Bile reflux index after therapeutic biliary procedures

Research articl

Ectopic opening of the common bile duct and duodenal stenosis: an overlooked association

<p>Abstract</p> <p>Background</p> <p>Ectopic opening of the common bile duct into the duodenal bulb (EO-CBD-DB) is a rare disease that may be complicated by duodenal ulcer, deformity, stenosis and biliary stones. The aim of this study is to report clinical presentations, endoscopic diagnosis and treatment of this entity as well as to investigate its association with duodenal stenosis.</p> <p>Methods</p> <p>Gastroduodenoscopic findings and radiological imaging were evaluated for ectopic papilla and duodenal stenosis. Diagnostic methods, endoscopic procedures and long-term outcomes of the endoscopic treatment were presented.</p> <p>Results</p> <p>EO-CBD-DB was found in 74 (77.1%) of the 96 patients with duodenal deformity/stenosis (79 male, 17 female, mean age: 58.5, range: 30-87 years). The papilla with normal appearance was retracted to the bulb in 11 while it was at its usual location in the remaining 11. The history of biliodigestive surgery was more common in patients with EO-CBD-DB who were frequently presented with the common bile duct stone-related symptoms than the other patients. Thirteen (17.6%) of the patients with EO-CBD-DB were referred to surgery. Endoscopic treatment was completed in 60 (81.1%) patients after an average of 1.7 (range: 1-6) procedures. These patients were on follow-up for 24.8 (range: 2-46) months. Endoscopic intervention was required in 12 (20%) of them because of recurrent biliary problems. Treatment of the patient who had stricture due to biliary injury during laparoscopic cholecystectomy is still continued.</p> <p>Conclusions</p> <p>The presence of EO-CBD-DB should be considered particularly in middle-aged male patients who have duodenal deformity/stenosis. Endoscopic treatment is feasible in these patients. The long-term outcomes of endoscopic therapy need to be compared with surgical treatment.</p

Myocardial integrated ultrasonic backscatter for early detection of cardiac involvement in patients with Wilson disease

WOS: 000349080900015PubMed ID: 25599781Background/Aims: Videodensitometry is a feasible noninvasive ultrasound tissue characterization method allowing early detection of myocardial changes. This study aimed to investigate ultrasonic backscatter properties of the myocardium in Wilson disease patients. Materials and Methods: We compared cardiologically asymptomatic Wilson disease patients (W group) (n=18) with age-matched (26.7 +/- 9.6 years) healthy controls (C group) (n=15). Diagnosis of Wilson disease was made on the basis of clinical manifestations, family history, and laboratory findings and confirmed by liver biopsy. Transthoracic echocardiographic quantitative texture analysis was performed on data from the septum and left ventricular posterior wall, and mean gray level (MGL) histograms at end-diastole (d) and end-systole (s) were obtained after background correction (c). Cyclic variation index (CVI) was calculated using the formula [(cMGLd -cMGLs)/cMGLd] x100. Results: There were no significant differences in sex, age, body mass index, heart rate or blood pressure, and conventional echocardiographic parameters between the 2 groups. The cMGLs value of the posterior wall was higher in the W group than in the C group (30.9 +/- 2.6 vs. 22.2 +/- 2.7, p=0.033). The W group had a significantly lower CVI of the septum than did the C group (-22 +/- 4.4% vs. 43.4 +/- 12.9%, p<0.001), and there was no significant difference in the CVI of the posterior wall (-67.0 +/- 15.9% vs. 41.7 +/- 18.6%, p=0.32). Conclusion: Abnormalities in two-dimensional echocardiographic grey-level distributions were present in Wilson disease patients. These videodensitometric myocardial alterations were significantly lower in Wilson disease patients than in the controls, and this probably represents an early stage of cardiac involvement

Safety of peginterferon alfa-2a (40KD) treatment in patients with chronic hepatitis B infection: An observational, multicenter, open label, non-interventional study in Turkish patients

