Inferior vena cava collapsibility index and stroke volume as predictors of blood transfusion in upper gastrointestinal bleeding in the emergency department.

BACKGROUND AND AIM: This study investigates the effectiveness of bedside ultrasonography in predicting blood transfusion requirements in patients with upper gastrointestinal bleeding (UGIB). It focuses on evaluating the inferior vena cava (IVC) diameter, IVC collapsibility index (CI), and stroke volume (SV) as ultrasonographic measures. METHODS: A hundred adult patients enrolled in this prospective clinical study. The patients were divided into two groups (group 1: only saline administered group, group 2: saline and blood administered group). IVC diameter, IVC CI, and SV were measured at the time of admission and after treatment. RESULTS: At the initial admission, group 1 exhibited an IVC CI of 20.4% and an SV of 65.0 mL, whereas group 2 displayed an IVC CI of 26.6% and an SV of 58.0 mL. Upon analyzing the relationship between the Glasgow-Blatchford score (GBS) and SV, we identified a significant negative correlation (r = -0.7350; P < 0.001). Similarly, a weak negative correlation was observed between the Rockall score (RS) and SV (r = -0.4718; P < 0.001). It is worth noting that patients with UGIB require blood transfusion if their SV falls below 62.5 mL, with an area under the curve (AUC) of 89.1% and a 95% confidence interval (CI) ranging from 82.8% to 95.4%. CONCLUSION: IVC CI and SV can be used as parameters to predict the need for blood transfusion in the ED in patients with UGIB.

Objective and Subjective Dysphagia Assessment in Inflammatory Bowel Diseases.

INTRODUCTION: Inflammatory bowel disease (IBD) is a chronic gastrointestinal disease that is separated into two types: ulcerative colitis (UC) and Crohn's disease (CD). Although dysphagia is a well-studied and important topic in head and neck cancers and neurological disorders, research on the relationship between IBD and swallowing problems is not yet elucidated. The aim of this study was to compare swallowing function in the UC and CD using objective and patient-reported evaluation modalities. METHODS: This was a prospective cross-sectional research with 86 patients (50 UC and 36 CD) treated at the gastroenterology department. The assessment includes flexible fiberoptic endoscopic examination (FEES). The penetration-aspiration scale, the functional oral intake scale (FOIS), the functional outcome swallowing scale (FOSS), the Eating Assessment Tool-10 (EAT-10) test, the Yale Pharyngeal Residue Severity Scale for vallecula (Yale PRSS-vallecula) and pyriform sinus (Yale PRSS-PS) were all used to determine extent of dysphagia. RESULTS: The CD group had higher EAT-10 scores than UC group (p = 0.014). In terms of PAS scores, there was no significant difference between the two groups in all three food types (water, yogurt, and crackers) (p > 0.05). There was not a statistically significant variance between the groups in terms of vallecular residue (p > 0.05) according to the Yale PRSS-vallecula. Based on the Yale PRSS-PS, the CD group had significantly more residue than the UC group with yogurt and cracker (p = 0.014 and 0.030, respectively). FOSS and FOIS scores did not vary significantly between the two groups (p > 0.05). CONCLUSION: CD impairs subjective and pharyngeal swallowing functions more than UC. It is obvious that swallowing should be assessed in patients with IBD.

Evaluation of Voice in Inflammatory Bowel Diseases.

INTRODUCTION: Inflammatory bowel diseases, which are among the most common chronic gastrointestinal diseases, can also affect the voice for different reasons.The aim of this study is to investigate acoustic, perceptual and subjective voice evaluation parameters in inflammatory bowel diseases (IBD). METHODS: This prospective case-control study included a total of 80 participants: 28 patients with ulcerative colitis (UC), 22 patients with Crohn's Disease (CD), and 30 healthy controls. Following the endoscopic examination, the fundamental frequency (F0), shimmer (dB), jitter (%), and harmonic/noise ratio (HNR) were measured. GRBAS (grade, roughness, breathiness, asthenia, strain) scale was used for perceptual evaluation, Voice Handicap Index-10 (VHI-10) Turkish version was used for subjective assessment. RESULTS: The F0 value was within normal limits in both disease groups in male and female participants and in the control group. Jitter and shimmer values were statistically higher in the UC and CD groups than the control group. HNR did not differ between CD and control, however it was statistically lower in the UC group when compared to both the control and CD group. The total GRBAS score did not differ between the UC and CD groups, however it was greater in IBD patients compared to the control group. However these differences were within normative parameters. Although total VHI-10 score did not differ between UC and CD groups, both had higher voice handicap than the control group. CONCLUSION: IBD might have an effect on the voice and voice quality. This disease group was discovered to have perceptual and subjective voice problems additionally.

