Euroasian journal of hepato-gastroenterology

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2018 | July-December | Volume 8 | Issue 2

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Prof. Hasan ÖzKAN


[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/ejohg-8-2-iv  |  Open Access |  How to cite  | 



Rosmawati Mohamed, Muhammad Radzi AH, Soek S Tan, Fauziah Jaya, Senamjit K , Azlida C Aun, Ghazali A Kutty, Hin S Wong, Rafidah Abdullah, Mohd R Seman, Zaki Morad, Teck-Onn Lim

Hepatitis Screening and Treatment Campaign in Malaysia- Validation of Low-cost Point of Care Screening Tests and Nucleic Acid Tests for Hepatitis B and C

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:7] [Pages No:101 - 107]

Keywords: Access to treatment, Diagnostic test, Health services, Hepatitis B, Hepatitis B virus dioxyribo nucleic acid, Hepatitis C, Hepatitis C virus ribonucleic acid, Nucleic Acid Tests, Point of Care tests, Screening, Validation

   DOI: 10.5005/jp-journals-10018-1273  |  Open Access |  How to cite  | 


Background: Two major challenges in implementing budget-constrained Hepatitis screening and treatment campaign in Malaysia are the availability of low-cost point of care tests (POCT) and nucleic acid tests (NAT) for hepatitis C virus ribonucleic acid (HCV RNA) and hepatitis B virus dioxyribo nucleic acid (HBV DNA). We evaluated the performance of these tests in this study. Methods: We conducted a cross-sectional study to evaluate the diagnostic performance of four POCT brands at 12 sites in Malaysia. We assessed the sensitivity and specificity of the POCTs for the detection of HBsAg and anti-HCV in a finger-stick capillary or venepuncture whole-blood samples compared with test results from lab-based enzyme immunoassay (EIA) or chemi-luminescence immunoassay (CLIA) assay as the reference standard. We also conducted a cross-sectional study on 30 to 139 serum specimen panel to evaluate the diagnostic performance of a low-cost in-house Applied Biosystem®TaqMan real-time polymerase chain reaction (PCR) assay (ABS) for the detection of HCV RNA and HBV DNA, compare with Roche Cobas® Ampliprep/TaqMan assay (COBAS). Results: Between March and December 2017, we enroll 295 participants for the evaluation of POCT for HBsAg and another 307 participants for POCT anti-HCV evaluation. Three of the four POCT brands dropped out of evaluation early on account of sub-optimal sensitivity. The sensitivity of the remaining POCT for HBsAg was 95.2%and specificity 100%, while the POCT for anti-HCV has a sensitivity of 98.1% and specificity 100%. Hepatitis B virus dioxyribo nucleic acid and HCV RNA concentrations detected by the ABS were systematically higher than those measured by COBAS (mean bias +0.10 and +0.17 log10 IU/mL respectively). The 95% limits of agreement between the two assays are -1.28 to 1.47 log10 IU/mL for HBV DNA and –0.41 to 0.75 log10 IU/mL for HCV RNA. Conclusion: We found adequate evidence for the diagnostic validity of a low-cost POCT for anti-HCV and HBsAg, as well as for an in-house nucleic acid tests (NAT), to provide support for their broader use in our Hepatitis screening and treatment campaign. Abbreviations: ABS: Applied Biosystem®TaqMan real-time PCR assay, CI: Confidence interval, CLD: Chronic liver disease, CLIA: Chemi-luminescence immunoassay, COBAS: Roche Cobas® Ampliprep/TaqMan assay, DAA: Direct Acting Anti-Viral drugs, EIA: Enzyme immunoassay, HBV: Hepatitis B virus, HCV: Hepatitis C virus, HFPM: Hepatitis Free Pahang Malaysia, LOA: Limits of agreement, LOD: Limit of detection, MOH: Ministry of Health, Malaysia, NAT: Nucleic Acid Tests, POCT: Point of Care Tests, SD: Standard deviation, WHO: World Health Organization



Musa Akoglu, Ilter Ozer, Murat Ulas, Volkan Oter, Tahsin Dalgic, Kadri Colakoglu, Murat Cayci, Erdal B Bostanci

Comparison of Early Postoperative Outcomes after Total Gastrectomy and D2 Lymph Node Dissection with and without Splenectomy

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:4] [Pages No:108 - 111]

