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Fibrosis regression in HCV chirrotic patients treated with interferon and ribavirin
41
43 HCV CHRONIC INFECTION AND PANCREATIC DAMAGE A POSSIBLE ROLE OF LIVER INVOLVEMENT D’Alessandro, T. Batin, M. Rigato, E. Ambrosini, G Peronato, U Lorenzoni, G. Softiati *, M. Salvagnini U.0 Medicina Gene& 2” and ‘Laboratorio Analisi Chimico Cliniche, Ospedale S Bortolo, Vicenza Few data are available in order to assess the role of HCV infection on pancreatic function The prevoius repats of serum pancreatic enzyme elevation in patients with liver diseases were. ascribed to a decreased liver clearance. Aim of the present study is to assess the role of the liver damage on the biochemical signs of pancreatic alteration during chronic HCV infection. Method and patients: serum pancreatic amylase and lipase concentmtioq f&al chymotripsin and serum transaminase (AST,ALT) were dam&d in 54 patients with HCV infection. -27 without any sign of liver disftmction, 19 females and 8 males, mean age -17 with chronic Hepatitis C (CHC) histologically proven, with 59, tmsaminase level Xx2 of normal value, 1I females and 6 males, mean age -10 with liver cirrhosis Child A histologically proven, 6 females and 59, 4 males, mean age 66. AU patients consumed less than 20 g/day of ethanol, were not treated with Interferon and bad no previous hystory of panaeatic disease ; all patients underwent to abdominal ultrasounds examination Results:
FIBROSIS TREATED Sj
REGRESSION IN HCV CHIRROTIC WITH INTERFERON AND RIBAVIRIN
PATIENTS
A. Colecchia, MF. Jab&, E. Roda, G Mazzella
Department of Internal Medicine Bologna, Italy
and Gastroenterology,
University
of
Interferon is indicated in chronic infection by hepatitis C virus (HCV), however, cirrhosis has been repotted as a bad response factor to the therapy 85 naive cirrhotic patients with HCV infection, evaluated by histological and biochimical parameters were enrolled, and undergoing to treatment with recombinant interferon-alpha and ribavirin All patients received ribavirin (800 mg/dl) in combination with IFN-a2b (I MU/Die) for 48 weeks. They were followed-up and evaluated with dosages of alanine
aminotransferase monthly (biochemical response) and of HCV-RNA every three months (vimlogical response). Fibrosis and iflammatory activity were graded by using the criteria of Desmet (FO to F4) and those of the French METAVIR Coop Sudy Group (A0 to A4), respectively. 76 of the 85 patients concluded therapy and underwent liver biopsy.
45 out of 85 (52%) interferon and ribavirin-treated patients showed a biochemical response at the end of therapy (29 bad genotype lb, 12 had
No macrosmylasemic complexes were found in any of hyperamilasemic sem Faecal chymotripsin low values were detected only in one patient with CHC and Sijogren syndrome In none patient the u.s examination was able to detect any alteration of pancreatic morfology Conclusions: 1) these data confirm that there is a real association between a progressive liver disfimction and abnormal values of serum amylase and lipase concentration, the changes in serum pancreatic enzyme were very small 2) the high prevalence of elevation of lipase and amylase in asymptomatic patients suggest also a possible toxic direct effect by HCV on pancreatic cells
2a; 1 had 3a and 3 unknown): 23 out of 45 (24%) had a timlogical response (13. lb, 7: Za, 3 unknown). Activity grade was unchanged in most of the non responders treated patients and improved in 86% of patients with a sustained vimlogical response (p < 0.005). A sustained response to interferon was associated with reduction fibrosis score (-0,25). The fibrosis increase in 3 of non responders patients. After 6 months after sospention of therapy 31 of the 45 responder treated patients had a biochemical response (32%) and 1I maintained the
virological response ( 12%) Our results suggest that the activity
grade improves after interferon
therapy, especially in patients wifh sustained virologic
response
42 INTEWERON INDUCTION THERAPY AND RIBAVIRIN IN CHROMC HEPATITIS C S Marchetto, A. Colecchia, MF Jaboli, E. Roda, G. Mazzella Department of Internal Medicine and Gastmentemlogy, University of Bologna, Italy Some shldies demonstrate that initial high dose of interferon increase the elimination of HCV RNA. We studied 197 patients (101 males and 96 females) age (16-74) with hepatitis chronic C, have just been treated with alfa interferon alone (81 Non responders and 1 I6 Relapser) All patients were evaluated by histological and biochimical parameters. All patients received ribatin (1200 mg/dl) in combination with lF’Na2b (5 Mu/die for 4 weeks, SMu/hv for 20 weeks and 3 Mu/ hv for 24 weeks) They were followed-up and evaluated with dosages of alanine aminotransferase monthly (biochemical respotue) and of HCV-RNA every three months (vimlogical response). AI1 patients underwent liver biopsy before and a&r thempy.Fibrosis and iflammatory activity were graded by using the criteria of Desmet (FO to