Assessment of serum hyaluronic acid and N-acetylglucosamine levels in chronic hepatitis C patients

Knowledge of the stage of liver fibrosis is essential for prognosis and decisions on antiviral treatment. Liver biopsy is currently the gold standard in assessing the liver histology. There is an increasing desire for non-invasive tests to assess the stage of liver fibrosis or cirrhosis. Serum hyaluronic acid [SHA] and N-acetylglucosamine [NAG] could be a hope for clinicians to diagnose or exclude fibrosis and cirrhosis. Therefore, the present study was done to assess SHA and NAG levels in chronic hepatitis C [CHC] patients and to determine the cut off values of these markers to predict fibrosis or cirrhosis. The present study was conducted on 89 subjects [20 controls and 69 CHC patients]. The HCV infection was diagnosed based on positive HCV antibodies and positive HCV-RNA. Percutaneous-ultrasoundassisted liver biopsies were done for all patients and assessed by the METAVIR scoring system. According to the results of the liver biopsy, the patients were classified into 3 groups. Group I included 15 patients without fibrosis [F0]. Group II included 35 patients with significant fibrosis [F1-F3]. Group III included 19 patients with cirrhosis [F4]. SHA levels were determined using enzyme-linked binding protein assay Kits and NAG levels were assayed by reverse phase-high performance liquid chromatography [RP-HPLC]. There were highly significant elevations of SHA and NAG in patient group when compared to the control group. Moreover levels of SHA and NAG increase with the extent of fibrosis. SHA with cut off value of less than 25 ng/ml was used to exclude fibrosis or cirrhosis with a sensitivity of 68% and specificity of 58%. SHA with cut off value of more than 200 ng/ml was used to detect significant fibrosis with sensitivity of 93% and specificity of 95%. SHA with cut off value of more than 350 ng/ml was used to detect cirrhosis with sensitivity of 92% and specificity of 100%. NAG with cut off value of less than 25 ng/ml was used to exclude fibrosis or cirrhosis with sensitivity of 60%, specificity of 55%. NAG with cut off value of more than 40 ng/ml was used to detect significant fibrosis with sensitivity of 90% and specificity of 92%. NAG with cut off value of more than 55 ng/ml was used to detect cirrhosis with sensitivity of 90% and specificity of 86%. SHA and NAG were correlated negatively with serum albumin, prothrombin concentrations and platelet count and positively with the degree of fibrosis. Serum hyaluronic acid and N-acetylglucosamine are highly valuable and informative in detection of significant fibrosis and cirrhosis while they are of limited value in exclusion of minimal fibrosis

Three endoscopic modalities in the emergency treatment of bleeding gastric varices

Bleeding gastric varices [GV] in portal hypertensive patients is usually massive with high mortality rate. The role of endoscopy in its management is still controversial and to date there is no consensus on the ideal endoscopic treatment modality. The aim of this prospective nonrandomized trial is to evaluate 3 endoscopic modalities \\\\\\\\\\\\\\\{injection of ethanolamine oleate [EO], band ligation BL] and cyanoacrylate [CA] injection] in the management of bleeding GV. Eighty-six patients with first and recent bleeding GV underwent 3 endoscopic treatment modalities: 1-endoscopic sclerotherapy[EOI injection for gastroesophageal varices-l[GOV1]: comprised 25 patients, 20 males and 5females with age ranged between 27 and 67 years, 2- endoscopic band ligation IBL] for gastroesophageal varices -2[GOV2], comprised 22 patients, 17 males and 5 females, with age ranged between 26 and 65 years, and 3- endoscopic obturation therapy of isolated gastric varices [IGV] using cyanoacrylate [CA][Histoacryl], comprised 39 patients, 33 males and 6 females, with age ranged between 29 and 68 years. Patients were followed -up for 1 week and monitored for control of acute attack, re bleeding, complications and mortality. The 3 groups of patients were comparable at trial entry in age, sex, etiology of portal hypertension, severity of the underlying hepatic disease, and initial endoscopic data The rate of initial hemostasis was 84.6%, 91.7%, 95.4% in EO group, BL group and CA group patients respectively [NS]. The rebleeding rate was 11.6% in all patients, of them, 20% of EO group, 13.6% of BL group and 5.1% of CA group [NS]. The overall incidence of complication did not differ significantly among the 3 groups. Hospital mortality was recorded in 10 patients [1 1.6%], of them, 12% of EO group, 13.6% of BL group and 10.2% of CA group [NS]. Six deaths were related to variceal bleeding. In conclusion: our data suggest that EO injection, BL and CA injection are efficacious endoscopic modalities for management of bleeding GOVI, GOV2 and IGV respectively