Objectives: Increased intestinal permeability is an important cause of serious complications in cirrhotic.In addition, intestinal permeability can promote impaired liver functions.Zonulin, well-known intestinal permeability marker, has never studied sufficiently before in cirrhotic as a potential marker of increased intestinal permeability.Materials and Methods: This is a cross-sectional study.Forty-one cirrhotic patients (11 patients in compensated phase and 30 patients in decompensated phase) were enrolled into the study.Meanwhile forty-one healthy controls were also enrolled.Zonulin was assessed by enzymelinked immunosorbent assay technique.Results: Zonulin levels was not significantly different between patients with cirrhotic and healthy individuals; however lower levels was observed in cirrhotic (p=0.068).In patients with cirrhotic, zonulin level was significantly different between child-pugh A and child-pugh B (p=0.05).Also zonulin was significantly lower in child-pugh C compared to child-pugh-A and child-pugh-B (p=0.011 and p=0.026, respectively).In all patients with cirrhotic, MELD score was positively correlated with zonulin levels (p=0.001,R=0.358). Conclusion:This study reveals that serum zonulin levels were decreased, especially in decompensated phase in cirrhotic compared to healthy individuals.It is possible to speculate that zonulin is not a causal factor for intestinal permeability in cirrhotic, instead of this, its synthesis effects negatively in cirrhotic situation.

Liver fibrosis is the most important factor in the prognosis and treatment plan of patients with chronic hepatitis B (CHB). Aspartate aminotransferase (AST)-to-platelet ratio index (APRI), fibrosis index based on 4 factors (FIB-4), and fibrosis index based on 5 factors (FIB-5) scores are noninvasive fibrosis markers, and previous comparative studies have shown that they are as effective as liver biopsy in detecting liver fibrosis in different liver diseases. The aim of our study is to investigate whether existing scoring systems are effective in demonstrating fibrosis in CHB patients and to compare the APRI, FIB 4, and FIB 5 scores in differentiating early and advanced fibrosis in 123 patients who underwent liver biopsy for CHB infection. APRI, FIB-4, and FIB-5 scores of patients who underwent liver biopsy due to CHB were calculated by means of calculators and recorded to be compared with liver biopsies in terms of fibrosis scoring. One hundred twenty-three patients who underwent liver biopsy due to chronic hepatitis B were included in the study. APRI (area under the receiver-operating characteristic [ROC] curve 0.728), FIB-4 (area under the ROC curve 0.693) and FIB-5 (area under the ROC curve 0.643) scores were evaluated as significant predictors of advanced fibrosis. The scoring system with the highest positive and negative predictive value was evaluated as FIB-4. APRI, FIB-4, and FIB-5 scoring systems are appropriate scoring systems in the assessment of advanced fibrosis in patients with CHB. Our study is the first to compare APRI, FIB-4, and FIB-5 values in CHB patients, and more comprehensive studies are needed.

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İntestinal tüberkülozis, gastrointestinal sistemin tüberküloz basili ile enfekte olma halidir. En sık tutulan bölge ileoçekal alandır. Tutulum yerlerinin benzer olması Crohn hastalığı ile dikkatli bir şekilde ayırıcı tanısının yapılmasını gerektirir. İntestinal tüberküloz klinikte sıklıkla non-spesifik şikayetlerle kendini belli eder. Kanama bu hastalarda sıklıkla kronik seyirlidir. Masif kanama literatürde çok nadir olarak bildirilmiştir. Biz burada cerrahi barsak rezeksiyonu ile hemostazın sağlanabildiği intestinal tüberkülozlu hastamızı sunduk. ,

Intestinal MALT lymphoma is a very rare neoplasm and there is limited data about clinical and pathological characteristics. They can become visible in a very short time. A 47-year-old woman was referred to our department because of epigastric pain. Gastroduodenoscopy revealed an irregular mucosal nodular lesion with ulceration extending from the bulb to the second portion of the duodenum. Endoscopic findings were normal about one year ago.

