Direct antiviral therapy for treatment of hepatitis C: A real-world study from Brazil.

INTRODUCTION AND OBJECTIVES: Direct antiviral agents (DAAs) including sofosbuvir (SOF), daclatasvir (DCV), simeprevir (SIM) and ombitasvir, paritaprevir and dasabuvir were introduced 2015 in Brazil for treatment of hepatitis C virus (HCV) infection. The aims of this study were to assess effectiveness and safety of HCV treatment with DAA in real-life world in a highly admixed population from Brazil. MATERIALS AND METHODS: All Brazilian reference centers for HCV treatment were invited to take part in a web-based registry, prospectively conducted by the Brazilian Society of Hepatology, to assess outcomes of HCV treatment in Brazil with DAAs. Data to be collected included demographics, disease severity and comorbidities, genotype (GT), viral load, DAA regimens, treatment side effects and sustained virological response (SVR). RESULTS: 3939 patients (60% males, mean age 58±10 years) throughout the country were evaluated. Most had advanced fibrosis or cirrhosis, GT1 and were treated with SOF/DCV or SOF/SIM. Overall SVR rates were higher than 95%. Subjects with decompensated cirrhosis, GT2 and GT3 have lower SVR rates of 85%, 90% and 91%, respectively. Cirrhosis and decompensated cirrhosis in GT1 and male sex and decompensated cirrhosis in GT3 were significantly associated with no SVR. Adverse events (AD) and serious AD occurred in 18% and 5% of those subjects, respectively, but less than 1% of patients required treatment discontinuation. CONCLUSION: SOF-based DAA regimens are effective and safe in the heterogeneous highly admixed Brazilian population and could remain an option for HCV treatment at least in low-income countries.

Reunião com expertos em hepatotoxicidade da Sociedade Brasileira de Hepatologia: analgésicos, antitérmicos, insumos vegetais, fitoterápicos, homeopáticos e AINEs / Meeting with Society's Hepatotoxic Experts Brazilian Institute of Hepatology: Analgesics, Antipyretics, Vegetable, Phytotherapic, Homeopathic and AINS

No dia 05 de agosto de 2010, no Hotel Blue Tree, no bairro do Morumbi em São Paulo, a Sociedade Brasileira de Hepatologia realizou uma reunião de expertos para discutir alguns assuntos importantes referentes à toxicidade hepática. Esta reunião foi de responsabilidade exclusiva da Sociedade Brasileira de Hepatologia (SBH), sem interferência de agências ou da indústria farmacêutica. Dentre os assuntos discutidos, três deles mereceram destaque pelo volume de solicitações de esclarecimentos encaminhadas diretamente à Sociedade Brasileira de Hepatologia. O site da SBH recebe com frequência tais solicitações de outras sociedades ou diretamente de colegas, assim como do público não-médico, por questões pertinentes a estes assuntos: 1. papel do acetaminofen/paracetamol nas alterações hepáticas da dengue; 2. eficácia e segurança da medicina alternativa (homeopatia, medicina natural, fitoterápicos); 3. alterações hepáticas induzidas por analgésicos, antitérmicos e anti-inflamatórios não-esteroides com foco no seu uso na dengue.Dentro deste contexto, a Sociedade Brasileira de Hepatologia organizou uma sessão durante todo o dia 05 de agosto para discutir unicamente estes temas.

Insulin resistance in non-diabetic patients with chronic hepatitis C: what does it mean?

OBJECTIVES: To determine the prevalence of insulin resistance (IR) in non-diabetic patients with chronic hepatitis C, and to assess the association between IR, laboratory parameters and histological findings. SUBJECTS AND METHODS: Eighty-two patients had their serum analyzed for glucose, lipid profile, C-reactive protein (CRP), ferritin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), HOMA-IR, viral load and HCV genotype. Patients with HOMA-IR levels > 2.5 were considered as carriers of insulin resistance. RESULTS: IR was observed in 27% of patients and was associated with age, waist circumference and body mass index. IR patients were more likely to have more advanced hepatic fibrosis and necroinflammatory activity, higher levels of aminotransferases and liver steatosis than patients without IR. CONCLUSIONS: Insulin resistance is often present in patients with chronic hepatitis C, and this parameter is associated with more advanced HCV-related hepatic fibrosis.

Insulin resistance in non-diabetic patients with chronic hepatitis C: what does it mean? / Resistência insulínica em portadores de hepatite crônica C não diabéticos: qual o significado?

