Gastroenterology Outpatient Clinic Research Articles

Evaluation of Diet and Symptom Severity in Disorder of Gut-Brain Interaction.

Background: Disorders of gut-brain interaction are chronic or recurrent symptoms originating in the gastrointestinal tract that cannot be substantiated by the results of standard clinical tests, such as radiologic studies, morphologies, or endoscopic examination. The diagnosis of these disorders is mainly based on symptoms and the standardized Rome IV criteria. These criteria classify functional disorders of the gastrointestinal tract according to anatomical location and define each disorder according to a set of symptoms. Methods: This study was conducted between October 2021 and February 2022. Participants in the study were patients of a gastroenterology outpatient clinic with a functional disease diagnosed by a gastroenterologist. A questionnaire was used to conduct the study, with questions regarding perceived functional discomforts of the gastrointestinal tract, dietary changes to alleviate discomforts, and frequency of consumption of various food groups. Results: Based on the study, statistical significance was demonstrated between the gender of the respondents and the severity of gastrointestinal complaints after the consumption of legumes and alcohol. The analysis performed confirmed the correlation between the age of the respondents and the severity of complaints when consuming raw vegetables and fruits, brassica vegetables, legumes, fried products, and spicy products. There was also a significant correlation between the body mass index (BMI) of the respondents and the severity of complaints after alcohol consumption. Conclusions: The results identify abdominal pain, bloating, and constipation as the most commonly reported gastrointestinal symptoms among participants. The association between the consumption of certain foods, such as milk and dairy products, as well as fried and fatty foods, and the severity of disorders of gut-brain interaction symptoms was confirmed. Despite this, the majority of respondents did not eliminate any food products to alleviate the discomfort.

Frequency of ABO and RhD Blood Groups in Patients with Celiac Disease

Celiac disease (CD) is a popular autoimmune disorder induced by gluten-containing foods and other environmental, and genetic factors. Every individual's red blood cell expresses over two million ABO blood-type antigens. Furthermore, the stomach and small intestine are major expression sites for the ABH antigens. This study was intended to assess the distribution of ABO and Rh blood types in Libyan patients with celiac disease as well as compare between CD and healthy control groups regarding complete blood count parameters. Samples from 250 CD patients and 45 healthy control groups represented by 80 males (27.1%) and 215 females (72.9%) were enrolled in the study. The samples of CD were collected from patients who attended the gastroenterology outpatient clinic at Tripoli University Hospital (TUH) for follow-up. Two hundred and fifty blood samples were serologically screened for ABO, and Rh antigens using a tube agglutination test. Another group of healthy subjects (n = 45) and CD patients (n = 45) were analyzed for CBC test. The findings showed that the most observed ABO blood group among celiac patients was blood group O 129 (51.6%), followed by blood group A 80 (32%), and Rh-positive 222 (88.8%). Furthermore, the heritable proportion was 33%, with 21% classified as first-degree and 12% as second-degree hereditary. Additionally, the result of the independent Sample (T) test to compare RBCs, HGB, HCT, and NUT levels in blood between CD patients and healthy control showed that there were significant differences in the RBCs, HGB, and HCT counts with p-value = 0.034, <0.001, and <0.001 respectively. In contrast, Mann-Whitney U test results revealed significant differences in the PLT, MCV, MCH, and MCHC counts with p-value = <0.001, and for LYM with p-value = 0.003. Future studies on these simple inflammatory markers can guide us in predicting the diagnosis and prognosis.

