1
|
Yaras S, Demir M, Barutcu S, Yildirim AE, Gurel S, Ucbilek E, Kurtulmus IA, Kayhan MA, Vatansever S, Adanir H, Danis N, Duman S, Turan I, Ari D, Kose S, Alkim H, Harputluoglu MM, Dilber F, Akyildiz M, Cosar AM, Durak S, Sirin G, Kefeli A, Gokcan H, Avcioglu U, Ayyildiz T, Sezgin O, Akarsu M, Dincer D, Guzelbulut F, Gunsar F, Akarca US, Idilman R. The efficacy and tolerability of glecaprevir/pibrentasvir treatment in a real-world chronic hepatitis C patients cohort. Hepatol Forum 2023; 4:92-96. [PMID: 37822314 PMCID: PMC10564251 DOI: 10.14744/hf.2023.2023.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 10/13/2023]
Abstract
Background and Aim The aims of the present study were to evaluate the real-life efficacy and tolerability of glecaprevir (GLE)/pibrentasvir (PIB) in the treatment of patients with chronic hepatitis C (CHC). Materials and Methods Between May 2019 and May 2022, 686 patients with CHC, treated with GLE/PIB combination from 21 participating centers in Turkiye, were enrolled in the study. Results All patients were Caucasian, and their median age was 56 years. At the start of GLE/PIB treatment, the median serum Hepatitis C virus RNA and serum alanine amino transaminase (ALT) levels were 6.74 log10 IU/mL and 47 U/L, respectively. Fifty-three percent of the patients were infected with genotype 1b, followed by genotype 3 (17%). Diabetes was the more common concomitant disease. The sustained virological response (SVR12) was 91.4% with intent-to-treat analysis and 98.5% with per protocol analysis. The SVR12 rates were statistically significant differences between the patients who were i.v. drug users and non-user (88.0% vs. 98.8%, p=0.025). From the baseline to SVR12, the serum ALT levels and Model for End-Stage Liver Disease score were significantly improved (p<0.001 and p=0.014, respectively). No severe adverse effect was observed. Conclusion GLE/PIB is an effective and tolerable treatment in patients with CHC.
Collapse
Affiliation(s)
- Serkan Yaras
- Department of Gastroenterology, Mersin University, School of Medicine, Mersin, Turkiye
| | - Mehmet Demir
- Department of Gastroenterology, Mustafa Kemal University, School of Medicine, Hatay, Turkiye
| | - Sezgin Barutcu
- Department of Medical Sciences, Gaziantep University, School of Medicine, Gaziantep, Turkiye
| | | | - Selim Gurel
- Department of Internal Medicine, Uludag University, School of Medicine, Bursa, Turkiye
| | - Enver Ucbilek
- Department of Gastroenterology, Mersin University, School of Medicine, Mersin, Turkiye
| | | | - Meral Akdogan Kayhan
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Health Sciences, Ankara City Hospital, Ankara, Turkiye
| | - Sezgin Vatansever
- Department of Gastroenterology, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkiye
| | - Haydar Adanir
- Department of Internal Medicine, Akdeniz University, School of Medicine, Antalya, Turkiye
| | - Nilay Danis
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, USA
| | - Serkan Duman
- Department of Gastroenterology, Toros State Hospital, Mersin, Turkiye
| | - Ilker Turan
- Department of Gastroenterology, Ege University, School of Medicine, Izmir, Turkiye
| | - Derya Ari
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Health Sciences, Ankara City Hospital, Ankara, Turkiye
| | - Sukran Kose
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylul University, School of Medicine, Izmir, Turkiye
| | - Huseyin Alkim
- Department of Gastroenterology, Sisli Etfal Training and Research Hospital, Istanbul, Turkiye
| | | | - Feyza Dilber
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkiye
| | - Murat Akyildiz
- Department of Gastroenterology, Koc University, School of Medicine, Istanbul, Turkiye
| | - Arif Mansur Cosar
- Department of Gastroenterology, Karadeniz Technical University, School of Medicine, Trabzon, Turkiye
| | - Serdar Durak
- Department of Gastroenterology, Karadeniz Technical University, School of Medicine, Trabzon, Turkiye