OBJECTIVES: To determine the prevalence of insulin resistance (IR) in non-diabetic patients with chronic hepatitis C, and to assess the association between IR, laboratory parameters and histological findings. SUBJECTS AND METHODS: Eighty-two patients had their serum analyzed for glucose, lipid profile, C-reactive protein (CRP), ferritin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), HOMA-IR, viral load and HCV genotype. Patients with HOMA-IR levels > 2.5 were considered as carriers of insulin resistance. RESULTS: IR was observed in 27 percent of patients and was associated with age, waist circumference and body mass index. IR patients were more likely to have more advanced hepatic fibrosis and necroinflammatory activity, higher levels of aminotransferases and liver steatosis than patients without IR. CONCLUSIONS: Insulin resistance is often present in patients with chronic hepatitis C, and this parameter is associated with more advanced HCV-related hepatic fibrosis.

OBJETIVOS: Em portadores de hepatite crônica C não diabéticos, verificar a prevalência de resistência insulínica (RI) e analisar a associação desta com os parâmetros laboratoriais e histológicos. SUJEITOS E MÉTODOS: Foram incluídos no estudo 82 pacientes, e amostras de sangue foram coletadas para determinação de glicose, perfil lipídico, alanina aminotransferase (ALT), aspartato aminotransferase (AST), ferritina, HOMA-IR, carga viral e genótipo do VHC. HOMA-IR superior a 2,5 foi considerado resistência insulínica. RESULTADOS: RI foi observada em 27 por cento dos pacientes e foi associada a idade, circunferência abdominal e índice de massa corpórea. Quando comparado a pacientes sem RI, aqueles com HOMA-IR superior a 2,5 apresentaram graus mais acentuados de fibrose hepática e atividade necroinflamatória, maiores níveis de aminotransferases e esteatose hepática mais frequente. CONCLUSÕES: É comum a presença de RI em portadores de hepatite crônica C e esta se associa com graus mais avançados de fibrose hepática induzida pelo vírus da hepatite C.

Tumores estromais do trato gastrointestinal: revisão da literatura / Gastrointestinal stromal tumors: review of literature

De um modo geral, os tumores estromais gastrointestinais (GISTs) são raros, entretanto, são as neoplasias mesenquimais mais frequentemente identificadas no trato gastrointestinal (TGI) e representam 0,1 a 3 % de todos os tumores gastrointestinais. Seu diagnóstico é baseado no quadro clínico, nas características morfológicas, mas, sobretudo, pela presença da proteína c-KIT (CD117) detectada por método imunoistoquímico. Na maioria das vezes, são assintomáticos, descobertos incidentalmente por exames de imagem. Os fatores prognósticos mais importantes são o tamanho do tumor e o índice mitótico. A ressecção cirúrgica é a terapia de escolha e o quimioterápico mesilato de imatinibe, que está indicado nos casos de irressecabilidade ou doença metastática.

Evaluation of reagent strips for ascitic fluid leukocyte determination: is it a possible alternative for spontaneous bacterial peritonitis rapid diagnosis?

In order to evaluate the accuracy of a urine reagent dipstick (Multistix 10SG) to determine ascitic fluid leukocyte count, we prospectively studied 106 cirrhotic patients from April 2003 to December 2004, in two different centers (Federal University of São Paulo - UNIFESP-EPM and Federal University of Juiz de Fora - HU-UFJF) for the rapid bedside diagnosis of spontaneous bacterial peritonitis. The mean age 54 +/- 12 years, there was a predominance of males (eighty-two patients, 77%), and alcohol was the most frequent etiology (43%). Forty-four percent of patients were classified as Child B and fifty-one as Child C (51%). Abdominal paracentesis was performed both in outpatient and inpatient settings and the Multistix 10SG was tested. Eleven cases of spontaneous bacterial peritonitis were identified by means of polymorphonuclear count. If we considered the positive Multistix 10SG result of 3 or more, the sensitivity, specificity, positive and negative predictive value were respectively 71%, 99%, 91% and 98%. With a positive reagent strip result taken as grade 2 (traces) or more, sensitivity was 86% and specificity was 96% with positive and negative predictive values of 60% and 99%, respectively. Diagnostic accuracy was 95%. We concluded that the use of a urine reagent dipstick (Multistix 10SG) could be considered a quick, easy and cheap method for ascitic fluid cellularity determination in SBP diagnosis.

