Comparison of heater probe coagulation and argon plasma coagulation in the management of Mallory-Weiss tears and high-risk ulcer bleeding.

BACKGROUND AND STUDY AIMS: Upper gastrointestinal (GI) bleeding is a common medical emergency. Endoscopic treatments often lead to better therapeutic outcomes than conventional conservative treatments. This study aimed to investigate and compare the use of heater probe coagulation (HPC) and argon plasma coagulation (APC) together with epinephrine injection for the treatment of Mallory-Weiss tears and high-risk ulcer bleeding. PATIENTS AND METHODS: A total of 97 patients (54 in the HPC group and 43 in the APC group) who were diagnosed with upper GI bleeding secondary to a Mallory-Weiss tear or high-risk gastric or duodenal ulcers were included in the study. Lesions were classified according to the Forrest classification. The HPC and APC groups were compared in terms of initial haemostasis, re-bleeding in the early period, need for surgery, average need for transfusion, and duration of hospital stay. RESULTS: There were no significant differences between the HPC and APC groups in terms of ensuring initial haemostasis (98% vs. 97.5%, p>0.05), re-bleeding rates (17% vs. 19%, p>0.05), need for surgery (2% vs. 9%, p>0.05), average need for transfusion (3.7±2.11 vs. 3.4±2.95 units, p>0.05), and average duration of hospital stay (4.6±2.24vs. 5.3±3.23days, p>0.05). CONCLUSION: There was no difference between HPC and APC when used together with epinephrine injection for the treatment of Mallory-Weiss tear and high-risk ulcer bleeding.

A Cause of Mortal Massive Upper Gastrointestinal Bleeding: Aortoesophageal Fistula.

INTRODUCTION: Aortoesophageal fistula is an uncommon but mortal cause of massive upper gastrointestinal bleeding. The most common causes are thoracic aortic aneurisym, foreign body reaction, malignancy and postoperative complication. It can be seen in different pattern on upper gastrointestinal endoscopy. There are surgical, endoscopic and interventional radiological treatment options, however, definitive treatment is surgical intervention. Diagnosis and treatment desicion should be made quickly because of rapid and mortal course. CASE REPORT: In this article, a case of aortoesophageal fistula was presented that resulted in mortality as a result of massive bleeding.

Effect of Systemic Infliximab Therapy in Patients with Sjögren's Syndrome.

OBJECTIVES: To investigate the effect of systemic infliximab therapy on tear function tests and the ocular surface in patients with Sjögren's syndrome secondary to various autoimmune diseases. MA­TE­RI­ALS AND MET­HODS: This prospective study included 22 eyes of 22 patients with Sjögren's syndrome who began treatment with systemic infliximab. Tear film break-up time (TBUT), anesthetized Schirmer's 1 test, fluorescein staining test, and Ocular Surface Disease Index (OSDI) scores were recorded before treatment and in the 3rd and 6th months of treatment. RE­SULTS: In the 3rd month of infliximab therapy, no significant changes were observed in Schirmer's values, TBUT, fluorescein staining, or OSDI scores (p=0.260, p=0.357, p=0.190 and p=0.07, respectively). In the 6th month of infliximab therapy, no significant changes were observed in TBUT, fluorescein staining, Schirmer's value or OSDI scores (p=0.510, p=0.320, p=0.220 and p=0.344, respectively). CONCLUSION: Infliximab therapy, which is commonly used in systemic autoimmune diseases such as rheumatoid arthritis, Crohn's disease, ulcerative colitis, and ankylosing spondylitis, did not show a positive effect on ocular surface and tear function tests.

Mean platelet volume could be possible biomarker in early diagnosis and monitoring of gastric cancer.

Gastric cancer is the fourth most frequent cancer and the second cause of cancer-related deaths worldwide. The early diagnosis of gastric cancer is fundamental in decreasing the mortality rates. It has been shown that MPV level is a sign of inflammation in hepatocellular carcinoma and pancreatic adenocarcinoma. The aim of this study is to examine whether MPV would be a useful inflammatory marker for differentiating gastric cancer patients from healthy controls. Thirty-one gastric cancer patients and 31 age-sexes matched healthy subjects included into the study. Patients with hypertension, hematological and renal disease, heart failure, chronic infection, hepatic disorder and other cancer were excluded from the study. MPV level was significantly higher in pre-operative gastric cancer patients compared to healthy subjects (8.31 fL vs. 7.85; p: 0.007). ROC analysis suggested 8.25 fL as the cut-off value for MPV (AUC: 0.717, sensitivity: 61%, specificity: 81%). Surgical tumor resection resulted in a significant decrease in MPV level (8.31 fL vs. 7.55 fL; p: 0.001). No significant difference was found in MPV level between the post-operative group and control subjects. We did not find statistically significant difference between MPV and TNM stages. In conclusion, changes in MPV values may be used as an easily available biomarker for monitoring the healthy patients for GC risk and may prompt physicians to make an early diagnosis of GC.

