Effects of Hot Pack Therapy on Post-Colonoscopy Pain: A Prospective, Randomized, Controlled Study.

BACKGROUND: Post-colonoscopy pain (PCP) is a negative condition that causes physical and psychological distress to patients and may lead to noncompliance with treatment and follow-up. The most common hypothesis for the cause of PCP is the inflation of the lumen with air to examine the mucosa. There are no previous studies that have examined the effects of thermal therapy in patients with PCP. AIMS: In this study, we aimed to investigate the effects of the Hot Pack (HP) method in patients with PCP. DESIGN: Randomized, controlled, prospective study. METHODS: Patients were randomized 1:1 into 2 groups of HP and control. In the HP group, hot packs of 40-45°C, kept in a hydrocollator heating unit for 30-35 minutes and wrapped in towels, were applied to the umbilical and hypogastric region of patients in the supine position for 30 minutes. Visual analog scale (VAS) scores were used to measure the pain after colonoscopy. Visual analog scores at 1, 6, and 24 hours were recorded and compared in both groups. RESULTS: There was a significant difference in the presence and severity of pain between the two groups at 1 and 6 hours after colonoscopy (p < .001 and p = .004, respectively). There was no significant difference in pain scores at 24 hours between two groups. CONCLUSIONS: This study showed that the application of HP to patients after colonoscopy is effective in reducing pain in the early period.

Does Hepatic Steatosis Influence the Virological Response with Chronic Hepatitis B Patients Treated with Entecavir or Tenofovir Disoproxil Fumarate?

BACKGROUND: The effect of hepatic steatosis on the response to antiviral therapy administered in chronic hepatitis B patients is yet to be clarified. In this study, our aim was to determine the effect of hepatic steatosis on the virological response in chronic hepatitis B patients who were treated with entecavir or tenofovir disoproxil fumarate. METHODS: This retrospective cohort study was performed using the data of liver biopsy-proven chronic hepatitis B patients with or without hepatic steatosis, who received entecavir or tenofovir disoproxil fumarate treatment between 2012 and 2017. The undetectable serum hepatitis B virus deoxyribonucleic acid level under treatment was defined as the complete virological response. The predictors of virological response were determined, and it was checked whether the virological response was affected by hepatic steatosis in chronic hepatitis B patients who have undergone entecavir or tenofovir disoproxil fumarate treatment. RESULTS: A total of 324 chronic hepatitis B patients, of which 203 (63%) were males, were included in the study. The median age of the patients was 42 years (range: 35-51 years). Hepatic steatosis was observed in 25% of the patients, and steatohepatitis in 4%. The median time to complete virological response was found to be 6 months (range: 3-9 months). In the full analysis model, the log hepatitis B virus deoxyribonucleic acid was determined as the factor most associated with virological response (P < .001). No statistically signifi- cant relationship was detected between hepatic steatosis and virological response (P = .409). CONCLUSION: Concomitant hepatic steatosis has no significant impact on the virological response in chronic hepatitis B patients who have undergone entecavir or tenofovir disoproxil fumarate treatment.

Relationship Between Systemic Immune-Inflammation Index and Irritable Bowel Syndrome.

BACKGROUND: Irritable bowel syndrome is accepted as a functional disorder; however, there is growing evidence in favor of the inflammatory process contributing to its pathogenesis. We aimed to evaluate the role of the systemic immune-inflammation index as a marker of inflammation in patients with irritable bowel syndrome. METHODS: The study was conducted in the outpatient clinic of the Gastroenterology Department with patients having constipationpredominant irritable bowel syndrome diagnosis according to Rome IV criteria between March 1, 2019 and December 31, 2020. The systemic immune-inflammation index was calculated and compared with age- and sex-matched healthy controls. RESULTS: The study was performed with 214 participants, 107 patients and 107 control groups. Platelet and neutrophil counts (P < .001, for both) were higher, and lymphocyte count (P = .003) was lower in the irritable bowel syndrome group. The systemic immune-inflammation index was higher in irritable bowel syndrome patients (P < .001). Multivariate logistic regression analyses showed the role of the systemic immune-inflammation index as an independent predictor of the presence of IBS (odds ratio: 1.100, P < .001). CONCLUSION: Systemic immune-inflammation index may be a cheap, universal, and reliable indicator of the inflammatory process in irritable bowel syndrome patients.

