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Background/aims:  Gastroenterologists have an important role in the treatment and management of comorbidities related to obesity. Assessment of gastroenterologists' perception and attitude toward obesity was aimed in this study., Materials and Methods:  Survey questions were determined for the study. An online questionnaire was prepared afterward. Participants were invited via e-mail by providing them with information about the study. It was ensured that those who accepted the study could access the questionnaire form with the relevant link. Participants who answered all questions were included in the study., Results:  Totally 117 gastroenterologists were included in the study. The proportion of gastroenterologists who thought that obesity complicates the management of gastroenterological diseases and those who thought obesity as a factor that negatively affects the prognosis of gastroenterological diseases was determined as 88.9% and 95.7%, respectively. Among the obese patients, the proportion of those who applied diet therapy, exercise, pharmacotherapy, and endoscopic methods was 94%, 91.5%, 35%, and 37.6%, respectively. The rates of intragastric balloon therapy and intragastric botulinum toxin A injection were 30% and 21.4%, respectively. The proportion of those who agreed that obese patients lost a significant amount of weight with the treatment methods applied was 47.2%. The proportion of participants who agreed that long-term maintenance of weight loss was impossible for most obese patients was 59.8%., Conclusion:  To our knowledge, this is the first study that evaluates the perception and attitude of gastroenterologists toward obesity. Our study results show that gastroenterologists think that obesity is a chronic disease and that gastroenterologists should be involved in management of obesity.

Background/aims: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population., Material and Methods: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)±ribavirin (RBV) orombitasvir/paritaprevir/ritonavir±dasabuvir (PrOD)±RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed., Results: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90±54.60 U/L to 17.00±14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51±4.54 to 7.32±3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0±16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%)., Conclusion: LDV/SOF or PrOD±RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.

Background/aims: Although living donor liver transplantation (LDLT) has been accepted as a primary treatment for adults with end-stage liver disease, concerns about donor health have been emerged. As LDLT is technically complex, it creates perioperative morbidity and mortality risk in donors. Biliary complications such as stricture and leakage are seen most frequently in donors after liver transplantation. While some of these complications get treated with conservative approach, endoscopic, surgical, and percutaneous interventions may be required in some others. We aimed to present endoscopic retrograde cholangiography (ERC) results in donors who developed biliary complications after LDLT., Materials and Methods: Between June 2010 and January 2018, a total of 1521 donors (1291 right lobe grafts, 230 left lobe grafts) of patients who underwent LDLT, were retrospectively reviewed. 63 donors who underwent ERC due to biliary complication, were included in the study., Results: Biliary stricture was found in 1.6% (25/1521), biliary leakage in 2.1% (33/1521), and stricture and leakage together in 0.3% (5/1521) donors. Our endoscopic success rates in patients with biliary leakage, biliary stricture, and stricture and leakage were 85% (28/33), 92% (23/25), and 80% (4/5), respectively. Surgical treatment was performed on 12.6% (8/63) donors who failed ERC., Conclusion: We found that ERC is a successful treatment for post-LDLT donors who have biliary complications.

Introduction: Risk stratification based on biochemical variables is a useful tool for monitoring ursodeoxycholic acid (UDCA)-treated patients with primary biliary cholangitis (PBC). Several UDCA response criteria and scoring systems have been proposed for risk prediction in PBC, but these have not been validated in large external cohorts., Methods: We performed a study on data of 1746 UDCA-treated patients with PBC from 25 centers in Europe, United States, and Canada. The prognostic performance of the risk scoring systems (GLOBE and UK-PBC) and the UDCA response criteria (Barcelona, Paris I, Paris II, Rotterdam, and Toronto) were evaluated. We regarded cirrhosis-related complications (ascites, variceal bleeding, and/or hepatic encephalopathy) as clinical end points., Results: A total of 171 patients reached a clinical end point during a median 7 years (range 1-16 years) of follow-up. The 5-, 10- and 15-year adverse outcome-free survivals were 95%, 85%, and 77%. The GLOBE and UK-PBC scores predicted cirrhosis-related complications better than the UDCA response criteria. The hazard ratio (HR) for a 1 standard deviation increase was HR 5.05 (95% confidence interval (CI): 4.43-5.74, P < 0.001) for the GLOBE score and HR 3.39 (95% CI: 3.10-3.72, P < 0.001) for the UK-PBC score. Overall, the GLOBE and UK-PBC risk scores showed similar and excellent prognostic performance (C-statistic, 0.93; 95% CI: 0.91%-95% vs 0.94; 95% CI: 0.91%-0.96%)., Discussion: In our international, multicenter PBC cohort, the GLOBE and UK-PBC risk scoring systems were good predictors of future cirrhosis-related complications.

