Ümit Karabulut

Background/Objectives: Terminal ileal nodular lymphoid hyperplasia (NLH) can mimic Crohn’s disease endoscopically, and data integrating its clinical, laboratory, endoscopic, and histopathological features in adults are limited. We aimed to describe these features and associated conditions. Methods: This retrospective single-center study included adults who underwent colonoscopy between January 2023 and December 2025 with terminal ileal biopsy for endoscopically suspected NLH; histopathological confirmation was required for inclusion. Giardia lamblia (G. lamblia)–positive and –negative patients were compared as a secondary exploratory analysis. Results: Histology confirmed NLH in 50 of 64 biopsied patients (78.1%); 43 with essential inclusion data were analyzed (mean age 35.1 ± 12.0 years; 67.4% male); fecal calprotectin was available in 40. Diarrhea and abdominal pain were leading indications. Findings were predominantly reactive, with no morphological features of lymphoma; one patient with Crohn’s-suggestive features was subsequently diagnosed with Crohn’s disease. No patient had hypogammaglobulinemia or positive celiac serology. G. lamblia infection (10/43, 23.3%) was associated with higher fecal calprotectin (median 36.5 vs. 9.0 µg/g; p = 0.016). Conclusions: On routine histology, adult terminal ileal NLH appears predominantly benign and reactive; however, endoscopic appearance alone was insufficient for diagnosis in one fifth of cases. The G. lamblia–calprotectin association is exploratory and requires confirmation.

Iron deficiency anemia may signal underlying gastrointestinal pathology in adults. This study aimed to evaluate endoscopic and histopathological findings in adults undergoing upper gastrointestinal endoscopy and colonoscopy for iron deficiency anemia and to compare selected lesion frequencies between age groups. This retrospective study included 328 adult patients who underwent upper gastrointestinal endoscopy for iron deficiency anemia between January 2024 and December 2025; 285 also underwent colonoscopy. The mean age was 61.2 ± 14.8 years, and 62.5% of patients were male; 64.3% were older than 50 years. Pangastritis (30.5%) and antral gastritis (23.8%) were the most common upper gastrointestinal findings. Among biopsied patients, Helicobacter pylori positivity was 54.2%, intestinal metaplasia 14.6%, and atrophic gastritis 7.5%. On colonoscopy, hemorrhoids were most common (32.3%), followed by colonic polyps (24.6%); colorectal adenocarcinoma was found in eight patients (2.8%), all older than 50 years. Tubular adenoma with low-grade dysplasia was the most frequent polyp histopathology. Gastric polyps ( P = 0.013) and colonic polyps ( P = 0.041), which were not uniformly subclassified histologically, were significantly more frequent after age 50, whereas intestinal metaplasia ( P = 0.051) and colorectal cancer (8/190 vs. 0/95; P = 0.055) did not differ significantly between age groups. In this descriptive, single-group cohort, bidirectional endoscopy identified premalignant and malignant lesions in adults with iron deficiency anemia. As no nonanemic control group was included, these findings describe the diagnostic yield within this population and do not establish the clinical benefit of combined endoscopic evaluation.

Splenic infarction is a rare but clinically important condition that is usually associated with underlying hematological, cardiovascular, infectious, or ma

Background: Early identification of disease severity in acute pancreatitis (AP) remains a major clinical challenge. The neutrophil percentage-to-albumin ratio (NPAR) is a novel inflammatory index that reflects systemic inflammation, but evidence regarding its role in predicting AP severity remains limited. This study aimed to evaluate the association between admission NPAR and AP severity and to compare its predictive performance with other inflammatory indices. Methods: This retrospective study included 261 patients with AP. NPAR, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and the systemic immune inflammation index (SII) were calculated using laboratory parameters obtained at hospital admission. Disease severity was assessed according to the revised Atlanta classification and the Bedside Index for Severity in Acute Pancreatitis (BISAP) score. Receiver operating characteristic (ROC) curve analysis was performed to compare predictive performance, and logistic regression analyses were used to identify independent predictors of disease severity. Results: Admission NPAR values were significantly higher in patients with moderately severe/severe AP according to the revised Atlanta classification and in patients with BISAP scores ≥ 3 (both p < 0.001). Among the evaluated inflammatory indices, NPAR demonstrated the highest predictive performance for disease severity according to both the revised Atlanta classification (AUC: 0.808) and BISAP score (AUC: 0.841). In multivariate logistic regression analysis, admission NPAR remained independently associated with AP severity (OR: 1.279, 95% CI: 1.174–1.393, p < 0.001). Admission NPAR levels were also significantly higher in non-survivors than in survivors (p = 0.017). Conclusions: Admission NPAR appears to be a simple, inexpensive, and readily available inflammatory index associated with disease severity in patients with AP. These findings suggest that NPAR may serve as a useful adjunctive tool for early risk stratification. However, larger prospective multicenter studies are required to validate these findings and confirm the proposed admission cut-off value before routine clinical implementation.

