Therapy with ombitasvir/paritaprevir/ritonavir plus dasabuvir is effective and safe for the treatment of genotypes 1 and 4 hepatitis C virus (HCV) infection in patients with severe renal impairment: A multicentre experience.

Limited data are available on direct-acting antivirals for treating hepatitis C virus (HCV) infection in patients with severe renal impairment. The aim of this study was to evaluate the effectiveness and safety of ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) ± dasabuvir (DSV) ± ribavirin (RBV) in patients with stage 4 or 5 chronic kidney disease (CKD) and HCV genotype 1 or 4 infection in real clinical practice, and to investigate pharmacological interactions. This retrospective study included patients treated with OBV/PTV/r+DSV±RBV or OBV/PTV/r+RBV with CKD stage 4 (eGFR: 15-29 mL/min/1.73m2 ) or 5 (eGFR<15 mL/min/1.73m2 or requiring dialysis) and HCV infection by genotypes 1 and 4 between April 2015 and October 2015 in nine Spanish centres. Sustained virological response at 12 weeks (SVR12) was assessed, and clinical and laboratory data, fibrosis stage, adverse events and pharmacological interactions were reported. Forty-six patients were included: 10 (21.7%) had CKD stage 4 and 36 (78.2%) CKD stage 5. Seventeen (36.9%) had cirrhosis. SVR12 rate in the intention-to-treat population was 95.7%. Twenty-one (45.6%) received RBV, which was discontinued in two (9.5%) patients. Anaemia (haemoglobin <10 g/dl) occurred in 12 patients (57.1%) with RBV vs 10 (40.0%) without RBV (P=.246). Renal function remained stable during antiviral therapy. Nine patients (19.5%) experienced serious adverse events unrelated to antiviral therapy. Concomitant medication was discontinued or modified in 41.3% of patients. In conclusion, the effectiveness of OBV/PTV/r±DSV±RBV in patients with CKD 4-5 was similar to that observed in those with normal renal function and was not associated with severe adverse events.

[Predictive factors of eosinophilic esophagitis in esophageal food bolus impaction]. / Factores predictores de esofagitis eosinofílica en impactación esofágica por bolo alimenticio.

BACKGROUND: Food bolus esophageal impaction is often the first symptom in patients diagnosed with eosinophilic esophagitis, representing a change in the epidemiology and management of this urgency. AIM: To detect eosinophilic esophagitis predictive factors in patients with esophageal impaction due to food bolus. METHODS: Patients seen for foreign body impaction were retrospectively analyzed. Epidemiologic characteristics, endoscopic findings, and impaction history were studied. The statistical analysis was carried out using the Student's t test and the chi square test and a logistic regression model. RESULTS: Of the 131 patients, 65% were men and the mean age was 56 years. The endoscopic suspicion of eosinophilic esophagitis was the most frequent finding in patients with food bolus impaction (n=89); those patients that did not have histologic confirmation were excluded (n=7). The remaining patients (n=82) were divided into two groups: confirmed eosinophilic esophagitis (Group A) (n=18) and other endoscopic findings (Group B) (n=64). Group A presented with a lower mean age (36.47 vs. 64.45, P=.001) and a more frequent past history of impaction (38% vs. 6%, OR=15.70, 95% CI (3.60-62.50), P=.001) than Group B. Age and impaction history acted as predictors for eosinophilic esophagitis with 82% sensitivity, 80% specificity, and 84% diagnostic accuracy (P<.001). CONCLUSIONS: Age and a history of impaction predict the presence of eosinophilic esophagitis in patients with food bolus impaction.

[Usefulness of self-expanding biodegradable prosthesis in the treatment of refractory benign stenosis: a case series study]. / Utilidad de las prótesis autoexpandibles biodegradables en el tratamiento de estenosis benignas refractarias. Estudio de una serie de casos.