Frequency of ABO and RhD Blood Groups in Patients with Celiac Disease

Celiac disease (CD) is a popular autoimmune disorder induced by gluten-containing foods and other environmental, and genetic factors. Every individual's red blood cell expresses over two million ABO blood-type antigens. Furthermore, the stomach and small intestine are major expression sites for the ABH antigens. This study was intended to assess the distribution of ABO and Rh blood types in Libyan patients with celiac disease as well as compare between CD and healthy control groups regarding complete blood count parameters. Samples from 250 CD patients and 45 healthy control groups represented by 80 males (27.1%) and 215 females (72.9%) were enrolled in the study. The samples of CD were collected from patients who attended the gastroenterology outpatient clinic at Tripoli University Hospital (TUH) for follow-up. Two hundred and fifty blood samples were serologically screened for ABO, and Rh antigens using a tube agglutination test. Another group of healthy subjects (n = 45) and CD patients (n = 45) were analyzed for CBC test. The findings showed that the most observed ABO blood group among celiac patients was blood group O 129 (51.6%), followed by blood group A 80 (32%), and Rh-positive 222 (88.8%). Furthermore, the heritable proportion was 33%, with 21% classified as first-degree and 12% as second-degree hereditary. Additionally, the result of the independent Sample (T) test to compare RBCs, HGB, HCT, and NUT levels in blood between CD patients and healthy control showed that there were significant differences in the RBCs, HGB, and HCT counts with p-value = 0.034, <0.001, and <0.001 respectively. In contrast, Mann-Whitney U test results revealed significant differences in the PLT, MCV, MCH, and MCHC counts with p-value = <0.001, and for LYM with p-value = 0.003. Future studies on these simple inflammatory markers can guide us in predicting the diagnosis and prognosis.

Diagnostic Role of Non-Invasive Risk Scores in Prediction of Simple Steatosis versus Non-Alcoholic Steatohepatitis

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is currently considered one of the most common liver diseases in the Western world. NAFLD includes a spectrum of diseases from simple fatty liver disease, to non-alcoholic steatohepatitis (NASH), liver cirrhosis and hepatocellular carcinoma (HCC). NASH, the critical stage in NAFLD progression, is the only bridge between NAFLD and liver cirrhosis, and its persistent existence has become one of the leading causes of liver cirrhosis and even HCC. Aim of the Work To assess the value of non-invasive risk scores in differentiation between simple steatosis and NASH Patients and Methods This was prospective cohort study, conducted Internal Medicine and Gastroenterology outpatient clinics and ward in Ain Shams University Hospitals, on 60 patients with NAFLD divided into 2 groups: (Group I): Patients with normal liver enzymes, (Group II): Patients with persistant elevation of liver enzymes, during a period of 6 months. Results There was statistically insignificant difference between the two studied groups and sex and age. There were 12 (40%) of the group I were males and 18 (60.0%) were females. There were 16(53.3%) of the group II were males and 14(46.7%) were females. The mean age of group I was 40.63 ± 10.53 SD with range (25.0 – 59.0). The mean age of group II was 40.83 ± 9.06SD with range (27.0 – 54.0). There was statistically significant difference between the two studied groups and weight, BMI and waist circumference. There was statistically insignificant difference between the two studied groups and height, DM and HTN. There was statistically significant difference between the two studied groups and ALT, AST, GGT, ALP, ALB and Platelets. There was statistically significant difference between the two studied groups and TC, HDL, LDL, TG and AST/ALT ratio. There was statistically insignificant difference between the two studied groups and FBG. There was statistically significant difference between the two studied groups and FLI, NFS, BARD, APRI, FIB-4 and Fibrosis score. There was statistically significant difference between the two studied groups and Ultrasound (Size, Findings and Fibrosis score). The mean size in group I was 10.03 ± 1.56 SD with range (8.0 – 12.0). The mean size in group II was 13.63 ± 1.22SD with range (12.0 – 16.0). Conclusion A combination of Fibroscan, Fib-4, NFS, BARD and APRI provides a valuable non- invasive method in diagnosis of NASH patients, and this can eliminate the need for liver biopsy in patients without clear indication, BMI, platelet count, HDL cholesterol level, ALT level, and the AST/ALT ratio were independent predictors of NAFLD.

Efficacy analysis of the empathy-based attribution analysis-cognitive restructuring-pharmacological treatment model in the management of globus syndrome

ObjectiveThe aim of this study is to investigate the clinical efficacy of the empathy-based attribution analysis-cognitive restructuring-pharmacological treatment model for the management of globus syndrome. MethodSixty-nine newly diagnosed patients with globus syndrome at the Wenzhou People's Hospital Department of Gastroenterology outpatient clinic were enrolled in this study. After obtaining informed consent, patients were randomly assigned to either the observation group (attribution analysis-cognitive restructuring-classical pharmacotherapy; n = 35) or the control group (pharmacotherapy alone; n = 34), with a treatment course of 4 weeks. Efficacy assessments were conducted before and during treatment using the 9-item Patient Health Questionnaire-9 (PHQ-9), the 7-item Generalized Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-15 (PHQ-15). ResultsAfter four weeks of treatment, the total efficacy rate was 100 % in the observation group and 27.6 % in the control group, with a statistically significant difference between the groups (P < 0.05). Scores on the PHQ-9, GAD-7, and PHQ-15 significantly improved in the observation group compared to before treatment and were better than those in the control group, with statistically significant differences (P < 0.05). ConclusionThe empathy-based attribution analysis-cognitive restructuring-pharmacological treatment model for the management of globus syndrome demonstrated good clinical efficacy, providing strong evidence for further clinical promotion.

