Search

After the declaration Global Health Sector Strategy on Viral Hepatitis by the World Health Organization in 2016, the Turkish Government defined a national strategy covering 2018-2023 to reach goals by 2030. Following a participatory decision process and a series of workshops, the strategy was built on eight separate subheadings. Apart from the official Prevention and Control Program, two separate road maps for hepatitis B and C were developed to obtain targets accessible with the cooperation of the Viral Hepatitis Society and the Turkish Association for the Study of the Liver in 2018 and 2020, respectively. Up to 2023, achievements and the current situation of the National Viral Hepatitis Prevention and Control Program and the hepatitis B virus and hepatitis C virus road maps were assessed in detail on June 28th, 2022, by the subject matter experts in Turkey. Besides the officially reported achievement rate (42\%) of the Program in 2021, participants mentioned undesirable effects of the coronavirus disease-2019 pandemic, unregulated migration, low levels of professional and public awareness, and barriers to access to anti-viral treatment. Recommendations focused on increasing the efficiency of screening and surveillance by integrating the viral carrier identity of individuals into the national health information system, simplifying the drug supplement and treatment initiation process and insisting on education to raise awareness.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 virus was found to have effects not only in the lungs but also in many different organs. We aimed to evaluate the management of our patients with inflammatory bowel disease in this pandemic, the incidence of coronavirus disease 2019 in terms of clinical, medical treatment, and features of inflammatory bowel disease, and to investigate the effects of the severe acute respiratory syndrome coronavirus 2 on this particular group of patients. METHODS: During the coronavirus disease 2019 pandemic, 207 patients who had inflammatory bowel disease for at least 6 months were questioned for coronavirus disease 2019 at their outpatient clinic admissions, and their medical records were evaluated prospectively. RESULTS: Of the 207 patients, 146 had Crohn’s disease. The mean disease duration was determined as 118.15 ± 72.85 months. Of the patients, 127 (61.4%) were using mesalazine, 110 (53.1%) azathioprine, and 148 (71.5%) biological agents. It was found that 66 (31.9%) patients changed their medications during the coronavirus disease 2019 pandemic. As a medication change, anti-Tumor Necrosis Factor (TNF) dose was observed to be omitted most frequently at a rate of 80%. Diarrhea was present in 20.8%, abdominal pain in 20.3%, nausea in 10.6%, anorexia in 13.5%, and weight loss in 15.9% of the patients. Twelve (5.79%) patients were diagnosed with coronavirus disease 2019. Lung involvement was present in 11 (91.7%) of the patients diagnosed with coronavirus disease 2019. Of the patients diagnosed and not diagnosed with coronavirus disease 2019, 75% vs. 71.6% were using biological agents (P = .80), respectively. Half of the patients diagnosed with coronavirus disease 2019 were active in terms of inflammatory bowel disease at the time of diagnosis, and 2 of these patients were severely active. CONCLUSION: The incidence of coronavirus disease 2019 infection in patients with inflammatory bowel disease was not different from the general population during the severe acute respiratory syndrome coronavirus 2 pandemic. Coronavirus disease 2019 infection does not progress with poor prognosis in patients with inflammatory bowel disease who receive immunosuppressive therapy including biological agents.

BACKGROUND: Cyclosporine is a rescue treatment alternative to avoid colectomy in corticosteroid refractory acute severe ulcerative ­colitis. In this study, we aimed to evaluate the long-term efficacy and safety of cyclosporine therapy in acute severe ulcerative colitis patients. METHODS: Acute severe ulcerative colitis (basal Lichtiger score > 10) patients who did not respond to 40 mg intravenous methylprednisolone therapy after 3-5 days were included in the study. The presence of clinical response and remission was assessed at 1st week, 1st, 6th, and 12th month according to the Lichtiger index. RESULTS: In this study, 40 patients, whose steroid refractory acute severe ulcerative colitis and basal Lichtiger score > 10 points were enrolled. The median disease duration was 49.3 months (2-204). All patients received cyclosporine for 132 ± 78 days (7-270). Clinical response was obtained on seventh day in 82.5%. The clinical response rates of the first and sixth months were 72.5% and 62.5%, ­respectively. A total of 17/40 (42.5%) patients underwent colectomy within 1 year. In the patients who underwent colectomy, the basal LS (14.2 ± 1.9 vs 12.3 ± 1.7) (P = .002) was higher and the basal hemoglobin value (11.8 ± 2.3 vs 10.1 ± 1.5) (P = .037) was lower than those who did not undergo colectomy. CONCLUSION: Our findings suggest that cyclosporine treatment may be successfully and safely used in steroid refractory acute severe ulcerative colitis patients. Cyclosporine is a drug that has recently started to come up again with the introduction of new maintenance treatments. Especially in patients who develop a loss of response to infliximab therapy, or where infliximab therapy is contraindicated, or who have azathioprine intolerance, or are unresponsive.

