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Celiac disease (CD) is an immune-mediated and chronic inflammatory enteropathy, triggered by the ingestion of gluten in genetically susceptible individuals. Immunoglobulin G4 (IgG4)-related diseases are a recently defined emerging clinical condition, characterized by increased serum IgG4 concentrations. The aim of this study was to investigate whether IgG4 levels correlate with the titers of intestinal antibodies and the degree of mucosal damage in CD patients.A total of 41 CD patients and 28 healthy controls were included in the study. All patients underwent a duodenal biopsy and were then diagnosed with the modified Marsh classification. Blood samples were obtained for IgG4 measurements. Serums were kept at -80 °C until the analysis was carried out and plasma IgG4 levels were determined using an enzyme-linked immune sorbent assay method with a diagnostic cutoff value of 135 mg/dl.The mean age of the CD and the control group was 26.8 ± 8.3 and 26.9 ± 6.2 years, respectively. The mean IgG4 levels were significantly higher in CD patients (283.21 ± 39.02 mg/dl) compared with the healthy control group (68.97 ± 15.89 mg/dl, P0.0001). In the CD group, 27/41 patients and in the control group, 4/28 patients had high IgG4 levels (135 mg/dl, P0.0001). A close correlation was found between the grade of mucosal damage, IgG4 levels, and antigliadin-IgA; the higher the grade Marsh score, the higher the measured IgG4 (P0.05).In our study, IgG4 levels of CD patients were higher than normal ranges whereas the results of the control group were within physiologic limits. We also showed for the first time that there was a correlation between IgG4 levels, autoantibody, and severity of mucosal damage. To the best of our knowledge, this is the first study to evaluate IgG4 levels and mucosal damage in CD patients.

Objective Fatty pancreas (FP) is related to obesity, and may have some clinical implications on glucose metabolism. The frequency and importance of FP in patients with nonalcoholic steatohepatitis (NASH) are not clear. This study aimed to investigate: the frequency of FP in patients with NASH, and its effects on serum glucose parameters. Methods FP was detected and graded by transabdominal ultrasonography (USG) in patients with biopsy-proven NASH and healthy controls. Body Mass Index and waist circumference were recorded, and serum lipids, fasting serum glucose, HbA1c, OGTT 2-h, insulin level, insulin resistance, type 2 diabetes mellitus (DM) and prediabetes rates were detected. Results Eighty-four subjects with NASH and 35 healthy controls were enrolled in the study. There was no FP in 41 (48.8%) of the NASH patients according to the study criteria. Forty-three of the NASH patients and 5 of the controls had different grades of fat in their pancreas (51.2% vs. 14%, p = 0.001). The HbA1c and OGTT 2-h results were significantly higher in NASH patients with FP compared to those without FP (p = 0.003 and p = 0.018). The rates of both prediabetes and DM were also found to be significantly increased in NASH patients with FP (p = 0.004). The mean waist circumference was higher in patients with FP (p = 0.027). Grade of FP by USG showed no effect on study parameters in subgroup analysis. Conclusion FP is common in patients with NASH and increases the rate of prediabetes and DM. The coexistence of both NASH and FP has a further impact on glucose metabolism and DM frequency.

Background A number of different therapies, including endoscopic resection, have been suggested for the treatment of Type 1 gastric neuroendocrine tumors (NETs). The current study aimed to determine the long-term efficacy of endoscopic resection for Type 1 gastric NETs. Methods Twenty-two patients (from 1999 to 2012) with Type 1 gastric NETs were included in the study. All patients were treated with endoscopic resection and received regular followed-up appointments at a tertiary referral center. Results All patients were initially diagnosed with hypergastrinemia, atrophic gastritis and intestinal metaplasia. Polyps' diameters were >1 cm in 4 patients, and between 0.5 and 1 cm in 18 patients. All detectable lesions were successfully resected. One patient required surgery due to gastric perforation during endoscopic mucosal resection. Recurrence was detected in four patients (18%) and endoscopic resection was performed again. Local or distant metastasis was not observed in any patient during follow-up. Median follow-up time was 7 years, with a maximum of 14 years. Seventeen patients (78%) completed a 5-year follow-up period, and overall disease-free survival rate was 100%. Conclusions Long-term follow-ups with 22 patients suggest that endoscopic resection of Type 1 gastric NETs is a safe and effective treatment option with a relatively low recurrence rate. J. Surg. Oncol. 2014 109:71–74. © 2013 Wiley Periodicals, Inc.

