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Autoimmune hemolytic anemia during interferon-alfa therapy for chronic hepatitis C
Abstracts
9
11 COMPUTED TOMOGRAPHY (CT) COMPARISON TO ILEO-COLONOSCOPY WITH CROEN’S DISEASE (CD) C. Hassan, P. Germ, A. Zullo, C. Spins, S. Morini. Gastroenterology and Radiology “‘Nuovo Hospital, Rome, Italy.
ENTEROCLYSIS IN IN PATIENTS
Regina
Margherita”
Background: Enteroclysis and CT scanning have been recently combined in CT enteroclysis. We compared the accuracy of CT enteroclysis to that of endoscopy in detecting bowel wall alterations in CD patients, and assessed whether postcontrast wall density was related to clinical activity of CD. Methods: Twenty-four patients were enrolled. CD diagnosis was performed by il-lonoscopy with histology, and clinical activity was measured by CDAI. Ten patients without CD were included as controls. Spiral CT was performed after distension of the small bowel with an enema of methylcelhdose. Results: At endoscqy, CD was localized to the ileum in 16 patients, to both the ileum and the colon in 5, and only to the colon in 3 cases. At CT enteroclysis CD involvement of the bowel wall was detected in 15/16 cases of CD ileitis, in 4/5 cases of &o-colitis, and in 2/3 cases of colitis, with a sensitivity of 87%. Two early post-surgical recurrences at the neotermina 1 ileum, and one segmental colitis were missed at CT enteroclysis. No false-positive cases occurred in controls. Postcontrast wall density value. was significantly higher in the 16 patients with active disease (CDAI>lSO) than in the 8 cases with inactive CD(llSti5 vs 32+2O,p
ABSORBABLE vs NON-ABSORBABLE ANTIBIOTICS IN THE THERAPY OF SMALL INTESTINE BAmERlAL OVERGROWTH (SIBO) IN PATIENTS WITH BLIND LOOP SYNDROME.
Di Stefano M, Pezzimenti D, Veneto G, Missanelli A, Corazza CR. Fastroenterology Unit, IRCCS “S.Matteo” Hospital, University of Pavia, Italy. Background & Aims: SlBO is frequently associated with a predisposing condition, such as stenosis, fistulas, gastrectomy, intestinal resections or impairment of intestinal motility. The extremely different pathophysiology of these conditions may affect the outcome of the therapy of this condition. Therefore, the aim of this study was to evaluate the efficacy of both absorbable and non-absorbable antibiotics in the therapy of SIB0 in a subgroup of patients affected by blind loop syndrome. Patients & Methods:
Seven patients (mean age 38 years, range 334$) took pan in the study. Diagnosis of SIB0 was made on the basis of the presence of (a) the predisposing condition (total gastrectomy in 2, Billmth II in 5); (b) abdominal symptoms, like diarrhoea, weight loss, abdominal pain, bloating, flatulence; (c) an increase of H* breath excretion more than 12
ppm over the baseline value within 2 hours after 5Dg of glucose; (d) fasting breath Hz levels higher than 12 ppm. This latter criterion was present in 3 patients. Following a cross over design, patients underwent a 7day course of rifaximin (4OOmg t.i.d.); then, on re-appearance of the symptoms (mean 24+7 days after completion of the therapy) patients were retested with glucose breath test and, if positive, treated with a 7day course of metronidazole (250 t.i.d.). Before and after each course of therapy, severity of symptoms was evaluated by a visu-analog scale and abdominal girth was measured. &&s: Cumulative breath Hz excretion was significantly (~~0.05) reduced after metronidamle (from 13973f3533 to 3449f2054 ppm/min), but not after rifaximin (from 14026k5433 to 8327f3221 ppmJmin). An improvement of severity of symptoms and of abdominal girth was evident both e&r metronidazole (from 7.7f2.2 to
3.4~.O;p
