Euroasian journal of hepato-gastroenterology

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2015 | July-December | Volume 5 | Issue 2

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Daniel Zaborski, Miroslaw Halczak, Wilhelm Grzesiak, Andrzej Modrzejewski

Recording and Analysis of Bowel Sounds

[Year:2015] [Month:July-December] [Volume:5] [Number:2] [Pages:7] [Pages No:67 - 73]

   DOI: 10.5005/jp-journals-10018-1137  |  Open Access |  How to cite  | 


Background: The aim of this study was to construct an electronic bowel sound recording system and determine its usefulness for the diagnosis of appendicitis, mechanical ileus and diffuse peritonitis. Materials and methods: A group of 67 subjects aged 17 to 88 years including 15 controls was examined. Bowel sounds were recorded using an electret microphone placed on the right side of the hypogastrium and connected to a laptop computer. The method of adjustable grids (converted into binary matrices) was used for bowel sounds analysis. Results: Significantly, fewer (p ≤ 0.05) sounds were found in the mechanical ileus (1004.4) and diffuse peritonitis (466.3) groups than in the controls (2179.3). After superimposing adjustable binary matrices on combined sounds (interval between sounds <0.01 s), significant relationships (p ≤ 0.05) were found between particular positions in the matrices (row-column) and the patient groups. These included the A1_T1 and A1_T2 positions and mechanical ileus as well as the A1_T2 and A1_T4 positions and appendicitis. For diffuse peritonitis, significant positions were A5_T4 and A1_T4. Conclusion: Differences were noted in the number of sounds and binary matrices in the groups of patients with acute abdominal diseases. Certain features of bowel sounds characteristic of individual abdominal diseases were indicated.



Göksel Bengi, Didem Keles, Ömer Topalak, Mustafa Yalçin, Rabia Kiyak, Gülgün Oktay

Expressions of TIMP-1, COX-2 and MMP-7 in Colon Polyp and Colon Cancer

[Year:2015] [Month:July-December] [Volume:5] [Number:2] [Pages:6] [Pages No:74 - 79]

   DOI: 10.5005/jp-journals-10018-1138  |  Open Access |  How to cite  | 


Objective: We aimed to investigate the relationship of expression of matrix metalloproteinase-7 (MMP-7), tissue inhibitor of metalloproteinase-1 (TIMP-1) and cyclooxygenase-2 (COX-2) in colon cancer and its predecessor colon polyp. Materials and methods: This study included 29 patients with colon polyp, 19 patients with colon cancer and 65 healthy control subjects. The expressions of MMP-7, TIMP-1 and COX-2 were investigated by real time-polymerase chain reaction (RT-PCR). Results: The expressions of TIMP-1, COX-2 and MMP-7 levels were significantly higher in polyp tissue compared to normal tissue (p = 0.024, p < 0.001, p = 0.009, respectively). Expression of TIMP-1, COX-2 and MMP-7 in cancer tissues were higher than both normal tissue and polyp tissue (p = 0.009 and p = 0.001; p < 0.001 and p < 0.001; p = 0.029 and p = 0.008, respectively). In the cancer group, no significant relationship was detected between metastasis and MMP-7, TIMP-1 and COX-2 expressions (p > 0.05). In the polyp tissues, no significant relationship was detected between the histologic type and size of polyps and MMP-7, TIMP-1 and COX-2 levels (p > 0.05). The areas under the receiver operating characteristic (ROC) curve for the cancer group were 0.821 for TIMP-1, 0.888 for COX-2, and 0.880 for MMP-7 (p = 0 < 0.001). Conclusion: A role and implication of expressions of MMP-7, COX-2 and TIMP-1 in colon cancer is predicted.