There are limited data about the safety of tenofovir disoproxil fumarate (TDF) in chronic renal failure (CRF). In this study, we aimed to evaluate the safety and efficacy of TDF in renal transplant recipients and hemodialysis patients with chronic hepatitis B (CHB) during long-term follow-up.CHB patients undergoing hemodialysis (group 1), renal transplant recipients (group 2) and patients with normal renal function were included in the study. All patients were treated with TDF for at least 6 months. The groups were compared with regards to safety and efficacy. HBV-DNA levels were studied using a Cobas-TaqMan 96 system.A total of 217 patients with CHB (group 1: 8 patients, group 2: 9 patients, group 3: 200 patients) were enrolled in this study. The frequency of clinical adverse effects was significantly higher in groups 1 and 2compared with group 3 (37.5% vs. 11.1% vs. 0.5%, respectively,Clinical adverse effects of TDF were more common in patients with CRF in comparison with patients without CRF. However, the occurrence of adverse effects did not necessitate discontinuation of the drug. TDF was safe and effective for this group of patients.

Karaciğerin paraziter hastalıklarından biri olan fasioliazisin en önemli etkeni bir trematod olan Fasciola hepatica’dır. Farklı klinikler ile ortaya çıkabilen Fasciola hepatica’nın tanısında ultrasonografi ve magnetik rezonans görüntüleme ilk tercih edilen görüntüleme yöntemleri olmakla birlikte, bu yöntemlerle yaşanan tanısal zorluklarda endosonografi ile çözüm üretilebilmektedir. Fasciola hepatica’nın neden olduğu kolestaz tablosunda endosonografi ile tanıya ulaştığımız bir olguyu sunduk.

Background and Aims:Hepatitis viruses induce not only chronic liver diseases but also the impairment of other organs and tissues as extrahepatic manifestations. It is necessary to consider possible complications associated with extrahepatic diseases in the treatment.Materials and Methods: We retrospectively evaluated the demographic features of 52 (2%) patients who had clinically symptomatic extrahepatic manifestations from among 2870 chronic viral hepatitis patients in the Gastroenterology Department of the Istanbul Medical Faculty between 1997 and 2010. Results: Twenty-seven of the 52 patients (52%) had hepatitis C, 24 (46%) hepatitis B, and 1 (2%) both hepatitis B and C. Of these, 25 (48%) were males, and the mean age was 51±13 (range, 18 to 78) years. Thirty-two patients (61%) were cirrhotic, while 20 (39%) were in the precirrhotic stage.Conclusions: Extrahepatic involvement is generally overlooked, and clinicians should be more sensitive to the diagnoses of these manifestations., Giriş ve Amaç:Hepatit etkeni virüsler kronik karaciğer hastalıklarına yol açmanın yanısıra ekstrahepatik bulgular olarak adlandırılan diğer organ ve dokularda da bozukluklara neden olabilirler. Tedavide ekstrahepatik tutulumları da gözardı etmemek gereklidir. Gereç ve Yöntem: İstanbul Tıp Fakültesi Gastroenteroloji Bilim Dalı'nda 1997-2010 yılları arasında takipli toplam 2870 hastada klinik olarak semptomatik ekstrahepatik tutulumu olan 52 hastanın (%2) demografik özellikleri retrospektif olarak değerlendirildi. Bulgular: Elli iki hastadan 27'si (%52) hepatit C, 24'ü (%46) hepatit B ve 1 (%2) hasta da hem hepatit B hem de hepatit C idi. Bunlardan 25'i (%48) erkekti, ortalama yafl 51±13 (18-78) yıldı. Otuz iki hasta (%61) sirotik evrede, 20 hasta (%39) ise presirotik evrede idi. Sonuç:Ekstrahepatik tutulumlar genellikle atlanmaktadır. Klinisyenler ekstrahepatik bulguların tanısında daha duyarlı olmalıdırlar.

