Chih-Lang Lin

Efficacy and safety of ribavirin plus pegylated interferon alfa in geriatric patients with chronic hepatitis C

Limited data are available on the efficacy and safety of antiviral therapy in geriatric patients with chronic hepatitis C virus (HCV) infection.

Significant renoprotective effect of telbivudine during preemptive antiviral therapy in advanced liver cancer patients receiving cisplatin-based chemotherapy: a case–control study

Abstract Objective. Cisplatin is a known nephrotoxic agent requiring vigorous hydration before use. However, aggressive hydration could be life-threatening. Therefore, in cirrhotic patients with advanced hepatocellular carcinoma (HCC) under cisplatin-based chemotherapy, the risk of nephrotoxicity increased. Because previous studies showed that long-term telbivudine treatment improved renal function in chronic hepatitis B virus (HBV) infected patients, we conducted a case–control study to evaluate the clinical outcome of telbivudine preemptive therapy in HBV-related advanced HCC patients treated by combination chemotherapy comprising 5-fluorouracil, mitoxantrone and cisplatin (FMP). Material and methods. From June 2007 to March 2012, 60 patients with HBV-related advanced HCC, all receiving the same FMP chemotherapy protocol, were enrolled. Of them, 20 did not receive any antiviral therapy, whereas the remaining 40 patients (sex and age matched) received telbivudine preemptive therapy. Results. Progressive decrease of aminotransferase levels (p < 0.05) and progressive increase of viral clearance rates (p < 0.001) were found in telbivudine-treated group. No drug resistance developed during the course of treatment. When compared with non-antiviral-treated patients, a significantly higher post-therapeutic estimated glomerular filtration rate (eGFR) was found in the telbivudine-treated group (p < 0.001). In patients with initial eGFR >100 ml/min (n = 34), the median overall survival was significantly longer in the telbivudine-treated group (12.1 vs. 4.9 months; p = 0.042). Conclusion. Preemptive use of telbivudine significantly prevented eGFR deterioration caused by cisplatin-based chemotherapy in HBV-related advanced HCC. In patients with initially sufficient eGFR level, telbivudine treatment was associated with a longer overall survival.

Diabetes, hepatocellular carcinoma, and mortality in hepatitis C-infected patients: a population-based cohort study

The effect of diabetes mellitus (DM) on the development of hepatocellular carcinoma (HCC) and all‐cause mortality after HCC development in chronic hepatitis C virus (HCV)‐infected patients remains inconclusive. This cohort study aimed to investigate these issues using the Taiwanese National Health Insurance Research Database.

A Circulating MicroRNA Signature Capable of Assessing the Risk of Hepatocellular Carcinoma in Cirrhotic Patients

With the availability of potent antiviral therapies, complete suppression of hepatitis B virus (HBV) replication and total eradication of hepatitis C virus (HCV) can now be achieved. Despite these advances, hepatocellular carcinoma (HCC) still develops in a substantial proportion of cirrhotic patients, suggesting that host factors remain critical. Dysregulation of miRNAs is noted in many cancers, and circulating miRNAs can be readily assayed. In this study, we aimed to develop a circulating miRNA signature to assess the risk of HCC in cirrhotic patients. We first discovered that HBV- and HCV-related cirrhotic patients had distinguishable circulating miRNA profiles. A cohort of 330 cirrhotic patients was then compared against a cohort of 42 early HCC patients with complete remission. A score comprising 5 miRNAs and a binary etiology variable was established that was capable of differentiating between these two groups (AUC = 72.5%, P < 0.001). The 330 cirrhotic patients were further stratified into high- and low-risk groups, and all patients were longitudinally followed for 752 (11–891) days. Of them, 19 patients developed HCC. The high-risk group had significantly higher cumulative HCC incidence (P = 0.038). In summary, a circulating miRNA-based score was developed that is capable of assessing HCC risks in cirrhotic patients.

Carbon dioxide insufflation during colonoscopy can significantly decrease post‐interventional abdominal discomfort in deeply sedated patients: A prospective, randomized, double‐blinded, controlled trial

CO2 has been reported to be absorbed from the bowel more rapidly than air, resulting in a discomfort reduction after colonoscopy. Its role in deeply sedated patients is limited. This study was designed to investigate the efficacy and safety of CO2 insufflation during colonoscopy in patients deeply sedated with propofol.

The Associations Between Helicobacter pylori Infection, Serum Vitamin D, and Metabolic Syndrome: A Community-Based Study.

AbstractThe associations between Helicobacter pylori infection, serum vitamin D level, and metabolic syndrome (MS) are controversial. The present community-based study aimed to investigate the effect of H pylori infection and serum vitamin D deficiency on MS development.Individuals from the northeastern region of Taiwan were enrolled in a community-based study from March, 2014 to August, 2015. All participants completed a demographic survey and underwent the urea breath test (UBT) to detect H pylori infection as well as blood tests to determine levels of vitamin D, adiponectin, leptin, and high-sensitivity C-reactive protein. The ATP III criteria for MS were used in this study.A total of 792 men and 1321 women were enrolled. The mean age was 56.4 ± 13.0 years. After adjusting for age and sex, the estimated odds of MS development for a UBT-positive subject were 1.503 (95% confidence interval [CI]: 1.206–1.872, P < 0.001) when compared to a UBT-negative subject. For participants with vitamin D deficiency (<20 ng/mL), the odds of MS development were 1.423 (95% CI: 1.029–1.967, P = 0.033) when compared to those with sufficient vitamin D level (>30 ng/mL). For participants with both H pylori infection and vitamin D deficiency, the odds of MS development were 2.140 (95% CI: 1.348–3.398, P = 0.001) when compared to subjects without H pylori infection and with sufficient vitamin D levels.H pylori infection and vitamin D deficiency could be predictors of MS. For individuals with both H pylori infection and vitamin D deficiency, the odds of MS development were 2.140 when compared to individuals without H pylori infection and with sufficient vitamin D levels.

