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Noureddin N, Huang DQ, Bettencourt R, Siddiqi H, Majzoub AM, Nayfeh T, Tamaki N, Izumi N, Nakajima A, Idilman R, Gumussoy M, Oz DK, Erden A, Gidener T, Allen AM, Ajmera V, Loomba R. Natural history of clinical outcomes and hepatic decompensation in metabolic dysfunction-associated steatotic liver disease. Aliment Pharmacol Ther 2024. [PMID: 38571305 DOI: 10.1111/apt.17981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/07/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND & AIMS The natural progression of hepatic decompensation in metabolic dysfunction-associated steatotic liver disease (MASLD) is not well-characterised. We aimed to describe it by conducting a retrospective analysis. METHODS This longitudinal, retrospective analysis of well-characterised MASLD cohorts followed for hepatic decompensation and death. The sequence of liver-related events was evaluated, and the median time between hepatic decompensation episodes and death versus. transplantation was measured. RESULTS Of the 2016 patients identified, 220 (11%) developed at least one episode of hepatic decompensation during a median follow-up of 3.2 years. Ascites was the most common first liver-related event [153 (69.5%)], followed by hepatic encephalopathy (HE) [55 (25%)] and variceal haemorrhage (VH) [30 (13.6%)]. Eighteen out of the 220 (8.1%) patients had more than one liver-related event as their first hepatic decompensation. Among the patients who had the first episode, 87 (39.5%) had a second episode [44 (50.5%) HE, 31 (35.6%) ascites, and 12 (13.7%) VH]. Eighteen out of 220 (8.1%) had a third episode [10 (55.5%) HE, 6 (33.3%) VH, and 2 (11.1%) ascites]. Seventy-three out of 220 (33.1%) died, and 31 (14%) received liver transplantation. The median time from the first episode to the second was 0.7 years and 1.3 years from the second episode to the third. The median survival time from the first episode to death or transplantation was 2.0 years. CONCLUSION The most common first liver-related event in MASLD patients is ascites. The median survival from the first hepatic decompensation to either death or transplantation is 2 years.
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Affiliation(s)
- Nabil Noureddin
- Department of Medicine, Division of Gastroenterology and Hepatology, MASLD Research Center, University of California at San Diego, La Jolla, California, USA
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California at San Diego, La Jolla, California, USA
| | - Daniel Q Huang
- Department of Medicine, Division of Gastroenterology and Hepatology, MASLD Research Center, University of California at San Diego, La Jolla, California, USA
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Ricki Bettencourt
- Department of Medicine, Division of Gastroenterology and Hepatology, MASLD Research Center, University of California at San Diego, La Jolla, California, USA
| | - Harris Siddiqi
- Department of Medicine, Division of Gastroenterology and Hepatology, MASLD Research Center, University of California at San Diego, La Jolla, California, USA
| | - Abdul M Majzoub
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Tarek Nayfeh
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama, Japan
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Mesut Gumussoy
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Digdem Kuru Oz
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Ayse Erden
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Tolga Gidener
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Alina M Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Veeral Ajmera
- Department of Medicine, Division of Gastroenterology and Hepatology, MASLD Research Center, University of California at San Diego, La Jolla, California, USA
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California at San Diego, La Jolla, California, USA
| | - Rohit Loomba
- Department of Medicine, Division of Gastroenterology and Hepatology, MASLD Research Center, University of California at San Diego, La Jolla, California, USA
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California at San Diego, La Jolla, California, USA
- Department of Medicine, The Herbert Wertheim School of Public Health and Human Longevity Science, University of California at San Diego, La Jolla, California, USA
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2
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Bajaj JS, Choudhury A, Kumaran V, Wong F, Seto WK, Alvares-Da-Silva MR, Desalgn H, Hayes PC, Idilman R, Topazian M, Torre A, Xie Q, George J, Kamath PS. Geographic disparities in access to liver transplant for advanced cirrhosis: Time to ring the alarm! Am J Transplant 2024:S1600-6135(24)00160-6. [PMID: 38387623 DOI: 10.1016/j.ajt.2024.02.018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024]
Abstract
Decompensated cirrhosis and hepatocellular cancer are major risk factors for mortality worldwide. Liver transplantation (LT), both live-donor LT or deceased-donor LT, are lifesaving, but there are several barriers toward equitable access. These barriers are exacerbated in the setting of critical illness or acute-on-chronic liver failure. Rates of LT vary widely worldwide but are lowest in lower-income countries owing to lack of resources, infrastructure, late disease presentation, and limited donor awareness. A recent experience by the Chronic Liver Disease Evolution and Registry for Events and Decompensation consortium defined these barriers toward LT as critical in determining overall survival in hospitalized cirrhosis patients. A major focus should be on appropriate, affordable, and early cirrhosis and hepatocellular cancer care to prevent the need for LT. Live-donor LT is predominant across Asian countries, whereas deceased-donor LT is more common in Western countries; both approaches have unique challenges that add to the access disparities. There are many challenges toward equitable access but uniform definitions of acute-on-chronic liver failure, improving transplant expertise, enhancing availability of resources and encouraging knowledge between centers, and preventing disease progression are critical to reduce LT disparities.
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Affiliation(s)
- Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA.
| | - Ashok Choudhury
- Department of Hepatology, Institute for Liver and Biliary Sciences, New Delhi, India
| | - Vinay Kumaran
- Division of Transplant Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Florence Wong
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wai Kay Seto
- Department of Medicine, School of Clinical Medicine, the University of Hong Kong, Hong Kong, China
| | - Mario Reis Alvares-Da-Silva
- Department of Hepatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Hailemichael Desalgn
- Gastroenterology and Hepatology Unit, St Paul's Hospital, Millennium Medical College, Addis Ababa, Ethiopia
| | - Peter C Hayes
- Hepatology, Division of Health Sciences, Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Mark Topazian
- Gastroenterology and Hepatology Unit, St Paul's Hospital, Millennium Medical College, Addis Ababa, Ethiopia
| | - Aldo Torre
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Qing Xie
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jacob George
- Storr Liver Centre, Westmead Millennium Institute, Westmead Hospital and University of Sydney, New South Wales, Australia
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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3
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Razavi-Shearer D, Child H, Razavi-Shearer K, Voeller A, Razavi H, Buti M, Tacke F, Terrault N, Zeuzem S, Abbas Z, Aghemo A, Akarca U, Al Masri N, Alalwan A, Blomé MA, Jerkeman A, Aleman S, Kamal H, Alghamdi A, Alghamdi M, Alghamdi S, Al-Hamoudi W, Ali E, Aljumah A, Altraif I, Amarsanaa J, Asselah T, Baatarkhuu O, Babameto A, Ben-Ari Z, Berg T, Biondi M, Braga W, Brandão-Mello C, Brown R, Brunetto M, Cabezas J, Cardoso M, Martins A, Chan H, Cheinquer H, Chen CJ, Yang HI, Chen PJ, Chien CH, Chuang WL, Garza LC, Coco B, Coffin C, Coppola N, Cornberg M, Craxi A, Crespo J, Cuko L, De Ledinghen V, Duberg AS, Etzion O, Ferraz M, Ferreira P, Forns X, Foster G, Fung J, Gaeta G, García-Samaniego J, Genov J, Gheorghe L, Gholam P, Gish R, Glenn J, Hamid S, Hercun J, Hsu YC, Hu CC, Huang JF, Idilman R, Jafri W, Janjua N, Jelev D, Jia J, Kåberg M, Kaita K, Kao JH, Khan A, Kim D, Kondili L, Lagging M, Lampertico P, Lázaro P, Lazarus J, Lee MH, Yang HI, Lim YS, Lobato C, Macedo G, Marinho R, Marotta P, Mendes-Correa M, Méndez-Sánchez N, Navas MC, Ning Q, Örmeci N, Orrego M, Osiowy C, Pan C, Pessoa M, Piracha Z, Pop C, Qureshi H, Raimondo G, Ramji A, Ribeiro S, Ríos-Hincapié C, Rodríguez M, Rosenberg W, Roulot D, Ryder S, Saeed U, Safadi R, Shouval D, Sanai F, Sanchez-Avila J, Santantonio T, Sarrazin C, Seto WK, Seto WK, Simonova M, Tanaka J, Tergast T, Tsendsuren O, Valente C, Villalobos-Salcedo J, Waheed Y, Wong G, Wong V, Yip T, Wong V, Wu JC, Yang HI, Yu ML, Yuen MF, Yurdaydin C, Zuckerman E. Adjusted estimate of the prevalence of hepatitis delta virus in 25 countries and territories. J Hepatol 2024; 80:232-242. [PMID: 38030035 DOI: 10.1016/j.jhep.2023.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND & AIMS Hepatitis delta virus (HDV) is a satellite RNA virus that requires the hepatitis B virus (HBV) for assembly and propagation. Individuals infected with HDV progress to advanced liver disease faster than HBV-monoinfected individuals. Recent studies have estimated the global prevalence of anti-HDV antibodies among the HBV-infected population to be 5-15%. This study aimed to better understand HDV prevalence at the population level in 25 countries/territories. METHODS We conducted a literature review to determine the prevalence of anti-HDV and HDV RNA in hepatitis B surface antigen (HBsAg)-positive individuals in 25 countries/territories. Virtual meetings were held with experts from each setting to discuss the findings and collect unpublished data. Data were weighted for patient segments and regional heterogeneity to estimate the prevalence in the HBV-infected population. The findings were then combined with The Polaris Observatory HBV data to estimate the anti-HDV and HDV RNA prevalence in each country/territory at the population level. RESULTS After adjusting for geographical distribution, disease stage and special populations, the anti-HDV prevalence among the HBsAg+ population changed from the literature estimate in 19 countries. The highest anti-HDV prevalence was 60.1% in Mongolia. Once adjusted for the size of the HBsAg+ population and HDV RNA positivity rate, China had the highest absolute number of HDV RNA+ cases. CONCLUSIONS We found substantially lower HDV prevalence than previously reported, as prior meta-analyses primarily focused on studies conducted in groups/regions that have a higher probability of HBV infection: tertiary care centers, specific risk groups or geographical regions. There is large uncertainty in HDV prevalence estimates. The implementation of reflex testing would improve estimates, while also allowing earlier linkage to care for HDV RNA+ individuals. The logistical and economic burden of reflex testing on the health system would be limited, as only HBsAg+ cases would be screened. IMPACT AND IMPLICATIONS There is a great deal of uncertainty surrounding the prevalence of hepatitis delta virus among people living with hepatitis B virus at the population level. In this study, we aimed to better understand the burden in 25 countries and territories, to refine techniques that can be used in future analyses. We found a lower prevalence in the majority of places studied than had been previously reported. These data can help inform policy makers on the need to screen people living with hepatitis B virus to find those coinfected with hepatitis delta virus and at high risk of progression, while also highlighting the pitfalls that other researchers have often fallen into.
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Akarsu M, Dolu S, Harputluoglu M, Yilmaz S, Akyildiz M, Gencdal G, Polat KY, Dincer D, Adanir H, Turan I, Gunsar F, Karasu Z, Gokcan H, Karademir S, Kabacam G, Kayhan MA, Kiyici M, Gulsen MT, Balaban Y, Dogrul AB, Senkaya A, Ellik ZM, Eren F, Idilman R. Changing trends in the etiology of liver transplantation in Turkiye: A multicenter study. Hepatol Forum 2024; 5:3-6. [PMID: 38283275 PMCID: PMC10809344 DOI: 10.14744/hf.2023.2023.0010] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/17/2023] [Accepted: 09/27/2023] [Indexed: 01/30/2024]
Abstract
Background and Aim This study aimed to identify the indications for liver transplantation (LT) based on underlying etiology and to characterize the patients who underwent LT. Materials and Methods We conducted a multicenter cross-sectional observational study across 11 tertiary centers in Turkiye from 2010 to 2020. The study included 5,080 adult patients. Results The mean age of patients was 50.3±15.2 years, with a predominance of female patients (70%). Chronic viral hepatitis (46%) was the leading etiological factor, with Hepatitis B virus infection at 35%, followed by cryptogenic cirrhosis (24%), Hepatitis C virus infection (8%), and alcohol-related liver disease (ALD) (6%). Post-2015, there was a significant increase in both the number of liver transplants and the proportion of living donor liver transplants (p<0.001). A comparative analysis of patient characteristics before and after 2015 showed a significant decline in viral hepatitis-related LT (p<0.001), whereas fatty liver disease-related LT significantly increased (p<0.001). Conclusion Chronic viral hepatitis continues to be the primary indication for LT in Turkiye. However, the proportions of non-alcoholic fatty liver disease (NAFLD) and ALD-related LT have seen an upward trend over the years.
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Affiliation(s)
- Mesut Akarsu
- Department of Gastroenterology, Dokuz Eylul University School of Medicine, Izmir, Turkiye
| | - Suleyman Dolu
- Department of Gastroenterology, Dokuz Eylul University School of Medicine, Izmir, Turkiye
| | - Murat Harputluoglu
- Liver Transplantation Institute, Inonu University School of Medicine, Malatya, Turkiye
| | - Sezai Yilmaz
- Liver Transplantation Institute, Inonu University School of Medicine, Malatya, Turkiye
| | - Murat Akyildiz
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Turkiye
| | - Genco Gencdal
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Turkiye
| | - Kamil Yalcin Polat
- Liver Transplant Center, Memorial Atasehir/Bahcelievler Hospitals, Istanbul, Turkiye
| | - Dinc Dincer
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Turkiye
| | - Haydar Adanir
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Turkiye
| | - Ilker Turan
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkiye
| | - Fulya Gunsar
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkiye
| | - Zeki Karasu
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkiye
| | - Hale Gokcan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkiye
| | - Sedat Karademir
- Department of Gastroenterology, Guven Hospital, Ankara, Turkiye
| | - Gokhan Kabacam
- Department of Gastroenterology, Guven Hospital, Ankara, Turkiye
| | - Meral Akdogan Kayhan
- Department of Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara, Turkiye
| | - Murat Kiyici
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Turkiye
| | - Murat Taner Gulsen
- Department of Gastroenterology, Gaziantep University School of Medicine, Gaziantep, Turkiye
| | - Yasemin Balaban
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkiye
| | - Ahmet Bulent Dogrul
- Department of General Surgery, Hacettepe University, School of Medicine, Ankara, Turkiye
| | - Ali Senkaya
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkiye
| | | | - Fatih Eren
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Turkiye
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkiye
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5
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Anastasiou OE, Caruntu FA, Curescu MG, Yalcin K, Akarca US, Gürel S, Zeuzem S, Erhardt A, Lüth S, Papatheodoridis GV, Keskin O, Port K, Radu M, Celen MK, Idilman R, Heidrich B, Mederacke I, von der Leyen H, Kahlhöfer J, von Karpowitz M, Hardtke S, Cornberg M, Yurdaydin C, Wedemeyer H. Five-year follow-up of 96 weeks peginterferon plus tenofovir disoproxil fumarate in hepatitis D. Liver Int 2024; 44:139-147. [PMID: 37787009 DOI: 10.1111/liv.15745] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/09/2023] [Accepted: 09/11/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND & AIMS Until recently, pegylated interferon-alfa-2a (PEG-IFNa) therapy was the only treatment option for patients infected with hepatitis D virus (HDV). Treatment with PEG-IFNa with or without tenofovir disoproxil fumarate (TDF) for 96 weeks resulted in HDV RNA suppression in 44% of patients at the end of therapy but did not prevent short-term relapses within 24 weeks. The virological and clinical long-term effects after prolonged PEG-IFNa-based treatment of hepatitis D are unknown. METHODS In the HIDIT-II study patients (including 40% with liver cirrhosis) received 180 μg PEG-IFNa weekly plus 300 mg TDF once daily (n = 59) or 180 μg PEG-IFNa weekly plus placebo (n = 61) for 96 weeks. Patients were followed until week 356 (5 years after end of therapy). RESULTS Until the end of follow-up, 16 (13%) patients developed liver-related complications (PEG-IFNa + TDF, n = 5 vs PEG-IFNa + placebo, n = 11; p = .179). Achieving HDV suppression at week 96 was associated with decreased long-term risk for the development of hepatocellular carcinoma (p = .04) and hepatic decompensation (p = .009). Including complications irrespective of PEG-IFNa retreatment status, the number of patients developing serious complications was similar with (3/18) and without retreatment with PEG-IFNa (16/102, p > .999) but was associated with a higher chance of HDV-RNA suppression (p = .024, odds ratio 3.9 [1.3-12]). CONCLUSIONS Liver-related clinical events were infrequent and occurred less frequently in patients with virological responses to PEG-IFNa treatment. PEG-IFNa treatment should be recommended to HDV-infected patients until alternative therapies become available. Retreatment with PEG-IFNa should be considered for patients with inadequate response to the first course of treatment. CLINICAL TRIAL REGISTRATION NCT00932971.
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Affiliation(s)
- Olympia E Anastasiou
- Institute for Virology, Medical Faculty of the University of Duisburg-Essen, Essen, Germany
| | | | | | - Kendal Yalcin
- Dicle University Medical Faculty, Diyarbakir, Turkey
| | | | - Selim Gürel
- Uludağ University Medical Faculty, Bursa, Turkey
| | - Stefan Zeuzem
- Johann Wolfgang Goethe University Medical Center, Frankfurt am Main, Germany
| | - Andreas Erhardt
- Heinrich Heine University, Dusseldorf, Germany
- Petrus Hospital, Wuppertal, Germany
| | - Stefan Lüth
- Department of Gastroenterology, Diabetology and Hepatology, University Hospital Brandenburg, Brandenburg Medical School (Theodor Fontane), Brandenburg, Germany
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, The Brandenburg Medical School Theodor Fontane and the University of Potsdam, Potsdam, Germany
| | | | - Onur Keskin
- Ankara University Medical School, Ankara, Turkey
| | | | - Monica Radu
- Institutul de Boli Infectioase, Bucharest, Romania
| | | | | | | | | | - Heiko von der Leyen
- Hannover Medical School, Hannover, Germany
- Orgenesis, Inc, Germantown, Maryland, USA
| | - Julia Kahlhöfer
- Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
- D-SOLVE Consortium an EU Horizon Europe funded project (No 101057917), Hannover, Germany
| | | | - Svenja Hardtke
- German Centre for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Cornberg
- Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
- D-SOLVE Consortium an EU Horizon Europe funded project (No 101057917), Hannover, Germany
- German Center for Infection Research, Partner Site Hannover-Braunschweig, Hannover, Germany
| | - Cihan Yurdaydin
- Department of Gastroenterology & Hepatology, Koc University Medical School, Istanbul, Turkey
| | - Heiner Wedemeyer
- Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
- D-SOLVE Consortium an EU Horizon Europe funded project (No 101057917), Hannover, Germany
- German Center for Infection Research, Partner Site Hannover-Braunschweig, Hannover, Germany
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Kim BK, Bergstrom J, Loomba R, Tamaki N, Izumi N, Nakajima A, Idilman R, Gumussoy M, Oz DK, Erden A, Truong E, Yang JD, Noureddin M, Allen AM, Loomba R, Ajmera V. Magnetic resonance elastography-based prediction model for hepatic decompensation in NAFLD: A multicenter cohort study. Hepatology 2023; 78:1858-1866. [PMID: 37203233 PMCID: PMC10663382 DOI: 10.1097/hep.0000000000000470] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/29/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND AIMS Magnetic resonance elastography (MRE) is an accurate, continuous biomarker of liver fibrosis; however, the optimal combination with clinical factors to predict the risk of incident hepatic decompensation is unknown. Therefore, we aimed to develop and validate an MRE-based prediction model for hepatic decompensation for patients with NAFLD. APPROACH AND RESULTS This international multicenter cohort study included participants with NAFLD undergoing MRE from 6 hospitals. A total of 1254 participants were randomly assigned as training (n = 627) and validation (n = 627) cohorts. The primary end point was hepatic decompensation, defined as the first occurrence of variceal hemorrhage, ascites, or HE. Covariates associated with hepatic decompensation on Cox-regression were combined with MRE to construct a risk prediction model in the training cohort and then tested in the validation cohort. The median (IQR) age and MRE values were 61 (18) years and 3.5 (2.5) kPa in the training cohort and 60 (20) years and 3.4 (2.5) kPa in the validation cohort, respectively. The MRE-based multivariable model that included age, MRE, albumin, aspartate aminotransferase, and platelets had excellent discrimination for the 3- and 5-year risk of hepatic decompensation (c-statistic 0.912 and 0.891, respectively) in the training cohort. The diagnostic accuracy remained consistent in the validation cohort with a c-statistic of 0.871 and 0.876 for hepatic decompensation at 3 and 5 years, respectively, and was superior to Fibrosis-4 in both cohorts ( p < 0.05). CONCLUSIONS An MRE-based prediction model allows for accurate prediction of hepatic decompensation and assists in the risk stratification of patients with NAFLD.
