The efficacy and adverse effects of budesonide in remission induction treatment of autoimmune hepatitis: a retrospective study

Aim To compare the early biochemical response and rate of adverse effects in patients who received prednisolone (PRED)/azathioprine (AZA) and those who received budesonide (BUD)/AZA as the first-line treatment for autoimmune hepatitis. Methods The study involved 25 patients receiving PRED 30 mg/day + AZA 50 mg/day and 25 patients receiving BUD 9 mg/day + AZA 50 mg/day from February 2015 to February 2018. Biochemical and hemogram data at baseline and after 6 months of treatment, and adverse effects observed in the follow-up, were compared. Results There was no difference between the groups in biochemical response (17 patients receiving PRED/AZA and 18 receiving BUD/AZA) and the rate of adverse effects (9 patients receiving PRED/AZA and 5 receiving BUD/AZA). The total number of adverse effects in the BUD/AZA group was lower (15 vs 7) and the treatment was discontinued in 2 (8%) patients in PRED/AZA group, while no treatment discontinuation was observed in BUD/AZA group. Conclusions This study showed no differences in biochemical response between the groups. Lower, although not significantly, rate of adverse effects and lower total number of adverse effects indicate that BUD/AZA may potentially be used as the first-line treatment of choice, especially in patients with obesity, diabetes, resistant hypertension, glaucoma, or osteoporosis

A Case of Adult-Onset Still's Disease Complicated with Diffuse Alveolar Hemorrhage

Adult-onset Still's disease (AOSD) is an inflammatory disease that presents with a variety of clinical symptoms. Pulmonary involvement is well-known in AOSD and is seen in up to 53% of AOSD cases, with the most common pulmonary diseases being pleural effusion and transient pulmonary infiltrates. We present the first case of chronic AOSD complicated with diffuse alveolar hemorrhage during the acute flare of the disease

Post-Covid-19 Irritable Bowel Syndrome

Objectives The long-term consequences of COVID-19 infection on the gastrointestinal tract remain unclear. Here, we aimed to evaluate the prevalence of gastrointestinal symptoms and post-COVID-19 disorders of gut-brain interaction after hospitalisation for SARS-CoV-2 infection. Design GI-COVID-19 is a prospective, multicentre, controlled study. Patients with and without COVID-19 diagnosis were evaluated on hospital admission and after 1, 6 and 12 months post hospitalisation. Gastrointestinal symptoms, anxiety and depression were assessed using validated questionnaires. Results The study included 2183 hospitalised patients. The primary analysis included a total of 883 patients (614 patients with COVID-19 and 269 controls) due to the exclusion of patients with pre-existing gastrointestinal symptoms and/or surgery. At enrolment, gastrointestinal symptoms were more frequent among patients with COVID-19 than in the control group (59.3% vs 39.7%, p < 0.001). At the 12-month follow-up, constipation and hard stools were significantly more prevalent in controls than in patients with COVID-19 (16% vs 9.6%, p=0.019 and 17.7% vs 10.9%, p=0.011, respectively). Compared with controls, patients with COVID-19 reported higher rates of irritable bowel syndrome (IBS) according to Rome IV criteria: 0.5% versus 3.2%, p=0.045. Factors significantly associated with IBS diagnosis included history of allergies, chronic intake of proton pump inhibitors and presence of dyspnoea. At the 6-month follow-up, the rate of patients with COVID-19 fulfilling the criteria for depression was higher than among controls. Conclusion Compared with controls, hospitalised patients with COVID-19 had fewer problems of constipation and hard stools at 12 months after acute infection. Patients with COVID-19 had significantly higher rates of IBS than controls

