Summary
Background : In patients with chronic hepatitis C virus infection and persistently normal alanine aminotransferase levels, liver fibrosis has been reported in 0–22% of cases and advanced ...liver disease in 5–10% of cases.
Aim : To determine whether patients with persistently normal alanine aminotransferase levels clear infection after anti‐viral therapy at equal or different rates from infected patients with raised alanine aminotransferase levels.
Methods : Thirty‐five hepatitis C virus RNA‐positive patients with fibrosis at liver histology (Group 1) were matched for genotype, sex, age and histology with patients with raised alanine aminotransferase levels (Group 2). Both groups were treated with 3 MU interferon‐α2b plus ribavirin (1000–1200 mg) for 12 months.
Results : End‐of‐therapy response was achieved in 71.4%95% confidence interval (CI), 56.4–86.3 of patients in Group 1 and in 52.3% (95% CI, 42.8–61.9) of those in Group 2 (P = 0.04). At week 72, 22 patients (62.8%; 95% CI, 46.8–78.1) in Group 1 and 50 patients (47.5%; 95% CI, 38.0–57.1) in Group 2 showed a sustained virological response (P = 0.11). Non‐1 genotype was the only independent predictor of sustained response (P = 0.002), with an odds ratio of 3.45 (95% CI, 1.58–7.50). At month 3 of therapy, the positive predictive values for non‐response were 100% and 96% in Groups 1 and 2, respectively.
Conclusions : Interferon and ribavirin induce comparable sustained virological response in patients with persistently normal or raised alanine aminotransferase levels. Stage 1 fibrosis, rather than alanine aminotransferase levels, may be the criterion on which to decide whether or not to treat patients with persistently normal alanine aminotransferase levels.
Background:
Effective anti‐Helicobacter pylori therapies with few side‐effects are needed.
Aim:
To study the effectiveness of short‐term triple therapy with amoxycillin, clarithromycin and either ...omeprazole or lansoprazole for eradication and healing of peptic ulcers.
Methods:
Patients with gastric or duodenal ulcers received amoxycillin (1 g b.d.), clarithromycin (500 mg b.d.) and lansoprazole (30 mg b.d.) (LAC) or omeprazole (20 mg b.d.) (OAC) for 7 days. Endoscopic examinations were performed before treatment and at least 4 weeks after completion of therapy. H. pylori status was confirmed by rapid urease test and histological examination (Giemsa stain) from gastric biopsies taken from both the antrum and the body.
Results:
A total of 356 patients were randomized in this single‐blind study. On a per protocol basis, H. pylori was eradicated in 134 of 170 patients (79%) in the lansoprazole group and in 105 of 146 (72%) in the omeprazole group (P = 0.189); and in intention‐to‐treat analysis 72% and 62%, respectively (P = 0.043). Healing of the ulcers was obtained in 166 of 186 (98%), and in 139 of 146 patients (95%), respectively (P = 0.357). Side‐effects occurred in two patients in the LAC group and in six in the OAC group B (four stopped therapy).
Conclusions:
This study has shown that the two regimens are highly effective in healing duodenal ulcers and are well tolerated. Neither treatment achieves the ideal cure rate for H. pylori. Lansoprazole does not appear to have a significant advantage over omeprazole either in ulcer healing or in H. pylori eradication.
Little is known concerning the usefulness and feasibility of quality assurance programs in gastrointestinal departments. The aim of this study was to identify the indicators of quality in ...colonoscopy, to check their use in clinical practice, and to identify their threshold values.
A prospective study was performed in four endoscopic units. In the first phase, a questionnaire was used to identify the indicators that were considered important and easy to record; in the second phase, the selected items were prospectively recorded.
Data from 603 colonoscopies were evaluated. The selected indicators were: rate of cecal intubation, rate of examinations with normal findings, rates of complications, appropriateness of indications, use of a washing machine for disinfection, duration of the disinfection procedure, rate of procedures repeated due to poor colon cleansing, rate of operative procedures, length of waiting time, rate of procedures performed for follow-up of known disease, experience of the operator, and rate of procedures performed with the patient under conscious sedation. A striking difference emerged between the technical standards at three centers, which were fairly good, and the standard at the fourth center, which was less satisfactory. The length of the waiting time was high in all centers, as well as the rate of examinations conducted with an inappropriate indication. The rate of procedures performed under conscious sedation varied widely between the centers.
The study of the indicators of quality of colonoscopy is feasible and easy to perform in clinical practice, and can be useful for quality assurance programs.
To compare the efficacy and patient acceptance of an oral high dose of senna to conventional polyethylene glycol-electrolyte lavage solution (PEG-ES) in adults undergoing elective colonoscopy.
...Consecutive outpatients referred for elective colonoscopy were prospectively randomly assigned to receive, the day before the procedure, either 24 tablets of 12 mg senna, divided into two doses at 1 p.m. and 9 p.m. (senna group, n=191), or standard 4-L PEG-ES (PEG-ES group, n=92). The overall quality of colon cleansing (primary outcome measure) and cleansing in the right colon were evaluated using the Aronchick scoring scale (1=excellent to 4=inadequate) by the investigator/endoscopist who was blinded to the treatment assignment. Patient acceptance and the safety of the preparation were assessed by a nurse, using a structured questionnaire covering compliance with the dosing, overall tolerance of the preparation (1=none or mild discomfort to 4=severely distressing), and adverse events.
The quality of colon cleansing, overall tolerance of the preparation, and compliance were significantly better with senna; overall cleansing was excellent or good in 90.6% of patients in the senna group and in 79.7% in the PEG-ES group (p= 0.003). The percentage of procedures rescheduled because of insufficient colon cleansing was 7.3% in the PEG-ES group and 2.6% in the senna group (p=0.035). Multivariate logistic regression modeling showed the PEG-ES preparation as negative independent predictor of unsuccessful bowel cleansing. The incidence of adverse reactions was similar in the two groups; patients who received senna experienced significantly less nausea and vomiting, but more abdominal pain.
An oral high dose of senna is a valid alternative to standard PEG-ES for outpatient colonoscopy preparation.
Liver Biopsy Diaz, L K; Teruya, J
The New England journal of medicine,
06/2001, Letnik:
344, Številka:
26
Journal Article
Recenzirano
To the Editor:
Bravo et al. (Feb. 15 issue)
1
list hemostatic contraindications to percutaneous liver biopsy. A prolonged bleeding time (≥10 minutes), in our opinion, has not been proved to predict a ...risk of biopsy-related bleeding. The evidence that supports the use of this test is based on clinical experience and expert opinion, not the results of controlled studies. The bleeding time is a poorly reproducible test, used for decades primarily because of the lack of a better substitute. Prospective studies in the literature have not convincingly shown that bleeding from a standardized cut in the skin reflects the risk . . .
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