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A shot in the arm for hepatitis A!
Vol. 94, No. 9, 1999 ISSN 0002-9270/99/$20.00 PII S0002-9270(99)00468-2
WHAT’S NEW IN GI EDITOR
Jon S. Thompson, M.D., F.A.C.S. GASTROENTEROLOGY
Randall E. Brand Rene´e L. Young John K. DiBaise Hemant K. Roy Timothy M. McCashland RADIOLOGY
Aurelio Matamoros, Jr. Jeff L. Fidler
PATHOLOGY
James L. Wisecarver
LIVER STUDY UNIT
Carol A. Casey PEDIATRIC GASTROENTEROLOGY
David R. Mack University of Nebraska Medical Center Omaha, Nebraska
A Shot in the Arm for Hepatitis A! Sagliocca L, Amoroso P, Stroffolini T, et al. Efficacy of hepatitis A vaccine in prevention of secondary hepatitis A infection: A randomised trial. Lancet 1999;353:1136 –9. Presently, the Center for Disease Control recommends the use of immunoglobulin for the prevention of infection after exposure to an affected individual with hepatitis A (secondary infection). Hepatitis A vaccine has been approved for prevention of primary infection; however, it is not clear whether its onset of action would be fast enough to prevent a secondary infection. Sagliocca et al. performed a randomized controlled trial to determine if the administration of hepatitis A vaccine could prevent secondary infection with hepatitis A virus. Household contacts from 196 individuals (index cases), who had a sporadic hepatitis A infection with symptom onset of ⬍1 wk, were randomized to a vaccination group or unvaccinated group. Immunoglobulin was not used in the study because its administration is not considered routine medical practice in Italy for the secondary prevention of hepatitis A infection. A total of 197 household contacts from 71 index cases were randomized to vaccination whereas 207 household contacts from 75 index cases were not treated. Two of the 197 (1%) individuals in the vaccinated group and 12 of 207 (5.8%) individuals in the unvaccinated group and 12 of 207 (5.8%) individuals in the unvaccinated group developed a secondary hepatitis A infection. Ten of the 12 infections in the unvaccinated group had either symptoms and/or abnormal transaminase values, whereas
the two individuals in the vaccinated group were completely asymptomatic. Thus, it appears that vaccination against hepatitis A is successful in the prevention of a secondary infection. It is anticipated that vaccination against hepatitis A will eventually be used, possibly either alone or in combination with immunoglobulin, for the prevention of infection after exposure to hepatitis A virus in the United States. R. E. Brand, M.D.
Abdominal Symptoms, Anorectal Function, and IBS Ragnarsson G, Hallbo¨o¨k O, Bodemar G. Abdominal symptoms are not related to anorectal function in the irritable bowel syndrome. Scand J Gastroenterol 1999;34:250 – 8. Although abnormalities of intestinal motility and visceral perception are frequently demonstrated in irritable bowel syndrome (IBS), a consistent association with abdominal symptoms such as pain, bloating, urgency, and feeling of incomplete evacuation has not been proven. Ragnarsson et al. investigated the association between such abdominal symptoms, as recorded in a daily diary over a 1-wk period, and anorectal function, as determined by manovolumetry before and after a standardized fatty meal. Fifty-two patients with IBS were studied. By using cluster analysis statistical methodology, symptom and manovolumetric subgroups were identified; however, no relation between abdominal symptoms and anorectal function was found. Furthermore, although a postprandial
WHAT’S NEW IN GI
THE AMERICAN JOURNAL OF GASTROENTEROLOGY © 1999 by Am. Coll. of Gastroenterology Published by Elsevier Science Inc.
WHAT’S NEW IN GI EDITOR
Jon S. Thompson, M.D., F.A.C.S. GASTROENTEROLOGY
Randall E. Brand Rene´e L. Young John K. DiBaise Hemant K. Roy Timothy M. McCashland RADIOLOGY
Aurelio Matamoros, Jr. Jeff L. Fidler
PATHOLOGY
James L. Wisecarver
LIVER STUDY UNIT
Carol A. Casey PEDIATRIC GASTROENTEROLOGY
David R. Mack University of Nebraska Medical Center Omaha, Nebraska
A Shot in the Arm for Hepatitis A! Sagliocca L, Amoroso P, Stroffolini T, et al. Efficacy of hepatitis A vaccine in prevention of secondary hepatitis A infection: A randomised trial. Lancet 1999;353:1136 –9. Presently, the Center for Disease Control recommends the use of immunoglobulin for the prevention of infection after exposure to an affected individual with hepatitis A (secondary infection). Hepatitis A vaccine has been approved for prevention of primary infection; however, it is not clear whether its onset of action would be fast enough to prevent a secondary infection. Sagliocca et al. performed a randomized controlled trial to determine if the administration of hepatitis A vaccine could prevent secondary infection with hepatitis A virus. Household contacts from 196 individuals (index cases), who had a sporadic hepatitis A infection with symptom onset of ⬍1 wk, were randomized to a vaccination group or unvaccinated group. Immunoglobulin was not used in the study because its administration is not considered routine medical practice in Italy for the secondary prevention of hepatitis A infection. A total of 197 household contacts from 71 index cases were randomized to vaccination whereas 207 household contacts from 75 index cases were not treated. Two of the 197 (1%) individuals in the vaccinated group and 12 of 207 (5.8%) individuals in the unvaccinated group and 12 of 207 (5.8%) individuals in the unvaccinated group developed a secondary hepatitis A infection. Ten of the 12 infections in the unvaccinated group had either symptoms and/or abnormal transaminase values, whereas
the two individuals in the vaccinated group were completely asymptomatic. Thus, it appears that vaccination against hepatitis A is successful in the prevention of a secondary infection. It is anticipated that vaccination against hepatitis A will eventually be used, possibly either alone or in combination with immunoglobulin, for the prevention of infection after exposure to hepatitis A virus in the United States. R. E. Brand, M.D.
Abdominal Symptoms, Anorectal Function, and IBS Ragnarsson G, Hallbo¨o¨k O, Bodemar G. Abdominal symptoms are not related to anorectal function in the irritable bowel syndrome. Scand J Gastroenterol 1999;34:250 – 8. Although abnormalities of intestinal motility and visceral perception are frequently demonstrated in irritable bowel syndrome (IBS), a consistent association with abdominal symptoms such as pain, bloating, urgency, and feeling of incomplete evacuation has not been proven. Ragnarsson et al. investigated the association between such abdominal symptoms, as recorded in a daily diary over a 1-wk period, and anorectal function, as determined by manovolumetry before and after a standardized fatty meal. Fifty-two patients with IBS were studied. By using cluster analysis statistical methodology, symptom and manovolumetric subgroups were identified; however, no relation between abdominal symptoms and anorectal function was found. Furthermore, although a postprandial
WHAT’S NEW IN GI
THE AMERICAN JOURNAL OF GASTROENTEROLOGY © 1999 by Am. Coll. of Gastroenterology Published by Elsevier Science Inc.