Clinical Hepatitis: Advances in the basis for and markers of progressive disease
585. Elevated levels of circulating
mesenchymal stem cells in patients with chronic hepatitis B and C.
J. A. Abrams; V. Jacob; J. S.
Manavalan; T. C. Wang; S. Wang
Background:
Adult stem cells play a crucial role in the repair and
maintenance of tissues. There are three major populations of adult stem cells:
mesenchymal stem cells (MSC), endothelial progenitor cells (EPC), and hematopoietic
stem cells (HSC). Mesenchymal stem cells generate fibrous connective tissue,
bone, cartilage, and the reticular network that supports blood cell formation.
The pathways that lead to hepatic fibrosis in chronic hepatitis are not
completely understood, and the recruitment of MSCs and other progenitor cells
may be involved in this process. We conducted an exploratory analysis of
circulating progenitor cells in patients with chronic viral hepatitis.
Methods:
Peripheral blood mononuclear cells (PBMCs) were isolated from
7 patients with chronic hepatitis B or C without cirrhosis and from 7 healthy
controls. Data were collected regarding age, gender, and stage of fibrosis on
liver biopsy. Quantification of circulating progenitor cells was performed by
flow cytometry. PBMCs were labeled with fluorochrome conjugated monoclonal
antibodies against CD45, CD34, CD133, VEGFR2, CD117, and CD44, and incubated
and washed prior to 6-color analysis using a LSR II flow cytometer. EPCs were
defined as CD34+ CD133+ VEGFR2+, HSCs as CD45+ CD34+ CD117+, and MSCs as CD45-
CD44+. Counts were expressed as number of progenitor cells per 10,000
mononuclear cells.
Results:
Patients with chronic hepatitis B or C had a significantly
higher mean number of MSCs per 10,000 mononuclear cells than healthy controls
(68.7 vs. 38.9, p=0.04) (Table 1). There was no difference between patients
with chronic viral hepatitis and controls with respect to number of circulating
EPCs (2.8 vs. 2.9, p=0.91) or HSCs (6.7 vs. 5.5, p=0.50). There was no
significant correlation between number of circulating MSCs and age, gender, or
stage of fibrosis on liver biopsy.
Conclusions:
Mesenchymal stem cells are present in significantly higher
levels in serum from patients with chronic hepatitis B and C than from healthy
controls. It is possible that recruitment of MSCs plays an important role in
the development of hepatic fibrosis. Further studies should be aimed at
defining the role of MSCs in hepatic fibrosis and identifying the signaling
mechanisms that trigger their recruitment.
|
|
Hepatitis B or C |
Controls |
p-value |
|
MSC |
68.7 (28.9) |
38.9 (18.1) |
0.04 |
|
EPC |
2.8 (1.3) |
2.9 (2.4) |
0.91 |
|
HSC |
6.7 (3.5) |
5.5 (2.9) |
0.50 |
588. Correlation of hepatic fibrosis with
serum ALT and viral levels in patient with chronic hepatitis B.
R. Vachhani; D. Moonka; V. Pampati; H. Vachhani; K. Brown; M.
Sherbondy; L. Lamerato; S. Gordon
Background:
Current guidelines emphasize the importance of
serum ALT and HBV DNA levels when assessing the role of HBV treatment. Because
of disease course fluctuation, however, patients with normal ALT or low-level
viremia may have significant fibrosis.
Objective:
We sought to determine the relationship between
hepatic fibrosis and serum ALT values and baseline viral levels in a large
cohort of US patients with chronic hepatitis B
Methods:
We reviewed the charts of consecutively
presenting treatment naďve chronic HBV patients who underwent liver biopsy between 1997-2006. We recorded liver histology and serum
ALT/HBV DNA levels done at the time of liver biopsy. We used means for patients
with multiple values. We defined normal ALT as ≤40 U/L for men and ≤35
U/L for women. Metavir scores (F0-F4) were used to grade fibrosis. Chi-square
table was used for statistical analysis.
Results:
We identified 105 HBV carriers (67% men),
including 38% Asian, 25% African American, and 30% Caucasian. The median age
was 43, median ALT was 55 and median HBV DNA was 214,000 copies/ml, including
13 patients with no detectable viremia (≤300 copies/ml or 0.02 pg/ml).
