and Methods: Item analysis of the Rome III criteria was performed, and the test was applied to 79 patients after their consistency had been validated with expert opinion. After the first application, the retest was applied to 77 cases, and the consistency between the two applications was examined by kappa analysis. IBS was diagnosed by expert opinion, which was accepted as ’the gold standard’.Results: Cronbach’s alpha of the Rome III criteria was calculated as 0.90. When the compliance between expert assessment and IBS Rome III diagnostic criteria was compared, the diagnostic criteria’s sensitivity was determined as 78.6%, and their specificity was 82.9%. When the Rome III criteria test-retest agreement was analysed, the sensitivity, specificity and negative and positive predictive values of the Rome III diagnostic criteria were determined as 97.4%. Conclusion: In this study, the internal consistency of the Rome III criteria for diagnosis of patients with IBS in our country was found to be an important criterion because of the fact that the Rome III criteria have high internal consistency and validation, they are a reliable measurement tool, they are able to distinguish IBS-positive and -negative cases with the same rate as a specialist and their application is very easy

İnvaziv mikropapiller karsinom yeni tanımlanan bir tümördür. Progressif kilo kaybı ve bulantı nedeniyle hastaneye yatırılan 77 yaşındaki kadın hastanın endoskopik biyopsisinde antral/prepilorik yerleşimli, orta derecede diferansiye adenokarsinom saptandı. Sonrasında subtotal gastrektomi ve lenf düğümü rezeksiyonu yapıldı. Tümör, orta derecede diferansiye hücrelerin oluşturduğu mikropapiller ve az sayıda glandüler yapılardan oluşmaktaydı. İmmunohistokimyasal olarak mikropapiller ve glandüler alanlarda pansitokeratin, sitokeratin 7 ve epitelyal membran antijen pozitifti. mikropapiller alanlarda, hücre kümelerinin çevresinde periferal lokalizasyonda epitelyal membran antijen ile invazive mikropapiller karsinom için karakteristik membranöz, sitoplazmik pozitiflik saptandı. Literatürde mide yerleşimli invazive mikropapiller karsinom oldukça nadirdir., Invasive micropapillary carcinoma is a recently identified neoplasm. A 77-year-old-female was admitted to the hospital due to progressive loss of weight and nausea. Endoscopic biopsy of the antral/prepyloric located mass was diagnosed as moderately differentiated adenocarcinoma. Subtotal gastrectomy and regional lymph node resection were performed. The tumor was composed of moderately differentiated cells arranged in micropapillary structures with only a few poorly formed glandular foci in lamina propria. Immunohistochemically, neoplastic cells of micropapillary and focal conventional adenocarcinoma areas were diffusely positive for pancytokeratin, cytokeratin 7 and epithelial membrane antigen. In micropapillary areas, membranous and peripheral cytoplasmic positivity with epithelial membrane antigen in outside of the cell clusters called “inside-out polarity” pattern that is characteristic for invasive micropapillary carcinoma were seen. Invasive micropapillary carcinoma is very rare in the stomach in the English literature.

