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Chinzon D, Moraes-Filho JPP, Domingues G, Roveda F, LobÃo Neto AA, Zaterka S. BRAZILIAN PHYSICIANS' PRACTICES ON THE MANAGEMENT OF SYMPTOMS SUGGESTING GASTROESOPHAGEAL REFLUX DISEASE: A MULTIDISCIPLINARY SURVEY. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:404-408. [PMID: 33331473 DOI: 10.1590/s0004-2803.202000000-74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Clinical guidelines are available to steer decisions regarding diagnosis, management and treatment of gastrointestinal disorders. Despite this, variations in physician's practices regarding gastroesophageal reflux disease (GERD) symptoms are well described in the literature. OBJECTIVE To describe practices of physicians from different specialties on the management of patients with typical symptoms of GERD (heartburn and regurgitation) in a Brazilian sample. METHODS National online survey enrolling a sample of general practitioners, gastroenterologists, cardiologists and otolaryngologists. The survey was conducted from August 6th to September 12th, 2018. Subjects answered a structured questionnaire addressing variables regarding physicians' profile (age, sex, specialty, practice setting, years in practice, type of medical expense reimbursement), their patients characteristics and prescribing behaviors. RESULTS The final weighted sample was comprised of 400 physicians, 64% male, with an average of 15 years of experience. Physicians' estimates of gastroesophageal symptoms prevalence among their pool of patients was 37.6% for the total sample, reaching 70.3% among gastroenterologists. The medical specialty with lower average percentage of patients presenting gastroesophageal symptoms was otolaryngology (24.5%). Physicians reported that they request ancillary tests for 64.5% of patients with GERD typical symptoms. The most common diagnostic test was endoscopy (69.4%), followed by video nasolaryngoscopy (16.6%). The percentage of patient to whom endoscopy is performed was significantly higher among gastroenterologists and general practitioners as compared to otolaryngologists and cardiologists, while video nasolaryngoscopy is markedly more frequent among otolaryngologists. In terms of therapeutic options, the most frequently reported strategy was lifestyle modifications followed by proton pump inhibitors. CONCLUSION Overall patients' profile and patterns of GERD diagnosis and management seem different between gastroenterologists, general practitioners, otolaryngologists, and cardiologists. Clinical guidelines should address this variability and include other medical specialties besides gastroenterologists in their scope.
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Affiliation(s)
- Decio Chinzon
- Universidade de São Paulo, Faculdade de Medicina, São Paulo, SP, Brasil
| | | | - Gerson Domingues
- Universidade Estadual do Rio de Janeiro, Faculdade de Medicina, Rio de Janeiro, RJ, Brasil
| | | | | | - Schlioma Zaterka
- Universidade de São Paulo, Faculdade de Medicina, São Paulo, SP, Brasil
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Pereira LB, Gonçalves AMRF, Fernandes CSE, Fontanella AT, Francisco PMSB, Mengue SS, Borges RB, Pizzol TDSD, Costa KS. Use of drugs for gastrointestinal disorders: evidence from National Survey on Access, Use and Promotion of Rational Use of Medicines. EINSTEIN-SAO PAULO 2020; 18:eAO5314. [PMID: 32785451 PMCID: PMC7416649 DOI: 10.31744/einstein_journal/2020ao5314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/12/2019] [Indexed: 11/10/2022] Open
Abstract
Objective To estimate the prevalence of use of drugs to treat gastrointestinal disorders, according to demographic, socioeconomic, and health characteristics of the Brazilian population. Methods This is a population-based survey that interviewed individuals residing in cities of the five regions in Brazil. The study sample was composed of 32,348 individuals aged 20 or more years. The profile of use of drugs for gastrointestinal disorders was evaluated considering the variables sex, age, healthcare plan, region, and number of chronic diseases. We also analyzed the frequency of individuals who declared using other drugs, besides those already employed for treatment of gastrointestinal disorders. Additionally, the estimated frequencies of the drug classes used were determined. Results The prevalence of use of drugs for gastrointestinal disorders in Brazil was 6.9% (95% confidence interval − 6.4-7.6), higher in females, among persons aged over 60 years, in those who had a private healthcare insurance, and presented with two or more chronic diseases. It was noted that 42.9% of the aged who used drugs for gastrointestinal disorders were also on polypharmacy. As to the classes of drugs, 82% corresponded to drugs for the food tract and metabolism, particularly proton pumps inhibitors. Conclusion The use of drugs for treatment of gastrointestinal disorders was significant among women and elderly. In this age group, consumption may be linked to gastric protection due to polypharmacy. This study is an unprecedented opportunity to observe the self-reported consumption profile of these drugs in Brazil and, therefore, could subsidize strategies to promote their rational use.
