Objectives. Gastric intestinal metaplasia (IM) is frequently encountered and is considered a precursor of gastric adenocarcinoma. In the Van region of Turkey, gastric adenocarcinoma incidence is high but the prevalence of gastric IM is not known.Helicobacter pylori(H. pylori) infection is a main factor leading to atrophy, IM, and cancer development in the stomach. The aim of the current study was to investigate the prevalence of IM and its subtypes and the prevalence ofH. pyloriinfection, atrophy, dysplasia, and cancer in gastric IM subtypes.Materials and Methods. This retrospective study was conducted on 560 IM among the 4050 consecutive patients who were undergoing esophagogastroduodenoscopy (EGD) with biopsy between June 2010 and October 2014. Clinical records and endoscopic and histopathologic reports of patients with IM were analyzed.Results. The prevalence of gastric IM was 13.8%. The prevalence of incomplete IM was statistically significantly higher than complete IM. Type III IM was the most frequent subtype.Conclusions. Gastric IM is a common finding in patients undergoing EGD with biopsy in this region. High prevalence of incomplete type IM, especially type III, can be associated with the high prevalence of gastric cancer in our region.

The incidence of gastric polyps (GPs) greatly differs according to study populations and was found to be 0.33%-6.7% in various studies. The majority of GPs are composed of hyperplastic polyps (HPs), fundic gland polyps (FGPs), and adenomatous polyps (APs). Although APs have a high risk of malignant potential, sporadic FGPs have no malignant potential. Conversely, HPs have a low risk of malignant potential. It is not sufficient to perform a biopsy to identify the polyp type and the presence of dysplasia; thus, some polyps may require multiple biopsies or total excision. This retrospective study included patients with GPs or polypoid lesions found on esophagogastroscopy with polyp or malignant histology on biopsy at Ankara Numune Training and Research Hospital Endoscopy Unit between 2005 and 2011. In a series of 56.300 upper endoscopies, 192 patients (0.34%) were found to have GPs. Among the patients, 51 (26.6%) were men and 151 (73.4%) were women. The average age of the patients was 61.9±13.3 (14-90) years. The frequency of HPs, APs, and FGPs were 88%, 2.6%, and 1.6%, respectively. The size of the polyps was ≤1 cm in 137 (70%) patients. One polyp was determined in 141 (73.4%) patients. The most common localizations of polyps were the antrum and corpus. Endoscopic snare polypectomy was performed in 64 patients. One bleeding episode was observed, which required endoscopic treatment after ESP. In our study, the GP frequency was low (0.34%), whereas the frequency of HP maybe high due to the high frequency of Helicobacter pylori (HPy) infection in our country. The frequency of FGP is probably low due to the high frequency of HPy infection and the short-term use of proton-pump inhibitors.

Background: In patients with ulcerative colitis, endoscopic and clinical indices are used to assess the disease activity. In addition, stud- ies have been carried out for easier and cheaper markers in recent years. For this purpose, we evaluated the monocyte/high-density lipoprotein ratio of the disease activity. Methods: According to clinical activity and partial Mayo scores, a total of 114 patients, 53 in the active ulcerative colitis group and 61 in the ulcerative colitis remission group were included in the study. Monocyte/high-density lipoprotein ratio, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, C-reactive protein, and erythrocyte sedimentation rate measurements of these 2 groups were recorded. Ulcerative colitis remission group and active ulcerative colitis group were compared in terms of activity. Results: The monocyte/high-density lipoprotein ratio value in the active ulcerative colitis group was significantly higher than that of the ulcerative colitis remission group (10.68 ± 3.39, 6.68 ± 1.39, P < .001, respectively). The monocyte/high-density lipoprotein ratio value for active ulcerative colitis at a cut-off value of 7.4 had 83% sensitivity and 81% specificity. In the active ulcerative colitis group, neutrophil/lymphocyte ratio, C-reactive protein, and erythrocyte sedimentation rate values were significantly higher than the ulcerative colitis remission group (P < .001, P < .001, P < .001, respectively). Conclusion: Monocyte/high-density lipoprotein ratio is an inexpensive and effective marker that can be used to determine the activity of ulcerative colitis.

We report here a very rare case of coexistence of gastric diverticulum and gastric cancer. A 48-year-old female patient was admitted to our hospital with complaints of fatigue, abdominal pain, and weight loss. Her medical history did not reveal any disease. On physical examination, conjunctivas were pale and there was mild epigastric tenderness. Laboratory examinations on admission revealed the following: hemoglobin, 7.0 g/dl (normal range: 8.5–11.0 g/L); and mean corpuscular volume, 67.2 fl (normal range: 80–100 fl). Serum ferritin level was 9.9 ng/ml (normal range: 12–150 ng/ml). Erythrocyte sedimentation rate level was 44 mm/hour (normal range: 1–20 mm/hour). Endoscopy showed a diverticulum formation approximately 4 × 3 cm in size, which originated from the gastric fundus (Figure 1A) along with a disseminated ulcerative mass originating from the gastric antrum (Figure 1B). Endoscopic biopsy of the relevant mass was performed, and the histopathological examination revealed a final diagnosis of gastric adenocarcinoma. Abdominal computed tomography revealed the exophytic diverticulum sac of the posteromedial gastric wall at the fundus region and abnormal wall thickening of the gastric antrum within a 6-cm length segment associated with pathological lymphadenopathies at the gastrohepatic region (Figure 2). The patient was inoperable at the time of admission due to the presence of disseminated bone metastasis, and chemotherapy management was administrated consequently. Gastric diverticulum is very rare, and the rate of detection by endoscopy ranges from 0.01% to 0.11% (Marano et al., 2013). It usually occurs in the fifth and sixth decades, with equal distribution among men and women, and can be congenital or acquired. Gastric diverticulum is often single, varying in size from 1 to 3 cm. On the contrary, multiple and larger diverticula being adjacent to the gastroesophageal junction and along the lesser curvature or posterior gastric wall have also been observed. Patients with gastric diverticulum are often asymptomatic and rarely have the symptoms such as dyspepsia, vomiting, and abdominal pain (Marano et al., 2013). Similarly, complications such as ulceration, perforation, hemorrhage, and malignancy are uncommon (Ho et al., 2013; Marano et al., 2013). Moreover, there have been a few reports of neoplasia arising in gastric diverticulum (Oya, Akahoshi, & Toyomasu, 2012). Although gastric cancer incidence and mortality have been appreciably declining for several decades, gastric cancer is still the fourth most common cancer and the second leading cause of cancer deaths worldwide (Oya et al., 2012). The incidence and mortality ratios range widely among different geographic regions in our country, Turkey. However, the incidence is significantly higher in Van, the place where we reside (Ferro et al., 2014; Yalcin, 2009). The treatment of a diverticulum depends basically on the symptoms and diverticulum size. There is no specific therapeutic strategy for an asymptomatic diverticulum. If the diverticulum is large, symptomatic, or complicated by bleeding, perforation, or malignancy, the recommended treatment option is surgical resection. Laparoscopic diverticulectomy is the preferred approach as well (Ho et al., 2013; Marano et al., 2013). In summary, although gastric carcinoma did not originate from the diverticulum region, we report this case because the coexistence is an unusual finding.