Long-term results with azathioprine therapy in patients with corticosteroid-dependent Crohn's disease: open-label prospective study.

BACKGROUND: A substantial number of patients with Crohn's disease (CD) become dependent on steroids after induction therapy. Treatment with azathioprine (AZA) may be beneficial in such patients. The present open-label study evaluated the long-term safety and efficacy of AZA in steroid-dependent CD patients. METHODS: Adult patients with steroid-dependent CD were enrolled for AZA therapy over a 7-year period. The average dose of AZA was 2.0-3.0 mg/kg per day, adjusted according to clinical response and occurrence of adverse effects. Steroid therapy was tapered off according to a predefined schedule. Long-term outcome and adverse reactions were evaluated. RESULTS: Sixty-nine patients were prospectively included. Steroid-free remission was achieved in 68-81% of patients, partial response in 14.5-27.3% and failure to respond to AZA in 4-15.9% over the initial 48 months. However, the rate of wean from steroid therapy decreased to 53-60% while the rate of failure increased from 6.7% to 17.6% after this period. A breakthrough of symptoms during continuous AZA therapy was common, particularly after 48 months on AZA. The mean leukocyte count at the end of 12 months of therapy was significantly lower in patients who achieved complete response on AZA than in the non-responders (5197 +/- 1250 cells/mm(3) vs 8340 +/- 1310 cells/mm(3), respectively; P < 0.01). Azathioprine was relatively well-tolerated and the incidence of serious adverse effects was small. CONCLUSIONS: Azathioprine was relatively safe and moderately effective for long-term maintenance of steroid-free clinical remission in corticosteroid-dependent CD patients. Patients were more successfully weaned from prednisone treatment, and clinical remission was more often maintained during the first 48 months of AZA therapy. A significant decrease in the white blood cell count at the end of 12 months on AZA was the single factor associated with weaning from steroid dependence.

Evaluation of reagent strips for ascitic fluid leukocyte determination: is it a possible alternative for spontaneous bacterial peritonitis rapid diagnosis?

In order to evaluate the accuracy of a urine reagent dipstick (Multistix 10SG®) to determine ascitic fluid leukocyte count, we prospectively studied 106 cirrhotic patients from April 2003 to December 2004, in two different centers (Federal University of São Paulo - UNIFESP-EPM and Federal University of Juiz de Fora - HU-UFJF) for the rapid bedside diagnosis of spontaneous bacterial peritonitis. The mean age 54 ± 12 years, there was a predominance of males (eighty-two patients, 77 percent), and alcohol was the most frequent etiology (43 percent). Forty-four percent of patients were classified as Child B and fifty-one as Child C (51 percent). Abdominal paracentesis was performed both in outpatient and inpatient settings and the Multistix 10SG® was tested. Eleven cases of spontaneous bacterial peritonitis were identified by means of polymorphonuclear count. If we considered the positive Multistix 10SG® result of 3 or more, the sensitivity, specificity, positive and negative predictive value were respectively 71 percent, 99 percent, 91 percent and 98 percent. With a positive reagent strip result taken as grade 2 (traces) or more, sensitivity was 86 percent and specificity was 96 percent with positive and negative predictive values of 60 percent and 99 percent, respectively. Diagnostic accuracy was 95 percent. We concluded that the use of a urine reagent dipstick (Multistix 10SG®) could be considered a quick, easy and cheap method for ascitic fluid cellularity determination in SBP diagnosis.

Azatioprina na doença inflamatória intestinal seria um fator de risco para Strongyloides stercoralis? / Would azathioprine in inflammatory bowel disease be a risk factor for Strongyloides stercoralis infection?

A azatioprina é um dos mais comuns imunomoduladores utilizados no tratamento de Doença de Crohn e Retocolite Ulcerativa Idiopática, sendo que alguns pacientes desenvolvem imunossupressão. Por outro lado, o Strongyloides stercoralis está relacionado à infecção em pacientes imunocomprometidos. No presente estudo, pesquisa-se a prevalência do parasita nos pacientes portadores de Doença Inflamatória Intestinal em uso de azatioprina, através de exames parasitológicos de fezes. Analisa-se também a relação entre eosinofilia e a referida parasitose. No grupo tratado com azatioprina, 5,8% (4/69) dos pacientes estavam infectadospor Strongyloides stercoralis e apresentavam eosinofilia. Naquele tratado com outras drogas, somente 1,8% (1/55) apresentou a infecção e o número de eosinófilos dentro do referencial. Concluiu-se que a infecção pelo parasita é mais freqüente em pacientes da zona rural e que a eosnofilia pode ser um marcador indireto desta infecção.

