Volume 71 - 2008 - Fasc.1 - Original articles
A pilot observational survey of hepatitis C in Belgium
Aim of the study : There is a lack of epidemiological data on hepatitis C (HCV) infected patients in Belgium. Therefore our purpose was to address this important question and to evaluate the feasibility of a national HCV observatory.
Patients and methods : From November 2003 to November 2004, every new patient prospectively seen for HCV antibody positivity in 9 Belgian hospital centres was recorded and a standardised 10- items questionnaire was completed during the consultation, including a Quality of Live (QOL) visual analogue scale.
Results : Three hundred and eighteen consecutive patients were recruited. Fifty five percent were male with a median age of 45 y (11-87 y). The main risk factors for infection were IV drug use (27%), blood transfusion (23%), and invasive medical procedure (11%). On the QOL scale, ranging from 0 and 100, mean value was 61 ± 31. Transaminases were abnormal in 66% with a median elevation 2 times above normal value. HCV RNA was positive in 87% with a viral load above 800 000 IU/ml in 42%. Genotype 1 was predominant (59%), followed by genotypes 3 (19%) and 4 (14%). A liver biopsy was performed in 190 patients, with minimal fibrosis (METAVIR F0-F1) in 43%, moderate fibrosis (F2) in 35% and advanced stages (F3-F4) in 22%. Antiviral treatment was not considered in 53% because of normal ALT (30%), old age (7%), minimal histological stage (6%) or patient refusal (4%).
Conclusions : This study highlights the feasibility of a national HCV survey using a simple questionnaire. This pilot study could be generalised throughout Belgium, and, if repeated, could allow a regular assessment of the changes in epidemiology and manage- ment of HCV infection in our country. (Acta gastroenterol. belg., 2008, 71, 4-8).
Incidence and characteristics of type 2 hepatorenal syndrome in patients with cirrhosis and refractory ascites
Background and aim : Type 2 hepatorenal syndrome (HRS) is a well described progressive impairment of renal function in patients with cirrhosis but its natural history, especially in patients with refractory ascites, is not well known. The aim of this study was to assess the incidence, predictive factors and outcome of type 2 HRS in patients with cirrhosis and refractory ascites.
Patients and methods : Thirty patients with refractory ascites were followed-up for 17.5 ± 26.3 months. The clinical characteris- tics, biological findings and outcome were analysed. The occur- rence of renal dysfunction, and type 2 HRS in particular, was sys- tematically analysed.
Results : Twenty-five patients (83.3%) developed renal dysfunc- tion. Type 2 HRS was diagnosed in 16 patients (53.3%). Patients with type 2 HRS were older than patients without (64.8 ± 9.1 yr vs 52.8 ± 9.0 yr ; p < 0.001). All the others studied variables were sim- ilar between type 2 HRS and non-type 2 HRS patients. There was no significant difference in the overall probability of survival between these 2 groups.
Conclusions : In patients with cirrhosis and refractory ascites, the development of type 2 HRS is frequent but does not occur in more severe liver disease and does not affect prognosis. (Acta gastroenterol. belg., 2008, 71, 9-14).
Comparison of standard polyethylene glycol and two doses of oral sodium phosphate solution in precolonoscopy bowel preparation: a randomized controlled trial
Background and study aims : This study was undertaken to com- pare the efficacy, side effects and patient acceptance of standard 4- liters polyethylene glycol (PEG) and 2 doses of sodium phosphate (NaP) solution for precolonoscopy colon cleansing.
Patients and methods : A total of 182 patients were randomized to receive either standard 4-L PEG (88 patients) or 80 mL of NaP (94 patients) in a split regimen of two 40 mL doses separated by 24 h, prior to colonoscopic evaluation. The primary endpoint was the segmental assessment of colonic wall visualization. Secondary out- comes included percent of assumed preparation, and the patient tolerance and acceptability.
Results : A significantly higher completion rate was found in the NaP group compared to the PEG group (84.3% vs 62.9% ; differ- ence, 21.40% ; 95% confidence interval [CI], 8.29% to 34.51% ; p = 0.001). PEG solution caused more nausea than NaP solution (p = 0.024). Patient acceptance for bowel preparation with NaP was greater (p = 0.019). Adequate colon wall visualization was achieved in similar proportion of patients in both groups with exception of the descending colon, where NaP regimen was supe- rior (72.0% vs 52.9% ; difference, 19.10% ; 95% CI, 5.20% to 33.00% ; p = 0.012).
Conclusions : Two doses of NaP solution, taken 24 h and 12 h before colonoscopy, tend to guarantee superior results in colonic cleansing with respect to standard 4-liters PEG solution. Taking the second dose of NaP 24 h after the first dose reduces side effects and allows achieving a more satisfactory compliance of the patient. (Acta gastroenterol. belg., 2008, 71, 15-20).
Infliximab in experimental alkali burns of the oesophagus in the rat
Backgrounds : We aimed to investigate the efficacy of inflix- imab, a chimeric TNF-a antibody, in the prevention of fibrosis in an experimental alkaline burn of the oesophagus in the rat.
Methods: Thirty-two Wistar albino rats divided into four experimental groups. Caustic oesophageal burn was induced by applying 37.5% NaOH to the distal oesophagus. Infliximab was given at a dose of 5 mg/kg via the intraperitoneal route. Group A (sham) animals were uninjured, group B had untreated oesophageal burns, group C had oesophageal burns treated with a single dose of infliximab on the first day, and Group D had oesophageal burns treated with infliximab on the first and 14th days. Efficacy of the treatment was assessed on the 28th-day by measuring stenosis index of the oesophagus and histopathological damage score, and biochemically by determining tissue hydrox- yproline content.
Results : There was no significant difference between the Group B and the infliximab treated Groups C and D in means of tissue hydroxyproline content and histopathological damage scores. Stenosis index was not significantly different between the Group B, Group C, and Group D.
Conclusion : Anti-TNF-a treatment with infliximab does not ameliorate the degree of fibrosis in alkali burns of the oesophagus in the rat. Further evaluation of inflammatory and immunological events leading to stricture in alkaline oesophageal burns may pro- vide new perspectives for the treatment of alkaline oesophageal burns. (Acta gastroenterol. belg., 2008, 71, 21-26).
