Changing HCV genotypes distribution in Poland--relation to source and time of infection.

BACKGROUND: Understanding the distribution of HCV genotypes has implications for prognosis and therapy of hepatitis C. OBJECTIVES: To describe the distribution of HCV genotypes in Poland in relation to route of transmission and year of infection. STUDY DESIGN: Patients with chronic liver disease were evaluated at the Department of Infectious Diseases, Bialystok (Poland). HCV genotype was determined by means of 5'UTR sequencing and comparison with known sequences of particular genotypes. RESULTS: The genotypes mostly frequently detected were genotype 1 (57.5%); genotype 3 (31.3%); and genotype 4 (8.4%). Genotype 1 constituted the majority of HCV infections caused by blood transfusion (68.8%) and only 34.8% of HCV infections in the intravenous drug use (IVDU) group (p<0.05). In contrast genotype 3 constituted the majority of HCV infections in the IVDU group (56.5%). We observed a significant increase in the proportion of genotype 3 infections detected after 2000--from 19.1% to 38.9%. CONCLUSIONS: The relative proportion of genotype 1b in Poland has decreased and that of genotype 3a has increased, especially among IVDU.

Intestinal fatty acid binding protein (I-FABP) as a possible biomarker of ileitis in patients with ulcerative colitis.

BACKGROUND: One of nine types of FABP, intestinal fatty acid binding protein (I-FABP) is primarily limited to the mature enterocytes of the small intestine, with only trace amounts identified in the stomach and large intestine. The aim of this study was to investigate the use of I-FABP as a possible plasma marker of intestinal injury in patients with ulcerative colitis (UC). MATERIAL AND METHODS: The study group consisted of 42 patients (11 females and 31 males) with active ulcerative colitis (UC), aged from 24 to 74 years (mean age: 41.8+/-3.5 years). Plasma I-FABP concentrations and hsCRP were compared using endoscopic pictures scored according to the system developed by Meyers et al., and analysed in the context of inflammatory process extension: pancolitis, or distal or left side colitis. RESULTS: The mean serum I-FABP concentration /mL), whereas individuals with left-side colitis had a mean I-FABP concentration of 61.8+/-8.5 pg/mL. Significant serum I-FABP elevation was observed in UC patients with a severe form of the disease, in contrast to the serum I-FABP concentration in patients with the mild form (260.5+/-60.6 vs. 61.5+/-7.9 pg/mL). CONCLUSION: The elevated serum I-FABP concentration in patients with UC may indicate ileitis. I-FABP may be a useful marker of the extended inflammatory process.

[Growth factors in chronic hepatitis C]. / Czynniki wzrostowe w przewleklym wirusowym zapaleniu watroby typu C.

UNLABELLED: GROWTH FACTORS: HGF, PDGF, TNF-alpha, IL-6 have important role in liver regeneration. The aim of our study was the evaluation of serum growth factors concentration in chronic hepatitis C. Studied growth factors and cytokines levels were analyzed in relation to inflammatory and fibrotic changes in liver. MATERIAL AND METHODS: Seventy-five chronic hepatitis C patients were enrolled in this study. All patients had liver biopsy performed and the microscopic examination of liver tissues were analized according to Scheuer's classification. Serum concentrations of growth factors in patients' serum were assessed by use of ELISA method. The control group consisted of 20 healthy individuals. RESULTS AND CONCLUSIONS: Serum HGF, PDGF, TNF-alpha level showed significant elevation in the chronic hepatitis C compared to healthy controls. There was a statistically significant correlation between serum HGF and inflammatory activity and fibrosis stage. HGF seems to play an important function during chronic HCV infection.

Increase in expression of monocytic tissue factor (CD142) with monocytes and blood platelet activation in liver cirrhosis.