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Affiliation(s)
- Beom Kyung Kim
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaclyn Bergstrom
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
| | - Rohan Loomba
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
| | - Nobuharu Tamaki
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital Tokyo, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital Tokyo, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama, Japan
| | - Ramazan Idilman
- Ankara University School of Medicine, Department of Gastroenterology, Ankara Turkey
| | - Mesut Gumussoy
- Ankara University School of Medicine, Department of Gastroenterology, Ankara Turkey
| | - Digdem Kuru Oz
- Ankara University School of Medicine, Department of Radiology, Ankara Turkey
| | - Ayse Erden
- Ankara University School of Medicine, Department of Radiology, Ankara Turkey
| | - Emily Truong
- Department of Gastroenterology and Hepatology, Cedars Sinai, Los Angeles, CA, USA
| | - Ju Dong Yang
- Department of Gastroenterology and Hepatology, Cedars Sinai, Los Angeles, CA, USA
| | - Mazen Noureddin
- Department of Gastroenterology and Hepatology, Cedars Sinai, Los Angeles, CA, USA
| | - Alina M. Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
- School of Public Health, University of California, San Diego
| | - Veeral Ajmera
- NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA
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Ozkan E, Demir B, Oz DK, Soydal C, Dursun E, Celebioglu EC, Idilman R, Kucuk NO. Demonstration of therapy response to radioembolization with 90Y resin microspheres on 68Ga-PSMA PET/MRI in a patient with hepatocellular carcinoma. Eur J Nucl Med Mol Imaging 2023; 51:316-317. [PMID: 37632564 DOI: 10.1007/s00259-023-06413-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Elgin Ozkan
- Department of Nuclear Medicine, Ankara University Medical School, Cebeci, Ankara, 06590, Turkey
| | - Burak Demir
- Department of Nuclear Medicine, Ankara University Medical School, Cebeci, Ankara, 06590, Turkey.
| | - Digdem Kuru Oz
- Department of Radiology, Ankara University Medical School, Ankara, Turkey
| | - Cigdem Soydal
- Department of Nuclear Medicine, Ankara University Medical School, Cebeci, Ankara, 06590, Turkey
| | - Ecenur Dursun
- Department of Nuclear Medicine, Ankara University Medical School, Cebeci, Ankara, 06590, Turkey
| | | | - Ramazan Idilman
- Department of Internal Medicine, Division of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Nuriye Ozlem Kucuk
- Department of Nuclear Medicine, Ankara University Medical School, Cebeci, Ankara, 06590, Turkey
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8
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Duman S, Kuru D, Gumussoy M, Kiremitci S, Gokcan H, Ulas B, Ellik Z, Ozercan M, Er RE, Karakaya F, Bodakci E, Erden A, Elhan AH, Savas B, Loomba R, Idilman R. A combination of non-invasive tests for the detection of significant fibrosis in patients with metabolic dysfunction-associated steatotic liver disease is not superior to magnetic resonance elastography alone. Eur Radiol 2023:10.1007/s00330-023-10441-5. [PMID: 37987833 DOI: 10.1007/s00330-023-10441-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/04/2023] [Accepted: 10/05/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES The aims of the present study were to investigate a combination of magnetic resonance elastography (MRE) and vibration-controlled transient elastography (VCTE) or MRE and fibrosis score 4 (FIB-4) in the detection of significant fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS Between November 5, 2021, and March 4, 2022, a total of 119 consecutive patients with MASLD were included. Liver stiffness was measured using liver biopsy, MRE, VCTE, and FIB-4. Data were collected from outpatient visit charts. Significant fibrosis was defined as ≥ stage 2 fibrosis. RESULTS All 119 MASLD patients were Caucasian, and their median age was 55 years. MRE, VCTE, and FIB-4 demonstrated significant accuracy in the detection of significant fibrosis with an area under the ROC curve (AUC) of 0.848 ± 0.036 (p < 0.001), 0.632 ± 0.052 (p = 0.012), and 0.664 ± 0.051 (p = 0.001), respectively. However, the diagnostic performance of MRE was superior compared to that of VCTE (AUC difference: 0.216 ± 0.053, p < 0.001) and FIB-4 (AUC difference: 0.184 ± 0.058, p = 0.001). With logistic regression analysis, it was determined that when compared to MRE alone, a combination of MRE and TE (p = 0.880) or MRE and FIB-4 (p = 0.455) were not superior for detecting significant fibrosis. CONCLUSIONS MRE alone is an accurate and non-invasive method for the identification of MASLD patients with significant fibrosis. CLINICAL RELEVANCE STATEMENT Magnetic resonance elastography alone accurately detects significant fibrosis in patients with metabolic dysfunction-associated steatotic liver disease. KEY POINTS • In routine clinical practice, several non-invasive biochemical-based biomarkers and imaging methods are widely used to assess liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease. • Magnetic resonance elastography (MRE) is more accurate than vibration-controlled transient elastography (VCTE) or fibrosis score 4 (FIB-4) for assessing liver fibrosis and identifying significant fibrosis in patients with metabolic dysfunction-associated steatotic liver disease. • The combination of MRE and VCTE or MRE and FIB-4 was not superior to MRE alone.
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Affiliation(s)
- Serkan Duman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.
| | - Digdem Kuru
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Mesut Gumussoy
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Saba Kiremitci
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Hale Gokcan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Bahar Ulas
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Ellik
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Mubin Ozercan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Ramazan Erdem Er
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Fatih Karakaya
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Emin Bodakci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Ayse Erden
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Atilla H Elhan
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Berna Savas
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.
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9
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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.
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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
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10
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Huang DQ, Noureddin N, Ajmera V, Amangurbanova M, Bettencourt R, Truong E, Gidener T, Siddiqi H, Majzoub AM, Nayfeh T, Tamaki N, Izumi N, Yoneda M, Nakajima A, Idilman R, Gumussoy M, Oz DK, Erden A, Allen AM, Noureddin M, Loomba R. Type 2 diabetes, hepatic decompensation, and hepatocellular carcinoma in patients with non-alcoholic fatty liver disease: an individual participant-level data meta-analysis. Lancet Gastroenterol Hepatol 2023; 8:829-836. [PMID: 37419133 PMCID: PMC10812844 DOI: 10.1016/s2468-1253(23)00157-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Data are scarce regarding the development of hepatic decompensation in patients with non-alcoholic fatty liver disease (NAFLD) with and without type 2 diabetes. We aimed to assess the risk of hepatic decompensation in people with NAFLD with and without type 2 diabetes. METHODS We did a meta-analysis of individual participant-level data from six cohorts in the USA, Japan, and Turkey. Included participants had magnetic resonance elastography between Feb 27, 2007, and June 4, 2021. Eligible studies included those with liver fibrosis characterisation by magnetic resonance elastography, longitudinal assessment for hepatic decompensation and death, and included adult patients (aged ≥18 years) with NAFLD, for whom data were available regarding the presence of type 2 diabetes at baseline. The primary outcome was hepatic decompensation, defined as ascites, hepatic encephalopathy, or variceal bleeding. The secondary outcome was the development of hepatocellular carcinoma. We used competing risk regression using the Fine and Gray subdistribution hazard ratio (sHR) to compare the likelihood of hepatic decompensation in participants with and without type 2 diabetes. Death without hepatic decompensation was a competing event. FINDINGS Data for 2016 participants (736 with type 2 diabetes; 1280 without type 2 diabetes) from six cohorts were included in this analysis. 1074 (53%) of 2016 participants were female with a mean age of 57·8 years (SD 14·2) years and BMI of 31·3 kg/m2 (SD 7·4). Among 1737 participants (602 with type 2 diabetes and 1135 without type 2 diabetes) with available longitudinal data, 105 participants developed hepatic decompensation over a median follow-up time of 2·8 years (IQR 1·4-5·5). Participants with type 2 diabetes had a significantly higher risk of hepatic decompensation at 1 year (3·37% [95% CI 2·10-5·11] vs 1·07% [0·57-1·86]), 3 years (7·49% [5·36-10·08] vs 2·92% [1·92-4·25]), and 5 years (13·85% [10·43-17·75] vs 3·95% [2·67-5·60]) than participants without type 2 diabetes (p<0·0001). After adjustment for multiple confounders (age, BMI, and race), type 2 diabetes (sHR 2·15 [95% CI 1·39-3·34]; p=0·0006) and glycated haemoglobin (1·31 [95% CI 1·10-1·55]; p=0·0019) were independent predictors of hepatic decompensation. The association between type 2 diabetes and hepatic decompensation remained consistent after adjustment for baseline liver stiffness determined by magnetic resonance elastography. Over a median follow-up of 2·9 years (IQR 1·4-5·7), 22 of 1802 participants analysed (18 of 639 with type 2 diabetes and four of 1163 without type 2 diabetes) developed incident hepatocellular carcinoma. The risk of incident hepatocellular carcinoma was higher in those with type 2 diabetes at 1 year (1·34% [95% CI 0·64-2·54] vs 0·09% [0·01-0·50], 3 years (2·44% [1·36-4·05] vs 0·21% [0·04-0·73]), and 5 years (3·68% [2·18-5·77] vs 0·44% [0·11-1·33]) than in those without type 2 diabetes (p<0·0001). Type 2 diabetes was an independent predictor of hepatocellular carcinoma development (sHR 5·34 [1·67-17·09]; p=0·0048). INTERPRETATION Among people with NAFLD, the presence of type 2 diabetes is associated with a significantly higher risk of hepatic decompensation and hepatocellular carcinoma. FUNDING National Institute of Diabetes and Digestive and Kidney Diseases.
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Affiliation(s)
- Daniel Q Huang
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | - Nabil Noureddin
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Veeral Ajmera
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Maral Amangurbanova
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Ricki Bettencourt
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Emily Truong
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tolga Gidener
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Harris Siddiqi
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Abdul M Majzoub
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, USA; Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri, Columbia, MO, USA
| | - Tarek Nayfeh
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, USA
| | - Nobuharu Tamaki
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA; Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Masato Yoneda
- Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama, Japan
| | - Ramazan Idilman
- Department of Gastroenterology, School of Medicine, Ankara University, Ankara, Turkey
| | - Mesut Gumussoy
- Department of Gastroenterology, School of Medicine, Ankara University, Ankara, Turkey
| | - Digdem Kuru Oz
- Department of Radiology, School of Medicine, Ankara University, Ankara, Turkey
| | - Ayse Erden
- Department of Radiology, School of Medicine, Ankara University, Ankara, Turkey
| | - Alina M Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Mazen Noureddin
- Houston Methodist Transplant Center, Houston, TX, USA; Houston Liver Institute, Houston, TX, USA
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
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11
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Dinkelborg K, Kahlhöfer J, Dörge P, Yurdaydin C, Hardtke S, Caruntu FA, Curescu MG, Yalcin K, Akarca US, Gürel S, Zeuzem S, Erhardt A, Lüth S, Papatheodoridis GV, Keskin O, Port K, Radu M, Celen MK, Idilman R, Weber K, Stift J, Wittkop U, Heidrich B, Mederacke I, von der Leyen H, Dienes HP, Cornberg M, Koch A, Manns MP, Wedemeyer H, Deterding K. Quality-of-life scores improve after 96 weeks of PEG-IFNa-2a treatment of hepatitis D: An analysis of the HIDIT-II trial. Liver Int 2023; 43:1663-1676. [PMID: 37183524 DOI: 10.1111/liv.15602] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/28/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND & AIMS Infection with the hepatitis D virus (HDV) causes the most severe form of viral hepatitis with a high risk to develop clinical complications of liver disease. In addition, hepatitis delta has been shown to be associated with worse patient-reported outcomes. Until recently, only pegylated interferon alfa could be used to treat hepatitis delta. METHODS Here, we investigated quality of life (QOL) as assessed by the Short Form 36 Health Survey (SF-36) in patients undergoing antiviral therapy with pegylated interferon alfa (PEG-IFNa-2a)-based treatment in the HIDIT-II trial. HIDIT-II was a randomized prospective trial exploring PEG-IFNa-2a with tenofovir disoproxil (TDF) or placebo for 96 weeks in patients with compensated hepatitis delta. Surveys completed by 83 study participants before, during, and after treatments were available. RESULTS Overall, we observed a reduced QOL of HDV patients compared with a reference population, both in physical as well as mental scores. Interestingly, PEG-IFNa-2a treatment showed only minor impairment of the QOL during therapy. Moreover, HDV-RNA clearance was not associated with relevant changes in physical or social SF-36 scores, whereas an improvement of fibrosis during treatment was associated with increased QOL. Overall, slight improvements of the QOL scores were observed 24 weeks after the end of treatment as compared with baseline. TDF co-treatment had no influence on QOL. CONCLUSIONS Overall, our findings suggest that PEG-IFNa-2a was reasonably tolerated even over a period of 96 weeks by hepatitis D patients reporting SF-36 questionnaires. Of note, several patients may benefit from PEG-IFNa-2a-based therapies with off-treatment improvements in quality of life.
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Affiliation(s)
- Katja Dinkelborg
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
- TWINCORE, Centre for Experimental and Clinical Infection Research, Hannover, Germany
| | - Julia Kahlhöfer
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
| | - Petra Dörge
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
| | - Cihan Yurdaydin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
- Department of Internal Medicine, Koc University Medical School, Istanbul, Turkey
| | - Svenja Hardtke
- German Center for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
- Institute for Infection Research and Vaccine Development, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Kendal Yalcin
- Dicle University Medical Faculty, Diyarbakir, Turkey
| | | | - Selim Gürel
- Uludağ University Medical Faculty, Bursa, Turkey
| | - Stefan Zeuzem
- Johann Wolfgang Goethe University Medical Center, Frankfurt am Main, Germany
| | | | - Stefan Lüth
- Institute for Infection Research and Vaccine Development, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Onur Keskin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Kerstin Port
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Monica Radu
- Institutul de Boli Infectioase, Bucharest, Romania
| | | | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Kristina Weber
- Institute for Biometry, Hannover Medical School, Hannover, Germany
| | - Judith Stift
- Department of Pahology, Institute for Infection Research and Vaccine Development, Medical University of Vienna, Vienna, Austria
| | | | - Benjamin Heidrich
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), Hannover-Braunschweig, Germany
- Excellence Cluster Resist, Hannover Medical School, Hannover, Germany
| | - Ingmar Mederacke
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | - Hans Peter Dienes
- Department of Pahology, Institute for Infection Research and Vaccine Development, Medical University of Vienna, Vienna, Austria
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
- German Centre for Infection Research (DZIF), Hannover-Braunschweig, Germany
- Center for Individualized Infection Medicine (CIIM), Hannover, Germany
| | - Armin Koch
- Institute for Biometry, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), Hannover-Braunschweig, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), Hannover-Braunschweig, Germany
- Excellence Cluster Resist, Hannover Medical School, Hannover, Germany
- D-SOLVE Consortium, Hannover, Germany
| | - Katja Deterding
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
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12
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Bajaj JS, Choudhury AK, Xie Q, Kamath PS, Topazian M, Hayes PC, Torre A, Desalegn H, Idilman R, Cao Z, Alvares-da-Silva MR, George J, Bush BJ, Thacker LR, Wong F. Global disparities in mortality and liver transplantation in hospitalised patients with cirrhosis: a prospective cohort study for the CLEARED Consortium. Lancet Gastroenterol Hepatol 2023; 8:611-622. [PMID: 37230109 PMCID: PMC10330833 DOI: 10.1016/s2468-1253(23)00098-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Cirrhosis, the end result of liver injury, has high mortality globally. The effect of country-level income on mortality from cirrhosis is unclear. We aimed to assess predictors of death in inpatients with cirrhosis using a global consortium focusing on cirrhosis-related and access-related variables. METHODS In this prospective observational cohort study, the CLEARED Consortium followed up inpatients with cirrhosis at 90 tertiary care hospitals in 25 countries across six continents. Consecutive patients older than 18 years who were admitted non-electively, without COVID-19 or advanced hepatocellular carcinoma, were enrolled. We ensured equitable participation by limiting enrolment to a maximum of 50 patients per site. Data were collected from patients and their medical records, and included demographic characteristics; country; disease severity (MELD-Na score); cirrhosis cause; medications used; reasons for admission; transplantation listing; cirrhosis-related history in the past 6 months; and clinical course and management while hospitalised and for 30 days post discharge. Primary outcomes were death and receipt of liver transplant during index hospitalisation or within 30 days post discharge. Sites were surveyed regarding availability of and access to diagnostic and treatment services. Outcomes were compared by country income level of participating sites, defined according to World Bank income classifications (high-income countries [HICs], upper-middle-income countries [UMICs], and low-income or lower-middle-income countries [LICs or LMICs]). Multivariable models controlling for demographic variables, disease cause, and disease severity were used to analyse the odds of each outcome associated with variables of interest. FINDINGS Patients were recruited between Nov 5, 2021, and Aug 31, 2022. Complete inpatient data were obtained for 3884 patients (mean age 55·9 years [SD 13·3]; 2493 (64·2%) men and 1391 (35·8%) women; 1413 [36·4%] from HICs, 1757 [45·2%] from UMICs, and 714 [18·4%] from LICs or LMICs), with 410 lost to follow-up within 30 days after hospital discharge. The number of patients who died while hospitalised was 110 (7·8%) of 1413 in HICs, 182 (10·4%) of 1757 in UMICs, and 158 (22·1%) of 714 in LICs and LMICs (p<0·0001), and within 30 days post discharge these values were 179 (14·4%) of 1244 in HICs, 267 (17·2%) of 1556 in UMICs, and 204 (30·3%) of 674 in LICs and LMICs (p<0·0001). Compared with patients from HICs, increased risk of death during hospitalisation was found for patients from UMICs (adjusted odds ratio [aOR] 2·14 [95% CI 1·61-2·84]) and from LICs or LMICs (2·54 [1·82-3·54]), in addition to increased risk of death within 30 days post discharge (1·95 [1·44-2·65] in UMICs and 1·84 [1·24-2·72] in LICs or LMICs). Receipt of a liver transplant was recorded in 59 (4·2%) of 1413 patients from HICs, 28 (1·6%) of 1757 from UMICs (aOR 0·41 [95% CI 0·24-0·69] vs HICs), and 14 (2·0%) of 714 from LICs and LMICs (0·21 [0·10-0·41] vs HICs) during index hospitalisation (p<0·0001), and in 105 (9·2%) of 1137 patients from HICs, 55 (4·0%) of 1372 from UMICs (0·58 [0·39-0·85] vs HICs), and 16 (3·1%) of 509 from LICs or LMICs (0·21 [0·11-0·40] vs HICs) by 30 days post discharge (p<0·0001). Site survey results showed that access to important medications (rifaximin, albumin, and terlipressin) and interventions (emergency endoscopy, liver transplantation, intensive care, and palliative care) varied geographically. INTERPRETATION Inpatients with cirrhosis in LICs, LMICs, or UMICs have significantly higher mortality than inpatients in HICs independent of medical risk factors, and this might be due to disparities in access to essential diagnostic and treatment services. These results should encourage researchers and policy makers to consider access to services and medications when evaluating cirrhosis-related outcomes. FUNDING National Institutes of Health and US Department of Veterans Affairs.
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Affiliation(s)
- Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, VA, USA.
| | - Ashok K Choudhury
- Department of Hepatology, Institute for Liver and Biliary Sciences, New Delhi, India
| | - Qing Xie
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Mark Topazian
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Gastroenterology and Hepatology Unit, St Paul's Hospital, Millennium Medical College, Addis Ababa, Ethiopia
| | - Peter C Hayes
- Hepatology, Division of Health Sciences, Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Aldo Torre
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Hailemichael Desalegn
- Gastroenterology and Hepatology Unit, St Paul's Hospital, Millennium Medical College, Addis Ababa, Ethiopia
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Zhujun Cao
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mario R Alvares-da-Silva
- Department of Hepatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research and Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - Brian J Bush
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Leroy R Thacker
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Florence Wong
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Yilmaz Y, Zeybel M, Adali G, Cosar AM, Sertesen E, Gokcan H, Bahcecioglu HI, Sahin M, Tulunay C, Ergun I, Turan I, Idilman IS, Celikel C, Kirimlioglu H, Akyol G, Yilmaz F, Sokmensuer C, Guveli H, Akarca US, Akyuz U, Genc V, Akyildiz M, Yazihan N, Tutar E, Ates F, Dincer D, Balaban Y, Kiyici M, Akdogan M, Sonsuz A, Idilman R, Yapali S, Dursun H, Aladag M, Satman I, Karcaaltincaba M, Arikan C, Gulerman F, Selimoglu A, Ozen H, Basaranoglu M, Karakan T, Yurci A, Demir K, Koruk M, Uygun A, Sezgin O, Gulec S, Besisik F, Simsek H, Hulagu S, Tozun N, Mardinoglu A, Demir M, Doganay L, Akarsu M, Karasu Z, Kaymakoglu S, Gunsar F. TASL Practice Guidance on the Clinical Assessment and Management of Patients with Nonalcoholic Fatty Liver Disease. Hepatol Forum 2023; 4:1-32. [PMID: 37920782 PMCID: PMC10588738 DOI: 10.14744/hf.2023.2023.0011] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a multisystem disease and is significantly associated with obesity, insulin resistance, type 2 diabetes mellitus, metabolic syndrome, and cardiovascular disease. NAFLD has become the most prevalent chronic liver disease in Western countries, and the proportion of NAFLD-related cirrhosis among patients on liver transplantation waiting lists has increased. In light of the accumulated data about NAFLD, and to provide a common approach with multi-disciplines dealing with the subject, it has become necessary to create new guidance for diagnosing and treating NAFLD. This guidance was prepared following an interdisciplinary study under the leadership of the Turkish Association for the Study of the Liver (TASL), Fatty Liver Special Interest Group. This new TASL Guidance is a practical application guide on NAFLD and was prepared to standardize the clinical approach to diagnosing and treating NAFLD patients. This guidance reflects many advances in the field of NAFLD. The proposals in this guidance are meant to aid decision-making in clinical practice. The guidance is primarily intended for gastroenterology, endocrinology, metabolism diseases, cardiology, internal medicine, pediatric specialists, and family medicine specialists.
