ABSTRACT
BACKGROUND/AIMS: Pancreatic steatosis (PS) is a pathology associated with metabolic syndrome (MS), endocrin and exocrine disfunctions of the pancreas, and fatty liver. The data on the frequency of PS are very limited. We aimed to evaluate the frequency of PS detected by transabdominal ultrasonography (TAU) in gastroenterology clinics located in different geographical regions of Turkey and the factors associated with it. MATERIALS AND METHODS: Volunteers were evaluated by TAU for PS and hepatosteatosis (HS), and its degree. Pancreatic stiffness was evaluated by ultrasonographic shear wave elastography (SWE). All demographic, physical, and biochemical parametres were measured. RESULTS: A total of 1700 volunteers from 14 centers throughout Turkey were included in the study. Mean age was 48.03 ± 20.86 years (56.9% female). Prevalance of PS was detected in 68.9%. In the PS group, age, body mass index (BMI), waist circumference, systolic blood pressure, fasting blood glucose (FBG), lipid levels, insulin resistance, diabetes mellitus, hypertension, MS frequency, and pancreatic SWE score were increasing, and fecal elastase level was decreasing in correlation with the degree of PS. The frequency of HS was 55.5%. Hepatosteatosis [odds ratio (OR): 9.472], increased age (OR: 1.02), and BMI (OR: 1.089) were independent risk factors for the occurrence of PS. Lean-PS rate was 11.8%. The lean-PS group was predominantly female and younger than non-lean PS. Also it has lower blood pressure, FBG, liver enzymes, lipid levels, and HS rates. CONCLUSION: The frequency of PS was found 68.9% in Turkey. Its relationship was determined with age, BMI, HS, MS (and its components), pancreatic stiffness, and fecal elastase level.
Subject(s)
Elasticity Imaging Techniques , Fatty Liver , Metabolic Syndrome , Pancreatic Diseases , Humans , Turkey/epidemiology , Female , Middle Aged , Male , Prevalence , Adult , Risk Factors , Metabolic Syndrome/epidemiology , Pancreatic Diseases/epidemiology , Fatty Liver/epidemiology , Body Mass Index , Aged , Pancreas/diagnostic imaging , Pancreatic Elastase/analysis , Waist Circumference , Insulin Resistance , Blood Glucose/analysis , Blood Glucose/metabolismABSTRACT
Functional gastrointestinal system disorders are common problems in practice. The most common symptoms are abdominal pain, gas, bloating, diarrhea, constipation, and a mixture of these, and similar symptoms can be seen in conditions such as inflammatory bowel disease, colorectal cancer, and celiac disease depending on the age of the patient, indicating the importance of differential diagnosis. The importance of patient management is shown by making a symptom-based diagnosis and making cost-effective, that is, limited advanced examinations. The pathophysiology of irritable bowel syndrome (IBS) is multifactorial, and stress is one of the leading triggers of IBS symptoms. Therefore, terminology will change to gut-brain interaction disorders in the future, and the patient-physician relationship has a special place in the treatment of functional bowel disorder. Dietary recommendation and medical treatment in IBS should be determined according to the predominant symptom and symptom severity. In addition to diet, some lifestyle changes can also be helpful in reducing IBS symptoms. Antispasmodics and antidepressants are not fast-acting. These drugs should be used for at least 2-4 weeks to see the efficacy of treatment. Drugs should be used according to the standard recommended duration and dose in intermittent treatments.
Subject(s)
Irritable Bowel Syndrome , Humans , Irritable Bowel Syndrome/therapy , Diagnosis, Differential , Antidepressive Agents/therapeutic use , Parasympatholytics/therapeutic use , Gastrointestinal Diseases/therapy , Gastrointestinal Diseases/etiology , Constipation/therapy , Constipation/etiologyABSTRACT
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.