WOS: 000304396700032, PubMed ID: 22297653, Familial Mediterranean fever (FMF) is an auto-inflammatory disorder characterized by febrile attacks. Increased acute-phase reactants are characteristic during febrile attacks. Ghrelin is a natural G-protein that decreases secretion of pro-inflammatory cytokines and acts as anti-inflammatory agent. The aim of this study was to investigate whether there is any change in ghrelin levels and whether increases in ghrelin levels can be used as a marker in these patients. Thirty-seven male patients and 30 healthy men as a control group were included in the study. Blood samples were obtained for ghrelin measurements both before the attacks (pre-attack period; ghrelin 1 group) and during the attacks (ghrelin 2 group). Samples were kept at -80A degrees C until the analysis was conducted and plasma ghrelin levels were measured using an immune-sorbent assay method. Mean ghrelin levels measured during the attacks were significantly higher (11.01 +/- A 4.78 pg/ml) as compared to pre-attack levels (5.78 +/- A 2.17 pg/ml; p < 0.001). Similarly, mean ghrelin levels measured in FMF patients during an attack were significantly different from that of the control group (6.57 +/- A 4.13 pg/ml; p < 0.001). In this study, high ghrelin levels were measured during attacks in FMF patients. This finding is in line with previous results regarding the fact that inflammatory response arising during an FMF attack is an acute inflammatory event. Our findings suggest that ghrelin levels measured during FMF attacks could be used as a biochemical indicator for the FMF attack in FMF patients and that it could be used for support of the diagnosis of the disease.

Background/aims Helicobacter pylori eradication rates with standard triple regimens are worsening, and alternative treatments are urgently needed in some populations. The present study aimed to compare the efficacy of bismuth-based quadruple and concomitant regimens. Methods Consecutive Helicobacter pylori-positive patients with non-ulcer dyspepsia were randomized to receive one of two regimens: (i) bismuth subsalicylate 300 mg q.i.d., esomeprazole 40 mg b.i.d., tetracycline 500 mg q.i.d., and amoxicillin 1 g b.i.d. (bismuth group) or (ii) esomeprazole 40 mg b.i.d., tetracycline 500 mg q.i.d., amoxicillin 1 g b.i.d., and metronidazole 500 mg t.i.d. (concomitant group) for 14 days. Gastroscopy and 14C-urea breath test were performed before enrollment, and urea breath test was repeated six weeks after the treatment. Results A total of 200 patients were randomized, and 180 of them completed the protocols. The intention-to-treat and per-protocol eradication rates were 79% (95% confidence interval 71-87) and 89.7% (95% confidence interval 83-95) in the bismuth group and 74% (95% confidence interval 68-81) and 80.4% (95% confidence interval 72-87) in the concomitant group. The bismuth regimen achieved a slightly better eradication rate compared to the concomitant group in both per-protocol and intention-to-treat analysis, but results were not statistically significant (p>0.05). Ten patients (6 in bismuth, 4 in concomitant groups) dropped out of the study because of side effects. Conclusions The quadruple regimens with or without bismuth achieved moderate eradication rates as a first-line eradication option of Helicobacter pylori in our population, in which a bismuth-based regimen seems more appropriate. The compliance and side effects are important issues affecting the success of these regimens.

Galectin-3 might serve as a biomarker of human metabolic alterations. We measured serum levels of galectin-3 in patients with nonalcoholic fatty liver disease (NAFLD) and examined their association with clinical and histological phenotypes.Serum levels of galectin-3 were assayed in 71 patients with biopsy-proven NAFLD and 39 controls.Serum galectin-3 levels did not differ in patients with NAFLD (median 4.1 ng/mL; interquartile range: 1.5-5.5 ng/mL) compared with healthy controls (median 3.1 ng/mL; interquartile range: 0.8-7.5 ng/mL, P=0.93). Among patients with NAFLD, however, serum galectin-3 levels correlated significantly with BMI (r=0.267, P0.05). This association persisted after adjustment for potential confounders (β=0.30; t=2.11, P0.05).Although galectin-3 was modestly associated with BMI, our results do not support the hypothesis that levels of this molecule are altered in patients with NAFLD.

