Renal function in patients with chronic hepatitis B during antiviral therapy.

Aim To analyse the impact of the length of antiviral therapy with tenofovir disoproxil fumarate (TDF) on the renal function in patients with chronic hepatitis B (CHB). Methods A cross-sectional study included 75 patients with CHB treated with tenofovir, who had a normal renal function at the beginning of the treatment. Renal function was determined based on glomerular filtration rate (eGFR) value using the Modification of Diet in Renal Disease formula (MDRD). Measurement of serum creatinine concentration and urinary protein excretion were performed using standard laboratory analyses. Viral load quantification (HBV-DNA) was determined by polymerase chain reaction (PCR). The degree of liver fibrosis was determined using fibrosis4 (FIB-4) and aspartate transaminase to platelet ratio index (APRI) fibrosis score. Results Out of 75 CHB patients, 37 were on antiviral treatment for up to 2 years (group 1) and 38 patients on antiviral treatment longer than two years (group 2). Mean age of patients was not significantly different between the groups (p=0.076), nor was the gender distribution. There was no statistically significant difference between the mean values of the eGFR in the two groups (91.89±9.24 vs. 88.42±7.84 mL/min/1.73m2; p=0.42), as well as between the mean values of serum creatinine (p=0.360) and 24-hour urine protein excretion (p=0.380). There was no statistically significant correlation between renal parameters and viral load, APRI and FIB-4 fibrosis score. Conclusion Results of our study did not show significant changes in the measured parameters of renal function in group 1 and group 2 of patients, regardless of the length of antiviral treatment, indicating a good renal safety profile of TDF.

Appropriateness of colonoscopy at a tertiary care centre - are we overdoing gastrointestinal endoscopy?

Aim To evaluate the pattern of indications and a spectrum of colonic pathology, and to determine appropriateness of indications for colonoscopy in order to improve patient selection for colonoscopy. Methods This retrospective study includes 294 patients who were referred to the Gastroenterology Department from a primary care physician in order to approach endoscopic examination. Study data included patients' anamnestic data (comorbidities, positive family history, performed radiological examinations) an indication for the procedure, and colonoscopy findings. Results Haematochezia was confirmed in 186 (63.26%), positive radiologic finding in183 (62.24%) and anaemia in 157 (53.40%) patients. Adenoma and colorectal carcinoma were detected in 40 (13.6%) and 53 (18%) patients, respectively. A significant association between haematochezia and colorectal neoplasm was confirmed (p=0.019), haematochezia and inflammatory bowel disease (p=0.027), and between radiological finding and colorectal neoplasm (p=0.018). There was no significant association between anaemia and any of the colonoscopic findings. According to EPAGE II criteria indications were appropriate in 187 (63.6%), uncertain in 67 (22.8%) and inappropriate in 40 (13.6%) patients. Conclusion This study confirmed a slightly larger number of uncertain and inappropriate indications for colonoscopy compared to other studies that examined indications for colonoscopy, which can be attributed to a high number of patients with functional bowel disorders.

Usefulness of laboratory data in estimation of Crohn's disease activity.

Crohn's disease (CD) is a chronic inflammatory disease characterized by unpredictable and severe course. Most clinicians use simple laboratory parameters of inflammatory activity such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the number of leukocytes (Le) and platelet count to assess disease activity. The aim of this paper was to determine the value of various laboratory parameters in the assessment of Crohn's disease activity. The study included 36 patients, 15 men and 21 women, treated for Crohn's disease at the Gastroenterohepatology Clinic, Clinical Centre, University of Sarajevo, in period 2006 and 2007. Assessed patients were divided into three groups, according to the degree of disease activity, which was determined using the Crohn's Disease Activity Index (CDAI). Mild disease (MD) was present in 15, moderately severe disease (MSD) in 14, and severe disease (SD) in 7 patients. Statistical significance of association between values of laboratory parameters with the degree of severity of illness was investigated using the 95% Confidence Interval test. CRP showed a statistical significance for the relationship between MD-MSD (95% CI 6,645-74,333) and the relationship between MD-SD (95% CI 4,114-135,278), while the relationship between MSD-SD was not statistically significant. MPV showed statistical significance only for the relationship between MD-MSD (95% CI 0,060-2,909). Sedimentation rate and the number of red blood cells showed statistical significance for the relationship MD-SD (95% CI 10,638-62,943 and 0,077-1,080). Haemoglobin, hematocrit and platelet count showed statistical significance for the relationship between MD-MSD and MD-SD. Number of leukocytes did not show any statistically significant relationship with clinical activity of disease. The most reliable indicators of activity of Crohn's disease in this study were CRP, MPV, haemoglobin, hematocrit and platelet count, while leukocyte number did not correlate with disease activity. Neither parameter was sensitive enough to distinguish the relationship between moderately severe disease and severe disease. Until finding a "gold standard" for assessment of clinical disease activity, various laboratory and other parameters must be combined and compared with other indicators, such as endoscopic findings and radiological results.