Background/aims: Steroids have been shown to prevent intestinal oxidative stress. We investigated the effects of methylprednisolone on intestinal oxidative damage and bacterial translocation in thioacetamide-induced liver failure in rats., Materials and Methods: Group 1 (n=8) was the control group. In group 2 (n=8), the thioacetamide group, rats received 300 mg/kg intraperitoneal thioacetamide daily for 2 days. In group 3 (n=8), the thioacetamide+methylprednisolone group, treatment with methylprednisolone (30 mg/kg intraperitoneal) was commenced 48 h before the first dose of thioacetamide. In group 4 (n=8), the methylprednisolone group, the rats received only methylprednisolone (30 mg/kg intraperitoneal)., Results: Serious hepatic and intestinal oxidative damage and high bacterial translocation frequencies were observed in the thioacetamide group compared with those of the controls. Bacterial translocation frequency in the thioacetamide+methylprednisolone group was significantly lower than that in the thioacetamide group (p<0.05). Intestinal thiobarbituric acid-reactive substances and myeloperoxidase levels and tissue damage scores for the intestines in the thioacetamide+methylprednisolone group were lower than those in the thioacetamide group (p<0.01, p<0.01, and p<0.0001, respectively)., Conclusion: Our findings suggest that methylprednisolone reduces bacterial translocation by preventing intestinal oxidative damage in this model of acute liver failure in rats.

Background/aims: Acute pancreatitis is a serious complication of organophosphate poisoning. There is no report in the literature dealing with the development of a pancreatic pseudocyst after complication of organophosphate-induced acute pancreatitis. Therefore, we present a case who developed pancreatic pseudocyst after complication of organophosphate-induced acute pancreatitis., Methods: A 17-year-old female patient with a history of ingestion of complication of organophosphate insecticide (DDVP EC 550, dichlorvos) was admitted with cholinergic symptoms. On admission, serum amylase and lipase levels were high and abdominal ultrasonography showed an edematous pancreas. No etiological factor for acute pancreatitis was evident., Results: We diagnosed complication of organophosphate-induced acute pancreatitis. After four weeks, abdominal abdominal ultrasonography and computerized tomography revealed a pancreatic pseudocyst of 6 cm diameter. During follow-up, the pancreatic pseudocyst size regressed to 4 cm., Conclusion: Complication of organophosphate poisoning can cause acute pancreatitis and its complications. Early diagnosis and appropriate treatment may reduce morbidity and mortality.

Background/aims: Gingko biloba is an antioxidant substance which has antagonistic activity on platelet-activating factor. We aimed to investigate the antioxidant effect and the histopathologic changes caused by Gingko biloba on acetic acid-induced colitis., Methods: Totally 22 rats were divided into three groups. Group 1 (n=7) served as the control group. Group 2 (n=7) and Group 3 (n=8) were given 2 ml/day of 4% acetic acid by intracolonic instillation for three days. Gingko biloba (100 mg/kg) was then given only to Group 3 intraperitoneally for three days. Oxidative stress was assessed by determinate tissue and serum malondialdehyde (MDA) levels, and colonic damage was assessed by histologic examination., Results: Depth of necrosis, extent of necrosis, degree of inflammation, extent of inflammation, fibrosis and total histologic scores in Group 2 were significantly higher than in the control group (p<0.05). The same parameters were lower in Group 3 versus Group 2, but the difference was not significant. Tissue and serum MDA levels in Group 2 were significantly higher than Group 1 (p<0.01 and 0.05, respectively). Again, the same parameters in Group 3 were lower than in Group 2, but the difference was not significant statistically., Conclusions: Gingko biloba did not significantly affect histopathological and oxidative stress parameters in experimental colitis.

