Investigation of the Relationship Between Laparoscopic Sleeve Gastrectomy and Gastroesophageal Reflux Disease Using 24-hour Multichannel Intraluminal Impedance With pH Testing According to Current Consensus

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) is a popular weight loss procedure with potential effects on gastroesophageal reflux disease (GERD). However, research on the association between LSG and GERD using objective evaluation criteria, such as multichannel intraluminal impedance combined with pH testing (MII-pH), is limited. This study aimed to investigate the impact of LSG on GERD using MII-pH and current consensus guidelines.

MATERIALS AND METHODS

It was conducted as a prospective clinical study on 33 patients who underwent LSG between January 2022 and August 2022. MII-pH and high-resolution manometry were performed preoperatively and 3 to 6 months postoperatively. GERD diagnosis was based on MII-pH results using the Lyon and Update Porto consensus guidelines.

RESULTS

Postoperative MII-pH analysis revealed a significant increase in acid reflux time, acid exposure time, reflux index, esophageal clearance, total reflux time, and longest reflux period. Weak acid reflux episodes decreased, while Demeester score and alkaline reflux showed nonsignificant increases. Pathologic reflux significantly increased postoperatively based on MII-pH diagnosis. High-resolution manometry showed a significant increase in unsuccessful motility.

CONCLUSION

Although the Demeester score calculation consists of 6 metrics, including acid exposure time, the acid exposure time is more specific in detecting pathologic reflux. Pathologic GERD increases significantly with LSG in the early period. Therefore, preoperative and postoperative endoscopy and MII-pH can provide valuable information regarding the need for closer follow-up after LSG.

Efficacy and Safety of Sofosbuvir and Ledipasvir for Hepatitis C in Kidney Transplant Recipients: A Single-center Retrospective Observational Study

Background

Treatment using direct-acting antivirals provides high rates of sustained virologic response and a favorable safety profile for patients with chronic hepatitis C virus infection. However, data on the efficacy of direct-acting antivirals in kidney transplant recipients are still limited.

Aims

We evaluated the safety and efficacy of fixed-dose sofosbuvir/ledipasvir combination in kidney transplant recipients.

Study Design

Retrospective, observational, single-center study.

Methods

Data of 29 kidney transplant recipients who received a fixed-dose safety and efficacy of fixed-dose sofosbuvir/ledipasvir combination for 12 or 24 weeks with or without ribavirin were analyzed. The primary outcome was SVR12, which was defined as undetectable HCV-RNA levels 12 weeks after the treatment. Secondary outcomes were graft function, proteinuria, and calcineurin inhibitor trough level variability.

Results

The predominant hepatitis C virus genotype was 1b (n = 19, 65.6%). All patients achieved SVR12. No graft failures nor deaths were reported during the study period. Throughout and after the treatment, the levels of aspartate aminotransferase [21 (range: 18-29.5) to 16 (range: 14-20) U/l, p < 0.001] and alanine aminotransferase [22 (range: 15-34) to 14 (range: 12-17.5) U/l, p < 0.001] improved significantly, unlike bilirubin, hemoglobin, and platelet levels. Renal function remained stable. Dose adjustments for calcineurin inhibitors were required. Serious adverse events were not observed.

Conclusion

Safety and efficacy of fixed-dose sofosbuvir/ledipasvir combination was effective and safe in kidney transplant recipients with hepatitis C virus. However, cautious monitoring of trough levels of calcineurin inhibitorss is needed due to potential drug-drug interactions during the treatment episode.

Small Bowel Video Capsule Endoscopy Guidance in Practice: Expert Opinion Report

Capsule endoscopy, in clinical use since the 2000s, has disrupted the diagnosis of various small bowel diseases, especially obscuregastrointestinal bleeding. An overview of information on indications, contraindications, patient management, and patient preparationfor capsule endoscopy, which allows the evaluation of the entire gastrointestinal tract, will be helpful for both referrers and capsuleendoscopy. This review critically considers current evidence on the optimal clinical use of capsule endoscopy and addresses areas in the "gray zone."