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, extraintestinal 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 Crohn's 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 Crohn's disease than ulcerative colitis (29,3% vs 3,6%). There was a positive correlation between extraintestinal manifestations and the complication rate in ulcerative colitis (p=0,007, r=0,173), and a positive correlation was observed between colonic involvement and extraintestinal manifestations in Crohn's disease (p=0,04, r=0,144). Conclusions: The most common extraintestinal manifestation was arthritis, and the most frequently seen complications were abscess and perforation. The complication rate was higher in Crohn's disease than ulcerative colitis. Extraintestinal manifestations may enhance the complication rate in UC. In Crohn's disease, the extraintestinal manifestations rate is higher in colonic involvement than in ileocolonic and ileal involvement. Colonic involvement in Crohn's disease is a predictive factor for extraintestinal manifestations, Giriş ve Amaç: İnflamatuvar barsak hastalığında ekstraintestinal bulguların sıklığı %6-47 olarak bildirilmiştir. Kliniğimizde takip edilen inflamatuvar barsak hastalarında görülen ekstraintestinal bulguları değerlendirdik. Gereç ve Yöntem:Nisan 1998 ve Ocak 2008 arasında takip edilen hastalar ekstraintestinal bulgular, epidemiyolojik veriler, hastalık süreleri, komplikasyonları açısından retrospektif olarak değerlendirildi. Bulgular:494 hasta (254 erkek, yaş ortalaması 38,63±13,32 yıl, yaş dağılımı 16-78) değerlendirmeye alındı. Bu hastalardan 283'ü (%57,3) ülseratif kolit, 194'ü (%39,3) Crohn hastalığı ve 17'si (%3.4) indetermine kolit idi. Hastalık yaşı ortalama 70,66±75,93 (1-1008) ay idi. Ortalama takip süresi 36,40±45,09 ay (1-288 ay) idi. Tüm inflamatuvar barsak hastalarında ekstraintestinal bulguların sıklığı %19,2 (95/494) olup dağılımı: seronegatif artrit 32 (%6,5), hepatik tutulum 13 (%2,6), deri tutulumu 13 (%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 (%29,3'e %3,6). Ülseratif kolitli hastalarda ekstraintestinal bulgular ile komplikasyon sıklığı arasında (p=0,007, R=0,173), Crohn hastalarında kolonik tutulum ile ekstraintestinal bulgular arasında (p=0,04, R=0,144) 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 tutulum, ekstraintestinal bulguların varlığını gösteren prediktif bir faktördür.

Anticoagulant therapy is an accepted treatment for Budd-Chiari syndrome (BCS). However, the natural course of untreated patients is unclear. We aimed to evaluate the efficacy of anticoagulant therapy on survival in BCS.Between 1995 and 2007, 45 patients diagnosed with BCS based on the clinical, biochemical, radiological and histological findings were retrospectively evaluated with respect to underlying disease, therapeutic interventions, complications and overall outcome. Complications and survival during the follow-up period were compared in between anticoagulant treated and untreated cases.Mean patient age was 34.4 +/- 11.8 years and 46.7% (21) of them were male. Median followup time was 24 months (6-132); 8.9% of patients were diagnosed as acute, 31.1% as subacute and 60% as chronic BCS according to disease duration. Centrilobular necrosis was found in 16 of 36 biopsy performed patients. Etiological factors were detected in 60% of patients and 40% of them were cryptogenic. Twenty four of them received anticoagulant therapy, the remaining 21 were followed-up with supportive medical therapy. Five patients who had shunt operation were excluded for survival analyses. Complications were similar between treated and untreated cases (p0.05). There was a positive correlation between survival and centrilobular necrosis (r=0.376, p=0.037). The mean survival periods were 95.5 months (%95 CI 73-117 months) and 72.5 months (%95 CI 42-103 months) in anticoagulant treated and untreated patients, respectively (p0.246).Most patients with BCS are admitted to hospital at the chronic stage and more than half of them have underlying thrombotic risk factor. In our study, no beneficial effects of anticoagulant therapy were observed on the survival and complications of liver disease.