Amaç: Bazı ilaçlar otoimmun hepatitite benzer hepatosellüler hasar yapabilirler. İlaçların ve şifalı bitkilerin ortaya çıkardığı ya da tetiklediği otoimmun hepatit mi veya basitçe ilacın tetiklediği hepatite eşlik eden otoimmun hepatit mi olduğu açık değildir. Biz otoimmun özelliği olan ornidazolun tetiklediği 8 hepatit olgusunun klinikopatolojik detaylarını tanımladık. Yöntem: fiubat 2001 ve Mart 2009 tarihleri arasında akut hepatit ile başvuran karaciğer hastalığı etyolojilerini gözden geçirdik. Akut viral hepatit, metabolik karaciğer hastalığı, Budd-Chiari sendromu gibi vasküler karaciğer hastalığı, biliyer obstrüksiyon ve alkol kullanımı olan olgular dışlandı. Tanı anında “International Autoimmune Hepatitis Group"un kriterlerine göre otoimmun hepatit skoru hesaplandı. Ek olarak, aynı grubun basitleştirilmiş kriterleri retrospektif olarak her bir hasta için uygulandı. Otoimmun hepatit ile birlikte olan ornidazolun tetiklediği toksik hepatit olguları çalışma grubunu oluşturdu. Olguların tümüne başlangıçta ve 1 olguya 3 yıl sonra karaciğer biyopsileri yapıldı. Biyopsilerin tümü Ishak ve ark.larının hepatit skorlama sistemine göre skorlandı. Bulgular: Tümü kadın 8 olgu ilacın tetiklediği otoimmun hepatit tanısı aldı. Bir olgu dışındaki tüm olgular prednisolone 30 mg/gün + azathioprine 50 mg/gün ile tedavi edildi. Prednisolone dozu transaminaz düzeylerindeki düşmeye göre azaltıldı. Tüm olgulara 2 yıllık tedavi planlandı. Sonuç: Ornidazol ilacın tetiklediği otoimmun hepatite neden olabilir. İlacın kesilmesi sonrasında uzun süre beklemeye karşın iyileşme olmayabilir. Böyle olgulara immunosüpresif tedavi önerilebilir., Background/aims: Certain drugs including oxyphenisatin, methyldopa, nitrofurantoin, diclofenac, interferon, infliximab, pemoline, minocycline, atorvastatin, and rosuvastatin can induce hepatocellular injury that mimics autoimmune hepatitis. Whether drugs and herbs unmask or induce autoimmune hepatitis or simply cause a drug-induced hepatitis with accompanying autoimmune features is unclear. We describe the clinicopathologic details of eight cases with ornidazole-induced hepatitis with autoimmune features. Material and Methods: Patients who presented with acute hepatitis between February 2001 and March 2009 were reevaluated for the etiology of liver disease. Patients with acute viral hepatitis, metabolic liver disease, vascular liver disease such as Budd-Chiari syndrome, biliary obstruction, or alcohol consumption were excluded. The autoimmune hepatitis scores, which were calculated at the time of diagnosis according to the criteria of the International Autoimmune Hepatitis Group, were recorded. In addition, the simplified criteria of the same group were applied retrospectively to each patient. Patients with ornidazole-induced toxic hepatitis with autoimmune hepatitis were included to constitute the study group of this report. All patients underwent initial liver biopsy, and one patient underwent liver biopsy three years later. All biopsies were scored according to the hepatitis scoring system by Ishak et al. (10). Results: Overall, eight patients (all female) were diagnosed as drug-induced autoimmune hepatitis. With the exception of one patient, all were treated with prednisolone 30 mg/day + azathioprine 50 mg/day. The prednisolone dose was tapered according to the decrease in the level of transaminases. A two-year treatment program was planned for all patients. Conclusions: Ornidazole may cause drug-induced autoimmune hepatitis. Withdrawal of the drug may not provide the recovery despite a rather long wait. Thus, immunosuppressive therapy may be suggested in these cases.

The techniques used in the diagnosis of gastroesophageal reflux disease (GERD) have insufficient specificity and sensitivity in diagnosing laryngopharyngeal reflux (LPR). The purpose of this study was to evaluate the role of esophagogastroduodenoscopy (EGD) and laryngological examination in the diagnosis of LPR. A total of 684 diagnosed GERD and suspected LPR patients were prospectively scored by the reflux finding score (RFS) which was suggested by Koufman. A total of 484 patients with GERD who had RFS ≥7 were accepted as having LPR. 248 patients with GERD plus LPR on whom an endoscopic examination was performed were evaluated. As a control group, results from 82 patients with GERD who had RFS

Annual Meeting on British-Society-of-Gasenterology -- MAR 14-17, 2011 -- Birmingham, ENGLAND, WOS: 000288323500348, British Soc Gasenterol

In patients with chronic hepatitis B (CHB) infection, precise definition of the hepatic fibrosis stage is the most important parameter to assess the risk of disease progression. Correlation between the prognosis of the CHB and the level of hepatitis-B virus DNA (HBV-DNA) is well considered in recent years.The aim of this study is to investigate the relationship between serum HBV-DNA level and histology of the liver. We also wanted to determine a threshold level of HBV-DNA for differentiation of low and high risk patients for progression.Two-hundred-fifty-nine patients with serum HBV-DNA level2000 copies/mL, determined by polymerase chain reaction (PCR), and biopsy proven naïve CHB infection were evaluated. Liver biopsies were evaluated histopathologically according to the Ishak scoring system. Laboratory values such as aspartate aminotransferase (AST), alanine aminotransferase ratio (ALT) were tested every 3 months and the highest value of each patient was evaluated.Mean age was 40 +/- 11 and 60% (155/259) of the patients were male. Mean laboratory values were as follows: AST: 52 +/- 46 U/L, ALT: 93 +/- 133 U/L, PLT: 224 +/- 60 1093)/l HBV DNA: 5.9 +/- 1.5 log copies/mL. In histological evaluation, mean inflammatory score was 4.34 +/- 2.72 and fibrosis score was 1.38 +/- 1.46. The fibrosis score was 0 or 1 in 63.3% (164/259) of the patients. The relationship between HBV-DNA level and histologic grade/stage was investigated and 15.000 copies/mL HBV DNA level was found as the threshold level to describe the activity of the disease. Fibrosis score was2 and/or gradeor = 5 in the patients who have HBV-DNA value below that level.In patients who have serum HBV-DNA levelor = 15000/copies/mL, histological activity was almost always low, and it seems that these patients do not need a liver biopsy regardless of hepatitis-B-e antigen (HBeAg) status.

