Comparison of the effect of BCAA granules on between decompensated and compensated cirrhosis.

BACKGROUND/AIMS: We designed a randomized trial to examine whether increase or preservation of serum albumin levels was attained with administration of branched-chain amino acid (BCAA) granules for compensated cirrhosis, compared with decompensated cirrhosis. METHODOLOGY: Sixty-five patients with HCV-related cirrhosis with serum albumin level less than 4.0 g/dl were enrolled in this study. Half of the patients were randomly assigned to receive 14.22 g/day of BCAA granules orally, and half were assigned to a control group. Patients were evaluated at entry and at 1-year intervals for at least 2 years. The parameters were divided into 3 categories. Class 1 was decompensated cirrhosis with serum albumin level less than 3.5 mg/dl. Class 2 was compensated cirrhosis with serum albumin level over 3.6 mg/dl and molar ratio of BCAA to tyrosine (BTR) less than 4. Class 3 was compensated cirrhosis with serum albumin level over 3.6 mg/dl and BTR over 4. RESULTS: In class 1 and class 2, the BCAA group exhibited significantly higher rates of maintaining serum albumin level than the control group for 2 years. In contrast, there was no significant difference between the BCAA group and control group in rate of maintaining serum albumin levels in class 3. CONCLUSIONS: Those results suggested that if cirrhotic patients were in the compensated stage at the entry but with lower BTR, as for decompensated cirrhosis, oral BCAA supplementation might be effective in maintaining serum albumin level for 2 years.

Ultrasonographic diagnosis of degree of chronic type C liver disease.

BACKGROUND/AIMS: We propose a method, named US score, for semi-quantitative determination of the stage of chronic type C liver disease by ultrasonography. METHODOLOGY: The subjects were 454 patients with chronic type C liver disease. Of the patients with chronic hepatitis C, 208 underwent US-guided or laparoscopic liver biopsy. US score was the sum of the scores representing five morphological variables, to be evaluated semi-quantitatively, and change in US score with chronic liver disease progression was determined. RESULTS: The average US score was 2.5 +/- 0.4 for F0, 2.8 +/- 0.6 for F1, 3.0 +/- 0.6 for F2, 3.7 +/- 0.9 for F3 and 5.5 +/- 0.8 for F4. There was a significant correlation between US score and the degree of fibrosis of chronic hepatitis C as assessed by the new European classification (p<0.0001). The average US score was 5.6 +/- 0.9 for Child A, 6.6 +/- 1.1 for Child B, and 7.8 +/- 0.7 for Child C. There was a significant correlation between US score and the results of classification by Child-Turcotte criteria (p<0.0001). CONCLUSIONS: These results suggest that US score is a stable, convenient method of evaluating the degree of progression of chronic type C liver disease.

Effect of oral supplementation with branched-chain amino acid granules on serum albumin level in the early stage of cirrhosis: a randomized pilot trial.

We designed a randomized pilot trial to examine whether increase or preservation of serum albumin levels was attained with earlier administration of branched-chain amino acid (BCAA) granules for cirrhosis in grade A according to Child-Pugh classification using branched-chain tyrosine ratio (BTR) as an indicator. Forty patients with HCV-related cirrhosis in grade A with serum albumin level between 3.5 and 3.9 g/dl were enrolled in this study. Half of the patients were randomly assigned to receive 14.3 g/day of BCAA granules orally, and half were assigned to a control. Patients were evaluated at entry and at 1-year interval for at least 2 years. For patients whose BTR was less than 4.0, mean change in serum albumin in the BCAA group was significantly higher than that in the control group after 1 and 2 years of treatment. However, for patients whose BTR was more than 4.0, mean change in serum albumin in the BCAA group was not significantly higher than that in the control group after 1 and 2 years of treatment. In conclusion, early oral supplementation of BCAA for HCV-related cirrhosis with serum albumin level between 3.5 and 3.9 g/dl and BTR less than 4.0, improves serum albumin levels and thus might improve prognosis.

Relationship between branched-chain amino acid to tyrosine ratio (BTR) and porto-systemic shunt in the Child-Pugh grade A cirrhosis determined by per-rectal portal scintigraphy.

We examined the difference between early cirrhotic patients with lower branched-chain amino acids (BCAA) to tyrosine ratio (BTR) (<4) and higher BTR (>4) in portal circulation using per-rectal portal scintigraphy with technetium-99m pertechnetate. Forty patients with Child-Pugh grade A cirrhosis and serum albumin level between 3.5 and 3.9 g/dl were enrolled in this study. Sixteen patients were infected with HBV and 24 with HCV. Thirteen patients had BTR<4.0 and 27 had BTR>4.0. Shunt index (SI) obtained through per-rectal portal scintigraphy was significantly correlated with BTR (r=-0.558, P<0.0002). ICGR-15 was most strongly correlated with BTR among six parameters representing liver reserve capacity. The mean SI of patients with BTR less than 4 (38.4+/-28.0%) was significantly higher than that of patients with BTR greater than 4 (17.3+/-14.3%) (P=0.0388). The mean concentration of serum BCAA did not significantly differ between the two groups, but the mean concentration of serum tyrosine in the patients with BTR<4 was significantly higher than that in the patients with BTR>4 (P=0.0081). These results suggested that the increase in porto-systemic shunt caused tyrosine passing through liver and stagnating in the serum, as a result of which BTR fall in early cirrhosis. In conclusion, decrease of blood flow through liver and increase in porto-systemic shunt might be partly responsible for deterioration of BTR in early cirrhosis.

Meshwork pattern is an important risk factor for development of hepatocellular carcinoma in patients with HBV-related chronic hepatitis and cirrhosis.

We analyzed the importance of 'meshwork pattern', a sign representing severe irregularity on the intra-hepatic echogram, in hepatitis B virus (HBV)-related chronic hepatitis and cirrhosis, as a risk factor for development of hepatocellular carcinoma (HCC). Two hundred and thirty-one patients (143 men and 88 women) with HBV-related chronic hepatitis and cirrhosis who visited our hospital from January 1993 to December 1994 were enrolled in this study. Since enrollment, abdominal ultrasonography had in principle been performed every 3 months for cirrhotic patients and every 4-6 months for patients with chronic hepatitis for HCC screening. Cumulative HCC incidences in patient groups positive or negative for meshwork pattern were calculated by the Kaplan-Meier method. The incidence of HCC was significantly higher in the group positive for meshwork pattern (average incidence per year: 4.4%) than in the group negative for it (average incidence per year: 0.5%) (P<0.0001, Mantel-Cox test). On regression analysis with Cox's proportional hazards model, sex, alpha-fetoprotein and meshwork pattern were selected as independent risk factors for HCC. In conclusion, meshwork pattern appears to be an ultrasonographic sign useful for detecting a latent risk factor for HCC in patients with HBV-related chronic hepatitis and cirrhosis.

Sporadic intra-abdominal desmoid with acute abdomen.

We report a 72-year-old man with sporadic intra-abdominal desmoid tumor manifesting as acute abdomen. CT scan revealed an air-containing tumor 7 cm in diameter; three weeks later, the tumor had shrunk to 4 cm on antibiotics. At surgery, a tumor arising from the transverse colon mesentery and infiltrating the jejunum was resected. No recurrence occurred over a 1-year follow-up.