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BACKGROUND/AIMS: The duration of Helicobacter pylori (H. pylori) eradication therapy as a range (e.g., 10-14 days) is an ignored problem. There is no any particular treatment duration described in current guidelines, and the conditions for when to use 10-day therapy vs. 14-day therapy have not been elucidated. The aim of this study is to determine an effective and reliable H. pylori treatment duration in clinical practice. There were four different treatment modalities administered to groups, and success rates were compared. MATERIALS AND METHODS: Patients were eligible to participate in the study if they had a biopsy-proven H. pylori infection. Each patient was randomly assigned to one of the four treatment groups according to a predetermined sequence: 14-day or 10-day bismuth-containing quadruple therapy (BQT) groups and 14-day or 10-day moxifloxacin-bismuth-combined treatment (MBCT) groups. RESULTS: A total of 216 patients (54 per group) were enrolled. Two-hundred six patients (95.3%) completed therapy. There was no significant difference in the eradication rates between those patients who received 10- and 14-days BQT regimens (p=0.67). The 14-BQT protocol had the highest eradication rate, the MBCT regimes had the highest compliance, and the 10-MBCT protocol had the poorest results for H. pylori eradication. The posttreatment questionnaire on adverse effects identified nausea/vomiting as the most common side effect (35.7%). CONCLUSION: Overall, the results of our study suggest that shortening the BQT protocol duration to 10 days does not weaken the H. pylori eradication rate. Moreover, quinolone-containing therapies with the lowest eradication rate among the groups should not be offered as a salvage treatment in case of the BQT failure.
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Antiácidos/administración & dosificación , Bismuto/administración & dosificación , Duración de la Terapia , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Adulto , Antibacterianos/administración & dosificación , Esquema de Medicación , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Moxifloxacino/administración & dosificación , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND/AIMS: A successful screening colonoscopy is closely linked to the quality of a bowel preparation. In this study, we aimed to determine the impact of a 1-day clear liquid diet (CLD) compared to a 3-day combined diet (CMD) accompanied by a split-dose regimen of polyethylene glycol and electrolyte lavage solution (PEG-ELS) for screening colonoscopy. MATERIALS AND METHODS: This was a prospective, randomized, endoscopist-blinded study. Patients referred for screening colonoscopy were randomized to four groups as a 1-day CLD+PEG-ELS vs. a 1-day CLD+sulfate free (SF)-PEG-ELS and a 3-day CMD+PEG-ELS vs. a 3-day CMD+SF-PEG-ELS. An assessment of the quality of colon cleaning, tolerability to the preparation, and symptoms related to the preparation were recorded. RESULTS: A total of 506 patients were enrolled in this study. The quality of bowel preparation was significantly inferior in the CMD+PEG-ELS group than CLD+PEG-ELS (p=0.004) and CMD+SF-PEG-ELS groups (p=0.007). There were no statistical differences among the groups in terms of the polyp detection rate. With respect to an easy rating of diet following and the consumption of laxative, there were no significant differences among the four groups. Gastric fullness and nausea/vomiting were pointed out much more, especially in the SF-PEG-ELS users (p=0.008 and p=0.004, respectively). CONCLUSION: A 1-day CLD was not inferior to a 3-day CMD for colonoscopy preparation in terms of bowel cleaning, the polyp detection rate, and patient tolerance.
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Colonoscopía , Dieta , Detección Precoz del Cáncer/métodos , Laxativos/administración & dosificación , Polietilenglicoles/administración & dosificación , Cuidados Preoperatorios/normas , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Método Simple Ciego , Factores de TiempoRESUMEN
A 67-year-old man presented non-specific abdominal pain. Polypoid mass at appendiceal orifice in the cecum was found on endoscopic investigation without appendicitis sign. Histopathology elucidated underlying mucosal infiltration that was chronic lymphocytic leukemia. This is an isolated and unusual gastrointestinal involvement of hematologic disorder in an older patient.
