Predicting short-term and long-term mortality of hospitalized Portuguese patients with alcoholic hepatitis.

BACKGROUND: Alcohol abuse can result in a spectrum of liver injury that ranges from mild fatty infiltration to alcoholic hepatitis (AH), cirrhosis, and hepatocellular carcinoma. The present study aimed to evaluate current scoring systems in predicting short-term and long-term mortality because of AH. PATIENTS AND METHODS: Records of 170 consecutive patients with AH admitted to a tertiary center between January 2005 and October 2015 were reviewed. Clinical and biochemical parameters were retrieved for the assessment of AH scores for the day of admission (D1) and for the seventh day of hospitalization (D7). Endpoints included admission to the ICU, and 30-day, 90-day, and 1-year mortality. RESULTS: The Maddrey discriminant function and the Model of End-Stage Liver Disease (MELD) were modest predictors of the need for ICU admission. In-hospital, 30-day, 90-day, and 1-year mortality were 15.9, 18.2, 21.8, and 30.0%, respectively. There was a numerical, albeit nonsignificant, trend for higher accuracy using D7 scores, especially the MELD, in predicting 30-day and 1-year mortality. Overall, all scores showed high negative predictive values (30 day: 91.2-98.7% and 1 year: 78.8-93.7%), but modest positive predictive values (30 day: 30.6-70.8% and 1 year: 42.1-61.2%). Survival rates were the highest among patients showing a decrease in the MELD, Glasgow Alcoholic Hepatitis Score, and Age, serum Bilirubin, International normalized ratio, and serum Creatinine score over the first week of admission. DISCUSSION: AH scores were comparable in identifying patients at low risk of mortality up to 1 year following admission. Reassessment of the MELD, Glasgow Alcoholic Hepatitis Score, and Age, serum Bilirubin, International normalized ratio, and serum Creatinine score scores after 1 week further improved mortality prediction.

Hemangioma of the rectum - How misleading can hematochezia be?

We present the case of an 18-year-old male patient that was referred to our gastrenterology department with history of intermittent painless hematochezia since childhood. During such instances, he was diagnosed with bowel intussusception, eosinophilic gastroenteritis and inflammatory bowel disease at 4, 6 and 8 years old, respectively. He underwent treatment with 5-aminosalicylic acid for two years, without improvement of symptoms. He was then lost to follow-up until our observation. His physical examination was unremarkable except for digital rectal examination which found a nodular compressible mass by the palpating finger. Blood tests revealed a mild iron deficiency anemia. The colonoscopy showed an extended reddish and bluish multinodular submucosal mass in the rectum, suggesting diffuse cavernous hemangioma of the rectum (DHCR). The Magnetic Resonance Imaging, showed diffuse thickening of the entire rectum extending into the distal sigmoid with the mesorectum revealing multiple serpiginous structures, corresponding to abnormal blood vessels. After discussion, we considered to perform a sphincter-sparing procedure, namely pull through transection and coloanal anastomosis. However, intervention was ruled out by the patient because of his fear of anal incontinence and permanent colostomy. We adopted a conservative strategy with clinical surveillance and iron supplementation. At the present, the patient remains with intermittent rectal bleeding, referring poor quality of life due to his ongoing symptoms. This is a rare case of DHCR. Despite of being a benign disease, the management of DHCR requires a sphincter mucosectomy and pull-through coloanal sleeve anastomosis which has become the first-line procedure. The surgical outcomes are non-expectable in 32% with permanent sphincter lesion or with incomplete DHCR removal. As in this case, the surgeons or patients refusal to perform the intervention is common which represents a challenge to the clinical follow-up.

Hemangioma of the rectum - How misleading can hematochezia be?

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An observational study of the direct costs related to hospital admissions, mortality and premature death associated with liver disease in Portugal.