High frequency of gastric cancer precursor lesions in patients with gastric xanthelasma: a prospective case-control study.

OBJECTIVE: An association of gastric cancer and precursor lesions with gastric xanthelasma has frequently been reported. However, the incidence of both gastric xanthelasma and gastric cancer precursor lesions increases with age. The aim of this study was to evaluate the frequency and characteristics of atrophic gastritis, intestinal metaplasia and dysplasia in patients with gastric xanthelasma compared to controls. MATERIAL AND METHODS: Cases with gastric xanthelasma endoscopically and histopathologically were included in this prospective study. The patients included in the study were compared with age- and sex-matched controls in terms of the frequency and characteristics of atrophic gastritis, intestinal metaplasia, dysplasia and cancer. RESULTS: In a series of 1892 upper endoscopies, 108 patients (5.7%) were found to have gastric xanthelasma. The average age of the patients was 61.41 ± 11.43 years. Among the patients, 58 (53.7%) were male. The frequencies of atrophic gastritis, intestinal metaplasia, dysplasia and gastric cancer in the xanthelasma group (n = 108) were 31.5, 68.5, 3.7 and 2.8%, respectively. The frequencies of atrophic gastritis, intestinal metaplasia, dysplasia and gastric cancer in the control group (n = 183) were 11.5, 31.7, 0.5 and 0.5%, respectively. Compared to the control group, the frequency of these cancer precursor lesions and the prevalence of advanced stage based on operative link on gastritis intestinal metaplasia assessment were found to be higher in the xanthelasma group (P < 0.05). CONCLUSION: Gastric xanthelasma is associated with an increased frequency of gastric precancerous lesions and should be considered an important marker.

A practical marker to determining acute severe ulcerative colitis: CRP/albumin ratio.

OBJECTIVE: There are many instruments to measure disease activity in ulcerative colitis. While determining clinical activity according to these instruments, many clinical and laboratory parameters are needed to be followed. Determination of disease activity with non-invasive and objective inflammatory indicators may be a practical and objective way. CRP/Albumin ratio (CAR) is an inflammatory marker that is considered to have prognostic value in various cancers, sepsis and acute pancreatitis. In this study, we aim to investigate diagnostic performance CAR in determining the clinical severity of ulcerative colitis. METHODS: Between November 2011 and February 2017, hospital records and follow-up cards of patients with ulcerative colitis were reviewed retrospectively. One hundred forty-nine patients were included in this study. Patient's demographic data, laboratory values, clinical disease activity, according to Truelove & Witts criteria and endoscopic activity according to the Mayo sub-score and treatments, were recorded. Diagnostic performance of CAR analyzed to determine the clinical severity. RESULTS: Of the patients included in this study, 99 (62%) were male, and 50 (38%) were female. Mean age was 45.22±14 years. When patients were grouped into remission, mild, moderate and severe disease according to disease activity, there was a statistically significant difference between CRP, CAR, erythrocyte sedimentation rate (ESR) and albumin levels (p=0.001; p<0.05). Area under the curve (AUC) values for the diagnosis of severe disease were 0.941, 0.931, 0.888 and 0.883 for CAR, CRP, ESR and albumin levels, respectively. Cut-off value to determine severe disease for CAR was 0.6 (sensitivity: 88.9%, specificity of 90.3%, positive predictive value (PPV) 85.1%, negative predictive value (NPV) 92.8%, AUC: 0.941, p<0.001). CONCLUSION: There was a significant relationship between CAR, CRP, ESR and albumin levels and clinical disease severity in patients with ulcerative colitis. CAR is a cheap and practical marker for the diagnosis of acute severe ulcerative colitis.