Duodenogastric reflux (DGR), defined as the retrograde flow of duodenal contents into the stomach, has an incompletely understood pathophysiology. This study aimed to evaluate the relationship between DGR and clinical, endoscopic, histopathological, and laboratory parameters in dyspeptic patients, and to assess its association with Helicobacter pylori (H. pylori) infection, intestinal metaplasia, and potential risk factors. This retrospective case-control study included 524 patients who underwent upper gastrointestinal endoscopy between January 2017 and December 2022. A total of 287 patients with endoscopic signs of DGR such as bile pooling, mucosal edema, or hyperemia were classified as the DGR group, while 237 patients without these findings served as controls. Clinical, biochemical, endoscopic, and histopathological data were compared, and risk factors were analyzed using multivariate logistic regression. Chemical gastropathy was significantly more frequent in the DGR group (p < 0.001). There were no significant differences regarding intestinal metaplasia or H. pylori positivity (p > 0.05). The DGR group showed higher total bilirubin and lower albumin levels (p < 0.05). Cholecystectomy and cholelithiasis were identified as independent strong risk factors (p < 0.001), while age contributed modestly; gender and H. pylori infection showed no significant association. DGR is a multifactorial condition associated with gastric mucosal injury and systemic biomarker changes. A history of cholecystectomy or gallstones markedly increases DGR risk. Its independent role in intestinal metaplasia remains uncertain, warranting further prospective research.

Background: Early risk assessment in non-variceal upper gastrointestinal bleeding (NVUGIB) is essential for guiding clinical management. The neutrophil percentage-to-albumin ratio (NPAR) has recently been proposed as a marker reflecting both inflammatory response and physiological reserve. This study aimed to evaluate the prognostic value of NPAR for in-hospital mortality and its relationship with established risk scores in patients with NVUGIB. Methods: This retrospective observational study included 94 patients hospitalized with NVUGIB. NPAR was calculated using laboratory parameters obtained at admission. Patients were stratified according to AIMS65 (p < 0.001 for both). NPAR demonstrated good discriminative ability for AIMS65 ≥ 2 (AUC: 0.843) and moderate performance for Rockall ≥ 5 (AUC: 0.714). For mortality prediction, NPAR showed excellent performance (AUC: 0.900). A cut-off value of 27.4 yielded a sensitivity of 91.7% and a specificity of 75.6%. Higher NPAR values were associated with increased mortality risk (OR 31.9, 95% CI: 3.88–102.59, p < 0.001), while the negative predictive value was high (98.4%). In contrast, NLR, PLR, and SII showed limited predictive value for in-hospital mortality. Conclusions: NPAR shows promise as a potential prognostic biomarker for assessing disease severity and in-hospital mortality in NVUGIB. Its high negative predictive value and association with established risk scores suggest that it may complement current risk stratification approaches. However, these findings should be considered preliminary, given the retrospective design and limited sample size, and require validation in larger prospective studies.

Kısa bağırsak sendromu (KBS), çoğunlukla ince bağırsağın cerrahi rezeksiyonuna ikincil olarak bağırsak kütlesi kaybının bir sonucu olarak ortaya çıkan nadir bir malabsorbtif bozukluktur. Diğer nedenler damar hastalıkları, neoplazmlar veya inflamatuar bağırsak hastalığıdır. Hastalığın spektrumu, ince bağırsağın kalan uzunluğuna, kalan bağırsağın fonksiyonuna bağlı olarak, tek bir mikro besin malabsorbsiyonundan tam bağırsak yetmezliğine kadar geniş bir değişkenlik gösterir. Kısa bağırsak sendromunun yönetimi zorlayıcı olabilir ve en iyi şekilde uzman, multidisipliner bir ekip tarafından yönetilir. İnce bağırsağın farklı bölümlerinin rezeksiyonunun patofizyolojik sonuçlarının iyi anlaşılması, KBS’ nin sonuçlarını önceden tahmin etmek ve mümkün olduğunda önlemek için gereklidir. Son yıllarda, etkilenen hastaların yönetimi, esas olarak evde parenteral beslenme (PN) alanındaki ilerlemeler sayesinde, hastaların yaşam kalitesi ve hayatta kalma oranlarındaki artışla birlikte önemli ölçüde iyileşti. Uzun süreli parenteral beslenmeyi tolere edemeyen hastalar için bağırsak nakli endikedir ancak artan deneyimle birlikte, gelecekte kullanımının potansiyel olarak genişleyen bir rolü olabilir. Bu bölümde, KBS epidemiyolojisi, patofizyolojisi, tıbbi ve cerrahi yönetimi ile ilgili güncel gelişmelere ağırlık verildi.

Celiac disease,remission status,villous atrophy