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Affiliation(s)
- Yusuf Yilmaz
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
| | - Mujdat Zeybel
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
| | - Gupse Adali
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
| | - Arif Mansur Cosar
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
| | - Elif Sertesen
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
| | - Hale Gokcan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
| | | | - Mustafa Sahin
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
| | - Cansin Tulunay
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
| | - Ihsan Ergun
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
| | - Ilker Turan
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
| | | | - Cigdem Celikel
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
| | - Hale Kirimlioglu
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
| | - Gulen Akyol
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
| | - Funda Yilmaz
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
| | - Cenk Sokmensuer
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Hakan Guveli
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
| | - Ulus Salih Akarca
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
| | - Umit Akyuz
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
| | - Volkan Genc
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
| | - Murat Akyildiz
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
| | - Nuray Yazihan
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
| | - Engin Tutar
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
| | - Fehmi Ates
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
| | - Dinc Dincer
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
| | - Yasemin Balaban
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Murat Kiyici
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
| | - Meral Akdogan
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
| | - Abdullah Sonsuz
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
| | - Members of Fatty Liver Special Interest Group
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Suna Yapali
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Hakan Dursun
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Murat Aladag
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Ilhan Satman
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Musturay Karcaaltincaba
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Cigdem Arikan
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Fulya Gulerman
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Ayse Selimoglu
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Hasan Ozen
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Metin Basaranoglu
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Tarkan Karakan
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Alper Yurci
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Kadir Demir
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Mehmet Koruk
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Ahmet Uygun
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Orhan Sezgin
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Sadi Gulec
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Fatih Besisik
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Halis Simsek
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Sadettin Hulagu
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Nurdan Tozun
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Adil Mardinoglu
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Mehmet Demir
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Levent Doganay
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Mesut Akarsu
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Zeki Karasu
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Sabahattin Kaymakoglu
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Fulya Gunsar
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
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Karaoğlan BB, Tulunay C, Uzun Ç, Peker E, Özyüncü N, Ellik Z, Kuru D, Turhan S, Savaş B, Erden A, Idilman R, Idilman R. Determining Subclinical Cardiovascular and Cardiac Diseases in Patients with Non-Alcoholic Fatty Liver Disease. Turk J Gastroenterol 2023; 34:242-253. [PMID: 36445056 PMCID: PMC10152151 DOI: 10.5152/tjg.2022.22075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aims of the present study were to determine the subclinical coronary atherosclerosis and myocardial dysfunction in patients with non-alcoholic fatty liver disease, who were asymptomatic for cardiac disease. METHODS A total of 61 non-alcoholic fatty liver disease patients were enrolled in the study. The 10-year probability of cardiovascular events was evaluated according to the pooled cohort equation risk score (atherosclerotic cardiovascular disease). The coronary artery calcium score was measured. Conventional echocardiographic examination was followed by 2- and 3-dimensional speckle tracking echocardiography. RESULTS Patients with non-alcoholic steatohepatitis had significantly higher insulin resistance (P = .018), serum alanine aminotransferase (P = .002) and aspartate aminotransferase levels (P = .021), hepatic steatosis (P = .023), and fibrosis (P = .001) than non-alcoholic fatty liver disease patients. The mean Atherosclerotic Cardiovascular Disease score was 7.5% ± 6.9% and 37% of the patients had medium and high cardiovascular disease risk. Cardiovascular disease (>1) was found in 30% of the patients. Interestingly, 56% had significant and extended atherosclerotic plaques. Among the patients with moderate-to-high atherosclerotic cardiovascular disease scores, 63% had significant atherosclerotic plaques and 21% had extensive plaque burden. The presence of non-alcoholic steatohepatitis did not significantly affect cardiovascular risk. Non-alcoholic steatohepatitis was deleterious on left ventricle diastolic functions. Mean A velocity in non-alcoholic steatohepatitis patients was significantly increased compared to non-alcoholic fatty liver disease patients (87.0 ± 17.5 cm/s vs. 72.3 ± 13.6 cm/s, P = .002). Mean E/e' ratio was 8.1 ± 2.0. Submyocardial fibrosis detected had a slightly higher occurrence in non-alcoholic steatohepatitis patients than in non-alcoholic fatty liver disease patients (P = .530). CONCLUSION The presence of non-alcoholic steatohepatitis did not significantly increase the risk of cardiovascular disease and subclinical myocardial dysfunction in asymptomatic patients for cardiac disease compared to non-alcoholic fatty liver disease patients.
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Affiliation(s)
- Beliz Bahar Karaoğlan
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Cansın Tulunay
- Department of Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Çağlar Uzun
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Elif Peker
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nil Özyüncü
- Department of Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Ellik
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Diğdem Kuru
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Sibel Turhan
- Department of Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Berna Savaş
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey; Department of Biostatistics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ayşe Erden
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
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15
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Karakaya MF, Er E, Kırımker O, Gümüşsoy M, Bodakçi E, Özercan M, Doğanay Erdoğan B, Gökcan H, Koloğlu M, Karayalçın K, Yurdaydın C, Tüzüner A, Haznedaroğlu S, Çınar K, Özkan H, Idilman R, Idilman R. Management of Biliary Complications in Liver Transplant Recipients with Duct-To-Duct Anastomosis: A Single-Center Experience. Turk J Gastroenterol 2023; 34:177-181. [PMID: 36843302 PMCID: PMC10081117 DOI: 10.5152/tjg.2023.22724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND The aims of this study were to investigate biliary complications in liver transplant recipients with choledochocholedocho stomy anastomosis, to identify the risk factors for the development of such complications, and to evaluate the success of endoscopic approaches in liver transplant recipients. METHODS Between January 2013 and May 2021, a total of 238 patients with liver diseases underwent liver transplantation: 174 recipients undergoing choledochocholedochostomy anastomosis were included in the analysis. RESULTS Their median age was 54.0 years. The median posttransplant follow-up period was 29 months. Hepatitis B virus infection (33%) was the most common indication for liver transplantation. Most patients (87%) received living donor liver transplantation. The overall prevalence of posttransplant biliary complications was 31%. Anastomotic biliary strictures were the most common biliary complications (72%), followed by biliary leakage (13%). The median time between endoscopic retrograde cholangiography and liver transplantation was 4 months, with a mean of 3 ± 1.6 sessions. Endoscopic retrograde cholangiography-guided drainage and balloon dilation with or without stent placement was the most common treatment modalities for recipients with biliary strictures. The overall success rate of endoscopic treatment modalities was 83.3%, with 65% of the recipients exhibiting complete biochemical and endoscopic responses. The response did not differ significantly between living donor liver transplantation and cadaveric donor liver transplant recipients (P > .05). Three recipients required revision surgery for biliary complication repair. Six patients died due to biliary sepsis. CONCLUSION Biliary stricture and leakages were the most common biliary complications after liver transplantation. Endoscopic treatment was successful in most recipients.
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Affiliation(s)
| | - Erdem Er
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Onur Kırımker
- Department of General Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mesut Gümüşsoy
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emin Bodakçi
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mubin Özercan
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Hale Gökcan
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Meltem Koloğlu
- Department of General Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Kaan Karayalçın
- Department of General Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Cihan Yurdaydın
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Acar Tüzüner
- Department of General Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Selçuk Haznedaroğlu
- Department of General Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Kubilay Çınar
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özkan
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
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16
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Kalkan Ç, Yılmaz Y, Erdoğan BD, Savaş B, Yurdcu E, Çalışkan A, Keskin O, Gencdal G, Zeybel M, Törüner M, Bozdayi AM, Idilman R, Yurdaydin C. Non-invasive fibrosis markers for assessment of liver fibrosis in chronic hepatitis delta. J Viral Hepat 2023; 30:406-416. [PMID: 36651603 DOI: 10.1111/jvh.13806] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023]
Abstract
Assessment of liver fibrosis by non-invasive means is clinically important. Studies in chronic hepatitis delta (CHD) are scarce. We evaluated the performance of eight serum fibrosis markers [fibrosis-4 score (FIB-4), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), age-platelet index (API), AST-to platelet-ratio-index (APRI), Goteborg University Cirrhosis Index (GUCI), Lok index, cirrhosis discriminant score (CDS) and Hui score] in CHD and chronic hepatitis B (CHB). Liver stiffness was assessed by transient elastography (TE) in CHD. The ability of fibrosis markers to detect significant fibrosis and cirrhosis were evaluated in 202 CHB and 108 CHD patients using published and new cut-offs through receiver operating characteristics (ROC) analysis. The latter was also applied to obtain cut-offs for TE. APRI, Fib-4, API and Hui score were assessed for significant fibrosis, and APRI, GUCI, Lok index, CDS and AAR for cirrhosis determination. Fibrosis markers displayed weak performance in CHB for significant fibrosis with area under ROC (AUROC) curves between 0.62 and 0.71. They did slightly better for CHD. TE displayed an AUROC of 0.92 and performed better than serum fibrosis markers (p < 0.05 for fibrosis markers). For cirrhosis determination, CDS and Lok Index displayed an AUROC of 088 and 0.89 in CHB and GUCI, Lok index and APRI displayed AUROCs around 0.90 in CHD. TE displayed the best AUROC (0.95). Hence TE is superior to serum fibrosis markers for diagnosing significant liver fibrosis and cirrhosis. GUCI, Lok index and APRI displayed a reasonable performance in CHD, which needs further confirmation.
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Affiliation(s)
- Çağdaş Kalkan
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Yusufcan Yılmaz
- Department of Internal Medicine, Ankara University Medical School, Ankara, Turkey
| | | | - Berna Savaş
- Department of Pathology, Ankara University Medical School, Ankara, Turkey
| | - Esra Yurdcu
- Hepatology Institute, Ankara University, Ankara, Turkey
| | - Aysun Çalışkan
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Onur Keskin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Genco Gencdal
- Department of Gastroenterology & Hepatology, Koç University Medical School, Istanbul, Turkey
| | - Müjdat Zeybel
- Department of Gastroenterology & Hepatology, Koç University Medical School, Istanbul, Turkey.,NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust & University of Nottingham, Nottingham, UK
| | - Murat Törüner
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | | | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Cihan Yurdaydin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey.,Department of Gastroenterology & Hepatology, Koç University Medical School, Istanbul, Turkey
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17
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Efe C, Kulkarni AV, Terziroli Beretta-Piccoli B, Magro B, Stättermayer A, Cengiz M, Clayton-Chubb D, Lammert C, Bernsmeier C, Gül Ö, la Tijera FHD, Anders M, Lytvyak E, Akın M, Purnak T, Liberal R, Peralta M, Ebik B, Duman S, Demir N, Balaban Y, Urzua Á, Contreras F, Venturelli MG, Bilgiç Y, Medina A, Girala M, Günşar F, Londoño MC, Androutsakos T, Kisch A, Yurci A, Güzelbulut F, Çağın YF, Avcı E, Akyıldız M, Dindar-Demiray EK, Harputluoğlu M, Kumar R, Satapathy SK, Mendizabal M, Silva M, Fagiuoli S, Roberts SK, Soylu NK, Idilman R, Yoshida EM, Montano-Loza AJ, Dalekos GN, Ridruejo E, Schiano TD, Wahlin S. Liver injury after SARS-CoV-2 vaccination: Features of immune-mediated hepatitis, role of corticosteroid therapy and outcome. Hepatology 2022; 76:1576-1586. [PMID: 35567545 PMCID: PMC9348326 DOI: 10.1002/hep.32572] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS A few case reports of autoimmune hepatitis-like liver injury have been reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. We evaluated clinical features, treatment response and outcomes of liver injury following SARS-CoV-2 vaccination in a large case series. APPROACH AND RESULTS We collected data from cases in 18 countries. The type of liver injury was assessed with the R-value. The study population was categorized according to features of immune-mediated hepatitis (positive autoantibodies and elevated immunoglobulin G levels) and corticosteroid therapy for the liver injury. We identified 87 patients (63%, female), median age 48 (range: 18-79) years at presentation. Liver injury was diagnosed a median 15 (range: 3-65) days after vaccination. Fifty-one cases (59%) were attributed to the Pfizer-BioNTech (BNT162b2) vaccine, 20 (23%) cases to the Oxford-AstraZeneca (ChAdOX1 nCoV-19) vaccine and 16 (18%) cases to the Moderna (mRNA-1273) vaccine. The liver injury was predominantly hepatocellular (84%) and 57% of patients showed features of immune-mediated hepatitis. Corticosteroids were given to 46 (53%) patients, more often for grade 3-4 liver injury than for grade 1-2 liver injury (88.9% vs. 43.5%, p = 0.001) and more often for patients with than without immune-mediated hepatitis (71.1% vs. 38.2%, p = 0.003). All patients showed resolution of liver injury except for one man (1.1%) who developed liver failure and underwent liver transplantation. Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution. None had a relapse during follow-up. CONCLUSIONS SARS-CoV-2 vaccination can be associated with liver injury. Corticosteroid therapy may be beneficial in those with immune-mediated features or severe hepatitis. Outcome was generally favorable, but vaccine-associated liver injury led to fulminant liver failure in one patient.
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Affiliation(s)
- Cumali Efe
- Department of GastroenterologyHarran University HospitalŞanlıurfaTurkey
| | - Anand V Kulkarni
- Department of Hepatology and Liver TransplantationAsian Institute of Gastroenterology HospitalsHyderabadIndia
| | | | - Bianca Magro
- Gastroenterology Hepatology and TransplantationASST Papa Giovanni XXIII-BergamoBergamoItaly
| | - Albert Stättermayer
- Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Mustafa Cengiz
- Department of GastroenterologyGülhane Training and Research HospitalAnkaraTurkey
| | | | - Craig Lammert
- Department of Medicine IndianaUniversity School of MedicineIndianapolisIndianaUSA
| | - Christine Bernsmeier
- Department of BiomedicineUniversity of BaselBaselSwitzerland.,University Centre for Gastrointestinal and Liver DiseasesBaselSwitzerland
| | - Özlem Gül
- Department of GastroenterologyKırıkkale UniversityKırıkkaleTurkey
| | | | - Margarita Anders
- Hepatology and Liver Transplant UnitHospital AlemánCiudad Autónoma de Buenos AiresArgentina
| | - Ellina Lytvyak
- Division of Gastroenterology and Liver UnitUniversity of AlbertaEdmontonAlbertaCanada
| | - Mete Akın
- Department of GastroenterologyAkdeniz University Faculty of MedicineAntalyaTurkey
| | - Tugrul Purnak
- Division of GastroenterologyHepatology and NutritionMcGovern Medical SchoolHoustonTexasUSA
| | - Rodrigo Liberal
- Gastroenterology and Hepatology DepartmentCentro Hospitalar e Universitário de São JoãoPortoPortugal.,World Gastroenterology Organization (WGO) Porto Training CenterPortoPortugal
| | - Mirta Peralta
- Hepatology SectionHospital Francisco J MuñizCiudad Autónoma de Buenos AiresArgentina.,Latin American Liver Research Educational and Awareness Network (LALREAN)PilarArgentina
| | - Berat Ebik
- Department of GastroenterologyGazi Yaşargil Education and Research HospitalDiyarbakirTurkey
| | - Serkan Duman
- Department of GastroenterologyAnkara University Medical FacultyAnkaraTurkey
| | - Nurhan Demir
- Department of GastroenterologyHaseki Training and Research HospitalIstanbulTurkey
| | - Yasemin Balaban
- Department of GastroenterologyFaculty of MedicineHacettepe UniversityAnkaraTurkey
| | - Álvaro Urzua
- Gastroenterology and Hepatology UnitHospital Clínico Universidad de ChileSantiago de ChileChile
| | | | | | - Yılmaz Bilgiç
- Department of GastroenterologyInönü University School of MedicineMalatyaTurkey
| | - Adriana Medina
- Gastroenterology and Hepatology UnitHospital de Clínicas, Universidad Nacional de AsunciónSan LorenzoParaguay
| | - Marcos Girala
- Gastroenterology and Hepatology UnitHospital de Clínicas, Universidad Nacional de AsunciónSan LorenzoParaguay
| | - Fulya Günşar
- Department of GastroenterologyEge University School of MedicineİzmirTurkey
| | | | - Theodoros Androutsakos
- Department of PathophysiologyNational and Kapodistrian University of AthensMedical SchoolAthensGreece
| | - Ayelen Kisch
- Hepatology SectionHospital Bonorino UdaondoCiudad Autónoma de Buenos AiresArgentina
| | - Alper Yurci
- Department of GastroenterologyErciyes University School of MedicineKayseriTurkey
| | - Fatih Güzelbulut
- Department of GastroenterologyHaydarpaşa Numune Education and Research HospitalİstanbulTurkey
| | - Yasir Furkan Çağın
- Department of GastroenterologyInönü University School of MedicineMalatyaTurkey
| | - Enver Avcı
- Department of GastroenterologyKTO Karatay University Medical School Affiliated Konya Medicana HospitalKonyaTurkey
| | - Murat Akyıldız
- Department of GastroenterologyKoc University School of MedicineIstanbulTurkey
| | | | - Murat Harputluoğlu
- Department of GastroenterologyInönü University School of MedicineMalatyaTurkey
| | - Rahul Kumar
- Department of Gastroenterology and HepatologyChangi General HospitalMedicine Academic Clinical ProgrammeSing Health Duke-NUS Academic Medical CentreSingapore
| | - Sanjaya K Satapathy
- Department of Internal MedicineDonald and Barbara Zucker School of MedicineNorthwell HealthManhassetNew YorkUSA
| | - Manuel Mendizabal
- Latin American Liver Research Educational and Awareness Network (LALREAN)PilarArgentina.,Hepatology and Liver Transplant UnitHospital Universitario AustralPilarArgentina
| | - Marcelo Silva
- Latin American Liver Research Educational and Awareness Network (LALREAN)PilarArgentina.,Hepatology and Liver Transplant UnitHospital Universitario AustralPilarArgentina
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and TransplantationASST Papa Giovanni XXIII-BergamoBergamoItaly
| | - Stuart K Roberts
- Department of GastroenterologyAlfred HealthMelbourneVictoriaAustralia.,Central Clinical SchoolDepartment of MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Neşe Karadağ Soylu
- Department of PathologyInönü University Faculty of MedicineMalatyaTurkey
| | - Ramazan Idilman
- Department of GastroenterologyAnkara University Medical FacultyAnkaraTurkey
| | - Eric M Yoshida
- Division of GastroenterologyUniversity of British Columbia and Vancouver General HospitalVancouverBritish ColumbiaCanada
| | - Aldo J Montano-Loza
- Division of Gastroenterology and Liver UnitUniversity of AlbertaEdmontonAlbertaCanada
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal MedicineNational Expertise Center of Greece in Autoimmune Liver DiseasesGeneral University Hospital of LarissaLarissaGreece.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER)General University Hospital of LarissaLarissaGreece
| | - Ezequiel Ridruejo
- Latin American Liver Research Educational and Awareness Network (LALREAN)PilarArgentina.,Hepatology and Liver Transplant UnitHospital Universitario AustralPilarArgentina.,Hepatology SectionDepartment of MedicineCentro de Educación Médica e Investigaciones Clínicas, CEMICCiudad Autónoma de Buenos AiresArgentina
| | - Thomas D Schiano
- Division of Liver Diseasesthe Mount Sinai Medical CenterNew YorkNew YorkUSA
| | - Staffan Wahlin
- Hepatology Division, Department of Upper GI DiseasesKarolinska Institutet and Karolinska University HospitalStockholmSweden
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18
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Gumussoy M, Koc O, Karatas G, Ozercan M, Ellik Z, Duman S, Kiremitci S, Gokcan H, Elhan AH, Savas B, Idilman R. Factors associated with the development of extrahepatic malignancy in patients with nonalcoholic fatty liver disease: a single-center longitudinal study. Eur J Gastroenterol Hepatol 2022; 34:1172-1177. [PMID: 36170687 DOI: 10.1097/meg.0000000000002448] [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
BACKGROUND AND AIMS The aim of the present study was to determine incident cases of extrahepatic malignancy in patients with nonalcoholic fatty liver disease (NAFLD) and to identify whether the factors are associated with cancer development. METHODS Between 15 January 2001 and 14 March 2021, a total of 1365 patients had been diagnosed with NAFLD were enrolled in the study. RESULTS The median follow-up period was 59.5 months. The mean age was 50.9 ± 10.9 years. The female gender was predominant (57%). During the follow-up period, 62 extrahepatic malignancies and 11 hepatocellular carcinomas were identified. Of all extrahepatic malignancies, 51 were solid organ malignancies and 11 were hematological malignancies. Female breast cancer was the most frequent (25.8%), followed by thyroid cancer (19.4%), lymphoma (12.9%), and lung cancer (9.7%). In univariate and multivariable analyses, after adjusting for age and sex, the presence of diabetes and high initial baseline gamma glutamyl transpeptidase (GGT) levels were significantly associated with the development of extrahepatic malignancies [hazard ratio (HR) = 1.82, 95% confidence interval (CI): 1.04-3.20, P = 0.036] and HR = 1.96, 95% CI: 1.14-3.38, P = 0.015, respectively). In 424 biopsy-proven NAFLD patients, the development of extrahepatic cancer was significantly associated with the severity of hepatic fibrosis (HR = 3.31, 95% CI: 1.36-8.07; P = 0.008). CONCLUSION Extrahepatic malignancies are frequently seen in patients with NAFLD. Diabetes mellitus, high baseline GGT levels, and significant hepatic fibrosis are associated with the development of extrahepatic cancer in patients with NAFLD.
