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Buyruk AM, Erdoğan Ç, Tekin F, Turan İ, Özütemiz Ö, Ersöz G. The use of fully covered self-expandable metal stents in the endoscopic treatment of portal cavernoma cholangiopathy. BMC Gastroenterol 2023; 23:414. [PMID: 38017393 PMCID: PMC10683077 DOI: 10.1186/s12876-023-03042-5] [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: 06/25/2023] [Accepted: 11/08/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND AND AIMS There are different therapeutic approaches for biliary strictures and reducing portal hypertension in patients with symptomatic portal cavernoma cholangiopathy (PCC). Endoscopic treatment includes endoscopic biliary sphincterotomy (EST), dilation of stricture with a biliary balloon, placement of plastic stent(s) and stone extraction. Fully covered self-expandable metal stent (FCSEMS) is placed as a rescuer in case of haemobilia seen after EST, dilation of stricture and removal of plastic stent rather than the stricture treatment itself. In this retrospective observational study, we sought to assess the clinical outcomes of FCSEMS as the initial treatment for PCC-related biliary strictures. MATERIALS AND METHODS Twelve symptomatic patients with PCC both clinically and radiologically between July 2009 and February 2019 were examined. Magnetic resonance cholangiopancreatography (MRCP) and cholangiography were employed as the diagnostic imaging methods. Chandra-Sarin classification was used to distinguish between biliary abnormalities in terms of localization. Llop classification was used to group biliary abnormalities associated with PCC. Endoscopic partial sphincterotomy was performed in all the patients. If patients with dominant strictures 6-8-mm balloon dilation was first performed. This was followed by removal of the stones if exist. Finally, FCSEMS placed. The stents were removed 6-12 weeks later. RESULTS The mean age of the patients was 40.9 ± 10.3 years, and 91.6% of the patients were male. Majority of the patients (n = 9) were noncirrhotic. Endoscopic retrograde cholangiopancreatography (ERCP) findings showed that 11 of the 12 patients were Chandra Type I and one was Chandra Type IIIa. All the 12 patients were Llop Grade 3. All patients had biliary involvement in the form of strictures. Stent placement was successful in all patients. FCSEMSs were retained for a median period of 45 days (30-60). Seven (58.3%) patients developed acute cholecystitis. There was no occurrence of bleeding or other complications associated with FCSEMS replacement or removal. All patients were asymptomatic during median 3 years (1-10) follow up period. CONCLUSIONS FCSEMS placement is an effective method in biliary strictures in case of PCC. Acute cholecystitis is encountered frequently after FCSEMS, but majority of patients respond to the medical treatment. Patients should be followed in terms of the relapse of biliary strictures.
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Affiliation(s)
| | - Çağdaş Erdoğan
- Department of Gastroenterology, University of Health Sciences, Ankara Etlik City Hospital, Ankara, Turkey.
| | - Fatih Tekin
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - İlker Turan
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Ömer Özütemiz
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Galip Ersöz
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
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Çelik F, Ünal NG, Şenkaya A, Aslanov S, Buyruk AM, Turan İ, Günşar F, Özütemiz AÖ, Karasu AZ. Outcomes of Patients with Acute Hepatotoxicity Caused by Mushroom-Induced Poisoning. Turk J Gastroenterol 2021; 32:678-684. [PMID: 34528881 DOI: 10.5152/tjg.2021.19875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study aimed to investigate the characteristics of severe hepatitis (SH), acute liver injury (ALI), and acute liver failure (ALF) in patients with mushroom-induced hepatotoxicity. METHODS Data of patients between 2010 and 2019 were retrospectively reviewed. Twenty-four patients with mushroom-induced hepatotoxicity were included and divided into 3 groups: SH, ALI, and ALF. SH was defined as transaminase level ≥10 times ULN, international normalized ratio (INR) ≤1.5, and the absence of hepatic encephalopathy (HE). ALI was defined as INR > 1.5, presumed acute illness onset, and the absence of HE. ALF was diagnosed based on the presence of HE of any degree, with INR > 1.5, presumed acute illness onset, and the absence of cirrhosis. RESULTS The mean age of the patients was 51.6 years; 13 (54.2%) were female. At admission, 18 patients (75%) had SH, 5 (21%) had ALI, and 1 (4.1%) had ALF. During follow-up, 6 of the 18 SH (33%) patients progressed to ALI and 2 of the 5 ALI (40%) patients progressed to ALF. No progression to ALI or ALF was observed in the 8 SH cases with a baseline MELD score of <15. One patient with grade 4 HE died (4.1%). None underwent liver transplantation. CONCLUSION The survival was 100% in the ALI and SH groups. A MELD score of <15 at admission may be used as a predictor of no progression to ALI or ALF in patients with SH. However, since 40% of ALI cases may progress to ALF, these cases should be followed up in a tertiary care center that is equipped to perform liver transplantation and advanced therapies.
