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.

The Role of Resolvin D1 in the Differential Diagnosis of the Cholangiocarcinoma and Benign Biliary Diseases.

BACKGROUND: The discrimination of malignant biliary strictures from benign biliary diseases (BBDs) is challenging and complicated. We aimed to investigate whether Resolvin D1 (RvD1) would aid in the discrimination of cholan-giocarcinoma (CCA) from BBDs. METHODS: Thirty-one patients with CCA, 27 patients with BBD, and 30 healthy controls were enrolled in this cross-sectional study. The diagnosis of CCA was based on results obtained from abdominal USG, MRCP, abdominal CT, endosonography, and tumor markers, including CEA and CA 19-9. Histopathological evaluation was performed in the majority of patients, and the final diagnosis was based on surgery or biopsy results. RvD1, CEA, and CA 19-9 were analyzed in all patients with CCA and BBD. RESULTS: RvD1 was significantly lower in those with CCA compared to patients with BBD and healthy controls. In addition, CEA and Ca 19-9 levels were significantly higher in the CCA group than the BBD group (p < 0.001). RvD1 concentration, CA 19-9 concentration, and total bilirubin level were found to be correlated with tumor stage (r = -0.702, 0.390, and 0.569, respectively). ROC curve analysis revealed that an RvD1 concentration of < 380 ng/mL (AUC: 0.783, 95% CI: 0673 - 0.893, p < 0.001) and CA 19-9 concentration of > 94.5 U/mL (AUC: 0.94, 95% CI: 0.898 - 0.998, p < 0.001) could be used to discriminate patients with CCA from those with BBD. CONCLUSIONS: Resolvin D1 and CA 19-9 levels might be used to effectively discriminate between BBD and CCA. Moreover, both RvD1 and CA 19-9 levels are associated with the stage of CCA, indicating that they may also be used in assessing disease progression.

Assessment of Atrial Electromechanical Delay and Left Atrial Mechanical Functions in Patients with Ulcerative Colitis.

OBJECTIVE: Ulcerative colitis (UC) is a common inflammatory bowel disease causing systemic inflammation, which may also affect the cardiovascular system, as well as other organ systems. The aim of the current study was to evaluate left atrial (LA) mechanical functions and duration of atrial electromechanical delay (AEMD) with echocardiography in patients with UC. METHOD: A total of 91 patients, 45 with UC (Group 1) and 46 healthy individuals as control (Group 2) were included in the study. The demographic and laboratory data were recorded, and echocardiographic measurements were taken for all patients. RESULTS: In the evaluation of basal clinical and laboratory findings, no difference was detected between the two groups, except for white blood cell count (WBC) (8.26 ± 2.71 vs. 7.06 ± 1.70, P = 0.013) and high-sensitivity C-reactive protein (Hs-CRP; 3.4 ± 1.7 vs. 1.0 ± 0.8, P < 0.001). The echocardiographic assessment revealed that the diastolic parameters such as E-, E/A-, and E- waves decreased in the UC group when compared to the control group. LA mechanical functions were different between groups, except for left atrial (LA) maximal volume: LA minimum volume (22.2 ± 12.9 vs. 15.3 ± 4.7, P = 0.001), LA volume before atrial systole (29.9 ± 14.2 vs. 24.2 ± 4.9, P = 0.021), LA ejection fraction (27.4 ± 16.5 vs. 38.6 ± 10.1, P < 0.001), LA total emptying volume (17.9 ± 6.9 vs. 21.9 ± 5.9, P = 0.004), LA active emptying fraction (27.4 ± 16.5 vs. 38.6 ± 10.1, P < 0.001), LA active emptying volume (7.7 ± 3.6 vs. 9.4 ± 2.9, P = 0.013), LA passive emptying fraction (26.8 ± 10.2 vs. 33.2 ± 9.2, P = 0.002), and LA passive emptying volume (10.3 ± 4.9 vs. 12.5 ± 4.5, P = 0.029). There was a significant difference between the groups in terms of AEMD durations, except time interval from the onset of the P-wave on the surface ECG to the peak of the late diastolic wave (PA) of the tricuspid valve. The correlation analysis revealed that age and duration of disease were correlated with AEMD. CONCLUSION: The current study reported that LA volume and mechanical functions degenerated and AEMD increased in patients with UC when compared to the control group. These findings demonstrate that UC may have effects on LA electromechanical functions related to duration of disease.

Intestinal fatty acid binding protein (I-FABP) as a promising test for Crohn's disease: a preliminary study.

