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.

Regular coffee intake improves liver enzyme levels and liver histology in patients with chronic alcohol consumption, non-alcoholic fatty liver and non-alcoholic steatohepatitis: Report of 259 cases.

Background and Aim: This study aims to investigate the effects of chronic coffee consumption (>5 years) and type of coffee in non-alcoholic steatohepatitis (NASH), non-alcoholic fatty liver (NAFLD) and patients who have regular alcohol consumption. Materials and Methods: In this study, 158 healthy individuals and 101 patients with histologically proven NASH were enrolled. The daily amount of coffee intake, amount of alcohol use and type of coffee were calculated for all patients. The degree of steatosis and fibrosis was analyzed by transient elastography and liver ultrasound in non-NASH and by liver biopsy in NASH patients. Results: Patients with a history of coffee consumption (n=132) had lower liver enzyme levels compared to the non-coffee group (n=127) (p=0.001). Serum ALT level was significantly lower [ALT: 21.2±11.7 U/L vs. 56.4±15.6 U/L (p=0.004)], and the liver histopathology was significantly better for patients with a coffee consumption of daily for >5years (p=0.045 for fibrosis score for NASH, p=0.036 for LSM and p=0.015 for CAP measurements for the non-NASH patient). Conclusion: Coffee seems to have a positive protective effect on liver histology and liver enzyme levels in healthy individuals, in patients with chronic alcohol consumption, NAFLD and NASH. These results are more prominent in patients who drink coffee on a regular daily base for more than five years.

Aortic flow propagation velocity, epicardial fat thickness, and osteoprotegerin level to predict subclinical atherosclerosis in patients with nonalcoholic fatty liver disease.

OBJECTIVE: Nonalcoholic fatty liver disease is the most common cause of liver dysfunction in Western countries and an independent risk factor for atherosclerotic heart disease. Appropriate noninvasive parameters are lacking for optimal risk stratification of cardiovascular disease in these patients. We evaluated several recently discovered noninvasive parameters for atherosclerosis in patients with nonalcoholic fatty liver disease: epicardial fat thickness, aortic flow propagation velocity, and osteoprotegerin level. METHODS: Forty-one patients (27 men and 14 women; mean age, 37.9±8.9 years) with nonalcoholic fatty liver disease and 37 control subjects (17 men and 20 women; mean age, 34.5±8.6 years) were enrolled in this observational case-control study. Patients with nonalcoholic fatty liver disease diagnosed at a gastroenterology outpatient clinic were included. Patients with cardiac pathology other than hypertension were excluded. Epicardial fat thickness and aortic flow propagation velocity were measured by echocardiography. The serum concentration of osteoprotegerin was measured using a commercial enzyme-linked immunosorbent assay kit. RESULTS: Nonalcoholic fatty liver disease patients exhibited a significantly lower aortic flow propagation velocity (155.17±30.00 vs. 179.00±18.14 cm/s, p=0.000) and significantly higher epicardial fat thickness (0.51±0.25 vs. 0.29±0.09 cm, p=0.000) than control subjects. Osteoprotegerin levels were higher, but not significant, in patients with nonalcoholic fatty liver disease (28.0±13.0 vs. 25.2±10.8 pg/mL, p=0.244). Binary logistic regression analysis showed that aortic flow propagation velocity (OR, -0.973; 95% CI, 0.947-0.999) and waist circumference (OR, -1.191; 95% CI, 1.088-1.303) were independent predictors of nonalcoholic fatty liver disease. CONCLUSION: In this study, epicardial fat thickness and osteoprotegerin level were higher and aortic flow propagation velocity was lower in patients with nonalcoholic fatty liver disease. Early detection of abnormal epicardial fat thickness and aortic flow propagation velocity may warrant a search for undetected cardiovascular disease in patients with nonalcoholic fatty liver disease.

Ongoing symptoms after eradication of Helicobacter pylori: psychiatric disorders may accompany.

BACKGROUND/AIMS: The precise mechanism of functional dyspepsia is yet to be elucidated. Helicobacter pylori infection and psychiatric disorders are implicated in the etiology. We aimed to determine the prevalence of psychiatric co-morbid disorders in patients with Helicobacter pylori-positive functional dyspepsia and the impact of existing psychiatric disorders on symptomatic response following eradication treatment. MATERIAL AND METHODS: Patients with Helicobacter pylori-positive functional dyspepsia and no previous diagnosis of any psychiatric disorder were included in the study. All patients' symptoms were evaluated with a visual analog scale and Likert scale. The Composite International Diagnostic Interview was applied to all patients by an experienced psychiatric nurse. RESULTS: At least one psychiatric disorder was diagnosed in 22 of 54 patients. The most common disorder was depression, found in 13 patients. Symptomatic response to treatment was significantly higher in functional dyspepsia patients with no psychiatric disorder compared to those with at least one psychiatric co-morbid disorder (84% vs. 50%; p=0.007). CONCLUSION: Psychiatric co-morbid disorders are common in patients with functional dyspepsia and affect symptomatic response to Helicobacter pylori eradication treatment. Psychiatric disorders should be considered in patients who fail to achieve sufficient symptomatic relief after Helicobacter pylori eradication treatment.

