Erhan Alkan

Long-term Efficacy and Safety of Lamivudine, Entecavir, and Tenofovir for Treatment of Hepatitis B Virus–Related Cirrhosis

BACKGROUND & AIMS Data are limited on the efficacy and safety of tenofovir and entecavir when given for more than 1 year to patients with hepatitis B-related cirrhosis. We investigated the long-term safety and efficacy of these antiviral drugs in patients with chronic hepatitis B virus (HBV) infection, with compensated or decompensated cirrhosis, and compared results with those from lamivudine. METHODS We performed a retrospective analysis of data from 227 adult patients with chronic HBV infection who were diagnosed with cirrhosis, beginning in 2005, at 18 centers throughout Turkey. There were 104 patients who had decompensated cirrhosis, and 197 patients were treatment naive before. Seventy-two patients received tenofovir (followed up for 21.4 ± 9.7 mo), 77 patients received entecavir (followed up for 24.0 ± 13.3 mo), and 74 patients received lamivudine (followed up for 36.5 ± 24.1 mo). We collected data on patient demographics and baseline characteristics. Laboratory test results, clinical outcomes, and drug-related adverse events were compared among groups. RESULTS Levels of HBV DNA less than 400 copies/mL were achieved in 91.5%, 92.5%, and 77% of patients receiving tenofovir, entecavir, or lamivudine, respectively. Levels of alanine aminotransferase normalized in 86.8%, 92.1%, and 71.8% of patients who received tenofovir, entecavir, and lamivudine, respectively. Child-Turcotte-Pugh scores increased among 8.5% of patients who received tenofovir, 15.6% who received entecavir, and 27.4% who received lamivudine. Frequencies of complications from cirrhosis, including hepatic encephalopathy, variceal bleeding, hepatocellular carcinoma, and mortality, were similar among groups. Lamivudine had to be changed to another drug for 32.4% of the patients. CONCLUSIONS Tenofovir and entecavir are effective and safe for long-term use in patients with compensated or decompensated cirrhosis from HBV infection.

Comparison of heater probe coagulation and argon plasma coagulation in the management of Mallory–Weiss tears and high-risk ulcer bleeding

BACKGROUND AND STUDY AIMS Upper gastrointestinal (GI) bleeding is a common medical emergency. Endoscopic treatments often lead to better therapeutic outcomes than conventional conservative treatments. This study aimed to investigate and compare the use of heater probe coagulation (HPC) and argon plasma coagulation (APC) together with epinephrine injection for the treatment of Mallory-Weiss tears and high-risk ulcer bleeding. PATIENTS AND METHODS A total of 97 patients (54 in the HPC group and 43 in the APC group) who were diagnosed with upper GI bleeding secondary to a Mallory-Weiss tear or high-risk gastric or duodenal ulcers were included in the study. Lesions were classified according to the Forrest classification. The HPC and APC groups were compared in terms of initial haemostasis, re-bleeding in the early period, need for surgery, average need for transfusion, and duration of hospital stay. RESULTS There were no significant differences between the HPC and APC groups in terms of ensuring initial haemostasis (98% vs. 97.5%, p>0.05), re-bleeding rates (17% vs. 19%, p>0.05), need for surgery (2% vs. 9%, p>0.05), average need for transfusion (3.7±2.11 vs. 3.4±2.95 units, p>0.05), and average duration of hospital stay (4.6±2.24vs. 5.3±3.23days, p>0.05). CONCLUSION There was no difference between HPC and APC when used together with epinephrine injection for the treatment of Mallory-Weiss tear and high-risk ulcer bleeding.

A Cause of Mortal Massive Upper Gastrointestinal Bleeding: Aortoesophageal Fistula

Introduction: Aortoesophageal fistula is an uncommon but mortal cause of massive upper gastrointestinal bleeding. The most common causes are thoracic aortic aneurisym, foreign body reaction, malignancy and postoperative complication. It can be seen in different pattern on upper gastrointestinal endoscopy. There are surgical, endoscopic and interventional radiological treatment options, however, definitive treatment is surgical intervention. Diagnosis and treatment desicion should be made quickly because of rapid and mortal course. Case report: In this article, a case of aortoesophageal fistula was presented that resulted in mortality as a result of massive bleeding.

Lamivudine Treatment Failure Risks in Chronic Hepatitis B Patients with Low Viral Load

Aim: To analyze the risk factors of lamivudine treatment failure (LTF) for the long-term use in patients with low viral load (LVL). Material and Methods: In this multicenter study, 548 antiviral naïve noncirrhotic adult patients with LVL (for HBeAg+ patients HBV DNA <109 copies/ml and for HBeAg- patients HBV DNA <107 copies/ml) were enrolled. As a control group, 46 lamivudine-initiated patients with high viral load (HVL) were included. Primary outcome was switching to or adding on another antiviral drug as a consequence of primary nonresponse, partial response, viral breakthrough or adverse events. Secondary outcomes included LTF rates at 1, 2, 3, 4 and 5 years and LTF-related viral and host factors. Results: Among 594 patients, 294 had to change lamivudine at the follow-up. Primary nonresponse, partial response, viral breakthrough or adverse events frequencies were 6.8, 1.6, 64.5 and 0.1%, respectively. Five-year LTF rates were 61.3 and 84.2% in patients with LVL and HVL, respectively. Among patients with LVL, patients with <100,000 copies/ml and ≥100,000 copies/ml had 54.8 and 67.3% LTF rates at the end of the 5th year, respectively. Logistic regression analysis of risk factors showed HBeAg+, hepatic activity index, HBV DNA, virological response at 6 months and duration of follow-up were independent predictors for LTF (p values were 0.001, 0.008, 0.003, 0.020 and 0.003, respectively). Conclusion: Similar to patients with HVL, first-line lamivudine therapy is not efficient for long-term use in patients with LVL. LTF risk is so high even in the absence of worse predictive factors.