BACKGROUND: The use of self-expanding biodegradable prosthesis treatment of refractory benign stenosis is still undefined. OBJECTIVE: To determine the utility and safety of biodegradable polydioxanone prostheses as treatment of gastrointestinal tract refractory benign strictures. METHODS: Consecutive patients diagnosed with refractory benign stricture of gastrointestinal tract following Kochman's criteria were included. The type of stenosis were anastomotic (n = 5), peptic (n = 1), post-radiotherapy (n = 1) and they were located in proximal esophagus-hypofarynge (n = 2), esophagus medium (n = 1), distal esophagus (n = 2) and rectum (n = 2). The prosthesis was placed under endoscopic and fluoroscopic control under conscious sedation with propofol. RESULTS: Seven patients (8 prosthesis) were included. Mean patient age was 49 years-old (range: 37-70). Insertion prosthesis was successful in all cases. Distal migration of prosthesis was observed in both rectal stenosis and was the indication of a second prosthesis placement in one case. At the end of follow-up (median follow-up 30 weeks for esophageal stricture, 33 weeks for rectal stricture) 5 patients remained asymptomatic. Eighty per cent of patients with esophageal stenosis showed partial and transient re-stenosis due to hyperplastic reaction during the degradation of the prosthesis, with transient dysphagia in two patients resolved medically. Complete prosthesis degradation was confirmed by endoscopy in all cases. CONCLUSIONS: The use of self-expanding biodegradable polydioxanone prosthesis is a safe and utile therapeutic option for refractory benign gastrointestinal stenosis.

[Treatment response to lamivudine in chronic hepatitis B patients]. / Respuesta al tratamiento con lamivudina en pacientes con hepatitis crónica por virus B.

OBJECTIVE: The main objective was to find a biochemistry and virology response in positive and negative HBeAg patients who had been treating with lamivudine. Furthermore, the secondary objective was to make a description about kidney function changes that could be found in patients under treatment with lamivudine. METHOD: Thirty patients with chronic B hepatitis under treatment with lamivudine had been retrospectively studied since November 1999 to March 2004, in a Digestive Unit, in Ciudad Real Hospital. RESULTS: Twenty nine out of 30 patients were included, 8 out of 29 were positive HBeAg, and 21 out of 29 were negative HBeAg. Seven patients had been treated with IFN. Thus, 8 patients had been in need of adefovir treatment after lamivudine trial. The average of treatment had been 23.7 months (3 months-46 months). In fact, none of them were changed from positive HBsAg to negative HBsAg. Nevertheless, we have observed those results after lamivudine treatment. Firstly, 50% positive HBe Ag patients have carried on negative DNA results. Although 25% positive HBe Ag patients had converted to negative HBe Ag. But they did not show any anti HBe. Secondly, 76% negative HBe Ag patients had been suffering a DNA decreased, even though some of them had had a negative DNA results. Thirdly, we found some lamivudine mutation (50% in positive HBe Ag patients and 19% in negative HBe Ag patients). Finally, all the patients with negative DNA had maintained a normal AST and ALT levels. Thus, function renal had been normal under lamivudine trial. CONCLUSION: According to several authors, the response to lamivudine treatment had been adequate in our population. Nevertheless, our study have shown that antiHBe levels had not been suffering any change during lamivudine treatment. In addition, we have found a smaller figures (19%) of lamivudine mutations in negative HBe Ag patients than other studies (25% in patients who were followed up for 1 year).

Respuesta al tratamiento con lamivudina en pacientes con hepatitis crónica por virus B / Treatment response to lamivudine in chronic hepatitis B patients

Objetivo: Descripción de la respuesta bioquímica y virológica en pacientes HBeAg positivo y negativo tratados con lamivudina. Como objetivo secundario, se valoró las modificaciones en la función renal de los pacientes tratados con este fármaco. Método: Se estudió de forma retrospectiva a treinta pacientes con hepatitis crónica por virus B que habían realizado tratamiento con lamivudina entre noviembre de 1999 y marzo de 2004, en la Unidad de Digestivo del Complejo Hospitalario de Ciudad Real. Resultados: Se incluyeron finalmente 29 pacientes, de los cuales 8 eran HBeAg positivo y 21 HBeAg negativo. La media de duración del tratamiento con lamivudina fue de 23,7 meses (3-46). Siete pacientes habían recibido tratamiento previo con IFN. En ocho casos, se inició tratamiento posterior con adefovir. Ninguno de los pacientes del estudio negativizó el HBsAg. Entre los pacientes HBeAg positivo un 50% presenta actualmente valores negativos de ADN y un 25% ha negativizado el HBeAg, aunque sin seroconversión anti-HBe. Entre los pacientes HBeAg negativo, un 76% han disminuido o negativizado el ADN. Observamos aparición de mutantes a la lamivudina en un 50% y 19% de los pacientes HBeAg positivo y negativo respectivamente, siendo la duración media del tratamiento de dos años. Los niveles de ADN viral negativos, se asociaron en todos los casos con niveles normales de transaminasas. Los pacientes no sufrieron modificaciones en la función renal. Conclusión: La respuesta de nuestros pacientes a la lamivudina es similar a la descrita en la literatura excepto en la tasa de seroconversión anti-HBe, que en nuestro caso ha sido nula y en el porcentaje de aparición de mutantes a la lamivudina en los pacientes HBeAg negativo, que en nuestro estudio ha sido menor de la esperada (19%; 25% referido apacientes con más de un año de tratamiento)