10 CORRELATION BETWEEN US DOPPLER FINDINGS AND LIVER FIBROSIS SCORE IN CHROMC HEPATITIS M.Pomnili, LAndria, F.M.Vecchio*, M.DeNinno*, CTromhino, M.Covino, R.Orefice, LD’Alonzo, GGasbarrini, G.L.Rapaccini. Cattedra di Medicina lntema II, *lstituto di Anatomia Patologica, Universiti Cattolica Sacro Cuore - Roma Aim of our study was to assess whether ultrasound (US) and US Doppler findings correlate with in&a-he-p&c fibrosis in a cohort of patients affected hy chronic hepatitis (CH) histologically assessed by US guided biopsy. One hundred-six patients (68 males, 38 females, mean age 47 yn. range 2371 yrs.) with clinical history of CH and without obvious clinical. biochemical, and US findings of liver cirrhosis, underwent, on the same day, US Doppler evaluation of the liver and of the portal system and US guided liver biopsy. Most of the patients wem affected by HCV- or HBVrelated CH. Nine&en US Doppler parameters, age, etiology. and disease duration, were comlati to the score of fibrosis measured according to Sheuer (1) by an experienced pathologist blind of US Doppler pammeters data. Statistical analysis was performed by means of Chi-square test and T student’s test for unpaired data. Thirty-six patienls had absent or mild fibrosis (score O-1, group A) while 70 patients had modemte-severe tibrosis or cirrhosis (score 2-4. group B). Group A compared to group B patients were. significantly different for: age (41f12 yrs. vs SOill yrs., p O.OOl), bipolar spkn diametu (107k14 mm vs 115tiS mm, p 0.04). mean velocity of portal trunk flow (25s cm/see vs 22ti em/se& p 0.04). portal trunk congestion index (0.04&0.001 vs O.OSM.002, p 0.02). right portal branch diameter (8fl mm vs 9f2 mm, p 0.05). right portal branch congestion index (0.02M.001 vs 0.03fo.001, p 0.04). Fmthermore, group A @ants had a significantly lower prevalence of flat flow pattern in the middle hepatic vein compared to group B patients (8% vs 24%, p 0.05). Our data suggest that US and US doppler findings could be use&l in the prediction of the gmde of liver fibrosis in patie-nts affeokd by CH. 1) Scheuer PJ et al. J Hepatol 1991;13:372374.
AUTOIMMUNE ALFA THERAPY Rita Rizzi*,
HEMOLYTIC ANEMIA DURING FOR CHRONIC HEPATITIS C
Teuta KurtiO, Mariella
Lamacchia*,
INTERFERON-
Giorgina
*Hematology Section, Department of Internal Medicin Medicin, University of Bari. “Hematology Laboratory, Hospital Center, University of Tirana.
Specchia*.
and Public “Madre Teresa”
The development of autoimmune haemolytic anemia (AIHA) is rarely observed in chronic hepatitis C patients during interferon alfa (IFNa) therapy. We report on an acute AIHA with warm type autoantibodies, occurred nine months after the start of recombinant IFN a-2b (3MU thrice a week). The patient was admitted to the hospital because of a pronounced drop in his hemoglobin (4.8 g/dl) and hematocrit (13.8%), jaundice, asthenia, dyspnea and cardiopafmw; the Coombs tests resulted positive for agglutinant IgG autoantibodies. Increased LDH (1224 U/l), hyperbilirubinemia (total 5.27 mg/dl, indirect 3.36 mg/dl), and low serum haptoglobin (10 mg/dl) were found. Anemia gradually improved after the IFN withdrawal and institution of methylprednisolone treatment at the initial dose of 1 mg/kg/&, tapered within three months until discontinued. The Coombs tests yielded a still positive result four months after the patient was taken off methylprednisolone; however, the titre of the indirect test dropped over time. In our patient, clinical data suggest a correlation between IFNa therapy and development of AIHA. The immunomodulatory effects of IFN may induce an overt autoimmune disease in chronic HCV infected patients by a transient increase or de now, appearance of autoantibodies. Before and during IFN treatment for chronic hepatitis C, a screening of serological autoimmunity markers including the direct Coombs test could be useful in assessing the risk of overlapping extrahepatic immunologic manifestations.