Gulsen, Murat Taner/0000-0002-8531-9402;WOS: 000311871900019PubMed: 23161301Background/aims: Pegylated alfa interferon is the only immunomodulatory drug licensed for hepatitis B. We evaluated the safety and tolerability of peginterferon alfa-2a (40KD) in patients with chronic hepatitis B. Materials and Methods: A total of 113 chronic hepatitis B patients under peginterferon alfa-2a (40KD; 180 mu g/week) treatment were included in this multicenter, open label, non-interventional study, and 66 patients completed the follow-up period. Vital signs, physical examination and laboratory findings, concomitant medications, and adverse events were recorded. A Quality of Life questionnaire (Short Form-36) was performed twice, at the beginning and at the end of the study. Results: There was no significant difference between initial and last visits in terms of physical examination findings and Short Form-36 scores. A total of 27 adverse events were reported in 15 patients (22.7%), with most of them being mild in intensity (70.4%). The rates of the adverse events were similar in the monotherapy and combination therapy groups (peginterferon alfa-2a + lamivudine, peginterferon alfa-2a + adefovir or peginterferon alfa-2a + entecavir therapy groups), at 23.7% and 14.3%, respectively. The dosage of peginterferon had to be reduced in 3 patients (4.5%) due to thrombocytopenia. Overall patient compliance to treatment was detected as 85.9%. Conclusions: Based on the lack of serious adverse events and absence of impairment in Quality of Life, peginterferon alfa-2a (40KD, 180 mu g/week, subcutaneously) treatment for 48 weeks led to a high level of patient compliance and was associated with a high degree of safety and tolerability for the treatment of adult patients with chronic hepatitis B in real-life practice

Transcutaneous Cervical Esophagus Ultrasound In Adults: Relation With Ambulatory 24-H Ph-Monitoring And Esophageal Manometry

AIM: To determine the gastroesophageal refluxate in the cervical esophagus (CE) and measure transcutaneous cervical esophageal ultrasound (TCEUS) findings [anterior wall thickness (WT) of CE, esophageal luminal diameter (ELD), esophageal diameter (ED)]; to compare TCEUS findings in the patient subgroups divided according to 24-h esophageal pH monitoring and manometry; and to investigate possible cut-off values according to the TCEUS findings as a predictor of gastroesophageal reflux (GER). METHODS: In 45/500 patients, refluxate was visualized in TCEUS. 38/45 patients underwent esophagogastroduo denoscopy (EGD), 24-h pH monitoring and manometry. RESULTS: The 38 patients were grouped according to 24-h pH monitoring as follows: Group A: GER-positive (n 20) [Includes Group B: isolated proximal reflux (PR) (n = 6), Group C: isolated distal reflux (DR) (n = 6), and Group D: both PR/DR (n = 8)]; Group E: no reflux (n = 13); and Group F: hypersensitive esophagus (HSE) (n = 5). Groups B + D indicated total PR patients (n = 14), Groups E + F reflux-negatives with HSE (n = 18), and Groups A + F reflux-positives with HSE (n = 25). When the 38 patients were grouped according to manometry findings, 24 had normal esophageal manometry; 7 had hypotensive and 2 had hypertensive lower esophageal sphincter (LES); and 5 had ineffective esophageal motility disorder (IEM). The ELD measurement was greater in group A + F than group E (P = 0.023, 5.0 +/- 1.3 vs 3.9 +/- 1.4 mm). In 27/38 patients, there was at least one pathologic acid reflux and/or pathologic manometry finding. The cut-off value for ELD of 4.83 mm had 79% sensitivity and 61% specificity in predicting the PR between Groups B + D and E (AUC = 0.775, P = 0.015). CONCLUSION: Visualizing refluxate in TCEUS was useful as a pre-diagnostic tool for estimating GER or manometric pathology in 71.1% of adults in our study, but it was not diagnostic for CE WT. (C) 2007 WJG. All rights reserved.Wo

