Is there a link between upper gastrointestinal polyps and colonic polyps? A retrospective study from a Turkish cohort / Existe conexão entre pólipos gastrointestinais proximais e pólipos colônicos? Estudo retrospectivo de uma coorte turca

OBJECTIVE: To investigate the incidence and associated demographical and clinical factors related to lower GI polyps and neoplasms in patients with upper GI polyps and neoplasms. METHODS: We investigated 99 patients who had upper GI polyps and neoplasms and who were screened with colonoscopy: the following data were collected: demographical and clinical data consisting of age, sex, smoking status, presence of H. pylori infection, placement of upper GI polyps or neoplasms, presence of gastric atrophy, usage of proton pump inhibitors (PPI), presence of lower GI polyp or neoplasm, type of colon polyp, pathological grade of colon polyp. The patients were grouped according to having/not having lower GI polyps and neoplasms; data was compared between groups. RESULTS: Smoking rate was significantly higher in patients with lower GI polyps and neoplasms (χ2: 4.35, p: 0.03). Furthermore, there was a signifant association between presence of lower GI polyps and neoplasms vs. smoking (OR: 2.44 CI: 1.01-5.84, p: 0.04). CONCLUSIONS: Patients with upper GI polyps and neoplasms who are smokers should be considered as candidates for having lower GI polyps and neoplasms and should be screened and followed more carefully. Additionally, we believe that large sampled and prospective studies are needed to higligt the association between upper GI polyps and presence of lower GI polyps and neoplasms.

OBJETIVO: investigar a incidência, demografia associada e fatores clínicos relativos a pólipos e neoplasias gastrointestinais distais em pacientes com pólipos e neoplasias do trato gastrointestinal superior. MÉTODOS: Foram investigados 99 pacientes que apresentaram pólipos ou neoplasias gastrointestinais superiores selecionados através de colonoscopia: os seguintes dados foram coletados: dados demográficos e clínicos consistentes em idade, sexo, tabagismo, presença de infecção por H. pylori, a presença de pólipos ou neoplasias gastrointestinais proximais, presença de atrofia gástrica, uso de inibidores da bomba de prótons (IBP), presença de pólipo ou neoplasia gastrointestinal distal, tipo de pólipo de cólon, grau patológico de pólipo de cólon. Os pacientes foram agrupados de acordo com ter/não ter pólipos ou neoplasias distais; os dados foram comparados entre os grupos. RESULTADOS: A taxa de tabagismo foi significativamente maior nos pacientes com pólipos e neoplasias distais (χ2: 4.35, p: 0,03). Além disso houve uma associação significante entre a presença de pólipos e neoplasias distais e tabagismo (OR: 2,44 CI: 1,01-5,84, p: 0,04). CONCLUSÕES: Os pacientes fumantes com pólipos e neoplasias do trato gastrointestinal superior devem ser considerados candidatos a pólipos e neoplasias distais e devem ser rastreados e seguidos com mais cuidado. Adicionalmente, grandes amostras e estudos prospectivos são necessários para esclarecer a associação entre pólipos gastrointestinais superiores e a presença de pólipos e neoplasias gastrointestinais distais.

Role of γ-glutamyl transferase levels in prediction of high cardiovascular risk among patients with non-alcoholic fatty liver disease.

Background & objectives: Non-alcoholic fatty liver disease (NAFLD) is an important cause of elevated liver functions. There is evidence showing an association between NAFLD and subclinical atherosclerosis independent of traditional risk factors. We undertook this retrospective study to determine the association of Framingham cardiovascular risk scoring system with liver function tests and inflammatory markers and to find the role of liver function tests in determination of CVD risk among non-obese and non-diabetic subjects with non-alcoholic fatty liver disease. Methods: A total of 2058 patients were included in the study. Framingham cardiovascular risk scoring was done of all patients according to the age, gender, systolic blood pressure, serum total cholesterol and HDL cholesterol levels, smoking and antihypertensive medication history. Liver function test, lipid profile, insulin, uric acid, ferritin levels, etc. were determined. Results: According to the ultrasonography findings, patients were grouped as without any fatty infiltration of the liver (control group) (n=982), mild (n= 473), moderate (n=363) and severe fatty liver disease (n= 240) groups. In severe fatty liver disease group, the mean Framingham cardiovascular risk score was significantly higher than that of other groups. There was a positive correlation between GGT, uric acid and ferritin levels with Framingham cardiovascular score. In multivariate analysis, high GGT levels were positively associated with high-risk disease presence (OR: 3.02, 95% CI: 2.62-3.42) compared to low GGT levels independent of the age and sex. Interpretation & conclusions: Cardiovascular disease risk increases with the presence and stage of fatty liver disease. Our findings showed a positive correlation between elevated GGT levels and Framingham cardiovascular risk scoring system among non-diabetic, non-obese adults which could be important in clinical practice. Though in normal limits, elevated GGT levels among patients with fatty liver disease should be regarded as a sign of increased cardiovascular disease risk. Larger studies are warranted to elucidate the role of GGT in prediction of cardiovascular risk.

Noninvasive methods in evaluation of inflammatory bowel disease: where do we stand now? An update

The inflammatory bowel diseases, consisting of Crohn's disease, ulcerative colitis and indeterminate colitis, are distinguished by idiopathic and chronic inflammation of the digestive tract. The distinction between inflammatory bowel diseases and functional bowel disorders, such as irritable bowel syndrome, can be complex because they often present with similar symptoms. Rapid and inexpensive noninvasive tests that are sensitive, specific and simple are needed to prevent patient discomfort, delay in diagnosis, and unnecessary costs. None of the current commercially available serological biomarker tests can be used as a stand-alone diagnostic in clinics. Instead, these are used as an adjunct to endoscopy in diagnosis and prognosis of the disease.Along these lines,, fecal lactoferrin and calprotectin tests seem to be one step further from other tests with larger number of studies, higher sensitivity and specificity and wider availability.

The role of fecal calprotectin in investigating inflammatory bowel diseases

INTRODUCTION: Invasive and non-invasive tests can be used to evaluate the activity of inflammatory bowel diseases. OBJECTIVE: The aim of the present study was to investigate the role of fecal calprotectin in evaluating inflammatory bowel disease activity and the correlation of fecal calprotectin with the erythrocyte sedimentation rate and C reactive protein values in inflammatory bowel disease. METHOD: Sixty-five patients affected with inflammatory bowel disease were enrolled. Twenty outpatients diagnosed with inflammatory bowel disease comprised the control group. RESULTS: In the present study, all patients in the control group had an fecal calprotectin value lower than the cut-off point (50 mg/kg). CONCLUSION: In conclusion, fecal calprotectin was found to be strongly associated with colorectal inflammation indicating organic disease. Fecal calprotectin is a simple and non-invasive method for assessing excretion of macrophages into the gut lumen. Fecal calprotectin values can be used to evaluate the response to treatment, to screen asymptomatic patients, and to predict inflammatory bowel disease relapses.