A. Elewaut

Efficacy of interferon alfa-2b with or without prednisone withdrawal in the treatment of chronic viral hepatitis B. A prospective double-blind Belgian-Dutch study

A prospective, double-blind study was carried out to assess the efficacy of interferon alfa-2b, with or without pre-treatment prednisone withdrawal, in patients with chronic hepatitis B. A total of 57 Belgian and Dutch patients were included in the study. Patients were divided into four treatment groups: Group A, prednisone withdrawal followed by interferon 5 million units per day; Groups B and C, placebo followed by interferon 5 or 1 million units, respectively; and Group D, untreated controls followed for 1 year. All treated patients received interferon for 16 weeks. Two of the 14 control patients lost hepatitis B e antigen during the year of study, and only one of 15 patients in the interferon 1 million units group. Among the 28 patients receiving 5 million units of interferon (with or without prednisone withdrawal), ten (36%) cleared hepatitis B e antigen during the study or within 6 months of the end of therapy. This was associated with a marked improvement in serum transaminase levels. When comparing Groups A and B, it was found that prednisone withdrawal therapy enhanced the response to interferon in patients with pre-treatment serum alanine aminotransferase levels below 100 IU/l, bringing the seroconversion rate up to 50%, compared to 17% on interferon alone. This effect was not seen in patients with high pre-treatment transaminase levels. All treatment responders showed a marked improvement in Knodell index score, whereas in the 15 non-responders from groups A and B, overall inflammatory activity remained the same in six, improved in five and worsened in four.(ABSTRACT TRUNCATED AT 250 WORDS)

Gallstone recurrence after successful shock wave therapy: the magnitude of the problem and the predictive factors.

Gallstone recurrence after successful shock wave therapy: the magnitude of the problem and the predictive factors

Long term response to interferon treatment in chronic hepatitis C patients is associated with a significant reduction in anti-E1 envelope antibody titers.

Interferon (IFN) alfa has been used widely for the treatment of chronic hepatitis C virus (HCV) infections but only a small number of patients treated have shown a sustained biochemical and virological response. Anti‐envelope E1 and E2 antibody titers were assessed retrospectively before, during, and after treatment with IFN in order to evaluate their usefulness for the prediction and monitoring of therapy outcome in 115 patients infected chronically with HCV genotype 1b. At baseline, E2 induced more frequent and stronger immunogenic responses than E1, irrespective of patient response to therapy. E1 and E2 antibodies also tended to be higher in patients with a long‐term or a transient response to IFN treatment than in patients who were absolute non‐responders. In most patients, E1 and E2 antibody levels tended to be lower after treatment. This reduction was most pronounced and occurred most frequently in long‐term responders to therapy. In this patient group, the reduction of E1 antibodies was more pronounced than that of E2 antibodies. In contrast to E2 antibodies, the decrease of E1 antibodies could already be observed at the end of therapy (week 24) and was significantly larger (p<0.05) than that observed in relapsers and non‐responders. Thus, a sustained elevation of E1 antibodies seems to be associated with ongoing infection even when HCV RNA levels were undetectable in serum. Monitoring of E1 antibody titers may represent a useful additional marker to discriminate sustained responders from those who relapse in patients receiving interferon therapy. J. Med. Virol. 60:126–132, 2000.

Results of extracorporeal shock wave lithotripsy of gall bladder stones in 693 patients: a plea for restriction to solitary radiolucent stones.

During a period of 24 months 693 consecutive patients with symptomatic gall bladder stones (526 males, 167 females; mean age 51 years, range 18-89) were treated by extracorporeal shock wave lithotripsy with a Piezolith 2300. The procedure was carried out on an out-patient basis without analgesics or sedatives. Concomitant chemolitholytic treatment (ursodeoxycholic and chenodeoxycholic acid 7.5 mg/kg/day each) was administered until three months after total fragment clearance for a maximum therapy period of 1.5 years. In 601 patients with radiolucent stones complete clearance of all fragments was obtained after three, six, 12, and 18 months in respectively 20, 41, 64, and 78%. Actuarial analysis of the subgroups according to the stone mass (size and number) selected an ideal patient population with solitary stones less than 20 mm diameter (84% stone free after one year). The results are significantly less good when the greater the number of stones or their maximal diameter increases. Treatment was interrupted in 3.6% of the patients. In 90 sludge or fragments remain present. Twenty five patients were lost to follow up for non-biliary reasons. Stone recurrence was 5.7% at one year and was observed both in patients with solitary and multiple stones. A cost effectiveness analysis suggests that laparoscopic cholecystectomy is the most effective and economic solution, although extracorporeal shock wave lithotripsy for solitary radiolucent stones less than 2 cm is cheaper than conventional cholecystectomy. Extracorporeal shock wave lithotripsy for multiple stones is the most expensive and least effective option.