DOI: 10.4328/JCAM.191 Received: 23.01.2010 Accepted: 19.02.2010 Printed: 01.01.2011 J Clin Anal Med 2011;2(1):17-20 Corresponding Author: Guldem Kilciler, Department of Gastroenterology, Gulhane Military Medical Academy, Ankara, Turkiye. Phone:+903123041118 · E-mail: mkilciler@yahoo.com Ozet Amac Bu prospektif calismanin amaci helikobakter pilori eradikasyonunun intestinal metaplazi yada atrofik gastriti iyilestirip iyilestirmedigini degerlendirmektir. Gerec ve Yontemler Helikobakter pilori enfeksiyonu olan 42 hasta merkezimizde atrofik gastrit ve intestinal metaplazi yonunden degerlendirildi. Helikobakter pilori eradikasyonundan once ve alti ay sonra antrumdan ve korpusdan ikiser biyopsi alindi. Tedaviden 2 ve 6 ay sonra ure nefes testi ile helikobakter pilori durumuna bakildi. Atrofik gastrit ve intestinal metaplazi derecesi guncellestirilmis Sydney klasifikasyonuna gore ciddi, orta ve hafif olarak siniflandirildi. Bulgular Alti ay sonra helikobakter pilori eradike edilen grupta gastrik atrofi skoru anlamli olarak azalirken, helikobakter pilori eradike edilmeyen grupta ise anlamli bir degisiklik olmadi. Intestinal metaplazi helikobakter pilori eradike edilen ve edilmeyen grupta degismedi. Sonuc Atrofi ve intestinal metaplazinin kaybolmasinin yillar icinde olabilecegi beklendiginden eradikasyon tedavisinden sonraki pozitif etkiler uzun sureli takiplerde daha iyi gorulebilir. Bunlar bizim 6. aydaki erken sonuclarimizdir. Anahtar Kelimeler Helikobakter Pilori, Eradikasyon, Atrofik Gastrit, Intestinal Metaplazi. Abstract Aim The aim of this prospective study was to evaluate whether helicobacter pylori eradication could improve gastric atropy or intestinal metaplasia. Material and Method Forty-two pylori infected patients were evaluated for the status of atrophic gastritis and intestinal metaplasia. Two biopsy specimens from antrum and two biopsy specimens from corpus were taken before and 6 months after the helicobacter pylori eradication therapy. Helicobacter pylori status was determined by C-urea breath test 2 and 6 months after for helicobacter pylori eradication. Severity of gastric atrophy and intestinal metaplasia was classified as mild, moderate or severe according to the updated Sydney classification. Results The scoring of gastric atrophy was found significantly decreased in helicobacter pylori eradicated group after 6 months, while no significant change was found in H. pylori non-eradicated group. Intestinal metaplasia wasn’t recorded as improved in neither helicobacter pylori eradicated group nor helicobacter pylori noneradicated group. Conclusion It can be suggested that reversal of atrophy and intestinal metaplasia may occur even after several years, so the positive effect of eradication therapy might have been even better with a longer follow-up period. The results reported here are those obtained during the 6 months period.

Background/aims Because of the increasing resistance to clarithromycin and metronidazole, the most frequently used antibiotics in the first-line therapy of Helicobacter pylori eradication, new therapeutic alternatives are needed. The aim of this study was to compare the efficacy of 7- and 14-day triple therapy including lansoprazole, levofloxacin and amoxicillin for Helicobacter pylori eradication as a first-line therapy. Methods Ninety-one non-ulcer dyspeptic patients infected with Helicobacter pylori as diagnosed by both histology and a rapid urease test were included in this study. Patients were randomized to receive either 7- (Group 1; 51 patients) or 14-day (Group 2; 40 patients) therapy with lansoprazole (30 mg b.i.d.), plus levofloxacin (500 mg o.i.d.) and amoxicillin (1000 mg b.i.d.) and they were followed for six weeks. Eradication was assessed by 14C-urea breath test four weeks after completing the treatment protocols. Results In Group 1, 41 patients completed the treatment and the eradication rate was 34.15%. In group 2, 36 patients completed the treatment and the eradication rate was 72.2% (p= 0.001 vs group 1). Conclusions Triple therapy with lansoprazole, levofloxacin and amoxicillin for 14 days was effective for Helicobacter pylori eradication, but 7-day therapy with the same protocol had a lower and unacceptable cure rate and should not be used.