F4) and those of the French METAVIR Coop Sudy Group (A0 to A4), respectively 82 out of II6 relapser (95%) interferon and rib&in-treated patients showed a biochemical response at the end of therapy (42 had genotype lb, 29 had 2a. 6 had 3a and 5 unknown): 61 out of 82 (70 7”) had a virological response (23. lb, 26: Za, 5 3a 4 unknown) 41 out of 81 non responders (50.6%) interferon and rib&in-treated patients showed a biochemical response at the end of therapy (31 had genotype lb; 9 bad 2a; I unknown): 20 out of 41 (16.2%) had a vimlogical response (IO : lb, 9, 24 I unknown) Activity grade was unchanged in most of the non respondem treated patients (9oo/o) and improved in 8UlO2 (83 6%) of patients with a sustained vimlogical response (p < 0.005). A sustained response to interferon was associated with reduction fibrosis score (-0.3). The fibrosis increav in 23 of non responders patients. After 6 months -2;; xxpention of therapy 61 of the I16 r&p&r responder treated patients bad a biochemical response (70.7%1 and 51 maintained the virolonical resoonse (59%) &mt~a%er sospention of therapy 28 of;he 81 &n res&nd&
Atter 6
treated patients had a biochemical response (34 5%) and 9 maintained the &ological re3ponse (I I 1%). Our results confirm oreviws studies that the combination therapy significantly induce the fibrosis regression in patients responder -to treatment
COMMON
COLORECTAL
R. Iuliano -, F. Abbonante, Mercurio, C. De Lellis - Uniti Divisione
Operativa di Chiirgia,
di
CANCER
(CRC)
A. Ciacci,
Gastroenterologia Azienda Ospedaliera
AND FAMILIARITY S. Iannini,
N. Mazzuca,
ed Endoscopia Pugliese-Ciaccio,
L
Digestiva, Catanzaro
Well-delineated but rare inherited syndromes of coforectal cancer have been clearly described. These include hereditary non polyposis colorectal cancer (HNPCC) and familial adenomatous polyposis(FAP). High familiarity has been reported also in patients with sporadic CRC, although the nature and course of the disease has been conflicting. Aim of this study was to evaluate the familiarity in patients with sporadic CRC and the main clinicopathological features and prognosis of patients with sporadic CRC. Patients and Methods: 201 consecutive patients (M/F: 102/99, mean age *SD: 65f10 years) with CRC undergoing surgery at our Hospital were studied. Patient with HNF’CC and FAP were excluded. One hundred and eighty-six subject controls (M/F: 95/91, mean agekSD: 65f12 years) without CRC were enrolled (control groups). AI1 patients undergoing colonscopy. Results: A positive family history (one or more at&ted firstdegree relatives) was 16% in CRC patients and 6% in control goup (P
43 HCV CHRONIC INFECTION AND PANCREATIC DAMAGE A POSSIBLE ROLE OF LIVER INVOLVEMENT D’Alessandro, T. Batin, M. Rigato, E. Ambrosini, G Peronato, U Lorenzoni, G. Softiati *, M. Salvagnini U.0 Medicina Gene& 2” and ‘Laboratorio Analisi Chimico Cliniche, Ospedale S Bortolo, Vicenza Few data are available in order to assess the role of HCV infection on pancreatic function The prevoius repats of serum pancreatic enzyme elevation in patients with liver diseases were. ascribed to a decreased liver clearance. Aim of the present study is to assess the role of the liver damage on the biochemical signs of pancreatic alteration during chronic HCV infection. Method and patients: serum pancreatic amylase and lipase concentmtioq f&al chymotripsin and serum transaminase (AST,ALT) were dam&d in 54 patients with HCV infection. -27 without any sign of liver disftmction, 19 females and 8 males, mean age -17 with chronic Hepatitis C (CHC) histologically proven, with 59, tmsaminase level Xx2 of normal value, 1I females and 6 males, mean age -10 with liver cirrhosis Child A histologically proven, 6 females and 59, 4 males, mean age 66. AU patients consumed less than 20 g/day of ethanol, were not treated with Interferon and bad no previous hystory of panaeatic disease ; all patients underwent to abdominal ultrasounds examination Results:
FIBROSIS TREATED Sj
REGRESSION IN HCV CHIRROTIC WITH INTERFERON AND RIBAVIRIN
PATIENTS
A. Colecchia, MF. Jab&, E. Roda, G Mazzella
Department of Internal Medicine Bologna, Italy
and Gastroenterology,
University
of
Interferon is indicated in chronic infection by hepatitis C virus (HCV), however, cirrhosis has been repotted as a bad response factor to the therapy 85 naive cirrhotic patients with HCV infection, evaluated by histological and biochimical parameters were enrolled, and undergoing to treatment with recombinant interferon-alpha and ribavirin All patients received ribavirin (800 mg/dl) in combination with IFN-a2b (I MU/Die) for 48 weeks. They were followed-up and evaluated with dosages of alanine
aminotransferase monthly (biochemical response) and of HCV-RNA every three months (vimlogical response). Fibrosis and iflammatory activity were graded by using the criteria of Desmet (FO to F4) and those of the French METAVIR Coop Sudy Group (A0 to A4), respectively. 76 of the 85 patients concluded therapy and underwent liver biopsy.
