Latent hepatic encephalopathy in outpatients with tips

Latent hepatic encephalopathy in outpatients with tips

476A 1477 AASLD ABSTRACTS IS MALLORY'S BODY A PROGNOSTIC FACTOR IN THE OUTCOME AFTER LIVER TRANSPLANTATION IN PATIENTS WITH ALCOHOLIC CIRRHOSIS? A...

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476A

1477

AASLD

ABSTRACTS

IS MALLORY'S BODY A PROGNOSTIC FACTOR IN THE OUTCOME AFTER LIVER TRANSPLANTATION IN PATIENTS WITH ALCOHOLIC CIRRHOSIS? A pinna. J Rakela. A Amin. I Dvorchik and JJ Fuw,. Pittsburgh Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA Mallory's Body (MB) is an intracytoplasmic, eosinophilic structure.forming a coarse network in hepatocytes. MB was first described in alcoholic hepatitis and alcoholic cirrhosis (AC) and it has also been noted in other liver diseases. In AC, MB seems to correlate with active alcohol consumption in the 3-6 months prior to its detection. The prognostic implication of MB after shunt surgery in patients with AC and portal hypertension has been contr0versial. Aim: To evaluate if MB has a prognostic value in the outcome of patients with AC who undergo liver transplant (OLTX). Material and +Methods: We studied 345 pts. transplanted for alcoholic liver disease at the Pittsburgh Transplant Institute between 1/1/90 and 12/30/94. Male:Female ratio was 3:1. In 216 pts. the native liver showed features of AC without MB, these pts constitute group 1 In 103 pts. the native liver showed.presence of MB, these pts. constitute group 2. Hepatocellular carcinoma was present in 6.4% of the pts. in group l and in'10.6% of the pts. in group 2,. The outcome after OLTX was evaluated in both groups analyzing patients' survival and grafts' survival with life table survival analysis. Results: Overall patients' and grafts' survival were not statistically different between the 2 groups. Thepatieuts' survival rates for group 1 and group 2 were 83%-75%, 78%-74%, 77%-74%, 72%-70%, 71%-66%, and 66%-57% at 6 months, l yr., 2 yr, 3 yr., 4 yr., and 5 yr. respectively. Graft survival rates were 82%-74%, 71%-66% and 68%-40% at 8 months, 3 yr. and 5 yr. for group 1 and 2 respectively. Conclusion: The presence of MB seems to be a histological epiphcnomenon+ in AC without a significant prognostic implication in the long term patient and graft survival after OLTX. However, patients with MB seem to have a worse early outcome (6 mo.) than patients with AC without MB with statistical significance (p < 0.05).

1 4 7 9 PATHOGENESIS OFPORTALH~'~SIVEGASTROPATHY(PHG); THE ROLE OF IIELICOBACTER PYLORI (HP). JO Pitta Pinheiro,AA Mattos; AP Cassal. Division of Gastroenterology and Hepatology. FundaGao Facul dade Federal de Ci~ncias MedicasdePortoAlegre.Braz~

The aim of the present Study was to assess the prevalenc e of gastric colonisation w i t h H P a n d its relationship withPHGinpatients with cirrhosis(CI)and portal hypertension (PH). Material and Methods: We have studied prospectively 36 patients with CI and PHG-mean age (MA) of 52,8 ± 7,8 years old;19 patients with CIand P H w i t h o u t PHGMA of 53,5 ± 15,2 years; 46 patients without CIand normal endoscopy-MA of 42,0 ± 14,7 years and 81 patients without CI and gastriti s at endoscopy-MA of 44,4 ± 15,3.Diagnosis of HP infection was done by histology through Giemsa stain (2 biopsies from antrum and 2 from body of stomach) and by urease test. None of the patients included in the study were previously treated for HP infection or had been treated with omeprazole. Results: HP infection was found in 41,7% Of the patients with PHG; 47,4% of the patients with CI without PHG and 45,7% of the patients with normal endoscopy and endoscopic gastritis (p> 0,05). Conclusion: The prevalence of HP infection in patients with C~ and PHG is the same as in the group controls, This results suggest that the HP is unlikely to have a pathogenetic role in PHG.

