Andres Pena

Predictors of morbidity and mortality after the first episode of upper gastrointestinal bleeding in liver cirrhosis.

BACKGROUND/AIMS Upper gastrointestinal (GI) bleeding is one of the most frequent causes of morbidity and mortality in the course of liver cirrhosis. The aim of this study was to determine the independent predictors of morbidity, mortality, and survival after the first episode of GI bleeding in patients with liver cirrhosis. METHODS In a retrospective study of 403 cirrhotic patients who were admitted in the period January 1982 to December 1994 because of a first episode of GI hemorrhage, epidemiological factors, bleeding-related variables and cirrhosis-related variables that may be associated with hepatic and extrahepatic complications, mortality at 48 h and 6 weeks, and survival up to 30 June 1996 were assessed. RESULTS Forty-five percent of patients developed hepatic and/or extrahepatic complications, with a mortality rate of 7.4% at 48 h and 24% at 6 weeks. Renal failure, rebleeding, hepatocellular carcinoma, and hepatic encephalopathy were independent predictors of mortality. The Kaplan-Meier method showed a median survival of 30.9+/-4.5 months (95% confidence interval 22 to 39.7 months). The cumulative percentage of survivors was 60.2% at 1 year, 33.6% at 5 years, and 14% at 10 years. In a Coxs multiple regression analysis, age, hepatic encephalopathy, hepatocellular carcinoma, Child-Pugh grade, and renal failure were independently associated with long-term survival. CONCLUSIONS The first episode of GI bleeding in patients with liver cirrhosis is associated with high morbidity and mortality. Renal failure, rebleeding, hepatocellular carcinoma, and hepatic encephalopathy were independent risk factors for early death.

Antioxidant status and glutathione metabolism in peripheral blood mononuclear cells from patients with chronic hepatitis C

BACKGROUND/AIMS Oxidative stress could play a role in the pathogenesis of hepatitis C virus infection. We investigated the oxidant/antioxidant status in peripheral blood mononuclear cells from patients with chronic hepatitis C and controls. METHODS/RESULTS Lipid peroxidation products and superoxide dismutase activity in peripheral blood mononuclear cells were higher in chronic hepatitis C patients than in healthy subjects while glutathione S-transferase activity was reduced in patients as compared to controls. Catalase, glutathione peroxidase and glutathione reductase were similar in chronic hepatitis C and normal individuals. No statistically significant differences were found between patients and controls with regard to glutathione levels in peripheral blood mononuclear cells, but 35% of patients with chronic hepatitis C showed values of glutathione and oxidized glutathione which were below and above, respectively, the limits of normal controls. Finally, the glutathione synthetic capacity of the cytosol of peripheral blood mononuclear cells was significantly higher in patients than in controls, indicating increased glutathione turnover in lymphocytes from patients with chronic hepatitis C. CONCLUSIONS Oxidative stress is observed in peripheral blood mononuclear cells from chronic hepatitis C patients. This process might alter lymphocyte function and facilitate the chronicity of the infection.

S1781 Large Balloon Papillary Dilation After Endoscopic Sphincterotomy: A One Year Nation Wide Multicentre Study

drome (OR=2.633, CI95% 1.451-4.778). The risk of GD being symptomatic was similar: 68.2% of cases (60/88) and 58.8% of controls (93/158) were cholecystectomized (p>0.05). Conclusions: We evaluated gallstone risk in patients with chronic HCV hepatitis and hospital controls. As compared to controls, the relative risk for GD in patients with chronic HCV hepatitis was higher in males, at younger age, in the presence of obesity and fatty liver, and was not related to dyslipidemia, diabetes mellitus or metabolic syndrome. Although we could not establish a temporal relationship between HCV infection and GD, our data suggest that chronic HCV infection represents an independent risk factor for gallstone formation.

Late recurrence of anal fissure after conservative therapy with botulinum toxin

Late Recurrence Of Anal Fissure ARer Conservative Therapy With Botufinum Toxin Miguel Minguez, Dept of Gastroenterology, Univ Clin Hosp, Valencia Spain; Alejandro Espi, Dept of Surg, Univ Clio Hosp, Valencia Spain; Vicente Sanchiz, Isabel Pascual, Dept of Gastroenterology, Univ Clin Hosp, Valencia Spain; Eduardo Garcia-Granero, Dept of Surg, Univ Clin Hosp, Valencia Spain; Andres Pena, Francisco Mora, Pedro Almela, Vicente Hernandez, Paloma Lluch, Cirilo Amoros, Adolfo Benages, Dept of Gastroenterology, Univ Clin Hosp, Valencia Spain