Recurrent hepatitis C and non-alcoholic fatty liver disease in transplanted patients: a review.

Non-alcoholic fatty liver disease (NAFLD) is a common occurrence after orthotopic liver transplantation (OLT). The association steatosis/HCV determines important implications for clinical practice: steatosis accelerates the progression of fibrosis and reduces the likelihood of obtaining a sustained virological response (SVR) with antiviral therapy. In post-transplant HCV patients we have evidenced a strong correlation between body mass index (BMI), cholesterol, triglycerides (TGC) and hepatic percentage of steatosis. In subjects with BMI <25 and TGC <160 ng/mL, the chance of SVR was 48 times higher than that of non response. The chances of SVR and sustained biochemical response for patients with percentage of steatosis <15 were 12 times higher than that with higher percentage of steatosis. We can conclude how the amount of steatosis be noted specifically in biopsy examination reports of patients with relapse chronic hepatitis C and how the management of dismetabolism, diet and exercise therapy can improve BMI, liver histology and the response to antiviral therapy.

Human carcinogenesis and alcohol in hepato-gastroenterology.

Alcohol consumption is one of the top-10 risks for worldwide burden of disease. The International Agency for Research for Cancer affirmed that there was evidence for the carcinogenicity of ethanol in animals and classified alcohol consumption as carcinogenic for humans. Alcohol consumption causes cancers of the oral cavity, pharynx, larynx, oesophagus, colorectum, liver, pancreas and female breast. Most alcohol-induced diseases increases in a linear fashion as intake increases: oral, oesophagus and colon cancer fall into this pattern: very little is known about safe margins of alcohol consumption. Given the linear dose-response relation between alcohol intake and risk of cancer, control of heavy drinking remains the main target for cancer control. European Code Against Cancer recommends keeping daily consumption within two drinks (20 g [corrected] of alcohol/day) for man and one drink for women and US Department of Health and Human Services suggest as a low risk, a maximum of 10 g [corrected] of alcohol a day in man and half of this in women.

Relationship between laboratory parameters and intensive care unit stay post-liver transplantation: proposal of a model.

UNLABELLED: The aim of this study was to create a model that forecasted the stay in the intensive care unit in post-liver transplantation. METHODS: Twenty-three consecutive patients who underwent liver transplantation provided samples for serum sodium, serum creatinine, total bilirubin, cholesterol, aspartate and alanine aminotransferase, alkaline phosphatase (ALP), albumin, and platelet count for correlation together with age at transplantation in a Pearson correlation model with intensive care unit stay. Multivariate analysis used a regression model to evaluate the relationship between the dependent variable "intensive care unit stay" and the predictor variables that were correlated by a Pearson correlation test. To test the acceptability and strength of the model, analyses of variance was performed and a multiple correlation coefficient R was calculated for the model. RESULTS: Pearson correlation test showed a strong correlation between intensive care unit stay and creatinine (correlation coefficient = 0.34, P = .03), serum sodium (correlation coefficient = -0.42, P < .01), and total bilirubin (correlation coefficient = -0.29, P = .06). Other variables showed no significant correlation, namely correlation coefficients < 0.24 (P > .1). The final model to evaluate the relationship between the dependent variable "intensive care unit stay" and laboratory parameters included ALP, serum creatinine, serum sodium, and total bilirubin as well as a correction for age. CONCLUSIONS: The most significant parameters were total bilirubin, serum creatinine, and serum sodium. The proposal model significantly correlated with the variable "intensive care unit stay." Such data are particularly important since increased intensive care unit stay correlates with a significant reduction in 1-year survival rate.

Collagenous colitis in symptomatic subjects without endoscopic morphologic evidence: case report.

Collagenous colitis (CC) is a rare pathology and, even though various etiopathogenetic hypotheses have been put forward, the etiology and pathology are still not well defined. We report the case of a female patient suffering from chronic watery diarrhoea, positive for guaiac-based fecal occult blood test and morphologically negative to endoscopic investigation, but histologically classifiable as CC. This case report suggests that the clinical history must lead towards the execution of a colonoscopy with bioptic samples done even on apparently normal mucosa. Furthermore, the clinic should always signal a suspect CC to the anatomopathologist in order to have a correct diagnosis.