Influence of Low-Dose Oral Contraceptives, Alcohol, and Grapefruit on [13C]Aminopyrine Breath Test

The aminopryine breath test (ABT) measures hepatic reserve in patients with acute and chronic liver disease and gives an assesment of the hepatic function in patients undergoing major liver surgery. Aminopyrine is metabolized by the mixed cytochrome P-450 system, which can be influenced by many foreign compounds and drugs. Whether these foreign compounds and drugs can influence the results of the ABT has seldomly been tested. We studied three groups: Healthy female volunteers, either normally menstruating or taking oral contraceptives, were asked to perform a [13C]ABT during the time of the menses and at midcylce. Healthy volunteers were asked to perform a ABT after consuming 30 g of alcohol. Healthy volunteers were asked to perform a ABT after consuming 250 ml of grapefruit juice. The 13C/12C ratio in expired air was measured by gas isotope ratio mass spectrometry.

Distribution and concentrations of 5-aminosalicylic acid in rectosigmoid biopsy specimens after rectal administration

PURPOSE: Using the autofluorescent properties of 5-aminosalicylic acid (5-ASA), we studied the penetration and distribution of this molecule in human colonic biopsies at different time intervals after administration of 5-ASA enemas. METHODS: Fluorescence scores of rectosigmoidal biopsy specimens were compared with 5-ASA and acetyl-5-aminosalicylic (Ac-5-ASA) concentrations, determined by high-performance liquid chromatography, in adjacent biopsies and in serum samples. RESULTS: 5-ASA penetrates into the rectal mucosa and into the epithelial cells after local application by means of an enema. We found a characteristic 5-ASA staining of two intramucosal structures that need further identification: intraepithelial triangular configurations and “5-ASA scavengers” in the lamina propria. Fluorescence scores correlate well with 5-ASA concentrations in adjacent biopsies (r=0.67;P<0.005) and correlate even better with serum concentrations of 5-ASA (r=0.84;P<0.005) and Ac-5-ASA (r=0.80;P<0.005), hence reflecting the amount of systemically absorbed and metabolized 5-ASA. CONCLUSION: 5-ASA penetrates into the rectal mucosa after local application. Local availability, assessed by means of fluorescence microscopy, correlates well with serum concentrations.

Les migrations lithiasiques spontanées

RÉsumÉUne expérience de onze années nous a permis de démontrer une migration spontanée de lithiase cholédocienne vers le duodénum chez 33 malades, soit 6,3 % des malades avec cholédocholithiase chez qui fut effectuée une cholangiographie rétrograde.Chez 3,2 % nous avons retrouvé une fistule bilio-duodénale periampullaire, tandis que chez 3,1 % des patients la papille était lacérée par le passage de calcul.Dans tous les cas un épisode de cholangite a précédé la migration. Les complications sérieuses comme maeléna (un cas) et pancréatite biliaire (deux cas) étaient absentes dans les cas avec fistule bilio-duodénale, et n’ont été retrouv#x00E9;e que lorsque le passage du calcul a eu lieu par ľorifice de la papille.SummaryDuring an 11 year experience with endoscopic retrograde cholangiography, we found evidence of spontaneous gallstone migration from the common bile duct into the duodenum in 33 patients, or 6.3 % of the patients with choledocholithiasis seen during that period.In 3.2 % of the patients we found periampullary biliary-enteric fistulas due to stone erosion, while a lacerated papilla after stone passage was found in 3.1 %. In all patients an episode of severe cholangitis preceded the migration. Severe, although not life-threatening complications were melena (I case) and biliary pancreatitis (two cases), and all occurred when the stone ulcerated through the papilla opening.