A93
9
11 COMPUTED TOMOGRAPHY (CT) COMPARISON TO ILEO-COLONOSCOPY WITH CROEN’S DISEASE (CD) C. Hassan, P. Germ, A. Zullo, C. Spins, S. Morini. Gastroenterology and Radiology “‘Nuovo Hospital, Rome, Italy.
ENTEROCLYSIS IN IN PATIENTS
Regina
Margherita”
Background: Enteroclysis and CT scanning have been recently combined in CT enteroclysis. We compared the accuracy of CT enteroclysis to that of endoscopy in detecting bowel wall alterations in CD patients, and assessed whether postcontrast wall density was related to clinical activity of CD. Methods: Twenty-four patients were enrolled. CD diagnosis was performed by il-lonoscopy with histology, and clinical activity was measured by CDAI. Ten patients without CD were included as controls. Spiral CT was performed after distension of the small bowel with an enema of methylcelhdose. Results: At endoscqy, CD was localized to the ileum in 16 patients, to both the ileum and the colon in 5, and only to the colon in 3 cases. At CT enteroclysis CD involvement of the bowel wall was detected in 15/16 cases of CD ileitis, in 4/5 cases of &o-colitis, and in 2/3 cases of colitis, with a sensitivity of 87%. Two early post-surgical recurrences at the neotermina 1 ileum, and one segmental colitis were missed at CT enteroclysis. No false-positive cases occurred in controls. Postcontrast wall density value. was significantly higher in the 16 patients with active disease (CDAI>lSO) than in the 8 cases with inactive CD(llSti5 vs 32+2O,p
ABSORBABLE vs NON-ABSORBABLE ANTIBIOTICS IN THE THERAPY OF SMALL INTESTINE BAmERlAL OVERGROWTH (SIBO) IN PATIENTS WITH BLIND LOOP SYNDROME.
Di Stefano M, Pezzimenti D, Veneto G, Missanelli A, Corazza CR. Fastroenterology Unit, IRCCS “S.Matteo” Hospital, University of Pavia, Italy. Background & Aims: SlBO is frequently associated with a predisposing condition, such as stenosis, fistulas, gastrectomy, intestinal resections or impairment of intestinal motility. The extremely different pathophysiology of these conditions may affect the outcome of the therapy of this condition. Therefore, the aim of this study was to evaluate the efficacy of both absorbable and non-absorbable antibiotics in the therapy of SIB0 in a subgroup of patients affected by blind loop syndrome. Patients & Methods:
Seven patients (mean age 38 years, range 334$) took pan in the study. Diagnosis of SIB0 was made on the basis of the presence of (a) the predisposing condition (total gastrectomy in 2, Billmth II in 5); (b) abdominal symptoms, like diarrhoea, weight loss, abdominal pain, bloating, flatulence; (c) an increase of H* breath excretion more than 12
ppm over the baseline value within 2 hours after 5Dg of glucose; (d) fasting breath Hz levels higher than 12 ppm. This latter criterion was present in 3 patients. Following a cross over design, patients underwent a 7day course of rifaximin (4OOmg t.i.d.); then, on re-appearance of the symptoms (mean 24+7 days after completion of the therapy) patients were retested with glucose breath test and, if positive, treated with a 7day course of metronidazole (250 t.i.d.). Before and after each course of therapy, severity of symptoms was evaluated by a visu-analog scale and abdominal girth was measured. &&s: Cumulative breath Hz excretion was significantly (~~0.05) reduced after metronidamle (from 13973f3533 to 3449f2054 ppm/min), but not after rifaximin (from 14026k5433 to 8327f3221 ppmJmin). An improvement of severity of symptoms and of abdominal girth was evident both e&r metronidazole (from 7.7f2.2 to
3.4~.O;p
