Yıldıran Songür

Prevalence of occult hepatitis B and hepatitis C virus infections in Turkish hemodialysis patients

Background and Objective. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are important causes of morbidity and mortality in maintenance hemodialysis patients. Although their exact prevalence is not known, HBV and HCV viral infections and occult viral hepatitis are frequent in these patients. This study aimed to determine the prevalence of occult HBV and HCV infections in maintenance hemodialysis patients. Materials and Methods. One hundred and eighty-eight end-stage renal disease patients on maintenance hemodialysis (100 male, mean age 49±29 [16–80] years, and mean duration of hemodialysis 98±66 [12–228] months) were enrolled in this study. Serological markers for HBV and HCV were determined with immunoenzymatic assay (ELISA) by using commercial diagnostic kits (Access and BioRad, Beckman-Coulter). HCV-RNA (Cobas Amplicor HCV kit) and HBV-DNA (Artus GmbH HBV kit) were determined quantitatively by polymerase chain reaction. Results. Among the patients screened, 25 (13.3%) had HBV infection alone and 38 (20.2%) had HCV infection alone, while seven (3.7%) had dual infection of both viruses. Serological markers for occult hepatitis B and occult hepatitis C were positive in five (2.7%) and nine (4.8%) of the patients, respectively. Isolated anti-HBc was positive in 12 (6.4%) of all patients, three (7.9%) of the patients with anti-HCV and two (40%) of the patients with occult hepatitis B. Isolated anti-HBc positivity was more frequent in patients with occult hepatitis B than in those without (40% [2/5] vs. 5.5% [10/183], p=0.002). None of the patients with HCV had occult hepatitis B. Conclusions. Both occult and non-occult forms of HCV infection are more prevalent than HBV infection in hemodialysis patients. Especially the patients with isolated anti-HBc positivity should be tested for probable occult hepatitis B infection.

Hepatitis B virus and hepatitis C virus seroprevalence in rural areas of the southwestern region of Turkey.

OBJECTIVES Most previous studies on the frequency of hepatitis B virus (HBV) and hepatitis C virus (HCV) have analyzed data obtained from blood donors and risk groups. Few studies have been conducted in the field in rural and urban areas of Turkey. The aim of this study was to determine the seroprevalence of HBV and HCV and to investigate the association with risk factors. METHODS Between January 2006 and March 2007, 2852 people aged 18 years and over were chosen in three districts using simple random sampling, and blood samples were drawn from them. The card test technique, which is highly sensitive, was applied to blood samples for the qualitative assessment of hepatitis B surface antigen (HBsAg), anti-hepatitis B surface antigen antibodies (anti-HBs), and anti-hepatitis C virus antibodies (anti-HCV). The ELISA technique was then applied only to positive samples for confirmation. In addition, participants answered survey questions on risk factors for infection with HBV and HCV. RESULTS Our results showed that 71 (2.5%) were HBsAg-positive, 462 (16.2%) were anti-HBs-positive, and 29 (1.0%) were anti-HCV-positive. Further survey results showed that seropositivity increased with some of the risk factors. CONCLUSIONS Studies on seropositivity that depend on field analyses reflect the true population more accurately. We conclude that such field studies and public education activities for hepatitis B and C are essential.

Triple or Quadruple Tetracycline-Based Therapies Versus Standard Triple Treatment for Helicobacter pylori Treatment

Background:Our aim was to compare lansoprazole-tetracycline-metranidazole (LTM) as first-line treatment with the classical lansoprazole-amoxicillin-clarithromycin (LAC) and bismuth-containing quadruple treatments. Patients and Methods:This prospective, single-center, randomized study included 464 consecutive Helicobacter pylori–positive patients with dyspeptic symptoms. A total of 415 patients completed the study. The patients were allocated into 4 study groups using random sampling numbers as follows—LAC group: lansoprazole 30 mg twice daily, amoxicillin 1000 mg twice daily, and clarithromycin 500 mg twice daily for 14 days; BLTM group: bismuth subcitrate 300 mg 4 times a day, lansoprazole 30 mg twice daily, tetracycline 500 mg 4 times a day, and metronidazole 500 mg twice daily for 10 days; RBLTM group: ranitidine bismuth citrate 400 mg twice daily, lansoprazole 30 mg twice daily, tetracycline 500 mg 4 times a day, and metronidazole 500 mg twice daily for 10 days; and LTM group: lansoprazole 30 mg twice daily, tetracycline 500 mg 4 times a day, and metronidazole 500 mg twice daily for 10 days. Results:The per protocol H. pylori eradication rate in LAC, BLTM, RBLTM, and LTM groups were 37 of 104 (35.6%), 56 of 102 (54.9%), 67 of 104 (64.4%), and 63 of 105 (60%), respectively. The intention-to-treat eradication rate was 37 of 113 (32.7%) in LAC, 56 of 119 (47.1%) in BLTM, 67 of 117 (57.3%) in RBLTM, and 63 of 115 (54.8%) in LTM group. The BLTM, RBLTM, and LTM treatment groups achieved a significantly better eradication rate than the LAC treatment group (P < 0.001). There was not any significant statistical difference between the groups of BLTM, RBLTM, and LTM. Conclusion:LTM treatment group achieved a significantly better eradication rate than the LAC treatment group. The success ratio of LTM therapy is comparable with quadruple bismuth-based treatments.