The relationship between the severity of inflammatory bowel diseases and expirium air carbon monoxide levels.

INTRODUCTION: We investigated the relationship between expirium air carbon monoxide (E-CO) levels and disease severity in patients with ulcerative colitis (UC) and Crohn's disease (CD). METHODS: After their first follow-ups, the E-CO levels of 162 patients with UC and 100 with CD were measured for four consecutive weeks. Blood samples were collected from all the patients, and their clinical severity was determined 1 month after their initial presentation. The clinical severity of CD was determined using the Harvey Bradshaw index (HBI), while the patients with UC completed the SEO clinical activity index (SEOI). The relationships between the disease severity and the means of these four E-CO readings were then compared. RESULTS: The mean age of the participants was 42.28 ± 14.9 years, and 158 (60.3%) were men. In addition, 27.2% of the UC group and 44% of the CD group were smokers. The mean SEOI score was 145.7 ± 42.0 (min = 90, max = 227), and the mean HBI score was 5.75 ± 3.3 (min = 1, max = 15). Increased CO ppm (OR = -9.047 to 7.654 95% CI) and the number of cigarettes smoked per day (OR = -0.161 to 1.157 95% CI) emerged as independent risk factors for lower SEO scores in the linear regression models (p < 0.001), while the number of cigarettes smoked per day (OR = 0.271 to 1.182% 95 CI) was a risk factor for higher HBI scores (p = 0.022). CONCLUSION: UC severity decreased with higher E-CO levels and the mean number of cigarettes smoked, while CD severity increased in line with the mean number of cigarettes smoked.

Evaluation of Hepatitis B screening and reactivation in patients receiving rituximab containing chemotherapy: A single-centre study.

AIMS: Hepatitis B virus (HBV) infection is a worldwide distributing viral disease. Hepatitis caused by HBV reactivation may progress to chronic illness and associated with increased risk of hepatic failure and hepatocellular cancer. Rituximab (RTX) is an immunosuppressive agent, is particularly used in the treatment of non-Hodgkin's Lymphoma. Patients have significant risk for HBV reactivation following chemotherapy with a RTX-containing regimen. This study aimed to determine the HBV screening manner and reactivation rates in patients with haematological neoplasm following chemotherapy including Rituximab. METHODS: This is a single-centered retrospective cohort study. A total of 331 adults with haematological disorders who received chemotherapy regimen including RTX between years of 2006 and 2016 were enrolled. Patients who experienced reactivation were evaluated. RESULTS: Only 130 of 331 patients were screened appropriately for HBV infection for 10-year period. We found 18 patients were Hepatitis B surface antigen (HBsAg) (+) and 16 (88.8%) of them received antiviral prophylaxis. Among screened patients, 27 were HBsAg (-)/AntiHBc (+) and only 10 (37%) of them received HBV prophylaxis. In total, nine patients experienced reactivation, six were from screened and three were from unscreened group. CONCLUSION: Incomplete screening and inappropriate prophylaxis may result in HBV reactivation in patients under RTX-based chemotherapy and related complications such as death.

Could a reduced hemoglobin, albumin, lymphocyte, and platelet (HALP) score predict autoimmune hepatitis and degree of liver fibrosis?

