Zeynel Abidin Öztürk

Inlet patch: Associations with endoscopic findings in the upper gastrointestinal system

Objective. Ectopic gastric tissue in the esophagus (inlet patch) mostly presents in the upper part of the esophagus and is usually under-diagnosed because of its localization. Little is known about its pathogenesis and significance. The aim of this study was to investigate whether there is an association between ectopic gastric tissue development and endoscopic features of the upper gastrointestinal tract, especially in the esophagus. Material and methods. A total of 9437 endoscopic examinations were analyzed prospectively. Endoscopic features and histological examinations of inlet patch and stomach specimens were documented. Endoscopic findings in patients with inlet patch were compared with those in patients without inlet patch. Results. Inlet patch was present in 171 (1.8%) of all patients. Forty-three (25.1%) patients with inlet patch and 519 (5.6%) patients without inlet patch had esophagitis (p=0.000). Histologically proven Barretts esophagus was more frequent among patients with inlet patch than among patients without inlet patch (3.5% versus 0.5%, p=0.000). Prevalences of hiatal hernia in the two groups were similar. Open cardia was diagnosed more frequently in the inlet patch group than in the other group (24.5% versus 10.0%, p=0.000). Helicobacter pylori colonization was detected in only 11% of inlet patch specimens, whereas 58% of stomach specimens from the same patients contained H. pylori colonies. Conclusions. Patients with inlet patch seem to have predisposing factors for gastroesophageal reflux, and Barretts esophagus is found more frequently in those patients. H. pylori colonization is involved in ectopic gastric tissue less frequently than in gastric tissue.

Serum adenosine deaminase levels in pancreatic diseases.

Background: Adenosine deaminase (ADA) is found in most tissues including the pancreas. Its role in inflammation and malignancy has been studied experimentally. To date, serum ADA levels in pancreatic diseases have not been studied before. Aim: To assess the levels of ADA in patients with pancreatitis and cancer of the pancreas. Methodology: Serum levels of ADA were investigated in 14 cases with acute pancreatitis (mean age 46 years; male/female 5/9), 38 with chronic pancreatitis (mean age 46 years; male/female 25/13), 21 with cancer of the pancreas (mean age 67 years; male/female 11/10), and 21 healthy controls (mean age 40 years; male/female 11/10). The ADA levels were also compared among patients with pancreatic cancer with regard to tumor size and localization and the presence of metastases. Correlation analysis between ADA and CA 19.9 was also performed. Results: Serum ADA levels were 12.66 (9.54–20.72), 12.51 (8.88–26.64), 15.36 (10.20–21.05) and 9.39 (6.58–11.84) U/l in patients with acute pancreatitis, chronic pancreatitis, pancreatic cancer, and healthy controls, respectively. Serum ADA levels were significantly higher in acute and chronic pancreatitis, and pancreatic cancer patients compared to the control group (p < 0.05). Pancreatic cancer patients had significantly higher serum ADA levels when compared with acute and chronic pancreatitis cases (p < 0.05). The serum ADA levels were comparable according to tumor size and location and the presence of metastases. There was a linear correlation between serum ADA and CA 19-9 levels (p = 0.027, r = 0.552). Conclusions: Our data suggest that the ADA enzyme may play a role in inflammatory diseases of the pancreas. Serum ADA levels increase in pancreatic disorders especially in pancreatic cancer. It may be a serum marker for the diagnosis of pancreatic cancer.

Inclusion of a spasmolytic in bowel cleansing: a prospective randomized study.

