Low dose ribavirin has been effective in the treatment of incapacitating muco-cutaneous extrahepatic manifestations in patients with hepatitis C with contraindication or no access for approved antiviral treatment

Background and study aims: Chronic hepatitis C virus [HCV] is a major public health problem and represents a common cause of chronic liver disease worldwide. The Egyptian Demographic Health Survey [EDHS] has estimated HCV prevalence in Egypt to be 14.7%. HCV can affect multiple organ systems and cause a variety of extrahepatic manifestations. Most of extrahepatic manifestations affect the skin and mucous membranes; such as lichen planus [LP], psoriasis, and leucocytoclastic vasculitis. The treatment of extrahepatic manifestations has been disappointing in patients not indicated for interferon with no access for the new costly all oral treatments

Patients and methods: In 2014, thirty Egyptian patients with incapacitating mucocutaneous extrahepatic manifestations due to chronic HCV infection, not indicated for interferon, have been randomised into two groups; group I treated with ribavirin [5-10 mg/kg daily divided into 2 doses], and group II treated with local steroids for 3 months. Patients were followed up for 3 months. Dermatology life quality index score has been measured before and after treatment for all patients

Results: A significant improvement of mucocutaneous lesions has been accomplished in group I in comparison to group II [p < 0.01]. All lesions in group I showed a significant improvement except psoriasis [p > 0.05]. A significant improvement of dermatology life quality index score has been found in patients in group I when compared to group II [p < 0.05]

Conclusion: We conclude that low dose ribavirin was effective in the treatment of incapacitating mucocutaneous extrahepatic manifestations of chronic HCV infection in patients with contraindication or no access to the approved antiviral treatments

Gastroenterologists and interventional radiologists: friends or foes? A multidisciplinary approach for solving gastrointestinal problems

While endoscopy used to have more therapeutic abilities than radiology, interventional radiology is now racing to lead the minimally invasive diagnostic and therapeutic techniques in medicine as well as surgery. Expecting the new epidemic of hepatocellular carcinoma, radiologists and gastroenterologists are on the run competing in many procedures that are needed. While some radiologists worry about non-radiologists who "intervene" in radiology, many gastroenterologists defend their specialty. Both gastroenterologists and radiologists are invited to collaborate in diagnosing and treating many diseases.Treatment of upper gastrointestinal bleeds should be multidisciplinary involving a team of gastroenterologists, radiologists and surgeons. The role of the interventional radiologist and surgeon arises only after the failure of the endoscopic treatment. Transjugular intrahepatic portosystemic shunt [TIPS] is the preferred treatment for variceal bleeding after failed endoscopy. As the entire field of gastroenterology continues towards less invasive, safer and more effective means of diagnosing and treating diseases, digestive endoscopy will continue to expand the ways in which this unique and minimally invasive technology can be applied to the benefit of patients. In line with this trend, there will be a decline in simple diagnostic standard endoscopies. Development of new techniques, such as CT colonography and capsule endoscopy will actually increase the demand for digestive endoscopy. The trend of future digestive endoscopy will continue to move from diagnostic to therapeutic modalities. Future gastroenterologists will be trained and expected to become micro-surgeons of the gastrointestinal tract working in multispecialty teams along with their colleagues: surgeons and radiologists

Long-term outcome of angiographic partial splenectomy in patients with decompensated liver cirrhosis and hypersplenism

Hypersplensim is one of the serious complications of splenomegaly complicating liver cirrhosis. Although partial splenic embolization has been proposed in patients with cirrhosis and thrombocytopenia, there are limited data on long-term outcome. The aim of our study was prospective evaluation of the long-term effects of angiographic partial splenectomy [APS] using polyvinyl alcohol [PVA] or gelfoam particles in patients with decompensated liver cirrhosis and hypersplenism. This study was done at Radiology and Tropical Medicine of Tanta University hospitals. Sixty patients were randomly assigned to two equal groups, PVA group, and gelfoam group. Control group included 18 patients, who refused invasive procedures and treated conservatively. Informed consent was obtained from every patient. All groups were matched as regards age, sex, Child class, presence of oesophageal varices and complete blood count findings. APS was successfully performed in all 60 patients. Post-embolization syndrome was the most frequent side effect in both test groups while the need for repeated transfusions was significantly higher in the control group. No significant difference in mortality for all groups was detected. Variceal bleeding was significantly more in the control group. The procedure related complications were comparable in both test groups. All blood indices have significantly improved in the gelfoam group than those in the PVA group [p<0.05]. APS is effective and has a favourable long-term outcome in the treatment of hypersplenism in Egyptian patients with decompensated post-hepatitis C cirrhosis. APS decreased the need for repeated transfusions. Both types of embolizing particles [PVA and gelfoam] were comparable as regards efficacy and post-procedure complications. APS may decrease the rate of variceal bleeding and future studies are needed to clarity its effects on portal hypertension

study of duodenal intraepithelial lymphocytic population and its relation to coeliac disease in a cohort of patients in the Nile delta of Egypt

Coeliac disease is the permanent intolerance to dietary gluten, the major protein component of wheat. Recent epidemiological studies have provided evidence showing that this disorder is common in various parts of the world. The counting and the immunoprofile of intraepithelial lymphocytes of the small bowel have been proposed as methods to measure mucosal infiltration in gluten-sensitive patients. The aim of the present study was to quantify and define the immunohistochemical profile of intraepithelial lymphocytes in the duodenal mucosa of patients suffering non-ulcer dyspepsia, and compare them with known cases of coeliac disease. Archival paraffin wax embedded duodenal sections from 50 endoscopic biopsies were stained using CD3, CD4, and CDS antibodies. Sections were obtained from 24 patients with confirmed coeliac disease, 20 patients with non-ulcer dyspepsia, and 6 patients with functional dyspepsia as control. Patients with non-ulcer dyspepsia were on gluten containing diets. The number of intraepithelial lymphocytes was quantified in five different villi by counting the number of lymphocytes/100 epithelial cells in each villus, and calculating the mean. Endomysial antibodies and testing for Helicobacter pylori were done in all cases. A positive correlation was observed between the degree of villous atrophy and CD3, CD4, and CD8+ intraepithelial lymphocytes. A positive correlation was also observed with the lamina propria lymphoid aggregates. H. pylori infection had a positive correlation with the degree of lymphoid aggregation in the lamina propria. Although the difference between potential coeliac disease and non-coeliac controls was significant, these lesions overlapped considerably. Clinicians as well as pathologists should increase the index of suspicion of coeliac disease. The frequent occurrence of duodenal intraepithelial lymphocyte expansions in other diseases may justify the use of immunohistochemical examination of duodenal biopsy specimens from patients suffering from dyspepsia