The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology (TURK J GASTROENTEROL)

Publications in this journal

• Article: Choreiform movements associated with pegylated interferon-alpha in a patient with chronic hepatitis C.

  Mete Akin, Mehmet Işler, Altuğ Senol, Süleyman Kutluhan, Ahmet Tüfekçı
  The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):618-9.
• Article: A case of eosinophilic gastroenteritis mimicking gastric lymphoma associated with pancreatitis due to duodenal involvement.

  Erkan Cağlar, Kadir Karişmaz, Ahmet Dobrucali
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  ABSTRACT: A case of eosinophilic gastroenteritis is reported in a 17-year-old woman. The disease has the signs of delayed gastric emptying, vomiting, weight loss, and substantial thickening of the gastric antrum. Histopathology established the diagnosis of eosinophilic gastroenteritis of panmural type. Improvement in the patient's symptoms and laboratory parameters was observed with steroid treatment. The clinicopathological features of this disease are summarized in the discussion.
  The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):585-9.
• Article: Simple non-invasive markers as a predictor of fibrosis and viral response in chronic hepatitis C patients.

  Mahmut Arabul, Fatih Aslan, Emrah Alper, Zehra Akpinar, Mustafa Celık, Altay Kandemır, Sezgin Vatansever, Belkıs Unsal
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  ABSTRACT: Background/aims: Chronic hepatitis C has a high prevalence and leads to development of cirrhosis and hepatocellular carcinoma. Liver fibrosis staging is one of the main factors that influence the decision to indicate therapy for chronic hepatitis C carriers. Several simple laboratory tests, scores and indices have been proposed for the non-invasive prediction of hepatic fibrosis in patients with chronic hepatitis C. The purpose of this study was to evaluate non-invasive liver fibrosis tests as a predictive factor of fibrosis and non-sustained viral response (relapse/non-responder) in chronic hepatitis C naive patients. Materials and Methods: We performed a retrospective case-control study with utilization of non-invasive liver fibrosis test, platelet count, aspartate aminotransferase/alanine aminotransferase ratio, age-platelet index and aspartate aminotransferase to platelet ratio index, as a predictor of non-sustained viral response in chronic hepatitis C naive patients between July 2008 and August 2010 in İzmir Atatürk Training and Research Hospital. Results: We observed non-invasive liver fibrosis test to be highly effective in predicting non-sustained viral response patients, especially with age-platelet index (Accuracy=73%, OR=6.93, 95% CI, 2.41-19.8). A strong relationship was shown with multivariate analysis between non-sustained viral response and some non-invasive liver fibrosis tests such as viral load (OR=4.51, 95% CI, 1.16 -17.6, p=0.03) and age-platelet index (OR=11.8, 95% CI, 2.25-62.15, p=0.004). Conclusions: If non-invasive tests could be standardized according to age, gender, race, and body mass index and individualized according to the fibrosis, then a nearly full correlation of non-invasive liver fibrosis test with histologic results could be obtained, stage of fibrosis could be predicted initially, sustained viral response/non-sustained viral response could be estimated, and the need for a repeat biopsy could be eliminated.
  The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):538-45.
• Article: Risk factors for higher anti-HCV positivity in a border city in southern Turkey with unique population characteristics.

  Birol Ozer, Gülşah Seydaoğlu, Akatlı Kürşat Ozşahın, Hakan Demırhındı
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  ABSTRACT: Background/aims: This study was conducted as a seroprevalence study on hepatitis C virus infection in a small city located in southern Anatolia, to estimate the prevalence of hepatitis C virus and to explore the potential risk factors for hepatitis C virus infection at this population level. Material and Methods: A total of 1427 (685 male (48%), 742 female) subjects agreed to participate in the study. Risk factors were examined using a questionnaire. All blood samples were tested using third-generation anti-hepatitis C virus enzyme-linked immunosorbent assays. Results: The overall anti-hepatitis C virus prevalence was 3.1% (44/1427). There was a steady rise in the prevalence of anti-hepatitis C virus positivity with age; the anti-hepatitis C virus prevalence was slightly higher in men (3.6%) than women (2.6%). The prevalence of anti-hepatitis C virus positivity was significantly higher in primary school graduates (3.4%) (odds ratio [OR]: 4.1, 95% confidence interval [CI]: 1.5-11.6, p=0.0001) and in illiterate subjects (5.0%) (OR: 2.7, 95% CI: 1.1-7.4, p=0.021) compared to secondary-plus graduates. Anti-hepatitis C virus positivity was higher (3.7%) in married subjects (OR: 8.7, 95% CI: 1.2-63.7, p=0.003) compared to single subjects (0.0%). Having dental procedure, delivery at home, provocative abortion, working abroad, hypertension, and diabetes mellitus were factors found to increase the anti-hepatitis C virus positivity significantly. Conclusions: In the region of the current study, the anti-hepatitis C virus seroprevalence was higher compared to the whole country. Illiteracy, previous dental procedures, and working abroad in neighboring countries seem to be factors that relate to this high ratio.
  The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):574-9.
• Article: Assessment of COX-2 expression presence and severity by immunohistochemical method in patients with chronic active gastritis and intestinal metaplasia.