Real-world efficacy and safety of Ledipasvir + Sofosbuvir and Ombitasvir/Paritaprevir/Ritonavir ± Dasabuvir combination therapies for chronic hepatitis C: A Turkish experience.

BACKGROUND/AIMS: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population. MATERIAL AND METHODS: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)±ribavirin (RBV) orombitasvir/paritaprevir/ritonavir±dasabuvir (PrOD)±RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed. RESULTS: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90±54.60 U/L to 17.00±14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51±4.54 to 7.32±3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0±16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%). CONCLUSION: LDV/SOF or PrOD±RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.

Day-night variations in thyroid stimulating hormone and its relation with clinical status and metabolic parameters in patients with cirrhosis of the liver.

To investigate day-night variations in thyroid stimulating hormone (TSH) and its relation with clinical status and metabolic parameters in patients with cirrhosis. Forty-one patients with negative thyroid antibodies and normal thyroid function tests who were diagnosed with cirrhosis were included. Thirty-five age- and gender-matched healthy subjects were included in control group.TSH, fT3, and fT4 levels, which were measured both in the morning and late evening. The difference between nocturnal TSH and morning TSH (ΔTSH) were compared between groups. Relation between Child-Turcotte-Pugh, model for End-Stage Liver Disease (MELD) and MELD-Na scores and levels of thyroid hormones, ΔTSH and serum sodium (Na) levels was investigated. Relation between ΔTSH and clinical status and metabolic parameters was also evaluated. The mean morning fT3, nocturnal fT3, nocturnal TSH, and ΔTSH levels were significantly lower, morning and nocturnal fT4 levels were higher in patients with cirrhosis (p<0.001, p<0.001, p=0.004, p<0.001, and p<0.001). As the ROC analysis, day-night variation was detected to be impaired in the event that difference between nocturnal TSH level and morning TSH level was lower than 1 uIU/mL in patients with cirrhosis with a sensitivity of 92.7% and specificity of 71.4% (p<0.001).A significant positive correlation was found between serum Na levels and fT3 in patients with cirrhosis (r=0.479, p=0.001), and a significant negative correlation was found between the severity of clinical status and low levels of fT3 in patients with cirrhosis (p<0.001).Nocturnal TSH increase does not occur in cases of cirrhosis without known thyroid disease and with normal thyroid function tests, which may be an early finding of impaired thyroid functions in patients with cirrhosis.

An Unusual Reason for Gastric Variceal Hemorrhage: Wandering Spleen.

Wandering spleen is the displacement of the spleen due to the loss or weakening of the ligaments of the spleen and is seen very rarely with an incidence of less than 0.5 %. It can cause portal hypertension, but gastric variceal hemorrhage is a quite rare condition within the spectrum of this uncommon disease. We report a 22-year-old woman with wandering spleen presenting with life-threatening gastric variceal hemorrhage. Her diagnosis was made by computerized tomography. Endoscopic therapy was not adequate to stop the bleeding, and urgent splenectomy was performed. After surgery she has been well with no symptoms until now.

Evaluation of gastric polyps detected by endoscopy: a single-center study of a four-year experience in Turkey.