BACKGROUND: Crohn's disease (CD) is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract from the mouth to the anus. The clinical course presents with remissions and activations. Also, clinical findings or endoscopic activity do not always reflect the overall appropriate disease activity. This is why specific markers are always an issue of concern for the diagnosis, prediction of relapse, and monitoring of CD activity. Fatty acid binding proteins (FABPs) are intracellular proteins that are expressed abundantly in several tissues. Intestinal FABP (I-FABP) is a plasma and urine marker that indicates intestinal damage. In this preliminary study, we aimed to determine whether serum I-FABP levels are a useful marker for CD. METHODS: Seventy-four patients with CD (41 active and 33 in remission) and 37 healthy controls were included in the study. The level of serum I-FABP was determined by ELISA. Crohn's disease activity index (CDAI) and CRP were used to assess the activity of Crohn's disease and to evaluate whether I-FABP is a useful laboratory marker. RESULTS: Serum I-FABP levels of patients with active disease were observed to be statistically higher than patients in the remission and control groups (p = 0.012 and p = 0.038, respectively). No statistically significant difference was observed among patients in the remission and control groups (p = 0.145). Correlation analysis showed a positive correlation between I-FABP and CDAI (r = 0.319, p = 0.006). In addition, a positive correlation was found between CRP and I-FABP levels. CONCLUSIONS: I-FABP seems to be a useful systemic marker for CD activity.

The protective effect of Echinacea spp. (Echinacea angustifolia and Echinacea purpurea) in a rat colitis model induced by acetic acid.

Ulcerative colitis (UC) is a chronic disease that causes an inflammatory condition in the colon. Several cytokines, including tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1ß) and transforming growth factor beta (TGF-ß) are crucial components of these inflammatory pathways. New therapeutic strategies are needed for improved clinical outcomes in UC and with less adverse effects. That is why alternative therapies such as herbal remedies are increasingly being used with favorable effects in the treatment of UC. Hence, in the present study, we aimed to evaluate the protective effect of Echinacea spp in an experimental rat colitis model induced by acetic acid (AA). Acetic acid was given via a rectal route to induce acute colitis in rats. Rats were placed in four groups: control, Echinacea, Echinacea-colitis and colitis. Tumor necrosis factor alpha, IL-1ß and TGF-ß levels were measured. Histopathological comparison of the groups was also performed. The disease activity index (DAI) was significantly higher in the colitis group compared to the control, Echinacea and Echinacea-colitis groups (p<0.001). There was no significant difference between the DAI of control, Echinacea and Echinacea-colitis groups (p>0.07). The inflammatory mediators IL-1ß and TNF-α were significantly elevated in the colitis group compared to the other groups (p<0.007, <0.001 respectively). Therefore, Echinacea spp. may likely have some therapeutic favorable effects in the management of UC.

The efficacy of two-week quadruple first-line therapy with bismuth, lansoprazole, amoxicillin, clarithromycin on Helicobacter pylori eradication: a prospective study.

AIM: To document the efficacy and tolerability of 14-day bismuth-lansoprazole-amoxicillin-clarithromycin (BLAC) regimen for Helicobacter pylori (H. pylori) eradication as a first-line therapy. METHOD: Patients were considered eligible for the study if they underwent upper gastrointestinal endoscopy, and H. pylori infection was diagnosed through histologic examination of antral and body biopsy samples. Primary end point of this study was to evaluate the eradication rate of 14-day BLAC regimen therapies. H. pylori eradication was assessed using the 13C urea breath test performed 6 weeks after the completion of treatment. All patients were asked to fill in a validated questionnaire to report therapy-related side effects. Each symptom was graded from absent or present. RESULTS: Ninety-seven (21 men and 76 women) were enrolled. All the patients completed the study. The H. pylori eradication rate was 90.7% (88 of 97 patients). Side effects were observed in reasonable percentages, and none of the patients left the study because of drug side effect. CONCLUSION: Bismuth-lansoprazole-amoxicillin-clarithromycin regimen as a 2-week course achieved an acceptable eradication rate with relatively mild side effects.

EFFICACY AND SAFETY OF GEMIFLOXACIN CONTAINING TREATMENT REGIMEN IN FIRST-LINE TREATMENT OF HELICOBACTER PYLORI.

•In eradication treatment of H. pylori gemifloxacin containing triple treatment regimen was as effective as bismuth containing quadruple treatment. •Drug adverse effects were fewer and milder in the gemifloxacin group. •Since treatment period was shorter and pills to be taken were fewer compared to quadruple treatment, patient compliance was significantly higher in the gemifloxacin group. Background - After eradication of Helicobacter pylori (H. pylori) chronic gastritis will resolve, complications due to H. pylori infection and recurrence of infection will be prevented. Objective - To determine efficacy and safety of gemifloxacin containing treatment regimen in first line treatment of H. pylori with comparison to bismuth containing quadruple therapy. Methods - This retrospective study was conducted in a tertiary care university hospital between January 2018 and January 2021 with 410 participants who were diagnosed to have H. pylori infection with biopsies obtained during upper gastrointestinal system endoscopy. Patients were distributed into two groups according to their first-line treatment regimens. First group patients were treated with amoxicillin, gemifloxacin and pantoprazole and second group patients were treated with amoxicillin, metronidazole, bismuth subcitrate and pantoprazole for seven days. Results - Intention to treat and per protocol ratios for gemifloxacin containing regimen were 90.0% and 91.2%, while quadruple treatment has these ratios as 91.7% and 93.8% respectively. Treatment success rate in both regimens were similar. But adverse effects were lower and patient compliance were better in patients who had gemifloxacin containing treatment (P<0.001). Conclusion - Gemifloxacin containing treatment regimen is as effective as bismuth containing quadruple treatment regimen for H. pylori infection and patient compliance is better in this group. Gemifloxacin containing treatment regimens may be novel and effective alternatives for eradication of H. pylori infection.