  Gülbanu Erkan, Ipek Işık Gönül, Uğur Kandılcı, Ayşe Dursun
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  ABSTRACT: Background/aims: The risk of gastric cancer is increased in patients with intestinal metaplasia. Cyclooxygenase-2 activity is crucial for gastric cancer cell survival and proliferation. We aimed to assess cyclooxygenase-2 expression in patients with intestinal metaplasia or chronic active gastritis and in patients with or without a family history of gastric cancer, i.e. a first-degree relative with gastric cancer. Materials and Methods: One hundred and six patients with histologically proven intestinal metaplasia, chronic active gastritis or normal gastric mucosa were included. Immunohistochemical staining was performed using the immunoperoxidase method. Results: Cyclooxygenase-2 expression was detected in 23.1% of normal gastric mucosa, 70.6% of chronic active gastritis, and 90.5% of intestinal metaplasia patients. Cyclooxygenase-2 expression was significantly higher in intestinal metaplasia than in chronic active gastritis (p=0.018). Cyclooxygenase-2 expression was significantly more severe in the intestinal metaplasia group when compared to the chronic active gastritis group (p=0.017). Severe cyclooxygenase-2 expression (>60% of cells) was more frequent in the intestinal metaplasia group. Cyclooxygenase-2 expression was higher in the Helicobacter pylori-positive group when compared to the Helicobacter pylori-negative group (80.3% vs 57.1%, respectively; p=0.012). Cyclooxygenase-2 expression did not significantly differ according to presence of a first-degree relative with gastric cancer. Conclusions: Patients with intestinal metaplasia demonstrated increased presence and severity of cyclooxygenase-2 expression. Our findings suggest that cyclooxygenase-2 plays an important role in the stepwise process that eventually leads to gastric cancer. There was no statistically significant difference between the patients with and without a first-degree relative with a history of gastric cancer in terms of cyclooxygenase-2 expression.
  The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):Isayfa-Ssafya.
• Article: Impact of an information video before colonoscopy on patient satisfaction and anxiety.

  Mahmut Arabul, Altay Kandemır, Mustafa Celık, Emrah Alper, Zehra Akpinar, Fatih Aslan, Sezgin Vatansever, Belkıs Unsal
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  ABSTRACT: Background/aims: Anxiety is a common problem in patients undergoing invasive medical procedures. Colonoscopy is a demanding procedure and requires a patient's good cooperation for successful results. We aimed to examine the effects of adding an information video to our usual preprocedural information. Materials and Methods: A total of 227 patients were assessed in this study (120 male, 107 female). The patients were divided into two groups as video (n=124) or verbal (n=103). When the patients in the polyclinic with indications for colonoscopy were selected, a text about the procedure and related complications was given to them. A colonoscopy appointment was scheduled for the patients 3-4 weeks following the procedure. On the appointment day, the patients selected randomly in groups of 10 as either verbal or video sections were taken into the communication room 1-5 hours before the procedure. The patients' anxiety was measured afterwards using the Spielberger State-Trait Anxiety Inventory questionnaire. In addition, patients answered individual questions. After the colonoscopy, the patients were asked if they would undergo colonoscopy again for health reasons and whether the procedure was similar to, better, or worse than they had expected (following the information sessions). Results: It was noted in univariate and multiple logistic regression analyses that low State-Trait Anxiety Inventory-State levels (p≤0.001 and p=0.016, respectively) and communication by video (p<0.001, p=0.007, respectively) had a significant impact on communication success. Conclusions: An information video shown to patients preparing for colonoscopy had an impact on the success of the procedure and on anxiety.
  The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):523-9.
• Article: Endosonography and magnetic resonance cholangiopancreatography show similar efficacy in selecting patients for ERCP in mild-moderate acute biliary pancreatitis.