The quality of colon cleansing and the tolerance of patients to the procedure are two major determinants of the quality of a colonoscopy. Many bowel-cleansing regimens are known, but there is no ideal regimen. Alverine citrate (Relaxyl, Spasmonal) is a spasmolytic agent that has been shown to affect responses of mechanoreceptors of the intestine to both mechanical and chemical stimuli. Patients who underwent colonoscopies at four centers were randomly assigned two different bowel-cleansing procedures. The bowel-cleansing methods were oral sodium phosphate (NaP) (Group I) and oral NaP plus alverine citrate (Group II). Patients were randomized into one of these regimens. The quality of colon cleansing was assessed by an endoscopist with an empirical, clinically meaningful 3-point scale. Both groups were similar with respect to age, gender, and pre- and postcolonoscopic diagnosis. In Group I, 76 patients (47 women and 29 men; aged 39.53 ± 7.87 years) and in Group II, 71 patients (41 women and 30 men; aged 39.78 ± 8.27 years) were included in the study. In Groups I and II, 37 (48.7%) and 41 (57.7%) patients had perfect bowel cleansing, respectively. The overall colon cleansing in the group with NaP plus alverine citrate was comparable with that in the NaP group. The tolerability of patients to the colonoscopy in the two groups was also similar. Based on the present data, adding oral alverine citrate to NaP does not increase either the quality of bowel cleansing or the tolerance of patients to the procedure.

Cancer antigen 125 levels in inflammatory bowel diseases

Background: Cancer antigen 125 (CA‐125) is a tumor marker used for the diagnosis and monitoring of ovarian carcinoma. It can also be elevated in endometriosis, inflammations, and in nongynecological malignancies. Up to date, serum CA‐125 levels in inflammatory bowel diseases (IBD) have not been studied before. Aim: To assess the levels of CA‐125 in patients with ulcerative colitis (UC) and Crohns disease (CD). Methods: Serum levels of CA‐125 were investigated in 68 cases with UC (male/female: 47/21), 32 CD (male/female: 21/11), and 31 healthy controls (male/female: 16/15). Levels of CA‐125 were also compared among UC patients according to lesion location, severity, and activity of CD. Results: Serum CA‐125 levels were 17.29±24.50 U/ml, 15.56±20.74 U/ml, and 8.85±2.62 U/ml in patients with UC, CD, and healthy controls, respectively. Serum CA‐125 levels were significantly higher in UC compared to control group (P=0.001). Serum CA‐125 levels were higher in CD patients compared to control group but there was no significance (P=0.087). Serum CA‐125 levels were higher in pancolitis compared to distal type and left‐sided UC. Conclusions: Our data suggest that serum CA‐125 levels may be increased in patients with IBDs. J. Clin. Lab. Anal. 23:244–248, 2009.

Should We Perform Polypectomy for All Colorectal Polyps, or Follow-Up?

Background: There is controversy as to whether all colorectal polyps detected on colonoscopy should be removed. This study evaluated the histopathological characteristics of colorectal polyps in Turkish patients, and further determined their relationship to age, gender, size, and location. We aimed to determine the risk of neoplasms in patients with small polyps (≤5 mm), and emphasize the importance of polyp removal. Materials and Methods: Of 4,145 colonoscopies reviewed between July 2004 and June 2006, 791 polypectomies and 211 polyp biopsies were performed in 576 patients. Results: Of the 1,002 polyps histologically analyzed, 586 (58.5%) were non-neoplastic, and 396 (39.5%) were neoplastic. For the remaining 20 (2%), data are missing. Among the neoplastic polyps, 311 (78.5%) were tubular, 41 (10.4%) were tubulovillous, 31 (7.8%) were villous, and 13 (3.3%) showed a malignant transformation. 63% of the non-neoplastic polyps were hyperplastic, and the remaining 37% were inflammatory polyps. Both neoplastic and non-neoplastic polyps were located predominantly in the left colon (rectum, sigmoid, descending colon). Though only 31.7% of the polyps measuring <5 mm were neoplastic, 82.4% of the polyps >20 mm in size were neoplastic. There was no significant gender difference in distribution of either neoplastic or non-neoplastic polyps. The peak prevalence of both neoplastic and non-neoplastic polyps occurred in the 50–70-year age group. Conclusion: About half of the colorectal polyps are neoplastic in patients more than 50 years old. Even small polyps seen during colonoscopy should be removed and subjected to histological analysis. Western guidelines regarding colorectal polyps may also be applicable for the Turkish population.