The long-term effects of lamivudine treatment in patients with HBeAg-negative liver cirrhosis.

INTRODUCTION: In hepatitis B virus (HBV)-related liver cirrhosis, patients with HBV replication show a higher mortality rate than those without. We aimed to investigate the long-term effects of lamivudine on HBV DNA suppression, Child-Pugh score, and survival in patients with hepatitis Be antigen (HBeAg)-negative liver cirrhosis. METHODS: Sixty-eight patients (51 male, 17 female) diagnosed with HBV-positive liver cirrhosis, who were monitored by the hepatology and liver transplantation outpatient clinics of our hospital between June 1999 and May 2007, were included in the study. Lamivudine (100 mg/day) was administered orally. Follow-up visits were scheduled monthly during the first 3 months, and every 3 months thereafter. Complete blood count, haemostasis, biochemistry (aspartate aminotransferase [AST], alanine aminotransferase [ALT], amylase, urea, creatinine, total bilirubin, direct bilirubin, total protein, albumin), and alpha-foetoprotein were recorded every 3 months. HBV DNA levels, abdominal ultrasound and the Child-Pugh score were evaluated every 6 months. RESULTS: Sixty-eight patients (mean age, 52.05+/-12.6 years) were monitored for 49.51+/-18.51 months. Basal ALT, HBV DNA levels and Child-Pugh scores were 103.9+/-73.9 IU/ml, 4133+/-121,94 IU/ml, and 7.6+/-2.4, respectively. The ALT normalisation was 59.7% during the first year, 68.2% during the second year and 44.4% during the fifth year. There was a significant decrease in Child-Pugh scores in the first 3 follow-up years when compared with the baseline score (P<0.05). During the treatment, HBV DNA positivity and YMDD mutations were determined in 20 of 68 (29.4%) patients at 46+/-17.9 months. Nine patients (13.2%) developed hepatocellular carcinoma at 44.8+/-21.5 months. Thirteen patients (19.1%) died during the treatment due to liver failure or variceal bleeding. CONCLUSION: Lamivudine is beneficial in patients with HBeAg-negative liver cirrhosis in terms of improvement in liver function and enhancement of survival and quality of life. An HBV DNA suppressive effect and improvement in Child-Pugh score were seen especially in the first years. It is important to be aware of YMDD mutation early, as addition of new antivirals is necessary to overcome unwanted results of the mutation.

The rate of mucosal healing by azathioprine therapy and prediction by artificial systems.

BACKGROUND/AIMS: We aimed to assess the effect of azathioprine on mucosal healing in patients with inflammatory bowel diseases (IBD). Artificial neural networks were applied to IBD data for predicting mucosal remission. MATERIALS AND METHODS: Two thousand seven hundred patients with IBD were evaluated. According to the computer-based study, data of 129 patients with IBD were used. Artificial neural networks were performed and tested. RESULTS: Endoscopic mucosal healing was found in 37% patients with IBD. Male gender group showed a negative impact on the efficacy of azathioprine (p<0.05). Responder patients with IBD were older than the nonresponder (p<0.05) patients. According to this study, the cascade-forward neural network study provides 79.1% correct results. In addition to a 0.16033 training error, mean square error (MSE) was taken at the 16th epoch from the feed-forward back-propagation neural network. This neural structure, used for predicting mucosal remission with azathioprine, was also validated. CONCLUSION: Analyzing all parameters within each other to azathioprine therapy were shown that which parameters gave better healing were determined by statistical, and for the most weighted six input parameters, artificial neural network structures were constructed. In this study, feed-forward back-propagation and cascade-forward artificial neural network models were used.

Antineutrophil cytoplasmic autoantibodies and anti-Saccharomyces cerevisiae antibodies in inflammatory bowel diseases.

BACKGROUND/AIMS: Perinuclear antineutrophil cytoplasmic autoantibody is a marker for ulcerative colitis, and anti-Saccharomyces cerevisiae antibody is known to be associated with Crohn's disease. The purpose of this study was to search the value of detecting perinuclear antineutrophil cytoplasmic autoantibody and anti-Saccharomyces cerevisiae antibody for the diagnosis of Turkish inflammatory bowel disease patients. METHODS: Serum samples were obtained from 80 patients with ulcerative colitis, 61 patients with Crohn's disease and 40 healthy controls. Determination of both anti-Saccharomyces cerevisiae antibody and antineutrophil cytoplasmic autoantibody was performed with the standardized enzyme-linked immunosorbent assay. RESULTS: In cases with ulcerative colitis, 65% tested seropositive for antineutrophil cytoplasmic autoantibody, whereas the controls showed 2.5% positivity. In cases with Crohn's disease, 63.9% tested seropositive for anti-Saccharomyces cerevisiae antibody, whereas the controls showed 2.5% seropositivity. The combination of a positive anti-Saccharomyces cerevisiae antibody test and a negative antineutrophil cytoplasmic autoantibody yielded a sensitivity and specificity of 32.0% and 97.5%, respectively. The combination of a positive perinuclear antineutrophil cytoplasmic autoantibody and a negative anti-Saccharomyces cerevisiae antibody test yielded a sensitivity and specificity of 44.2% and 97.5%, respectively. CONCLUSIONS: Both serologic tests may aid in the differential diagnosis of inflammatory bowel disease.

