Huseyin Savas Gokturk

Background/Aims: Chronic gastritis progression is a multistep process of atrophy, intestinal metaplasia (IM), and dysplasia, which may lead to invasive carcinoma. In this study, we identified an association of colonic polyps with gastric IM in patients undergoing colonoscopy. Materials and Methods: This retrospective case-control, cross-sectional study was conducted in a tertiary-care institution in Turkey. Pathology and endoscopy reports were reviewed. The study group comprised 400 patients with colonic adenomatous polyps, and the control group comprised 360 patients without colonic adenomatous polyps on colonoscopy. Results: The risk of gastric IM was 1.42-fold higher in the study group (p<0.05). The risk of IM in patients aged ≥50 years with colonic polyps was 3.35-fold higher than in those aged <50 years (p<0.05). The risk of Helicobacter pylori infection in the study group was 1.07-folder higher than that in the control group (p<0.05). H. pylori infection prevalence was higher only in patients with high-grade colonic polyp dysplasia (p<0.05). There were no statistically significant differences in the proportion of incomplete IM between the groups (p<0.05). Conclusion: This study observed increased rates of gastric IM with colonic polyps. An increased risk of gastric IM was associated with higher grades of polyp dysplasia.

Malnutrition is common in patients with chronic liver disease and is associated with poor outcomes. Inadequate intake, poor quality diet, maldigestion, malabsorption, altered macronutrient metabolism, and hypermetabolism all contribute to the development of malnutrition in this patient population. Although it is generally easy to detect, clinicians often overlook malnutrition and its measurement is complicated by the lack of a simple, standardized diagnostic method. Early detection of malnutrition and multidisciplinary treatment approaches greatly increase the probability for successful outcomes.

Dysphagia represents a difficulty in passage of solid or liquid foods from the oral cavity into the stomach and is considered as an alarm symptom of gastrointestinal system. It often indicates an organic disease and needs to be explained. In this paper, a case of 61-year-old man with posterior tongue abscess is presented.

The intrauterine device (IUD) is among the most common reversible contraception products available world wide.

BACKGROUND: Ascites is defined as the pathological accumulation of fluid in the peritoneal cavity. It is the most common complication of cirrhosis, which is also the most common cause of ascites. Viscosity is a measure of the resistance of a fluid to deform under shear stress. Plasma viscosity is influenced by the concentration of plasma proteins and lipoproteins, with the major contribution from fibrinogen. To our knowledge, the viscosity of ascitic fluid has not yet been studied.OBJECTIVE: To evaluate the role of ascitic fluid viscosity in discriminating between ascites due to portal hypertension‐related and nonportal hypertension‐related causes, and to compare results with the serum‐ascites albumin gradient (SAAG).METHODS: The present study involved 142 patients with ascites presenting with diverse medical problems. Serum total protein, albumin, glucose, lactate dehydrogenase (LDH) levels and complete blood count were obtained for all subjects. Paracentesis was performed routinely on admission and all ascitic fluid samples were evaluated by manual cell count with differential, ascitic fluid culture and biochemistry (total protein, albumin, glucose and LDH). Cultures of ascitic fluid were performed at bedside in all patients using blood culture bottles. Ascitic fluid viscosity was measured in a commercially available cone and plate viscometer.RESULTS: Of the 142 patients studied, 34 (24%) had an SAAG of 11 g/L or less, whereas 108 (76%) had an SAAG of greater than 11 g/L. Sex and mean age did not differ significantly between the two groups (P>0.05). Serum total protein, albumin, glucose, LDH levels, leukocyte count, ascitic fluid glucose levels and ascitic fluid leukocyte counts were similar in both groups, with no statistically significant relationship detected (P>0.05). However, the mean (±SD) ascitic fluid total protein (0.0172±0.1104 g/L versus 0.043±0.011 g/L), albumin (0.0104±0.0064 g/L versus 0.0276±0.0069 g/L) and LDH (102.76±80.95 U/L versus 885.71±199.93 U/L) were found to be higher in patients with an SAAG of 11 g/L or less than in those with an SAAG of greater than 11 g/L (P<0.001). The mean ascitic fluid viscosities were 0.86±0.12 centipoise (cP) and 1.22±0.25 cP in patients with an SAAG greater than 11 g/L and an SAAG of 11 g/L or less, respectively (P<0.001). Although ascitic fluid infection was detected in 35 patients (24.6%) (19 patients with spontaneous bacterial peritonitis, seven patients with culture‐negative neutrocytic ascites, three patients with monobacterial non‐neutrocytic bacterascites and six patients with secondary bacterial peritonitis), no significant effect on ascitic fluid viscosity was detected. Multiple linear regression analysis revealed that ascitic fluid total protein, albumin and LDH levels were independent predictors of ascitic fluid viscosity (P<0.001). The sensitivity, specificity, and positive and negative predictive values of ascitic fluid viscosity for the discrimination between ascites due to portal hypertension‐related and nonportal hypertension‐related causes according to the SAAG were determined by receiver operating characteristic analysis. Regarding the cut‐off value of 1.03 cP, ascitic fluid viscosity measurement had a high sensitivity, specificity (98% and 80%, respectively), and positive and negative predictive value (79% and 94%, respectively) for the etiological discrimination of ascites.CONCLUSION: The measurement of ascitic fluid viscosity correlates significantly with SAAG values. In view of its simplicity, low cost, small sample volume requirement and allowance for measurement in previously frozen samples, measurement of ascites viscosity could be useful for the accurate and rapid classification of ascites.

