Background: The initial treatment for fecal incontinence (FI) includes supportive treatment and medical treatment. If the initial treatment fails, biofeedback therapy (BFT) is recommended. However, there are limited and conflicting results in the literature supporting the beneficial effect of BFT for FI. The aim of the study is to analyze the efficacy of BFT in 126 patients who have FI due to several causes. Methods: The data of 126 patients (88 females (69.8%) and 38 males (30.2%)) were collected retrospectively. Colonoscopy, anorectal manometry (ARM), and 3D-Endoanal ultrasonography (EAUS) were performed for all patients before applying BFT. In addition, all patients received toilet training instruction and training in Kegel and other pelvic floor strengthening exercises from an experienced nurse, before BFT. Results: The median age of participants was 54 years (range 18-75 years). While 80 patients (63.5%) had clinical and manometric benefit from BFT, 46 patients (36.5%) did not respond to BFT. According to the EAUS and ARM findings, BFT was beneficial in patients who had partial external sphincter failure, and was unsuccessful in patients who had both internal and external sphincter failure, both internal and external sphincter tears, and external sphincter tear rates of more than 25%. After BFT, significant increases in squeeze pressures were observed, with this increase being higher in the positive-response group. Conclusion: The results suggest that BFT is effective in the treatment of FI for specific patient populations.

Background/Objectives: Chat Generative Pretrained Transformer (ChatGPT) is a useful resource for individuals working in the healthcare field. This paper will include descriptions of several ways in which ChatGPT-4 can achieve greater accuracy in its diagnosis and treatment plans for ulcerative colitis (UC) and Crohn’s disease (CD) by following the guidelines set out by the European Crohn’s and Colitis Organization (ECCO). Methods: The survey, which comprised 102 questions, was developed to assess the precision and consistency of respondents’ responses regarding the UC and CD. The questionnaire incorporated true/false and multiple-choice questions, with the objective of simulating real-life scenarios and adhering to the ECCO guidelines. We employed Likert scales to assess the responses. The inquiries were put to ChatGPT-4 on the initial day, the 15th day, and the 180th day. Results: The 51 true or false items demonstrated stability over a six-month period, with an initial accuracy of 92.8% at baseline, 92.8% on the 15th day, and peaked to 98.0% on the 180th day. This finding suggests a negligible effect size. The accuracy of the multiple-choice questions was initially 90.2% on Day 1, reached its highest point at 92.2% on Day 15, and then decreased to 84.3% on Day 180. However, the reliability of the data was found to be suboptimal, and the impact was deemed negligible. A modest, transient increase in performance was observed at 15 days, which subsequently diminished by 180 days, resulting in negligible effect sizes. Conclusions: ChatGPT-4 demonstrates potential as a clinical decision support system for UC and CD, but its assessment is marked by temporal variability and the inconsistent execution of various tasks. Essential initiatives that should be carried out before involving artificial intelligence (AI) technology in IBD trials are routine revalidation, multi-rater comparisons, prompt standardization, and the cultivation of a comprehensive understanding of the model’s limitations.

Background: The aim of the study was to share the effectiveness of pneumatic dilation in geriatric achalasia patients. Methods: Achalasia patients over the age of 65 and those under the age of 65 as the control group who received pneumatic dilation as the first-line treatment were evaluated in the study. Results: The average age of geriatric patients was 72.5 ± 55.92 years (65-90), with 50.3% of them being male. Follow-up was conducted for a mean of 64.52 ± 38.73 months. While pneumatic dilation was successful in 98.6% (141/143) of geriatric patients, it was also successful in 94% (141/150) of non-geriatric patients. Remission after single balloon dilatation was observed in 81.8% of geriatric patients, while it was observed in only 52.7% of non-geriatric patients (P = .000). When comparing remission after single dilatation and multiple dilatations, it was observed that geriatric patients who achieved remission after multiple balloon dilatation had higher lower esophageal sphincter pressure and Eckardt scores at the diagnosis and higher lower esophageal sphincter pressure and esophageal body resting pressures after the first balloon dilatation. Conclusions: The proportion of elders in the world population is increasing daily and this disease has been known to disproportionately afflict this group. Although surgical treatments, in particular per-oral endoscopic myotomy, have recently gained popularity as therapies for achalasia, pneumatic dilation remains the most commonly used in geriatric patients. Cite this article as: Tenlik İ, Öztürk Ö, Özin Y, et al. Pneumatic dilation in geriatric achalasia patients. Turk J Gastroenterol. 2023;34(4):332-338.