Efetividade e segurança do regime de tratamento contendo gemifloxacino no tratamento de primeira linha para Helicobacter pylori / Efficacy and safety of gemifloxacin containing treatment regimen in first-line treatment of helicobacter pylori

ABSTRACT Background: After eradication of Helicobacter pylori (H. pylori) chronic gastritis will resolve, complications due to H. pylori infection and recurrence of infection will be prevented. Objective: To determine efficacy and safety of gemifloxacin containing treatment regimen in first line treatment of H. pylori with comparison to bismuth containing quadruple therapy. Methods: This retrospective study was conducted in a tertiary care university hospital between January 2018 and January 2021 with 410 participants who were diagnosed to have H. pylori infection with biopsies obtained during upper gastrointestinal system endoscopy. Patients were distributed into two groups according to their first-line treatment regimens. First group patients were treated with amoxicillin, gemifloxacin and pantoprazole and second group patients were treated with amoxicillin, metronidazole, bismuth subcitrate and pantoprazole for seven days. Results: Intention to treat and per protocol ratios for gemifloxacin containing regimen were 90.0% and 91.2%, while quadruple treatment has these ratios as 91.7% and 93.8% respectively. Treatment success rate in both regimens were similar. But adverse effects were lower and patient compliance were better in patients who had gemifloxacin containing treatment (P<0.001). Conclusion: Gemifloxacin containing treatment regimen is as effective as bismuth containing quadruple treatment regimen for H. pylori infection and patient compliance is better in this group. Gemifloxacin containing treatment regimens may be novel and effective alternatives for eradication of H. pylori infection.

RESUMO Contexto: Após a erradicação do Helicobacter pylori (HP), a gastrite crônica será resolvida, as complicações devido à infecção por HP e a recorrência da infecção serão prevenidas. Objetivo: Determinar a eficácia e segurança do regime de tratamento contendo gemifloxacino no tratamento de primeira linha do HP, em comparação com a terapia quádrupla contendo bismuto. Métodos: Este estudo prospectivo foi conduzido em um hospital universitário de atendimento terciário entre janeiro de 2018 e janeiro de 2021, com 410 participantes diagnosticados com infecção por HP, obtidos por meio de biópsias durante a endoscopia do sistema gastrointestinal superior. Os pacientes foram divididos em dois grupos de acordo com seus regimes de tratamento de primeira linha. Os pacientes do primeiro grupo foram tratados com amoxicilina, gemifloxacino e pantoprazol, e os pacientes do segundo grupo foram tratados com amoxicilina, metronidazol, subcitrato de bismuto e pantoprazol por 7 dias. Resultados: As taxas de intenção de tratar e por protocolo para o regime contendo gemifloxacino foram de 90,0% e 91,2%, enquanto o tratamento quádruplo apresentou essas taxas como 91,7% e 93,8%, respectivamente. A taxa de sucesso do tratamento em ambos os regimes foi similar. No entanto, os efeitos adversos foram menores e a adesão dos pacientes foi melhor nos que receberam o tratamento contendo gemifloxacino (P<0,001). Conclusão: O regime de tratamento contendo gemifloxacino é tão eficaz quanto o regime de tratamento quádruplo contendo bismuto para a infecção por HP, e a adesão dos pacientes é melhor neste grupo. Os regimes de tratamento contendo gemifloxacino podem ser alternativas novas e eficazes para a erradicação da infecção por HP.

Celiac disease prevalence in a large series of patients with Behçet's disease.

AIM: There are common findings between Behçet's disease (BD) and celiac disease (CD) based on similar immunological pathogenesis and there is only limited data available investigating the link between these two diseases. Furthermore, documented gastrointestinal (GI) involvement with marked upper GI symptoms in BD has been rarely reported. The aim of this study was to assess the prevalence of CD and to evaluate endoscopic findings in Turkish BD patients. METHODS: A total of 210 BD patients were included in the study. All patients underwent serological testing for anti-gliadin and tissue transglutaminase antibodies. Endoscopic examinations were performed in 190 patients who accepted upper GI system endoscopy. Multiple biopsies were taken from the second portion of the duodenum in patients with positive serological assessment for CD. RESULTS: A total of 4.2% of patients with BD had positive anti-gliadin and tissue transglutaminase antibody immunoglobulin A (IgA) and IgG antibodies. The prevalence of biopsy-confirmed CD was 1.05% in Turkish BD patients. The most common endoscopic findings of patients with BD were found to be antral gastritis, duodenitis and esophagitis. CONCLUSION: Although BD and CD share many similar clinical manifestations, our results did not support a possible association between these two diseases.