Aims: Endoscopic submucosal dissection (ESD) is an established technique for the curative resection of large colorectal lesions; however, intraoperative bleeding remains a major technical challenge. Electrosurgical coagulation modes are modifiable procedural factors that may influence bleeding control and procedural efficiency. This study aimed to compare the clinical outcomes of Swift and Spray coagulation modes during colorectal ESD. Methods: This retrospective, single-center study included 594 consecutive patients who underwent colorectal ESD between January 2021 and December 2025. Patients were divided into the Spray and Swift coagulation groups according to the coagulation mode used during submucosal dissection. Procedural characteristics, intraoperative and delayed bleeding, perforation rates, and other adverse events were analyzed and compared between groups. Results: Baseline patient and lesion characteristics were comparable between the two groups. The mean procedure time was significantly shorter in the Spray coagulation group compared with the Swift coagulation group (42.2±23.7 vs 51.7±31.9 minutes, p

Background/Aims: Endoscopic submucosal dissection (ESD) is an established curative treatment for early gastric neoplasms; however, procedure-related bleeding remains a frequent and clinically significant complication. Electrosurgical settings, particularly the choice of coagulation mode, represent potentially modifiable procedural factors that may influence bleeding control and procedure efficiency during gastric ESD. The current study aimed to compare procedure time and procedure related complications, particularly bleeding, between spray coagulation and swift coagulation modes in patients undergoing gastric ESD. Materials and Methods: This single-center retrospective cohort study included 194 patients who underwent gastric ESD between 2021 and 2025. Patients were divided into 2 groups according to the electrosurgical coagulation mode used during the procedure: spray coagulation (n = 113) and swift coagulation (n = 81). Procedure time, intraprocedural and delayed bleeding, use of hemostatic forceps, perforation, post-ESD electrocoagulation syndrome (PECS), recurrence, and stricture formation were analyzed and compared between groups. Results: Procedure time was significantly shorter in the spray coagulation group compared with the swift coagulation group (38.2 ± 20.7 vs. 44.4 ± 19.1 minutes; P = .0003). Overall intraprocedural bleeding occurred less frequently in the spray coagulation group (44.2% vs. 75.3%; P < .001), and the need for hemostatic forceps was significantly reduced. Severe bleeding events were rare and comparable between groups. Rates of perforation, delayed bleeding, PECS, recurrence, and stricture formation did not differ significantly between groups. Procedural success rates were high and comparable between the groups (93.8% in both groups; P = .99). Similarly, en bloc resection rates (92.9% vs. 92.6%; P = .94) and complete (R0) resection rates (91.2% vs. 91.4%; P = .97) were comparable between the spray and swift coagulation groups. Conclusion: Spray coagulation during gastric ESD is associated with improved bleeding control and shorter procedure time compared with swift coagulation, without increasing procedure-related complications. Optimization of electrosurgical coagulation mode may enhance procedural efficiency and safety during gastric ESD. Cite this article as: Bas B, Küçükdemirci Ö, Kandemir A, et al. Impact of swift versus spray coagulation on procedural outcomes in gastric endoscopic submucosal dissection. Turk J Gastroenterol. Published online June 18, 2026. doi:10.5152/tjg.2026.26081.

Although Dientamoeba fragilis is a common protozoan in humans, its pathogenicity and clinical significance in human diseases remain poorly understood. This study aimed to determine the frequency of D. fragilis in adult ulcerative colitis patients and to assess its relationship with clinical findings, disease characteristics, and biochemical parameters. Patient data were analysed in a prospective, single-centre, cross-sectional design. Faecal samples were consecutively collected from June to December 2024 and screened for D. fragilis positivity using polymerase chain reaction. Of the 110 patients, 33 (30%) were in the active stage of the disease, while 77 (70%) were in remission. The overall frequency of D. fragilis was 10.9% (n = 12), with all isolates classified as genotype 1 according to SSU rRNA sequence analysis. Other protozoa identified were Blastocystis sp. (n = 5, 4.5%), Entamoeba coli (n = 1, 0.9%), and Iodamoeba bütschlii (n = 1, 0.9%). Two patients were co-infected with D. fragilis and Blastocystis. No significant associations were found between D. fragilis positivity and the disease stage, gastrointestinal symptoms, treatment response, or biochemical findings. In conclusion, despite the relatively small sample size, these findings highlight a limited clinical role of D. fragilis in adult ulcerative colitis patients.