Subject(s)
Pancreatitis , Humans , Female , Aged , Male , Pancreatitis/etiology , Prospective Studies , Acute Disease , Turkey , Severity of Illness Index , Retrospective StudiesABSTRACT
BACKGROUND/AIMS: In 2016, World Health Organization introduced global goals to eliminate hepatitis C virus by 2030. The aim of this study is to analyze the epidemiologic and economic burden of hepatitis C virus in Turkey and compare current practice (regular care) with a hypothetical active screening and treatment approach (active scenario). MATERIALS AND METHODS: A Markov model was used to analyze and compare regular care with a scenario developed by experts including the screening and treatment of all acute and chronic hepatitis C virus infections between 2020 and 2050. General and targeted populations were focused. The model reflected the natural history of the disease, and the inputs were based on a literature review and expert opinions. Costs were provided by previous studies and national regulations. RESULTS: The active scenario resulted in higher spending for all groups compared with regular care in the first year. Cumulative costs were equalized in the 8th, 12th, 13th, and 16th year and followed by cost-savings of 49.7 million, 1.1 billion, 288.6 million, and 883.4 million Turkish liras in 20 years for prisoners, refugees, people who inject drugs (PWID), and all population, respectively. In all groups, the mortality was found to be lower with the active scenario. In total, 62.8% and 50.6% of expected deaths with regular care in 5 and 20 years, respectively, were prevented with the active scenario. CONCLUSIONS: An active screening and treatment approach for hepatitis C virus infection could be cost-effective for PWID, prisoners, and refugees. Almost two-thirds of deaths in regular care could be prevented in 5 years' time with this approach.
Subject(s)
Hepatitis C, Chronic , Hepatitis C , Substance Abuse, Intravenous , Humans , Hepacivirus , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/epidemiology , Hepatitis C, Chronic/drug therapy , Cost-Benefit Analysis , Substance Abuse, Intravenous/drug therapy , Turkey/epidemiology , Financial Stress , Hepatitis C/diagnosis , Hepatitis C/epidemiology , Hepatitis C/drug therapy , Antiviral Agents/therapeutic useABSTRACT
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.
Subject(s)
Bile Duct Diseases/diagnosis , Bile Duct Neoplasms/diagnosis , Cholangiocarcinoma/diagnosis , Docosahexaenoic Acids/blood , Aged , Biomarkers, Tumor/blood , CA-19-9 Antigen/blood , Cross-Sectional Studies , Diagnosis, Differential , Female , Humans , Male , Middle Aged , ROC CurveSubject(s)
Anaphylaxis/chemically induced , Cefuroxime/adverse effects , Colitis, Ischemic/chemically induced , Colitis, Ischemic/pathology , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Anaphylaxis/pathology , Anaphylaxis/therapy , Biopsy, Needle , Cefuroxime/administration & dosage , Colitis, Ischemic/therapy , Colonoscopy/methods , Combined Modality Therapy , Computed Tomography Angiography/methods , Diarrhea/diagnosis , Diarrhea/etiology , Emergency Service, Hospital , Female , Follow-Up Studies , Humans , Immunohistochemistry , Middle Aged , Rare Diseases , Treatment OutcomeABSTRACT
Erratum to: Cancer Chemother Pharmacol (2014), 74:11391147, DOI 10.1007/s0028001425866. Unfortunately, the part of acknowledgement detail was omitted in the published article and the below line must be considered as the last sentence: "This study is a Turkish Oncology Group trial".
ABSTRACT
PURPOSE: This phase II trial aimed to evaluate the efficacy and safety of docetaxel, cisplatin, and fluorouracil (DCF) combination in neoadjuvant setting in patients with locally advanced gastric adenocarcinoma. METHODS: Fifty-nine patients with resectable or unresectable locally advanced gastric and gastroesophageal cancer were recruited in this multicenter, single-arm, open-label, local clinical phase II study conducted at three centers from Turkey between June 2006 and March 2012. Patients had T3-4 or lymph node-positive disease. After staging with imaging and laparotomy or laparoscopy, they received three cycles of DCF with lenograstim. Imaging studies were repeated after the last two cycles. Patients who underwent surgery were followed up for at least 1 year after the surgery. Toxicity and response were evaluated in accordance with NCI-CTC version3.0 and RECIST 1.0. RESULTS: At baseline, 66.1 % of patients were considered resectable. In 47 patients evaluable, partial response in 16 (34.0 %), stable disease in 27 (57.5 %), and progressive disease in four (8.5 %) were observed. Forty-six patients underwent surgery. In 38 (64.4 %; 95 % confidence interval (CI) 52.2-76.6 %) out of 59 patients, complete resection (R0) was achieved. Median overall and disease-free survival were 19.1 months (95 % CI 13.5-24.7) and 11.6 months (95 % CI 5.9-17.4), respectively. The most frequent grade 3-4 adverse events were neutropenia (52.5 %), febrile neutropenia (11.9 %), leukopenia (39.0 %), and diarrhea (10.5 %). One patient died from an unknown cause. CONCLUSIONS: Classical DCF triplet with lenograstim showed a good clinical response with acceptable safety profile in the treatment of locally advanced gastric and gastroesophageal cancer with a significant R0 rate and manageable toxicity.
