Volume 78 - 2015 - Fasc.4 - Original articles
Ethnic epidemiological profiles and antiviral therapy among patients infected with hepatitis C virus genotype 4 : a multicenter study from Belgium
Background : Hepatitis C virus genotype 4 (HCV-4) is the most prevalent genotype in Central Africa.
Aim : To compare epidemiology, clinical characteristics and any differences in access to HCV therapy in two populations of HCV-4 patients residing in Belgium.
Methods : This multicenter study selected 473 HCV-4 patients from seven hospital databases and compared them according to ethnic origin, i.e., Black African (n = 331) or not (n = 142), for epi- demiological, clinical, biological and histological characteristics. Interleukin 28B polymorphism (CC-genotype) was evaluated in a second cohort of 69 Black African and 30 non-Black African pa- tients.
Results : Compared to other patients, the Black African patients were more likely to be female and were older, commonly over- weight, frequently had abnormal glucose metabolism and arterial hypertension ; they were less likely to have dyslipidemia, a history of alcohol consumption or ALT elevation. The route of infection was more frequently unknown in Black African than in other pa- tients. Black African patients had more HCV-4 subtypes, were less frequently of IL28B CC-genotype and had less severe liver fibrosis. The proportion of patients who received antiviral treatment was similar in the two groups.
Conclusion : In this Belgian cohort, patients with HCV-4 infec- tion were more frequently of Black African origin than of other origin. Infected Black African patients were more commonly female, older at diagnosis, and had more co-morbidities than other patients ; they also had less advanced liver fibrosis than infected non-Black African patients and fewer had a CC genotype. (Acta gastroenterol. belg., 2015, 78, 365-372).
Validation of APRI and FIB-4 score in an Antwerp cohort of chronic hepatitis C patients
Background and aims : Evaluation of liver fibrosis in chronic hepatitis C patients guides clinical decision-making. The aim of this study is to validate APRI and FIB-4, two easily calculated non- invasive tests to predict fibrosis, in chronic HCV patients using biopsy as a gold standard and to compare accuracy between HCV monoinfected and HIV/HCV coinfected patients.
Patients and methods : We retrospectively studied HCV patients of two centres who underwent liver biopsy. Liver fibrosis was staged according to METAVIR.
Results : 136 patients were included. The AUROC of FIB-4 (0.896) to discriminate F0-F2 vs. F3-F4 was significantly higher (p = 0.0186) than the AUROC of APRI (0.842). The difference in AUROC between HIV-negative and positive patients was not significant for APRI (p = 0.471), nor for FIB-4 (p = 0.495). Perfor- mance status was lower in HIV-positive patients with 46.7% and 69.0% of patients correctly classified using APRI and FIB-4, com- pared to 56.6% and 73.6% in HIV-negative patients, respectively. Conversion of transaminase values from one hospital to the other did not significantly change the AUROC of FIB-4 (p = 0.928).
Conclusions : APRI and FIB-4 have a better performance status in HCV monoinfected patients compared to HIV/HCV coinfected patients. FIB-4 has a better AUROC compared to APRI and is the preferred noninvasive fibrosis score to discriminate between F0-F2 and F3-F4. Different hospitals should use their local absolute serum transaminase values without conversion. (Acta gastroenterol. belg., 2015, 78, 373-380).
Has patient knowledge of Inflammatory Bowel Disease improved since 1999 ?
Background : In the UK Inflammatory Bowel Disease (IBD) Standards have highlighted the importance of patient education and support [1]. Little literature exists however regarding the im- pact of these standards on patient's understanding of their disease.
Aim: To utilise the Crohn's and Colitis Knowledge Score (CCKNOW) to assess patient knowledge and make a comparison with results achieved in 1999. To assess whether disease CCKNOW scores differ between white and Asian populations in Leicester- shire.
Methodology : 100 outpatients with CD or UC were prospective- ly enrolled to complete the CCKNOW questionnaire between May and September 2013 at two Leicestershire Hospitals.
