Long-term follow-up evaluation in HCV chronic hepatitis treated with alpha-2b interferon. A comparison of two protocols.

In a long-term study (27 months) of patients affected by C-virus active hepatitis we have evaluated the effect of decreasing the dose of interferon by 50% and by 75% with respect to the initial efficacious dose (6 MU tiw). Sixty patients received recombinant interferon alpha-2b(r-IFN- alpha-2b) 6 MU tiw for two months followed by 3 MU for seven months (Group A), and 60 patients received r-IFN alpha-2b 6 MU tiw for two months followed by 1.5 MU for seven months (Group B). Three patients in group B failed to return to follow-up and were not considered in subsequent evaluations. Side effects such as to cause suspension of treatment occurred only during the first two months of the study at 6 MU of interferon (3 patients in group A and 6 in group B). During the two months at 6 MU, transaminase values returned to normal in 94 patients (80%). At the end of follow-up, 49 of these patients (42% of the 117 patients examined; or 48.3% in group A and 35.1% in group B) had normal transaminase levels. In no case did the anti-HCV test become negative. On a reduced dose of interferon, relapses occurred more frequently in group B (21.4%) than in group A (9.6%), but the difference was not significant. No difference between responders and non-responders, including relapsing patients, was observed in relation to gender, age, presence of cirrhosis, presence of B-virus antibodies and initial levels of serum transaminase.

Gastric endoscopic features in patients with liver cirrhosis: correlation with esophageal varices, intra-variceal pressure, and liver dysfunction.

This study was aimed at evaluating the gastric endoscopic features in patients with liver cirrhosis and at assessing whether endoscopic findings correlated with the severity of portal hypertension and of the underlying liver disease. We studied 394 cirrhotic patients and 110 controls. Prevalence of a mosaic-like pattern of the gastric mucosa was significantly higher in cirrhotics than controls (80.5 vs. 0.9%; p < 0.001). Red spots of the gastric mucosa were found in 8.1% of cirrhotic patients and in none of the control subjects. Erosions and petechiae were found in 14.5 and 5.4% of the control population, but their prevalence was significantly higher in cirrhotics (28.7 and 12.7%, respectively; p < 0.05). Severity of the mosaic-like pattern as well as the presence of red spots were closely related to the size and hemorrhagic risk of esophageal varices and to the presence of fundic varices. Also, severe mosaic-like patterns were found more frequently in patients with severe impairment of liver function, as assessed by the Child-Pugh's criteria. Furthermore, the mosaic-like pattern was more severe in cirrhotic patients with a higher degree of portal hypertension as indirectly assessed by measurement of esophageal intravariceal pressure. In conclusion, (1) a mosaic-like pattern and red spots of the gastric mucosa are the only specific signs of congestive gastropathy in liver cirrhosis, and (2) the severity of the mosaic-like pattern correlates with the severity of liver dysfunction and of portal hypertension.

Regional variations in total and nonprotein sulfhydryl compounds in the human gastric mucosa and effects of ethanol.

This study evaluated the regional distribution of sulfhydryl compounds in the human gastric mucosa and the effect of ethanol on gastric sulfhydryl tissue levels. Total sulfhydryl, glutathione, and cysteine and their oxidized forms were measured in biopsy specimens taken from the gastric body and antrum of 22 healthy volunteers. Total sulfhydryl and glutathione contents of the body of the stomach were significantly higher than those of the antrum. In contrast, cysteine concentration was higher in the gastric antrum than in the body. No difference was found in the levels of oxidized sulfhydryls between the gastric body and antrum. The effect of acute administration of ethanol on gastric sulfhydryl content was studied in nine subjects. Ethanol caused gross mucosal damage and lowered the concentration of sulfhydryl compounds in both the body and the antrum. In 10 chronic alcoholics total sulfhydryl and glutathione, but not cysteine, were markedly decreased in the gastric body but not in the antrum as compared with nonalcoholic controls. In conclusion, 1) the human gastric body contains significantly higher tissue levels of total sulfhydryls and glutathione and lower concentrations of cysteine than the antrum; 2) ethanol in a damaging concentration significantly decreases gastric tissue levels of sulfhydryl compounds; and 3) chronic ethanol intake lowers total sulfhydryl and glutathione tissue levels in the gastric body.

Prevalence of HBcAg and delta-Ag in liver tissue of patients with HBsAg positive chronic hepatitis.

One hundred and twenty HBsAg positive patients with chronic liver disease, 94 with CAH and 26 with CPH, were studied in order to characterize chronic HBsAg positive hepatitis virologically. All patients came from a geographical area (Campania, Italy) with a high prevalence of HBV and HDV infection. Each patient was tested for the presence of HBsAg, HBeAg, anti-HBe and anti-delta in serum (by RIA techniques), and of HDV (by direct immunofluorescence) and HBcAg (by indirect immunofluorescence and PAP-immunoperoxidase) in liver biopsy specimens. Anti-delta serum positivity was remarkably more frequent in patients with CAH (40%) than in those with CPH (19%). Delta-Ag was found in 94.7% of the anti-delta positive patients with CAH, but in none of the five anti-delta positive patients with CPH. In contrast, the frequency of HBcAg tissue positivity was similar in CAH and CPH. Positivity for HBcAg was less frequent in CAH with cirrhosis than in CAH without cirrhosis, while there was no difference in the prevalence of delta-Ag.

Phenotypic characterization of mononuclear cell infiltrate in chronic active hepatitis (CAH) of different etiology.

The morphologic characterization of portal and lobular infiltrates of chronic active hepatitis (CAH) was performed on liver biopsy sections from 18 patients: 6 HBsAg-positive/anti-delta-negative with tissue signs of hepatitis B virus (HBV) replication, 6 HBsAg-positive/anti-delta-positive with tissue signs of hepatitis delta virus (HDV) replication, and 6 HBsAg-negative without clinical or serologic evidence of autoimmune disease. No statistically significant differences were found among all the three groups of patients studied. Results from the 6 HBsAg-negative cases with T4/T8 ratio greater than 1 confirm the differences reported between this type and autoimmune forms of CAH. The lack of statistically significant differences among patients with CAH of different etiology suggests that etiologic factors play a minor role in determining the characteristics of the inflammatory liver infiltrates.

Differences in the etiology of chronic non-alcoholic liver disease in Naples and Copenhagen.

A group of patients with non-alcoholic chronic liver disease from Copenhagen (148) and one from Naples (116) were investigated for the presence of viral and autoimmune serological variables by standardized methods. There were more hepatitis B virus (HBV)-induced cases among the Italians (38.8 versus 15.5%), but the sex ratio and biochemical activity were not different from the Danish ones. Autoimmune markers were much more frequent and in higher titers in Danish HBV-negative patients than in Italian ones. Fewer were women, and thus few Italians fit the theory of autoimmune pathology; rather, their chronic liver disease is caused by other hepatitis viruses than B.