Carbohydrate antigen CA19-9 is commonly used in the diagnosis of pancreatic and biliary malignancies. However, increases in its level in benign conditions such as acute cholangitis or pancreatitis have also been reported. A 79-year-old woman presented with cholangitis and a pancreatic pseudocyst while showing elevation of CA19-9 up to 35,500 U/mL. The patient was adequately treated and at two months' follow-up the CA19-9 level had returned to normal.

Background Nonalcoholic fatty liver disease (NAFLD) is a common disorder and becoming a leading cause of cirrhosis in the western world. The monitoring of the disease is challenging and the prognostic importance of a-fetoprotein (AFP) level elevation in NAFLD remains uncertain. Methods Eighty-four patients were evaluated in the study. Patients with evidence of fatty liver in an abdominal ultrasonography performed for any reason were enrolled in the study. Degree of liver steatosis was graded into three groups. As a control group, patients without fatty liver or other liver diseases were included. All patients and controls were asked about prior hepatic diseases, consumption of alcohol, smoking, drug use, and a physical examination, biochemical analyses including liver function tests, different components of the metabolic syndrome, and the homeostasis model assessment-estimated insulin resistance (HOMA-IR) score were also performed. Results Body mass index, aspartate aminotransferase, alanine aminotransferase, glucose, insulin, and HOMA-IR in patients with NAFLD were higher than in control group. Triglyceride, total cholesterol, low-density lipoprotein, and high-density lipoprotein cholesterol levels were higher in NAFLD group than in control group. A statistically significant increase in AFP levels was noted in patients with NAFLD (4.09 ± 1.68) when compared with healthy controls (2.95 ± 0.41) (P \ 0.05). A statistically significant increase in AFP levels was noted in patients with grade 3 NAFLD (5.43 ± 1.51) when compared with grade 1 (2.92 ± 1.06) and grade 2 NAFLD groups (3.97 ± 1.45). Also, AFP was significantly higher in grade 2 NAFLD group than in grade 1 NAFLD group. AFP was correlated with NAFLD grade, but neither ALT nor AST showed correlation. According to multivariate analysis, correlation between NAFLD grade and serum AFP levels was independent from the other factors. Conclusion Patients with NAFLD have higher AFP levels than those without fatty liver changes. AFP levels rise as grade of liver steatosis increases. NAFLD should be among the differential diagnosis of elevated serum AFP levels.

Background: Our aim was to document the frequency of gastrointestinal (GI) involvement of Behçet’s disease (BD) at endoscopic examination. Also, we aimed to analyze whether GI lesions were correlated with other systemic components of BD. Methods: Fifty patients with BD were enrolled in the study. Patients in whom optimal colonoscopic examination of both the colon and terminal ileum could be performed were included. An ileum biopsy was taken from all cases. Upper GI endoscopy findings, presence of genital ulcers, uveitis, dermatological lesions, pathergy test, neurological involvement and peripheral vasculitis, and laboratory findings were recorded. Thirty age- and sex-matched persons who had perfect bowel cleansing and had a macroscopically normal colon and terminal ileum at colonoscopy without any systemic diseases were enrolled as the control group. Results: Nine patients and 1 case had macroscopic ileum and colon lesions, respectively. Microscopic examination of BD patients with normal colon and terminal ileum at colonoscopy revealed 61% abnormal ileum histologies. That ratio was 30% for the control group (p < 0.001). None of the patients had any lesions suggesting BD at upper GI endoscopy. There was no correlation between macro- or microscopic GI involvement and other components of BD. Conclusions: Lower GI tract, especially ileum involvement, is frequent in BD. Most of the patients have inflammation in the ileum even in the absence of macroscopic lesions.

OBJECTIVE:To discover whether scattered white spots (SWS) in the duodenum are related to a specific kind of disease. We also scrutinized other upper endoscopic findings which might be associated with SWS. METHODS:Among the patients who were admitted for upper gastrointestinal system endoscopy, those having the endoscopic appearance of SWS in duodenum were enrolled in this study. In total 107 patients [70 women, 37 men, mean age: 51.6 Ϯ 16.88 years (range: 17-82 years)] were included. At least three duodenal biopsies were taken from each patient and histopathological examinations were done by experienced pathologists. RESULTS:The histopathological examination revealed that 39 (36.4%) patients had intestinal lymphangiectasia (IL), 15 (14%) patients had giardiasis (G) and 30 (28.1%) patients had chronic non-specific duodenitis (CD). Two patients with IL were also found to have G. Twenty patients had both IL and CD. One had both G and CD. G was the least common etiology for SWS in the duodenum. The most common reasons for SWS in the duodenum in this study group were IL and CD, in order of decreasing frequency. There was no significant relationship with the other upper endoscopic findings in all these patients. CONCLUSION:Histopathological examinations should be provided for each patient with SWS in the duodenum to assess the etiology.KEY WORDS: chronic non-specific duodenitis, giardiasis, intestinal lymphangiectasia, scattered while spots in duodenum.

The differential diagnosis of Behcet's disease (BD) from inflammatory bowel disease (IBD) is sometimes difficult and challenging. Hereby, we suggested the utility of anti-saccharomyces cerevisiae antibody (ASCA) and anti-neutrophilic cytoplasmic antibody (p-ANCA) in the differential diagnosis of BD from IBD.

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We believe upper endoscopy should be performed to investigate esophageal LP and gastrointestinal pathologies especially when LP patient is symptomatic. Although we didn't detect esophageal LP, our study had the limitation of taking biopsies from pathological sites only. Since histopathological examination of normal appearing esophagus may help in diagnosing occult LP, and prevent eventual complications, it may be further evaluated in larger study groups. A new technique, magnification chromoendoscopy, may be useful in detecting esophageal involvement. We believe the possible role of H. pylori in LP is yet to be determined also.

Celiac disease (CD) is a genetically based chronic inflammatory disorder of the small bowel induced by the dietary gluten and possibly other environmental cofactors. The objective of this study was to investigate the relation of adenosine deaminase (ADA), a cytoplasmic enzyme involved in the catabolism of purine bases, as an index of altered immune response, with adult CD patients. ADA has been shown to increase in several inflammatory conditions, but there is no literature data indicating an alteration in CD. Serum levels of ADA were investigated in newly diagnosed 20 CD patients. ADA levels were compared in patients with CD and in healthy controls. Correlation analysis was also performed between ADA and other serum markers of CD (anti-gliadin and anti-endomysial antibodies) Mean serum ADA levels were significantly elevated in CD patients compared with control group. ROC curve analysis suggested that the optimum ADA level cut-off point for CD was 12.27 U/l. At a cut-off value of 12.27 U/l, the sensitivity was 80% and specificity was 100%. There was no statistically significant correlation between ADA and anti-gliadin and anti-endomisium antibodies. Serum ADA levels elevated significantly in CD patients, suggesting a partial role in activated T-cell response in the disease pathophysiology. ADA can be used as a supportive diagnostic marker in patients with CD.