Subject(s)
Adenocarcinoma/drug therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Esophageal Neoplasms/drug therapy , Neoadjuvant Therapy/methods , Stomach Neoplasms/drug therapy , Adenocarcinoma/pathology , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Cisplatin/administration & dosage , Disease-Free Survival , Docetaxel , Esophageal Neoplasms/pathology , Female , Fluorouracil/administration & dosage , Follow-Up Studies , Humans , Male , Middle Aged , Neoadjuvant Therapy/adverse effects , Neoplasm Staging , Stomach Neoplasms/pathology , Survival Rate , Taxoids/administration & dosage , Treatment Outcome , TurkeyABSTRACT
BACKGROUND AND AIMS: The aim of this prospective study is to evaluate the safety of both diagnostic and therapeutic endosonography (EUS) in geriatric population. METHODS: The study population, consisting of 222 patients who underwent endosonographic evaluation for different indications, was divided into two groups. Group I consisted of 165 patients, ≥ 65 years old; Group II consisted of 57 controls, <65 years old. The demographic information with clinical parameters, procedure medication used and complications was noted. RESULTS: The median age of Group I was 72 years (range 65-93 years) vs. 46 years (range 26-64 years) for Group II. Female-to-male ratio was 82/83 in Group I, while 32/25 in Group II. Pulse rate (84 vs. 89 beats/min, p = 0.024) and basal oxygen saturation (94 vs. 97 %, p < 0.001) levels were lower in Group I when compared with the control group, while systolic blood pressure measurements (150 vs. 130 mmHg, p < 0.001) were significantly higher in Group I. No cases of procedure-related bleeding, perforation and mortality were observed in both groups. CONCLUSION: Despite the well-known relative increased procedural risks, advanced age is not a contraindication for advanced endoscopic interventions. EUS can be regarded as a safe and effective procedure in ≥ 65 years old population.
Subject(s)
Endosonography , Aged , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
OBJECTIVES: The aim was to compare the use of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in cytology and the biochemical analysis of cyst fluid, together with the size of the lesion in the differentiation between benign and malignant pancreatic cystic lesions. METHODS: Data of patients who underwent EUS-FNA for pancreatic cystic lesions in our center from January 2006 to October 2010 were retrospectively analyzed. The diagnostic accuracy of EUS-FNA was determined. RESULTS: Of the 56 patients, 37 (66.1%) had evaluable cytology for diagnosis and sufficient cyst fluid was available for biochemical analysis in 58.9% (33/56) of the patients. The sensitivity, specificity, positive predictive value and negative predictive value of EUS-FNA for detecting malignancy were 63%, 100%, 100% and 85%, respectively. EUS-FNA was the most accurate diagnostic method for differentiating malignant and benign pancreatic cystic lesions (88%). Cyst fluid carcinoembryonic antigen (CEA) > 365 ng/mL had a sensitivity of 100% for the detection of malignant cystic lesions. CONCLUSIONS: Although the rate of insufficient cyst fluid aspiration is high, the combination of cytological evaluation and CEA analysis of cyst fluid obtained by EUS-FNA is accurate in differentiating malignant cystic lesions from benign ones. Safe techniques are essential to improve the yield of cyst fluid aspiration by EUS.
