Characterization of hepatitis b among incidentally detected asymptomatic hepatitis b surface antigen [HBSAG] positive subjects in Egypt

Background: Although chronic hepatitis B virus infections are common in Egypt, the incidentally discovered asymptomatic forms are very frequent. Their serological profile and clinical significance have not been determined

Aim: to characterize the clinical, serological and histological liver damage among incidentally detected asymptomatic hepatitis B surface antigen [HBsAg]-positive subjects [IDAHS] in Egypt

Methods: we prospectively studied 70 consecutive IDAHS patients who were long term HBsAg carriers. Tests for liver function, serological markers for HBV, HCV, HDV and schistosomiasis were done for all patients. HBV DNA was determined by the branched DNA technique and PCR at the core promotor/precore region and the S region. Liver biopsy specimens from 44 patients were studied and scored for activity and fibrosis stage by modified Knodell score and the METAVIR score. HBsAg and HBcAg were immunohistochemically evaluated in the liver tissue

Results: of the studied 70 patients, 57 [81.6%] were HBeAg negative and 13 [18.4%] were HBeAg positive. There was statistically significantly elevated hepatic transaminases in HBeAg-positive patients when compared to HBeAg-negative patients. HBV DNA was detected in only 3% of patients by the b-DNA technique and in 97% by the PCR techniques. Coinfection with HDV was found in 4.2% of patients. Pathological examination of liver tissue revealed mild activity in 21 [47.7%] of patients. Also, 21 patients [47.7%] revealed mild to moderate expansion of portal areas while 7 patients [15.9%] showed bridging fibrosis and no patient was cirrhotic

Conclusion: among 1DAHS sub jects, the majority are HBeAg negative without elevation of hepatic transaminases. They should be considered patients since viremia is detected in almost all cases using PCR technique, and histopathological evidence of chronic hepatitis B virus infection and liver damage is noted in varying degrees

Response to ribavirin in patients with chronic hepatitis c and its relation to HCV genotyping, schistosomiasis and disease severity

The association of HCV infection and schistosomiasis is prevalent in Egypt, however its impact on the outcome of therapy for chronic hepatitis C is unclear. Patients and Seventeen patients with biopsy proven chronic hepatitis C. HCV-PCR+ve [5 of them have active cirrhosis] were treated with ribavirin 15 mg/kg/day for 6 months. Histological Activity Index [HAI] and, HCV genotyping, serum IgG for schistosomiasis were done for all the patients 9/17 patients [53%] were genotype 4 and 8/17 [47%] were mixed genotype 2+4 Ribavirin was well tolerated. with minor side effects which were completely reversible. Mean ALT and AST levels were significantly lower than pre-treatment Levels [P<0.01]. complete response [normalization] was observed in 5/17 patients [29.5%] and partial response [50% reduction of ALT] in 8/1 7patients [47%], no response [no substantial changes in ALT] in 4/17 patients [23.5%]. HCV/PCR was negative in 5/17 patients [29.5%] two of them have active cirrhosis, After treatment cessation, HCV PCR becomes positive again and serum ALT returns to pretreatment. levels in all patients. The response to ribavarin was correlated with the presence of schistosomiasis [in 76.5% of patients] but not with the disease severity as graded by knodell s classification where total score of HAI was 12-18 in all patients with no significant differrence between responders and non-responders. Also there was no correlation between the determined genotypes and the response to Ribavarin treatment. Ribavirin is a relatively safe oral drug that could be used for treatment of chronic hepatitis C even in the presence of cirrhosis. But its antiviral effect is not sustained after the end of treatment. The outcome of therapy of chronic hepatitis C could be affected at least partially-by the co-existence of schistosomiasis

Is esophageal band ligation superior to injection sclerotherapy of varices

Although endoscopic injection sclerotherapy is widely used to treat bleeding oesophageal varices effectively, it has several complications. Endoscopic band ligation of the varices claimed to be more safe and effective. The aim in this study was to assess that effcacy and safty of EVL [endoscopic variceal ligation] and compare the results withthoes of EIS [endoscopic injection sclerotherapy]. Compared 42 patients in EVL group to 43 patients in EIS group with follow up more than 6 months, active bleeding which was present in 0.5% in EVL group was successfully controlled in 88.2% compared to 78.9% controll in EIS groupwhere the active bleeding was 44.2%. Also the incidence of re-bleeding, oblitration of the varices and complications were statistically non-significant. We concluded that both techniques were effective without big advantage of one over the other, but everyone has preferable situations. Combination of both techniques may be better than either one alone

Octreotide infusion plus emergency sclerotherapy versus sclerotherapy alone for the control of bleeding oesophageal varices: a prospective randomized clinical trial

