Aim: We have previously shown that CRP < 2.9 mg/L is a better predictor of endoscopic remission (ER) than CRP < 5 mg/L in ulcerative colitis (UC). Here, we prospectively evaluate CRP and FCP cut-offs and compare them in predicting ER and histological remission (HR) in UC. Method: One hundred thirty-five steroid-free UC patients were evaluated prospectively. ER was defined as Mayo endoscopic sub-score 0–1. In colonoscopy, the colon was evaluated as seven segments: rectum, sigmoid, descending, proximal-transverse, distal-transverse, ascending colon, and cecum. Two biopsies of each segment were evaluated for histological inflammation and graded using the Nancy and Geboes scores. All segment biopsies with Nancy < 1 and Geboes < 2 were defined as HR. Results: The optimum cut-off values for FCP and CRP were 120 μg/g and 2.75 mg/L for ER, respectively. AUC values of FCP and CRP were similar for ER and Mayo-0 disease in ROC analysis. CRP and FCP also had similar performances with these cut-offs regarding ER. While CRP was a predictor to assess the extensiveness of active UC, FCP was not. ROC analysis showed no difference between CRP and FCP regarding HR. Cut-off values for HR were 2.1 mg/L and 55 μg/g for CRP and FCP, respectively. CRP and FCP, in combination with the mentioned cut-off values, detected ER and HR in nearly 2/3 and ½ of the patients, respectively, with high specificity. Conclusions: Reappraised CRP (ER: 2.75 mg/L, HR: 2.1 mg/L) has as much diagnostic contribution as relevant FCP in predicting ER and HR and contributes more to revealing the proximal extension in active colitis compared to FCP. Relevant CRP and FCP combinations may improve the prediction rates.

Background: Coronavirus disease 2019 pandemic was expected to have traumatic effects and increase the anxiety levels of inflamma- tory bowel disease patients. Methods: We aimed to investigate the psychosocial effects of the coronavirus disease 2019 pandemic on patients with inflammatory bowel disease by revealing the risk perception for present disease, coping strategies, follow-up characteristics, and treatment adher- ence. This is a cross-sectional, web-based survey study including 798 inflammatory bowel disease patients who were followed at our outpatient clinic and 303 volunteer who did not have any known chronic diseases and were not health professionals were included as the control group. Results: In this study, 281 of the patients were diagnosed with Crohn’s disease and 215 with ulcerative colitis. The mean age of patients with Crohn’s disease, ulcerative colitis, and the control group were 40.9 ± 13.1, 42.3 ± 12.7, and 39.9 ± 11.6, respectively. Here, 119 (42%) of the Crohn’s disease cases, 116 (54%) of the ulcerative colitis cases, and 170 (56%) of the control group were male. Among the 3 groups, coronavirus disease 2019-related post-traumatic stress disorder rates (Impact of Event Scale-Revised > 33) and State-Trait Anxiety Inventory of current status of anxiety-related anxiety rates were not statistically different while State-Trait Anxiety Inventory of anxiety tendency-related constant anxiety was higher in inflammatory bowel disease patients than the control group (P < .017). Conclusion: Inflammatory bowel disease patients with anxiety have a lower quality of life, and this may worsen the clinical course of the disease. Coronavirus disease 2019 is a major source of stress for such a vulnerable population. During the pandemic, psychological support and mental health awareness should be made accessible to all individuals.

Background: This study aimed to find the prevalence of gastrointestinal symptoms in hospitalized COVID-19 patients and to investigate the effects of gastrointestinal symptoms on the course of the disease during hospitalization. Methods: Patients who were hospitalized due to COVID-19 were included in this retrospective study. The diagnostic method of COVID-19 was either a positive reverse transcription polymerase chain reaction test or a typical finding in chest computed tomography. This study was conducted by contacting patients by phone 1 month after they were discharged from hospital to investigate gastrointestinal symptoms. Patients’ laboratory findings at the time of admission, medications they used, and clinical findings were obtained from hospital records retrospectively. Patients with gastrointestinal symptoms were divided into 2 groups according to the start of treatment: pre-treatment and post-treatment groups. Results: At least 1 gastrointestinal symptom (anorexia, weight loss, diarrhea, nausea, vomiting, and abdominal pain) was present in 67.5% of 435 patients (55.6% male, mean age 52.8). If anorexia and weight loss are excluded, the rate of the presence of at least 1 gastrointestinal symptom is 54%. Gastrointestinal symptoms were present in 48.9% before the initiation of COVID-19 treatment. The most prevalent 3 symptoms were anorexia, weight loss, and diarrhea (56%, 52%, and 35.6%, respectively). Presence of pre-treatment gastrointestinal symptoms was associated with elevated C-reactive protein levels. Pre-treatment gastrointestinal symptoms were more common in those who received oxygen supply and who were intubated. Resolution of gastrointestinal symptoms takes longer time in those who were admitted to intensive care unit. Weight loss and diarrhea were more common in COVID-19 patients with gastrointestinal symptoms who were intubated than who were not intubated. Abdominal pain was not found to be a significant predictor of disease severity. Conclusion: The prevalence of at least 1 gastrointestinal symptom in hospitalized COVID-19 patients was 67%. The most prevalent symptoms were anorexia, weight loss, and diarrhea. Presence of pre-treatment gastrointestinal symptoms was associated with elevated C-reactive protein levels, use of oxygen supply, and intubation. Gastrointestinal symptoms persist longer in those admitted to intensive care unit. Cite this article as: Kurt EA, Bakkaloğlu OK, Eşkazan T, et al. Comparison of hospitalized COVID-19 patients in terms of disease course according to the presence of gastrointestinal symptoms before and after admission. Turk J Gastroenterol. 2023;34(4):322-331.