Post COVID-19 irritable bowel syndrome

Objectives: The long-term consequences of COVID-19 infection on the gastrointestinal tract remain unclear. Here, we aimed to evaluate the prevalence of gastrointestinal symptoms and post-COVID-19 disorders of gut-brain interaction after hospitalisation for SARS-CoV-2 infection. Design: GI-COVID-19 is a prospective, multicentre, controlled study. Patients with and without COVID-19 diagnosis were evaluated on hospital admission and after 1, 6 and 12 months post hospitalisation. Gastrointestinal symptoms, anxiety and depression were assessed using validated questionnaires. Results: The study included 2183 hospitalised patients. The primary analysis included a total of 883 patients (614 patients with COVID-19 and 269 controls) due to the exclusion of patients with pre-existing gastrointestinal symptoms and/or surgery. At enrolment, gastrointestinal symptoms were more frequent among patients with COVID-19 than in the control group (59.3% vs 39.7%, p&lt;0.001). At the 12-month follow-up, constipation and hard stools were significantly more prevalent in controls than in patients with COVID-19 (16% vs 9.6%, p=0.019 and 17.7% vs 10.9%, p=0.011, respectively). Compared with controls, patients with COVID-19 reported higher rates of irritable bowel syndrome (IBS) according to Rome IV criteria: 0.5% versus 3.2%, p=0.045. Factors significantly associated with IBS diagnosis included history of allergies, chronic intake of proton pump inhibitors and presence of dyspnoea. At the 6-month follow-up, the rate of patients with COVID-19 fulfilling the criteria for depression was higher than among controls. Conclusion: Compared with controls, hospitalised patients with COVID-19 had fewer problems of constipation and hard stools at 12 months after acute infection. Patients with COVID-19 had significantly higher rates of IBS than controls. Trial registration number: NCT04691895

Evaluation of 880 patients diagnosed with acute pancreatitis according to the Revised Atlanta Classification: A single-center experience

OBJECTIVE: The Revised Atlanta Classification (RAC) is increasingly used in the evaluation of patients diagnosed with acute pancreatitis (AP). In our study, we aimed to evaluate the etiology, disease severity, and mortality rates of patients diagnosed with AP in our center in the previous 6 years

The role of the BISAP score in predicting acute pancreatitis severity according to the revised Atlanta classification: a single tertiary care unit experience from Turkey

Background/Aims: In this study, we examine the utility of Bedside Index of Severity in Acute Pancreatitis (BISAP), which is an increasingly more commonly used simple and practical novel scoring system for predicting the prognosis and severity of the disease at presentation. Materials and methods: Consecutive patients diagnosed with AP between January 2013 and December 2020 were evaluated retrospectively. The AP severity was assessed using the revised Atlanta classification (RAC). BISAP score, demographic characteristics, pancreatitis etiology, pancreatitis history, duration of hospital stay, and mortality rates of the patients were recorded. Results: A total of 1000 adult patients were included, of whom 589 (58.9%) were female and 411 (41.1%) were male. The mean age in female and male patients was 62.15 +/- 17.79 and 58.1 +/- 16.33 years, respectively (p >0.05). The most common etiological factor was biliary AP (55.8%), followed by idiopathic AP (23%). Based on RAC, 389 (38.9%), 418 (41.8%), and 193 (19.3%) patients had mild, moderate, and severe AP. Of the 1000 patients, 42 (4.2%) died. Significant predictors of mortality included advanced age (>65 y) (p=0.003), hypertension (p=0.007), and ischemic heart disease (p=0.001). A BISAP score of >= 3 had a sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of 79.79%, 91.57%, 69.37%, and 94.99%, respectively, for determining SAP patients according to RAC. Conclusion: BISAP is an effective scoring system with a high NPV in predicting the severity of AP in the early course of the disease in a Turkish population. (Acta gastroenterol. belg., 2021, 84, 571-576)

Indications, complications and patient satisfaction in percutaneous endoscopic gastrostomy

