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BACKGROUND/AIMS: Gastroenterologists have an important role in the treatment and management of comorbidities related to obesity. Assessment of gastroenterologists' perception and attitude toward obesity was aimed in this study. MATERIALS AND METHODS: Survey questions were determined for the study. An online questionnaire was prepared afterward. Participants were invited via e-mail by providing them with information about the study. It was ensured that those who accepted the study could access the questionnaire form with the relevant link. Participants who answered all questions were included in the study. RESULTS: Totally 117 gastroenterologists were included in the study. The proportion of gastroenterologists who thought that obesity complicates the management of gastroenterological diseases and those who thought obesity as a factor that negatively affects the prognosis of gastroenterological diseases was determined as 88.9% and 95.7%, respectively. Among the obese patients, the proportion of those who applied diet therapy, exercise, pharmacotherapy, and endoscopic methods was 94%, 91.5%, 35%, and 37.6%, respectively. The rates of intragastric balloon therapy and intragastric botulinum toxin A injection were 30% and 21.4%, respectively. The proportion of those who agreed that obese patients lost a significant amount of weight with the treatment methods applied was 47.2%. The proportion of participants who agreed that long-term maintenance of weight loss was impossible for most obese patients was 59.8%. CONCLUSION: To our knowledge, this is the first study that evaluates the perception and attitude of gastroenterologists toward obesity. Our study results show that gastroenterologists think that obesity is a chronic disease and that gastroenterologists should be involved in management of obesity.
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Atitude do Pessoal de Saúde , Gastroenterologistas , Gastroenterologia , Obesidade , Humanos , Obesidade/psicologia , Obesidade/terapia , Turquia , Gastroenterologistas/psicologia , Gastroenterologistas/estatística & dados numéricos , Feminino , Masculino , Inquéritos e Questionários , Adulto , Pessoa de Meia-Idade , Gastroenterologia/estatística & dados numéricos , Percepção , Padrões de Prática Médica/estatística & dados numéricosRESUMO
AIM: It was to assess the diagnostic performance characteristics of a novel index, (ABA), which utilizes age, bilirubin and albumin to predict significant and severe fibrosis, and cirrhosis in patients with chronic hepatitis C infection. METHODS: A total of 114 patients were included in this study. The liver biopsies were graded using the Ishak scoring system. Diagnostic performance of the ABA index was compared to aspartate aminotransferase (AST) to alanine aminotransferase ratio, age platelet index, AST to platelet ratio index, γ-glutamyl transpeptidase (GGT) to platelet ratio index, FIB-4, FibroQ, Goteborg University Cirrhosis Index, King's score, GGT/international normalization ratio, platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, white blood cell to platelet distribution width ratio and mean platelet volume to platelet distribution width ratio (MPV/PDW) by receiver operating characteristics (ROC) curve analysis. RESULTS: The ABA index was formulated as 1.5 + (0.065 × age) + (1.85 × bilirubin) - (1.65 × albumin) according to the multivariate logistic regression analysis. According to the ROC curve analyses, the ABA index had the area under these ROC curves (AUROCs) of 0.805 [95% confidence interval (CI), 0.727-0.883] for significant fibrosis, 0.874 (95% CI, 0.804-0.943) for severe fibrosis and 0.895 (95% CI, 0.828-0.961) for cirrhosis. CONCLUSION: The ABA index was found to be superior to other evaluated noninvasive indexes of liver fibrosis by use of the cutoff point of 0 and 1. These findings should be confirmed by prospective and multicenter studies in patients with chronic hepatitis C infection.