OBJECTIVE: Autoimmune hepatitis is a rare inflammatory disease of the liver that is characterized by elevated liver enzymes. The hemoglobin, albumin, lymphocyte, and platelet score, which is derived from hemoglobin, serum albumin, circulating lymphocyte count, and platelet count, is also associated with inflammatory conditions. The aim was to examine the hemoglobin, albumin, lymphocyte, and platelet score of patients with autoimmune hepatitis and to compare it to that of healthy individuals in this retrospective analysis. METHODS: Subjects diagnosed with autoimmune hepatitis were enrolled in the study, and healthy individuals were enrolled as controls. Moreover, autoimmune hepatitis subjects were grouped into mild or moderate/advanced fibrosis. Furthermore, aspartate to platelet ratio index, Fibrosis-4, and hemoglobin, albumin, lymphocyte, and platelet scores of the autoimmune hepatitis patients and controls were compared. In addition, the hemoglobin, albumin, lymphocyte, and platelet score of the autoimmune hepatitis patients with mild fibrosis is compared to that of those with moderate/advanced fibrosis. RESULTS: The mean hemoglobin, albumin, lymphocyte, and platelet score of the autoimmune hepatitis patients was 44.2±14.5 while this value was 76.8±15.5 in control subjects. The hemoglobin, albumin, lymphocyte, and platelet score was significantly reduced in autoimmune hepatitis patients than healthy controls (p<0.001). The hemoglobin, albumin, lymphocyte, and platelet score was significantly and negatively correlated with C-reactive protein, aspartate, alanine transaminase, gamma glutamyl transferase, aspartate to platelet ratio index, and Fibrosis-4 values. A hemoglobin, albumin, lymphocyte, and platelet score that was lower than 52.3 had 83% sensitivity and 73% specificity in predicting autoimmune hepatitis. The sensitivity and specificity of the hemoglobin, albumin, lymphocyte, and platelet score were higher than the Fibrosis-4 score in predicting moderate/advanced fibrosis in autoimmune hepatitis. CONCLUSION: We suggest that the hemoglobin, albumin, lymphocyte, and platelet score be used as an additional noninvasive diagnostic tool for autoimmune hepatitis and to predict moderate/advanced liver fibrosis in patients with autoimmune hepatitis.

Helicobacter pylori eradication increases telomere length in gastric mucosa.

BACKGROUND/AIMS: Our purpose in this study was to analyze telomere length and telomerase activity before and after eradication treatment in gastric mucosa in patients positive for H. pylori. METHODOLOGY: There were two groups: a control group (n=17) and a study group (n=21). For H. pylori eradication, the patients were administrated proton pump inhibitor (PPI) + clarithromycin + amoxicillin or PPI + metronidazole + tetracycline + bismuth for 14 days. Telomere length was analyzed with RT-PCR and telomerase activity with PCR-ELISA on biopsy specimens from the antrum. The result p<0.05 was considered significant. RESULTS: Prior to eradication, there was no significant difference between telomere lengths of the patient and control groups (2481.2±1823 and 2958.9±1345.7 bp, p=0.11, respectively). The telomere length of the study group became longer after eradication (before 2481.2±1823bp, after 3766.3±1608.8bp, p=0.01). Telomerase activity was not detected in either the patient or the control group. CONCLUSIONS: An increase in telomere length was observed with H. pylori eradication. This finding may indicate the importance of H. pylori eradication to avoid the development of gastric cancer.

The gamma-glutamyl transferase to platelet ratio for noninvasive evaluation of liver fibrosis in patients with primary biliary cholangitis.

The gamma-glutamyl transferase to platelet ratio (GPR) has been reported to be as effective as the aspartate transaminase to platelet ratio index (APRI) and fibrosis index based on the 4 factors (FIB-4) in showing the fibrosis stage in patients with chronic hepatitis B. It has been demonstrated that APRI and FIB-4 are successful in the assessment of fibrosis in primary biliary cholangitis (PBC). We investigated the effectiveness of GPR in predicting advanced fibrosis and cirrhosis in patients with biopsy-proven untreated PBC. A total of 35 patients with biopsy-proven PBC were included in this study. The biopsy fibrosis stages of all patients at diagnosis were compared using the APRI, FIB-4, and GPR values. The diagnostic accuracy of GPR for detecting advanced fibrosis and cirrhosis was also investigated. The area under the receiver operating characteristic curve (AUROC) of GPR was 0.84, the cutoff point was 4.81, the sensitivity was 0.41, and the specificity was 0.96 for detecting advanced fibrosis. Our study showed that GPR was more sensitive than APRI and FIB-4 in detecting advanced fibrosis in patients with PBC. GPR could be used as an effective noninvasive marker in PBC to show advanced fibrosis at the time of diagnosis.

