Volume 87 - 2024 - Fasc.2 - Original articles
How to better improve the treatment and outcomes of HCV in psychiatric patients: review of a Belgian monocentric psychiatric center
Introduction: Hepatitis C (HCV) is one of the major worldwide
infections with 58 million infected persons in the world. HCV can
lead to chronic liver disease, cirrhosis, and cancer. These past
few years, clinical progress allowed a curative rate of 95% of the
patients. There are still populations in which, treating the disease
is more difficult, especially psychiatric patients, when substance
abuse, psychiatric disorders are important risks factors for getting
HCV. With the WHO organization establishing goals for clinical
management and treatment of HCV, it is important to target where
the difficulties lie in getting a better treatment program for those
populations.
Aim: Try to highlight the challenges of treating a certain group
of patients compare to the general population.
Method: This is a cross sectional monocentric study. 79
patients from a mental facility were included between 2012 and
2022. Inclusion criteria were: >18 years old, an active viral HCV
infection.
Results: 34.7% of patients with a positive PCR were treated
with a significant difference between the closed psychiatric unit
and the open one (66.5 vs 22.6%, p<.05). There was an 82.4%
eradication rate (Sustained Viral Response at 3 months). There
were significantly more schizophrenic disorders in the closed unit
and significantly more alcohol abuse in the open one.
Conclusion: Treatment of HCV in a psychiatric population is
feasible with eradication rate equivalent at those in the general
population. Patients with more severe mental illness are better
treated in the configuration of a closed psychiatric unit.
Diagnosing and managing irritable bowel syndrome with predominant diarrhoea in clinical practice: online survey among gastroenterologists and general practitioners
Introduction: Irritable bowel syndrome (IBS) represents the
most common disorder of gut-brain interaction encountered in
clinical practice. The Rome IV criteria define the disorder. Over the
years, many guidelines proposed guidance during the diagnostic
and therapeutic approach of patients with presumed IBS.
Aim: This study investigates the management of IBS with
predominant diarrhoea (IBS-D) by Belgian gastroenterologists
(GE) and general practitioners (GP) in daily practice.
Methods: An online vignette-based survey was conducted
exploring the diagnostic and therapeutic approach of patients
suffering from IBS with predominant diarrhoea (IBS-D) in
primary and secondary care.
Results: 64 GE and 31 GP completed the survey. Abdominal
pain and discomfort led to an IBS diagnosis in 88% and 84%
of cases, respectively. The diagnosis rate dropped to 58.3% with
diarrhoea as main presentation and 26.8% for patients aged 65.
Additional tests were ordered by 89.5% of physicians, including
biochemistry (77.9%), stool culture and parasites (59.3%), iFOBT
(60.5%), breath testing (17.4%), imaging (12.8%), and endoscopy
(9.3%). Upon normal results, 57% of physicians did not order
further investigations. Both GP and GE preferred spasmolytics
(64.3%) and dietary interventions (23.9%) as first-line treatment
for IBS. Second-line treatment options included referral to a
specialist or colleague (19.4%), dietary intervention (22.6%),
neuromodulators (19.4%), and spasmolytics (14.5%). No GP
initiated neuromodulators.
Conclusion: In Belgium, abdominal pain or discomfort are
equivalent cardinal symptoms when diagnosing IBS. During the
further diagnostic and therapeutic approach most physicians
order only limited additional non-invasive testing. Spasmolytics
and dietary interventions are favoured in first-line. Upon failure,
only GE prescribe neuromodulators, while GP opt for referral.
These findings are consistent with the general principles and
recommendations outlined in the recently published Belgian
guideline for IBS. (
Bismuth-based quadruple therapy versus standard triple therapy for the eradication of Helicobacter pylori in Belgium: a multicentre, non-blinded randomized, prospective study
Background: Helicobacter pylori (Hp) infection predisposes to
malignant and non-malignant diseases warranting eradication. In
Belgium, resistance rates for clarithromycin demonstrate regional
variations making the use of standard triple therapy (STT)
borderline acceptable. According to a recent Belgian survey, STT
and bismuth-based quadruple therapy (BQT), are equally frequent
prescribed as first line treatment for treatment naïve Hp positive
patients. This study aims to evaluate the eradication rates (ER) of
BQT versus STT.
Methods: Multicentre, non-blinded randomized, prospective
study comparing ER in treatment-naïve Hp positive patients. ER
were compared by intention to treat (ITT) and per protocol (PP)
analysis.
