Causes of acute exacerbations of chronic hepatitis B.

The authors analyzed acute exacerbations of chronic hepatitis B in 24 chronic HBsAg carriers (20 with positive HBeAg, 4 with anti-HBe), more than half of whom were treated with glucocorticoids, by examining specific antigens and antibodies of the hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis delta virus (HDV), Epstein-Barr virus (EBV) and cytomegalovirus (CMV). Of 38 observed exacerbations of the disease they found in 7 (18%) deterioration after discontinuation of glucocorticoids, in 7 (18%) seroconversion of HBeAg to anti-HBe, in 9 (24%) spontaneous exacerbation of chronic hepatitis B, in 11 (29%) chronic activation, reactivation of EBV superinfection, in 3 (8%) CMV reactivation or superinfection and in one (3%) HDV superinfection. In no instance HAV superinfection was observed. Exacerbations were found five times more frequently in subjects in the stage of active viral replication (in HBeAg+ subjects) than in subjects with anti-HBe. In eight patients EBV reactivation was found after glucocorticoids withdrawal: in five patients after an average period of 5 months (range 3-7) and in three patients after an average period of 33 months (range 22-48). The results provide evidence that in addition to already known causes of acute exacerbations of chronic hepatitis B in our geographical area probably an important cause of deterioration of hepatitis is reactivation or superinfection with EBV and CMV in some patients in conjunction with previous glucocorticoid treatment.

[Dynamic scintigraphy of the esophagus in young persons with functional algesic-dyspeptic disorders of the upper digestive tract]. / Dynamická scintigrafie jícnu u mladých jedincu s funkcními algicko-dyspeptickými potízemi horního typu.

The authors examined a group of 30 young people aged 19-23 years who suffered from chronic algic dyspeptic complaints of the upper type persisting for 3-36 months. The prerequisite for inclusion into the group were normal results of endoscopy, the physical finding and standard biochemical examinations. In all these patients dynamic scintigraphy of the oesophagus was made. A quite normal finding was recorded only in three patients (10%). In the remaining 27 (90%) major or minor abnormalities were recorded. This is in marked contrast with the results of dynamic scintigraphy of the oesophagus in 19 healthy volunteers of the same age. In the latter a normal finding was obtained in 15 (79%) and deviations from it only in four subjects (21%). Dynamic scintigraphy of the oesophagus is a simple easily performed method which in a selected group of patients has become an objective criterion of their chronic complaints.

Clinical importance of assessment of HBsAg/IgM complexes in chronic hepatitis B.

In serum of patients with chronic hepatitis B (HB) in the stage of active viral replication HBsAg/IgM complexes were detected. Using a commercial kit AU-IGM-K Sorin Biomedica HBsAg/IgM complexes in 136 patients with chronic HB and cirrhosis of the liver were examined, incl. 89 men, 42 women and 5 children, mean age 48 +/- 17 years. With regard to the results of the serological examination for HB virus (HBV) markers the results in 54 patients with positive HBeAg and HBsAg in serum (group 1) were compared with 68 patients with positive HBsAg only (group 2) and with 14 patients with positive antibodies against HBV or unrelated to HBV (group 3). The mean positivity index of HBsAg/IgM complexes in group 1, 2 and 3 was 9.89, 1.85 and 0.50, respectively. The results suggest a significant predominance of HBsAg/IgM complexes in patients during the stage of active viral replication with positive HBeAg in serum, as compared with patients without HBeAg (p = 0.001) and the control group (p = 0.001). A similar significant difference between groups was found as regards to ALT and AST activities. We conclude that in patients with chronic HBeAg positive hepatitis and a moderately elevated transaminase activity usually also HBsAg/IgM complexes, which are closely correlated with HBeAg, are positive.

Assessment of alpha-fetoprotein in chronic HBsAg carriers and in HBsAg negative cirrhosis of the liver.

Alpha-fetoprotein (AFP) was assessed in 159 subjects with chronic liver disease, incl. 125 chronic HBsAg carriers (42 suffered from cirrhosis of the liver) and in 34 HbsAg negative cirrhotic patients. In the group of 83 patients with chronic hepatitis B a slightly elevated AFP value was recorded in 7.2%, however, during the check-up examination it was already normal. During a one-year follow up hepatocellular carcinoma (HCC) was revealed in 4 of 42 HBsAg positive cirrhoses (9.5%) and in 2 of 34 (5.9%) HBsAg negative cirrhoses, the difference was not, however, significant. Five patients with HCC had markedly elevated or rising AFP value, one patient had abnormal AFP level despite advanced HCC. All cases of HCC were diagnosed late, in one patient radical treatment was not successful. We conclude that to improve the adverse prognosis of patients with HCC it is necessary to follow-up prospectively all patients with cirrhosis of the liver by sonography twice a year and examine after the same time intervals serum AFP to detect early stages HCC where there is still some chance of successful treatment.