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19
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Ajmera V, Kim BK, Yang K, Majzoub AM, Nayfeh T, Tamaki N, Izumi N, Nakajima A, Idilman R, Gumussoy M, Oz DK, Erden A, Quach NE, Tu X, Zhang X, Noureddin M, Allen AM, Loomba R. Liver Stiffness on Magnetic Resonance Elastography and the MEFIB Index and Liver-Related Outcomes in Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Individual Participants. Gastroenterology 2022; 163:1079-1089.e5. [PMID: 35788349 PMCID: PMC9509452 DOI: 10.1053/j.gastro.2022.06.073] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/01/2022] [Accepted: 06/27/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Magnetic resonance elastography (MRE) is an accurate biomarker of liver fibrosis; however, limited data characterize its association with clinical outcomes. We conducted an individual participant data pooled meta-analysis on patients with nonalcoholic fatty liver disease to evaluate the association between liver stiffness on MRE and liver-related outcomes. METHODS A systematic search identified 6 cohorts of adults with nonalcoholic fatty liver disease who underwent a baseline MRE and were followed for hepatic decompensation, hepatocellular carcinoma, and death. Cox and logistic regression were used to assess the association between liver stiffness on MRE and liver-related outcomes, including a composite primary outcome defined as varices needing treatment, ascites, and hepatic encephalopathy. RESULTS This individual participant data pooled meta-analysis included 2018 patients (53% women) with a mean (± standard deviation) age of 57.8 (±14) years and MRE at baseline of 4.15 (±2.19) kPa, respectively. Among 1707 patients with available longitudinal data with a median (interquartile range) of 3 (4.2) years of follow-up, the hazard ratio for the primary outcome for MRE of 5 to 8 kPa was 11.0 (95% confidence interval [CI]: 7.03-17.1, P < .001) and for ≥ 8 kPa was 15.9 (95% CI: 9.32-27.2, P < .001), compared with those with MRE <5 kPa. The MEFIB index (defined as positive when MRE ≥3.3 kPa and Fibrosis-4 ≥1.6) had a robust association with the primary outcome with a hazard ratio of 20.6 (95% CI: 10.4-40.8, P < .001) and a negative MEFIB had a high negative predictive value for the primary outcome, 99.1% at 5 years. The 3-year risk of incident hepatocellular carcinoma was 0.35% for MRE <5 kPa, 5.25% for 5 to 8 kPa, and 5.66% for MRE ≥8 kPa, respectively. CONCLUSION Liver stiffness assessed by MRE is associated with liver-related events, and the combination of MRE and Fibrosis-4 has excellent negative predictive value for hepatic decompensation. These data have important implications for clinical practice.
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Affiliation(s)
- Veeral Ajmera
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California; Division of Gastroenterology, University of California at San Diego, La Jolla, California
| | - Beom Kyung Kim
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California; Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kun Yang
- School of Public Health, University of California, San Diego, San Diego, California
| | - Abdul M Majzoub
- Division of Internal Medicine, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania
| | - Tarek Nayfeh
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - Nobuharu Tamaki
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California; Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama, Japan
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Mesut Gumussoy
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Digdem Kuru Oz
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Ayse Erden
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Natalie E Quach
- School of Public Health, University of California, San Diego, San Diego, California
| | - Xin Tu
- School of Public Health, University of California, San Diego, San Diego, California
| | - Xinlian Zhang
- School of Public Health, University of California, San Diego, San Diego, California
| | - Mazen Noureddin
- Department of Gastroenterology and Hepatology, Cedars Sinai, Los Angeles, California
| | - Alina M Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California; Division of Gastroenterology, University of California at San Diego, La Jolla, California; School of Public Health, University of California, San Diego, San Diego, California.
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20
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Efe C, Taşçılar K, Gerussi A, Bolis F, Lammert C, Ebik B, Stättermayer AF, Cengiz M, Gökçe DT, Cristoferi L, Peralta M, Massoumi H, Montes P, Cerda E, Rigamonti C, Yapalı S, Adali G, Çalışkan AR, Balaban Y, Eren F, Eşkazan T, Barutçu S, Lytvyak E, Zazueta GM, Kayhan MA, Heurgue-Berlot A, De Martin E, Yavuz A, Bıyık M, Narro GC, Duman S, Hernandez N, Gatselis NK, Aguirre J, Idilman R, Silva M, Mendizabal M, Atay K, Güzelbulut F, Dhanasekaran R, Montano-Loza AJ, Dalekos GN, Ridruejo E, Invernizzi P, Wahlin S. SARS-CoV-2 vaccination and risk of severe COVID-19 outcomes in patients with autoimmune hepatitis. J Autoimmun 2022; 132:102906. [PMID: 36088883 PMCID: PMC9448709 DOI: 10.1016/j.jaut.2022.102906] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 07/27/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 02/06/2023]
Abstract
Background Data regarding outcome of Coronavirus disease 2019 (COVID-19) in vaccinated patients with autoimmune hepatitis (AIH) are lacking. We evaluated the outcome of COVID-19 in AIH patients who received at least one dose of Pfizer- BioNTech (BNT162b2), Moderna (mRNA-1273) or AstraZeneca (ChAdOx1-S) vaccine. Patients and methods We performed a retrospective study on AIH patients with COVID-19. The outcomes of AIH patients who had acute respiratory syndrome coronavirus 2 (SARS-CoV-2) breakthrough infection after at least one dose of COVID-19 vaccine were compared to unvaccinated patients with AIH. COVID-19 outcome was classified according to clinical state during the disease course as: (i) no hospitalization, (ii) hospitalization without oxygen supplementation, (iii) hospitalization with oxygen supplementation by nasal cannula or mask, (iv) intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v) ICU admission with invasive mechanical ventilation or (vi) death, and data was analyzed using ordinal logistic regression. Results We included 413 (258 unvaccinated and 155 vaccinated) patients (81%, female) with a median age of 52 (range: 17–85) years at COVID-19 diagnosis. The rates of hospitalization were (36.4% vs. 14.2%), need for any supplemental oxygen (29.5% vs. 9%) and mortality (7% vs. 0.6%) in unvaccinated and vaccinated AIH patients with COVID-19. Having received at least one dose of SARS-CoV-2 vaccine was associated with a significantly lower risk of worse COVID-19 severity, after adjusting for age, sex, comorbidities and presence of cirrhosis (adjusted odds ratio [aOR] 0.18, 95% confidence interval [CI], 0.10–0.31). Overall, vaccination against SARS-CoV-2 was associated with a significantly lower risk of mortality from COVID-19 (aOR 0.20, 95% CI 0.11–0.35). Conclusions SARS-CoV-2 vaccination significantly reduced the risk of COVID-19 severity and mortality in patients with AIH.
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Affiliation(s)
- Cumali Efe
- Department of Gastroenterology, Harran University Hospital, Şanlıurfa, Turkey.
| | - Koray Taşçılar
- Department of Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Alessio Gerussi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Francesca Bolis
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Craig Lammert
- Department of Medicine Indiana, University School of Medicine, Indianapolis, IN, USA
| | - Berat Ebik
- Department of Gastroenterology, Gazi Yaşargil Education and Research Hospital, Diyarbakir, Turkey
| | - Albert Friedrich Stättermayer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Mustafa Cengiz
- Department of Gastroenterology, Gülhane Training and Research Hospital, Ankara, Turkey
| | | | - Laura Cristoferi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Mirta Peralta
- Hepatology Section, Hospital Francisco J Muñiz, Ciudad Autónoma de Buenos Aires, Argentina; Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina
| | - Hatef Massoumi
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Pedro Montes
- Gastroenterology and Hepatology Unit, Hospital Nacional Daniel A. Carrión, Callao, Peru
| | - Eira Cerda
- Hepatology Unit, Hospital Militar Central de México, Ciudad de México, Mexico
| | - Cristina Rigamonti
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy; Division of Internal Medicine, "AOU Maggiore della Carità", Novara, Italy
| | - Suna Yapalı
- Department of Gastroenterology, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Gupse Adali
- Department of Gastroenterology, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Ali Rıza Çalışkan
- Department of Gastroenterology, Adıyaman University, Adıyaman, Turkey
| | - Yasemin Balaban
- Department of Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Fatih Eren
- Department of Gastroenterology, Medical Faculty, Uludag University, Bursa, Turkey
| | - Tuğçe Eşkazan
- Department of Gastroenterology, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Sezgin Barutçu
- Department of Gastroenterology, University of Gaziantep Medical Faculty, Gaziantep, Turkey
| | - Ellina Lytvyak
- University of Alberta Division of Gastroenterology and Liver Unit, Edmonton, AB, Canada
| | - Godolfino Miranda Zazueta
- Gastroenterology Unit, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, Mexico
| | - Meral Akdogan Kayhan
- Department of Gastroenterology, Gülhane Training and Research Hospital, Ankara, Turkey
| | | | - Eleonora De Martin
- Centre Hepato-Biliaire, Hôpital Paul-Brousse, FHU Hepatinov, INSERM Unit UMR 1193, Univ Paris-Saclay, France
| | - Ahmet Yavuz
- Division of Gastroenterology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - Murat Bıyık
- Division of Gastroenterology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - Graciela Castro Narro
- Gastroenterology Unit, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, Mexico
| | - Serkan Duman
- Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey
| | - Nelia Hernandez
- Gastroenterology and Hepatology Unit, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Nikolaos K Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Jonathan Aguirre
- Hepatology Unit, Hospital Ángeles Pedregal, Ciudad de México, Mexico
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey
| | - Marcelo Silva
- Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina; Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Manuel Mendizabal
- Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina; Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Kadri Atay
- Department of Gastroenterology, Mardin State Hospital, Mardin, Turkey
| | - Fatih Güzelbulut
- Department of Gastroenterology, Haydarpaşa Numune Education and Research Hospital, İstanbul, Turkey
| | | | - Aldo J Montano-Loza
- University of Alberta Division of Gastroenterology and Liver Unit, Edmonton, AB, Canada
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Ezequiel Ridruejo
- Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina; Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina; Hepatology Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas, CEMIC, Ciudad Autónoma de Buenos Aires, Argentina
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Staffan Wahlin
- Hepatology Division, Department of Upper GI Diseases, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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21
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Yurdaydin C, Keskin O, Yurdcu E, Çalişkan A, Önem S, Karakaya F, Kalkan Ç, Karatayli E, Karatayli S, Choong I, Apelian D, Koh C, Heller T, Idilman R, Bozdayi AM, Glenn JS. A phase 2 dose-finding study of lonafarnib and ritonavir with or without interferon alpha for chronic delta hepatitis. Hepatology 2022; 75:1551-1565. [PMID: 34860418 DOI: 10.1002/hep.32259] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [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] [Received: 10/06/2020] [Revised: 10/04/2021] [Accepted: 11/21/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Proof-of-concept studies demonstrated lonafarnib (LNF), a first-in-class oral prenylation inhibitor, efficacy in patients infected with HDV. The lonafarnib with ritonavir for HDV-2 (LOWR-2) study's aim was to identify optimal combination regimens of LNF + ritonavir (RTV) ± pegylated interferon alpha (PEG-IFNα) with efficacy and tolerability for longer-term dosing. Here we report the safety and efficacy at end of treatment for up to 24 weeks. APPROACH AND RESULTS Fifty-five patients with chronic HDV were consecutively enrolled in an open-label, single-center, phase 2 dose-finding study. There were three main treatment groups: high-dose LNF (LNF ≥ 75 mg by mouth [po] twice daily [bid] + RTV) (n = 19, 12 weeks); all-oral low-dose LNF (LNF 25 or 50 mg po bid + RTV) (n = 24, 24 weeks), and combination low-dose LNF with PEG-IFNα (LNF 25 or 50 mg po bid + RTV + PEG-IFNα) (n = 12, 24 weeks). The primary endpoint, ≥2 log10 decline or < lower limit of quantification of HDV-RNA from baseline at end of treatment, was reached in 46% (6 of 13) and 89% (8 of 9) of patients receiving the all-oral regimen of LNF 50 mg bid + RTV, and combination regimens of LNF (25 or 50 mg bid) + RTV + PEG-IFNα, respectively. In addition, multiple patients experienced well-tolerated transient posttreatment alanine aminotransferase increases, resulting in HDV-RNA negativity and alanine aminotransferase normalization. The proportions of grade 2 and 3 gastrointestinal adverse events in the high-dose versus low-dose groups were 49% (37 of 76) and only 22% (18 of 81), respectively. CONCLUSIONS LNF, boosted with low-dose RTV, is a promising all-oral therapy, and maximal efficacy is achieved with PEG-IFNα addition. The identified optimal regimens support a phase 3 study of LNF for the treatment of HDV.
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Affiliation(s)
- Cihan Yurdaydin
- Department of GastroenterologyUniversity of Ankara Medical SchoolAnkaraTurkey
- Hepatology InstituteUniversity of AnkaraAnkaraTurkey
- Department of Gastroenterology and HepatologyKoç University Medical SchoolIstanbulTurkey
| | - Onur Keskin
- Department of GastroenterologyUniversity of Ankara Medical SchoolAnkaraTurkey
| | - Esra Yurdcu
- Hepatology InstituteUniversity of AnkaraAnkaraTurkey
| | - Aysun Çalişkan
- Department of GastroenterologyUniversity of Ankara Medical SchoolAnkaraTurkey
| | - Soner Önem
- Department of GastroenterologyUniversity of Ankara Medical SchoolAnkaraTurkey
| | - Fatih Karakaya
- Department of GastroenterologyUniversity of Ankara Medical SchoolAnkaraTurkey
| | - Çağdaş Kalkan
- Department of GastroenterologyUniversity of Ankara Medical SchoolAnkaraTurkey
| | - Ersin Karatayli
- Hepatology InstituteUniversity of AnkaraAnkaraTurkey
- Department of Medicine IISaarland University Medical CenterSaarland UniversityHomburgGermany
| | - Senem Karatayli
- Hepatology InstituteUniversity of AnkaraAnkaraTurkey
- Department of Medicine IISaarland University Medical CenterSaarland UniversityHomburgGermany
| | - Ingrid Choong
- Eiger BioPharmaceuticals, Inc.Palo AltoCaliforniaUSA
| | - David Apelian
- Eiger BioPharmaceuticals, Inc.Palo AltoCaliforniaUSA
| | - Christopher Koh
- Translational Hepatology SectionLiver Diseases BranchNational Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthBethesdaMarylandUSA
| | - Theo Heller
- Translational Hepatology SectionLiver Diseases BranchNational Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthBethesdaMarylandUSA
| | - Ramazan Idilman
- Department of GastroenterologyUniversity of Ankara Medical SchoolAnkaraTurkey
| | | | - Jeffrey S Glenn
- Departments of Medicine (Division of Gastroenterology and Hepatology) and Microbiology & ImmunologyStanford School of MedicineStanfordCaliforniaUSA
- Palo Alto Veterans AdministrationPalo AltoCaliforniaUSA
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22
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Jang H, Yoon JS, Park SY, Lee HA, Jang MJ, Kim SU, Sinn DH, Seo YS, Kim HY, Kim SE, Jun DW, Yoon EL, Sohn JH, Ahn SB, Shim JJ, Jeong SW, Cho YK, Kim HS, Nam JY, Lee YB, Kim YJ, Yoon JH, Zoulim F, Lampertico P, Dalekos GN, Idilman R, Sypsa V, Berg T, Buti M, Calleja JL, Goulis J, Manolakopoulos S, Janssen HLA, Papatheodoridis GV, Lee JH. Impact of HBeAg on Hepatocellular Carcinoma Risk During Oral Antiviral Treatment in Patients With Chronic Hepatitis B. Clin Gastroenterol Hepatol 2022; 20:1343-1353.e16. [PMID: 34500103 DOI: 10.1016/j.cgh.2021.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND & AIMS Antiviral treatment from hepatitis B envelope antigen (HBeAg)-positive status may attenuate the integration of hepatitis B virus DNA into the host genome causing hepatocellular carcinoma (HCC). We investigated the impact of HBeAg status at the onset of antiviral treatment on the risk of HCC. METHODS The incidence of HCC was evaluated in Korean patients with chronic hepatitis B who started entecavir or tenofovir in either HBeAg-positive or HBeAg-negative phase. The results in the Korean cohort were validated in a Caucasian PAGE-B cohort. RESULTS A total of 9143 Korean patients (mean age, 49.2 years) were included: 49.1% were HBeAg-positive and 49.2% had cirrhosis. During follow-up (median, 5.1 years), 916 patients (10.0%) developed HCC. Baseline HBeAg positivity was not associated with the risk of HCC in the entire cohort or cirrhotic subcohort. However, in the non-cirrhotic subcohort, HBeAg positivity was independently associated with a lower risk of HCC in multivariable (adjusted hazard ratio [aHR], 0.41; 95% confidence interval [CI], 0.26-0.66), propensity score-matching (aHR, 0.46; 95% CI, 0.28-0.76), and inverse probability weighting analyses (aHR, 0.44; 95% CI, 0.28-0.70). In the Caucasian cohort (n = 719; mean age, 51.8 years; HBeAg-positive, 20.3%; cirrhosis, 34.8%), HBeAg-positivity was not associated with the risk of HCC either in the entire cohort or cirrhotic subcohort. In the non-cirrhotic subcohort, none of the HBeAg-positive group developed HCC, although the difference failed to reach statistical significance (aHR, 0.21; 95% CI, 0.00-1.67). CONCLUSIONS This multinational cohort study implies that HBeAg positivity at the onset of antiviral treatment seems to be an independent factor associated with a lower risk of HCC in patients with chronic hepatitis B without cirrhosis, but not in those with cirrhosis.
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Affiliation(s)
- Heejoon Jang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jun Sik Yoon
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Soo Young Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Han Ah Lee
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Myoung-Jin Jang
- Medical Research Collaboration Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Up Kim
- Department of Internal Medicine and Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Hyun Sinn
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yeon Seok Seo
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hwi Young Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Republic of Korea
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Eileen L Yoon
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Joo Hyun Sohn
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si, Republic of Korea
| | - Sang Bong Ahn
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea
| | - Jae-Jun Shim
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soung Won Jeong
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Yong Kyun Cho
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyoung Su Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Joon Yeul Nam
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yun Bin Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Fabien Zoulim
- Cancer Research Centre of Lyon, INSERM U, Lyon University, Hospices Civils de Lyon, Lyon, France
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Maria Buti
- Hospital General Universitario Vall Hebron and Ciberehd, Barcelona, Spain
| | | | - John Goulis
- The Department of Internal Medicine, Αristotle University of Thessaloniki Medical School, General Hospital of Thessaloniki "Hippokratio", Thessaloniki, Greece
| | - Spilios Manolakopoulos
- Second Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Hippokratio", Athens, Greece
| | - Harry LA Janssen
- Liver Clinic, Toronto Western and General Hospital, University Health Network, Toronto, ON, Canada
| | - George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece.
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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23
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Efe C, Lammert C, Taşçılar K, Dhanasekaran R, Ebik B, Higuera-de la Tijera F, Calışkan AR, Peralta M, Gerussi A, Massoumi H, Catana AM, Purnak T, Rigamonti C, Aldana AJG, Khakoo N, Nazal L, Frager S, Demir N, Irak K, Melekoğlu-Ellik Z, Kacmaz H, Balaban Y, Atay K, Eren F, Alvares-da-Silva MR, Cristoferi L, Urzua Á, Eşkazan T, Magro B, Snijders R, Barutçu S, Lytvyak E, Zazueta GM, Demirezer-Bolat A, Aydın M, Heurgue-Berlot A, De Martin E, Ekin N, Yıldırım S, Yavuz A, Bıyık M, Narro GC, Kıyıcı M, Akyıldız M, Kahramanoğlu-Aksoy E, Vincent M, Carr RM, Günşar F, Reyes EC, Harputluoğlu M, Aloman C, Gatselis NK, Üstündağ Y, Brahm J, Vargas NCE, Güzelbulut F, Garcia SR, Aguirre J, Anders M, Ratusnu N, Hatemi I, Mendizabal M, Floreani A, Fagiuoli S, Silva M, Idilman R, Satapathy SK, Silveira M, Drenth JPH, Dalekos GN, N Assis D, Björnsson E, Boyer JL, Yoshida EM, Invernizzi P, Levy C, Montano-Loza AJ, Schiano TD, Ridruejo E, Wahlin S. Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis. Liver Int 2022; 42:607-614. [PMID: 34846800 DOI: 10.1111/liv.15121] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/25/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH). PATIENTS AND METHODS Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression. RESULTS We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients. CONCLUSION Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH.
