RESUMEN
To further characterize the genetic basis of primary biliary cirrhosis (PBC), we genotyped 2426 PBC patients and 5731 unaffected controls from three independent cohorts using a single nucleotide polymorphism (SNP) array (Immunochip) enriched for autoimmune disease risk loci. Meta-analysis of the genotype data sets identified a novel disease-associated locus near the TNFSF11 gene at 13q14, provided evidence for association at six additional immune-related loci not previously implicated in PBC and confirmed associations at 19 of 22 established risk loci. Results of conditional analyses also provided evidence for multiple independent association signals at four risk loci, with haplotype analyses suggesting independent SNP effects at the 2q32 and 16p13 loci, but complex haplotype driven effects at the 3q25 and 6p21 loci. By imputing classical HLA alleles from this data set, four class II alleles independently contributing to the association signal from this region were identified. Imputation of genotypes at the non-HLA loci also provided additional associations, but none with stronger effects than the genotyped variants. An epistatic interaction between the IL12RB2 risk locus at 1p31and the IRF5 risk locus at 7q32 was also identified and suggests a complementary effect of these loci in predisposing to disease. These data expand the repertoire of genes with potential roles in PBC pathogenesis that need to be explored by follow-up biological studies.
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Cromosomas Humanos Par 13 , Cromosomas Humanos Par 1 , Cromosomas Humanos Par 7 , Epistasis Genética , Sitios Genéticos , Cirrosis Hepática Biliar/genética , Polimorfismo de Nucleótido Simple , Alelos , Estudios de Casos y Controles , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Genotipo , Antígenos HLA/genética , Antígenos HLA/inmunología , Humanos , Cirrosis Hepática Biliar/inmunología , Análisis de Secuencia por Matrices de OligonucleótidosRESUMEN
UNLABELLED: Liver biopsy is important for diagnosing primary biliary cirrhosis (PBC). Prior investigations suggest that immunostaining for biliary keratin 19 (K19) may show the earliest changes suspicious for PBC, namely, loss of the canals of Hering (CoH). We aimed to study the clinical outcomes of patients whose biopsy specimens appeared histologically near normal or with minimal inflammatory changes, but in which K19 staining revealed widespread periportal CoH loss, a finding we termed "minimal change PBC." Ten patients were identified prospectively as having nearly normal or mildly inflamed biopsy specimens without diagnostic or suggestive histologic features of PBC, but with near complete CoH loss; six had available follow-up clinical data, one had follow-up biopsy. Controls for clinical and/or K19 analysis included six normal livers and biopsy specimens from 10 patients with confirmed early PBC, 10 with early stage chronic hepatitis C (CHC), and nine with resolving, self-limited hepatitis (RSLH). Staining for K19 in normal controls, livers with "minimal change" PBC, CHC, and RSLH showed 9.2 ± 6.0, 0.44 ± 0.37 (P < 0.0001), 5.7 ± 4.6 (n.s.), 4.1 ± 2.1 (P < 0.02) CoH per portal tract, respectively. Patients with available clinical follow up, compared to patients with diagnostic early-stage PBC biopsies, showed identical treatment responses to ursodeoxycholic acid, similar rates and types of nonhepatic autoimmune diseases, and/or subsequent development of autoimmune hepatitis overlap syndrome. CONCLUSION: We suggest that CoH loss demonstrated by K19 immunostaining is an early feature in PBC. Clinical findings in the years following biopsy, including response to ursodeoxycholic acid, show identical changes to patients with biopsy confirmed PBC. We suggest that this "minimal change" feature may support a clinical diagnosis of PBC even in the absence of characteristic, granulomatous, duct destructive lesions.