Results : Mean and median scores for IBD patients were 10.15 (95% C.I. 9.2-11.1) and 9 (95% CI 8-11) respectively. CD (38) patients achieved a significantly higher score than UC (61), median scores of 10.5 and 9 respectively, p = 0.007. CCKNOW scores achieved were significantly lower with increasing age, p = 0.0006. Patient ethnicity, gender, disease duration or perceived disease activity had no significant effect upon CCKNOW score.
Conclusion : Patient understanding of inflammatory bowel disease is no better now than when assessed in 1999, median scores being 9 and 10 respectively. There are persisting knowledge deficits regarding the subjects of fertility and the complications of IBD. CCKNOW scores achieved were significantly lower with increasing age, elderly patients may therefore benefit the most from increased access to appropriate educational programmes and support. (Acta gastroenterol. belg., 2015, 78, 381-385).
Neutrophil to lymphocyte ratio as a reliable marker to predict insulin resistance and fibrosis stage in chronic hepatitis C virus infection
Background : Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepatitis C (CHC) had biochemical evidence of insulin resistance (IR). The neutrophil/lymphocyte ra- tio (NLR) integrates information on the inflammatory milieu and physiological stress.
Aim : We aimed to investigate the clinical utility of NLR to pre- dict the presence of IR and fibrosis in CHCvirus infection.
Methods : The study included 234 CHC patients and 50 healthy controls. The CHC group was divided into two subgroups ; CHC with HOMA-IR > 3 and CHC with HOMA-IR = 3. Liver biopsy, homeostasis model assessment-IR (HOMA-IR), neutrophil and lymphocyte counts were recorded ; and NLR was calculated. Pro- inflammatory cytokines [tumor necrosis factor-alpha (TNF-a) and interleukin-6 (IL-6)] were measured by an enzyme-linked immuno- sorbent assay.
Results : Patients with HOMA-IR > 3 had a higher NLR com- pared with patients with HOMA-IR = 3 [2.61 ± 0.95 and 1.92 ± 0.86, respectively, P < 0.001]. The NLR ratio was positively correlated with HOMA-IR, C-reactive protein, TNF-a and IL-6 cytokines ; P < 0.001). Patients with advanced fibrosis (F3-4) had an elevated N/L ratio [2.4 ± 0.99] compared with patients with fibrosis stage 1-2 [1.86 ± 0.66], P < 0.001.
Conclusions : The N/L ratio is higher in patients with CHC with HOMA-IR > 3 and advanced fibrosis. This ratio can be used as a novel noninvasive marker to predict IR and advanced disease. (Acta gastroenterol. belg., 2015, 78, 386-392).
Fibrolamellar carcinoma versus scirrhous hepatocellular carcinoma : diagnostic usefulness of CD68
Background : Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare variant of hepatocellular carcinoma that commonly affects young individuals without a prior history of liver disease. The principal differential diagnosis is conventional hepatocellular carcinoma especially the scirrhous variant. Despite their distinctive appearance, recent studies have demonstrated a lack of consistency in how FL-HCC are diagnosed by pathologists.
Aim : To investigate the diagnostic utility of CD68 in differenti- ating between FL-HCC and scirrhous hepatocellular carcinoma.
Patients and Methods : In our retrospective study, we reviewed four cases of FL-HCC that were diagnosed at the pathology depart- ment of Mongi Slim hospital over a thirteen-year period (2002- 2014). Relevant clinical information and microscopic slides were available in all cases and were retrospectively reviewed. Immuno- histochemical analysis was performed using the avidin-biotin complex technique with antibodies against CD68 and CK7.
Results : Our study group included one man and three women (sex ratio M/F = 0.33) aged between 23 and 34 years (mean = 28 years). All cases arose in non-cirrhotic liver. Immunohisto- chemically, all cases were positive for CK7 and for CD68 (n = 4).
Conclusions : CD68 immunostaining is a sensitive marker for FL-HCC that may be of use in routine diagnostic surgical patholo- gy. Lack of CD68 staining should suggest caution in making a diag- nosis of FL-HCC. (Acta gastroenterol. belg., 2015, 78, 393-398).