What is the effect of subepithelial lesions of the esophagus on esophageal motility?

OBJECTIVE

Esophageal motility is regulated both by coordinated stimulation and inhibition of the circular and longitudinal muscle layers of the esophagus. Although there are many diseases known to have an effect on esophageal motility, the effect of subepithelial lesions (SELs) of the esophagus on esophageal motility, which is often detected incidentally, remains still unclear. The aim of this study is to reveal the effect of SELs of the esophagus on esophageal motility evaluating it by high-resolution manometry (HRM).

PATIENTS AND METHODS

A total of 32 patients with SELs in the esophagus and 12 healthy individuals were included. All patients and controls included in the study underwent HRM using a Unisensor UniTip High Resolution catheter (Laborie, Amsterdam, Netherlands) and endosonographic examination.

RESULTS

The mean age was 52.60±15.56 years (range: 23-79) and the average body mass index (BMI) was 26.63±4.71 kg/m2. Gender, height, weight, and BMI measurements, smoking status, alcohol use, and DM status did not statistically differ significantly between the groups (p>0.05). Of 32 patients with SELs, 65.6% (n=21) had lesions originating in the muscularis propria, while 34.4% had lesions originating in the submucosa. The rate of abnormal motility both in the supine and in upright positions of patients with SELs was found to be significantly higher than in the control group (p=0.001, p<0.01, respectively). In patients with SELs, the incidence of infective motility was higher than the normal group (p=0.001, p<0.01, respectively). As the size of the lesion increases (>2 cm), the probability of abnormal HRM results increased.

CONCLUSIONS

SELs of the esophagus have pathological effects on esophageal motility, mainly ineffective esophageal motility disorder.

Is anterior segment OCT superior to slit-lamp biomicroscopic examination for Kayser Flesicher ring in Wilson's disease?

OBJECTIVE

Detection of the Kayser-Fleischer (KF) ring in the diagnostic scoring and treatment follow-up of Wilson's Disease (WD) is important. Slit lamp (SL) biomicroscopic examination has traditionally been used in the evaluation of the KF ring. The role of Anterior Segment Optical Coherence Tomography (AS-OCT), which is used in various corneal diseases, in the detection of KF rings has attracted attention in recent years. In our study, we tried to demonstrate the effectiveness of AS-OCT in detecting the KF ring by comparing it with SL biomicroscopic examination.

PATIENTS AND METHODS

64 of 356 patients followed in our outpatient clinic due to WD were included in the study in the order of their admission to the outpatient clinic. The KF ring was evaluated in both eyes by SL-biomicroscopic examination and AS-OCT. Ophthalmic examination, and findings were performed by the same physician.

RESULTS

Age range was 18-67 years, mean 33.06±10.83 years, gender was 39.1% (n: 25) female. At the time of diagnosis, the mean age was 19.48 ± 9.36 years, range was minimum 5 years and maximum 51 years. Clinical presentation was mixed type involvement n: 18 (28.1%), hepatic involvement n: 32 (50%), neurological involvement n: 14 (21.9%). The follow-up period was 2-257 months (74.6±76.16). The presence of KF ring was evaluated together with both AS-OCT and slit-lamp examination, the presence of KF could be detected in both AS-OCT and SL biomicroscopic examination in 10 patients (15.6%), in 12 (18.8%) of the cases KF ring is positive in AS-OCT but was negative in Slit-lamp biomicroscopic examination, in 65.6 (n: 42) of the cases OCT and slit-lamp biomicroscopic examination results were negative.

CONCLUSIONS

The sensitivity of AS-OCT in detecting the KF ring was higher than the slit-lamp biomicroscopic examination. AS-OCT can detect early stage of KF rings in Wilson's Disease patients, so that diagnosis and treatment accuracy can be evaluated effectively.

What is the clinical impact of occult HBV infections and anti-HBc positivity in patients with chronic hepatitis C?

