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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) ombitasvir/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, Turkish Association for the Study of The Liver (TASL), The present study was supported by The Turkish Association for the Study of The Liver (TASL).

Giriş ve Amaç: İnflamatuvar barsak hastalığında ekstraintestinal bulgu - ların sıklığı %6-47 olarak bildirilmiştir. Kliniğimizde takip edilen inflama- tuvar barsak hastalarında görülen ekstraintestinal bulguları değerlendir- dik. Gereç ve Yöntem: Nisan 1998 ve Ocak 2008 arasında takip edilen hastalar ekstraintestinal bulgular, epidemiyolojik veriler, hastalık sürele- ri, komplikasyonları açısından retrospektif olarak değerlendirildi. Bulgu- lar: 494 hasta (254 erkek, yaş ortalaması 38,6313,32 yıl, yaş dağılımı 6-78) değerlendirmeye alındı. Bu hastalardan 283ü (%57,3) ülseratif kolit, 194ü (%39,3) Crohn hastalığı ve 17si (%3.4) indetermine kolit idi. Hastalık yaşı ortalama 70,6675,93 (1-1008) ay idi. Ortalama takip süresi 36,4045,09 ay (1-288 ay) idi. Tüm inflamatuvar barsak hastala- rında ekstraintestinal bulguların sıklığı %19,2 (95/494) olup dağılımı: seronegatif artrit 32 (%6,5), hepatik tutulum 13 (%2,6), deri tutulumu 3 (%2,6), kombine 16 (%3,2), renal kalkül 12 (%2,4), tromboemboli 5 (%1), göz tutulumu 4 (%0,8) idi. 78 hastada (%15,8) komplikasyon görüldü: [29 abse (%5,9), 15 perforasyon (%3), 5 malignite (%1), 1 toksik megakolon (%0,2) ve 15 diğer komplikasyonlar (%2,6)]. Crohn hastalığında komplikasyon oranı ülseratif kolitten fazla idi (%29,3e %3,6). Ülseratif kolitli hastalarda ekstraintestinal bulgular ile kompli- kasyon sıklığı arasında (p0,007, R0,173), Crohn hastalarında kolonik tutulum ile ekstraintestinal bulgular arasında (p0,04, R0,144) pozitif korelasyon tesbit edildi. Sonuç: İnflamatuvar barsak hastalarında en sık ekstraintestinal bulgu seronegatif artrittir. En sık komplikasyon ise abse ve perforasyondur. Ekstraintestinal bulguların varlığı ülseratif kolit seyrinde komplikasyon riskini arttırır. Crohn hastalığında kolonik tutu - lum, ekstraintestinal bulguların varlığını gösteren prediktif bir faktördür. Background and Aims: The reported frequency of extraintestinal manifestations in inflammatory bowel disease varies from 6% to 47%. We evaluated extraintestinal manifestations of inflammatory bowel disease patients who were followed up in our clinic. Materials and Methods: The epidemiological findings, disease duration, extraint- estinal manifestations, and complications were evaluated between April 1998 and April 2008, retrospectively. Results: Four hundred and ninety-four patients (254 males; mean age, 38,63±13,32 years; range, 16-78) were evaluated: 283 (57,3%) with ulcerative colitis, 194 (39,3%) with Crohns disease and 17 (3.4%) with indeterminate colitis. The mean disease duration was 70,66±75,93 months (1-1008 months), and the mean follow-up was 36,40±45,09 months (1-288 months). The extraintestinal manifestation rate was 19.2% (95/494) in the whole group, and included arthritis in 32 (6,5%), hepatobiliary in 13 (2,6%), skin in 13 (2,6%), multiple extraintestinal manifestations in 16 (3,2%), renal calculus in 12 (2,4%), thromboembolic events in 5 (1%), and eye involvement in 4 (0,8%). Complications were observed in a total of 78 patients (15,8%). Complication rates were as follows: 29 (5,9%) abscess, 15 (3%) perforation, 5 (1%) malignancy, 1 (0,2%) toxic megacolon, and 15 (2,6%) others. The complication rate was higher in Crohns disease than ulcerative colitis (29,3% vs 3,6%). There was a positive correlation between extraintestinal manifestations and the complication rate in ulcerative colitis (p0,007, r0,173), and a positive correlation was observed between colonic involvement and extraintesti- nal manifestations in Crohns disease (p0,04, r0,144). Conclusions: The most common extraintestinal manifestation was arthritis, and the most frequently seen complications were abscess and perforation. The complication rate was higher in Crohns disease than ulcerative colitis. Extraintestinal manifestations may enhance the complication rate in UC. In Crohns disease, the extraintestinal manifestations rate is higher in colonic involvement than in ileocolonic and ileal involvement. Colonic involvement in Crohns disease is a predictive factor for extraintestinal manifestations.