Giant colonic lipoma arising from the ileocecal valve and causing cecal-transverse colonic intussusception

Intussusception is rare in adults, representing only 1% of bowel obstruction and 5% of all intussusceptions. Previous reports have shown that > 90% of adults diagnosed with intussusception had an identifiable pathological leading point—a malignant tumor in 43–63% of the cases. Colonic lipomas are rare nonepithelial neoplasms, but represent the most common benign tumors in the large intestine. Most colonic lipomas present as submucosal, sessile polypoid masses with intact mucosa, and they rarely produce symptoms when < 2 cm in diameter. However, all the intussuscepted lipomas in the literature had a tumor size > 4 cm in diameter. As the clinical presentations of adult intussusception are not pathognomonic and the image study may not provide a typical presentation, a precise preoperative diagnosis of whether a benign or malignant tumor is causing the colon intussusception can be difficult. Here, we report the case of a 50‐year‐old man who presented with abdominal pain and lower gastrointestinal bleeding and was diagnosed postoperatively with ileocecal valve lipoma with cecal‐transverse colon intussusception. This report emphasizes colonic lipomas > 4 cm in diameter should receive surgical resection before intussusception develops. However, if the nature of the tumor causing colon intussusception cannot be identified before the operation, en bloc resection is recommended as there is a high risk of malignancy spreading.

Unawareness of Hepatitis B Virus Infection confers on Higher Rate of Metabolic Syndrome: A Community-based Study

The objective of this study was to determine whether awareness of hepatitis B virus (HBV) serostatus was discordant with metabolic syndrome (MetS) among people with chronic HBV infection. We conducted a community-based study in four Taiwanese districts. A total of 3493 adult participants were recruited. Participants who were hepatitis B surface antigen (HBsAg) seropositive and had self-reported HBV infection were considered aware of hepatitis B (aHB); those who denied a history of HBV infection were considered unaware of hepatitis B (uaHB). Among the 454 participants who were HBsAg seropositive, 275 (60.6%) were aHB and 179 (39.3%) were uaHB. Hypertriglyceridemia showed significant inverse association with HBsAg seropositive, especially among those who were aHB. Insulin resistance was significantly, positively associated with HBsAg seropositive, especially among participants who were uaHB. Those who were uaHB had a higher risk of central obesity, hyperglycemia, insulin resistance, and MetS than those who were aHB (odds ratio = 2.33, 1.64, 2.15, 1.85, respectively, all p < 0.05). The association among the prevalence of MetS, its individual components and HBsAg seropositivity varies according to awareness of HBV infection. It is important to recognize an individual’s risk for MetS, especially who were unaware of HBV infection.

UGT2B28 genomic variation is associated with hepatitis B e-antigen seroconversion in response to antiviral therapy.

Seroconversion of hepatitis B virus (HBV) e-antigen (HBeAg) is a critical but often-missed therapeutic goal in standard antiviral treatments. An extreme-phenotype genome-wide association study was performed, comparing untreated spontaneous recoverers (with seroconversion of HBV surface antigen) versus entecavir-treated patients failing to achieve HBeAg seroconversion. A single-nucleotide-polymorphism rs2132039 on the UGT2B28 gene, alongside an adjacent copy number polymorphism (CNP605), manifested the strongest clinical associations (P = 3.4 × 10−8 and 0.001, respectively). Multivariate analysis showed that rs2132039-TT genotypes, but not CNP605 copy numbers, remained associated to spontaneous recoverers (P = 0.009). The clinical association of rs2132039 was validated successfully in an independent cohort (n = 302; P = 0.002). Longitudinal case-only analyses revealed that the rs2132039-TT genotype predicted shorter time-to-HBeAg-seroconversion in all antiviral-treated patients (n = 380, P = 0.012), as well as the peginterferon-treated subgroup (n = 123; P = 0.024, Hazard ratio [HR] = 2.104, Confidence interval [CI] = 1.105–4.007). In the entecavir-treated subgroup, the predictive effect was restricted by pretreatment alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, with effective prediction observed in patients with ALT < 200 IU/ml and ALT/AST ratio <2 (n = 132; P = 0.013, HR = 10.538, CI = 1.420–78.196).

Primary duodenal Burkitt lymphoma presenting as sessile, button-like bleeding polyps

Primary gastrointestinal (GI) lymphoma accounts for 30–50% of all extranodal non‐Hodgkins lymphomas, making the GI tract the most common site of extranodal non‐Hodgkins lymphomas. Most GI lymphomas belong to the B cell lineage. Burkitt lymphoma (BL) is a highly aggressive mature B cell neoplasm that occurs in three forms: endemic, sporadic, and immunodeficiency‐associated. Sporadic BL accounts for 1–2% of all adult lymphomas and usually presents as an abdominal manifestation of extranodal disease involving the distal ileum or cecum. Primary BL of the duodenum is rare. However, this report emphasizes the importance of awareness of the malignancy potential of duodenal polyps. We report the case of a 70‐year‐old woman admitted to our ward with upper GI bleeding due to duodenal polyps. An upper GI endoscopic examination showed button‐like polyps with central depression, and an immunohistochemical study of the polyps revealed a high‐grade B cell malignancy (BL). Consequently, the patient was treated with aggressive chemotherapy. The tumors regressed after chemotherapy. Although primary duodenal Burkitt lymphoma is very rare, the possibility of malignancy should be considered if a patient presents with duodenal button‐like polyps with a central depressed surface.