Five-year follow-up of patients with chronic C hepatitis and sustained virological response.

OBJECTIVE: to assess persistence of sustained viral response at 5 years of follow-up in patients with chronic viral hepatitis C treated with pegylated interferon and ribavirin. DESIGN: a descriptive study. PATIENTS: from August 2001 to May 2004, all patients treated at our center with pegylated interferon and ribavirin who achieved a sustained viral response were consecutively enrolled (93 patients). Demographic, histological, biochemical, and virological data were collected during treatment and 5 years after achievement of the sustained viral response. Eighty-six percent of patients enrolled (n = 80) attended the control visit at 5 years. RESULTS: mean age of enrolled patients was 41 years (standard deviation = 10 years), and 30.1% (n = 28) were women. Liver biopsy had been performed before treatment in 68.8% of patients (n = 64), showing no or mild fibrosis in 62.3% (F0 and F1) and significant fibrosis and cirrhosis in 37.7% (F ≥ 3). Genotype distribution was: 58.1% genotype 1 (n = 54); 8.6% genotype 2 (n = 8); 24.7% genotype 3 (n = 23); 7.5% genotype 4 (n = 7), and indeterminate in one patient. Only one patient experienced virological recurrence. All other patients had negative HCV RNA levels and, in the absence of other liver diseases, normal ALT levels. CONCLUSION: in patients treated with pegylated interferon and ribavirin with sustained viral response, long-term recurrence rate was very low.

Seguimiento a 5 años de pacientes con hepatitis crónica C y respuesta viral sostenida / No disponible

Objetivo: evaluar la persistencia de respuesta viral sostenida a los 5 años de seguimiento en pacientes con hepatitis crónica por virus C tratados con interferón pegilado y ribavirina. Diseño: estudio descriptivo. Pacientes: desde agosto de 2001 hasta mayo de 2004, se incluyeron de forma consecutiva todos los pacientes de nuestro centro tratados con interferón pegilado y ribavirina que alcanzaron respuesta viral sostenida (93 pacientes). Se recogieron datos demográficos, histológicos, bioquímicos y virológicos durante el tratamiento y a los 5 años de haber obtenido la respuesta viral sostenida. Se presentaron a la visita de control a los 5 años un 86% de los pacientes incluidos (n = 80). Resultados: los pacientes incluidos presentaron una edad media de 41 años (desviación estándar = 10 años); mujeres 30,1% (n = 28). En el 68,8% de los pacientes (n=64) se había realizado biopsia hepática previa al tratamiento, que mostraba ausencia de fibrosis o fibrosis leve en un 62,3% (F0 y F1) y fibrosis significativa o cirrosis en un 37,7% (F≥3). La distribución por genotipos fue: 58,1% genotipo 1 (n = 54); 8,6% genotipo 2 (n = 8); 24,7% genotipo 3 (n = 23); 7,5% genotipo 4 (n = 7) e indeterminado en un caso. Sólo uno de los pacientes presentó recurrencia virológica. El resto de pacientes presentaron niveles de ARN-VHC negativo y, en ausencia de otra hepatopatía, niveles de ALT normales. Conclusión: en pacientes tratados con interferón pegilado y ribavirina con respuesta viral sostenida la tasa de recurrencia a largo plazo es muy baja(AU)

Objective: to assess persistence of sustained viral response at 5 years of follow-up in patients with chronic viral hepatitis C treated with pegylated interferon and ribavirin. Design: a descriptive study. Patients: from August 2001 to May 2004, all patients treated at our center with pegylated interferon and ribavirin who achieved a sustained viral response were consecutively enrolled (93 patients). Demographic, histological, biochemical, and virological data were collected during treatment and 5 years after achievement of the sustained viral response. Eighty-six percent of patients enrolled (n = 80) attended the control visit at 5 years. Results: mean age of enrolled patients was 41 years (standard deviation = 10 years), and 30.1% (n = 28) were women. Liver biopsy had been performed before treatment in 68.8% of patients (n = 64), showing no or mild fibrosis in 62.3% (F0 and F1) and significant fibrosis and cirrhosis in 37.7% (F ≥ 3). Genotype distribution was: 58.1% genotype 1 (n = 54); 8.6% genotype 2 (n = 8); 24.7% genotype 3 (n = 23); 7.5% genotype 4 (n = 7), and indeterminate in one patient. Only one patient experienced virological recurrence. All other patients had negative HCV RNA levels and, in the absence of other liver diseases, normal ALT levels. Conclusion: in patients treated with pegylated interferon and ribavirin with sustained viral response, long-term recurrence rate was very low(AU)

[Diagnosis and treatment of hepatic encephalopathy in Spain: results of a survey of hepatologists]. / Diagnóstico y tratamiento de la encefalopatía hepática en España: resultados de una encuesta dirigida a hepatólogos.

