F. Gentili

The Natural History of Portal Hypertensive Gastropathy in Patients with Liver Cirrhosis and Mild Portal Hypertension

BACKGROUND:Portal hypertensive gastropathy is a potential cause of bleeding in patients with liver cirrhosis. Studies on its natural history have often included patients submitted to endoscopic or pharmacological treatment for portal hypertension.PATIENTS AND METHODS:A total of 222 cirrhotic patients with mild degree of portal hypertension (i.e., with no or small varices at entry, without previous gastrointestinal bleeding and medical, endoscopic, or angiographic treatment) were followed up with upper endoscopy every 12 months for 47 ± 28 months.RESULTS:Upon enrollment 48 patients presented portal hypertensive gastropathy (43 mild and 5 severe) and the presence of esophageal varices was the only independent predictor of the presence of this gastric lesion at multivariate analysis. The incidence of portal hypertensive gastropathy was 3.0% (1.1–4.9%) at 1 yr and 24% (18.1–29.9%) at 3 yr, while the progression was 3% (1–6.9%) at 1 yr and 14% (4.2–23.8%) at 3 yr. The presence of esophageal varices and the Child-Pugh class B or C at enrollment were predictive of the incidence of portal hypertensive gastropathy, while only Child-Pugh class B or C was correlated with the progression from mild to severe, at multivariate analysis. During follow-up 16 patients bled from portal hypertensive gastropathy (9 acutely and 7 chronically) and one patient died of exsanguination from this lesion.CONCLUSIONS:The natural history of portal hypertensive gastropathy is significantly influenced by the severity of liver disease and severity of portal hypertension. Acute bleeding from portal hypertensive gastropathy is infrequent but may be severe.

Ribavirin priming improves the virological response to antiviral treatment in transplanted patients with recurrent hepatitis C: a pilot study.

INTRODUCTION Patients with hepatitis C recurrence after liver transplantation represent a clinical challenge. Antiviral treatment in transplant patients has usually poor tolerability and limited efficacy, with a mean sustained virological response (SVR) of 30%. Our pilot study was aimed at evaluating whether 8-week ribavirin pre-treatment could increase either adherence or antiviral effect of a 48-week combination therapy. METHODS Ribavirin pre-treatment (8 weeks) was started with 600 mg daily and increased to 10.4 mg/kg/day. After pre-treatment, 1.5 μg/kg/week pegylated interferon-α2b was added for 48 additional weeks of combination therapy. Blood count, liver function tests and plasma HCV-RNA were examined monthly. Ribavirin plasma concentrations were determined by HPLC. RESULTS Thirteen patients (mean age 53±2 years, 11 males) were treated: eight were HCV genotype 1/4; five were genotype 2/3. The median baseline HCV RNA level was 6.5 log(10) (range 5.84-7.42 log(10)). During ribavirin pre-treatment the median HCV RNA levels decreased significantly (5.7 log(10) ; P=0.023). During combination therapy 6/13 (46%) patients exhibited a rapid virological response (RVR) and 10/13 (77%) patients a complete early virological response, two were non-responders. A decline of 0.5 log(10) HCV RNA during pre-treatment predicted RVR. SVR occurred in six patients (46%): four were genotype 2/3. Stable ribavirin dose reduction was required in only two patients (15%) in whom transient interferon reduction was also required. CONCLUSION This proof-of-concept study indicates that ribavirin pre-treatment increased the tolerability of the antiviral treatment, and improved its efficacy in liver transplant patients. Moreover, the degree of HCV RNA decline during pre-treatment allowed one to predict on-treatment response.

1477 – Role of rotigotine, a dopaminergic modulator, in the management of pharmacoresistant depressed patients

Introduction Pharmacoresistant depression is a challenging clinical condition faced daily by psychiatrists. Although several strategies have been tried to optimize the outcome of this condition, depressive symptoms management remains difficult. Serotonin is regarded as the target neurotransmitter of mood regulation while other monoamines are considered as secondary characters in symptoms management although their role has not been fully explored. Objectives Verify the role of dopaminergic modulation in management of pharmacoresistant depression. Aims Aim of our study is to evaluate the role of a dopaminergic treatment in pharmacoresistant depression management by administration of transdermal rotigotine. Methods Pharmacoresistant depressed patients, with a stabilized antidepressant treatment and in lack of symptomatic improvement in last six weeks, underwent a clinical trial with transdermal rotigotine, up to 4 mg/day. Symptoms were evaluated at the beginning of treatment and after one month by three validated scales: Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) and Global Assessment of Functioning (GAF). Results Ten patients (9 F / 1 M; mean age 48,1 yrs) fulfilled inclusion criteria in the roll-in period. The mean scores before rotigotine treatment were: 22.80±5.8 for HAMD, 25.9±4.9 for HAMA and 41.4±11.62 for GAF. After one month of treatment with rotigotine, scores respectively changed in 11.3±3.3 (t=5.76; p Conclusions Dopaminergic modulation achieved by rotigotine improved mood, motor and anxiety and global functioning scores, in lack of any side effect. In particular, transdermal administration avoided drug plasmatic peacks related to side effects

474 THE PREDICTION OF CHRONIC RENAL DYSFUNCTION FOLLOWING LIVER TRANSPLANTATION: A TIME-DEPENDENT ANALYSIS

10% of patients were non adherent to therapy, to outpatient visit and to requested blood tests, respectively. Non adherent vs. good adherent patients had better MELD at LT (p = 0.04), were drinking alcohol (p = 0.001) and reported >3 side effects of IS (p = 0.02). At 12 months after LT 60%, 50% and 50% of patients were non adherent to therapy, to outpatient visit and to requested blood tests, respectively, significantly worse compared to 6 months evatuation. Non adherent vs. good adherent patients, were younger (p = 0.05), had better MELD at LT (p = 0.04), were drinking alcohol (p = 0.001) and reported >3 side effects of IS (p = 0.02). 50% of patients with poor adherence after LT, had poor adherence before LT. Conclusions: Adherence to medical regimen is poor in cirrhotic patients being the risk factors to be divorced and having good liver function. It seems that adherence improves in the short-term, but deteriorates again in the longer time after LT, when being relatively stable at LT and experiencing side effects due to IS are associated with poor adherence. Educational programs for such patients are badly needed.