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Conductos Biliares Intrahepáticos/patología , Queratina-19/análisis , Cirrosis Hepática Biliar/diagnóstico , Cirrosis Hepática Biliar/patología , Adulto , Biopsia , Femenino , Humanos , Inmunohistoquímica , Hígado/patología , Persona de Mediana Edad , Estudios Prospectivos , Ácido UrsodesoxicólicoRESUMEN
OBJECTIVES: We evaluated the efficacy of a hepatitis care coordination intervention to improve linkage to hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination and clinical evaluation of hepatitis C virus (HCV) infection among methadone maintenance patients. METHODS: We conducted a randomized controlled trial of 489 participants from methadone maintenance treatment programs in San Francisco, California, and New York City from February 2008 through June 2011. We randomized participants to a control arm (n = 245) and an intervention arm (n = 244), which included on-site screening, motivational-enhanced education and counseling, on-site vaccination, and case management services. RESULTS: Compared with the control group, intervention group participants were significantly more likely (odds ratio [OR] = 41.8; 95% confidence interval [CI] = 19.4, 90.0) to receive their first vaccine dose within 30 days and to receive an HCV evaluation within 6 months (OR = 4.10; 95% CI = 2.35, 7.17). A combined intervention adherence outcome that measured adherence to HAV-HBV vaccination, HCV evaluation, or both strongly favored the intervention group (OR = 8.70; 95% CI = 5.56, 13.61). CONCLUSIONS: Hepatitis care coordination was efficacious in increasing adherence to HAV-HBV vaccination and HCV clinical evaluation among methadone patients.
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Hepatitis A/prevención & control , Hepatitis B/prevención & control , Metadona/uso terapéutico , Tratamiento de Sustitución de Opiáceos , Vacunación , Adulto , Intervalos de Confianza , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Evaluación de Resultado en la Atención de Salud , Cooperación del Paciente/estadística & datos numéricos , San FranciscoRESUMEN
Inadequate organ donation limits transplantation for many in need of a life-saving organ. Race of donor families and requesting coordinators may impact the authorization rate for organ donation. We evaluated authorization rates for organ donation within the New York Organ Donor Network by race during 2009 and 2010. The donation authorization rate varied considerably according to the race of the donor. The authorization rate was 57% for Hispanic, 53% for Caucasian, 48% for African-American, and 23% for Asian donor families. Fifty-five percent of donor families agreed to donation when there was racial concordance between coordinator and donor. Donation authorization was 49% when a racial mis-match existed. When adjusted for coordinator training and experience, racial discordance had a lesser impact on authorization rates. Our findings suggest the need for education and communication strategies to overcome racial-associated perception during the organ donation process.
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Enfermedad Hepática en Estado Terminal/cirugía , Trasplante de Hígado , Grupos Raciales/etnología , Obtención de Tejidos y Órganos/tendencias , Adulto , Negro o Afroamericano/etnología , Anciano , Asiático/etnología , Educación en Salud , Hispánicos o Latinos/etnología , Humanos , Persona de Mediana Edad , New York , Estudios Retrospectivos , Obtención de Tejidos y Órganos/estadística & datos numéricos , Población Blanca/etnologíaRESUMEN
BACKGROUND AND AIMS: Liver chemistry abnormalities (LCA) are common in patients with coronavirus disease 2019 (COVID-19), but their causes and clinical impact have not been adequately studied. We assessed the associations between LCA and clinical characteristics, inflammatory serum markers, in-hospital mortality. METHODS: Ten thousand eight hundred fifty-six adult patients with COVID-19 hospitalized in 13 hospitals in New York (1 March to 27 April 2020) were analyzed retrospectively. Abnormalities of liver chemistries [aspartate aminotransferase (AST), alanine aminotransferase, alkaline phosphatase, or total bilirubin] were defined as absent, mild-moderate (at least one value up to four times elevated), or severe. RESULTS: LCA were mild-moderate in 63.9% and severe in 7.6% at admission. Risk factors for severe LCA were male sex and chronic liver disease. Conversely, hypertension and diabetes mellitus were less likely associated with severe LCA. AST elevation correlated weakly to modestly with inflammatory markers. On adjusted analysis, in-hospital mortality was 1.56 times and 1.87 times increased in patients with mild-to-moderate and severe LCA, respectively. Diabetes, hypertension, male sex, and age greater than 60 years was associated with incremental risk of mortality with increase severity of LCA, especially in the first week of hospitalization. HTN was not associated with increased in-hospital mortality unless LCA was present. CONCLUSION: Increasing severity of LCA on hospital admission predicts early in-hospital mortality in COVID-19 patients. Mortality associated with the known risk factors, hypertension, diabetes, male sex, and old age was accentuated in the presence of LCA. AST correlated modestly with inflammatory markers.
