Efficacy of two levofloxacin-containing second-line therapies for Helicobacter pylori: a pilot study.

BACKGROUND: An ideal second-line therapeutic regimen for the treatment of patients who do not respond to standard triple therapy is currently being investigated. In this study, we aimed to investigate the efficacy of two levofloxacin-containing second-line therapies for Helicobacter pylori (H. pylori). MATERIALS AND METHODS: One hundred and forty eight consecutive H. pylori -positive patients who did not respond to the standard triple therapy (77 female, 71 male) were enrolled in the study. The patients were randomized consecutively to two-second-line therapy groups; 73 to the levofloxacin-containing sequential (LCS) and 75 to the levofloxacin-containing quadruple (LCQ) therapy group. The LCS therapy group received pantoprazole 40 mg and amoxicillin 1,000 mg twice daily for 5 days followed by pantoprazole 40 mg twice daily and metronidazole 500 mg three times daily and levofloxacin 500 mg one time daily for 7 days. The LCQ therapy group received pantoprazole 40 mg twice daily, tetracycline 500 mg four times daily, bismuth subcitrate 300 mg four times daily and levofloxacin 500 mg one time daily for 10 days. H. pylori eradication was confirmed by stool antigen testing at least 6 weeks after cessation of therapy. Side-effects and compliance were assessed by a questionnaire. RESULTS: Intention-to-treat cure rates were: 82.2% (95%CI; 73-91) and 90.6% (95%CI; 79-95) in the LCS and LCQ therapy, respectively. Per protocol cure rates were: 85.7% (95%CI; 75-92) and 93.1% (95%CI; 85-98) in the LCS and LCQ therapy, respectively. No statistically significant difference was found between two groups (p = .1). No differences in compliance or adverse effects were demonstrated between two groups. CONCLUSIONS: This prospective trial demonstrates that both levofloxacin-containing sequential therapy and levofloxacin-containing quadruple therapy regimens have higher H. pylori eradication rates and are well tolerated. The levofloxacin-containing quadruple therapy is likely the best treatment option for a second-line therapy, at least in the Turkish population.

Effects of Long-Term Tenofovir and Entecavir Treatment on Bone Mineral Density in Patients with Chronic Hepatitis B.

Background: We aimed to investigate the long-term effects of tenofovir disoproxil fumarate and entecavir treatment on bone mineral density and evaluated the fracture risk assessment tool score in patients with chronic hepatitis B. Methods: A total of 58 chronic hepatitis B patients treated with tenofovir disoproxil fumarate (n = 40) and entecavir (n = 18) were included in this prospective study from 2012 to 2016. To evaluate bone mineral density, dual-X-ray absorptiometry, fracture risk assessment tool, and laboratory examinations were performed in all patients first at baseline and second at the end of the study. Results: Age, sex, body mass index, fibrosis score, and viral load were similar in both groups. The mean follow-up was 33 months in the tenofovir disoproxil fumarate group and 31 months in the entecavir group. In patients treated with entecavir, there was no statistically significant difference between baseline and second bone mineral density including lumbar spine (L) and total hip T score. In patients treated with tenofovir disoproxil fumarate, there was a significant difference in the second bone mineral density compared with baseline bone mineral density for L3 (P = .033) and the major fracture risk assessment tool score (P = .03). When patients were divided into 3 groups (normal bone mineral density, osteopenic, and osteoporotic), there was a significant increase in the number of osteopenic patients in the total hip T score after tenofovir disoproxil fumarate treatment (P = .034). Conclusion: Our results suggest a decrease in the bone mineral density for lumbar spine (L3), an increase in the number of patients with hip osteopenia, and major fracture risk assessment tool score after long-term tenofovir disoproxil fumarate treatment in patients with rechronic hepatitis B.

Polypoid lesions detected in the upper gastrointestinal endoscopy: A retrospective analysis in 19560 patients, a single-center study of a 5-year experience in Turkey.

