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Volume 68 - 2005 - Fasc.4 - Original articles

The HepCar registry : report on a one-year registration program of hepato- cellular carcinoma (HCC) in Belgium. What is daily practice in HCC?

Introduction : Due to a rise in HCV induced liver cirrhosis, hepatocellular carcinoma becomes more prevalent in Western European countries. The HepCar registry is an initiative in which patients with hepatocellular carcinoma, their treatment and follow up are registered. Materials and Methods. Belgian physicians were asked to report all new cases of hepa- tocellular carcinoma which were seen between January 2003 and December 2003. Reporting was done on a voluntary basis. Data reported were : demographic figures, the nature of the underlying liver disease, presentation characteristics of the tumour, laborato- ry findings and choice of therapy. Every six months, a reminder was sent to determine survival. Results : 131 patients (94 male/37 female) were reported. Mean age was 63 years ± 13. Underlying liver disease was HCV (n = 54, 41%), HBV (n = 22, 17%), alcoholic liver disease (n = 39, 30%) and miscellaneous (n =16, 12%). Diagnosis of hepatocellular car- cinoma was made by surveillance in 47 (36%) patients. After logis- tic regression, survival was 5 times better for patients inside the Milan criteria (one lesion less than 5 cm in diameter or less than 3 nodules each less than 3 cm in the absence of vascular invasion and metastasis). Discussion : Tumours inside the Milan criteria have a better survival. The majority of the patients have an underlying cirrho- sis as background for the development of a HCC. (Acta gastro- enterol. belg., 2005, 68, 403-411).


Feasibility of Endoscopic Ultrasound-guided Portal Vein Embolization with Enteryx

Background : Portal vein embolization (PVE) has been used as a preoperative strategy to induce hepatic lobar atrophy and con- tralateral lobe hypertrophy. We determined the feasibility of endo- scopic ultrasound (EUS)-guided Enteryx (EVAL/ethylene-vinyl alcohol copolymer) embolization of the portal vein (EUS-PVE) in an animal model as a potential, minimally invasive, endoscopic technique. Methods : EUS-guided embolization of the portal vein (EUS- PVE) using Enteryx was performed in a Yorkshire breed swine. Portal pressure measurements were obtained before and after vas- cular embolization. The animal was carefully monitored for seven days for evidence of abdominal pain, shock, or bleeding. An upper abdominal contrast-CT scan was performed to verify the location of the embolus. Results : The PV pressure increased from 3 mmHg at baseline to a mean of 15 mmHg after EUS-PVE. The CT-scan on day 4 demonstrated Enteryx in the main portal vein with extension into the left branch. At sacrifice on day 7, a solid thrombus was visible grossly and histologically inside the main portal vein and the left branch of the portal vein. Conclusions : Selective embolization of the portal vein by EUS guidance appears to be feasible and a potential, minimally inva- sive, preoperative treatment option for patients undergoing exten- sive hepatectomy(Acta gastroenterol. belg., 2005, 68, 412-415).


Prokinetic Agents in Childen with Poor Appetite

Background : Of the feeding disorders in children, poor appetite is probably one of the most common complaints notified by parents. Since gastric motility disorders may be the cause of this symptom, the aim of our study was to investigate the effect of prokinetics on children with poor appetite and delayed gastric emptying. Methods : Poor appetite was graded by VAS at start and end of treatment. Delayed gastric emptying was assessed by 99mTechnetium tincolloid scintigraphy. Malnutrition was defined according to Water- low criteria. After initial assessment behavioural feeding recommen- dations were provided and trimebutine given for 6 months. Scinti- graphy was repeated during treatment. Anthropometrical measure- ments and daily energy intake calculations were performed monthly Results : 21 children (M/F : 12/9) with a mean age of 7 ± 3 years were studied. At the end of treatment, weight and height standard devi- ation scores improved significantly (-1.0 ± 0.6 vs. -0.8 ± 0.7, p = 0.008 and -1.1 ± 1.0 vs. -0.8 ± 0.9, p=0.003, respectively) and malnutrition rate decreased from 81% to 66.7%. Improvement of gastric emptying was shown in 11 out of 16 children but was not statiscally significant (P = 0.059). The visual analogue scale scores of appetite showed sig- nificant improvement with therapy (7.5 ± 1.3 vs. 5.3 ± 2.0, p = 0.012). Conclusion : Children with poor appetite who have delayed gastric emptying might benefit from prokinetic agent therapy combined with behavioural feeding recommendations (Acta gastroenterol. belg., 2005, 68, 416-418).