The goal of this study was to identify the optimal marker or marker combinations for detection of gastrointestinal malignancies using reverse-transcriptase polymerase chain (RT-PCR) reaction. To detect the presence of tumors, we analyzed mucin 1 (MUC1), cytokeratin 19 (CK19), cytokeratin 20 (CK20), and human telomerase reverse transcriptase (hTERT) mRNA in the peripheral blood of 31 patients with gastrointestinal (esophagus, stomach, and colorectal) cancer and 30 healthy individuals. In RT-PCR analysis of the peripheral blood, 77.4% (24/31), 61.29% (19/31), and 45.16% (14/31) of cancer patients were positive for MUC1, CK20, and hTERT mRNA, respectively. According to our results, any one of these mRNA markers is a predictor of the presence of gastrointestinal tumors (P < 0.001) and colorectal tumors (P < 0.05). However, they did not have predictive potential for presence of metastasis in gastrointestinal tumors. As a result, combination of these 3 tumor-specific mRNA markers would increase the detection rate and may be clinically helpful in predicting tumor presence.

Postmenopausal hormone replacement therapy (HRT) protects women from the risk of cardiovascular system disease, osteoporosis, and dementia. There are conflicting reports about the effects of HRT on insulin resistance. The purpose of this study was to investigate the effects of HRT on insulin resistance with the hyperinsulinemic euglycemic clamp technique, the most sensitive technique measuring insulin resistance. Conjugated estrogen (0.625 mg/d) and medroxyprogesterone acetate (5 mg/d) were given to 15 postmenopausal women with insulin resistance. After 3 mo of HRT, the M value (total glucose consumption) increased 28% (p0.001), low-density lipoprotein (LDL) cholesterol decreased 12.9% (p0.044), high-density lipoprotein (HDL) cholesterol increased 17% (p0.009), total cholesterol decreased 9.1% (p0.016), and serum insulin decreased 33% (p0.022) compared to baseline values before HRT was started. No significant changes in glucose, C-peptide, and triglyceride levels were observed. Whereas there were no differences regarding glucose, total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels between the insulin-resistant (n = 15) and non-insulin-resistantwomen (n = 24) (p0.05), there were significant differences in M value, insulin, and C-peptide levels between these groups (p0.05). We believe that HRT with this combination may protect postmenopausal women from coronary artery disease (CAD) through its beneficial effects on insulin resistance, hyperinsulinemia, and lipid levels, which are considered to be important factors in CAD pathogenesis.

Background/Aims: Cancer is a consequence of the disruption of cellular regulation. Epigenetic is one of the reasons of this disruption. Epigenetic factors play a role in the carcinogenesis by affecting proto-oncogenes and tu mor suppressor genes and it is one of the most popular research areas in recent years. DNA methylation, which is an epigenetic mechanism, occurs in the early stages of tumorigenesis. Promoter methylation which causes the silence of tumor suppressor genes have been studied extensively in various tumor types. The aim of this study was to investigate promoter methylation of certain tumor suppressor genes, Cyclin-dependent kinase inhibitor 2A (p16) and Adenomatous polyposis coli (APC), which take part in gastrointestinal tumorigenesis. Materials and Methods: To detect the promoter methylation of p16 and APC genes, tissue samples from 20 gastrointestinal cancer patients and peripheral blood samples from 15 healthy individuals were collected for Methylation-Specific Polymerase Chain Reaction (MSP) analysis. Results: According to the statistical analysis, in tumor tissue, positive methylation ratio of p16 and APC genes was found respectively 30% (6/20) and 50% (10/20). The difference of promoter methylation of these genes between tumor tissues and control group was significantly observed (p=0.02 and 0.001, respectively). An alteration of pro moter methylation of APC gene according to tumor localization was found (p=0.007), but there was no significant difference observed in p16. Conclusion: In our study, promoter methylation which was considered to be occurred as an early event in gastrointestinal carcinogenesis was observed in p16 and APC genes.