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Affiliation(s)
- Cumali Efe
- Department of Gastroenterology, Harran University Hospital, Şanlıurfa, Turkey
| | - Craig Lammert
- Department of Medicine Indiana, University School of Medicine Indianapolis, Indianapolis, Indiana, USA
| | - Koray Taşçılar
- Department of Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Renumathy Dhanasekaran
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Berat Ebik
- Department of Gastroenterology, Gazi Yaşargil Education and Research Hospital, Diyarbakir, Turkey
| | | | - Ali R Calışkan
- Department of Gastroenterology, Adıyaman University, Adıyaman, Turkey
| | - Mirta Peralta
- Hepatology Section, Hospital Francisco J Muñiz, Ciudad Autónoma de Buenos Aires, Argentina.,Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina
| | - Alessio Gerussi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Hatef Massoumi
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Andreea M Catana
- Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Tugrul Purnak
- Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, Houston, Texas, USA
| | - Cristina Rigamonti
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,Division of Internal Medicine, "AOU Maggiore della Carità", Novara, Italy
| | - Andres J G Aldana
- Gastroenterology and Hepatology Unit, Fundación Santa Fe de Bogotá y universidad de Los Andes, Bogotá, Colombia
| | - Nidah Khakoo
- Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Leyla Nazal
- Gastroenterology and Hepatology Unit, Clínica Las Condes, Santiago de Chile, Chile
| | - Shalom Frager
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Nurhan Demir
- Department of Gastroenterology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Kader Irak
- Department of Gastroenterology, SBU Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | | | - Hüseyin Kacmaz
- Department of Gastroenterology, Adıyaman University, Adıyaman, Turkey
| | - Yasemin Balaban
- Department of Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kadri Atay
- Departmant of Gastroenterology, Mardin State Hospital, Mardin, Turkey
| | - Fatih Eren
- Departmant of Gastroenterology, Ordu State Hospital, Ordu, Turkey
| | - Mario R Alvares-da-Silva
- Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Laura Cristoferi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Álvaro Urzua
- Gastroenterology and Hepatology Unit. Hospital Clínico, Universidad de Chile, Santiago de Chile, Chile
| | - Tuğçe Eşkazan
- Department of Gastroenterology, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Bianca Magro
- Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII-Bergamo, Bergamo, Italy
| | - Romee Snijders
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Nijmegen, The Netherlands
| | - Sezgin Barutçu
- Department of Gastroenterology, University of Gaziantep Medical Faculty, Gaziantep, Turkey
| | - Ellina Lytvyak
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Godolfino M Zazueta
- Gastroenterology Unit, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, México
| | | | - Mesut Aydın
- School of Medicine, Department of Gastroenterology, Van Yuzuncu Yil University, Van, Turkey
| | | | - Eleonora De Martin
- Centre Hepato-Biliaire, Hôpital Paul-Brousse, FHU Hepatinov, INSERM Unit UMR 1193, Univ Paris-Saclay, Gif-sur-Yvette, France
| | - Nazım Ekin
- Department of Gastroenterology, Gazi Yaşargil Education and Research Hospital, Diyarbakir, Turkey
| | - Sümeyra Yıldırım
- Department of Gastroenterology, Erciyes Hospital, Kayseri, Turkey
| | - Ahmet Yavuz
- Division of Gastroenterology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Murat Bıyık
- Division of Gastroenterology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Graciela C Narro
- Gastroenterology Unit, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, México
| | - Murat Kıyıcı
- Department of Gastroenterology, Medical Faculty, Uludag University, Bursa, Turkey
| | - Murat Akyıldız
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Turkey
| | | | - Maria Vincent
- Department of Internal Medicine, Donald and Barbara Zucker School of Medicine, Northwell Health, Manhasset, NY, USA
| | - Rotonya M Carr
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fulya Günşar
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Eira C Reyes
- Hepatology Unit. Hospital Militar Central de México, Ciudad de México, México
| | - Murat Harputluoğlu
- Department of Gastroenterology, Inönü University School of Medicine, Malatya, Turkey
| | - Costica Aloman
- Section of Hepatology, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikolaos K Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Yücel Üstündağ
- Department of Gastroenterology, Bulent Ecevit University of Medicine, Zonguldak, Turkey
| | - Javier Brahm
- Gastroenterology Unit, Clínica Las Condes, Santiago, Chile
| | - Nataly C E Vargas
- Hepatology Unit Hospital Nacional Almanzor Aguinaga Asenjo, Chiclayo, Perú
| | - Fatih Güzelbulut
- Department of Gastroenterology, Haydarpaşa Numune Education and Research Hospital, İstanbul, Turkey
| | - Sandro R Garcia
- Gastroenterology Unit, Hospital Víctor Lazarte Echegaray, Trujillo, Perú
| | - Jonathan Aguirre
- Hepatology Unit, Hospital Ángeles Pedregal, Ciudad de México, México
| | - Margarita Anders
- Hepatology and Liver Transplant Unit, Hospital Alemán, Buenos Aires, Argentina
| | - Natalia Ratusnu
- Hepatology Unit, Hospital Regional de Ushuaia, Ushuaia, Argentina
| | - Ibrahim Hatemi
- Department of Gastroenterology, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Manuel Mendizabal
- Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina.,Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Annarosa Floreani
- Scientific Consultant IRCCS Negrar, Verona, Italy.,Senior Scholar, University of Padova, Padova, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII-Bergamo, Bergamo, Italy
| | - Marcelo Silva
- Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina.,Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey
| | - Sanjaya K Satapathy
- Department of Internal Medicine, Donald and Barbara Zucker School of Medicine, Northwell Health, Manhasset, NY, USA
| | - Marina Silveira
- Department of Medicine, Section of Digestive Diseases Yale School of Medicine, New Haven, Connecticut, USA
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Nijmegen, The Netherlands
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - David N Assis
- Department of Medicine, Section of Digestive Diseases Yale School of Medicine, New Haven, Connecticut, USA
| | - Einar Björnsson
- Department of Internal Medicine, Section of Gastroenterology, Landspitali University Hospital, Reykjavik, Iceland
| | - James L Boyer
- Department of Medicine, Section of Digestive Diseases Yale School of Medicine, New Haven, Connecticut, USA
| | - Eric M Yoshida
- Division of Gastroenterology, University of British Columbia and Vancouver General Hospital, Vancouver, Canada
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Cynthia Levy
- Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Aldo J Montano-Loza
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas D Schiano
- Division of Liver Diseases, The Mount Sinai Medical Center, New York, New York, USA
| | - Ezequiel Ridruejo
- Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina.,Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina.,Hepatology Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas, CEMIC, Ciudad Autónoma de Buenos Aires, Argentina
| | - Staffan Wahlin
- Hepatology Division, Department of Upper GI Diseases, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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24
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Melekoglu Ellik Z, S. Idilman I, Kartal A, Balaban Y, H. Elhan A, Karcaaltincaba M, Ozkan H, Idilman R. Evaluation of Magnetic Resonance Elastography and Transient Elastography for Liver Fibrosis and Steatosis Assessments in the Liver Transplant Setting. Turk J Gastroenterol 2022; 33:153-160. [PMID: 35238782 PMCID: PMC9128353 DOI: 10.5152/tjg.2022.21705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/02/2021] [Indexed: 08/10/2023]
Abstract
BACKGROUND Liver graft fibrosis affects long-term graft and patient survival in liver transplant recipients. Transient elastography and magnetic resonance elastography are widely used for the assessment of liver fibrosis in routine clinical practice, but are limited in liver transplant settings. The aims of the present study were to evaluate the accuracy of magnetic resonance elastography and transient elastograph in the assessment of liver fibrosis in liver transplant recipients, and to determine the recurrence rates of post-transplant hepatic steatosis and liver fibrosis. METHODS A total of 126 consecutive liver transplant recipients were included. Magnetic resonance elastography and transient elastography were performed for to measure liver stiffness. RESULTS The most common cause of liver transplantation was hepatitis B virus-induced cirrhosis (50%). The mean liver stiffness value with transient elastography was 6.1 ± 3.0 kPa, and the mean magnetic resonance elastography value was 2.7 ± 1.0 kPa. A significant positive correlation was found between magnetic resonance elastography and transient elastography in terms of liver stiffness measurement (r = 0.61, P < .001). Obesity and the underlying etiology of liver diseases did not have any significant negative effect on magnetic resonance elastography and transient elastography measurements. During the follow-up, the post-transplant recurrence rates of hepatic steatosis and hepatic fibrosis were 26% and 37%, respectively. The recurrence rates of post-transplant hepatic steatosis and liver fibrosis were slightly higher in recipients with non-alcoholic fatty liver disease-related cirrhosis than those with viral hepatitisrelated etiologies (44% vs 27%, P = .43; 44% vs 30%, P = .45, respectively). CONCLUSION Magnetic resonance elastography and transient elastography are accurate in assessing liver fibrosis in the liver transplant setting. Obesity and the underlying etiology of primary liver disease do not influence the measurements.
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Affiliation(s)
| | - Ilkay S. Idilman
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Aysun Kartal
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Yasemin Balaban
- />Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Atilla H. Elhan
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | | | - Hasan Ozkan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
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25
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Kim HY, Lampertico P, Nam JY, Lee HC, Kim SU, Sinn DH, Seo YS, Lee HA, Park SY, Lim YS, Jang ES, Yoon EL, Kim HS, Kim SE, Ahn SB, Shim JJ, Jeong SW, Jung YJ, Sohn JH, Cho YK, Jun DW, Dalekos GN, Idilman R, Sypsa V, Berg T, Buti M, Calleja JL, Goulis J, Manolakopoulos S, Janssen HLA, Jang MJ, Lee YB, Kim YJ, Yoon JH, Papatheodoridis GV, Lee JH. An artificial intelligence model to predict hepatocellular carcinoma risk in Korean and Caucasian patients with chronic hepatitis B. J Hepatol 2022; 76:311-318. [PMID: 34606915 DOI: 10.1016/j.jhep.2021.09.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Several models have recently been developed to predict risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). Our aims were to develop and validate an artificial intelligence-assisted prediction model of HCC risk. METHODS Using a gradient-boosting machine (GBM) algorithm, a model was developed using 6,051 patients with CHB who received entecavir or tenofovir therapy from 4 hospitals in Korea. Two external validation cohorts were independently established: Korean (5,817 patients from 14 Korean centers) and Caucasian (1,640 from 11 Western centers) PAGE-B cohorts. The primary outcome was HCC development. RESULTS In the derivation cohort and the 2 validation cohorts, cirrhosis was present in 26.9%-50.2% of patients at baseline. A model using 10 parameters at baseline was derived and showed good predictive performance (c-index 0.79). This model showed significantly better discrimination than previous models (PAGE-B, modified PAGE-B, REACH-B, and CU-HCC) in both the Korean (c-index 0.79 vs. 0.64-0.74; all p <0.001) and Caucasian validation cohorts (c-index 0.81 vs. 0.57-0.79; all p <0.05 except modified PAGE-B, p = 0.42). A calibration plot showed a satisfactory calibration function. When the patients were grouped into 4 risk groups, the minimal-risk group (11.2% of the Korean cohort and 8.8% of the Caucasian cohort) had a less than 0.5% risk of HCC during 8 years of follow-up. CONCLUSIONS This GBM-based model provides the best predictive power for HCC risk in Korean and Caucasian patients with CHB treated with entecavir or tenofovir. LAY SUMMARY Risk scores have been developed to predict the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. We developed and validated a new risk prediction model using machine learning algorithms in 13,508 antiviral-treated patients with chronic hepatitis B. Our new model, based on 10 common baseline characteristics, demonstrated superior performance in risk stratification compared with previous risk scores. This model also identified a group of patients at minimal risk of developing HCC, who could be indicated for less intensive HCC surveillance.
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Affiliation(s)
- Hwi Young Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Joon Yeul Nam
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Chul Lee
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Up Kim
- Department of Internal Medicine and Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Sinn
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon Seok Seo
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College, Republic of Korea
| | - Han Ah Lee
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College, Republic of Korea; Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Soo Young Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Young-Suk Lim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Eun Sun Jang
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Eileen L Yoon
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyoung Su Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Republic of Korea
| | - Sang Bong Ahn
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea
| | - Jae-Jun Shim
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Soung Won Jeong
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Yong Jin Jung
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Republic of Korea
| | - Joo Hyun Sohn
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si, Republic of Korea
| | - Yong Kyun Cho
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Vana Sypsa
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Maria Buti
- Hospital General Universitario Vall Hebron and Ciberehd, Barcelona, Spain
| | | | - John Goulis
- 4th Department of Internal Medicine, Aristotle University of Thessaloniki Medical School, General Hospital of Thessaloniki "Hippokratio", Thessaloniki, Greece
| | - Spilios Manolakopoulos
- 2nd Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Hippokratio", Athens, Greece
| | - Harry L A Janssen
- Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada
| | - Myoung-Jin Jang
- Medical Research Collaboration Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yun Bin Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece.
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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26
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Özbaş B, Keskin O, Hecker H, Karahan I, Özbaş C, Kalkan Ç, Kartal A, Önder FO, Öncü BK, Gençdal G, Akyildiz M, Günşar F, Idilman R, Weissenborn K, Özütemiz Ö, Yurdaydin C. Determination of Turkish norms of psychometric tests for diagnosing minimal hepatic encephalopathy and proposal of a high sensitive screening test battery. Hepatol Int 2021; 15:1442-1455. [PMID: 34085147 DOI: 10.1007/s12072-021-10207-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Psychometric hepatic encephalopathy score (PHES) needs local standardization. AIMS This study aimed at standardizing PHES for Turkish patients and compare them with German norms; to determine minimal hepatic encephalopathy (mHE) prevalence with two different methods [PHES battery and Critical Flicker Frequency (CFF)] and to assess whether sub-tests of the battery can be used for screening for mHE. METHODS Healthy volunteers (n = 816; 400 male) and cirrhotics (n = 124; 58 male) were included. For mHE diagnosis PHES score threshold was set at ≤ - 5 points and that of CFF at < 39 Hz. For comparing German and Turkish norms, datasets were combined. Multiple backward procedure was applied to assess effects of age, sex and education on single tests of the battery. Receiver operating characteristic (ROC) curves were created for assessing diagnostic capabilities of subtests of the battery. RESULTS PHES norms for Turks were developed. MHE prevalence in compensated cirrhotics was 29.8% and 27.4% with PHES and CFF tests, respectively, with low compatibility (kappa coefficient 0.389); mHE prevalence decreased to 16% when both tests were combined. Turks performed worse vs Germans in the digit symbol (DS) and serial dotting (SD) subtests but performed better in other subtests. In ROC analyzes of subtests, the combination of DS + SD tests achieved an AUROC of 0.974 versus PHES. CONCLUSIONS Use of two methods for diagnosing mHE is important for research purposes. From a clinical perspective, sensitivity with acceptable specificity may suffice for screening instruments for mHE. Combined use of DS and SD subtests of the PHES battery appears suitable for this purpose.
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Affiliation(s)
- Burak Özbaş
- Department of Internal Medicine, Ankara University Medical School, Ankara, Turkey
| | - Onur Keskin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Hartmut Hecker
- Department of Biometrics, Hannover Medical School, Hannover, Germany
| | - Irfan Karahan
- Department of Internal Medicine, Ankara University Medical School, Ankara, Turkey
| | - Cansu Özbaş
- Department of Public Health, Gazi University Medical School, Ankara, Turkey
| | - Çağdaş Kalkan
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Aysun Kartal
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Fatih Oğuz Önder
- Department of Internal Medicine, Ankara University Medical School, Ankara, Turkey
| | - Burcu Kahveci Öncü
- Department of Psychiatry, Ankara University Medical School, Ankara, Turkey
| | - Genco Gençdal
- Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey
| | - Murat Akyildiz
- Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey
| | - Fulya Günşar
- Department of Gastroenterology, Ege University Medical School, Izmir, Turkey
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | | | - Ömer Özütemiz
- Department of Gastroenterology, Ege University Medical School, Izmir, Turkey
| | - Cihan Yurdaydin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey.
- Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey.
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27
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Salih Akarca U, Unsal B, Sezgin O, Yalcin K, Akdogan M, Gonen C, Gunduz F, Ozenirler S, Sonsuz A, Dincer D, Basol Tekin S, Yucel I, Akbulut H, Alkım C, Ozyilkan O, Baygul A, Cevik ZM, Idilman R. Characteristics of Newly Diagnosed Hepatocellular Carcinoma Patients Across Turkey: Prospective Multicenter Observational 3K Registry Study. Turk J Gastroenterol 2021; 32:1019-1028. [PMID: 34876392 PMCID: PMC8975510 DOI: 10.5152/tjg.2021.201171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS To evaluate patient profile for epidemiological and clinicopathological characteristics and potential risk/prognostic factors in newly diagnosed hepatocellular carcinoma (HCC) patients across Turkey. METHODS A total of 547 patients (mean (SD) age 62.6 (10.3) years, 81.9% were males) were included in this registry study. Data on patient characteristics, etiologies of HCC, laboratory values, and tumor characteristics and stages were recorded at study enrollment. RESULTS HBV infection (68.2%) was the leading etiology, followed by HCV infection (17.2%), HDV infection (5.5%), alcohol (6.4%), and NAFLD (3.5%), as the major etiologies. Considering that 51.6% of the patients had >5 cm HCC, 44% were Child-Pugh B/C and 57% were BCLC B-D, it appears that a significant group of HCC patients were diagnosed at advanced stages. Of 540 patients, 271 (50.2%) were referred or applied with the diagnosis of HCC. Patients with HCC at presentation had larger tumor size (median (min-max) 6.6 (0-30) vs. 4.8 (0-90) cm, P < .001) and more advanced BCLC stage (Stage C-D in 40.8% vs. 26.4%, respectively, P = .005), compared to patients who were diagnosed during follow-up. CONCLUSIONS Our findings revealed that HBV infection was the leading etiology and a moderate-to-advanced disease was evident in more than half of patients at the time of diagnosis. HCC patients diagnosed at follow-up had smaller tumor size and earlier BCLC stage.
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Affiliation(s)
- Ulus Salih Akarca
- Department of Gastroenterology, Ege University Faculty of Medicine, Izmir, Turkey
- Corresponding author: Ulus Salih Akarca, e-mail:
| | - Belkis Unsal
- Clinic of Gastroenterology, Izmir Ataturk Training and Research Hospital, Izmir, Turkey
| | - Orhan Sezgin
- Department of Gastroenterology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Kendal Yalcin
- Department of Gastroenterology, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Meral Akdogan
- Clinic of Gastroenterology, Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Can Gonen
- Clinic of Gastroenterology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Feyza Gunduz
- Clinic of Gastroenterology, Marmara University Faculty of Medicine Pendik Training and Research Hospital, Istanbul, Turkey
| | - Seren Ozenirler
- Department of Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Abdullah Sonsuz
- Department of Gastroenterology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Dinc Dincer
- Department of Gastroenterology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Salim Basol Tekin
- Department of Oncology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Idris Yucel
- Department of Oncology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Hakan Akbulut
- Department of Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Canan Alkım
- Clinic of Gastroenterology, Sisli Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ozgur Ozyilkan
- Department of Oncology, Adana Baskent University Faculty of Medicine, Adana, Turkey
| | - Arzu Baygul
- Department of Biostatistics, Koc University School of Medicine, Istanbul, Turkey
| | | | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Faculty of Medicine, Turkey
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28
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Akarsu M, Onem S, Turan I, Adali G, Akdogan M, Akyildiz M, Aladag M, Balaban Y, Danis N, Dayangac M, Gencdal G, Gokcan H, Sertesen E, Gurakar M, Harputluoglu M, Kabacam G, Karademir S, Kiyici M, Idilman R, Karasu Z. Recommendations for Hepatitis B Immunoglobulin and Antiviral Prophylaxis Against Hepatitis B Recurrence After Liver Transplantation. Turk J Gastroenterol 2021; 32:712-719. [PMID: 34609299 DOI: 10.5152/tjg.2021.21608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The combination of hepatitis B immunoglobulin and potent nucleos(t)ide analogs after liver transplantation is considered as the standard of care for prophylaxis against hepatitis B virus recurrence. However, the recommended doses, route of administration, and duration of HBIG administration remain unclear. Moreover, hepatitis B immunoglobulin-free prophylaxis with potent nucleos(t)ide analogs has shown promising disease outcomes in preventing hepatitis B virus recurrence. The current recommendations, produced by the Turkish Association for the Study of the Liver, Acute Liver Failure and Liver Transplantation Special Interest Group, suggest a reduced need for hepatitis B immunoglobulin administration with effective long-term suppression of hepatitis B virus replication using potent nucleos(t) ide analogs after liver transplantation.
