Effect of anti-viral therapy for occult hepatitis C virus infection.

BACKGROUND: Occult hepatitis C virus infection is defined by the presence of hepatitis C virus-RNA in liver but with undetectable anti-hepatitis C virus and serum viral RNA. AIM: To study the response to anti-viral therapy in occult hepatitis C virus infection to assess the pathogenic effect of occult hepatitis C virus. METHODS: Ten patients with occult hepatitis C virus infection were treated with pegylated-interferon plus ribavirin for 24 weeks and were followed-up 24 weeks after therapy. All patients had abnormal alanine aminotransferase, hepatitis C virus-RNA positive in peripheral blood mononuclear cells and liver necroinflammation. RESULTS: At the end of treatment and follow-up, the percentage of patients with normal alanine aminotransferase was 80% (95% CI: 48-96%) and 60% (95% CI: 31-84%) respectively, and hepatitis C virus-RNA in peripheral blood mononuclear cells was negative in 80% (95% CI: 48-96%) and 70% (95% CI: 40-90%) cases. At the end of follow-up sustained response was observed in 30% (95% CI: 11-61%) of cases. Five patients underwent a second liver biopsy. In all cases, liver hepatitis C virus-RNA persisted, although hepatitis C virus-RNA load was significantly lower (3.2 x 10(4) +/- 5.1 x 10(4) copies/microg RNA) than in the basal biopsy (2.4 x 10(5) +/- 3.8 x 10(5) copies/microg RNA); (P = 0.043). Necroinflammation and fibrosis decreased in three cases. CONCLUSION: The biochemical, virological and histological response to therapy achieved in patients with occult hepatitis C virus infection demonstrates the pathologic effects of occult hepatitis C virus.

[Chronic hepatitis C. Epidemiology and therapeutic results in 255 cases]. / Hepatitis crónica por virus C. Datos epidemiológicos y de eficacia terapéutica en 255 casos.

A review of the statistics of the years 2003, 2004 to August 2005 has provided data corresponding to 255 patients that were diagnosed and included in the treatment protocol of chronic hepatitis C. Epidemiologically, the 2/1 man/woman ratio, mean age of 43 years and history of transfusion (transf.) in 18.6% are to be noted. Parenteral drug addicition (PDA) in 17% and alcoholism in 14.1%, of unknown origin in 58.74% of the cases. 79.05% corresponded to genotype 1, 4.74% to genotype 4, 14.22% to genotype 3, and 2.76% to genotype 2. Genotypes 1 and 4 were included in the treatment regime with PEG-Interferon alpha-2b + Ribavirin (with doses adjusted for weight) and those of genotype 3 and 2 in the regime with Interferon alpha 2b + Ribavirin. In 95 cases of Genotype 1 (87) and 4 (8), a sustained viral response (SVR) of 61.95% was obtained, with three drop-outs. In the 20 cases of genotypes 3 (17) and 2 (3), SVR was 85%, with no drop-outs. In the 20 cases of genotypes 3 (17) and 2 (3), SVR was 85%, with no drop-outs. The adjustment of treatment to body mass involved an economic savings per case amounting to 868.94 Euro. Finally, in 16 cases of Genotype 1, before treated with Interferon in monotherapy, a sustained viral response of 31.25% was obtained with combined therapy.

Multicenter randomized, controlled study of intramuscular administration of interferon-beta for the treatment of chronic hepatitis C.

The intramuscular administration of interferon-beta (IFN-beta) at a dosage of 6 million units three times per week for 6 months has been evaluated in 90 patients included in a multicenter, randomized, controlled trial for the treatment of chronic hepatitis C. Transaminase levels were significantly reduced in IFN-beta-treated patients (p = 0.015) and were significantly lower with respect to those of the untreated controls (p = 0.040 at 6 months). Four treated (8%) and one untreated (2.5%) patients had normal transaminase values after 6 months. At study end (12 months), three quarters of the IFN-beta-treated patients had sustained transaminase normalization, whereas the untreated case had relapsed. Hepatitis C viremia was cleared in 6 (12%) treated patients but in none of the untreated controls (p = 0.058). Side effects of IFN-beta were infrequent (a mild flu-like syndrome in < 10%, asthenia in 16%, anorexia in 8%, headaches and weight loss in 8%, and hair loss in 4%). Leukocyte and platelet counts decreased during IFN-beta treatment, but no dose modifications were necessary. Such decreases were not statistically significant when compared with the levels in the untreated controls. Intramuscular IFN-beta at the dosage used has little efficacy in the treatment of chronic hepatitis C. Because of IFN-beta tolerance, higher doses and alternate routes of injection might prove beneficial for the treatment of this disease.

