Assessment of left ventricular contractile functions in inflammatory bowel disease according to disease activity.

OBJECTIVES: The study aimed to investigate the subclinical involvement of cardiac functions in patients with inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD) according to their disease activity status by two-dimensional speckle tracking echocardiography (2DSTE). METHODS: This prospective study included 72 consecutive patients with IBD and 93 age- and sex-matched healthy controls (HC). All participants underwent conventional and 2DSTE assessments. The IBD patients were subdivided into active disease and remission groups for further investigation of the effect of disease activity on left ventricular (LV) contractile functions. RESULTS: The longitudinal strain values differed significantly between the IBD group and the control group (global longitudinal strain [GLS] from two-chamber view: [-15.74 ± 6.33]% vs [-18.8 ± 2.87]%, P = 0.001; GLS from four-chamber view: [-16.61 ± 9.91]% vs [-20.12 ± 2.57]%, P = 0.008; GLS: [-15.47 ± 6.87]% vs [-19.48 ± 2.16]%, P = 0.0001). The circumferential strain measurements showed a nonsignificant trend of depressed contractile functions in the IBD group. Patients with active IBD had similar GLS and global circumferential strain (GCS) values as those in remission. A correlation analysis revealed that the neutrophil-lymphocyte ratio was positively correlated and the platelet count was negatively correlated with GCS. Deterioration of LV diastolic functions examined with E/e' and mitral deceleration time was found in the IBD group compared with the controls. CONCLUSIONS: LV global longitudinal contractile and diastolic functions were decreased in patients with IBD. Clinicians should maintain patients' remission periods and prevent flare-ups.

Role of baseline adenoma characteristics for adenoma recurrencein patients with high-risk adenoma

Background/aim: The present observational study aimed to determine the predictive value of 3-year recurrence adenoma characteristics at baseline conventional colonoscopy in patients with high-risk adenoma.Materials and methods: A total of 47 patients with high-risk adenoma at baseline colonoscopy were followed up and underwent a surveillance colonoscopy at 3 years. Correlations between adenoma recurrence and baseline adenoma characteristics (size, number, histological features, and location) were analyzed.Results: Among 135 patients with high-risk adenoma, 47 patients (35%) who underwent surveillance colonoscopy at 3 years following baseline colonoscopy were included in the study. In these 47 patients, at least one new adenoma was detected in 19 (40.4%) patients, and new advanced adenomas were detected in 5 (10.6%) patients during the surveillance colonoscopy. No significant difference was found in patients who had adenoma recurrence versus those who did not in terms of size of adenomas (P = 0.143), number of adenomas (P = 0.562), histological properties of adenomas (P = 0.658), or locations of adenomas (P = 0.567).Conclusion: Baseline adenoma characteristics were not associated with the recurrence of adenomas or advanced adenomas in patients with high-risk adenoma.

Is glycogenic acanthosis a predictor of insulin resistance and metabolic syndrome?

BACKGROUND/AIMS: To evaluate the incidence of insulin resistance and metabolic syndrome (MetS) in patients with glycogenic acanthosis (GA). MATERIALS AND METHODS: Thirty patients with GA, detected upon endoscopy, and 30 age- and sex-matched control patients without GA were included in this case-control study. Patients with GA were considered group 1 and control group was considered group 2. Anthropometric measurements [height, weight, and waist circumference (WC)], biochemical parameters [fasting plasma glucose (FPG), triglyceride, high-density lipoprotein (HDL), and low-density lipoprotein (LDL)], and serum fasting insulin levels were evaluated. Insulin resistance (IR) was estimated by the homeostatic model assessment of IR. MetS was diagnosed using the criteria of the National Cholesterol Education Program Adult Treatment Panel III. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated to evaluate associations with GA. RESULTS: There were no differences in terms of FPG, triglyceride, HDL, and LDL between groups (p-values 0.118, 0.114, 0.192, 0.086, respectively). WC was significantly higher in group 1 than in group 2 (103.77 vs 97.03, p=0.032). The number of patients with IR and MetS were significantly higher in group 1 than in group 2 (53.3% vs 13.3%, p=0.003 and 53.3% vs 23.3%, p=0.034). ORs [95% CI] of WC, IR, and MetS for GA were 0.68 [0.17-2.62], 7.12 [1.89-26.72], and 4.11 [1.04-16.21], respectively. CONCLUSION: These findings showed that IR and MetS were significantly associated with the presence of GA.

The evaluation of left ventricular functions with tissue doppler echocardiography in adults with celiac disease.

BACKGROUND/AIM: The aim of this study was to investigate the effects of celiac disease on cardiac functions using tissue Doppler echocardiography (TDE). PATIENTS AND METHODS: The study included 30 patients with celiac disease (CD) and 30 healthy volunteers. Echocardiographic examinations were assessed by conventional echocardiography and tissue Doppler imaging. The peak systolic velocity (S'm), early diastolic myocardial peak velocity (E'm), late diastolic myocardial peak velocity (A'm), E'm/A'm ratio, myocardial precontraction time (PCT'm), myocardial contraction time (CT'm), and myocardial isovolumetric relaxation time (IVRT'm), E to E'm ratio were measured. RESULTS: In pulsed wave Doppler echocardiography, mitral late diastolic flow (A) velocity and E to E'm ratio were significantly higher (P = 0.02 and P = 0,017), E/A ratio was significantly lower (P = 0.008) and IVRT was significantly prolonged (P = 0.014) in patients with CD. In TDE, S'm, E'm, and E'm/A'm ratio were significantly lower, IVRT'm was longer (P = 0.009) from septal mitral annulus and S'm, E'm, E'm/A'm ratio were significantly lower, PCT'm, PCT/ET ratio, IVRT'm were longer, and MPI was higher from lateral mitral annulus in celiac group than controls. CONCLUSION: Our study confirms that patients with CD have impaired diastolic function. More importantly, we also demonstrated an impairment of myocardial systolic function in patients with CD by TDE. We recommend using TDE in addition to conventional echocardiography parameters for the cardiovascular risk assessment of patients with CD.

Association between aortic stiffness and left ventricular function in inflammatory bowel disease.

BACKGROUND: Recent studies have reported an increased incidence of both aortic stiffness and left ventricular (LV) systolic and diastolic dysfunction in patients with inflammatory bowel disease (IBD). However, the association between aortic stiffness and the LV function has not been fully defined. We aimed to investigate the relationship between aortic stiffness and the LV function in IBD patients. METHODS AND RESULTS: Seventy-two patients with IBD (56 cases of ulcerative colitis and 16 cases of Crohn's disease) and 50 healthy controls were consecutively enrolled in this study. The LV systolic and diastolic functions were assessed using conventional echocardiographic techniques, including tissue Doppler echocardiography. The degree of aortic strain and distensibility were calculated based on the aortic diameters measured on M-mode echocardiography at thelevel of 3 cm above the aortic valve and the blood pressure values obtained on sphygmomanometry. There were significant differences between the IBD and control group in the degree of aortic strain and distensibility. Significant differences were also observed between the patient and control groups in the parameters of the LV systolic and diastolic functions. Moreover, aortic stiffness was found to be associated with the LV function in the patient group. CONCLUSIONS: There is a significant relationship between aortic stiffness and LV systolic and diastolic dysfunction in patients with IBD, based on the findings of this study. The parameters of aortic elasticity measured according to 2-dimensional echocardiographic methods can be beneficial for predicting early cardiovascular risk in cases of IBD. (.

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.