Although azathioprine is one of the most common immunomodulatory drugs used in the treatment of Crohn's disease and ulcerative colitis, some patients can develop imunnosuppression. Strongyloides stercoralis infection may be associated with immunocompromised patients. In this study, our aim was to evaluate the prevalence of this infection in patients with Inflammatory bowel disease being treated with azathioprine, through parasitologic stool examination. The association between peripheral blood eosinophil counts and the infection was also studied. In the group treated with azathioprine, 5.8% (4/69) patients were infected by Strongyloides stercoralis and showed high level of eosinophil. In the other group, treated with different drug, only one patient (1.8%) revealed the infection and the number of eosinophil was normal. These observations demonstrated that the infection caused by this parasite was more frequent in patients from rural area. Besides, the high level of eosinophil could be an indirect marker for this infection.

Oral refeeding in patients with mild acute pancreatitis: prevalence and risk factors of relapsing abdominal pain.

BACKGROUND AND AIM: In acute pancreatitis (AP), oral refeeding may stimulate pancreatic secretion, increasing the inflammation of the glandular tissue causing relapse of abdominal pain or even exacerbation of the disease. This study aimed to assess the prevalence and risk factors of abdominal pain relapse over oral refeeding in patients convalescing with AP as well as the impact of pain recurrence on the hospital stay. METHODS: Inclusion criteria were AP confirmed by biochemical and/or radiological data in the absence of severe disease or extensive necrosis. The same diet was offered to all patients during oral refeeding. Demographic, clinical, biochemical and radiological data were prospectively recorded and analyzed. RESULTS: A total of 130 patients were included. During the oral refeeding period, 32 (24.6%) patients had pain relapse, which was more common on days 1 (68.8%) and 2 (28.1%). Pain relapse was related to higher serum levels of lipase on the day before refeeding, higher serum levels of C-reactive protein on the fourth day, and presence of peripancreatic fluid collections (P < 0.01). Pain relapse significantly increased total hospital stay (P < 0.01). CONCLUSIONS: In patients with mild AP, pain relapse during oral refeeding was relatively high (24.6%), particularly on the first or second day. Their risk appeared be associated with more intense or persistent pancreatic inflammation on the day before refeeding, and presence of peripancreatic fluid collections. Pain relapse increased hospital stay, and likely overall costs on disease treatment.

Hereditary hemochromatosis: population screening based on phenotype in Brazilian blood donors.

GOALS: A population of blood donors was screened for hereditary hemochromatosis (HH) based on the phenotype strategy in accordance with the European consensus. STUDY: Nonfasting serum samples were obtained from 1,050 donors. Transferrin saturation (TS) was measured using a threshold of 45%. Donors with a TS > or = 45% were retested in a fasting sample. If TS was elevated, the participants were tested for iron overload by ferritin measurement followed by genetic testing. All donors underwent clinical and laboratory workup for expression of the disease. RESULTS: A total of 775 (74.6%) of the donors were men, 749 (72.1%) white, and had a mean age of 30 years (range, 8-60 years). Mean +/- SD TS was 25.9% +/- 13.1% (range, 2.1%-85.8%), and there were 58 (5.6%) donors with a TS > or = 45%. Fifty-four subjects had a repeat TS in a fasting serum sample with a mean +/- SD TS of 32.1% +/-16.1% (range, 15.4%-63.0%), and 12 donors had a TS > or = 45%. Ten complied with genetic testing and ferritin measurement. The study found four donors with HH-related mutations (C282Y and/or H63D); therefore, a gene allele frequency of 0.4%. Only the C282Y homozygote had diagnostic criteria for HH, defining a disease frequency of 0.1%. None of the donors who were mutations carriers had clinical or laboratory manifestations of organic injury. CONCLUSION: We conclude that this is a feasible screening strategy that, by timely diagnosing HH, allows patients not only to benefit from effective treatment but also to have disease progression halted.

Internal pancreatic fistulas: proposal of a management algorithm based on a case series analysis.