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OBJECTIVES: Hepatocellular carcinoma is the most frequent primary malignant tumor of the liver and the third most common cause of all cancer-related mortalities. There is a need to develop new strategies to prevent hepatocellular carcinoma, as the incidence of this cancer continues to increase despite all advancements. In this study, our aim was to determine the effects of propranolol treatment on the incidence of hepatocellular carcinoma in cirrhotic patients waiting for liver transplant. MATERIALS AND METHODS: We retrospectively reviewed the data of patients waiting for liver transplant with cirrhosis due to various causes registered at the Hepatocellular Carcinoma Surveillance Program between June 2011 and December 2017 in our center. These data were compared between patients using propranolol and those not using propranolol. RESULTS: Of the 231 patients, 135 (58.4%) were male and 96 (41.6%) were female. The mean age was 58.1 ± 14 years. We noted that 153 of total patients (66.2%) were using propranolol. Three patients (2%) were using 20 mg propranolol, 125 (81.7%) were using 40 mg propranolol, 10 (6.5%) were using 60 mg propranolol, and 15 (9.8%) were using 80 mg propranolol. Of total patients, 36 (15.6%) developed hepatocellular carcinoma, including in 12 patients (7.8%) using propranolol and 24 patients (30.8%) who did not use this agent (P < .001). Thus, the hepatocellular carcinoma frequency was 5.22 times lower in patients receiving propranolol than in those not receiving propranolol. CONCLUSIONS: Although causes of cirrhosis and initial stages were similar in both groups using and not using propranolol, incidence of hepatocellular carcinoma was significantly lower in the propranolol group than in the group without propranolol. This result showed that propranolol treatment has a protective effect for hepatocellular carcinoma in patients waiting for liver transplant with cirrhosis.
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Carcinoma Hepatocelular/epidemiología , Carcinoma Hepatocelular/prevención & control , Cirrosis Hepática/cirugía , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/prevención & control , Trasplante de Hígado , Propranolol/uso terapéutico , Adulto , Anciano , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Estudios Retrospectivos , Centros de Atención Terciaria , Listas de EsperaRESUMEN
OBJECTIVES: The introduction of direct-acting antiviral agents has allowed significant chances for treatment for difficult-to-treat populations. This study aimed to investigate the efficacy, tolerability, and safety of these therapies in both patients with end-stage renal disease and kidney transplant recipients with chronic hepatitis C virus infection. MATERIALS AND METHODS: This study was a retrospective analysis with prospective follow-up of patients. The antiviral combination of ombitasvir 25 mg, paritaprevir 75 mg, ritonavir 50 mg, and dasabuvir 50 mg was prescribed to patients with end-stage renal disease or kidney transplant recipients with noncirrhotic or compensated cirrhotic liver disease. The other antiviral combination consisted of sofosbuvir 400 mg and ledipasvir 90 mg, which was recommended to patients with decompensated cirrhosis or those who could not tolerate the first combination regimen. Ribavirin was given to all patients with genotype 1a hepatitis C virus infection. All clinical and laboratory data were recorded at week 4, at end of the treatment, and at 12 weeks after completion of treatment. RESULTS: In terms of efficacy, sustained virologic response at 12 weeks was achieved in 94% of patients in the end-stage renal disease group and 92% of patients in the kidney transplant group. In terms of tolerability, antiviral treatment was well tolerated in both groups. Cardiac arrest and cerebrovascular accident were seen in the end-stage renal disease group; severe mucositis and glossitis were seen in the kidney transplant group. Hospitalization was needed in 2 patients for treatment of drug interactions with tacrolimus and sirolimus. Renal allograft function worsened in 2 patients, with 1 patient having biopsyproven antibody-mediated rejection. CONCLUSIONS: We observed great efficacy and safety in both kidney transplant recipients and patients with end-stage renal disease with these agents in treatment of chronic hepatitis C. However, clinicians should remain aware of drug interactions and adverse events in this fragile patient population.