Background/Objectives: This study aims to investigate the effects of betanin, which possesses antioxidant and anti-inflammatory properties, against colitis, a disease in which inflammation and oxidative stress play a role in its pathophysiology, during the acute and subacute period. Methods: Thirty-two rats were included in the study and divided into four groups: control, colitis, 3-day betanin supplementation + colitis (bet3+colitis), and 15-day betanin supplementation + colitis (bet15+colitis). Experimental colitis was induced with trinitrobenzene sulfonic acid. Results: In the colitis group, malondialdehyde, myeloperoxidase, superoxide dismutase (SOD) inhibition rate, tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), interleukin-6, mucosal damage, and cell infiltration scores were higher than in the control group, while catalase and glutathione peroxidase (GPx) levels were lower. In the betanin supplementation groups, malondialdehyde, myeloperoxidase, TNF-α, IL-1β, mucosal damage, and cell infiltration scores were lower than in the colitis group, while GPx levels were higher. In addition, the SOD inhibition rate and interleukin-6 levels were lower in the bet15+colitis group than in the colitis group. TNF-α, IL-1β, interleukin-6, and GPx levels in the betanin groups were similar to the control group. Conclusions: Betanin supplementation demonstrated a significant anti-inflammatory effect by reducing inflammatory parameters and histopathological scores in both periods. Additionally, it exhibited a glutathione-related antioxidant effect by increasing GPx levels in both periods. However, although SOD inhibition rates decreased in the subacute period, no significant change in catalase levels was observed in either period. This indicates that it did not provide complete protection in terms of antioxidant effects in either period.

Objective: Adequate bowel preparation is crucial for the effective diagnosis and treatment of colorectal diseases prior to undergoing a colonoscopy. This study aims to assess the significance of preparation for colonoscopy and to identify factors that influence its effectiveness positively or negatively. Materials and Methods: The study included all patients who underwent colonoscopy at the Endoscopy Unit of the Gastroenterology Clinic at Ayd & imath;n Adnan Menderes University Hospital from January 2021 to January 2022. Results: A total of 303 patients participated in the study, comprised of 155 females and 148 males. It was found that Laxeno/Sennozid A+B Calcium (Ca)-based preparations were the most commonly used (55.4%) for bowel cleansing. Evaluation of drug-related side effects revealed that nausea and vomiting were the most frequently reported issues, occurring in 45.6% of patients. The Boston bowel readiness scale assessment indicated that patients most often received scores of 2 and 3 across all colon segments. Statistically significant differences were observed in the parameters of creatinine and phosphorus between pre- and post-procedure assessments for those using Lax phosphosode/sodium phosphate. Similar differences were noted for the Ca parameter in patients using pegdine/polyethylene glycol (PEG). Conclusion: This study concluded that neither age nor gender significantly influenced the quality of bowel cleansing. Furthermore, when comparing the cleaning efficacy and side effects of various agents, no particular agent demonstrated superiority. Additionally, the potential for renal damage and electrolyte imbalances resulting from these agents was examined; post-usage evaluations indicated no impact following PEG use, while elevated phosphate levels were noted after sodium phosphate and senna usage, with creatinine levels rising after senna administration.