INTRODUCTION: Hepatic encephalopathy is a common complication of cirrhosis. Recent studies have challenged the efficacy of nonabsorbable disaccharides and have reported that protein restriction may pose risks to patients with cirrhosis and hepatic encephalopathy. AIM: To determine the diagnostic and therapeutic practices of physicians treating patients with hepatic encephalopathy. MATERIAL AND METHODS: We designed a 20-item questionnaire, which was mailed to the members of the Spanish Society for the Study of the Liver. RESULTS: We received 128 questionnaires, completed by physicians with wide clinical experience. They reported that the most common precipitating factors in episodic encephalopathy were infections (22%), diuretics (21%), and gastrointestinal bleeding (21%). The usual treatment of episodic encephalopathy was administration of nonabsorbable disaccharides (90%) and protein restriction (52%). Patients with chronic encephalopathy were also usually treated with nonabsorbable disaccharides (94%) and protein restriction (40%). Fifty-nine percent of the hepatologists never carried out neurophysiologic or neuropsychologic assessment for the diagnosis of minimal hepatic encephalopathy. CONCLUSION: Although their efficacy has been questioned, nonabsorbable disaccharides and protein restriction are the most commonly prescribed treatments for hepatic encephalopathy. Future studies are needed to assess the efficacy and risks of these treatments. Most hepatologists never assess minimal hepatic encephalopathy in patients with cirrhosis.

Diagnóstico y tratamiento de la encefalopatía hepática en España: resultados de una encuesta dirigida a hepatólogos / Diagnosis and treatment of hepatic encephalopathy in Spain: results of a survey of hepatologists

Introducción: La encefalopatía hepática es una complicación frecuente de la cirrosis hepática. Estudios recientes han cuestionado la eficacia de los disacáridos no absorbibles y han señalado que la restricción proteica podría tener riesgos en pacientes con cirrosis y encefalopatía hepática. Objetivo: Conocer los hábitos diagnósticos y terapéuticos de los médicos que tratan a pacientes con encefalopatía hepática. Material y métodos: Se elaboró un cuestionario de 20 preguntas que se envió por correo a los miembros de la Asociación Española para el Estudio del Hígado (AEEH). Resultados: Se recibieron 128 encuestas, completadas por médicos con larga experiencia. En referencia a la encefalopatía episódica, los encuestados consideraron que los factores precipitantes más frecuentes fueron las infecciones (22%), los diuréticos (21%) y la hemorragia digestiva (21%). El tratamiento habitual de la encefalopatía episódica consiste en la administración de disacáridos no absorbibles (90%) y en la restricción proteica (52%). La encefalopatía crónica también se trata habitualmente con disacáridos no absorbibles (94%), junto con restricción proteica (40%). Un 59% de los hepatólogos nunca realizan exploraciones neurofisiológicas o neuropsicológicas para el diagnóstico de la encefalopatía hepática mínima. Conclusión: A pesar de las dudas acerca de la eficacia de los disacáridos no absorbibles y de la restricción proteica, éstas son las medidas terapéuticas habituales en la encefalopatía hepática, lo que muestra la importancia de aclarar la eficacia y los riesgos de los disacáridos no absorbibles y de la restricción proteica. La mayoría de los hepatólogos no investigan nunca la encefalopatía hepática mínima en los pacientes con cirrosis hepática