Long-term therapy with interferon in anti-HCV positive chronic hepatitis: is it conceivable?

HCV positive hepatitis possesses a relevant social impact as regards national health costs. On the other hand, interferon (IFN) therapy represents to date the best therapeutic approach to this problem. However, several clinical questions have arisen regarding the efficacy and safety of long-term treatments, and above all the management of those patients who did not respond to acute therapy. Nevertheless, it is well known there is a high rate of relapse after the cessation of treatment. The goal of the present paper has therefore been to verify both efficacy and safety of a weekly single dose of IFN in maintaining an adequate remission rate in 38 outpatients who obtained a good response (either type I or II according to Marcellin's classification) to a 12 months' IFN course. Our results evidenced that a maintenance therapy with a single a weekly dose of IFN (3MU) did not seem to lead to a lower rate of relapses when compared to patients who were not given any treatment.

Gastric ulcer and cancer ulcer. Retrospective evaluation of the current endoscopic diagnosis.

Aim of this experience has been to evaluate the current diagnostic potentiality of the endoscopy in the framework of the gastric ulcerous pathology. On the total of the gastric ulcers 17.9% have resulted to be neoplastic with the hystologic examination. The diagnostic accurracy of the endoscopy has resulted to be of the 87% compared to hystology. From our data it is evidenced how the endoscopy examination has a relevant diagnostic accuracy in defining the nature of the gastric ulcer which however has to be confirmed by the histology which seems to be diriment.

[The parietal cell mass and acid secretion: Helicobacter pylori does not induce changes in the course of a duodenal ulcer]. / Massa cellulare parietale e secrezione acida: l'Helicobacter pylori non induce modificazioni in corso di ulcera duodenale.

Some studies have postulated that Helicobacter pylori (HP) itself might be responsible for hypergastrinemia and acid secretion in duodenal ulcer (DU). In each DU patient parietal cell mass (expressed by a parietal index) and stimulated acid secretion (expressed by maximal acid output) were evaluated. The study has been conducted grouping DU patients in relation to HP infection in antral mucosa. HP infection does not modify parietal cell mass and stimulated acid secretion. Therefore, mild chronic hypergastrinemia induced by HP infection is not sufficient to justify any increase of parietal index and acid secretion. In fact, parietal cells and acid secretion remain higher in DU subjects independently from HP infection.

[Total peptic activity in gastric juice in patients with duodenal ulcer. Variations in relation to age and role of Helicobacter pylori]. / Attività peptica totale nel succo gastrico in soggetti con ulcera duodenale. Variazioni in rapporto all'età e ruolo dell'Helicobacter pylori.

The aim of this study was to evaluate total peptic activity in gastric juice in duodenal ulcer patients in relation to age and Helicobacter pylori infection. In duodenal ulcer patients peptic activity increases significantly in comparison to normal subjects. In relation to age there is no variation. Therefore, gastric secretion has an autonomous behaviour independently of any physiological variation in healthy subjects. Helicobacter pylori infection is present in 89.4% of duodenal ulcer patients. The bacterium infection does not imply a significant increase of peptic activity in gastric juice. Its lesive action is therefore not attributable to a modification of peptic activity, but it is due to its direct action on gastric metaplasia in the duodenum.

24-hour study of gastric acidity in normal subjects and in cholecystectomized patients using continuous pH monitoring.

The circadian pattern of gastric acidity was assessed in 53 normal subjects and in 33 patients with prior cholecystectomy using continuous pH monitoring. The 24-hour and nocturnal median pH values were significantly higher in cholecystectomized patients than in controls (p less than 0.03 and p less than 0.001, respectively). In the operated group there were higher median pHs also in the after-dinner (p less than 0.003) and after-lunch (p less than 0.01) periods, while no difference between the two populations was observed after breakfast. The percentage of 24-hour pH readings above 4.0 units was markedly higher (p approximately 0) in postcholecystectomy patients. We conclude that circadian gastric acidity is reduced in cholecystectomized patients with respect to healthy subjects, both in nocturnal and postprandial states. Episodes of duodenogastric reflux may be responsible for this, but impaired acid production related to advanced age (14 patients were more than 60 years old) or to fundic chronic atrophic gastritis (5 cases) may also account for the elevation of pH values in our postcholecystectomy patients.