Objective: To measure anterior and posterior segmental ocular parameters in patients with celiac disease using swept-source optical coherence tomography and compare with those of healthy subjects.Method: Fourteen patients with celiac disease referred from the gastroenterology clinic and 14 control subjects selected from the individuals with minor complaints who admitted the ophthalmology outpatient clinic were included in the study.Mean and segmental retinal nerve fiber layer thickness in four quadrant, average and sectoral ganglion cell inner plexiform layer thickness in six quadrant, foveal and parafoveal vessel density in four quadrant, optic nerve head parameters, including rim area, disc area, horizontal cup-to-disc ratio, vertical cup-to-disc ratio, cup volume, and additionally superficial/deep foveal avascular zone areas, choroidal thickness, and central corneal thickness of patients and controls were quantified using swept-source optical coherence tomography.Results: Among all the measurements, retinal nerve fiber layer in nasal quadrant and subfoveal choroid of patients were significantly thicker than those of controls.Nasal quadrant retinal nerve fiber layer thickness for patients and controls were 91.62±15.27µm and 79.93±10.43µm, respectively (P=0.02).Choroidal thickness was 377.69±50.77µm for patients and 310.93±95.13µm for controls (P=0.03).Conclusions: Even though celiac disease is primarily a disease of small intestine, this study demonstrated that the disorder can affect the eye as an extra intestinal involvement.

Introduction Gastric cancer is ranked fourth among all cancers in the world and second in cancer-related deaths. Gastritis leads to the activation of neutrophils, lymphocytes, macrophages, and platelets. Long-term inflammation leads to multistage histopathologic changes called Correa tract, which includes gastritis, atrophy, intestinal metaplasia (IM), dysplasia, and cancer stages. Aim To determine if there is any difference in haematological parameters between gastric cancer (GC) patients, patients with IM, and healthy controls (HC). Material and methods Seventy-three GC patients, 79 patients with IM, and 70 HCs were included in the study. Demographics and laboratory parameters of complete blood count were extracted from the hospital medical database records. Results The mean Hb levels were statistically significant between all three groups. Mean red cell distribution width (RDW), white blood cells (WBC), mean platelet volume (MPV), platelet distribution width (PDW), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and monocyte-to-lymphocyte (MLR) levels were statistically significantly different between gastric cancer and healthy controls. Mean RDW, MPV, and PDW levels were statistically significantly different between the IM and healthy control groups. Mean WBC, NLR, PLR, and MLR levels were statistically significantly different between the gastric cancer and IM groups. Conclusions RDW, platelet count, NLR, MLR, and PLR have diagnostic value and can help to distinguish patients with GC from those with IM. These parameters are accessible easily, the cost is not high, and it may help patients not to delay endoscopic screening.

OBJECTIVE:Recent studies have demonstrated that angiogenesis is impaired in patients with celiac disease (CD). In this study, we evaluated the levels of the novel antiangiogenic factor pigment epithelium-derived factor (PEDF) in CD patients.METHODS:Eighty-four patients were included in the study; 71 patients with CD and 13 healthy controls. In the CD patient cohort, there were 21 newly diagnosed patients, 19 with adherence to a gluten-free diet and 31 practicing no adherence to this diet. The PEDF levels were measured using enzyme-linked immunosorbent assays.RESULTS:The data revealed that celiac patients had higher levels of PEDF than did healthy controls. PEDF levels were not significantly different among the three CD groups. Additionally, the PEDF levels were not correlated with tissue transglutaminase IgA or IgG.CONCLUSIONS:Our data indicate that PEDF levels are significantly higher in CD patients than those in the healthy controls. This result suggests that PEDF negatively affects angiogenesis in CD. Although we did not observe any differences of PEDF levels among celiac patients, additional studies including more patients could clarify this issue.

Letter to the Editor common in patients with hepatic steatosis [4,5].Inflammation plays an essential role in the pathogenesis of both celiac disease and hepatic steatosis, and high levels of PEDF determined in both diseases suggest that they occur on a common background.Based on this information, when a patient with high levels of PEDF is diagnosed with celiac disease, further investigations should be performed for the presence of hepatic steatosis.On the contrary, we also suggest that celiac disease should be considered as a priority in patients diagnosed with hepatic steatosis and having high levels of PEDF, in addition to growth retardation and gastrointestinal symptoms.

