Turkish Journal of Gastroenterology最新文献

Background/Aims: High-sensitivity C-reactive protein (hs-CRP) is a known inflammatory biomarker linked to various metabolic disorders. This study sought to examine the association between hs-CRP levels and the risk of metabolic dysfunction-associated steatotic liver disease (MASLD) and liver fibrosis (LF). Materials and Methods: Data from 2787 participants of the 2017-2020 National Health and Nutrition Examination Survey were analyzed. The evaluation of liver steatosis and fibrosis was performed using transient elastography. Furthermore, logistic regression models were applied to examine the correlation between 4 categorized levels of hs-CRP and the risks of MASLD and LF. Results: Compared to individuals with hs-CRP ≤3 mg/L, those with hs-CRP levels of 3.01-6 mg/L, 6.01-10 mg/L, and ≥10.01 mg/L exhibited markedly increased risks of MASLD, with odds ratios and 95% CI of 2.229 (1.892-2.625), 2.474 (1.982-3.090), and 3.175 (2.497-4.037), respectively. The receiver operating characteristic and calibration curves of the model validated the significant association of higher hs-CRP levels with increased MASLD and LF risk. Conclusion: Elevated hs-CRP levels are prominently associated with increased risks of MASLD and LF. High-sensitivity C-reactive protein could serve as a potential biomarker for identifying and managing MASLD and related fibrosis risks.

Background/aims: Inflammatory bowel diseases (IBDs) are increasingly prevalent and challenging globally. Data regarding IBD frequency and severity between Europe and Asia are needed. The aim was to investigate the trend of IBD in Türkiye during the last 3 decades.

Materials and methods: The study was conducted retrospectively at 14 centers in Türkiye between June 1993 and March 2024.

Results: Over 30 years, 4308 patients, of whom 2507 (58.2%) had ulcerative colitis (UC) and 1717 (39.9%) had Crohn's Disease (CD), were included in the study. The overall median age at the onset of IBD was 34.43 (25.28-45.64) years; the age at onset of IBD was younger in CD compared to UC (32.72 vs. 35.52 years respectively, P < .001). The peak age onset range was 28-32 years in CD, whereas 23-27 years in UC. Overall, 2526 (58.6%) patients were male. The most common location was left-sided colitis in UC patients (45.1%), followed by extensive colitis (31.2%), and proctitis (23.7%), while ileal involvement in CD patients (45.2%), afterward ileocolonic (409%), and colonic (13.5%). Both illnesses are becoming increasingly prevalent. The UC/CD ratio tends to decrease over time. During the study period, 1577 (36.6%) patients received biologic treatment. During the study period, 418 (24.3%) underwent resective surgery for CD and 88 (3.5%) total colectomy for UC; the major abdominal surgery has declined over time.

Conclusion: The frequency and characteristic features of IBD in Türkiye appear to be between Europe and Asia. Over time, while the usage of biologic therapy and the rate of CD have increased, the frequency of surgery has decreased.

Background/aims: Oxaliplatin is a frontline chemotherapeutic agent for gastric cancer (GC) patients; yet, its clinical efficacy is often hindered by drug resistance. Recent studies have suggested a link between fatty acid oxidation (FAO) in GC and chemoresistance, but the precise mechanisms remain elusive.

Materials and methods: In this study, SALL4 was identified as a gene that is not only overexpressed in GC but also remarkably enriched in the FAO pathway through differential gene expression screening and gene set enrichment analysis. SALL4 could enhance the FAO process and oxaliplatin resistance in GC, as corroborated by western blot, assessment of FAO rates and adenosine triphosphate levels, and cell counting kit-8.

Results: Reversal experiments demonstrated that the small molecule drug Alectinib can counteract the promotion of FAO and oxaliplatin resistance by the upregulation of SALL4. The binding relationship between Alectinib and SALL4 protein was validated through molecular docking simulations and cellular thermal shift assay.

Conclusion: This research has brought to light that Alectinib targets SALL4 to modulate the FAO process, thereby reducing the oxaliplatin resistance of GC cells. These findings may open up new avenues to tackle chemoresistance in GC.

Background/aims: Endoscopic ultrasound (EUS) has become an increasingly important tool in modern medicine, particularly in the diagnosis and treatment of pancreatic pathologies. The aim of this study is to elucidate the diagnostic and predictive roles of EUS in pancreatic cysts.

Materials and methods: Patients who underwent EUS for various clinical indications were retrospectively analyzed. Among them, the detailed characteristics of pancreatic cysts identified during the procedures were documented from the patients' medical records.