Objective: The main objetive was to find a biochemistry and virology response in positive and negative HBeAg patients who had been treating with lamivudine. Furthermore, the secondary objetive was to made a description about kidney function changes that could be found in patients under treatment with lamivudine. Method: Thirty patients with chronic B hepatitis under treatment with lamivudine had been retrospectively studied since November 1999 to March 2004, in a Digestive Unit, in Ciudad Real Hospital. Results: Twenty nine out of 30 patients were included, 8 out of 29 were positive HBeAg, and 21 out of 29 were negative HBeAg. Seven patients had been treated with IFN. Thus, 8 patients had been in need of adefovir treatment after lamivudine trial. The average of treatment had been 23.7 months (3 months- 46 months). In fact, none of them were changed from positive HBsAg to negative HBsAg. Nevertheless, we have observed those results after lamivudine treatment. Firtsly, 50% positive HBe Ag patients have carried on negative DNA results. Although 25% positive HBe Ag patients had conversed to negative HBe Ag. But they did not show any anti HBe. Secondly, 76% negative HBe Ag patients had been suffering a DNA decreased, even though some of them had had a negative DNA results. Thirstly, we found some lamivudine mutation (50% in possitive HBe Ag patients and 19% in negative HBe Ag patients). Finally, all the patients with negative DNA had maintained a normal AST and ALT levels. Thus, function renal had been normal under lamivudine trial. Conclusion: According to several authors, the response to lamivudine treatment had been adequate in our population. Nevertheless, our study have shown that antiHBe levels had not been suffering any change during lamivudine treatment. In addition, we have found a smaller figures (19%) of lamivudine mutations in negative HBe Ag patients than other studies (25% in patients who were followed up for 1 year)

[Idiopathic esophageal ulcer with fistulization to the bronchial tree in a HIV-positive patient]. / Ulcera esofágica idiopática fistulizada a arbol bronquial en paciente VIH-positivo.

Idiopathic esophageal ulcerations (IEUs) associated with human immunodeficiency virus (HIV) infection are now recognized as an important cause of esophageal disease in this population. We report one case of IEU complicated with a fistula to the bronchial tree. Given his variable appearance, which may mimic other causes of esophageal ulceration and the high response rate to oral corticosteroid therapy, all HIV infected patients with esophageal ulceration should undergo endoscopy with biopsy to obtain a definitive diagnosis. We review the literature about the etiology, pathogenesis, management and treatment of the IEU.

[Tracheoesophageal fistula secondary to endoscopic sclerotherapy of esophageal varices]. / Fístula traqueoesofágica secundaria a escleroterapia endoscópica de varices esofágicas.

Over the past 15 years, endoscopic variceal sclerotherapy (EVS) has become the main therapy for patients with bleeding esophageal varices. EVS has the advantage of a low associated mortality and morbidity, but may lead to serious complications. We report a case of esophagotracheal fistula complicating sclerotherapy that resolved with nonsurgical management.

[Mixed cryoglobulinemia associated with hepatitis C virus]. / Crioglobulinemia mixta asociada al virus de la hepatitis C.

We report six cases of essential mixed cryoglobulinemia associated with chronic liver disease and positive HCV markers, who showed several acute symptoms of vasculitis, arthralgias, neuropathy and glomerulonephritis. The presence in the serum and cryoprecipitates of anti HCV antibodies detected by the second-generation ELISA (ELISA 2) and the of HCV RNA by PCR in the serum in all six cases, suggest an important role for this virus in the pathogenesis of mixed cryoglobulinemia.