ALT values were not available for five patients. Fifty-four percent were HBeAg
negative. Serum ALT values strongly correlated with degree of fibrosis (p <
0.001) but 19% of those with normal ALT had significant fibrosis (F2 or F3).
Increasing HBV DNA levels trended toward more advanced fibrosis (p=0.063). HBV
DNA levels >105 copies/ml correlated with more advanced fibrosis (p=0.007)
although 34% (16/47) with viral loads ≤105 copies/ml were ≥F2. Age
was not significantly correlated with degree of fibrosis. The sensitivity,
specificity, PPV and NPV of abnormal ALT and viral load >105 copies/ml to
detect fibrosis ≥F2 were 87,46,58,81 and 69,57,60,66 respectively.
Conclusion:
Although higher ALT and higher HBV DNA levels were
associated with more advanced fibrosis, 34% of patients with viral levels ≤105
copies/ml at presentation and 19% with normal ALT values had fibrosis grades of
≥F2. These findings validate the role of liver biopsy to assess HBV
disease severity, especially among those patients with a low suspicion of
significant fibrosis.
|
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Clinical Portal Hypertension Poster Session
T1039. Impact of prophylactic
antibiotics in cirrhotic patients presenting with sepsis.
L. Lim; S. Lim; D. Sutedja; Y. Dan; Y. Lee; C. Wai
Aim:
Cirrhotic patients are prone to infection.
Prophylactic antibiotics after an episode of spontaneous bacterial peritonitis
(SBP) could potentially select out resistant organisms, such as extended
spectrum beta-lactamase (ESBL)-producing organisms. We aimed to investigate the
characteristics and outcomes of patients with cirrhosis who were admitted for
sepsis of any source in our institution, which is a tertiary university liver
transplant center.
Methods:
All patients with liver cirrhosis admitted to our
institution from March 2004 to August 2006 for sepsis, who had documented
organisms in any body fluid cultures, including blood, urine, ascites, sputum
or pleural fluid, were retrospectively studied.
Results:
47 patients with a total of 63 admissions (16 for
SBP, 15 for urinary tract infection) were studied: 26 (55%) were male, aged
65.3±1.6 years, whose major etiology of cirrhosis were cryptogenic cirrhosis
(32%), chronic hepatitis B (26%), and alcoholic liver disease (26%). 13 (28%)
had hepatocellular carcinoma. Of the 63 admissions, fever and abdominal pain
was the presenting complaint in 36 (57%) and 26 (41%) respectively, with mean
white cell count at 9.1±0.9 x10(9)/L, and mean C-reactive protein at 6.8±0.7mg/dL.
Organisms isolated in cultures were, in decreasing order of frequency:
Escherichia coli (22%), Klebseilla pneumoniae (18%), ESBL-producing Escherichia
coli (13%), ESBL-producing Klebseilla pneumoniae (8%).
Patients on prophylactic ciprofloxacin for prior SBP were more likely to harbor
ciprofloxacin-resistant organisms (90% vs. 43%, p=0.007), and ESBL-producing
organisms (50% vs. 15%, p=0.012) than those without. 5 of 6 (83%) episodes due
to pneumonia compared with 12 of 57 (21%) episodes with infection other than
pneumonia resulted in death (p=0.001). 16 of 37 (43%) septic episodes involving
Child’s C patients resulted in death, compared with 1 of 26 (4%) involving
Child’s A or B patients (p=0.001). The mean Child’s score (12.9±0.4 vs 9.4±0.4,
p= 0.000) and MELD score (24.4±1.9 vs 17.3±0.9, p=0.000) were higher in those
who died than those who survived. Using multivariate analysis, high Child-Pugh
score (OR=0.579, p=0.021) and pneumonia (OR=12.6, p=0.043) had significant
correlations with mortality.
Conclusions:
Sepsis, in particular pneumonia, was an important
cause of mortality in cirrhotics, especially in those with high Child-Pugh
score. Cirrhotics who were on antibiotic prophylaxis were more likely to be
infected with ESBL-producing organisms, and should be started empirically on
second line antibiotics such as carbapenems upon diagnosis.
