The endoscopic course of scattered white spots in the descending duodenum: a prospective study.

AIM: Scattered white spots (SWSs) in the descending duodenum are an uncommon finding of upper gastrointestinal system endoscopy (UGSE). Intestinal lymphangiectasia, chronic nonspecific duodenitis and giardiasis are associated with a SWS appearance. The aim of this study was to determine the frequency of SWS during routine endoscopy, as well as to evaluate the effect of treatment on this finding. MATERIALS AND METHODS: Patients undergoing UGSE with a SWS appearance in the descending duodenum were included prospectively. Appearance of SWSs was graded endoscopically based on density, after which patients were divided into two groups; group 1 (treated group) and group 2 (untreated group). Patients with Helicobacter pylori infection were given eradication therapy, whereas a diet was recommended to patients with intestinal lymphangiectasia. Proton pump inhibitors were initiated for patients with H. pylori negative gastritis. All patients were re-evaluated three months after therapy for the presence of any changes in the SWS appearance. RESULTS: SWSs were observed in 97 (3.2%) out of 3010 patients. This appearance was most commonly associated with chronic non-specific duodenitis followed by intestinal lymphangiectasia. While in the untreated group no statistically significant change in SWS appearance was observed, the decrease in endoscopic grade seen in the treated group was statistically significant (p<0.001). CONCLUSION: The prevalence of SWSs during routine UGSE was 3.2%, with this finding being more commonly associated with chronic non-specific duodenitis and intestinal lymphangiectasia. Treatment of the underlying causes, including H. pylori eradication, proton pump inhibitors and diet decreased the density of the SWSs.

Ileocolonic involvement in Behçet's disease: endoscopic and histological evaluation.

BACKGROUND: Our aim was to document the frequency of gastrointestinal (GI) involvement of Behçet's disease (BD) at endoscopic examination. Also, we aimed to analyze whether GI lesions were correlated with other systemic components of BD. METHODS: Fifty patients with BD were enrolled in the study. Patients in whom optimal colonoscopic examination of both the colon and terminal ileum could be performed were included. An ileum biopsy was taken from all cases. Upper GI endoscopy findings, presence of genital ulcers, uveitis, dermatological lesions, pathergy test, neurological involvement and peripheral vasculitis, and laboratory findings were recorded. Thirty age- and sex-matched persons who had perfect bowel cleansing and had a macroscopically normal colon and terminal ileum at colonoscopy without any systemic diseases were enrolled as the control group. RESULTS: Nine patients and 1 case had macroscopic ileum and colon lesions, respectively. Microscopic examination of BD patients with normal colon and terminal ileum at colonoscopy revealed 61% abnormal ileum histologies. That ratio was 30% for the control group (p < 0.001). None of the patients had any lesions suggesting BD at upper GI endoscopy. There was no correlation between macro- or microscopic GI involvement and other components of BD. CONCLUSIONS: Lower GI tract, especially ileum involvement, is frequent in BD. Most of the patients have inflammation in the ileum even in the absence of macroscopic lesions.

Elevated adenosine deaminase levels in celiac disease.

Celiac disease (CD) is a genetically based chronic inflammatory disorder of the small bowel induced by the dietary gluten and possibly other environmental cofactors. The objective of this study was to investigate the relation of adenosine deaminase (ADA), a cytoplasmic enzyme involved in the catabolism of purine bases, as an index of altered immune response, with adult CD patients. ADA has been shown to increase in several inflammatory conditions, but there is no literature data indicating an alteration in CD. Serum levels of ADA were investigated in newly diagnosed 20 CD patients. ADA levels were compared in patients with CD and in healthy controls. Correlation analysis was also performed between ADA and other serum markers of CD (anti-gliadin and anti-endomysial antibodies) Mean serum ADA levels were significantly elevated in CD patients compared with control group. ROC curve analysis suggested that the optimum ADA level cut-off point for CD was 12.27 U/l. At a cut-off value of 12.27 U/l, the sensitivity was 80% and specificity was 100%. There was no statistically significant correlation between ADA and anti-gliadin and anti-endomisium antibodies. Serum ADA levels elevated significantly in CD patients, suggesting a partial role in activated T-cell response in the disease pathophysiology. ADA can be used as a supportive diagnostic marker in patients with CD.