Results: A total of 1146 patients were included in the study, with a mean age of 56.4 years; 51.7% were female and 48.3% were male. Endoscopic ultrasound was primarily used to evaluate pancreatic lesions, focusing on cysts. Of a total of 200 pancreatic cysts evaluated pathologically, 74% (148) were benign, 24.5% (49) were malignant, and 1.5% (3) were borderline. No significant correlation was found between cyst size and malignancy (P = 1.00). However, malignancy rates significantly varied according to ultrasonographic characteristics, including simple cysts, mixed-type cysts (with solid components), pseudocysts, and infected cysts. The malignancy rate was significantly higher in mixed-type cysts (with solid components) (P = .0001). The presence of cyst-associated lymphadenopathy was also statistically significant for suspicion of malignancy (P = .005).

Conclusion: This study highlights the importance of early diagnosis or surgical intervention for pancreatic cysts with mixed-type characteristics and associated lymph nodes. This underscores the need to prioritize triage for these patients.

Background/Aims: Liver fibrosis is linked to higher rates of death and disease. This study examined the hepatoprotective properties of vincamine and its potential therapeutic application in treating liver damage caused by methotrexate in rats. Materials and Methods: Thirty male Wistar albino rats, with weights ranging from 150 to 200 g and ages between 10 and 12 weeks, were included in the study. A total of 10 rats were selected to serve as the control group, receiving no medication. A group of 20 rats was given a single intraperitoneal dose of 20 mg/kg methotrexate in order to cause liver damage. Subsequently, the participants were randomly allocated into 2 cohorts and administered either 1 mL/kg/day tap water or 50 mg/kg/day vincamine orally through gavage on a daily basis for a duration of 10 days. Following the completion of the treatment period, the animals were euthanized and their livers were examined histologically. Furthermore, the levels of plasma galectin-3 (gal-3), cytokeratin 18, malondialdehyde (MDA), alanine transaminase (ALT), liver MDA, and transforming growth factor beta (TGF-β) levels were evaluated. Results: Treatment with vincamine resulted in a significant decrease in plasma gal-3, cytokeratin, MDA, and ALT levels and liver MDA and TGF-β levels compared to the methotrexate and saline group. Vincamine treatment effectively protected against liver injury, and histopathological examination of the livers confirmed these results. Conclusion: This study demonstrates that vincamine alleviates methotrexate-induced liver toxicity via exhibiting antioxidant, antiinflammatory, and anti-fibrotic activities and improved liver functionally, biochemically, and histopathologically.

Background/aims: Helicobacter pylori (H. pylori) affects half of the world's population. Increasing antibiotic resistance seems to be causing significant clinical problems. The efficacy of bismuth-containing sequential therapy with clarithromycin (BSTC), bismuth-containing sequential therapy with levofloxacin (BSTL), and bismuth-containing quadruple therapy (BQT) regimens on H. pylori eradication was investigated. The authors also investigated whether high gastric H. pylori colonization density affected treatment success through different treatment regimens.

Materials and methods: A total of 751 H. pylori-positive patients were included retrospectively in the following treatment groups: sequential therapy with clarithromycin, sequential therapy with levofloxacin, and bismuth-containing quadruple therapy.

Results: There was a significant difference between the 3 treatment protocols in terms of treatment success rates. When the success rates of the applied treatments were examined, the highest success rate was BSTL (85.3%), which was statistically significantly higher than BQT (74.8%) and BSTC (74.8%). A significant difference was found between the success rates of the protocols applied in the group with high bacterial density (P = .003). The success rates in this group were calculated as BSTL (88.6%), BQT (71.4%), and BSTC (79.4%).

Conclusion: It was concluded that BSTL may be the best option for treating H. pylori infections in first-line treatment. This regimen is particularly effective in cases of severe H. pylori colonization.

