Fecal elastase 1 and vitamin D3 in patients with osteoporotic bone fractures.

BACKGROUND AND AIMS: The aim of the present study was to clarify if patients with osteoporotic bone fractures have exocrine pancreatic insufficiency, especially reduced fecal elastase 1, connected with lowered serum levels of vitamin D3 that could be relevant for predominant osteoporosis. METHODS: Between October 1999 and September 2001, we investigated on 167 patients with an average age of approx. 69 years suffering from typical osteoporotic bone fractures, as well as 20 healthy controls with an average age of 53 years. A standardized osteodensitometry via dual energy X-ray absorptiometry (DEXA) was performed in all participants. Levels of PTH, 1,25(OH)(2) Vitamin D(3), 25(OH) Vitamin D(3), calcium and phosphate in serum, elastase 1 in feces as well as the body mass index were determined in all patients and controls. RESULTS: In patients 25(OH)D3 was more than 60% and 1,25(OH)(2)D(3) was more than 53% decreased compared to controls. Fecal elastase 1 was lower than the lowest reference of 200 microg/g feces in more than 34% of the patients and it was more than 65% reduced in comparison to healthy controls (fecal elastase 1 patients: 240.7 +/- 96.3 microg/g; controls 694.9 +/- 138.6 microg/g). Separation of the patients in accordance with the elastase 1 contend in feces into four groups (below 100 microg/g, between 100 and 200 microg/g, between 201 and 300 microg/g and above 300 microg/g) resulted in significant variations for 25(OH)D(3), 1,25(OH)(2)D(3), calcium and PTH between these groups (p < 0.01). Furthermore 25(OH)D(3), 1,25(OH)(2)D(3), calcium and PTH correlated significantly with elastase 1 in feces (p < 0.01) the way, that lower fecal elastase 1 was connected with lower levels of the other parameters. BMI shows no relevant differences within the patients or between patients and controls. CONCLUSION: Exocrine pancreatic insufficiency, especially lowered fecal elastase 1, may be much more frequent in patients with osteoporotic bone fractures than suggested so far. Lowered exocrine pancreatic function with lowered fecal elastase 1 seems to be relevant as a reason for reduced levels of circulating vitamin D3 metabolites being an appropriate additional cause for predominant osteoporosis.

Parathormone levels and Vitamin D metabolism in female patients with various grades of fecal elastase 1 deficiency.

BACKGROUND: There are still too few conclusive reports about conspicuous parathormone (PTH) and Vitamin D metabolism in patients with fecal elastase 1 deficiency or any connection of the calcium metabolism to the severity of exocrine pancreas insufficiency. METHODS: Between March 1998 and September 2002, we investigated on 240 female patients with fecal elastase 1 deficiency at an average age of approx. 56.4 years and suffering from meteorism and weight loss as well as on age matched 80 healthy female controls. Serum levels of PTH, total calcium, D subset3-vitamins, calcitriol and calcefediol, as well as the concentration of fecal elastase 1 were determined in patients and controls. RESULTS: In 240 female patients with deficiency of fecal elastase 1 only two patients show milder cases of new diagnosed primary hyperparathyroidism. Calcitriol was markedly decreased (14.3 +/- 6.1 and 20.7 +/- 9.4 pg/ml) compared to controls (41.8 +/- 8.3 pg / ml) ( p < 0.01). Calcefediol was not significantly different within the various elastase-groups (p = 0.07). Nevertheless, vitamin D subset3 and fecal elastase 1 in patients correlated significantly (p < 0.01) and, compared to controls, both were extremely low (means in patients. Both D subset3-vitamins in patients were significantly lower when elastase 1 in feces was under 200 microg/g compared to the others (for calcitriol p < 0.05, for calcefediol p < 0.05). CONCLUSION: In female patients elastase 1 in feces confirm the grade of vitamin D supply, and thus show a vitamin D subset3-deficiency, depending on the loss of stool content. There seems to be a connection here between the loss of exocrine function and may be even the characteristic of sterol-binding of elastase 1 in the pancreas, which seems to be relevant for vitamin D-supply.

Alterations of vitamin D3 metabolism in young women with various grades of chronic pancreatitis.

