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(087). Interferon monotherapy treatment in haemodialysis patients with chronic hepatitis C virus
Gastro-oesophageal reflux disease / Arab Journal of Gastroenterology 10 (2009) AB36–AB44 Table 1 Prevalence of increased ALT in HCV positive patients. Total (%)
ALT increased
ALT normal
HCV Ab+
8 (100) 54 (100)
6 (25%) 5 (3/9%)
6 (75%) 49 (7/90%)
Positive Negative
The risk factors that introduced in incidence of HCV and the relationship with our patients in this study: All our positive HCV patients had received blood products. Most of the patients had more than 30 months of dialysis which related to P < 0.001 has statistical worth. All patients had negative HBS Ag and 2 cases only was positive HBc Ab which does not have statistical significance. doi:10.1016/j.ajg.2009.07.161
(087)
Interferon monotherapy treatment in haemodialysis patients with chronic hepatitis C virus F. Houissa, W. Sekri, S. Bouzaidi, L. Mouelhi, R. Dabbech, H. Mekki, M. Ben Rejeb, S. Trabelssi, A. Moussa, Y. Said, M. Salem, T. Najjar Gastroenterology and Hepatology Department, Charles Nicolle Hospital, Tunisia
Hepatitis C virus (HCV) infection is prevalent among patients undergoing haemodialysis. Management of chronic hepatitis C is also more complicated in haemodialysis patients because of altered pharmacokinetics and a predisposition for drug related toxicity. The aim of this study is to assess efficacy and safety of antiviral monotherapy in haemodialysis patients. Patients and methods: We conduct a retrospective study including 17 patients with chronic hepatitis C undergoing haemodialysis and candidate for renal transplantation. All these patients were treated with standard interferon monotherapy. Results: Thirteen (13) men and four (4) women were included with the mean age of 37 years. Fifteen (15) patients undergo haemodialysis whereas two have peritoneal dialysis. Forty-seven (47%) of patients were infected by genotype 1b, 41% by genotype 4 and 12% by genotype 2. Histopathological examination of liver biopsy done in all cases, show fibrosis F2 in six patients (35.2%). Early virological response (EVR) was obtained in 73% of patients. Sustained virological response (SVR) was obtained in 46.6% of patients. Four patients relapse during the 6 months after the end of treatment. Treatment was well-tolerated in the majority of patients. Only two patients had neuropsychological symptoms who lead to the discontinuation of therapy. Conclusion: This study corroborate that interferon monotherapy was effective and well-tolerated in haemodialysis patients, so as in general population.
AB41
Methods: We retrospectively analysed data of all consecutive cases of PBC diagnosed in our department between January 1996 and January 2008. PBC was defined by the presence of cholestasis with positive antimitochondrial antibodies and/or compatible liver histology. Cases of overlap syndrome auto-immune hepatitis (AIH) – PBC were included. Results: Forty-three patients, 40 women and 3 men with mean age of 52 years (range 19–77), were enrolled. Commonly reported complaints were: pruritus (N = 18), jaundice (N = 17), abdominal pain (N = 11) and weight loss (N = 20). Physical exam revealed hepatosplenomegaly (N = 11), melanodermia (N = 2) and oedemato-ascitic syndrome (N = 6). Biochemistry analysis noted cholestasis syndrome (N = 31) and moderated cytolysis (N = 15). Immunoserology tests revealed: positive Anti mitochondrial antibodies (N = 39), positive antinuclear antibodies (N = 19). The immunoglobulin M was increased (N = 17). Liver biopsy (N = 31) revealed stage I (N = 6), II (N = 11), III (N = 7), IV (N = 7) of Scheuer’s classification. PBC was associated to extrahepatic auto-immune disease in 21 cases: auto-immune thyroiditis (N = 6), Sjogren’s syndrome (N = 10), rheumatoid arthritis (N = 2), CREST syndrome (N = 1), diabetes (N = 1) and dermatologic affections (N = 7). The overlap syndrome AIH-PBC was reported in 10 cases. Seventeen patients were treated by ursodesoxycholic acid. Patients with overlap syndrome were treated by: association of ursodesoxycholic acid-corticosteroids-azathioprin (N = 9) or ursodesoxycholic acid (N = 1). Sixteen patients with advanced disease (N = 6) or without follow-up (N = 10) had not been treated. The mean duration of follow-up was 58 months. The evolution was marked by clinical and biological improvement (N = 21) or stabilisation (N = 2). Progressive disease and complications were noted in 10 cases: ascite (N = 7), oesophageal variceal bleeding (N = 4) and encephalopathy (N = 3). No case of hepatocellular carcinoma had been reported. Conclusion: PBC is a rare disease in Tunisia affecting essentially woman. Diagnosis was made at advanced stage in the half of cases, suggesting a diagnostic delay. The association to others auto-immunes diseases are frequent requiring systematic research. These preliminary data need confirmation by prospective multicentric studies. doi:10.1016/j.ajg.2009.07.163
