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

Evaluation of some liver fibrosis markers in chronic liver diseases

Liver fibrosis is a dynamic bi-directional process involving phases of progression and regression. Its diagnosis is dependent on histopathological examination of biopsy specimens. The aim of this study was to evaluate some non invasive serum markers of liver fibrosis and to correlate them with liver biopsy. Fifty patients with chronic liver diseases matched with 10 age and sex healthy blood donors were included in the study. For both groups; estimation of serum matrix metalloproteinase 9[MMP-9], tissue inhibitor of metalloproteinase 1[TIMP-1] by ELISA technique and haptoglobin by RID, scoring of the age-platelet index [API], AST to platelet ratio index[APRI],and prothrombin time [PT] were done. For the patients, histopathological examination of liver biopsy specimens for assessment of necroinflammatory grade [A] and fibrosis stage [F] applying the METAVIR scoring system. API showed a significant positive correlation with both fibrosis and necroinflammatory activity, by using ROC curve for discrimination of significant fibrosis [F>/= 2] and moderate to severe necroinflammatory activity [A>/= 2], the AUROCs were 0.88 +/- 0.09 and 0.69 +/- 0.16 respectively. In case of Platelet count the AUROC was 0.80 +/- 0.12 for the diagnosis of established cirrhosis [F4]. PT showed a significant positive correlation with fibrosis progression, and it was a sensitive predictor of significant fibrosis and the AUROCs, for [F >/= 2] and [F4] were 0.67 +/- 0.15 and 0.76 +/- 0.15 respectively. While APRI showed a significant positive correlation with both fibrosis stage and necroinflammatory grade and the AUROCs were 0.68 +/- 0.15 and 0.69 +/- 0.15, for [F >/= 2] and [F4] respectively .The mean serum level of MMP-9 was significantly higher in patients than controls [P < 0.05] and showed a significant negative correlation with fibrosis stage [P < 0.05]. By using ROC curve to assess MMP-9 for discrimination of significant fibrosis [F>/= 2] and cirrhosis [F4], the AUROCs were 0.67 +/- 0.17 and 0.69 +/- 0.18 respectively, while for [A>/= 2], it was0.75 +/- 0.16. The mean value of serum TIMP-1 was significantly higher in patients than controls [P < 0.05], with significant positive correlation with necroinflammatory grade[P < 0.05]. The AUROCs for [F>/= 2] and [F4] were 0.58 +/- 0.2 and 0.53 +/- 0.19 respectively, while for [A>/= 2], it was 0.67 +/- 0.17. Haptoglobin showed a significant negative correlation with fibrosis progression[r=-0.4, P < 0.05] and AUROC for [F>/= 2] and [F4] were 0.75 +/- 0.17 and 0.78 +/- 0.15 respectively. MMP-9 was a fair marker of fibrosis as well as inflammatory activity, and TIMP-1 was a sensitive and to a lesser extent specific marker of advanced liver disease, discriminating inflammatory activity rather than fibrosis stage. On the other hand API was the best marker that can discriminate significant fibrosis, while platelet count for diagnosis of cirrhosis. Among the assessed serum markers, haptoglobin, API and PT were the most sensitive predictors of significant fibrosis, while haptoglobin and API were the most sensitive predictors of cirrhosis. Finally, these serum assays, although promising, are still in need of being refined with further prospective studies

Serum level of tumor necrosis factor-alpha in patients with hepatic encephalopathy due to chronic liver diseases

Tumor necrosis factor-alpha [TNF-alpha] is involved in many acute and chronic liver disease [CLD]. This work was conducted on 69 patients with CLD [50 patients with overt hepatic encephalopathy [HE] and 19 patients with no evidence of HE] and 13 healthy subjects as a control group. The aim was to assess the serum level TNF-alpha in patients with HE due CLD and to correlate this level with the severity and precipitating factors of HE. All patients and control subjects were subjected to clinical, laboratory and abdominal ultrasonography in addition to measurement of serum level of TNF-alpha. HE was more common in male patients [P<0.002] but not related to the age [P = 0.826]. Serum TNF- alpha level was significantly elevated in patients with CLD in comparison with the control and patients with overt HE than those with no evidence of HE [16.88 pg/ml. 33.85 pg/ml and 78.48 pg/ml] respectively. TNF-alpha was positively correlated to the synthetic liver function but not related to the liver enzyme levels. TNF-alpha was positively related to the severity of liver disease represented by Child-Pugh score [P<0.001] being highest in Child C patients. The serum level of TNF-alpha was significantly correlated to the severity of HE reaching its highest levels in Grade IV. but not related to the precipitating factors of HE. serum level of TNF-alpha was higher in cirrhotic patients with HE and correlates with severity but not the precipitating factors of HE

Neurophysiologic and psychometric changes in patients with liver cirrhosis

Because of its prognostic and socioeconomic relevance, interest has focused on SHE, which describes a poorly defined syndrome found in the grey zone between normality and manifest HE. the aim was to study the neurophysiologic and nero psychologic changes in chronic liver diseases to diagnoses subclinical heptic encephalopathy [SHE]. Sixty patients with chronic liver disease 30 had cirrhosis due to chronic HCV [group 1], and 30 patients had liver fibrosis due to Schistosomiasis [alone or with hepatitis] [group2]. and 20 healthy subjects as control [group 3], all were subjected to, clinical examination, assessment of liver function, routine tab., investigations, Abd, US. and EEG and psychometric assessment by [NCT] and symbol [SDT]. NCT abnormal score was found in 46.7% group2. ranging from 42.3% to 75% in Child-Pugh grade A, B respectively, however the control group had normal NCT score. Positive EEG changes were in [60%]and [50%] ranging from [47.05% to 76.92%] and from [46.15% to 75.0%], in group 1 and group 2 in Child-Pugh grade A and B, respectively, while in group 3 EEG was normal in [90%] and non specific changes found in[10%]. EEC changes and psychometric defects were detected in considerable percentage of cirrhotic patients and were related to the severity of liver cirrhosis, so psychometric tests and EEG may be suitable tools for diagnosis of SHE