The Saudi Gastroenterology Association consensus on the clinical care pathway for the diagnosis and treatment of GERD.

Gastroesophageal reflux disease (GERD) is one of the most common problems encountered in outpatient general medicine and gastroenterology clinics. GERD may present with classic esophageal symptoms, extraesophageal symptoms, or mixed symptoms. The diagnosis and treatment of GERD are challenging due to the variety of symptoms and multifactorial pathophysiology. Since there is no consensus on the diagnosis and treatment of GERD in Saudi Arabia, the Saudi Gastroenterology Association established an expert group to formulate a consensus on the clinical care pathway for the diagnosis and treatment of GERD to update health-care providers in Saudi Arabia. The expert group reviewed the literature including recently published international guidelines, clinical trials, and expert opinion and conducted virtual and in-person meetings. A total of 22 statements on the definition, diagnosis, and treatment of GERD were formulated, and three algorithms for the clinical care of GERD were developed with a detailed description for each step. The expert group endorsed the new definition of GERD, the practical principles of interpretation of the diagnostic GERD evaluation, and the practical guidance for GERD treatment including medical, surgical, and endoscopic therapy. The expert group recommends further studies to investigate local data on the diagnosis and treatment of GERD.

Efficacy of ferric carboxymaltose therapy in celiac patients

Aims: Iron deficiency anemia (IDA) is the most common cause of anemia worldwide. IDA can be caused by reduced iron intake, impaired iron absorption or losses. Celiac disease can cause iron malabsorption by decreasing the surface absorption area in the duodenum and consequently can cause IDA. Oral or intravenous iron preparations are used in the treatment of IDA. In this study, we wanted to investigate the efficacy of ferric carboxymaltose (FCM) in celiac patients with RIA. Methods: Twenty-three patients who were followed up in the gastroenterology outpatient clinic of İnönü University Medical Faculty Hospital Turgut Özal Medical Center with the diagnosis of CD and who received FCM were included in the study. The hemogram, ferritin, iron and iron binding levels of the patients were retrospectively screened through the hospital medical record system. Results: Of the 23 patients included in the study, 3 (13.05%) were male and 20 (86.95%) were female. Hemoglobin concentration, iron and iron binding capacity before and after treatment showed a significant increase in all parameters after treatment. Ferritin value increased, although not significantly. Conclusion: In our study, we found that FCM is an effective and safe treatment modality in the treatment of IDA in celiac patients.

Long-term proton pump inhibitors therapy and prevalence of hyperprolactinemia. a cross-sectional study in outpatient gastroenterology clinics

Objective: To evaluate serum prolactin and macroprolactin levels in patients on long-term proton pump inhibitors therapy. Method: The cross-sectional study was conducted from January 2018 to November 2019 after approval from the ethics review committee of the Commission on Science and Technology for Sustainable Development in the South University, Abbottabad, Pakistan. And comprised patients from two gastroenterology outpatient clinics in the Khyber Pakhtunkhwa province using proton pump inhibitors for &gt;3 months either alone or in combination with either histamine receptor antagonists or prokinetics. Blood samples were collected from each patient for hormonal screening. Data was analysed using SPSS 25. Results: Of the 166 patients, 101(60.8%) were females and 65(39.2%) were males. The overall mean age was 42.5±14.2 years, and the median serum prolactin level was 23.2ng/ml (interquartile range: 14.0-38.0ng/ml). There were 96(58%) patients with normoprolactinemia and 70(42%) with hypreprolactinemia. There were 19(11.4%) patients using combination therapy, while the rest were on proton pump inhibitors monotherapy. There was a significant increase in serum prolactin level with combination therapy compared to monotherapy (p=0.001). Pateints having treatment duration 11-20 months (p=0.006) and &gt;40 months (p=0.001) were at high risk of developing hyperprolactinemia. Conclusion: Long-term use of proton pump inhibitors could increase serum prolactin levels, and appropriate evaluation is essential for clinical management. Key Words: Proton pump inhibitors, Long-term therapy, Hyperprolactinemia, Omeprazole, Prolactin.

