Gastric polyps: a 10-year analysis of 18,496 upper endoscopies.

BACKGROUND/AIMS: Gastric polyps (GPs) are usually asymptomatic lesions of the upper gastrointestinal tract observed in 1-3% of esophagogastroduodenoscopies (EGD). Most GPs are benign. The aim of this study was to precise the frequency of different types of gastric polyps in our population, and to analyze their possible association with other factors. MATERIALS AND METHODS: A total of 18,496 consecutive patients undergoing EGD over a 10-year period (between 2007 and 2018) in a tertiary hospital were retrospectively reviewed. Eighty-six patients diagnosed with gastric polyps were analysed. Demographics, medical history of the patients, and indication for gastroscopy were collected. Morphological, histological characteristics of polyps, and therapeutic management data were also collected. RESULTS: GPs were found in 86 out of 18,496 (0.46%) reviewed EGD, corresponding to a total of 141 polyps. There were 64 female (74.4%) and 22 male patients (25.6%) with a sex ratio (M/F) of 0.34. The average age was 58.1 years. One hundred and forty one polyps were included, and histopathology was obtained on 127 GPs. The most common location was the fundus (59.6%) and 48.9% were smaller than 5 mm. The polyp was unique in 75.6% of cases. According to Paris classification, 80% of the polyps were sessile (Is). Hyperplastic polyps were the most common (55.9%), followed by sporadic fundic gland polyps observed in 23 patients (18.1%), 7 (5.5%) were adenomas and 4 (3.1%) were neuroendocrine tumors type 1. The following factors were associated with hyperplastic polyps: anemia (p = 0.022), single polyp (p = 0.025) and size ≥ 5 mm (p = 0.048). Comparing hyperplastic polyps' biopsies to resected polyps, no difference was found in the evolutionary profile of the 2 groups. A size less than 10 mm (p = 0.013) was associated with fundic gland polyps. Sixty polyps (47.2%) were treated by cold forceps, 19 (15%) treated by a mucosal resection and 15 (11.8%) with diathermic snare. Five procedural bleeding incidents were observed (3.9%). Only the use of anticoagulant treatment was associated with a high bleeding risk (p = 0.005). The comparative histological study between specimens of biopsied GPs and endoscopic polypectomy led to an overall agreement of 95.3%. CONCLUSION: In our study, the GPs frequency was 0.36%. Hyperplastic polyps and fundic gland are the most common in our country. The high frequency of Helicobacter pylori infection in our patients and in our area may explain the high frequency of HP.

Prognostic factors of survival during hepatocellular carcinoma.

INTRODUCTION: Despite advances in diagnostic and therapeutic means,mortality of hepatocellular carcinoma (HCC) on liver cirrhosis remainsheavy in the absence of curative treatment. AIM: To evaluate survival and to identify prognostic factors during HCC. METHODS: A mono centric retrospective study over a period of13 years (January 2002-October 2015), including all patients with HHConcirrhotic liver was performed. Survival analysis was performed accordingto the Kaplan-Meier method. The prognostic factors of survival weredetermined by the Log Rank test. RESULTS: Ninety four patients wereincluded (meanage 66.18 years, sexratio 1.65). Cirrhosiswassecondary to hepatitis B or C in 73.6%). Twentytwo patients responded to the MILAN criteria. Cirrhosiswasrated Child A,B and C in 30.9%, 46.8% and 22.3% of patients, respectively. A Curativetreatment was possible for only 10 patients (11.2%). In our study, meansurvival was 15.1 months and overall survival at 1 year and 2 years were25.5% and 21.3%, respectively. Nine factors associated with shortersurvival were identified : a Child-Pugh stage B or C; the absence ofscreening; an AFP level of> 400ng / ml; the existence of vascularthrombosis; a CHC evolved according to the classification of Milan; anOKUDA III score; CLIP score ≥ 3; a BCLC stage C or D; palliative orsymptomatic treatment. CONCLUSION: Although the best treatment of HCC remainspreventive, theuse of new prognostic scores couldimprove the management of patientsifintegrated in therapeuticalgorithms.

Hypogammaglobulinemia associated with nodular lymphoid hyperplasia of the intestine and pernicious anaemia.