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Affiliation(s)
- Ferit Çelik
- Division of Gastroenterology, Department of Internal Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Nalan Gülşen Ünal
- Division of Gastroenterology, Department of Internal Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Ali Şenkaya
- Division of Gastroenterology, Department of Internal Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Seymur Aslanov
- Division of Gastroenterology, Department of Internal Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Abdullah Murat Buyruk
- Division of Gastroenterology, Department of Internal Medicine, Ege University School of Medicine, İzmir, Turkey
| | - İlker Turan
- Division of Gastroenterology, Department of Internal Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Fulya Günşar
- Division of Gastroenterology, Department of Internal Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Ahmet Ömer Özütemiz
- Division of Gastroenterology, Department of Internal Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Abdullah Zeki Karasu
- Division of Gastroenterology, Department of Internal Medicine, Ege University School of Medicine, İzmir, Turkey
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Yamazhan T, Bulut Avşar C, Zeytunlu M, Taşbakan M, Sertöz R, Zeytinoğlu A, Aydemir Ş, Ünalp Ö, Ergün O, Uğuz A, Özgenç F, Günşar F, Turan İ, Ulukaya S, Deniz N, Yilmaz F, Nart D, Güler E, Turhan K, Karasu Z. Infections developing in patients undergoing liver transplantation: Recipients of living donors may be more prone to bacterial/fungal infections. Turk J Gastroenterol 2020; 31:894-901. [PMID: 33626002 PMCID: PMC7928243 DOI: 10.5152/tjg.2020.19286] [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] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/05/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Despite surgical advances in liver transplantation and effective prophylactic strategies, posttransplant infections are the most important cause of morbidity and mortality. Diagnosis and management of infections because of developing immunosuppression is difficult and adversely affects mortality. This study aimed to review bacterial and fungal infections in patients after liver transplantation and to reveal the resistance rates. MATERIALS AND METHODS A total of 107 patients who underwent liver transplantation between January 2017 and February 2018 were evaluated retrospectively with regard to demographic characteristics, causes of transplantation, conditions that may lead to infection, postoperative infections, pathogens, and resistance patterns. RESULTS Of the 107 patients who underwent liver transplantation, 48 (44.8%) had an infection. Bacterial infections were detected in 41% of the patients, and fungal infections were found in 13%. When we compared living and cadaveric transplants in terms of infection development, these rates were found to be 53% and 33%, respectively (p=0.034). No statistically significant results could be obtained when evaluating conditions such as sex, presence of underlying primary disease, Model for End-Stage Liver Disease MELD score, diabetes status, total parenteral nutrition, and risk factors for infection. CONCLUSION After liver transplantation, infections are often seen in the first month of the postoperative period. Knowing the most common pathogens and resistance states in this process reduces infection-related deaths by providing appropriate treatment regimens at the right time.