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Affiliation(s)
- Lucas Borges Pereira
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | - Andréia Turmina Fontanella
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Sotero Serrate Mengue
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rogério Boff Borges
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Tatiane da Silva Dal Pizzol
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Karen Sarmento Costa
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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de Oliveira FAB, Mazo DF. Direct access endoscopy in a Brazilian public healthcare facility: comparable results with specialist referred endoscopy. Scand J Gastroenterol 2020; 55:970-975. [PMID: 32619367 DOI: 10.1080/00365521.2020.1787500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Direct access endoscopy (DAE) is the procedure performed without the pre-evaluation of the patient by a specialist. It is widely available in many medical services around the world, but there is lack of data about this strategy in the setting of the public health system in Brazil. Therefore, the aim of this study is to compare the main endoscopic findings of upper gastrointestinal endoscopy requested through DAE and by specialists. METHODS Longitudinal, retrospective single center study in patients who underwent upper digestive endoscopy in a public healthcare facility at the southern region of the state of Mato Grosso, Brazil, from August 2011 to December 2018. Age, gender, modality of endoscopy request (DAE or endoscopy requested by specialists), and endoscopic findings were analyzed. RESULTS A total of 2810 patients were included. Most of them were female 65.23% (1833), mean age was 47.36 years, and 50.71% of the exams (1425) were DAE. Only 4.62% of the exams had normal reports. The most frequent endoscopic findings were gastritis (91.99%), bulboduodenitis (43.59%) and reflux esophagitis (14.76%). Patients who underwent endoscopy requested by specialists were older (50.25 ± 16.57 vs. 44.55 ± 16.31 years, p < .0001) and more frequently men (36.61 vs. 32.98%, p = .0437) in comparison to DAE. However, endoscopic findings were similar in both groups. CONCLUSION This study shows that direct access upper endoscopy had comparable results to specialist requested endoscopy in a public healthcare facility in the southern region of the state of Mato Grosso, Brazil.
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Affiliation(s)
- Fernando Augusto Borges de Oliveira
- School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.,Medicine Course, Institute of Exact and Natural Sciences (ICEN), Federal University of Rondonópolis (UFR), Rondonópolis, Brazil
| | - Daniel F Mazo
- Division of Gastroenterology (Gastrocentro), School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.,Division of Clinical Gastroenterology and Hepatology, Department of Gastroenterology, University of São Paulo School of Medicine (FMUSP), Sao Paulo, Brazil
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Zaterka S, Marion SB, Roveda F, Perrotti MA, Chinzon D. HISTORICAL PERSPECTIVE OF GASTROESOPHAGEAL REFLUX DISEASE CLINICAL TREATMENT. ARQUIVOS DE GASTROENTEROLOGIA 2019; 56:202-208. [PMID: 31460587 DOI: 10.1590/s0004-2803.201900000-41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal diseases. GERD generates significant impairment in patients' quality of life and it is associated to relevant medical resources utilization. A better understanding of GERD pathophysiology in the past five decades has favored the evolution of therapeutic strategies from non-drug interventions and antacids to more efficacious and safer alternatives. OBJECTIVE To summarize data about the historical evolution of GERD management in Brazil, focusing on medical therapy and addressing evidence on efficacy and safety of drug classes currently recommended. METHODS A narrative review was conducted by systematizing information about discoveries on GERD pathophysiology. We also addressed efficacy and safety of medications currently used to reduce symptoms and improve endoscopic healing of esophageal lesions. A structured search on Pubmed was performed to identify systematic reviews and meta-analysis investigating GERD outcomes positively impacted by proton pump inhibitors (PPIs), the first choice of pharmacotherapy for the disease. RESULTS The chronological development of therapeutic measures for GERD in Brazil evolved from lifestyle interventions with relative poor effect on symptoms related to esophageal acid exposure, particularly heartburn, to effective and safe pharmacological interventions such as histamine H2-receptor antagonists and PPIs. In the present days, some drug classes play a minor role in disease management, namely prokinetics and antacids, due to their reduced efficacy and relevant safety concerns (particularly with prokinetics). The main challenge for prescribers and researchers seems to be finding long-acting acid suppressants strategies able to ameliorate patients' symptoms and quality of life, thereafter, reducing medical resource consumption. The dual delayed-release PPI dexlansoprazole seems to respond for some of the limitations other PPIs have. CONCLUSION Recognizing the historical evolution of GERD management can help care providers to better understand therapeutic options for their patients, as well as focus on unmet needs that deserve further attention. PPIs are still the first choice therapy, with good evidence in favor of their efficacy, despite some safety concerns. However, as with any medical intervention, it is recommended to prescribe PPIs for patients with clear indication, using adequate dosing and monitoring for adverse events.
