Publications (82)288.03 Total impact
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Article: Late autoimmune hepatitis after hepatitis C therapy.
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ABSTRACT: BACKGROUND: De-novo or reactivated autoimmune hepatitis (AIH) has been reported during or a short time after administration of interferon (IFN) in patients treated for hepatitis C (HCV). Reports on AIH during long-term follow-up after IFN treatment are scarce. PATIENTS AND METHODS: Patients diagnosed with both HCV and AIH were identified in clinical databases of four gastroenterology departments. The medical records of patients diagnosed with AIH after IFN therapy were retrospectively assessed. RESULTS: Five patients (four female, one male) with a mean age of 50 years (range: 34-59) were identified. AIH developed at a mean duration of 4.8 years (range: 1-10) after HCV therapy. Three of five patients had a sustained viral response to antiviral therapy, whereas two were nonresponders. All patients were treated with immunosuppressive therapy after being diagnosed with AIH. Biochemical remission was achieved in four patients; however, one patient had an aggressive course and died despite immunosuppressive therapy. We could not identify any risk factors associated with the development of AIH. CONCLUSION: AIH may develop in patients treated with IFN, not only during or after a short time from therapy but also after a long time from discontinuation of therapy.European journal of gastroenterology & hepatology 04/2013; · 1.66 Impact Factor -
Dataset: Late autoimmune hepatitis after hepatitis C therapy
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ABSTRACT: Background De-novo or reactivated autoimmune hepatitis (AIH) has been reported during or a short time after administration of interferon (IFN) in patients treated for hepatitis C (HCV). Reports on AIH during long-term follow-up after IFN treatment are scarce. Patients and methods Patients diagnosed with both HCV and AIH were identified in clinical databases of four gastroenterology departments. The medical records of patients diagnosed with AIH after IFN therapy were retrospectively assessed. Results Five patients (four female, one male) with a mean age of 50 years (range: 34–59) were identified. AIH developed at a mean duration of 4.8 years (range: 1–10) after HCV therapy. Three of five patients had a sustained viral response to antiviral therapy, whereas two were nonresponders. All patients were treated with immunosuppressive therapy after being diagnosed with AIH. Biochemical remission was achieved in four patients; however, one patient had an aggressive course and died despite immunosuppressive therapy. We could not identify any risk factors associated with the development of AIH. -
Dataset: Late autoimmune hepatitis after hepatitis C therapy
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ABSTRACT: Background De-novo or reactivated autoimmune hepatitis (AIH) has been reported during or a short time after administration of interferon (IFN) in patients treated for hepatitis C (HCV). Reports on AIH during long-term follow-up after IFN treatment are scarce. Patients and methods Patients diagnosed with both HCV and AIH were identified in clinical databases of four gastroenterology departments. The medical records of patients diagnosed with AIH after IFN therapy were retrospectively assessed. Results Five patients (four female, one male) with a mean age of 50 years (range: 34–59) were identified. AIH developed at a mean duration of 4.8 years (range: 1–10) after HCV therapy. Three of five patients had a sustained viral response to antiviral therapy, whereas two were nonresponders. All patients were treated with immunosuppressive therapy after being diagnosed with AIH. Biochemical remission was achieved in four patients; however, one patient had an aggressive course and died despite immunosuppressive therapy. We could not identify any risk factors associated with the development of AIH. -
Article: The impact of sphincterotome design on selective cannulation of the common bile duct.