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Affiliation(s)
- Tansu Yamazhan
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, İzmir, Turkey
| | - Cansu Bulut Avşar
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, İzmir, Turkey
| | - Murat Zeytunlu
- Department of General Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Meltem Taşbakan
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, İzmir, Turkey
| | - Rüçhan Sertöz
- Department of Medical Microbiology, Ege University School of Medicine, İzmir, Turkey
| | - Ayşın Zeytinoğlu
- Department of Medical Microbiology, Ege University School of Medicine, İzmir, Turkey
| | - Şöhret Aydemir
- Department of Medical Microbiology, Ege University School of Medicine, İzmir, Turkey
| | - Ömer Ünalp
- Department of General Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Orkan Ergün
- Department of Pediatric Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Alper Uğuz
- Department of General Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Funda Özgenç
- Department of Pediatrics, Division of Paediatric Gastroenterology, Hepatology and Nutrition, Ege University School of Medicine, İzmir, Turkey
| | - Fulya Günşar
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - İlker Turan
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Sezgin Ulukaya
- Department of Anaesthesiology and Reanimation, Ege University School of Medicine, İzmir, Turkey
| | - Nuri Deniz
- Department of Anaesthesiology and Reanimation, Ege University School of Medicine, İzmir, Turkey
| | - Funda Yilmaz
- Department of Pathology, Ege University School of Medicine, İzmir, Turkey
| | - Deniz Nart
- Department of Pathology, Ege University School of Medicine, İzmir, Turkey
| | - Ezgi Güler
- Department of Radiology, Ege University School of Medicine, İzmir, Turkey
| | - Kutsal Turhan
- Director of Transplantation Council, Ege University School of Medicine, İzmir, Turkey
| | - Zeki Karasu
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
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Turan İ, Özsan N, Doğanavşargil B, Davulcu EA, Bülbül H. The first report of colonic involvement of angioimmunoblastic T-cell lymphoma. Turk J Gastroenterol 2020; 31:413-414. [PMID: 32519962 DOI: 10.5152/tjg.2020.19506] [Citation(s) in RCA: 0] [Impact Index Per Article: 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)
- İlker Turan
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Nazan Özsan
- Department of Pathology, Ege University School of Medicine, İzmir, Turkey
| | | | | | - Hale Bülbül
- Department of Hematology, Ege University School of Medicine, İzmir, Turkey
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Danış N, Tekin F, Akarca US, Ünal NG, Işık Erdoğan E, Akat K, Demirkoparan Ü, Karasu Z, Turan İ, Oruç N, Aydın A, Ersöz G, Vardar R, Özütemiz Ö, Günşar F. Changing patterns of upper gastrointestinal bleeding over 23 years in Turkey. Turk J Gastroenterol 2020; 30:877-882. [PMID: 31258140 DOI: 10.5152/tjg.2019.19239] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND/AIMS This study aimed to compare the causes of nonvariceal upper gastrointestinal bleeding (NVUGB), demographics, risk factors, and outcomes of patients during two periods between 1993 and 2016 in a tertiary health-care center in Turkey. MATERIALS AND METHODS We compared the causes of NVUGB and clinical outcomes in 421 patients hospitalized between January 1993 and December 1995 with those of 231 patients with NVUGB hospitalized between January 2015 and September 2016. We also compared epidemiological characteristics, risk factors, and the rates of endoscopic hemostatic procedures. RESULTS We observed significant increases in patients' mean age, in the percentage of patients with comorbid conditions, and in the percentage of patients who received direct-acting oral anticoagulants before bleeding. We also observed a statistically nonsignificant increase in the diagnoses of gastric ulcer, along with a significant concordant decrease in diagnoses of duodenal ulcer as a cause of bleeding. The use of emergency surgical hemostasis decreased among cases of peptic ulcer bleeding. The overall rate of mortality from bleeding did not significantly change between the two periods. CONCLUSION Over the 23 years studied, the causes of NVUGB changed, probably because the population was increasingly elderly population and because of the use of anticoagulants and better therapeutic approaches to chronic duodenal ulcers. The use of emergency surgical hemostasis reduced, but mortality rate did not significantly change between the two specific periods.