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Hepatite C Crônica , Albuminas , Aspartato Aminotransferases , Bilirrubina , Hepatite C Crônica/complicações , Hepatite C Crônica/diagnóstico , Humanos , Cirrose Hepática , Contagem de Plaquetas , Estudos Prospectivos , Curva ROC , Índice de Gravidade de Doença , gama-GlutamiltransferaseRESUMO
BACKGROUND AND AIMS: Development of noninvasive liver fibrosis indexes has been research of interest due to the limitations of liver biopsy. Therefore, we aimed to develop and evaluate the diagnostic accuracy of a novel noninvasive index for predicting significant fibrosis, advanced fibrosis and cirrhosis in patients with chronic hepatitis B (CHB) infection based on age and routine clinical laboratory tests. METHODS: A total of 396 treatment naïve liver biopsy performed patients were divided into training (n = 262) and validation cohorts (n = 134). Histological staging was assessed by Ishak fibrosis scoring system. RESULTS: In training cohort, we developed a novel fibrosis index, GAPI, using γ-glutamyl transpeptidase (GGT), age, platelet, and international normalized ratio (INR) results. The diagnostic accuracies of alanine aminotransferase ratio, age platelet index, aspartate aminotransferase to platelet ratio index, GGT to platelet ratio index, AST to lymphocyte ratio index, fibrosis index based on the four factors, Fibro Q, Goteborg University Cirrhosis Index, King's score, Pohl score, Wang I, fibrosis index, fibrosis cirrhosis index, cirrhosis discriminant score, Lok score, Doha score, Mehdi's model, GqHBsAg, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, RDW to lymphocyte ratio, RDW to platelet ratio, GGT/INR, GGT/albumin, white blood cell/platelet distribution width (PDW), mean platelet volume/PDW and platelet/PDW indexes were compared to GAPI index. For the prediction of significant fibrosis, advanced fibrosis and cirrhosis, the area under the receiver operating characteristic curves (AUROCs) of GAPI index were 0.776, 0.868, and 0.885 in training cohort, and 0.731, 0.883, and 0.919 in validation cohort, respectively. The AUROCs of the GAPI index were higher than those of the evaluated 27 noninvasive indexes to predict significant fibrosis, advanced fibrosis, and cirrhosis. CONCLUSION: In resource limited settings, GAPI is a promising noninvasive liver fibrosis index for predicting significant fibrosis, advanced fibrosis and cirrhosis, and for decreasing the need for liver biopsy in patients with CHB infection using cutoff points of 2.00 and 3.50.
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Hepatite B Crônica , Alanina Transaminase , Aspartato Aminotransferases , Hepatite B Crônica/complicações , Hepatite B Crônica/diagnóstico , Humanos , Cirrose Hepática/diagnóstico , Cirrose Hepática/etiologia , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença , gama-GlutamiltransferaseRESUMO
Introduction Colonic wall thickening (CWT) is frequently observed incidentally via abdominal computerized tomography (aCT). Although the general approach to evaluating incidental CWT is a colonoscopic examination, there is a lack of definitive recommendation guidelines. Thus, we aimed to determine neoplasia rates and identify the factors predictive of neoplasia via colonoscopic examinations of patients with CWT incidentally diagnosed via aCT. Methods We retrospectively reviewed 5,300 colonoscopy reports. A total of 122 patients who had CWT incidentally observed via aCT were included in the study. CWT was graded as mild (3-5 mm), moderate (6-12 mm), or severe (≥12 mm). A logistic regression model was used to determine the predictive factors for neoplasia. Results The mean age of the patients was 60 years, and abnormal findings were noted in 52% of the colonoscopies. Neoplastic lesions were detected in 24 patients (19.6%), while colon adenocarcinoma was detected in 8 patients (6.5%). Multivariate analysis showed that moderate-severe, focal, and asymmetric CWT were independent factors for predicting neoplasia (p=0.049, p=0.033, and p=0.018, respectively). Conclusion Pathological findings can be noted via colonoscopic examination in cases of incidental CWT; therefore, patients with moderate-severe, focal, or asymmetric CWT require colonoscopic examination for the purpose of detecting neoplasia.
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BACKGROUND: Liver biopsy is an invasive procedure that is currently still necessary for predicting underlying hepatic injury related to chronic viral hepatitis B (CVHB). To date, none of the studied non-invasive methods have been able to replace liver biopsy. An apoptotic serum marker, M30, which has been reported to indicate ongoing liver fibrosis, has been popular in recent years. OBJECTIVES: We aimed to investigate the possible role of M30 in predicting CVHB-associated hepatic injury and its severity. METHODS: Forty-eight patients undergoing liver biopsy for evaluation of the severity of CVHB-related liver injury and 40 healthy controls were included in this cross-sectional study. M30 levels were determined for all CVHB patients and controls, and other laboratory parameters and demographic features were obtained from our hospital's database. RESULTS: The mean ages of patients and controls were 39.7 and 45.7 years, respectively, and 35% of the controls and 52% of the patients were male. In contrast to lower platelet counts, transaminase and M30 levels were both higher in the patient group than in the controls. Among the investigated parameters, only transaminase increased as the fibrosis stage changed from mild to moderate; however, none of the laboratory parameters, including M30, differed as the histological activity index (HAI) score increased. CONCLUSIONS: M30 levels were higher in CVHB patients compared to healthy controls. However, M30 levels were similar in the mild and moderate stages of fibrosis, so they did not indicate the severity of underlying fibrotic or inflammatory processes in CVHB patients.
