Thyroid dysfunction and long-term outcome during and after interferon-alpha therapy in patients with chronic hepatitis C

<p><b>INTRODUCTION</b>Thyroid dysfunction (TD) is a well-established adverse effect in chronic hepatitis C virus (HCV)-infected patients, treated with interferon-alpha (IFN-α), with or without ribavirin. However, the long-term outcome is not well-studied. The purpose of this study was to estimate the prevalence and long-term outcome of TD after HCV-therapy.</p><p><b>MATERIALS AND METHODS</b>Retrospective analysis of 109 HCV-treated patients (for 6 to 12 months, according to HCV genotype), for the period 1996 to 2008. Thyroid function tests were performed every 3 months during therapy and after discontinuation (3 months to 12 years). Routine laboratory tests and virological assessment were performed according to generally accepted practice.</p><p><b>RESULTS</b>TD was observed in 26 patients (23.85%). The positive and negative predictive value for thyroid autoantibodies (ATA) was 80% and 72.7%, respectively. Relative risk for those with positive ATA was 2.9 (95% CI: 1.6 to 5.3, P = 0.014). The median duration of TD was 12.0 months (min: 3; max: 132). The median follow-up period for the patients with TD was 25.5 months (min: 12; max: 144). Finally, 15 patients developed permanent TD (57.69%), compared to 11 with temporary TD (42.31%). Sex is a risk factor for TD, as there were more females than males affected (P = 0.011). Genotype, viral load, time of HCV-exposure prior to therapy, and virological response did not differ between patients with and without TD.</p><p><b>CONCLUSION</b>TD among HCV-treated patients was more frequent than usually reported, with >50% developing permanent TD. ATA status may play a role in estimating the risk of subsequent TD. Women appear to be more vulnerable to TD than men.</p>

Diagnostic yield and clinical impact of capsule endoscopy in obscure gastrointestinal bleeding during routine clinical practice: a single-center experience

This study assessed the diagnostic yield of capsule endoscopy [CE] and its impact on patients with obscure gastrointestinal bleeding [OGIB]. Between May 2007 and May 2009, 63 patients with OGIB [overt bleeding: 25, and occult blood loss with chronic ferropenic anemia: 38] and normal upper and lower endoscopy were studied by CE. Demographic characteristics, prior diagnostic tests, CE findings, therapeutic interventions, medical treatment and clinical outcomes following CE were evaluated. The overall diagnostic yield was 44.44% of patients and included findings of angiectasia in 11 [17.46%] patients, nonsteroidal anti-inflammatory drugs enteropathy in 6 [9.52%] patients, celiac disease in 3 [4.76%] patients, tumors in 2 [3.17%] patients, and a variety of other diagnoses ranging from varices to ulcers [due to congenital afibrinogenemia and amyloidosis]. The diagnostic yield was notably higher in overt bleeders [15/25, 60%] compared to occult bleeders [13/38, 34.21%; p = 0.044], and in patients with overt bleeding who had CE within the first 10 days [14/16, 87.5%] after the bleeding episode in comparison to overt bleeders who underwent CE >10 days after the bleeding episode [2/16, 11.1%; p < 0.0001]. During follow-up [11.8 +/- 7 months], CE findings led to specific therapy that resolved the underlying disease or improved the clinical condition in 45 of 63 patients, thus having a positive clinical impact of 71.43%. CE has a high diagnostic yield and a positive influence on clinical management in a significant proportion of patients with OGIB. These data further support the role of CE in routine clinical practice

Eradication therapy in helicobacter pylori-positive patients with halitosis: Long-term outcome

The aim of this study was to investigate the incidence and long-term outcome of halitosis before and after eradication therapy in patients with functional dyspepsia and Helicobacter pylori infection. Halitosis and dyspepsia-related symptoms were investigated by way of a questionnaire. Only patients with functional dyspepsia, H. pylori infection and no histological evidence of atrophy were included in the study. A total of 18 patients fulfilled these criteria and completed the study. Four to six weeks after the end of eradication treatment, endoscopy or [13C] breath test was performed to check for H. pylori in the gastric mucosa. Halitosis and dyspeptic symptoms were re-evaluated during and at the end of follow-up. H. pylori infection was eradicated in all patients, in the 14/18 patients [77.8%] with triple drug therapy, and the 4/18 patients [22.2%] with quadruple drug therapy. During the follow-up period [mean 55.8 +/- 21.3 months [range 6-108 months]] resolution of halitosis was observed in 16/18 patients [88.9%], while 2 patients [11.1%] [p < 0.001] continued to present with halitosis. Also, eradication therapy resulted in statistically significant relief of all dyspeptic symptoms, except bloating. Eradication of H. pylori in patients with functional dyspepsia and halitosis results in sustained resolution of halitosis during long-term follow-up in the majority of cases. This finding supports the existence of a link between H. pylori infection and halitosis and suggests that H. pylori eradication might be considered in patients with halitosis