ABSTRACT
BACKGROUND: Ursodeoxycholic acid (UDCA) could potentiate the effect of interferon (IFN) in patients with chronic hepatitis C resistant to IFN. We compared the efficacy of IFN with that of a combination of IFN and UDCA. METHODS: Patients were randomized to receive UDCA (13-15 mg/kg/day) (n = 47) or placebo (n = 44) plus interferon (3 MU three times weekly) for 6 months and were then followed up for 6 additional months. RESULTS: At entry 30% of patients had cirrhosis, and 70% had HCV genotype 1. Five and four patients withdrew from the combination and the monotherapy groups, respectively. At 6 months alanine aminotransferase (ALAT) and gamma-glutamyl transferase (GGT) activities were significantly lower (P < 0.001) in the combination group than in the monotherapy group; the differences were no longer significant at 1 year. At 6 months ALAT activities normalized in 10 and 8 patients in the combination and the monotherapy groups, respectively (P = 0.67). In 10 of them (5 in each group) HCV RNA levels became undetectable. At 1 year four versus one patient had a sustained normalization of ALAT, and in one patient the HCV RNA became negative. There was no difference in the histologic progression. In this setting, in contrast to chronic cholestasis, UDCA administration induced an increase in total serum bile acids and did not change primary bile acids. CONCLUSIONS: An IFN plus UDCA combination is more effective than IFN alone in terms of ALAT but not in terms of the virologic response. These results favor the hypothesis that UDCA has an effect on the biochemical indices of cellular injury independent of a change in primary bile acids.
Subject(s)
Antiviral Agents/administration & dosage , Cholagogues and Choleretics/administration & dosage , Hepatitis C, Chronic/drug therapy , Interferon-alpha/administration & dosage , Ursodeoxycholic Acid/administration & dosage , Adult , Aged , Dose-Response Relationship, Drug , Double-Blind Method , Drug Resistance, Microbial , Drug Therapy, Combination , Female , Follow-Up Studies , Hepatitis C, Chronic/diagnosis , Humans , Interferons/administration & dosage , Male , Middle Aged , Reference Values , Statistics, Nonparametric , Treatment OutcomeABSTRACT
Using scanning electron microscopy (SEM), then light microscopy, the authors have studied 25 colonic adenomas, 5 specimens of peri-adenomatous mucosa and 9 specimens of normal colonic mucosa. Comparison between SEM features and histological characteristics has shown that each of the three histological entities had an specific surface architecture. Comparative analysis of the different aspects observed at SEM has shown a close architectural relationship between the adenomas and the adjacent mucosa, and suggests the hypothesis that adenomatous polyps are formed by invagination of the surface epithelium which has a well-known capacity of proliferation.