Kronik hepatit B’li hastalarda peginterferon alfa-2a (40KD) tedavisinin güvenilirliği: Türk hastalarda yürütülen çok merkezli, açık etiketli, müdahalesiz, gözlemsel bir çalışma

Amaç: Pegile interferon alfa hepatit B tedavisinde kullanımı onaylanmış tek immunmodulator ilactır. Biz, bu calışmada kronik hepatit B’li hastalarda peginterferon alfa-2a (40KD) tedavisinin guvenilirli.ini de.erlendirdik. Gereç ve Yöntem: Bu cok merkezli, acık etiketli, mudahalesiz, gozlemsel calışmaya dahil edilen peginterferon alfa-2a tedavisi (40KD; 180 ?g/hafta) altındaki 113 kronik hepatit B hastasından 66’sı takip donemini tamamladı. Vital bulgular, fizik muayane ve laboratuvar bulguları, eşlik eden ilac kullanımı ve advers olaylar kaydedildi. Yaşam kalitesi anketi (kısa form-36) calışmanın başında ve sonunda olmak uzere toplamda iki kez uygulandı. Bulgular: Başlangıc ve calışma sonu vizitleri arasında fizik muayene bulguları ve kısa form-36 skorları acısından anlamlı bir faklılık gozlenmedi. Toplamda 15 hastada (%22.7) rapor edilen 27 adet advers olayın co.unlu.u (%70.4) hafif şiddette idi. Monoterapi ve kombinasyon tedavisi (peginterferon alfa-2a + lamivudin, peginterferon alfa-2a + adefovir veya peginterferon alfa-2a + entekavir tedavi grupları) gruplarında advers olay oranları sırasıyla %23.7% ve %14.3 olarak benzer şekilde bulundu. Peginterferona yonelik doz azaltımı trombositopeni nedeniyle toplamda 3 hastada (%4.5) gercekleştirildi. Hastaların tedaviye uyum oranı %85.9 olarak belirlendi. Sonuç: Ciddi advers olaylara ve yaşam kalitesinde belirgin bir bozuklu.a yol acmaması esas alındı.ında, 48 haftalık peginterferon alfa-2a (40KD, 180 ?g/hafta, subkutan) tedavisi erişkin kronik hepatit B hastaları na yonelik klinik uygulamada; hasta uyumu, guvenlilik ve tolerabilite acısından olumlu sonuclar vermiştir.Background/aims: Pegylated alfa interferon is the only immunomodulatory drug licensed for hepatitis B. We evaluated the safety and tolerability of peginterferon alfa-2a (40KD) in patients with chronic hepatitis B. Materials and Methods: A total of 113 chronic hepatitis B patients under peginterferon alfa-2a (40KD; 180 &amp;#956;g/week) treatment were included in this multicenter, open label, non-interventional study, and 66 patients completed the follow-up period. Vital signs, physical examination and laboratory findings, concomitant medications, and adverse events were recorded. A Quality of Life questionnaire (Short Form-36) was performed twice, at the beginning and at the end of the study. Results: There was no significant difference between initial and last visits in terms of physical examination findings and Short Form-36 scores. A total of 27 adverse events were reported in 15 patients (22.7%), with most of them being mild in intensity (70.4%). The rates of the adverse events were similar in the monotherapy and combination therapy groups (peginterferon alfa-2a + lamivudine, peginterferon alfa-2a + adefovir or peginterferon alfa-2a + entecavir therapy groups), at 23.7% and 14.3%, respectively. The dosage of peginterferon had to be reduced in 3 patients (4.5%) due to thrombocytopenia. Overall patient compliance to treatment was detected as 85.9%. Conclusions: Based on the lack of serious adverse events and absence of impairment in Quality of Life, peginterferon alfa-2a (40KD, 180 &amp;#956;g/week, subcutaneously) treatment for 48 weeks led to a high level of patient compliance and was associated with a high degree of safety and tolerability for the treatment of adult patients with chronic hepatitis B in real-life practice