BACKGROUND: There are still too few conclusive reports about conspicuous vitamin D-deficiency in young female patients with chronic pancreatitis, or any connection of the deficiency to the severity of the disease. Therefore the aim of this study was to examine marker of vitamin D3 metabolism in female patients with episode of biliary pancreatitis to determine if increased severity of the disease would correlate with impaired vitamin D3 metabolism. METHODS: Between 1996 and 2003, we investigated 53 premenopausal patients with an average age of approximately 33 years suffering from an episode of chronic pancreatitis, as well as 30 female healthy controls with an average age of 32.4 years. The severity of chronic pancreatitis in patients was determined via endoscopic retrograde cholangiopancreaticography (ERCP) and assigned to 1 of 3 grades based on the Cambridge classification. Additional parameter assessed were demographics, smoking, consumption of alcohol and CD-transferrin, fasting metabolic parameters, biochemical markers of vitamin D3 metabolism and fecal elastase 1. None of the patients received hormone replacement therapy, Vitamin D or Calcium-supplementation. RESULTS: The serum levels of 1,25-dihydroxyvitamin D [1,25(OH2)D] were significantly reduced compared to female healthy controls. Fecal elastase 1 correlated with this classification of severity of chronic pancreatitis (p < 0.01). Furthermore, fecal elastase 1 of patients correlated the same way with both D-vitamins (p <0.01). The level of both D3 vitamins in patients were significantly lowered when the content of fecal elastase 1 was under 200 microg/g compared to the others [for 1,25-(OH2)D3 p < 0.01; 25-OH- D3 p < 0.01]. CONCLUSION: Premenopausal patients with chronic pancreatitis are at risk of developing decreased levels of 1,25(OH2)D3. This fact may contribute to a negative calcium balance and alteration of bone metabolism. Therefore, ERCP and fecal elastase 1 verify the severity grade of a chronic pancreatitis, and thus show a vitamin D3 deficiency in young women, depending on the progress of disease.

[Plant sterols and stanols]. / Pflanzen-Sterole und Stanole--Wissenschaftliche Befunde zur Wirkung und Sicherheit.

Plant sterols and stanols are similar in chemical structure to cholesterol, differing in their side chain configuration. The mechanism by which they lower cholesterol is thought to involve inhibition of cholesterol absorption. A number of products containing plant sterols are now available. A limitation on the development of such products is the poor water solubility of plant sterols. The most common solution is to esterify plant stanols or sterols with fatty acids to enhance availability in food fats such as margarines and salad dressings. A number of studies have shown the efficacy of plant stanol- and sterol-enriched margarines for lowering cholesterol. However, there have been no studies demonstrating that consumption of these stanol ester-containing margarines influences the incidence of coronary heart disease.

Anomalous pancreaticobiliary junction (APBJ) with the drainage of the uncinate process into the minor papilla: demonstration by MRI.

We report a case of a 30-year-old patient with anomalous pancreaticobiliary junction (APBJ) that has not been described before. The patient had a clinical history of recurrent attacks of pancreatitis, cholangitis and cholecystitis that were confirmed by abnormal laboratory values. Endoscopic retrograde cholangiopancreatography revealed a 20 mm long junction of choledoc and pancreatic duct, and uncinate process draining into the minor papilla. On MR cholangiopancreatography, strictures at the junction of hepatic duct, increased gallbladder wall thickness and intraductal stone in the pancreatic duct were demonstrated as complementary findings. Other MRI findings included decreased signal intensity of the pancreas consistent with fibrosis from past pancreatitis attacks and atrophy of the left liver lobe.

Treatment of type II hyperlipoproteinemia with d-thyroxine.

The effectiveness of a new, almost l-thyroxine free preparation of d-thyroxine (Dynothel) was tested in 15 patients with Type IIa and 4 patients with Type IIb hyperlipoproteinemia. Eleven patients with Type IIa and 3 with Type IIb were responsive to treatment and showed an average 26% decrease in plasma TC. This decrement in plasma TC was mirrored in a significant reduction of LDL cholesterol in Type IIa and IIb. While VLDL cholesterol slightly decrease in Type IIb, it remained the same in Type IIa and so did the HDL cholesterol in both types. As neither VLDL nor LDL or HDL triglyceride levels changed very much in either type, the total plasma triglycerides remained the same. The plasma phospholipids were higher in Type IIa and lower in Type IIb on therapy. Thus, Dynothel seems to be a potent d-thyroxine preparation for lowering plasma cholesterol, this decrease being brought about by reduction of LDL cholesterol levels. The effect of the drug on plasma TG and PL is less certain.