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Anilidas/uso terapéutico , Antivirales/uso terapéutico , Carbamatos/uso terapéutico , Hepacivirus/efectos de los fármacos , Hepatitis C Crónica/tratamiento farmacológico , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Compuestos Macrocíclicos/uso terapéutico , Ritonavir/uso terapéutico , Sulfonamidas/uso terapéutico , Uracilo/análogos & derivados , 2-Naftilamina , Adulto , Anciano , Anilidas/efectos adversos , Antivirales/efectos adversos , Carbamatos/efectos adversos , Ciclopropanos , Interacciones Farmacológicas , Quimioterapia Combinada , Femenino , Genotipo , Hepacivirus/genética , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/virología , Humanos , Inmunosupresores/efectos adversos , Fallo Renal Crónico/diagnóstico , Trasplante de Riñón/efectos adversos , Lactamas Macrocíclicas , Compuestos Macrocíclicos/efectos adversos , Masculino , Persona de Mediana Edad , Prolina/análogos & derivados , Estudios Prospectivos , Estudios Retrospectivos , Ribavirina/uso terapéutico , Factores de Riesgo , Ritonavir/efectos adversos , Sulfonamidas/efectos adversos , Respuesta Virológica Sostenida , Factores de Tiempo , Resultado del Tratamiento , Uracilo/efectos adversos , Uracilo/uso terapéutico , ValinaAsunto(s)
Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/etiología , Procedimiento de Fontan/efectos adversos , Cardiopatías Congénitas/cirugía , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/etiología , Adulto , Carcinoma Hepatocelular/terapia , Fibrosis , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/patología , Humanos , Neoplasias Hepáticas/terapia , MasculinoAsunto(s)
Obstrucción de la Salida Gástrica/etiología , Neoplasias Gastrointestinales/complicaciones , Tumores del Estroma Gastrointestinal/complicaciones , Anciano de 80 o más Años , Femenino , Obstrucción de la Salida Gástrica/diagnóstico por imagen , Neoplasias Gastrointestinales/diagnóstico por imagen , Tumores del Estroma Gastrointestinal/diagnóstico por imagen , Humanos , Ilustración Médica , Tomografía Computarizada por Rayos XRESUMEN
More than 600 000 people die from hepatocellular carcinoma each year. Worldwide, research on the disease needs to be intensified in both the medical and pharmaceutical fields, with a focus on providing help to geographic areas where resources are limited. Treatment approaches depend on the stage of the disease at diagnosis and on access to complex treatment regimens. However, advanced disease is not curable, and treating these patients is expensive and only marginally effective for increasing quality-adjusted life-years. Although the Milan criteria are often used to determine which patients will benefit from liver transplantation, many centers have their own criteria for patient selection. According to criteria developed by Baskent University in Ankara, Turkey, patients with hepatocellular carcinoma and a cirrhotic liver but without extrahepatic disease should be candidates for liver transplant when possible, and living-donor liver transplant should be considered as an alternative rescue therapy for many of these patients. Tumor size and number should not be the sole criteria for excluding liver transplant. Although significant vascular invasion and extrahepatic dissemination definitely indicate major tumor dissemination, until sensitive tests for measuring circulating tumor cells are developed, we continue to recommend liver transplant regardless of tumor size and number. Various locoregional therapies for hepatocellular carcinoma are used before transplant to prevent tumor progression and to decrease the risk of recurrence after transplant. In turn, response to locoregional therapy to decrease tumor stage in hepatocellular carcinoma may be an indicator of tumor behavior and may determine a patient's selection for liver transplant. The delivery of healthcare services for hepatocellular carcinoma could be improved by developing centers of excellence. Concentrating medical care in this way can lead to an increased level of expertise so that resections are performed by surgeons who understand liver disease and the limitations of these and other procedures.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Trasplante de Hígado , Carcinoma Hepatocelular/epidemiología , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/prevención & control , Carcinoma Hepatocelular/cirugía , Detección Precoz del Cáncer/métodos , Humanos , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/prevención & control , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/métodos , Donadores Vivos , Estadificación de Neoplasias , Selección de Paciente , Valor Predictivo de las Pruebas , Factores de Riesgo , Resultado del TratamientoRESUMEN
Hepatitis C virus (HCV)-related liver disease is a significant cause of morbidity and mortality in patients with end-stage renal disease (ESRD) who is treated with dialysis or kidney transplantation (KT). The survival rate for HCV-infected renal transplant recipients is better than that for HCV-infected hemodialysis patients on transplant waiting lists. Early diagnosis and treatment HCV infection prior to KT prevents complications post-transplantation and reduces mortality. In addition to screening for anti-HCV antibodies and detecting HCV RNA, percutaneous liver biopsy is particularly valuable for assessing the stage of liver damage in HCV-infected patients, because the stage of fibrosis is important determining optimal treatment for HCV. Studies have been demonstrated that with conventional interferon (IFN) monotherapy or pegylated IFN monotherapy are similar efficacy and safety in HCV-infected hemodialysis patients. Sustained viral responses (SVRs) with these monotherapies have ranged approximately 30% to 40%. Limited reports support the use of IFN and ribavirin combination therapy as antiviral treatment for ESRD patients or patients on hemodialysis. Ribavirin can be started at low dose and careful monitoring for side effects. Patients that show SVR after treatment are strong candidates for KT. It is also generally accepted that ESRD patients with decompensated cirrhosis and portal hypertension should be referred to the liver transplant team for consideration of combined liver-KT.