BACKGROUND/AIMS:This study aimed to investigate the possible positive effects of arbutin in a trinitrobenzene sulfonic acid (TNBS)- induced experimental colitis model, to compare it with mesalazine, which is used in treating inflammatory bowel disease and to observe the effect of its concomitant use. MATERIALS AND METHODS:Forty Wistar albino species male rats were randomized into 5 groups as control, colitis, colitis+arbutin (Arb), colitis+mesalazine (Mes), and colitis+mesalazine+arbutin (M+A). Proinflammatory cytokines [interleukin (IL)-6, IL-1β, tumor necrosis factor alpha (TNF-α)] and oxidant/antioxidant parameters [malondialdehyde (MDA), superoxide dismutase inhibition (SOD) inhibition, myeloperoxidase (MPO), and catalase, glutathione peroxidase (GPx)] were processed from the samples. Histopathological evaluation evaluated goblet cell reduction, cellular infiltration, and mucosal loss. RESULTS:When the treatment groups and the TNBS group were compared, statistical significance was achieved in MDA, MPO, SOD inhibition, GPx values, IL-6, IL-1β and TNF-α levels. Histopathological evaluation revealed a statistically significant decrease in the mucosal loss value in the group where mesalazine and arbutin were used together compared to the TNBS group. CONCLUSION:Our study's results elaborated that using arbutin alone or in combination with mesalazine produced positive effects in colitis-induced rats.

Amaç: Bu çalışmada Helicobacter pylori enfeksiyonunu saptamada altın standart olarak kabul edilen histopatolojik inceleme ile gaitada antijen testi ve üre nefes testlerini karşılaştırarak bu testlerin biyopsinin yerini alıp alamayacağını araştırdık. Gereç ve Yöntemler: Üre nefes testi ve gaitada antijen testinin araştırma popülasyonumuzda kullanılabilirliğin araştırmak için 50 kadın 50 erkek olmak üzere toplamda 100 Helicobacter pylori pozitif hasta üzerinde üre nefes testi ve gaitada antijen testi uygulanmış ve sonuçları karşılaştırılmıştır. Bulgular: Çalışmamızda kadınların ortalama yaşı 45±12,90, erkeklerin ortalama yaşı 50±13,49 olarak saptandı (p=0.432). Hastalardan alınan gaita örnekleri gaita antijen testi kullanılarak değerlendirilmiş ve toplamda 52 (%52) hastada pozitif sonuç elde edilirken 48 (%48) hastada sonuç negatif gelmiştir. Hastalara üre nefes testi uygulandığında ise 71 (%71) hastada pozitif sonuç elde edilirken geri kalan 29 (%29) hastada ise negatif sonuç elde edilmiştir. Gaita antijen testinin sensitivitesi %52.1, üre nefes testinin sensitivitesi %71.2 olarak hesaplandı. Sonuç: Elde edilen sonuçlar literatüre kıyasla daha düşük sensitiviteye sahiptir. Bu bulgular ışığında toplumumuzda görülen Helicobacter pylori suşuna yönelik gaita antijen testi ve üre nefes testi histopatolojik incelemenin yerini alamamaktadır.

