Volume 80 - 2017 - Fasc.2 - Original articles
Is there an association between Health Related Quality of Life, socio-demographic status and Fatigue in Patients with Chronic Hepatitis B?
Background : Chronic hepatitis B CHB) is a serious and preva- lent disease which may negatively influence health related qual- ity of life (HRQOL) and fatigue. The aim of the present study was to examine the relationship between demographic variables, HRQOL, and fatigue.
Methods : A cross-sectional study was conducted involving 418 Iranian patients with CHB (average age 44.1 years, major- ity males). Participants completed a multidimensional fatigue inventory, chronic liver disease questionnaire, Euro quality of life-five dimensions questionnaire, and demographic information. Bivariate analyses were conducted using the Spearman correlation and Mann-Whitney U test. Hierarchical logistic regression model- ing identified independent predictors of fatigue.
Results : The most prevalent problems related to HRQOL were anxiety/depression and pain/discomfort. Except for reduced moti- vation other dimensions of fatigue were significantly higher among those with CHB compared to healthy controls (p<0.05). Age, sex, education, employment, disease stage and all HRQOL subscales were significantly related to fatigue level. The Nagelkerke R Square for the logistic regression model was 0.542.
Conclusions: Poor HRQOL and fatigue are widespread among patients with CHB. Given these associations between demographic, psychological, and other HRQOL dimensions and fatigue, inter- ventions that address these factors may help to reduce fatigue in patients with CHB. (Acta gastroenterol. belg., 2017, 80, 229-236).
Prevalence of fat-soluble vitamin (A, D, and E) and zinc deficiency in patients with cirrhosis being assessed for liver transplantation
Purpose : To evaluate the prevalence of fat-soluble vitamin (A, D, and E) and zinc deficiency in patients with cirrhosis being assessed for liver transplantation and the correlations between vitamin deficiencies, nutritional markers, and severity of liver disease.
Methods : This is a single centre retrospective study. Serum vitamin A, D, E, and zinc levels were collected in adult patients being assessed for liver transplantation between January and July 2012. Patient and liver disease demographics, nutritional markers, Child-Pugh score, and MELD-Na score were collected. Fisher's exact test and multiple variable logistic regression was used for statistical analysis.
Does advanced chronic kidney disease impact transjugular intrahepatic portosystemic shunt efficacy and safety?
Background and study aims : There are currently limited data available summarizing the clinical outcomes and safety of tran- sjugular intrahepatic portosystemic shunts (TIPS) in cases of advanced chronic kidney disease (CKD). The study aimed to assess efficacy and safety of TIPS in patients with advanced CKD.
Patients and methods : Seventeen patients (M :F 8 :9, age 55 years, MELD 24) with grade 4-5 CKD who underwent TIPS for ascites (n = 7) or varices (n = 10) were analyzed. The primary outcome was TIPS efficacy - assessed by comparing paracentesis frequency and diuretic regimen pre- and post-TIPS among ascites patients - and through bleeding cessation in variceal bleeding patients. Other outcomes included hepatic encephalopathy (HE), GFR increase, and mortality.
Results : Median baseline GFR was 19.9 mL/min. No patients were hemodialysis dependent. Median post-TIPS pressure gradient was 8 mm Hg. Among ascites patients, 5/6 (83%) were TIPS responsive, with reduced or stable diuretics in 4/5 (80%). Among variceal hemorrhage cases, bleeding cessation rate was 90% (9/10). New or worsening HE incidence was 47% (8/17), and one patient required shunt reduction. Of 8 patients with lab follow-up, 6 (75%) demonstrated significant GFR increase (42.2 versus 20.0 mL/min, P = 0.028). The 90-day mortality incidence was 29% (5/17).
Conclusions : In conclusion, TIPS can potentially address ascites and variceal bleeding in advanced CKD patients, though HE incidence may be increased. Further investigation in larger cohorts may corroborate these results. (Acta gastroenterol. belg., 2017, 80, 243-248).
Percutaneous stenting in malignant biliary obstruction caused by metastatic disease: clinical outcome and prediction of survival according to tumor type and further therapeutic options
Background and study aims : Obstructive jaundice caused by metastatic disease leads to deterioration of general condition and short survival time. Successful decompression can offer symptom control and enable further treatment with chemotherapy, which can improve survival.
Patients and methods : Ninety-nine percutaneous transhepatic cholangiography (PTC) procedures with metallic stent placement were performed in 93 patients between 2007 and 2013.
Files were retrospectively studied and a review of patients' de- mographics, clinical and laboratory parameters, treatment and survival was performed. Kaplan-Meier survival analysis with log- rank test was done in function of bilirubin level, tumor type and treatment with chemotherapy.
Results : Hyperbilirubinemia resolved in 73% of procedures. Median survival time after the procedure was 48 (95%CI 34.8 - 61.1) days. If additional chemotherapy was possible, a median sur- vival of 170 (95%CI 88.5 - 251.4) days was noted versus 32 (95%CI 22.4 - 41.5) days without chemotherapy (p < 0.01).
Survival rates greatly differed between primary tumor type, with the largest benefit of PTC in colorectal cancer.
In 35 % of the procedures minor or more severe complications were noted. The 30-day mortality was 33%, with 3 procedure re- lated deaths.
Conclusions : PTC with metallic stenting can bring symptom re- lief and enable further treatment with chemotherapy, which can lead to a longer survival time, especially in colorectal cancer.
However, in patients in whom palliative stenting failed to resolve the hyperbilirubinemia survival is short. (Acta gastroenterol. belg., 2017, 80, 249-255).