Keywords: Gastric cancer surgery, Postoperative outcomes, Splenectomy, Total gastrectomy

   DOI: 10.5005/jp-journals-10018-1274  |  Open Access |  How to cite  | 


Background: A famous prognostic ingredient for gastric cancer is the lymph node metastasis. Previously in the therapy of gastric cancer, splenectomy was considered as a definitive part of lymph node dissection. Currently, preservation of the spleen is the accepted approach during total gastrectomy and routine splenectomy is abandoned. The aim of this study was to estimate the impression of splenectomy for D2 lymph node dissection with total gastrectomy. Methodology: Between February 1998 and January 2012, 1531 patients underwent gastric cancer surgery. Of these 257 patients, 205 patients underwent total gastrectomy with splenectomy, and the remaining 52 underwent a spleen-preserving total gastrectomy. Results: No statistical difference between these two groups in terms of age, gender, comorbidity, stage and American Society of Anesthesiologists score, surgical complications were detected. A significant difference was not seen in these groups with regard to postoperative mortality too. Conclusion: Early postoperative results were similar after TG ± splenectomy. Performing splenectomy did not increase the postoperative morbidity and mortality.



Ayumi Morita, Ryouzi Watanabe

Low Serum Levels of Zonulin in Patients with HCV-Infected Chronic Liver Diseases

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:4] [Pages No:112 - 115]

Keywords: Intestinal permeability, Leaky gut syndrome, Liver cirrhosis, Zonulin

   DOI: 10.5005/jp-journals-10018-1275  |  Open Access |  How to cite  | 


Aim: The aim of the study was to assess the implication of Zonulin, a mediator protein synthesized by intestine and the liver, in patients with chronic liver diseases. Materials and methods: Twenty-six patients with chronic liver diseases due to hepatitis C virus (HCV) and hepatitis B virus (HBV) were enrolled in this study. Out of total 26 patients, 17 were diagnosed as chronic hepatitis (CH) and 9 were patients with liver cirrhosis (LC). Twenty-four of these patients were infected with hepatitis C virus (HCV) and the rest two by hepatitis B virus (HBV). The study was conducted at Saiseikai- Imabari Hospital, Imabari, Ehime, Japan. Serum levels of Zonulin along with different parameters of liver function test were measured in all patients and comparative analyses were accomplished. Results: The serum levels of Zonulin were significantly lower in CH patients compared to controls (p<0.001). Also, the levels of Zonulin were significantly lower in patients with LC compared to CH and normal controls (p<0.001). Further analysis revealed that serum Zonulin was significantly lower in patients with LC having ascites than those without ascites (p <0.05). There was a significant correlation of serum levels of Zonulin with platelet count, cholinesterase, and albumin in patients with chronic liver diseases. Discussion: Decreased levels of Zonulin may be related to impaired production of this mediator in the diseased liver. It will be tempting to assess the regulation of Zonulin in the liver, a production site of the mediator.



Rauf M Aghayev, Fariz H Jamalov, Idris T Achundov, Shahin G Huseynov, Tarana P Jamalova

Antibacterial Prophylaxis in Emergency Surgery of Abdominal Infection

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:5] [Pages No:116 - 120]

Keywords: Amoxiclav, Antibiotic prophylaxis, Emergency abdominal surgery, Purulent-septic complications

   DOI: 10.5005/jp-journals-10018-1276  |  Open Access |  How to cite  | 


The results of antibiotic prophylaxis in 148 patients with destructive acute surgical sicknesses of abdominal cavity being urgently operated in the Republican hospital of Baku city from 2011 to 2016 were analyzed. Sixty-five patients were in the basic group which had got as preoperative antibiotic prophylaxis 120-hour course of amoxiclav (amoxicillin in combination with clavulanic acid). Eighty-three patients were in the control group who have performed a surgical intervention with pre-operative 120-hour antibiotic prophylaxis by Claforan (cefotaxime) combining with Metrogel (metronidazole). Ýt was showed that applying antibiotic prophylaxis using amoxiclav positively lowered the frequency of as postoperative purulent-septic complications as recurring operations to 8.1%.



