Long-term entecavir or tenofovir disoproxil fumarate therapy in treatment-naïve chronic hepatitis B patients in the real-world setting.

The aim of this study was to determine the long-term efficacy of entecavir (ETV) and tenofovir disoproxil fumarate (TDF) on the natural course of disease in chronic hepatitis B patients (CHB) with/without cirrhosis in clinical practice. A total of 355 treatment-naïve CHB patients were enrolled into the study. The primary outcome measure was viral suppression as defined by serum HBV DNA level <20 IU/mL. A secondary outcome measure was to determine the development of Hepatocellular carcinoma (HCC). Virological and biochemical responses were similar between the two treatment groups over time. The presence of cirrhosis and hepatitis B e antigen (HBeAg) positivity did not appear to impact viral suppression. The cumulative probability of HBeAg loss was 41% at 4 years of therapy. Hepatitis B surface antigen (HBsAg) loss occurred in four patients. Model for End-Stage Liver Disease score was significantly improved from baseline to week 48 and 96 under antiviral therapy (P = 0.013, P = 0.01). HCC was diagnosed in 17 patients (4.8%). The cumulative probability of the development of HCC was 3.3% at 1 year and 7.3% at 4 years of therapy. The development of HCC was independently associated with older age (P = 0.031) and the presence of cirrhosis (P = 0.004). Serum creatinine levels and creatinine clearance remained stable over time. ETV and TDF effectively maintained virological and biochemical responses in long-term follow-up of CHB patients with/without cirrhosis. HCC may still develop, although at a lower rate, and is more likely to develop in patients with cirrhosis, especially in older patients.

Fascioliasis: a report of five cases presenting with common bile duct obstruction.

Fascioliasis is a zoonotic infection caused by Fasciola hepatica. It is rarely seen with icterus caused by obstruction of the common bile duct. We report five patients with obstructive jaundice due to Fasciola hepatica, who were diagnosed and managed with endoscopic retrograde cholangiopancreatography (ERCP). All cases were admitted to hospital with complaints of icterus and pain in the right upper quadrant of the abdomen; their biochemical values were interpreted as obstructive jaundice. Ultrasound and computer tomography (CT) revealed biliary dilatation in the common bile duct, but did not help to clarify the differential diagnosis. ERCP showed the presence of Fasciola hepatica in the common bile duct. After removing the flukes, the symptoms disappeared and the biochemical values returned to normal. Biliary fascioliasis should be considered in the differential diagnosis of obstructive jaundice. This report confirms the diagnostic and therapeutic role of ERCP in patients with obstructive jaundice caused by biliary fascioliasis.

Prevalence of hepatitis G virus (HGV) infection in patients with chronic liver disease.

Hepatitis G virus (HGV) may cause acute and chronic infection in humans but its role in liver injury and chronic hepatitis is unclear. In this study, the prevalence of HGV was investigated in patients with chronic liver diseases in an endemic area of hepatitis B and C virus. Sixty patients with chronic liver diseases, 11 with hepatitis B virus, 44 with hepatitis C virus and 5 patients with hepatitis of unknown etiology and 60 healthy blood donors as the control were included in the study. HGV RNA was investigated by the reverse transcription polymerase chain reaction. HGV RNA was detected in none of the patients with chronic liver diseases (0%) and only one patient (1.6%) in the control group. There was no difference between the groups. This observation indicated that the prevalence of HGV is very low in patients with chronic liver diseases and healthy people in our geographical area. The role of this novel virus in the pathogenesis of chronic liver injury seems insignificant.

Effect of cisapride on gastric emptying in patients with gastro-oesophageal reflux disease.

To investigate the effect of cisapride in gastro-oesophageal reflux disease (GERD), gastric emptying time, measured using scintigraphy, and reflux symptoms were compared before and after cisapride therapy in 30 patients with endoscopically proven GERD. Gastric emptying time was also measured in 20 age-matched controls. Patients with GERD were treated with 30 mg cisapride orally three times daily for 7 days. Gastric emptying time was significantly reduced following cisapride therapy in 28 of these patients (71.6 +/- 18.1 min versus 57.9 +/- 13.9 min), although it was still longer than the gastric emptying time of the control group (i.e. 46.2 +/- 8.1 min). In addition, cisapride relieved heartburn, which is a representative symptom of GERD. These findings suggest that cisapride may be useful in treating reflux symptoms and oesophagitis in patients with GERD.

Paget's disease of the esophagus.

We describe the case of a 72-year-old male patient who was suffering from Pagetoid spread to the esophageal mucosa from adenocarcinoma located in the distal esophagus and proximal stomach. Esophageal Paget's disease is rare. The histogenesis of extramammary Paget's disease has remained controversial. In the majority of cases, it originates from a primary esophageal tumor. In this report, we describe a patient who was suffering from esophageal adenocarcinoma and discuss the origin of extramammary Paget's disease in the light of the literature.

Doxycycline-induced pill esophagitis.

Pill-induced esophagitis is a complication seen in patients who use certain medications such as tetracycline and non-steroidal anti-inflammatory drugs. In this short report, we described five cases of doxycycline-induced esophagitis with endoscopic images. All of the patients were young or middle-aged women. Dysphagia or odynophagia with retrosternal pain were the main presenting symptoms in all cases. The observed injuries were at the middle third of esophagus with a normal surrounding mucosa. All patients had a history of swallowing the capsule with a small amount of water or in a recumbent position. Two patients with dysphagia were managed by intravenous fluid support and parenteral acid suppression. The symptoms were improved in 2-7 days after the ceasing of the drug and control endoscopies were completely normal in all cases after 3-4 weeks of admission. The drug-induced esophagitis is not rare with certain drugs and should be suspected in all patients presenting with chest pain and dysphagia. Physicians must warn the patients to take the pills and capsules with enough liquid and in the upright position.