Occult hepatitis B infection (OBI) is defined by the persistence of the hepatitis B virus (HBV) genome in the liver of individuals testing negative for hepatitis B surface antigen (HBsAg). Hepatitis B core antibody (anti-HBc) is the serological marker that indicates HBV exposure. The impact of anti-HBc and OBI on patients with chronic hepatitis C remains unclear. The aim of the present study was to determine the prevalence of anti-HBc and OBI and to evaluate their impact on the clinical and pathological outcomes of patients with chronic hepatitis C. The study included 59 HBsAg-negative chronic hepatitis C patients who underwent a liver parenchymal biopsy. The presence of HBV DNA was investigated using an in-house nested PCR method. OBI was detected in 16 (27.1%) of the 59 cases and also in 10 (62.5%) of 22 (37.3%) anti-HBc-positive patients. None of the patients had positive serum HBV DNA. OBI was associated with the presence of anti-HBV antibodies (p<0.05). There was also an association between anti-HBc positivity and the activity grades and fibrosis stages of the liver and also a prevalence of liver steatosis (p<0.05). Positive anti-HBc results may predict OBI and also be associated with the progression of liver injury in HBsAg-negative patients with chronic hepatitis C. Therefore, it is suggested that patients with chronic hepatitis C should be screened for anti-HBc positivity, and anti-HBc-positive patients should be carefully evaluated for disease progression. This article is protected by copyright. All rights reserved.

Cyclosporine Therapy as a Rescue Treatment in Steroid Refractory Acute Severe Ulcerative Colitis: A Real Life Data From a Tertiary Center

BACKGROUND

Cyclosporine is a rescue treatment alternative to avoid colectomy in corticosteroid refractory acute severe ulcerative colitis. In this study, we aimed to evaluate the long-term efficacy and safety of cyclosporine therapy in acute severe ulcerative colitis patients.

METHODS

Acute severe ulcerative colitis (basal Lichtiger score > 10) patients who did not respond to 40 mg intravenous methylpredniso- lone therapy after 3-5 days were included in the study. The presence of clinical response and remission was assessed at 1st week, 1st, 6th, and 12th month according to the Lichtiger index.

RESULTS

In this study, 40 patients, whose steroid refractory acute severe ulcerative colitis and basal Lichtiger score > 10 points were enrolled. The median disease duration was 49.3 months (2-204). All patients received cyclosporine for 132 ± 78 days (7-270). Clinical response was obtained on seventh day in 82.5%. The clinical response rates of the first and sixth months were 72.5% and 62.5%, respectively. A total of 17/40 (42.5%) patients underwent colectomy within 1 year. In the patients who underwent colectomy, the basal LS (14.2 ± 1.9 vs 12.3 ± 1.7) (P = .002) was higher and the basal hemoglobin value (11.8 ± 2.3 vs 10.1 ± 1.5) (P = .037) was lower than those who did not undergo colectomy.

CONCLUSION

Our findings suggest that cyclosporine treatment may be successfully and safely used in steroid refractory acute severe ulcerative colitis patients. Cyclosporine is a drug that has recently started to come up again with the introduction of new maintenance treatments. Especially in patients who develop a loss of response to infliximab therapy, or where infliximab therapy is contraindicated, or who have azathioprine intolerance, or are unresponsive.

POS1360 TRANSIENT ELASTOGRAPHY (FIBROSCAN); AS A NEW NON-INVASIVE DIAGNOSTIC METHOD FOR DETECTING HEPATIC INVOLVEMENT OF AMYLOIDOSIS

Background

Demonstration of deposits by non-invasive methods is important especially for organs difficult to sample in amyloidosis. Transient elastography (fibroscan) is a diagnostic method being used to measure liver stiffness (LS) in different chronic liver diseases.

Objectives

We herein aimed to test the place of fibroscan method for detecting increased LS associated with amyloid deposition in patients (pts) with amyloidosis.