Lack of relationships between FGF19 staining pattern, lymph node metastasis and locally invasive characteristics of the tumor in colorectal cancers.

INTRODUCTION: Colorectal cancers are in the top of the cancer-related causes of death in the world and lymph node metastasis is accepted as the primary prognostic factor. In this study, correlations of FGF19 staining pattern with local invasion and lymph node metastasis in a series of colorectal cancers were investigated. METHODS: This studyincluded 81 colorectal cancer patients who underwent surgery in our hospital with no evidence of preoperative radiological distant metastasis. Routine pathological examination of the resection material was performed in order to identify vascular, perineural and serosal infiltration, regional lymph node metastasis and the degree of differentiation. Tumor tissue samples were stained with an immunohistochemistry method for FGF 19 evaluation and the staining pattern was statistically compared with the above mentioned characteristics of the tumors. RESULTS: The patient population consisted of 47 females and 34 males with a median age of 70 years. In 40 patients regional lymph nodes were positive and 51%, 32% and 38% had serosal, perineural and vascular invasion. While 64 cases were moderately-differentiated, 11 cases were well-differentiated and 6 poorly- differentiated, there was no association with FGF 19 staining, including intensity. CONCLUSION: No evidence of significant statistically correlation was found between FGF 19 staining pattern and serosal, perineural, vascular invasion, lymph node involvement and degree of differentiation.

Acute pancreatitis following doxycycline and ornidazole coadministration.

CONTEXT: Drugs are related to the etiology of acute pancreatitis in approximately 1.4-2.0% of cases. Although antibiotics constitute a small number of the drugs suspected, tetracycline is the most encountered antibiotic among those drugs. CASE REPORT: A 33-year-old woman was admitted to the emergency room complaining of nausea and abdominal pain after the use of doxycycline 500 mg and ornidazole 500 mg twice daily for three days for a vaginal infection. She experienced epigastric pain, which worsened over time and radiated to her back. After a detailed evaluation, she was diagnosed as having mild acute pancreatitis which improved with medical treatment. All other possible causes of pancreatitis were eliminated. CONCLUSIONS: Antibiotic-associated pancreatitis usually has a silent and mild course. To the best of our knowledge the literature reports only two cases of doxycycline-induced acute pancreatitis reported and there are no reports of pancreatitis associated with ornidazole. Our case is the first case reported in which doxycycline and ornidazole coadministration induced acute pancreatitis.

Extraordinarily elevated serum levels of CA 19-9 and rapid decrease after successful therapy: a case report and review of literature.

Carbohydrate antigen 19-9 is most valuable as a serum marker for pancreatic and biliary cancer, but increased concentrations occur in several other gastrointestinal malignancies. A carbohydrate antigen 19-9 value of >1,000 U/ml usually indicates a digestive cancer and has been reported to have a specificity greater than 99% for pancreatic cancer; nevertheless, false-positive results owing to benign diseases such as pancreatitis or liver cirrhosis have been noted. We present a patient with cholelithiasis and choledocholithiasis with acute cholangitis who had very high serum levels of carbohydrate antigen 19-9 (9586 IU/ml). The rapid decrease in carbohydrate antigen 19-9 after successful treatment was as interesting as the pretreatment high serum level of carbohydrate antigen 19-9.

Acute acalculous cholecystitis associated with acute hepatitis B virus infection.

During the course of acute viral hepatitis, some functional and structural changes to the gallbladder can occur. Acute acalculous cholecystitis is an extremely rare complication of acute viral hepatitis. Acalculous cholecystitis associated with acute viral hepatitis can present as different conditions. Some of these are self-limiting and heal spontaneously, while a limited number of cases progress to a gangrenous state, gallbladder perforation, and even to death. We present here a case of acute acalculous cholecystitis associated with an acute hepatitis B virus infection.

Subacutely formed bezoar resulting from accidentally ingested industrial material.

