Volume 82 - 2019 - Fasc.1 - Original articles
Clinical features and treatment outcomes of eosinophilic gastroenteritis : an analysis of 28 cases
Background : Eosinophilic gastroenteritis (EG) is uncommon disease, and the pathogenesis of this disease have yet to be fully clarified.
Aim : This study was to describe the clinical manifestations, endoscopic features and treatment outcomes of a cohort of patients with EG.
Method : This retrospective study was included 28 consecutive patients who were diagnosed EG between January 2011 and December 2015 in Taizhou Hospital. The patients' clinical manifestations, endoscopic features and treatment outcomes were reviewed from a prospectively maintained database.
Results : Twenty-eight patients with EG were enrolled in the study (median age 54 years). The main symptoms were abdominal pain (78.6%), abdominal distension (50.0%), nausea and vomiting (28.6%) and diarrhea (25.0%). Laboratory examinations showed the elevation of blood eosinophil count (85.7%), serum IgE (71.4%). Endoscopic findings included small patchy mucosal erythema or erosions (75.0%), mucosal fold thickening (17.9%), submucosal nodules (21.4%), small gastroduodenal ulcers (14.3%). Twenty patients were treated and responded to prednisolone but five patients (25.0%) relapsed during the follow-up. The other 8 patients were treated with loratadine, proton pump inhibitors and dietary modification, 5 patients had clinical resolution during the follow-up. The other 3 patients did not achieve clinical remission, and then were given prednisone treatment.
Conclusion : For some patients with gastrointestinal symptoms and peripheral eosinophilia, a high suspicion of EG is necessary and multiple endoscopic examinations might be helpful in diagnosis of EG. Most patients with EG could achieve remission after with the treatment of steroid or dietary elimination therapy. (Acta gastroenterol. belg., 2019, 82, 5-10).
Surgical management and outcomes of duodenal gastrointestinal stromal tumors
Background and study aims : This retrospective study purports to examine these characteristics and compare the surgical procedures available and appropriate for the treatment of patients affected by duodenal GISTs.
Patients and methods : A retrospective examination of reports and studies carried out between May 2012 and March 2017, and covering patients with primary GISTs of the duodenum was performed using modules from the SPss package. Comparisons of treatment effects resulting from the administration of two differential methods of surgical treatment namely pancreaticoduodenectomy (PD), and limited resection (LR), were effected on the reports of the GIST patients thus selected.
Results : Out of these 62 patients who had undergone resection of duodenal GISTs, 47 (76%) had limited resection (LR) and 15 (24%) underwent pancreaticoduodenectomy (PD). In Multivariate analyses, tumor size was an independent predictive factor for recurrence (p=0.008). ASA, tumor size, and PD were independent and significant prognostic factors on OS (p=0.021, p=0.024, and p=0.030, respectively). In the very low and low risk group, and high-risk group, there were no significant differences in the RFS (recurrence-free survival) and OS (overall survival) between the LR and PD groups.
Conclusions : When technically feasible, LR should be given due consideration as a reliable and curative option for duodenal GISTs achieving satisfactory RFS and OS. (Acta gastroenterol. belg., 2019, 82, 11-18).
Colorectal laterally spreading tumours : subtype evaluation by EUS and BLI and outcome of ESD
Background and study aims : Colorectal laterally spreading tumour (LST) is a specific type of colonic space-occupying lesion unlike other common polypoid lesions. Here, we explored the diagnostic values of endoscopic ultrasonography (EUS) and blue laser image (BLI) in LST subtypes, their relationship with histopathological characteristics and the therapeutic effect of endoscopic submucosal dissection(ESD) for LST.
Patients and methods : A prospective study of 138 patients with LST was conducted. All LSTs were explored for invasion depth and superficial microstructure through EUS and BLI before ESD. Histopathological characteristics of LSTs were demonstrated through pre-operative biopsy and post-operative specimen detection. Finally, the correlations among varied morphologies, manifestations of EUS and BLI, and histopathological characteristics of LSTs were analysed comprehensively. All patients underwent follow-up after ESD.
Results : Nodular-mixed and pseudodepressed subtypes were more likely to invade the submucosa, and BLI revealed a greater proportion of types B and C than the homogeneous or flat-elevated subtypes. These endoscopic features were consistent with and proved by histopathological results. Pathological severity of LST on post-ESD specimen detection was greater than that on pre-ESD biopsy analysis. En bloc R0 resection was achieved in 128 cases, and only two patients suffered recurrence during follow-up.
Conclusions : Pre-operative evaluation through EUS and BLI examination provided clues of possible pathological features and helped guide the treatment of LST. ESD is a safe and effective therapy for colorectal LST. (Acta gastroenterol. belg., 2019, 82, 19-26).
Hepatitis B virus vaccination and revaccination response in children diagnosed with coeliac disease : a multicentre prospective study
Aim : This study evaluates hepatitis B virus (HBV) vaccination response in children with celiac disease (CD). Response in initial non-responders after a single booster vaccination as well as factors influencing HBV vaccination response were evaluated.
Methodology : Anti-hepatitis B surface antibodies (a-HBsAB) were checked in all children with CD and a documented complete HBV vaccination. An a-HBsAB <10 U/L was considered as non-response. A single intramuscular HBV-vaccine booster was advised to all non-responders. Response was checked at the next appointment.
