Real-world efficacy and safety of Ledipasvir plus Sofosbuvir and Ombitasvir/Paritaprevir/Ritonavir +/- Dasabuvir combination therapies for chronic hepatitis C: A Turkish experience

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<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.Turkish Association for the Study of The Liver (TASL

Delta Hepatitine Bağlı Sirozlu Hastada Hepatosellüler Kanserin Yttrium-90 ile Radyoembolizasyon Tedavisi: Olgu Sunumu

Ülkemizde sirozun önemli etyolojik nedenlerinden biri delta hepatitidir. Hepatosellür kanser (HSK) sıklıkla siroz zemininde gelişmektedir. HSK tedavisinde radyoembolizasyon olarak adlandırılan yttrium-90 tedavisi son yıllarda gittikçe daha yaygın kullanılmaktadır. Radyoaktif mikropartiküllerin transarteryal olarak infüze edilmesinden oluşan ve daha yeni bir yöntem olan radyoembolizasyonun rezeke edilemeyen karaciğer tümörlerinde umut vaat ettiği bildirilmiştir. Delta hepatitine bağlı kompanse karaciğer sirozu zemininde HSK gelişen ve yttrium-90 ile başarılı kemoembolizasyonu yapılan 55 yaşında erkek hasta sunulmuştur.Cirrhosis due to delta hepatitis is one of the most important etiologic factors in our country. Hepatocellular carcinoma (HCC) often develops on the base of cirrhosis. Recently, yttrium-90 radioembolization therapy has been increasingly used in the treatment of HCC. Transarterial infusion of yttrium-90 radioactive microspheres is a new promising method in treating unresectable liver tumors. Herein, we present a 55-year-old male HCC patient who developed HCC due cirrhosis associated with delta hepatitis and was successfully treated with yttrium-90 radioembolization therapy

Treatment of Hepatocellular Cancer Due to Hepatitis Delta with Yttrium-90 Radioembolization in a Patient with Cirrhosis: A Case Report

Cirrhosis due to delta hepatitis is one of the most important etiologic factors in our country. Hepatocellular carcinoma (HCC) often develops on the base of cirrhosis. Recently, yttrium-90 radioembolization therapy has been increasingly used in the treatment of HCC. Transarterial infusion of yttrium-90 radioactive microspheres is a new promising method in treating unresectable liver tumors. Herein, we present a 55-year-old male HCC patient who developed HCC due cirrhosis associated with delta hepatitis and was successfully treated with yttrium-90 radioembolization therapy

Kronik viral hepatitlerde ekstrahepatik bulgular: Günlük klinik pratikte unutulmaması gereken bir nokta

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: stanbul Tıp Fakültesi Gastroenteroloji Bilim Dalında 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 27si (%52) hepatit C, 24ü (%46) hepatit B ve 1 (%2) hasta da hem hepatit B hem de hepatit C idi. Bunlardan 25i (%48) erkekti, ortalama yaş 5113 (18-78) yıldı. Otuz iki hasta (%61) sirotik evrede, 20 hasta (%39) ise presirotik evrede idi. Sonuç: Ekstrahepatik tutulumlar genelliklatlanmaktadır. Klinisyenler ekstrahepatik bulguların tanısında daha duyarlı olmalıdırlar.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

MASSIVE BLEEDING DUE TO PARACENTESIS-ACASE REPORT

Abdominal paracentesis is a generally safe intervention that is performed for diagnostic and therapeutic reasons in patients with hepatic disease and accompanying ascites. Although abdominal wall hematomas occurring in needle puncture site is seen at less than 2%, severe bleeding requiring transfusion develops in less than 1% of patients. Complication rate is less than 1% in interventions performed at subinguinal median line. Bleeding complication may be less frequent because linea alba found at this site is avascular

Gastroenterolojide yirmi yılda tanısal laparoskopinin rolü değişti mi? ,

Giriş ve Amaç: Girişimsel olmayan görüntüleme metotlarındaki ge - lişmeler sonrasında tanısal laparoskopinin kullanımı azalmıştır. Biz de gastroenteroloji ünitemizde tanısal laparoskopi olgularını inceledik. Gereç ve Yöntem: 1989-2010 yılları arasında İstanbul Tıp Fakültesi Gastroenteroloji Bilim Dalında laparoskopik işleme giren 1484 hasta - nın raporları retrospektif olarak değerlendirildi. Laparoskopi işlemi lokal anestezi altında Storz marka laparoskopi cihazı ile yapıldı. Bulgular: Asitli hastalar serum-asit albumin farklarına göre 1,1 g/dL ve 1,1 g/dL olacak şekilde iki gruba ayırılarak incelendi. Toplamda 93 (%6,3) hastanın tanısı laparoskopik inceleme sonrası değişti. Son beş yılda ek- suda asit ve peritoneal hastalık için yapılan tanısal laparoskopi sayısı azalmış olsa da bu azalma transuda asitlilerle karşılaştırıldığında azalma oranının daha düşük olduğu görülmektedir. Sonuç: Tanısal laparoskopi halen peritoneal tüberküloz tanısını koymada ve diğer malign hastalık- ların ayırıcı tanısında tercih edilen bir yöntemdir.Background and Aims: The use of diagnostic laparoscopy seems to have markedly reduced since the advent of major developments in noninvasive imaging modalities. We aimed to investigate the role of diagnostic laparoscopy in our gastroenterology unit. Materials and Methods: Reports of 1484 laparoscopy patients seen in the Gas- troenterology Department of Istanbul University, Istanbul Faculty of Medicine between 1989 and 2010 were evaluated retrospectively. Laparoscopy was performed using the Storz laparoscope under local anesthesia. Results: Patients with ascites were evaluated in two differ- ent groups according to serum-ascites albumin gradient values as >1.1 g/dL and <1,1 g/dL. Diagnoses of 93 (6,3%) patients were revised af- ter the laparoscopic examination. Although diagnostic laparoscopy for evaluation of exudative ascites and peritoneal disease has decreased in the last quarter, the decrease was relatively less when compared with that for transudative ascites. Conclusions: Diagnostic laparoscopy is still the preferred method both for the diagnosis of peritoneal tubercu - losis and to rule out other diseases such as malignancy