Background/Aims: The role of semi-quantitative strain ratio (SR) using real-time endoscopic ultrasound strain elastography (EUS-E) in chronic liver disease (CLD) and cirrhosis is yet to be determined. Herein, the aim was to assess the usefulness of EUS-E to detect CLD and cirrhosis. Materials and Methods: Patients with cirrhosis and non-cirrhotic CLD were enrolled prospectively. Patients without liver disease and undergoing EUS examinations for non-hepatic indications were taken as control group. Strain ratio was calculated from strains of hepatic vein and liver parenchyma. Fibrosis-4 (FIB-4) and aspartate aminotransferase (AST)-to-Platelet Ratio Index (APRI) scores were recorded, and blood cytokeratin-18 (CK-18) levels were measured to assess hepatic fibrosis. A clinical evaluation was also conducted. Results: One hundred participants (control: 49, CLD: 33, cirrhotic: 18) were included. The SR and liver parenchyma strains in cirrhotics were significantly higher than those in the CLD (P < .001) and control (P < .001) groups. Strain ratio threshold set at 5.67 had a sensitivity of 94.4% and a specificity of 95.9% to differentiate cirrhotics from control patients. An SR threshold of 10.65 had a sensitivity of 94.4% and a specificity of 84.8% in differentiating cirrhotics from CLD patients. The SR showed a strong positive correlation with FIB-4 and APRI scores, but not with CK-18 levels. Conclusions: Strain ratio thresholds of 5.67 and 10.65 obtained by EUS-E are useful to differentiate cirrhotics from non-cirrhotic CLD patients and liver-disease-free subjects, respectively. This pilot study is the first one evaluating the role of EUS-E in liver diseases, and future studies involving patients having CLD of specific etiologies are warranted.

Background/aims: Acute pancreatitis (AP) is a common and potentially severe condition, and early identification of its severity is critical for appropriate clinical management. This study aimed to investigate the role of the Neutrophil-Lymphocyte Ratio (NLR) and Lactate dehydrogenase (LDH)/Albumin Ratio (LAR) in predicting the severity and prognosis of patients with AP and to determine the optimal NLR value.

Materials and methods: The demographic, clinical, and laboratory data of patients diagnosed with AP were retrospectively analyzed. Neutrophil-Lymphocyte Ratio was measured at admission (0 hours), and at 24 and 48 hours; C-reactive protein (CRP) values were recorded at 0 and 48 hours; and the LAR was calculated based on LDH and albumin values measured at 48 hours post admission. These values were compared with disease severity, mortality, organ failure, length of hospital stay, and the need for intensive care according to Ranson and bedside index of severity in AP (BISAP) scores.

Results: According to the BISAP scoring, 38 patients (16%) were classified as having severe AP, while 200 patients (84%) had mild AP. The best parameter for predicting severe AP was found to be the 24-hour NLR with a sensitivity of 79% and specificity of 67%. The best parameter for predicting mortality and organ failure was the NLR at 48 hours. There was a statistically significant difference between the length of hospital stay and the need for intensive care with the CRP value at 48 hours. Additionally, there was a statistically significant relationship between LAR and mortality, length of hospital stay, organ failure, and the need for intensive care.

Conclusion: This study demonstrates that the NLR and the LDH/Albumin Ratio are important and easily accessible markers for determining the severity and prognosis of AP. The NLR at 48 hours is an effective parameter for predicting mortality and organ failure, while the LDH/Albumin Ratio is significant in predicting mortality.

Background/aims: Secreted frizzled-related proteins (SFRPs) are antagonists that bind Wnt and inhibit signaling through this pathway. Secreted frizzled-related proteins are silenced by promoter methylation and cause hyperactivation of the Wnt pathway. In this study, the aim was to evaluate the relationship between methylation and expression of genes involved in the Wnt signaling pathway and the risk of cancer development in inflammatory bowel disease.

Materials and methods: The patient group consisted of 20 individuals who were diagnosed with left-side ulcerative colitis and underwent surveillance colonoscopy; the control group consisted of 15 individuals without symptoms and endoscopic pathology who were screened for colorectal cancer. Tissue samples were obtained from inflamed and non-inflamed areas of the colon. Methylation and gene expression profiles of the Wnt pathway genes APC1A, APC2, SFRP1, SFRP2, SFRP4, and SFRP5 were analyzed from DNA and RNA obtained from these tissues.

Results: A significant correlation was found between the methylation status and expression of the SFRP4 gene in the proximal colon in the patient group compared to controls (P = .018). For the methylation of the APC2 gene, 8 patients were methylated (40%), and 12 were unmethylated (60%), while 1 of the controls was methylated (6.7%) and 14 were unmethylated (93.3%) (P = .018). There was no statistically significant association between methylation, expression, and inflammation status for other genes between patients and controls.

Conclusion: In ulcerative colitis, inflammation is thought to be associated with both increased APC2 methylation and decreased expression findings due to decreased SFRP4 methylation in non-inflamed areas. However, more research is needed to establish a link with ulcerative colitis-related neoplasia.