Investigation of the effects of anti-TNF agents on hemoglobin levels in patients with inflammatory bowel disease.

Inflammatory bowel disease (IBD) is characterized by many clinical features. Anemia is 1 of the most frequent complications and/or extraintestinal manifestations of IBD. There are conflicting data regarding the relationship between changes in hemoglobin levels and disease prevalence in IBD patients with and without antitumor necrosis factor (antiTNF) therapy. In our study, we aimed to investigate the long-term effect of antiTNF agents on anemia in IBD. The records of IBD patients followed-up in our hospital between January 2011 and January 2021 were reviewed retrospectively. Demographic, clinical, endoscopic, radiological and medical treatment data of the patients were recorded. Complete blood count and laboratory markers of inflammation and disease activation, were recorded at the beginning and at the first year of treatment in all patients. The data of patients with and without antiTNF therapy were analyzed statistically. A total of 240 IBD patients who met the inclusion criteria were enrolled in the study. The number of patients with and without antiTNF therapy was 102 (42.5%) and 138 (57.5%), respectively. The change in all laboratory parameters between the beginning and the first year of treatment was statistically significant (P < .001) in all IBD patients with and without antiTNF therapy. The change in Hb level after 1 year of treatment was significantly different in patients with antiTNF therapy compared to those without therapy (3.00 ± 1.78 g/dL vs 1.19 ± 1.38 g/dL, P < .001). In the multiple regression analysis, male gender, antiTNF therapy, baseline Hb level and iron therapy were independent significant variables of hematopoietic response. This study showed that with appropriate treatment, hemoglobin levels of IBD patients with and without antiTNF therapy increased within 1 year, and the use of antiTNF agents in the treatment of IBD was an independent variable in correcting anemia.

Analysis of the patients with nonvariceal upper gastrointestinal bleeding and comparison of Rockall and Glasgow-Blatchford scores.

BACKGROUND: Nonvariceal upper gastrointestinal bleeding (UGB) has important morbidity and mortality. Predicting high-risk patients for mortality and rebleeding is necessary for a treatment plan. In the present study, we aimed to define the epidemiological and etiological characteristics of patients presenting with nonvariceal UGB and to observe mortality and morbidity rates. We also aimed to compare Rockall and Glasgow-Blatchford scoring systems in predicting rebleeding and mortality. METHODS: Subjects presenting with nonvariceal UGB over a 3-year period were included. Demographic characteristics, symptoms, and signs on physical examination, laboratory data, endoscopic signs and diagnosis, interventions during hospitalization and follow-up period were recorded. Glasgow-Blatchford and Rockall scores were calculated for every participant at the first day of the admission. RESULTS: A total of 709 patients were enrolled in the study. A total of 490 of them (69.1%) were men. The mean age of the women and men was 60.7±1.2 and 58.6± 0.7 years, respectively. Melena was the most common presenting symptom. Duodenal ulcer (31%), gastric ulcer (20.7%), and erosive disease (17.6%) were the most common causes of bleeding. History of use of aspirin and/or nonsteroidal anti-inflammatory drug use were present in 63.7% of the subjects. All patients were followed up for 30th-day mortality. Overall, rebleeding and mortality rates were 11% and 7%, respectively. A Rockall score greater than 6 was the most important predictor of mortality (odds ratio:39.1) and rebleeding (odds ratio:4.7). CONCLUSION: Nonvariceal UGB patients with a Rockall score greater than 6 should undergo aggressive endoscopic treatment and inpatient care.