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Affiliation(s)
- Mesut Akarsu
- Department of Gastroenterology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Soner Onem
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkey
| | - Ilker Turan
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkey
| | - Gupse Adali
- Department of Gastroenterology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Meral Akdogan
- Department of Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Murat Akyildiz
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Turkey
| | - Murat Aladag
- Department of Gastroenterology, Turgut Özal University School of Medicine, Malatya, Turkey
| | - Yasemin Balaban
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Nilay Danis
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkey
| | - Murat Dayangac
- Center for Organ Transplantation, Medipol University Hospital, Istanbul, Turkey
| | - Genco Gencdal
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Turkey
| | - Hale Gokcan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Elif Sertesen
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Merve Gurakar
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Murat Harputluoglu
- Department of Gastroenterology, Liver Transplantation Institute, İnönü University School of Medicine, Malatya, Turkey
| | - Gokhan Kabacam
- Department of Gastroenterology, Güven Hospital, Ankara, Turkey
| | - Sedat Karademir
- Department of Gastroenterology, Güven Hospital, Ankara, Turkey
| | - Murat Kiyici
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Turkey
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Zeki Karasu
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkey
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Muhammad H, Zaffar D, Tehreem A, Ting PS, Simsek C, Gokcan H, Gurakar A, Idilman R. HBV/HDV management after liver transplantation: Review. Journal of Liver Transplantation 2021. [DOI: 10.1016/j.liver.2021.100046] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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30
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Gokcan H, Idilman R. Hepatitis D Infection in Asia: A Perspective From an Endemic Region. Clin Liver Dis (Hoboken) 2021; 18:26-29. [PMID: 34484701 PMCID: PMC8405052 DOI: 10.1002/cld.1106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/06/2021] [Accepted: 02/21/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- Hale Gokcan
- Department of GastroenterologyAnkara University School of MedicineAnkaraTurkey
| | - Ramazan Idilman
- Department of GastroenterologyAnkara University School of MedicineAnkaraTurkey
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31
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Idilman IS, Celik A, Savas B, Idilman R, Karcaaltincaba M. The feasibility of T2 mapping in the assessment of hepatic steatosis, inflammation, and fibrosis in patients with non-alcoholic fatty liver disease: a preliminary study. Clin Radiol 2021; 76:709.e13-709.e18. [PMID: 34266657 DOI: 10.1016/j.crad.2021.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/16/2021] [Indexed: 01/04/2023]
Abstract
AIM To determine the feasibility of magnetic resonance imaging T2 mapping in the quantification of liver steatosis in patients with biopsy-proven non-alcoholic fatty liver disease (NAFLD), and to assess the effect of inflammation and fibrosis on T2 values of the liver. MATERIAL AND METHODS Twenty-three consecutive patients with biopsy-proven NAFLD who underwent T2 mapping between December 2013 and September 2014 were included in this study. All patients underwent fast spin echo multi-echo sequence with eight echoes for T2 measurements. RESULTS The mean liver T2 value and percentage of histological steatosis was 64.9 ± 7.4 ms and 46.5 ± 27.6%, respectively. There was a good correlation between the liver T2 value and histology-determined steatosis (r = 0.780, p<0.001) and grade of steatosis (rs = 0.779, p<0.001). The mean T2 value in patients with definitive non-alcoholic steatohepatitis (NASH) was significantly higher in comparison with patients without NASH (69 ± 7.37 versus 61.73 ± 5.99 ms, p=0.016). The correlation between T2 value and NAFLD activity score (NAS) was significant (rs = 0.443, p=0.034); however, the correlation disappeared after adjustment for hepatic steatosis and fibrosis (r=0.131, p=0.572). There was a close inverse correlation between T2 value and fibrosis stage after adjusting for hepatic steatosis (r=-0.536, p=0.012). CONCLUSION T2 mapping can be used for quantification of hepatic steatosis, as there is a close correlation between T2 relaxation values and histology-determined steatosis. Patients with definite NASH have increased T2 values and there is an inverse correlation between the T2 value and fibrosis stage of the liver. T2 mapping in NAFLD may be a useful clinical tool for disease assessment and prognostication.
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Affiliation(s)
- I S Idilman
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - A Celik
- General Electric Healthcare, Istanbul, Turkey
| | - B Savas
- Department of Pathology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - R Idilman
- Department of Gastroenterology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - M Karcaaltincaba
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey.
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32
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Efe C, Dhanasekaran R, Lammert C, Ebik B, Higuera‐de la Tijera F, Aloman C, Rıza Calışkan A, Peralta M, Gerussi A, Massoumi H, Catana AM, Torgutalp M, Purnak T, Rigamonti C, Gomez Aldana AJ, Khakoo N, Kacmaz H, Nazal L, Frager S, Demir N, Irak K, Ellik ZM, Balaban Y, Atay K, Eren F, Cristoferi L, Batıbay E, Urzua Á, Snijders R, Kıyıcı M, Akyıldız M, Ekin N, Carr RM, Harputluoğlu M, Hatemi I, Mendizabal M, Silva M, Idilman R, Silveira M, Drenth JP, Assis DN, Björnsson E, Boyer JL, Invernizzi P, Levy C, Schiano TD, Ridruejo E, Wahlin S. Outcome of COVID-19 in Patients With Autoimmune Hepatitis: An International Multicenter Study. Hepatology 2021; 73:2099-2109. [PMID: 33713486 PMCID: PMC8250536 DOI: 10.1002/hep.31797] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Data regarding outcome of COVID-19 in patients with autoimmune hepatitis (AIH) are lacking. APPROACH AND RESULTS We performed a retrospective study on patients with AIH and COVID-19 from 34 centers in Europe and the Americas. We analyzed factors associated with severe COVID-19 outcomes, defined as the need for mechanical ventilation, intensive care admission, and/or death. The outcomes of patients with AIH were compared to a propensity score-matched cohort of patients without AIH but with chronic liver diseases (CLD) and COVID-19. The frequency and clinical significance of new-onset liver injury (alanine aminotransferase > 2 × the upper limit of normal) during COVID-19 was also evaluated. We included 110 patients with AIH (80% female) with a median age of 49 (range, 18-85) years at COVID-19 diagnosis. New-onset liver injury was observed in 37.1% (33/89) of the patients. Use of antivirals was associated with liver injury (P = 0.041; OR, 3.36; 95% CI, 1.05-10.78), while continued immunosuppression during COVID-19 was associated with a lower rate of liver injury (P = 0.009; OR, 0.26; 95% CI, 0.09-0.71). The rates of severe COVID-19 (15.5% versus 20.2%, P = 0.231) and all-cause mortality (10% versus 11.5%, P = 0.852) were not different between AIH and non-AIH CLD. Cirrhosis was an independent predictor of severe COVID-19 in patients with AIH (P < 0.001; OR, 17.46; 95% CI, 4.22-72.13). Continuation of immunosuppression or presence of liver injury during COVID-19 was not associated with severe COVID-19. CONCLUSIONS This international, multicenter study reveals that patients with AIH were not at risk for worse outcomes with COVID-19 than other causes of CLD. Cirrhosis was the strongest predictor for severe COVID-19 in patients with AIH. Maintenance of immunosuppression during COVID-19 was not associated with increased risk for severe COVID-19 but did lower the risk for new-onset liver injury during COVID-19.
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Papatheodoridis GV, Dalekos GN, Idilman R, Sypsa V, Van Boemmel F, Buti M, Calleja JL, Goulis J, Manolakopoulos S, Loglio A, Papatheodoridi M, Gatselis N, Veelken R, Lopez-Gomez M, Hansen BE, Savvidou S, Kourikou A, Vlachogiannakos J, Galanis K, Yurdaydin C, Esteban R, Janssen HL, Berg T, Lampertico P. Predictive performance of newer Asian hepatocellular carcinoma risk scores in treated Caucasians with chronic hepatitis B. JHEP Rep 2021; 3:100290. [PMID: 34041470 PMCID: PMC8144729 DOI: 10.1016/j.jhepr.2021.100290] [Citation(s) in RCA: 1] [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: 02/05/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 12/22/2022] Open
Abstract
Background & Aims Recently, several risk scores for prediction of hepatocellular carcinoma (HCC) were developed in cohorts of treated Asian patients with chronic hepatitis B (CHB), but they have not been assessed in non-Asian patients. We evaluated the predictability and comparative utility of our PAGE-B and recent Asian HCC risk scores in nucleos(t)ide analogue (NA)-treated adult Caucasian patients with CHB, with or without well-documented compensated cirrhosis but not previous diagnosis of HCC. Methods We included 1,951 patients treated with entecavir/tenofovir and followed up for a median of 7.6 years. The c-statistic was used to estimate the predictability of PAGE-B, HCC-Rescue, CAMD, mPAGE-B, and AASL score for HCC development within 5 or 10 years. The low- and high-risk group cut-offs were used for estimation of negative (NPV) and positive predictive values (PPV), respectively. Results HCC developed in 103/1,951 (5.3%) patients during the first 5 years and in another 39/1,428 (2.7%) patients between years 5 and 10. The 3-, 5-, and 10-year cumulative HCC rates were 3.3%, 5.9%, and 9.6%, respectively. All scores offered good 5- and 10-year HCC prediction (c-statistic: 0.78–0.82). NPVs were always >99% (99.3–100%), whereas PPV ranged between 13% and 24%. Conclusions In NA-treated Caucasian patients with CHB including compensated cirrhosis, HCC risk scores developed in NA-treated Asian patients offer good 5- and 10-year HCC predictability, similar to that of PAGE-B. PAGE-B and mPAGE-B scores are simpler in clinical practice, as they do not require an accurate diagnosis of cirrhosis, but the addition of albumin in mPAGE-B score does not seem to offer an advantage in patients with well compensated liver disease. Lay summary Several risk scores for prediction of hepatocellular carcinoma (HCC) were recently developed in cohorts of treated Asian patients with chronic hepatitis B (CHB). In Caucasian patients with CHB treated with oral antivirals, newer Asian HCC risk scores offer good 5- and 10-year HCC predictability, similar to that of PAGE-B. For clinical practice, PAGE-B and mPAGE-B scores are simpler, as they do not require an accurate diagnosis of cirrhosis. In treated Caucasian patients with chronic hepatitis B, newer Asian hepatocellular carcinoma risk scores offer good 5- and 10-year predictability, similar to that of PAGE-B. PAGE-B and mPAGE-B scores are simpler in clinical practice, as they do not require an accurate diagnosis of cirrhosis. The addition of albumin in mPAGE-B does not seem to offer an advantage in patients with well-compensated liver disease.
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Key Words
- ALT, alanine aminotransferase
- AUROC, area under receiver operating characteristic
- CHB, chronic hepatitis B
- Cirrhosis
- ETV, entecavir
- Entecavir
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- NA, nucleos(t)ide analogue
- NPV, negative predictive value
- PPV, positive predictive value
- Prediction
- TDF, tenofovir disoproxil fumarate
- Tenofovir
- ULN, upper limit of normal
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Affiliation(s)
- George V. Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens, Greece
- Corresponding author. Address: Department of Gastroenterology, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital of Athens, 17 Agiou Thoma Street, 11527 Athens, Greece. Tel: +30-2132061115, Fax: +30-2107462601
| | - George N. Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Vana Sypsa
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Florian Van Boemmel
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Maria Buti
- Hospital General Universitario Vall Hebron and Ciberehd, Barcelona, Spain
| | | | - John Goulis
- 4th Department of Internal Medicine, Αristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - Spilios Manolakopoulos
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens, Greece
- 2nd Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Hippokratio”, Athens, Greece
| | - Alessandro Loglio
- Division of Gastroenterology and Hepatology, CRC “A. M. and A. Migliavacca” Center for Liver Disease, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Margarita Papatheodoridi
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens, Greece
| | - Nikolaos Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Rhea Veelken
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | | | - Bettina E. Hansen
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
- Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada
| | - Savvoula Savvidou
- 4th Department of Internal Medicine, Αristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - Anastasia Kourikou
- 2nd Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Hippokratio”, Athens, Greece
| | - John Vlachogiannakos
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens, Greece
| | - Kostas Galanis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Cihan Yurdaydin
- Department of Gastroenterology & Hepatology, Koc University Medical School, Istanbul, Turkey
| | - Rafael Esteban
- Hospital General Universitario Vall Hebron and Ciberehd, Barcelona, Spain
| | - Harry L.A. Janssen
- Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, CRC “A. M. and A. Migliavacca” Center for Liver Disease, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Bremer B, Anastasiou OE, Hardtke S, Caruntu FA, Curescu MG, Yalcin K, Akarca US, Gürel S, Zeuzem S, Erhardt A, Lüth S, Papatheodoridis GV, Radu M, Idilman R, Manns MP, Cornberg M, Yurdaydin C, Wedemeyer H. Residual low HDV viraemia is associated HDV RNA relapse after PEG-IFNa-based antiviral treatment of hepatitis delta: Results from the HIDIT-II study. Liver Int 2021; 41:295-299. [PMID: 33217778 DOI: 10.1111/liv.14740] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/20/2020] [Accepted: 11/13/2020] [Indexed: 12/27/2022]
Abstract
The role of low levels of HDV-RNA during and after interferon therapy of hepatitis D is unknown. We re-analysed HDV RNA in 372 samples collected in the HIDIT-2 trial (Wedemeyer et al, Lancet Infectious Diseases 2019) with the Robogene assay (RA; Jena Analytics). Data were compared with the previously reported in-house assay (IA). We detected HDV-RNA in one-third of samples previously classified as undetectable using the highly sensitive RA. Low HDV viraemia detectable at week 48 or week 96 was associated with a high risk for post-treatment relapse, defined as HDV RNA positivity in both assays at week 120. HDV RNA relapses occurred in 10/15 (67%) patients with detectable low HDV RNA at week 48 and in 10/13 (77%) patients with low viraemia samples at week 96. In contrast, the post-treatment relapse rate was lower in patients with undetectable HDV RNA in both assays during treatment.
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Affiliation(s)
- Birgit Bremer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Olympia E Anastasiou
- Institute for Virology, Essen University Hospital and Medical Faculty of the University of Duisburg-Essen, Essen, Germany
| | - Svenja Hardtke
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infectious Disease Research (DZIF), HepNet Study-House, Hannover, Germany
| | | | | | - Kendal Yalcin
- Dicle University Medical Faculty, Diyarbakir, Turkey
| | | | - Selim Gürel
- Uludağ University Medical Faculty, Bursa, Turkey
| | - Stefan Zeuzem
- Johann Wolfgang Goethe University Medical Center, Frankfurt/Main, Germany
| | | | - Stefan Lüth
- Center of Internal Medicine II, University Hospital Brandenburg, Brandenburg Medical School, Brandenburg, Germany
| | | | - Monica Radu
- National Institute for Infectious Diseases Prof.Dr.Matei Bals, Bucharest, Romania
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infectious Disease Research (DZIF), HepNet Study-House, Hannover, Germany
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infectious Disease Research (DZIF), HepNet Study-House, Hannover, Germany
| | - Cihan Yurdaydin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey.,Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infectious Disease Research (DZIF), HepNet Study-House, Hannover, Germany.,Department of Gastroenterology and Hepatology, Essen University Hospital and Medical Faculty of the University of Duisburg-Essen, Essen, Germany
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35
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Fan R, Papatheodoridis G, Sun J, Innes H, Toyoda H, Xie Q, Mo S, Sypsa V, Guha IN, Kumada T, Niu J, Dalekos G, Yasuda S, Barnes E, Lian J, Suri V, Idilman R, Barclay ST, Dou X, Berg T, Hayes PC, Flaherty JF, Zhou Y, Zhang Z, Buti M, Hutchinson SJ, Guo Y, Calleja JL, Lin L, Zhao L, Chen Y, Janssen HLA, Zhu C, Shi L, Tang X, Gaggar A, Wei L, Jia J, Irving WL, Johnson PJ, Lampertico P, Hou J. aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis. J Hepatol 2020; 73:1368-1378. [PMID: 32707225 DOI: 10.1016/j.jhep.2020.07.025] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/02/2020] [Accepted: 07/14/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) is the leading cause of death in patients with chronic hepatitis. In this international collaboration, we sought to develop a global universal HCC risk score to predict the HCC development for patients with chronic hepatitis. METHODS A total of 17,374 patients, comprising 10,578 treated Asian patients with chronic hepatitis B (CHB), 2,510 treated Caucasian patients with CHB, 3,566 treated patients with hepatitis C virus (including 2,489 patients with cirrhosis achieving a sustained virological response) and 720 patients with non-viral hepatitis (NVH) from 11 international prospective observational cohorts or randomised controlled trials, were divided into a training cohort (3,688 Asian patients with CHB) and 9 validation cohorts with different aetiologies and ethnicities (n = 13,686). RESULTS We developed an HCC risk score, called the aMAP score (ranging from 0 to 100), that involves only age, male, albumin-bilirubin and platelets. This metric performed excellently in assessing HCC risk not only in patients with hepatitis of different aetiologies, but also in those with different ethnicities (C-index: 0.82-0.87). Cut-off values of 50 and 60 were best for discriminating HCC risk. The 3- or 5-year cumulative incidences of HCC were 0-0.8%, 1.5-4.8%, and 8.1-19.9% in the low- (n = 7,413, 43.6%), medium- (n = 6,529, 38.4%), and high-risk (n = 3,044, 17.9%) groups, respectively. The cut-off value of 50 was associated with a sensitivity of 85.7-100% and a negative predictive value of 99.3-100%. The cut-off value of 60 resulted in a specificity of 56.6-95.8% and a positive predictive value of 6.6-15.7%. CONCLUSIONS This objective, simple, reliable risk score based on 5 common parameters accurately predicted HCC development, regardless of aetiology and ethnicity, which could help to establish a risk score-guided HCC surveillance strategy worldwide. LAY SUMMARY In this international collaboration, we developed and externally validated a simple, objective and accurate prognostic tool (called the aMAP score), that involves only age, male, albumin-bilirubin and platelets. The aMAP score (ranged from 0 to 100) satisfactorily predicted the risk of hepatocellular carcinoma (HCC) development among over 17,000 patients with viral and non-viral hepatitis from 11 global prospective studies. Our findings show that the aMAP score had excellent discrimination and calibration in assessing the 5-year HCC risk among all the cohorts irrespective of aetiology and ethnicity.
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Affiliation(s)
- Rong Fan
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - George Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Jian Sun
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hamish Innes
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, UK
| | - Hidenori Toyoda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Qing Xie
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Vana Sypsa
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Indra Neil Guha
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Takashi Kumada
- Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan
| | - Junqi Niu
- Department of Hepatology, First Hospital, Jilin University, Changchun, China
| | - George Dalekos
- Department of Internal Medicine, Thessalia University Medical School, Larissa, Greece
| | - Satoshi Yasuda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Eleanor Barnes
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine and the Oxford NIHR Biomedical Research Centre, Oxford University, Oxford, UK
| | - Jianqi Lian
- Centers of Infectious Diseases, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China
| | | | - Ramazan Idilman
- Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey
| | | | - Xiaoguang Dou
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang, China
| | - Thomas Berg
- Division of Hepatology, Clinic and Polyclinic for Gastroenterology, Hepatology Infectious Disease and Pneumology, University Clinic Leipzig, Leipzig, Germany
| | | | | | - Yuanping Zhou
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhengang Zhang
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Maria Buti
- Hospital General Universitario Valle Hebron and Ciberehd, Barcelona, Spain
| | - Sharon J Hutchinson
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, UK
| | - Yabing Guo
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | | | | | - Longfeng Zhao
- Department of Infectious Diseases, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yongpeng Chen
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Harry L A Janssen
- Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada
| | - Chaonan Zhu
- Big Data Research and Biostatistics Center, Hangzhou YITU Healthcare Technology Co. Ltd., Hangzhou, China
| | - Lei Shi
- Big Data Research and Biostatistics Center, Hangzhou YITU Healthcare Technology Co. Ltd., Hangzhou, China
| | - Xiaoping Tang
- Guangzhou Eighth People's Hospital, Guangzhou, China
| | | | - Lai Wei
- Peking University Hepatology Institute, Peking University People's Hospital, Beijing, China
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - William L Irving
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Philip J Johnson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico - Division of Gastroenterology and Hepatology - CRC 'A.M. and A. Migliavacca' Center for Liver Disease, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Jinlin Hou
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Wranke A, Hardtke S, Heidrich B, Dalekos G, Yalçin K, Tabak F, Gürel S, Çakaloğlu Y, Akarca US, Lammert F, Häussinger D, Müller T, Wöbse M, Manns MP, Idilman R, Cornberg M, Wedemeyer H, Yurdaydin C. Ten-year follow-up of a randomized controlled clinical trial in chronic hepatitis delta. J Viral Hepat 2020; 27:1359-1368. [PMID: 32707605 DOI: 10.1111/jvh.13366] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 12/13/2022]
Abstract
Hepatitis delta virus (HDV) infection causes the most severe form of viral hepatitis. PEG-interferon alpha-2a (PEG-IFNα-2a) is the only effective treatment but its long-term clinical impact is unclear. The aim of this study was to investigate the long-term outcome after 48 weeks of pegylated interferon alpha-2a therapy. We performed a retrospective follow-up study of the Hep-Net-International-Delta-Hepatitis-Intervention-Study 1 (HIDIT-I trial). Patients had received 48 weeks of treatment with either PEG-IFNα-2a plus adefovir dipivoxil (ADV) (Group I), PEG-IFNα-2a alone (Group II) or adefovir dipivoxil alone (Group III). Liver-related complications were defined as liver-related death, liver transplantation, liver cancer and hepatic decompensation defined as development of Child-Pugh scores B or C or an increase in Model for End-stage Liver Disease (MELD) scores of five or more points in relation to baseline values. Patients were considered for further analysis when they were retreated with PEG-IFNα-2a. Follow-up data (at least 1 visit beyond post-treatment week 24) were available for 60 patients [Group I, (n = 19), Group II (n = 20), Group III (n = 21)]. Mean time of follow-up was 8.9 (1.6 - 13.4) years. 19 patients were retreated with IFN-based therapy: 42% (n = 8) in PEG-IFNα-2a arms and 58% (n = 11) in the adefovir only arm. Clinical complications on long-term follow-up occurred in 17 patients and were associated with nonresponse to therapy and baseline cirrhosis. The annual event-free survival rate in patients with cirrhosis vs noncirrhotic patients at year 5 and 10 was 70% vs 91% and 35% vs 76%. Long-term follow-up of a large randomized clinical trial suggests that off-treatment HDV RNA response to PEG-IFNα-2a treatment leads to improved clinical long-term outcome.