In a prospective trial, 189 patients with acute variceal bleeding were underwent emergency sclerotherapy of them, 93 patients were randomly assigned to receive a continuous infusion of octreotide [25 microgram per hour] for 5 days [group II]. The rest of patients [96 patients] treated with only sclerotherapy [group I]. After 7 days of follow up, the proportion of patients who had survived without re-bleeding was higher in group II patients who treated with both urgently sclerotherapy and octreotide [89 of 93 patients or 95.7%] than in patients treated with emergency sclerotherapy alone [group I]. The mean number of units of blood transfused was lower in group II than in group I. Also, bleeding was controlled rapidly in group II [2.26 +/- 0.8 days] versus group II [2.84 +/- 0.84 days]

Prevalence of hepatitis C in patients with bleeding oesophageal varices: clinical significance and impact on the outcome of sclerotherapy

The aim of the work was to find out the prevalence of hepatitis C in patients with bleeding varices and its clinical significance. 200 patients with bleeding esophageal varices were included. Viral markers for hepatitis B and for hepatitis C were done by ELISA and confirmed by RIBA test for all patients with Anti-HCV positive ELISA. Endoscopic sclerotherapy is done for all patients every week until complete eradication then every 3 months for one year. The prevalence of anti-HCV was 55% and HBsAg 8%, both viruses 5.5%. There was a significant number of patients positive to hepatitis markers categorized under child B and C than in patients negative to hepatitis markers. Moreover, most patients positive to both markers were child B and C mainly. Re-bleeding from esophageal varices was more in patients positive to viral markers when compared to negative patients. Patients with both viruses had the highest rate of re-bleeding

DR polymorphism in chronic active hepatitis C

The aims of this study were to evaluate the association between DR antigens and chronic active hepatitis patients [CAH] and to seek correlations between these antigens and chronicity, disease severity and auto- antibodies in this condition. The frequency of different HLA-DRB I alleles was studied in 30 patient with chronic active hepatitis C [CAH] and 15 cross-matched control group. Both groups were subjected to HLA-DRBI typing using reversed hybridization technique, detection of Sjogren Syndrome Antibody RNA-A [SSA] and Sjogren syndrome antibody RNA-B [SSB] antibodies and detection of ANA, ASMA and AMA antibodies by immunofluorescent technique. Results showed that chronic hepatitis C may be genetically determined as DR3 is significantly higher in patients as compared to controls and DR5, DR2 and DR52 may be protective genes being more frequent in controls. The presence of auto-antibodies with HCV infection may also be genetically determined as it is associated with certain DR alleles. Certain auto-antibodies SSA and ANA are associated with disease severity being more common in patients with chronic active hepatitis C associated with cirrhotic changes

Value of sclerotherapy of bleeding oesophageal varices on the portal blood flow

It is well known nowadays that injection sclerotherapy of esophageal varices is the best method for controlling the life-threatening hemorrhage due to its rupture, and for the prevention of re-bleeding. There are many controversies regarding the effect of esophageal sclerotherapy on the portal blood flow. In the 16 patients using pulsed colored Doppler sonographic examination before starting esophageal sclerotherapy and after complete eradication of esophageal varices, it is found that portal blood flow was increased in 15 patients and decreased in 1 patient [which may be due to partial portal vein thrombosis, which were existed before sclerotherapy]. The mean increase in portal blood flow was about 26%. So, endoscopic sclerotherapy increases the blood flow, preserves the hepatopetal direction of the blood and portal vein thrombosis related to this type of therapy could not be detected

Serum pepsinogen in ulcer and non ulcer lesions

This study comprised 60 patients with ulcer and non ulcer lesions and 20 persons as a control group, with age ranging from 16-66 years. Three biopsies were taken from stomach, antrum and duodenum for pathological studies and radio- immunoassay detection of serum pepsinogens level. The results of this study showed increased level of serum PGI and high PGI/PGII ratio in cases with duodenal ulcers and duodenitis than those of control group, gastric ulcer patients and patients with gastritis. Also we found that elevated serum level of PGII with decreased PGI/PGII ratio in cases of gastric ulcer and patients with gastritis than those of control group, duodenal ulcer patients, patients with non ulcer lesions as patients with duodenitis and gastro duodenitis. Radio immunoassay of serum pepsinogens I and II are considered as a good markers for detection of early gastro duodenal lesions and they are markedly changed in established cases with duodenal or gastric ulcers

Duodenal varices and its treatment by endoscopic sclerotherapy

This study comprised 8 patients with different stages of hepatosplenic schistosomiasis presented with haematemesis and melena or melena alone, proved by endoscopic examination to have bleeding duodenal varices Because of the critical condition of the patient, injection sclerotherapy was tried and the results were very successful as no further bleeding occurred and by follow up endoscopy, the varices completely disappeared. In three cases superficial ulcerations were noticed but completely healed on follow up after one month treatment by sucralfate 4 gm/day