Treatment of primary hypercholesterolemia: fluvastatin versus bezafibrate.

The effects of fluvastatin and bezafibrate on lipids, lipoproteins, and apoproteins (apo) were investigated in a multicenter randomized, double-blind, parallel-group study. After 8 weeks of strictly controlled (computer-based assessment) dietary stabilization, patients with primary hypercholesterolemia (low-density lipoprotein cholesterol [LDL-C] > or = 160 mg/dL; triglycerides < or = 300 mg/dL) were enrolled into a 6-week placebo phase. Altogether, 131 patients were randomized to receive either fluvastatin at 40 mg once daily (n = 64; mean age 53 years) or bezafibrate at 400 mg once daily (n = 67; mean age 52 years) for 12 weeks. Compliance with the diet was monitored (3-day food records) after 6 and 12 weeks. Fluvastatin led to significant reductions in LDL-C (-23%), total cholesterol (-17%), LDL-C/high-density lipoprotein cholesterol (HDL-C) (-24%) and apo B (-19%). Fluvastatin significantly increased LpA-I (+8%) and apo E (+20%). Bezafibrate produced significant reductions in LDL-C (-17%), total cholesterol (-13%), LDL-C/HDL-C (-24%), triglycerides (-28%), apo B (-15%), and LpA-I (-10%) and significantly increased HDL-C (+12%), apo A-I (+9%), apo A-II (+30%), apo E (+14%), and Lp(a) (+3%). No clinically notable increases in levels of liver enzymes or creatine phosphokinase were observed with either treatment. Both treatments were well tolerated. There was a low incidence of adverse events that tended to be mild and included headache, muscular pain, angina, and dyspepsia. The frequency of adverse events was similar in both treatment groups, and no significant differences in dietary behavior were observed. In conclusion, fluvastatin is a well tolerated 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor for the treatment of primary hypercholesterolemia. Effects of fluvastatin on LpA-I occur irrespective of changes in HDL-C.

Doubling the omeprazole dose (40 mg b.d. vs. 20 mg b.d.) in dual therapy with amoxycillin increases the cure rate of Helicobacter pylori infection in duodenal ulcer patients.

BACKGROUND: Several studies have shown that dual therapy with omeprazole and amoxycillin may cure Helicobacter pylori infection. However, the optimum dose of omeprazole has still to be established. METHODS: An international, randomized, double-blind multicentre trial was conducted in patients with duodenal ulcers to compare the H. pylori cure rates obtained by dual therapy consisting of either omeprazole 20 mg b.d. plus amoxycillin 750 mg b.d. or omeprazole 40 mg b.d. plus amoxycillin 750 mg b.d. for 2 weeks. Dual therapy was followed by omeprazole 20 mg once daily for 2 weeks. Before entering the trial and 4 weeks after cessation of treatment H. pylori infection was assessed by histology and a 13C-urea breath test. RESULTS: 381 patients were randomized into the study, of whom 345 were evaluable for the all-patients-treated analysis of efficacy and 378 were valid for the evaluation of safety. Histology results showed that H. pylori infection was cured in 64 out 174 patients treated with omeprazole 20 mg b.d. plus amoxycillin and in 102 out of 171 patients treated with omeprazole 40 mg b.d. plus amoxycillin (37% vs. 60%; P < 0.001). Both treatment regimens were well tolerated, with adverse events reported by 29 (15.2%) and 35 patients (18.7%), respectively. CONCLUSIONS: This study has shown that dual therapy with amoxycillin 750 mg b.d. and omeprazole 40 mg b.d. is superior to dual therapy with amoxycillin and omeprazole 20 mg b.d. in patients with H. pylori-positive duodenal ulcers. Thus, a true dose-response relationship exists between omeprazole and treatment success. However, a combination of omeprazole with two of amoxycillin, clarithromycin and nitroimidazole is a preferable alternative for routine clinical use.

Alterations of bone mineral density and bone metabolism in patients with various grades of chronic pancreatitis.