Gastroesophageal reflux disease is seen frequently in patients with progressive systemic sclerosis. The aim of the present study was to determine the prevalence of intestinal metaplasia-squamocolumnar junction in patients with progressive systemic sclerosis and to investigate the association with gastroesophageal reflux disease.Thirty-one patients with progressive systemic sclerosis (Group A), 58 patients with gastroesophageal reflux disease--without progressive systemic sclerosis (Group B) and 36 patients without progressive systemic sclerosis or gastroesophageal reflux disease (Group C) were prospectively enrolled into this study. Biopsies were taken from the antrum, body, squamocolumnar junction (Z-line), and from the esophagus (3 cm above the Z-line). All biopsies were independently evaluated by two pathologists who were unaware of the diagnosis.We found that grade C-D esophagitis, esophageal stricture and Barrett's esophagus were statistically significantly higher in Group A (p0.05). Intestinal metaplasia at squamocolumnar junction was detected in 31% of Group A, in 32% of Group B and in 29% of Group C patients (p0.05), and prevalence of Helicobacter pylori was 61%, 67% and 38% in Groups A, B and C, respectively. Prevalence of Helicobacter pylori was similar in Group B and Group A, and significantly higher in Group B than Group C. Within each group, no significant relationship was detected between intestinal metaplasia at squamocolumnar junction and gender, age, smoking, alcohol consumption, body mass index, gastric atrophy, and prevalence of Helicobacter pylori.Patients with progressive systemic sclerosis have a higher tendency to the more severe forms and complications of gastroesophageal reflux disease including Barrett's esophagus than in those without progressive systemic sclerosis. However, there was no difference in the prevalence of intestinal metaplasia at squamocolumnar junction between groups, and it can be pointed out that intestinal metaplasia at squamocolumnar junction might not be related with gastroesophageal reflux disease.

Consuming wild mushrooms is an ordinary habit in late summer and autumn in our region. Every year, several cases of hepatic toxicity secondary to mushroom poisoning are observed because of poor identification of the mushrooms. Unfortunately some of them are fatal. Prometheus system is a newly developed extracorporeal liver support device for fractionated plasma separation and adsorption (FPSA) that enables removal of albumin-bound and water-soluble toxins. Therefore, it may be a promising treatment option for patients with liver failure due to mushroom poisoning.We studied 8 patients with mushroom poisoning. All patients underwent 1 to 4 consecutive FPSA (Prometheus)-system in addition to medical and supportive treatment such as fluid replacement, Penicillin G, N-acetylcysteine (NAC) and silymarin. A variety of clinical and biochemical parameters were assessed.We had improvement of the biochemical parameters after first treatment with FPSA-system. Seven of 8 patients survived and were discharged to resume an independent life. One patient who had grade III encephalopathy when admitted to hospital died. No major adverse events were observed during the application of this therapy modality.FPSA-system may be a safe and effective treatment option for patient with mushroom poisoning. Early hospitalization is essential in order to be successful. Controlled studies are needed to evaluate the efficacy of this new treatment choice on survival of patients with acute liver failure (ALF) due to mushroom poisoning.

TO THE EDITOR: Viruses are obligate intracellular parasites. An immune response against the viruses should involve the mechanisms to eliminate both intra- and extracellular (free) viruses. However, neither the humoral nor the cellular immune response is sufficient to eradicate infection in most patients with hepatitis C infection. It is reported that host-related factors might be as important as virus-related factors (1, 2). Interferon (IFN) and ribavirin, the medicine used for treatment of hepatitis C virus (HCV) infection, have some immunomodulatory effects in addition to their antiviral effects (3).

