Non-Surgical Causes of Acute Abdominal Pain

Abdominal pain constitutes 5% of the causes of emergency admissions and is an important part in the practice of emergency services in all centers. Patients may suffer from acute surgical abdomen, acute abdomen with nonsurgical diseases or acute problems of chronic diseases. Abdominal pain is sometimes associated with acute trauma. Clinical assessment is a process where diagnosis and treatment must be done quickly and must be well managed. We have tried here to discuss the non-surgical causes of abdominal pain

Extraintestinal Manifestations in Helicobacter pylori Infection – Iron Deficiency Anemia and Helicobacter pylori

Iron is an essential element for all living organisms. Iron metabolism is mainly controlled by its absorption. Iron deficiency (ID) is the most common nutritional deficiency, causing important clinical outcomes. One of the most common results of ID is iron deficiency anemia (IDA). The ID results from increased physiological needs, blood losses, inadequate intake, and diminished absorption. Helicobacter pylori (H. pylori) infection is one of the important causes of IDA, especially in undetermined and refractory cases

A gastric stump cancer with unusual appearance

A 60 year old man was referred to our hospital with the chief complaints of abdominal pain and vomiting. He underwent a distal gastrectomy with a Billroth II gastrojejunostomy for a peptic ulcer 13 years ago. Esophagogastroduodenoscopy (EGD) did not reveal any gross lesion in the stomach but depigmented areas were seen in the anastomosis line. The histopathology of the anastomotic area revealed poorly differentiated adenocarcinoma. Gastric stump cancers can be polypoid, fungating, ulcerated and diffusely infiltrating tumors respectively. In our case, the appearance of adenocarcinoma was quite different from that described in the classification system

Thymic stromal lymphopoietin levels are increased in patients with celiac disease

Thymic stromal lymphopoietin (TSLP) is a cytokine produced by epithelial cells in the lungs, skin and intestinal mucosa, and is involved in several physiological and pathological processes. In this study, we evaluated serum TSLP levels in patients with celiac disease (CD). The prospective study was conducted at a gastroenterology outpatient clinic between March 2018 and August 2018. Eighty-nine participants aged between 18 and 75 years were classified into following groups: 22 patients with newly diagnosed CD; 20 patients with CD who were compliant with a gluten-free diet (GFD); 32 patients with CD who were not compliant with a GFD; and 15 healthy controls. Demographic characteristics, disease duration, and selected biochemical and hematologic parameters were recorded and compared between groups. Median serum TSLP levels were 1193.65 pg/mL (range: 480.1–1547.1) in newly diagnosed CD patients, 110.25 pg/mL (range: 60.3–216.7) in CD patients who were compliant with a GFD, 113.1 pg/mL (range: 76.3–303.4) in CD patients who were not compliant with a GFD, and 57 pg/mL (range: 49–67.8) in healthy controls. Overall, there was a significant difference in serum TSLP levels between groups (p = 0.001). Patients with newly diagnosed CD had the highest serum TSLP levels. There was no significant difference in serum TSLP levels between patients with CD who were or were not compliant with a GFD. TSLP appears to be involved in the pathogenesis of CD. Further studies are required to determine if the TSLP signaling pathway can be used in the treatment of CD

The impact of bismuth addition to sequential treatment on Helicobacter pylori eradication: A pilot study

