Correlation of genotypes and route of transmission with histologic activity and disease stage in chronic hepatitis C.

Our objective was to evaluate the histopathological features of chronic hepatitis C of 64 liver biopsies and to correlate this with the route of transmission of hepatitis C virus, the genotype of HCV, and the patient's age. Moderate chronic hepatitis was the most frequently observed (62.5%). Cirrhosis was observed in 14 patients (21.9%) and was more frequently found among patients over 40 years of age (34.3% vs. 6.9%, P = 0.025). The mean histopathological activity index (HAI) was significantly higher in the sporadic (10+/-3.1) than the posttransfusional (7.5+/-3.7) and the intravenous drug use (IVDU) groups (6.3+/-2.8) (P<0.02). Moreover the sporadic group showed more fibrosis (P<0.04) than the posttransfusional group. No liver cirrhosis was found in the IVDU group. The overall prevalence of HCV variants was: 54.7% type 1b, 4.6% type 1a, 37.5% type 2c, 1.6% type 2b, 1.6% type 2. The genotype distribution showed no relation to the HAI, hepatitis activity (grade), and fibrosis (stage) of the liver disease. In conclusion, the sporadic route of transmission of HCV was related to a more severe chronic hepatic disease, a finding that could influence future antiviral therapies. The predominance of HCV type 1b in this study reflects the higher frequency of this variant in our area. Our data suggests that the ultimate consequence of HCV chronic infection depends on patient age rather than on HCV genotype.

Idiopathic hypereosinophilic syndrome presenting as cholestatic liver disease.

We report the case of a 34-year-old white man with recurrent episodes of abdominal pain, cholestasis and eosinophilia. The diagnosis of idiopathic hypereosinophilic syndrome (IHS) was made after exclusion of all known causes of eosinophilia. Liver biopsy revealed an eosinophilic infiltrate with biliary damage. The patient recovered after prednisolone treatment. We review the literature on the association between IHS and liver disease.

Nonalcoholic steatohepatitis. Clinicopathological comparison with alcoholic hepatitis in ambulatory and hospitalized patients.

This study reports a clinicopathological analysis of 105 patients whose liver histology showed a pattern of alcohol-like steatohepatitis. There were 32 nonalcoholic, 21 asymptomatic ambulatory, and 52 hospitalized alcoholic hepatitis patients. Female sex, obesity, and diabetes predominated in nonalcoholics. Clinical and laboratory presentation were similar in nonalcoholics and ambulatory alcoholics, but different from the hospitalized alcoholics. Histology showed an increasing degree of severity of hepatocellular damage, Mallory bodies, neutrophil and mononuclear infiltration, and pericellular and portal fibrosis from the nonalcoholics to the hospitalized alcoholics, with ambulatory alcoholics displaying an intermediate degree of severity. Steatosis and glycogenated nuclei were prevalent in the obese, diabetic nonalcoholics, of whom 47% had significant fibrosis and 8% cirrhosis, the latter present in 38% and 89% of ambulatory and hospitalized alcoholic hepatitis (P = 0.0001), respectively. In asymptomatic subjects with suspected liver disease, a liver biopsy is the only way of establishing the type and severity of liver lesions.

Tamoxifen-associated steatohepatitis--report of three cases.

The authors describe three cases of tamoxifen-associated steatohepatitis, which resulted from a daily dosage of 20 mg used as the adjuvant treatment of breast carcinoma. Liver tests became normal after discontinuation of tamoxifen.

The distribution of endocrine cell types of the gastrointestinal mucosa in genetically diabetic (db/db) mice.

BACKGROUND/AIMS: Genetically diabetic (db/db) mice are a model for non-insulin-dependent diabetes in humans. The gastrointestinal tracts in 12-week-old db/db and nondiabetic control (db/+) mice were studied with particular emphasis on the endocrine cells. METHODS: Immunocytochemical and quantification techniques were used to localize and determine the number of cells containing serotonin and various regulatory peptides. RESULTS: In the antrum, the gastrin- and serotonin-immunoreactive cells were increased in number. In the large intestine, the enteroglucagon and the peptide tyrosine-immunoreactive cells were increased in number, whereas there were fewer serotonin-immunoreactive cells. There were also fewer somatostatin-immunoreactive cells in most gastrointestinal regions. In diabetic mice, the intestine was longer and its mucosa thicker than in control mice. CONCLUSIONS: The results indicate that the genetic diabetic (db/db) condition exerts a significant influence on the gastrointestinal tract and on the endocrine cell systems studied. The observed alterations may reflect the effect of indirect factors rather than the diabetes per se.

Is there an alternative to alpha-interferon in chronic hepatitis B?

At present immune-based therapies are not an alternative to alpha-interferon in the treatment of chronic hepatitis B. Patients who do not respond to alpha-interferon should probably be followed without re-treatment. Re-treatment using a short course of prednisone before alpha-interferon deserves further study. Future investigation of immune-based therapies should be done in the context of available antiviral therapies. Alternatives need to be propounded and tested, especially alternatives that cause us to question assumptions and to rethink our current beliefs about chronic HBV immunopathogenesis.

Long-term prognosis of patients with cirrhosis of the liver and upper gastrointestinal bleeding.

A study has been carried out on the 5-yr survival curves of 287 patients admitted with upper gastrointestinal bleeding and portal hypertension. In 78.7%, the cause of bleeding was from esophageal varices. Only 2.4% had noncirrhotic portal hypertension, and 80% were alcoholics. At 5 yr, the overall survival probability was 26.2%. The curve had three segments with survival rates of 69% at 2 wk and 46.6% at 12 months. According to Child's grade, the curves were very different at 2 wk, 12 months, and 60 months: Group A, 94.0, 78.0, and 51.8%; group B, 77.0, 46.0, and 32.2; group C, 52.0, 11.0, and 2.3%. The largest differences were observed in the first 2 wk immediately after the first bleeding. The recurrence of bleeding in a period of 6 months significantly decreased the survival. Age, as well as the introduction of prophylactic measures (propranolol or sclerotherapy), did not influence long-term survival. Alcohol abstinence was accompanied by better survival. This difference was due to the impact of abstinence only in group B patients.