Sleep quality in functional dyspepsia patients: A cross-sectional study from a tertiary care hospital in Karachi.

Objective: To determine sleep quality among functional dyspepsia (FD) patients presenting to gastroenterology out-patient clinic in a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: March 2022 to December 2023. Methods: FD diagnosis was established in view of ROME-IV criteria. Sleep quality was evaluated using Pittsburgh Sleep Quality Index PSQI scoring tool. A global score of 5 or more indicates poor sleep quality. Binary logistic regression was applied and odds ratio with 95% confidence level were figured out to assess relationship of patients' profile with FD. Results: In a total of 240 patients, the mean age was 37.3±6.5 years. There were 122 (50.8%) male patients. The most common dyspeptic feature was postprandial fullness (60.4%) followed by early satiety epigastric pain (50%) and epigastric burning (39.6%). Mean PSQI score was 14.7±3.5. Frequency of poor sleep quality among FD patients was 79.2%. None of the parameter was significantly associated with sleep quality except urban residence (p=0.005). Conclusion: Very high burden of poor sleep quality was found among FD patients. While most dyspeptic symptoms did not show a significant association with sleep quality, urban residence emerged as a notable factor.

Evaluation of Circular RNA SMARCA5 as a Novel Biomarker for Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is the fourth most prevalent type of cancer in Egypt and the sixth globally. Most patients with HCC are typically diagnosed during the advanced stages of the disease due to the absence of biomarkers for early detection. Consequently, these patients miss the optimal timeframe for receiving therapy. we aimed to assess the circular RNA SMARCA5 level and SMARCA5 mRNA gene expression as a potential biomarker for early detection of HCC. The present study utilized a case-control design comprising 159 participants. Participants were selected from both inpatient and outpatient hepatology and gastroenterology clinics at the National Liver Institute Hospital, Menoufia University. They were evenly distributed among three groups: Group I: 53 control subjects, Group II: 53 HCV cirrhotic patients, and Group III: 53 HCC patients. Tumor staging was done using BCLC staging system. Each patient underwent a thorough clinical examination, radiological examination, complete history taking, and serum Alpha-fetoprotein (AFP) assessment and detection of circular RNASMARCA5 and SMARCA5mRNA gene sutilizing quantitative real-time polymerase chain reaction. Statistically substantial differences were observed in the examined groups in terms of AFP, SMARCA5, and CircSMARCA5 (P-value = 0.001, 0.001 & 0.001). CircSMARCA5 and SMARCA5mRNA were markedly down regulated in the HCC group compared to HCV cirrhotic patients and controls. ROC analysis for early HCC diagnosis demonstrated that the CircSMARCA5 area under the curve (AUC) at cut-off point 4.55 yielded a specificity of 83.8% and sensitivity of 91.7%. The AUC for AFP at a cut-off point of 515ng/ml yielded a specificity of 89.2% and a sensitivity of 91.3%. CircSMARCA5 has the potential to be a more sensitive predictor of HCC disease compared to AFP.

Assessing impaired gastric accommodation in children with functional constipation using the water load test.

This study aimed to evaluate gastric accommodation in pediatric patients with functional constipation using the water load test. This was a cross-sectional case-control study. Herein, the water load test results of children aged >4 years with functional constipation referred to a Pediatric Gastroenterology Outpatient Clinic (functional constipation group) were compared with those of a control group (without functional constipation or chronic abdominal pain) recruited from two public schools. Clinical manifestations outlined in the Rome IV criteria were used to diagnose functional constipation. Water load tests were performed after 3 h of fasting. For the test, the participants were asked to drink as much water as possible in 3 min. A total of 36 patients and 77 students were included in the functional constipation and control groups, respectively. There was no significant difference in age between the groups (8.6 ± 2.3 years and 8.8 ± 1.8 years in the functional constipation and control groups, respectively). The water load test showed intake volumes of 390 ± 245 mL and 528 ± 219 mL in the functional constipation and control groups, respectively (p = 0.001). The maximum volume in the water load test correlated with the 24 h daily intake of energy (rS = +0.42, p = 0.012), protein (rS = +0.48, p = 0.004), and water (rS = +0.39, p = 0.020) only in the group with functional constipation. According to the water load test, gastric accommodation was impaired in children with severe functional constipation. The impairment of gastric accommodation in children with severe functional constipation is related to food intake.

