Enver Ucbilek

A Pilot Study Evaluating Sequential Administration of a PPI–Amoxicillin Followed by a PPI–Metronidazole–Tetracycline in Turkey

Background:  There is no effective regimen for the eradication of Helicobacter pylori in our country. It may be due to the increasing prevalence of resistance to antibiotics used for the treatment of H. pylori. Recently, a study from Turkey has revealed that a new treatment scheme consisting of sequential administration of pantoprazole plus amoxicillin for 7 days followed by pantoprazole plus metronidazole, and tetracycline for the remaining 7 days was effective in the first‐line treatment of H. pylori. Therefore, we aimed to confirm efficacy of a new therapy scheme in the first‐line H. pylori eradication.

Low efficacy rate of moxifloxacin-containing Helicobacter pylori eradication treatment: in an observational study in a Turkish population.

Background:  Standard triple therapy for Helicobacter pylori has an eradication rate of about 50% in Turkey. It may be due to an increased resistance of H. pylori to antibiotics. Therefore, we aimed to investigate the effectiveness of a new second‐generation fluoroquinolone, moxifloxacin‐containing triple therapy in H. pylori eradication.

Critical gastrointestinal bleed due to secondary aortoenteric fistula

Secondary aortoenteric fistula (SAEF) is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to establish diagnosis. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Each test has variable sensitivity and specificity. Maintaining the hemodynamic status, control of bleeding, removal of the infected graft, and infection control may improve clinical outcomes. This review entails the updated literature on diagnosis and management of SAEF. A literature search was conducted for articles published in English, on PubMed and Scopus using the following search terms: secondary, aortoenteric, aorto-enteric, aortoduodenal, aorto-duodenal, aortoesophageal, and aorto-esophageal. A combination of MeSH terms and Boolean operators were used to device search strategy. In addition, a bibliography of clinically relevant articles was searched to find additional articles (Appendix A). The aim of this review is to provide a comprehensive update on the diagnosis, management, and prognosis of SAEF.

Ectopic opening of the common bile duct into various sites of the upper digestive tract: a case series

BACKGROUND Ectopic opening of the common bile duct (CBD) into the GI tract is an extremely rare congenital anomaly. The clinical implications and frequency of this anomaly are not clearly known. OBJECTIVE To present a case series of ectopic opening of the CBD into various sites of the upper digestive tract and discuss clinicopathological features of this condition. DESIGN AND SETTING Retrospective, observational study in a single tertiary care medical center. PATIENTS Consecutive patients undergoing ERCP who received a diagnosis of an ectopic opening of the CBD between September 2001 and August 2009 were reviewed. INTERVENTIONS Endoscopic and cholangiographic findings were reviewed. MAIN OUTCOME MEASUREMENTS The endoscopic and cholangiographic findings and clinical course of these patients were reviewed. RESULTS During the study period, 1040 patients underwent ERCP. A total of 11 patients (6 men and 5 women with a median age of 59.2 years) received a diagnosis of an ectopic opening of the CBD. The opening sites of the CBD were located as follow: 1 in the stomach, 4 in the duodenal bulb, 3 at a more lateral site of the second portion of the duodenum, and 3 in the third part of the duodenum. Seven patients had choledocholithiasis, 2 had acute pancreatitis, and 3 had severe cholangitis. CONCLUSION Although an ectopic opening of the CBD is rare, it may be associated with severe pancreaticobiliary disorders. Endoscopists should be aware of this anomaly and know what to do in case they encounter the condition.

A call to action for the prevention of hepatitis C infection among intravenous drug users in Turkey

1Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Istanbul Turkey 2Erenkoy Mental Health and Neurology Training and Research Hospital, Center for Alcohol and Substance Dependence (AMATEM) / University of Health Sciences Addiction Research and Application Center, Istanbul Turkey 3Mersin University, Department of Gastroenterology, Mersin Turkey 4Akdeniz University Medical Faculty, Department of Infectious Disease and Clinical Microbiology, Antalya Turkey Editorial / Editoryal Dusunen Adam The Journal of Psychiatry and Neurological Sciences 2017;30:271-277 DOI: 10.5350/DAJPN20173004001

Distribution of hepatitis C virus genotypes among intravenous drug users in the Çukurova region of Turkey.