Autoantibodies are frequently detected in the presence of autoimmune liver diseases (ALD) [autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC)] and are widely used to classify the disease clinically. The aim of this study was to investigate the contribution of autoantibodies for the diagnosis of ALD and the identification of other accompanying systemic autoimmune rheumatic diseases (SARD). In addition, it was aimed to compare the results of indirect immunofluorescence (IIF) antinuclear antibody (ANA) patterns and extractable nuclear antigen (ENA) antibodies. A total of 593 patients, including 544 patients with high liver function tests from general surgery/gastroenterology clinics and 49 patients referred from internal medicine/rheumatology clinics to investigate ALD, were included in the study. HBsAg and anti-HCV test results of the patients were found to be negative. ANA, anti-mitochondrial antibody (AMA)/anti-liver-kidney microsomal antibody (LKM), anti-smooth muscle antibody (ASMA), antineutrophil cytoplasmic antibody (ANCA) assays were performed by indirect immunofluorescence method (IIF) (Euroimmune AG, Luebeck, Germany). Extractable nuclear antigen (ENA) (nRNP/Sm, Sm, SS-A, SS-B, Scl-70, Jo-1, dsDNA, nucleosome, histone, ribosomal P-protein, AMA-M2, Ro-52, PM-Scl, CENP-B, PCNA, DFS70) and liver profiles [soluble liver antigen\liver pancreas antigen (SLA/LP), liver cytosolic antigen1(LC-1), LKM-1, anti-mitochondrial antibody M2(AMA-M2)] (Euroimmune AG, Luebeck, Germany) were detected by immunoblot (IB) method. Demographic characteristics, clinical data, presence of systemic autoimmune rheumatic diseases (SARD), radiological and laboratory findings were determined from the medical records. Autoantibody tests were found to be negative in 461 (77.7%) of 593 patients (mean age= 53.3 ± 15.6, age range= 18-90), and were positive in 132 (22.3%) (86.4% female) of the patients. Of the patients with positive autoantibodies, 60.6% (80/132) were diagnosed as PBS and 1.5% (2/132) were diagnosed as AIH (positive anti-LC-1 and anti-LKM1 antibodies). Fourteen of the patients (10.6%) with centromere, nuclear membrane (NM), multiple nuclear dot (MND) staining patterns and elevated liver enzymes could not be diagnosed as a specific disease and were followed up. PBS (13/30) was detected in approximately half of the patients diagnosed with SARD. The most common accompanying SARD in PBC patients was Sjögren's syndrome (SS) (7.5%, 6/80), followed by rheumatoid arthritis (RA) (5.0%, 4/80), scleroderma (2.5%, 2/80), and systemic lupus erythematosus (SLE) (1.3%, 1/80) respectively. The most common pattern was the AMA staining pattern (34.8%, 46/132) among the autoantibody positive patients. AMA and ANA staining patterns were detected together in 31.1% (41/132) of the patients. In the ENA profile results of these patients, the most common profile detected was anti-Ro-52 (65.9%, 27/41), followed by anti-SSA (34.1%, 14/41), anti-SSB (22.0%, 9/41) and anti-CENP-B (12.2%, 5/41) autoantibodies , respectively. ANA patterns were detected in 32.6% (43/132) of the patients (NM 9.1%, centromere 9.1%, MND 6.8%, respectively). In our study, 87.5% (70/80) of the patients diagnosed as PBS were found to have AMA positivity and 12.5% (10/80) of them had ANA positivity (such as NM, CNN, centromere). The characteristics, laboratory and radiological findings of the patients with isolated AMA positivity alone (Group 1) and patients with multiple patterns/autoantibodies (Group 2) were compared. In patients with multiple patterns/autoantibodies (Group 2), the presence of cirrhosis and liver heterogeneity were found to be higher than Group 1 (p= 0.049). ALD associated autoantibodies can be detected before years from the clinical disease. ALD may be associated with various SARD. Detection of ALD-related autoantibodies in patients diagnosed with SARD can provide early diagnosis of these patients. These autoantibodies guide both diagnosis and prognosis as in PBC. Collaboration between the laboratory specialist and the clinician is critical in the diagnosis, management and early recognition of these patients before clinical disease.

Objective: Hypertriglyceridemia is the third most common cause of acute pancreatitis. Immediate triglyceride level lowering is beneficial in patients with severe hypertriglyceridemia [triglyceride (TG) >1,000 mg/dL]. This study aimed to compare the severity of acute pancreatitis, in-hospital mortality, and local and systemic complications, as well as hospitalization duration between patients with hypertriglyceridemia-induced acute pancreatitis treated with conservative treatment only and with therapeutic plasma exchange (TPE) in addition to conservative treatment. Materials and Methods: A total of 120 patients diagnosed with hypertriglyceridemia-induced acute pancreatitis treated with TPE in addition to conservative treatment (group 1) or conservative treatment only (group 2) participated in the study. Results: Group 1 consisted of 38 patients (9 females and 29 males) and group 2 had 82 patients (29 females and 53 males). No difference was found between the two groups regarding patient characteristics. The TG levels in group 1 decreased by 56.8% in one treatment session. The rate of patients with moderately severe acute pancreatitis + severe acute pancreatitis in group 1 was 36.8%, whereas 59.8% in group 2 (p=0.029). The local complication rate was 34.2% and 57.3% in group 1 and group 2, respectively (p=0.031). No significant difference was found between the groups regarding organ failure, systemic complication, hospitalization duration, and in-hospital mortality rates. Conclusion: Our study revealed that TPE treatment is effective in reducing local complications (especially pancreatic pseudocyst).