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ABSTRACT: BACKGROUND AND AIM: There is a paucity of data regarding the impact of sphincterotome design on cannulation success. METHODS: We aimed to compare the 5.5 F standard sphincterotomes of two different manufacturers (sphincterotome 1: Endo-flex 5.5F, Germany versus sphincterotome 2: Ultratome 5.5F, USA). Adult patients undergoing their first ERCP were included in two study groups. The sphincterotome preloaded with a guidewire was used for selective common bile duct cannulation in each group. Precut methods were applied in failed cases without crossover. Successful biliary cannulation in 10 attempts was the primary outcome. RESULTS: Baseline features and indications were similar between groups (n:100, group I, sphincterotome 1, versus n:100, group II, sphincterotome 2). A higher success in initial cannulation was obtained in group II compared to group I (92% vs 81%, p=0.03). Moreover, number of cannulation attempts and time to cannulation differed. No statistical significance was noted in group I (8%) vs group II (3%), regarding pancreatitis rate. The overall cannulation success after precut in failed cases, was 95% (group I) and 97% (group II). CONCLUSIONS: There was a significant difference in cannulation success between two different sphincterotome. 5.5F Ultratome with guidewire was superior to 5.5F Endo-flex sphincterotome with guidewire in initial selective cannulation of CBD. The results may show the importance of sphincterotome features to overcome the obstacles during cannulation such as complex intrapapillary mucosal features.Journal of Gastroenterology and Hepatology 04/2013; · 2.87 Impact Factor -
Dataset: Late autoimmune hepatitis after hepatitis C therapy
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ABSTRACT: Background De-novo or reactivated autoimmune hepatitis (AIH) has been reported during or a short time after administration of interferon (IFN) in patients treated for hepatitis C (HCV). Reports on AIH during long-term follow-up after IFN treatment are scarce. Patients and methods Patients diagnosed with both HCV and AIH were identified in clinical databases of four gastroenterology departments. The medical records of patients diagnosed with AIH after IFN therapy were retrospectively assessed. Results Five patients (four female, one male) with a mean age of 50 years (range: 34–59) were identified. AIH developed at a mean duration of 4.8 years (range: 1–10) after HCV therapy. Three of five patients had a sustained viral response to antiviral therapy, whereas two were nonresponders. All patients were treated with immunosuppressive therapy after being diagnosed with AIH. Biochemical remission was achieved in four patients; however, one patient had an aggressive course and died despite immunosuppressive therapy. We could not identify any risk factors associated with the development of AIH. -
Article: Diagnostic difficulties, therapeutic strategies, and performance of scoring systems in patients with autoimmune hepatitis and concurrent hepatitis B/C.
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ABSTRACT: Abstract Background. The diagnosis of autoimmune hepatitis (AIH) is already difficult, and that of AIH with chronic viral hepatitis including hepatitis B (HBV) or hepatitis C (HCV) is even more challenging. To date, only a few case-based studies have described this association. Aims. The aim was to retrospectively assess diagnostic difficulties, therapeutic approaches, and performance of the scoring systems in AIH patients with concurrent HBV and HCV. Methods. A total of 25 patients from United States, Sweden, Italy, and Turkey were retrospectively evaluated. Both revised and simplified criteria suggested by the International Autoimmune Hepatitis Group were applied for each patient. All study data were obtained from medical records. Results. Of the 25 patients, 20 (80%) had concomitant HCV and 5 (20%) had HBV. Based on the revised scoring system and simplified criteria, 18 (72%) and 12 (48%) patients were diagnosed as "probable" AIH. None of the patients were diagnosed as "definite" AIH according to both scoring systems. Patients with HCV initially were treated with immunosuppressive agents, and antiviral therapy was commenced when biochemical remission occurred. AIH patients with HBV were first treated with antiviral and thereafter, immunosuppressive therapy was started. Conclusions. This large case series describes concurrent AIH and chronic viral hepatitis. The revised scoring system for AIH had a better performance than the simplified scoring system. However, neither scoring system is optimal for diagnosing AIH alone. In these patients, a definitive diagnosis of AIH should be based on a combination of serological profiles, histological findings, scoring systems, treatment response, and outcomes.Scandinavian journal of gastroenterology 03/2013; · 2.08 Impact Factor -
Article: Antibodies to soluble liver antigen in patients with various liver diseases: A multicentre study (pages 190–196)
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ABSTRACT: Abstract Background Antibodies to soluble liver antigen (anti-SLA) are specific serological markers of autoimmune hepatitis (AIH). The clinical significance and frequency of anti-SLA have never been reported among AIH patients from Italy and Turkey. To retrospectively assess the estimated prevalence, sensitivity, specificity and clinical significance of anti-SLA in AIH and various liver diseases. Methods A total of 986 patients who had been tested for serum anti-SLA were included in study. The presence of anti-SLA was detected using recombinant enzyme linked immunosorbent assay and immuno-blot. The general characteristics and outcome of patients were obtained from their medical records. Results Antibodies to SLA were found in 30 (3%) of 986 patients. Of these, 27 (90%) had AIH and its variants, whereas the remaining three (10%) had primary biliary cirrhosis. The prevalence of anti-SLA was 9% in AIH patients from Italy and 15% in patients from Turkey. The specificity of these antibodies was 99.5%, whereas sensitivity was 11%. The positive predictive and negative predictive values were 90% and 77.5% respectively (95% confidence interval). Biochemical remission was achieved in 90% of anti-SLA positive AIH patients, but relapse after immunosuppressive withdrawal or during maintenance therapy was observed in 53% of the patients. Conclusions Seropositivity for anti-SLA occurs at similar frequencies in AIH patients from different geographical regions and ethnic groups. The sensitivity of anti-SLA is low, but it has high specificity for AIH. Additional studies are necessary to prove clinical significance of anti-SLA in AIH.Liver International 02/2013; Volume 33,(Issue 2):(pages 190–196). -
Article: Antibodies to soluble liver antigen in patients with various liver diseases: A multicentre study.