  Emrah Alper, Sinan Akay, Zafer Buyraç, Fatih Aslan, Işık Alper, Belkıs Unsal
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  ABSTRACT: Background/aims: We aimed to compare the value of endoscopic ultrasonography and magnetic resonance cholangiopancreatography in identifying the patients with mild-moderate acute biliary pancreatitis who require endoscopic retrograde cholangiopancreatography. Material and Methods: The study was prospectively conducted in a tertiary hospital between June 2006 and October 2009. Ninety-five patients without urgent endoscopic retrograde cholangiopancreatography requirement and with mild-moderate acute biliary pancreatitis were included in the study. Patients whose amylase, C-reactive protein, and bilirubin levels had decreased more than 50% on the fifth day compared to admission levels were randomized to magnetic resonance cholangiopancreatography or endoscopic ultrasonography, and the common bile duct was evaluated. Endoscopic retrograde cholangiopancreatography was performed in patients with stone detected with endoscopic ultrasonography or magnetic resonance cholangiopancreatography. With regard to the presence of common bile duct stone in endoscopic retrograde cholangiopancreatography, endoscopic retrograde cholangiopancreatography performances were classified as therapeutic or diagnostic. Results: Endoscopic retrograde cholangiopancreatography was performed in 16 of the 48 patients (33.3%) in the endoscopic ultrasonography group and in 18 of the 47 patients (38%) in the magnetic resonance cholangiopancreatography group. Therapeutic endoscopic retrograde cholangiopancreatography was performed in 14/16 patients (87%) in the endoscopic ultrasonography group and in 16/18 patients (88%) in the magnetic resonance cholangiopancreatography group. The ratio of total number of endoscopic retrograde cholangiopancreatographis was not significantly lower in the endoscopic ultrasonography (16/48) than in the magnetic resonance cholangiopancreatography (18/47) group, and the ratio of therapeutic endoscopic retrograde cholangiopancreatographis (14/16) was not higher in the endoscopic ultrasonography group than in the magnetic resonance cholangiopancreatography group (16/18). Conclusions: The necessity of therapeutic endoscopic retrograde cholangiopancreatography was determined with similar efficacy by endoscopic ultrasonography and magnetic resonance cholangiopancreatography in mild-moderate acute biliary pancreatitis.
  The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):580-4.
• Article: Evaluation of serum ghrelin levels in patients with hyperplastic gastric polyps.

  Osman Ersoy, Reyhan Ersoy, Ebru Akin, Aylin Demırezer, Semnur Büyükaşik, Eyüp Selvı, Bekir Cakir
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  ABSTRACT: Background/aims: Ghrelin is a 28 amino acid peptide and the main source of serum ghrelin is the stomach. The aim of this study was to evaluate serum ghrelin levels in patients with hyperplastic gastric polyp. Materials and Methods: Eighty patients (50 female, 30 male) were included in this study: 28 with hyperplastic gastric polyp, 20 with benign gastric ulcer and 32 with chronic active gastritis. Serum ghrelin levels were measured by radioimmunoassay method. Results: Serum ghrelin level was significantly lower in patients with hyperplastic gastric polyp (1139.86±279.23 pg/ml) than in those with benign gastric ulcer (1362.45±335.35 pg/ml) and chronic active gastritis (1362.91±269.67 pg/ml) (p=0.016 and p=0.003, respectively). The benign gastric ulcer and chronic active gastritis groups had similar serum values (p=0.996). Serum ghrelin level was not affected by Helicobacter pylori, with levels of 1298.70±309.01 pg/ml and 1252.12±303.04 pg/ml in 56 positive and 24 negative patients, respectively (p=0.536). In the patients with hyperplastic gastric polyp, Helicobacter pylori infection was found to have no effect on serum ghrelin level (p=0.855). Conclusions: Serum ghrelin levels of patients with hyperplastic gastric polyp were lower than in patients with benign gastric ulcer and chronic active gastritis. In patients with various benign stomach lesions, the presence of Helicobacter pylori does not seem to affect serum ghrelin levels.
  The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):444-7.
• Article: Alpha-1 antitrypsin deficiency in patients with chronic hepatitis.

