Endoscopic ultrasonography in patients with chronic liver disease: a case control study

The portal system and azygos vein are the main drainage systems during portal hypertension. This study aims to compare the diameter of these veins by endoscopic ultrasonography [EUS] in patients with and without chronic liver disease [CLD]. During one year, patients with CLD enrolled as the study group. Patients who underwent EUS for other reasons during the same period served as controls. In cases with CLD, we assessed the relationship between degrees of hepatic dysfunction [Child-Pugh class], history of variceal bleeding, presence of hyponatremia, thrombocytopenia, and endoscopic grading of varices with the sizes of the portal, splenic, and azygos veins on EUS. During the study period, there were 63 patients [20 females and 43 males] with CLD and 85 control subjects [42 females and 43 males] enrolled. The mean ages of cases was 45.60 +/- 14 years and controls was 48.5 +/- 15 years. The most common cause of CLD was post-necrotic cirrhosis due to hepatitis B virus. Patients with CLD had significantly higher mean portal, splenic, and azygos vein diameters than the control group [p < 0.001]. With azygos, portal, and splenic vein diameters of 10, 11 and 9 mm, sensitivity for the diagnosis of portal hypertension was 66%, 71%, and 66%, while specificity was 94%, 99% and 99%, respectively. Splenic and portal vein dilation, and thrombocytopenia significantly correlated with variceal bleeding [p < 0.05]. EUS allows for the collection of valuable quantitative data from the portal system, the diagnosis of portal hypertension, and follow up of patients with CLD

Methotrexate hepatotoxicity in patients with rheumatoid arthritis

Increases in aminotransferases [transaminitis] are potential major adverse reactions seen with long-term use of methotrexate [MTX]. The aim of this study, therefore was to evaluate the incidence of MTX induced hepatotoxicity and its risk factors among rheumatoid arthritis [RA] patients. This retrospective study described 286 patients with RA who received >/= 7.5 mg MTX weekly in an academic rheumatology clinic over a 15 year period. The results of serial liver function tests, concurrent MTX dose, cumulative dose and use of hepatotoxic drugs were collected and statistically analyzed according to a consecutive elevation in aminotransferases which occurred over at least a two week interval. During the study period, 286 patients [84.4% female] with mean age of 46.6 +/- 12.7 years [18-84 years] were enrolled. Transaminitis occurred among 23.7% of patients [incidence: 6.9 per 100 person-years] during 40.5 +/- 34.6 month's exposure to MTX [989.6 person-years]. The time difference between onset of therapy and occurrence of transaminitis was 22.1 +/- 22.0 months. The only significant factor related to the occurrence of transaminitis was the duration of MTX therapy. The average duration of treatment among patients with transaminitis [59.6 +/- 42.3 months] was greater than those with no transaminitis [p<0.001]. The cumulative dose of MTX was significantly related to the occurrence of transaminitis [p<0.001]. MTX hepatotoxicity is a common complication of long-term treatment with MTX. It is associated with mild liver enzyme elevation and related to the duration of therapy