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ABSTRACT: Antibodies to soluble liver antigen (anti-SLA) are specific serological markers of autoimmune hepatitis (AIH). The clinical significance and frequency of anti-SLA have never been reported among AIH patients from Italy and Turkey. To retrospectively assess the estimated prevalence, sensitivity, specificity and clinical significance of anti-SLA in AIH and various liver diseases. A total of 986 patients who had been tested for serum anti-SLA were included in study. The presence of anti-SLA was detected using recombinant enzyme linked immunosorbent assay and immuno-blot. The general characteristics and outcome of patients were obtained from their medical records. Antibodies to SLA were found in 30 (3%) of 986 patients. Of these, 27 (90%) had AIH and its variants, whereas the remaining three (10%) had primary biliary cirrhosis. The prevalence of anti-SLA was 9% in AIH patients from Italy and 15% in patients from Turkey. The specificity of these antibodies was 99.5%, whereas sensitivity was 11%. The positive predictive and negative predictive values were 90% and 77.5% respectively (95% confidence interval). Biochemical remission was achieved in 90% of anti-SLA positive AIH patients, but relapse after immunosuppressive withdrawal or during maintenance therapy was observed in 53% of the patients. Seropositivity for anti-SLA occurs at similar frequencies in AIH patients from different geographical regions and ethnic groups. The sensitivity of anti-SLA is low, but it has high specificity for AIH. Additional studies are necessary to prove clinical significance of anti-SLA in AIH.Liver international: official journal of the International Association for the Study of the Liver 02/2013; 33(2):190-6. · 3.82 Impact Factor -
Article: Reply to Dr Onal: the importance of serum angiotensin-converting enzyme level in chronic hepatitis B.
Journal of Renin-Angiotensin-Aldosterone System 12/2012; 13(4):504. · 2.44 Impact Factor -
Article: The evaluation of bone mineral density in patients with nonalcoholic fatty liver disease.
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ABSTRACT: BACKGROUND AND AIM: Nonalcoholic fatty liver diseases (NAFLD) are a clinical spectrum of disorders, of which nonalcoholic steatohepatitis (NASH) is the most strongly associated with inflammation. Inflammation is a known risk factor for low bone mass in the body. The primary goal of the present study was to evaluate the association between bone mineral density and liver function in patients with NASH. MATERIALS AND METHODS: Consenting patients with a diagnosis of NAFLD were included in the study. Extent of fatty change was graded based on ultrasonographic appearance (Grade 1, mild; Grade 2, moderate; Grade 3, severe). Bone mineral density was measured using the dual-energy x-ray absorptiometry method. ALT and hs-CRP were considered as noninvasive marker of NASH. According to ALT levels, patients were divided into two subgroups. RESULTS: A total of 102 patients with NAFLD and 54 healthy controls participated in the study. None of the patients with NAFLD had an abnormal bone mineral density. Furthermore, there was no difference between groups with regard to serum vitamin D levels. A subgroup analysis revealed that female patients with elevated serum ALT level had significantly lower bone mineral densities and higher hsCRP levels than female patients with normal ALT levels. The difference in vitamin D levels and body mass indices between the same subgroups was statistically insignificant. CONCLUSIONS: Simple steatosis of the liver does not affect bone mineral density. However, in a subgroup of patients with NAFLD, the presence of elevated serum ALT and hs-CRP levels, which are suggestive of NASH, was associated with lower bone mineral densities. Better understanding of the biological basis and the complex interactions between NAFLD and bone mass may help guide the clinical management of bone diseases associated with inflammation of the liver.Wiener klinische Wochenschrift 08/2012; 124(15-16):526-531. · 0.81 Impact Factor -
Article: The ınvolvement of nitric oxide in the physiopathology of hepatoportal sclerosis.