BACKGROUND: Nodular lymphoid hyperplasia of the gastrointestinal tract, recurrent acute pulmonary infections and autoimmune disease are well-recognized complications of common variable immunodeficiency. AIM: We aimed to focus on clinical presentation and differential diagnosis of diffuse nodular lymphoid and hyperplasia of the gastrointestinal tract coexisting with hypogammaglobulinemia. CASE-REPORT: We report the case of nodular lymphoid hyperplasia associated with pernicious anaemia in a young man with hypogammaglobulinemia and a long history of pulmonary infections. CONCLUSION: The considerable point was a mismatch primary clinical diagnosis of familial adenomatous polyposis, due to prominent polyplike endoscopic appearance of the lesions throughout the digestive tract.

Microbiological study and antimicrobial susceptibility of bile in biliary therapeutic endoscopy.

BACKGROUND: Biliary obstruction together with bacterial colonization of the bile duct may lead to development of acute cholangitis. The reported incidence of infectious complications may reach up to 10%. Nevertheless, no antibiotic prophylaxis is administered routinely, prior to endoscopic therapeutic procedures. AIM: To investigate the presence and degree of biliary bacterial colonization during endoscopic retrograde cholangiopancreatography (ERCP) in patients with biliary obstruction. Furthermore, we evaluated antibiotic therapy regimens, which would cover the bacterial species obtained by ERCP and subsequent culture in each patient. METHODS: Forty-four patients with biliary obstruction who underwent an ERCP with biliary drainage were prospectively included. The primary indication of ERCP was choledocholithiasis (48%), followed by benign biliary strictures (32%) and malignant bile duct obstruction (18%). Bile cultures were obtained by means of bile aspiration via the cannulation catheter. Aerobic and anaerobic cultures were prepared from all obtained specimens and the isolated organisms were identified. In the case of positive cultures, an in-vitro resistance test for different antibiotics was performed. RESULTS: The overall positive rate of bile culture was 93%. The organisms cultured were Escherichia coli (26.8%), Enterococcus (17%), Klebsiella (14.6%), Enterobacter (14.6%) and Pseudomonas (9.7%) in decreasing order. In-vitro testing of different antibiotics was carried out in these 41 isolates. Imipenem showed the best antimicrobial activity (sensitivity, 100%), followed by colistin (94%), tobramycin (93%), amikacin (89.6%), gentamycin (85.2%) and ceftazidin (82%). Amoxicillin/clavulanic acid and ofloxacin were less sensitive (66% and 60% respectively). Ceftazidin was the most effective antibiotic on Escherichia coli (sensitivity 83%). Multi-resistant organisms were noted in 22% of the cases. CONCLUSIONS: Escherichia coli was found to be the pathogen most frequently detected in bile following endoscopic interventions in the biliary tract. Enterococci and Klebsiella were found in bile cultures with an incidence exceeding 10%. In view of the in-vitro test results, amoxicillin/clavulanic acid or quinolons are not suitable antibiotics for the prophylaxis of biliary infections. Moreover, Gram-positive bacteria such as Enterococcus are emerging as causative microorganisms. If these organisms are isolated, antimicrobial drugs should be replaced by narrower-spectrum antimicrobials.

[Cutaneous metastasis of a ring cell gastric adenocarcinoma]. / Métastases cutanées d'un adenocarcinoma gastrique à cellules indépendantes.

INTRODUCTION: Cutaneous metastasis of gastric tumors are very rare. Their topography is generally near to the primitive tumor, in the abdominal wall but rarely in cervical region. AIM: the aim of our study was to describe the topography and the clinic-pathological characteristics of cutaneous metastasis of ring cells gastric adenocarcinoma. Observation1: Our first patient is aged of 33 years has epigastralgias and vomiting. Gastric adenocarcinoma with independent cells was diagnosed by gastroscopy and gastric biopsy made for gastric pain and loss of weigh. During hospitalization, he developed 4 cutaneous nodes localized in cervical region. Cutaneous biopsy with histological examination confirmed the metastatic nature of the nodes. Patient was addressed in oncology unit in order to begin palliative systemic chemotherapy. Observation 2: Our second patient is a women aged of 4 3years who had surgical resection for independent cell gastric carcinoma diagnosed by gastroscpy and biopsy for gastric pain and loss of weigh. She had total gastrectomy without any complications and was addressed in oncology unit for adjuvant chemotherapy. After 2 years, she developed peritoneal carcinosis and cutaneous abdominal nodes. Cutaneous metastasis were confirmed by histological examination of cutaneous biopsy and the patient died within one month. CONCLUSION: Cutaneous metastasis of gastric cancer and especially ring cell adenocarcinoma are rare but do occur. They must be early diagnosed because they modify therapeutic options. Their prognosis remains poor.