BACKGROUND/AIM The most common hepatitis C virus (HCV) genotype in Turkey is genotype 1. However, there has not been a study about the distribution of HCV genotypes among intravenous drug users (IVDUs) in the Çukurova region of Turkey. This study was planned to understand if there is a difference between IVDUs and the normal population. MATERIALS AND METHODS Between May 2010 and May 2014, anti-HCV positive IVDUs who applied to the 6 hospitals in the Çukurova region of Turkey were included in this study. Their HCV genotypes were studied. RESULTS Ninety-seven anti-HCV positive IVDUs were screened in terms of HCV RNA and genotype. Ten were excluded from the study because their HCV RNA results were negative. Fifty-one of the 87 patients (58.6%) had genotype 3. Genotype 2 was detected in 26 (29.9%) and genotype 1 was detected in 10 (11.5%) patients. CONCLUSION HCV genotypes seem to be different between the normal population and IVDUs according to studies worldwide. Among IVDUs, we detected a dominance of genotype 3 and genotype 2, which is apparently different from the normal population. The reason for this difference can be simply explained by infection through shared needles. However, there may still be a different immunological response in IVDUs, the investigation of which may lead to further studies.

Magnetic Resonance Imaging in Diagnosis and Monitoring of Hepatocellular Carcinoma in Liver Transplantation: A Comprehensive Review

Hepatocellular carcinoma (HCC) is the most common primary liver cancer. One of the most important risk factors of HCC is cirrhosis. The optimal treatment of HCC is liver transplantation, since it treats both the underlying cirrhosis and the cancer. Patients that have risk factors should be included in surveillance programs since HCC can be cured only during the early stages. Surveillance can be performed by ultrasonography (US), which is an inexpensive, non-invasive, and widely available technique, but it is considered to have a low sensitivity. If a suspicious lesion is detected on US exam, computerized tomography (CT) or magnetic resonance imaging (MRI) can be used to further evaluate this lesion. MRI is considered to be superior to CT because it has greater contrast resolution and tissue characterization. In this article, we present a review of MRI for HCC in liver transplantation (LT) with a focus on characteristic MR features of this tumor and current guidelines.

Detection of hepatitis B virus polymerase gene variants associated with Lamivudine, Adefovir and Entecavir resistance and some undefined mutations isolated from chronic hepatitis B patients in the south of Turkey

In order to detect the mutation patterns related to Lamivudine (LAM), Adefovir (ADV) and Entecavir (ETV) resistance, we examined totally 230 stored HBsAg (+) and HBV DNA (+) sera samples of patients suffering chronic hepatitis B and treated with LAM, ADV and ETV in the south of Turkey. 100, 110 and 20 sera were obtained from patients treated with LAM (for at least 2 years), ADV (for at least 2 years) and ETV (for at least 1 year), respectively. A 422 bp segment of HBV polymerase gene which included B, C and D domains of viral polymerase gene was amplified by a nested PCR protocol and sequenced by a silver staining based cycle-sequencing reaction. Mutation patterns related to LAM, ADV and ETV resistance were detected in 23 of 100 (23.00%), 3 of 110 (2.75 %) and 0 of 20 (0.00%) sera in 3 groups, respectively. rtM204I and rtM204V-rtL180M dual mutations were detected in 13 of 100 (13.00%) and 10 of 100 (10.00%) sera, respectively in LAM treated group. rtN236T mutation was detected in 3 of 110 (2.75%) sera in ADV treated group. rtM204I and rtM204V-rtL180M mutations were also detected in 8 of 110 (7.27%) and 5 of 110 (4.54%) sera in ADV treated group. No mutation pattern was detected related to ETV resistance. However, rtM204I mutation was also detected in 3 of 20 (15.00%) in ETV treated group. Additionally, some undefined mutations such as rtI233V, rtN238R, P237H and rtK241E were detected in 3 of 110 (2.75%), 2 of 110 (1.80%), 1 of 110 (0.90%) and 1 of 110 (0.90%) sera, respectively in ADV treated group. The study reveals that detection of mutations associated with viral polymerase inhibitors is important for better patient treatment. Antiviral therapy of hepatitis with viral polymerase inhibitors is still controversial.