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BACKGROUND: Dieulafoy's lesion (DL) is a relatively uncommon medical condition characterized by a large tortuous arteriole in the submucosa of any part of gastrointestinal (GI) tract wall that bleeds via erosion likely caused in the submucosal surface by protrusion of the pulsatile arteriole. Compared with other endoscopic hemostatic techniques, clipping alone for DL is limited. AIMS: The aim of the present case series study is to identify common clinical and endoscopic features, rates of occurrence, to review the outcome of endoscopic management of upper GI tract DL, and to illustrate the use and the efficiency of endoclips in maintaining the GI bleeding due to DL. PATIENTS AND METHODS: This case series was conducted at Department of Gastroenterology, Diskapi Yildirim Beyazit Educational and Research Hospital. The patients who were admitted to the emergency department of Diskapi Yildirim Beyazit Educational and Research Hospital underwent gastrointestinal system (GIS) endoscopy between 2008 and 2013 and were assessed retrospectively. Five cases of GI bleeding related to DL were given endoscopic treatment with hemoclip application. Clinical data, endoscopic findings, and the effects of the therapy were evaluated. RESULTS: The median number of endoscopic hemoclips application in first endoscopy was 4 (2-9). Rebleeding developed in all patients who had hemoclips applied. Re-endoscopy was performed in three of these patients, which controlled the bleeding. Two patients were transferred to surgery. CONCLUSIONS: Combination of endoscopic injection and mechanical therapies seems a suitable method for maintaining upper GIS bleeding due to DL. Also, further studies are needed to better define the best endoscopic approach for the treatment of DL.
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Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Hemostase Endoscópica/instrumentação , Instrumentos Cirúrgicos , Anormalidade Torcional/complicações , Anormalidade Torcional/cirurgia , Adulto , Idoso , Arteríolas/anormalidades , Arteríolas/cirurgia , Desenho de Equipamento , Feminino , Hemorragia Gastrointestinal/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Anormalidade Torcional/diagnóstico , Resultado do TratamentoRESUMO
BACKGROUND/AIM: Irritable bowel syndrome (IBS) is a gastrointestinal condition characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any organic cause. This trial investigated the presence of microscopic colitis (MC) and associated factors related to MC in patients diagnosed with IBS. MATERIALS AND METHODS: The study group (group I) consisted of 91 consecutive patients diagnosed with IBS based on the Rome III Criteria for whom colonoscopic examination was requested. The control group (group II) had 41 patients diagnosed with IBS considered as eligible for colonoscopic investigation due to specific conditions, and for whom colonoscopic examination was recommended for screening purposes due to a familial history of colon cancer. Clinical data, endoscopic findings, and the effects of the therapy were evaluated. RESULTS: In the diarrhea-predominant IBS group, nine patients (9.89%) were diagnosed with microscopic colitis, seven with lymphocytic colitis (7.69%), and two with collagenous colitis (CC) (2.19%). None of the patients in group II were found to have MC (P = 0.007). There were no diagnoses of MC in the constipation-predominant and mixed type IBS groups. CONCLUSION: Clinicians should keep MC in mind for patients presenting with diarrhea-predominant IBS symptoms.
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Colite Microscópica , Colo , Colonoscopia/métodos , Diarreia/diagnóstico , Síndrome do Intestino Irritável , Adulto , Biópsia , Colite Microscópica/complicações , Colite Microscópica/diagnóstico , Colite Microscópica/epidemiologia , Colite Microscópica/terapia , Colo/patologia , Colo/fisiopatologia , Diagnóstico Diferencial , Diarreia/etiologia , Gerenciamento Clínico , Feminino , Humanos , Incidência , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/epidemiologia , Síndrome do Intestino Irritável/terapia , Masculino , Avaliação de Sintomas , Turquia/epidemiologiaRESUMO
BACKGROUND/AIM: Even though polyethylene glycol-electrolyte lavage (PEG-EL)-based regimes have become the gold standard in recent years, to finish drinking 4 L of PEG-EL solution can be difficult. The quality of sennoside-based bowel-cleansing regimes used in Turkey has been known for some time. Therefore, we aimed to investigate the efficacy of both bowel-cleansing regimes. MATERIALS AND METHODS: Patients over 18 years old undergoing elective colonoscopic procedures between January and March 2011 were included in the study. The patients were divided into 2 groups; in Group 1, 91 patients were given sennoside a + b calcium 500 mg/250 mL (X-M solution, Yenisehir Laboratuari, Ankara, Turkey), and in Group 2, 94 patients were given 4 L of PEG-EL (Golytely, Boston, MA, USA). RESULTS: The mean age of the patients and the male distribution were similar in the 2 groups. Both inadequate bowel cleansing and the best cleansed bowels were seen in Group 1. The number of inadequate colonoscopies declined when using a whole bowel-cleansing regime from 24.5% to 19.3% in Group 2, but it did not decline in Group 1. CONCLUSION: The best bowel cleansing can be achieved with sennoside-based regimes, whereas a greater proportion of adequate results via colonoscopy were reached with the PEG-EL-based regimes.