Colonic tuberculosis or Crohn's disease? An important differential diagnosis.

Abdominal tuberculosis can mimic any disease affecting the gastrointestinal tract such as infectious processes, tumors, periappendiceal abscess, and Crohn's disease. The differential diagnosis of Crohn's disease and intestinal tuberculosis is a dilemma to clinicians and pathologists as both are chronic granulomatous disorders with similar clinical features. Lower gastrointestinal bleeding is an infrequent presentation of both intestinal tuberculosis and Crohn's disease. Herein, we report a 56-year-old woman presenting with massive hematochezia due to isolated colon tuberculosis in whom the initial diagnostic work-up suggested Crohn's disease and review the current literature. Our report highlights the need for awareness of colonic tuberculosis in the differential diagnosis of massive hematochezia from Crohn's disease, especially before initiating treatment with immunosuppressive agents.

Plasma transforming growth factor-beta1 level in inflammatory bowel disease.

BACKGROUND/AIMS: The aim of this study was to evaluate plasma transforming growth factor-B1 concentration in patients with inflammatory bowel disease at different stages of disease activation and to compare these values with those of healthy controls. METHODS: A total of 70 patients (31 women) evaluated in the Inflammatory Bowel Disease Clinics of TUrkiye YUksek Ihtisas Hospital, Gastroenterology Department, and 20 healthy controls (10 women) were enrolled in the study. Serum samples were obtained from 40 patients with ulcerative colitis (female/male: 18/22, mean age: 41.5+/-12), 30 patients with Crohn's disease (female/male: 17/13, mean age: 36.9+/-1.9) and 20 healthy controls (female/ male: 10/10, mean age: 32.1+/-1.7). The control group included normal blood donors without gastrointestinal complaints or a familial history of inflammatory bowel disease. Clinical activity in Chron's disease was measured by Crohn disease activity index and in ulcerative colitis patients by Rachmilewitz endoscopic index. Chron's disease patients with a Chron's disease activity index >150 and ulcerative colitis patients with a Rachmilewitz index > or =4 were accepted to have active disease. Determination of transforming growth factor-B1 level was performed with the enzyme- linked immunosorbent assay. RESULTS: Serum transforming growth factor-B1 levels were measured as: Chron's disease 1133.3+/-766.5 pg/ml, ulcerative colitis 1362.5+/-880.6 pg/ml and control group 1230.0+/-572.7 pg/ml. There were no significant differences between the three groups. In patients with active disease in ulcerative colitis, transforming growth factor-B1 level was measured as 1952.5+/-543.7, while this value was 772.5+/-750.5 in patientsin remission in ulcerative colitis. There was a significant difference between patients with active ulcerative colitis and remission ulcerative colitis. CONCLUSIONS: In inflammatory bowel disease, transforming growth factor-B1 can be used as a marker for differential diagnosis of active ulcerative colitis patients and remission ulcerative colitis patients. Nevertheless, more studies with larger patient groups are necessary.

Effects of polymorphism in G2677T/A triallelic region of MDR1 gene in Turkish patients with inflammatory bowel disease.

BACKGROUND/AIMS: Crohn's disease and ulcerative colitis are both chronic inflammatory disorders of the gastrointestinal tract, the main causes of which remain unknown. Crohn's disease and ulcerative colitis are characterized by cell-mediated immune response against the luminal bacteria. It is suggested that expression levels and function of P-glycoprotein, encoded by the MDR1 gene, are important for protection of the gut against xenobiotics and bacterial toxins. Therefore, the mutations of the MDR1 gene are thought to be related with the pathogenesis of inflammatory bowel disease. The aim of this study was to investigate the G2677T/A polymorphism in the MDR1 gene in Turkish patients with inflammatory bowel disease and a healthy control group. METHODS: In our study, the genotypes of endoscopically or histopathologically diagnosed Crohn's disease (n: 35; 14 F, 21 M) and ulcerative colitis (n: 82; 36 F, 46 M) patients and of 70 healthy individuals (39 F, 31 M) were compared. In the patient and control groups, polymerase chain reaction restriction fragment length polymorphism analysis was performed for two polymorphisms (G2677T and G2677A) of the MDR1 gene. RESULTS: In this study, the frequency of alleles at position 2677 of the MDR1 gene, which has a triallelic polymorphism, was not found to be significantly different between the patient and the healthy control groups. Moreover, the 2677A allele was not detected in either the patient group or the healthy control group. CONCLUSIONS: In this study, the G2677T/A polymorphism observed in the MDR1 gene was not found to be a risk factor for Crohn's disease or ulcerative colitis.