Tissue factor (TF) is one of the proteins that participate in hemostatic and inflammatory processes. Activated monocytes present in the liver increase expression of TF, and while accumulating in the organ they can intensify inflammation. The aim of the present study was to evaluate the expression of TF on monocytes in advanced liver cirrhosis with regard to other activation markers. The flow cytometric analysis of TF (CD142), CD14, adhesive molecules CD11b and CD11c, costimulatory molecules CD40, CD80 and CD86, and HLA-DR on monocytes was carried out in 45 patients with postalcoholic liver cirrhosis (Child Pugh B, 20 patients; Child Pugh C, 25 patients) and in 25 healthy persons. The positive correlation between monocytic TF expression and monocyte [soluble CD14 (sCD14), CD11b, monocyte aggregates] activation, the expression of costimulatory molecules on monocytes (CD40, CD80), blood platelet (soluble P-selectin, microplatelets) activation, the level of tumor necrosis factor-alpha, biochemical parameters of liver damage (alanine aminotransferase, aspartate aminotransferase, alkaline phosphate, gamma-glutamyltransferase, and bilirubin) as well as coagulation disorders were observed in the study. In conclusion, the study revealed that the activation of monocytes and blood platelets is accompanied by the elevation of monocytic TF expression in advanced liver cirrhosis. The monocytic TF is a significant link connecting clotting processes and inflammatory and immunological phenomena in liver cirrhosis.

Pigment epithelium-derived factor in ulcerative colitis: possible relationship with disease activity.

OBJECTIVES: Pigment epithelium-derived factor (PEDF) is an endogenous most potential angiogenic inhibitor and increased expression of PEDF in intestinal mucosa specimens was shown in the course of ulcerative colitis (UC). The aim of the present study was to evaluate serum concentration of pigment epithelium-derived growth factor, a potent anti-angiogenic factor and its possible association with vascular endothelial growth factor (VEGF) levels and disease activity. METHODS: Concentrations of PEDF and VEGF were measured in sera of 33 patients (13 females and 20 males) with active UC. RESULTS: There was significant increase of serum PEDF (32.3+/-2.9 vs. 20.6+/-4.7 ng/mL, P<0.05) as well as VEGF (326.4+/-58.1 vs. 110.9+/-15.7 pg/mL, P<0.05) in UC patients compared to healthy controls. Serum PEDF showed strong, positive correlation with endoscopic score (r=0.622, P<0.001), while such association was absent in respect to VEGF (r=0.05, P=0.77). In contrast serum VEGF decreased in severe UC comparing to patients with a mild course of disease, however the difference was not significant (274.9+/-64.9 vs. 360.4+/-103.4 pg/mL, P=0.53). CONCLUSIONS: Increase in serum PEDF during UC, especially in severe forms of disease suggests its involvement in UC pathogenesis.

[Analysis of prognostic factors in patients with autoimmune hepatitis]. / Ocena wskazników rokowniczych u chorych na autoimmunologiczne zapalenie watroby.

Autoimmune hepatitis (AIH) is the chronic inflammatory liver disease of unknown etiology, demonstrating progressive injury of liver, finally leading to insufficiency of this organ. Possible association between clinical forms, course and prognosis of AIH has been considered recently. Aim of this study is to evaluate autoimmune hepatitis exacerbation risk in respect to epidemiological, clinical and laboratory signs demonstrated in patients with freshly diagnosed AIH. Retrospective study included 42 patients hospitalized in Liver Unit of Department of Infectious Diseases Medical University of Bialystok between 1999 and 2003, suspected for autoimmune hepatitis. In majority of patients onset of the disease was sudden and associated with significant increase of ALT activity. The most frequent, first sign of the disease was jaundice, that was observed in over 50% among patients, pruritus was reported by 1/4 patients. In 12 patients (41.4%) beginning of the disease was oligosymptomatic, i.e. without jaundice and pruritus. These patients demonstrated significantly lower ALT activity, bilirubin and gamma-globulin concentrations. Moreover prevalence of antinuclear antibodies in this group was less frequent, and frequency of hospitalization because of AIH exacerbations was also lower. Concluding, oligosynptomatic course of the disease accompanied by lower ALT activity can be related to better prognosis of AIH, and indicate mild course associated with low risk of exacerbations. On the c:her hand faster progression of the disease can be expected in younger patients demonstrating significant increase of ALT activity at the moment of initial diagnosis.