Gluten-free diet adherence in pediatric celiac patients: Evaluating CDAT questionnaire and test for gluten detection in urine.

This study aimed to evaluate the contributions of the Adapted Celiac Dietary Adherence Test (CDAT) and the Rapid Urinary Gluten Detection Test (u-GIP) in assessing gluten-free diet adherence in children and adolescents with celiac disease. Fifty-four celiac patients from two pediatric gastroenterology outpatient clinics affiliated with university hospitals were evaluated. The original CDAT was adapted for children through a transcultural process, and the original cutoff point was adopted to define adherence. A single examiner carried out the u-GIP test in fresh urine samples. Sociodemographic and clinical factors and family food security status were also evaluated. A total of 88.9% of participants (confidence interval [CI]: 77.4-95.8; p<0.001) adhered to the gluten-free diet, as determined by the adapted CDAT score, while 87.0% (CI: 75.1-94.6; p<0.001) had negative u-GIP results. Among the 48 children adhering to the CDAT, six exhibited positive u-GIP results in a urine sample. Of the six nonadherent participants, only one had a positive u-GIP result. Notably, none of the children and adolescents with celiac disease who tested positive for u-GIP reported symptoms on the day of testing, and their growth rates remained stable. Even celiac children and adolescents adhering to the CDAT questionnaire may show a positive u-GIP in a single measurement without accompanying symptoms or growth impairment. The u-GIP could be helpful in complementary tests in specific situations, such as for patients who exhibit compliant behavior but still experience symptoms or maintain persistent positive serology.

Healthcare Utilization Patterns: Irritable Bowel Syndrome, Inflammatory Bowel Disease, and Gastroesophageal Reflux Disease.

Limited information is available about patterns of healthcare utilization for prevalent gastrointestinal conditions and their link to symptom burden. To identify patterns of healthcare utilization among outpatients with highly prevalent gastrointestinal conditions and define the link between healthcare utilization, symptom burden, and disease group. We randomly selected patients from the gastroenterology outpatient clinic at Princess Alexandra Hospital who had chronic gastrointestinal conditions such as constipation-predominant irritable bowel syndrome (IBS-C, n = 101), diarrhea-predominant IBS (IBS-D, n = 101), mixed IBS (n = 103), inflammatory bowel disease with acute flare (n = 113), IBD in remission (n = 103), and gastroesophageal reflux disease (n = 102). All had presented at least 12months before and had a 12-month follow-up after the index consultation. Healthcare utilization data were obtained from state-wide electronic medical records over a 24-month period. Intensity of gastrointestinal symptoms was measured using the validated Structured Assessment of Gastrointestinal Symptoms (SAGIS) Scale. Latent class analyses (LCA) based on healthcare utilization were used to identify distinct patterns of healthcare utilization among these patients. LCA revealed four distinct healthcare utilization patterns across all diagnostic groups: Group A: Emergency department utilizers, Group B: Outpatient focused care utilizers, Group C: Inpatient care utilizers and Group D: Inpatient care and emergency department utilizers. LCA groups with high emergency utilization were characterized by high gastrointestinal symptom burden at index consultation regardless of condition (Mean (standard deviation)) SAGIS score Group A: 24.63 (± 14.11), Group B: 19.18 (± 15.77), Group C: 22.48 (± 17.42), and Group D: 17.59 (± 13.74, p < 0.05). Distinct healthcare utilization patterns across highly prevalent gastrointestinal conditions exist. Symptom severity rather than diagnosis, likely reflecting unmet clinical need, defines healthcare utilization.

