Background: Ectopic opening of the common bile duct (CBD) is extremely rare, and its importance has not been adequately defined. The aim of our study is to present the characteristics of patients with this abnormality. Methods: This retrospective study was conducted in a tertiary center in Dicle University Hospital, Diyarbakır, Turkey, between October 2008 and December 2020. We present clinical, laboratory, endoscopic and cholangiographic features as well as the success rate of therapeutic interventions of consecutive patients with this abnormality undergoing endoscopic retrograde cholangiopancreatography (ERCP). Results: Ectopic opening of the CBD was identified in 29 (21 men; mean age 62) out of 3872 (0.74%) patients. There was a history of cholecystectomy in 14 (48%) and recurrent acute cholangitis in 20 (69%) patients. We found peptic ulcer in 13 (45%) and duodenal deformity associated with apical stenosis in 21 (72%) patients. Opening site was seen as abnormal in all patients, and it opened into the antrum in 2 (6.8%) and into the first part of the duodenum in 27 (93%) patients. Copious amount of bile and/ or bile sediment in the stomach were seen in all patients. We observed dilatation in both intrahepatic and extrahepatic bile ducts together with tapered narrowing and a hook-shaped distal end of CBD in all patients. There was bile stone in 26 (89%) and sludge in 3 (10%) patients. Sphincterotomy was not performed in any patients because there was not enough incision distance. Balloon dilatation was performed for extraction of stone and sludge in all patients. Complete stone extraction was achieved in only 7 out of 26 (27%) patients. Conclusion: Ectopic opening of CBD is usually associated with gastroduodenal and bile ducts disease. Endoscopic treatment is unsatisfactory in most patients with this abnormality.

Amaç: Akut pankreatit (AP) tanısıyla hastaneye yatırılan hastalarda yatıştan itibaren hastalığın şiddetini belirlemek tedavinin planlaması için büyük önem arz etmektedir. RDW (Eritrosit Dağılım Hacmi) ve MPV’nin (Ortalama Trombosit Hacmi) pankreatitin şiddetini öngörebilme özelliğinin olup olmadığını araştırmak amacıyla bu çalışmayı yaptık. Materyal ve metod: 2019-2022 yılları arasında AP nedeniyle hastaneye yatırılan 262 hastanın verileri retrospektif olarak incelendi. Hastalar Atlanta kriterleri referans alınarak pankreatitin şiddetine göre gruplara ayrıldı. Daha sonra RDW ve MPV değerlerinin pankreatitin şiddeti ve prognozuyla ilişkisi istatistiksel olarak incelendi. Bulgular: AP’li hastaların %83.9’u (n=220) hafif; %16.1’i (n=42) şiddetli pankreatit idi. Ortalama RDW indeksi hafif AP’li hastalarda 42.5±6.9 fL iken, şiddetli AP hastalarında 42.0±6.6 fL idi (p=0.625). Ortalama MPV seviyesi açısından da her iki grup arasında anlamlı bir farklılık saptanmadı (9.7±1.0 fL vs 9.8±1.3 Fl, p=0.687). Yapılan ROC analizi pankreatitin şiddetini saptayacak anlamlı ve kritik bir MPV ve RDW eşik değerinin olmadığını gösterdi (AUC (MPV): 0.499; AUC (RDW):0.453). Sonuç: AP nedeniyle hastaneye yatırılan ve takipleri sırasında Atlanta kriterlerine göre şiddetli pankreatit gelişen hastaların RDW ve MPV seviyesinin hafif pankreatitli hastalardan farklı olmadığını belirledik. AP’li hastalarda MPV ve RDW seviyesinin pankreatitin şiddetini ve prognozunu öngörmede yeterli ve güçlü bir parametre olmadığını söyleyebiliriz.

Background: Early risk assessment in non-variceal upper gastrointestinal bleeding (NVUGIB) is essential for guiding clinical management. The neutrophil percentage-to-albumin ratio (NPAR) has recently been proposed as a marker reflecting both inflammatory response and physiological reserve. This study aimed to evaluate the prognostic value of NPAR for in-hospital mortality and its relationship with established risk scores in patients with NVUGIB. Methods: This retrospective observational study included 94 patients hospitalized with NVUGIB. NPAR was calculated using laboratory parameters obtained at admission. Patients were stratified according to AIMS65 (<2 vs. ≥2) and Rockall (<5 vs. ≥5) scores. In addition, inflammation-based indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were calculated. Predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis, and associations with clinical outcomes were assessed. Results: The in-hospital mortality rate was 12.8%. NPAR values were significantly higher in patients with AIMS65 ≥ 2 and Rockall ≥ 5 (p < 0.001 for both). NPAR demonstrated good discriminative ability for AIMS65 ≥ 2 (AUC: 0.843) and moderate performance for Rockall ≥ 5 (AUC: 0.714). For mortality prediction, NPAR showed excellent performance (AUC: 0.900). A cut-off value of 27.4 yielded a sensitivity of 91.7% and a specificity of 75.6%. Higher NPAR values were associated with increased mortality risk (OR 31.9, 95% CI: 3.88–102.59, p < 0.001), while the negative predictive value was high (98.4%). In contrast, NLR, PLR, and SII showed limited predictive value for in-hospital mortality. Conclusions: NPAR shows promise as a potential prognostic biomarker for assessing disease severity and in-hospital mortality in NVUGIB. Its high negative predictive value and association with established risk scores suggest that it may complement current risk stratification approaches. However, these findings should be considered preliminary, given the retrospective design and limited sample size, and require validation in larger prospective studies.

Duodenogastric reflux (DGR), defined as the retrograde flow of duodenal contents into the stomach, has an incompletely understood pathophysiology. This study aimed to evaluate the relationship between DGR and clinical, endoscopic, histopathological, and laboratory parameters in dyspeptic patients, and to assess its association with Helicobacter pylori (H. pylori) infection, intestinal metaplasia, and potential risk factors. This retrospective case-control study included 524 patients who underwent upper gastrointestinal endoscopy between January 2017 and December 2022. A total of 287 patients with endoscopic signs of DGR such as bile pooling, mucosal edema, or hyperemia were classified as the DGR group, while 237 patients without these findings served as controls. Clinical, biochemical, endoscopic, and histopathological data were compared, and risk factors were analyzed using multivariate logistic regression. Chemical gastropathy was significantly more frequent in the DGR group (p < 0.001). There were no significant differences regarding intestinal metaplasia or H. pylori positivity (p > 0.05). The DGR group showed higher total bilirubin and lower albumin levels (p < 0.05). Cholecystectomy and cholelithiasis were identified as independent strong risk factors (p < 0.001), while age contributed modestly; gender and H. pylori infection showed no significant association. DGR is a multifactorial condition associated with gastric mucosal injury and systemic biomarker changes. A history of cholecystectomy or gallstones markedly increases DGR risk. Its independent role in intestinal metaplasia remains uncertain, warranting further prospective research.

Celiac disease,remission status,villous atrophy

Summary Immune checkpoint inhibitors are cell membrane proteins that regulate the immune response. It is used in the treatment of non-small cell lung cancer, renal cell carcinoma, melanoma and some other tumor types. They affect the dermatological, gastrointestinal, hepatic, endocrine and other systems. We present a case of adrenal insufficiency caused by nivolumab in a patient presenting with complaints of weakness, fatigue, nausea and vomiting.