BACKGROUND AND AIMS: Internal pancreatic fistulas (IPF) are an uncommon but well-recognized complication of chronic pancreatitis (CP) that are associated with significant morbidity and mortality. Because of their low incidence, management is still controversial. The aims of this study are to report the 8-year experience with IPF management in a Brazil University-affiliated hospital and to propose a management algorithm. STUDY: A centralized diagnostic index was used to retrospectively identify all patients with IPF admitted to a teaching hospital from 1995 to 2003. The patient's medical records were reviewed for clinical features, diagnostic work-up, treatment strategies, response to therapy, and the length of hospital stay. All patients underwent contrast-enhanced computed tomography of the abdomen and endoscopic retrograde cholangiopancreatography, to guide the therapeutic modality to be offered. Conservative therapy included withholding of oral feedings in conjunction with total parenteral nutrition, octreotide subcutaneously, and multiple paracentesis or thoracentesis. Interventional therapy was either endoscopic or surgical. RESULTS: IPF was identified in 11 (7.3%) of 150 patients with CP. They ranged in age from 24 to 47 years (mean 36.1), with a male to female ratio of 10:1. All patients had underlying alcoholic CP. The presentation was pancreatic ascites in 9 patients and pleural effusion in 2 cases. Five patients were undergoing the conservative treatment, all presenting main pancreatic duct (MPD) dilatation; endoscopic placement of transpapillary pancreatic duct stent was performed in 4 patients who presented partial MPD stricture or disruption; surgical therapy was performed in 2 patients exhibiting complete MPD obstruction or disruption. Stents were removed 3 to 6 weeks after initial placement. IPF resolved in 10 of 11 patients (90.9%) within 6 weeks. The resolution of IPF was faster (13 +/- 5 vs. 25 +/- 13 days, P < 0.01) and the length of hospital stay was significantly shorter (17.2 +/- 5.6 vs. 31.2 +/- 4.4 days, P < 0.01) in patients subject to interventional treatment compared with those treated conservatively. There was 1 death due to sepsis in a patient managed conservatively; no death was recorded in the interventional therapy group. There was no recurrence of IPF at a mean follow-up of 38 months. CONCLUSIONS: Our results suggest that interventional therapy should be considered the best approach for the management of IPF in patients presenting MPD disruption or obstruction. Conservative therapy must be reserved for those showing MPD dilatation without ductal disruption or stricture. Early interventional therapy reduced hospital stay and convalescence, which likely resulted in lower healthcare overall costs.

Hemorragia digestiva alta / Upper gastrointestinal bleeding

Hemorragia digestiva alta é uma condição grave e potencialmente fatal associada com muitas doenças sistêmicas e gastrointestinais. Embora a mortalidade varia de acordo com a etiologia do sangramento, em geral, é cerca de 10%. Metade desses pacientes têm mais de 60 anos de idade, e neste grupo etário de mortalidade é ainda maior. que podem ser provenientes de várias fontes, principalmente: úlcera péptica, hypertesion portal, anomalias vasculares e neoplasias. Avaliação inicial inclui a estabilização do quadro hemodinâmico e de reposição de sangue sempre que necessário. Endoscopia desempenha um papel importante no diagnóstico e tratamento da maioria das condições de sangramento. O tratamento farmacológico inclui agentes anti-secretores octreotide, e vasopressina. A cirurgia é eventualmente necessário.

Upper gastrointestinal bleeding is a serious and potentially life threatening condition associated with many systemic and gastrointestinal diseases. Although mortality varies according to the etiology of the bleeding, in general, it is around 10%.Half of these patients are over 60 years of age, and in this age group mortality is even higher. it may originate from a number of sources, mainly: peptic ulcer disease, portal hypertesion, vascular anomalies and neoplasms. Initial evaluation includes stabilization of the hemodynamic status and blood replacement whenever necessary. Endoscopy plays an important role in diagnosis and treatment of most bleeding conditions. Pharmacological treatment includes anti-secretory agents, octreotide and vasopressin. Surgery is eventually necessary.