(089)
Primary sclerosing cholangitis, epidemiological and clinical profile: About a Tunisian panel Soufiene Chouaïb a, L. Abbes a, H. Ouerghi a, N. Belkahla a, N. Màamouri a, K. Nouira b, F. Ben Hriz a, H. Chaabouni a, E. Menif b, N. Ben Mami a a Department of Gastroenterology B, LARABTA Hospital, Tunis, Tunisia b Department of Radiology, LARABTA Hospital, Tunis, Tunisia
doi:10.1016/j.ajg.2009.07.162
(088)
Primary biliary cirrhosis in Tunisia: About a panel of 43 cases Soufiene Chouaïb, L. Abbes, H. Ouerghi, N. Màamouri, F. BenHriz, N. Belkahla, H. Chaabouni, N. Ben Mami Department of Gastroenterology B, LARABTA Hospital, Tunis, Tunisia
Background and aims: Primary biliary cirrhosis (PBC) is a chronic and slowly progressive cholestatic liver disease of autoimmune etiology characterized by injury of the intrahepatic small bile ducts. Variable clinical and biochemical presentation were reported. There have been no available data about clinical presentation of PBC in North Africa. The purpose of this study was to analyse the epidemiological, clinical, biological and histological profile of PBC in Tunisia.
Background and aims: Primary sclerosing cholangitis (PSC) is a rare cause of chronic liver disease characterized by chronic inflammation and obliterative fibrosis of mainly the large bile ducts. PSC is closely linked to inflammatory bowel disease and specially the ulcerative colitis. Published studies described a large clinical and epidemiological variability. There have been no available data about PSC in North Africa. The purpose of this study was to analyse the epidemiological, clinical, biological and morphological profile of PSC in Tunisia. Methods: We retrospectively analysed data of all consecutive cases of PSC diagnosed in our department between January 1996 and January 2007. The secondary sclerosing cholangitis were excluded. Results: Ten patients, 6 men and 4 women with mean age of 43 years (range 18–63), were enrolled. The disease was symptomatic in seven cases, revealed by pruritus or jaundice (N = 6). Diagnosis
ALT increased
ALT normal
HCV Ab+
8 (100) 54 (100)
6 (25%) 5 (3/9%)
6 (75%) 49 (7/90%)
Positive Negative
The risk factors that introduced in incidence of HCV and the relationship with our patients in this study: All our positive HCV patients had received blood products. Most of the patients had more than 30 months of dialysis which related to P < 0.001 has statistical worth. All patients had negative HBS Ag and 2 cases only was positive HBc Ab which does not have statistical significance. doi:10.1016/j.ajg.2009.07.161
(087)
Interferon monotherapy treatment in haemodialysis patients with chronic hepatitis C virus F. Houissa, W. Sekri, S. Bouzaidi, L. Mouelhi, R. Dabbech, H. Mekki, M. Ben Rejeb, S. Trabelssi, A. Moussa, Y. Said, M. Salem, T. Najjar Gastroenterology and Hepatology Department, Charles Nicolle Hospital, Tunisia
Hepatitis C virus (HCV) infection is prevalent among patients undergoing haemodialysis. Management of chronic hepatitis C is also more complicated in haemodialysis patients because of altered pharmacokinetics and a predisposition for drug related toxicity. The aim of this study is to assess efficacy and safety of antiviral monotherapy in haemodialysis patients. Patients and methods: We conduct a retrospective study including 17 patients with chronic hepatitis C undergoing haemodialysis and candidate for renal transplantation. All these patients were treated with standard interferon monotherapy. Results: Thirteen (13) men and four (4) women were included with the mean age of 37 years. Fifteen (15) patients undergo haemodialysis whereas two have peritoneal dialysis. Forty-seven (47%) of patients were infected by genotype 1b, 41% by genotype 4 and 12% by genotype 2. Histopathological examination of liver biopsy done in all cases, show fibrosis F2 in six patients (35.2%). Early virological response (EVR) was obtained in 73% of patients. Sustained virological response (SVR) was obtained in 46.6% of patients. Four patients relapse during the 6 months after the end of treatment. Treatment was well-tolerated in the majority of patients. Only two patients had neuropsychological symptoms who lead to the discontinuation of therapy. Conclusion: This study corroborate that interferon monotherapy was effective and well-tolerated in haemodialysis patients, so as in general population.