Steatohepatitis: Clinical
T1064.
Health Utility Assessment Using SF-6D and Health Utility
Index (HUI) in Patients with Chronic Viral Hepatitis and Non-alcoholic Fatty
Liver Disaese (NAFLD).
A. Dan; J. Kallman; R. Srivastava; Z.
Younoszai; A. Kim; Z. M. Younossi
Introduction:
Assessment of health-related quality of life
(HRQL) and health utilities have become important aspects of clinical research.
Patient-derived utility-adjustments are frequently used in economic analysis.
Although SF-36 is widely used as a generic HRQL instrument for patients with
liver disease, extensive data on the health utilities of patients with liver
disease are not available. Recently, SF-6D has been developed to obtain utility
scores from the SF-36 questionnaire.
Aim:
To assess health
utilities of patients with chronic liver disease using two utilities assessments
(SF-6D and HUI). Methods: Patients with chronic liver disease were identified from
our HRQL databases with available clinical data, SF-36, and HUI scores. SF-6D
scores were calculated from SF-36.
Results:
140 patients were included[(42%
female, age 49.4±11.2, 36% Hepatitis B, 29% Hepatitis C, 24% cholestatic liver
disease, and 11% NAFLD. Analyses indicate that Hepatitis B patients had the
best HRQL as measured by the SF-6D subscales (only mental health scores did not
vary by health condition), while patients with Hepatitis C and cholestatic
liver disease had similar HRQL, and those with NAFLD/other had the poorest HRQL
(Table 1). HUI scores did not differ as much as SF-6D scores, but those scales
that varied also indicated that those with other liver diseases had the poorest
quality of life. Female patients experienced poorer HRQL as measured by the
pain, social functioning and vitality SF-6D subscales and six of the HUI
subscales. Older age was also moderately associated with many of the HRQL
subscales.
Conclusion:
SF-36 with SF-6D scoring provides not only a
generic assessment of HRQL but also a utility score that can be used for
economic analysis.
|
|
Cholestatic Liver Disease |
Hepatitis C |
Hepatitis B |
NAFLD/Other |
Possible Range |
|
SF-6D |
|
|
|
|
|
|
Physical Functioning |
4.5 (1.2) |
4.4 (1.6) |
5.0 (1.2) |
3.4 (1.9) ** |
1-6 |
|
Role limitation |
1.6 (.5) |
1.5 (.5) |
1.3 (.4) |
1.8 (.4) *** |
1-2 |
|
Social Functioning |
3.8 (1.2) |
3.6 (1.3) |
4.4 (.9) |
3.4 (1.5) ** |
1-5 |
|
Bodily Pain |
3.9 (1.3) |
3.9 (1.2) |
5.0 (1.3) |
3.9 (1.2) *** |
1-6 |
|
Mental Health |
4.5 (1.0) |
4.3 (1.1) |
4.6 (.8) |
4.1 (1.1) |
1-5 |
|
Vitality |
3.4 (1.5) |
3.3 (1.5) |
4.3 (1.0) |
3.1 (1.3) *** |
1-5 |
|
HUI- Mark 2 |
|
|
|
|
|
|
Overall |
0.8 (.2) |
0.7 (.2) |
0.9 (.2) |
0.7 (.2) ** |
0-1 |
|
Cognition |
0.9 (.1) |
0.9 (.1) |
1.0 (.1) |
0.9 (.1) |
0-1 |
|
Emotion |
0.9 (.1) |
0.9 (.2) |
0.9 (.1) |
0.9 (.2) |
0-1 |
|
Mobility |
1.0 (.1) |
0.9 (.1) |
1.0 (.0) |
0.9 (.2) * |
0-1 |
|
Pain |
0.9 (.2) |
0.8 (.2) |
0.9 (.2) |
0.9 (.3) |
0-1 |
|
Self Care |
1.0 (.2) |
1.0 (.2) |
1.0 (.1) |
0.9 (.3) |
0-1 |
|
Sensation |
0.8 (.1) |
0.8 (.2) |
0.9 (.1) |
0.8 (.1) |
0-1 |
*p<.05 **p<.01
***p<.001 Note: Higher values on utility scale
scores as presented above reflect higher HRQL.