N47 Spiritual needs of patients with IBD: preliminary results of a pilot study

Abstract Background Inflammatory bowel disease (IBD) includes Crohn's Disease (CD) and Ulcerative Colitis (UC), and both lead to manifestations that affect the patient's quality of life (QoL). The issue of chronicitỳ makes the disease difficult to manage and requires a radical change in patients’ habits, leading to a decrease in QoL after diagnosis. The literature emphasises how spiritualitỳ positively influences the psychophysical well-being of chronic patients and consequently their QoL. This study aims to describe the spiritual needs of patients with IBD to promote holistic care and improve their QoL and aims to explore their eventual association with sociodemographic and clinical variables. Methods A cross-sectional study was carried out in the outpatient gastroenterology clinics of a university hospital, administering the validated Spiritual Needs Questionnaire (SpNQ) during outpatient follow-up visits to patients over 18 years of age after informed consent to participate in the study. The SpNQ consist of 27 items divided into four domains: Religious needs, Needs for Inner Peace, Existential needs, and Giving/Generativity Needs. Some clinical and sociodemographic data were also collected. Results A total of 103 completed the questionnaire: 53% had CD, 35% UC and 12% had undetermined IBD. 44% were males the median age was 45 years, and half of the sample was more than 10 years from IBD diagnosis. More than 40% were in biologics, 47% had a high educational level, 28% were smokers, and 4% had a stoma. 65% were Christian, 26% had no religion, and the frequency of their participation in religious gatherings varies from never (15%), to rarely (59%) and often (26%). They cultivate their spirituality mainly by conducting their existence in accordance with values that are fundamental to them (47.7%), staying in contact with nature (30.5%), praying (15.8%), engaging in introspection and self-knowledge (14.7%), volunteering (12.6%), and practising extreme sports (10.5%). The analyses showed statistically significant differences between sexes regarding the domains "Needs for Inner Peace" and "Religious Needs" (p&amp;lt;0.001) more relevant to women than men, and significant differences between ages regarding the domains "Existential Needs", more relevant to middle age (p=0.037), and "Giving/Generativity Needs", more relevant to middle age and to elderly (p=0.015). Conclusion Spiritual needs may play a major role in the care of patients with IBD, and nursing should consider this dimension to improve the holistic care of the patients. Research should be expanded through studies involving a larger sample size and evaluating the IBD outcome by acting on spiritual needs.

Role of Alanine Transaminase and Transient Elastography in Categorising Nonalcoholic Fatty Liver Disease Subgroups.

To investigate the association of alanine transaminase (ALT) with transient elastography grades to define various nonalcoholic fatty liver disease (NAFLD) groups for disease status. Cross-sectional, descriptive study. Place and Duration of the Study: Gastroenterology Outpatient Clinic, Ziauddin Hospital, from January to December 2022. This study included 194 NAFLD patients. Demographic data, body mass index, enzymes, and transient elastography (TE) findings were recorded. NAFLD patients were categorised as nonalcoholic fatty liver (NAFL), nonalcoholic steatohepatitis (NASH), steatofibrosis (significant fibrosis F2-F3 with normal ALT), and cirrhosis using TE grades. The median age of the patients was 44 [IQR 18.25] years; 146 (75.3%) were males. Out of 194 NAFLD patients, 21 (10.8%) were NAFL, 116 (59.8%) were NASH, 14 (7.2%) showed steatofibrosis, and 43 (22.2%) were cirrhotic. On transient elastography, the majority were with S3 steatosis (n=107, 55.2%) and 59 (30.2%) had F0-F1 fibrosis. There was a statistically significant difference in the mean rank of age, ALT, AST, and GGT levels within 4 groups of NAFLD (p <0.001). Most of the patients with all the stages of fibrosis had increased ALT levels (p=0.034). This study concluded that a combination of ALT levels and transient elastography findings could be considered for differentiating uncomplicated steatosis from NASH, steatofibrosis, and cirrhosis, hence limiting the use of liver biopsy. This may prove a reliable way to measure the severity of the disease. Nonalcoholic fatty liver disease, Cirrhosis, Transient elastography.

Is There A Connection Between Primary Hypophysitis and Celiac Disease?