Iodine status in Turkish populations and exposure to iodide uptake inhibitors.

Perchlorate, nitrate, and thiocyanate are competitive inhibitors of the sodium iodide symporter of the thyroid membrane. These inhibitors can decrease iodine uptake by the symporter into the thyroid gland and may disrupt thyroid function. This study assesses iodine status and exposure to iodide uptake inhibitors of non-pregnant and non-lactating adult women living in three different cities in Turkey (Istanbul, Isparta and Kayseri). We measured iodine and iodide uptake inhibitors in 24-hr urines collected from study participants (N = 255). All three study populations were mildly iodine deficient, with median urinary iodine (UI) levels of 77.5 µg/L in Istanbul, 58.8 µg/L in Isparta, and 69.8 µg/L in Kayseri. Perchlorate doses were higher in the study population (median 0.13 µg/kg/day), compared with a reference population (median 0.059 µg/kg/day), but lower than the U.S. EPA reference dose (0.7 µg/kg/day). Urinary thiocyanate levels increased with increasing exposure to tobacco smoke, with non-smokers (268 µg/L) significantly lower than light smokers (1110 µg/L), who were significantly lower than heavy smokers (2410 µg/L). This pilot study provides novel data indicating that study participants were moderately iodine deficient and had higher intakes of the iodide uptake inhibitor perchlorate compared with a reference population. Further investigation is needed to characterize the thyroid impact resulting from iodine deficiency coupled with exposure to iodide uptake inhibitors such as perchlorate, thiocyanate and nitrate.

Comparison of infusion or low-dose proton pump inhibitor treatments in upper gastrointestinal system bleeding

BACKGROUND The most effective schedule of proton pump inhibitor (PPI) administration following endoscopic hemostasis of bleeding ulcers remains uncertain. AIM To compare the treatment effects of continuous infusion and low-dose esomeprazole therapies in patients with non-variceal upper gastrointestinal (GI) bleeding. METHODS This prospective clinical study compared continuous infusion of esomeprazole (80 mg bolus followed by 8 mg∕h continuous infusion for 72 h) and low-dose esomeprazole (40 mg twice daily IV) treatments in GI bleeding patients with peptic ulcer presenting a high risk of re-bleeding, who were administered a successful endoscopic homeostasis. The primary end point was the occurrence of re-bleeding during hospitalization and within one month of discharge. Secondary outcomes were defined as duration of hospitalization, need of transfusion, surgical treatment, and mortality rate. After 72 h, both groups were switched to oral esomeprazole therapy for one-month. RESULTS A hundred thirty-two subjects were enrolled. Re-bleeding occurred in 11 (16.7%) patients in the infusion therapy group and in 12 (18.2%) patients in the low-dose group (P=0.819) within the first 72 h. No patient experienced re-bleeding in the first month following discharge. There was no statistical significant difference between the two groups in terms of transfusion need, durations of hospitalization, need for surgery and mortality rate. CONCLUSION PPI infusion therapy following endoscopic hemostasis treatment was not found superior to low-dose PPI therapy in the terms of re-bleeding, need of surgery and mortality.

Gastroesophageal scintigraphy in the evaluation of adult patients with chronic cough due to gastroesophageal reflux disease.