AMAÇ VE HİPOTEZ: Bu çalışmanın amacı PEG endikasyonlarını, erken ve geç dönem komplikasyonları, mortalite ve morbidite oranlarını ve hasta yada hasta yakınlarının bu yöntemle ilgili memnuniyetini prospektif olarak araştırmaktır. YÖNTEM: Çalışmaya DEU gastroenteroloji kliniğinde 01/10/2005 ve 01/06/2007 tarihleri arasında PEG tüpü yerleştirilen 42 hasta (21 E, 21 K, ortalam yaş: 61.2 + 17.7 yıl) alınmıştır. Hastalar PEG yerleştirildikten sonra PEG tüpü ile ilişkili komplikasyonlar ve gastrointestinal sistem problemleri açısından birinci gün, birinci hafta, birinci ve üçüncü aylarda ve izleyen dönemde 3 ayda bir değerlendirilmiştir. Bu görüşmeler arasında kalan zaman dilimlerinde hastada gelişen herhangi bir sorun, hasta yakını, bakıcısı veya beslenme hemşireleri tarafından sorumlu hekimlere bildirilmiştir. PEG tüpü çevresindeki yara yerleri Jain ve arkadaşlarının geliştirdiği yara yeri skorlama sistemi ile takip edilmiştir. Üçüncü aya kadar yaşayan hastaların PEG tüpü ile ilişkili memnuniyeti Löser ve arkadaşlarının kullandığı subjektif tolerabilite skalası ile değerlendirilmiştir. BULGULAR: Kırk iki hastanın 30'una malignite dışı nedenlerle, 12'sine ise malignite nedeniyle PEG tüpü yerleştirilmiştir. Malignite dışı nedenleræ serebrovasküler hastalık (n:13), kronik santral sinir sistemi hastalığı (n:11), sık pulmoner aspirasyon (n:5) ve solunum yetmezliği (n:1) idi. Toplam 25 PEG ile ilişkili komplikasyon (4 major ve 21 minör) tespit edildi. En sık görülen komplikasyon PEG ile ilişkili yara yeri enfeksiyonu idi. Erken dönem (ilk bir ayda) ve birinci yıldaki mortalite oranları % 17 ve % 60'dı. Tüm hastalar arasında ilk bir ay içinde gelişen ölüm oranları ile hemoglobin değerinin 10 g/dl'nin altında olması, beyaz küre sayısının 10 x 109/ml üzerinde olması, CRP değerinin 10 mg/L'nin üzerinde olması, albümin değerinin 3 g/dl'nin altında olması, kreatinin değerinin 1,2 mg/dl'nin üzerinde olması, glaskow koma skalası değerinin 10'nun altında olması arasında istatistiksel olarak anlamlı bir ilişki bulunamadı. Sık pulmoner aspirasyon nedeniyle PEG tüpü yerleştirilen hastaların erken dönemdeki mortalite oranı, tüm hastalarla karşılaştırıldığında anlamlı olarak yüksek bulundu (% 80 vs % 17æ p=0,01). PEG tüpü yerleştirilen hasta veya hasta yakınları % 97'si PEG tüpü ile beslenmenin yeterli bir metod veya iyi bir deneyim olduğunu belirtmişlerdir. SONUÇ: PEG güvenli, etkin, hasta ve hasta yakını memnuniyeti yüksek bir beslenme yöntemidir. ANAHTAR KELİMELER: Perkütan endoskopik gastrostomiæ Endikasyonæ Komplikasyonæ Mortalite OBJECTIVE AND HYPOTHESIS: The aim of this study was to prospectively evaluate the PEG indications, early and late term complications, mortality, morbidity rates, and patient or patient-relative satisfaction about this method. METHODS: Forty two patients (21 M, 21 F, median age: 61.2 + 17.7 years) who inserted PEG tube in DEU gastroenterology clinic between 01/10/2005 and 01/06/2007 were enrolled into the study. Patients were evaluated for PEG tube related complications and gastrointestinal system problems at the first day, the first week, the first month and the third month after the PEG insertion and every 3 months thereafter. If any problem occurred between these periods, it had been reported to his physician by his relatives, care workers or nurses. The scar lesions around PEG tube were evaluated according to the scoring system proposed by Jain et al. In patients that had survived for 3 months, PEG tube related patient satisfaction was evaluated by subjective tolerability scale which is proposed by Loser and his co-workers. RESULTS: PEG tubes were placed in 30 patients for non-malign disorders and 12 for malign disorders for a total of 42. Non-malign disorders were cerebrovascular disease (n:13), chronic central neurologic disease (n:11), frequent pulmonary aspiration (n:5) and respiratory insufficiency (n:1). Overall 25 PEG related compliacations (4 major and 21 minor) were observed. The most frequent complication was PEG related wound infection (n:10). Early (in the first month) and first year mortality rates were 17 % and 60 %, respectively. There were no statistical significance between conditions as haemoglobin concentration below 10 g/dl, leukocyte count above 10 x 109/ml, CRP concentration more than 10 mg/L, albumin concentration below 3 g/dl, creatinin concentration above 1.2 mg/dl, Glasgow coma scale above 10 and the rate of mortality in first month. PEG placed patients for frequent pulmonary aspiration had statistically significantly higher death ratio in 1 month compared to the other groups (80 % vs. 17 %æ p=0, 01). 97 % of PEG placed patients or their relatives indicated that feeding with PEG tube was an efficient method or a good experience. CONCLUSİON: PEG is a reliable, efficient method and has a high patient and patient-relative satisfaction. KEY WORDS: Percutaneous endoscopic gastrectomyæ Mortalityæ Indicationæ Complication

