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.
How to cite this article:
Bengi G, Keles D, Topalak Ö, Yalçin M, Kiyak R, Oktay G. Expressions of TIMP-1, COX-2 and MMP-7 in Colon Polyp and Colon Cancer. Euroasian J Hepatogastroenterol 2015; 5 (2):74-79.
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
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
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.
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:
How to cite this article:
Saxena D, Tandon M, Shah Y, Gedam B. Hyperbilirubinemia as a Diagnostic Tool for the Prediction of Appendicular Perforation: A Prospective Study. Euroasian J Hepatogastroenterol 2015; 5 (2):87-89.
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
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,
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.
How to cite this article:
Tulek N, Ozsoy M, Moroglu C, Cagla Sonmezer M, Temocin F, Tuncer Ertem G, Sebnem Erdinc F. Seroprevalence of Hepatitis A Virus Antibodies among the Patients with Chronic Hepatitis B in Turkey. Euroasian J Hepatogastroenterol 2015; 5 (2):95-97.
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.
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% (http://www.unos.org). 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.
How to cite this article:
Shukla A, Kanaiyalal Modi T, Parikh H, Sadalge A, Gupte A, Bhatt P. Autoimmune Hepatitis with Distal Renal Tubular Acidosis and Small Bowel Partial Malrotation. Euroasian J Hepatogastroenterol 2015; 5 (2):107-109.
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,
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.
Hava Uskudar Teke,
Safak Meric Ozgenel,
Aysegul Harmanci Ozakyol
How to cite this article:
Temel T, Gunduz E, Sadigova E, Uskudar Teke H, Meric Ozgenel S, Harmanci Ozakyol A. Hepatitis B Virus Reactivation under Treatment with Nilotinib. Euroasian J Hepatogastroenterol 2015; 5 (2):112-114.
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.
How to cite this article:
Temel T, Meric Ozgenel S, Harmanci Ozakyol A, Canaz F, Arik D, Tokmak S. A Case Report of Ulcerative Colitis Induced by Therapy of Colorectal Carcinoma. Euroasian J Hepatogastroenterol 2015; 5 (2):115-117.
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.
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.
Ayub Al Mamun,
Biplob Kumar Saha,
Sharker Mohammad Shahadat Hossain,
Dulal Chandra Das
How to cite this article:
Begum R, Al Mamun A, Kumar Saha B, Mohammad Shahadat Hossain S, Chandra Das D. A Case of Antimitochondrial Antibody Negative Primary Biliary Cirrhosis from Bangladesh and Review of Literature. Euroasian J Hepatogastroenterol 2015; 5 (2):122-126.
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.
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,
Mohammad Shahed Ashraf,
Faiz Ahmad Khondaker
How to cite this article:
Alam Sarker J, Alam MS, Khan M, Shahed Ashraf M, Ahmad Khondaker F. Variant of Ascitic Fluid Bacterial Infections in Patients of Liver Cirrhosis. Euroasian J Hepatogastroenterol 2015; 5 (2):131-133.
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.
LETTER TO EDITOR
How to cite this article:
El-Sherbiny W, Elegezy M, Wagih Shaltout S. New Cutoff Point for Platelet Count/Spleen Diameter Ratio to Predict Esophageal Varices in Patients with Hepatitis C Virus-related Hepatic Cirrhosis. Euroasian J Hepatogastroenterol 2015; 5 (2):136-137.