Comparison of intravenous pantoprazole and ranitidine in patients with dyspepsia presented to the emergency department: a randomized, double blind, controlled trial

BACKGROUND This study aimed to compare pantoprazole, a proton-pomp inhibitors (PPIs), and ranitidine, a H2 receptor antagonists (H2RA), in ceasing dyspeptic symptoms in the emergency department (ED). METHODS This randomized, double-blinded study compared the effectiveness of 50 mg ranitidine (Ulcuran(®)) and 40 mg pantoprazole (Pantpas(®)), given in a 100 mL saline solution by an intravenous rapid infusion within 2-4 minutes in patients with dyspepsia presented to the ED. Pain intensity was measured at baseline, 30 and 60 minutes after the drug administration. RESULTS A total of 72 patients were eligible for the study. Of these patients, 2 were excluded from the study because the initial visual analogue scale (VAS) scores were under 20 mm and 4 were excluded from the statistical analysis because of being diagnosed as having other causes of epigastric pain despite being allocated to one of the study groups. Thirty-three patients in the pantoprazole group and 33 patients in the ranitidine group were analyzed ultimately. The mean age of the patients was 36.6±15 years, and 26 (39.4%) patients were male. Both of the groups reduced pain effectively at 30 [27.6±28 (18 to 37) vs. 28.3±23 (20 to 37), respectively] and 60 minutes [39.6±39 (26 to 53) vs. 42.3±25 (33 to 51), respectively]. There were 13 (39.4%) patients in the pantoprazole group and 8 (24.2%) patients in the ranitidine group who required additional drug at the end of the study (P=0.186). CONCLUSION Intravenous pantoprazole and ranitidine are not superior to each other in ceasing dyspeptic symptoms at 30 and 60 minutes in the ED.

Association of Mean Platelet Volume And Severity of Bleeding In Patients With Non-Variceal Upper Gastrointestinal Bleeding

Objective: Upper gastrointestinal (GI) bleeding is a common medical condition that might require surgery and can result in mortality in high risk lesions. The present study aimed to investigate the association with severity of bleeding and mean platelet volume (MPV) as an indicator of platelet function and activation, in patients with upper GI bleeding.. Material and Methods: A total of 97 patients diagnosed with upper GI bleeding secondary to Mallory-Weiss tear and high-risk gastric or duodenal ulcer and who underwent endoscopic treatment with epinephrine injection plus heater prob coagulation or argon plasma coagulation were analyzed retrospectively. Patients were compared according the median MPV levels, in terms of initial hemostasis, mean transfusion count and duration of hospital stay, recurrent bleeding rates and need for surgery. results: Median MPV level was 8.3 fL in enrolled patients. MPV was lower than the median level in 52 (53%) patients and higher in 45 (47%) patients. There were no statistically significant differences between the two groups in terms of initial hemostasis (100% vs. 96%, p>0.05), average transfusion count (3.5 ± 2.25 and 3.66 ± 2.77 units, p>0.05). average duration of hospital stay (5.1 ± 3.05 and 4.89 ± 2.33 days, p>0.05). recurrent bleeding rates (15% vs. 20%, p>0.05) and need for surgical treatment (6% vs. 4%, p>0.05). conclusion: MPV was not found to related with the severity of bleeding in patients with upper GI bleeding secondary to Mallory-Weiss tear or high-risk of gastric or duodenal ulcer. key Words: Upper gastrointestinal bleeding, Mean platelet volume, Peptic ulcer, Mallory-Weiss tear Mete AKIN1, Erhan ALKAN2, Yaşar TUNA1, Tolga YALÇINKAYA1, Bülent YILDIRIM1 Varis Dışı Üst Gastrointestinal Sistem Kanamalarında Ortalama Trombosit Hacminin Kanama Ciddiyeti İle İlişkisi Association of Mean Platelet Volume And Severity of Bleeding In Patients With Non-Variceal Upper Gastrointestinal Bleeding 1Akdeniz Üniversitesi, İç Hastalıkları, Gastroenteroloji Bilim Dalı, Antalya, Türkiye 2Burdur Devlet Hastanesi, Gastroenteroloji Bölümü, Burdur, Türkiye

Nadir bir perkütan endoskopik gastrostomi komplikasyonu: mide çıkış obstrüksiyonu

Perkutan endoskopik gastrostomi, oral alimi yeterli olmayan hastalar icin uzun sureli enteral beslenme destegi amaciyla yaygin olarak kullanilan bir yontemdir. Genel olarak guvenilir kabul edilir ancak islem sirasinda ve sonrasinda cesitli komplikasyonlar gorulebilir. Bu yazida nadir bir komplikasyon olarak perkutan endoskopik gastrostomi tupu balonunun pilordan duodenuma gecerek impakte olmasi sonucu mide cikis yolu obstruksiyonu gelisen bir hasta bildirilmistir.