The aim of this study was to examine bone mineral density (BMD) and bone metabolism in patients with chronic pancreatitis to determine if increased severity of the disease would correlate with increased bone loss. Between October 1999 and September 2000, we investigated 42 patients with an average age of approximately 53 years suffering from chronic pancreatitis, as well as 20 healthy male controls with an average age of 49 years. Dual energy x-ray absorptiometry (DEXA) was performed on patients and controls, and serum levels of parathyroid hormone (PTH), osteocalcin (OC), carboxy-terminal propeptide of type I procollagen (CICP), bone-specific alkaline phosphatase (BAP), 1,25(OH)(2) vitamin D(3) and 25(OH) vitamin D(3), as well as fecal elastase 1 were also determined. The severity of chronic pancreatitis in patients was determined via endoscopic retrograde cholangiopancreatography (ERCP) and assigned to 1 of 3 grades based on the Cambridge classification. BMD of patients with chronic pancreatitis was markedly decreased compared to controls (means in patients: DEXA lumbar vertebra anterior/posterior (LV ap) 96.8% +/- 4.2%, DEXA Ward's triangle (WARD) 92.2% +/- 5.2%; controls: DEXA LV ap 98.7% +/- 3.7%, DEXA WARD 97.1% +/- 3.1%; P <.05 and P <.0001) and correlated with the various Cambridge-grades (DEXA LV ap and DEXA WARD, P <.01). Fecal elastase 1 showed sensitivities of 14%, 87%, and 95% for the Cambridge-grades I, II, and III, respectively, and correlated with this classification of severity of chronic pancreatitis (P <.01). Furthermore, fecal elastase 1 of patients correlated the same way with both D(3)-vitamins (P <.01), as well as with parameters of BMD (P <.01). If fecal elastase 1 in patients was below 200 micro g/g, then the BMD and vitamin D(3) values were also significantly decreased compared to those with fecal elastase 1 above 200 micro g/g. In patients with Cambridge grades II and III 1,25(OH)(2)D(3) was markedly decreased (26.7 +/- 7.7 pg/mL and 27.6 +/- 9.0 pg/mL) compared to those with Cambridge grade I (38.0 +/- 10.5 pg/mL; between I and II, P =.027; between I and III, P =.033). 25(OH)D(3) was not significantly different within the various Cambridge groups (P =.07). Compared to controls, both D(3) vitamins, as well as fecal elastase 1, were extremely low (means in patients: fecal elastase 1, 140.7 +/- 75.7 micro g/g; 1,25(OH)(2)D(3), 29.9 +/- 9.5 pg/mL; 25(OH)D(3), 26.7 +/- 9.7 nmol/L; controls: fecal elastase 1, 694.9 +/- 138.6 micro g/g; 1,25(OH)(2)D(3), 67.5 +/- 4.3 pg/mL; 25(OH)D(3), 69.5 +/- 13.5 nmol/L). A significant correlation was observed between increased severity of chronic pancreatitis based on both endoscopic retrograde cholangiopancreatography and levels of fecal elastase 1, with decreased circulating levels of vitmain D(3) and decreased BMD. This supports a connection between the inflammatory destruction of the pancreas (Cambridge classification), exocrine pancreatic insufficiency (fecal elastase 1), altered levels of vitamin D metabolites, and loss of skeletal mass.

Elastase 1 and chymotrypsin B in pancreatic juice and feces.

A chymotrypsin-like protease was detected along with elastase 1 in pancreatic secretion and stool. This enzyme was isolated from necrobiotic human pancreas, purified, partially characterized and designated as chymotrypsin B. Quantitative studies by rocket immunoelectrophoresis indicated that neither elastase 1 nor chymotrypsin B was degraded during intestinal passage. On the basis of a clinical study, both enzymes were found to reflect pancreatic function.

Prospective evaluation of novel system for jejunal feeding.

BACKGROUND: Enteral nutrition should be restored immediately after trauma, acute lesion, or surgical intervention. Nutrition through nasogastric tubes is often not feasible in patients in the posttraumatic state in medical intensive care units because of recurrent episodes of gastroesophageal reflux and subsequent aspiration due to gastric paresis. Placement of nasojejunal tubes with available techniques is unreliable. METHODS: We developed a new combined catheter system for jejunal delivery and simultaneous drainage of gastric juice (Cath-in-Cath, PreOx-RS, Germany). CONCLUSION: In this article, this new tube system is presented. The safety and excellent efficacy of the novel system for enteral nutrition therapy are reported in the first series of patients worldwide.

Pancreatic exocrine function in patients with type 1 and type 2 diabetes mellitus.

