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.

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.

En tr Objective: To determine the prevalence of anxiety and depression in diabetic versus non-diabetic persons in relation to socio-demographic and clinical risk factors Methods: A total of 217 patients with type 2 diabetes mellitus (mean(SD) age: 53.7(8.1) years, 56.7% were females) and 100 age-matched non-diabetic control subjects (mean(SD) age: 36.9(10.6) years, 67.0% were females) were included in this cross-sectional questionnaire based survey. Hospital Anxiety and Depression Scale (HADS) subscale scores for anxiety (HADS-A) and depression (HADS-D) were evaluated in diabetic patients in comparison to non-diabetics as well as in relation to socio-demographic and diabetes related characteristics. Results: Similar prevalence of anxiety and depression was noted in diabetic (42.4% and 35.5%, respectively) and non-diabetic (49.0% and 39%, respectively) groups. In the diabetic group, female gender (p<0.001 and p=0.009, respectively) and low income status (p=0.035 and p=0.025, respectively) were associated with higher scores for both HADS-A and HADS-D, while in the control group, both HADS-A and HADS-D scores were significantly higher in the younger age (<45 years, p=0.008 for each). Apart from significantly higher scores for HADS-A in diabetic patients in case of ≥1 diabetic complications (p=0.009), no significant difference in HADS scores was noted with respect to disease characteristics. Conclusion: Our findings revealed socio-demographic rather than diabetes related factors to be important correlates of anxiety and depression among patients with diabetes and thereby no difference between diabetics and controls in terms of depression and anxiety levels. Amaç: Diyabetik ve non-diyabetik kişilerde anksiyete ve depresyon prevalansının sosyo-demografik ve klinik risk faktörleri ile ilişkili olarak belirlenmesi Yöntemler: Bu kesitsel ankete dayalı çalışmaya toplam 217 tip 2 diabet hastası (ortalama (SS) yaş: 53.7(8.1) yıl, %56.7’si kadın) ve non-diyabetik 100 sağlıklı kontrol (ortalama (SS) yaş: 36.9(10.6) yıl, %67.0’si kadın) dahil edildi. Hastane Anksiyete ve Depresyon Ölçeği (HADS) için anksiyete (HADS-A) ve depresyon (HADS-D) alt ölçek skorları sosyo-demografik ve diyabete ilişkin özellikler bağlamında diyabetik ve non-diyabetik hastalarda, değerlendirildi. Bulgular: Sınırda veya anormal anksiyete ve depresyon prevalansları açısından diyabetik (sırasıyla %42.4 ve %35.5) ve non-diyabetik (sırasıyla %49.0 ve %39.0) gruplar arasında anlamlı bir farklılık saptanmadı. Diyabetik grupta, kadın cinsiyeti (sırasıyla, p<0.001 ve p=0.009) ve düşük gelir düzeyi (sırasıyla, p=0.035 ve p=0.025) daha yüksek HADS-A ve HADS-D skorları ile ilişkili bulundu. Kontrol grubunda HADS-A ve HADS-D skorları gençlerde daha yüksekti (<45 yaş, her biri için p=0.008). Diyabetik hastalarda ≥1 diyabetik komplikasyon varlığında anlamlı şekilde daha yüksek bulunan HADS-A skorları (p=0.009) dışında, HADS skorlarında hastalık özelliklerine göre anlamlı bir farklılık saptanmadı. Sonuç: Sonuç olarak, bulgularımız diyabet hastalarında diyabete ilişkin faktörlerden ziyade sosyo-demografik faktörlerin anksiyete ve depresyon üzerine etkin değişkenler olduğunu ve bu bağlamda diyabet hastaları ve kontrol olguları arasında depresyon ve anksiyete düzeyleri açısından bir farklılık olmadığını göstermektedir.