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ABSTRACT: BACKGROUND AND AIM: Hepatoportal sclerosis (HPS) is a clinical syndrome of unspecified etiology depicted by enlarged spleen and portal hypertension in the lack of other chronic liver disease findings, hematological disorders or any infectious disease in the liver. Nitric oxide (NO) molecule has many important functions in human body including phagocytosis in macrophages, neural transmission and endothelial relaxation. Although there is no data in literature that depicts the role of NO in HPS pathogenesis, this study was conducted in order to evaluate the potential role of NO in patients with HPS. PATIENTS AND METHODS: The study participants included 24 HPS patients and 20 healthy controls. The median age of HPS and control patients was 41.2±13.9 and 46.5±12.4years, respectively. NO was predicted as nitric oxide metabolites (NOx) by Griess reaction after transformation of nitrate to nitrite by nitrate reductase using the commercially obtainable Nitric Oxide Assay Kit. RESULTS: Serum NOx levels were 2.69±2.98μmol/L and 0.85±1.05μmol/L for the HPS patients and controls, respectively. Serum NO levels were significantly higher in patients with HPS compared to the control group (p<0.001). ROC curve analysis suggested that the optimum NOx cut-off point for HPS was 1.305 with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 83.3%, 90 %, 90.9 %, and 81.8% respectively. CONCLUSION: Circulating NO concentration was notably higher in patients with HPS in comparison to the control group. Our study verified that an elevated level of NO might have a role in the pathogenesis of HPS.Clinical biochemistry 07/2012; · 2.02 Impact Factor -
Article: Mean platelet volume as a non-invasive marker of fibrosis in chronic hepatitis C.
Gastroentérologie Clinique et Biologique 07/2012; 36(4):e83. · 0.80 Impact Factor -
Article: Mean platelet volume is increased in chronic hepatitis C patients with advanced fibrosis.
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ABSTRACT: BACKGROUND AND AIMS: Liver biopsy is the gold standard procedure for documenting liver damage in chronic hepatitis C (CHC), as for many other chronic liver diseases. Mean platelet volume (MPV) is a laboratory marker obtained from complete blood count (CBC) analysers in routine clinical practice. The goal of the present study was to evaluate whether MPV would be useful in predicting liver histologic severity in CHC. PATIENTS AND METHODS: A total of 59 patients with CHC and 25 control subjects were recruited into the present study. There were 26 men and 33 women in the CHC group and 12 men and 13 women in the control group. MPV was recorded at the time of admission. The clinical characteristics of CHC patients, including demographics, laboratory and liver biopsy findings, were reviewed. RESULTS: A statistically significant increase in MPV values was observed in CHC patients (8.54±0.63 fL) compared to healthy controls (7.65±0.42 fL) (P<0.001). Moreover, MPV values were significantly higher among patients with advanced fibrosis as compared to those with mild fibrosis (8.99±0.57 fL vs. 8.19±0.50 fL P<0.001). Receiver operator characteristic (ROC) curve analysis suggested that the optimum cut-off point for MPV value in advanced fibrosis was 8.75 fL. (Sensitivity: 80.8%, specificity: 81.8%, positive predictive value [PPV] 77.8%, negative predictive value [NPV] 84.4%, accuracy 81.3%, AUC: 0.98 P<0.001) CONCLUSION: The current study showed that MPV is increased in CHC with advanced fibrosis. Calculation of MPV along with the use of other markers may give further information about liver fibrosis severity in CHC.Gastroentérologie Clinique et Biologique 05/2012; · 0.80 Impact Factor -
Article: Autoimmune hepatitis/primary biliary cirrhosis overlap syndrome and associated extrahepatic autoimmune diseases.