| | - Goktug Sirin
- Department of Gastroenterology, Kocaeli University, School of Medicine, Kocaeli, Turkiye
| | - Ayse Kefeli
- Department of Gastroenterology, Tokat Gaziosmanpasa University, School of Medicine, Tokat, Turkiye
| | - Hale Gokcan
- Department of Gastroenterology, Ankara University, School of Medicine, Ankara, Turkiye
| | - Ufuk Avcioglu
- Department of Gastroenterology, Ondokuz Mayis University, School of Medicine, Samsun, Turkiye
| | - Talat Ayyildiz
- Department of Gastroenterology, Ondokuz Mayis University, School of Medicine, Samsun, Turkiye
| | - Orhan Sezgin
- Department of Gastroenterology, Mersin University, School of Medicine, Mersin, Turkiye
| | - Mesut Akarsu
- Department of Gastroenterology, Dokuz Eylul, School of Medicine, Izmir, Turkiye
| | - Dinc Dincer
- Department of Gastroenterology, Akdeniz University, School of Medicine, Antalya, Turkiye
| | - Fatih Guzelbulut
- Departments of Gastroenterology and Pathology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkiye
| | - Fulya Gunsar
- Department of Gastroenterology, Ege University, School of Medicine, Izmir, Turkiye
| | - Ulus Salih Akarca
- Department of Gastroenterology, Ege University, School of Medicine, Izmir, Turkiye
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University, School of Medicine, Ankara, Turkiye
| |
Collapse
|
2
|
Dilbaz N, Kuloğlu M, Evren EC, Paltun SC, Bilici R, Noyan CO, Kulaksizoglu B, Karabulut V, Umut G, Unubol B, Ucbilek E. HCV Genotype Distribution Among People Who Inject Drug in Turkey: Findings from Multicenter and Cross-Sectional Study. Subst Abuse 2023; 17:11782218231157340. [PMID: 36865052 PMCID: PMC9972049 DOI: 10.1177/11782218231157340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/29/2023] [Indexed: 03/03/2023]
Abstract
Background Hepatitis C virus (HCV) infection is very common in people who inject drugs (PWID). Studies about the prevalence and genotype distribution of the HCV among PWID are very crucial for developing strategies to manage HCV infection. This study's objective is to map the distribution of HCV genotypes among PWID from various regions of Turkey. Method This prospective, multicenter, cross-sectional study involved 197 PWID who tested positive for anti-HCV antibodies from 4 different addiction treatment facilities in Turkey. Interviews were done with people who had anti-HCV antibodies, and blood samples were taken to check the HCV RNA viremia load and genotyping. Results This study was conducted on 197 individuals with a mean age of 30.3 ± 8.6 years. 9.1% (136/197 patients) had a detectable HCV-RNA viral load. Genotype 3 was the most commonly observed genotype by 44.1%, followed by genotype 1a by 41.9%, genotype 2 by 5.1%, genotype 4 by 4.4%, and genotype 1b by 4.4%. Whereas genotype 3 was dominant with 44.4% at the central Anatolia region of Turkey, the frequencies of genotypes 1a and 3, which were predominantly detected in the south and northwest regions of Turkey, were very close to each other. Conclusion Although genotype 3 is the predominant genotype in the PWID population in Turkey, the prevalence of HCV genotype varied across the country. To eliminate HCV infection in the PWID, treatment and screening strategies that differ by genotype are essentially required. Especially identification of genotypes will be useful in developing individualized treatments and determining national prevention strategies.
Collapse
Affiliation(s)
- Nesrin Dilbaz
- Faculty of Medicine, Uskudar
University, İstanbul, Turkey
| | - Murat Kuloğlu
- Faculty of Medicine, Akdeniz
University, Antalya, Turkey
| | - Ekrem Cuneyt Evren
- Bakirkoy Prof. Dr. Mazhar Osman Mental
and Neurological Hospital, İstanbul, Turkey
| | | | - Rabia Bilici
- Erenkoy Mental and Neurological
Diseases Education and Research Hospital, İstanbul, Turkey
| | - Cemal Onur Noyan
- Faculty of Medicine, Uskudar
University, İstanbul, Turkey,Cemal Onur Noyan, Faculty of Medicine,
Uskudar University, İstanbul 34662, Turkey.