  Halis Sımşek, Aslı Pinar, Akif Altinbaş, Alparslan Alp, Yasemin H Balaban, Yahya Büyükaşik, Osman Ozcebe, Gülşen Hasçelık, Gökhan Gedıkoğlu, Gonca Tatar
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  ABSTRACT: Background/aims: Alpha-1 antitrypsin deficiency causes accumulation of mutant alpha-1 antitrypsin molecules in hepatocytes, and is attributed to severe liver injury even in heterozygous state. However, there is a question as to whether alpha-1 antitrypsin deficiency is only a cause of liver injury or has a worsening effect on the underlying liver disease. We aimed to determine the role of alpha-1 antitrypsin deficiency in the ongoing chronic hepatitic process. Materials and Methods: Fifty-four patients with the diagnosis of chronic hepatitis by liver biopsy (36 chronic hepatitis B virus, 8 chronic hepatitis C virus, 7 non-alcoholic steatohepatitis, 2 primary biliary cirrhosis, and 1 autoimmune hepatitis) and 51 ageand sex-matched control subjects chosen from among healthy blood donors were included in the study. Isoelectric focusing for identifying alpha-1 antitrypsin phenotypes was performed in all patients and control subjects, whereas the histopathological examination was done only in patients. Results: Alpha-1 antitrypsin-deficient variant was absent in patients and controls. The mean serum alpha-1 antitrypsin level was significantly lower in patients (157.4±33 mg/dl) than controls (134.8±30 mg/dl) (p<0.00). Histological activity index and fibrosis grade in the liver were not related to the serum alpha-1 antitrypsin level (p: 0.276 and 0.902, respectively). Additionally, the serum alpha-1 antitrypsin levels among normal variants of alpha-1 antitrypsin did not differ according to the underlying liver diseases (p: 0.928). Conclusions: This prospective case-control study could not define any additional effect of alpha-1 antitrypsin deficiency on liver histopathology in chronic hepatitis patients.
  The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):569-73.
• Article: 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.

  Nurdan Tözün, Orhan Sezgın, Murat Gülşen, Sabite Kacar, Necati Yenıce, Serif Yilmaz, Saadettin Hülagü, Bülent Kantarçeken, Fahri Yakaryilmaz, Alper Yurcı, Kemal Mustafa Serez, Halil Bahçecıoğlu, Sait Bağci
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  ABSTRACT: 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 μg/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 μg/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.
  The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):552-9.
• Article: Cyclosporine rescue therapy in autoimmune liver cirrhosis: A case report.

  Chan Wah-Kheong, Vijayasangkar Jaganathan, Mahadeva Sanjiv
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  ABSTRACT: Autoimmune hepatitis is an inflammatory condition of the liver that can lead to significant morbidity and mortality. Corticosteroids with or without azathioprine have been shown to improve outcome and are the current standard of care in autoimmune hepatitis patients. However, long-term use of corticosteroids and use of azathioprine could be associated with significant adverse effects that prevent their continued use at optimal dosages or may even require complete cessation. We present a patient with autoimmune liver cirrhosis who was intolerant of corticosteroid and azathioprine, who was successfully treated with cyclosporine. To our knowledge, cyclosporine use has not been reported previously in autoimmune cirrhosis, although it has been used in autoimmune hepatitis patients with reported success and good tolerability. We conclude that cyclosporine seems to be an effective alternative to azathioprine as a steroid-sparing agent in both non-cirrhotic and cirrhotic autoimmune hepatitis.
  The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):599-603.
• Article: An unusual case of polycythemia vera with a complication of pancreatic pseudocyst.

  Memduh Sahın, Mehmet Cındoruk, Ilker Sen, Ozlem Gül Utku
  The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):623-5.
• Article: Esophageal duplication cyst: A rare cause of back pain.

  Ilgın Karaman, Duygu Gürel, Mehtat Unlü, Erkan Yilmaz, Volkan Karaçam, Aydanur Kargi
  The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):610-1.
• Article: Ogilvie's syndrome in sickle cell disease.

  Emel Gürkan
  The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):617-8.
• Article: A case of ulcerative colitis complicated with bronchiolitis obliterans organizing pneumonia (BOOP) and air leak syndrome.