Expression of beta2-integrin on leukocytes in liver cirrhosis.

AIM: To analyze beta2-integrin expression on blood leukocytes in liver cirrhosis. METHODS: In 40 patients with liver cirrhosis and 20 healthy individuals, the evaluation of expression of CD11a (LFA-1alpha), CD11b (Mac-1alpha), CD11c (alphaX) and CD49d (VLA-4alpha) on peripheral blood leukocytes was performed using flow cytometry. The analysis was carried out in groups of patients divided into B and C according to Child-Pugh's classification. RESULTS: An increased CD11a, CD11b, CD11c and CD49d integrin expression was observed on peripheral blood leukocytes in liver cirrhosis. The integrin levels were elevated as the advancement of liver failure progressed. The highest expression of integrins occurred predominantly on monocytes. A slight expression of VLA-4 was found on lymphocytes and granulocytes and it increased together with liver failure. A positive correlation was noted between median intensity of fluorescence (MIF) expression on polymorphonuclear cells of CD11a and CD11c and CD49d (r = 0.42, P < 0.01; r = 053, P < 0.01, respectively) in liver cirrhosis stage C. However, no correlation was observed between integrin expression on leukocytes. The concentrations of sICAM-1, sVCAM-1, and TNFalpha, were significantly elevated in liver cirrhosis. CONCLUSION: beta2-integrin expression on leukocytes increases in liver cirrhosis decompensated as the stage of liver failure increases, which is a result of permanent activation of leukocytes circulating through the inflamed liver environment. beta2-integrin expression on circulating leukocytes can intensify liver cirrhosis.

Expression of p53, Bax and Bcl-2 proteins in hepatocytes in non-alcoholic fatty liver disease.

AIM: To analyze the protein expression essential for apoptosis in liver steatosis. METHODS: The expression of proapoptotic proteins p53, Bax, and antiapoptotic Bcl-2 in hepatocytes with steatosis (SH) and without steatosis (NSH) was evaluated in 84 patients at various stages of non-alcoholic fatty liver disease (NAFLD). RESULTS: Immunohistochemical staining of liver tissue showed the activation of p53 protein in SH and NSH with increased liver steatosis, diminished Bcl-2 and slightly decreased Bax protein. Positive correlation was found between the stage of liver steatosis with p53 expression in SH (r = 0.54, P < 0.01) and NSH (r = 0.49, P < 0.01). The antiapoptotic protein Bcl-2 was diminished together with the advancement of liver steatosis, especially in non-steatosed hepatocytes (r = 0.43, P < 001). CONCLUSION: Apoptosis is one of the most important mechanisms leading to hepatocyte elimination in NAFLD. The intensification of inflammation in NAFLD induces proapoptotic protein p53 with the inhibition of antiapoptotic Bcl-2.

Does HAART improve renal function? An association between serum cystatin C concentration, HIV viral load and HAART duration.

AIM: The prevalence of renal disease in human HIV-infected individuals varies between 2% and 10%. Many reports have demonstrated the beneficial effect of antiretroviral (ARV) therapy on slowing the progression of renal diseases. The aim of our cross-sectional study was to determine serum cystatin C concentration in different stages of HIV infection and the relationship between cystatin C concentration and ARV treatment. METHODS: Cystatin C concentration was measured in the sera of 77 HIV-1-infected individuals and 18 HIV-seronegative volunteers. The glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease Study formula. RESULTS: HIV infection resulted in a significant increase in serum cystatin C concentration compared with healthy individuals (933.4 +/- 32.1 vs 621.1 +/- 56.8 ng/ml, P < 0.001). There were no significant differences in urea, creatinine and GFR between those groups. On multivariate analyses serum cystatin C was independently associated with highly active antiretroviral therapy (HAART) duration (beta = -0.34, P = 0.04) and HIV viral load (beta = 0.33, P = 0.04), whereas there were no significant relationships with age, body mass index, HIV duration, CD4+ and CD8+ T-cell counts and serum high sensitivity C-reactive protein concentration. CONCLUSIONS: Our initial observations indicate that serum cystatin C, which may reflect mild renal dysfunction, is increased during HIV-infection and is associated with HIV viral load. Long-lasting HAART seems to decrease cystatin C concentration, thus potentially improves renal function.