| | | | - Vahap Karabulut
- Bakirkoy Prof. Dr. Mazhar Osman Mental
and Neurological Hospital, İstanbul, Turkey
| | - Gokhan Umut
- Bakirkoy Prof. Dr. Mazhar Osman Mental
and Neurological Hospital, İstanbul, Turkey
| | - Basak Unubol
- Erenkoy Mental and Neurological
Diseases Education and Research Hospital, İstanbul, Turkey
| | - Enver Ucbilek
- Faculty of Medicine, Mersin University,
Mersin, Turkey
| |
Collapse
|
3
|
Boga S, Yildirim AE, Ucbilek E, Koksal AR, Sisman ST, Durak I, Sen I, Dogu B, Serin E, Ucbilek AB, Yildirim MO, Erturk SM, Alkim H, Alkim C. The effect of sarcopenia and serum myokines on prognosis and survival in cirrhotic patients: a multicenter cross-sectional study. Eur J Gastroenterol Hepatol 2022; 34:1261-1268. [PMID: 36281901 DOI: 10.1097/meg.0000000000002461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Sarcopenia is one of the most significant contributors to morbidity in patients with chronic liver disease. Serum myokines are potential biomarkers for detecting early sarcopenia. We aimed to investigate the relationship between serum myokines and cirrhosis-related mortality in the early stages of the disease. METHODS In total, 262 patients and 50 healthy controls were enrolled in this study, which was designed as a multicenter cross-sectional study. At the beginning of the study, sarcopenia was defined by computed tomography scans using the third lumbar vertebra skeletal muscle index. Serum myostatin, irisin, and follistatin levels, nutritional status of the patients, and muscle strength as measured by the handgrip test were recorded. Cirrhosis-related mortality and overall survival were evaluated in the fourth year of the study as the second checkpoint of cross-sectional analysis. RESULTS A total of 145 (55.3%) patients were diagnosed with sarcopenia. Multivariate analysis revealed that low BMI, high levels of myostatin, and decreased irisin levels were independent predictors of sarcopenia. While serum irisin level was the most predictive parameter in terms of 4th-year cirrhosis-related mortality in the CHILD A group, serum myostatin levels were found more indicative in the CHILD BC group regardless of sarcopenia status ( P < 0.001). CONCLUSION Serum myostatin levels predict sarcopenia in all stages of cirrhosis. Serum irisin levels can also be used as a potential biomarker to predict both treatable sarcopenia and cirrhosis-related mortality in CHILD A patients.
Collapse
Affiliation(s)
- Salih Boga
- Department of Gastroenterology, Memorial Bahcelievler Hospital, Istanbul
| | | | - Enver Ucbilek
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Turkey
| | - Ali Riza Koksal
- Department of Gastroenterology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | | | | | | | | - Erdinc Serin
- Biochemistry, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul
| | - Ayse Bolat Ucbilek
- Department of Radiology, University of Health Sciences Turkey, Adana Teaching and Research Hospital, Adana
| | | | - Sukru Mehmet Erturk
- Department of Radiology, Istanbul University, School of Medicine, Istanbul, Turkey
| | | | | |
Collapse
|
4
|
Akkuzu MZ, Sezgin O, Ucbilek E, Aydin F, Rizaoglu Balci H, Yaras S, Ozdogan O, Ates F, Altintas E. Efficacy and Safety of Percutaneous Endoscopic Gastrostomy in Elderly Patients Aged Over 65: A Tertiary Center Long-term Results. Haseki 2021. [DOI: 10.4274/haseki.galenos.2021.6429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
5
|
Ofosu A, Durand CM, Saberi B, Alqahtani S, Ucbilek E, Belden M, Cameron AM, Gurakar A. Implications of Treating Hepatitis C Virus Infection Among Patients Awaiting Cadaveric Liver Transplant: A Single-Center Experience. EXP CLIN TRANSPLANT 2016; 13 Suppl 3:7-10. [PMID: 26640901 DOI: 10.6002/ect.tdtd2015.l16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES We examined hepatitis C virus positivity among the donors in our center to investigate whether hepatitis C treatment affected liver transplant Model for End-Stage Liver Disease. MATERIALS AND METHODS We retrospectively reviewed all deceased-donor liver transplants performed between January 2013 and December 2014 at our center, with the primary indication of hepatitis C virus. Baseline demographic and laboratory characteristics of recipients and donors were collected. Statistical analyses were done with P values ≤ .05 considered significant. RESULTS Seventy-five liver transplants were performed, and 62 of them were hepatitis C virus RNA-positive at the time of liver transplant donor offer. In 2013, during the Pre-Direct Antiviral Agents era, 14 of 33 hepatitis C virus RNA-positive recipients (42%) were matched to hepatitis C virus-positive donors. During the Direct Antiviral Agents era in 2014, this ratio was 38% (11/29) (P = .72). The mean Model for End-Stage Liver Disease at transplant of the 62 hepatitis C virus RNA-positive recipients was 29, whereas the mean Model for End-Stage Liver Disease of 13 hepatitis C virus RNA-negative recipients was 31. This was not statistically significant (P = .25). CONCLUSIONS Although hepatitis C virus treatment before liver transplant is an attractive option to eliminate the risk of complications because of recurrent hepatitis C virus after liver transplant, its potential effect on limiting the donor pool for the recipient must also be considered. In our observation, 40% of our donor pool consists of hepatitis C virus-positive donors. Further multiregional studies are warranted to verify this observation and to see the potential effect of direct antiviral agent treatment into waiting times and the Model for End-Stage Liver Disease at organ allocation.