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Affiliation(s)
- Anika Wranke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Svenja Hardtke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), Partner Site HepNet Study-House, Hannover, Germany
| | - Benjamin Heidrich
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), Partner Site HepNet Study-House, Hannover, Germany
| | - George Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, University Hospital of Larissa, Larissa, Greece
| | - Kendal Yalçin
- Dicle University Medical Faculty, Diyarbakir, Turkey
| | - Fehmi Tabak
- Department of Infectious Diseases Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Selim Gürel
- Uludağ University Medical School, Bursa, Turkey
| | | | | | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Düsseldorf, Germany
| | | | - Michael Wöbse
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), Partner Site HepNet Study-House, Hannover, Germany
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), Partner Site HepNet Study-House, Hannover, Germany
| | - Heiner Wedemeyer
- German Center for Infection Research (DZIF), Partner Site HepNet Study-House, Hannover, Germany.,Department of Gastroenterology and Hepatology, Essen University Hospital, Medical Faculty of the University Duisburg-Essen, Essen, Germany
| | - Cihan Yurdaydin
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.,Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey
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37
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Idilman R, Aydogan M, Oruncu MB, Kartal A, Elhan AH, Ellik Z, Gumussoy M, Er R, Ozercan M, Duman S, Toruner M, Cinar K, Soykan I, Beyler AR, Ozkan H. Natural History of Cirrhosis: Changing Trends in Etiology Over the Years. Dig Dis 2020; 39:358-365. [PMID: 33142287 DOI: 10.1159/000512746] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/02/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND GOALS The aims of the present study were to investigate the natural history of cirrhosis and to determine trends in the etiology of cirrhosis. METHODS Between January 2001 and January 2018, a total of 1,341 patients had been diagnosed with cirrhosis and were included. RESULTS A total of 898 cirrhotic patients, who were followed up for at least 6 months were included into the analysis. The median age was 54 years. The median Child-Pugh and MELD scores were 7.5 and 11, respectively. Ascites (51%) was the most common causes of decompensation. Chronic viral hepatitis was the most frequent cause of cirrhosis (58%). Hepatitis B virus (HBV) infection was the main etiology (34%), followed by hepatitis C virus (HCV) infection (18%). Among 129 patients with cryptogenic cirrhosis (CC), 60 had metabolic abnormalities. If these 60 patients with CC were considered to have nonalcoholic fatty liver disease (NAFLD)-related cirrhosis, the proportion of NAFLD-related cirrhosis increased from 1.8 to 8.0%. At admission, 74 patients (8%) had been diagnosed with hepatocellular carcinoma (HCC). A new HCC developed in 80 patients during the follow-up period. The probability of developing HCC was 3.9% at 12 months. Logistic regression analysis showed that the development of HCC was significantly associated with older age (p < 0.001), male gender (p < 0.001), viral etiology (p = 0.026), and baseline high aspartate aminotransferase level (p = 0.01). Overall, 104 cirrhotic patients died. CONCLUSION HBV and HCV remain the leading causes of etiology in cirrhosis and HCC. However, NAFLD-related cirrhosis is recognized as a growing burden.
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Affiliation(s)
- Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey,
| | - Merve Aydogan
- Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Mehmet Berk Oruncu
- Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Aysun Kartal
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Atilla Halil Elhan
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Ellik
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Mesut Gumussoy
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Ramazan Er
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Mubin Ozercan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Serkan Duman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Murat Toruner
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Kubilay Cinar
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Irfan Soykan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Resit Beyler
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Hasan Ozkan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
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Papatheodoridis GV, Dalekos GN, Idilman R, Sypsa V, Van Boemmel F, Buti M, Calleja JL, Goulis J, Manolakopoulos S, Loglio A, Papatheodoridi M, Gatselis N, Veelken R, Lopez-Gomez M, Hansen BE, Savvidou S, Kourikou A, Vlachogiannakos J, Galanis K, Yurdaydin C, Esteban R, Janssen HLA, Berg T, Lampertico P. Similar risk of hepatocellular carcinoma during long-term entecavir or tenofovir therapy in Caucasian patients with chronic hepatitis B. J Hepatol 2020; 73:1037-1045. [PMID: 32553667 DOI: 10.1016/j.jhep.2020.06.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/15/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS A recent study in Asian patients with chronic hepatitis B (CHB) reported that the incidence of hepatocellular carcinoma (HCC) was lower in patients treated with tenofovir disoproxil fumarate (TDF) than entecavir (ETV), but this finding remains controversial. We aimed to identify any differences in HCC incidence, or other patient outcomes, between patients receiving TDF or ETV in the well monitored, multicenter European PAGE-B cohort. METHODS We included 1,935 Caucasians with CHB, with or without compensated cirrhosis, treated with ETV (n = 772) or TDF (n = 1,163) monotherapy. Mean follow-up was 7.1 ± 3.0 years from ETV/TDF onset. RESULTS The 5-year cumulative HCC incidence was 5.4% in ETV- and 6.0% in TDF-treated patients (log-rank, p = 0.321), with no significant difference in any patient subgroup (with or without cirrhosis, naïve or experienced to oral antiviral(s) [total, with or without cirrhosis]). In multivariable Cox regression analyses, the hazard of HCC was similar between ETV- and TDF-treated patients after adjustment for several HCC risk factors. ETV- and TDF-treated patients had similar rates of on-therapy biochemical and virological remission, HBsAg loss, liver transplantation and/or death. Elastographic reversion of cirrhosis at year 5 (liver stiffness <12 kPa) was observed in 245/347 (70.6%) patients with pretreatment cirrhosis, being more frequent in TDF- than ETV- treated patients (73.8% vs. 61.5%, p = 0.038). CONCLUSION In Caucasian patients with CHB, with or without cirrhosis, long-term ETV or TDF monotherapy is associated with similar HCC risk, rates of biochemical/virological remission, HBsAg loss and liver transplantation or death, but elastographic reversion of cirrhosis at year 5 was more frequent with TDF. LAY SUMMARY In a large cohort of Caucasians with chronic hepatitis B treated with entecavir (ETV) or tenofovir disoproxil fumarate (TDF) monotherapy, cumulative rates of hepatocellular carcinoma did not differ (up to 12 years). Nor did rates of biochemical/virological remission, HBsAg loss and liver transplantation or death. However, elastographic reversion of cirrhosis at year 5 was more frequent in TDF- than ETV-treated patients with pretreatment cirrhosis.
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Affiliation(s)
- George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
| | - George N Dalekos
- Department of Internal Medicine, Thessalia University Medical School, Larissa, Greece
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Vana Sypsa
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Florian Van Boemmel
- Division of Hepatology, Clinic for Oncology, Gastroenterology, Hepatology, Infectious Diseases and Pneumology, University Clinic Leipzig, Leipzig, Germany
| | - Maria Buti
- Hospital General Universitario Valle Hebron and CIBERehd, Barcelona, Spain
| | | | - John Goulis
- 4th Department of Internal Medicine, Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - Spilios Manolakopoulos
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece; 2nd Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokratio General Hospital of Athens, Athens, Greece
| | - Alessandro Loglio
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy
| | - Margarita Papatheodoridi
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Nikolaos Gatselis
- Department of Internal Medicine, Thessalia University Medical School, Larissa, Greece
| | - Rhea Veelken
- Division of Hepatology, Clinic for Oncology, Gastroenterology, Hepatology, Infectious Diseases and Pneumology, University Clinic Leipzig, Leipzig, Germany
| | | | - Bettina E Hansen
- Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center, Rotterdam, Netherlands; Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada
| | - Savvoula Savvidou
- 4th Department of Internal Medicine, Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - Anastasia Kourikou
- 2nd Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokratio General Hospital of Athens, Athens, Greece
| | - John Vlachogiannakos
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Kostas Galanis
- Department of Internal Medicine, Thessalia University Medical School, Larissa, Greece
| | - Cihan Yurdaydin
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey; Department of Gastroenterology and Hepatology, Koc University Medical School, Istanbul, Turkey
| | - Rafael Esteban
- Hospital General Universitario Valle Hebron and CIBERehd, Barcelona, Spain
| | - Harry L A Janssen
- Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada
| | - Thomas Berg
- Division of Hepatology, Clinic for Oncology, Gastroenterology, Hepatology, Infectious Diseases and Pneumology, University Clinic Leipzig, Leipzig, Germany
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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39
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Wedemeyer H, Yurdaydin C, Hardtke S, Caruntu FA, Curescu MG, Yalcin K, Akarca US, Gürel S, Zeuzem S, Erhardt A, Lüth S, Papatheodoridis GV, Keskin O, Port K, Radu M, Celen MK, Idilman R, Weber K, Stift J, Wittkop U, Heidrich B, Mederacke I, von der Leyen H, Dienes HP, Cornberg M, Koch A, Manns MP. Peginterferon alfa-2a plus tenofovir disoproxil fumarate for hepatitis D (HIDIT-II): a randomised, placebo controlled, phase 2 trial. Lancet Infect Dis 2020; 19:275-286. [PMID: 30833068 DOI: 10.1016/s1473-3099(18)30663-7] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/28/2018] [Accepted: 10/22/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatitis D is the most severe form of chronic viral hepatitis. Treatment guidelines recommend 1 year of peginterferon alfa, which is effective in 25-30% of patients only. Whether prolonged therapy with peginterferon alfa-2a for 96 weeks and combination therapy with tenofovir disoproxil fumarate (TDF) would increase hepatitis D virus (HDV) RNA suppression is unknown. We aimed to explore whether prolonged treatment of HDV with 96 weeks of peginterferon would increase HDV RNA response rates and reduces post-treatment relapses. METHODS We did two parallel, investigator-initiated, multicentre, double-blind randomised, controlled trials at 14 study sites in Germany, Greece, Romania, and Turkey. Patients with chronic HDV infection and compensated liver disease who were aged 18 years or older were eligible for inclusion. All patients were HBsAg positive for at least 7 months, anti-HDV positive for at least 3 months, and HDV-RNA positive at the local laboratory at the screening visit. Patients were ineligible if alanine aminotransferase levels were higher than ten times above the upper limit of normal and if platelet counts were lower than 90 000 per μL, or if they had received interferon therapy or treatment with a nucleoside and nucleotide analogue within the preceding 6 months. Patients were randomly assigned by blinded stratified block randomisation (1:1) to receive 180 μg of peginterferon alfa-2a weekly plus either TDF (300 mg once daily) or placebo for 96 weeks. The primary endpoint was the percentage of patients with undetectable HDV RNA at the end of treatment assessed by intention to treat. The trials are registered as NCT00932971 and NCT01088659. FINDINGS Between June 24, 2009, and Feb 28, 2011, we randomly assigned 59 HDV RNA-positive patients to receive peginterferon alfa-2a plus TDF and 61 to receive peginterferon alfa-2a plus placebo, including 48 (40%) patients with cirrhosis to the two treatment groups (23 in the peginterferon alfa-2a plus TDF group and 25 in the peginterferon alfa-2a plus placebo group). The primary endpoint was achieved in 28 (48%) of 59 patients in the peginterferon alfa-2a plus TDF group and in 20 (33%) of 61 patients in the peginterferon alfa-2a plus placebo group (odds ratio 1·84, 95% CI 0·86-3·91, p=0·12). We recorded 944 adverse events (459 in the peginterferon alfa-2a plus TDF group and 485 in the peginterferon alfa-2a plus placebo group). The most common adverse events were haematological, behavioural (eg, fatigue), musculoskeletal, influenza-like syndromes, and psychiatric complaints. INTERPRETATION Addition of TDF resulted in no significant improvement in HDV RNA response rates at the end of treatment. These findings highlight that alternative treatment options are needed for hepatitis D. FUNDING The HepNet Study-House (a project of the German Liver Foundation founded by the German Liver Foundation, the German Ministry for Education and Research, and the German Center for Infectious Disease Research), Hoffmann-La Roche, and Gilead Sciences.
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Affiliation(s)
- Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; German Center for Infectious Disease Research, HepNet Study-House, Hannover, Germany; Department of Gastroenterology and Hepatology, Essen University Hospital, Essen, Germany; Medical Faculty of the University of Duisburg-Essen, Essen, Germany.
| | - Cihan Yurdaydin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey; Department of Internal Medicine, Koc University Medical School, Istanbul, Turkey
| | - Svenja Hardtke
- German Center for Infectious Disease Research, HepNet Study-House, Hannover, Germany
| | | | | | - Kendal Yalcin
- Dicle University Medical Faculty, Diyarbakir, Turkey
| | | | - Selim Gürel
- Uludağ University Medical Faculty, Bursa, Turkey
| | - Stefan Zeuzem
- Johann Wolfgang Goethe University Medical Center, Frankfurt am Main, Germany
| | | | - Stefan Lüth
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Onur Keskin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Kerstin Port
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Monica Radu
- Institutul de Boli Infectioase, Bucharest, Romania
| | | | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Kristina Weber
- Institute for Biometry, Hannover Medical School, Hannover, Germany
| | | | | | - Benjamin Heidrich
- German Center for Infectious Disease Research, HepNet Study-House, Hannover, Germany
| | - Ingmar Mederacke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Heiko von der Leyen
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Hannover Clinical Trial Center, Hannover, Germany
| | | | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Armin Koch
- Institute for Biometry, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; German Center for Infectious Disease Research, HepNet Study-House, Hannover, Germany
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40
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Idilman R, Razavi H, Robbins-Scott S, Akarca US, Örmeci N, Kaymakoglu S, Aygen B, Tozun N, Güner R, Bodur H, Lazarus JV. A micro-elimination approach to addressing hepatitis C in Turkey. BMC Health Serv Res 2020; 20:249. [PMID: 32209103 PMCID: PMC7093960 DOI: 10.1186/s12913-020-5019-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 02/21/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In 2016, WHO passed the Global Health Sector Strategy on Viral Hepatitis (GHSS), calling for its elimination by 2030. Two years later, Turkey approved a strategy to reach the WHO targets. This study reports new national prevalence data, breaks it down by subpopulation, and models scenarios to reach HCV elimination. METHODS Literature was reviewed for estimates of HCV disease burden in Turkey. They were discussed with stakeholders and used as inputs to develop a disease burden model. The infected population was estimated by sequelae for the years 2015-2030. Three scenarios were developed to evaluate the disease burden in Turkey: a Base 2017 scenario, representing the current standard of care in Turkey; an increased treatment scenario, representing the impact of improved access to DAAs; and a WHO targets scenario, which meet the WHO GHSS viral hepatitis targets of a 65% reduction in mortality and 90% diagnosis rate of the infected population by 2030. RESULTS At the beginning of 2017, 271,000 viremic infections were estimated. Of these, 58,400 were diagnosed and 10,200 treated. Modelling results showed that, with the current treatment paradigm in Turkey, by 2030 the total number of viremic HCV infections would decline by 35%, while liver-related deaths, hepatocellular carcinoma (HCC), and decompensated cirrhosis would decrease by 10-25%. In the increased treatment scenario, by 2030 viremic HCV infections would decrease by 50%; liver-related deaths, HCC and decompensated cirrhosis would decrease by 45-70%. In the WHO targets scenario, HCV infections would decrease by 80%; sequelae would decrease by 80-85%. Data on disease burden in micro-elimination target subpopulations are largely unavailable. CONCLUSIONS To meet the WHO Global Health Sector Strategy targets for the elimination of HCV, Turkey needs to increase treatment. Better data are needed as well as countrywide access to DAAs.
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Affiliation(s)
- Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey
| | - Homie Razavi
- Center for Disease Analysis, Lafayette, CO 80026 USA
| | | | - Ulus Salih Akarca
- Department of Gastroenterology, Ege University Medical Faculty, Izmir, Turkey
| | - Necati Örmeci
- Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey
| | - Sabahattin Kaymakoglu
- Department of Gastroenterology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Bilgehan Aygen
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Nurdan Tozun
- Department of Internal Medicine and Gastroenterology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yildirim Beyazit University, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Diseases, Ankara Numune Training and Research Hospital, University of Healthcare Sciences, Ankara, Turkey
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Calle del Rossellón 132, 4th Floor, ES-08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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Cox IJ, Idilman R, Fagan A, Turan D, Ajayi L, Le Guennec AD, Taylor-Robinson SD, Karakaya F, Gavis E, Andrew Atkinson R, Williams R, Sikaroodi M, Nizam S, Gillevet PM, Bajaj JS. Metabolomics and microbial composition increase insight into the impact of dietary differences in cirrhosis. Liver Int 2020; 40:416-427. [PMID: 31544308 PMCID: PMC6980909 DOI: 10.1111/liv.14256] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/04/2019] [Accepted: 09/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Dietary changes can modulate gut microbiota and interact with cirrhosis. Our prior study demonstrated that microbial diversity was higher in cirrhotics from Turkish vs the USA, which was associated with lower risk of 90-day hospitalizations. We aimed to define gut microbial functional and metabolomic changes to increase insight into benefits of the Mediterranean compared to Western diets. METHODS In all, 139 Turkish (46 controls/50 compensated/43 decompensated) and 157 American subjects (48 controls/59 compensated/50 decompensated) were studied. Turkish subjects consumed a modified Mediterranean diet with daily fermented milk intake, whereas Americans consumed a Western diet. Predicted gut microbial functionalities and plasma metabolomics were compared between/within countries. Correlation network differences between microbiota and metabolites in cirrhotics from Turkey vs the USA were evaluated. RESULTS Predicted microbial function showed lower amino acid, bioenergetics and lipid pathways, with functions related to vitamin B, glycan, xenobiotic metabolism, DNA/RNA synthesis, in cirrhotics from Turkey compared to the USA. Plasma metabolomics demonstrated higher relative lactate levels in Turkey vs the USA. The metabolite changes in decompensated cirrhosis, compared to controls, showed similar trends in Turkey and the USA, with reduced lipids and phosphocholines. Phosphocholines were significantly lower in patients hospitalized in 90 days (P = .03). Correlation networks in cirrhotics demonstrated linkage differences between beneficial taxa, Blautia and Oscillispira, and lactate and unsaturated lipids, in Turkey compared to American patients. CONCLUSIONS A modified Mediterranean diet was associated with altered plasma metabolomics and beneficially alters microbiota functionality and correlations compared to Western diet in cirrhosis. These altered diet-microbial interactions could potentially affect the 90-day hospitalization risk.