Differentiation of Behcet's disease from inflammatory bowel diseases: anti-Saccharomyces cerevisiae antibody and anti-neutrophilic cytoplasmic antibody.

The differential diagnosis of Behcet's disease (BD) from inflammatory bowel disease (IBD) is sometimes difficult and challenging. Hereby, we suggested the utility of anti-saccharomyces cerevisiae antibody (ASCA) and anti-neutrophilic cytoplasmic antibody (p-ANCA) in the differential diagnosis of BD from IBD.

Primary anorectal malignant melanoma: two case reports and review of the literature.

Anorectal melanoma is a very rare tumor with poor prognosis because of delay in diagnosis. It is often mistaken for benign conditions such as hemorrhoids or rectal polyps. Surgical treatment ranges from local excision to radical abdominoperinal resection. Herein, we report 2 cases of anorectal malignant melanoma and further review the diagnostic and therapeutic approaches in light of the pertinent literature.

Impact of hepatitis B core antibody (anti HBc) seropositivity on interferon/ribavirin treatment response in patients with chronic hepatitis C.

AntiHBc seropositivity among patients with chronic HCV infection is not a rare entity (57.14 %). We observed that antiHBc antibody seropositivity does not have a significant impact on treatment responses to interferon/ribavirin therapy in patients for chronic HCV infection in contrast to some reports in the literature (Tab. 6, Ref. 39) Full Text (Free, PDF) www.bmj.sk.

Two cases with hepatocellular carcinoma and spleen metastasis.

Metastasis of hepatocellular carcinoma to various organs is frequently seen. The lungs, regional lymph nodes, kidney, bone marrow and adrenals are relatively common sites of metastasis. However, metastasis to the spleen is extremely rare. Herein, two patients with hepatocellular carcinoma who developed splenic metastasis are described and distinctive features of spleen metastasis are summarized.

The usefulness of ulcer size and location in the differential diagnosis of benign and malignant gastric ulcer.

AIM: Gastric cancer can present as a gastric ulcer, which can mimic a benign gastric ulcer. In this study, we aimed to investigate the value of gastric ulcer size and location in the differential diagnosis of benign and malignant gastric ulcers. METHODS: We reviewed retrospectively the upper endocopic findings of 14,400 patients between April 2008 and March 2010. Total 276 patients with gastric ulcers were divided into two groups according to histopathological examination. Ulcer location, size, age, and gender were compared between the two groups. RESULTS: The predominant region of ulcer location was the corpus for the malignant ulcer group and the antrum for the benign ulcer group. The malignant ulcer ratios according to region in the whole group were: cardia 19 ulcers with 14 malignant (73.68 %), corpus 70 ulcers with 38 malignant (54.2 %), angulus 45 ulcers with 6 malignant (13.3 %), and antrum 142 ulcers with 20 malignant (14.8 %), respectively. The median size of ulcer was significantly higher in the malignant ulcer group compared with the benign ulcer group (p < 0.001). CONCLUSIONS: These results suggest that the location and diameter of gastric ulcers may be used as a marker of risk factors for developing gastric cancer.

Investigation of upper gastrointestinal tract involvement and H. pylori presence in lichen planus: a case-controlled study with endoscopic and histopathological findings.