Introduction: Interleukin-35 (IL-35) is a newly defined potent anti-inflammatory cytokine that is predominantly produced by regulatory T cells, and pentraxin-3 belongs to the acute-phase proteins. Aim: To measure the serum IL-35 and pentraxin-3 levels in the early phase of mild acute pancreatitis (AP). Material and methods: Eighty-three patients with mild AP and 30 healthy controls were included in the study. The serum levels of IL-35 and pentraxin-3 were measured by enzyme-linked immunosorbent assay upon admission and at the 48th hour after diagnosis. Results: The mean value of serum IL-35 levels in patients with mild acute pancreatitis at admission was 5.91 ng/ml (4.21-7.90) and was significantly lower than those in healthy controls (25.53 ng/ml (12.79-54.73, p < 0.001)) and 48-hour value were (6.79 ng/ml (4.42-9.62) (p = 0.015)). The mean value of serum pentraxin-3 levels in patients at the time of admission was 6.75 ng/ml (4.42-9.62) and there was no significant difference from healthy controls, at 7.64 ng/ml (6.58-8.62, p > 0.05). Also there was no significant difference between the mean value at admission and the mean value at 48-hour, 6.75 ng/ml (4.74-9.06, p > 0.05). Conclusions: Interleukin-35 can be used in diagnosis and follow-up in patients with mild AP.

Objectives: Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure with well-known efficacy and safety that is frequently used in patients who cannot be fed orally.In the literature, studies investigating long-term follow-up results in patients undergoing PEG are limited.In this study, we aimed to determine the long-term follow-up results and the factors affecting mortality in patients undergoing PEG.Materials and Methods: Two hundred and three patients who underwent PEG placement between January 2013 and June 2018 were evaluated retrospectively.The demographic characteristics of the patients, postoperative follow-up times, complications, PEG indications, laboratory parameters during the procedure were recorded from the patient files.During the follow-up period, the mortality and time of the patients were determined via the death notification system.Results: A total of 203 patients (101 male, 102 female) were included in the study.The median age of the patients was 77 years (18-96).The most frequent PEG placement indication was stroke with a frequency of 34%, followed by dementia (28.6%), malignancy (10.8%) and other (15.8%)reasons.The median follow-up period was 33.6 months (30.5-36.7)and the median survival was 22 months [95% confidence interval (CI): 22.8-30.5].Mortality rates were 1.5% in the first month, 3% in 3 months, 12.3% in 1 year, 26.6 years in 2 years, 34.5% in 3 years and 44.3% in 5 years.There was no correlation between PEG indications and mortality, but there was a statistically significant correlation between hyponatremia and mortality (Odds ratio: 1.07, p=0.027, %95 CI).Conclusion: There was no statistically significant relationship between PEG placement indications and mortality, but there was a statistically significant correlation between hyponatremia and mortality.

Objective: To measure some ocular parameters in inflammatory bowel disease and evaluate whether there are any differences between the measurements obtained from the patients and healthy subjects. Methods: Thirteen patients with inflammatory bowel disease referred from the gastroenteroloji clinic and 14 control subjects selected from the individuals with minor complaints who admitted the ophthalmology outpatient clinic were included in the study. Average and segmental retinal nerve fiber layer thickness in four quadrant, average and sectoral ganglion cell inner plexiform layer thickness in in six guadrant, foveal and parafoveal vessel density in four quadrant, optic nerve head parameters, including rim area, disc area, horizontal cup-to-disc ratio, vertical cup-to-disc ratio, cup volume and additionally superficial/deep foveal avascular zone areas, choroid thickness, and central corneal thickness of the patients and controls were quantified using the swept-source optical coherence tomography. Results: All measurements taken from the patients with inflammatory bowel disease and controls showed a great similarity and did not differ statistically. Conclusion: Even though several inflammatory systemic diseases affect the eye and alter the particular structures, this study revealed that inflammatory bowel disease has no inluence on neural and vascular layers of the eye.