Background/aims: Data suggests on the basis of thrice a week therapy, efficacy of mono consensus interferon is comparable to other alpha interferons. One-year follow-up after 12-month daily consensus interferon monotherapy for chronic hepatitis C among non-responders or relapsers to previous consensus interferon monotherapy is investigated., Methods: Between February and August 1998, 11 non-cirrhotic patients with previous consensus interferon failure were treated. Six were relapsers and five non-responders. Serum HCV-RNA was tested at the 12th and 48th weeks of treatment and followed for one year thereafter., Results: Eight (72%) were HCV-RNA negative at both 12th and 48th weeks. Of these, 60% (3/5) were among previous non-responders and 83% (5/6) were among previous relapsers. One year sustained virological response was 55%. Of this, 40% (2/5) were among non-responders and 66% (4/6) previous relapsers., Conclusions: These findings suggest that daily consensus interferon needs to be further investigated as an alternative to pegylated formulations, especially with the addition of ribavirin.

Spontaneous bacterial peritonitis is a well-known entity, with a reported incidence of 15-20% in advanced cirrhotic patients. Escherichia coli and Klebsiella pneumoniae are the most common causes of spontaneous bacterial peritonitis; Brucella is extremely rare. We aimed to present one case of such a rare condition in a cirrhotic patient who also had hepatocellular carcinoma. Routine laboratory tests, abdominal ultrasonography and peritoneal fluid examinations were studied in a cirrhotic patient with ascites. Peritoneal fluid white blood cell count was 1300/mm3, with lymphocyte predominance (80%). Peritoneal fluid and blood culture both yielded Brucella melitensis. The patient also had a mass in the right lobe of the liver confirmed as hepatocellular carcinoma by biopsy. Brucella should be suspected as a cause of spontaneous bacterial peritonitis in cirrhotic patients with no response to standard spontaneous bacterial peritonitis treatments and with immunodeficiency such as hepatocellular carcinoma.

Background/aims: Acute upper gastrointestinal bleeding is a common and potentially life-threatening medical emergency. Various factors modulating morbidity and mortality on upper gastrointestinal bleeding have been reported. However, there are no reports on the prognosis of bleeding ulcers on the anterior wall of corpus (on fundus-corpus junction, 10-15 mm from the lesser curvature) bleeding ulcers on the anterior wall of the corpus. Thus, in this trial we tried to investigate the role of bleeding ulcers on the anterior wall of the corpus on acute upper gastrointestinal bleeding mortality and morbidity., Methods: One hundred seventy-seven (63 women and 114 men, mean age 52 years) patients with a clinical diagnosis of upper gastrointestinal bleeding were endoscoped between August 1999 and December 2002. All patients were treated endoscopically, medically or with surgery. The site of the bleeding was noted and compared regarding rebleeding and mortality rates., Results: 50% (3/6) of the patients with bleeding ulcers on the anterior wall of the corpus required further surgical procedure or were associated with mortality, but only 7% (12/171) of the patients with bleeding sites other than bleeding ulcers on the anterior wall of the corpus had mortality or required further surgical intervention (p<0.05). Recurrent bleeding occurred in 50% (3/6) of our patients with bleeding ulcers on the anterior wall of the corpus during their hospitalization compared to 7.60% (13/171) (p<0.05) of patients with bleeding sites other than bleeding ulcers on the anterior wall of the corpus., Conclusions: Bleeding ulcers on the anterior wall of the corpus is indicative of recurrence or persistence of the hemorrhage and of greater mortality. Bleeding from this site needs more aggressive and diligent care.