Methods

Six categories of pts enrolled into this cross-sectional study; AA amyloidosis (AA-a), AL amyloidosis (AL-a), Familial Mediterranean Fever (FMF) pts without amyloidosis, cirrhotic chronic liver disease, non-cirrhotic chronic hepatitis B infection (CHB) and healthy controls (HC). LS assessment by fibroscan were categorized as normal for kPa<7, significant stiffness for kPa≥7, advanced stiffness for kPa≥9.5 and kPa≥F4 stiffness. FIB-4 and APRI scores were calculated for each patient when they indicated chronic liver disease. Pts with known chronic liver disease and viral hepatitis excluded from amyloidosis and FMF groups.

Results

A total of 165 pts (AA-a, n=65; AL-a, n=15; FMF, n=20; cirrhotic pts, n=16; CHB, n=22; HC, n=27) constituted the study group. Average age was higher in the AL-a group compared to others. Median LS was highest in cirrhotic pts, and it was also higher in AA-a and AL-a pts compared to FMF and HC. Median LS was numerically higher in AL-a compared to AA-a, but it did not reach statistical significance. Median LS was also higher in FMF pts compared to HC. FIB-4 and APRI scores were lower compared to cirrhotic patients in AA-a and AL-a. ALP levels were higher in AA-a and AL-a groups compared to FMF, CHB and HC. FIB-4 and APRI scores, ALP and GGT levels were correlated with LS both in AA-a (r=0.534***,r=0.485***,r=0.437***, r=0.506***) and, AL-a (r=0.536*, 0.579*, r=0.645*, r=0.752**) and FMF-AA (r=0.584***, r=0.566***,r=0.322*, r=0.306*; *p<0.001, **p<0.01, *p<0.5) groups.

Higher patient age, age at diagnosis of amylodosis, FIB-4 and LS scores, ALP levels, non-FMF causes of AA were associated with hepatic AA amyloid involvement in biopsy-proven pts. A cut-off value 12.05 kPa of LS provided 100% sensitivity and 85.5% specificity (LR=6.9, AUC=0.901, 95% CI 0.81-0.99) for pts with AA-a.

Conclusion

In our single center cohort, we showed a higher median LS by fibroscan in both AL-a and AA-a pts compared to CHB, FMF and HC. It was thought to be that fibroscan may be useful in detecting hepatic amyloid involvement.

Table 1.AA-a (n=65)FMF (n=20)AL-a (n=15)Cirrhosis (n=16)Chronic Hepatitis B (non-cirrhotic) (n=22)HC (n=27)p1p2p3p4p5p6Age (years)*46 (19)42.5(13)58 (16)49 (15)45 (21)45 (23)0.40.30.80.50.80.002Gender (n, %)Male38 (59)10 (50)6 (40)10 (62.5)13 (59)17 (55)0.50.810.70.70.2Female27 (41.5)10 (50)9 (60)6 (37.5)9 (40.9)14 (45.2)Diabetes Mellitus (n, %)5 (8)2 (11)2 (13)3 (15)2 (13)3 (10)0.70.60.40.80.90.6Body Mass Index (kg/m2) *25.7 (1.4)25.6 (5.4)24.8 (3.6)26.7 (6.7)25.5 (7)26 (5.7)0.90.410.70.70.3Liver stiffness (kPa)*6.7 (5.6)6.45 (2.7)9.8 (12)26.7 (22)5.7 (5)4.9 (1.6)<0.001<0.0010.03<0.001<0.0010.16Significant stiffness (kPa≥7)31 (48)11 (55)8 (58)16 (100)4 (18)2 (6.5)0.4<0.0010.012<0.001<0.0010.6Advanced stiffness (kPa≥9.5)17 (26)4 (20)7 (50)16 (100)3 (14)00.4<0.0010.20.0010.020.1S4 stiffness (kPa≥12.5)10 (15)05 (36)16 (100)2 (9)00.057<0.0010.40.020.1FIB-4 score0.97 (0.9)0.76 (0.56)1.3 (0.95)2.5 (3.4)0.85 (0.8)0.7 (0.5)<0.001<0.0010.40.0050.60.1APRI score*0.25 (0.2)0.26 (0.2)0.24 (0.2)0.77 (1.3)0.22 (0.2)0.16 (0.08)<0.001<0.0010.30.0020.020.4ALP (U/L)*97 (65)79 (55)103 (54)79 (126)76 (39)67 (22)<0.0010.50.002<0.0010.0020.7GGT (U/L)*18 (18)17 (26)24 (61)24 (51)16 (14)14 (14)0.070.20.20.070.20.08