Can computed tomography aid in diagnosis of intramural hematomas of the intestinal wall ?
Background : We sought to use computed tomography (CT) data to support the correct differential diagnosis of patients with spon- taneous intramural hematomas of the gastrointestinal tract, to aid in the clinical management of those using oral anticoagulants.
Methods : Patient data were retrospectively analyzed and pa- tients were divided into two groups. The first group contained 10 patients (5 females, 5 males, median age 65 years [range 35- 79 years]) who had been diagnosed with spontaneous intramural hematomas of the gastrointestinal tract. The second group con- tained nine patients (5 females, 4 males, median age 41 years [range 24-56 years]) who exhibited intestinal wall thickening on CT, and who had been diagnosed with ulcerative colitis, Crohn's disease, ameboma, and lymphoma. The enhancement patterns in the CT images of the two groups were compared by an experienced and inexperienced radiologist. The differences in values were subjected to ROC analysis.
Comparison of newly found polyps after removal of small colorectal polyps with cold or hot snare polypectomy
Background and study aims : There are limited data regarding polyp recurrence following cold or hot snare polypectomy for small colorectal polyps. The aim of this study was to evaluate the preva- lence of newly found polyp after cold or hot snare polypectomy and the predictive factors.
Patients and methods : This was a retrospective case-control study at a single municipal hospital. Patients undergoing cold or hot snare polypectomy for colorectal polyps = 8 mm included in a previous study (Digestion 2011; 84:78) were enrolled. Newly found polyps were defined as polyps detected at follow-up colono- scopy within 3 years. Predictive factors for new polyps were as- sessed by multivariate analysis using logistic regression.
Results : A total of 72 patients (female 22, mean age 68) with 184 polyps were enrolled. Eighty-nine polyps (mean size ± SD, 5.3 ± 2 mm) were resected with cold snare while 95 polyps (mean size 5.5±6mm) were resected with hot snare polypectomy. Twenty-four new polyps (< 5 mm) were found at follow-up. No polypectomy scars were detected in the vicinity of the new polyps. The prevalence of new polyps was similar (i.e., cold vs. hot snare polypectomy ; 23% vs. 19%, P = 0.68). Multivariate analysis re- vealed that the removal of = 4 polyps was an independent predictor associated with new polyps (odds ratio : 7.8, 95% confidence inter- val : 2.1-32, P = 0.0022).
Conclusions : Diminutive polyps were newly found with similar prevalence after cold or hot snare polypectomy, but there were no recurrent polyps detected. (Acta gastroenterol. belg., 2015, 78, 406- 410).
Colonoscopy in patients with liver cirrhosis : success and safety issues
Background : Patients with liver cirrhosis undergo screening colonoscopy before liver transplantation. Screening colonoscopy is subject to specific quality criteria, among which caecal intubation rate. Several factors associated with failed caecal intubation have been identified.
Aims : We investigated whether liver cirrhosis influenced success and safety of screening colonoscopy.
Methods : Caecal intubation and complication rate of 93 candi- dates for liver transplantation due to liver cirrhosis were compared with the control rates of our endoscopy unit. Several patient and colonoscopy variables were taken into account.
Results : In patients with liver cirrhosis caecal intubation rate was only 83%, whereas in the control group it was 94% (P < 0.0001). The presence of high volume ascites tends to compromise a success- ful colonoscopy. Serious complication rate was 0,4% in controls without colonoscopy-related mortality. In the cirrhotic population two severe complications were encountered (2,2%, P < 0.05) and one patient died due to colonic perforation and sepsis (mortality 1.1%).
Conclusions : Caecal intubation rate is significantly lower in patients with liver cirrhosis undergoing screening colonoscopy, possibly related to the presence of ascites. Complication and mortality rate of screening colonoscopy is significantly higher in patients being screened for liver transplantation. (Acta gastro- enterol. belg., 2015, 78, 411-414).