10 CORRELATION BETWEEN US DOPPLER FINDINGS AND LIVER FIBROSIS SCORE IN CHROMC HEPATITIS M.Pomnili, LAndria, F.M.Vecchio*, M.DeNinno*, CTromhino, M.Covino, R.Orefice, LD’Alonzo, GGasbarrini, G.L.Rapaccini. Cattedra di Medicina lntema II, *lstituto di Anatomia Patologica, Universiti Cattolica Sacro Cuore - Roma Aim of our study was to assess whether ultrasound (US) and US Doppler findings correlate with in&a-he-p&c fibrosis in a cohort of patients affected hy chronic hepatitis (CH) histologically assessed by US guided biopsy. One hundred-six patients (68 males, 38 females, mean age 47 yn. range 2371 yrs.) with clinical history of CH and without obvious clinical. biochemical, and US findings of liver cirrhosis, underwent, on the same day, US Doppler evaluation of the liver and of the portal system and US guided liver biopsy. Most of the patients wem affected by HCV- or HBVrelated CH. Nine&en US Doppler parameters, age, etiology. and disease duration, were comlati to the score of fibrosis measured according to Sheuer (1) by an experienced pathologist blind of US Doppler pammeters data. Statistical analysis was performed by means of Chi-square test and T student’s test for unpaired data. Thirty-six patienls had absent or mild fibrosis (score O-1, group A) while 70 patients had modemte-severe tibrosis or cirrhosis (score 2-4. group B). Group A compared to group B patients were. significantly different for: age (41f12 yrs. vs SOill yrs., p O.OOl), bipolar spkn diametu (107k14 mm vs 115tiS mm, p 0.04). mean velocity of portal trunk flow (25s cm/see vs 22ti em/se& p 0.04). portal trunk congestion index (0.04&0.001 vs O.OSM.002, p 0.02). right portal branch diameter (8fl mm vs 9f2 mm, p 0.05). right portal branch congestion index (0.02M.001 vs 0.03fo.001, p 0.04). Fmthermore, group A @ants had a significantly lower prevalence of flat flow pattern in the middle hepatic vein compared to group B patients (8% vs 24%, p 0.05). Our data suggest that US and US doppler findings could be use&l in the prediction of the gmde of liver fibrosis in patie-nts affeokd by CH. 1) Scheuer PJ et al. J Hepatol 1991;13:372374.
AUTOIMMUNE ALFA THERAPY Rita Rizzi*,
HEMOLYTIC ANEMIA DURING FOR CHRONIC HEPATITIS C
Teuta KurtiO, Mariella
Lamacchia*,
INTERFERON-
Giorgina
*Hematology Section, Department of Internal Medicin Medicin, University of Bari. “Hematology Laboratory, Hospital Center, University of Tirana.
Specchia*.
and Public “Madre Teresa”
The development of autoimmune haemolytic anemia (AIHA) is rarely observed in chronic hepatitis C patients during interferon alfa (IFNa) therapy. We report on an acute AIHA with warm type autoantibodies, occurred nine months after the start of recombinant IFN a-2b (3MU thrice a week). The patient was admitted to the hospital because of a pronounced drop in his hemoglobin (4.8 g/dl) and hematocrit (13.8%), jaundice, asthenia, dyspnea and cardiopafmw; the Coombs tests resulted positive for agglutinant IgG autoantibodies. Increased LDH (1224 U/l), hyperbilirubinemia (total 5.27 mg/dl, indirect 3.36 mg/dl), and low serum haptoglobin (10 mg/dl) were found. Anemia gradually improved after the IFN withdrawal and institution of methylprednisolone treatment at the initial dose of 1 mg/kg/&, tapered within three months until discontinued. The Coombs tests yielded a still positive result four months after the patient was taken off methylprednisolone; however, the titre of the indirect test dropped over time. In our patient, clinical data suggest a correlation between IFNa therapy and development of AIHA. The immunomodulatory effects of IFN may induce an overt autoimmune disease in chronic HCV infected patients by a transient increase or de now, appearance of autoantibodies. Before and during IFN treatment for chronic hepatitis C, a screening of serological autoimmunity markers including the direct Coombs test could be useful in assessing the risk of overlapping extrahepatic immunologic manifestations.
A93