p1: AA-a and FMF

p2: AA-a and cirrhosis

p3: AA-a and chronic liver disease

p4: AA-a and HC

p5: FMF and HC

p6: AA-a and AL-a

*Median, interquartile of range

Disclosure of Interests

None declared

POS1359 TRANSIENT ELASTOGRAPHY (FIBROSCAN) AS A NON-INVASIVE METHOD FOR DETECTING AMYLOID DEPOSITION IN TRANSPLANTED KIDNEYS IN PATIENTS WITH AA AMYLOIDOSIS

Background

Amyloidosis is characterized by accumulation of insoluble fibrils composed of different monomers in extracellular spaces of different organs, and demonstration of deposits by non-invasive methods is important especially for organs difficult to sample. Transient elastography (Fibroscan) is a diagnostic method of measuring liver stiffness (LS) being used in chronic liver diseases.

Objectives

We herein aimed to search potential of fibroscan detecting kidney stiffness (KS) associated with amyloid deposition in patients with AA who received kidney transplants.

Methods

Renal transplant recipients (RTR) because of AA amyloidosis-related kidney failure (amyloidosis group; AG) and RTR due to other underlying diseases (control group; CG) enrolled into this study. KS and LS were measured by the same physician blinded to diagnosis. The stiffness results were expressed in kilopascals (kPa). Local ethics committee approval and patient consents were obtained.

Results

Nineteen AG and 16 CG patients included into the study. Patient age (p=0.4), gender (p=1), body mass index (BMI) (p=0.4), donor type (p=0.2), donor age (p=0.3), frequency of rejection history (p=0.4) and graft loss (p=0.2) did not show significant difference between two groups. Frequency of diabetes mellitus (DM) (p=0.01), median creatinine (p=0.015) and proteinuria (p<0.001) were higher in AG group than CG. Although median KS was higher in CG group (19.8 [IQR:34] vs 15.8 [IQR:16]), the difference was not significant (p=0.5). Baseline clinical and laboratory features were similar in AG patients with recurrent-amyloidosis (n=6) and non-recurrent AG patients (n=13). Median KS score was higher in recurrent compared to non-recurrent AG patients (p< 0.001). However median LS did not differ between two groups (p=0.4). In multivariate analysis only KS was associated with renal recurrence of AA (p=0.031; OR=1.18, 95% CI 1.015-1.362). In ROC analysis, a cut-off value of 24.55 kPa provided 83.3% sensitivity and 92.3% specificity (LR=10.8, AUC=0.936, p=0.003). Median KS was higher in patients with a history of rejection both among the patients with AG and CG, but the difference was not significant. Additionally, LS scores were similar between two groups.

In FMF-associated AA, median KS was higher in patients with one MEFV variant compared to those with two variants and tended to be higher in other MEFV variants compared to M694V homozygotes (p=0.027 and p=0.08, respectively). There was no correlation between the patient age, disease duration, duration of renal transplantation, donor age, BMI, LS, creatinine, CRP, proteinuria, and KS both in patients with AG and CG.

Table 1.

