Nonalcoholic steatohepatitis and hepatocellular carcinoma: Brazilian survey

OBJECTIVE: The majority of cases of hepatocellular carcinoma have been reported in individuals with cirrhosis due to chronic viral hepatitis and alcoholism, but recently, the prevalence has become increasingly related to nonalcoholic steatohepatitis around the world. The study aimed to evaluate the clinical and histophatological characteristics of hepatocellular carcinoma in Brazilians' patients with nonalcoholic steatohepatitis at the present time. METHODS: Members of the Brazilian Society of Hepatology were invited to complete a survey regarding patients with hepatocellular carcinoma related to nonalcoholic steatohepatitis. Patients with a history of alcohol intake (>20 g/day) and other liver diseases were excluded. Hepatocellular carcinoma diagnosis was performed by liver biopsy or imaging methods according to the American Association for the Study of Liver Diseases’ 2011 guidelines. RESULTS: The survey included 110 patients with a diagnosis of hepatocellular carcinoma and nonalcoholic fatty liver disease from nine hepatology units in six Brazilian states (Bahia, Minas Gerais, Rio de Janeiro, São Paulo, Paraná and Rio Grande do Sul). The mean age was 67±11 years old, and 65.5% were male. Obesity was observed in 52.7% of the cases; diabetes, in 73.6%; dyslipidemia, in 41.0%; arterial hypertension, in 60%; and metabolic syndrome, in 57.2%. Steatohepatitis without fibrosis was observed in 3.8% of cases; steatohepatitis with fibrosis (grades 1-3), in 27%; and cirrhosis, in 61.5%. Histological diagnosis of hepatocellular carcinoma was performed in 47.2% of the patients, with hepatocellular carcinoma without cirrhosis accounting for 7.7%. In total, 58 patients with cirrhosis had their diagnosis by ultrasound confirmed by computed tomography or magnetic resonance imaging. Of these, 55% had 1 nodule; 17%, 2 nodules; and 28%, ≥3 nodules. CONCLUSIONS: Nonalcoholic steatohepatitis is a relevant risk factor associated with hepatocellular carcinoma in patients with and without cirrhosis in Brazil. In this survey, hepatocellular carcinoma was observed in elevated numbers of patients with steatohepatitis without cirrhosis.

Aspectos clínicos da hepatite C crônica: experiência do Ambulatório de Hepatites Virais/Instituto ALFA de Gastroenterologia/Hospital das Clínicas da UFMG / Clinical aspects of chronic hepatitis C: experience of the Ambulatório de Hepatites Virais/Instituto ALFA de Gastroenterologia/Hospital das Clínicas da UFMG/MG/Brazil

Este estudo retrospectivo investigou os aspectos clínicos de 295 pacientes com hepatite C crônica. A idade variou entre 13 e 81 anos (mediana=49 anos) sendo 55% entre 40 a 60 anos. O fator de risco principal foi hemotransfusão, seguido pelo uso de drogas injetáveis. A maioria dos casos era assintomática. Cinqüenta por cento dos pacientes apresentavam complicações da cirrose hepática ao diagnóstico. Não houve associação entre o genótipo e a gravidade da fibrose hepática. Os fenômenos auto-imunes foram diagnosticados em 10% dos pacientes. A ALT estava aumentada em 69% dos casos. Trinta e dois por cento tinham ALT normal e 8% destes eram cirróticos. Somente 26% dos pacientes tratados com interferon mais ribavirina por 48 semanas apresentaram resposta virológica sustentada. Os resultados deste estudo alertam para a alta morbidade da hepatite C no nosso meio.

Clinical aspects of chronic hepatitis C in a retrospective study including 295 patients were studied. The age ranged from 13 to 81 years (mean = 49 years); 55% were 40 to 60 years old. The mainly risk factor to infection was blood transfusion, followed by drug injection. Most patients were asymptomatic but 50% had cirrhosis by the time of diagnosis. Genotype was not related to worse status of fibrosis. Auto-immune events appeared in 10% of patients. High and normal levels of alanine-aminotransferase (ALT) were found in 69% and 32% of the patients, respectively. Eight per cent of the patients with normal levels of ALT were cirrhotic. Only 26% of treated patients had sustained response to virus after treatment with interferon and ribavirin for 48 weeks. The results show a high morbidity.

Estudo clinico, laboratorial e da histologia hepática de candidatos a doadores de sangue HBsAg positivos em Belo Horizonte / Volunters blood donnors HBsAg positives in Belo Horizonte, State of Minas Gerais, Brasil : Clinical, laboratorial and histological study

Duzentos e cinquenta e dois candidatos a doadores de sangue HBsAg positivos (media de idade= 32,6 anos, 97,7masculino) foram investigados num estudo transversal para determinar suas caracteristicas clinicas, laboratoriais e histologicas. Foi tambem comparada a positividade e a negatividade dos marcadores sorologicos HBeAg, anti-HBe e IgM anti-HBc com os valores das aminotransferases sericas...