Results: Overall 250 patients were included (STT 126, BQT 124).
Seventeen patients were lost to follow-up (6,8%). No significant
difference in ER between BQT and STT was observed in ITT (73%
vs 68%, p= 0,54) neither in PP analysis (81% vs 75%, p= 0,33). Side
effects and endoscopic findings were comparable between groups.
Post-hoc analysis showed no differences according to gender or site
allocation.
Conclusion: The numerical advantage of BQT did not translate
in a significant improvement of ER when compared with STT. These
results question the cost-effectiveness of BQT, while confirming the
suboptimal eradication rates on STT. A nationwide monitoring of
resistance patterns, maximal investments in treatment adherence
as well as a detailed follow-up of the changing treatment landscape
are mandatory to continuously optimise Hp ER in Belgium.
Exploring parental thoughts and clinical experiences on blended food in a paediatric population, a qualitative study
Background: There’s a growing interest in blended food (BF) as
an alternative to commercial food (CF) for tube-fed children. Thus,
we investigated parental and medical experiences with BF as an
option for tube feeding in children
Methods: In this cross-sectional study, all patients were already
using BF, chosen by parents. In March 2022, all patients using BF
provided consent and completed a questionnaire assessing their
experiences. Medical data were collected retrospectively from
patient charts, including biometric changes, dietary adjustments,
and nutritional status. A non-validated parent satisfaction score
was computed from 17 questions, rated on a scale from one to
five. A score of ≥ 51 points, indicating an average score of > 3 per
question, was deemed indicative of a positive parental experience
with BF.
Results: Nine children receiving BF were identified (median
age: 4.7 years; weight: 14.9 kg; 66% male). All parents were
satisfied with BF, reflected in the parent satisfaction score. Parents
cited reduced feeding-related discomforts as the main reason for
switching to BF. Weight (+0.3 SD) and length (+0.5 SD) showed
positive changes. None discontinued BF, though modifications were
made for five patients by the dietician. Nutritional deficiencies,
mainly iron with or without zinc deficiency, were observed in four
patients, with uncertain onset due to lack of pre-BF laboratory
testing.
Conclusions: In this small BF cohort overseen by an experienced
multidisciplinary team, BF was well tolerated, resulting in high
parental satisfaction and maintaining good nutritional status.
Continued PPI use and gastrointestinal evaluations after a negative pH study in patients with throat symptoms from possible extraesophageal GERD
Background: Recent guidelines have advocated for upfront
pH testing in patients with isolated symptoms of extra-esophageal
gastrointestinal reflux disease (EE-GERD) under the assumption
that a negative pH study will prevent further gastrointestinal (GI)
investigations, proton pump inhibitor (PPI) use, and reduce cost.
We sought to evaluate if this actually occurs.
Methods: A retrospective study was performed on patients who
underwent 24-hour combined pH-impedance testing off PPI for
suspected EE-GERD. A negative study was defined as DeMeester
score <14.7.
Results: 59 patients were included (mean age 53.2; 50.8%
women). Most (38, 64.4%) had a negative study. Findings of
laryngopharyngoreflux on laryngoscopy did not predict pH results.
Those with a negative study had the same number of followup
GI appointments, repeat endoscopies, and repeat pH studies
compared to those with a positive study (p=NS). While PPIs were
more frequently stopped in those with a negative pH study, still
14 (36.8%) were continued on a PPI. At the end of the follow-up
period (mean 43.6 months), 18 (47.4%) subjects with a negative
pH study were still prescribed PPIs. Patients who were diagnosed
with post-nasal drip or rhinits were significantly less likely to still
be receiving a PPI (5.6% vs 35.0%, p=0.045).
Conclusions: Despite a negative pH study, a substantial number
of patients with isolated EE-GERD symptoms are continued on a
PPI and they undergo GI follow-up at the same rate as those with
a positive study. These findings bring into question the recent
recommendations for upfront pH testing in suspected EE-GERD
and its reported cost savings.
SARS-CoV-2 antibody vaccine response in Inflammatory Bowel Disease patients with positive anti-nucleocapsid serology or history of COVID-19 infection
Background: Previous history of COVID-19 infection is a
natural booster of the vaccine response in the general population.
The response to COVID-19 vaccines is lessened in Inflammatory
Bowel Disease patients on selected class of immunosuppressive
treatments.
Aims: The study was to assess anti-SARS-CoV-2 spike-specific
IgG antibody response in Inflammatory Bowel Disease patients
with a history of COVID-19 infection.