Melena: An Unusual Manifestation of Metastatic Lung Cancer.

Lung cancer is the most common cancer around the world, and the leading cause of cancer-related deaths. Clinical manifestations of lung cancer may vary from non-specific respiratory symptoms to symptoms due to metastases. The most common sites of metastases are the lymph nodes, liver, adrenals, bone, and brain. Metastasis of lung cancer to stomach is very rare. Here, we present a case of squamous cell lung cancer in a 71-year male metastasing to the stomach, a very uncommon site of metastasis. Key Words: Lung cancer, Melena, Metastasis, Stomach.

Serum Immune-Inflammation Index Assessment in the Patients with Ulcerative Colitis.

Radiologic and endoscopic diagnostic methods are used to determine disease activity in ulcerative colitis (UC). In order for endoscopic procedures to be invasive and to prevent radiation exposure, especially in young people, studies have been carried out frequently to determine a simple, fast, and reliable activity marker with laboratory methods. Our aim in this study is to determine the usefulness of serum immune-inflammatory index as a noninvasive marker of activation in patients with ulcerative colitis. A total of 82 consecutive patients treated with a diagnosis of ulcerative colitis were included in the study. The disease activation was assessed using the Mayo endoscopic subscore. The site of involvement was grouped into two as left colitis and extensive colitis. Patients were divided into two groups as those who had active disease based on clinical and endoscopic findings and those who were in remission. C-reactive protein (CRP) levels, platelets, neutrophils, and lymphocytes were recorded in all participants. The systemic immune-inflammation index (SII) and CRP values were compared between UC patients with active disease or remission. The correlations between CRP, SII, and Mayo endoscopic subscores were analyzed. In addition, ROC curve analysis for SII was performed to determine the cut-off value, sensitivity, and specificity in determining ulcerative colitis activity. The value of SII was significantly higher in the active group than the remission group (respectively, 1497 ± 1300 and 495 ± 224, p < 0.001). In the correlation analysis, a significant correlation was found between SII and Mayo subscore. In ROC curve analysis, SII was found to be significantly effective in determining activity in ulcerative colitis patients. For 0.860 area under the curve, the sensitivity was 68.1% and the specificity was 91.2% at a cut-off value of 781.5. SII is significantly higher in patients with active ulcerative colitis than those in remission. It shows promise for use as a noninvasive marker of active ulcerative colitis.

Elevated platelet distribution width and red cell distribution width are associated with autoimmune liver diseases.

OBJECTIVE: Red blood cell distribution width (RDW) and platelet distribution width (PDW) are reported to be associated with inflammation. We aimed to determine the association between RDW and PDW with autoimmune liver disease (ALD). MATERIAL AND METHODS: We retrospectively analyzed 126 patients who were diagnosed with ALD. Sixty-nine healthy individuals represented the control group. Characteristics and laboratory parameters of the ALD patients and control subjects were compared. RESULTS: The aspartate transaminase (AST) (P < 0.001), alanine transaminase (ALT) (P < 0.001), C-reactive protein (CRP) (P < 0.001), RDW (P < 0.001) and PDW (P < 0.001) levels of the ALD group were significantly higher than those of the control subjects. RDW was significantly correlated with AST (r = 0.17, P = 0.02) and CRP (r = 0.19, P = 0.01) levels. Moreover, PDW was significantly correlated with AST (r = 0.23, P = 0.002), ALT (r = 0.23, P = 0.001) and CRP (r = 0.23, P = 0.001) levels. The sensitivity and specificity of RDW higher than 13.7% level were 76% and 62%, respectively [AUC: 0.74, P < 0.001, 95% confidence interval (CI): 0.67-0.81]. The sensitivity and specificity of PDW higher than 17.9% level were 80% and 71%, respectively (AUC: 0.85, P < 0.001, 95% CI: 0.79-0.90). The sensitivity and specificity of CRP higher than 2.9 U/l level were 92% and 85%, respectively (AUC: 0.91, P < 0.001, 95% CI: 0.86-0.95). CONCLUSION: Our study demonstrates that RDW and PDW have considerable sensitivity and specificity in determining ALD.