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COVID-19 , Adulto , Mortalidad Hospitalaria , Humanos , Hígado , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , SARS-CoV-2RESUMEN
BACKGROUND AND AIMS: Liver biopsy plays a crucial role in assessing inflammation and fibrosis in chronic hepatitis. The aim of this study was to compare the indications and methods for performing a liver biopsy over a 15-year period when there were evolving strategies and increasing therapeutic options for the treatment for chronic hepatitis B (HBV) and C (HCV). METHODS: We reviewed all percutaneous liver biopsies performed at our center from 1992 to 2007 using a pathology database. Variables collected included indication for biopsy, use of real-time ultrasound (US) guidance, and complications associated with the biopsy. RESULTS: A total of 3,572 total liver biopsies were performed between 1992 and 2007 with a gradual increase in annual liver biopsies from 1992 to 2001. After a peak in 2003, there was a gradual decline in liver biopsies performed. The number of liver biopsies done for HCV peaked in 2003, followed by an annual decrease until 2006, while the number of annual biopsies done for HBV increased during the same period. In addition, the proportion of liver biopsies performed with real-time US-guidance increased steadily since 1997. CONCLUSIONS: Changes in liver biopsy trends at our center may be related to several factors, including the evolving treatment strategies for HCV and HBV. Percutaneous liver biopsies were increasingly performed using real-time US-guidance over the past decade, a change that may reflect practice patterns around the country.
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Biopsia/estadística & datos numéricos , Biopsia/tendencias , Hepatitis B Crónica/patología , Hepatitis C Crónica/patología , Hígado/patología , Biopsia/efectos adversos , Bases de Datos Factuales , Gastroenterología/tendencias , Hepatitis B Crónica/diagnóstico por imagen , Hepatitis C Crónica/diagnóstico por imagen , Humanos , Hígado/diagnóstico por imagen , Ultrasonografía IntervencionalRESUMEN
BACKGROUND: Adherence to chronic hepatitis C (CHC) treatment may be particularly challenging in methadone maintenance patients. We assessed the safety, tolerability, and efficacy of peginterferon alfa-2a/ribavirin treatment in methadone maintenance patients previously untreated for CHC. METHODS: Patients were randomized 1:1 to direct observed therapy (DOT) or self-administration (SA) of peginterferon alfa-2a. DOT patients were seen weekly at methadone clinics; SA patients were seen less frequently, only at investigative sites. Genotype 1-infected patients were treated for 48 wk with peginterferon alfa-2a (180 microg/wk)/ribavirin (1,000/1,200 mg/day); genotypes 2- and 3-infected patients were treated for 24 wk with peginterferon alfa-2a (180 microg/wk)/ribavirin (800 mg/day). RESULTS: Based on defined efficacy stopping rules, 77% (37/48) completed their targeted length of treatment, and 44% (21/48) achieved sustained virologic response (SVR). Two DOT and 3 SA patients were withdrawn for safety reasons and 6 and 9, respectively, for nonsafety reasons. Over 60% and 50% of each group were >80% compliant with the planned cumulative doses of peginterferon alfa-2a and ribavirin, respectively, and over 60% with overall treatment duration. SVR rates were 54% (13/24) for DOT and 33% (8/24) for SA; 23% (3/13) and 38% (6/16), respectively, for genotype 1 and 91% (10/11) and 25% (2/8), respectively, for genotypes 2 and 3. Stepwise logistic regression analysis, showed that DOT (vs SA; OR 3.27, 95% CI 0.90-11.91, P = 0.073) and Caucasian race (vs Other; OR 13.31, 95% CI 1.42-124.71, P = 0.023) were predictors of SVR. CONCLUSION: Peginterferon alfa-2a/ribavirin can be used safely and successfully in CHC patients receiving methadone maintenance.
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Antivirales/administración & dosificación , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/administración & dosificación , Metadona/administración & dosificación , Narcóticos/administración & dosificación , Polietilenglicoles/administración & dosificación , Ribavirina/administración & dosificación , Adulto , Terapia por Observación Directa , Femenino , Hepatitis C Crónica/complicaciones , Humanos , Interferón alfa-2 , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Proteínas Recombinantes , Autoadministración , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/tratamiento farmacológico , Resultado del TratamientoRESUMEN
Chronic hepatitis C virus HCV infection progresses through liver fibrosis and cirrhosis to hepatocellular carcinoma HCC. It appears to be causally related to B-cell non-Hodgkin's lymphoma since regression after antiviral therapy has been described. Two cases are described of non-Hodgkin's lymphoma and HCC arising simultaneously in two patients. The first patient did not have cirrhosis on liver biopsy. HCV had been undetectable in plasma following successful therapy with interferon and ribavirin treatment 7 years earlier. The second patient developed an aggressive form of hepatocellular carcinoma HCC within weeks of stopping treatment with interferon and ribavirin. Therapy had induced complete viral suppression for over 40 weeks. The two cases suggest that non-Hodgkin's lymphoma and HCC can develop in the absence of detectable hepatitis C viremia and argues for continued surveillance even after sustained virological response to treatment.