Non-gastric upper gastrointestinal system polyps are detected rarely and mostly incidentally during upper gastrointestinal endoscopy. While the majority of lesions are asymptomatic and benign, some lesions have the potential to become malignant, and may be associated with other malignancies. Between May 2010 and June 2022, a total of 127,493 patients who underwent upper gastrointestinal endoscopy were retrospectively screened. Among these patients, those who had polyps in the esophagus and duodenum and biopsied were included in the study. A total of 248 patients with non-gastric polyps were included in this study. The esophageal polyp detection rate was 80.00/100,000, while the duodenal polyp detection rate was 114.52/100,000. In 102 patients (41.1%) with esophageal polyps, the mean age was 50.6 ± 15.1, and 44.1% (n = 45) were male. The most common type of polyps was squamous papilloma (n = 61, 59.8%), followed by inflammatory papilloma (n = 18, 17.6%). In 146 patients (58.9%) with duodenal polyps, the mean age of patients was 58.3 ± 16.5, and 69.8% (n = 102) were male. Brunner's gland hyperplasia, inflammatory polyp, ectopic gastric mucosa, and adenomatous polyp were reported to be the most prevalent types of polyps in the duodenum overall (28.1%, 27.4%, 14.4%, and 13.7%, respectively). It is crucial to identify rare non-gastric polyps and create an effective follow-up and treatment plan in the era of frequently performed upper gastrointestinal endoscopies. The epidemiological assessment of non-gastric polyps, as well as a follow-up and treatment strategy, are presented in this study.

Aim: Celiac Disease (CD) which is an autoimmune disease affecting 1% of the population is associated with other autoimmune diseases and has extraintestinal manifestations. In the present study, we investigated the demographic and laboratory data of 94 patients and diseases related to anemia, osteoporosis and other autoimmune diseases. Material and Method: This study was conducted retrospectively by examining the records of 94 patients who were followed up with the diagnosis of CD between January 2014 and December 2019. Results: Of the patients, 74 were female (79%), 20 were male (21%). The mean age of the patients was 35 (18-73). The average disease duration was 6.6 years (0-29). Anti-endomysium Ig A positivity in 81 patients (86%), tissue transglutaminase Ig A positivity in 87 patients (93%), and tissue transglutaminase IgG positivity in 45 patients (48%) were detected. 14 patients had hypothyroidism (15%) and 8 patients had diabetes mellitus (9%). Osteoporosis or osteopenia was detected in 61 patients as the result of bone mineral densitometry (65%). According to the ferritin results, half of the patients and according to the transferrin saturation result, 47% had iron deficiency. 13 patients had B12 deficiency (14%) and 24 patients had folic acid deficiency (26%). Vitamin D deficiency was found in 74% of the patients. TSH value was found over 4.5 mIU/L in 10 patients. Conclusion: CD is associated with iron, folate, vitamin B12, and vitamin D deficiency and is associated with anemia and osteoporosis, and the disease is often accompanied by autoimmune thyroid diseases and diabetes.