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Doenças do Colo/diagnóstico , Colonoscopia , Eletrólitos/uso terapêutico , Polietilenoglicóis/uso terapêutico , Extrato de Senna/uso terapêutico , Irrigação Terapêutica/métodos , Adulto , Catárticos/uso terapêutico , Colonoscopia/métodos , Colonoscopia/normas , Feminino , Humanos , Masculino , Soluções Farmacêuticas/uso terapêutico , Reprodutibilidade dos Testes , Senosídeos , Resultado do TratamentoRESUMO
Colorectal cancer (CRC) is the third most common cause of cancer-related death in Europe. The aim of the present study was to elucidate the efficiency of the neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR), and the mean platelet volume (MPV) as tools for the preoperative diagnosis of CRC and their usefulness in the follow-up of CRC. A total of 144 CRC patients, as diagnosed by colonoscopy, and 143 age-matched and sex-matched healthy participants were included in the study. Medical records were used to compare preoperative and postoperative data including hemoglobin levels, platelet counts, MPV, NLR, and PLR. NLR, PLR, and MPV were significantly higher in CRC patients preoperatively, compared with healthy participants. Receiver-operating characteristic curve analysis suggested 2.02 as the cutoff value for NLR [area under the curve (AUC): 0.921, sensitivity: 86%, specificity: 84%], 135 as the cutoff value for PLR, (AUC: 0.853, sensitivity: 70%, specificity: 90%) and 8.25 fl as the cutoff value for MPV (AUC: 0.717, sensitivity: 54%, specificity: 76%). Subgroup analysis showed that NLR, PLR, and MPV levels were also significantly higher in nonanemic CRC patients compared with the control group, which is of great theoretical and clinical value for the early detection of CRC. Surgical tumor resection resulted in a significant decrease in NLR, PLR, and MPV. Our results suggest that NLR, PLR, and MPV may be used as easily available additional biomarkers for CRC in screening the general population, as well as in postoperative follow-up.
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Adenocarcinoma/sangue , Neoplasias Colorretais/sangue , Contagem de Linfócitos , Volume Plaquetário Médio , Neutrófilos/citologia , Contagem de Plaquetas , Adenocarcinoma/diagnóstico , Idoso , Biomarcadores , Estudos de Casos e Controles , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Feminino , Hemoglobinas/metabolismo , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
Gastrointestinal tract lymphangiomas are extremely rarely seen. Here, we present the first case of lymphangioma of the duodenal bulb diagnosed with a deep bite on a bite endoscopic biopsy and treated with polypectomy.
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Neoplasias Duodenais/cirurgia , Linfangioma Cístico/cirurgia , Dor Abdominal/etiologia , Adulto , Neoplasias Duodenais/patologia , Endoscopia Gastrointestinal , Humanos , Linfangioma Cístico/patologia , MasculinoAssuntos
Tumor Carcinoide/patologia , Neoplasias do Ducto Colédoco/patologia , Ductos Pancreáticos/patologia , Doenças Raras/patologia , Idoso , Tumor Carcinoide/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Coledocolitíase/diagnóstico , Coledocolitíase/cirurgia , Neoplasias do Ducto Colédoco/cirurgia , Humanos , Masculino , Ductos Pancreáticos/cirurgia , Doenças Raras/cirurgiaRESUMO
BACKGROUND: The values of C-reactive protein (CRP) can prove useful in determining disease progress. Because of synthesis by the liver, production of CRP in response to inflammation may be attenuated in patients with liver dysfunction. This may result in differences interpreting CRP levels in patient with portal and non-portal hypertension ascites. AIM: The aim of the present study is to assess discriminant value of serum and ascitic fluid CRP, which is easily accessible and inexpensive laboratory marker of inflammation, concentrations for diagnosis of underlying cause of ascites. METHODS: This prospective study was conducted at Diskapi Yildirim Beyazit Educational and Research Hospital Department of Gastroenterology. Patients with ascites were further divided into two subgroups based on underlying cause of ascites: Group 1, patient with ascites due to portal hypertensive etiology (high-gradient ascites); Group 2, patient with ascites due to non-portal hypertensive etiology (low-gradient ascites). RESULTS: A total of 91 patients fulfilling the criteria for a diagnosis of ascites were enrolled in the study. Of these patients, 50 had proven (Group 1) ascites due to portal hypertensive etiology (high-gradient ascites) and 41 had clinical (Group 2) ascites due to non-portal hypertensive etiology (low-gradient ascites). Mean baseline serum and ascites levels of CRP were significantly higher in Group 2 compared to those in Group 1 (p = 0.021, p = <0.0001, respectively). CONCLUSIONS: Increased levels of serum and ascitic fluid CRP were associated with malignant ascites.