Introduction: Hepatic encephalopathy is a common complication of cirrhosis. Recent studies have challenged the efficacy of nonabsorbable disaccharides and have reported that protein restriction may pose risks to patients with cirrhosis and hepatic encephalopathy. Aim: To determine the diagnostic and therapeutic practices of physicians treating patients with hepatic encephalopathy. Material and methods: We designed a 20-item questionnaire, which was mailed to the members of the Spanish Society for the Study of the Liver. Results: We received 128 questionnaires, completed by physicians with wide clinical experience. They reported that the most common precipitating factors in episodic encephalopathy were infections (22%), diuretics (21%), and gastrointestinal bleeding (21%). The usual treatment of episodic encephalopathy was administration of nonabsorbable disaccharides (90%) and protein restriction (52%). Patients with chronic encephalopathy were also usually treated with nonabsorbable disaccharides (94%) and protein restriction (40%). Fifty-nine percent of the hepatologists never carried out neurophysiologic or neuropsychologic assessment for the diagnosis of minimal hepatic encephalopathy. Conclusion: Although their efficacy has been questioned, nonabsorbable disaccharides and protein restriction are the most commonly prescribed treatments for hepatic encephalopathy. Future studies are needed to assess the efficacy and risks of these treatments. Most hepatologists never assess minimal hepatic encephalopathy in patients with cirrhosis

Diagnóstico y tratamiento de la encefalopatía hepática en España: resultados de una encuesta dirigida a hepatólogos / Diagnosis and treatment of hepatic encephalopathy in Spain: results of a survey of hepatologists

Introducción: La encefalopatía hepática es una complicación frecuente de la cirrosis hepática. Estudios recientes han cuestionado la eficacia de los disacáridos no absorbibles y han señalado que la restricción proteica podría tener riesgos en pacientes con cirrosis y encefalopatía hepática. Objetivo: Conocer los hábitos diagnósticos y terapéuticos de los médicos que tratan a pacientes con encefalopatía hepática. Material y métodos: Se elaboró un cuestionario de 20 preguntas que se envió por correo a los miembros de la Asociación Española para el Estudio del Hígado (AEEH). Resultados: Se recibieron 128 encuestas, completadas por médicos con larga experiencia. En referencia a la encefalopatía episódica, los encuestados consideraron que los factores precipitantes más frecuentes fueron las infecciones (22%), los diuréticos (21%) y la hemorragia digestiva (21%). El tratamiento habitual de la encefalopatía episódica consiste en la administración de disacáridos no absorbibles (90%) y en la restricción proteica (52%). La encefalopatía crónica también se trata habitualmente con disacáridos no absorbibles (94%), junto con restricción proteica (40%). Un 59% de los hepatólogos nunca realizan exploraciones neurofisiológicas o neuropsicológicas para el diagnóstico de la encefalopatía hepática mínima. Conclusión: A pesar de las dudas acerca de la eficacia de los disacáridos no absorbibles y de la restricción proteica, éstas son las medidas terapéuticas habituales en la encefalopatía hepática, lo que muestra la importancia de aclarar la eficacia y los riesgos de los disacáridos no absorbibles y de la restricción proteica. La mayoría de los hepatólogos no investigan nunca la encefalopatía hepática mínima en los pacientes con cirrosis hepática

Introduction: Hepatic encephalopathy is a common complication of cirrhosis. Recent studies have challenged the efficacy of nonabsorbable disaccharides and have reported that protein restriction may pose risks to patients with cirrhosis and hepatic encephalopathy. Aim: To determine the diagnostic and therapeutic practices of physicians treating patients with hepatic encephalopathy. Material and methods: We designed a 20-item questionnaire, which was mailed to the members of the Spanish Society for the Study of the Liver. Results: We received 128 questionnaires, completed by physicians with wide clinical experience. They reported that the most common precipitating factors in episodic encephalopathy were infections (22%), diuretics (21%), and gastrointestinal bleeding (21%). The usual treatment of episodic encephalopathy was administration of nonabsorbable disaccharides (90%) and protein restriction (52%). Patients with chronic encephalopathy were also usually treated with nonabsorbable disaccharides (94%) and protein restriction (40%). Fifty-nine percent of the hepatologists never carried out neurophysiologic or neuropsychologic assessment for the diagnosis of minimal hepatic encephalopathy. Conclusion: Although their efficacy has been questioned, nonabsorbable disaccharides and protein restriction are the most commonly prescribed treatments for hepatic encephalopathy. Future studies are needed to assess the efficacy and risks of these treatments. Most hepatologists never assess minimal hepatic encephalopathy in patients with cirrhosis