HEPATOLOGY O c t o b e r 1995

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LATENT HEPATIC ENCEPHALOPATHY IN OUTPATIENTS WITH T I P S . J.Piotraschke. K.Haaa. E.Beraer. A.Ochs. V. Sieaerstetter. G. Kircheis. HE Blum. M.RSssle. U n i v e r s i t y S c h o o l o f Medicine, Freiburg, Germany. Latent hepatic encephalopathy (HE) is a common complication of portal hypertension found in up to 70% of unselected patients with cirrhosis (Plauth, J Hepatol 1992). The aim of this study was to investigate its incidence in patients with a transjugular intrahepatic portosystemic shunt (TIPS), In i00 outpatients (Child A : 61, B: 39) without clinical symptoms of HE and duplex-sonographicaily patent shunts a total of 167 Reitan A and B tests was performed 3 months or later after the establishment of the shunt. Latent HE was defined as failure to p e r f o r m the Reitan A and B tests within 40 and i00 seconds, respectively. Results: The mean time for all 167 Reitan A and B tests was 38 ± 15 (SD) and 103 ± 48 seconds, respectively. Patients older than 60 years (n = 34) required significantly more time to perform the tests than patients below 60 (46 ± 14 and 134 ± 44 vs 35 ± 15 and 89 ± 42 seconds). Test performance was bet£er in Child A compared to Child B patients, however, the difference was significant Only in the group of patients below age 60. Taken both tests together, a total of 47% of the patients had latent HE. The incidence of latent HE for patients above and below age 60 was 82 and 35% and for Child A and B patients 41 and 68%, respectively. Conclusions: Latent HE is frequent in outpatients with a functioning TIPS. Further studies are needed to demonstrate whether medical treatment of this asymptomatic state is effective.

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P K E V A L g N ~ OF PRIMARY 8,CLgROSING CHOLANGYI'IS (PSC) IN PATIENTS WITH ~ A M A T O R Y BOWEL DISEASE (IBD). A PROSPECTIVE STUDY. A. Podcsta. A. SLmbudl/, A. GiI~C. Migu~, S. Gonealv~ S. Negreira, Z. go~an, L. Boerr, g.Tm'~. ~flmnatory Bowel Disease Section and Liver Ur~t. Hospital de Gastr0enterol0~ia B. Udaundo. Buenos Akes,.Argentina BACKGROUND: The PSC has been reported as the most frequent hepatic and bifiasy disease in patients with IBD.However, the prevalence could variate according to the criteria used to select patients with IBD and PSC. AIM: to evaluate prospectively, the prevalence of PSC in pts. with IBD using humoral criteria during long term follow up. MATERIAL AND METHODS: From 1985 to 1995, 660 pts. with IBD : 539 with ulcerative colitis (UC) and 121 with Crohn disease (CD) were studied. At admission and dining the follow up. alkaline phosfatase, ALAT,ASAT and bliirnsbin were performed. Patients underwent ERCP and liver biopsy when sustained increase in alkafine phosfatase ( twice normal value) were found longer than 8 weeks at least in two consecutive determination (group 1). Patients with sustained abnonnafities but normal afi~alinephosfatase were sludicd by liver biopsy ( group 2). RESULTS: The mean follow up in IBD pts. was 8.1 + 8.2 years. Twenty pts. with UC (3.7 %o) and one pt. with CD ( 0.8 %) meet criteria compS'hie with PSC. In 10 pts. diagnosis of PSC was done in asintomatic period. In all pts of group ! ERCP demonstrated findings compatiblewith PSC, whereas in patients of group 2 liver biopsy showed lesions not associated to PSC. The mean age at the moment of diagnosis of IBD was significantly lower in pts. with PSC than pts. without PSC ( 24.7 vs 32.8 years) ( p < 0.01). Patients w~h PSC had a significm~ly higher extensive colon hr~,olvement than pts. without PSC ( 95% vs. 44%, respectively, p< 0.001). Colcetomy in patients with UC was most frequent in those with than without PSC ( 55% vs. 31% respeclively, p<0.05).Six pts with PSC dead ~ the follow up (complications of IBD in 3,cholangiocarcinoma in 2 and varietal bleeding in 1).CONCLUSION: the prevalence of PSC in argentine pts with IBD is similar to anglosajon pts.The sistcmatic humoral follow up in PSC asintomatyc pts. is useful for the diagno~ of this disease.