The need for colonoscopy is common among diabetics. In this study, we aimed to evaluate the effect of autonomous neuropathy on bowel preparation in type 2 diabetes mellitus (DM) patients. The study population consisted of 45 patients with DM and 48 non-diabetic, age- and sex-matched subjects. All colonoscopies were performed 5 h after the last dose of sodium phosphate. Colonoscopists rated the bowel preparation quality during the procedure using the Aronchick scale. All patients underwent a detailed cardiologic examination and 24-h Holter rhythm monitoring. Orthostatic hypotension and impairment in heart rate variability were accepted as indicators of autonomous neuropathy. Gender, age, blood pressure, and heart rates did not differ significantly between groups (p > 0.05). Autonomous neuropathy was detected in 14 (31.1%) patients in the DM group and in two (4.2%) in the control group (p < 0.05). Optimal bowel cleansing was achieved in 93.8% of controls and 73.3% of diabetics; bowel cleansing was suboptimal in 26.7% of diabetics and 6.2% of controls (p < 0.05). Optimal bowel cleansing was achieved in six of 14 (42.8%) diabetic patients with autonomous neuropathy; however, optimal bowel cleansing was achieved in 27 of 31 (87.1%) diabetic patients without autonomous neuropathy (p < 0.05). Although optimal bowel cleansing was more prevalent among control patients than in diabetic patients without autonomous neuropathy, the difference was not significant (87.1% vs 93.8%; p > 0.05). These data suggest that optimal bowel cleansing is poorer in diabetics with autonomous neuropathy than in those without autonomous neuropathy and controls.

Aim The prevalence of occult hepatitis B virus (HBV) infection is relatively frequent among patients with immune suppression. The impairment of the immune system is well demonstrated in diabetics. We aimed to investigate the prevalence of occult HBV infection among hepatitis B core antibody (HbcAb)± hepatitis B surface antibody (anti-HBs) positive type 2 diabetes mellitus patients. Materials and Methods The study involved 100 HBcAb±anti-HBs type 2 diabetes mellitus patients and 100 age and sex matched, HBcAb±anti-HBs healthy blood donors. Exclusion criteria were positive serology for HBsAg, hepatitis C virus or HIV, diagnosis of malignancy or earlier organ transplantation history, use of immunosuppressive therapy. All patients were questioned about their past medical history and were tested for serum alanine aminotransferase and HBV DNA level. Results The diabetic patients did not differ significantly from healthy controls in terms of sex and age. HBV DNA was detected in 11% of the diabetic patients (1×10²–5×10³ copies/ml) and in 3% of the controls (4×10³–1×10⁵ copies/ml). The difference between groups was statistically significant (P0.05). The serum alanine aminotransferase levels in diabetic patients were close to those of controls (26.2±16.4 IU/l vs. 23.9±9.7 IU/l; P>0.05). Conclusion These data suggest that the prevalence of occult HBV infection is higher in diabetics compared with healthy controls and this may contribute to the increased prevalence of primary hepatocellular carcinoma in diabetics.