The success of the current anti-Helicobacter pylori (H. pylori) treatment protocols is reported to decrease by years, and research is needed to strengthen the H. pylori eradication treatment. Sequential treatment (ST), one of the treatment modalities for H. pylori eradication, includes amoxicillin 1 gr b.i.d and proton pump inhibitor b.i.d for first 5 days and then includes clarithromycin 500 mg b.i.d, metronidazole 500 mg b.i.d and a proton pump inhibitor b.i.d for remaining 5 days. In this study, we investigated efficacy and tolerability of bismuth addition in to ST. We included patients that underwent upper gastrointestinal endoscopy in which H. pylori infection was diagnosed by histological examination of antral and corporal gastric mucosa biopsy. Participants were randomly administered ST or bismuth containing ST (BST) protocols for the first-line H. pylori eradication therapy. Participants have been tested by urea breath test for eradication success 6 weeks after the completion of treatment. One hundred and fifty patients (93 female, 57 male) were enrolled. There were no significant differences in eradication rates for both intention to treat population (70.2%, 95% confidence interval [CI]: 66.3-74.1% vs. 71.8%, 95% CI: 61.8-81.7%, for ST and BST, respectively, p > 0.05) and per protocol population (74.6%, 95% CI: 63.2-85.8% vs. 73.7%, 95% CI: 63.9-83.5% for ST and BST, respectively, p > 0.05). Despite the undeniable effect of bismuth, there may be several possible reasons of unsatisfactory eradication success. Drug administration time, coadministration of other drugs, possible H. pylori resistance to bismuth may affect the eradication success. The addition of bismuth subcitrate to ST regimen does not provide significant increase in eradication rates

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. Trial registration number: NCT04691895

The relationship between gastric preneoplastic findings and colon polyps

Giriş ve Amaç: Helicobacter pylori enfeksiyonu ile kolon polibi gelişimi arasındaki ilişkiye yönelik çalışmalarda çelişkili sonuçlar elde edilmiştir. Mide için preneoplastik olduğu bilinen atrofi ve intestinal metaplazi ile kolon polibi gelişimi arasındaki ilişki ise henüz yeterince irdelenmemiş- tir. İki merkezde yürütmüş olduğumuz çalışmada, gastrik preneoplas- tik bulgu varlığı ile kolon polibi arasındaki ilişkiyi araştırmayı amaçla- dık. Gereç ve Yöntem: Kırıkkale Üniversitesi Tıp Fakültesi ve Kırıkkale Yüksek İhtisas Hastanesi Gastroenteroloji polikliniklerine 01.01.2012 ile 01.09.2012 tarihleri arasında başvuraran hastalardan özofagogastrodu - odenoskopi yapılarak Helicobacter pylori için biyopsi örneği alınan ve eş zamanlı kolonoskopi işlemi yapılan olgular çalışmaya dahil edildi. Olgu - ların demografik özellikleri, polip saptanan olgularda polip karakteristik- leri (büyüklük, sayı, histoloji) ve özofagogastroduodenoskopik biyopsi sonucuna göre gastrik atrofi-intestinal metaplazi ve Helicobacter pylori pozitifliği Sydney klasifikasyonuna göre kaydedildi. Bulgular: Çalışma- ya yaş ortalaması 57,413,3 olan toplam 150 (93 erkek, %62,0) olgu dahil edildi. Olguların 51inde (%34,0) en az 1 kolon polibi mevcuttu. Kolon polibi ve adenoma varlığı için atrofi [(Sırasıyla; OR:3,1 (p0,01) ve OR:3,2 (p0,02)] bağımsız risk faktörü idi. Toplam adenomatöz po- lip çapı atrofinin derecesi (p0,04) ve intestinal metaplazinin derecesi (p0,01) ile, toplam adenom sayısı ise atrofinin derecesi (p0,01), intes- tinal metaplazinin derecesi (p0,001) ile korele idi. Sonuç: Çalışmamız- da; gastrik atrofi kolon polibi/adenom gelişimi için bağımsız risk faktörü olarak bulundu. Helicobacter pylori pozitifliğinin kolon polibi varlığı ile ilişkisi saptanmadı. Gastrik preneoplastik lezyonlar ile kolon neoplazisi arasındaki ilişkinin konfirme edilebilmesi için geniş ölçekli, popülasyon tabanlı çalışmalara ihtiyaç bulunmaktadır.Background and Aims: There are conflicting data regarding the rela- tionship of Helicobacter pylori infection and the development of colon polyp. Although it is known that gastric atrophy and intestinal metapla- sia are gastric preneoplastic findings, to date, the relationship between these findings and colonic polyp development has not been studied sufficiently. In our two-center study, we aimed to study the association between gastric preneoplastic lesions and the occurrence of colonic polyp. Materials and Methods: The patients who admitted to the Gastroenterology Outpatient Clinics of Kırıkkale University Faculty of Medicine and Kırıkkale Yüksek Ihtisas Hospital from January 1, 2012 to September 1, 2012 and underwent routine colonoscopy and had gastric biopsies taken for Helicobacter pylori infection on esophago - gastroduodenoscopy were enrolled in the study. Patient demographic data (gender and age), information on colon polyp characteristics (size, number of polyps, and histology), and the presence and density of Helicobacter pylori, gastric atrophy and intestinal metaplasia in gastric biopsies according to Sydney classification were recorded. Results: The study group included 150 patients (males: 93, 62,0%), and the mean age of the participants was 57,4±13,3 years. Fifty-one (34,0%) of the patients had at least one colon polyp. Gastric atrophy was an indepen - dent risk factor for the development of colon polyp and adenoma (odds ratio: 3,1 (p0,01) and odds ratio: 3,2 (p0,02), respectively). Total ad- enomatous polyp size and the density of gastric atrophy (p0,04) and of intestinal metaplasia were positively correlated (p0,01). The total number of colonic adenomas was positively correlated with the density of atrophy (p0,01) and of intestinal metaplasia (p<0,001). Conclu- sions: In our study, gastric atrophy was an independent risk factor for the development of colon polyp/adenoma. The presence of Helico - bacter pylori was not related with the development of colon polyp or adenoma. Large, population-based studies are required to confirm the relationship between gastric preneoplastic findings and the develop - ment of colon polyp