Göksel Bengi, Mustafa Yalçin, Mesut Akarsu, Tarkan Ünek, İbrahim Astarcıoğlu

Liver Transplantation in Cases with Acute Liver Failure

[Year:2015] [Month:July-December] [Volume:5] [Number:2] [Pages:3] [Pages No:80 - 82]

   DOI: 10.5005/jp-journals-10018-1139  |  Open Access |  How to cite  | 


Background: Acute liver failure (ALF) is a rare, life-threatening clinical condition that is characterized by severe hepatocellular necrosis, jaundice, coagulopathy and encephalopathy. The aim of this study was to evaluate patients who underwent liver transplantation at Dokuz Eylül University of Medicine Faculty (DEUMF) due to ALF. Materials and methods: The patients who underwent liver transplantation at DEUMF due to ALF were evaluated retrospectively. Results: All of the liver transplantations performed in this study were successful; toxicity was the major cause of ALF in these patients (84%). Conclusion: Results of this study may not be generalizable to all of Turkey since the patients included in this study were only from one region. However, our study is in accordance with others that show that liver transplantation is a very safe and effective method for the treatment of ALF.



Klyarytskaya Iryna, Maksymova Helen, Stilidi Elena

Drug-induced Liver Disease in Patients with Diabetes Mellitus

[Year:2015] [Month:July-December] [Volume:5] [Number:2] [Pages:4] [Pages No:83 - 86]

   DOI: 10.5005/jp-journals-10018-1140  |  Open Access |  How to cite  | 


The study presented here was accomplished to assess the course of drug-induced liver diseases in patient’s rheumatoid arthritis receiving long-term methotrexate therapy. Diabetes mellitus was revealed as the most significant risk factor. The combination of diabetes mellitus with other risk factors (female sex) resulted in increased hepatic fibrosis, degree of hepatic encephalopathy and reduction of hepatic functions. The effectiveness and safety of ursodeoxycholic acid and cytolytic type-with S-Adenosyl methionine was also evaluated. Abbreviations: 13C-MBT: 13C-methacetin breath test; ALT: alanine aminotransferase; AP: alkaline phosphatase; AST: aspartic transaminase; DILD: drug-induced liver disease; DM: diabetes mellitus; HE: hepatic encephalopathy; HFM: hepatic functional mass; SAMe: S-Adenosyl methionine; UDCA: ursodeoxycholic acid.



Divish Saxena, Mrinal Tandon, Yunus Shah, BS Gedam

Hyperbilirubinemia as a Diagnostic Tool for the Prediction of Appendicular Perforation: A Prospective Study

[Year:2015] [Month:July-December] [Volume:5] [Number:2] [Pages:3] [Pages No:87 - 89]

   DOI: 10.5005/jp-journals-10018-1141  |  Open Access |  How to cite  | 


Background: The certainty of diagnosing acute appendicitis in patients presenting with right iliac fossa pain still remains a mystery though acute appendicitis being the commonest surgical procedure done in emergency. In acute appendicitis, serum bilirubin levels are raised due to hepatocellular damage as a result of direct insult caused by Gram-negative bacterial endotoxemia. The need for the study is to conclude whether the serum bilirubin can be considered as a new laboratory marker to aid in the diagnosis of acute appendicitis and if so, does it have the predictive capacity to warn us about appendicular perforation. Materials and methods: This is a prospective study carried out at rural tertiary healthcare center and includes 213 patients clinically diagnosed as acute appendicitis. Results: Out of 213 patients, raised serum bilirubin ≥1.2 mg/dl was present in 195 (91.5%) patients, out of which 194 (99.4%) patients had histopathologically inflamed appendix and this difference was statistically highly significant with p-value < 0.0001. In this study, 32 patients had perforated appendix. Out of those, 30 patients had bilirubin ≥ 4 mg/dl and 2 patients had bilirubin level between 1.2 and < 4 mg/dl. Raised serum bilirubin (≥4 mg/dl) was present in 35 (17.9%) patients, out of which 30 (87.7%) patients had perforated appendix.