Objective: This study aimed to compare the complications of outpatient and inpatient endoscopic retrograde cholangiopancreatography (ERCP) procedures in patients with bile duct stones and to investigate whether it is a safe approach to perform outpatient ERCP or not. Materials and Methods: This prospective study consisted of 203 patients who had undergone ERCP for the first time with a diagnosis of choledocholithiasis between January 2013-July 2013. Results: Of the patients included in the study, 102 had undergone outpatient and 101 had undergone inpatient ERCP. Complications following ERCP occurred in 9.8% of the outpatient group (pancreatitis in 5.9%, hemorrhage in 1.9%, cholangitis in 1%, perforation in 1%), while they occurred in the 11.9% of the inpatient group (pancreatitis in 6.9%, bleeding in 1%, cholangitis in 2%, perforation in 2%) (p=0.230, p=0.386, p=0.386, p=0.333, respectively; total complication comparison p=0.618). An amylase level below 150 U/L at the 4 th hour after ERCP had a negative predictive value of 99.4% for pancreatitis to be negative. When the 4 th hour amylase value of 300 U/L was taken as a limit, it had a positive predictive value of 52.1% in of pancreatitis positive. Additionally, the outpatient procedure was more cost-effective when the two groups were compared in terms of the cost lira (TL) TL, p=0.001]. Conclusion: Our study demonstrated that outpatient ERCP was safe and cost-effective in selected cases with bile duct stones. The 4 th hour amylase level below 150 U/L after ERCP showed that patients can be safely sent home and that the amylase value above 3-fold at the 4 th hour can be considered the limit value for admission to the hospital for pancreatitis.

Objective: This study aimed to compare the complications of outpatient and inpatient endoscopic retrograde cholangiopancreatography (ERCP) procedures in patients with bile duct stones and to investigate whether it is a safe approach to perform outpatient ERCP or not. Materials and Methods: This prospective study consisted of 203 patients who had undergone ERCP for the first time with a diagnosis of choledocholithiasis between January 2013-July 2013. Results: Of the patients included in the study, 102 had undergone outpatient and 101 had undergone inpatient ERCP. Complications following ERCP occurred in 9.8% of the outpatient group (pancreatitis in 5.9%, hemorrhage in 1.9%, cholangitis in 1%, perforation in 1%), while they occurred in the 11.9% of the inpatient group (pancreatitis in 6.9%, bleeding in 1%, cholangitis in 2%, perforation in 2%) (p=0.230, p=0.386, p=0.386, p=0.333, respectively; total complication comparison p=0.618). An amylase level below 150 U/L at the 4th hour after ERCP had a negative predictive value of 99.4% for pancreatitis to be negative. When the 4th hour amylase value of 300 U/L was taken as a limit, it had a positive predictive value of 52.1% in terms of pancreatitis positive. Additionally, the outpatient procedure was more cost-effective when the two groups were compared in terms of the cost [873.6 +/- 272.2 Turkish lira (TL) vs 1389.7 +/- 612.6 TL, p=0.001]. Conclusion: Our study demonstrated that outpatient ERCP was safe and costeffective in selected cases with bile duct stones. The 4th hour amylase level below 150 U/L after ERCP showed that patients can be safely sent home and that the amylase value above 3-fold at the 4th hour can be considered the limit value for admission to the hospital for pancreatitis.

Meandros Med Dent J 2021;22:172-7 ORCID ID: orcid.org/0000-0001-5450-5133 Ad dress for Cor res pon den ce/Ya zış ma Ad re si: İsmail Taşkıran MD, Aydın Adnan Menderes University Faculty of Medicine, Department of Gastroenterology, Aydın, Turkey Phone : +90 +90 505 441 93 41 E-mail : dr_istaskiran@hotmail.com Received/Geliş Ta rihi : 23.02.2021 Accepted/Ka bul Ta ri hi : 23.03.2021 Anah tar Ke li me ler Hiperplastik polip, Helicobacter pylori, fundik gland polibi