T1084. Elevated Serum Alanine Aminotransferase
(ALT) Activity Does Not Increase Cardiovascular Disease (CVD) Mortality in the
C. E. Ruhl; J. E. Everhart
Introduction:
A concern exists that
nonalcoholic fatty liver disease may increase the risk of CVD independently of
metabolic syndrome components. In a prospective, national, population-based
sample, we examined whether elevated ALT was associated with increased risk of
all-cause and CVD mortality.
Methods:
Data were analyzed from 14,950 adult participants
in the third U.S. National Health and Nutrition Examination Survey, 1988-94, who
were negative for markers of viral hepatitis B and C. Abnormal ALT activity was
defined as >40 U/L in men or >31 U/L in women. Participants were followed
through 2000 for all-cause and CVD mortality as identified by death certificate
underlying-cause diagnoses. Hazard rate ratios (HR) for mortality outcomes were
calculated using Cox proportional hazards analysis to adjust for CVD risk
factors. All analyses incorporated sample weights and the design effects of the
survey.
Results:
The prevalence of elevated ALT was 5.3%. During
the up to 12 years of follow-up, the cumulative mortality was 13.9% (2,189
deaths) from all causes and 4.2% (665 deaths) from CVD. Participants with an
elevated ALT had a non-statistically significant 40% higher risk of all-cause
mortality both in age-adjusted analysis (HR=1.4, 95% confidence interval
(CI)=0.90-2.1) and after adjusting for multiple factors (HR=1.4, 95%
CI=0.88-2.3). Interestingly, the risk of CVD mortality was not increased among
persons with an elevated ALT in either age-adjusted (HR=1.1, 95% CI=0.44-2.8)
or multivariate-adjusted analysis (HR=1.0, 95% CI=0.37-2.9).
Conclusion:
In the
Epidemiology
W1044. Digestive Diseases in the Native American Population
of the
B. Kizer; H. Lazarte; G. Haynatzki; R. Patel; A. Dajani; J. O'Brien
Background:
Little is known about the prevalence of digestive diseases
among the Native American population from the
Methods:
A retrospective study of 449 randomly selected Fred Leroy
charts. Each patient chart was reviewed for medical and social history, and the
documentation of the prevalence, clinical presentation, and treatments of the
ten most common digestive diseases in the
Results:
449 patient charts were reviewed. 138 patients were male; 311
were female. 330 patients were 19 to 50 years old; 119 patients were aged 50 to
79.
The Body Mass Index could be calculated for all but 2
patients. 113 patients were overweight (BMI 25 to < 30), 131 were obese (BMI
30 to < 35), and 137 were morbidly obese (BMI > 35). The prevalence in
this study population of overweight / obesity is 85.3 % (p<0.00001,
No statistical difference existed between the study
population and the
61 patients (13.6%) have a history of cholelithiasis. No
statistically significant difference exists between the prevalence of
cholelithiasis in this Native American population and the
27 patients (6%, p<0.00001) have a history of Hepatitis C
infection (
Conclusion:
This is the first study looking at the prevalence of digestive
diseases in the Native American population of the
Immune Response
280. The Envelope Protein of the Hepatitis C virus (E2)
inhibits IL-2 Secretion from T lymphocytes.
D. Petrovic; L. Golden-Mason; S. Mitchell; Y. Volkov; C. O'Farrelly; D. Kelleher; A. Long
Introduction:
T-cell activation is one of the primary responses of the
adaptive immune system to pathogens, such as Hepatitis C virus (HCV). Recognition
of antigen, via the T cell receptor, initiates signal transduction and the
resultant production of IL-2 is central to this response. We have previously
demonstrated that the PKC-B enzyme is critical for the process of IL-2
secretion but not mRNA production (Long; et al). More recently we have shown
that the Envelope Protein (E2) of the HCV, through its interaction with CD81,
modulates PKC-B activity by stimulating its sequestration in lipid rafts,
preventing T cell migration (Volkov; et al).
