Florencia Vargas

Colchicine in the Treatment of Cirrhosis of the Liver

There is preliminary evidence that colchicine, an inhibitor of collagen synthesis, may be beneficial in the treatment of cirrhosis of the liver. To evaluate the use of colchicine (1 mg per day, five days per week) in the treatment of hepatic cirrhosis, we performed a randomized, double-blind, placebo-controlled trial in which 100 patients were followed for up to 14 years. Forty-five patients had alcoholic cirrhosis, 41 had posthepatitic cirrhosis, and the remaining 14 had cirrhosis with various other causes. Histologic studies were available for 92 percent of patients. Seventy-three patients were in Child-Turcotte class A, 26 were in class B, and one was in class C. Fifty-four patients received colchicine, and 46 received placebo. The overall survival in the colchicine group was markedly better than in the placebo group (median survival, 11 and 3.5 years, respectively; P less than 0.001). The cumulative 5-year survival rates were 75 percent in the colchicine group and 34 percent in the placebo group; the corresponding 10-year survival rates were 56 percent and 20 percent. Among the 30 patients treated with colchicine who underwent repeated liver biopsies, histologic improvement was seen in 9; the liver appeared normal in 2, and 7 had minimal portal fibrosis. No histologic improvement was observed in the 14 members of the placebo group who had two or more biopsies. Few side effects were observed in either group.

Treatment of chronic portal—Systemic encephalopathy with vegetable and animal protein diets

A controlled crossover clinical comparison of 40-g/day and 80-g/day vegetable protein diets vs a 40g/day meat protein diet plus neomycin-milk of magnesia (as control therapy) was performed on 10 cirrhotic patients with mild chronic portal-systemic encephalopathy. The 40-g vegetable protein diet had a high fiber volume and contained low methionine and low aromatic amino acids. The 80-g vegetable protein diet was rich in branched-chain amino acids and fiber, with a similar content of sulfur-containing amino acids as compared to the 40-g meat protein diet. Serial semiquantitative assessments were done, including mental state, asterixis, number connection tests electroencephalograms and blood ammonia levels. No patient developed deep coma while ingesting either vegetable protein diet or neomycin-milk of magnesia plus 40-g meat protein diet. A significant improvement in the number connection test times was observed during the 40-g vegetable protein diet (P<0.05) and during the 80-g vegetable protein diet (P<0.05) as compared to their previous 40-g meat protein-neomycin periods. In addition, during the period of 80-g vegetable protein diet, the patients showed a significant improvement in their electroencephalograms (P<0.05). The frequency of bowel movements significantly increased (P<0.05) during the 80-g vegetable protein diet period. During the 40-g vegetable protein diet, two cirrhotic-diabetic patients experienced hypoglycemia. Three patients complained of the voluminous 80-g vegetable protein diet. Patients with mild portal-systemic encephalopathy may be adequately controlled with vegetable protein diets as a single therapy.

Beneficial Effect of Vegetable Protein Diet Supplemented With Psyllium Plantago in Patients With Hepatic Encephalopathy and Diabetes Mellitus

A controlled crossover study was performed in 8 diabetic patients with chronic portal-systemic encephalopathy. After a basal period the patients were treated during periods A and B. During period A, a meat protein diet (0.8 g/kg body wt, approximately 1800 kcal/day) was consumed and neomycin plus laxatives were given. During period B patients received vegetable protein (0.8 g/kg body wt, 1800 kcal/day). This diet was supplemented with psyllium fiber to reach 35 g of fiber per day. Four patients were randomly assigned to receive the treatments in the order A-B and the other 4 patients in the order B-A. At the end of the first experimental period, fasting glucose levels were 204 +/- 86 mg% in the meat protein diet group and 127 +/- 8 mg% in the vegetable protein diet group (p less than 0.014). The patients were receiving 2.5 +/- 0.2 g/day and 2.1 +/- 0.5 g/day of tolbutamide at the end of the meat protein diet and vegetable protein diet, respectively. In all cases, fasting glucose levels decreased at the end of the vegetable diet period regardless of the previous treatment. An improvement of greater than or equal to 25 mg% of fasting glucose levels was observed in 7 of the 8 patients after the vegetable protein diet and in no case after the meat protein diet (p less than 0.0078). The parameters of encephalopathy were comparable at the end of both the meat protein diet and the vegetable protein diet. A significant increase in the number of bowel movements was noticed after the vegetable diet plus fiber (p less than 0.01). We propose the use of vegetable diet plus fiber to facilitate the treatment of patients with both diabetes and hepatic encephalopathy.

Lactitol, a second-generation disaccharide for treatment of chronic portal-systemic encephalopathy: a double-blind, crossover, randomized clinical trial

A double-blind crossover trial was performed to test the therapeutic usefulness and safety of lactitol, a beta-galactoside sorbitol, against lactose in 18 patients with chronic portal-systemic encephalopathy (PSE). The study included four periods: two for washout and two for lactitol and lactose administration. During washout periods, which lasted two weeks each, patients were stabilized with neomycin plus milk of magnesia. Lactitol and lactose were administered during four weeks each. Ten patients were randomly assigned to receive lactose (group A) and eight patients to receive lactitol (group B) first. PSE parameters, ie, mental state, number connection test performance, asterixis and blood ammonia levels were assessed fortnightly. Electroencephalographic tracings and stool pHs were evaluated at the end of each study period. After the first administration of lactose and lactitol, no statistically significant differences in PSE parameters were found. At the same stage, a significant stool acidification (P<0.05) was detected. It is concluded that lactitol seems to be safe and efficacious in treating patients with chronic PSE.

Frequency of different subgroups of patients with non erosive gastroesophageal reflux disease (NERD) according to esophageal acid exposure and symptom index

Studies using 24 hr esophageal pH monitoring (24pH) and s)qmptom index (SI) have demonstrated that the population of NERD is hetemgenous. Dflierent subgroups of NERD patients have been described: patients witb abnormal esophageal acid exposure (EAE), patients with normal EAE v4th good correlation between heartburn and retktx episodes and patients with normal EAE and no correlation between heartburn and refltux episodes. However, the exact prevalence of these subgroups is unknown. Aim: To invesugate the frequency of difterent subgroups of patients with NERD according to EAE and SL Patients and Methods: Patients with heartburn at least 3 times per week, during a minimum of I2 weeks, in the last preceedmg year and negative upper GI endoscopy were studied. All patients were undergone to 24pH with one sensor located at 5 cm above the LES % time of pH 4.2% of time pH 14.7), I1)Normal 24pH with positwe SI (>50%) and Ill)Normal 24pH and negative SI (<50%). Results: 300 patients (F:206) were included Median age was 44 years (15-81) Frequency of groups was: I:i37(46%), if: 62(21%) and lie 101(33%). There were no significant differences m gender and age between groups. Tbe pH parameters and SI are shown in the table. Conclnsions: In NERD, 46% of the patients had abnormal EAE. Among patients with normal EAE (h_mctional fieartbum) 38% had positive 5I (hypersensitive esophagus) and 62% had no correlation between heartburn and acid reflux episodes