Comparison of the effects off on-pump and off-pump coronary artery bypass grafting surgeries on quality of life

Bu çalışmada çalışan kalpte koroner arter baypas greft (off-pump KABG = grup 1) ile pompalı koroner arter baypas greft (on-pump KABG = grup 2) cerrahisi geçiren hastaların yaşam kalitesi üzerine etkisini karşılaştırmayı amaçladık. Uludağ Üniversitesi Tıp Fakültesinde 01.08.2012 - 31.01.2013 tarihleri arasında koroner arter baypas greft (KABG) ameliyatı olan, çalışmaya katılmayı kabul eden grup 1'de 25 hasta, grup 2'de 25 hasta toplamda 50 hasta çalışmaya alındı. Preoperatif özellikleri açısından hastalar açısından anlamlı fark yoktu. Çalışma SF-36 ölçeği kullanılarak KABG'den 1 hafta ve 1 ay sonra gerçekleştirildi. Çalışmanın analizleri SPSS 20.0 programında yapılmış olup p<0.05 istatistikel olarak anlamlı kabul edildi. Off pump KABG'den 1 hafta sonra fiziksel fonksiyon, fiziksel rol, sosyal fonksiyon ve emosyonel rol; 1 ay sonra fiziksel rol on pump KABG'den anlamlı çıktı. KABG'den 1 hafta sonra kadın cinsiyette fiziksel fonksiyon erkeklerden anlamlı çıktı. Off pump ve on pump KABG'den 1 hafta sonra mental sağlık, zindelik/yorgunluk, ağrı ve genel sağlık açısından anlamlı fark yoktu. Off pump, on pump KABG ve her iki cinsiyette ameliyattan 1 ay sonra fiziksel fonksiyon, sosyal fonksiyon, emosyonel rol, mental sağlık, zindelik-yorgunluk, ağrı, cinsiyet ve genel sağlık açısından anlamlı fark yoktu. Bu çalışmamızın sonucunda yaşam kalitesi açısından 1.hafta sonuçları off pump KABG lehine anlamlı olmasına rağmen 1.ay sonuçları açısından on pump ile off pump grupları arasında anlamlı fark görülmedi.In this study, we aimed to compare the impact of beating-heart coronary artery bypass graft (off-pump CABG = group 1) and on-pump coronary artery bypass graft (on-pump CABG = group 2) on quality of life. Of fifty patients who agreed to participate in the study and performed coronary artery bypass graft (CABG) in Uludag University Faculty of Medicine between 01.08.2012 - 31.01.2013, 25 patients performed off-pump CABG and 25 patients performed on-pump CABG, enrolled in this study. There is no significant difference between patients in terms of preoperative features. Study conducted a week and a month after CABG using SF-36 scale. SPSS 20.0 was used for study analysis and p <0.05 was considered statistically significant. Physical function, physical role, social function and emotional role has been significant one week after off-pump CABG surgery; and physical role has been significant 1 month after on-pump CABG in Group 1. Physical function was significant in females compared with males a week after CABG. There was no significant difference in terms of mental health, fitness-/ fatigue, pain, and general health a week after off-pump and on-pump CABG. There was no significant difference in off-pump CABG, on-pump CABG and both in terms of physical function, social function, emotional role, mental health, fitness-fatigue, pain, and general health genders a month after surgery. In our study, although results of first week were significant in favor of off-pump CABG in terms of life quality, we found that there was no significant difference between on-pump and off-pump groups in terms of results of first month

Assessment of rectum cancer patients applied for neoadjuvant and adjuvant chemotherapy

