Prevalence of hepatic steatosis in Egyptian patients with chronic hepatitis C [CHC] virus infection and histopathological correlation

Hepatic steatosis is a histological characteristic in patients with chronic hepatitis C [CHC] virus infection. It has been proposed that hepatic steatosis is a cytopathic effect of hepatitis C virus genotype 3a, but not other genotypes. Several studies have demonstrated that more than 90% of [CHC] patients in Egypt are infected with genotype 4. To our knowledge there is no enough data about the prevalence of steatosis in genotype 4. The aim of study was to evaluate the prevalence of hepatic steatosis in Egyptian patient with [CHC] genotype 4 and looking for possible correlation with various biochemical and histopathological variables. This study was carried out on 153 patients, with proved chronic hepatitis C [CHC] [positive HCV antibody and HCV RNA], the patients were excluded if they have concomitant hepatitis B infection, liver cell failure, severe renal, heart disease or history of alcohol abuse. Biochemical and histopathological findings were compared between patients with and without hepatic steatosis. Steatosis was found in 73 patients [47.7%], 40 of them [54.8%] had mild steatosis, 21 [28.8%] and 12 [16.4%] had moderate and severe steatosis respectively. No significant differences in level of total serum bilirubin, level of ALT, AST and serum albumin were found among patients with hepatic steatosis and patients without. Histopathological study showed that patients with hepatic steatosis had higher mean fibrotic score and higher mean necroinflammation grading than patients without hepatic steatosis [3.33 +/- 1.49 Vs 2.92 +/- 1.84], [6.96 +/- 2.26 Vs 6.04 +/- 2.64] but with no statistically significant difference. There was no significant statistical differences in the mean age, level of ALT, AST, Serum bilirubin and S. albumin with the increase of grade of steatosis. Steatosis is a feature of CHC Genotype 4 in almost 50% of patients and half of them had moderate to severe steatosis, no significant correlation were found between steatosis and necroinflammatory changes or the meanfibrotic score although steatosis was associated with higher mean necroinflammation score and high mean fibrotic score but without significant statistical difference

Portal hypertensive gastropathy [PHG]: clinical, endoscopoc, and portal haemodynamic assessment

Portal hypertensive gastropathy [PHG] is an important complication of both generalized and segmental portal hypertension. The pathophysiology of PHG is still unclear. The aim of this study was to detect the prevalance of PIEIG and factors influencing its development. This study was conducted on 82 patients with portal hypertension. They were divided into 2 groups: Group I [non-bleeders] comprised 31 patients, serves as a control group. Group II [bleeders] comprised 51 patients and were subdivided into: Group IIa 28 patients who were followed up by endoscopic sclerotherapy [[EST] and Group IIb: 23 patients who were followed up by endoscopic band ligation [EBL]. Endoscopy was repeated every 2 weeks till variceal obliteration. All patients were subjected to thorough history taking, clinical examination, laboratory investigations and Doppler ultrasonographic evaluation. In this study the prevalance of PHG was 756%, with no age or sex difference, with increased frequency and severity in patients with child-pugh class B than in patients with class A and C but without statistically significant difference. Again the prevalance of PHG was higher in patients with post-hepatitic cirrhosis than in patients with mixed cirrhosis and patients with pure bilharzial fibrosis but without statistically significant difference. The prevalance and severity of PI-IG was in the presence of esophageal varices, large variceal size, and presence of red signs, while the prevalance and severity was decreased in the presence of gastric varices; however, there were no statistically significant difference. The prevalance and severity of PHG were collectively after endoscopic managment especially with EBL without statistically significant difference. PHG was associated with insignificantly increased portal cross-sectional area, congestion index and portal blood flow. Also, it was associated with decreased portal maximum and mean velocities but the difference was statistically insignificant. We concluded that PHG is quite frequent in patients with cirrhosis, however, the factors studied are not good predictors for its presence