  Müge Aydoğdu, Gül Gürsel, Ezgi Ozyilmaz, Nalan Akyürek, Leyla Memış
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  ABSTRACT: Extraintestinal manifestations of inflammatory bowel diseases are well recognized and mainly affect the joints, skin, liver, and eyes; however, clinically significant pulmonary involvement is very rare. Early identification of pulmonary involvement is important and will be life-saving. We report herein a case of an ulcerative colitis patient, presenting with acute respiratory distress syndrome and bilateral recurring pneumothorax, pneumomediastinum and subcutaneous emphysema, i.e., air leak syndrome. He was diagnosed with open lung biopsy as bronchiolitis obliterans organizing pneumonia most probably due to viral etiology and responded well to steroid therapy, with almost complete resolution of radiographic and clinical findings. In inflammatory bowel disease patients, bronchiolitis obliterans organizing pneumonia developing due to viral or fungal infectious etiology or due to the inflammatory bowel disease itself may progress to acute respiratory distress syndrome and may present with air leak syndrome. Early detection is important and life-saving, since bronchiolitis obliterans organizing pneumonia often responds well to steroid treatment provided an infectious etiology has been excluded or adequate antimicrobial therapy has already been initiated.
  The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):590-5.
• Article: Effects of statins in an indomethacin-induced gastric injury model in rats.

  Günnur Ozbakiş-Dengız, Aşkın Hekımoğlu, Nilüfer Kandemır, Zehra Kurcer
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  ABSTRACT: Background/aims: Statins have additional pleiotropic effects beyond their lipid-lowering effects. In this study, the effects of statins were evaluated in an indomethacin-induced gastric injury model in rats. Materials and Methods: Animals were divided into eight groups. Distilled water (control group), omeprazole (30 mg/kg), atorvastatin (20 and 40 mg/kg), simvastatin (20 and 40 mg/kg), and rosuvastatin (20 and 40 mg/kg) were given orally (gavage). Thirty minutes later, indomethacin (25 mg/kg) was administered orally to all groups. Six hours later, the animals were sacrificed by decapitation. The mean ulcer indexes for each group were calculated, and the stomachs were evaluated histopathologically. Results: The ulcer indexes were as follows: control 1.72±0.16, omeprazole 0±0.00, and atorvastatin, simvastatin and rosuvastatin (at 20 and 40 mg/kg doses, respectively) 4.28±0.39, 4.99±0.96, 1.72±0.73, 1.90±0.48, 1.85±0.26, and 1.67±0.18. Atorvastatin significantly increased the indomethacin-induced ulcer index at both doses and the erosion score at 40 mg/kg dose. Although the 20 mg/kg dose of simvastatin inhibited mononuclear leukocyte infiltration, the 40 mg/kg dose induced hyperemia. Rosuvastatin did not decrease mononuclear leukocyte or neutrophil infiltrations at 20 mg/kg dose, and only neutrophil infiltration at the 40 mg/kg dose. Conclusions: In patients with gastric discomfort, statins must be used carefully. If statin therapy is needed, we recommend to avoid using atorvastatin and to use the other statins only in the minimum effective dose.
  The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):456-62.
• Article: A rare cause of obstructive jaundice: Fasciola hepatica mimicking cholangiocarcinoma.

  Orçun Yalav, Ozgür Yağmur, Abdullah Ulkü, Atılgan Tolga Akcam, Hüsnü Sönmez
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  ABSTRACT: Fasciola hepatica is an endemic zoonotic disease in Turkey and neighboring countries. The usual definitive host is the sheep; humans are accidental hosts in the life cycle of the Fasciola. There are two disease stages: the hepatic (acute) and biliary (chronic) stages. When the flukes enter the bile ducts, the symptoms of cholestasis and cholangitis may present, which can easily be misdiagnosed as obstructive jaundice of other causes. We present a case of fascioliasis, which was difficult to differentiate from cholangiocarcinoma. A 47-year-old woman from Eastern Turkey presented with fever, right upper quadrant abdominal pain, and jaundice. Total bilirubin was 4.2 mg/dl, aspartate aminotransferase 55 IU/L, alanine aminotransferase 65 IU/L, alkaline phosphatase 325 IU/L, and gamma-glutamyl transpeptidase 172 IU/L. All tumor markers including carcinoembryonic antigen and Ca19-9 were in normal values. After extended evaluation, an explorative laparotomy with cholecystectomy, choledochostomy and T-tube drainage was performed. Multiple flukes were removed from the choledochus. One of the parasites was sent to the parasitological clinic for identification. The result of an indirect hemagglutination test for F. hepatica was 1/320 (+). In conclusion, the chronic phase of this zoonotic infection can be easily misdiagnosed as any other cause of obstructive jaundice. Thus, F. hepatica should be considered in the differential diagnosis of common bile duct obstruction, especially in endemic areas.
  The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):604-7.
• Article: Clinical remission after strict gluten-free diet in a patient with celiac disease, advanced cryptogenic cirrhosis and splenic atrophy.

  Muhsin Kaya, Remzi Beştaş, Sedat Cetın, Hüseyin Büyükbayram
  The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):619-21.