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BACKGROUND/AIMS: The aim of this study was to compare the utility of the revised Mayo risk model (rMRM) and Child-Pugh scores (CPSs) for predicting the prognosis of disease in patients with primary sclerosing cholangitis (PSC). MATERIALS AND METHODS: Patients were divided into 2 groups: Group I (37 patients; alive and not requiring liver transplantation) and Group II (8 patients; deceased or requiring liver transplantation). rMRM suggests the possible survival percentage over a 4-year period. Thus, rMRM scores and CPSs on the first visit were calculated from the data at the time of diagnosis for patients diagnosed with PSC <4 years ago. rMRM scores and CPSs of patients with >4 years of follow-up were calculated using data from the visit 4 years prior to their last follow-up. RESULTS: Bivariate analyses showed that need for liver transplantation/mortality was correlated with either first visit CPS (r=0.481, p=0.001) or rMRM (r=0.452, p=0.002). Analysis of the area under the curve showed that both models performed similarly in terms of predicting the need for liver transplantation/mortality (rMRM: 0.780; CPS: 0.762; p=0.8). There was a significant difference in Kaplan-Meier survival rates between Group I and Group II for both risk models (rMRM: p<0.001; CPS: p<0.001) when the decisive event was death or need for liver transplantation. CONCLUSION: Both rMRM and CPSs are useful in risk assessment of patients with PSC. The ability to predict prognosis is similar for both risk models.
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Colangitis Esclerosante/clasificación , Colangitis Esclerosante/cirugía , Trasplante de Hígado , Modelos Teóricos , Adolescente , Adulto , Edad de Inicio , Anciano , Área Bajo la Curva , Colangitis Esclerosante/mortalidad , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Pronóstico , Medición de Riesgo/métodos , Adulto JovenRESUMEN
BACKGROUND/AIMS: To assess intestinal inflammation, simple, inexpensive and objective tools are desirable in inflammatory bowel disease. This study aimed to evaluate fecal calprotectin as a marker of active disease in ulcerative colitis. MATERIALS AND METHODS: Sixty patients with a diagnosis of ulcerative colitis and 20 controls were recruited into the study. The disease activity of ulcerative colitis was determined by modified Truelove-Witts criteria and Rachmilewitz endoscopic index. The enzyme-linked immunosorbent assay was used to measure the concentrations of fecal calprotectin. C-reactive protein, erythrocyte sedimentation rate and hemogram were also measured, and inflammatory markers were compared with fecal calprotectin in determining disease activity. RESULTS: Fecal calprotectin concentration in the patients with active ulcerative colitis (n=30) was significantly higher than that in the inactive ulcerative colitis group (n=30) and in the controls (n=20) (95% confidence interval: 232.5 (0.75-625) vs 11.7 (0.2-625), 7.5 (0.5-512) mg/L, p<0.001). There was no significant difference between the patients with inactive ulcerative colitis and controls (p>0.05). The calprotectin concentration was greater in the patients with a more severe clinical index, higher endoscopic activity (>4), elevated C-reactive protein, leukocytosis, and extensive colitis (p<0.05). The areas under the curve of the receiver operating characteristics were 0.817, 0.809, 0.532, and 0.507 for C-reactive protein, fecal calprotectin, leukocyte count, and erythrocyte sedimentation rate, respectively. There was a significant correlation between the fecal calprotectin concentration and the endoscopic activity in ulcerative colitis (r = 0.548, p<0.001). CONCLUSIONS: Fecal calprotectin is a useful marker in the diagnosis of active disease and evaluation of clinical and endoscopic activity in ulcerative colitis.