Acute pancreatitis is a paranchymal inflamatory disease of the pancreas. According to the clinical presentation, pancreatitis is divided into two groups; mild (edematous) and severe (necrotizing) pancreatitis. Gall stones and alcohol use are the most common etiologic reasons. Hypertriglyceridemia is a rare etiological factor in non-biliary pancreatitis. Serum amylase levels may be at normal ranges in acute pancreatitis due to hypertriglyceridemia. Radiological screening and serum lipase levels are helpful for diagnosis. Herein we present a case of acute pancreatitis secondary to hypertriglyceridemia with normal amylase values., ÖzetAkut pankreatit, pankreas parankiminin inflamatuvar bir hastalığıdır. Klinik prezentasyona göre hafif (ödematöz) ve şiddetli (nekrotizan) pankreatit olarak iki gruba ayrılmaktadır. En sık etyolojik nedenler safra taşı ve alkoldür. Hipertrigliseridemi, akut non-biliyer pankreatitte nadir görülen bir etyolojik faktördür. Hipertrigliseridemiye bağlı oluşan akut pankreatit tablosunda amilaz normal seviyede saptanabilir Görüntüleme tetkikleri ve serum lipaz düzeyi tanıda yardımcıdır. Biz burada hipertrigliseridemiye sekonder olarak gelişen ve amilaz değeri normal olan akut pankreatit olgusunu sunuyoruz.

Introduction.Ingestion of corrosive substances may lead to stricture formation in esophagus as a late complication. Full thickness injury seems to exterminate tissue stem cells of esophagus. Mesenchymal stem cells (MSCs) can differentiate into specific cell lineages and have the capacity of homing in sites of injury.Aim and Methods.We aimed to investigate the efficacy of MSC transplantation, on prevention of esophageal damage and stricture formation after caustic esophagus injury in rats. 54 rats were allocated into four groups; 4 rats were sacrificed for MSC production. Group 1, untreated controls (n: 10). Group 2, membrane labeled MSCs-treated rats (n: 20). Group 3, biodistribution of fluorodeoxyglucose labeled MSCs via positron emission tomography (PET) imaging (n: 10). Group 4, sham operated (n: 10). Standard caustic esophageal burns were created and MSCs were transplanted 24 hours after. All rats were sacrificed at the 21st days.Results.PET scan images revealed the homing behavior of MSCs to the injury site. The histopathology damage score was not significantly different from controls. However, we demonstrated Dil labeled epithelial and muscle cells which were originating from transplanted MSCs.Conclusion.MSC transplantation after caustic esophageal injury may be a helpful treatment modality; however, probably repeated infusions are needed.

A number of different therapies, including endoscopic resection, have been suggested for the treatment of Type 1 gastric neuroendocrine tumors (NETs). The current study aimed to determine the long-term efficacy of endoscopic resection for Type 1 gastric NETs.Twenty-two patients (from 1999 to 2012) with Type 1 gastric NETs were included in the study. All patients were treated with endoscopic resection and received regular followed-up appointments at a tertiary referral center.All patients were initially diagnosed with hypergastrinemia, atrophic gastritis and intestinal metaplasia. Polyps' diameters were1 cm in 4 patients, and between 0.5 and 1 cm in 18 patients. All detectable lesions were successfully resected. One patient required surgery due to gastric perforation during endoscopic mucosal resection. Recurrence was detected in four patients (18%) and endoscopic resection was performed again. Local or distant metastasis was not observed in any patient during follow-up. Median follow-up time was 7 years, with a maximum of 14 years. Seventeen patients (78%) completed a 5-year follow-up period, and overall disease-free survival rate was 100%.Long-term follow-ups with 22 patients suggest that endoscopic resection of Type 1 gastric NETs is a safe and effective treatment option with a relatively low recurrence rate.