BACKGROUND: Lichen planus (LP) is a common disease of unknown etiology. Rare mucosal involvements like esophageal LP have been reported increasingly. Infectious agents including H. pylori and other autoantigens have been investigated in etiology and association with certain gastrointestinal pathologies have been well documented. OBJECTIVES: The aim of this study is to investigate the upper gastrointestinal tract involvement in LP and to evaluate the possible etiologic role of H. pylori. PATIENTS, MATERIALS AND METHODS: 49 LP patients and 35 volunteers (without LP) with gastrointestinal symptoms were included in the study as the control group. LP group was divided into subgroups regarding gastrointestinal symptoms. Upper videoendoscopy was performed in both groups and biopsies were taken from suspicious areas for LP, gastrointestinal diseases, H. pylori and examined histopathologically. SPSS 13 was used for the analysis. Groups/subgroups were compared via xi-square test, Mann-Whitney U test, and t-test. RESULTS: Gastrointestinal symptoms were recorded in 71% of LP group; none of LP patients presented typical esophageal LP. Gastrointestinal diseases were more frequent in LP group than controls, endoscopically. Chronic gastritis (91.8%) was the leading diagnosis in LP patients. Superficial gastritis was significantly higher (13.3%) in LP patients than controls (p = 0.04). LP was not diagnosed in any of the esophageal mucosa biopsies whereas lymphoid follicles were observed significantly higher in control group (p < 0.01) histopathologically. H. pylori positivity was found higher in LP group (81.6%) though statistically insignificant. CONCLUSIONS: We believe upper endoscopy should be performed to investigate esophageal LP and gastrointestinal pathologies especially when LP patient is symptomatic. Although we didn't detect esophageal LP, our study had the limitation of taking biopsies from pathological sites only. Since histopathological examination of normal appearing esophagus may help in diagnosing occult LP, and prevent eventual complications, it may be further evaluated in larger study groups. A new technique, magnification chromoendoscopy, may be useful in detecting esophageal involvement. We believe the possible role of H. pylori in LP is yet to be determined also.

Serum α-fetoprotein levels in liver steatosis.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a common disorder and becoming a leading cause of cirrhosis in the western world. The monitoring of the disease is challenging and the prognostic importance of α-fetoprotein (AFP) level elevation in NAFLD remains uncertain. METHODS: Eighty-four patients were evaluated in the study. Patients with evidence of fatty liver in an abdominal ultrasonography performed for any reason were enrolled in the study. Degree of liver steatosis was graded into three groups. As a control group, patients without fatty liver or other liver diseases were included. All patients and controls were asked about prior hepatic diseases, consumption of alcohol, smoking, drug use, and a physical examination, biochemical analyses including liver function tests, different components of the metabolic syndrome, and the homeostasis model assessment-estimated insulin resistance (HOMA-IR) score were also performed. RESULTS: Body mass index, aspartate aminotransferase, alanine aminotransferase, glucose, insulin, and HOMA-IR in patients with NAFLD were higher than in control group. Triglyceride, total cholesterol, low-density lipoprotein, and high-density lipoprotein cholesterol levels were higher in NAFLD group than in control group. A statistically significant increase in AFP levels was noted in patients with NAFLD (4.09 ± 1.68) when compared with healthy controls (2.95 ± 0.41) (P < 0.05). A statistically significant increase in AFP levels was noted in patients with grade 3 NAFLD (5.43 ± 1.51) when compared with grade 1 (2.92 ± 1.06) and grade 2 NAFLD groups (3.97 ± 1.45). Also, AFP was significantly higher in grade 2 NAFLD group than in grade 1 NAFLD group. AFP was correlated with NAFLD grade, but neither ALT nor AST showed correlation. According to multivariate analysis, correlation between NAFLD grade and serum AFP levels was independent from the other factors. CONCLUSION: Patients with NAFLD have higher AFP levels than those without fatty liver changes. AFP levels rise as grade of liver steatosis increases. NAFLD should be among the differential diagnosis of elevated serum AFP levels.

Do scattered white spots in the duodenum mark a specific gastrointestinal pathology?

OBJECTIVE: To discover whether scattered white spots (SWS) in the duodenum are related to a specific kind of disease. We also scrutinized other upper endoscopic findings which might be associated with SWS. METHODS: Among the patients who were admitted for upper gastrointestinal system endoscopy, those having the endoscopic appearance of SWS in duodenum were enrolled in this study. In total 107 patients [70 women, 37 men, mean age: 51.6 +/- 16.88 years (range: 17-82 years)] were included. At least three duodenal biopsies were taken from each patient and histopathological examinations were done by experienced pathologists. RESULTS: The histopathological examination revealed that 39 (36.4%) patients had intestinal lymphangiectasia (IL), 15 (14%) patients had giardiasis (G) and 30 (28.1%) patients had chronic non-specific duodenitis (CD). Two patients with IL were also found to have G. Twenty patients had both IL and CD. One had both G and CD. G was the least common etiology for SWS in the duodenum. The most common reasons for SWS in the duodenum in this study group were IL and CD, in order of decreasing frequency. There was no significant relationship with the other upper endoscopic findings in all these patients. CONCLUSION: Histopathological examinations should be provided for each patient with SWS in the duodenum to assess the etiology.