Thymic stromal lymphopoietin (TSLP) is a cytokine produced by epithelial cells in the lungs, skin, and intestinal mucosa and is involved in several physiological and pathological processes. In this study, we evaluated serum TSLP levels in patients with celiac disease (CD). The prospective study was conducted at a gastroenterology outpatient clinic between March 2018 and August 2018. Eighty-nine participants aged between 18 and 75 years were classified into following groups: 22 patients with newly diagnosed CD; 20 patients with CD who were compliant with a gluten-free diet (GFD); 32 patients with CD who were not compliant with a GFD; and 15 healthy controls. Demographic characteristics, disease duration, and selected biochemical and hematologic parameters were recorded and compared between groups. Median serum TSLP levels were 1193.65 pg/mL (range: 480.1-1547.1) in newly diagnosed CD patients, 110.25 pg/mL (range: 60.3-216.7) in CD patients who were compliant with a GFD, 113.1 pg/mL (range: 76.3-303.4) in CD patients who were not compliant with a GFD, and 57 pg/mL (range: 49-67.8) in healthy controls. Overall, there was a significant difference in serum TSLP levels between groups (p = 0.001). Patients with newly diagnosed CD had the highest serum TSLP levels. There was no significant difference in serum TSLP levels between patients with CD who were and were not compliant with a GFD. TSLP appears to be involved in the pathogenesis of CD. Further studies are required to determine if the TSLP signaling pathway can be used in the treatment of CD.

Giriş ve Amaç: Linitis plastika, diffüz infiltratif mide kanseri olup kötü prognoza sahiptir. Endoskopik olarak spesifik bir bulgusu olmadığı için tanınması güçtür. Endoskopik olarak şüphe edilse bile biyopsi ile tanı koymak da zor olabilir. Biz burada kliniğimizde linitis plastika tanısı konulan olgularımızı endoskopik özellikleri ile beraber paylaştık. Gereç ve Yöntem: Bu çalışma retrospektif olarak Keçiören Eğitim ve Araştırma Hastanesi, Gastroenteroloji Kliniğinde 2009-2019 tarihleri arasında yürütülmüştür. Endoskopilerinde linitis plastika ön tanısı olan olgular bu tarihler arasında toplanmıştır. Bulgular: Toplam 28 hastadan linitis plastika ön tanısı ile biyopsi alınmış, bu olguların 5 tanesinde linitis plastika tanısı konulmuştur. Linitis plastika olan olguların hepsinde endoskopik olarak mide ekspansiyonunda kısıtlılık, gastrik foldlarda belirginleşme, mukozal erozyon ve ülserler vardı. Sonuç: Linitis plastik için belirtilmiş tipik bir endoskopik bulgu olmayıp mide ekspansiyonunda kısıtlılık ve gastrik foldlarda belirginleşme olan olgularda klinik şüphenin yüksek olması gerekir. İlk biyopsilerde linitis plastika tanısının konulmaması da sürpriz olmamalıdır.