Background: Vedolizumab, which is a monoclonal antibody that selectively binds to α4β7 integrin in the gastrointestinal system, may be an effective and safe treatment alternative in those with anti-tumor necrosis factor-resistant inflammatory bowel disease. Methods: Patients administered vedolizumab due to anti-tumor necrosis factor resistant or anti-tumor necrosis factor side effects between August 2017 and November 2020 were included in the study. Crohn’s patients were evaluated using the Harvey–Bradshaw index and Simple Endoscopic Score for Crohn’s Disease, whereas ulcerative colitis patients were evaluated with the Partial Mayo Score Index and Rachmilewitz score. All patients were followed up for 3 months and their blood samples were taken every 3 months. Hemoglobin, white blood cell, leukocyte, lymphocyte, and platelet counts of the patients were performed. Albumin, C-reactive protein, and erythrocye sedimentation rate values were recorded. The side effect profile for vedolizumab was evaluated for all patients. Among the side effects, arthralgia and flu-like symptoms were observed. Results: A total of 48 patients (18 ulcerative colitis and 30 Crohn’s disease) were included in the study. Vedolizumab therapy was initi- ated in the patients due to anti-tumor necrosis factor resistance (17 ulcerative colitis and 26 Crohn’s disease) or anti-tumor necrosis factor side effects (1 ulcerative colitis and 4 Crohn’s disease). A total of 30 (63%) patients, including 15 (83%) ulcerative colitis and 15 (50%) Crohn’s disease, responded to treatment (both response and remission). The mean duration of response to treatment was 4.5 ± 1.5 months. A total of 20 (42%) patients in the vedolizumab therapy subgroup (10/10, ulcerative colitis/Crohn’s disease) went into remission. The mean Harvey–Bradshaw Index value was 9.8 ± 2.8 in the Crohn’s disease patients at the time of initial treatment. The mean Simple Endoscopic Score for Crohn’s disease value was 11.2 ± 3.1 at the time of initial treatment. The mean Harvey–Bradshaw Index value was 6.5 ± 3.0 and the mean Simple Endoscopic Score for Crohn’s disease value was 4.9 ± 3.6 at 6 months post-treatment. The mean Ulcerative Colitis Endoscopic Index (Rachmilewitz) value was 9.3 ± 1.2 at the time of initial treatment. In addition, the mean Partial Mayo Scoring Index was 6.4 ± 1.5 at the time of initial treatment. The mean Ulcerative Colitis Endoscopic Index (Rachmilewitz) value was 0 (0-6.0), and the mean Partial Mayo Scoring Index was 1.5 (0.3-4.0) at 6 months post-treatment. Conclusion: Vedolizumab therapy is effective in both induction and maintenance of remission in inflammatory bowel disease patients who are resistant to anti-tumor necrosis factor or who can not receive anti-tumor necrosis factor therapy due to side effects. No signifi- cant side effect was observed in the patients during follow-up. Cite this article as: Erdoğan Ç, Yeşil B, Bacaksız F, et al. Use of vedolizumab in inflammatory bowel disease: A single-center experience. Turk J Gastroenterol. 2022;33(10):831-837.

