Volume 69 - 2006 - Fasc.4 - Original articles
Relationship between the degree of portal hypertension and the onset of spontaneous bacterial peritonitis in patients with cirrhosis
Background/Aim : Spontaneous bacterial peritonitis (SBP) is a severe complication of cirrhosis but its exact pathogenesis has not yet been elucidated and the role of portal hypertension in the development of SBP has been suggested. The aim of this study was to test the hypothesis that an association exists between the degree of portal hypertension and the occurrence of SBP.
Methods : 292 patients with cirrhosis who underwent a mea- surement of the hepatic venous pressure gradient (HVPG) were retrospectively studied. Following their ascites profile, patients were classified in three groups : patients with ascites who suffered from SBP, patients with sterile ascites, and patients who had no ascites.
Results: Among the 137 patients with ascites, 24 patients suffered from SBP (17.5%). The mean HVPG was significantly different : 20.7 ± 6.2 mm Hg in the SBP group, 17.5 ± 5.1 mm Hg in the sterile ascites group and 14.7 ± 5.6 mm Hg in the group without ascites (p < 0.05). Patients with the most severe portal hypertension (HVPG ?? 30 mm Hg) had the highest risk to suffer from SBP (50%). Using the multivariate analysis, only the serum albumin level (p = 0.004) and the HVPG (p = 0.02) were indepen- dently correlated with the occurrence of ascites infection.
Conclusions : This study suggests that in patients with SBP the degree of portal hypertension is greater than in the non infected patients. Ascites infection is independently associated with a low serum albumin level and a high HVPG. (Acta gastroenterol. belg., 2006, 69, 355-360).
Improvement of routine diagnosis of intestinal parasites with multiple sampling and SAF-fixative in the Triple-Faeces-Test
Background and study aim : To perform optimal laboratory diagnosis of intestinal parasites is demanding. Because intestinal parasites are intermittently shedded, examination of multiple stools is imperative. For reliable detection of vegetative stages of protozoa, fresh stools should be examined direct after production, or stools should be preserved in a fixative. These aspects in routine practice are often neglected with as a result lower sensitivity of the diagnostic procedure. With application of the Triple-Faeces-Test (TFT) protocol, where both multiple sampling and a SAF-fixative are included, these practical problems could be overcome.
The aim of this study was to compare the recovery of intestinal parasites in faecal specimens using TFT protocol versus the con- ventional diagnostic method (ether-sedimentation of one fresh stool sample).
Methods : During a three years period, results obtained in rou- tine practice with the TFT protocol were compared with results from examination of sediment obtained with the ethyl-acetate-sed- imentation technique of one unpreserved faeces specimen.
Results : From 2,776 patients, 28.1% were positive for one or more intestinal parasites after examination of the TFT test, com- pared to 10.3% positivity with the conventional method (P < 0.05). Pathogenic species and non pathogenic species were observed respectively 191 and 449 times with TFT and 105 and 152 times with conventional method (P< 0.05).
Conclusions : The application of the Triple-Faeces-Test in routine clinical practice significantly increased recovery of intestinal parasitic infections. (Acta gastroenterol. belg., 2006, 69, 361-366).
Imatinib for the treatment of patients with unresectable or metastatic malignant KIT-positive gastrointestinal stromal tumours : an open-label Belgian trial
Background : Gastrointestinal stromal tumours (GIST) are the most common mesenchymal tumours of the gastrointestinal tract. They are defined immunohistologically as KIT positive tumours. The only effective treatment for malignant GIST was surgery until 200O.Imatinib mesylate (STI571, Glivec®) has shown substantial anticancer activity in patients with metastatic or unresectable GIST.
Patients and methods : 57 patients who were diagnosed with unre- sectable or metastatic malignant GIST were entered into this study. The patients were given 400 mg Glivec orally once daily. The dose could be increased to 600 mg orally once daily and then to 400 mg twice daily if tumour progression was noticed. Daily treatment was interrupted or dose was decreased only in the case of limiting toxi- cities. We evaluated the tumour response and the safety of the drug.
Results : 85% of GIST patients showed a partial response or stable disease after 8 weeks of treatment with imatinib. The main side effects were nausea, vomiting, anorexia, skin rash, periorbital oedema and diarrhea.
Conclusion : This study confirms that imatinib is an active agent against malignant GIST with manageable toxicities. (Acta gastro- enterol. belg., 2006, 69, 367-371).
Effectiveness of bougie dilation for the management of corrosive esophageal strictures
Background and study aims : Caustic ingestion caused by swal- lowing a detergent can produce a progressive and devastating injury in the esophagus and stomach. One of the most important outcomes of the corrosive oesophagitis is the stricture formation, which is resistant to treatment. The aim of this study was firstly to determine the relation between agent, inflammation and stricture, and secondly investigate the efficiency of dilation in patients having esophageal stricture due to corrosive oesophagitis.
Patients and methods : In this study, 58 cases with post caustic oesophagitis, which had been admitted to our clinic or emergency department between January 1999 and December 2004, were assessed retrospectively. Dilation of esophageal stricture of the cases was performed by Savary-Gilliard bougies.
Results : The most frequently ingested substance was alkaline (48.2%). Concerning all the patients, the most frequent location of caustic injury was upper esophagus (36.2%), and grade I injury was the most frequently encountered one (34.4%). Thirty patients (51.7%) developing stricture were treated by repeated dilations. The most common location of stricture was middle esophagus (50%), and severe stricture was the most common one among all stricture grades (46.7%). Alkaline ingestions yielded more severe stricture than acids. Eight of the patients with stricture (26.6%, 8/30), who didn't respond to periodic esophageal dilation, under- went esophageal resection or bypass surgery.
Conclusion : Dilation with Savary-Gilliard bougies is a quite effective method for stricture after corrosive oesophagitis. (Acta gastroenterol. belg., 2006, 69, 372-376).