Metastatic lung adenocarcinoma in appearance of diminutive colonic polyp

Although about 50% of lung cancers have distant metastasis at the time of initial diagnosis, colonic metastases are extremely rare. This report presents a rare clinical case of colonic metastasis from primary adenocarcinoma of the lung

A very rare cause of markedly elevated CA 19.9: Autoimmune hepatitis

KISA, Ucler/0000-0002-8131-6810WOS: 000384674200012PubMed: 27098926Carbohydrate antigen 19.9 (CA 19.9) is a specific tumour marker of the biliary, pancreatic and gastrointestinal tracts. Autoimmune hepatitis is a chronic immune-mediated liver disorder characterised by female predominance. We report a case of approximately 30-fold increased serum CA 19.9 in a 57-year-old woman who was diagnosed with autoimmune hepatitis. She had no evidence of any malignant disease in pancreatobiliary or gastrointestinal tracts. CA 19.9 levels decreased to normal levels with immunosuppressive treatment. Markedly elevated serum CA 19.9 levels might be encountered with benign liver diseases such as autoimmune hepatitis

Nadir Bir Enfeksiyonun Çok Nadir Bir Klinik Prezentasyonu: Parankimal Fasciola hepatica

Fascioliazis düz, kahverengi bir karaciğer paraziti olan Fasciola hepaticaun sebep olduğu, öncelikle sığır, koyun gibi çiftlik hayvanlarında görülen bir enfeksiyon hastalığıdır. Enfeksiyonun tanısı hastalıktan şüphe etmekle mümkündür. Radyolojik bulgular oldukça spesifiktir. Genellikle Bilgisayarlı Tomografi (BT) ve diğer görüntüleme yöntemleri karaciğerde hipodens, hareketli lezyonlar göstermektedir. Parankimal F. hepatica çok nadir izlenmektedir. Biz burada F. Hepaticanın çok nadir bir klinik prezentasyonu olan parankimal F. hepaticalı bir vakayı sunmayı amaçladık. (Turkiye Parazitol Derg 2013; 37: 305-6)Fascioliasis is primarily an infection of livestock such as cattle and sheep, caused by the flat, brown liver fluke Fasciola hepatica. Humans are accidental hosts. The diagnosis of infection depends on suspicion. Radiologic findings are specific. Usually, Computed Tomography (CT) and other imaging studies show hypodense migratory lesions of the liver. The development of a chronic liver abscess appears to be extremely rare. Here we present our case with hepatic abscess due to F. hepatica, which is a rare clinical presentation. (Turkiye Parazitol Derg 2013; 37: 305-6