Known and probable risk factors for hepatitis C infection: a case series in north-eastern Poland.

AIM: To describe the risk profile of patients in hospital with hepatitis C virus (HCV) infection in Poland. METHOD: Using a structured questionnaire, all patients with confirmed HCV infection were interviewed about the risk factors. RESULTS: Among the 250 patients studied, transfusion before 1993 was the primary risk factor in 26%, intravenous drug use setting in 9% and occupational exposure in health-care in 9%. Women were more likely to have a history of occupational exposure or transfusion before 1993 and less likely to undergo minor surgery. Known nosocomial risk factors (transfusion before 1993, dialysis) were responsible for 27% of infections, probable nosocomial factors (transfusions after 1992, minor surgery) for 14% and further 9% were occupationally acquired infections. CONCLUSION: A careful history investigation can identify a known or probable risk factor for HCV acquisition in 59% of patients with HCV infection. Preventive activities in Poland should focus on infection control measures in health-care setting.

High concentration of antimitochondrial antibodies predicts progressive primary biliary cirrhosis.

AIM: To evaluate the serum concentration of antimitochondrial antibodies (AMAs) as a prognostic indicator of progressive primary biliary cirrhosis (pPBC). METHODS: Serum concentrations of AMA subtypes (anti-M2, anti-M4, and anti-M9), biochemical indices of liver function and Mayo risk factor (MRF) were determined in 30 women with diagnosed primary biliary cirrhosis (PBC) selected among 348 females with elevated alkaline phosphatase but without signs of hepatic decompensation. They were followed up for 5 years for possible development of hepatic decompensation. RESULTS: Anti-M2 concentration was significantly correlated with bilirubin and albumin levels as well as MRF, whereas anti-M4 was significantly correlated with albumin level, prothrombin time and MRF. During the 5-year follow-up, progressive PBC (pPBC) was diagnosed in 3 among 23 patients available for evaluation. These 3 patients were positive for both anti-M2 and anti-M4. Anti-M2 serum concentration exceeded 1 300 RU/mL in patients with pPBC and only in 1 among 20 non-progressive PBC persons (5%). Anti-M4 serum concentration exceeded 400 RU/mL in 2 of the progressive patients and none in the non-progressive group. In contrast, anti-M9 serum concentration was below 100 RU/mL in all patients with pPBC, and higher than 100 RU/mL in 11 women (55%) among the non-progressive group. CONCLUSION: Females with elevated alkaline phosphatase and high anti-M2 and anti-M4 concentrations are at a high risk for developing pPBC. Quantitative AMA detection should be considered as a method for early diagnosis of pPBC.

[The apoptosis of hepatic tissues in hepatitis C]. / Apoptoza w tkance watrobowej w zakazeniach HCV.