Aim:
The aim of this study was to investigate the effect of HCV E2
on T cell IL-2 production.
Results:
Analysis of cytokine levels in extracts of snap-frozen liver
biopsies from individuals infected with HCV, measured by ELISA, revealed
significantly lower levels of IL-2 in these patients when compared to those
with other inflammatory liver diseases, such as ALD and PBC (IL-2 levels in
ng/100mg protein: 5 ± 0.93 (HCV) vs 25 ± 2.9 (ALD), p<0.027 vs 20 ± 2 (PBC),
p<0.003). In a HuT 78 T cell line model, pretreatment of cells with E2
substantially attenuated PMA stimulated IL-2 production (IL-2 levels in pg/ml:
PMA stimulated cells 889.3 ± 19.1 vs E2/PMA stimulation 105.9 ± 0.2,
p<0.016, (resting cells 20 ± 0.9)). This was also observed in PBMCs,
obtained from healthy donors, stimulated with either PMA/Ionomycin or anti CD3
/ anti CD28 antibodies (IL-2 levels in pg/ml: antiCD3/antiCD28 1825 ± 58.3 vs
E2/antiCD3/antiCD28 53 ± 1.5, p<0.022, (resting cells 27.4 ± 1.4)). In
contrast, cells pretreated with viral core protein C22 and NS3 protein C33 did
not affect IL-2 secretion, confirming specificity of E2 in inhibition of IL-2
secretion. Inhibition of IL-2 was at the level of secretion and not
transcription, as demonstrated by Real Time PCR (IL-2 mRNA level in PMA stimulated
cells increased 2.07 fold over resting cells, p<0.01 while it increased IL-2
mRNA 2.19 fold in the presence of E2, p<0.0005). In addition, intracellular
IL-2 was detectable by immunofluorescence in PMA activated cells pretreated
with E2. Treatment of the HuT 78 cells with the lipid raft disruptor
methyl-β-cyclodextrin (MCD) reversed the ability of E2 to inhibit IL-2
secretion.
Introduction:
These data suggest that targeting of PKC-B to the lipid raft
microdomains in the T cell membrane, following E2 - CD81 interaction, disrupts
the association of PKC-B with the microtubule cytoskeleton, thereby inhibiting
export of IL-2. E2-mediated inhibition of IL-2 secretion represents a mechanism
whereby HCV can undermine the human immune response to establish persistent
infection and chronic disease.
Hepatotoxicity and Steatohepatitis
513. Associate Factors Of Nonalcoholic Fatty
Liver Disease : Results From A Population-Based
Study.
A. Colecchia; A. Vestito; E. Paltrinieri; M. Bacchi-Reggiani; A. Di Biase;
G. Mazzella; M. Montagnani; F. Lodato; A. Morselli-Labate; F. Pasqui; D. Festi
Introduction:
Nonalcoholic fatty liver disease (NAFLD)
represents one of the most common liver disease;
however a few studies assessed its prevalence in general population and its
association with abnormal liver enzymes is not still clear.
Aim:
To evaluate the
prevalence and associated factors of NAFLD in a general population and its
relationship with abnormal liver enzymes.
Material
and Methods:
We carried out a cross sectional study in a
general population, aged 18-84 yrs, of a small town; 1534 out of 1646 ( 93%)
subjects agreed to participate to the study. All subjects underwent abdominal
ultrasound, physical examination, fasting blood specimen collection, seven day
dietetic diary.
Results:
479 out of 1534 ( 31.2%) subjects were excluded
(391 alcohol, 20 HBV, 63 HCV and 5 autoimmune); thus analyses were performed on
1055 subjects (68%). 382 out of 1055 subjects ( 36.1%)( males 57.8%, mean age:
52.1 ± 12.7) had NAFLD evaluated by US. 88 out of 1055 subjects ( 8.3%) had
abnormal ALT ( 15.7% in NAFLD vs 4.2 % in normal subjects; p< 0.001);
prevalence of NAFLD was higher in subjects with abnormal ALT than those with
normal ALT [ 60 out of 88 (68.2%) vs 319 out of 967( 33%)( p< 0.001)].