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Carcinoma Hepatocelular/etiología , Hepatitis C Crónica/complicaciones , Neoplasias Hepáticas/etiología , Linfoma de Células B Grandes Difuso/etiología , Anciano , Antivirales/uso terapéutico , Femenino , Hepatitis C Crónica/tratamiento farmacológico , Hepatitis C Crónica/virología , Humanos , Interferones/uso terapéutico , Masculino , Ribavirina/uso terapéutico , Factores de TiempoRESUMEN
Treatment of nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) is focused on patients with NASH because they are at highest risk for progressive liver disease. Current first-line treatment consists of lifestyle modifications. Patients should lose at least 7% to 10% of body weight via a combination of physical exercise and calorie restriction dieting. Surgical or endoscopic surgery for weight loss can be considered in obese patients, depending on degree of excess body weight and comorbidities. There is no currently approved pharmacotherapy for NASH. Vitamin E and pioglitazone have the most evidence of therapeutic efficacy but have limitations. The treatment modality chosen should be individualized.
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Cirugía Bariátrica , Estilo de Vida , Enfermedad del Hígado Graso no Alcohólico/terapia , Dieta , Suplementos Dietéticos , Ejercicio Físico , Humanos , Tiazolidinedionas/uso terapéutico , Pérdida de PesoRESUMEN
There are multiple possible causes of ascites in patients with end-stage renal disease on hemodialysis therapy. In this report, we describe a patient with chronic hepatitis C infection who presented with refractory inflammatory ascites, along with cachexia, hypoalbuminemia, and erythropoietin resistance associated with the chronic inflammatory state induced by a failed kidney transplant. Evaluation showed only mild hepatic fibrosis, absence of portal hypertension, and no other identifiable cause of the ascites. Furthermore, the inflammatory ascites did not respond to antibiotic therapy, but promptly resolved, along with the other manifestations of the chronic inflammatory state, after transplant nephrectomy. This report describes a novel cause for refractory inflammatory ascites in a patient with a failed kidney transplant and emphasizes the importance of transplant nephrectomy.
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Ascitis/patología , Ascitis/cirugía , Asepsia/métodos , Rechazo de Injerto/patología , Rechazo de Injerto/cirugía , Fallo Renal Crónico/patología , Trasplante de Riñón/efectos adversos , Nefrectomía/métodos , Adulto , Ascitis/etiología , Rechazo de Injerto/complicaciones , Humanos , Fallo Renal Crónico/cirugía , Masculino , Inducción de RemisiónRESUMEN
OBJECTIVES: Patients with cirrhosis can acquire pulmonary conditions that may or may not be related to their illness. Although posing a greater risk for complications, chest tubes are sometimes placed as treatment for hepatic hydrothorax and other pulmonary conditions. The aim of this study was to analyze the outcomes of chest tube placement in cirrhotic patients. METHODS: A retrospective analysis was performed of 59 adults with cirrhosis undergoing chest tube placement. Variables that were investigated included reason for chest tube placement, complications developing while having the tube in place, and outcome. RESULTS: The 59 subjects were classified as having Child-Turcotte-Pugh (CTP) class A cirrhosis (n = 3), CTP class B cirrhosis (n = 31), and CTP class C cirrhosis (n = 25). Indications for having a chest tube placed were hepatic hydrothorax (n = 24), pneumothorax (n = 9), empyema (n = 8), video-assisted thoracoscopy (VAT) [n = 7], non-VAT (n = 5), and hemothorax (n = 3). The CTP class A subjects had their chest tubes removed without further complications early in the course, and were excluded from further statistical analysis. Twenty-five subjects (42%) had significant pleural effusions requiring chest tube placement. Among the CTP class B and class C subjects, the median duration with chest tube in place was 5.0 days (range, 1 to 53 days). Serum total bilirubin levels, presence of portosystemic encephalopathy, and CTP C classification were predictors of mortality. Mortalities were seen in 5 of 31 CTP class B subjects (16%), and 10 of 25 CTP class C subjects (40%). The tubes were successfully removed in a total of 39 subjects (66%) with no further procedure. Forty-seven subjects (80%) acquired one or more of the following complications: renal dysfunction, electrolyte imbalances, and infection. CONCLUSIONS: When placed for all indications, chest tubes may be successfully removed in the majority of cirrhotic patients. However, a third of all patients still die with the chest tube still in place. Failure to remove the chest tube increases mortality in patients with increasing severity of liver disease.
