[ natural history of hepatitis B virus cirrhosis after the first hepatic decompensation in Tunisia]

To define the natural long term course of viral B cirrhosis after the onset of hepatic decompensation and to determine the predictive factors of death. Retrospective longitudinal study including 77 cases of viral B cirrhosis among 192 consecutive patients with cirrhosis, hospitalized between 1997 and 2005 for the first hepatic decompensation. All those patients were followed- up until death or until December 2006. The probability of survival after the first hepatic decompensation was calculated using the Kaplan Meier method. The predictive factors of death were determined through univariate and multivariate analyses with the Cox regression model. Fifty four men and 23 women with an average age of 54 +/- 14.9 years were hospitalized for the first decompensation of the viral B cirrhosis. The 77 patients had been under observation for an average period of 24.2 +/- 21.1 months. During that time 64% among them died. The probability of survival after decompensation was 47% in 2 years and 22% in 5 years. During follow- up, ascites was the most frequent decompensation [85%] followed by hepatic encephalopathy [38%], variceal hemorrhage [34%], jaundice [30%], hepato renal syndrome [27%], hepatocellular carcinoma [21%], and spontaneous bacterial peritonitis [14%]. At univariate analysis four factors were predictive of death: Child Pugh C score [p=0.009], hepatocellular carcinoma [p=0.01], rate of serum gammaglobulin superior to18g / l [p=0.008] and prothrombin time inferior to 50% [p=0.02]. According to the multivariate analysis only the rate of serum gammaglobulin superior to 18g /l was an independent predictive factor of mortality [p=0,001] with IC [95%] [1.623 - 5.88]. In Tunisia, the prognosis of viral B cirrhosis after the first decompensation is bad, because a patient on 5 only was able to survive beyond 5 years. Ascites is the most frequent decompensation. Only the rate of serum gammaglobulin superior to 18g / l is an independent predictive factor of mortality

Variceal band ligation in the prevention of variceal bleeding: a multicenter trial

Variceal bleeding is a life-threatening complication of portal hypertension with a high probability of recurrence. Treatment to prevent first bleeding or rebleeding is mandatory. The study has been aimed at investigating the effectiveness of endoscopic band ligation in preventing upper gastrointestinal bleeding in patients with portal hypertension and to establish the clinical outcome of patients. We analyzed in a multicenter trial, the efficacy and side effects of endoscopic band ligation for the primary and secondary prophylaxis of esophageal variceal bleeding. We assigned 603 patients with portal hypertension who were hospitalized to receive treatment with endoscopic ligation. Sessions of ligation were repeated every two to three weeks until the varices were eradicated. The primary end point was recurrent bleeding. The median follow-up period was 32 months. A total of 126 patients had recurrent bleeding. All episodes were related to portal hypertension and 79 to recurrent variceal bleeding. There were major complications in 51 patients [30 had bleeding esophageal ulcers]. Seventy-eight patients died, 26 deaths were related to variceal bleeding and 1 to bleeding esophageal ulcers. A great improvement in the prevention of variceal bleeding has emerged over the last years. However, further therapeutic options that combine higher efficacy, better tolerance and fewer side effects are needed

particularity of helicobacter pylori chronic gastritis in the west center of Tunisia

The Helicobacter pylori [HP] is strongly associated with chronic gastritis. Our study was to determine prevalence of the HP chronic gastritis in the west center of Tunisia and to clarify the clinical and the histological particularities of this infection. It is a prospective study carried out from September 2002 to July 2005 and had included 352 patients. All the patients had an upper endoscopy in which five gastric biopsies were taken for a histological study. The biopsy specimens were fixed in 10% buffered formol and then included in paraffin. The specimens were cut at 4 pm and stained with Hematoxylin Eosin, modified Giemsa and Alcian bleu SAP. The histological examination revealed HP specimens, the lymphoplasmocytic infiltration, the gastritis activity, the gastric atrophy and the intestinal metaplasia according to Sydney system. They were 162 men and 190 women, with a mean age of 48,3 years. The erythematous antral gastritis was the most frequent at endoscopy [26, 7%] The prevalence of HP chronic gastritis was 89% in patients with endoscopic lesions The activity of the gastritis was 89,7% in the antrum and 52,2% in the fundus. The activity mean score in the antrum was 2, 1,8 and 0,3 respectively in the case of duodenal ulcer and gastric adenocarcinoma vs 0,68, 1,1 and 0,16 in gastric fundus. The prevalence of gastric atrophy was 35%. The atrophy was found in the antrum in 98% of cases. The prevalence of intestinal metaplasic was 11%. The HP chronic gastritis is very frequent in the west center of Tunisia. Its prevalence is found elevated since the adolescence. It predominate the gastric antrum. It is often associated with a duodenal ulcer rather than gastric cancer