Epidemiological evolution of epidemiology of the inflammatory bowel diseases in a hospital of Tunis.

BACKGROUND: The epidemiological studies showed that the incidence of the inflammatory bowel diseases describes a gradient North-South. Besides, concerning the evolution according to the time,recent studies noted an increase of the incidence of the Crohn's disease at the expense of the one of the ulcerative colitis. AIM: To determine the evolution of the epidemiology of the inflammatory bowel diseases across the time. METHODS: The study included inpatients followed for Crohn's disease, ulcerative colitis and indeterminate colitis, in the department of gastroenterology of Habib Thameur hospital. For every patient were collected the sex, the age and the year of the diagnosis, the type of inflammatory bowel disease and the initial location. We compared the evolution of the frequency of the inflammatory bowel diseases,them type and their initial location according to 5 periods of 3 years. RESULTS: During this period, 202 cases of inflammatory bowel disease were diagnosed (55,5% of Crohn's disease, 41,5% of ulcerative colitis, 6% of indeterminate colitis). For the first period,we noted 21 cases of inflammatory bowel disease, for the 5th period, we noted 43 cases. The frequency of the Crohn's disease passed from 8 cases in the 1st period to 23 cases in the 5th one. The frequency of the ulcerative colitis passed from 12 cases in the 1st period to 17 cases in the 5th one. The number of indeterminate colitis was 1 in the 1st period and 3 in the 5th one. These differences did not been significant. The distribution of initial locations of the Crohn's disease and the ulcerative colitis increased in a proportional manner for each period. The average age to the diagnosis was 32 years in the 1st period and 35 years in the 5th period and comparable whatever the inflammatory bowel disease type. CONCLUSION: Although we cannot amount the exact incidence, we noted an increase of the frequency of the inflammatory bowel diseases, with a more marked elevation for the Crohn's disease.

Tunisian consensus on the management of Helicobacter Pylori infection.

Helicobacter pylori infection is the most common infectious disease worldwide. It is associated with duodenal and gastric ulcer disease and the risk of gastric neoplasia. The management of helicobacter pylori infection currently represents a real challenge for clinicians, given the ever-increasing rate of resistance of Helicobacter pyolori to various antibiotics. In this consensus document, we present recommendations adapted to the Tunisian context, including indications for the detection of helicobacter pylori infection, indications for the use of different diagnostic methods, and a therapeutic strategy for the management of Helicobacter pylori infection.

Correlation of C-reactive protein with clinical and endoscopic activity in patients with ulcerative colitis.

BACKGROUND AND AIMS: Evaluating disease activity is important in ulcerative colitis. Laboratory markers should be a non-invasive alternative to endoscopy for patients. The objective of our study was to scrutinize the correlation between C-reactive protein (CRP) levels and clinical and endoscopic activity in ulcerative colitis patients. MATERIALS AND METHODS: We conducted a prospective study between January 2007 and December 2009. In the study we chose consecutive patients of our department with ulcerative colitis. All patients received a standardized questionnaire, clinical examination, and colonoscopy. Based on clinical and endoscopic data, we calculated the disease activity index (DAI) and the Rachmilewitz score. RESULTS: One-hundred and one patients were included. At the time of inclusion, 67 patients had an active disease and 34 patients were in remission. The mean DAI was 6.9 (1-12). The mean Rachmilewitz score was 4.7 (0-12). The median CRP rate was 20.2 ± 24.5 mg/l (1-107 mg/l). An increased CRP was found in 46 patients (46%). An increased CRP level was observed in patients with active disease (P < 0.0001). The DAI was higher in patients with increased CRP (9.5 ± 1.6 vs. 4.7 ± 3.6; P < 0.0001). The Rachmilewitz score was also higher in patients with increased CRP (7.2 ± 2.3 vs. 2.7 ± 3.2; P < 0.0001). A statistically significant association was found between the CRP and the DAI (r = 0.51, P < 0.0001) and between the CRP and the Rachmilewitz score (r = 0.46, P < 0.0001). The optimum cut-off of CRP level that separates active or inactive disease was calculated to be 10 ml/l, with AUC estimated at 0.81 ± 0.04 (95%CI: 0.72-0.88), a sensitivity of 67.1 (95%CI: 54.6-78.1) and a specificity of 97% (95%CI: 84.6-99.5). CONCLUSION: Levels of CRP are correlated to clinical and endoscopic activity in ulcerative colitis patients.