Background and Aims: In this study, we evaluated the role of neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio and C-reactive protein/albumin ratio in determining ulcerative colitis endoscopic activity. Materials and Methods: Patients over the age of 18 who were followed up with the diagnosis of ulcerative colitis were retrospectively screened. In order to eliminate the difference in terms of age, gender, and comorbid diseases, the datas of the patients in the endoscopic remission periods compared with their own datas in the activation periods. Results: Eighty-seven patients who met the study criteria were included in the study, of which 69% were male and 31% were female. The most common localization was left-side (48.3%) and the median endoscopic activity index was 8 (6 - 12) in the active period. During the endoscopically active disease period, leukocyte, neutrophil, monocytes, thrombocyte, sedimentation, and C-reactive protein levels were significantly higher, while hemoglobin and albumin levels were significantly lower (p < 0.05). Median platelet/lymphocyte ratio [152.4 (70.1 - 422.7) and 137.5 (36 - 1212), p = 0.009)], monocyte/lymphocyte ratio [(0.06 (0.01 - 1.54) and 0.04 (0.01 - 0.9), p = 0.03], neutrophil/lymphocyte ratio [2.47 (0.73 - 9.92) and 2.08 (0.55 - 6.54), p = 0.007] and C-reactive protein/albumin ratio [2.3 (0.1 - 80) and 0.51 (0.04 - 8.48), p < 0.001] values were higher in the endoscopically active period compared to the inactive period. In the ROC analysis, only neutrophil/lymphocyte ratio and C-reactive protein/albumin ratio were sensitive and specific enough to predict endoscopic active disease. When the cutoff value of neutrophil/lymphocyte ratio was taken as 2.35, sensitivity for active disease was 59.8%, specificity was 66.7%, and area under the curve was 0.619 (p = 0.007). And, when the cutoff value of C-reactive protein/albumin ratio was taken as 0.87, the sensitivity for active disease was 74.7%, the specificity was 72.4%, and the area under the curve was 0.806 (p < 0.001). Conclusions: Although neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio, and C-reactive protein/albumin ratio values increase significantly in active disease in ulcerative colitis, only neutrophil/lymphocyte ratio and C-reactive protein/albumin ratio are useful in the estimation of endoscopic active disease and have sufficient sensitivity and specificity. Giriş ve Amaç: Bu çalışmamızda, ülseratif kolit hastalık aktivitesinin belirlenmesinde nötrofil/lenfosit oranı, platelet/lenfosit oranı, monosit/lenfosit oranı ve C-reaktif protein/albümin oranının rolünü değerlendirdik. Gereç ve Yöntem: Ülseratif kolit tanısı ile takip ettiğimiz 18 yaş üstü hastalar retrospektif olarak tarandı. Yaş, cinsiyet, komorbid hastalıklar açısından farklılığı ortadan kaldırmak için aynı hastaların endoskopik remisyon ve aktivasyon dönemlerindeki laboratuvar ve tedavi verileri karşılaştırıldı. Bulgular: Çalışma kriterlerine uygun olan 87 hasta çalışmaya alındı. Hastaların %69’u erkek, %31’i kadındı. En sık sol tip (%48.3) tutulum saptandı ve aktif dönemde median endoskopik aktivite indeksi 8’di (6-12). Endoskopik olarak aktif hastalık döneminde istatistiksel açıdan lökosit, nötrofil, monosit, trombosit, sedimentasyon, C-reaktif protein düzeyi anlamlı olarak yüksekken, hemoglobin ve albümin düzeyleri anlamlı olarak düşüktü (p < 0.05). Median platelet/lenfosit oranı [152.4 (70.1 - 422.7) ve 137.5 (36 - 1212), p = 0.009)], monosit/lenfosit oranı [(0.06 (0.01 - 1.54) ve 0.04 (0.01 – 0.9), p = 0.03], nötrofil/lenfosit oranı [2.47 (0.73 - 9.92) ve 2.08 (0.55 - 6.54), p = 0.007] ve C-reaktif protein/albümin oranının [2.3 (0.1-80) ve 0.51 (0.04 - 8.48), p < 0.001] değerleri aktif hastalık döneminde hastalığın inaktif olduğu döneme göre anlamlı olarak daha yüksek saptandı. Yapılan ROC analizde nötrofil/lenfosit oranı ve C-reaktif protein/albümin oranının endoskopik aktif hastalığı tahmin etmede yararlı olduğu, platelet/lenfosit oranı ve monosit/lenfosit oranının ise aktif hastalığı göstermede faydalı olmadığı tespit edildi. Nötrofil/lenfosit oranı için eşik değer 2.35 alındığında aktif hastalık için sensitivite %59.8, spesifite %66.7, eğri altında kalan alan 0.619 saptandı (p = 0.007). C-reaktif protein/albümin oranı için eşik değer 0.87 alındığında aktif hastalık için sensitivite %74.7, spesifite %72.4, eğri altında kalan alan 0.806 saptandı (p < 0.001). Sonuç: Ülseratif kolit hastalarında nötrofil/lenfosit oranı, platelet/lenfosit oranı, monosit/lenfosit oranı, C-reaktif protein/albümin oranı değerleri aktif hastalıkta anlamlı olarak yükselmekle birlikte, endoskopik aktif hastalığın tahmininde sadece nötrofil/lenfosit oranı ve C-reaktif protein/albümin oranı yeterli sensitivite ve spesifiteye sahiptir.