Results : 133 children with CD were included, median age of 7.3 years (range 1.7-17.3) and 46 (35%) were male. The age at CD diagnosis was 6.0 years (range 1.1-15.7). HBV non-response was documented in 55% (n=73/133). No other factors were influencing the response. A booster was documented in 34/73 (47 %) initial non-responders (3 refused (4%), 36 (49%) had no follow up). Response after booster vaccination resulted in immunity in 22/34 (65%) and persisting non-response in 12/34 (35%). A single booster is able to reduce non-response from 55% (73/133) to 23% (22/94).
Conclusion : A significantly lower immune response following HBV vaccination in children with CD was confirmed. A single intramuscular booster vaccination is able to induce a serologic response in two thirds of the initial non-responders. Control of HBV vaccination response has to become part of the follow-up in CD patients. (Acta gastroenterol. belg., 2019, 82, 27-30).
Comparison of the 48-week efficacy of Lamivudine plus Adefovir or Entecavir monotherapy in patients with HBeAg negative hepatitis following Lamivudine treatment failure
Aims : To compare the efficacy of treatment with lamivudine (LAM) plus adefovir (ADV) or entecavir (ETV) monotherapy in LAM treatment failure patients with HBeAg negative chronic hepatitis B (CHB) patients during 48 weeks of therapy.
Patients and Methods : Thirty patients with HBeAg negative CHB were enrolled in the study. The serum levels of HBV DNA, HBsAg/HBsAb, and ALT were assessed by enzyme-linked immunosorbent assay at 0, 12, 24, 36, and 48 weeks.
Results : The rate of undetectable HBV DNA in the LAM+ADV group was 100%, which was higher than the ETV group at 48 weeks (73.33%, ?2 = 4.615, P = 0.032). Multivariate analysis using the Cox proportional hazards model showed that therapy with LAM+ADV or baseline levels of HBV DNA <107 copies/ml were independent predictive factors for undetectable HBV DNA rates in all patients (RR: 2.488, P = 0.042; RR: 0.201, P = 0.035).
Conclusions : During the 48 weeks of treatment in patients with HBeAg negative CHB, LAM plus ADV suppressed HBV replication more effectively than ETV monotherapy. In addition, no virologic breakthrough was detected in the LAM add-on ADV group. Additionally, therapy with LAM+ADV or baseline levels of HBV DNA < 107copies/ml were independent predictive factors for undetectable HBV DNA rates in patients. (Acta gastroenterol. belg., 2019, 82, 31-34).
Diagnostic hepatitis C testing of people in treatment for substance use disorders in Belgium between 2011 and 2014 : a cross-sectional study
Background : Hepatitis C prevalence figures for people who use drugs in Belgium are scarce, and particularly for people who inject drugs. The current study refines the existing HCV estimates by focussing on diagnostic HCV testing practices for this population at risk.
Methods : The analysis is the result of a descriptive cross- sectional study, based on data extracted from the linkage between a database of people in treatment for substance use disorders in Belgium and a database of the Belgian health insurance companies. By using national nomenclature codes for HCV tests, the number of people in treatment for substance use disorders who were tested on HCV, were estimated.
Results : 18,880 out of 30,905 patients (61.1%) in treatment for substance use disorders between 2011 and 2014 have been screened at least once for HCV between 2008 and 2015. 58.0% of those who had never injected and 59.1% of those with an unknown injecting status were tested for HCV, compared to 86.5% of the patients who had recently injected and 84.5% of those who had ever injected. 36.8% of the people who had recently injected were tested for HCV RNA.
Conclusions : This study supports the need of a continued effort of health care providers to identify people infected with HCV. For a population at risk such as people who use drugs, regular screening is needed to reach the goal set by WHO of near viral elimination of HCV by 203O.(Acta gastroenterol. belg., 2019, 82, 35-42).
A multicentre, observational study on demographic and disease characteristics of patients seeking care for chronic hepatitis C in Belgium in 2016
Background and Study Aims : Direct-acting antivirals provide interferon-free treatments for chronic hepatitis C (CHC) virus infection. In Belgium, in 2016, access to these agents was limited to patients with advanced liver fibrosis stages F3 and F4. This study is the first to describe Belgium's patient population ineligible for interferon-free treatment.
Patients and Methods : This was an observational, cross- sectional, multicentre study that enrolled adult patients with CHC ineligible for interferon-free treatment. Patient data recorded at a single visit included demographic data, disease characteristics, comorbidities, co-medications, treatment status, and laboratory data.
Results : Three hundred and three patients from 16 centres in Belgium were included in the statistical analysis. On average, patients were aged 53.5 years and 50.2% were women ; 94.1% had health insurance and 99.0% resided in Belgium. The current hepatitis C virus (HCV) infection was the first infection for 96.0% of patients and the mean time since infection was 20.0 years. Liver fibrosis stage was F0 for 23.7%, F0/F1 or F1 for 38.3%, F1/ F2 or F2 for 25.8%, F3 for 7.1%, and F4 for 5.1% of patients ; 28.4% of patients were CHC treatment-experienced. The main reason for ineligibility for interferon-free treatment was lack of reimbursement (84.8%). Other reasons included no treatment urgency or medical decision to wait (27.1%), waiting for future treatment option (8.3%), and no social insurance coverage (3.6%).
Conclusions : This study provides recent data on the CHC patient population and disease characteristics in Belgium that could help medical communities and government agencies manage CHC disease burden. (Acta gastroenterol. belg., 2019, 82, 43-52).