The purpose of this study is to evaluate serum levels of vascular endothelial growth factor (VEGF), pigment epithelium–derived factor (PEDF), tumor necrosis factor alpha (TNF-α), and progranulin in patients with gastric cancer (GC) and precancerous lesions (PCL) and to determine the usefulness of these markers as diagnostic biomarkers in these diseases. A total of 32 GC patients, 35 PCL patients, and 23 healthy controls participated in the study. The serum levels of VEGF, PEDF, TNF-α, and progranulin were measured by enzyme-linked immunosorbent assay (ELISA). The mean serum VEGF levels were 30.6 ± 12.98 pg/mL in GC, 18.2 ± 5.72 pg/mL in PCL, and 17.5 ± 5.59 pg/mL in controls. GC VEGF levels were significantly higher than both PCL and control groups (p < 0.001). The mean serum PEDF levels were 1516.1 ± 993.8 pg/mL in GC, 1039.1 ± 1002.3 pg/mL in PCL, and 767.5 ± 661.5 pg/mL in controls. The serum PEDF level in the GC group was significantly higher than that in both PCL and control groups (p = 0.004 and p = 0.038, respectively). The mean serum TNF-α levels were 46.7 ± 14.82 pg/mL in GC, 38.4 ± 11.89 pg/mL in PCL, and 33.8 ± 12.77 pg/mL in controls. There was a significant difference between GC and controls (p = 0.022) in TNF-α levels. The mean serum progranulin levels in GC were 2496.6 ± 737.8 pg/mL, 2332.0 ± 482.1 pg/mL in PCL, and 1288.7 ± 830.9 pg/mL in controls. Progranulin levels in both GC and PCL groups were significantly higher than that in the control group (p < 0.001 for both). There were significant differences among patients with GC and PCL and healthy controls in terms of serum VEGF, PEDF, TNF-α, and progranulin levels.

INTRODUCTION:Progranulin is a novel growth factor that has several physiological and pathological roles such as cell growth, tumourigenesis, embryogenesis, wound healing, and inflammation.AIM:To compare the pre-treatment and post-treatment serum levels of the angiogenic factor vascular endothelial growth factor (VEGF), pro-inflammatory cytokine tumor necrosis factor α (TNF-α), and progranulin in peptic ulcer (PU) patients with a healthy control group.MATERIAL AND METHODS:Serum VEGF, TNF-α, and progranulin levels were studied with ELISA in 42 PU patients (antral ulcer (AU): 22, duodenal ulcer (DU): 20) and 15 healthy controls.RESULTS:The serum progranulin levels before treatment were 4237.35 ±1091.30 pg/ml in the patients with AU, 4682.64 ±1501.46 pg/ml in the patients with DU, 3055.66 ±626.88 pg/ml in the control group, and 4460 ±1315 pg/ml in the ulcer (AU and DU) group. The serum progranulin levels were 3607.7 ±869.4 pg/ml in the AU group, 4286.5 ±1208.78 pg/ml in the DU group, and 3947.1 ±1094.64 pg/ml in the ulcer group after the treatment. When comparing pre-treatment serum progranulin levels of the AU group, DU group, and ulcer group with the control group there were statistically significant differences (p < 0.001, p < 0.0001, p < 0.0001, respectively).CONCLUSIONS:The disappearance of the difference in terms of post-treatment serum levels of progranulin between the AU group and the control group suggests that serum levels of progranulin can be used as a biomarker of gastric ulcer healing.

Giriş ve Amaç: Kolorektal kanserli hastalarımızın demografik özelliklerini ve tanı anındaki endoskopik özelliklerinin kolorektal kanserin patolojik özellikleri ile olan ilişkisini incelemeyi hedefledik. Gereç ve Yöntem: Hastanemiz Endoskopi Ünitesinde Ocak 2010-Ekim 2017 tarihleri arasında kolonoskopi esnasında kolorektal kanser ön tanısı ile biyopsi alınan ve patolojileri kolorektal kanser gelen hastalar çalışmaya dahil edildi. Tümöre bağlı lüminal obstrüksiyon, tümörün makroskopik özellikleri gibi endoskopik özellikler ve kolorektal kanserin patolojik özellikleri retrospektif olarak incelendi. Bulgular: Çalışmamıza 168 hasta dahil edildi. Hastaların en sık başvuru şikayeti kabızlık olup kolonda kanserin en sık izlendiği yer sigmoid kolondu. Hematokezya sol kolon yerleşimli kanserlerde diğer bölgelerdekine göre anlamlı olarak daha sık izlendi (p=0.02). Cinsiyetler arasında başvuru şekli, kanser lokalizasyonu ve endoskopik obstrüksiyon farklılık göstermedi. Endoskopik obstrüksiyonu olan hastalarda kolorektal kanserin kötü diferansiasyonu anlamlı olarak daha fazlaydı (p=0.015). Sonuç: Endoskopun geçemeyeceği şekilde lüminal obstrüksiyonu olan hastaların yakından izlenmeleri, ameliyatlarının geciktirilmeden yapılması ve ameliyat sonrası daha kısa aralıklarla takibi bu hastaların sağkalımları üzerine etkili olabilir.