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Affiliation(s)
- Nilay Danış
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Fatih Tekin
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Ulus Salih Akarca
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Nalan Gülsen Ünal
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Elvan Işık Erdoğan
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Kıvanç Akat
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Ümit Demirkoparan
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Zeki Karasu
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - İlker Turan
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Nevin Oruç
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Ahmet Aydın
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Galip Ersöz
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Rukiye Vardar
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Ömer Özütemiz
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Fulya Günşar
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
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Yamazhan T, Turan İ, Ersöz G, Günşar F, Pullukçu H, Danış N, Ünal NG, Vardar R, Oruç N, Tekin F, Taşbakan M, Sipahi OR, Akarca US. Real-life experience of ledipasvir and sofosbuvir single-tablet regimen among chronic hepatitis C patients in Turkey. Turk J Gastroenterol 2020; 31:239-245. [PMID: 32343236 DOI: 10.5152/tjg.2020.19076] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND/AIMS Ledipasvir (LDV) and sofosbuvir (SOF) as single-tablet regimen (STR) has been approved for treatment of chronic HCV infection (CHC) for treatment-naïve or experienced cirrhotic or non-cirrhotic patients. Our aim was to analyse the effectiveness and safety of 12-24 weeks treatment of LDV/SOF (90mg/400 mg)±ribavirin in a real-life setting in Turkey. MATERIALS AND METHODS Between May-Dec 2016, 104 treatment-naïve or experienced adult patients with CHC and with or without cirrhosis (including decompensated cirrhosis) were included in this observational study. Patients were administered LDV/SOF STR± ribavirin once daily for 12 -24 weeks. SVR12 rates and effects of the baseline characteristics on SVR12 rates were assessed. RESULTS Out of 104 enrolled patients (61.5% female, mean age 62.0 years); 60.6% were cirrhotic, 76.0% previously used peg-IFN, 94.2% had GT1. At the end of the treatment, 77.8% (77/99, no data for 21 patients) had undetectable HCV-RNA and 98.9% (94/95) had SVR12. In the baseline characteristics subgroups, the SVR12 rates varied between 94.4% and 100%, and none of the baseline characteristics had a significant effect on the SVR12 rates. During the study, 6 (5.8%) patients died and none of the deaths was suspected to be related to the LDV/SOF. No treatment-emergent adverse event was reported. CONCLUSION In conclusion, LDV/SOF±ribavirin yielded very high SVR12 rates, without any safety or tolerability concern in Turkey. The effectiveness of the LDV/SOF treatment was not affected by the patient demographics or medical characteristics such as fibrosis level, cirrhosis status, previous treatment status, HCV-RNA level or HCV genotype.
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Affiliation(s)
- Tansu Yamazhan
- Department of Infectious Disease, Ege University, İzmir, Turkey
| | - İlker Turan
- Department of Gastroenterology, Ege University, İzmir, Turkey
| | - Galip Ersöz
- Department of Gastroenterology, Ege University, İzmir, Turkey
| | - Fulya Günşar
- Department of Gastroenterology, Ege University, İzmir, Turkey
| | - Hüsnü Pullukçu
- Department of Infectious Disease, Ege University, İzmir, Turkey
| | - Nilay Danış
- Department of Gastroenterology, Ege University, İzmir, Turkey
| | - Nalan G Ünal
- Department of Gastroenterology, Ege University, İzmir, Turkey
| | - Rukiye Vardar
- Department of Gastroenterology, Ege University, İzmir, Turkey
| | - Nevin Oruç
- Department of Gastroenterology, Ege University, İzmir, Turkey
| | - Fatih Tekin
- Department of Gastroenterology, Ege University, İzmir, Turkey
| | - Meltem Taşbakan
- Department of Infectious Disease, Ege University, İzmir, Turkey
| | - Oğuz R Sipahi
- Department of Infectious Disease, Ege University, İzmir, Turkey
| | - Ulus S Akarca
- Department of Gastroenterology, Ege University, İzmir, Turkey