Frequency of NAFLD was related to increased BMI,;
however 80 out of 382 ( 20%) subjects had normal BMI. Associated factors were,
at univariate analysis, male sex, aging , blood hypertension, diabetes,
hypercholesterolemia, low HDL-cholesterol, Tg/Hdl ratio ≥ 3.5,
hypertriglyceridemia, BMI, large waist circumference and abnormal ALT, AST and
gGT; while, at multivariate analysis, they were sex male (OR:1.89), systolic
hypertension (OR:1.9), hyperglicemia (OR:1.9), visceral obesity (OR:4.9),
Tg/HDL ratio (OR:2.9), ALT (OR:2,5) and gGT (OR:1.8).
Conclusion:
NAFLD is highly prevalent in general population;
among the associated factors, obesity and Tg/HDL ratio (marker of insulin
resistance) were the strongest ones. Furthermore, abnormal liver enzymes
(namely ALT) are significantly associated with NAFLD; however, since they
largely underestimate the disease prevalence, they cannot be used as markers of
NAFLD.
Clinical Epidemiology II
M1015. Rates and Predictors of Depression in an
Out-patient Hepatology Practice .
G. S. Sayuk; S. El-Dirani; J. E. Elwing; P. Lustman;
M. Lisker-Melman; J. S. Crippin; R. E. Clouse
Introduction/Aim:
Depression interferes with all aspects of daily
living, adherence to medical recommendations, and treatment outcomes.
Depression may be under-recognized in patients with chronic liver disease (CLD)
because many of its symptoms overlap with symptoms attributable to liver
dysfunction. The rate of depression symptoms across types of CLD is not known.
We administered a commonly used depression
assessment instrument, the Beck Depression Inventory (BDI), to out-patients
attending a university-based practice to determine the rate of current
depression symptoms and predictors of elevated scale scores.
Methods:
345 pts with CLD [51.1 ±11.9 yr; 193 (55.9%)
female; 104 (30.1%) cirrhotic] completed the 21-item BDI during an office visit
(max score 63). Etiologies of liver disease were: hepatitis C (HCV) 115
(33.3%), NASH/cryptogenic 78 (22.6%), primary sclerosing cholangitis (PSC) 18
(5.2%), primary biliary cirrhosis (PBC) 13 (3.8%), hepatitis B (HBV) 16 (4.6%),
autoimmune hepatitis (AIH) 25 (7.2%), other CLD 52 (15.1%). Prevalence rates of
pts having total BDI ≥16, an accepted cut-off for suspecting major
depressive disorder, and a score ≥10 on the cognitive symptom scale
(cBDI, excludes overlapping somatic symptoms) were determined per CLD group.
Predictors of total BDI score were determined from a linear regression model
that included demographic (age, sex, BMI), clinical [type 2 diabetes (T2DM),
prednisone use, interferon use, IV drug use (IVDU), current alcohol use], and
liver disease variables (MELD score, encephalopathy, AST).
Results:
BDI scores ≥16 were found in 37.4% of the
total subject group, ranging from 25.0 – 42.6 % without significant difference
across the represented disorders (HCV 42.6%, NASH 34.6%, PSC 38.9%, PBC 38.5%,
HBV 25.0%, AIH 40.0%, other 29.6%; χ2 = 3.96, p=0.78). cBDI
scores ≥10 were found in 24.6% of CLD, ranging from 12.5 – 27.8% across
disorders (HCV 27.8%, NASH 26.9%, PSC 27.8%, PBC 23.1%, HBV 12.5%, AIH 16.0%,
other 24.1%; χ2=3.65, p=0.81). In regression models of all CLD subjects,
younger age, female sex, T2DM, and IVDU predicted higher total BDI and higher
cBDI scores (p<0.05 for each). Liver disease variables were not independent
predictors of BDI scores in either model.
Conclusions:
High levels of current depression symptoms are
present in a large proportion of out-patients with CLD. This finding is not related
solely to CLD symptoms that might mimic depression and is not conspicuously
affected by type of CLD. Depression symptoms are best predicted by clinical
features associated with depression in non-CLD populations (female sex, T2DM,
IVDU) rather than type of liver disease or measures of liver disease severity.