Fasciola hepatica infeksiyonu ülkemizin bazı bölgelerinde endemik olarak rastlanan bir karaciğer trematodudur. Klinik bulgular nonspesifik olup; karın ağrısı, sağ üst kadranda hassasiyet şeklinde olabilir. Laboratuvarda eozinofi- li, karaciğer enzimlerinin yükselmesi, pozitif seroloji görülür. Görüntüleme yöntemlerinde karaciğerde çok sayıda nodüller ve safra yollarında dilatasyon görülür. Triclabendazol hepatik ve biliyer fazda etkilidir. Endoskopik retrog- rad kolanjiopankreatografi ile canlı Fasciola hepaticaların biliyer kanaldan uzaklaştırılması ile de tedavi edilir. Burada karaciğerde kitle nedeniyle tetkik edilen, safra yollarında dilatasyona neden olan ve endoskopik retrograd ko- lanjiopankreatografi ile tedavi edilen fasciola hepaticalı genç bayan olgusu sunulmuştur. Fasciola hepatica is a liver trematode that is endemic in some parts of Turkey. Clinical findings are nonspecific, such as abdominal pain and right upper quadrant tenderness. Eosinophilia, elevated liver enzymes and positive se- rology can be detected in laboratory investigations, while multiple nodules in the liver and dilated bile ducts can be seen in imaging modalities. Tricla- bendazole is effective in the hepatic and biliary phases. Fasciola hepatica is also treated with endoscopic retrograde cholangiopancreatography by biliary duct removal. Herein, we present a young woman who was evaluated with a mass in the liver and biliary tract dilatation caused by Fasciola hepatica and who was treated with endoscopic retrograde cholangiopancreatography.

Background and aim : Positron emission tomography/computed tomography(PET/CT) scans detects benign clinical conditions in addition to malignancy, and this leads to additional investigation and expenditure. The purpose of our study was to assess the endoscopic and histupathologic results of incidental 18F-FDG uptake in the GI tract. Patients and Method: We enrolled 110 patients who underwent gastroscopy/colonoscopy for incidental GI tract involvement in PET/CT. Histopathologic and endoscopic results were compared with FDG uptake level, pattern of uptake(diffuse/focal), and site or involvement. Results : In our study, 52.7% of the patients were male and the mean age was 57 +/- 11 years. Among the participants, 47.3% and 52.7% of patients had upper GI tract and colorectal involvement In PET/CT, respectively. Gastritis and colonic polyps were the most common endoscopic diagnoses that caused FDG uptake in the upper and lower GI tract, respectively. Endoscopic evaluation was normal in 23.6% of patients with pathologic FDG involvement. The rates of adenomatous polyps, malignancy, and hyperplastic polyps were 18.5%, 13.6%, and 6.8%, respectively. The mean SUVmax were higher in malignant lesions than in non-malignant lesions (14.3 +/- 8.9 vs. 9.3 +/- 5.3)(p=0.02). Diffuse or focal FDG involvement patterns on PET/CT did not help to discriminate malignancy in the GI tract. Conclusion : Malignancy was detected in only 13.6% of patients with FDG involvement in the GI tract, and the involvement pattern(diffuse/local) and SUVmax did not differentiate malignancy.