Bezoars are the most common foreign bodies of the gastrointestinal tract. Clinical manifestations vary depending on the location of the bezoar, from no symptoms to acute abdominal syndrome. The ingestion of cling film, which is used for preserving food, may lead to a mechanical obstruction of the gut, especially at the second portion of the duodenal segment, and could manifest with abdominal pain, epigastric distress, nausea, vomiting, and fullness. We report the case of a 72-year-old man who presented with gastric outlet obstruction after accidentally ingesting cling film. He completely recovered after it was endoscopically removed. Cling film is not toxic but has erosive effects. Endoscopic removal of such material is recommended. Moreover, psychiatric intervention and management is imperative to prevent recurrence in such cases.

Total colonic polyp diameter: a marker for the risk of malignancy?

BACKGROUND/AIMS: The correlation of the risk of malignancy with the sum of the diameters of small colonic polyps is unknown, and data regarding this topic are lacking. In this study, the relationship between the sum of the diameters of the total number of colonic polyps and poor histopathologic characteristics was examined. METHODS: A total of 920 neoplastic colon polyps were evaluated in 480 patients. The "total polyp diameter" (i.e. the sum of all polyp diameters identified during colonoscopy), which was calculated in each patient by adding the diameter of each polyp to a sum, was categorized as "small" (<10mm in diameter) or "large" (> or =10mm in diameter). The polyps were further categorized by histopathologic component as "unfavorable" or "favorable" and were divided into 2 groups: group 1 (those identified as carci noma, carcinoma in situ, villous adenoma, and tubulovillous adenoma with a villous component of more than 25%) and group 2 (mixed adenomatous polyps with various degrees of hyperplastic or inflammatory components and adenomas with a tubular component of more than 75%). RESULTS: Large polyps that had a total diameter greater than or equal to 10mm tended to have poor histopathologic characteristics (p<0.05). Polyps generally tended to localize in the left portion of the colon, and malignant polyps or those at risk for malignancy in particular tended to localize in the left colon (p<0.05). CONCLUSIONS: Polypectomy is recommended for patients in whom the sum of the diameter of all colonic polyps exceeds 10mm.

Factors prognostic of survival in patients awaiting liver transplantation for end-stage liver disease.

In this study, we investigated possible independent predictive factors for survival, other than MELD score, in patients with cirrhosis. We reviewed the serum sodium, cholesterol, albumin, and platelet levels of 99 patients with cirrhosis and investigated the possible correlation of these parameters with survival period. We found that 77% and 81% of patients with cirrhosis were hypocholesterolemic and hypoalbuminemic, respectively. We noted that the survival time of 6 months in patients with serum sodium levels <125 mM at the time of admission to the study was 27% less than that in patients with sodium levels >130 mM. Patients with cirrhosis and serum sodium levels >130 mM survived for more than 1 year (95% CI). MELD scores of patients with serum sodium levels >130, between 125 and 129, and <125 mM were 15.8 to 19.9, 19.7 to 23.6, and 23.3 to 27.2, respectively (95% CI). In conclusion, we suggest that although all of these parameters are correlated with survival in patients with cirrhosis, the serum sodium level is the most accurate prognostic factor and a valid tool for predicting survival when considered in combination with the MELD score.

Malignancy risk of small polyps and related factors.

The aim of this study was to determine the risk of polyps <6 and between 6 and 10 mm in terms of progression to malignancy and to evaluate the influence of age, gender, and colonic localization on malignancy development. Thirteen hundred sixty-nine polyps <10 mm identified in 680 patients were retrospectively evaluated. Sixty-seven and two-tenths percent of polyps <10 mm were of a neoplastic nature. The incidence of neoplasia was higher in left-sided and small polyps than diminutive polyps. In patients older than 60 years, small polyps showed a higher rate of high-risk histology than diminutive polyps,while the same relationship did not exist in other age groups. In male patients over 60 years of age, the rate of high-risk histology was higher in small polyps than in diminutive polyps.

Esophageal mucosal sensitivity: possible links with clinical presentations in patients with erosive esophagitis and laryngopharyngeal reflux.

The goal of this study was to assess whether mucosal sensitivity is related to different combinations of symptoms and lesions in laryngopharyngeal reflux (LPR) and erosive esophagitis and to determine whether reflux pattern is important in the development of the symptoms and lesions of gastroesophageal reflux disease (GERD) or LPR. We conducted a prospective study of 55 unselected new patients: 27 erosive esophagitis patients and 28 LPR patients. The erosive esophagitis group had a significantly higher rate of Bernstein test positivity than the LPR group. The proportions of patients with pathologic acid reflux at the proximal and distal probe were similar in the erosive esophagitis group and in the LPR group. These results were inconsistent with the endoscopic findings. Both retrosternal heartburn and regurgitation symptoms were higher in erosive esophagitis patients. The paucity of classical GERD symptoms and lesions in LPR patients could be attributable to mucosal insensitivity but not to reflux pattern.