AMAÇ VE HİPOTEZ: Bu çalışmanın amacı, neoadjuvan ve adjuvan kemoterapi almak üzere başvuran rektum kanserli hastaların genel özellikleri, prognostik faktörleri ve aldıkları tedaviler doğrultusunda genel sağkalım ve progresyonsuz sağkalım sürelerini değerlendirmektir. YÖNTEM: Dokuz Eylül Üniversitesi Tıp Fakültesi İç Hastalıkları Medikal Onkoloji Bilim Dalı'na Ocak 2002 - Ağustos 2007 tarihleri arasında neoadjuvan ve adjuvan tedavi almak için başvuran 126 (ortalama yaş: 59,0 + 12.7 yıl, 72 erkek/54 kadın) rektum kanserli hasta incelendi. Hastalar ile ilgili verilere, hastane hasta bilgisayar sistemi ve bölüm dosyalarının retrospektif olarak incelenmesiyle ulaşıldı. Uzun süredir kontrole gelmeyen hastaların bilgilerine evlerine telefon edilerek ulaşıldı ve genel sağkalım verileri Haziran 2008 tarihi itibariyle güncelleştirildi. BULGULAR: Rektum kanserinde prognostik özelliklerine göre değerlendirilen hastaların yaş, operasyon öncesi ve sonrası tümör invazyon derecesi, lenf bezi tutulumu, operasyon öncesi CEA düzeyi, tümörün diferansiyasyon derecesi, perivasküler ve lenfatik invazyonuna göre hastalar arasında anlamlı fark bulunmadı. Sadece tümörü perinöral invazyonu olan hastalarda olmayanlara göre 5 yıllık sağkalım oranı anlamlı olarak düşük bulundu (p= 0,03). Hastaların genel ve progresyonsuz sağkalım oranları iki yıllık % 93,9 ve % 81,7æ beş yıllık % 72,4 ve % 56,8 bulundu. SONUÇ: Bu çalışmada, hastaların genel ve hastalıksız sağkalım oranları literatür ile paralellik göstermekte olup, prognostik faktörlerden ise sadece tümörün perinöral invazyonuna göre sağkalım oranları arasında anlamlı fark bulunmuştur. Bu nedenle, prognostik faktörlerin daha iyi değerlendirilebilmesi için, daha fazla hastanın yer aldığı prospektif çalışmalara gerek duyulmaktadır. ANAHTAR KELİMELER: Rektum kanseri, radyoterapi, kemoterapi. OBJECTIVES AND HYPOTHESIS: This study was planned to evaluate particularities, overall survival, progression free survival and prognostic factors of rectum cancer patients who were subject to adjuvanr or neoadjuvanr chemoradiotherapy. METHODS : 126 rectum cancer patients (72 men, 54 womenæ mean age: 59 + 12,7 yr) who were subject to adjuvant or neoadjuvant chemotherapy from January 2002 to August 2007 in the Department of Medical Oncology, Faculty of Medicine, University of Dokuz Eylül were evaluated. Patients data were obtainedby retrospective analysis of the electronic hospital recordss and patients files in the department. Patients who were missing their follow up visits were reached by phone calls. Survival data were updated in June 2008. RESULTS: No stattistically significant differences for survival were found according to age, preoperative and postoperative T, lymph node involvement, CEA level, tumor differentiation, vascular and lymphatic invasion. Perineural invasion was found as a statistically bad prognostic factor (p=0,003). Patients overall and progression free survival were found respectively at 2 years as 93,9 % and 81,7 % and at 5 years 72,4 % and 56,8 %. CONCLUSION: The overall and progression survival of the patients were equivalent to that reported in the literature. Only perineural invasion was a significant prognostic factor. Multicenter prospective analysis are needed in order to evaluate the role of other candidate prognosticfactors KEY WORDS: Rectum cancer, radiotherapy, chemotherapy

Evaluation of adult celiac disease from a tertiary reference center: a retrospective analysis

OBJECTIVE: It has been observed that celiac disease (CD) is not restricted to a single type characterized by diarrhea but also has atypical, asymptomatic (silent), and latent forms. The prevalence of this autoimmune disease, which affects approximately 1% of the world, is estimated to be around 3%, including atypical and asymptomatic cases. In our study, we aimed to evaluate adult celiac patients