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Turan İ. Covering the Cover Editor of this Issue. Turk J Gastroenterol 2020; 30:1-2. [PMID: 30644361 DOI: 10.5152/tjg.2018.241218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Danış N, Toz H, Ünal N, Yılmaz M, Turan İ, Günşar F, Karasu Z, Ersöz G, Özkahya M, Akarca US. Paritaprevir, ritonavir, ombitasvir, and dasabuvir treatment in renal transplant patients with hepatitis C virus infection. Turk J Gastroenterol 2020; 30:695-701. [PMID: 31418413 DOI: 10.5152/tjg.2019.18833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS The Social Security System of our country reimburses only paritaprevir, ritonavir, ombitasvir, and dasabuvir (PrOD) regime in treatment-naive patients with hepatitis C regardless of kidney disease. Most of our renal transplant (RT) recipients were treated with PrOD. The aim of the present study was to investigate the efficacy and safety of PrOD in RT patients with hepatitis C virus (HCV) infection in a single center real-life experience. MATERIALS AND METHODS RT recipients with a post-transplant follow-up of at least 1 year were included in the study. The patients were treated and monitored according to the guidelines. Blood levels of immunosuppressive patients were closely followed up and adjusted. RESULTS A total of 21 (12 male and nine female) patients were assessed. The age of the patients was 50.8±8.5 years. Ten patients were infected with G1a, 10 patients with G1b, and one patient with G4 HCV. Two patients had compensated cirrhosis. Eighteen patients were treatment-naive, and three were peginterferon+ribavirin-experienced. Sustained virologic response (SVR12) was achieved in all patients. None of the patients discontinued the treatment. Cyclosporine (Csa) and tacrolimus (Tac) doses were reduced to once a day to once a week to maintain the blood level within normal range. The most common adverse effect was anemia in patients receiving ribavirin. Renal functions did not change during the treatment period. CONCLUSION In this real-life experience, all of the 21 PrOD-treated RT recipients reached SVR12. Tac or Csa serum levels were maintained within the normal range with close monitoring. PrOD regime can be successfully and safely used in RT recipients with HCV infection with close follow-up.
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Affiliation(s)
- Nilay Danış
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Hüseyin Toz
- Department of Nephrology, Ege University School of Medicine, İzmir, Turkey
| | - Nalan Ünal
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Mümtaz Yılmaz
- Department of Nephrology, Ege University School of Medicine, İzmir, Turkey
| | - İlker Turan
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Fulya Günşar
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Zeki Karasu
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Galip Ersöz
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Mehmet Özkahya
- Department of Nephrology, Ege University School of Medicine, İzmir, Turkey
| | - Ulus Salih Akarca
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
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Turan İ, Özütemiz AÖ, Ersöz G, Karasu Z, Günşar F, Tekin F, Çoker A, Sözbilen EM, Ünalp Ö, Uguz A, Göker E, Yılmaz F, Nart D, Caner A, Haydaroğlu A, Akarca US. Karaciğer, safra kesesi ve safra yolu kanserlerinde epidemiyoloji ve sağ kalım özellikleri. Ege Tıp Dergisi 2019. [DOI: 10.19161/etd.668367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Danış N, Pullukçu H, Yamazhan T, Ersöz G, Ünal N, Günşar F, Turan İ, Karasu Z, Akarca US. The Efficacy of Paritaprevir/Ritonavir/Ombitasvir/Dasabuvir with or without Ribavirin in Patients with Hepatitis C Undergoing Chronic Haemodialysis: A Single Center Experience. Egypt J Immunol 2019. [DOI: 10.4274/vhd.galenos.2019.2019.