Pediatric guidelines on the diagnosis of celiac disease (CD) have reported that the positivity of anti-endomysium antibodies in the presence of anti-transglutaminase antibodies (TGA) 10 times higher than normal is sufficient for the diagnosis. In this study, we aimed to evaluate whether this diagnostic process for children can also be applied to adult patients. We retrospectively examined patients aged >18 years who were diagnosed with CD. The results of serological tests and endoscopic biopsy were evaluated. Patients with more than one month of duration between celiac serology and endoscopy, those diagnosed with CD before admission, those on a gluten-free diet, and those with selective IgA deficiency were excluded from the study. A total of 269 patients were included in the study. TGA value was significantly higher in patients with villous atrophy (p<0.001) and positively correlated with mucosal damage (r=0.60, p10 ULN) for the TGA antibodies, in line with the criteria regulated by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) for the diagnosis of CD, the sensitivity was 71.64%, the specificity was 100%, and the positive predictive value (PPV) was 100%. When the cut-off value was taken as 29.42 U/mL, the sensitivity was 100% and the specificity was 99.5%. For a TGA cut-off value of 52.7 U/mL (5.27 ULN), which determines the presence of partial or complete villous atrophy in the evaluation made considering mucosal damage, the sensitivity was 90%, the specificity was 100%, and the PPV was 100%. Based on our findings, TGA titers were highly effective in demonstrating CD-related mucosal damage. This study endorses a biopsy-free strategy in adult patients in line with the ESPGHAN criteria. Local validation of test-specific thresholds will ensure that this approach has a significant impact on adult patients.

Introduction: The objective of our study was to examine the correlation between hepatosteatosis and the triglyceride glucose index (TyG), plasma atherogenic index (PAI), and cardiometabolic index (CMI) in nondiabetic patients. We also aimed to assess the usefulness of these indices in evaluating cardiometabolic risk in metabolic dysfunction-associated steatotic liver disease (MAFLD).Material and methods: This retrospective cross-sectional study included 695 individuals who did not have diabetes, with an average age of 39.8±11.3 years. A total of 595 individuals, comprising 359 women and 236 men, were diagnosed with MAFLD. The control group consisted of 100 individuals who did not have MAFLD. All the subjects underwent transabdominal ultrasonography, anthropometric measurements, and blood analyses. The groups were assessed based on the TyG index, PAI, and CMI.Results: TyG, PAI, and CMI were greater in patients with MAFLD than those without MAFLD. The TyG index, with a cutoff point of 8.47, excluded significant simple steatosis with a sensitivity of 65.3% and a specificity of 66.0%. The PAI and CMI cutoff values were 0.39 and 1.40, with sensitivities of 66.6% and 70.1% and specificities of 67.0% and 70.1%, respectively. The TyG index was independently associated with MAFLD (OR=2.21, 95% CI: 1.339-3.665).Conclusions: The presence of MAFLD patients with a normal BMI and waist circumference indicates that these variables alone do not provide enough evidence for the diagnosis of MAFLD. Hence, it is advisable to incorporate the TyG index, the PAI, and the CMI into regular clinical practice to obtain a more precise and thorough evaluation of MAFLD and cardiometabolic risk.

OBJECTIVE: At present, there is no reliable indicator for dietary compliance and disease severity in patients with celiac disease (CD). The aim of this study is to evaluate mean platelet volume (MPV) level as a biomarker for detection of disease activation, dietary adherence, and assessment of disease severity. METHODS: Eighty-one patients with CD and 50 healthy subjects were enrolled in this study. The diagnosis of CD was estab-lished by both positive antibodies against endomysium or gliadin and histopathological criteria (lymphocytic infiltration and total villous atrophy in duodenal biopsies). RESULTS: MPV was observed to be significantly higher among CD patients when compared to healthy controls (8.14 +/- 0.26 fL vs. 7.82 +/- 0.29 fL and p=0.001). Overall dietary adherence rate was 72.8% (58/81 CD patients). After induction of a gluten-free diet, the MPV was significantly lower in the dietary adherent group than non-adherent patients (7.86 +/- 0.17 fL vs. 8.07 +/- 0.30 fL and p=0.001). The increase of MPV was correlated with Marsh classification (Marsh 3 active CD vs. Marsh 2 active CD vs. Marsh 1 active CD; 8.32 +/- 0.27 fL vs. 8.12 +/- 0.19 fL vs. 7.98 +/- 0.19 fL; p=0.004 and p=0.009). CONCLUSION: Based on these data, we believe that increased MPV can provide additional benefit to screening in patients with CD. It can indicate the activation of the disease and adherence to the diet.