Comparison of clinical and laboratory features between patients had amyloidosis recurrence and not

VariablesTotalRecurrence -Recurrence +p valueAge (years)*48 (22)47 (17)50 (27)1Gender, maleƗ13 (68.4)9 (69.2)4 (66.7)1Duration of amyloidosis (months)*206 (89)220 (99)163 (203)0.08Diagnosis age of amyloidosis (years)*28 (17)27.5 (17)28 (20)1Duration of renal transplantation (months)*145 (137)144 (110)123 (50)0.7Kidney stiffness (kPa)*15.8 (15.8)10.9 (7.7)29.3 (18.9)<0.001Liver stiffness (kPa)*5.45 (2.8)5.4 (2.7)5.9 (8.9)0.4RejectionƗ(n, %)3 (15.8)2 (15.4)1 (16.7)1Creatinine (mg/dL)*1.4 (0.6)1.4 (0.7)1.7 (0.5)0.24CRP (mg/L)*2.7 (4.4)1.3 (4.1)3.5 (13.9)0.3ProteinuriaƗ3 (15.8)1 (7.7)2 (33.3)0.2Proteinuria (g/day)*0.4 (1.2)0.4

*median; IQR Ɨ n, %

Conclusion

Median KS scores were similar between AG and CG groups; however it was higher in AG patients with recurrent kidney amyloidosis than those without recurrent disease, which may support using the fibroscan method as a useful screening method for establishing AA recurrence. Additionally, higher KS scores in patients with one MEFV variant compared to those with two variants need further studies to be able to identify other yet unidentified amyloidogenic factors.

Disclosure of Interests

None declared

Is there any predictor for relapse after treatment withdrawal in autoimmune hepatitis patients in the real life?

Backgrounds and Aims

In autoimmune hepatitis, there are uncertainties about whether to discontinue the treatment, when the treatment should be discontinued, and the risks of relapse in the cases where remission is achieved with immunosuppressive therapy. In this study, patients with AIH, whose immunosuppressive treatments were discontinued, were evaluated for the rates of remission and the risk of relapse.

Materials and Methods

A total of 119 patients, who were diagnosed with AIH based on the AIHG scoring systems between 1990 and 2015, were evaluated. Patients were receiving standard azathioprine and steroid therapy. The treatment was discontinued in patients, who had been receiving treatment for at least 2 years, who had no clinical complaints, and whose aminotransferases were normal and when an increase occurred in AST values more than two times the normal after the treatment was interrupted, the case was considered as a relapse.

Results

Among the patients, 83%(n = 99) were women. When the patients were diagnosed with AIH, their mean age was 36 ± 16(8–79) years; 70.6%(n = 84) were type 1, 3.4%(n = 4) type 2, and 26%(n = 31) were autoantibody-negative AIH. At the time of discontinuation, liver biopsy was performed in 8 of the patients and minimal-mild abnormalities were detected. Patients whose treatment was discontinued received treatment for an average of 101 ± 75(range: 24–280, median: 68.5) months; and, they were followed up for an average of 19 (1–110) months during the period without medication. Relapse occurred in 67%(n = 12) of the patients with drug withdrawal. Relapse occurred within the first 12 months in 67% of these patients (n = 8) and developed with an acute hepatitis attack in 42%. None of the clinical, laboratory, and histological data were found to be effective on relapse.

Conclusion

In patients with AIH, relapse occurs in two-thirds of patients within an average of 19 month after the discontinuation of the medication. Most relapses occur at the early period and they are accompanied by an acute hepatitis attack.

Metastases to the Stomach: Clinicopathologic Features of Metastases Mimicking Gastric Primaries

OBJECTIVE

Metastatic involvement of the stomach is a rare event. Our aim in this study was to document the clinicopathological findings in patients with gastric metastases and find out if there are any potentially significant features to be used in the differential diagnosis.

MATERIAL AND METHOD

Our cohort consisted of 17 histologically verified gastric metastasis cases. Clinical, endoscopic and microscopic features were retrospectively analyzed.