Background: crohn disease is a chronic bowel disease that causes serious complications. Prevalence of Crohn disease is increasing. Studies have shown that the behavior of the disease is not stable and severe complications secondary to behavior change over time have been shown. In this study, we aimed to evaluate the prognostic risk factors associated with phenotypic change in Crohn disease in a Turkish patient cohort. Methods: patients followed up from March 1986 to August 2011 were evaluated for demographic and clinical characteristics to determine possible risk factors and initial clinical phenotype of the disease based on the Montreal classification. The cumulative probabilities of developing stricturing or penetrating intestinal complications were estimated using the Kaplan-Meier analysis. Univariate and multivariate Cox-proportional hazard models were used to assess associations between baseline clinical characteristics and intestinal complications. Results: three hundred and thirty patients (mean age, 30.6 ± 11.1 years; 148 female) were included in the study. Mean follow-up duration was 7.4 ± 5.3 years (range: 1.0-25.0 years). At baseline 273 patients had inflammatory-type disease, 57 patients experienced stricturing/penetrating intestinal complications before or at the time of diagnosis. The cumulative probability of developing complicated disease was 37.4% at 5 years, 54.3% at 10 years, 78.8% at 25 years. Independent predictors associated with progression to intestinal complications were current smoking, perianal disease, extra-intestinal manifestations, and location of disease. Conclusions: location of disease is the most powerful indicator for the development of stenosis and penetrating complications in inflammatory-type disease. Patients with ileal involvement should be considered for more aggressive immunosuppressive therapy., NA

Objectives: Spontaneous bacterial peritonitis (SBP) is a common and high-mortality infectious complication of patients with cirrhosis. New inflammatory markers are associated with morbidity/mortality in various diseases. The aim of our study was to find the 30-day mortality rate of SBP and their predictors. Patients and methods: Seventy patients with cirrhosis complicated with SBP and 55 non-SBP controls were enrolled into the study, and patients were evaluated for mortality rate and its predictors. Results: The 30-day and 3-month mortality rates in the SBP group were 26.1 and 50.7%, respectively. Mortality rates were higher in the SBP group than in the controls. Symptoms at hospital admission and cell counts in ascitic fluid made no difference in predicting 30-day mortality. Patients with SBP with high serum neutrophil counts, high neutrophil-lymphocyte ratio, high C reactive protein (CRP)/albumin ratio, and high model for end-stage liver disease (MELD) score had higher 30-day mortality rates. We determined optimal cutoff values of MELD scores and serum neutrophil counts for predicting 30-day mortality as 20.5 and 6850/mm(3), respectively. The sensitivity and specificity for the MELD cutoff value were 83.3 and 80.4%, respectively. We also followed up patients for 60 months after SBP; the patients with high inflammatory markers and MELD scores at the time of SBP diagnosis had worse survival compared with the group with lower levels. Conclusion: Our results suggest that SBP has high 30-day mortality. MELD scores and inflammatory markers (CRP, CRP albumin ratio, neutrophil-lymphocyte ratio) may be used to predict mortality in patients with SBP., NA

