Ilkay Simsek

Epidemiology and survival of hepatocellular carcinoma in Turkey: outcome of multicenter study.

OBJECTIVE Hepatocellular cancer (HCC) is one of the important health problems in Turkey. We aimed to determine the clinical and demographic features of HCC in the Turkish population and to evaluate the prognostic and survival features. METHOD Two hundred and twenty-one patients with HCC from five hospitals in Turkey are included in this study. RESULTS In 44.4% of the 221 patients with hepatitis B virus and in 21.3% of the 221 patients with hepatitis C virus were found to be responsible for HCC etiology. It has been shown that HCC developed on cirrhosis basis in 74.2% of the patients. HCC was presented with single solitary nodule in 69.2% of the patients. Non-liver metastasis was present in 12.5% of the patients. In 21.7% of the patients, alpha-fetoprotein (AFP) levels were above the diagnostics level of 400 ng/ml. The median overall survival (OS) of 221 patients was 14 months. The median OS of the patients with Child-Pugh A class was significantly longer than that with Child-Pugh B and C classes. The OS of the individuals with normal AFP levels was also longer than that with high AFP levels. The OS of the patients with Stage I HCC according to tumor node metastasis (TNM) classification, the female patients and the treated patients group was found to be significantly good. CONCLUSIONS In conclusion, the viral etiology (hepatitis B and C infections) in Turkish population is found to be an important factor in HCC development. The Child-Pugh classification, AFP levels, TNM classification, being female and treatment were determined to be important prognostic factors in HCC patients.

Relationship between non-steroidal anti-inflammatory drug use and Helicobacter pylori infection in bleeding or uncomplicated peptic ulcers: A case-control study.

Background and Aims: Non‐steroidal anti‐inflammatory drug (NSAID) use has been closely associated with an increased risk of bleeding peptic ulcers, while the prevalence of Helicobacter pylori infection has been reported to be lower in bleeding ulcers than in non‐bleeding ones. However, whether an interaction exists between NSAID use and H. pylori infection has not clearly been elucidated yet. The aims of this study were to determine the frequency of NSAID use and H. pylori infection, to predict risk factors in bleeding peptic ulcers and to determine whether NSAID use and H. pylori infection interact with each other.

Comparison of High Resolution Magnifying Endoscopy and Standard Videoendoscopy for the Diagnosis of Helicobacter pylori Gastritis in Routine Clinical Practice: A Prospective Study

Background:  It has been shown that standard endoscopic features often labeled as gastritis has a poor correlation with histopathology. Recently, high resolution magnifying endoscopy has been reported to be an effective method to diagnose gastritis. The aim of the present study was to compare standard endoscopy with magnifying endoscopy for the diagnosis of Helicobacter pylori gastritis, and to determine whether gastritis can be diagnosed based on findings at magnification endoscopy.

Assessment of sexual functions in patients with chronic liver disease

We aimed to determine the sexual problems and the prevalence of erectile dysfunction (ED) in patients with chronic liver disease by means of International Index of Erectile Function (IIEF). A total of 81 patients with stable chronic liver disease were included in the study. Patients were grouped as mild to moderate (Child Pugh A and B) (n=10), chronic hepatitis (hepatitis B, C and D) (n=28) and carriers (n=43) according to the type of their chronic liver disease. All patients were asked to complete a questionnaire including IIEF and demographics. The IIEF domain scores were calculated and ED grading was determined on erectile function domain. IIEF domain scores were compared between these groups. The mean age was 54.8 ± 10.8 y. Using the IIEF, the prevalence of any ED was 50.6% for all patients, and 50, 50, and 51.1% for cirrhosis, chronic hepatitis and carriers, respectively. The IIEF domain scores were not significantly different among the patient groups. Sexual functions did not appear to be affected by the stable chronic liver disease.

Detection of Helicobacter pylori DNA by a simple stool PCR method in adult dyspeptic patients.

Introduction.  Helicobacter pylori is the major agent causing peptic ulcer, gastric cancer and mucosa‐associated lymphoid tissue (MALT) gastric lymphoma. A simple stool polymerase chain reaction (PCR) method was performed and compared with the gold standards for the diagnosis of H. pylori infection.