OBJECTIVE: The purpose of the study was the evaluation of p53 and bcl2 protein expression on intrahepatic hepatocytes in chronic hepatitis C before and after the treatment with interferon alpha 2b (IFNa2b) combined with ribavirin (RBV). METHODS: using immunohistochemical method, the percentage of cells with p53 and bcI2 protein expression was assessed in hepatic tissues of 30 patients suffering from chronic hepatitis C. The examinations were performed in hepatic bioptates before IFNa2b treatment (9MU/week/48 weeks) combined with RBV (1-1.2g/24hrs/48 weeks) and after the therapy. The parameters were analyzed in the responders group (R) and non-responders (NR). RESULTS: The highest increase in p53 protein expression was observed in tissues in which interferon alpha decreased inflammatory activity and fibrosis. The elimination of HCV infection did not have any influence on p53 protein expression. Diminishing of p53 positive hepatocyte percentage was revealed in tissues where inflammatory activity and fibrosis did not change before and after the treatment or where histological damage was intensified. IFNa2b+RBV therapy diminished bcl2 positive cell percentage, specifically in patients with eliminated HCV. CONCLUSIONS: Tissue p53 protein expression increase and bcl-2 decrease can be a prognostic marker as far as a positive effect of IFNa2b+RBV treatment and HCV elimination are concerned. It can occur either due to the elevation of growth factors inducing regeneration or HCV-infected hepatocyte apoptosis. It was shown that IFNa2b+RBV therapy decreases bcl2 protein expression, which can make hepatocyte apoptosis and HCV elimination possible.

Plasma transforming growth factor beta1, metalloproteinase-1 and tissue inhibitor of metalloproteinases-1 in acute viral hepatitis type B.

AIM: Antiproliferative, pro-apoptotic and immunosuppressive activity effects suggest crucial role of transforming growth factor (TGF)-beta1, metalloproteinase (MMP)-1 and its tissue inhibitor (TIMP)-1 in the pathogenesis of acute liver injury that in some patients precede development of chronic liver diseases and fibrogenesis. The aim of this study was to evaluate effect of acute HBV infection on plasma TGF-beta1, MMP-1 and TIMP-1 levels. METHODS: TGF-beta1, MMP-1 and TIMP-1 plasma concentrations were measured with an enzyme immunoassay in 39 patients with acute viral hepatitis type B. Baseline measurement was performed within the first week of jaundice and then weekly up to the fourth week of the disease. Results were compared to baseline and normal values and to liver function tests. RESULTS: Plasma concentrations of TGF-beta1, TIMP-1 and MMP-1 were significantly elevated in the first week of acute viral B hepatitis in comparison to normal. Analysis of individual values demonstrated significant positive correlation between plasma concentrations of TGF-beta1 and TIMP-1. There was no correlation between MMP-1 and TGF-beta1 or TIMP-1. Significant correlation was demonstrated between both TGF-beta1 and ALT or AST as well as between TIMP-1 and ALT, AST or bilirubin. Elevated baseline levels of both TGF-beta1 and TIMP-1 decreased gradually in consecutive weeks of the disease. TGF-beta1 but not TIMP-1 plasma concentrations were significantly lower in 3rd and 4th week than baseline values. MMP-1 concentration remained on baseline level in the 2nd week of the disease. However in the 3rd week its values increased suddenly but the significant difference in comparison to baseline was observed only in 4th week. CONCLUSIONS: These results indicate important role of TGF-beta1, TIMP-1 and MMP-1 in acute viral hepatitis, that seems to be connected first of all with hepatocytes damage. Their role in extracellular matrix metabolism during acute liver injury needs further evaluation.

p53 protein expression in chronic hepatitis C; effect of interferon alpha 2b therapy.

BACKGROUND/AIMS: Gene p53 plays an important role in apoptosis or regeneration of damaged tissues. HCV activates gene p53 directly and/or indirectly. In chronic hepatitis, hepatocyte regeneration is regulated by gene p53 and growth factors. The aim of the study was the evaluation of protein p53 expression on hepatocytes in chronic hepatitis C regarding inflammatory activity and fibrosis as well as the influence of interferon alpha 2b (IFNalpha2b) on gene p53 activity. METHODOLOGY: In 24 patients with chronic hepatitis C treated with IFNalpha2b (18MU sc/week/48 weeks), in whom liver biopsies were performed before and after IFNalpha2b treatment. The immunohistochemical method determined protein p53 in formalin-fixed, paraffin-embedded liver tissue sections. The percentage of p53-positive hepatocytes and intensity of protein p53 accumulation were evaluated under a light microscope. RESULTS: IFN treatment caused the increase in the percentage of p53-positive hepatocytes and the intensity of protein p53 accumulation. The highest level of protein p53 expression was observed in IFNalpha2b-treated tissues with the decrease in inflammatory activity and fibrosis. HCV infection elimination did not affect protein p53 expression. We observed the decrease in p53-positive hepatocytes in tissues without improvement of morphological regeneration during IFNalpha2b therapy. CONCLUSIONS: The increase in protein p53 expression can be considered a prognostic marker of the positive effect of IFNalpha2b treatment and HCV elimination. It may result from the effect of the increase in regeneration or apoptosis of HCV infected hepatocytes.