To investigate the autoimmune and genetic relationship between primary hypophysitis (PH) and celiac disease (CD). The study was retrospective and patients with PH followed in our clinic between 2007 and 2022 were evaluated. Clinical, endocrinologic, pathologic, and radiologic findings and treatment modalities were assessed. Patients diagnosed with CD in the Gastroenterology outpatient clinic in 2020-2022 were included in the study as a control group. Information such as sociodemographic data, year of diagnosis, human leukocyte antigen (HLA) DQ2/8 information, CD-specific antibody levels, pathologic results of duodenal biopsy, treatment received, follow-up status, additional diseases, hormone use, and surgical history was obtained from patient records at PH.In patients diagnosed with PH, a duodenal biopsy was obtained, and the tissue was examined for CD by experienced pathologists. Anti-pituitary antibody (APA) and anti-arginine-vasopressin (AAVP) antibody levels of individuals with PH and CD were measured. The study included 19 patients with lymphocytic hypophysitis, 30 celiac patients, and 30 healthy controls. When patients diagnosed with lymphocytic hypophysitis were examined by duodenal biopsy, no evidence of CD was found in the pathologic findings. The detection rate of HLA-DQ2/8 was 80% in celiac patients and 42% in PH (p=0.044). (APA and AAVP antibodies associated with PH were tested in two separate groups of patients and in the control group. APA and anti-arginine vasopressin (AAVP) levels in PH, CD and healthy controls, respectively M [IQR]: 542 [178-607];164 [125-243]; 82 [74-107] ng/dL (p=0.001), 174 [52-218]; 60 [47-82]; 59 [48-76] ng/dL (p=0.008) were detected. The presence of an HLA-DQ2/8 haplotype correlates with posterior hypophysitis and panhypophysitis (r=0.598, p=0.04 and r=0.657, p=0.02, respectively). Although patients with PH were found to have significant levels of HLA-DQ2/8, no CD was found in the tissue. Higher levels of pituitary antibodies were detected in celiac patients compared with healthy controls, but no hypophysitis clinic was observed at follow-up. Although these findings suggest that the two diseases may share a common genetic and autoimmune basis, the development of the disease may be partially explained by exposure to environmental factors.

Frequency of Non-Alcoholic Fatty Liver Disease among the Non-Obese Population Presenting to the Gastrointestinal Outpatient Clinic

Background: It has been reported that Asian males with BMI ≤ 23 kg/m2 have considerably higher content of fat and visceral adipose tissue as compared to their Western counterparts. Multiple studies have reported variable frequency of Non-alcoholic Fatty Liver Disease (NAFLD) in lean population. However, the data is scarce regarding the prevalence of NAFLD in the lean Asian population. Objective: To determine the frequency of NAFLD among the non-obese population presenting to our clinic Methods: This cross-sectional study included all the lean individuals with BMI&lt; 23 kg/m2 presenting to the gastroenterology outpatient clinic from 1st November 2020 to 31st March 2022. Ultrasound abdomen was performed for the presence or absence of fatty liver which was diagnosed based on hyperechoic liver texture. The analysis of continuous variables was performed using the student t-test while the Chi-square test was applied for the analysis of categorical variables. A p-value ≤ 0.05 was considered as significant. Results: Among the 283 individuals presenting to the gastrointestinal clinic with BMI &lt; 23 kg/m2, the majority were females [150 (53%)]. Out of 283 patients, 118(41.7%) had hypertension, 114(40.3%) had hypertriglyceridemia while 86(29.7%) patients had diabetes. On ultrasound abdomen, fatty liver was observed in 92 (32.5%) patients including 59 (64.1%) females and 33 (35.9%) males. The statistical analysis documented a significant association of NAFLD with female gender (p=0.006), hypertension (p&lt;0.001), hypertriglyceridemia (p=0.13), high total lipids (p&lt;0.001), and serum cholesterol levels (p=0.005). However, no statistically significant association of fatty liver was observed with body mass index (p=0.823), age (p=0.169), and diabetes (p= 0.522). Conclusion: The presence of hypertension, hypertriglyceridemia, raised total lipids and serum cholesterol levels and female gender were the factors significantly associated with the presence of fatty liver in the lean population. However, to validate our results, multicentered studies on a larger scale are required.

Outcomes of the use of infliximab biosimilars in rheumatology and gastroenterology clinics.