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Tubos Torácicos , Cirrosis Hepática/cirugía , Toracostomía/métodos , Femenino , Mortalidad Hospitalaria , Humanos , Cirrosis Hepática/clasificación , Cirrosis Hepática/etiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Most cases of cytomegalovirus colitis occur in adults with severe immune deficiency. Only a few cases involving immunocompetent patients have been reported. We describe the first case reported in English, of cytomegalovirus colitis in an immunocompetent patient with preceding amebiasis. Eight previous cases have been reported of cytomegalovirus colitis occurring after colonic mucosal injury in immunocompetent patients. Similar to our case, all eight of these cases resolved without the use of antiviral therapy. This suggests that disruption of colonic mucosa may predispose immunocompetent patients to cytomegalovirus colitis, and that the colitis may become self-limited once the preceding intestinal damage resolves.
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Colitis/virología , Infecciones por Citomegalovirus/diagnóstico , Disentería Amebiana/virología , Inmunocompetencia , Adulto , Colitis/diagnóstico , Colitis/tratamiento farmacológico , Infecciones por Citomegalovirus/complicaciones , Infecciones por Citomegalovirus/tratamiento farmacológico , Disentería Amebiana/complicaciones , Disentería Amebiana/tratamiento farmacológico , Humanos , Masculino , Metronidazol/uso terapéutico , Paromomicina/uso terapéuticoRESUMEN
AIM: To study the significance and clinical implication of hepatic lipogranuloma in chronic liver diseases, including fatty liver disease and hepatitis C. METHODS: A total of 376 sequential, archival liver biopsy specimens were reviewed. Lipogranuloma, steatosis and steato-fibrosis were evaluated with combined hematoxylin and eosin and Masson's trichrome staining. RESULTS: Fifty-eight (15.4%) patients had lipogranuloma, including 46 patients with hepatitis C, 14 patients with fatty liver disease, and 5 patients with other diseases. Hepatic lipogranuloma was more frequently seen in patients with hepatitis C (21%) and fatty liver disease (18%), and its incidence was significantly higher than that in control group (P < 0.0002 and P < 0.007, respectively). In addition, 39 out of the 58 patients with lipogranuloma were associated with steatosis and/or steato-fibrosis. Of the 18 lipogranuloma patients with clinical information available for review, 15 (83%) had risk factors associated with fatty liver disease, such as alcohol use, obesity, hyperlipidemia, and diabetes mellitus. Although the incidence of these risk factors was greater in patients with lipogranuloma than in control group (60%), it did not reach statistical significance. CONCLUSION: Hepatic lipogranuloma is not limited to mineral oil use and commonly associated with hepatic steatosis, hepatitis C and fatty liver disease. With additional histological features of steato-fibrosis, lipogranuloma can also be used as a marker of prior hepatic steatosis.
Asunto(s)
Granuloma/epidemiología , Hepatitis C Crónica/complicaciones , Hepatopatías/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Hígado Graso/complicaciones , Femenino , Granuloma/diagnóstico , Granuloma/patología , Humanos , Incidencia , Hígado/patología , Hepatopatías/diagnóstico , Hepatopatías/patología , Masculino , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Background. Current treatment of chronic hepatitis C with pegylated interferon and ribavirin has the ability to eliminate viral infection in about half of the patients treated. Therapeutic options, for those with remaining chronic hepatitis, will remain limited until novel antivirals become available in the future. Consensus interferon is currently available and has demonstrated clinical efficacy with superior invitro antiviral activity, but the maximum tolerated dose is not defined. Methods. We assessed the efficacy of daily high-dose (24 ug) consensus interferon with weight-based (1000-1200 mg daily) ribavirin in HCV genotype 1-infected non-responder patients. Results. Six adverse events were documented in five patients, and the trial was terminated with no subject achieving viral clearance. Conclusions. The occurrence of serious adverse events effectively defined the upper limit of acceptable dose, while also revealing that this dose did not offer enhanced sustained viral clearance.