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ABSTRACT: To assess the prevalence of concurrent extrahepatic autoimmune diseases in patients with autoimmune hepatitis (AIH)/primary biliary cirrhosis (PBC) overlap syndrome and applicability of the 'mosaic of autoimmunity' in these patients. The medical data of 71 AIH/PBC overlap patients were evaluated for associated autoimmune diseases. In the study population, 31 (43.6%) patients had extrahepatic autoimmune diseases, including autoimmune thyroid diseases (13 patients, 18.3%), Sjögren syndrome (six patients, 8.4%), celiac disease (three patients, 4.2%), psoriasis (three patients, 4.2%), rheumatoid arthritis (three patients, 4.2%), vitiligo (two patients, 2.8%), and systemic lupus erythematosus (two patients, 2.8%). Autoimmune hemolytic anemia, antiphospholipid syndrome, multiple sclerosis, membranous glomerulonephritis, sarcoidosis, systemic sclerosis, and temporal arteritis were identified in one patient each (1.4%). A total of 181 autoimmune disease diagnoses were found in our patients. Among them, 40 patients (56.4%) had two, 23 (32.3%) had three, and eight (11.3%) had four diagnosed autoimmune diseases. A large number of autoimmune diseases were associated with AIH/PBC overlap patients. Therefore, extended screening for existing autoimmune diseases during the routine assessment of these patients is recommended. Our study suggests that the concept of 'mosaic of autoimmunity' is a valid clinical entity that is applicable to patients with AIH/PBC overlap syndrome.European journal of gastroenterology & hepatology 05/2012; 24(5):531-4. · 1.66 Impact Factor -
Article: Autoimmune hepatitis in the postpartum period.
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ABSTRACT: Autoimmune hepatitis (AIH) presenting primarily in the postpartum period has rarely been reported. The medical data of 58 female patients diagnosed with AIH was assessed. In the study population, three (5.1%) patients were diagnosed postpartum. Based on clinical, laboratory and liver biopsy findings, two of these patients were considered to have subclinical AIH and were diagnosed by disease flare after delivery. The remaining patient was considered as new onset of AIH in the postpartum period. AIH can present in the postpartum and should be actively considered among the differential diagnosis if liver dysfunction is observed after delivery.Gastroentérologie Clinique et Biologique 04/2012; 36(4):391-3. · 0.80 Impact Factor -
Article: Liver fibrosis may reduce the efficacy of budesonide in the treatment of autoimmune hepatitis and overlap syndrome.
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ABSTRACT: The aim of the present study was to assess the efficacy and tolerability of budesonide as an alternative first line treatment option for autoimmune hepatitis (AIH) and the overlap syndrome. A total of 18 AIH or overlap syndrome patients were evaluated. Outcomes of treatment by the end of the study were defined as treatment failure, partial response, complete response and remission. Complete response and remission were achieved in 61.1% (11/18) of patients, while 38.9% (7/18) of patients were considered treatment failures. Liver fibrosis was observed in 55.5% of patients' biopsies. More patients with liver fibrosis failed to respond to treatment compared to patients without fibrosis, a difference bordering on statistical significance (60% vs. 12.5%; p=0.066). Although statistically insignificant, the presence of at least one side effect was observed more frequently in patients with fibrosis compared to those without fibrosis (80% vs. 37.5%; p=0.145). Overall, side effects occurred significantly more commonly in non-responders than responders (100% vs. 36%; p=0.013). Budesonide is an effective treatment option for the management of AIH, with a low incidence of side effects in patients without findings of advanced liver disease. The presence of liver fibrosis may increase the likelihood of treatment failure as well as the risk of developing side effects. Our study findings suggest that budesonide may be effective in a select group of AIH patients. Further studies are needed to determine its exact place for the treatment of AIH and overlap syndrome.Autoimmunity reviews 03/2012; 11(5):330-4. · 6.37 Impact Factor -
Article: Chronic hepatitis C, inflammatory bowel disease and interferon therapy.