WOS: 000310319900011, PubMed ID: 23067136, Background Eradication rates of Helicobacter pylori with standard triple therapy are not satisfactory. Sequential therapy is an alternative method to overcome this problem. Objectives The aim of this study was to assess efficacy of a modified sequential therapy with the addition of a bismuth preparation, as first-line treatment in the eradication of H. pylori infection. Materials and Methods One hundred and forty-two H. pylori-positive patients were included in the study. Patients were given a 14-day sequential therapy program consisting of pantoprazole, 40 mg (b.i.d. for 14 days); colloidal bismuth subcitrate, 300 mg 4 (two tablets before breakfast and dinner, for 14 days); amoxicillin, 1 g (b.i.d.for the first 7 days); tetracycline, 500 mg (q.i.d. for the second 7 days); and metronidazole, 500 mg (t.i.d. for the second 7 days). Eradication was tested by urea breath test (UBT) 6 weeks after completion of treatment. Results Of the 142 patients included, 131 completed the study. Per-protocol and intention-to-treat analyses revealed high eradication rates in this group (92.095% CI, 87.296.8%, and 81.095% CI, 74.587.4%, respectively). There was no relation to sex and age with this modified sequential therapy. Compliance was satisfactory (11 patients four women and seven men were unavailable for follow-up), and side effects were minimal (six patients had to stop treatment metronidazole-related facial swelling and numbness on the face and hands in two patients; tetracycline-related fever and epigastric pain and nausea and vomiting in two patients; and amoxicillin-related diarrhea and vaginal discharge in two patients). These side effects were reversible and resolved after the cessation of the related medication. Conclusions This 14-day modified sequential treatment, including bismuth, achieves a significantly high eradication rates in patients with H. pylori infection, with five satisfactory patient compliance and minor side effects.

Background:Elevated progranulin levels are associated with visceral obesity, elevated plasma glucose, and dyslipidemia. Progranulin has not been previously investigated as a biomarker of nonalcoholic fatty liver disease (NAFLD). We sought to determine whether serum progranulin levels are altered in patients with biopsy-proven NAFLD and if they are associated with their clinical, biochemical, and histological characteristics.Subjects and methods:We measured serum progranulin levels in 95 patients with biopsy-proven NAFLD and 80 age- and sex-matched controls. The potential associations between progranulin and the characteristics of NAFLD patients were examined by multiple linear regression analysis.Results:Serum progranulin levels were significantly higher in NAFLD patients (34 ± 13 ng/mL) than in controls (28 ± 7 ng/mL,P< 0.001). In NAFLD patients, serum progranulin levels were associated with lipid levels and the degree of hepatic fibrosis. After adjustment for potential confounders, serum progranulin remained an independent predictor of the degree of hepatic fibrosis in NAFLD patients (β= 0.392;t=2.226,P< 0.01).Conclusions:Compared with controls, NAFLD patients have higher serum progranulin concentrations, which are closely associated with lipid values and the extent of hepatic fibrosis.

Helicobacter pylori eradication rates have tended to decrease recently, mostly due to antibiotic resistance. In the present study, our aim was to determine Hp eradication rate with the LAC plus tid metronidazole regimen and the secondary objective of this study was to identify an effective regimen for our population.Eighty-four Hp-positive patients with non-ulcer dyspepsia were assigned into the same group. Patients were administered the classical LAC protocole (lansoprazole 30 mg bid, amoxicillin 1 g bid and claritromycin 500 mg bid for 14 days) plus metronidazole 500 mg tid for 14 days. Gastroscopy and histopathological assessment were performed before enrollment and C(14) urea breath test and stool antigen test were performed 6 weeks after treatment.All 84 patients completed the study. No patient left the study because of drug side effect. Total eradication rate was 75% (63/84).Although LAC plus tid metronidazole regimen achieved a much better eradication rate compared with the standard LAC regimen; this is the first study that has a relatively low success with a concomitant therapy. So in areas of high resistance like Turkey, one cannot expect a high success with any clarithromycin containing regimen and those should be avoided.