Prithpal Singh Matreja, Prithpal S Matreja, HK Rao, PML Khanna

Prevalence and Impact of Hepatitis on the Quality of Life of Patients

[Year:2015] [Month:July-December] [Volume:5] [Number:2] [Pages:5] [Pages No:90 - 94]

   DOI: 10.5005/jp-journals-10018-1142  |  Open Access |  How to cite  | 


Background: Hepatitis is a disorder which is emerging as major health problem with increasing morbidity and mortality. Inappropriate management of this disease leads to several complications that can impair the health related quality of life (HRQoL) of the individuals. There, we designed this study to assess the HRQoL in patients suffering from hepatitis. Materials and methods: This prospective, observational study was conducted for 2 months in patients with hepatitis. All patients with hepatitis were recruited in the study after giving written informed consent. The participants were given both World Health Organization Quality of Life-Bref (WHO QoL-Bref) and short form (SF-36) health survey questionnaires for assessing the quality of life (QoL) of patients. The participants were given counseling of lifestyle modification and underwent a thorough medical examination and a detailed history was taken. Results: A total of 65 volunteers participated in the study, out of which 30 were control and 35 were patients suffering from hepatitis; hepatitis C was found to be more prevalent. The patients with hepatitis had a significantly poor QoL as compared to control. In hepatitis patients, physical health and physical functioning was better in males as compared to females. Social relationships were also good in males than females. But females had higher score in role limitation due to physical health, emotional wellbeing, social functioning, pain, general health as per SF-36 scores but it was not statistically significant. Conclusion: Hepatitis affected the HRQoL in Indian population and parameters seem to be heterogeneously affected in males and females.



Necla Tulek, Metin Ozsoy, Cigdem Moroglu, Meliha Cagla Sonmezer, Fatih Temocin, Gunay Tuncer Ertem, Fatma Sebnem Erdinc

Seroprevalence of Hepatitis A Virus Antibodies among the Patients with Chronic Hepatitis B in Turkey

[Year:2015] [Month:July-December] [Volume:5] [Number:2] [Pages:3] [Pages No:95 - 97]

   DOI: 10.5005/jp-journals-10018-1143  |  Open Access |  How to cite  | 


Background: Hepatitis A virus (HAV) can cause significant pathology in patients with chronic hepatitis B virus (HBV), however, HAV can be prevented by vaccination. The aim of this study was to determine the implication of vaccination against HAV vaccine in patients with chronic hepatitis B. Materials and methods: The seroprevalence of anti-HAV IgG antibodies was investigated in the patients with chronic hepatitis B. Anti-HAV IgG antibodies were detected by commercially available ELISA kit. Results: A total of 673 patients (354 males, 319 females with age range of 17–78 years) with chronic hepatitis B were included the study. Hepatitis A virus seropositivity rate was 34% in the patients younger than 20 years, 79% in the age group of 20 to 29 years, and 100% after 35 years of age. Discussion: Hepatitis A virus vaccination may be recommended for young adult patients with chronic hepatitis B in Turkey.



Ahmet Gurakar, Serkan Dogan

Liver Transplantation Update: 2014

[Year:2015] [Month:July-December] [Volume:5] [Number:2] [Pages:9] [Pages No:98 - 106]