Mesalazine-induced myopericarditis in a patient with ulcerative colitis

Dear Editor: Cardiac involvement is an uncommon condition seen during the course of inflammatory bowel disease [1]. The pathogenesis of myopericarditis in inflammatory bowel disease has not yet been clearly identified. It has also been described as a side effect of the treatment of inflammatory bowel disease with 5-ASA and mesalazine [2]. A 21-year-old man recently diagnosed with ulcerative colitis on the basis of endoscopic and pathological findings was admitted to our hospital because of uncontrollable bloody diarrhea. He was on mesalazine (2 g/day) for 10 days. He complained of bloody diarrhea ten times a day. Physical examination was unremarkable. The laboratory data were within the normal range with the exception of the erythrocyte sedimentation rate, which was 21 mm/h, and C-reactive protein, which was 14 mg/l (normal 0–5 mg/l). He was considered to have active disease and budesonide (9 mg/ day) was added to the mesalazine. On the 2nd day of admission the patient had fever of 38.4°C. The ECG was normal. The chest X-ray did not show any signs of infection. Blood cultures were negative. Three days later the patient developed tachycardia and dyspnea on minimal exertion. The ECG showed ST-segment elevations in leads V2–V4, T wave inversions and biphasic Twaves in leads V4–V6. A pericardial rub was heard. Echocardiography showed global hypokinesia with decreased ejection fraction (EF) to 41%. Inferior and posterior pericardial leaflets had increased echogeneity. Cardiac troponin I and CK-MB were elevated (2.6 and 9.7 ng/ml respectively). Tuberculin skin test and the serological examinations for antinuclear antibodies (ANA) and rheumatoid factor (RF) were negative. Polymerase chain reaction (PCR) test for enterovirus RNA was negative in the nasopharynx. The patient was diagnosed with acute myopericarditis and mesalazine was stopped, as it was considered a possible etiologic agent. One week after the drug was stopped, the chest pain had gone, and the ECG showed normal findings. Cardiac troponin I and CK-MB decreased to normal levels. Repeated echocardiography revealed an EF of 67%. More than 100 inflammatory bowel disease patients have been reported to have associated cardiac diseases as extra-intestinal manifestations of inflammatory bowel disease or as a consequence of drug-induced side effects [4]. Once the patient is on inflammatory bowel disease therapy it is usually problematic to determine the cause of cardiac involvement. In our case the symptoms resolved without any treatment following withdrawal of mesalazine, so we assume that mesalazine was the causative agent for myopericarditis. In the reported cases reviewed it is generally recommended to administer L. Doganay . B. Akinci Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey

The efficacy, safety and tolerability of pantoprazole-based one-week triple therapy in H. pylori eradication and duodenal ulcer healing

SUMMARY Objective: Recently, proton pump inhibitor (PPi)-based triple therapy has been recommended as a first line treatment in the eradication of Helicobacter pylori. The aim of this open, multicentre trial was to investigate the efficacy, safety, tolerability and the ulcer healing rate of a triple regimen consisting of pantoprazole∗ 40 mg, clarithromycin 500 mg and amoxicillin 1000 mg twice daily for 7 days, in the eradication of H. pylori in patients with duodenal ulcer in Turkey. Research design and methods: H. pylori infection was assessed by histological examination and rapid urease test at baseline and 4 weeks after the completion of the therapy. Seventy-seven patients were enrolled, 5 were excluded due to various reasons and 72 completed the entire course of the trial. Results: H. pylori eradication was confirmed in 49 of these patients; the eradication rate was 68% by per-protocol analysis and 63.6% by intention-to-treat analysis. The ulcers were completely healed in 61 patients (85%) at the second endoscopic examination. Drug compliance was excellent (97.3%) and there were no serious adverse events. Conclusion: Pantoprazole-based 1-week triple therapy was well tolerated and the ulcer healing rate was high (85%). Relatively low H. pylori eradication rates may be attributed to rising antibiotic resistance over recent years. A large scale, comparative study with other PPi-based regimens is warranted based on the results of this open study with the pantoprazole-based regimen.

Prevalence patterns of gastric cancers in Turkey: model of a developing country with high occurrence of Helicobacter pylori.

Aim:  In developed countries, there has been a recent increase in the prevalence of adenocarcinoma of the esophagus and cardia, along with a decrease in distal gastric cancers. Little is known regarding the prevalence of these diseases in developing countries. The aim of the present study was to evaluate changes in the prevalence of gastric adenocarcinomas in Turkey as a function of anatomic location.

Is There a Possible Relation Between Atrophic Gastritis and Premature Atherosclerosis

Background.  In this study, we have aimed to show the possible relation between atrophic gastritis and premature atherosclerosis via hyperhomocysteinemia.

The prevalence of Helicobacter pylori infection in patients with gastric and duodenal ulcers – a 10-year, single-centre experience

Introduction Helicobacter pylori (H. pylori) occurs throughout the world and causes gastroduodenal diseases. There is data indicating a change in the prevalence of H. pylori infection worldwide. The prevalence of H. pylori is 80% in Turkey, while it is higher in many developing countries, and the rate of infection varies throughout the world. In many developing countries, the prevalence of infection exceeds 90% by adulthood. Aim To determine the change in the rate of H. pylori infection in gastric ulcers and duodenal ulcers for a 10-year period in a single centre. Material and methods The study population included 550 patients (342 in 2004, 208 in 1994) with gastric and duodenal ulcers. Results In 2004 there were 125 (36.5%) patients with gastric ulcer and 217 patients with duodenal ulcer (64.5%). CLO test positivity was 39.2% in patients with gastric ulcers and 60% in patients with duodenal ulcers. In 1994 there were 208 patients (159 duodenal ulcers, 49 gastric ulcers). Urease test was positive in 74.2% of patients with duodenal ulcer and in 65.2% of patients with gastric ulcer. The decrease in the rate of urease positivity in patients with gastric ulcer was statistically significant (p = 0.01) during this 10-year period. Conclusions In the present study we found that the urease positivity decreased significantly in patients with gastric ulcer between 1994 and 2004.