[Latent sprue in a 62-year-old man]. / Esprue latente en varón de 62 años.

We report a case of a 62-years-old male, diagnosed by radiology, antigliadin antibodies and intestinal biopsy of sprue, without fat malabsorption. The patient with a free gluten diet evolved to a clinic and radiologic normalization in three months and a great histological improvement.

Helicobacter pylori, efficacy of the new triple therapy in six and twelve-day schedules.

OBJECTIVE: Assessment of four eradicating patterns of 6 and 12 days duration with new triple therapies adapted to our environment. PATIENTS: After an endoscopic diagnosis of Duodenal or Gastric Ulcer, and the confirmation of the presence of Helicobacter pylori using a rapid urease test in antral biopsies, 274 patients were treated with one of four eradicating therapies, verifying its efficacy with the C-13 urea breath test, at least one month after the end of the treatment and 10 days after withdrawal of proton pump inhibitors. RESULTS: Maximum eradicating efficacy was achieved with Omeprazole (20 mg/12 hours), Clarithromycin (500 mg/12 hours) and Amoxycillin (1 g/12 hours), given for 12 days (96.6%), and Omeprazole (20 mg/12 hours), Tinidazole (500 mg/12 hours) and Clarithromycin (500 mg/12 hours), also given for 12 days (95.2%). The same drugs and doses, when given during six days, achieved percentages of 78.3% and 82.2% respectively. Results with Tinidazole suggest lack of resistance to this drug in the Community of Madrid.

[A consensus on Helicobacter pylori and gastroduodenal pathology]. / Consenso sobre Helicobacter pylori y patología gastroduodenal.

The current debate involving Helicobacter pylori (H.p.) and its potential role as an etiological factor for some digestive diseases, as well as the recent discussion through different mass media of this bacterium, including the American N.I.H. Consensus, have lead to the discussion of the H.p. problem, in order to clarify its real importance in acid-related diseases. Thus we want, as gastroenterologists, to give an overview of the current status, so as to facilitate the general practitioner work when confronted with gastrointestinal diseases, particularly related to H.p. Our purpose is to provide a critical and objective view regarding the implications of H.p. infection, and explain when treatment is needed and how this treatment should be accomplished.

Gastroscopic cytology in intestinal metaplasia.

Based on the findings of goblet cells the authors established cytologic criteria for the diagnosis of intestinal metaplasia. With this technique they made the diagnosis of intestinal metaplasia in 79.4% of the cases surgically confirmed, this contrast to endoscopic biopsy with only 35.2%. on the other hand, the cytologic diagnosis of malignancy is obtained in the same series in 92% of 25 gastric cancers against 80% of endoscopic biopsy. Among the controls surgically verified there was no cytologic false positive neither for malignancy nor for the diagnosis of intestinal metaplasia. The authors believe that any case with signs of malignancy and intestinal metaplasia may have a better preoperative prognosis.

[Chronic intestinal inflammatory disease. Review of our case load]. / Enfermedad inflamatoria crónica intestinal. Revisión de nuestra casuística.

A review was made of the differences between 21 cases of Crohn's disease and 40 cases of ulcerative colitis, diagnosed in the same 10-year period. In terms of sex, age, symptoms, location, complications and evolution, the findings were similar to those obtained in England and northern Europe.

Treatment of gastric pyrosis with almagate in patients with and without endoscopically demonstrable duodenal ulcer. A multicentre clinical trial.

An open multicentre trial of a new clinical antacid, almagate (hydrated aluminium-magnesium hydroxycarbonate, Al2Mg6(OH)14(CO3)2 X 4H2O, Almax) has been made in 169 patients suffering from gastric pyrosis (heartburn). Clinical and endoscopical exploration revealed that 104 of the patients had an active duodenal ulcer and 60 of these (group II) were treated with antisecretory drugs (cimetidine or ranitidine) plus Almax and 44 (group III) with Almax alone. Endoscopic exploration in the remaining 65 patients (group I) failed to reveal the presence of an ulcer and they were also treated with Almax alone. In all groups Almax proved to be very effective and the majority of patients were symptom free by the end of the two week trial. 79.5% of the ulcer patients in group III required doses of 6-8 g/d whereas only 21.7% of those in group II with concomitant treatment with antisecretory drugs took more than 4 g/d. The nonulcer patients of group I also used lower doses and only 29.3% needed to reach 6-8 g/d. There was a significant increase in daily bowel movements in all groups which was considered to be advantageous by most patients. Overall tolerance was excellent and side effects (diarrhoea 7 cases, nauseas 5 cases and constipation 1 case) were few and transient and 84.2% of the patients expressed a clear preference for Almax over their previous antacid treatment.