Subject(s)
Pancreatic Cyst/diagnosis , Pancreatic Neoplasms/diagnosis , Adult , Aged , Biomarkers, Tumor/analysis , Carcinoembryonic Antigen/analysis , Diagnosis, Differential , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Female , Humans , Male , Middle Aged , Pancreatic Cyst/diagnostic imaging , Pancreatic Cyst/pathology , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/pathology , Predictive Value of Tests , Retrospective StudiesSubject(s)
Cholestasis/therapy , Prosthesis Implantation/methods , Adult , Bile Ducts/injuries , Bile Ducts/pathology , Cholangiography , Cholangitis, Sclerosing/complications , Cholestasis/etiology , Constriction, Pathologic/etiology , Constriction, Pathologic/therapy , Female , Humans , Male , StentsSubject(s)
Ampulla of Vater/abnormalities , Cholangiopancreatography, Magnetic Resonance/methods , Cholangitis, Sclerosing/complications , Duodenum/abnormalities , Adult , Ampulla of Vater/diagnostic imaging , Ampulla of Vater/pathology , Cholangitis, Sclerosing/diagnosis , Diagnosis, Differential , Disease Progression , Duodenoscopy , Duodenum/diagnostic imaging , Duodenum/pathology , Follow-Up Studies , Humans , Male , Middle Aged , RadiographyABSTRACT
BACKGROUND: The aim of this study was to evaluate the endosonographic ultrasound (EUS) findings of patients with suspected extraluminal compression or subepithelial intramural lesions observed during upper gastrointestinal endoscopy. METHODS: EUS findings were grouped as follows; compression by an extramural pathologic lesion, compression by an adjacent vascular structure, compression by adjacent organs, subepithelial intramural lesion, and normal EUS. RESULTS: The data of 211 patients referred to the EUS unit between February 2004 and January 2010 for further evaluation of suspected extraluminal compression or subepithelial intramural lesions after upper gastrointestinal endoscopy were retrospectively analyzed. Mean age of the patients was 51.0±15.2 years, 124 (58.9%) of which were female. EUS examination was normal in 48 (22.7%) patients. EUS confirmed the presence of a pathological finding in the esophagus in 38 (92.6%) out of 41 patients when compared with abnormal findings in 122 (73.4%) of 166 patients who were evaluated for suspected lesions of the stomach (P=0.009). Suspected extraluminal compression of the esophagus (n=41) was due to a vascular structure in 17 (41.4% ) patients, an adjacent organ in four (9.7%) patients, an extramural pathological lesion in two (4.9%) patients, and a subepithelial intramural lesions in 15 (36.6%) patients, whereas in three patients (7.4%) EUS findings were normal. Of the 166 patients referred for evaluation of gastric lesions EUS findings were normal in 44 (26.5%) patients, whereas compression due to an adjacent organ was observed in 66 (39.7%) patients followed by compression by an adjacent vascular structure in 34 (20.4%) patients. An extramural pathologic lesion was discovered in 14 (8.6%) patients, whereas suspected compression was due to a subepithelial intramural lesion in eight (4.8%) patients. CONCLUSION: Accurate diagnosis of suspected extraluminal compression or subepithelial intramural lesions, particularly in the stomach, requires meticulous evaluation. EUS provides an invasive but effective option. In one-third of cases, suspected extraluminal compression of the esophagus is actually due to a subepithelial intramural lesion.
Subject(s)
Endosonography , Gastrointestinal Diseases/diagnostic imaging , Gastroscopy , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
A 65-year-old female patient admitted to our clinic with complaints of abdominal pain and watery diarrhea. She was diagnosed with colovesical fistula based on virtual colonoscopy findings. Since endoscopic and other radiological diagnostic tools were not able to establish a definite diagnosis, we found this case suitable for presentation.
Subject(s)
Colonography, Computed Tomographic , Diverticulosis, Colonic/complications , Diverticulosis, Colonic/diagnostic imaging , Intestinal Fistula/diagnostic imaging , Intestinal Fistula/etiology , Aged , Female , HumansABSTRACT
The objective was to assess EUS-FNA for diagnosing intramural upper GI tract lesions. The subjects were 50 patients (21M/29F) with upper GI submucosal lesions who underwent EUS-FNA at a referral center for GI system over a 12-month period. All cases were followed for 1 year after initial EUS-FNA. Cytologic diagnoses were categorized as benign, malignant, suspicious for malignancy, mesenchymal tumor, endocrine tumor, or nondiagnostic. All tumors were assessed for various cytomorphologic features. The accuracy of the initial FNA diagnoses was evaluated for each patient who also underwent subsequent histopathological examination of a core biopsy and/or surgical biopsy/resection material of the same lesion. According to the site of the lesions; while 84% of all esophageal lesions were diagnosed as mesenchymal; 67% of all gastric lesions were mesenchymal. The sole lesion was nonmesenchymal (benign cyst) in duodenum. The sensitivity, specificity, positive and negative predictive values, and accuracy of EUS-FNA for diagnosing submucosal mesenchymal tumors of the upper GI tract were 82.9, 73.3, 87.9, 64.7, and 80%, respectively. The corresponding values for nonmesenchymal lesions were 100, 85.7, 80, 100, and 90.9%. Our experience confirms that EUS-FNA is an extremely valuable tool for diagnosing submucosal lesions of the upper GI, and is particularly useful in cases where endoscopic forceps biopsy does not lead to diagnosis. Optimal results can be yielded by a close working relationship between the gastroenterologist and pathologist.