Objective: In this study we aimed to compare the clinical and biochemical characteristics of primary Sjögren’s syndrome patients with that of keratoconjunctivitis sicca, secondary Sjögren syndrome and undifferentiated disease. Patients and Methods: Patients with Sjögren’s syndrome and keratoconjunctivitis sicca who applied between August 2009 and January 2010 were included in this study. Demographic data, laboratory characteristics, Schirmer’s test and salivary gland biopsies of the patients were recorded. Results: Average diagnosis age for 87 primary Sjögren’s syndrome, 25 secondary Sjögren’s syndrome, 27 keratoconjunctivitis sicca and 44 undifferentiated group patients were 45±13, 43±14, 44±11 ve 45±11 years (p>0.05), accordingly. Critical and severe mouth dryness rate was 45% in primary Sjögren’s syndrome group and 7% in keratoconjunctivitis sicca group, critical and severe eye dryness was 43% in primary Sjögren’s syndrome group and 78% in keratoconjunctivitis sicca group (p<0.001). Grade 3≥ positivity in salivary gland biopsy was found as 71.2% in primary Sjögren’s syndrome group and 27.2% in the undifferentiated group (p<0.001). Conclusions: More dense lymphocyte infiltration was detected in primary Sjögren’s syndrome in salivary gland biopsies. As 27.2% of undifferentiated group patients had positive salivary gland biopsies, they might need follow-ups in terms of having increased risk of developing primary Sjögren’s syndrome.

Objective: Gastric polyps are often detected incidentally during endoscopic examination performed for a different purpose. Hyperplastic polyp is the most common type of polyp in the stomach. This study aimed to determine the frequency, locations and histopathological features of polyps detected in gastroscopic procedures performed at the Gastroenterology Department of Aydin State Hospital and their relationship with Helicobacter pylori (H. pylori) infection. Materials and Methods: Data of 129 patients with polyps during 8,787 gastroscopic procedures performed between July 2016 and January 2020 at the Gastroenterology Department were retrospectively analysed. The size, location and histopathological features of the polyps, H. pylori positivity, presence of intestinal metaplasia and gastric atrophy and use of proton pump inhibitors were recorded. Results: Polyps were localised in the corpus in 43 (33.3%) patients, in the antrum in 36 (27.9%) patients and in the fundus in 20 (15.5%) patients. On histopathological examination, hyperplastic polyp was detected in 84 (65.4%) patients, fundic gland polyp in 19 (14.7%) patients, adenomatous polyp in 11 (8.5%) patients, squamous papilloma in 6 (4.7%) patients and inflammatory polyp in 5 (3.9%) patients. H. pylori positivity was significantly higher in hyperplastic polyps compared to other polyps (40.8% vs 23.4%) (p=0.04), while it was found to be significantly less in fundic gland polyps compared to other polyps (15.8% vs 41.8%) (p=0.03). Conclusion: In this study, hyperplastic polyp is the most common type of polyp found on gastroscopic examination. While H. pylori positivity rate was significantly higher in hyperplastic polyps, it was significantly less in fundic gland polyps. Fundic gland polyps are more common with long-term use of proton pump inhibitors. In the literature, the histopathology of polyps and the relationship of H. pylori infection show similarities.