Ahmed L Moben, Faiz A Khondaker, Masuda Mohsena, Masuda Begum, Md. A Islam, Md. A Rahim, Md. A Alam, Md. Sakirul I Khan, Md. Z Huq, Swati Munshi, Ashraful Hoque, Sheikh A Haque

Stem Cell Therapy for Cirrhosis of Liver in Bangladesh: Specific Design Compatible for Developing Country

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:5] [Pages No:121 - 125]

Keywords: Ascites, Decompensated, Liver cirrhosis, Stem cell

   DOI: 10.5005/jp-journals-10018-1277  |  Open Access |  How to cite  | 


Aims and objectives: To assess the safety and efficacy of stem cell therapy in patients with cirrhosis of the liver (LC) in the context of developing country with limited facilities for cell-based therapy and advanced technologies. Materials and methods: A total of 34 patients received granulocyte colony-stimulating factor at a dose of 30 IU, daily for 2 to 11 days to upregulate the numbers of white blood cells and stem cells. Subsequently, stem cells were isolated from the peripheral blood of LC patients in a closed chamber using a harvesting machine. Variable amounts of autologous stem cells were injected to LC patients for once. The patients were followed for 3 months and various factors related to safety and parameters of efficacy were analyzed in this interim report. Results: Out of 34 patients available for final analysis, 3 months after the start of stem therapy, 4 patients died within this period. There was no significant alteration in biochemical parameters due to stem cell therapy, and patients also did not develop any features of acute liver failure indicating that short-term safety parameters of stem cell therapy may be acceptable. Stem cell therapy had a dominant effect on ascites of in this cohort. Although 24 of 34 patients had ascites at the start of therapy, ascites were found in 11 patients after one month and only 4 patients had ascites after 3 months. The positive role of stem cell therapy on ascites in LC patients may be attributed, even in part, to increased serum levels of albumin after therapy compared to basal levels (p <0.001). Conclusion: This first study about stem cell therapy in Bangladesh indicates that cell therapy may be accomplished in general hospitals of developing countries if the proper design and mild to moderate types of invasive approach is utilized. The apparent safety of administered stem cells in LC patients and the observed effect on ascites of LC patients inspire optimism about the installation of new and innovative therapy in Bangladesh. Future studies with phase I/II may with stem cell and others cell may be planned at Bangladesh in patients with LC and other intractable diseases with suitable control arms.



Ahmet Aydin, Rengin Reis, Hande Sipahi, Gülþah Zeybekoðlu, Nur Çelik, Hasan Kírmízíbekmez, Neþe Kaklíkkaya

Hydroxytyrosol: The Phytochemical Responsible for Bioactivity of Traditionally used Olive Pits

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:7] [Pages No:126 - 132]

Keywords: Analgesic, Anti-inflammatory, Hydroxytyrosol, Nitric oxide, Olea europaea, Olive pit

   DOI: 10.5005/jp-journals-10018-1278  |  Open Access |  How to cite  | 


The fruits of Olea europaea L. is widely consumed as food, and olive pits are utilized in folk medicine to relieve gastric disturbances. In the present study, the possible anti-inflammatory, analgesic and antioxidant activities of aqueous extracts of black (BP) and green olive (GP) pit prepared at gastric fed state pH were evaluated in vitro. Moreover, the bioactive compound, hydroxytyrosol (HT), was isolated from the extracts for the first time. According to results, GP extract (62.5 to 1000 ìg/mL) showed significant anti-inflammatory activity in a dose-dependent manner and HT displayed significant nitrite inhibition at 100 ìM with slight analgesic activity. Extracts and HT showed a significant antioxidant activity according to Total Antioxidant Capacity (TOAC), cupric ion reducing antioxidant capacity (CUPRAC), and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging assays. As a conclusion, a proper formulation containing HT might be a potential remedy to relieve gastric disturbances and olive pits, can be utilized as a valuable industrial tool for the low-cost production of HT.



Julio Cesar Aguilar, Yamila León, Yadira Lobaina, Freya Freyre, Guillermo Fernández, Ana L Sanchez, Everardo Jerez, Luis E Anillo, Jorge A Aguiar, Zurina Cinza, Pablo A Diaz, Nelvis Figueroa, Verena Muzio, Gerardo G Nieto, Arístides Aguilar, Eduardo Penton

Five-year Follow-up of Chronic Hepatitis B Patients Immunized by Nasal Route with the Therapeutic Vaccine HeberNasvac

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:7] [Pages No:133 - 139]