Collapse
Affiliation(s)
- Andrew Ofosu
- From the Johns Hopkins University School of Medicine, Division of Gastroenterology, Baltimore, MD, United States
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Malik MU, Ucbilek E, Trilianos P, Cameron AM, Gurakar A. Prophylaxis Among Hepatitis B Core Antibody-positive Deceased-donor Liver Transplant Recipients: Hepatitis B Immunoglobulin Plus Oral Antiviral Agents Versus Antiviral Agents Alone: A Single-center Experience. EXP CLIN TRANSPLANT 2016; 15:183-188. [PMID: 27212251 DOI: 10.6002/ect.2015.0277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Hepatitis B core antibody immunoglobulin G seropositivity is evidence of past exposure to hepatitis B virus. Donor or recipient hepatitis B core antibody positivity may pose a risk of reactivation, especially early after liver transplant. Although most centers advocate using antiviral agents plus hepatitis B immunoglobulin, some have recently relied on antivirals only as prophylaxis after liver transplant. Here, we retrospectively investigated patient survival in hepatitis B core antibody-positive recipients, comparing those treated with antivirals plus hepatitis B immunoglobulin versus antivirals alone. MATERIALS AND METHODS After Internal Review Board approval, we reviewed medical records of deceased-donor liver transplant recipients between 1995 and 2013. Demographic characteristics, transplant indication, hepatitis B core antibody status, time to death, and type of posttransplant prophylaxis were recorded. We also recorded whether donors showed hepatitis B core antibody positivity. Patients who died within 30 days of liver transplant were excluded. RESULTS There were 148 hepatitis B core antibody-positive recipients. Prophylaxis was given to 75 recipients after transplant: 8 (5%) received hepatitis B immunoglobulin, 22 (15%) received antivirals, and 45 (30%) received the combination. There were 34 deaths: 3 (38%) in hepatitis B immunoglobulin only, 3 (14%) in antiviral only, 8 (18%) in the combination, and 20 (27%) in no prophylaxis groups. One- and 5-year survival rates were similar for binary comparisons among prophylaxis groups (P > .05). CONCLUSIONS Preliminary results support the current practice of using hepatitis B immunoglobulin plus antivirals for prophylaxis after liver transplant. The similar survival benefit with the combination versus antiviral agents alone suggests equal effectivity for prophylaxis posttransplant. However, a clear benefit of antivirals was not evident in our analysis. Future larger prospective studies are warranted to identify potential benefits of using antivirals alone as prophylaxis after liver transplant and to further clarify their role as the sole prophylactic regimen.
Collapse
Affiliation(s)
- Mohammad U Malik
- >From the Division of Gastroenterology and Hepatology, Transplant Hepatology, Johns Hopkins Hospital School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | |
Collapse
|
7
|
Trilianos P, Agnihotri A, Ucbilek E, Gurakar A. Greater Biosynthetic Liver Dysfunction in Primary Sclerosing Cholangitis Suggests Co-existent or Impending Cholangiocarcinoma. J Clin Transl Hepatol 2016; 4:1-4. [PMID: 27047765 PMCID: PMC4807136 DOI: 10.14218/jcth.2015.00048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/29/2016] [Accepted: 01/20/2016] [Indexed: 12/18/2022] Open
Abstract
Background and Aim : Patients with primary sclerosing cholangitis (PSC) who develop cholangiocarcinoma (CCA) have a median survival of less than 6 months. In half of cases, PSC and CCA will be diagnosed either concurrently or within a year of one another. The aim of the present study is to demonstrate that the degree of biochemical liver dysfunction is associated with concomitant or impending CCA. Methods : We did a chart review of patients diagnosed with PSC and CCA up to 18 months from presentation ("CCA" group) as well as patients with PSC that underwent transplantation with no sign of CCA in their explanted liver ("nCCA" group). Along with demographic data and follow-up length, we recorded their presenting liver function tests, including alanine and aspartate aminotransferases (ALT, AST), total bilirubin (TBil), alkaline phosphatase (ALP), international normalization ratio (INR), and serum Ca 19-9 levels. Differences between mean values of the two groups were analyzed with a student's t-test. Results : Twenty-four patients were included. The "CCA" group consisted of eight patients, and the "non-CCA" group had 16 patients. There was no significant difference between the two groups in their presenting values of ALT, ALP, or serum Ca 19-9. However, the "CCA" group had significantly higher levels of AST, TBil, and INR. Conclusion : Patients with PSC and concurrent or impending CCA appear to exhibit significantly greater biochemical liver dysfunction than those who do not develop CCA. Therefore, newly-diagnosed PSC patients presenting with these findings may warrant more rigorous evaluation.
