D. Sprengers

Measurement of variceal pressure with an endoscopic pressure sensitive gauge: validation and effect of propranolol therapy in chronic conditions.

AIM/METHODSnVariceal pressure was measured at endoscopy in 98 patients with a non-invasive, pressure-sensitive gauge technique.nnnRESULTSnIn nine patients undergoing sclerotherapy, the values obtained correlated closely with those determined by fine-needle puncture of the varices (r = 0.95, p < 0.001). In 15 patients receiving placebo as part of a double-blind, placebo-controlled prospective evaluation of prophylactic treatment with propranolol, variceal pressure did not change significantly over a 1-year period: 16.5 +/- 3.2 mmHg at onset: 16.7 +/- 3.4 after 3 months and 15.9 +/- 3.5 after 12 months. In contrast, propranolol therapy given to 15 patients decreased the pressure from 16.2 +/- 3.0 mmHg before therapy to 13.5 +/- 2.0 after 3 months (p < 0.001) and to 13.1 +/- 4.1 after 12 months (p < 0.05). Patients with a recent bleeding episode had higher pressures than those who had not yet experienced any haemorrhage (19.3 +/- 3.5 mmHg, n = 17 vs 13.9 +/- 3.3, n = 62) (p < 0.001). This was confirmed in a prospective study: the last variceal pressure in bleeders and non-bleeders was respectively 17.2 +/- 1.7 mmHg (n = 4) and 14.8 +/- 4.1 mmHg (n = 26) (p < 0.01). Overall, variceal pressure measurements correlated with the size of varices, the presence of red colour signs and with the North Italian Endoscopic Club score.nnnCONCLUSIONSnThis study has shown that the non-invasive pressure gauge Varipress represents a reproducible method to regularly assess variceal pressure, an important parameter related to the risk of bleeding, and to assess the effects of pharmacological therapy with propranolol.

The effect of different doses of a bolus injection of somatostatin combined with a slow infusion on transmural oesophageal variceal pressure in patients with cirrhosis

Transmural variceal pressure was measured by fine-needle puncture following a 250-micrograms bolus injection of somatostatin given intravenously, together with a slow infusion of 250 micrograms/h, and compared with results following a 500-micrograms bolus and with placebo in 19 patients with cirrhosis who had recently bled. Pressure was recorded continuously for a 4-min period. Placebo did not alter variceal pressure (n = 6), whereas a 250- or 500-micrograms bolus produced a rapid decrease in pressure from 33 +/- 7 cmH2O to 20 +/- 6 (n = 7) and from 35 +/- 5 cmH2O to 24 +/- 6 (n = 6), respectively. The difference between the two groups was not significant. This decrease occurred within 30 to 90 s, but was followed by a progressive increase in variceal pressure over the next 2 min in all except two patients. After 3-4 min, variceal pressure still remained below pretreatment levels. Further studies are needed to evaluate the optimal infusion rate. These results seem to indicate that future clinical studies using somatostatin in the treatment of variceal haemorrhage should include repeated bolus injections to arrest variceal bleeding.

Hepatitis B virus and hepatitis C virus infections in Belgium: similarities and differences in epidemics and initial management.

Introduction Nationwide studies comparing patients with hepatitis B and C virus (HBV and HCV) infections are mandatory for assessing changes in epidemiology. Aim The aim of this study was to compare epidemiological data and initial management of newly diagnosed patients with persistent HBV (HBsAg positive) or HCV (detectable HCV RNA) infection in Belgium. Patients and methods Data were extracted from two Belgian observational databases. Results A total of 655 patients (387 HBV and 268 HCV) were included. Compared with HCV patients, HBV patients were younger, more frequently men, more often of Asian or African origin (43 vs. 10%, P<0.0001), and less frequently contaminated by transfusion or intravenous drug use (9 and 6% vs. 34 and 44%, P<0.0001). Viral replication was assessed in 89% of HBV patients. Compared with HCV patients, HBV patients more frequently had normal alanine aminotransferase (ALT) levels (65 vs. 29%, P<0.0001), less frequently underwent liver biopsy (29 vs. 67%, P<0.0001), and were less often considered for antiviral therapy (25 vs. 54%, P<0.0001). When taking only HBV patients with detectable viral replication into consideration, results remained unchanged. During the multivariate analysis, ALT was a major factor for performing liver biopsy or considering antiviral therapy in both groups. Conclusion HBV and HCV screening policies should be targeted toward immigrants and intravenous drug users, respectively. Guidelines recommending systematic search for viral replication should be reinforced in HBV patients. HBV patients less frequently underwent liver biopsy and were less often considered for antiviral therapy compared with HCV patients. Despite the lack of sensitivity and specificity, ALT remains a pivotal decision-making tool for liver biopsy and antiviral therapy in both infections.

711 HEPATITIS B VIRUS (HBV) INFECTION IN BELGIUM: RESULTS OF THE BELGIAN ASSOCIATION FOR THE STUDY OF THE LIVER (BASL) REGISTRY OF 1421 HBSAG CHRONIC CARRIERS

response and improved clinical outcome in HBeAg positive patients. In previous studies, age, gender, ALT, AFP, fibrosis, HBV-DNA, precore/core promoter mutation, HLA, and genotype are considered to be important factors for HBeAgSC. The aim of our study is to identify predicting factors for HBeAgSC within a year. Methods: From 1991 to 2005, liver biopsies were performed on 851 Hepatitis B s antigen positive patients in our hospital. From this group, 234 HBeAg positive patients were chosen to be subjects for this study. In 60 (26%) patients, HBeAgSC was observed within a year after liver biopsy, but in the remaining 174 (74%) patients, HBeAgSC was not observed. We compared the following factors between the two groups; age; gender; ALT; platelets; albumin; AFP; pathological features; HBeAg; HBV DNA; HBcrAg levels; mutations in the precore (G1896A) / core promoter (A1762T / G1764A) domain; and antiviral treatments. Results: Age (37 vs. 37: n.s.); gender (M/F) (43/17 vs. 118/56: n.s.); median ALT level (213 vs.125 IU/L: p = 0.004); median platelets level (171 vs. 186×103/ml: n.s.); median albumin level (4.1 vs. 4.1 g/dl: n.s.); median AFP level (12.0 vs. 6.0: p = 0.048); F0–1/2–4 (13/47 vs. 75/99: 0.043); cell infiltration in portal area 0–1/2–4 (12/48 vs. 59/115: 0.043); piecemeal necrosis 0–1/2–4 (20/40 vs. 91/83: 0.011); lobular inflammation 0–1/2–4 (15/45 vs. 80/94: p = 0.004); median HBeAg level (99 vs. 888 s/co: p< 0.000); median HBV DNA level (7.2 vs.8.0 log copies/ml: p< 0.000); median HBcrAg level (7.2 vs. 8.1 LogU/ml: p < 0.000), antiviral treatment (yes/no) (29/31 vs. 62/112: n.s.). Under multivariate analysis, HBeAg (<500 s/co), lobular inflammation (≥2), precore mutant, core promoter mutant were identified as independent factors for HBeAgSC. Especially, the patients with 2 favorable predictors (HBeAg and lobular inflammation) achieved HBeAgSC in 55% of cases. But, the patients without 2 favorable factors experienced HBeAgSC in only 6 % of cases. Conclusions: Low serum HBeAg level (<500) and severe lobular inflammation (≥2) are independent factors for HBeAgSC within a year. HBeAgSC could be predicted by evaluation for these two factors.