   DOI: 10.5005/jp-journals-10018-1144  |  Open Access |  How to cite  | 


The first liver transplantation (LT) was performed by Thomas E Starzl five decades ago, and yet it remains the only therapeutic option offering gold standard treatment for end-stage liver disease (ESLD) and acute liver failure (ALF) and certain early-stage liver tumors. Post-liver transplantation survival has also dramatically improved over the last few decades despite increasing donor and recipient age and more frequent use of marginal organs to overcome the organ shortage. Currently, the overall 1 year survival following LT in the United States is reported as 85 to 90%, while the 10 years survival rate is ~50% ( The improvements are mainly due to progress in surgical techniques, postoperative intensive care, and the advent of new immunosuppressive agents. There are a number of factors that influence the outcomes prior to transplantation. Since 2002, the model for end-stage liver disease (MELD) score has been considered a predicting variable. It has been used to prioritize patients on the transplant waiting list and is currently the standard method used to assess severity in all etiologies of cirrhosis. Hepatocellular carcinoma (HCC) is the most common standard MELD exception because the MELD does not necessarily reflect the medical urgency of patients with HCC. The criteria for candidates with HCC for receiving LT have evolved over the past decade. Now, patients with HCC who do not meet the traditional Milan (MC) or UCSF criteria for LT often undergo downstaging therapy I an effort to shrink the tumor size. The shortage of donor organs is a universal problem. In some countries, the development of a deceased organ donation program has been prevented due to socioeconomic, cultural, legal and other factors. Due to the shortage of cadaveric donors, several innovative techniques have been developed to expand the organ donor pool, such as split liver grafts, marginal- or extended-criteria donors, live donor liver transplantation (LDLT), and the use of organs donated after cardiac death. Herein, we briefly summarize recent advances in knowledge related to LT. We also report common causes of death after liver transplant, including the recurrence of hepatitis C virus (HCV) and its management, and coronary artery disease (CAD), including the role of the cardiac calcium score in identifying occult CAD.



Akash Shukla, Tejas Kanaiyalal Modi, Hardik Parikh, Abhishek Sadalge, Amit Gupte, Pratin Bhatt

Autoimmune Hepatitis with Distal Renal Tubular Acidosis and Small Bowel Partial Malrotation

[Year:2015] [Month:July-December] [Volume:5] [Number:2] [Pages:3] [Pages No:107 - 109]

   DOI: 10.5005/jp-journals-10018-1145  |  Open Access |  How to cite  | 


Renal tubular acidosis (RTA) is not uncommon in patient with chronic autoimmune hepatitis (AIH), but usually remains latent. Here, we report a case of renal tubular acidosis RTA who presented with AIH. She was also diagnosed to have partial bowel malrotation. A 9-year-old girl, a case of distal RTA, presented with jaundice, abdominal distension and altered sensorium. She was diagnosed to be AIH, which was successfully treated with steroids and azathioprine. Coexistent midgut partial malrotation with volvulus was diagnosed during the treatment. She was treated successfully with anti-tuberculous treatment for cervical lymphadenitis. Autoimmune hepatitis should not be ruled out in each case of RTA presenting with jaundice.



Vijay P Agrawal, Nikhil S Shetty, Ashwin Narasimhaprasad

Obstructed Umbilical Hernia: A Normal Presentation with Abnormal Contents

[Year:2015] [Month:July-December] [Volume:5] [Number:2] [Pages:2] [Pages No:110 - 111]

   DOI: 10.5005/jp-journals-10018-1146  |  Open Access |  How to cite  | 


Umbilical hernia is a common problem encountered in children. The rarity of finding cecum and appendix is probably due to the fact that the appendix is seldom found in the proximity of the umbilicus. It would, therefore, appear worthwhile to report the occurrence of cecum and an inflamed appendix with Ladd’s bands in an umbilical hernia of a child. The last case with similar presentation was presented in 1950s.



Tuncer Temel, Eren Gunduz, Esmira Sadigova, Hava Uskudar Teke, Safak Meric Ozgenel, Aysegul Harmanci Ozakyol

Hepatitis B Virus Reactivation under Treatment with Nilotinib

[Year:2015] [Month:July-December] [Volume:5] [Number:2] [Pages:3] [Pages No:112 - 114]

   DOI: 10.5005/jp-journals-10018-1147  |  Open Access |  How to cite  | 


Hepatitis B virus (HBV) reactivation with imatinib, a tyrosine kinase inhibitor, has been reported in chronic myeloid leukemia. Nilotinib is a more potent second generation tyrosine kinase inhibitor and it inhibits the Src-family kinase LCK and hamper proliferation and function of CD8 (+) T lymphocytes. CD8 (+) T lymphocytes are the main cellular subset responsible for viral clearance in patients with HBV infection. We report a case of HBV reactivation under treatment with nilotinib. Fatal HBV reactivation is not usually related to death in chronic myeloid leukemia patients who have an expectation of longevity with well-tolerated oral drugs. Thus, screening for latent chronic HBV infections including assessment of hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti-HBc antibody) and antibody to hepatitis B surface antigen (anti-HBs), especially at countries with intermediate and high prevalence of HBsAg is warranted. Treatment with nucleoside analogs and close monitoring may be life-saving in this context.



