Volume 62 - 1999 - Fasc.4 - Symposium
Diagnosis and treatment of hepatocellular carcinoma
Several advances have been produced in the diagnosis and treatment of patients with hepatocellular carcinoma. It is possible to diagnose the neoplasm at an early stage when radical treatment options may be applied. The criteria to apply them successfully have been refined and the expected outcome has been improved, but we still lack a useful treatment for the vast majority of patients who are still diagnosed at an advanced stage. Efforts have to be done during the next years to develop such an option (perhaps based on gene manipulation) and until then the management of this tumour will still constitute a challenge for physicians taking care of patients with this neoplasm.
NSAID use and abuse in gastroenterology : refractory peptic ulcers
With current antiulcer therapies to eliminate H. pylori infection, non-steroidal antiinnammatory drug use is the main factor involved in resistant peptic ulcers which must be defined as those ulcers that do not heal after 6 (duodenal ulcers) or 8 (gastric ulcers) weeks of treatment with proton pump inhibitors, despite H. pylori erradication. NSAID use (especially aspirin abuse) in patients with resistant ulcers is often surreptitious. "cers tend to complicate with stenosis and bleeding, commonly change site, are multicentric and have poorly defined margins. These patients should never undergo surgery unless they develop uncontrolled complications, since ulcer recurrence is the rule. Analgesic abuse and personality disorders @ght present in some of these patients. Refractory ulcers with no evidence of NSAID use and no evidence of H. pylori infection are rare but not exceptional. Smoking and genetic background seem important factors in patients with this type of ulcers. Idiopathic basal gastric acid hypersecretion might be important in a few patients, but the Zollinguer-Ellison syndrome must be ruled out.
Novel nonsteroidal anti-inflammatory drugs
The authors first briefly review how the concept of COX-2 selectivity was brought to light, then tested against the known gastrotoxicity ranking of currently used NSAIDS, from the old classics to the most recent. One truly selective COX-2 agent - celecoxib - is now being marketed in an ever increasing number of countries. So far it seems to keep its main promises, i.e. high - albeit not total - safety regarding gastrointestinal adverse effects, and undisturbed platelet function. Association with warfarin drugs seems to raise no problems, but one should still be wary of possible renal side-effects. Efficacy, at least as assessed in osteoarthritis and rheumatoid patients, appears satisfactory. However, treatment of intense inflammatory crises, such as gout or ankylosing spondylitis, has not been assessed, as yet. Another COX-2 agent - rofecoxib - is on the brink of being released. Its even more potent COX-2 selectivity raises new issues. What about some COX-1 activity that several authors detected in rheumatic synovitis ? On the other hand, in particular circumstances, organs such as the stomach, the kidney and small blood vessels, seem to have their homeostasis partly controlled by COX-2 mechanisms also. These questions should be answered soon, whilst clinical experience with the COX-2 agent builds up.
Non-steroidal antiinflammatory drugs and the intestine
Hepatitis C recurrence after liver transplantation
Hepatitis C-retated cirrhosis is the major indication for liver transplantation (LT). This disease recurs histologically in nearly all the HCV-infected patients during the first postoperative year. Chronic hepatitis C evolves to cirrhosis in 20% of the cases within 5 years after LT. However, the 5-year survival for a HCV-infected recipient is still comparable to that of a patient grafted for another indication ; it will become worse later. High vireniia after LT is associated with a more severe liver recurrent disease. The influence of viral genotype remains controversial. The impact of the type of immanosuppression on HCV recurrence is unclear. Steroids, that increase viremia, might have a deleterious effect on the outcome of chronic HCV-disease after LT. Antiviral combined therapy (Interferon + Ribavirin) soon after transplantation, before disease recurrence, is probably the best treatment at the present time; this remains still unproven. Retransplantation for HCV recurrent cirrhosis allows a 60% survival at I year. (Acta gastroeriterol. belg., 1999, 62, 428-431).
Multimodality Treatment of cancer of the digestive tube the standard in 1998. Colorectal Cancer
New drugs in chronic hepatitis B
