Volume 72 - 2009 - Fasc.4 - Symposium
Sexually transmitted diseases and anorectum
Sexually transmitted diseases (STD) are a major public health problem because their incidence is increasing worldwide despite prevention campaigns and because they raise the risk of HIV infec- tion. Anorectal localisations of STD are common among men who have sex with men (MSM) but can also be seen among hetero- sexuals (men or women). Transmission of such infections is due to anal sex or to other sexual behaviours like "fisting".
Although some pathogens (like Human Papillomavirus-HPV) are common in gastroenterologist/proctologist consultations, others are not so well-known. Furthermore during the last years, sexual risky behaviours have led to resurgence of old affections (like syphilis) or to emergence of unknown diseases (like lymphogranuloma venereum) in our countries.
This presentation tends to focus on clinical manifestation, diag- nosis and treatment of different STD : HPV, Herpes Simplex Virus, Neisseria gonorrhoeae, Chlamydia trachomatis (in particularly lym- phogranuloma venereum) and Treponema pallidum. (Acta gastro- enterol. belg., 2009, 72, 413-419).
Virological tools for optimal management of chronic hepatitis C
Serological and virological tests are useful in management of HCV patients, and include anti-HCV antibody assays, measure- ment of HCV RNA and HCV genotyping. They are used to diag- nose infection, initiate treatment and assess the virological response to antiviral therapy. Monitoring of viral kinetics during the early phases of antiviral treatment is crucial in making treat- ment decisions concerning arrest of treatment and optimization of its duration. A 2-log drop in viral load at week 12 (early virological response) has good negative predictive value when assessing the sustained virological response (SVR), as most patients without a 2- log drop in viral load at week 12 will not attain a SVR. In contrast, undetectable HCV RNA at week 4 (rapid virological response) has good positive predictive value, as patients with undetectable HCV RNA at week 4 have high probability of reaching a SVR. Recent data suggest that some rapid responders can be treated for shorter periods than usually recommended without compromising their chance of a sustained response. On the other hand, slow virological responders infected with genotype 1 should be treated longer to increase the probability of viral eradication. Future studies should focus on identification of the earliest criterion which is both highly sensitive and highly specific in order to predict early SVR and non- response, as well as to avoid useless treatment prolongation. (Acta gastroenterol. belg., 2009, 72, 421-424).
Hemostasis in patients with liver disease
In patients with liver disease alterations in the hemostatic system frequently occur. Although it was generally believed that these changes result in a bleeding tendency, laboratory models and clinical data have shown evidence for a rebalanced hemostasis in liver disease, as a result of a concomitant decrease in both pro- and antihemostatic systems. The rebalanced system presumably has much narrower margins as compared to healthy individuals and therefore can more easily turn to either a hypo- or hyper- coagulable state.
Bleeding does occur in patients with liver disease but this is fre- quently related to non-hematological factors, for example bleeding from ruptured esophageal varices. Further clinical data support- ing the concept of rebalanced hemostasis include the lack of major blood loss in a great proportion of patients during liver transplan- tation and the fact that patients with liver disease are not fully protected from thromboembolic complications including venous thrombosis and thrombosis of the hepatic vessels.
It is still common practice to prophylactically treat patients with liver disease prior to invasive procedures to prevent bleeding. Because of a lack of data supporting the effectiveness of this management and the proven side-effects of transfusion of blood products, we believe transfusion of blood products can and should be restricted.
The most important thrombotic problem after liver transplanta- tion is hepatic artery thrombosis, a potentially devastating compli- cation. Since the bleeding tendency in patients with liver disease may not be primarily caused by a deranged hemostatic system, the restricted use of anticoagulant drugs in the post-transplant setting should be reconsidered. (Acta gastroenterol. belg., 2009, 72, 433- 440).
