Volume 76 - 2013 - Fasc.3 - Original articles
Longitudinal observation of viral load changes in untreated HBeAg negative chronic hepatitis B
Introduction : An HBV DNA level of 2000 IU/ml has been used to differentiate HBeAg negative chronic hepatitis B from the inactive carrier state. We sought to examine the nature and frequency of fluctuations in viral load and ALT around this threshold.
Methods : A retrospective review of St Vincent's Hospital data- base was performed to identify patients who had been observed, untreated, with HBV DNA and ALT levels over a period of at least 18 months.
Results : 27 HBeAg negative patients with HBV DNA < 2000 IU/ ml at baseline (Group 1) and 20 HBeAg negative patients with HBV DNA = 2000 IU/ml (Group 2) were identified.
Of group 1 patients, only 8/27 had persistently normal ALT and HBV DNA persistently < 2000 IU/ml over a median followup of 24 months. 11/27 (41%) Group 1 patients showed fluctuations above 2000 IU/ml over a median of 24 months followup, most of which were transient and in the range < 20,000 IU/ml. They were accompanied by persistently normal ALT in 5/11 (45%). 8 of 20 (40%) Group 2 patients had a drop of HBV DNA to < 2000 IU/ml over followup. These had a significantly lower baseline HBV DNA (8610 v/s 208763, p = 0.03) than those that remained persistently > 2000 IU/ml.
Conclusions : Minor fluctuations in HBV DNA up to 20,000 IU/ ml, accompanied by persistently normal ALT occur frequently in HBeAg negative chronic hepatitis B. (Acta gastroenterol. belg., 2013, 76, 275-281).
Liver transplantation for alcoholic liver disease : a retrospective analysis of recidivism, survival and risk factors predisposing to alcohol relapse
Background and study aims : Alcoholic liver disease (ALD) is the second most common indication for liver transplantation. The aim of this study was to evaluate the alcohol relapse rate and long-term survival after liver transplantation for ALD and to identify risk factors predisposing to alcohol relapse.
Patients and methods : Between 2000 and 2007, 108 patients transplanted for ALD in the Ghent University Hospital were in- cluded in this retrospective analysis. Relapse was defined as any drinking after transplantation, problem drinking as more than 2 units/day for women and 3 units/day for men. A wide range of variables was obtained from a questionnaire and medical records.
Results : The mean follow-up was 55 months. Relapse was ob- served in 29%, 16% in problem drinking. The one- and five-year survival was 87% and 74% respectively. No significant difference in survival was found between non-relapsers, occasional drinkers and problem drinkers. The following risk factors were found to be significantly associated with relapse into problem drinking in an univariate analysis : a shorter pre-transplant abstinence period, the presence of a first degree relative with alcohol abuse and a high- er number of prior attempts to quit. In multivariable analysis, the presence of a first degree relative with alcohol abuse was found as- sociated with relapse into problem drinking.
Conclusions : The presence of a first degree relative with alcohol abuse is a valuable pre-transplant variable evaluating an ALD pa- tient's eligibility for liver transplantation. Other variables are also helpful to outline the broader context of the drinking behavior of the patient. (Acta gastroenterol. belg., 2013, 76, 282-290).
Response of Black African patients with hepatitis C virus genotype 4 to treat- ment with peg-interferon and ribavirin
Aim : To compare responses to therapy of Black African (BA) and non-Black African (non- BA) patients with hepatitis C virus genotype 4 (HCV-4) residing in Belgium.
Methods : In this retrospective multicenter study, 473 patients with HCV-4 were selected from databases at 7 Belgian centers ; 209 treatment-naïve patients (154 BA) had received treatment with peg-interferon (peg-IFN) plus ribavirin (RBV) and were included in the study.
Results : There was a greater percentage of female patients in the BA group than in the non- BA group ; BA patients were also older, had a greater body mass index, and more frequently had abnormal glucose metabolism. The route of contamination was more fre- quently unknown in BA than in non-BA patients and BA patients had more HCV-4 subtypes. There were no differences in other de- mographic factors between the groups. Sustained viral response (SVR) and complete early viral response rates were significantly lower and relapse rates significantly higher in BA than in non-BA patients. There were no differences between groups in rates of dose modification or in drug tolerance.
Conclusion : In our cohort, treatment-naïve BA patients with HCV-4 who were treated with peg-IFN and ribavirin had a much lower SVR rate than treatment-naïve non-BA patients with HCV- 4 who were treated with peg-IFN and ribavirin, and a higher relapse rate, possibly related to a weaker response to interferon- based therapy. Treatment may need to be adapted in this popula- tion. (Acta gastroenterol. belg., 2013, 76, 291-299).
Diagnosing oesophagitis in children : how discriminative is histology ?
Background and study aims : We set out to evaluate the discrimi- natory value of currently available histologic criteria in the differ- ential diagnosis of reflux oesophagitis and eosinophilic oesophagitis in children.
Patients and Methods : We evaluated the oesophageal biopsies of 145 children and selected 28 demonstrative cases of clinically con- firmed eosinophilic oesophagitis (n = 7), and reflux oesophagitis (n = 11) with a control group with normal histology (n = 10). Histo- logical assessment was performed for the presence of papillary elongation, dilatation of intercellular spaces, basal cell hyperplasia and the number of intraepithelial eosinophils, lymphocytes and neutrophils.
Percutaneous endoscopic gastrostomy for critically ill patients in a general intensive care unit
Background and Aim : percutaneous endoscopic gastrostomy (PEG) is an effective way of providing enteral feeding to patients with functionally normal gastrointestinal tract who cannot meet their nutritional needs because of inadequate oral intake. This ret- rospective study evaluated the clinical outcome of critically ill pa- tients with high assistance level undergoing PEG in a general ICU over a 12 year period.
Patients and Methods : we studied a cohort of 82 patients who underwent PEG over a 12-year period between 1 January 1999 and 31 December 201O.Patients were followed-up for 1 year after PEG placement.
Results : There were no complications related either to the pro- cedure or to the management of PEG, even in house nursing. In one patient, PEG with a collapsible bumper was successfully removed because the patient fully recovered from his neurological problem. Catheter substitution was necessary in three patients during the first year, because of stoma inflammation due to enteric reflux be- tween the stoma and the catheter. One year after PEG, 66 patients were still alive while 16 patients died from the underlying disease during hospitalization. None of the patients with PEG had aspira- tion pneumonia.
Conclusions : PEG, in expert hands, is a safe and effective proce- dure for enteral nutrition. Moreover, catheters should be chosen in relation to the duration of enteral feeding and as to whether the patient is likely to recover from his underlying disease. (Acta gastro- enterol. belg., 2013, 76, 306-310).
Azathioprine induced serious portal hypertension : a case series of three IBD patients and review of the literature
We report 3 male IBD patients (2 Crohn's Disease, 1 Ulcerative Colitis) developing thrombocytopenia and splenomegaly on aza- thioprine treatment. All patients were diagnosed with significant portal hypertension due to histological proven nodular regenera- tive hyperplasia (NRH) of the liver. In two of three patients, liver function tests remained completely normal.
In addition we provide a short literature review of azathioprine induced NRH covering etiology, imaging, pathology, prognosis and treatment. (Acta gastroenterol. belg., 2013, 76, 342-346).