[Long term evolution of corticodependant and corticoresistant Crohn's disease patients treated by azzathioprine]. / Évolution a long terme des patients atteints de maladie de Crohn corticodépendante et corticorésistante traites par azathioprine.

BACKGROUND: Immunosupressors, particularly azathioprine, represents the therapeutic alternative in patients with corticodependant or corticoresistant Crohn's disease. The prescription of azathioprine in Tunisia is common, but there is not Tunisian studies evaluating the long term results of this drug in Crohn's disease patients. AIMS: To evaluate the long term results of azathioprine treatment with determination of rates of relapses, surgery and need to corticosteroids in patients with corticodependant or corticoresistant Crohn's disease, and to look for predictive factors to theses events. METHODS: A retrospective study on 12 years including all patients treated by azathioprine for corticodependant or corticoresistant Crohn's disease. We excluded the cases of follow up less than 6 months. RESULTS: We studied 56 patients (46 corticodependant and 10 corticoresistant). Induction of remission was obtained in 89% of the cases. Concerning the long term results, the relapse rate was 60% of patients treated with azathioprine, with actuarial rates of 38% at one year, 65% at 5 years and 75% at 10 years. Need for corticosteroid treatment was estimated at 42% and need for surgical treatment was estimated at 24%. The only predictive factor for relapse was duration of treatment by azathioprine more than 36 months, with sensitivity of 93% and specificity of 50%. CONCLUSION: Although an excellent result of azathioprine in induction remission, long term results showed deterioration of results of treatment. Physicians must be followed up Crohn's disease patients in order to rapidly detect and treat the clinical relapses of the disease.

A pseudotumoral form of Crohn's disease: A case report and review of the literature.

In front of a colonic tumor, the diagnosis of a pseudotumoral form of Crohn's disease must be considered. However, it is a rare form, especially when inaugural and a neoplasia must be eliminated before retaining the diagnosis.

Predictive factors of azathioprine prescription in adult patients with Crohn's disease.

BACKGROUND/AIMS: Azathioprine is the most commonly used immunomodulator in Crohn's disease. The aims of the study are to determine the cumulative frequency of azathioprine prescription in non selected consecutive inpatients with Crohn's disease and to identify a subgroup of patients with high risk of azathioprine prescription during the follow-up. METHODOLOGY: We studied consecutive in patients with established diagnosis of Crohn's disease admitted in our department in years 2002 and 2003. Cumulative frequency of azathioprine use during the follow-up was calculated. Predictive factors of azathioprine use were studies based on clinical, biological and endoscopic charts at the first hospitalization in our department. RESULTS: We include 88 patients (52 males, mean age 31.3 years (18 - 68)). Azathioprine was prescribed in 38 patients (43.2%) with a mean period of 12.9 months (1 - 90) after the first hospitalization. The cumulative frequency of azathioprine prescription was 11% the first month, 31% at 6 months, 35% at one year and 49% at 6 years. In univariate analysis, azathioprine use was more frequent in previously treated patients in an other department (p = 0.05), in case of ileal involvement > 40 cm (p = 0.02), previously treated patients with corticosteroids (p = 0.001), first treatment in our unit by corticosteroids (p < 0.0001), duration of the flare more than 6 months (p = 0.01), CDAI > 204 points (p < 0.0001), Hemoglobin level < 9.7 g/ dl (p < 0.0001) and cholesterolemia level < 1.32 g/l (p < 0.0001). Independent factors associated with azathioprine use in our population were diffuse involvement of the ileum at initial hospitalization (p = 0.0001; OR [95%CI]: 17.9 [4.1-77.9]), and previous prescription of corticosteroid therapy (p = 0.04; OR [95% CI]: 5 [1.1-25]). CONCLUSION: Azathioprine is frequently used in adult Crohn's disease patients, maximally within the first year after the first hospitalization. Patients with diffuse ileal involvement and previously treated patients with corticosteroids are at higher risk to azathioprine use and should have systematically the preventive strategies to ovoid opportunistic infections since their first visit.

[Difficulty in diagnosing pseudotumoral autoimmune pancreatitis: two cases]. / Difficultés diagnostiques de la pancréatite auto-immune pseudotumorale: à propos de deux cas.