Patients with History of Colonoscopy Are Less Likely to Achieve High Quality Preparation After Implementing Split-Dose Bowel Preparation
Background : Anecdotally, we observed that patients who had previous colonoscopies were less likely to follow newly implemented split-dose bowel preparation (SDBP) instructions. We investigated whether the indication for colonoscopy is an independent factor for achieving high quality bowel preparation among patients asked to follow SDBP.
Methods : We performed a retrospective study of data from 1478 patients who received outpatient colonoscopies in 2014 (the year of SDBP implementation) at our Veterans Affairs Medical Center. We collected information related to demographics and factors known to affect bowel preparations. Reasons for colonoscopy were dichotomized into surveillance (previous colonoscopy) vs. non-surveillance (positive occult blood test or screening). Bowel preparation quality was scored using the Boston Bowel Preparation Scale (BBPS), and was categorized as either excellent vs. not excellent (BBPS=7 vs. BBPS<7), or adequate vs. inadequate (BBPS=6 vs. BBPS<6).
Results : Bowel preparation quality was excellent in 60% of colonoscopies and adequate in 84% of colonoscopies. Thirty-six percent (535) were surveillance colonoscopies. In multivariate logistic regression analysis, more patients in the non-surveillance group achieved excellent (OR
0.8 ; 95% CI [0.7-0.8], P <0.0001) and adequate (OR 0.8 ; 95% CI [0.7-0.9], P <0.006) bowel preparation than did patients in the surveillance group.
Conclusion: Patients with a prior colonoscopy might not follow the split-dose bowel preparation instructions. Educational interventions emphasizing the benefits of SDBP in this group of patients may help ensure compliance and prevent the habitual use of day-before preparations. (Acta gastroenterol. belg., 2017, 80, 257- 261).
The safety and efficacy of ERCP in octogenarians: a comparison of two geriatric age cohorts
Background/Aims : The application of endoscopic retrograde cholangiopancreatography (ERCP) in the octogenarian population is limited. The aim of the study was to compare the clinical characteristics and outcomes of ERCP in octogenarian patients with non-octogenarian elderly patients.
Materials and Methods : A total of 1044 patients who underwent ERCP for the first time and are over the age of 65 were enrolled in this study. Data regarding demographic characteristics, medical history of patients, indications, technical success rate, final clinical diagnosis and complications were analyzed. 284 patients and 760 patients composed the octogenarian and non-octogenarian group, respectively.
Results : The mean ages in octogenarian and non-octogenarian groups were 83.99±3.85 and 71.50±4.27 years of age respectively. Both groups had similar values with regards to chronic concomitant diseases (96.6% vs. 96.5%). The most common indication of ERCP in the two groups was common bile duct stones. There was no significant difference in technical success and failure of cannulation in procedures of either group (p > 0,05). The duration of overall ERCP procedure was shorter in length in the non-octogenarian group in comparison to the octogenarian group (p = 0.004). The overall complication rate was similar in both groups (p > 0.177). The most common complication in either group was post-ERCP pancreatitis.
Conclusions : ERCP is an effective and safe procedure in both octogenarian and non-octogenarian patients with naive papilla when performed by experienced endoscopists. (Acta gastroenterol. belg., 2017, 80, 263-270).
Apoptosis and Disease Severity is Associated with Insulin Resistance in Non- alcoholic Fatty Liver Disease
Background & Aims : Non-alcoholic fatty liver disease (NAFLD) is associated with insulin resistance (IR). We evaluated whether IR contributes to hepatocyte apoptosis, inflammation, and fibrosis in NAFLD.
Methods: Forty-four teetotaller patients with biopsy-proven diagnosis of NAFLD were enrolled. Twenty-eight NAFLD patients with IR were compared with 16 subjects without IR. For apoptotic activity caspase 3 and 8, transcription nuclear factor kB (NF- kB), and anti-apoptotic Bcl-2 protein were determined through immunohistochemical methods.
Results: HOMA-IR index was significantly correlated with the stage and caspase 3- and 8 levels (p= 0.001, 0.02, and 0.01, respectively). HOMA-IR index was independently associated with the severity of fibrosis (? = 5.9, p = 0.001), caspase-3 (? = 0.16, p = 0.001), and caspase-8 (b =0.032, p = 0.018) levels. TNF-sRp55 level was positively correlated with HOMA-IR index (p = 0.024). Patients with IR had significantly higher necroinflammatory grade, stage, caspase-3, and caspase-8 levels than those without IR (p = 0.022, 0.007, 0.031, and p = 0.011, respectively). HOMA-IR index had statistically significant values for distinguishing of severe necroinflammatory grade, stage and for differentiating NASH from simple fatty liver (AUC = 0.78, 0.76, and 0.82, respectively). Conclusion: This study demonstrates that IR in NAFLD is associated with enhanced hepatocyte apoptosis and histopathologic disease severity. These data indicate that NAFLD patients with IR may have increased risk for disease progression. (Acta gastroenterol. belg., 2017, 80, 271-277).
The knowledge and expectations about IBD - difference between pediatric patients and their parents
Background and study aims : The aim of this prospective survey was to determine and compare the knowledge of children with inflammatory bowel disease (IBD) and their parents about their disease. Furthermore, patients and parents were ask to provide the main source for disease related information and to give opinion for possible improvement.
Patients and methods : This was a prospective survey which included children with IBD with = 12 years of age and their parents. Only ambulatory patients treated in tertiary medical center were included.
Results : 38 child/parent pairs (79% mothers) were enrolled. Major differences between parents and children were in a) internet search where majority of parents (n = 28 ; 73.7%) and only 17 (44.7%) children gathered disease related information over the internet (p = 0.01) ; b) need for participation in patients' organization (97.4% parents comparing 55.3% children would like to participate ; p<0.001) and c) clinical practice with time reserved for child/adolescent to be with his/her physician alone (78.9% of parents encourage this practice comparing to 2.6% of children ; p <0.001).