Reduced exocrine pancreatic function has been observed in a high percentage of patients with type 1 diabetes in the past. There are only few data for type 2 diabetes available and they are contradictory. In this study we investigated exocrine pancreatic function in 105 controls and 114 patients with type 1 or type 2 diabetes mellitus by means of an indirect test (faecal elastase-1 concentration). This test has good sensitivity and specificity for moderate and severe pancreatic insufficiency as compared to the gold standard. Reduced faecal elastase-1 concentrations were found in 56.7% of type 1 patients, 35% of type 2 patients and 18.1% of the controls. Elastase-1 concentrations did not correlate with alcohol consumption, diabetes duration or diabetes therapy. The data found for type 1 patients correspond to those reported in earlier studies. The results for type 2 diabetics show that exocrine pancreatic function is also impaired in a high percentage in this group of patients. Pathogenetic concepts to explain these findings as consequences of diabetes complications or insulin deficiency are still under debate. Observations from autopsies and the data of the controls in this study suggest that chronic pancreatitis might be a common problem. In consequence, diabetes secondary to exocrine disease could be much more frequent than believed so far.

Short term effects of dietary medium-chain fatty acids and n-3 long-chain polyunsaturated fatty acids on the fat metabolism of healthy volunteers.

BACKGROUND: The amount and quality of dietary fatty acids can modulate the fat metabolism. OBJECTIVE: This dietary intervention is based on the different metabolic pathways of long-chain saturated fatty acids (LCFA), which are mostly stored in adipocytic triacylglycerols, medium-chain fatty acids (MCFA) which are preferentially available for hepatic mitochondrial beta-oxidation and n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) suggested to modulate fat oxidation and storage by stimulating the peroxisomal beta-oxidation. Combined dietary MCFA and n-3 LCPUFA without LCFA may synergistically stimulate fatty acid oxidation resulting in blood lipid clearance and LCFA release from adipocytes. DESIGN: In a short term, parallel, randomized, double-blind trial effects on the fatty acid metabolism of 10 healthy volunteers (Body Mass Index 25-30) of a formula containing 72% MCFA and 22% n-3 LCPUFA without LCFA (intake: 1.500 kcal/day; fat: 55.5% of energy) were measured in comparison to an isoenergetic formula with equal fat amount and LCFA dominated lipid profile. RESULTS: The plasma triacylglycerol (p < 0.1) and cholesterol (p < 0.05) content decreased in the test group. The n-3/n-6 LCPUFA (> or = C 20) ratio increased (p < 0.0001) after 4 days treatment. The LCFA content was similar in both groups despite missing LCFA in the test formula indicating LCFA release from adipocytes into the plasma. Both groups significantly reduced body weight considerably 4 kg (p < 0.01) and fat mass up to 50% of weight loss (p < 0.05). CONCLUSION: Combined dietary 72% MCFA and 22% n-3 LCPUFA without LCFA stimulate the fatty acid oxidation and release from adipocytes without affecting any safety parameters measured.

Liquid pancreatic enzyme therapy for a patient with short bowel syndrome and chronic pancreatitis in a complicated case of Crohn's disease.

The case of a 45 year old female with multiple complications of Crohn's disease is reported. After multiple resections in the gastrointestinal tract she had been suffering from short bowel syndrome and severe malnutrition. With a special continuous gastric tube feeding system, she was able to maintain her weight for years. In the beginning of 1997 the enteral nutrition was not longer tolerated for an exacerbation of chronic pancreatitis. There was a weight loss, permanent pain and total parenteral nutrition had to be performed. In this situation a new liquid preparation of pancreatic enzymes which had been tested in the laboratory before, was used for continuous enzyme replacement via gastric tube. In combination with this enzyme preparation, enteral nutrition could successfully be started again.

Nutrition and cardiovascular disease.

The association between nutrition and coronary heart disease is mainly due to the effect of nutrients on serum lipids and lipoproteins. Cholesterol intake does not play a very important role for plasma cholesterol although there is a strong interindividual difference in response. The intake of saturated fatty acids strongly negatively affects plasma low-density lipoprotein cholesterol concentration while mono- and polyunsaturated fatty acids are generally regarded as beneficial. Omega-3 fatty acids mainly decrease triglyceride concentration while omega-6 polyunsaturated fatty acids mainly affect low-density lipoprotein cholesterol. Other nutrients which affect risk for coronary heart disease are dietary fiber, calcium, magnesium, iron, antioxidants as well as vitamins. Dietary fiber decrease intake of calories and fat, while iron and antioxidants play a role in oxidative modification of low-density lipoproteins. A low intake would lead to an accelerated uptake of low-density lipoprotein into the macrophage. Yet, intervention studies have not shown conclusively the benefit of a high-dose supplementation of the antioxidants vitamin E or beta-carotene on coronary heart disease. Homocysteine plasma concentration is influenced by folate as well as vitamin B6 and B12. Whether a high-dose supplementation with these substances does not only decrease plasma concentrations of homocysteine but also positively influence the course of coronary heart disease remains to be established.