Lack of gastric acid rebound after stopping a successful short-term course of nizatidine in duodenal ulcer patients.

To assess whether there is rebound of gastric acidity after a short-term course of H2-receptor antagonists, we performed a 24-h in situ pH monitoring on 17 duodenal ulcer patients before, during, and after completing 4 wks' treatment with nizatidine 300 mg at bedtime (2200 h). Three around-the-clock continuous intragastric pH-metries were carried out the day before beginning treatment, at the end of the nizatidine course, and 67 h after the last dose of the drug was given. Nizatidine produced mean pH values that were significantly higher (p less than 0.001) than those of the pretreatment profile during both the whole 24-h period and the nighttime (2400-0759), and this confirms that it effectively inhibited gastric acidity. Conversely, there was no significant difference between the acidity indexes of pH profiles obtained before dosing and after discontinuing treatment in any of the time intervals considered. Therefore, it appears that a short term course of nizatidine therapy does not cause rebound hyperacidity in duodenal ulcer patients.

Single morning and nightly doses of ranitidine 300 mg: an appraisal of their antisecretory effects by continuous pH monitoring.

Gastric acidity of 12 patients with healed duodenal ulcers was continuously monitored over 24 h in order to assess the antisecretory effects of two different administration times of a single daily dose of ranitidine 300 mg. Each patient orally received either (a) placebo at 08.00 h and 22.00 h; (b) ranitidine 300 mg at 08.00 h and placebo at 22.00 h, or (c) placebo at 08.00 h and ranitidine 300 mg at 22.00 h in randomized and double-blind fashion. Each medication was administered on three separate occasions, with intervals of at least 1 week. Both the morning and the bedtime doses of ranitidine were significantly superior (p less than 0.001) to placebo in controlling 24-hour gastric acidity, while, in the same period, ranitidine nocte was more effective (p less than 0.001) than ranitidine mane. During the night, bedtime ranitidine caused more acid inhibition (p less than 0.001) than morning ranitidine, but the opposite (p less than 0.01) occurred during the daytime. This study shows that the antisecretory effect of morning ranitidine during the daytime is less consistent than that achieved by bedtime ranitidine during the nocturnal period. As similar rates of duodenal ulcer healing have recently been achieved with morning and conventional nighttime administration of H2 antagonists, it becomes clear that antisecretory drugs can also be beneficial with an acid inhibition which is shorter-lasting than that which was previously thought to be necessary or, alternatively, that also daytime acidity is important in ulcerogenesis.

Antimony and glass pH electrodes can be used interchangeably in 24-hour studies of gastric acidity.

Antimony and glass pH electrodes show almost identical experimental errors in continuously measuring buffer solutions at constant temperature over 24 hr. These errors are lower than the nominal quantization error of the instruments and are not properly described by the 24-hr drift determination. The addition of food particles to the solutions can induce severe reading artifacts. The longer response time reported in vitro of antimony electrodes when moving from pH 1 to pH 7 (3.4 sec vs 0.8 sec with glass electrodes) is irrelevant during in vivo pH-metry studies, because we found that the greatest absolute difference between raw fast acquired (4-6 sec) consecutive pH readings of two commonly used devices was 0.7 pH units in circadian profiles obtained from 413 subjects with various clinical conditions. In our in vivo studies, gastric acidity was monitored continuously with two side-by-side minielectrodes, which were variously combined (antimony-glass, A-G; antimony-antimony A1-A2; glass-glass, G1-G2) and applied on groups of 27 subjects matched for clinical condition. The 24-hr pH means and the 24-hr [H+] means calculated from the acidity profiles obtained with the three electrode combinations, lie on the identity line in each group. Using the Bland-Altman technique for assessing measurement agreement, the differences between the 24-hr pH means and the 24-hr [H+] means obtained with the three combined systems are similar (P = .903 and P = 0.824, respectively) and their 95% confidence limits are comprised within the range (+/-) of the reading error of the measuring systems (namely, +/- 0.3 pH units and +/- 12 mmol/liter in terms of [H+]).(ABSTRACT TRUNCATED AT 250 WORDS)

Continuous acidity monitoring in the study of gastric antisecretory drugs: pH or antilog transformation of pH, mean or median?