OBJECTIVE: In our study, we aimed to evaluate the endoscopic features such as prevalence and localization of polypoid lesions determined by us using esophagogastroduodenoscopy and histopathological characteristics of biopsy specimens taken in detail. METHODS: The data of 19,560 patients undergoing upper gastrointestinal endoscopy for any reason between 2009 and 2015 in our endoscopy unit were screened retrospectively and endoscopic and histopathological findings were analyzed in detail. RESULTS: In our study, the polypoid lesion was detected in 1.60% (n=313) of 19,560 patients. The most common localization of the polypoid lesions was determined to be gastric localization (n=301, 96.2%) and antrum with a rate of 33.5% (n=105). When 272 patients in whom biopsy specimen could be taken was investigated, the most frequently seen lesion was polyp (n=115, 43.4%). Hyperplastic polyps (n=81, 29.8%) were the most frequently seen type among all polyps. In histopathological evaluation of the lesions, the prevalence rates of intestinal metaplasia (IM), surrounding tissue IM, atrophy, dysplasia, and neoplasia (adenocarcinoma, squamous cell carcinoma, gastrointestinal stromal tumor, neuroendocrine tumor, and metastatic tumor) among premalignant lesions were determined to be 16.9%, 11.2%, 4.1%, 1.1%, and 3.7%, respectively. CONCLUSION: Polypoid lesions can be seen in endoscopic investigations. In histopathological investigations, while the vast majority of these lesions are benign polyps, some of them are diagnosed as premalignant or malignant lesions. In our study, we determined malignant lesions higher than the similar studies in the literature. This condition shows how effective endoscopic procedure and histopathological evaluation are of vital importance.

Evaluation of In-patients with Iron Deficiency Anemia in terms of Etiology.

OBJECTIVES: In this study, we aimed to evaluate in-patients with iron deficiency anemia concerning etiology. METHODS: In our study, we retrospectively evaluated 150 in-patients (60 male and 90 female) with iron deficiency anemia in Sisli Etfal Hospital, Department of Internal Diseases between 2005 and 2010. Anemia was defined as Hb <12 g/dl for women and <13 g/dl for men and transferrin saturation ≤15%. RESULTS: In our study, 60 male and 90 female patients were included. Analyzing the etiology of iron deficiency anemia in 150 patients, we identified erosive gastritis in 35 (23.3%) patients, gastric cancer in 15 (10%) patients, colon polyps in 14 (9.3%) patients, erosive gastritis in 14 (9.3%) patients, myoma in 14 (9.3%) patients, diverticulosis in 13 (8.6%) patients, colon cancer in seven (4.6%) patients, menometrorrhagia in seven (4.6%) patients, malabsorption in six (4%) patients, hemorrhoids in six (4%) patients, celiac disease in four (2.6%) patients, bladder cancer in three (2%) patients, hematologic malignancy in three (2%) and other diseases (unexplained etiology) in 23 (15.3%) patients. CONCLUSION: When iron deficiency anemia is detected, it may be a warning of an underlying severe illness. Reasons for many cases arise from upper and lower gastrointestinal tract diseases. Endoscopic examinations are important for diagnosis. We suggest performing gastroscopy and colonoscopy together in patients with iron deficiency anemia.

Relationship between size of varices and platelet count/spleen size ratio in cirrhotic patients.

OBJECTIVE: This study investigated the relationship between size of gastroesophageal varices and platelet count/spleen diameter ratio in cirrhotic patients. METHODS: The present study included 186 cirrhotic patients in whom gastroesophageal varices were seen during upper gastrointestinal system endoscopy. Clinical features, laboratory parameters, upper gastrointestinal system endoscopy, and abdominal ultrasonographic findings of patients were evaluated retrospectively. Platelet count/spleen diameter ratio (P/S) was calculated by dividing number of platelets in complete blood count (CBC) to largest diameter of spleen. Varices were classified as small, medium, or large, and patients were separated into two groups for comparison: those with small varices and those with medium or large varices. Of the total, 66.7 % of the patients were men (n=124) and 33.3% were women (n=62). Esophageal varices were found in 82.7% and gastric varices were found in 17.3%. RESULTS: Patients with large esophageal varices were found to have significantly lower P/S compared to patients with small esophageal varices (p=0.04). In receiver operating characteristic (ROC) curve analysis, P/S and large varices correlated with 82% sensitivity and 79% positive predictive value. However, no statistically significant correlation between size of varices and P/S was found in patients with gastric varices (p=0.78). CONCLUSION: In patients with esophageal varices, P/S was found to be correlated with large varices with 82% sensitivity. However, this ratio did not predict large varices in patients with gastric varices. Prospective and randomized clinical researches are needed to clarify our findings.