Evaluation of ERCP- and endoscopic sphincterotomy-induced pancreatic damage: a prospective study on the time course and the significance of serum levels of pancreatic secretory enzymes.

In the present study the time courses of serum lipase, serum amylase and serum elastase 1 after ERCP/ES as indicators for pancreatic damage were prospectively analysed in 46 cases. The elevations of pancreatic enzymes after ERCP/ES scattered in a wide range and elevations occured which were greater than one hundred times the upper limit of normal. A moderate increment was seen as early as 5 minutes after intubation of the papilla. Elevations above the upper limit of normal were still seen at 24 hours after the procedure. The maxima occurred about 6 hours after the procedure. Lipase was the most sensitive among the parameters tested, nearly 50% of the cases with previously normal values revealed elevated lipase after the procedure. For daily clinical routine a single lipase measurement at 2 hours after the beginning of the ERCP/ES provides valuable information for planning further surveillance. Younger age and high calcium levels seem to be risk factors for ERCP/ES-induced pancreatic damage. The time course of serum lipase seems to be a more reliable criterion for ERCP/ES-induced pancreatic damage than the poorly defined complication of post-ERCP pancreatitis . The high incidence of a measurable pancreatic injury after ERCP/ES provides a sensitive tool for the testing of drugs claimed to be protective for the pancreas and for evaluating new ERCP/ES techniques. Measurement of the serum lipase before, 8 and 24 hours after the procedure, and a detailed description of degree and duration of pain, are necessary for such studies.

Octreotide in the prevention of pancreatic damage induced by endoscopic sphincterotomy.

Somatostatin and the long acting analogue octreotide have been proposed as a therapeutic agent in acute pancreatitis and for the prophylaxis of pancreatic damage by ERCP and EST for their ability to reduce exocrine pancreatic secretion. However, clinical trials could not show significant beneficial effects in acute pancreatitis and ERCP. In patients undergoing EST, data remained controversial, most authors describing positive effects of prophylaxis. In this study we investigated the use of octreotide prophylaxis to reduce EST-induced pancreatic damage in a randomised, double blind trial. 94 consecutive ERCP/EST-patients were randomised to receive either octreotide 200 microgram s.c. or placebo 3 times daily, starting the night before endoscopic procedures. In 59 patients EST was performed. Blood samples were collected before and 40 min, 2 hrs, 6 hrs, 24 hrs, 48 hrs and 72 hrs after the endoscopic procedures. Samples were analysed for pancreatic serum enzymes, acute phase proteins and blood counts. A clinical pain score was investigated. Post-EST-pancreatitis (amylase > 3x upper limit and persistent abdominal pain) was diagnosed in 3 patients in the treatment group, in 4 patients in the placebo group. There were no significant differences in the time-courses of serum enzymes or acute phase proteins in-between the groups, nor in the pain-score. According to these data, prophylactic octreotide application does not prevent acute pancreatic damage induced by endoscopic sphincterotomy.

The prevalence of hepatitis B virus (HBV) among Turkish immigrants in Germany.

AIM: To determine the seroprevalence of Hepatitis B (HBV) among Turkish immigrants living in Germany. SUBJECTS AND METHODS: A cross-sectional, multi-centered study was conducted among 1319 Turkish immigrants who were living in Germany and admitted to the clinics for any reason. Participants were tested for Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (Anti-HBs) and antibodies to hepatitis B core antigen (Anti-HBc). RESULTS: 37.3% of the participants were tested positive for Anti-HBc. Of these, 45.8% percent was showed positivity for anti-HBc. 25.6% of all donors were showed positive results for Anti-HBc. HbsAg seroprevalence was found as 5%. Furthermore, 90% of participants with positive HBsAg had positive results for Anti-HBc. Males had significantly higher rates of Anti-HBc and HBsAg positivity than females. CONCLUSIONS: Turkish immigrants living in Germany represented higher seroprevalence rate of HBV than total population of Germany.