BACKGROUND: In recent years, autoimmune pancreatitis (AIP) has been increasingly recognized. The diagnosis of AIP is based on a series of clinical, biological and radiological criteria. In imaging, it may appear as two different forms: a diffuse form by destroying channels and pseudotumoral lesions that can cause inadequate resections. AIM: To report two new cases of pseudotumoral autoimmune pancreatitis CASES REPORT: We report two cases of pseudotumoral autoimmune pancreatitis, with different clinical, biological and radiologic features. The diagnosis was established easily in one case and after surgery in a 2nd case. CONCLUSION: Our two cases underline the difficulties still encountered in the diagnosis of AIP.

[Sleep disorders in patients with gastroesophageal reflux disease: an open clinical and pH metric prospective study]. / Perturbations du sommeil au cours du reflux gastro-oesophagien: Résultats d'une etude prospective ouverte clinique et Ph-métrique.

BACKGROUND: Sleep disorders are frequent in patients with GERD. Severity of sleep disorders could be related to occurrence of nighttime symptoms, but the relationship between severity of GERD and the severity of sleep disorders is not well established. AIM: To identify the frequency of sleep disorders in patients with suspected GERD and the correlation between the severity of sleep disorders and pHmetric parameters in these patients. METHODS: We studied prospectively 50 patients with esophageal and supra-esophageal symptoms of GERD. 24-hour esophageal pH monitoring examination was performed in all patients. Standard survey was applied to determine the frequency and the severity of sleep disorders in these patients. RESULTS: We included 50 patients (10 men, 40 women), mean age 43.7 years (18-70). Nighttime symptoms were present in 26 patients (52%). Pathological acid gastro-esophageal reflux was diagnosed by 24-hour esophageal pH recording in 18 patients (36%), with nocturnal acid reflux in 19 patients (38%). Sleep disorders were reported by 29 patients (58%). Mean number of hours of sleep was 6.8 hours by night (4-9 hours). Clinical factors associated with higher frequency of sleep disorders were occurrence of nighttime symptoms (p < 0.0001) and duration of symptoms of GERD (53.2 +/- 41.4 months vs 26.0 +/- 18.1 months ; p = 0.007), with no association with BMI, age and sex. pHmetric parameters associated with sleep disorders were pathological acid reflux (p < 0.0001; OR [CI 95%]: 28.3 [3.3-240.8]) and nocturnal acid reflux (p < 0.0001; OR[CI95%] :32.7 [3.8 - 279.2]). Patients with sleep disorders had significant changes of pHmetric parameters compared to those without sleep disorders: Acid exposition time, numbers of reflux episodes, number of episodes longest than five minutes, duration of longest reflux episode and DeMeester score (respectively 6.1 +/- 8.8 vs 1.3 +/- 1.5 p = 0.01; 59.2 +/- 52.0 vs 20.7 +/- 21.6 p = 0.001; 3.1 +/- 6.1 vs 0.1 +/- 0.3 p = 0.03; 8.9 +/- 9.3 minutes vs 3.4 +/- 4.0 minutes p = 0.01; 24.0 +/- 33.2 vs 4.8 +/- 4.9 p = 0.01). Number of hours of sleep was significantly lower in patients with pathological acid reflux (5.3 +/- 1.2 hours vs 7.6 +/- 1.7 hours, p < 0.0001) and in patients with nocturnal acid reflux (5.2 +/- 1.1 hours vs 7.8 +/- 1.5 hours, p < 0.0001). Number of hours of sleep was strongly correlated with esophageal pH parameters CONCLUSION: Sleep disorders are frequent in patients with GERD symptoms. Severity of sleep disorders are strongly correlated with severity of global and nocturnal acid reflux as attested by 24-hour esophageal pH monitoring.

Predictors of failure of endoscopic retrograde pancreatocholangiography during common bile duct stones.