AB41
Methods: We retrospectively analysed data of all consecutive cases of PBC diagnosed in our department between January 1996 and January 2008. PBC was defined by the presence of cholestasis with positive antimitochondrial antibodies and/or compatible liver histology. Cases of overlap syndrome auto-immune hepatitis (AIH) – PBC were included. Results: Forty-three patients, 40 women and 3 men with mean age of 52 years (range 19–77), were enrolled. Commonly reported complaints were: pruritus (N = 18), jaundice (N = 17), abdominal pain (N = 11) and weight loss (N = 20). Physical exam revealed hepatosplenomegaly (N = 11), melanodermia (N = 2) and oedemato-ascitic syndrome (N = 6). Biochemistry analysis noted cholestasis syndrome (N = 31) and moderated cytolysis (N = 15). Immunoserology tests revealed: positive Anti mitochondrial antibodies (N = 39), positive antinuclear antibodies (N = 19). The immunoglobulin M was increased (N = 17). Liver biopsy (N = 31) revealed stage I (N = 6), II (N = 11), III (N = 7), IV (N = 7) of Scheuer’s classification. PBC was associated to extrahepatic auto-immune disease in 21 cases: auto-immune thyroiditis (N = 6), Sjogren’s syndrome (N = 10), rheumatoid arthritis (N = 2), CREST syndrome (N = 1), diabetes (N = 1) and dermatologic affections (N = 7). The overlap syndrome AIH-PBC was reported in 10 cases. Seventeen patients were treated by ursodesoxycholic acid. Patients with overlap syndrome were treated by: association of ursodesoxycholic acid-corticosteroids-azathioprin (N = 9) or ursodesoxycholic acid (N = 1). Sixteen patients with advanced disease (N = 6) or without follow-up (N = 10) had not been treated. The mean duration of follow-up was 58 months. The evolution was marked by clinical and biological improvement (N = 21) or stabilisation (N = 2). Progressive disease and complications were noted in 10 cases: ascite (N = 7), oesophageal variceal bleeding (N = 4) and encephalopathy (N = 3). No case of hepatocellular carcinoma had been reported. Conclusion: PBC is a rare disease in Tunisia affecting essentially woman. Diagnosis was made at advanced stage in the half of cases, suggesting a diagnostic delay. The association to others auto-immunes diseases are frequent requiring systematic research. These preliminary data need confirmation by prospective multicentric studies. doi:10.1016/j.ajg.2009.07.163
(089)
Primary sclerosing cholangitis, epidemiological and clinical profile: About a Tunisian panel Soufiene Chouaïb a, L. Abbes a, H. Ouerghi a, N. Belkahla a, N. Màamouri a, K. Nouira b, F. Ben Hriz a, H. Chaabouni a, E. Menif b, N. Ben Mami a a Department of Gastroenterology B, LARABTA Hospital, Tunis, Tunisia b Department of Radiology, LARABTA Hospital, Tunis, Tunisia
doi:10.1016/j.ajg.2009.07.162
(088)
Primary biliary cirrhosis in Tunisia: About a panel of 43 cases Soufiene Chouaïb, L. Abbes, H. Ouerghi, N. Màamouri, F. BenHriz, N. Belkahla, H. Chaabouni, N. Ben Mami Department of Gastroenterology B, LARABTA Hospital, Tunis, Tunisia
Background and aims: Primary biliary cirrhosis (PBC) is a chronic and slowly progressive cholestatic liver disease of autoimmune etiology characterized by injury of the intrahepatic small bile ducts. Variable clinical and biochemical presentation were reported. There have been no available data about clinical presentation of PBC in North Africa. The purpose of this study was to analyse the epidemiological, clinical, biological and histological profile of PBC in Tunisia.
Background and aims: Primary sclerosing cholangitis (PSC) is a rare cause of chronic liver disease characterized by chronic inflammation and obliterative fibrosis of mainly the large bile ducts. PSC is closely linked to inflammatory bowel disease and specially the ulcerative colitis. Published studies described a large clinical and epidemiological variability. There have been no available data about PSC in North Africa. The purpose of this study was to analyse the epidemiological, clinical, biological and morphological profile of PSC in Tunisia. Methods: We retrospectively analysed data of all consecutive cases of PSC diagnosed in our department between January 1996 and January 2007. The secondary sclerosing cholangitis were excluded. Results: Ten patients, 6 men and 4 women with mean age of 43 years (range 18–63), were enrolled. The disease was symptomatic in seven cases, revealed by pruritus or jaundice (N = 6). Diagnosis