Amac: Otoimmun hepatit (OIH), dolasimdaki otoantikorlar ve yuksek serum globulin duzeyiyle birlikte seyreden, nedeni bilinmeyen kronik bir nekroinflamatuar karaciger hastaligidir. Immunogenetik calismalarda, otoimmunite ile HLA (Human Leukocyte Antigen) antijenleri arasinda iliski bulunmus olup, lenfositlerin yuzeyinde bulunan HLA antijeninde azalma ve HLA tarafindan duzenlenen genlerin ekspresyonunda bozulma saptanmistir. Yapilan calismalarda otoimmun hepatit ile HLA-DRB1*03, *04, *13 antijenleri arasinda anlamli birliktelikler bulunmustur. Bu calismada otoimmun hepatit ile HLA-DRB1 antijenleri arasindaki iliski arastirilmistir. Hastalar ve Yontemler: Calismamiza 113 hasta (55 kadin, 58 erkek; ort. yas 44.8±21.21; dagilim 10-82) ve otoimmun hastaligi olmayan 300 saglikli birey (198 kadin, 102 erkek; ort. yas 32.4±10.48; dagilim 17-50) dahil edilmistir. Standart yontemler ile DNA izolasyonu yapildiktan sonra PCR-SSP yontemi ile HLA-DRB1 doku tiplendirmesi yapilmistir. Elde edilen sonuclar Fisher’s exact testi kullanilarak degerlendirilmistir. Bulgular: Hasta grubunda DRB1*03 alel sikliginin kontrol grubuna oranla yuksek bulunurken DRB1*13 aleli ise kontrole gore anlami olarak dusuk siklikta oldugu gorulmustur. Sonuc: HLA-DRB1*03 alelinin hastaliga yatkinligi HLA-DRB1*13 alelinin ise hastaliga karsi koruyucu ozellikte oldugu dusunulmektedir.

SEN viruses are transmitted parenterally and can cause post-transfusion hepatitis. The prevalence and clinical significance of SEN viruses have been investigated in patients with chronic hepatitis C and B but not in D. We aimed to determine the prevalence and clinical significance of SEN viruses- H in patients with chronic hepatitis C, B and delta in Turkey.SEN viruses-H was analyzed in 85 patients with chronic viral hepatitis (30 HCV, 30 HBV and 25 HDV) and 43 non-professional blood donors. HBV DNA, HCV RNA and HDV RNA were positive in patients with hepatitis B, C and D, respectively. SEN viruses-H DNA was detected by semi-nested polymerase chain reaction method (L2AS, C5S primer in first step, L2AS, D11 in second step) after extraction of DNA from sera (NucleoSpin blood; Macherey-Nagel GmbHCo KG, Germany).SEN viruses-H DNA was found to be positive in 7/30 (23.3%), 10/30 (33.3%), 6/25 (24%), and 7/43 (16.2%) of patients with chronic C, B, and D hepatitis and healthy blood donors, respectively. There was no significant difference in clinical features and treatment response between SEN viruses- H-positive and -negative patients with chronic viral hepatitis.SEN viruses is more frequent in chronic hepatitis patients than in healthy blood donors. These results indicate that SEN viruses has no effect on the clinical course and treatment response of chronic viral hepatitis.

To determine the role of thrombopoietin and spleen volume in thrombocytopenia diagnosed in cirrhotic and noncirrhotic portal hypertensive patients.Seventy- four portal hypertensive patients (group 1: 28 noncirrhotic; group 2: 46 cirrhotic) were enrolled into this study. Spleen volume was measured by magnetic resonance imaging. Thrombopoietin and hyaluronic acid were detected by ELISA in sera.Splenic volume was significantly higher in group 1 (1375+/-658.74 ml) than group 2 (981.78+/-512.39 ml). In group 1, thrombopoietin and hyaluronic acid levels were 76.6+/-30.39 pg/ml and 78.17+/-66.67 ng/ml, respectively. These values were significantly higher in group 2, at 99.89+/-38.5 pg/ml and 271.97+/-197.34 ng/ml, respectively (p0.05). Platelet counts and thrombopoietin levels had a negative correlation with spleen volume in both groups (p0.05). Serum thrombopoietin levels were not correlated with platelet counts in cirrhotic and noncirrhotic groups; however, thrombopoietin levels were negatively correlated with splenic volume in the whole group (p= 0.044, r= - 0.23). Although spleen volume was significantly larger in noncirrhotic patients, platelet counts were similar in both groups.This study confirms that splenic sequestration is the main factor in the thrombocytopenia in portal hypertensive patients. The balance of thrombopoietin production and degradation may be more important for platelet counts than decreasing synthesis.