Patients and methods: This single-center prospective study
involved 504 Inflammatory Bowel Disease patients. Demographic
data and clinical data were gathered through questionnaires
and patient charts. Anti-SARS-CoV-2 spike-specific and antinucleocapsid
antibody levels were measured at T1, T2 (after the
2-dose series), and T3 or T4 (booster vaccine).
Results: This study included 504 Inflammatory Bowel Disease
patients, and 234 completed one year follow-up with blood tests.
Positive anti-nucleocapsid serology or history of COVID-19
infection was significantly associated with increased median anti-
SARS-CoV-2 spike-specific IgG titers after the 2-dose series (1930
BAU/mL vs. 521 BAU/mL p < 0.0001) and the booster vaccine (4390
BAU/mL vs. 2160 BAU/mL, p = 0.0156). Multivariate analysis
showed that higher anti-SARS-CoV-2 spike-specific IgG levels
were independently associated with anti-nucleocapsid antibodies
at T2 (OR=2.23, p < 0.0001) and T3 (OR=1.72, p = 0.00011).
Immunosuppressive treatments did not impact the antibody
response or levels in patients with a history of COVID-19 infection
or positive anti-nucleocapsid serology.
Conclusions: In Inflammatory Bowel Disease, prior COVID-19
infection or positive anti-nucleocapsid serology leads to increased
anti-SARS-CoV-2 spike-specific IgG levels after vaccination,
regardless of immunosuppressive treatments. This emphasizes
the significance of accounting for previous infection in vaccination
approaches.
Different aspects of immunological profile in patients with Non-Alcoholic Fatty liver disease
Background: NAFLD is thought to affect approximately one-fourth of the world’s population. Therefore, we evaluated the role of serum complement and immunoglobulins in the NAFLD pathogenesis.
Patients and methods: 200 participants were used in this study, divided into two groups; Group I: 100 NAFLD patients and Group II: 100 healthy volunteers. The diagnosis of NAFLD is based on non-invasive methods, following the EASL guideline 2022. IgG, IgM, IgA, C3, and C4 assays were performed on all participants.
Results: When the immunological profiles of patients with NAFLD and healthy controls were compared, it was found that the mean IgA in NAFLD patients was (4.20±5.07), whereas the mean IgA in healthy controls was (2.22±1.05) (P=0.000). Additionally, a significant increase in IgG was found in NAFLD patients (17.08±3.87) compared with healthy controls (11.59±3.34), with a P value of (p<0.001). complement C3 and complement C4 levels significantly increased in nonalcoholic fatty liver disease patients (1.28± 0.61 and 0.40 ± 0.19, respectively), compared to healthy controls (0.90 ±0.27 and 0.30 ±0.12, respectively), with a significant P value (p<0.001 for each).
Conclusions: Elevated IgA, IgG, C3 and C4 exist in patients with NAFLD and could be associated with fatty liver development and progression of hepatic fibrosis in patients with NAFLD.
Evaluation of patients with positive anti-mitochondiral antibody and normal alkaline phosphatase levels for primary biliary cholangitis
Primary Biliary Cholangitis (PBC) is a chronic cholestatic liver disease typically diagnosed by elevated cholestatic liver enzymes and a positive anti-mitochondrial antibody (AMA) test. The clinical importance of AMA positivity in patients with normal cholestatic liver enzymes is unclear. The aim of this study was to determine the relationship between PBC and AMA positivity detected in individuals with normal cholestatic enzyme levels. The files of patients with AMA and/or AMA-M2 positivity between 2009 and 2018 and whose alkaline phosphatase (ALP) levels were below upper limit of normal (ULN) at initial admission were retrospectively analyzed. The ALP levels were normal in all patients. All patients had AMA positivity demonstrated by indirect immunofluorescence (IIF) or AMA-M2 positivity demonstrated by ELISA. A total of 16 patients underwent liver biopsy and seven (43.75%) showed changes consistent with those with PBC. A total of 12 patients were diagnosed with PBC and were treated and followed up with this diagnosis.
People with AMA positivity and normal cholestasis enzyme levels are closely associated with PBC. Some of these patients were diagnosed with PBC as a result of biopsy and some were diagnosed by clinical and laboratory findings during follow-up.. The patients with an AMA titration of 1/20 were not associated with PBC. In our study, results similar to the studies confirmed by biopsies were obtained. In this regard, there is a need for prospective and retrospective studies with longer follow-up periods.