RESULTS

The primary sites were the breast, skin, lungs, ovaries, colon, and gluteal soft tissue. Three patients were symptomatic because of the metastatic involvement of the stomach and 9 patients had concomitant metastasis in other sites. Invasive lobular breast carcinoma and malignant melanoma were the most common metastatic malignancies. The most common macroscopic appearance was the diffuse infiltrative type (Borrmann Type 4). Most of the metastatic lesions endoscopically mimicked primary gastric cancer. Furthermore, some of the metastatic lesions, particularly invasive lobular carcinoma of the breast and malignant melanoma, displayed histopathologic features similar to the primary gastric malignancies to a certain extent.

CONCLUSION

The possibility of metastatic involvement of stomach must be kept in mind while dealing with a gastric mass lesion in a cancer patient, even though the clinical and endoscopic features suggest primary gastric cancer. Our study points out the importance of conveying the information about medical history and clinical findings of the patients for correct pathologic differential diagnosis.

What is the effective clinical use of small bowel capsule endoscopy in real life?

Capsule endoscopy is a noninvasive and easy method for evaluating the gastrointestinal tract. Since the wireless capsule endoscopy system was first developed, many new technical improvements have been made in order to gain maximum benefit from the procedure. However, at this stage, it remains a diagnostic modality, the main indication for its use being obscure gastrointestinal bleeding. Capsule endoscopy is only contraindicated in symptomatic intestinal obstruction. New indications for use and therapeutic options may become possible with the further development of nanotechnologies.

Assessment of prognostic and diagnostic value of some biomarkers in hepatocellular carcinoma

BACKGROUND

Hepatocellular carcinoma (HCC) is an increasing problem worldwide. Determining a prognosis is important for the management of HCC.

AIM

We aimed to investigate the impact of interleukin (IL)-29, galectin-3, leptin, fibronectin and protease-activated receptor-1 on the prognosis and diagnosis of patients with HCC.

MATERIALS AND METHODS

60 HCC patients (75% male) and 20 healthy volunteers (70% male) were enrolled in this prospective study. Serum samples were obtained during the first admission before any adjuvant or metastatic treatments were administered. Serum biomarkers were determined using ELISA kits.

RESULTS

All patients had cirrhosis, and the Child - Pugh stages were as follows: 61.5% Child - Pugh A, 35.9% Child - Pugh B and 2.6% Child - Pugh C (61.7% hepatitis B virus, 11.7% hepatitis C virus, 6.7% hepatitis B virus + hepatitis C virus, 11.7% alcoholic and 8.3% cryptogenic). Fifty-three percent of the HCC patients died within a median of 7.5 months. The mean serum level of IL-29 in patients with HCC was higher than that in the control group (32.55 pg/ml vs 11.46 pg/ml, p < 0.015). Galectin-3 levels were significantly higher in the HCC group (6.7 ng/ml vs 1.38 ng/ml, p < 0.001). Fibronectin levels were higher in the control group than in the HCC group (260 635 ng/ml vs 257 353 ng/ml). However, the mean protease-activated receptor-1 and leptin levels were similar between the two groups (p > 0.05). The biomarkers were divided into two groups according to their median level. In the log rank analysis, biomarkers had no effect on survival (p > 0.05).

CONCLUSIONS

IL-29 and galectin-3 levels were significantly higher in HCC patients. Although IL-29 and galectin-3 can be used as diagnostic markers for HCC, they had no prognostic value in HCC patients.

Cryptogenic liver cirrhosis and hepatitis E virus (HEV): Are they related?

INTRODUCTION AND OBJECTIVES

Hepatitis E virus (HEV) is one of the most common causes of acute hepatitis. In recent years, its role in the development of chronic hepatitis and cirrhosis especially in immunosuppressed patients and its wide range of extrahepatic involvement have increased the amount of research on HEV. In this study we aimed to investigate the presence of HEV infection in individuals with cryptogenic cirrhosis.