Plasma transforming growth factor-beta(1) in acute viral hepatitis.

BACKGROUND: TGFbeta(1) has a confirmed role in liver fibrosis and its antiproliferative, proapoptotic, and immunosuppressive activities can play important roles in the pathogenesis of viral hepatitis. MATERIAL/METHODS: The concentrations of transforming growth factor-beta(1) (TGFbeta(1)) was measured with enzyme immunoassay in the plasma of 70 patients with acute viral hepatitis types A, B, and C to evaluate an association with the course and severity of the disease. RESULTS: The highest concentrations of TGFbeta(1) were observed in the first week of acute viral hepatitis types A and B (52.8+/-7.4 and 50.0+/-7.7, respectively). They were significantly higher than normal values or levels in patients with hepatitis type C. Significant correlation was observed between TGFbeta(1) concentrations and alanine aminotransferase in all groups, whereas with aspartate aminotransferase only hepatitis A and B. A four-week follow-up showed a gradual decrease in TGFbeta(1) levels in hepatitis A and B patients. In patients with acute C hepatitis, the relatively low initial TGFbeta(1) concentrations increased in the second and third weeks of follow-up. Among HBV-infected patients the highest TGFbeta(1) concentrations (75+/-17 ng/ml) were observed in the severe form of the disease. CONCLUSIONS: These results support an important role of TGF-beta(1) in the pathogenesis of acute viral hepatitis that seems to be connected with the degree of hepatocyte damage, but not with its mechanism or etiology.

Blood platelet and monocyte activations and relation to stages of liver cirrhosis.

AIM: Blood platelets (plt) and monocytes are the cells that play a crucial role in the pathogenesis of liver damage and liver cirrhosis (LC). In this paper, the analysis of mutual relationship between platelets and monocytes activation in LC was conducted. METHODS: Immunofluorescent flow cytometry was used to measure the percentage of activated platelet populations (CD62P, CD63), the percentage of plt-monocyte aggregates (pma) (CD41/CD45), and activated monocytes (CD11b, CD14, CD16) in the blood of 20 volunteers and 40 patients with LC. Platelet activation markers: sP-selectin, platelet factor 4 (PF4), beta-thromboglobulin (betaTG) and monocyte chemotactic peptide-1 (MCP-1) were measured and compared in different stages of LC. RESULTS: Platelet activation with the increase in both betaTG serum concentration and elevation of plt population (CD62P and CD63 as well as MIF CD62P and CD63) is elevated as LC develops and thrombocytopenia rises. There is a positive correlation between medial intensity of fluorescence (MIF) CD62P and MIF CD63 in LC. We did not show any relationship between monocyte activation and pma level. SP-selectin concentration correlates positively with plt count and pma, and negatively with stage of plt activation and MIF CD62P and MIF CD63. There was no correlation between MCP-1 concentration and plt, monocyte activation as well as pma level in LC. CD16 monocytes and MIF CD16 populations are significantly higher in the end stage of LC. A positive correlation occurs between the value of CD11b monocyte population and MIF CD14 and MIF CD16 on monocytes in LC. CONCLUSION: Platelet and monocyte activation plays an important role in LC. Platelet activation stage does not influence monocyte activation and production of plt aggregates with monocytes in LC. With LC development, thrombocytopenia may be the result of plt consumption in platelet-monocyte aggregates.

Acute hepatitis E complicated by acute pancreatitis: a case report and literature review.