ÖZET Ülkemizde mide adenokanseri en sık görülen gastrointestinal sitem (gis) kanseri olmakla birlikte, gelişmiş ülkelerde sıklığı giderek azalmaktadır. Buna karşılık midenin kardiya kaynaklı kanserinin insidansında giderek artma gözlenmektedir. Özofagus adenokanserlerjnin çoğunun Barrett özofagusundaki intestinal metaplaziden (İM) köken aldığı bilinmekteyken, kardiya kanserinin premaNgn lezyonunun ne olduğu henüz netlik kazanmamakla birlikte, intestinal metaplazinin premalign lezyon olabileceği üzerinde durulmaktadır. Ancak bu görüşler mide kanserinin ve H. pylori infeksiyonunun nispeten az olduğu ülkelerin çalışmalarıdır. Halbuki ülkemizde H. pylori infeksiyonu ve mide kanseri sıktır. Çalışmamızda prospektif olarak üst gastrointestinal sistem (gis) endoskopisi uygulanan hastalarda kardiyadaki İM prevalansı ve bu bölgedeki İM sıklığının H. pylori, sigara, alkol, Barrett özofagusu ve midenin diğer bölgelerindeki ve özofagusdaki İM sıklığı ile ilişkisi araştırılmıştır. Bu amaçla, İstanbul Tıp Fakültesi Gastroenterohepatoloji Bilim Dalı Endoskopi Laboratuvarına çeşitli nedenlerden dolayı üst gastrointestinal sistem endoskopileri yapılmak üzere gönderilmiş olan 60 hasta dahil edildi. Hastaların 31' i kadın, 29' u erkek, yaş ortalaması ise 41 ±13 yıl idi. Hastaların üst gastrointestinal endoskopileri sırasında antrumdan ( küçük kurvatur, pilorun 2-3 cm dahili), insisura angularisden, korpusdan, skuamokolumnar bileşkenin kolumnar kısmından, skuamokolumnar bileşkenin skuamöz kısmından, ÖGB hizasından, ÖGB iki cm distalinden biyopsiler alınarak İM ve H. pylori araştırıldı. 27Biyopsilerinde H. pylori görülen hasta sayısı 38 (%63.3) idi. Altmış hastanın 17 sinde (%28.3) alınan biyopsilerden en az birinde intestinal metaplazi mevcuttu. Bunlardan dördünde (%6.6) sadece kardiyada İM var iken, birinde (%1.7) hem kardiya hem de Z çizgisinde, birinde (%1.7) ise kardiya, distal mide ve Z çizgisinde birlikte İM mevcuttu. Kardiyasında İM olan toplam vaka sayısı altı (%10) idi. Sadece distal midede İM bulunan hasta sayısı 13 (%21.6) idi. Bir (%1.7) hastada distal mide ile birlikte Z çizgisinde İM saptandı. Sadece Z çizgisinde İM olan hasta sayısı beş (%8.3) idi. Bir (%1.7) hastada Barrett özofagusu bulundu. Kardiyasında İM olan hastaların ortalama yaşı: 56.6±12.5 yıl, olmayanların ise 39.2±12.1 yıl idi ve istatiksel olarak anlamlı idi (p=0.018). Yaş ile kardiyada İM bulunması arasında korelasyon mevcuttu (r=0.286, p=0.008). Kardiyada İM bulunması ile prozis, regürjitasyon, disfaji, alkol ve sigara kullanma, endoskopik özofajit, histolojik özofajit ve cinsiyet arasında anlamlı ilişki bulunmadı (p>0.05). Kardiyasında İM olan hastaların, H. pylori pozitiflik oranı anlamlı olarak daha az idi (p=0.025). Kardiyasında İM bulunan altı hastanın birinde (%16.7) H. pylori (+) iken, kardiyasında İM olmayan 54 hastanın 37' sinde (%68. 5) H. pylori (+) idi. Kardiyasında İM bulunanlarda bulunmayanlara göre midenin diğer bölgelerinde İM olup olmaması faklılık göstermiyordu (p>0.05). Sonuç olarak kardiyadaki İM ile cins, alkol kullanımı, sigara kullanımı, reflü semptomları, endoskopik özofajit, histolojik özofajit ve midenin diğer kısımlarındaki İM arasında anlamlı ilişki yok iken, kardiyadaki İM' nin yaşla birlikle görülme sıklığının arttığı ve H. pylori (+) olan hastalarda anlamlı olarak daha seyrek görüldüğü bulunmuştur. Kardiyadaki İM' nin bu bölge adenokanserleri için premalign lezyon olup olmadığı ve İM gelişmesinde etkili risk faktörlerinin belirlenmesinde daha fazla çalışmaya ihtiyaç vardır tC YuKSDCDGRETIM KURULU 41