Acute pancreatitis in Turkey: Results of a nationwide multicenter study.

BACKGROUND: Acute pancreatitis (AP) is the most common gastrointestinal disease requiring hospitalization, with significant mortality and morbidity. We aimed to evaluate the clinical characteristics of AP and physicians' compliance with international guidelines during its management. METHODS: All patients with AP who were hospitalized at 17 tertiary centers in Turkey between April and October 2022 were evaluated in a prospective cohort study. Patients with insufficient data, COVID-19 and those aged below 18 years were excluded. The definitions were based on the 2012 revised Atlanta criteria. RESULTS: The study included 2144 patients (median age:58, 52 % female). The most common etiologies were biliary (n = 1438, 67.1 %), idiopathic (n = 259, 12 %), hypertriglyceridemia (n = 128, 6 %) and alcohol (n = 90, 4.2 %). Disease severity was mild in 1567 (73.1 %), moderate in 521 (24.3 %), and severe in 58 (2.6 %) patients. Morphology was necrotizing in 4.7 % of the patients. The overall mortality rate was 1.6 %. PASS and BISAP had the highest accuracy in predicting severe pancreatitis on admission (AUC:0.85 and 0.81, respectively). CT was performed in 61 % of the patients, with the majority (90 %) being within 72 h after admission. Prophylactic NSAIDs were not administered in 44 % of the patients with post-ERCP pancreatitis (n = 86). Antibiotics were administered to 53.7 % of the patients, and 38 % of those received them prophylactically. CONCLUSIONS: This prospective study provides an extensive report on clinical characteristics, management and outcomes of AP in real-world practice. Mortality remains high in severe cases and physicians' adherence to guidelines during management of the disease needs improvement in some aspects.

Which is the best choice for Helicobacter pylori eradication? Dual therapy or quadruple therapy?

Introduction: Standard triple therapy used to be the first-line treatment for Helicobacter pylori (Hp) infection, but today it is a treatment regimen with a low eradication rate due to increasing resistance to the antibiotics included in the triple therapy.Aim: To compare the eradication rates of dual treatment regimens and quadruple treatment regimens. Material and methods: Patients over 18 years of age, who were indicated to undergo upper gastrointestinal system (GIS) endoscopy for any reason, had their upper gastrointestinal endoscopy performed, were detected to have Hp as a result of the histopathological evaluation of the biopsy material, and in whom eradication control was also performed by histopathological evaluation, were included in the study. These patients were divided into 4 groups, each containing 50 people. Results: Considering the eradication rates of Hp-positive patients according to different treatment options, 78% (n = 39) of the patients in Group 1 were eradicated after the treatment while 66% (n = 33) of the patients in Group 3, 58% of the patients in Group 2 (n = 29), and 58% (n = 29) of the patients in Group 4 had Hp negative results after treatment. When high-dose dual treatments were compared, the highest eradication rate was obtained with rabeprazole, but no statistically significant difference was detected (p = 0.11). Conclusions: This is the first study to include dual therapies consisting of 3 different PPIs at the same time. The low eradication rates obtained in our study suggest that the determination of individualized treatment strategies in which CYP2C19 polymorphism is detected may result in higher eradication rates.

Evaluation of colon mucosa using screening colonoscopy and flexible spectral imaging color enhancement in patients with long lasting ulcerative colitis.

AIM: To determine which flexible spectral imaging color enhancement (FICE) channel best visualizes colon mucosa in ulcerative colitis (UC) and to compare FICE imaging with standard imaging. METHODS: The study enrolled patients with ulcerative colitis in remission who had inflammatory bowel disease for at least 8 years. All patients underwent screening colonoscopy. The entire colon, especially the suspicious areas in terms of dysplasia, were imaged with standard endoscopy and FICE. Random and target biopsies were obtained. Histopathological diagnosis was made and image patterns were evaluated. Seven endoscopists evaluated normal, colitis, and polyp images obtained with FICE. RESULTS: One hundred and twenty-three colon segments were evaluated and 1831 images were obtained from 18 patients. A total of 1652 images were FICE and 179 were standard images. Separate FICE images were obtained for normal colon mucosa, polypoid lesions, and colitis areas. Normal colon mucosa was best visualized using the second, sixth, and ninth FICE channel; polyps using the third, seventh, and ninth channel; and colitis using the second, third, and ninth channel. When all images were analyzed, the second and ninth channel were significantly better than the other channels. A total of 584 biopsies were obtained, including 492 (84.2%) random biopsies and 92 (15.7%) target biopsies. Random biopsies detected no dysplasia, but target biopsies detected low-grade dysplasia in three diminutive polyps. CONCLUSION: FICE was not significantly better at dysplasia screening than the standard procedure, but it effectively detected diminutive polyps and evaluated surface patterns without using magnification. FICE might contribute to the assessment of inflammation severity in patients with UC in clinical remission. However, more extensive studies are necessary to confirm these findings.

Evaluation of fibrosis in chronic hepatitis C patients treated with direct-acting antivirals.