Background: The polymorphisms in the region between 58 and 62 amino acids of the 194-amino acid CagL protein (CagL hypervariable motif) affect the binding affinity of CagL to integrin α5β1 (ITGA5B1) receptor in host epithelial cells and have an effect on the development of various gastrointestinal diseases. We aimed to evaluate the associations of gastroduodenal pathologies, with the polymorphisms of cagL gene of Helicobacter pylori (H. pylori) and also associations between vacA genotypes and cagL polymorphisms. Methods: A total of 19 gastric cancer, 16 duodenal ulcer, and 26 non-ulcer dyspepsia patients were included in this case-control study. All cases had H. pylori. A fragment of 651 bp from gene cagL (hp0539) and cagA, vacA genes was amplified by polymerase chain reaction. Purified polymerase chain reaction products were sequenced by Sanger sequencing, and nucleotide sequences were translated into amino acid sequences. Results: All of the H. pylori strains had cagL and cagA genes. In the 16 (84%) gastric cancer cases, the D58 amino acid polymorphism was significant than the 4 (15.4%) duodenal ulcer cases (P = .029), and the D58/K59 amino acid polymorphism was significant in 12 (63.1%) of the gastric cancer cases than 1 (3.85%) duodenal ulcer case (P = .008). D58/K59 and DKIGQ (n = 10; 52.63%) were the most common polymorphisms in the gastric cancer and were associated with the vacA genotype s1/m2, respectively (P = .022 and P = .008). The D58/K59 amino acid polymorphism was found to have a significant Odds Ratio (OR) value of 8.9 (P = .0017) in multivariate logistic regression analysis. Conclusions: The risk of gastric cancer development is 8.9 times higher with D58/K59 polymorphism Cite this article as: Özbey D, Demiryas S, Akkuş S, et al. The relationship between gastroduodenal pathologies and Helicobacter pylori cagL (cytotoxin-associated gene L) polymorphism. Turk J Gastroenterol. 2023;34(4):346-355.

Background/Objectives: Budesonide is a corticosteroid with low systemic bioavailability, commonly used for localized treatment in inflammatory bowel disease (IBD). While its short-term safety is well established, data on long-term effects—particularly regarding bone mineral density (BMD)—are limited. This study assessed the impact of prolonged oral budesonide use on BMD and related adverse events (AEs) in IBD patients. Methods: We retrospectively reviewed IBD patients treated with budesonide for ≥24 months who underwent baseline and follow-up DEXA scans. A matched control group with no history of budesonide use was selected. Clinical and biochemical data, along with DEXA scans, were collected. Changes in BMD of the femur and lumbar spine and BMD status (osteoporosis/osteopenia) were compared between the groups. Results: A total of 52 budesonide-treated patients (6 with ulcerative colitis and 46 with Crohn’s disease) and 52 matched controls were included. The mean disease duration of the budesonide group and the control group was 8.8 years and 9 years, respectively. Mean budesonide treatment duration was 46.1 ± 15.4 months (range: 25–94). No significant differences were observed between the control and treatment groups when the last BMD status was compared with the initial assessment. While femoral BMD remained stable in the budesonide group, it significantly declined in the control group (p = 0.019). L1-L4 BMD improved in the budesonide group (p = 0.002). The osteoporosis rate remained unchanged (OR: 0.136, 95% CI: 0.007–2.73, p = 0.19), while osteopenia decreased, favoring the budesonide group (OR: 0.197, 95% CI: 0.038–1.018, p = 0.05). No fragility fractures or systemic AEs occurred during follow-up. Conclusions: Long-term oral budesonide use in IBD appears safe with respect to BMD and is not associated with an increased risk of osteoporosis, osteopenia, or previously unrecognized AEs, even with treatment durations of up to four years. The slightly favorable outcome of BMD in IBD patients treated with budesonide needs further verification.

Gastrik bezoar, sindirilmeyen kitlelerin birikmesidir. Hastalar genellikle karın ağrısı, şişkinlik, mide bulantısı ve kusmayı içeren mide çıkışının engellenme belirtileri ile başvururlar. 61 yaşında erkek hasta, midede dolgunluk, erken doyma, hazımsızlık şikayetleri ile başvurdu. Hastanın yapılan endoskopisinde 10x3 cm boyutlarında, korpusu dolduran, bezoar ile uyumlu lezyon tespit edildi. Bezoar, göbek üstü median insizyonla anterior duvar gastrostomisi yoluyla laparatomik olarak çıkarıldı.