Subject(s)
Biopsy, Fine-Needle , Endosonography , Gastrointestinal Diseases/diagnosis , Gastrointestinal Neoplasms/diagnosis , Upper Gastrointestinal Tract/pathology , Adult , Aged , Aged, 80 and over , Diagnostic Techniques, Digestive System , Female , Gastrointestinal Diseases/pathology , Gastrointestinal Neoplasms/pathology , Humans , Male , Middle Aged , Prospective Studies , Sensitivity and SpecificityABSTRACT
The mitochondrial neurogastrointestinal encephalomyopathy syndrome (MNGIE) is a rare and life-threatening, autosomal recessive, multisystem disorder, caused by the mutations in the thymidine phosphorylase gene. Herein, we report a case of a 21 year-old male with a long history of intestinal pseudo-obstruction who was diagnosed with MNGIE syndrome after an extensive examination. In this case, our objective was to bring the gastroenterologist's attention to this difficult to diagnose syndrome in the coexistence of intestinal pseudo-obstruction and neurologic manifestations. The patient was a member of a consanguineous family of six children, in whom two sisters had died due to this disorder and one sister was affected and is still alive. The patient presented with cachexia, abdominal pain, diarrhea and muscle weakness, and was previously considered to have gluten sensitive enteropathy and treated with dietary solutions.
Subject(s)
Intestinal Pseudo-Obstruction/genetics , Mitochondrial Encephalomyopathies/diagnosis , Nervous System Diseases/genetics , Abdominal Pain/genetics , Barium Sulfate , Cachexia/genetics , Cerebrum/pathology , Chronic Disease , Contrast Media , DNA Mutational Analysis , Diagnosis, Differential , Diarrhea/genetics , Genetic Predisposition to Disease , Humans , Intestinal Pseudo-Obstruction/enzymology , Intestinal Pseudo-Obstruction/therapy , Magnetic Resonance Imaging , Male , Mitochondrial Encephalomyopathies/enzymology , Mitochondrial Encephalomyopathies/genetics , Mitochondrial Encephalomyopathies/therapy , Mutation , Nervous System Diseases/enzymology , Nervous System Diseases/pathology , Nervous System Diseases/physiopathology , Nervous System Diseases/therapy , Pedigree , Thymidine Phosphorylase/genetics , Weight Loss/genetics , Young AdultABSTRACT
OBJECTIVES: In this study, we prospectively compared the use of endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS), and fecal elastase 1 in patients with chronic pancreatitis and searched for correlation with symptoms, clinical findings, and elastase 1 levels. METHODS: Twenty-four consecutive patients (19 were male, and 5 were female) with chronic pancreatitis who had already undergone ERCP within the last 2 years and 19 healthy control subjects (10 were male, and 9 were female) are studied prospectively. Clinical and laboratory parameters of the patients were recorded, and all underwent EUS and fecal elastase 1 testing. Fecal elastase 1 was measured in healthy control subjects. RESULTS: The ERCP and EUS severity scores were 1 in 0 to 2 patients, 2 in 6 to 8 patients, and 3 in 18 to 14 patients. Sensitivity and specificity of fecal elastase for chronic pancreatitis were 75% and 100%, respectively. There was a negative correlation between disease duration and fecal elastase 1 levels. Patients with dyspepsia or those who use pancreatic enzyme preparations had significantly lower fecal elastase 1 levels than others. CONCLUSIONS: Endoscopic retrograde cholangiopancreatography and EUS are nearly equal in staging chronic pancreatitis. Fecal elastase 1 correlates well with these tests. Fecal elastase 1 also correlates well with some clinical symptoms such as dyspepsia and disease history.