Endoscopic Findings of Gastro-Esophageal Reflux Disease in Elderly and Younger Age Groups.

Objective: To determine and compare the clinical features and endoscopic findings of gastro-esophageal reflux disease (GERD) in elderly and younger age groups. Materials and Methods: The clinical and endoscopic features were evaluated for all patients with GERD between January 2017 and September 2020. The criteria for inclusion were being aged over 65 and under 50 years and having an upper gastrointestinal endoscopy with reflux symptoms resistant to ppi theraphy. The exclusion criteria included prior surgery, age under 18 years, and pregnancy. The diagnosis of GERD was made according to the patients' symptoms. The SPSS 11.0 for Windows pocket program was used for statistical analysis. Results: Two hundred eighty-six patients aged over 65 years and 261 patients aged below 50 years were enrolled in this study. The mean age of the older group was 68.2 ± 4.5 years and the mean age of the young group was 38 ± 7.2 years. The male/female ratio was 5/3 and 2/1 in the young and older groups, respectively. The older patients had less severe and rare typical symptoms than the young patients. However, significantly more serious endoscopic findings were noted in the older patients compared with the younger patients. Conclusion: The older and young patients with GERD were predominantly male and typical reflux problems were less common in older patients with GERD. Older patients had more important endoscopic findings such as hernia, esophagitis, and cancer.

The telomere length of gastric mucosal samples and peripheral blood lymphocytes in patients who have undergone Billroth II distal gastrectomy.

INTRODUCTION: Telomeres play an important role in maintaining chromosomal integrity. Functional loss of telomeres increases the risk of cancer by causing genomic instability. Telomere length abnormalities have been reported in several precancerous lesions. There is no study that evaluates telomere length in Billroth II distal gastrectomy, which is known as a risk factor for gastric stump carcinogenesis, in the literature. The aim of this study was to assess the relationship between the telomere length of residual gastric mucosal samples, peripheral blood lymphocytes, and other clinicopathological parameters of patients who had undergone Billroth II distal gastrectomy. MATERIAL AND METHODS: There were two groups: a control group (n = 15) and a patient group (n = 15). In all cases, upper gastrointestinal endoscopy was performed, and biopsies were taken during endoscopy. Telomere lengths were measured by qRT-PCR. RESULTS: It was observed that the lengths of the telomeres were shortened as the time of postoperative period increased in the patient group (r = -0.126) (p > 0.05). Also, the lengths of the telomeres were shortened in chronic inflammation, neutrophil activity, glandular atrophy, and intestinal metaplasia. CONCLUSIONS: The telomere length was shortened as the time of postoperative period increased in the patient group. The telomeres were also shorter in chronic inflammation, neutrophil activity, intestinal metaplasia, and glandular atrophy, in all of the study groups. Telomere length abnormalities in gastric stump carcinogenesis process may be a guide for early diagnosis and treatment.

Could a reduced hemoglobin, albumin, lymphocyte, and platelet (HALP) score predict autoimmune hepatitis and degree of liver fibrosis?