The expression of gastric acidity as pH or antilog transformation of pH and the use of the mean or the median as the better summary variable are among the major problems concerning the assessment of antisecretory drugs' effects by means of continuous intraluminal pH monitoring. In this study, we reviewed data deriving from 23 normal subjects, 69 asymptomatic duodenal ulcer patients treated with bedtime (52) or twice daily (17) doses of H2-antagonists, and 10 H2-receptor blocker nonresponders. The whole group underwent continuous 24-h acidity monitoring, and the arithmetic mean and median were calculated on each individual pH and pH antilog transformed profile. One-way analysis of variance and Kruskall-Wallis test were used for statistical comparison between the four subgroups studied. The greatest discrimination between them was obtained when using the mean of pHs [p(F) approximately 0, p[KW] = 2.10(-12)), instead of the median of pHs (p[F] = 8.10(-8), p[KW] = 7.10(-8)). The antilog transformation of pH did not improve the results. It can be concluded that the use of pH to express gastric acidity and the choice of the mean to summarize the drug-related profiles provides a better characterization of the acidity behavior than would the antilog transformation of pHs and the median.

24-hour gastric pH-metry analysis: influence of arbitrarily predefined time intervals on the reliability of acidity indexes.

The use of arbitrarily predefined time intervals during the circadian cycle is common practice in 24-h studies of gastric acidity. To determine whether slight displacements of a given time interval can be responsible for relevant changes in the acidity indexes calculated from pH profiles, we analyzed pH frequency distributions, and individual median and mean pH levels in three different, commonly adopted nocturnal time windows related to 132 curves obtained with single bedtime (10 PM) doses of various H2-antagonists. The time period 12 PM-8 AM has significantly less acid values (p less than 0.001) than the other two (10 PM-6 AM and 8 PM-8 AM), and therefore identifies the drugs' actions more closely. The individual median pH levels describe the H2-antagonist effect in 93% of profiles in the former time segment, whereas the percentage of accuracy is significantly lower (p less than 0.01) in both remaining periods (73% and 67%, respectively). The corresponding percentages of the individual mean pH levels are similar, even though their decline is less evident in the 10 PM-6 AM and 8 PM-8 AM time intervals. Our findings suggest that 1) slight shiftings of arbitrarily predefined time segments are associated with relevant fluctuations of acidity indexes and, therefore, should be standardized whenever possible, in order to favor international comparisons of results; 2) time intervals should be set to fit in as closely as possible with the drug-induced alkalinization wave; 3) pH frequency distribution should always be calculated and taken into careful consideration.

Analysis of circadian fluctuations of bile salt concentration and pH in the stomach of normal subjects and patients suspected of having duodenogastric reflux.

This study was undertaken to evaluate whether intrigastric pH measurements and bile salt concentrations show synchronous fluctuations, in both postprandial and fasting states. It was performed on 5 normal volunteers and 17 non-operated patients suspected of having duodenogastric reflux. In controls the two variables showed different behaviour, especially after eating, while in suspected refluxers they presented more synchronous elevations both in postprandial states and in the nocturnal period. The first derivatives of both pH and bile salt interpolations using Fourier's truncated Series give evidence that these two variables behave differently in the time domain of the two groups. In fact, their first derivatives show equal signs for 521 min (36.2%) out of the 1440 of the study in controls (p less than 0.05) and for 1024/1440 min. (71.1%) in suspected refluxers (p less than 0.005). The difference between the time elapsed in min with equal sign derivatives in the two groups is significant (p less than 0.005). Despite this more coherent behaviour of pH and bile salt fluctuations in patients with suspected reflux, the two variables do not present coincident numerical values even in this population and therefore a close quantitative relationship between them can be excluded in both groups. As a consequence of these results, the use of bile salt concentrations seems inadequate to validate the fact that alkalinizations observed in pH-metry studies are related to episodes of duodenograstric reflux.