The originator infliximab product, Remicade, was approved by the US Food and Drug Administration in August 1998 for the management of Chron's disease. Since this time, several infliximab biosimilar agents have entered the market to introduce competition and lower costs for patients as well as health care systems. Clinical trials comparing infliximab biosimilars with the originator product have consistently demonstrated noninferiority, along with similar adverse effect profiles, leading to the approval of 3 additional biosimilars: Renflexis (infliximab-abda), Avsola (infliximab-axxq), and Inflectra (infliximab-dyyb). In 2021, the University of North Carolina rheumatology and gastroenterology outpatient clinics began an initiative to convert patients from the originator infliximab product to biosimilar agents Renflexis or Avsola based on market costs. Subsequently, a retrospective evaluation was conducted to analyze the clinical outcomes of patients that were switched to a biosimilar agent compared with those that were only ever using either the originator or biosimilar agent. A total of 180 patients were analyzed, of which half were prescribed a biosimilar as a result of the conversion initiative. Of these 90 patients, 79 (87.8%) were maintained on a single biosimilar agent without requiring a switch to an alternative infliximab product. We conclude that the effort to convert clinically stable patients to a biosimilar product resulted in a significant increase in biosimilar use within the health system. This is thought to have resulted in significant financial advantages both to our institution as well as patients, without sacrificing overall clinical control.

Frequency of fibrosis in patients with incidentally detected hepatosteatosis.

In this study, we aimed to elucidate fibrosis in patients who visited our outpatient clinic with complaints such as abdominal pain and dyspepsia and who had fatty liver by ultrasound imaging. A total of 119 patients who were admitted to the gastroenterology outpatient clinic of our institution with incidentally detected hepatosteatosis on ultrasound imaging were included in the study. Patients with hepatosteatosis were examined for fibrosis with the FibroScan-502-touch (Echosens, Paris, France) elastic tissue ultrasonography device. The effects of these parameters on hepatosteatosis and possible fibrosis degree were investigated. No fibrosis was detected in 75 (63.02%) patients with hepatosteatosis on ultrasound imaging, 20 (10.05%) F1, 22 (18.48%) F2, 1 (0.8%) F3, and 0.1 (0.8%) F4. Accordingly, as the degree of steatosis increases in patients with incidentally detected hepatosteatosis, the degree and frequency of fibrosis increase with statistical significance (p<0.05). A statistically significant difference was found between the alanine transaminase increase and the hepatosteatosis degree (p=0.028). The median value of gamma-glutamyltransferase was 15 U/L in S0, 18.5 U/L in S1, 22 U/L in S2, and 26 U/L in S3 (p<0.047). To date, no research exists on fibrosis in patients with incidental hepatosteatosis. The outcomes of this study elaborated that patients with hepatosteatosis in the community could be detected at least at an early stage by following up and diagnosing them with serum markers before they progress to end-stage fibrosis.

Validity and reliability of the Indonesian version of the 9-item Inflammatory Bowel Disease Questionnaire (IBDQ-9)

BACKGROUND Decreasing the quality of life (QoL) of patients with inflammatory bowel disease (IBD) will increase morbidity and mortality. A valid and reliable instrument is needed to assess the QoL of patients with IBD. This study aimed to analyze the validity and reliability of the Indonesian version of the 9-item Inflammatory Bowel Disease Questionnaire (IBDQ-9).&#x0D; METHODS This cross-sectional study was conducted using the Indonesian version of the IBDQ-9 in adult patients with IBD at the Gastroenterology Outpatient Clinic, Cipto Mangunkusumo Hospital, Jakarta, in November 2022. Patients aged 18 to 59 years who had experienced IBD for at least 2 weeks and provided informed consents were included. The total score of the IBDQ-9 Indonesian version was compared with the 36-item Short-Form Health Survey (SF-36) using the Spearman's correlation test. Reliability tests were examined using Cronbach’s alpha and the intraclass correlation coefficient (ICC).&#x0D; RESULTS A total of 124 participants were included in this study. The Spearman's test showed a high and significant result for the IBDQ-9 Indonesian version and the SF-36 (r = 0.769 and p&lt;0.001). Cronbach’s alpha and ICC coefficient were equal to 0.883.&#x0D; CONCLUSIONS This study provided evidence of the good validity and reliability of the IBDQ-9 Indonesian version for assessing the QoL of patients with IBD in Indonesia.