Non-invasive serum markers are being used to determine fibrosis score as an alternative to liver biopsy. The aim of the present study was to evaluate the accuracy and predictive value of the non-invasive markers in identifying the presence or absence of significant fibrosis in patients with chronic viral hepatitis.A total of 557 patients (401 chronic hepatitis B (CHB), 156 chronic hepatitis C (CHC)) were enrolled into the study retrospectively. Liver biopsies were evaluated histopathologically according to the Knodell scoring system. Laboratory values such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), y-glutamyltranspeptidase (GGT) and platelet count (PLT) was tested on the same day of liver biopsy. Using these laboratory values, AST/ALT ratio (AAR), age-platelet index (API) and AST/ PLT ratio index (APRI), GGT/PLT ratio index (GAPI) and AST to GGT ratio (AGR) were calculated.Advanced liver fibrosis including stage 3-4 was observed in 197 (49%) of patients with CHB, 84 (54%) of patients with CHC. Mean age and GGT were higher and PLT was lower in patients with advanced liver fibrosis (stage 3-4) than those in patients with absence of significant fibrosis (stage 0-1) (p0.001). But, there was no statistically significant relationship for mean value of AST and ALT between patients with stage 0-1 and stage 3-4. The API and GAPI were found to be significantly associated with the fibrosis score and correlation co-efficient (r) were 0.35 and 0.23, respectively (p0.001), while the APRI, AAR and AGR values were not associated with the fibrosis score in all of the patients (p0.05). But, APRI has showed correlation with liver fibrosis in patients with CHC contrary to patients with CHB.Age, GGT, PLT, API and GAPI are significantly associated with the extent of fibrosis. But these non-invasive markers can not replace liver biopsy.

Many studies have reported image analysis techniques, such as nuclear morphometry, counting or calculating of mitotic figures or estimation of the ratio of positive-stained areas immunohistochemically. The esophagus is the most commonly involved organ during caustic ingestion, which leads to progressive and devastating results after caustic burn. The aim of this work was to compare the classical stenosis index method with a new objective method based on image analysis that was used to determine experimental stricture of the rat esophagus.We investigated this technique by randomly allocating 20 rats each to sham laparotomy and corrosive esophagitis groups. The images of the sham laparotomy group and corrosive esophagitis group were reviewed, analyzed and used in a mathematical operation on the computer. The numbers and the ratio of luminal area and total esophageal area were used to determine the esophageal stricture of the rat, and results were compared with stenosis index ratios.The mean area of the lumen of the esophagus and the ratio of esophageal lumen/total esophageal area were 0.83 (0.51-1.28) mm2 and 0.21 (0.08-0.37), respectively, in the corrosive esophagitis group. In the sham laparotomy group, these values were 1.28 (0.47-3.03) mm2 and 0.26 (0.13-0.92), respectively. The differences between the two groups in luminal area and ratio of esophageal lumen/total esophageal area were statistically significant (p0.05).This new technique based on image analysis seems more objective and reproducible than the classical, manual method. It is concluded that the use of this new technique dramatically reduced the subjectivity of the measurement process.

Aim: In developed countries, there has been a recent increase in the prevalence of adenocarcinoma of the esophagus and cardia, along with a decrease in distal gastric cancers. Little is known regarding the prevalence of these diseases in developing countries. The aim of the present study was to evaluate changes in the prevalence of gastric adenocarcinomas in Turkey as a function of anatomic location. Methods: Data were retrospectively collected from 16 centers from January 1990 to December 2000. Owing to the exclusion criteria, a total of 4065 cases of tumors of the stomach and distal esophagus were included. Tumors localized to the body, the antrum and pyloric channel were considered distal cancers. Helicobacter pylori (H. pylori) was also detected. Results: Patients' mean age was 60.7 ± 9 years, with a male : female ratio of 68:32. The ratio of distal/proximal adenocarcinoma was 2:1 for the western part of Turkey and 3:8 for the eastern part of the country (P

Heterotopic pancreas is a congenital anomaly defined as pancreatic tissue occurring outside its normal anatomical location, lacking both anatomic and vascular connections. Ninety percent of heterotopic pancreata are found in the upper part of the gastrointestinal tract and clinical presentations show differences.We present two different cases of heterotopic pancreas. One of them was a 56-year-old man noted to have a mass in the proximal duodenum during elective cholecystectomy for cholelithiasis. The mass was excised locally and primary duodenal repair was carried out. The second case was a 41-year-old man admitted to our hospital with an intestinal obstruction caused by a jejunal heterotopic pancreas; he was operated on under emergency conditions. Both patients' postoperative periods were uneventful.Resection of the heterotopic pancreas tissue-bearing area is advisable when the condition is encountered coincidentally at surgery, and surgical exploration should be done for all symptomatic patients, particularly in the absence of a histological diagnosis.