Adding pineapple juice to a polyethylene glycol-based bowel cleansing regime improved the quality of colon cleaning.

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.

Non-invasive tests in prediction of liver fibrosis in chronic hepatitis B and comparison with post-antiviral treatment results.

BACKGROUND AND AIM: The aim of this study was to assess and compare the performance of a series of non-invasive tests to detect fibrosis in patients with chronic hepatitis B (CHB). PATIENTS AND METHODS: Seventy-six patients with CHB, whose blood samples were collected and biopsies were done on the same day, were included in this study. Pre-treatment calculations of aspartate aminotransferase to platelet ratio index (APRI), Forn's index, FIB-4, S-index, Shanghai Liver Fibrosis Group's index (SLFG) and Hepascore(®) were done and relations with mild and advanced fibrosis and cirrhosis were assessed. Post-treatment values of APRI, Forn's index, FIB-4, S-index with oral antiviral agents were also investigated. RESULTS: APRI, S-index, SLFG, FIB-4, Forn's index and Hepascore(®) had 0.669, 0.669, 0.739, 0.741, 0.753, 0.780; retrospectively Area Under the Receiver Operating Characteristic Curve (AUROC) for significant fibrosis. APRI, Forn's index, S-index, FIB-4, SLFG, and Hepascore(®) had 0.681, 0.714, 0.715, 0.738, 0.747, 0.777 retrospectively AUROC for advanced fibrosis. APRI, SLFG, FIB-4, Forn's index, S-index, and Hepascore(®) had 0.741, 0.742, 0.768, 0.779, 0.792, 0.824 retrospectively AUROC for cirrhosis. APRI, Forn's index, FIB-4 and S-index were significantly lower in post-treatment group compared with pre-treatment group (P-values: <0.05, 0.001, 0.003, 0.018; respectively). CONCLUSION: Hepascore(®) showed the best performance to predict significant fibrosis. Our study also suggests that the use of non-invasive test to predict fibrosis in patients with CHB may reduce the need for liver biopsy and may help to monitor the efficacy of treatment.

Liver fatty acid-binding protein is a diagnostic marker to detect liver injury due to chronic hepatitis C infection.

BACKGROUND AND AIMS: Liver fatty acid-binding protein (L-FABP) is a small molecule. The aim of this study was to examine L-FABP levels and to detect its diagnostic value in chronic hepatitis C (CHC). METHODS: We studied 22 patients with CHC and 20 healthy control subjects. Patients with persistently elevated serum aminotransferases and positive HCV RNA were included in the study. Patients with CHC underwent percutaneous liver biopsy. Serum level of L-FABP was determined by ELISA method. RESULTS: Patients with CHC had significantly increased levels of L-FABP compared to controls. A strong correlation between serum L-FABP concentrations and aspartate aminotransferases, alanine aminotransferases, HCV RNA levels and hepatic inflammation was found. When a cut-off value was 29,000 pg/mL for L-FABP, sensitivity and specificity were 75 and 100%, respectively. Positive and negative predictive values for L-FABP were 100 and 78%, respectively. CONCLUSIONS: Serum L-FABP is used as a new diagnostic marker to detect liver injury.

Long-term efficacy and safety of lamivudine, entecavir, and tenofovir for treatment of hepatitis B virus-related cirrhosis.