Keywords: Chronic hepatitis B, HeberNasvac, Therapeutic vaccine

   DOI: 10.5005/jp-journals-10018-1279  |  Open Access |  How to cite  | 


A novel therapeutic vaccine for chronic hepatitis B (CHB) treatment comprising the recombinant hepatitis B surface (HBsAg) and nucleocapsid (HBcAg) antigens has been developed. Preclinical and clinical trials (CT) evidenced safety and immunogenicity in animal models as well as in phases I, II, and III clinical trials. A phase I CT has conducted in Cuba in 6 CHB patients refractory or incomplete responders to α-IFN. Patients were immunized ten times every two weeks via. nasal spray, with 100 μg HBsAg and 100 μg HBcAg. Clinical efficacy was monitored by assessing the levels of hepatitis B virus deoxyribonucleic acid (HBV DNA), alanine aminotransferase (ALT), HBeAg, and anti-HBeAg seroconversion as well as by qualitative/ quantitative HBsAg serology during this period. After a 5 year follow-up, HBeAg loss was verified in the three HBeAg (+) patients, in two cases with seroconversion to anti-HBeAg. A reduction to undetectable viral load was observed in 5 out of 6 patients, and in two cases HBsAg seroconversion was also detected. ALT increases above the 2X upper limit of normal (ULN) were only detected in HBeAg (+) patients and associated with HBe antigen loss. All patients had stiffness levels below 7.8 KPa by Fibroscan assessment at the end of this period. Although only a few patients were enrolled in this study, it seems that HeberNasvac may maintain some of the therapeutic effects for a prolonged period.



Shivaram P Singh, Girish K Pati

Alagille Syndrome and the Liver: Current Insights

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:8] [Pages No:140 - 147]

Keywords: Alagille syndrome, Bile duct paucity, Butter fly vertebra cholestasis, Posterior embryotoxon

   DOI: 10.5005/jp-journals-10018-1280  |  Open Access |  How to cite  | 


Alagille syndrome (ALGS) is an autosomal dominant disorder, with multisystem involvement, which usually occurs due to Notch signaling pathway defects, mostly due to JAG1 mutation (ALGS type 1), but rarely due to neurogenic locus notch homolog protein (NOTCH2) mutation (ALGS type 2). It was suspected in cases having at least three out of five major clinical criteria: cholestasis with a paucity of the bile duct, congenital cardiac defects, ocular posterior embryotoxon, typical facial features, and skeletal malformation. Till date, no early predictive marker for hepatic outcome in ALGS has found. No genotypic or, phenotype features or correlation could predict the development of endstage liver disease, which poses a unique management challenge. Cases with progressive liver damage, unremitting cholestasis and intractable pruritus often depend on liver transplantation as last resort. The cardiac, and renal status should be well accessed before liver transplant for the better post-transplantation outcome. Most of the clinical manifestations usually improve the following transplant, except any change in stature. The post liver transplantation outcome was usually comparable with other conditions which require liver transplantation as a last resort, but in this disease the effect of long term immunosuppression on other affected systems not evaluated well till date. Therefore long term post transplant prospective study is required to address these issues.



Ramesh GN, Richard Hunt, Leonid B Lazebnik, Yury C Marakhouski, Mircea Manuc, Khin S Aye, Dmitry S Bordin, Natalia V Bakulina, Baurzhan S Iskakov, Abror A Khamraev, Yurii M Stepanov, Reidwaan Ally, Amit Garg

International Consensus on Guiding Recommendations for Management of Patients with Nonsteroidal Antiinflammatory Drugs Induced Gastropathy-ICON-G

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:13] [Pages No:148 - 160]

Keywords: Gastropathy, Gastroprotective agents, Non-prescription drugs, Nonsteroidal Anti-inflammatory Agents, Proton pump inhibitor