BACKGROUND: Liver disease, one of the most common causes of hospitalization worldwide, is particularly prevalent in Europe. This study aimed to determine the number of hospital discharges and admissions, mortality, premature death and costs associated with liver disease from the perspective of the National Health Service in Portugal. METHODS: A descriptive, retrospective analysis of data from 97 hospitals between 2000 and 2008, and mortality data for 2011 collected from the Portuguese National Institute of Statistics. The 9th and 10th revisions of the international classification of diseases were used to establish diagnoses. National data on demographics, average length of stay, in-patient mortality and direct costs associated with hospital admissions and liver transplantation were compared for the most common liver diseases. Mortality and premature death were compared using the potential years of life lost (PYLL) index. RESULTS: The annual mean number of discharges for liver disease was 11,503 between 2000 and 2008. Most cases of liver disease were diagnosed in men (70.4 %) and the prevalence of liver disease peaked in patients aged from 20 to 64 years (60.7 %). Alcoholic cirrhosis was the most frequent liver-disease diagnosis leading to discharge (38.6 %). In addition, alcoholic cirrhosis emerged as the main cost-driver, accounting for €26,818,930 (42.6 %) of the total cost imposed by liver disease. Overall, chronic hepatic disease was the 10th most common cause of mortality in Portugal in 2011, causing 21.8 deaths per 100,000. Chronic hepatic disease and hepatocellular carcinoma are even more important causes of premature death, ranking third based on PYLL. CONCLUSION: In 2011, liver disease was the 10th most common cause of death and the third most important cause of premature death in Portugal. Alcohol cirrhosis was the leading cause of liver-related hospital admissions between 2001 and 2008. It appears that liver disease imposes a considerable social and economic burden on Portugal. Our results suggest that educational, legislative and therapeutic interventions to prevent morbidity, mortality and premature death from liver disease are urgently required to minimise the economic and clinical burdens.

Benefits of curing hepatitis C infection.

The hepatitis C virus (HCV) infection is one of the most important chronic viral infections worldwide and affects 3% of the world population, approximately 170-200 million people. The consequences of chronic infection are liver cirrhosis and hepatocellular carcinoma, which develop in 20-30% of the patients, leading to hepatic failure, need for liver transplantation and death. The hepatitis C virus is a RNA virus that is prevalent worldwide and is classified by the World Health Organization (International Agency for Research on Cancer) as one of the six oncogenic viruses. Hepatocellular carcinoma is one of the most important cancers and is fifth worldwide, but third in men in terms of mortality. Hepatitis C kills approximately 350,000 people every year, surpassing HIV infection in many countries as a cause of death. Hepatitis C virus can kill in different ways: it can cause cirrhosis, cancer or severe liver disease in people co-infected with HIV. Hepatitis C treatment started in the mid 1980s with a 6% efficacy rate among patients taking thrice-weekly injections of human interferon. This therapy had numerous side effects. The efficacy of hepatitis C treatment has increased, and currently, the efficacy of the so-called direct antiviral agents (DAAs) is 80-90%. The benefits of a cure are enormous and include a lifetime negative serum HCV RNA, disappearance of HCV in the liver, regression of cirrhosis, decreased risk of developing hepatocellular carcinoma, disappearance of oesophageal varices, no more risk of HCV transmission to sexual partners or children, and increased survival. At present, hepatitis C can be considered a curable disease.

Ibandronate-associated ischemic colitis: case report.

Ibandronate is considered to be a safe drug, and the few reported side-effects in the digestive system are usually related to the upper gastrointestinal tract. Large bowel lesions associated to ibandronate use in humans have not been reported. We describe the case of a 52-year-old female with two episodes of lower abdominal pain after the intake of oral ibandronate. The second pain episode was followed by hematochezia with endoscopic and histological evidence of sigmoid ischemia. No other possible causes of colonic ischemia were found. After a short hospital admission, there was a complete clinical, endoscopic and histological recovery. Ibandronate was withdrawn and the patient reported no further gastrointestinal complaints. This is the first reported case of colon bleeding related to the use of Ibandronate.