The coincidence of viral hepatitis and acute pancreatitis is well described. Most of the cases are related to acute hepatitis A or B. Hepatitis E virus (HEV) infections are rare in Europe, and very few reports describe HEV as a causative agent of acute pancreatitis in areas of endemic hepatitis E prevalence. We report a case of acute pancreatitis in the course of acute hepatitis E in a 28-year-old male patient. The majority of reported cases, including our case, show several common epidemiological and clinical features: young age, male predominance, onset of acute pancreatitis at the early stage of acute hepatitis, and favorable outcome. Acute pancreatitis should be considered in acute hepatitis E, especially in young, male patients presenting with severe epigastric pain early in the course of disease. The pancreatitis in these patients usually runs a benign course. The patients should be closely monitored because life-threatening complications have been reported.

Epidemiological characteristics of inflammatory bowel disease in North-Eastern Poland.

AIM: To provide the clinical and epidemiological data of inflammatory bowel disease (IBD) patients of North-Eastern Poland. METHODS: A total of 248 IBD patients diagnosed and hospitalized in the Department of Infectious Diseases in Bialystok between 1990 and 2003 were included in the study. We analyzed age, sex, education, characteristics of job, type of the environment, discontinuation of employment due to IBD, colitis extent, need of surgical treatment, and coexistence of other diseases. RESULTS: Two hundred and thirty-three IBD patients (94%) were diagnosed as ulcerative colitis (UC), and only 15 (6%) were diagnosed as Crohn's disease (CD). Patients with CD were significantly younger at the time of diagnosis and male predominance was observed. The mean age of the patients at the time UC diagnosis was 44.9+/-1.1 years. Histogram of the age of patients showed the characteristic biphasic distribution with two peaks between 20 and 40 years and between 60 and 70 years. The predominant form of UC was left sided colitis, which affected almost 80% of the studied population. The most extensive form--pancolitis was present in 34 patients (15%). Only 6% of UC patients required surgery, whereas 36% of CD patients underwent surgery (P<0.005). Among coexisting disorders, cholelithiasis was the most prevalent and demonstrated in 35 patients (14%), pulmonary disorders were diagnosed in 2%, and psoriasis in 1.4%. Since 1998, the number of admitted IBD patients has slightly increased. CONCLUSION: Occurrence of UC in Poland is much higher than that of CD. The majority of UC cases are diagnosed in young people (20-40 years) with the predominance of male patients. The most common clinical form of UC is left sided colitis.

Four-year follow up of hepatitis C patients vaccinated against hepatitis B virus.

AIM: Patients with chronic hepatitis C have been recommended to receive vaccinations against hepatitis B. Our study aimed at evaluating the hepatitis B immunogenicity and efficacy against hepatitis B virus infection 4 years after primary immunization series in a group of patients with chronic hepatitis C. METHODS: We recruited 36 out of 48 hepatitis C virus (HCV) infected individuals who were vaccinated against hepatitis B virus (20 mug of recombinant HBsAg at 0-1-6 mo schedule) in 1998. Here we measured anti-HBs titers and anti-HBc 4 years after delivery of the third dose of primary immunization series. RESULTS: After 4 years a total of 13/36 (36%) HCV infected patients had seroprotective titers of anti-HBs compared with 9/10 (90%) in the control group, (P<0.05). Similarly the mean concentration of anti-HBs found in hepatitis C patients was significantly lower than that found in healthy subjects (18.3 and 156.0 mIU/mL respectively (P<0.05). None of the HCV infected patients or controls became infected with HBV during the study period as confirmed by anti-HBc negativity. CONCLUSION: We demonstrated that 4 years after HBV immunizations' more than 60% of vaccinated HCV patients did not maintain seroprotective levels of anti-HBs, which might put them at risk of clinically significant breakthrough infections. Further follow-up studies are required to clarify whether memory B and T lymphocytes can provide protection in chronic hepatitis C patients in the absence or inadequate titers of anti-HBs.