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Affiliation(s)
- I Jane Cox
- Institute for Hepatology London, Foundation for Liver Research, London, UK
- Faculty of Life Sciences & Medicine, King's College Hospital, London, UK
| | | | - Andrew Fagan
- Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, VA, USA
| | | | - Lola Ajayi
- Institute for Hepatology London, Foundation for Liver Research, London, UK
- Faculty of Life Sciences & Medicine, King's College Hospital, London, UK
| | - Adrien D Le Guennec
- Randall Centre for Cell & Molecular Biophysics and Centre for Biomolecular Spectroscopy, King's College London, London, UK
| | | | | | - Edith Gavis
- Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, VA, USA
| | - R Andrew Atkinson
- Randall Centre for Cell & Molecular Biophysics and Centre for Biomolecular Spectroscopy, King's College London, London, UK
| | - Roger Williams
- Institute for Hepatology London, Foundation for Liver Research, London, UK
- Faculty of Life Sciences & Medicine, King's College Hospital, London, UK
| | | | | | | | - Jasmohan S Bajaj
- Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, VA, USA
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42
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Seval GC, Kabacam G, Yakut M, Seven G, Savas B, Elhan A, Cinar K, Idilman R. The natural course of non-alcoholic fatty liver disease. Hepatol Forum 2020; 1:20-24. [PMID: 35949661 PMCID: PMC9344371 DOI: 10.14744/hf.2020.0008] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/16/2020] [Indexed: 05/08/2023]
Abstract
BACKGROUND AND AIM The present study aims to describe the characteristics and long-term clinical outcomes of patients with non-alcoholic fatty liver disease (NAFLD). MATERIAL AND METHODS A total of 1308 individuals with NAFLD were seen in the Liver Diseases Outpatient Clinic. Diagnosis of NAFLD in each case was based on biochemical, radiological and histological criteria, when available. After diagnosis, all NAFLD patients were administered a conventional diet and exercise program. The median follow-up period was 55.3 months. RESULTS At the time of the diagnosis, the mean age was 50.8±11.3 years, and female gender was slightly predominant (51.4%). The median body mass index was 29.2±4.7 kg/m2: 39% were obese. Seventeen percent of the patients had diabetes mellitus, 53% insulin resistance, 60% hyperlipidemia, and 32% hypertension. Median serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase levels were 31 U/L (range: 10-248 U/L), 45 U/L (range: 10-285 U/L) and 41 (range: 8-1200 U/L), respectively. Liver biopsy was performed in 293 individuals. The median NAFLD activity score was 5.0, median hepatic steatosis 2, ballooning 1, lobular inflammation 1, portal inflammation 0, and fibrosis 0. Of note, 41.3% of the samples (121/293) revealed the presence of fibrosis and 31% of the samples (37/121) showed significant fibrosis. With multivariate analysis, diabetes and obesity were associated with the presence of significant fibrosis. Among them, 765 patients (M/F: 353/412, mean age: 51.0±10.9) had at least six months of follow-up. In this group, from baseline to the end of the follow-up period, a significant improvement in the serum AST and ALT levels was observed. CONCLUSION NAFLD is a potentially progressive disease. Diabetes and obesity were associated with the presence of advanced fibrosis.
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Affiliation(s)
- Guldane Cengiz Seval
- Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Gokhan Kabacam
- Department of Gastroenterology, Ankara UniversitySchool of Medicine, Ankara, Turkey
| | - Mustafa Yakut
- Department of Gastroenterology, Ankara UniversitySchool of Medicine, Ankara, Turkey
| | - Gulseren Seven
- Department of Gastroenterology, Ankara UniversitySchool of Medicine, Ankara, Turkey
| | - Berna Savas
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Atilla Elhan
- Department of Biostatistics , Ankara University School of Medicine, Ankara, Turkey
| | - Kubilay Cinar
- Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara UniversitySchool of Medicine, Ankara, Turkey
- Corresponding author: Ramazan Idilman; Ankara Universitesi Tip Fakultesi, Gastroenteroloji Bolumu, 06100 Cebeci, Ankara, Turkey Phone: +90 312 438 66 76; e-mail:
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43
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Yurdaydin C, Keskin O, Kalkan Ç, Karakaya F, Çaliskan A, Kabaçam G, Önder FO, Karatayli S, Karatayli E, Deda X, Bozkaya H, Bozdayi AM, Idilman R. Interferon Treatment Duration in Patients With Chronic Delta Hepatitis and its Effect on the Natural Course of the Disease. J Infect Dis 2019; 217:1184-1192. [PMID: 29425306 DOI: 10.1093/infdis/jix656] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 01/16/2018] [Indexed: 12/18/2022] Open
Abstract
Background Interferon is the only treatment option in chronic delta hepatitis (CDH). A CDH database (333 patients, 161 with interferon treatment history) was analyzed for effects of treatment duration on virologic response and clinical outcomes. Methods Ninety-nine CDH patients who received at least 6 months of interferon were selected. Maintained virologic response (MVR) was defined as hepatitis D virus RNA negative for 2 years after treatment discontinuation. Cumulative median interferon treatment duration was 24 months (range 6-126 months), with a median of 2 courses (range 1-8). Post-treatment median follow-up was 55 months (24-225 months). Results Thirty-five patients achieved MVR. Cumulative probability of MVR increased with treatment duration and reached 50% at 5 years. Patients with MVR were less likely to die from liver disease or develop complications compared to patients without MVR (P = .032, P = .006, respectively). Cirrhosis at baseline and no response to therapy (odds ratio 16.1 and 5.23, respectively) predicted an adverse endpoint. Hepatitis B surface antigen clearance occurred in 37% of patients with MVR. Conclusion Viral response to interferon increases with treatment duration and favorably affects the natural course of disease. Interferon treatment duration has to be individualized with careful post-treatment assessment.
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Affiliation(s)
- Cihan Yurdaydin
- Department of Gastroenterology, University of Ankara Medical School, Turkey
- Hepatology Institute, University of Ankara, Turkey
| | - Onur Keskin
- Department of Gastroenterology, University of Ankara Medical School, Turkey
| | - Çagdas Kalkan
- Department of Gastroenterology, University of Ankara Medical School, Turkey
| | - Fatih Karakaya
- Department of Gastroenterology, University of Ankara Medical School, Turkey
| | - Aysun Çaliskan
- Department of Gastroenterology, University of Ankara Medical School, Turkey
| | - Gökhan Kabaçam
- Department of Gastroenterology, University of Ankara Medical School, Turkey
| | - F Oguz Önder
- Department of Gastroenterology, University of Ankara Medical School, Turkey
| | | | | | - Xheni Deda
- Department of Gastroenterology, University of Ankara Medical School, Turkey
| | - Hakan Bozkaya
- Department of Gastroenterology, University of Ankara Medical School, Turkey
| | | | - Ramazan Idilman
- Department of Gastroenterology, University of Ankara Medical School, Turkey
- Hepatology Institute, University of Ankara, Turkey
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44
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Idilman R, Demir M, Aladag M, Erol C, Cavus B, Iliaz R, Koklu H, Cakaloglu Y, Sahin M, Ersoz G, Koksal İ, Karasu Z, Ozgenel M, Turan İ, Gunduz F, Ataseven H, Akdogan M, Kiyici M, Koksal AS, Akhan S, Gunsar F, Tabak F, Kaymakoglu S, Akarca US. Low recurrence rate of hepatocellular carcinoma following ledipasvir and sofosbuvir treatment in a real-world chronic hepatitis C patients cohort. J Viral Hepat 2019; 26:666-674. [PMID: 30740820 DOI: 10.1111/jvh.13075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 01/11/2019] [Indexed: 01/05/2023]
Abstract
The aims of the present study were to evaluate the efficacy and tolerability of ledipasvir/sofosbuvir (LDV/SOF) with or without ribavirin in the treatment of chronic hepatitis C (CHC) in patients with advanced liver disease and to analyse whether the use of LDV/SOF treatment is associated with a new occurrence of hepatocellular carcinoma (HCC) during and after LDV/SOF treatment. The Turkish Early Access Program provided LDV/SOF treatment to a total of 200 eligible CHC patients with advanced liver disease. The median follow-up period was 22 months. All patients were Caucasian, 84% were infected with genotype 1b, and 24% had a liver transplantation before treatment. The sustained virological response (SVR12) was 86.0% with ITT analysis. SVR12 was similar among patients with Child-Pugh classes A, B and C disease and transplant recipients. From baseline to SVR12, serum ALT level and MELD score were significantly improved (P < 0.001). LDV/SOF treatment was generally well tolerated. Only one patient developed a new diagnosed HCC. Seventeen of the 35 patients, who had a history of previous HCC, developed HCC recurrence during the LDV/SOF treatment or by a median follow-up of 6 months after treatment. HCC recurrence was less commonly observed in patients who received curative treatment for HCC compared with those patients who received noncurative treatment (P = 0.007). In conclusion, LDV/SOF with or without ribavirin is an effective and tolerable treatment in CHC patients with advanced liver disease. Eradication is associated with improvements in liver function and a reduced risk of developing a new occurrence of HCC.
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Affiliation(s)
- Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Mehmet Demir
- Department of Gastroenterology, Mustafa Kemal University School of Medicine, Hatay, Turkey
| | - Murat Aladag
- Department of Gastroenterology, İnönü University School of Medicine, Malatya, Turkey
| | - Cihan Erol
- Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Bilger Cavus
- Department of Gastroenterology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Raim Iliaz
- Department of Gastroenterology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Hayrettin Koklu
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Yilmaz Cakaloglu
- Department of Gastroenterology, Memorial Sisli Hospital, İstanbul, Turkey
| | | | - Galip Ersoz
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - İftihar Koksal
- Department of Infectious Disease, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - Zeki Karasu
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Meric Ozgenel
- Department of Gastroenterology, Osmangazi University School of Medicine, Eskişehir, Turkey
| | - İlker Turan
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Feyza Gunduz
- Department of Gastroenterology, Marmara University School of Medicine, İstanbul, Turkey
| | - Huseyin Ataseven
- Department of Gastroenterology, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - Meral Akdogan
- Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey
| | - Murat Kiyici
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Turkey
| | - Aydın Seref Koksal
- Department of Gastroenterology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Sila Akhan
- Department of Gastroenterology, Kocaeli University School of Medicine, Department of Infectious Disease and Clinical Microbiology, Kocaeli, Turkey
| | - Fulya Gunsar
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Fehmi Tabak
- Department of Infectious Disease and Clinical Microbiology, İstanbul University Cerrahpasa School of Medicine, İstanbul, Turkey
| | - Sabahattin Kaymakoglu
- Department of Gastroenterology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Ulus S Akarca
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
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45
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van Campenhout MJH, Brouwer WP, Xie Q, Guo S, Chi H, Qi X, Tabak F, Streinu-Cercel A, Wang JY, Zhang NP, Idilman R, Reesink HW, Diculescu M, Simon K, Akdogan M, Mazur W, de Knegt RJ, Verhey E, Hansen BE, Janssen HLA. Long-term follow-up of patients treated with entecavir and peginterferon add-on therapy for HBeAg-positive chronic hepatitis B infection: ARES long-term follow-up. J Viral Hepat 2019; 26:109-117. [PMID: 30187612 DOI: 10.1111/jvh.12997] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/12/2018] [Accepted: 08/08/2018] [Indexed: 12/23/2022]
Abstract
Addition of peginterferon alpha (PEG-IFN add-on) to entecavir (ETV) treatment after a short lead-in phase results in more response than ETV monotherapy in HBeAg-positive chronic hepatitis B infection (CHB). This study is the first to assess long-term efficacy of this treatment strategy. Patients who received ETV ± 24 weeks of PEG-IFN add-on in a global trial (ARES study) and completed follow-up were eligible to participate in this observational LTFU study if they had at least one combined HBeAg and HBV DNA measurement beyond week 96 of the ARES study. The primary endpoint was combined response (HBeAg loss and HBV DNA <200 IU/mL) at LTFU. In total, 48 patients treated with PEG-IFN add-on and 48 patients treated with ETV monotherapy were included. The median follow-up duration was 226 (IQR 51) weeks, and 86/96 (90%) patients were initial non-responders. At LTFU, combined response was present in 13 (27%) vs 11 (23%) patients (P = 0.81), and 1 log10 HBsAg decline in 59% vs 28% (P = 0.02) for PEG-IFN add-on and ETV monotherapy, respectively. In 41 initial non-responders who continued ETV therapy, combined response at LTFU was present in 9 patients (PEG-IFN add-on: 5/22 [23%]; ETV monotherapy: 4/19 [21%]). Beyond week 96 of follow-up, rates of serological response became comparable between PEG-IFN add-on and ETV monotherapy. Although in this LTFU study initial non-responders were overrepresented in the add-on arm, PEG-IFN add-on possibly leads rather to accelerated HBeAg loss than to increased long-term HBeAg loss rates.
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Affiliation(s)
- Margo J H van Campenhout
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Willem Pieter Brouwer
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Qing Xie
- Infectious Diseases, Ruijin Hospital, Jiaotong University, Shanghai, China
| | - S Guo
- Infectious Diseases, Ruijin Hospital, Jiaotong University, Shanghai, China
| | - Heng Chi
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Xun Qi
- Gastroenterology and Hepatology, Shanghai Public Health Center, Fu Dan University, Shanghai, China
| | - Fehmi Tabak
- Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Adrian Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania
| | - Ji-Yao Wang
- Gastroenterology and Hepatology, Zhong Shan Hospital, Fu Dan University, Shanghai, China
| | - Ning-Ping Zhang
- Gastroenterology and Hepatology, Zhong Shan Hospital, Fu Dan University, Shanghai, China
| | | | - Hendrik W Reesink
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Mircea Diculescu
- Department of Gastroenterology, Fundeni Clinical Institute, Bucharest, Romania
| | - Krzysztof Simon
- Division of Infectious Diseases and Hepatology, Wroclaw Medical University, Wroclaw, Poland
| | - Meral Akdogan
- Department of Gastroenterology, Yuksek Ihtisas Hospital, Ankara, Turkey.,Department of Infectious Diseases, Silesian Medical University, Katowice, Poland
| | - Włodzimierz Mazur
- Department of Infectious Diseases, Silesian Medical University, Katowice, Poland
| | - Rob J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Elke Verhey
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Bettina E Hansen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Toronto Center for Liver Disease, Toronto Western and General Hospital, University Health Network, Toronto, Canada
| | - Harry L A Janssen
- Toronto Center for Liver Disease, Toronto Western and General Hospital, University Health Network, Toronto, Canada
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46
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Hesimov I, Kirimker E, Duman B, Keskin O, Cetinkaya O, Hayme S, Ustuner E, Idilman R, Yurdaydin C, Dokmeci A, Kumbasar H, Yilmaz A, Kologlu M, Karayalcin K, Balci D. Health-related Quality of Life of Liver Donors: A Prospective Longitudinal Study. Transplant Proc 2018; 50:3076-3081. [DOI: 10.1016/j.transproceed.2018.07.018] [Citation(s) in RCA: 2] [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] [Received: 06/28/2018] [Accepted: 07/09/2018] [Indexed: 01/16/2023]
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47
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Lutterkort GL, Wranke A, Hengst J, Yurdaydin C, Stift J, Bremer B, Hardtke S, Keskin O, Idilman R, Manns MP, Dienes HP, Falk C, Wedemeyer H, Heidrich B. Viral dominance patterns in chronic hepatitis delta determine early response to interferon alpha therapy. J Viral Hepat 2018; 25:1384-1394. [PMID: 29888837 DOI: 10.1111/jvh.12947] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/30/2018] [Indexed: 12/17/2022]
Abstract
Chronic hepatitis D is caused by coinfection of hepatitis B and hepatitis D virus. While HDV is the dominant virus over HBV in the majority of cases, mechanisms and consequences of viral dominance are largely unknown. We aimed to investigate associations between viral dominance patterns and patients' characteristics and inflammatory features; 109 HDV-infected patients treated with PEG-IFNa-2α within the international multicentre, prospective HIDIT-2 trial were studied. Patients were classified as D- or B-dominant if the viral load of one virus exceeded that of the other virus by more than 1log10 . Otherwise, no viral dominance (ND) was described. We used Luminex-based multiplex technology to study 50 soluble immune mediators (SIM) in pretreatment samples of 105 HDV RNA-positive patients. Dominance of HDV was evident in the majority (75%) of cases. While only 7% displayed B-dominance, 17% showed nondominance. D-dominance was associated with downregulation of 4 interleukins (IL-2ra, IL-13, IL-16 and IL-18) and 5 chemokines/cytokines (CTACK (CCL27), MCP-1 (CCL2), M-CSF, TRAIL and ICAM-1) while no analyte was increased. In addition, D-dominance could be linked to a delayed HDV RNA response to pegylated interferon as patients with B-dominance or nondominance showed higher early HDV RNA responses (61% at week 12) than D-dominant patients (11%; P < .001). In conclusion, this study revealed unexpected effects of viral dominance on clinical and immunological features in chronic hepatitis delta patients. Individualizing PEG-IFNa-2α treatment duration should consider viral dominance. Overall, our findings suggest an activated but exhausted IFN system in D-dominant patients.
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Affiliation(s)
- G L Lutterkort
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - A Wranke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - J Hengst
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - C Yurdaydin
- Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey
| | - J Stift
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - B Bremer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - S Hardtke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infectious Disease Research (DZIF), partner site Hannover-Braunschweig, HepNet Study-House, Hannover, Germany
| | - O Keskin
- Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey
| | - R Idilman
- Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey
| | - M P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infectious Disease Research (DZIF), partner site Hannover-Braunschweig, HepNet Study-House, Hannover, Germany
| | - H P Dienes
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - C Falk
- Institute of Transplant Immunology, Hannover Medical School, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover, Germany
| | - H Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infectious Disease Research (DZIF), partner site Hannover-Braunschweig, HepNet Study-House, Hannover, Germany.,Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - B Heidrich
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infectious Disease Research (DZIF), partner site Hannover-Braunschweig, HepNet Study-House, Hannover, Germany
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48
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Tabak F, Yurdaydın C, Kaymakoğlu S, Akarsu M, Akıncı EG, Akkız H, Alkım C, Çekin AH, Çuvalcı NÖ, Demir K, Değertekin B, Dökmetaş İ, Ersöz G, Hizel K, Kandemir FÖ, Önlen Y, Sonsuz A, Şenateş E, Tosun S, Tözün N, Idilman R, Guidelines Study Group VH. Diagnosis, management and treatment of hepatitis B virus infection: Turkey 2017 Clinical Practice Guidelines. Turk J Gastroenterol 2018; 28:73-83. [PMID: 29303103 DOI: 10.5152/tjg.2017.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Fehmi Tabak
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Cihan Yurdaydın
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Sabahattin Kaymakoğlu
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Mesut Akarsu
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Esra G Akıncı
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Hikmet Akkız
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Canan Alkım
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ayhan H Çekin
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Nefise Ö Çuvalcı
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Kadir Demir
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Bülent Değertekin
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - İlyas Dökmetaş
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Galip Ersöz
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Kenan Hizel
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Fatma Ö Kandemir
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Yusuf Önlen
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Abdullah Sonsuz
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ebubekir Şenateş
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Selma Tosun
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Nurdan Tözün
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ramazan Idilman
- Turkish Association for the Study of the Liver, Istanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
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49
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Idilman R, Baykam N, Kaymakoğlu S, Tabak F, Bahçecioğlu HI, Bektaş A, Bulut C, Günşar F, İnan D, Karaosmanoğlu HK, Karasu Z, Kuşçu F, Mete B, Özbakır Ö, Özdoğan OC, Parlak M, Sırmatel F, Topalak Ö, Ünsal B, Guidelines Study Group VH. Turkey 2017 Clinical Practice Guidelines on recommendations for screening diagnosing and managing hepatitis C virus. Turk J Gastroenterol 2018; 28:90-93. [PMID: 29303105 DOI: 10.5152/tjg.2017.21] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The present guideline updates the Turkish recommendations for the screening, diagnosis and management of Hepatitis
C virus (HCV) infection prepared by the Turkish Association for the Study of the Liver (TASL) and Viral Hepatitis
Society (VHS). The aim of this guidance was to provide updates recommendations to physicians, who are interested
in HCV care on the optimal screening, diagnosis and pre-treatment management for patients with HCV infection
in Turkey. These recommendations, produced by panel experts, were aimed to addresses the management issues
ranging from diagnosis and linkage to care, to the optimal treatment regimen in patients with HCV infection. Recommendations
are based on evidence and opinions of more than 70% of the panelists. This guidance is supported by
the memberships of two societies and not by pharmaceutical companies. This guidance will be updated frequently
as new data become available.
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Affiliation(s)
- Ramazan Idilman
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Nurcan Baykam
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Sabahattin Kaymakoğlu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Fehmi Tabak
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Halil I Bahçecioğlu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ahmet Bektaş
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Cemal Bulut
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Fulya Günşar
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Dilara İnan
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Hayat K Karaosmanoğlu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Zeki Karasu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ferit Kuşçu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Birgül Mete
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ömer Özbakır
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Osman C Özdoğan
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Mehmet Parlak
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Fatma Sırmatel
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ömer Topalak
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Belkis Ünsal
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
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50
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Kaymakoğlu S, Köksal İ, Tabak F, Akarca US, Akbulut A, Akyüz F, Bodur H, Çağatay A, Dinçer D, Esen Ş, Güner R, Gürel S, Köse Ş, Şentürk Ö, Şimşek H, Yamazhan T, Yılmaz Y, Idilman R, Guidelines Study Group VH. Recommendation for treatment of hepatitis C virus infection. Turk J Gastroenterol 2018; 28:94-100. [PMID: 29303106 DOI: 10.5152/tjg.2017.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Sabahattin Kaymakoğlu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - İftihar Köksal
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Fehmi Tabak
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ulus S Akarca
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ayhan Akbulut
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Filiz Akyüz
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Hürrem Bodur
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Atahan Çağatay
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Dinç Dinçer
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Şaban Esen
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Rahmet Güner
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Selim Gürel
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Şükran Köse
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ömer Şentürk
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Halis Şimşek
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Tansu Yamazhan
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Yusuf Yılmaz
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ramazan Idilman
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
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