SUMMARY OBJECTIVE: Autoimmune hepatitis is a rare inflammatory disease of the liver that is characterized by elevated liver enzymes. The hemoglobin, albumin, lymphocyte, and platelet score, which is derived from hemoglobin, serum albumin, circulating lymphocyte count, and platelet count, is also associated with inflammatory conditions. The aim was to examine the hemoglobin, albumin, lymphocyte, and platelet score of patients with autoimmune hepatitis and to compare it to that of healthy individuals in this retrospective analysis. METHODS: Subjects diagnosed with autoimmune hepatitis were enrolled in the study, and healthy individuals were enrolled as controls. Moreover, autoimmune hepatitis subjects were grouped into mild or moderate/advanced fibrosis. Furthermore, aspartate to platelet ratio index, Fibrosis-4, and hemoglobin, albumin, lymphocyte, and platelet scores of the autoimmune hepatitis patients and controls were compared. In addition, the hemoglobin, albumin, lymphocyte, and platelet score of the autoimmune hepatitis patients with mild fibrosis is compared to that of those with moderate/advanced fibrosis. RESULTS: The mean hemoglobin, albumin, lymphocyte, and platelet score of the autoimmune hepatitis patients was 44.2±14.5 while this value was 76.8±15.5 in control subjects. The hemoglobin, albumin, lymphocyte, and platelet score was significantly reduced in autoimmune hepatitis patients than healthy controls (p<0.001). The hemoglobin, albumin, lymphocyte, and platelet score was significantly and negatively correlated with C-reactive protein, aspartate, alanine transaminase, gamma glutamyl transferase, aspartate to platelet ratio index, and Fibrosis-4 values. A hemoglobin, albumin, lymphocyte, and platelet score that was lower than 52.3 had 83% sensitivity and 73% specificity in predicting autoimmune hepatitis. The sensitivity and specificity of the hemoglobin, albumin, lymphocyte, and platelet score were higher than the Fibrosis-4 score in predicting moderate/advanced fibrosis in autoimmune hepatitis. CONCLUSION: We suggest that the hemoglobin, albumin, lymphocyte, and platelet score be used as an additional noninvasive diagnostic tool for autoimmune hepatitis and to predict moderate/advanced liver fibrosis in patients with autoimmune hepatitis.

Levels of TAFI, TFPI and ADAMTS-13 in inflammatory bowel disease.

BACKGROUND/AIMS: There is an increased tendency for thrombosis and thromboembolic complications in patients with inflammatory bowel disease (IBD). The aim of the present study was to determine the serum concentrations of thrombin-activatable fibrinolysis inhibitor (TAFI), tissue factor pathway inhibitor (TFPI) and a disintegrin and metalloproteinase with thrombospondin motif-13 (ADAMTS-13) in patients with IBD and to assess their possible role in the etiopathogenesis of the disease. MATERIALS AND METHODS: Thirty-four patients with IBD (23 ulcerative colitis and 11 Crohn's disease) and 20 healthy controls were included in the present study. TAFI, TFPI, and ADAMTS-13 concentrations were determined by enzyme-linked immunosorbent assay. RESULTS: Mean TAFI, TFPI, and ADAMTS-13 concentrations in the patient group were 17.75 ng/ml, 72.10 ng/ml, and 14.90 U/l, respectively. In the control group, these values were 117.10 ng/ml, 300 ng/ml, and 191.55 U/l, respectively. TAFI, TFPI, and ADAMTS-13 values were significantly lower in the patient group than in the control group (all p<0.01). CONCLUSION: TAFI, TFPI, and ADAMTS-13 levels were significantly lower in the patient group. These findings indicate the presence of a clear, multifactorial imbalance in the coagulation-fibrinolytic system in the patient group. It is also possible that this imbalance in the coagulation and fibrinolytic system may play a role in the still unclear etiopathogenesis of the disease.

Incisional hernia as an unusual cause of hepatic encephalopathy in a 62-year-old man with cirrhosis: a case report.

INTRODUCTION: Hepatic encephalopathy may be initiated by many factors such as gastrointestinal bleeding, infections, fluid and electrolyte disturbances. Hypokalemia is one of the most commonly encountered electrolyte abnormalities causing hepatic encephalopathy in patients with cirrhosis. CASE PRESENTATION: We present the case of a 62-year-old Caucasian man with decompensated liver cirrhosis having multiple episodes of hepatic encephalopathy precipitated by vomiting. He had an incisional hernia at the right lumbar region. A barium contrast study of the small intestine and magnetic resonance imaging showed that the hernial sac included gastric antrum and bowel. We observed that hepatic encephalopathy coincided with hypokalemia as a result of a large volume of vomiting triggered by the collapsed hernial sac. Hepatic encephalopathy was resolved by administration of intravenous potassium. CONCLUSION: This case illustrates that a hernia causing a large volume of vomiting may be a precipitant factor in the development of hepatic encephalopathy.