INTRODUCTION: Endoscopic retrograde cholangiopancreatography associated with sphincterotomy and stone extraction with balloon or Dormia basket represents the gold standard for the management of common bile duct stones. The aim of our study were to investigate the predictors of failure of standard endoscopic techniques during the management of common bile duct stones. METHODS: A retrospective study including all endoscopic retrograde cholangiopancreatography for common bile duct stones between January 2014 and December 2017 was conducted. First line treatment was based on endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy and balloon or Dormia extraction. Second line endoscopic treatment was based on macrodilatation of Oddi sphincter, mechanical lithotripsy, biliary stent or nasobiliary drain placement. Predictors of failure of standard endoscopic techniques were sought by uni and multivariate analysis (SPSS software, p significant if < 0.05). RESULTS: One hundred eighty one patients (mean age 64 years and sex ratio M/W = 0.4) were included. Main indications for endoscopic retrograde cholangiopancreatography were residual or recurrent lithiasis (67.4%, n = 122). Cholangiography revealed multiple stones in 53 patients with an average size of 12.5mm [3-40]. The success rate of first line treatment was 61.9%. Independent predictors of failure of standard endoscopic techniques (failure of papillary cannulation or stone extraction) according to multivariate analysis were: an age greater than 65 years OR 0.516 [0.272-0.979], an intra-diverticular papilla OR 0.179 [0.035-0.914], a common bile duct diameter greater than 15 mm OR 0.161 [0.068-0.385] and a stenosis of the common bile duct OR 0.068 [0.008-0.605]. The success rate of the second line treatment was 73%. CONCLUSION: Endoscopic retrograde cholangiopancreatography results in a successful clearance of the common bile duct in almost two-thirds of patients. In case of predictors of failure, alternative techniques can increase this rate.

Ampullary and pancreatic adenocarcinoma-a comparative study.

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) and ampullary adenocarcinoma (AAC) are 2 gastrointestinal cancers that share overlapping symptoms. Although some studies have proposed the hypothesis of differences in pathogenesis and prognosis in these 2 cancers; they remain treated similarly. The classification of AAC into three subtypes [pancreatobiliary (PB), intestinal (IT) and mixed (M)] is especially crucial for the 3 axes of patients management (diagnosis, prognosis and therapy). Some studies suggest that PB subtype pathogenesis is comparable to PDAC. The objective of this study was to conduct a comparative analysis between PDAC and AAC; notably PB subtype; via mutational status analysis of 3 oncogenes (KRAS, NRAS and BRAF) hoping to consolidate AAC biology understanding. METHODS: Nine hot spot mutation sites of KRAS, NRAS and BRAF were analysed using pyrosequencing in 39 PDAC and 21 AAC from Tunisian patients. Comparative study was performed using SPSS software. RESULTS: Mutations in oncogenes were detected in almost 43% of AAC, especially in PB (47%) and 95% of PDAC. KRAS was the most mutated oncogene. There were statistical significant differences between PDAC and AAC in tumor differentiation (P<0.001), perineural invasion (P<0.001), vascular emboli (P=0.001), T stage (P=0.007), N stage (P=0.001) and mutational status (P<0.001). When comparing PDAC and PB subtype, there were also significant differences in tumor size (P=0.001), tumor differentiation (P<0.001), perineural invasion (P<0.001), vascular emboli (P=0.001), T stage (P=0.033), N stage (P<0.001) and mutational status (P<0.001). CONCLUSIONS: AAC even PB subtype is different from PDAC. We think that these different tumor types require highly individualized therapy guided by their histomolecular characteristics and that we should stop diagnosing and treating them as a unique entity.

Effect of low dose albumin administration in spontaneous bacterial peritonitis on renal function and survival.

BACKGROUND AND STUDY AIMS: Current guidelines favour albumin administration during spontaneous bacterial peritonitis (SBP). However, its use is limited in clinical practice and low doses are preferred. The aim of our study was to determine the effect of low dose albumin perfusion during SBP on mortality and prevention of hepatorenal syndrome (HRS) in cirrhotic patients. PATIENTS AND METHODS: A retrospective study including consecutive patients with SBP hospitalized from 2002 to 2015 was performed. All patients were treated by intravenous empiric antibiotics associated with albumin infusion (30 g/day the first and third day) irrespective of patient's weight. The diagnosis of HRS was assessed according to the International Ascites Club criteria. The survival, the frequency of HRS and any disturbance in renal function were recorded. RESULTS: Fourty nine patients (sex ratio = 0.81, mean age 60.6 years [23-89]) were included. Main cause of cirrhosis was hepatitis B and C in 42.9% of cases. 63.3% were of Child Pugh C score%. The first line intravenous antibiotic treatment was based on cefotaxime in 87.8% of cases, followed by ofloxacin in 6.1% of cases. The outcome was favourable in 85.7% of cases. HRS was observed in 9 patients (18.3%) within 18 months [1-55]. Otherwise, 10 patients (20.4%) experienced an increase in creatinine level despite of albumin perfusion. The immediate mortality was 4%, and the six months survival was of 81.8%. CONCLUSION: Despite even a low dose administration of albumin during SBP, renal dysfunction and HRS occurred less than described in literature. These results associated with cost considerations could suggest to use such an intervention during SBP or to select high risk patients who must receive albumin perfusion during SBP.