Journal of Crohn s and Colitis 01/2012; 6(5):626-7. · 2.57 Impact Factor -
Article: Serum angiotensin-converting enzyme level as a marker of fibrosis in patients with chronic hepatitis B.
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ABSTRACT: and aims: Hepatitis B virus (HBV) infection is a public health problem and affects nearly 350 million people worldwide. The present study was conducted in order to investigate the role of circulating angiotensin-converting enzyme (ACE) in the context of renin-angiotensin-aldosterone in newly diagnosed chronic hepatitis B infection. Moreover the association between liver fibrosis and serum ACE levels was also investigated. The study was performed on 50 chronic hepatitis B (CHB) patients (24 males, 26 females; median age 39.4 years, range 18-63) and 20 healthy controls. The clinical features of CHB patients including demographics, laboratory and liver biopsy findings were summarized. Serum ACE levels were measured by using commercially available kits. Serum median ACE levels were 48.4 (14-83) U/L and 26.2 (12-48) U/L for the CHB patients and controls, respectively. Serum ACE levels were significantly higher in patients with CHB compared with the control group (p<0.001). Twenty-two patients (44%) had advanced liver fibrosis (Ishak score >2) and 28 patients (56%) had mild liver fibrosis (Ishak score ≤ 2). Mean serum levels of ACE were significantly higher among patients with advanced fibrosis as compared with those without advanced fibrosis (60.3±14.2 U/L vs. 39.0±10.5 U/L, p<0.001). Receiver operating characteristic (ROC) curve analysis suggested that the optimum ACE level cut-off point for advanced fibrosis was 52.5 U/L (sensitivity: 81.8%, specificity: 82.1%, PPV 78.3%, NPV 85.2%, accuracy 82%, AUC: 0.890). Our study showed that elevated circulating ACE levels are commonly observed in CHB patients. This finding was more prominent in patients with advanced fibrosis in liver. When evaluating a patient along with other parameters, the inclusion of ACE levels in the evaluation of CHB patients may grant additional prognostic information.Journal of Renin-Angiotensin-Aldosterone System 01/2012; 13(2):244-9. · 2.44 Impact Factor -
Article: Liver biopsy is a superior diagnostic method in some patients showing the typical laboratory features of autoimmune hepatitis.
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ABSTRACT: To investigate whether liver diseases other than autoimmune hepatitis (AIH) can present with the typical features of AIH, and to determine the impact of liver biopsy for differentiating AIH from these conditions. The study used data collected at Hacettepe university hospital and numune education and research hospital from 2007 to 2011. The clinical, laboratory and histological findings of patients diagnosed with non-alcoholic steatohepatitis, drug-induced liver injury, primary biliary cirrhosis, primary sclerosing cholangitis, hemochromatosis and Wilson's disease were evaluated to identify those who presented with the typical features of AIH, but had no liver histology compatible with or suggestive of AIH. A total of 386 patients were evaluated, and four patients with typical features of AIH were identified. Three patients were positive for antinuclear antibodies, and one was positive for smooth muscle antibodies. Also, all four had increased levels of immunoglobulin G, and aminotransferase levels that were five times above the upper limit. According to simplified AIH criteria, all patients had a score of 6, indicating probable AIH. On liver biopsy, two patients were diagnosed with non-alcoholic steatohepatitis, another with drug-induced liver injury and a further one with primary biliary cirrhosis. Liver diseases other than AIH can present with the typical laboratory features of AIH and, without liver biopsy, it is difficult to distinguish AIH than these conditions. Although histological findings have little impact on patients' management and outcomes, for a definitive diagnosis of AIH, liver biopsy is essential and should be performed in all patients in whom it is suitable and not contraindicated.Gastroentérologie Clinique et Biologique 10/2011; 36(2):185-8. · 0.80 Impact Factor -
Article: Acute autoimmune hepatitis.
Hepatology Research 10/2011; 41(10):1015. · 2.20 Impact Factor
Top co-authors
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Institutions
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2004–2013
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Ankara Numune Training and Research Hospital
Ankara, Ankara, Turkey
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2002–2012
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Hacettepe University
- Department of Gastroenterology
Ankara, Ankara, Turkey
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