RESUMEN
Methadone maintenance therapy (MMT) is commonly used in the treatment of opioid dependence. Several small-scale reports have suggested that methadone may lead to nonobstructive dilatation of the common bile duct (CBD). We present the first large study to retrospectively evaluate this hypothesis in asymptomatic patients with chronic hepatitis on long-term MMT. Methods: Charts of all adult patients with chronic hepatitis with and without MMT between 2002 and 2007 at Beth Israel Medical Center were reviewed. Data collected included age, gender, CBD size, presence of cirrhosis, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, bilirubin, and dose and duration of methadone use. Patients with a history of pancreatitis and cholecystectomy were excluded. Results: CBD size in the MMT group (n=215) was significantly increased compared to controls (n=108; 5.87 mm vs 3.79 mm; P<.0001). CBD dilatation (CBD ≥8 mm) was seen in 26.1% and 2.78% of MMT and control groups, respectively (P<.0001), and was significantly associated with duration of methadone use (P=.01), but not with methadone dose (P=.83). Multivariate logistic regression showed that patients on MMT are 17.5 times more likely to develop CBD dilatation (odds ratio, 17.5). Conclusion: Chronic MMT is associated with CBD dilatation and should be considered in the differential diagnosis of asymptomatic CBD dilatation. Less invasive studies such as magnetic resonance cholangiopancreatography or endoscopic ultrasound should be considered over endoscopic retrograde cholangiopancreatography in patients without clinical or laboratory evidence suggesting biliary obstruction.
RESUMEN
BACKGROUND: Serrated adenomas (SA) are histologically defined by the presence of both hyperplastic and adenomatous features. These uncommon polyps are thought to play an important role in the development of sporadic colorectal cancers (CRC) with microsatellite instability (MSI). There is paucity of data on the risk of progression of SA to CRC. This study was undertaken to define the relationship between SA and the future development of adenomatous polyps. METHODS: Colonoscopic biopsies that contained a pathologic diagnosis of SA were identified from a pathology database of a major urban academic medical center. Those patients with absence of concomitant malignancy, complete colonoscopy, good or adequate prep and presence of at least one follow-up procedures were identified. These were matched to controls by age, sex, indication for colonoscopy, polyp type and number and duration of follow-up. Outcomes of the follow-up procedures were compared. RESULTS: Between January 1997 and June 2005 17,226 colonoscopic biopsies and polypectomies were performed. Of these, 80 patients (0.5%) with SA were found, and of these SA, 80% were found in the left colon. The average age of patients undergoing colonoscopy was 58.5 years, and the average age of patients with SA was 68 years (P = 0.004). Of all patients with SA, 7 (9%) had concomitant CRC. The final groups contained 17 patients and 17 controls, respectively, and were well matched. The mean follow-up interval in the patient group was 29 months vs. 31 months in the control group (P = 0.82). On follow-up examination four patients (24%) and no controls had adenomatous polyps (P = 0.01). CONCLUSIONS: While SA are uncommon, they are commonly associated with colorectal cancer. Serrated adenomas appear to be found more commonly in the left colon and in older patients. This study found a significant association between SA and the subsequent development of adenomatous polyps. Further studies are needed to define appropriate preventive strategies for these patients.
Asunto(s)
Adenoma/patología , Neoplasias del Colon/patología , Pólipos del Colon/patología , Lesiones Precancerosas/patología , Adenoma/clasificación , Anciano , Estudios de Casos y Controles , Colonoscopía , Progresión de la Enfermedad , Femenino , Humanos , Hiperplasia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Celiac disease (CD) has been epidemiologically associated with chronic hepatitis C (HCV), and CD activation after the initiation of interferon (IFN-alpha) in patients with HCV is documented. However, clear association of CD and HCV is lacking. A prospectively maintained database of 878 CD patients showed a prevalence of 0.68% (six patients). Symptoms of diarrhea, weight loss, and depression prompted the diagnosis of CD during or after IFN-alpha therapy in four cases. Also, 294 subjects with liver disease (195 with HCV, 80 normal controls and 19 disease controls) were prospectively screened for CD. The mean age of the subjects was 50.1 years (SD 12.3), 58% males:42% females. A total of 30% received IFN-alpha therapy (16% at the time of testing for CD). Two HCV patients (1%) had positive tTG-IgA but these had negative endomysial antibody (EMA) and normal duodenal biopsies. CD prevalence is not increased in patients with HCV. Routine screening of CD in HCV patients is not warranted, however, the presence of CD should be considered in the setting of clinical deterioration during or after IFN-alpha therapy.