MATERIALS AND METHODS

HEV antibodies were analysed using the Anti HEV enzyme-linked immunosorbent assay (ELISA) kit (anti-HEV ELISA; Diapro Prodiagnostic Bioprobes, Milan, Italy). HEV RNA was isolated with using QIAMP Viral RNA mini kit (QIAGEN, Hilden, Germany). The HEV RNA titre was detected with the Rotor Gene 3000 real time polymerase chain reaction (PCR) system using GenoSen's HEV (Rotor Gene) Quantitative Real Time PCR Kit (Genome Diagnostics Private Limited, the Netherlands).

RESULTS

Our study included 21 healthy volunteers (12 males) and 35 cryptogenic cirrhosis patients (19 males). The ages of the patients and the controls were similar (46±12.1 vs. 37.5±9.7years). The mean Child-Pugh score was 8±2.5. The anti HEV immunoglobulin G(IgG) positivity rate was 9.5% and 25.7% in the control and patient groups respectively (p>0.05). HEV RNA positivity was not detected in the control group, but 3 cases (8.6%) in the patient group were positive (p>0.05). The HEV RNA, aspartate aminotransferase (AST) and alanine aminotransferase(ALT) levels for these 3 cases were 326.461copies/mL, 91IU/L and 67IU/L; 480copies/mL, 68IU/L and 36IU/L and 72copies/mL, 42IU/L and 24IU/L respectively. There were positive correlations between HEV RNA levels and AST and ALT levels (p<0.05).

CONCLUSIONS

Anti HEVIgG and HEV RNA positivity rates are high in cryptogenic cirrhosis although it is not statistically significant and there is a positive correlation between HEV RNA and aminotransferases.

Brucellosis as the Cause of Non-Viral Bacterial Hepatitis: A Case Report

BACKGROUND

Brucellosis can lead to different clinical pictures such as hepatomegaly, granulomatous liver disease, hepatic abscess, and it can cause mild hepatic transaminase elevation in the laboratory investigations.

CASE REPORT

We found out that the etiologic agent was Brucella in our two cases admitted with acute hepatitis presentation in the investigations conducted. Liver transaminases were as follows for case 1 and case 2; AST: 306/187U/L, ALT: 368/312U/L, ALP: 355/264U/L, GGT: 116/197U/L, LDH: 887/549U/L, respectively. Sacroiliitis also accompanied the clinical picture in our first case. Our patients showed clinical and laboratory improvement with rifampicin, doxycycline, (additional streptomycin for 21 days in the patient with sacroiliitis) treatment.

CONCLUSION

Brucellosis which may manifest as a clinical picture regarding numerous medical branches should be considered in case of acute hepatitis, especially in endemic regions, along with viral hepatitis.

Microscopic colitis in patients with Takayasu's arteritis: a potential association between the two disease entities

The association of Takayasu's arteritis (TAK) and inflammatory bowel disease (IBD) has previously been reported in case series. Microscopic colitis (MC) has IBD-like symptoms with regard to clinical and histopathological feature. We aim to assess the presence of MC in TAK patients in this study. We cross-sectionally assessed TAK patients, between the ages of 18-65 years, who were diagnosed according to the American College of Rheumatology (ACR) criteria. Disease activity was evaluated by Kerr's criteria. Age- and sex-matched irritable bowel syndrome (IBS) patients were selected as control group. All patients and controls have been interviewed for IBD and IBS symptoms using the questionnaires of WHO guideline and Rome III criteria, respectively. Lower endoscopic procedure was performed with at least five random biopsies taken from different colonic segments and the terminal ileum. A blinded expert pathologist evaluated the specimens for the features of MC. Thirty TAK patients (29 females and 1 male) with the mean age of 35 ± 11 years (range, 20-59 years) and 15 IBS controls with the mean age of 38 ± 13 years were included in the study. TAK patients all fulfilled the MC criteria (three "complete" and six "incomplete" cases). MC was found to be significantly higher in active TAK patients in comparison to inactive group (67 vs 14 %, p = 0.03, OR = 7.9). Our results show that there is an increased frequency of MC in TAK patients, and this is the first report on the association of TAK and MC.