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Affiliation(s)
- Schlioma Zaterka
- Universidade de Campinas, Disciplina de Gastroenterologia, Campinas, SP, Brasil
| | | | - Fabiana Roveda
- Takeda Brasil Ringgold Standard Institution, São Paulo, SP, Brasil
| | | | - Decio Chinzon
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, São Paulo, SP, Brasil
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Eusebi LH, Ratnakumaran R, Yuan Y, Solaymani-Dodaran M, Bazzoli F, Ford AC. Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis. Gut 2018; 67:430-440. [PMID: 28232473 DOI: 10.1136/gutjnl-2016-313589] [Citation(s) in RCA: 312] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/26/2017] [Accepted: 01/27/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Gastro-oesophageal reflux symptoms are common in the community, but there has been no definitive systematic review and meta-analysis of data from all studies to estimate their global prevalence, or potential risk factors for them. DESIGN Medline, Embase and Embase Classic were searched (until September 2016) to identify population-based studies that reported the prevalence of gastro-oesophageal reflux symptoms in adults (≥15 years); gastro-oesophageal reflux was defined using symptom-based criteria or questionnaires. The prevalence was extracted for all studies, and according to the criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, OR and 95% CIs were calculated. RESULTS Of the 14 132 citations evaluated, 102 reported the prevalence of gastro-oesophageal reflux symptoms in 108 separate study populations, containing 460 984 subjects. Prevalence varied according to country (from 2.5% in China to 51.2% in Greece) and criteria used to define gastro-oesophageal reflux symptoms. When only studies using a weekly frequency of heart burn or regurgitation to define presence were considered, pooled prevalence was 13.3% (95% CI 12.0% to 14.6%). Prevalence was higher in subjects ≥50 years (OR 1.32; 95% CI 1.12 to 1.54), smokers (OR 1.26; 95% CI 1.04 to 1.52), non-steroidal anti-inflammatory drug (NSAID)/aspirin users (OR 1.44; 95% CI 1.10 to 1.88) and obese individuals (OR 1.73; 95% CI 1.46 to 2.06). CONCLUSIONS The prevalence of gastro-oesophageal reflux symptoms varied strikingly among countries, even when similar definitions were used to define their presence. Prevalence was significantly higher in subjects ≥50 years, smokers, NSAID users and obese individuals, although these associations were modest.
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Affiliation(s)
- Leonardo H Eusebi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,The Royal Free Hospital and University College London Institute for Liver and Digestive Health, London, UK
| | - Raguprakash Ratnakumaran
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.,Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
| | - Yuhong Yuan
- Division of Gastroenterology, Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | | | - Franco Bazzoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alexander C Ford
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.,Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
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Objective Evaluation of Gastroesophageal Reflux Disease in Patients with Paroxysmal Atrial Fibrillation. World J Surg 2017; 42:1458-1462. [DOI: 10.1007/s00268-017-4337-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Kim YS, Kim N, Kim GH. Sex and Gender Differences in Gastroesophageal Reflux Disease. J Neurogastroenterol Motil 2016; 22:575-588. [PMID: 27703114 PMCID: PMC5056567 DOI: 10.5056/jnm16138] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 12/13/2022] Open
Abstract
It is important to understand sex and gender-related differences in gastroesophageal reflux disease (GERD) because gender-related biologic factors might lead to better prevention and therapy. Non-erosive reflux disease (NERD) affects more women than men. GERD symptoms are more frequent in patients with NERD than in those with reflux esophagitis. However, men suffer pathologic diseases such as reflux esophagitis, Barrett’s esophagus (BE), and esophageal adenocarcinoma (EAC) more frequently than women. The prevalence of reflux esophagitis is significantly increased with age in women, especially after their 50s. The mean age of EAC incidence in women is higher than in men, suggesting a role of estrogen in delaying the onset of BE and EAC. In a chronic rat reflux esophagitis model, nitric oxide was found to be an aggravating factor of esophageal injury in a male-predominant way. In addition, the expression of esophageal occludin, a tight junction protein that plays an important role in the esophageal defense mechanism, was up-regulated in women. This explains the male predominance of reflux esophagitis and delayed incidence of BE or EAC in women. Moreover, the symptoms such as heartburn, regurgitation, and extra-esophageal symptoms have been more frequently reported by women than by men, suggesting that sex and gender play a role in symptom perception. Differential sensitivity with augmented symptoms in women might have diagnostic and therapeutic influence. Furthermore, recent studies have suggested that hormone replacement therapy has a protective effect against esophageal cancer. However, an anti-inflammatory role of estrogen remains compelling, which means further study is necessary in this area.
