ABSTRACT
In this clinical trial, polyethylene glycol [PEG] solution was compared with lactulose in the treatment of hepatic encephalopathy in patients with cirrhosis
Methods: This randomized controlled trial was performed on 40 patients in two groups. The patients in the lactulose group received either 20-30 grams of lactulose orally or by a nasogastric tube, or 200 grams of lactulose enema by a rectal tube. The patients in the PEG-lactulose group received the same amount of oral or rectal lactulose, plus 280 grams of PEG in 4 liters of water orally as a single dose in 30-120 minutes. Serial physical examinations, hepatic encephalopathy scoring algorithm [HESA], blood level of ammonia, and serum biochemical studies were used to evaluate the severity of hepatic encephalopathy
Results: In comparison with lactulose alone, PEG-lactulose could improve HESA score in 24 hours more effectively [p =0.04]. Overall, PEG-lactulose regimen was associated with a decrease in length of hospital stay compared with lactulose treatment [p =0.03] but in subgroup analysis we found that PEG-lactulose regimen could only decrease the length of hospital stay in women significantly [p =0.01]
Conclusion: The use of PEG along with lactulose in comparison with lactulose alone is more effective in the treatment of hepatic encephalopathy in patients with cirrhosis and results in more rapid discharge from hospital
ABSTRACT
Liver fibrosis is a potentially reversible response to hepatic insults, triggered by different chronic diseases most importantly viral hepatitis, alcoholic, and nonalcoholic fatty liver disease. In the course of the chronic liver disease, hepatic fibrogenesis may develop, which is attributed to various types of cells, molecules, and pathways. Activated hepatic stellate cell [HSC], the primary source of extracellular matrix [ECM], is fundamental in pathophysiology of fibrogenesis, and thus is the most attractable target for reversing liver fibrosis. Although, liver biopsy has long been considered as the gold standard for diagnosis and staging of hepatic fibrosis, assessing progression and regression by biopsy is hampered by its limitations. We provide recent views on noninvasive approaches including serum biomarkers and radiologic techniques
ABSTRACT
Patients with bleeding disorders are frequently infected with hepatitis C virus [HCV]. There are few reports on the effect of standard interferon in these patients and no published report on pegylated interferon. The aim of this study was to compare pegylated interferon alpha-2a and standard interferon alpha with ribavirin in patients with bleeding disorders and chronic HCV infection. Consecutive patients referring to a specialized clinic in Tehran were included in the study. The first 37 patients received pegylated interferon [PEGASYS, Hoffmann-La Roche Inc., Basel, Switzerland], 180 microg weekly and the next 38 patients received standard interferon, 3 million units 3 times a week. Both groups also received ribavirin 800 mg daily. Patients were treated for 48 weeks and were followed for 24 weeks. Liver biopsy was not performed due to the potential risks involved in patients with bleeding disorders. 34 patients in each group completed the study. The intention-to-treat sustained viral response was 34% and 62% in the standard interferon and pegylated interferon group, respectively [p=0.02]. Pegylated interferon alpha-2a and ribavirin is almost twice as effective as standard interferon and ribavirin in treating HCV infection in patients with bleeding disorders and is an acceptable treatment option even when histologic data is not available
ABSTRACT
Patients with bleeding disorders are frequently infected with hepatitis C virus [HCV]. There are few reports on the effect of standard interferon in these patients and no published report on pegylated interferon. The aim of this study was to compare pegylated interferon alpha-2a and standard interferon alpha with ribavirin in patients with bleeding disorders and chronic HCV infection. Consecutive patients referring to a specialized clinic in Tehran were included in the study. The first 37 patients received pegylated interferon [PEGASYS, Hoffmann-La Roche Inc., Basel, Switzerland], 180 microg weekly and the next 38 patients received standard interferon, 3 million units 3 times a week. Both groups also received ribavirin 800 mg daily. Patients were treated for 48 weeks and were followed for 24 weeks. Liver biopsy was not performed due to the potential risks involved in patients with bleeding disorders. 34 patients in each group completed the study. The intention-to-treat sustained viral response was 34% and 62% in the standard interferon and pegylated interferon group, respectively [p=0.02]. Pegylated interferon alpha-2a and ribavirin is almost twice as effective as standard interferon and ribavirin in treating HCV infection in patients with bleeding disorders and is an acceptable treatment option even when histologic data is not available