Tuncer Temel, Safak Meric Ozgenel, Aysegul Harmanci Ozakyol, Funda Canaz, Deniz Arik, Salih Tokmak

A Case Report of Ulcerative Colitis Induced by Therapy of Colorectal Carcinoma

[Year:2015] [Month:July-December] [Volume:5] [Number:2] [Pages:3] [Pages No:115 - 117]

   DOI: 10.5005/jp-journals-10018-1148  |  Open Access |  How to cite  | 


Although patients with ulcerative colitis have an increased risk for colon cancer which is associated with disease activity, location of involvement or the accompanying primary sclerosing cholangitis, ulcerative colitis induced by resections for colorectal carcinoma or chemotherapy drugs are very rare as case presentations in the literature. Fifty-nine year-old female patient with the diagnosis of sigmoid colon carcinoma have been developed ulcerative colitis 2 months after low anterior resection and oral capecitabine treatment. Development of colitis after colon cancer may be associated with some causes as mutual genetic factors that take part at the pathophysiological mechanisms liable from occurrence of ulcerative colitis and colorectal carcinoma, chemotherapy agents, perioperative stress and underlying silent ulcerative colitis. It is unclear which role is certain. Increasing reports like this case will be useful in resolving this issue.



Taran Khangura, Gias Uddin, Albert Davies, John Keating

A Rare Variant of Pancreatic Sarcoidosis: Diagnostic Challenge

[Year:2015] [Month:July-December] [Volume:5] [Number:2] [Pages:4] [Pages No:118 - 121]

   DOI: 10.5005/jp-journals-10018-1149  |  Open Access |  How to cite  | 


Pancreatic sarcoidosis is one of the variant of systemic sarcoidosis which is extremely rare in literature and opined as an enigma. Hence, its diagnosis is very challenging as its presentation mimics pancreatic carcinoma. In view of a better understanding, we are presenting a case of pancreatic sarcoidosis to emphasize the above. To clearly distinguish sarcoidosis from malignancy, repeated computed tomography scans, Positron emission tomography scans, fine needle aspiration cytology, endoscopic retrograde cholangio-pancreatography supplemented with histology and relevant blood tests proved it to be a pancreatic sarcoidosis then a malignancy. Over the course, concrete evidence was divulged from lymph node biopsy and histology in clinching the diagnosis which later transformed into a malignancy. Therefore, we concluded it is a rare variant of pancreatic sarcoidosis and careful serial investigations include repeated imaging, histology and blood tests are essential to establish and most importantly differentiate the diagnosis.



Roksana Begum, Ayub Al Mamun, Biplob Kumar Saha, Sharker Mohammad Shahadat Hossain, Dulal Chandra Das

A Case of Antimitochondrial Antibody Negative Primary Biliary Cirrhosis from Bangladesh and Review of Literature

[Year:2015] [Month:July-December] [Volume:5] [Number:2] [Pages:5] [Pages No:122 - 126]

   DOI: 10.5005/jp-journals-10018-1150  |  Open Access |  How to cite  | 


Primary biliary cirrhosis (PBC) is very closely associated with the presence of antimitochondrial antibodies (AMA). Nevertheless, 5 to 10% of patients with typical features of primary biliary cirrhosis do not have detectable AMA. They are referred to as AMA negative PBC. We report a case of PBC who was AMA-negative. The patient was a middle-aged woman seeking help of dermatologist for her complaint of itching. The diagnosis was confirmed by histopathology, whereas other possible causes of cirrhosis were excluded.



