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Nitroimidazole derivatives are commonly used in the treatment of protozoal and anaerobic infections, and reports of their hepatotoxicity are rare. We report a case of severe hepatitis due to the long-term (8 weeks) use of ornidazole. A 27-year-old woman presented for evaluation of elevated serum transaminase and total bilirubin levels. Liver biopsy revealed portal inflammation, hepatocellular and canalicular cholestasis, porto-portal and portocentral bridging fibrosis, and a tendency to form nodules. No aetiological factors associated with chronic liver disease were identified. The abdominal ultrasonographic findings were compatible with chronic liver disease. We therefore made the diagnosis of severe hepatitis resulting from the long-term use of ornidazole. We conclude that nitroimidazole derivatives may lead to serious liver damage, especially in female patients.

WOS: 000273799600004, PubMed ID: 20163034, Background and study aims : Abnormal expression of claudin-4 and beta-catenin play a role in carcinogenesis. The purpose of the present study was to examine claudin-4 and beta-catenin expression in normal and precancerous gastric mucosa. Patients and methods : Endoscopic biopsy specimens [normal gastric mucosa (n = 22), intestinal metaplasia (n = 24), dysplasia (n = 18), Helicobacter pylori (H. pylori)-associated chronic gastritis (n = 32) and remnant gastric mucosa (n = 18)] obtained from different 114 patients were examined by immunohistochemistry. Results : Claudin-4 expression was present in 94.4% of dysplasia, 87.5% of intestinal metaplasia, 62.5% H. pylori-associated chronic gastritis, and 88.9% remnant gastric mucosa but only 18.2% of normal gastric mucosa biopsies. Decreased expression of beta-catenin was present in 27.8% of dysplasia, 8.3% of intestinal metaplasia, 15.6% of H. pylori-associated chronic gastritis, and 22.2% of remnant gastric mucosa biopsies, but was not present in normal gastric mucosa. When compared with normal gastric mucosa, there was a significant difference in claudin-4 expression in all groups (P < 0.05), but a significant difference was detected in dysplasia and remnant gastric mucosa for beta-catenin (P < 0.05). Conclusions : Our results suggest that claudin-4 expression is upregulated in premalignant gastric alterations. (Acta gastroenterol. belg., 2009, 72, 407-412).

INTRODUCTION: HBV reactivation is a serious problem in immunosuppressive (IS) treated patients. The guidelines recommend the use of nucleoside (t) id analogs to prevent reactivation in patients undergoing immunosuppressive therapy. In this study, we aimed to compare the efficacy of antivirals in patients receiving immunosuppressive therapy. Current guidelines recommend the use of prophylactic nucleoside (t) id analogs in the prevention of hepatitis B virus (HBV) reactivation due to immunosuppressive (IC) therapies. There is no prospective randomized study evaluating the efficacy of tenofovir disoproxil fumarate (TDF) in this indication and its recommendations are based on experience with chronic HBV treatment. The aim of this study was to compare the efficacy of TDF and entecavirine (ECV) in preventing HBV reactivation in patients receiving IS. METHODS: The patients who were diagnosed as HBsAg and/or Anti-HBc IgG positive and who had HBV prophylaxis treatment according to current guidelines were included in the study. Hepatitis C, viral hepatitis D, HIV, chronic HBV infection and those under the age of 18 were not included in the study. Lamivudine 100 mg, Entecavi 0.5mg or Tenofovir fumarate 245MG/day (TDF) were given before immunosuppressive treatment. The antiviral treatment was continued during the treatment according to the risk status for HBV reactivation and for 6–12 period after the end of treatment. The patients were followed up every 3 months and their side effects and HBV reactivation rates were compared. RESULTS: The mean age of the patients was 54 (20–84). Tenofovir was given to 90 cases, Entecavir to 45 patients and Lamivudine to 15 cases. There was no significant difference between the groups in terms of gender and age. HBsAg positivity was 60% in the Lamivudine group, 57% in the Entecavir group, and 62% in the Tenofovir group. Anti-HBc Ig G positivity was respectively (Lam 47%, TDF 38% and EC 45%). The HBeAg positivity was Lam 2.3%, TDF 3.2% and EC 4. The reactivation risk profiles for HBV were similar between the groups. The majority of patients in all three drug groups received prophylactic antiviral treatments. Few cases failed to complete their treatment. Similarly, in all three drug groups, death was observed due to primary disease in very few cases. HBV reactivation was not observed in any cases with Tenofovir and Entecavir, and only one patient who received Lamivudine had HBV reactivation. All drugs were well tolerated. No side effects were seen during the prophylactic treatment. The most common side effects related to drugs were headache, insomnia, abdominal pain, loss of appetite, itching and skin rashes in very few cases. CONCLUSION: In patients receiving immunosuppressive therapy, HBsAg and/or Anti-HBc Ig G positive antiviral drugs used for HBV prophylaxis were found to be very effective and safe drugs and no HBV reactivation was found during treatment. As a result, it was concluded that the appropriate dose and duration of antiviral drugs were effective and safe in appropriate cases.

Bacterial translocation (BT) has been implicated in the development of infectious complications in many serious clinical conditions such as fulminant hepatic failure (FHF). We aimed to investigate the effects of Gingko biloba (GB), vitamin E (Vit E) and melatonin on intestinal oxidative damage and BT in thioacetamide (TAA)-induced FHF in rats.A total of 42 rats were divided into five groups. Group 1 (n = 8) was the control group. Group 2 (n = 10) was the TAA group, in which rats received 350 mg/kg TAA daily by the intraperitoneal (ip) route for 3 days. Oral 100 mg/kg GB per day was administered to group 3 (n = 8), oral 200 mg/kg Vit E per day to group 4 (n = 8) and ip 3 mg/kg melatonin per day to group 5 (n = 8) 48 h prior to the first TAA injection and was continued for 5 consecutive days.When compared with the control group, serious hepatic and intestinal oxidative damage, increased Escherichia coli counts in ileal aspirates and high BT frequencies were observed in the TAA group (all p0.0001). Only GB treatment attenuated hepatic oxidative damage (p0.0001). There was no difference in intestinal oxidative damage, E. coli counts in ileal aspirates and BT frequency between TAA and the other antioxidant treatment groups (p0.05).Our results suggest that intestinal oxidative damage plays a major role in the development of BT by disrupting the barrier function of intestinal mucosa.

Biliary complications are an important cause of mortality and morbidity after living donor liver transplantation (LDLT). We present our endoscopic treatment results after LDLT as a single center with high volume.Patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) after LDLT between 2005 and 2015 were included. Clinical data included patient demographics, ERCP indications (stricture or leak), and treatment outcomes, including need for percutaneous and surgical interventions.ERCP was performed in 446 (39.2%) patients with duct-to-duct anastomosis of 1136 LDLT patients. The most common biliary complication was stricture ± stone (70.6%, 315/446). Stricture and leak occurred in 60 (13.4%) patients. Only biliary leak was found in 40 (8.9%) patients. Our endoscopic treatment success rate in patients with biliary stricture after LDLT was 65.1%. Overall endoscopic success rates in our patients were 55.0% in patients with both leak and stricture, and only leak. In all, our percutaneous transhepatic biliary interventions (PTBI) and ERCP success rate was 90.6% in patients with biliary complications after LDLT.Endoscopic treatments are highly effective for biliary complications after LDLT. Effective use of percutaneous interventions in collaboration with endoscopic treatments significantly reduces the need for surgical treatment.