Greater Biosynthetic Liver Dysfunction in Primary Sclerosing Cholangitis Suggests Co-existent or Impending Cholangiocarcinoma

Background and Aim: Patients with primary sclerosing cholangitis (PSC) who develop cholangiocarcinoma (CCA) have a median survival of less than 6 months. In half of cases, PSC and CCA will be diagnosed either concurrently or within a year of one another. The aim of the present study is to demonstrate that the degree of biochemical liver dysfunction is associated with concomitant or impending CCA. Methods: We did a chart review of patients diagnosed with PSC and CCA up to 18 months from presentation (“CCA” group) as well as patients with PSC that underwent transplantation with no sign of CCA in their explanted liver (“nCCA” group). Along with demographic data and follow-up length, we recorded their presenting liver function tests, including alanine and aspartate aminotransferases (ALT, AST), total bilirubin (TBil), alkaline phosphatase (ALP), international normalization ratio (INR), and serum Ca 19-9 levels. Differences between mean values of the two groups were analyzed with a student’s t-test. Results: Twenty-four patients were included. The “CCA” group consisted of eight patients, and the “non-CCA” group had 16 patients. There was no significant difference between the two groups in their presenting values of ALT, ALP, or serum Ca 19-9. However, the “CCA” group had significantly higher levels of AST, TBil, and INR. Conclusion: Patients with PSC and concurrent or impending CCA appear to exhibit significantly greater biochemical liver dysfunction than those who do not develop CCA. Therefore, newly-diagnosed PSC patients presenting with these findings may warrant more rigorous evaluation.

Prophylaxis Among Hepatitis B Core Antibody-positive Deceased-donor Liver Transplant Recipients: Hepatitis B Immunoglobulin Plus Oral Antiviral Agents Versus Antiviral Agents Alone: A Single-center Experience.

OBJECTIVES Hepatitis B core antibody immunoglobulin G seropositivity is evidence of past exposure to hepatitis B virus. Donor or recipient hepatitis B core antibody positivity may pose a risk of reactivation, especially early after liver transplant. Although most centers advocate using antiviral agents plus hepatitis B immunoglobulin, some have recently relied on antivirals only as prophylaxis after liver transplant. Here, we retrospectively investigated patient survival in hepatitis B core antibody-positive recipients, comparing those treated with antivirals plus hepatitis B immunoglobulin versus antivirals alone. MATERIALS AND METHODS After Internal Review Board approval, we reviewed medical records of deceased-donor liver transplant recipients between 1995 and 2013. Demographic characteristics, transplant indication, hepatitis B core antibody status, time to death, and type of posttransplant prophylaxis were recorded. We also recorded whether donors showed hepatitis B core antibody positivity. Patients who died within 30 days of liver transplant were excluded. RESULTS There were 148 hepatitis B core antibody-positive recipients. Prophylaxis was given to 75 recipients after transplant: 8 (5%) received hepatitis B immunoglobulin, 22 (15%) received antivirals, and 45 (30%) received the combination. There were 34 deaths: 3 (38%) in hepatitis B immunoglobulin only, 3 (14%) in antiviral only, 8 (18%) in the combination, and 20 (27%) in no prophylaxis groups. One- and 5-year survival rates were similar for binary comparisons among prophylaxis groups (P > .05). CONCLUSIONS Preliminary results support the current practice of using hepatitis B immunoglobulin plus antivirals for prophylaxis after liver transplant. The similar survival benefit with the combination versus antiviral agents alone suggests equal effectivity for prophylaxis posttransplant. However, a clear benefit of antivirals was not evident in our analysis. Future larger prospective studies are warranted to identify potential benefits of using antivirals alone as prophylaxis after liver transplant and to further clarify their role as the sole prophylactic regimen.