HCV:Pathogenesis/Virology/Diagnosis and Natural History
M1842.
Transient elastography in chronic hepatitis B and C predicts severe fibrosis
similarly.
C. Verveer; H. R. van Buuren; P. E. Zondervan; B. E. Hansen; H.
Janssen; R. J. de Knegt
Background:
Assessment of liver fibrosis is important in chronic liver
diseases. In chronic hepatitis B and C it helps to determine prognosis and
indication for therapy. Transient elastography is a novel method for
measurement of liver fibrosis. In contrast with the liver biopsy it is
comfortable and without any risk.
The Fibroscan® has been validated in large cohorts of
hepatitis C patients, but its use in hepatitis B patients is still
undetermined. We investigated whether reliability of the Fibroscan® in viral
hepatitis B and C are comparable.
Methods:
All consecutive patients undergoing a liver biopsy had an
additional Fibroscan®-measurement. Correlation between liver histology
(Metavir) and the outcome of liver elasticity (Fibroscan®, kPa) was determined.
In this cohort we studied the outcomes between both groups of elasticity
measurements and liver fibrosis stages in order to investigate comparability.
Results:
Among 68 hepatitis B patients 7 had Metavir F0, 25 F1, 21 F2,
9 F3 and 6 F4; corresponding elasticity was (mean:) F0 5.36 kPa, F1 7.69 kPa, F2 9.15 kPa, F3 13.41 kPa and F4 17.05
kPa. Among 73 hepatitis C patients 3 had Metavir F0, 31 F1, 23 F2, 13 F3
and 3 F4; corresponding elasticity was (mean): F0 3.40 kPa, F1 6.48 kPa, F2
7.82 kPa, F3 12.86 kPa and F4 13.73 kPa.
To determine the predictive value of the elasticity
corresponding to severe fibrosis logistic regression was performed. Graphs for
HBV and HCV were not significant different indicating comparable elasticity
measurements for predicting fibrosis in HBV or HCV.
Conclusion:
The Fibroscan® is applicable in both chronic hepatitis B and
C with a similar predictive value for liver fibrosis.
Clinical Portal Hypertension Poster
Session
M. Jang; J. Jang; H.
Kim; H. Kim; W. Shin; J. Lee; K. Kim; J. Park; J. Lee; H. Kim
Background/Objective:
Endoscopic injection sclerotherapy (EIS) with cyanoacrylate has been used in conditions with both cardiac (GOV1) and fundal (GOV2/IGV1) variceal bleeding of gastric varices. However, cardiac varices are very different from fundal varices both hemodynamically and pathophysiologically. Therefore, therapeutic strategies should be individualized. This pilot study was aimed to evaluate the efficacy of endoscopic band ligation (EBL) in active cardiac variceal bleeding, not fundal variceal bleeding.
Methods:
We consecutively enrolled a total of 23 patients with liver cirrhosis presenting with active cardiac variceal bleeding. They were treated by EBL (6/19, EBL group) or EIS (13/19, EIS group). Remained 4 patients could not undergo therapeutic procedures because of sudden cardiac collapse by massive bleeding. GOV1 was defined as the varices within 2-5cm of gastroesophageal junction.
Results:
Total patients were 95% of male and 52 (36-72) years old in median (range). The causes of liver cirrhosis were alcoholic (62%), HBV-associated (30%), HCV-associated (4%) and cryptogenic (4%), respectively. The patients had experienced early rebleeding (within 48 hours) in 17% (1/6) of the EBL group and 23% (3/13) of the EIS group (P=NS), and late rebleeding(within 6 months) in 17% (1/6) and 46% (6/13) in each group (P=NS). Rebleeding-free survival was not significantly different between EBL group and EIS group (165 days (1-450) vs. 90 days (1-870), P=0.39 on Kaplan-Meier curve). Mortality by cardiac variceal bleeding was not significantly different between 2 groups (17% vs. 8%, P=NS).
Conclusions:
EBL may not be inferior to EIS in controlling an active cardiac variceal bleeding in this pilot study. Therefore, it will be warranted to perform the larger-scale study to reevaluate the role of EBL in active cardiac variceal bleeding, not fundal variceal bleeding.