BACKGROUND & AIMS: Data are limited on the efficacy and safety of tenofovir and entecavir when given for more than 1 year to patients with hepatitis B-related cirrhosis. We investigated the long-term safety and efficacy of these antiviral drugs in patients with chronic hepatitis B virus (HBV) infection, with compensated or decompensated cirrhosis, and compared results with those from lamivudine. METHODS: We performed a retrospective analysis of data from 227 adult patients with chronic HBV infection who were diagnosed with cirrhosis, beginning in 2005, at 18 centers throughout Turkey. There were 104 patients who had decompensated cirrhosis, and 197 patients were treatment naive before. Seventy-two patients received tenofovir (followed up for 21.4 ± 9.7 mo), 77 patients received entecavir (followed up for 24.0 ± 13.3 mo), and 74 patients received lamivudine (followed up for 36.5 ± 24.1 mo). We collected data on patient demographics and baseline characteristics. Laboratory test results, clinical outcomes, and drug-related adverse events were compared among groups. RESULTS: Levels of HBV DNA less than 400 copies/mL were achieved in 91.5%, 92.5%, and 77% of patients receiving tenofovir, entecavir, or lamivudine, respectively. Levels of alanine aminotransferase normalized in 86.8%, 92.1%, and 71.8% of patients who received tenofovir, entecavir, and lamivudine, respectively. Child-Turcotte-Pugh scores increased among 8.5% of patients who received tenofovir, 15.6% who received entecavir, and 27.4% who received lamivudine. Frequencies of complications from cirrhosis, including hepatic encephalopathy, variceal bleeding, hepatocellular carcinoma, and mortality, were similar among groups. Lamivudine had to be changed to another drug for 32.4% of the patients. CONCLUSIONS: Tenofovir and entecavir are effective and safe for long-term use in patients with compensated or decompensated cirrhosis from HBV infection.

A novel appetite peptide, nesfatin-1 in patients with non-alcoholic fatty liver disease.

BACKGROUND AND AIMS: Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver pathology worldwide and is strongly associated with obesity and insulin-resistance and food intake. Nesfatin-1 is a new peptide that controls appetite and food intake. The objective of this research was to examine the serum concentrations of nesfatin-1 in NAFLD. MATERIAL AND METHODS: Thirty NAFLD patients who had elevated liver enzymes and 40 age- and sex-matched healthy subjects were included in this study. NAFLD was diagnosed and graded with the findings of liver ultrasound scan. Nesfatin-1 concentrations were measured using an ELISA method and the relationship between nesfatin-1 and metabolic parameters were investigated. The subjects were divided into two groups according to their body mass index (≥ 30 and < 30) and nesfatin-1 concentrations were examined between both groups. RESULTS: Serum nesfatin-1 concentrations in NAFLD patients were lower than healthy controls (0.26 ± 0.14 ng/ml, 0.38 ± 0.18 ng/ml, respectively, and p = 0.008). We found a negative correlation between nesfatin-1 and fasting glucose and body mass index. In obese subjects, serum nesfatin-1 concentrations were significantly lower when compared with non-obese subjects (0.26 ± 0.12 ng/ml, 0.37 ± 0.19 ng/ml, respectively; p = 0.014). In addition, we showed that nesfatin-1 concentrations in subjects with insulin resistance were significantly lower in comparison with insulin-sensitive ones (0.27 ± 0.17 ng/ml, 0.38 ± 0.17 ng/ml, respectively; p = 0.015). CONCLUSION: Our study has shown that nesfatin-1 concentrations were reduced in NAFLD. The results of this study indicate that nesfatin-1 may have a significant role in NAFLD.

Factors affecting the success of endoscopic bougia dilatation of radiation-induced esophageal stricture.

AIMS: The purpose of this retrospective study was to assess clinical outcomes of endoscopic bougie dilation of esophageal strictures after radiation therapy for head and neck cancer, and to assess the risk factors which affect the treatment success. METHODS: Thirty-one patients with esophageal stricture due to radiation therapy were treated with endoscopic bougie dilation. The following parameters were evaluated; age, gender, primary site of the tumor, initial treatment of the tumor, prescribed dose of radiation, the time to onset of esophageal stricture after radiation therapy, grade of esophageal stricture according to clinical and endoscopic findings, number of dilatations, recurrence of esophageal stricture, and the result of the therapy. RESULTS: The average follow-up was 26 months with a range of 1-84 months. Successful endoscopic bougie dilation was achieved in 26 of 31 patients. The median time to onset of esophageal stricture after radiation therapy was significantly shorter in patients who did not respond to endoscopic bougie dilation. CONCLUSION: Endoscopic bougie dilation is a safe and effective procedure for the management of radiation-induced esophageal stricture. Time to onset of esophageal stricture is the most important factor for the treatment success. In addition, the total prescribed dosage of radiation has minimal effects on the result of endoscopic bougie dilation.

Neuroendocrine tumor of the cecum in a young boy diagnosed by colonoscopic examination.

Cecal NETs are very uncommon and can be easily misdiagnosed, resulting in advanced-stage disease at initial diagnosis. For that reason, a high level of vigilance and awareness of NETs in the differential diagnosis of lower abdominal pain is crucial even when the patient has no symptoms from hormone secretions.