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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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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Ünal NG, Özütemiz Ö, Tekin F, Turan İ, Osmanoğlu N. Colorectal cancer and dysplasia risk of ulcerative colitis patients in a tertiary referral center in Turkey. Turk J Gastroenterol 2018; 30:139-147. [PMID: 30460897 DOI: 10.5152/tjg.2018.18221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS Patients with ulcerative colitis (UC) are at increased risk of colorectal cancer (CRC). High-grade dysplasia (HGD) and low-grade dysplasia (LGD) are premalignant conditions. The aim of this study is to evaluate the risk of CRC/dysplasia in patients with UC, and the related risk factors. MATERIALS AND METHODS Medical records of 1659 patients dating between 1993 and 2016 were scanned from an inflammatory bowel disease database. A total of 801 patients with UC who underwent at least one colonoscopic procedure with at least 1-year follow-up period were included in the study. Clinical, endoscopic, and histopathological data were assessed. RESULTS The mean disease duration was 6.7±6.6 years. The total disease duration was 5334 person-years duration (pyd), and 34% of patients had the disease for 8 years or longer. The prevalence of UC-associated CRC was 0.7%, and the prevalence of dysplasia was 0.85%. The overall incidence of CRC was determined to be 1.1/1000 pyd. The cumulative risk of CRC was 0.3% at 10 years, 1.3% at 20 years, and 5.9% at 30 years. The Cox regression analysis indicated that primary sclerosing cholangitis (HR:13.677, 95% CI:2.6-70.8, p = 0.012) was an independent risk factor for developing UC-associated CRC. CONCLUSION This study underlined the low risk of CRC and dysplasia in patients with UC in a tertiary referral center in the western part of Turkey. Primary sclerosing cholangitis was found to be the most important risk factor for the development of CRC in patients with UC. Identification of risk factors is important to categorize patients into subgroups to know which patients will require frequent surveillance.
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Affiliation(s)
- Nalan Gülşen Ünal
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Ömer Özütemiz
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Fatih Tekin
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - İlker Turan
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Necla Osmanoğlu
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
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Zeytunlu M, Uğuz A, Ünalp Ö, Ergün O, Karasu Z, Günşar F, Akarca U, Yılmaz F, Turan İ, Nart D, Tekin F, Özütemiz Ö, Ulukaya S, Deniz N, Aydoğdu S, Özgenç F, Tasçı E, Sertöz R, Parıldar M, Elmas N, Harman M, Güler E, Kısmalı E, Akyol R, Yamazhan T, Taşbakan M, Tiftikcioğlu Y, Bacakoğlu F, Nalbantgil S, Noyan A, Karapınar B, Kılınç A, Uyar M, Demirağ K, Özalp S, Özdemir N, Aras S, Altuğ N. Results of 1001 liver transplantations in 23 years: Ege University experience. Turk J Gastroenterol 2018; 29:664-668. [PMID: 30381274 PMCID: PMC6284687 DOI: 10.5152/tjg.2018.18058] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/15/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND/AIMS Liver transplantation (LT) is now the standard of care for most end-stage liver diseases. Over the next 30 years, advances in medicine and technology will greatly improve the survival rates of patients after this procedure. The aim of the present study was to analyze retrospectively the results of 1001 patients withLT. MATERIALS AND METHODS Medical reports of 989 patients were analyzed retrospectively. Data were obtained from the patient's data chart. Descriptive statistics were used to describe continuous variables (mean, median, and standard deviation). RESULTS A total of 1001 LTs for 989 recipients were performed at Ege University Organ Transplantation and Research Center between 1994 and 2017. Therewere 639 male and 350 female recipients. Among 1001 LTs, there were 438 deceased donors and 563 living donors. The age interval of the patients was 4 months to 71 years old. The median Model for End-Stage Liver Disease score was 20. There were 12 deceased liver donors using the split method. There were 12 cases subject to retransplantation. In living donor LT grafts, 423 right lobes, 46 left lobes, and 94 left lateral sectors were used. In the first monitoring,the total annual mortality rate was 130 cases (13%). The mortality rate in retransplantation was found to be 66%. A 1-year survival rate of 87% was generally stablished. CONCLUSION LThas been improving consistently over the last two decades. Ege University is one of the biggest liver transplant centers in Turkey for both technical and educational perspective.