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Ascite/diagnóstico , Líquido Ascítico/química , Proteína C-Reativa/química , Adulto , Idoso , Ascite/patologia , Feminino , Humanos , Hipertensão Portal/diagnóstico , Cirrose Hepática/diagnóstico , Neoplasias Hepáticas/diagnóstico , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND/AIMS: During removal of intragastric balloon, there is a great deal of gastric undigested food even after an eight-hour starvation. Bromelain, a proteolytic enzyme existing in the pineapple juice seems to be a good choice for the undigested food remnants in the stomach. We aimed to investigate the effect of drinking pineapple juice on dissolving food remnants in patients undergoing endoscopic procedure for removal of intragastric balloon. MATERIALS AND METHOD: In this study, we included patients who had undergone endoscopic placement of intragastric balloon (BIB®, BioEnterics Intragastric Balloon, Inamed Health, CA, USA) between February 2009 and March 2012. First 8 patients were asked to fast the whole night before the procedure (at least 8 hours) and to apply clear liquid diet for 3 days before the endoscopic removal. A great amount of food remnants was seen in the stomach during the endoscopic balloon removal procedure. A second endoscopic procedure was planned 3 days later and, in order to decrease the food remnants, the patients were asked to drink 1 L pineapple juice per day. The next 11 patients were also advised to drink 1 liter per day of 100% pineapple juice for 3 days before the endoscopic removal. RESULTS: Totally, 19 obese patients (17 female, 2 male) were included in the study. Mean age was 38,68±7,95 years, mean weigh was 124,23±19,30 kg, and mean body mass index was 49,73±9,22 kg/m 2 . There was undigested food in the stomach during endoscopic removal in the first 8 patients. However, no undigested food in the stomach was found at the second endoscopic examination. In the other 11 patients, no food remnants were observed after taking pineapple juice prior to the endoscopic removal procedure. CONCLUSION: Drinking pineapple juice for 3 days before endoscopic balloon removal seems to be effective in dissolving food remnants in the stomach. Drinking pineapple juice may be recommended in all patients undergoing endoscopic procedure for removal of intragastric balloon.
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Ananas/enzimologia , Bebidas , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/métodos , Balão Gástrico/efeitos adversos , Esvaziamento Gástrico/efeitos dos fármacos , Adulto , Bromelaínas/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/terapia , Redução de PesoRESUMO
BACKGROUND/AIMS: An unsuccessful colonoscopy procedure is often related to inadequate bowel cleansing. It is difficult for patients to finish the whole 4 liters of polyethylene glycol-electrolyte lavage (PEG-EL) because of its salty taste and the large quantity. Pineapple juice has been shown to be an effective agent in the dissolution of undigested food in the stomach. This study assessed the effectiveness of both 2 and 4 liters of PEG-EL in precolonoscopic bowel cleansing and the quality of colonoscopic cleaning by adding 1 liter of pineapple juice to a reduced-volume PEG-based regime. METHODS: The patients were chosen from those undergoing a colonoscopic procedure. A total of 126 patients were randomized into 3 groups receiving 3 different PEG-EL (Golytely®) regimes, i.e. 4 liters of PEG-EL (group 1, n = 44), 2 liters of PEG-EL (group 2, n = 39) or 2 liters of PEG-EL with 1 liter of pineapple juice (Dimes® 100%; group 3, n = 43). RESULTS: Both the 4- and 2-liter PEG-EL regimes resulted in similar bowel cleansing scores in all parts of the colonic segments. However, adding 1 liter of pineapple juice to the reduced-volume PEG-EL regime improved the quality of the cleansing on the right side of the colon and in the transverse colon. Adequate bowel cleansing was achieved in 68.1% of the patients in group 1, 63.9% in group 2 and 80% in group 3 (the lowest score in one of the segments). On the other hand, the tolerability of the regimes was similar in all 3 groups (p = 0.509). CONCLUSIONS: Reduced PEG-EL (2 rather than 4 liters) may be sufficient for precolonoscopic bowel cleansing in the Turkish population. Administration of pineapple juice in the reduced-dose preparation regime may improve the quality of the bowel cleaning.