There is an important concern about the success of standard triple treatment for Helicobacter pylori (H. pylori) in recent years. Better eradication rates have been reported with sequential treatment in current studies. This study aimed to compare the success of a novel levofloxacin-containing sequential regimen with standard triple therapy.H. pylori-positive patients with non-ulcer dyspepsia were randomly allocated to one of the study groups. The patients on sequential arm were given esomeprazole 40 mg BID and amoxicillin 1g BID for the first week followed by esomeprazole 40 mg BID, levofloxacin 500 mg QD and metronidazole 500 mg TID for the second week. The patients on standard triple arm were given esomeprazole 40 mg BID, amoxicillin 1g BID and clarithromycin 500 mg BID for 2 weeks. Eradication was assessed by urea breath test on 6th weeks.Seventy-five patients were enrolled in each group; 72 in sequential arm and 67 in standard arm completed the protocols. H. pylori eradication rate of per protocol was 90% in sequential versus 57% in standard treatment groups with a statistical significance (p0.000). Both regimens were similarly well tolerated and side effects were comparable. Only one patient in sequential arm stopped the treatment because of side effects.The levofloxacin-containing sequential therapy is a significantly better strategy than the standard triple treatment for H. pylori eradication. Standard triple treatment is no more effective for H. pylori in our population and levofloxacin-containing sequential regimen might be used as a first-line eradication option.

Although Helicobacter pylori (H. pylori) has been identified in heterotopic gastric mucosa of Meckel’s diverticulum, controversial results are reported in the pertinent literature. The aim of this study was to evaluate for the presence of H. pylori histologically using hematoxylin–eosin and Toluidine Blue in Meckel’s diverticulum and by real-time TaqMan polymerase chain reaction (PCR) in those with heterotopic gastric mucosa. The study included 21 consecutive patients who had undergone resection of Meckel’s diverticulum at our hospital between 1995 and 2007. The paraffin-embedded tissues were retrieved and reviewed for the presence of histological abnormalities and H. pylori-like organisms and for the presence or absence of heterotopic mucosa. H. pylori was sought in those cases that contained heterotopic gastric mucosa using real-time TaqMan PCR to amplify a fragment of the 23S ribosomal RNA (rRNA) gene of H. pylori. Upon histological examination, heterotopic gastric mucosa was found to be present in 12 cases. H. pylori was not identified in any of the sections examined. A genomic PCR product was also not obtained in real-time PCR study. We have confirmed that colonization of H. pylori, if it occurs at all, is exceedingly rare in heterotopic gastric mucosa of Meckel’s diverticulum.

Introduction and Aim: Duodenal eosinophilia has been previously described in subsets of patients with functional dyspepsia1 (FD), non-celiac wheat sensitivity2 and celiac disease (CD)3. CD has varied clinical presentations, including symptoms of functional gastrointestinal disorders (FGIDs), FD and irritable bowel syndrome (IBS). We aimed to determine if duodenal eosinophilia is present in patients with CD presenting with dyspepsia. Methods: The celiac study population comprised 61 patients, 44 female, mean age 42, (range 17-74) years with a new presentation of subsequent biopsy proven coeliac disease to a single centre from 2003-13. A standard symptom questionnaire was documented for all patients. The control population (53 adults) presenting for endoscopy with no CD was drawn from the same centre with similar demographics for age and gender1. Duodenal biopsies from both groups were assessed for eosinophil counts/ mm2. Results: In patients with coeliac disease 37/61 (60%) had symptoms of a FGID, 9 FD, 17 IBS, 11 overlap FD and IBS. 15 (71% of FD) had early satiety (ES) symptoms, 19 with reflux symptoms. In controls 33/53 (64%) had symptoms of FD, 17 (51%) with ES, 21 IBS. Early satiety was an equally common presentation in celiac and control patients. IBS was more common in celiac patients (p= 0.01). See Table. Compared to a similar population from the same hospital, duodenal eosinophils are significantly raised in CD compared to a group without coeliac disease attending for endoscopy, mean 45/mm2 vs 65/mm2 p=0.005. Eosinophil counts were similar in control patients with symptoms of dyspepsia (mean 50/ mm2) and early satiety (ES) (mean 55/ mm2), compared to those with CD and dyspepsia (mean 47/ mm2), p=0.80 and CD and ES (mean 56/ mm2), p=0.87. In controls with no dyspepsia eosinophil counts were significantly lower (mean 40/ mm2) than those with CD and no dyspepsia (mean 70/ mm2), p=0.005. See Figure. Among control patients, 3 reported food allergies, 2 with ES all 3 with D2 eosinophilia. Conclusions: Duodenal eosinophilia in coeliac patients with dyspepsia and ES is of a similar level to patients without CD with FD and ES. As duodenal eosinophilia is described in non-celiac wheat sensitivity it is possible that eosinophils are a sign of wheat intolerance and suggests a wheat free diet may benefit certain FD patients if duodenal eosinophilia is present.