45 out of 85 (52%) interferon and ribavirin-treated patients showed a biochemical response at the end of therapy (29 bad genotype lb, 12 had
No macrosmylasemic complexes were found in any of hyperamilasemic sem Faecal chymotripsin low values were detected only in one patient with CHC and Sijogren syndrome In none patient the u.s examination was able to detect any alteration of pancreatic morfology Conclusions: 1) these data confirm that there is a real association between a progressive liver disfimction and abnormal values of serum amylase and lipase concentration, the changes in serum pancreatic enzyme were very small 2) the high prevalence of elevation of lipase and amylase in asymptomatic patients suggest also a possible toxic direct effect by HCV on pancreatic cells
2a; 1 had 3a and 3 unknown): 23 out of 45 (24%) had a timlogical response (13. lb, 7: Za, 3 unknown). Activity grade was unchanged in most of the non responders treated patients and improved in 86% of patients with a sustained vimlogical response (p < 0.005). A sustained response to interferon was associated with reduction fibrosis score (-0,25). The fibrosis increase in 3 of non responders patients. After 6 months after sospention of therapy 31 of the 45 responder treated patients had a biochemical response (32%) and 1I maintained the
virological response ( 12%) Our results suggest that the activity
grade improves after interferon
therapy, especially in patients wifh sustained virologic
response
42 INTEWERON INDUCTION THERAPY AND RIBAVIRIN IN CHROMC HEPATITIS C S Marchetto, A. Colecchia, MF Jaboli, E. Roda, G. Mazzella Department of Internal Medicine and Gastmentemlogy, University of Bologna, Italy Some shldies demonstrate that initial high dose of interferon increase the elimination of HCV RNA. We studied 197 patients (101 males and 96 females) age (16-74) with hepatitis chronic C, have just been treated with alfa interferon alone (81 Non responders and 1 I6 Relapser) All patients were evaluated by histological and biochimical parameters. All patients received ribatin (1200 mg/dl) in combination with lF’Na2b (5 Mu/die for 4 weeks, SMu/hv for 20 weeks and 3 Mu/ hv for 24 weeks) They were followed-up and evaluated with dosages of alanine aminotransferase monthly (biochemical respotue) and of HCV-RNA every three months (vimlogical response). AI1 patients underwent liver biopsy before and a&r thempy.Fibrosis and iflammatory activity were graded by using the criteria of Desmet (FO to F4) and those of the French METAVIR Coop Sudy Group (A0 to A4), respectively 82 out of II6 relapser (95%) interferon and rib&in-treated patients showed a biochemical response at the end of therapy (42 had genotype lb, 29 had 2a. 6 had 3a and 5 unknown): 61 out of 82 (70 7”) had a virological response (23. lb, 26: Za, 5 3a 4 unknown) 41 out of 81 non responders (50.6%) interferon and rib&in-treated patients showed a biochemical response at the end of therapy (31 had genotype lb; 9 bad 2a; I unknown): 20 out of 41 (16.2%) had a vimlogical response (IO : lb, 9, 24 I unknown) Activity grade was unchanged in most of the non respondem treated patients (9oo/o) and improved in 8UlO2 (83 6%) of patients with a sustained vimlogical response (p < 0.005). A sustained response to interferon was associated with reduction fibrosis score (-0.3). The fibrosis increav in 23 of non responders patients. After 6 months -2;; xxpention of therapy 61 of the I16 r&p&r responder treated patients bad a biochemical response (70.7%1 and 51 maintained the virolonical resoonse (59%) &mt~a%er sospention of therapy 28 of;he 81 &n res&nd&
Atter 6
treated patients had a biochemical response (34 5%) and 9 maintained the &ological re3ponse (I I 1%). Our results confirm oreviws studies that the combination therapy significantly induce the fibrosis regression in patients responder -to treatment
COMMON
COLORECTAL
R. Iuliano -, F. Abbonante, Mercurio, C. De Lellis - Uniti Divisione
Operativa di Chiirgia,
di
CANCER
(CRC)
A. Ciacci,
Gastroenterologia Azienda Ospedaliera
AND FAMILIARITY S. Iannini,
N. Mazzuca,
ed Endoscopia Pugliese-Ciaccio,
L
Digestiva, Catanzaro
Well-delineated but rare inherited syndromes of coforectal cancer have been clearly described. These include hereditary non polyposis colorectal cancer (HNPCC) and familial adenomatous polyposis(FAP). High familiarity has been reported also in patients with sporadic CRC, although the nature and course of the disease has been conflicting. Aim of this study was to evaluate the familiarity in patients with sporadic CRC and the main clinicopathological features and prognosis of patients with sporadic CRC. Patients and Methods: 201 consecutive patients (M/F: 102/99, mean age *SD: 65f10 years) with CRC undergoing surgery at our Hospital were studied. Patient with HNF’CC and FAP were excluded. One hundred and eighty-six subject controls (M/F: 95/91, mean agekSD: 65f12 years) without CRC were enrolled (control groups). AI1 patients undergoing colonscopy. Results: A positive family history (one or more at&ted firstdegree relatives) was 16% in CRC patients and 6% in control goup (P