Collapse
Affiliation(s)
- Panagiotis Trilianos
- Department of Gastroenterology & Hepatology, Section of Transplant Hepatology, The Johns Hopkins School of Medicine, Baltimore MD, USA
- Department of Medicine, MetroWest Medical Center, Framingham, MA, USA
- Correspondence to: Panagiotis Trilianos, Dept. of Medicine, MetroWest Medical Center, 115 Lincoln Str., 2 Floor, Framingham, MA 01701, USA. Tel: 508-596-2856, Fax: 508-872-4794, E-mail:
| | - Abhishek Agnihotri
- Department of Gastroenterology & Hepatology, Section of Transplant Hepatology, The Johns Hopkins School of Medicine, Baltimore MD, USA
| | - Enver Ucbilek
- Department of Gastroenterology & Hepatology, Section of Transplant Hepatology, The Johns Hopkins School of Medicine, Baltimore MD, USA
| | - Ahmet Gurakar
- Department of Gastroenterology & Hepatology, Section of Transplant Hepatology, The Johns Hopkins School of Medicine, Baltimore MD, USA
| |
Collapse
|
8
|
Samanci C, Sobhani F, Ucbilek E, Rakestraw K, Dagher NN, Kamel IR, Gurakar A. Magnetic Resonance Imaging in Diagnosis and Monitoring of Hepatocellular Carcinoma in Liver Transplantation: A Comprehensive Review. Ann Transplant 2016; 21:68-76. [PMID: 26831626 DOI: 10.12659/aot.895595] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer. One of the most important risk factors of HCC is cirrhosis. The optimal treatment of HCC is liver transplantation, since it treats both the underlying cirrhosis and the cancer. Patients that have risk factors should be included in surveillance programs since HCC can be cured only during the early stages. Surveillance can be performed by ultrasonography (US), which is an inexpensive, non-invasive, and widely available technique, but it is considered to have a low sensitivity. If a suspicious lesion is detected on US exam, computerized tomography (CT) or magnetic resonance imaging (MRI) can be used to further evaluate this lesion. MRI is considered to be superior to CT because it has greater contrast resolution and tissue characterization. In this article, we present a review of MRI for HCC in liver transplantation (LT) with a focus on characteristic MR features of this tumor and current guidelines.
Collapse
Affiliation(s)
- Cesur Samanci
- Department of Radiology, Division of MRI, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fatemeh Sobhani
- Department of Radiology, Division of MRI, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Enver Ucbilek
- Department of Medicine, Division of Gastroenterology and Hepatology, Transplant Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katie Rakestraw
- Department of Surgery, Section of Transplant Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nabil N Dagher
- Department of Surgery, Section of Transplant Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ihab R Kamel
- Department of Radiology, Division of MRI, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahmet Gurakar
- Department of Medicine, Division of Gastroenterology and Hepatology, Transplant Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
9
|
Malik MU, Ucbilek E, Sherwal AS. Critical gastrointestinal bleed due to secondary aortoenteric fistula. J Community Hosp Intern Med Perspect 2015; 5:29677. [PMID: 26653698 PMCID: PMC4677592 DOI: 10.3402/jchimp.v5.29677] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/28/2015] [Accepted: 10/30/2015] [Indexed: 12/22/2022] Open
Abstract
Secondary aortoenteric fistula (SAEF) is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to establish diagnosis. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Each test has variable sensitivity and specificity. Maintaining the hemodynamic status, control of bleeding, removal of the infected graft, and infection control may improve clinical outcomes. This review entails the updated literature on diagnosis and management of SAEF. A literature search was conducted for articles published in English, on PubMed and Scopus using the following search terms: secondary, aortoenteric, aorto-enteric, aortoduodenal, aorto-duodenal, aortoesophageal, and aorto-esophageal. A combination of MeSH terms and Boolean operators were used to device search strategy. In addition, a bibliography of clinically relevant articles was searched to find additional articles (Appendix A). The aim of this review is to provide a comprehensive update on the diagnosis, management, and prognosis of SAEF.