Eosinophilic esophagitis is an inflammatory condition of the esophagus characterized by eosinophilic infiltration. It is a condition mainly affecting children; the adult form has only recently gained recognition as a distinct entity. The major symptom among adults with eosinophilic esophagitis is dysphagia. It is often misdiagnosed as gastroesophageal reflux disease because of the similarity in symptoms. An endoscopic biopsy is required to distinguish between the conditions. The cause of eosinophilic esophagitis is poorly understood, but food allergy has been implicated. Topical steroids are the most effective and convenient method for the treatment of eosinophilic esophagitis in adults. The long-term prognosis of eosinophilic esophagitis is uncertain; however, data suggests a benign course. We herein present two eosinophilic esophagitis cases that were the first to be diagnosed in our clinic.

Achalasia is an esophageal motility disorder that is accepted as a risk factor for the development of cancer. Especially in megaesophagus, chronic irritation of foods and bacterial overgrowth may contribute to the formation of high-grade dysplasia and squamous cell carcinoma. We present a case of advanced stage achalasia with high-grade dysplasia detected three years after a cardiomyotomy operation. Cancer risk continues after surgical operation in achalasia, like in this case. In conclusion, endoscopic follow up is necessary for these patients even after surgical treatment.

Celiac disease and type 1 diabetes mellitus are both autoimmune diseases which have a common genetic predisposition. The aim of this study was to determine the prevalence of manifest and latent celiac disease in type 1 diabetic patients.Anti-endomysium IgA was tested by indirect immunofluorescence using sections of human umbilical cord for screening in 100 adult patients with type 1 diabetes mellitus and in 80 age and sex matched controls with no known disease. Distal duodenal biopsy, human leukocyte antigen typing, urinary D-xylose excretion test, stool analysis, biochemistry profile, blood counts, serum ferritin level and small intestinal radiography were performed in anti-endomysium IgA positive cases. Small bowel biopsy specimens consistent with celiac disease were defined as manifest celiac disease, while positive antiendomysium IgA and normal intestinal histology with the presence of human leukocyte antigen class II antigens consistent with the disease were defined as latent celiac disease.Anti-endomysium IgA was positive in eight diabetic patients, while it was negative in all controls. Celiac disease was found in a total of six (6%) patients, four with manifest and two with latent disease. Only one patient had symptoms.The prevalence of celiac disease is increased in patients with type 1 diabetes mellitus. Since many patients may be asymptomatic, it is suggested that all diabetic patients should be screened for this disease.

Drug-induced hepatotoxicity is an important cause of hepatocellular injury. Hepatic necrosis may range from asymptomatic elevations in transaminases to fulminant hepatic failure and death. Alverine is an antispasmodic drug which is especially used in patients with irritable bowel syndrome. Only a few cases of alverine associated hepatotoxicity have been reported previously. We present the case of a patient with alverine induced hepatotoxicity and cholestasis, which has only seldomly been reported in the literature.

Cyclosporin-A is used as a alternative medical therapy in steroid resistant ulcerative colitis with severe activity. In spite of its known efficacy, the long term effects of are not entirely clear.The records of 13 steroid resistant patients treated with cyclosporin-A were retrospectively assessed. Cyclosporin-A had been prescribed orally at a dose of 8 mg/kg/day in four patients and intravenously, 4mg/kg/day in nine patients. Intravenous therapy was changed to oral therapy after one week and patients also received 5-ASA and azathioprine. Steroid treatment was tapered.Ten patients responded to treatment in a mean of nine days (range: 2-30 days). Three patients who did not respond underwent total colectomy on day seven, 11 and 19 of therapy. The 10 patients who initially responded received the drug for an average of 4.9 months; four of these relapsed during and one relapsed soon after discontinuation of therapy. Four of the five patients who relapsed underwent colectomy and the one patient who did not accept surgical intervention continued medical therapy. The remaining five patients (38% of the total group; 50% of the patients who initially responded) remained in remission at the end of an average 17 month follow up period.Cyclosporin-A therapy in severe ulcerative colitis that is resistant to steroids, provides initial remission in 80% of patients and allows 40% to retain their colon for one year.

Pyogenic liver abscess is a rarely seen extraintestinal complication of Crohn's disease. It has different features from other liver abscesses. Its clinical and laboratory findings are not specific and mimic the reactivation of Crohn's disease and diagnosis can be delayed. The radiological methods are very useful in diagnosis and treatment of liver abscess. In this paper, we present a patient with pyogenic liver abscess which developed in the course of Crohn's disease.