BACKGROUND/AIMS: The aim of this study was to evaluate the gastric polyps detected by endoscopy in our institution with respect to their frequency, size, anatomic location, presence of dysplasia, and histopathologic features. MATERIALS AND METHODS: Records of a total of 14,240 patients who underwent endoscopy between January 2008 and January 2012 were reviewed retrospectively. Of the 14,240 patients, 174 determined to have at least 1 histopathologically proven polyp were included in the study. RESULTS: Three hundred eleven gastric polyps were found in 174/14,240 (1.2%) patients (1.79 polyps per patient). Gastric polyps were found most commonly in the antrum (41.5%). Of all gastric polyps, 189 (60.8%) were less than 1 cm. Histopathologically, the most common polyp type was hyperplastic (n: 261, 83.9%), followed by adenomatous (n: 23, 7.4%). Eight (34.8%) of the adenomatous polyps showed dysplasia, and in 4 (17.4%) of these cases, the dysplasia was high-grade. Nineteen (6.1%) of all gastric polyps were identified to be fundic gland polyps. CONCLUSION: According to this study from Turkey, the majority of polyps detected by endoscopy was solitary, smaller than 1 cm, and found in the antrum; furthermore, the most common type was a hyperplastic polyp.

Analysis of 2222 colorectal polyps in 896 patients: a tertiary referreal hospital study.

BACKGROUND/AIMS: In Turkey, there are a limited number of studies including the characteristics of colorectal polyps, and the number of patients was too small in most of them. The aim of this study was to evaluate histological characteristics of colorectal polyps that were determined by colonoscopy and clinical features of patients who had removal of the polyp. MATERIALS AND METHODS: Patients who underwent colonoscopy were analyzed retrospectively from January 2007 to December 2011. Adult patients (≥18 years) with no history of previous colorectal neoplasms who had removal of colorectal polyp were included. RESULTS: A total of 2222 colorectal polyps were removed in 896 patients. Of these, 621 were male (69.3%) and 275 were female (30.7%). Most of the patients with polyps presented in the age group of 50-59 years (251 patients, 28%). It was recorded that 1816 (81.7%) of all polyps were adenomas. Of 1816 adenomas, 1577 (86.8%) were tubular adenomas. Of patients with adenomas, 19.7% was younger than 50 years. A total of 337 (37.6%) patients were in the high-risk group. Mean age of the high-risk patients was higher than the others (62±13 years and 58±13 years, respectively, p=0.001). CONCLUSION: This study is the largest series of colorectal polyps in Turkey to date. We determined the clinical and histologic characteristics of colorectal polyps and consider that the detection rate of colorectal adenomas in patients under the age of 50 years may be increased by the widespread use of colonoscopy as a diagnostic test.

Impact of anti-aggregant, anti-coagulant and non-steroidal anti-inflammatory drugs on hospital outcomes in patients with peptic ulcer bleeding.

BACKGROUND/AIMS: There are a limited number of studies including the impact of antiplatelet drugs use on hospital outcomes for nonvariceal upper gastrointestinal bleeding. The aim of this study was to determine the effect of anti-aggregant, anti-coagulant and non-steroidal anti-inflammatory drugs upon hospital outcomes in patients with peptic ulcer bleeding. MATERIALS AND METHODS: The patients under treatment with antiaggregant, anticoagulant or non-steroidal anti-inflammatory drugs were categorized as exposed group (n = 118) and the patients who were not taking any of these drugs were categorized as non-exposed group (n = 81). We analyzed the data of drug intake, comorbid disease, blood transfusion, duration of hospital stay, Blatchford/total Rockall score and diagnosis of patients. RESULTS: In total, 199 patients were included. Of these 59.3% (exposed group) were taking drugs. The patients in exposed group were significantly older than those in non-exposed group (62.9 ± 17.3 years; 55.5 ± 19.3 years, P = 0.005, respectively). Mean number of red blood cell units transfused (2.21 ± 1.51; 2.05 ± 1.87, P = 0.5), duration of hospital stay (3.46 ± 2.80 days; 3.20 ± 2.30 days, P = 0.532) and gastric ulcer rate (33% vs 23.4%, P = 0.172) were higher in exposed group than in non-exposed group but the differences were not statistically significant. Total Rockall and Blatchford scores of the patients were significantly higher in exposed group than in non-exposed group (3.46 ± 1.72 vs 2.94 ± 1.87, P = 0.045; 10.29 ± 3.15 vs 9.31 ± 3.40, P = 0.038). CONCLUSION: Our study has shown that anticoagulants, antiaggregants and nonsteroidal anti-inflammatory drugs do not effect duration of hospital stay, red blood cell transfusion requirement and rebleeding for peptic ulcer bleeding.