   DOI: 10.5005/jp-journals-10018-1281  |  Open Access |  How to cite  | 


Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs), one of the most commonly used medications worldwide, are frequently associated with gastrointestinal adverse events. Primary care physicians often face the challenge of achieving adequate pain relief with NSAIDs, while keeping their adverse events to a minimum. This is especially true when long-term use of NSAIDs is required such as in patients with osteoarthritis and rheumatoid arthritis. To help primary care physicians deal with such challenges more effectively, a panel of expert gastroenterologists came together with the aim of developing practice recommendations. Methods: A modified ‘Delphi’ process was used to reach consensus and develop practice recommendations. Twelve gastroenterologists from nine countries provided their expert inputs to formulate the recommendations. These recommendations were carefully developed taking into account existing literature, current practices, and expert opinion of the panelists. Results: The expert panel developed a total of fifteen practice recommendations. Following are the key recommendations: NSAIDs should be prescribed only when necessary; before prescribing NSAIDs, associated modifiable and non-modifiable risk factors should be considered; H. pylori infection should be considered and treated before initiating NSAIDs; patients should be properly educated regarding NSAIDs use; patients who need to be on long-term NSAIDs should be prescribed a gastroprotective agent, preferably a proton pump inhibitor and these patients should be closely monitored for any untoward adverse events. Conclusion/clinical significance: These practice recommendations will serve as an important tool for primary care physicians and will guide them in making appropriate therapeutic choices for their patients.



Ayþegul Babalí, Basak Cakal, Alpaslan Tanoglu, Fatih Karaahmet, Murat Kekilli

Boceprevir-induced Herpes Zoster

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:2] [Pages No:161 - 162]

Keywords: Boceprevir, Herpes zoster, Infection

   DOI: 10.5005/jp-journals-10018-1282  |  Open Access |  How to cite  | 


Herpes zoster is caused by reactivation of the varicella zoster virus (VZV), that attacks peripheral or cranial nerves and result in painful cutaneous inflammation. Boceprevir is a protease inhibitor which used as a new therapeutic agent for chronic hepatitis C infection. Boceprevir associated herpes zoster is extremely rare condition. We present herpes zoster infection assosiated Boceprevir in patint with chronic hepatitis C.



Ezgi Yangín-Ergon, Nebahat Ermis, Ruya Colak, Burak Polat, Senem Alkan-Ozdemir, Meral Yíldíz, Ferit Kulalí, Cigden Omur-Ecevit, Orkan Ergun, Sebnem Calkavur

Abernethy Malformation Type 2 and Biliary Atresia Coexistence: A Rare Cause of Infantile Liver Transplant

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:4] [Pages No:163 - 166]

   DOI: 10.5005/jp-journals-10018-1283  |  Open Access |  How to cite  | 



Masanori Abe, Hiromi Higaki, Satoshi Takeji, Keitaro Kawasaki, Youhei Kashimoto, Takatoshi Murakami, Tomotaka Yamaguchi

A Case of Severe Drug-induced Liver Injury Caused by Over the Counter Herb (Cinnamon): Review of Literature

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:5] [Pages No:167 - 171]

Keywords: Cinnamon, Drug-induced liver injury, Herb medicine, Over-the-counter, Severe hepatitis

   DOI: 10.5005/jp-journals-10018-1284  |  Open Access |  How to cite  | 


A case of severe drug-induced liver injury caused by over the counter (OTC) herb medicine, is reported here. A 40-year-old male took herb drugs “Za ga-doKowa ®,” “Ohta-Isan®.” These two drugs contained the same two herb medicines (cinnamon, fennel). About 4 months later after taking medicine, jaundice appeared. Prothrombin time activation (PT) was 45%, aspartate transaminase (AST) was 1104 IU/l, and total bilirubin (T-bil) 14.7 mg/dL. Serum tests for hepatitis viruses (A, B, C, E) were negative. Lymphocyte stimulating test was positive for Za ga-do Kowa ® and Ohta-I Isan®. Liver 3D constructed by construct-CT revealed findings of the potato-like liver. The liver biopsy specimen revealed multilobular hepatic necrosis accompanied by scar formation, severe zonal degeneration and necrosis of hepatocytes mainly in the central area of the lobule. In the reported 13 cases of cinnamon-induced liver diseases, there has been a severe abnormality of PT and T-bil. Biopsy findings of these cases showed wide ranges of necrosis. Liver injury due to cinnamon shows very severe damages, and the possibility of liver failure due to cinnamon may be imminent.



Fatih Karaahmet, Murat Kekilli, Zeynal Dogan

A Rare and Late Postoperative Complication of Nissen Fundoplication: Mixed Hiatus Hernia

[Year:2018] [Month:July-December] [Volume:8] [Number:2] [Pages:1] [Pages No:172 - 172]

Keywords: Gastroesophageal reflux disease, Mixed hiatus hernia, Nissen fundoplication

   DOI: 10.5005/jp-journals-10018-1285  |  Open Access |  How to cite  | 


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