Evaluation of serum HBV viral load, transaminases and histological features in chronic HBeAg-negative hepatitis B patients

Aim: To evaluate the association between biochemical, virologic and histologic features in patients with HBeAg-negative chronic hepatitis B [CHB]

Background: Hepatitis-B e-antigen [HBeAg]-negative is common in Iran, is progressive with poor prognosis. Therefore, it seems necessary to perform a comprehensive evaluation of different spectrum of laboratory measurements accompanying histological findings

Methods: HBeAg- negative CHB patients referring to two university hospitals during two years were enrolled. Alcohol consumption, liver mass, fatty liver and positive results of Anti HDV, Anti HCV or Anti HIV were excluded. The relationship between viral loads, liver enzymes [old and new cutoffs] and histopathological features was analyzed using descriptive and analytic statistical methods

Results: A total of 150 HBeAg-negative CHB [males=110, mean age=38.44 +/- 11.34 years] were assessed. ALT had a significant relation with the logarithm of serum HBV-DNA [P<0.0001], grade and stage on liver biopsy [P<0.001, P=0.034, respectively]. Serum viral load, AST and ALT were independent predictors of histological grade, age was the only independent predictor of the stage of liver fibrosis. There was a significant relationship between serum ALT and stage of liver fibrosis [P<0.0001] when new cutoff values for ALT were considered. We found that age had a significant relation with histological grade but it showed a reverse relation with ALT levels [P=0.009]

Conclusion: In HBeAg-negative CHB, AST had a better prediction for liver necrosis and inflammation. Age could be an independent predictor for liver fibrosis. New cutoff values for ALT had superiority over conventional values to identify higher risk of liver fibrosis

Resolution of bile duct adenoma over follow-up period; a case report

Bile duct adenoma [BDA] is a rare neoplasm of bile ducts with various clinical manifestations and imaging appearances. A few cases of BDA and their predisposing factors have been described. We report a 35-year-old woman with right upper quadrant pain who consumed oral contraceptive pills. Ultrasound study revealed three hypoechoic subcapsular liver masses; two of them were hypodense in computed tomography. Fine needle biopsy of the largest mass showed bile duct adenoma. Liver masses disappeared after discontinuing the pills over a 2-year follow-up. BDAs can manifest in imaging. Although previous studies have not reported tumor resolution over a follow-up period, we suggest paying more attention to predisposing factors in order to give an opportunity for tumor resolution by risk factor elimination

Causes of persistently elevated alanine aminotransferase levels in patients who presented to two referral hospitals in Mashhad, Iran during 2011

Worldwide, chronic liver disease is a major cause of morbidity and mortality. Causes of elevated serum alanine aminotransferase [ALT] levels vary depending on the population under study. The aim of this study is to evaluate the frequency and causes of persistently elevated ALT levels in patients of the Gastroenterology [GI] Clinics in Ghaem and Emam Reza Hospitals in Mashhad, Iran. A total of 100 consecutive patients with persistently elevated ALT levels that referred to the GI Clinics at Ghaem and Emam Reza Hospitals in 2011 were studied. Elevated levels were defined as ALT >/= 40 U/L at least twice within six months. A comprehensive history that included previous surgeries, transfusion, alcohol consumption and medications was obtained. Patients underwent physical examinations, laboratory analyses and ultrasonography studies. When necessary, liver biopsies were performed. Patients' mean age was 44.4 +/- 11.83 years. Females comprised 62% of cases. Patients presented with the following conditions: non-alcoholic fatty liver disease [NAFLD, 55%], hepatitis B [17%], autoimmune hepatitis [13%], hepatitis C [4%], autoimmune hepatitis and hepatitis C [2%], overlapping autoimmune disease [2%], Wilson disease [1%], celiac disease [1%], alcoholic hepatitis [1%], primary biliary cirrhosis [PBC, 1%], primary sclerosing cholangitis [PSC, 1%], and cryptogenic [2%]. NAFLD was the most common cause of persistently elevated serum ALT levels in this study.

Evaluation of osteoporosis in patients with non-alcoholic liver cirrhosis

The liver is a vital organ that plays an important role in the metabolism of nutritional agents, drugs and hormones,synthesis of various proteins, coagulation factors and maintenance of hemostasis between calcium,and phosphorous. Biochemical changes in the skeletal system such as osteopenia and pathologic fractures may follow hepatic failure. This researchevaluates metabolic bone changes in non-alcoholic cirrhotic patients. We evaluated 50 known cases of nonalcoholic cirrhosis in the Internal Medicine Clinic and Ward of GhaemHospital during the second half of 2004. Inclusion criteria were: age >14 years anda Child-Pugh score of A or B. Exclusion criteria were: history of previous bone metabolic disorders; endocrine disease; hepatocellular carcinoma; liver metastasis;previous use of calcium, vitamin D, calcitonin, bisphosphonates, hormone replacement therapy, and prednisolone; and alcoholics. Patients underwent clinical and laboratory studies in addition to bone densitometry analyses of the femoral neck and second to fourth lumbar spine area. Patients' mean age was 41.18 +/- 15.94 years and the male to female ratio was 1.5 to 1. Cases presented with the following types of non-alcoholic cirrhosis: post-hepatitis B [58%], cryptogenic [26%], autoimmune hepatitis [10%], post-hepatitis C [4%] and primary biliary cirrhosis [2%]. There were 68% of our cases classified as Child-Pugh score A; 32% were Child-Pugh score B. Osteoporosis and osteopenia were more common in the Child-Pugh B group. T-score of the femoral neck was normal in 39 [78%] cases. The lumbar spine Z-score was normal in 46 [92%] and the femoral neck Z-score was normal in 48 [98%] cases. There were more post-hepatitis B and cryptogenic cirrhosis cases that had decreased bone density.The Child-Pugh A group had more increased calcium, phosphorous, and PTH levels and decreased ALP levels compared to the Child-Pugh B group. Progression of liver failure [according to Child-Pugh] in patients with non-alcoholic cirrhosis to some extent causes increased osteoporosis and osteopenia. It is necessary to place increased emphasis on the importance of mineral supplementation in cirrhotic patients

Congenital esophageal stenosis in a patient with Turner's syndrome, a case report

A fifteen years old turkaman girl with Turner's mosaic karotype is presented. She had congenital esophageal stenosis with severe dysphagia since birth and iron deficiency anemia in addition to other classical features of syndrome. To the author's knowledge this is the first report of a new congenital structural gastrointestinal anomaly with this disease