Influence Of Injection Sclerotherapy Of Oesophageal Varices In Liver Cirrhosis On The Haemostatic System

SummaryPlatelet counts, coagulation and fibrinolysis tests were done before, 10 min. 1, 3 and 24 hr after the performance of 24 sessions of injection Serotherapy with Polidocanol 1 % of oesophageal varices in 16 patients with liver cirrhosis. Thrombocytopenia was often present no significant changes occurred after sclerotherapy. The APTT and PT values did not change. The levels of F II. F V. F VII-X, F VIII F IX. and F X remained in the same range. Also the fibrinogen and plasminogen values did not change after the selerotherapy session. A rise in the scrum fibrin/fibrinogen degradation Products was not found, levels of antithrombin protein C, x antiplasmin and t-PA antigen femaincd stable. The absence of any change in the clotting parameters measured is in accordance with the clinical safety of the injection sclerotherapy of aesophageal varices in patients with liver cirrhosis.

Fistule aorto-duodénale ― rôle de l'endoscopie

Résumé25 cas de fistules aorto-duodénales sont rapportés. La fistule primaire s’est développée chez un patient souffrant de lupus erythematosus. Les 24 fistules secondaires sont survenues 1 mois ð 14 ans après la chirurgie reconstructive de l’aorte.Une hémorragie digestive (96 %), une douleur abdominale (16 %) ou une infection constituaient l’essentiel de la Symptomatologie initiale. Chez 12 patients, une endoscopie digestive a été réalisée : dans 8 cas elle suggéra ou confirma le diagnostic.Trois artériographies sélectives ont été effectuées : chez un seul patient, celui porteur de la fistule primaire, elle révéla une extravasation discrète du produit de contraste de l’aorte vers le duodénum.Tous les patients ont subi une laparotomie avec une mortalité globale de 58 % pour les fistules secondaires.Un diagnostic précoce dépend d’une suspicion clinique et d’une endoscopie réalisée en urgence. Une intervention chirurgicale précoce et agressive est impérative.SummaryWe reviewed 25 patients with aortoduodenal fistula. One primary fistula occured in a patient with lupus erythematosus. The 24 secondary fistulae developed 1 month to 14 years (mean 6.8 years) after reconstructive aortic surgery.The initial symptoms were gastrointestinal bleeding (96 %), abdominal pain (16 %) and infection (16 %). Upper gastrointestinal endoscopy performed in twelve patients was highly suggestive or diagnostic in 8.Selective angiography was performed in 3 cases : only in the patient with primary fistula an extravasation of contrast from the aorta into the bowel was demonstrated. All patients underwent laparotomy. The overall hospital mortality of the secundary ADF was 58 %.Early diagnosis depends upon a high index of suspicion and requires early endoscopy. Urgent and aggressive surgery is mandatory.

Efficacy of vedolizumab for induction of clinical response and remission in patients with moderate to severe inflammatory bowel disease who failed at least two TNF antagonists

Background Vedolizumab is a recently available monoclonal antibody targeting α4β7 integrin for the treatment of ulcerative colitis (UC) and Crohn’s disease (CD). Objective The objective of this article is to evaluate the efficacy of vedolizumab induction therapy in anti-TNF-refractory/intolerant UC and CD patients in real life. Methods A cohort of 149 moderately to severely active UC and CD patients who failed or showed intolerance to at least two TNF antagonists participated in a medical need program and received vedolizumab in 37 Belgian centers (April–September 2015). Rates of clinical response and remission were retrospectively evaluated at Week 10 for UC and Week 14 for CD using the physician’s global assessment (PGA), Mayo score and Harvey Bradshaw index (HBI) or Crohns disease activity score (CDAI) scores. Results Eighty-four patients (29 UC, 55 CD) had sufficient data for analysis. For UC patients, clinical response was observed in 76% based on PGA and 59% based on the Mayo score. The corresponding percentages for CD patients were 80% for PGA and 65% for HBI/CDAI. Clinical remission rates were 10% and 40% for UC and CD, respectively. Steroid-free remission was observed in respectively 10% and 35%. Globally, corticosteroids were stopped in 14 out of 48 patients (29%). No new safety signals were reported. Conclusion Up to 70% TNF-refractory/intolerant UC and CD patients achieved a clinical response after 10 to 14 weeks of vedolizumab treatment in this real-life cohort.