Background/aims: In this study, we aimed to determine the value of mean platelet (PLT) volume (MPV), PLT and PLT distribution width (PDW) levels as a marker in the prediction of mucosal healing (MH), steroid resistance (SR) and steroid dependence (SD) in newly diagnosed moderate and severely active patients with ulcerative colitis (UC), who did not receive medical treatment before. Patients/methods: Two hundred forty-nine patients with severely or moderately active UC and 50 healthy subjects were enrolled in the study after retrospective analysis. Disease severity and MH of UC were determined according to the Mayo Score. According to the results of remission induction therapy, the patients were divided into two groups: Group 1; MH positive and Group 2; MH negative. UC patients with clinical remission (CR) but without MH were divided into two subgroups SD and non-SD during their follow-up. These two groups and subgroups were compared for variables. Results: 42.6% of patients with UC had severe disease activation. 44.6% of patients with UC had pancolitis. After remission induction therapy, CR was observed in 84.3% of patients with UC. MH rate was 53.0%. SR rate was 15.7% and the SD rate was 16.1%. A strong positive correlation was observed between C reactive protein (CRP), PLT and Mayo score in the activation period (r=0.835 and p<0.001; r=0.883 and p<0.001; respectively). A strong negative correlation was observed between mean PLT volume (MPV), PDW levels and Mayo score (r=-0.905 and p<0.001; r=-0.805 and p<0.001; respectively). According to the receiver operating characteristic curve (ROC) analysis, PLT had a sensitivity of 42.4% and a specificity of 22.7% in the prediction of MH at a cut-off value of 266.5x10³/µL. MPV had a sensitivity of 83.5% and a specificity of 73.5% in the prediction of MH at a cut-off value of 8.05 fL. PDW had a sensitivity of 88.6% and a specificity of 84.5% in the prediction of MH at a cut-off value of 2.95 fL. PLT was determined with 92.5% sensitivity and 86.8% specificity in the prediction of SD at a cut-off value of 287.0x10³/µL. MPV had a sensitivity of 86.8% and a specificity of 67.5% in the prediction of SD at a cut-off value of 7.95 fL. PDW had a sensitivity of 73.7% and a specificity of 72.5% in the prediction of SD at a cut-off value of 12.55 fL. Conclusions: There was a positive correlation between PLT levels and Mayo score, and a negative correlation between Mayo score and MPV or PDW levels. We think that PLT, MPV and PDW levels may be promising markers in the evaluation of disease activation/remission and severity. We believe that PLT, MPV and PDW levels will be determinative especially in the exclusion of SD, for UC patients with CR but without MH.

Fasciola hepatica is a trematode that is visible to the naked eye. The diagnosis can be made by serology or by clinical improvement and decrease of eosinophilia after triclabendazole treatment or by finding parasite eggs in the stool. Sometimes the diagnosis is possible during unnecessary surgery, laparoscopic cholecystectomy, and endoscopic retrograde cholangiopancreatography (ERCP). F. hepatica infection should be considered in patients with typical clinical findings; the elevation of liver enzymes indicating cholestasis, eosinophilia, and characteristic computed tomography (CT) or ultrasonography (USG) findings. Here, we presented a case with the preliminary diagnosis of choledocholithiasis and diagnosed with F. hepatica infection by ERCP procedure. Keywords: Fasciola hepatica, obstructive jaundice, eosinophilia

Objectives: The aim of the study was to evaluate the oxidative stress level in patients, diagnosed with Helicobacter pylori infection, using a novel marker (thiol/disulphide homeostasis) and to compare the level in infected individuals with that in healthy volunteers.Methods: A total of 60 patients diagnosed with gastritis, erosive gastritis or ulcer by endoscopy were included and biopsied. The 30 patients diagnosed with H. pylori and 30 healthy individuals were enrolled. Medical histories, physical examination results, body mass index (BMI), hemogram, free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), urea, creatinin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, total cholesterol, triglycerides, high density lipoprotein (HDL), low density lipoprotein) LDL and thiol/disulphide levels obtained in the study groups were compared.Results: There was no significant difference between the total thiol, native thiol, disulphide/native thiol and dissulphide/total thiol ratios of the patient and control group. When the H. pylori patients were stratified by endoscopic evaluation as having mild (superficial gastritis or normal appearance) or severe (ulcer or erosive areas) symptoms, there were significant differences in disulphide, disulphide/native thiol, disulphide/total thiol and native thiol/total thiol levels. We also observed BMI and the total, native thiol levels of H. pylori patients were inversely related.( r: 0.562, p = 0.001; r: 0.0552, p = 0.002). Conclusions: Thiol/disulphide homeostasis is likely to differ with both duration and severity of H. pylori infection. Further investigations are needed to investigate the effect of H. pylori on oxidative stress.