Doença de Whipple com comprometimento hepático: relato de caso / Whipple's disease with liver involvement

Neste relato apresenta-se um caso de Doença de Whipple (DW) em um paciente com sintomas de diarréia crônica,perda de peso e poliartralgia, com acometimento hepático e pulmonar. O diagnóstico de DW foi confirmado por endoscopia digestiva alta com biópsia duodenal, e o comprometimento hepático por biópsia hepática percutânea com achado de granulomas e estruturas PAS positivas. Penicilina G cristalina seguida de Sulfametoxazol / Trimetoprima foi a terapêutica instituída e observamos significativa melhora clínica e praticamente normalizaçäo das enzimas colestáticas após 30 dias de tratamento. Salientamos a importância de incluir a DW no diagnóstico diferencial de todos os pacientes que apresentem as manifestaçöes cardinais da doença (dor abdominal, diarréia crônica, artralgia e perda de peso), uma vez que adequada terapia em tempo hábil pode prevenir complicaçöes. Além disso, DW cursando com elevaçäo das enzimas colestáticas deve sugerir infiltraçäo hepática pelos bacilos causadores da doença ou a presença de granulomas reacionais.

Prevalence and pathogenesis of duodenal ulcer in chronic alcoholic pancreatitis.

BACKGROUND: The prevalence of duodenal ulcer (DU) has been considered high in patients with chronic pancreatitis; however, its pathogenesis is unclear. We hypothesized that Helicobacter pylori infection plays the major pathogenetic role. STUDY: One hundred seven cases (97 men, 10 women) of chronic alcoholic pancreatitis (CAP) were prospectively investigated from 1997 to 2001. One hundred thirty-seven DU patients and 59 nonulcer dyspepsia patients formed the two control groups. Pancreatic function was evaluated by determination of fecal fat excretion and fasting blood glucose concentration. Upper gastrointestinal endoscopy was performed in all patients, and gastric mucosal biopsies were taken for assessment of H. pylori infection with a modified Giemsa stain and rapid urease test. RESULTS: Fifteen (14%) of the 107 patients with CAP had active DU. There was a trend toward an association between the presence of diabetes mellitus and/or steatorrhea and the occurrence of DU in patients with CAP (p = 0.06). The rate of H. pylori infection was significantly higher in patients with CAP and DU than in those with only CAP (86.7% vs. 54.3%, p = 0.02) but the rate similar to that in patients with simple DU (75.2%). Trends toward higher prevalence of H. pylori infection in CAP with DU were noticed when they were compared with the nonulcer dyspepsia group (86.7% vs. 66.1%). There was no significant difference in prevalence of H. pylori between CAP patients without DU and dyspeptic patients (54.3% vs. 66.1%). CONCLUSIONS: These data demonstrate that the prevalence of DU in CAP is relatively high. H. pylori infection seems to play the major pathogenetic role in DU associated with CAP.

Pancreatite aguda grave: abordagem atual / Severe acute pancreatitis: a modern approach

Pancreatite aguda grave é uma condiçäo patológica frequentemente resultante de necrose pancreática, situaçäo esta associada a maior morbi-mortalidade. O diagnóstico da necrose pancreática pode ser sugerido por parâmetros clínicos e bioquímicos, e confirmado por métodos de imagem. A identificaçäo precoce de pacientes graves é importante para assegurar tratamento rápido e adequado em Unidade de Terapia Intensiva. A tomografia computadorizada dinâmica, com reforço de contraste venoso, constitui o método de escolha atual para o seu diagnóstico. Na suspeita de infecçäo pancreática deve-se realizar punçäo aspirativa percutânea guiada por tomografia computadorizada ou ultra-som, com coloraçäo pelo Gram e cultura do material aspirado. O tratamento da pancreatite aguda grave é, a princípio, conservador. A antibioticoterapia profilática reserva-se aos casos de pancreatite biliar e às formas clinicamente graves ou com áreas de necrose extensa revelada pela tomografia computadorizada. a necrose estéril é conduzida com tratamento clínico, enquanto que na necrose infectada, indica-se conduta cirúrgica.

Hemocromatose hereditária: relato de caso e revisão da literatura / Hereditary hemochromatosis: case report and review of the literature

BACKGROUND: HFE-associated hemochromatosis is one of the most common inherited liver disease in Caucasian populations and refers to the association of increased iron stores with tissue damage (e.g., cirrhosis, diabetes, cardiomyopathy), which is progressive when diagnosis and treatment are delayed. AIMS: Description of a case of hereditary hemochromatosis in an asymptomatic 44-years-old patient, whose diagnosis was made through casual identification of abnormal iron markers. We will also present a brief review of the literature about the topic. CONCLUSIONS: Hereditary hemochromatosis is an ideal disease for primary prevention since the disease can be detected well before serious complications develop. This intervention has been shown to prevent the manifestations of the disease, altering its natural history