BACKGROUND/AIMS:Hemorrhagic ascites in patients with cirrhosis is described as a RBC (Red Blood cell) > 50,000/mm³ and leads to increased morbidity and mortality. Positive red blood cells at a level of less than 50,000/mm³ (10,000-50,000) may be encountered in the ascites but it is not known whether this is clinically significant or not. This study aimed to examine the outcome of hemorrhagic ascites in patients with advanced cirrhosis. MATERIALS AND METHODS:Data from 329 cirrhotic patients with ascites who received paracentesis at least once due to ascites was retrospectively analyzed from the period of 2007-2013 from the Türkiye Yüksek İhtisas Hospital, Department of Gastroenterology. Patients were divided according to the number of RBC, with greater than 10,000/mm³ being described as hemorrhagic ascites, and less than 10,000/mm³ described as the normal or control group. Patient data included: number of accepted intensive unit service stays, acute kidney injury (AKI), hepatic encephalopathy (HES), model for end-liver disease (MELD) score, Child Pugh score (CPS), degree of esophageal varices, spleen size and mortality rates. RESULTS:Patients were defined as having hemorrhagic ascites with a RBC count greater than 10,000/mm³ in 118 (35.9%) patients and as a non-hemorrhagic ascites group with less than 10,000/mm³ in 211 (64.1%) patients. The hemorrhagic ascites group had advanced liver disease symptoms compared to the control group. Meld score in the hemorrhagic group was statistically higher than in the control group (21.5±8.3 vs. 17.3±6.6; p value: 0.001). The median value of bilirubin was 5.9 (0.45-33) in the hemorrhagic ascites group and 4.01 (0.39-33) in the non-hemorrhagic group (p value: 0.001). Using multivariate logistic regression analysis, hemorrhagic ascites was also an independent predictor of mortality (HR 2.7 1.4-6.3), with other mortality indicators being HCC (HR 3.1 1.5-6.4) and HRS (HR 2.6 1.2-5.5). CONCLUSION:Patients with hemorrhagic ascites had higher HRS, SBP and admissions to the intensive care unit. We believe that the presence of hemorrhagic ascites can be used as a marker for advanced liver disease and for predicting mortality.

AbstractAt present, we do not know the exact prevalence of Barrett esophagus (BE) developing later in patients without BE in their first endoscopic screening. The purpose of this study was to determine the prevalence of BE on the second endoscopic examination of patients who had no BE in their first endoscopic examination.The data of the patients older than 18 years who had undergone upper gastrointestinal system endoscopy more than once at the endoscopy unit of our clinic during the last 6 years were retrospectively analyzed.During the last 6 years, 44,936 patients had undergone at least one endoscopic examination. Among these patients, 2701 patients who had more than one endoscopic screening were included in the study. Of the patients, 1276 (47.3%) were females and 1425 (52.7%) were males, with an average age of 54.9 (18–94) years. BE was diagnosed in 18 (0.66%) of the patients who had no BE in the initial endoscopic examination. The patients with BE had reflux symptoms in their medical history and in both endoscopies, they revealed a higher prevalence of lower esophageal sphincter laxity, hiatal hernia, and reflux esophagitis when compared to patients without BE (P < 0.001).Our study showed that in patients receiving no diagnosis of BE on their first endoscopic examination performed for any reason, the prevalence of BE on their second endoscopy within 6 years was very low (0.66%).

Background. Despite advances in the understanding of the pathophysiological basis of autoimmune hepatitis (AIH), it is still difficult to delineate the mechanisms involved in progression from hepatic inflammation toward fibrosis. Our aim was to study serum concentrations of NO in AIH of different histological severity and possible effects of immunosuppressive therapy on NO production. Materials and methods. We studied serum NO metabolites (NOx) in 47 consecutive patients with AIH and in 28 age-and sex-matched controls. Results. Serum NOx concentrations were higher in AIH patients than in controls (10.3 (4.5-27.3 mu mol/L) vs. 4.3 (1.6-14.3 mu mol/L), p < 0.001). According to liver histology, median NOx concentrations were significantly higher in patients with severe interface hepatitis compared to patients with mild-moderate interface hepatitis (12.3 (4.5-27.3 mu mol/L) vs. 9.3 (4.6-20.3 mu mol/L), p = 0.029). Similarly, serum NOx concentrations were significantly higher in patients with advanced fibrosis than in those with early fibrosis (12.2 (4.6-27.3 mu mol/L) vs. 9.3 (6.6-12.8 mu mol/L), p = 0.018). NOx concentrations decreased in 16 AIH patients who were tested also after biochemical remission was achieved (12.6 (4.5-22.8 mu mol/L) at baseline and 5.9 (2.8-10.5 mu mol/L) after remission, p = 0.001). Conclusion. This study shows that serum NOx levels are associated with the histological severity of AIH. Hepatocyte inflammation and injury may activate hepatic stellate cells and kupffer cells, and the consequences may include release of NO, which ultimately promotes hepatic fibrosis. Immunosuppressive therapy inhibits this process and the production of NO.