Giriş ve Amaç: Mide mukozasındaki Helicobacter pylori yoğunluğu, inflamasyonun aktivite derecesi, gastrit şiddeti ile eradikayon başarısı arasındaki ilişkiyi gösteren çalışma sayısı sınırlıdır. Biz çalışmamamızda; Helicobacter pylori eradikasyon başarısı üzerine gastrit şiddetinin ve Sidney klasifikasyon parametrelerinin etkisini araştırmayı amaçladık. Gereç ve Yöntem: Çalışmaya; Temmuz 2017 ve Aralık 2017 tarihleri arasında Keçiören Eğitim ve Araştırma Hastanesi’nde Helicobacter pylori enfeksiyonu patoloji olarak konmuş, eradikasyon için bizmut içeren standart dörtlü tedaviyi tamamlayan hastalar dahil edildi. Bulgular: Çalışmaya toplam 634 hasta dahil edildi. Antrumda atrofi varlığında Helicobacter pylori eradikasyon başarısı düşükken, intestinal metaplazi varlığında eradikasyon başarısı etkilenmemiştir (sırasıyla p=0,025 ve p >0,05); benzer şekilde korpustaki atrofi ve intestinal metaplazi olan grupta da eradikasyon başarısı daha azdı (sırasıyla p=0,016 ve p=0,01). Şiddetli gastrit gruplarında eradikasyon başarısızlığı daha fazlaydı (OLGA III-IV için p=0.015, OLGIM III-IV için p=0.032). Multiple lineer regresyon analizinde değerlendirildiğinde korpus intestinal metaplazi ve lenfoid agregasyon şiddeti bağımsız risk faktörü olarak değerlendirilmiştir (sırasıyla p=0.002 ve p=0.042). Sonuç: Gastrit ciddiyeti, intestinal metaplazi ve gastrik atrofi Helicobacter pylori eradikasyon tedavisi başarısı üzerinde negatif etki göstermektedir. Bu yüzden, patolojilerinde bu özelliklere sahip olan hastalarda tedavi protokolü ve tedavi süresi yeniden gözden geçirilmelidir.

ABSTRACT BACKGROUND: The role of villous atrophy in apoptosis, a distinctive feature of celiac disease, is a matter of controversy. The aim of this study was to determine the apoptosis rate through immunohistochemical staining for M30 and M65 in celiac disease cases. DESIGN AND SETTING: Analytical cross-sectional study in a tertiary-level center. METHODS: Duodenal biopsies from 28 treatment-naive patients with celiac disease, 16 patients with potential celiac disease, 10 patients with a gluten-free diet and 8 controls were subjected to immunohistochemical staining for the end-apoptotic marker M30 and the total cell death marker M65. H-scores were compared. Several laboratory parameters were recorded concomitantly, and at the one-year follow-up for celiac disease and potential celiac disease patients. RESULTS: There was a significant difference in H-score for M30 expression between the celiac disease, potential celiac disease and gluten-free diet groups (P = 0.009). There was no significant difference in H-score for M65 expression. There was a positive correlation between the H-score for M30 expression and the anti-tissue transglutaminase immunoglobulin A (anti-tTgIgA) and anti-tissue transglutaminase immunoglobulin G (anti-tTgIgG) levels (R = 0.285, P = 0.036; and R = 0.307, P = 0.024, respectively); and between the H-score for M65 expression and the anti-tTgIgA and anti-tTgIgG levels (R = 0.265, P = 0.053; and R=0.314, P = 0.021, respectively). There was no difference between celiac disease and potential celiac disease patients regarding the laboratory parameters selected. CONCLUSION: The rates of apoptosis and nutritional deficiencies in patients with potential celiac disease were similar to those in patients with celiac disease.