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Affiliation(s)
- Young Sun Kim
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Nayoung Kim
- Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
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Bashashati M, Sarosiek I, McCallum RW. Epidemiology and mechanisms of gastroesophageal reflux disease in the elderly: a perspective. Ann N Y Acad Sci 2016; 1380:230-234. [PMID: 27526197 DOI: 10.1111/nyas.13196] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/08/2016] [Accepted: 07/13/2016] [Indexed: 12/18/2022]
Abstract
Gastroesophageal reflux disease (GERD) seems to be more common in older individuals. Disturbed esophageal motility; anatomical disorders, such as hiatal hernia, increased obesity, defective mucosal integrity, and alteration in salivary secretion; and concomitant medications all attribute to the higher rate of GERD in the elderly. In this review, we discuss the underlying mechanisms that could explain this higher rate of GERD in the elderly.
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Affiliation(s)
- Mohammad Bashashati
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Irene Sarosiek
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Richard W McCallum
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas.
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Iliaz S, Iliaz R, Onur ST, Arici S, Akyuz U, Karaca C, Demir K, Besisik F, Kaymakoglu S, Akyuz F. Does gastroesophageal reflux increase chronic obstructive pulmonary disease exacerbations? Respir Med 2016; 115:20-5. [PMID: 27215499 DOI: 10.1016/j.rmed.2016.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/01/2016] [Accepted: 04/18/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The relationship between chronic obstructive pulmonary disease (COPD) exacerbations and gastroesophageal reflux (GER) has been investigated less than asthma-GER. We aimed to evaluate the presence of GER in patients with COPD and its impact on exacerbations. METHODS We included 24 patients with stable mild-moderate stage COPD and 19 volunteers as the control group. We conducted a gastroesophageal reflux disease (GERD) symptom questionnaire, gastroscopy, manometry, and an ambulatory 24-h pH-impedance study. RESULTS According to the GERD questionnaire, only 5 (20.8%) patients with COPD had typical GER symptoms. According to the 24-h pH-impedance study, the mean DeMeester score (DMS) was 38.1 ± 34.6 in the COPD group and 13.3 ± 16.8 in the control group (p = 0.01). The acid reflux (DMS > 14.7) rate was higher in patients with COPD than in controls (73.9% vs 26.3%, p = 0.01). The symptom association probability positivity rate was 17.4% (n = 4) in the COPD group, which was similar to the controls (p = 0.11). The mean proximal extension rate of reflux (Z 17 cm) was 26.4 ± 12.9% in the COPD group. The proximal extent of reflux was positively correlated with the number of COPD exacerbations per year (p = 0.03, r = 0.448). In the motility results, only 2 (20%) patients in the control group had a minor motility disorder. Seventeen (70.8%) patients in the COPD group had a minor motility disorder, and 4 (16.7%) had major motility disorders (p < 0.001). CONCLUSION In our study, gastroesophageal reflux was frequent in patients with COPD, but only a quarter had typical reflux symptoms. The proximal extent of reflux may trigger frequent exacerbations of COPD.
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Affiliation(s)
- Sinem Iliaz
- Koç University Hospital, Department of Pulmonology, Istanbul, Turkey.
| | - Raim Iliaz
- Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology, Istanbul, Turkey.
| | - Seda Tural Onur
- Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Department of Pulmonology, Istanbul, Turkey.
| | - Serpil Arici
- Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology, Istanbul, Turkey.
| | - Umit Akyuz
- Fatih Sultan Mehmet Educational and Research Center, Department of Gastroenterohepatology, Istanbul, Turkey.
| | - Cetin Karaca
- Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology, Istanbul, Turkey.
| | - Kadir Demir
- Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology, Istanbul, Turkey.
| | - Fatih Besisik
- Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology, Istanbul, Turkey.
| | - Sabahattin Kaymakoglu
- Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology, Istanbul, Turkey.
| | - Filiz Akyuz
- Istanbul University, Istanbul Medical Faculty, Department of Gastroenterohepatology, Istanbul, Turkey.
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