Afghanistan is one of the endemic regions of chloroquine resistant P. falciparum. Mefloquine and doxycycline are among the recommended prophylactic regimes. The aim of the study was to compare the efficacy and tolerability of the two regimes on the Turkish soldiers settled in Kabul, Afghanistan.A total number of 1400 soldiers were subjected to prophylactic regimes with either doxycycline 100 mg/day (n=986) or mefloquine 250 mg/week (n=414). Prophylaxis lasted about 12 weeks. The side effects and compliances were investigated by questionnaires. All soldiers were monitored up to 6 months after returning home.No malaria case was observed and there was no severe side effect in either group. The total side effects in doxycycline group were significantly higher (P0.001). The compliance of mefloquine takers was better than the doxycycline takers (P0.05).The tolerability of the mefloquine regime is better than the doxycycline regime in malaria prophylaxis.

Gardner Syndrome is a rare multi systemic, autosomal dominant inherited disorder characterized with poliposis, skin and soft tissue tumors. In this syndrome, if prophylactic total colectomy is not performed, malignant neoplasms may develop nearly in all patients. Half of the osteomas occur in head region. Gardner syndrome must be investigated in patients with three or more osteomas. Skin findings include epidermoid cyst, fibroid, lipoma, leiomyoma ve desmoid tumors. We present a case of a 21-year-old patient with polyposis coli and osteoma, which admitted to our hospital with abdominal pain and diarrhea.

Munchausen syndrome is a serious psychiatric factitious disorder, or mental illness, wherein sufferers feign disease, illness, or psychological trauma in order to draw attention or sympathy to themselves. In this attention-seeking syndrome associated with severe emotional difficulties, affected person repeatedly acts as if he or she has a physical or mental disorder when, in truth, he or she has caused the symptoms. The atypical manifestations of Munchausen syndrome represent a broad spectrum of clinical findings and features. It may be very difficult, labor intensive, expensive and time consuming to establish the accurate diagnosis. Herein, we report of a 28-year-old patient with coagulation disorder caused by self-inflicted warfarin use admitting repeatedly to many different hospitals with abdominal pain. Thorough psychiatric assessment and workup to shed light on the challenging clinical situation revealed the diagnosis of Munchausen syndrome for this patient.

To the Editor, Primary neoplasm of the small bowel is very rare. This constitutes 7–8 % of all tumours of gastrointestinal tract and only 1 % of the malignant ones [1]. Adenocarcinoma is the most common histolopathologic subtype of carcinoma of the small bowel [2]. Adenocarcinoma risk increases with progressing age. Adults older than 65 years demonstrate an increased prevalence of small bowel carcinoma. Herein, we report of an unusual and rare case with jejunal adenocancer. A 66-year-old man was presented to the gastroenterology outpatient clinic for iron deficiency anemia symptoms such as weakness, fatigue, and palpitation. His physical examination did not show any pathologic signs. Laboratory analysis showed hemoglobin: 10 g/dL, ferritin: 0.9 (22–322) ng/dL, iron: 24 (53–167) mcg/dL, total iron binding capacity: 418 (155–300) lg/dL and normal electrolyte panel values. Abdominal ultrasound was normal. Performed esophagogastroduodenoscopy and colonoscopy revealed no pathology. Capsule endoscopy confirmed jejunal ulcer. Double balloon enteroscopy demonstrated this lesion which causes narrowness of the lumen of the jejunum and endoscopic biopsy was performed. Histopathological examination confirmed the presence of adenocarcinoma. Computerized tomography scan of the abdomen with intravenous and oral contrast showed no pathology. Surgical resection was performed. After 3 months, whole body positron emission tomography scan was normal. Small intestine adenocancer is a rare tumor and to our knowledge a barely published elderly cases in the literature. Because small intestine is relatively unattainable with routine endoscopy, most of the patients are diagnosed in advanced stage. A precise and early diagnosis is crucial. This is the most important prognostic factor for curative radical surgery [3]. Consequently, when a small bowel neoplasm is doubted, capsule endoscopy and double balloon enteroscopy are the most useful techniques [4].