Histological features of chronic hepatitis c with persistently normal serum ALT level

Approximately one third of patients with chronic hepatitis C [CHC] injection have normal alanine transaminases [ALT] levels, definition and Meal significance of persistently normal ALT in CHC have been revised. Liver biopsy is usually the most accurate test for assessing the severity of liver disease. To evaluate the liver histological feature of patients suffering from CHC with persistently normal ALT levels. In this study 50 patients with CHC with persistently normal ALT since last six months who enrolled for the antiviral treatment and subjected to liver biopsy for assessing the severity of liver disease. Histological results were scored using the METAVIR system. Mean age of these patients was 40.1 +/- 9.3 years; out of these 39 [78%] were male. Significant fibrosis [F 2-4] in 19 patients [38%] and insignificant fibrosis [stage 0-1] 62%. Cirrhosis [F 4] were present in 6 patients [12%]. The necro-inflammatory changes were grade 1 in 36 [72%] patients and grade 2 in 14 [28%] patients, no patients showed more severe changes. Steatosis were minimal [0-1] in 43 [86%] patients and severe [score 2-3] in 7 patients [14%]. Viral load were weak in 16, [32%] moderte in 27 [54%] and high in 7 [14%] patients, severity of fibrosis were highly correlated to grade of inflammation [P=0.002] and slightly to steals [p=0.048] but no correlated to age, sex, ALT value or viral load. The grade of inflammation were related to age [p=0.011]. Extent of steatosis were not correlated to clinical or laboratory variables. There was no correlation found between the transaminase level and biopsy scores. Approximately 38% of the patients with normal transaminases have fibrosis equal to or greater than stage 2 and 12% have cirrhosis. The grade of inflammation and extent of steatosis is related to the score of fibrosis

effect of proton pump inhibitors on post endoscopic variceal band ligation complications

The study was done to evaluate the effect of proton pump inhibitors on the complications of variceal band ligation [EVL] and ulcer formation. It was conducted on 46 patients with esophageal varices [EV] asking for secondary prevention. Patients were randomly classified into group I of 22 patients received PPI [pantoprazole 40 mg] and group II of 24 patients received Placebo. Band ligation was done to all patients. Patients contacted after one week to assess for complications and adverse reactions. They re-endoscoped after 2 weeks and at that time the size and number of formed ulcer, chest pain and dysphagia all were assessed. EVL has a greater efficacy and fewer side effects for eradication of large EV with decrease in size and extent of varices. Post band ligation ulcer formation is of low incidence and risk. There is no significant difference in the number [13:15] or the size of the formed ulcer [4.8mm:5.6mm] between the two groups. The post band ligation rebleeding were more in group II than group I. Band ligation has no harmful effect on fundal varices or congestive gastropathy. Post band ligation administration of PPI has no significant effect on post band ulcer formation but associated with low risk of rebleeding