What is the role of celiac disease in enteropathy-type intestinal lymphoma ? A retrospective study of nine cases

Background and aims : It is generally accepted that enteropa- thy-type intestinal lymphoma (EATL) arises against a background of gluten enteropathy. We investigate whether patients with this diagnosis had celiac disease or pre-existing celiac disease, based on gliadin and endomysium antibodies, as well as duodenal biopsies, HLA typing and response to gluten-free diet. Methods and results : Retrospective study of patients with the diagnosis of peripheral T cell lymphoma of the intestine between January 1990 and January 2002 at the university hospital Gasthuisberg Leuven (n = 14). Patients in whom serologic testing was performed or patients known with pre-existing celiac disease (CD) were included (n = 9). Six of these nine patients were tested for endomysium antibodies (AEM), none of them were positive. Of the six patients with biopsies of mucosa uninvolved by lymphoma, all of them had villous atrophy ; five had increased intraepithelial lymphocytes (IEL). In the four patients were HLA typing was per- formed, the results were compatible with CD. The three patients with initially diagnosed celiac disease all improved on gluten free diet (control biopsies improved as well, but failed to normalise). Of the six other patients, one patient never started GFD, two didn't get better, one initially went better after GFD, and one went better with the concomitantly started chemotherapy. Conclusion : There are two possible explanations : Either these patients with EATL have indeed gluten intolerance but the sensi- tivity of AEM is overestimated in this patient population ; or these patients don't have gluten intolerance and EATL itself can mimic CD or other factors mimicking CD are at risk for developing EATL (Acta gastroenterol. belg., 2005, 68, 419-423).


The prevalence of liver function abnormalities in pediatric Celiac disease patients and its relation with intestinal biopsy findings

Abnormal liver function tests and liver damage are seen fre- quently with celiac disease. However, the pathogenesis of liver functions abnormality is not clearly understood. The aim of this study was to determine the frequency of abnormal liver functions in children with celiac disease and its relation with anthropomet- ric measurements and severity of intestinal damage. Patients and methods : Twenty seven patients with celiac disease were included in the study. Anthropometric and laboratory exam- inations and intestinal biopsies were performed in all the patients. Mucosal lesions were classified according to the Marsh classifica- tion. Villous area, crypt height and mitotic count were measured morphometrically for all biopsy samples. Results : The mean age of patients was 6 ± 5 years on admis- sion. Alanine aminotransferase levels were normal (group 1) or elevated (group 2) in 20 and 7 patients, respectively. The mean ala- nine aminotransferase levels were 22.0 ± 7.2 in group 1 and 70.5 ± 31.1 U/L in group 2 patients, (p < 0.001). Complaints, mean age, height for age, weight for height, serum albumin level, villous area, crypt height and mitotic count were not significantly different between the two groups. Similarly, the ratio of Marsh classifica- tion was not significantly different between the two groups. All patients were given a gluten-free diet. Serum aminotransferase values returned to normal after 7.4 ± 2.7 months of a gluten-free diet. Conclusion : Abnormalities of liver functions are frequently seen in paediatric celiac disease patients. These abnormalities are not correlated with malnutrition and severity of intestinal mucos- al lesions. Liver enzyme activities return to normal levels in a few months after gluten-free diet (Acta gastroenterol. belg., 2005, 68, 424-427).