Background and Aim: This study is an evaluation of liver fibrosis measurements determined using transient elastography and aspartate aminotransferase-to-platelet ratio index (APRI) scores of patients diagnosed with chronic hepatitis C (CHC) who were treated with direct-acting antivirals (DAAs). Materials and Methods: The liver fibrosis measurements recorded using transient elastography, APRI scores, and the biochemical data from before and after treatment of 40 patients with CHC who were treated with DAA were reviewed. Patients who received paritaprevir+ritonavir/ombitasvir+dasabuvir were included in Group 1 (n=20), and patients who received sofosbuvir+ledipasvir±ribavirin in Group 2 (n=20). Results: The mean liver fibrosis measurement of the patients was 15.73±10.63 kPa (min-max: 5.20-45.00 kPa) before treatment and 2.56±8.84 kPa (min-max: 4.30-42.00 kPa) after treatment. There was a significant improvement in liver fibrosis with a regression of 20.16% at the end of treatment compared with the start (p=0.001) with no significant difference between treatment groups (p=0.542). The highest regression rate of 75% was seen in patients with F2 fibrosis at the end of treatment. Significant regression was also found in patients with F3 fibrosis, with a rate of 57.2%, and in those with F4 fibrosis, with a rate of 17.6% (p=0.035). Significant reduction was also observed in the APRI scores of patients at the end of treatment compared with the start of treatment (p<0.001), with no significant difference between treatment groups (p=0.328). Conclusion: Noninvasive assessments of CHC patients treated with DAA revealed regression in liver fibrosis measurements and APRI scores and significant improvements were seen in the stage of fibrosis in the early phases following treatment.

High-resolution magnified endoscopy combined with flexible spectral imagining colour enhancement techniques in the diagnosis of Helicobacter pylori disease.

AIM: To evaluate the efficiency of the flexible spectral imaging colour enhancement (FICE) procedure added to high-resolution magnified endoscopy (HRME) for the evaluation of structural changes in gastric mucosa infected with Helicobacter pylori (H. pylori). MATERIAL AND METHODS: A total of 104 patients were included in the study. First HRME and then HRME + FICE methods were used for the evaluation of the gastric mucosal structure, and examined areas were studied histopathologically. Mucosal appearance was evaluated with the modified Yagi classification. Images were shown to five endoscopists in order to examine inter- and intra-observer variability in image assessment. RESULTS: Sensitivity and specificity of the image pattern noted with HRME in the antrum in the detection of H. pylori were 67.9% and 84.6%, respectively, while these were 93.5% and 92.3%, respectively, with HRME + FICE. Type 5 pattern in the antrum, which we thought to be associated with intestinal metaplasia, was not observed in any patient with HRME. Sensitivity and specificity values of type 5 pattern noted with HRME + FICE technique for intestinal metaplasia were 50% and 98.8%, respectively. CONCLUSIONS: The results show that HRME + FICE as a digital chromoendoscopic method provided an additional diagnostic contribution to HRME for showing the presence of H. pylori and intestinal metaplasia and is a method with higher sensitivity and specificity. The "patchy appearance" (type 5) observed in the antrum not previously described in the evaluations with FICE can be a guiding sign especially for the diagnosis of intestinal metaplasia.

The efficacy and safety of tenofovir in the prevention of hepatitis B virus recurrence following liver transplantation.

BACKGROUND/AIMS: In this study, a tenofovir disoproxil fumarate (TDF) + hepatitis B immunoglobulin (HBIG) regimen was compared with lamivudine (LAM) + HBIG to determine the efficacy and safety of TDF in the prevention of hepatitis B virus (HBV) recurrence following liver transplantation (LT). MATERIALS AND METHODS: Thirty-six patients, 18 treated with TDF+HBIG (TDF group) and 18 with LAM+HBIG (LAM group), were evaluated retrospectively over a median 36-month follow-up in the Liver Transplantation Outpatient Unit of Dokuz Eylül University after having an LT. In the TDF group, TDF treatment was initiated in six patients due to resistance to LAM, in one patient due to relapse, in three patients to prevent relapse, and in eight patients due to de novo hepatitis. In the LAM group, LAM therapy was initiated in two patients due to de novo hepatitis and in 16 patients to prevent relapse. RESULTS: In the TDF group, an increase of greater than 0.5 mg/dL in creatinine values was observed in two patients. In the LAM group, creatinine values did not increase to greater than 0.5 mg/dL. No cases of acute renal failure associated with TDF or LAM, mild or serious adverse events, or HBV recurrence were observed among the patients. Glomerular filtration rates (GFRs) of these patients were calculated with a modification of renal disease (MDRD) formulation. There was no significant difference (p<0.05) in the GFRs between the two groups. CONCLUSION: The results of this study, after a 36-month follow-up period, were encouraging and demonstrated that TDF therapy is safe and efficacious in treating HBV-positive organ transplant patients. However, patients should be monitored carefully in terms of renal function. Given the limited experience with TDR in LT, this study is of importance due to its long follow-up period.

The prevalence of giardia intestinalis in dyspeptic and diabetic patients.

Background and Aims. We aimed to investigate the prevalence of Giardiasis in patients with dyspepsia and patients with diabetes mellitus. Methods. 400 patients and 100 healthy persons were included in this clinical prospective study. The number of patients in each group was equal, 200 dyspeptic and 200 diabetic, respectively. The antigen of G. lntestinalis was determined in the stool specimens by ELISA method. Results. The frequency of Giardiasis was 7% in dyspeptic and 15% in diabetic patients. There was no positive results in any of the healthy persons. There was a significant difference in prevalence rate of Giardiasis between patients with dyspepsia and diabetes mellitus (P < 0.05). Conclusions. These results revealed that the prevalence of Giardiasis in dyspepsia and with diabetes mellitus was high in our country. This is the first study investigating the prevalence of Giardiasis in diabetic patients. To investigate Giardiasis in diabetic patients, who have dyspepsia or not, may be a good approach for public health.