Effects of ursodeoxycholic acid on serum liver enzymes in patients with hepatitis C virus-related chronic liver disease.

OBJECTIVE: To study the effect of ursodeoxycholic acid (UDCA) on serum liver enzyme levels [alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT)] in 101 patients with hepatitis C virus-related chronic liver disease. METHODS: Forty-nine patients were assigned to receive UDCA (450 mg/day) over a period of 6 months and 52 to receive no treatment. RESULTS: In the UDCA group, serum ALT and GGT levels significantly improved. ALT values decreased from pre-treatment levels of 157.0 +/- 62.6 IU/l to 82.5 +/- 46.4 IU/l (P < 0.05), and GGT fell from 141.3 +/- 86.2 IU/l to 66.0 +/- 49.5 IU/l (P < 0.001). No significant change occurred in the mean ALT and GGT levels in the control group. CONCLUSION: Although our encouraging preliminary results must be validated by double-blind histological trials, UDCA may be an alternative treatment for patients who fail to respond to interferon therapy.

Risk factors and association with HBV infection in chronic C hepatitis.

The route of transmission in more than 50% of the patients with hepatitis C virus (HCV) infection is unknown. Only a minority of patients have had a previous blood transfusion; sporadic spread seems to be much more important, although the role of inapparent parenteral exposure is yet to be established. Aim of this study was to investigate if a relationship exists between history for exposure to known risk factors, concurrent HBV status and histological findings (presence of cirrhosis) in patients with chronic HCV liver disease. We studied 86 subjects with chronic HCV liver disease, subdivided according to their HBV status. Fifty four patients were anti-HBV negative; in the remaining 32 subjects, antibodies to HBV were found. Our data show that: 1) history for exposure to known risk factors is more likely to be present in patients with chronic HCV liver disease and concurrent positivity for antibodies to HBV than in anti-HCV positive patients without HBV antibodies (62.5% vs 38.9%); and 2) the incidence of liver cirrhosis is higher in anti-HCV positive patients with anti-HBV antibodies than in exclusively anti-HCV positive patients (56.2% vs 12.9%). We conclude that the association of history for exposure to known risk factors and anti-HBV positivity could be a marker of progression from mild to severe liver damage in patients with chronic HCV liver disease (i.e. in the absence of both identifiable risk factors and HBV antibodies, HCV infection could have a less severe clinical outcome). Therefore, in these patients a closer follow-up and earlier interferon therapy are probably needed.

The effect of a short course of calcium and vitamin D on bone turnover in older women.

Calcium and vitamin D (1200 mg/day + 800 IU) has been shown to reduce hip fracture incidence in older women living in long-term care facilities who had borderline low vitamin D levels. We examined the effect of a short course of calcium and vitamin D on biochemical markers of bone turnover in older community-living women. Twelve community-living women (mean age 75 years) in good general health, without diseases or on medications known to affect bone, were entered into the study. All women were treated with calcium citrate (1500 mg/day of elemental calcium) and vitamin D3 (1000 IU/day) (Ca + D) for 6 weeks. Biochemical markers of bone turnover were measured in serum and urine collected at baseline (two samples), 5 and 6 weeks on Ca + D, and 5 and 6 weeks after termination of Ca + D. Markers of bone formation were osteocalcin, bone alkaline phosphatase and type I procollagen peptide. Markers of bone resorption were urinary hydroxyproline, free pyridinoline and deoxypyridinoline crosslinks, and N-telopeptides of type I collagen. Parathyroid hormone (PTH) and 25-hydroxyvitamin D were also measured at baseline, 6 weeks on treatment and 6 weeks after termination of treatment. All markers of bone resorption decreased on Ca + D and returned to baseline after termination of Ca + D (p < 0.05). Markers of bone formation did not change with Ca + D treatment. PTH decreased on Ca + D and returned to baseline after treatment, and 25-hydroxyvitamin D increased with treatment and remained elevated 6 weeks after the end of treatment. We conclude that Ca + D reduces bone resorption in older women, possibly by suppressing PTH levels.