Acute pancreatitis caused by bortezomib.

Drug-induced pancreatitis has been reported rarely. Bortezomib is a selective and reversible proteasome inhibitor used for the treatment of patients with multiple myeloma (MM). Recently, one case report about acute pancreatitis (AP) caused by bortezomib was published in the international literature. Herein we report a case of AP in a 67-year-old male on bortezomib therapy. On the fourth day after the first administration of bortezomib, the patient admitted to the hospital with symptoms of AP. The common etiological factors for AP were all excluded. Than the patient was diagnosed as bortezomib-induced pancreatitis.

Anticoagulant-induced intramural duodenal haematoma presenting with upper-gastrointestinal haemorrhage.

Warfarin is an anticoagulant agent known to have a common complication, bleeding. Intramural intestinal haematoma is an uncommon incidence of warfarin-induced haemorrhage. Abdominal pain is its most frequent symptom and presentation with upper-gastrointestinal haemorrhage is rarely seen. Here, we present a 67-year-old male who was admitted to the hospital with active upper-gastrointestinal haemorrhage. In this case, the cause of bleeding has been attributed to duodenal intramural haematoma due to warfarin overuse.

Insulin resistance in liver cirrhosis.

BACKGROUND/AIMS: Liver cirrhosis is a chronic disease by degeneration, regeneration and fibrosis in the liver parenchyma, caused by many diseases. Insulin resistance can be defined as any type of decrease in the effect that may occur at the phases following insulin's secretion from beta-cells of the pancreas, where it is produced, until it has the expected effects in the target cells. The aim of the present study is to demonstrate the presence of insulin resistance in LC, which is common in our country and region, and investigate the existence of association between insulin resistance occuring in LC and cytokine levels, age, gender, CRP, Hs-CRP, Child-Pugh score and etiology of LC. METHODOLOGY: A total of 79 patients with liver cirrhosis (group 1) were included in the study, and 50 subjects as controls (group 2). Of liver cirrhosis patients, 49 (62%) were male and 30 (38%) were female, with a mean age of 54.71 +/- 14.68. Of the controls, 23 (46%) were male and 27 (54%) were female, with a mean age of 41.9 +/- 11.54. Severity of cirrhosis was assessed by Modified Child-Turcoutte-Pugh score. Seven cases (8.9%) were at the Child-Pugh stage A, 35 cases (44.3%) at the Child-Pough stage B, and 37 cases (46.8%) at the Child-Pough stage C. HOMA-IR was calculated and values > 2.7 were regarded as presence of insulin resistance (HOMA-IR +). Serum glucose, albumin, bilirubin values were studied with enzymatic method (Architect C-16000); serum CRP, Hs-CRP values with nephelometric method by Beckman Coulter Image Nephelometer (immunochemistry system); insulin, C-peptide with electrochemiluminance immunological method; prothrombin time with radiation method by ACL-Advance brand device. RESULTS: In this study, glucose (p = 0.004), insulin (p = 0.010), C-peptide (p < 0.001), HOMA-IR (p < 0.001), TNF-alpha (p < 0.001), IL-2RES (p < 0.001), IL-6 (p = 0.002), CRP (p < 0.001) and HsCRP (p = 0.006) levels are elevated in LC patients, compared to control group. Consequently, high HOMA-IR in LC supports the fact that insulin resistance develops in LC, as it is reported in similar studies. When HOMA-IR positive and negative patients within LC patients are compared, it is seen that insulin resistance develops independently of age, etiology, gender, Child-Pugh classification, spleen size, TNF-alpha, IL-16, IL-2RES, IL-6, IL-10, CRP, Hs-CRP (p > 0.05) levels.