Aims: Üst gastrointestinal kanamaları özofagus, mide ve duedonumu kapsayan geniş bir bölgede çeşitli patolojilere bağlı olarak gelişir. Klinik hastalar arasında oldukça değişkendir ve takip altında hızla kötüleşebilir hatta mortal seyredebilir. Hastanın tedavisinde medikal ajanlar, endoskopik girişimler, cerrahi gerekebilir ve yüksek miktarda kan transfüzyon ihtiyacı doğabilir. Hangi hastanın diğerlerinden daha fazla riskli ve acil olduğunu öngörmek hastaların doğru tedavi edilebilmesi için önemlidir. Üre/hemoglobin oranı hastaların endoskopi ihtiyacını öngörmede basit, hızlı uygulanabilir ve güvenilir bir gösterge olabilir. Methods: Bu çalışma tek merkezli ve retrospektif bir çalışma olup çalışma kapsamında 361 üst gastrointestinal sistem kanaması ile tedavi edilmiş hasta araştırılmıştır. Hastaların yaş ve cinsiyet verileri, endoskopi kayıtları, kan tetkikleri çalışma kapsamında incelenmiştir. Yoğun bakım endikasyonu, endoskopik endikasyonu, kan transfüzyon endikasyonunda median UHR değerleri anlamlı olarak yüksek bulunmuştur (p<0,05). Results: Hastaların çoğunluğu %72,3 ile erkekti. Median yaş 56 idi (15-96). Peptik ülser (70,9%) en sık, anjioektazi (6,65%) ikinci sıklıkta etiyolojik neden olarak tespit edildi. Hastaların 29,1%’inde yoğun bakım takibi, 36,01%’inde eritrosit replasmanı ve 46,81%’inde endoskopik tedavi gerekti. 13 hasta hayatını kaybetmiştir (3,6%). Median değer üre için 58, hemoglobin için 10,50 ve UHR için 5,75 olarak tespit edildi. Conclusion:. Üst gastrointestinal sistem kanamaları değişken ve hızlı kötüleşmeye aday kliniklerdir. Hastalar ile her zaman ideal şartlar altında karşılaşılmayabilir ve kısıtlı imkanlar ile yönetilmesi gerekebilir. Bu sebeple acil tedavi ve girişimlere ihtiyaç duyabilecek hastaları diğerlerinden ayırt edebilecek erişimi kolay, hızlı ve güvenilir yardımcı tekniklere ihtiyaç vardır. Üre ve Üre/hemoglobin oranı bu şartları bünyesinde barındırmakta olup üst gastrointestinal sistem kanamaları açısından önemi araştırılmalıdır. Abstract Aims: Upper gastrointestinal bleeding develops due to various pathologies in a wide region, including esophagus, stomach, and duodenum. The clinical presentation is highly variable between patients and can rapidly deteriorate and even be fatal without follow-up. Medical agents, endoscopic interventions, and surgery may be required in the treatment of the patient, and a high blood transfusion may be required. Predicting which patients are more at risk and urgent than others is important for the correct treatment of patients. The urea/hemoglobin ratio can be a simple, rapidly applicable, and reliable indicator to predict the need for endoscopy. Methods: This was a single-center retrospective study in which 361 patients treated for upper gastrointestinal bleeding were investigated. Age and gender data, endoscopy records, and blood tests of the patients were analyzed within the scope of the study. Median UHR values were significantly higher in intensive care indication, endoscopic indications, and blood transfusion indications (p<0.05). Results: The majority of patients were male, with 72.3%. The median age was 56 years (15-96). Peptic ulcer (70.9%) was the most common etiologic cause, and angioectasia (6.65%) was the second most common etiologic cause. Intensive care follow-up was required in 29.1%, erythrocyte replacement in 36.01%, and endoscopic treatment in 46.81% of patients. 13 patients died (3.6%). The median value was 58 for urea, 10.50 for hemoglobin and 5.75 for UHR. Conclusion: Upper gastrointestinal bleeding is a variable and rapidly deteriorating clinical entity. Patients may not always be encountered under ideal conditions and may need to be managed with limited resources. Therefore, there is a need for easy-to-access, rapid, and reliable auxiliary techniques to differentiate patients who may need urgent treatment and interventions from others. Urea and Urea/hemoglobin ratio fulfill these requirements, and their significance in terms of upper gastrointestinal bleeding should be investigated.

Aims: Acute cholangitis is a potentially fatal bacterial illness that poses a significant risk to patients if not promptly addressed, despite the progress made in the field of diagnosis and treatment. Multiple laboratory and clinical data are employed in assessing the severity and fatality rates associated with acute cholangitis. This study aimed to assess the predictive utility of the ratio between elevated laboratory results and albumin levels in determining the severity of disease and mortality rates in patients with cholangitis. Methods: The study comprised a cohort of 471 individuals diagnosed with acute cholangitis, alongside a control group of 150 individuals without acute cholangitis. The patients' information was acquired by conducting a retrospective search of the computerized database. The study collected data on the age, gender, routine laboratory parameters, concomitant disorders, etiology of cholangitis, and outcomes (discharge or death) of all patients. The patients were categorized into three grades, namely grade 1, grade 2, and grade 3, based on the severity of cholangitis, using the Tokyo 2018 standards as a reference. Results: The study comprised a sample size of 621 people. Out of the whole sample size, 53.1% (330 individuals) were identified as male. The study observed a broad range of ages (23-98) with a median age of 67 years, which was found to be greater in the cholangitis group. Among the patients in the cholangitis group, a mortality rate of 6.8% (32 individuals) was observed. A notable disparity was seen in all laboratory parameters between the two groups. The cholangitis group had greater levels of albumin-related ratios, and there was a positive correlation observed between all ratios and the severity of the condition. In deceased individuals, there were greater rates observed for variables other than the γ-glutamyl transferase/albumin ratio (GAR). The results of both univariate and multivariate regression analyses demonstrated a significant correlation between the ratios of direct bilirubin to albumin (DBAR), international normalized ratio to albumin (IAR), neutrophil to albumin (NAR), and mortality. Additionally, the study revealed that the mortality and severity of cholangitis could be predicted by all the albumin-related ratios examined, particularly the INR/albumin ratio (IAR), as indicated by the ROC analysis. Conclusion: It is posited that the utilization of albumin-related ratios, obtainable through routine laboratory testing, may serve as an effective means to assess the severity of acute cholangitis and predict mortality rates associated with the condition. Immediate biliary drainage is recommended for patients with elevated ratios.