Collapse
Affiliation(s)
- Mohammad U Malik
- Department of Internal Medicine, Conemaugh Memorial Medical Center, Johnstown, PA, USA;
| | - Enver Ucbilek
- Division of Gastroenterology and Hepatology - Transplant Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amanpreet S Sherwal
- Department of General Surgery, Conemaugh Memorial Medical Center, Johnstown, PA, USA
| |
Collapse
|
10
|
Altintas E, Altintas ZM, Sezgin O, Ucbilek E, Nayir E, Erdal ME, Polat A, Orekeci G. Polymorphisms in methylenetetrahydrofolate reductase gene: Their impact on liver steatosis and fibrosis of chronic hepatitis c patients. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojgas.2014.42013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
11
|
Kara T, Gurses I, Serinsoz E, Bozdogan Arpaci R, Ucbilek E, Polat A. Neurogenous hyperplasia in the oesophagus. Malays J Pathol 2013; 35:99-102. [PMID: 23817402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Leiomyoma and gastrointestinal stromal tumours take first place among mesenchymal tumours of the oesophagus, where tumours of peripheral nerve origin are rarely seen. Schwann and enterochromaffi n cell proliferation occur in neurogenous hyperplasia, an entity observed in the appendix which has not been reported in the oesophagus in the medical literature. Oesophagogastroscopy of a 58-year-old woman showed linear erosions and nodularity at the gastroesophageal junction. The microscopic examination of biopsies taken from this area revealed proliferation of spindle cells with oval-round nuclei forming focal fascicular arrangement in the lamina propria. These cells stained positive for synaptophysin and S100-protein, while immunohistochemistry for smooth muscle actin and CD117 were negative. The case was diagnosed as neurogenous hyperplasia with these findings. Control endoscopic biopsies showed no evidence of neurogenous hyperplasia. Neurogenous hyperplasia can be considered as a distinct entity which might also be observed in the oesophagus as in the appendix.
Collapse
Affiliation(s)
- T Kara
- Department of Pathology, Mersin University, Mersin, Turkey.
| | | | | | | | | | | |
Collapse
|
12
|
Serin MS, Bekiroglu E, Polat S, Dogen A, Tezcan S, Aslan G, Sezgin O, Altintas E, Emekdas G, Ucbilek E. Detection of hepatitis B virus polymerase gene variants associated with Lamivudine, Adefovir and Entecavir resistance and some undefined mutations isolated from chronic hepatitis B patients in the south of Turkey. Mol Genet Microbiol Virol 2010. [DOI: 10.3103/s0891416810040075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
13
|
Altintas E, Ucbilek E, Ulu O, Sezgin O, Uzer C, Tataroglu C, Camdeviren H. Helicobacter pylori-associated atrophic gastritis and carotid intima-media thickness: is there a link? Int J Clin Pract 2007; 61:810-4. [PMID: 17343667 DOI: 10.1111/j.1742-1241.2006.01133.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Chronic infections are associated with cardiovascular diseases. Helicobacter pylori-induced chronic active gastritis results in atrophic gastritis. In this study, we attempted to determine carotid intima-media thickness in patients with and individuals without H. pylori-induced atrophic gastritis. Oesophagogastroduodenoscopy was performed on 123 patients for various reasons. Helicobacter pylori were considered positive when histological examination and rapid urease test showed H. pylori. Helicobacter pylori-positive cases were divided into two groups, namely atrophic gastritis and non-atrophic gastritis. Of 123 patients, 92 patients had H. pylori-positive non-atrophic gastritis and 31 had H. pylori-positive atrophic gastritis. There was no significant difference in carotid intima-media thickness between the two groups. Carotid intima-media thickness is not associated with H. pylori-induced atrophic gastritis.
Collapse
Affiliation(s)
- E Altintas
- Department of Gastroenterology, School of Medicine, Mersin University, Mersin, Turkey.
| | | | | | | | | | | | | |
Collapse
|