Mustafa Qureshi, Zaigham Abbas

Clinical Presentation of Ulcerative Colitis in Pakistani Adults

[Year:2015] [Month:July-December] [Volume:5] [Number:2] [Pages:4] [Pages No:127 - 130]

   DOI: 10.5005/jp-journals-10018-1151  |  Open Access |  How to cite  | 


Objective: The aim of this study was to determine the clinical presentation and severity of ulcerative colitis (UC) in Pakistani adult patients. Materials and methods: An observational study. Data were obtained by reviewing the medical records of patients who visited a gastroenterology clinic between 2008 and 2012. Results: There were 54 patients diagnosed as UC. The male to female ratio was 1:1. Mean age at diagnosis of UC was 38.7 ± 11.8 years (median 36.5, range 18–64). The predominant presenting symptoms were mucus diarrhea in 49 (90.7%), gross blood in stools in 42 (77.8%), abdominal pain or cramps in 40 (74.1%) and weight loss in 15 (27.7%). Left-sided colitis was present in 23 (42.6%), pancolitis in 15 (27.8%), extensive colitis in 11 (20.4%), and proctitis in five (9.2%). The severity of UC as judged by the Mayo scoring system showed that 68.5% were suffering from moderate to severe disease while 31.5% had mild disease. The extra-intestinal manifestation were found only in seven patients; arthritis in five patients and anterior uveitis in two patients. The arthritis was unilateral and the sites were knee joint in three patients and sacroiliac joint in two patients. Conclusion: Ulcerative colitis presents in our adult patients may present at any age with no gender preponderance. The disease severity is moderate to severe in the majority of patients and more than half of them have left-sided colitis or pancolitis at the time of presentation. Extraintestinal manifestations were not common.



Jahangir Alam Sarker, Md Shahinul Alam, Mobin Khan, Mohammad Shahed Ashraf, Faiz Ahmad Khondaker

Variant of Ascitic Fluid Bacterial Infections in Patients of Liver Cirrhosis

[Year:2015] [Month:July-December] [Volume:5] [Number:2] [Pages:3] [Pages No:131 - 133]

   DOI: 10.5005/jp-journals-10018-1152  |  Open Access |  How to cite  | 


Background and aims: Bacterial infections of ascitic fluid of cirrhotic patients are related to high morbidity and mortality. The aim of the study was to determine the variants of ascitic fluid bacterial infection in patients with advanced cirrhosis (Child Pugh Class C). Materials and methods: We analyzed 35 consecutive cirrhotic patients of Child Pugh Class C with ascites attending the outpatient department (OPD) of Hepatology Department, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2008 to December 2009. Clinical and laboratory parameters of these patients were recorded. Results: Among the total 35 patients, eight patients were symptomatic and 27 patients were asymptomatic. Out of eight symptomatic patients, two had ascitic fluid bacterial infection (25%), whereas six of 27 asymptomatic patients (22.2%) had ascitic fluid bacterial infection. Conclusion: Bacterial infection should always be considered in patients with ascites with liver cirrhosis irrespective of their symptoms.



Sebahat Basyigit,, Yasar Nazligül, Murat Eser, Mithat Eser

Propylthiouracil-related Toxic Hepatitis: Impact of Silent Cases

[Year:2015] [Month:July-December] [Volume:5] [Number:2] [Pages:2] [Pages No:134 - 135]

   DOI: 10.5005/jp-journals-10018-1153  |  Open Access |  How to cite  | 



Walid El-Sherbiny, Mohamed Elegezy, Shaker Wagih Shaltout

New Cutoff Point for Platelet Count/Spleen Diameter Ratio to Predict Esophageal Varices in Patients with Hepatitis C Virus-related Hepatic Cirrhosis

[Year:2015] [Month:July-December] [Volume:5] [Number:2] [Pages:2] [Pages No:136 - 137]

   DOI: 10.5005/jp-journals-10018-1154  |  Open Access |  How to cite  | 


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