Reversible autonomic dysfunction during antiviral treatment in patients with chronic hepatitis C virus infection

The first clinical sign of chronic hepatitis C virus [HCV] infection can be one of the various extrahepatic manifestations. During antiviral treatment, symptoms of HCV-associated neuropathies usually improve, but can also worsen and lead to discontinuation of anti-HCV therapy. Recently, we have reported autonomic dysfunction in patients with HCV infection. In the present prospective study, we analyzed the changes of autonomic function during anti-HCV treatment. Cardiovagal autonomic function was assessed in 22 HCV RNA-positive, treatment-naive patients by determining heart rate variability [HRV] and baroreflex sensitivity [BRS], at the beginning of treatment and 12, 24 and 48 weeks of antiviral therapy. interferon alfa-2 and ribavirin were given according to the guidelines. Both HRV and BRS time and frequency domain indices decreased after 12 weeks of therapy compared to the pre-treatment values; then the mean +/- SD values increased significantly by week 24 and continued to improve by week 48 of therapy-253.0 +/- 156.1 ms before therapy vs 111.6 +/- 81.9 at week 12, and 183.4 +/- 169.6 at week 24 vs 211.6 +/- 149.1 ms at week 48 for low-frequency HRV index; p<0.05 for all comparisons]. These changes were independent from the presence of cryoglobulins and from virologic response. The first rise followed by reversible autonomic dysfunction during antiviral therapy may be caused by the immunomodulatory actions of interferon alfa-2

Does Body Mass Index associate with the endoscopic severity of gastroesophageal reflux disease?

To evaluate the association between body mass index [BMI] and gastroesophageal reflux disease [GERD] severity in the group of patients frequently suffering from moderate severe gastroesophageal reflux symptoms, one hundred and fifty eight previously untreated patients underwent upper pan-endoscopy as indicated by typical moderate severe reflux symptoms, occurring three or more times per week. Patients' BMI values were tabulated and compared to the severity of endoscopic findings [according to Savary-Millerimodified by Siewert]. Association between reflux disease activity and BMI was analyzed by Kruskall-Wallis test, while mild and severe group were compared using Mann Whitney test. Analyzing the whole group, including the patients who had no endoscopically verified erosions [Savary-Miller 0 stage = non erosive reflux disease/NERD] association was found at the level of perceivable statistical significance [p=0.0501]. However subdividing the examined population into mild [Savary-Miller 0- 1 stage] and severc [Savary-Miller 2-4 stage] groups according to the endoscopically verified mucosal lesions of the esophagus, there was a strong significant relationship between severity of GERD and BMI [p=0.0056]. In the group of patients with moderate and severe GERD symptoms elevation of BMI can be a risk factor of increased severity of GERD particularly in those who already have erosive mucosal, lesions at the time of examination