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Affiliation(s)
- Murat Zeytunlu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Alper Uğuz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ömer Ünalp
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Orkan Ergün
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Zeki Karasu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Fulya Günşar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ulus Akarca
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Funda Yılmaz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - İlker Turan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Deniz Nart
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Fatih Tekin
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ömer Özütemiz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sezgin Ulukaya
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nuri Deniz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sema Aydoğdu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Funda Özgenç
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ezgi Tasçı
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Rüçhan Sertöz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Mustafa Parıldar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nevra Elmas
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Mustafa Harman
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ezgi Güler
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Erkan Kısmalı
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Rahmi Akyol
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Tansu Yamazhan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Meltem Taşbakan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Yiğit Tiftikcioğlu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Feza Bacakoğlu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sanem Nalbantgil
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ayşin Noyan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Bülent Karapınar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Arda Kılınç
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Mehmet Uyar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Kubilay Demirağ
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sibel Özalp
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nebile Özdemir
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sinem Aras
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nurşen Altuğ
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
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Tekin F, Turan İ, Ersöz G, Özütemiz Ö. Endoscopic biopsy techniques for proximal biliary strictures. Turk J Gastroenterol 2017; 28:225. [PMID: 28294954 DOI: 10.5152/tjg.2017.17059] [Citation(s) in RCA: 0] [Impact Index Per Article: 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)
- Fatih Tekin
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey.
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Turan İ, Demirkoparan Ü, Altınel Ç, Karasu Z. The development of dry eye disease during tenofovir and entecavir therapy in a patient with chronic hepatitis B. Turk J Gastroenterol 2016; 27:474. [PMID: 27782899 DOI: 10.5152/tjg.2016.16304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- İlker Turan
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey.
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Yaprak M, Çeltik A, Turan İ, Nart D, Turan MN, Sezer TÖ, Hoşçoşkun C, Töz H. Rare cause of weight loss in a kidney transplant recipient: iron overload. Ren Fail 2013; 36:119-22. [PMID: 24059653 DOI: 10.3109/0886022x.2013.832860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Various reasons such as malignancies and chronic infections may cause weight loss in kidney transplant patients. In this report, iron overload as a rare cause of weight loss in a kidney transplant patient is presented. Forty-seven-year-old male patient who transplanted from a deceased donor 5 years ago was hospitalized because of 20 kg of weight loss. In medical history, he had history of hemodialysis for 89 months and received 100-300 mg of intravenous iron therapy per week before transplantation and transfused eight units of blood. In physical examination, weight and height were 45 kg and 185 cm, respectively. Respiratory and cardiac auscultation was normal. Laboratory results revealed as follow: glucose 76 mg/dL, urea 60 mg/dL, creatinine 1.35 mg/dL, aspartate aminotransferase 74 U/L, alanine aminotransferase 77 U/L, C-reactive protein 2.59 mg/dL, albumin 3.3 g/dL, globulin 3.4 g/dL, white blood cells 3200/mm(3), hemoglobin 13.1 g/dL and platelets 190,000/mm(3). Chest and abdominal tomography didn't reveal any pathology. Portal Doppler ultrasound showed signs of early cirrhosis. Viral and autoimmune hepatitis markers were negative. Ferritin was 5300 ng/mL and transferrin saturation was 82%. In liver biopsy, hemosiderosis was diagnosed and heterozygous H63D gene mutation was detected. Totally, 19 units of phlebotomy were performed. Liver function tests and serum ferritin decreased gradually. At outpatient follow-up in 6 months, he returned to former weight. In conclusion, there can be several causes of weight loss in kidney transplant patients. Iron overload can come across as a rare cause of weight loss. In these patients, ferritin levels should be checked and diagnosis should be clarified by liver biopsy and gene mutation analysis.
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Turan İ. Acquisition time: a key point of hepatitis C virus-related liver disease in renal transplant recipients. Turk J Gastroenterol 2013; 23:821-3. [PMID: 23864472 DOI: 10.4318/tjg.2012.0466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kılcıler G, Kantarcioğlu M, Turan İ, Uygun A, Bai S. Stomach full of ingested foreign bodies: more than a "metallic taste". Turk J Gastroenterol 2010; 21:322-3. [PMID: 20931443 DOI: 10.4318/tjg.2010.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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