ObjectiveThe aim of this study was to evaluate the findings of gastroesophageal scintigraphy (GES) with late lung imaging in adult patients with chronic cough due to gastroesophageal reflux disease and a group of healthy participants. MethodsFifty-five patients with chronic cough with reflux symptoms, and a control group of 12 healthy participants were examined. All patients had reflux esophagitis documented by upper gastrointestinal endoscopy and histology. All participants underwent laryngoscopic examination and GES. The correlation between gastroesophageal reflux and several related variables was evaluated. ResultsOverall, 51 patients (92.7%) had positive GES findings for pathologic reflux; 19 (37.2%) of these patients had proximal reflux; and the remaining 32 (62.7%) had distal reflux. The frequency, duration, and percentage volume of gastric content of reflux episodes were significantly greater in patients with proximal reflux than in patients with distal reflux (P<0.0001). No statistically significant differences were seen between proximal reflux and distal reflux patients in terms of pulmonary function parameters, duration of cough, and reflux symptoms scores. However, severe grade (B and C) of esophagitis and the posterior laryngitis were more common in the patients with proximal reflux. Late lung imaging demonstrated evidence of pulmonary aspiration in only three of 51 (6%) patients. ConclusionOur study suggests that GES with late lung imaging objectively showed the presence of pathologic distal and/or proximal reflux, but rarely pulmonary aspiration, in the majority of chronic cough patients with gastroesophageal reflux disease. As the chronic cough patients with proximal reflux have more severe reflux characteristics, this examination may be effective in screening and following up these patients.

Is gastroesophageal reflux contribute to the development chronic cough by triggering pulmonary fibrosis.

BACKGROUND/AIMS Previous studies have shown that the prevalence of abnormal acid reflux in fibrotic lung disease patients is high, and in particular, patients with secondary pulmonary fibrosis show higher esophageal acid exposure than normal controls. There are also some findings that, in patients with pathological reflux, pulmonary fibrosis may develop. The aim of this study is to investigate if pulmonary fibrosis is involved in the pathogenesis of chronic cough due to Gastroesophageal Reflux. MATERIALS AND METHODS A prospective study was performed in twenty-one patients with chronic cough due to gastroesophageal reflux who was diagnosed as reflux esophagitis by upper gastrointestinal endoscopy, histology, and in ten healthy controls without GER or any lung disease. All participitants underwent laryngoscopic examination and gastroesophageal scintigraphy with late lung imaging. Bronchoalveolar lavage fluid total and differential cell counts, T and B cell subsets, and the concentrations of IL- 1β and TNF-α were measured. RESULTS Reflux extending into the proximal esophagus was noted in 52.5%, and posterior laryngitis was present in 90.5% of the patients. No evidence of pulmonary aspiration was noted in the patients with reflux on scintigraphic examination. No significant difference was found between the GER and control groups in terms of cellular content, IL-1β and TNF-α levels or mean T cell subsets and B cell counts in bronchoalveolar lavage fluid. Forced expiratory volume in one second, forced vital capacity FEV1/FVC, total lung capacity, and carbon monoxide diffusion capacity values were within normal limits in the gastroesophageal reflux group. CONCLUSION Our findings do not support the hypothesis that gastroesophageal reflux leads to chronic cough by triggering alveolar epithelial injury and subsequent pulmonary fibrosis.

A Different Pattern of Brunner Gland Adenoma on Endoscopic Ultrasonography

DOI: 10.4328/JCAM.1474 Received: 15.12.2012 Accepted: 02.01.2013 Publihed Online: 02.01.2013 Corresponding Author: Mete Akin, Burdur Devlet Hastanesi, Gastroenteroloji Klinigi, 15030 Yenimahalle, Burdur, Turkiye. T.: +9

Serial Changes in Alpha-Fetoprotein Levels During Therapy for Chronic Hepatitis C

1 Altuğ Şenol1, Mete Akın2, Yıldıran Songür3, Mehmet İşler4, M.Cem Koçkar1 1Süleyman Demirel University School of Medicine, Department of Gastroenterology, Isparta, 2Akdeniz University School of Medicine, Department of Gastroenterology, Antalya, 3Memorial Şişli Hospital, Department of Gastroenterology, İstanbul, 4Şifa Hospital, Department of Gastroenterology, Isparta, Turkey Alpha-Fetoprotein Levels in Chronic Hepatitis C Serial Changes in Alpha-Fetoprotein Levels During Therapy for Chronic Hepatitis C

Sigmoid özofaguslu bir olguda akalazya balon dilatasyonu

We report herein a method for pneumatic dilatation in a patient with achalasia complicated with sigmoid esophagus, since it could not be performed using the standard methods.