Prevalence of specific IgA and IgM anti-HBc antibodies compared with HBV DNA in the sera of HBsAg chronic carriers.

OBJECTIVE: We evaluated the significance of IgA antibodies directed against the hepatitis B virus core antigen (IgA anti-HBc) as a marker for viral replication. STUDY DESIGN/METHODS: Serum samples of 143 hepatitis B surface antigen (HBsAg) carriers and 189 HBsAg-negative subjects were studied. Hepatitis B virus (HBV) DNA was detected by polymerase chain reaction. IgA anti-HBc was determined by a capture enzyme-linked immunosorbent assay developed in our laboratory. The results were compared with those for IgM anti-HBc, which were determined by a commercially available method. RESULTS: IgA anti-HBc was detected in 57 (40%) and HBV DNA in 38 (27%) of the HBsAg carriers. Among the HBsAg-negative subjects, IgA anti-HBc and HBV DNA were detected simultaneously in four samples. All 42 HBV DNA-positive samples were IgA anti-HBc positive. IgM anti-HBc was detected in 27 (64%) of them. CONCLUSIONS: IgA anti-HBc is a sensitive marker for HBV replication, and its absence may exclude HBV replication. The role of IgA anti-HBc in monitoring response to therapy and predicting clinical course is being evaluated.

Helicobacter pylori infection and blood groups.

OBJECTIVES: Bacterial attachment is a prerequisite for colonization of the gastric epithelial surface. Recently, it was demonstrated that the receptor for Helicobacter pylori is the blood group antigen Lewis b, which is exposed only in blood group O. We prospectively examined the prevalence of blood groups in H. pylori-positive and -negative patients. To avoid a genetic bias, we compared blood group prevalence of our patients with the general population of Israel. METHODS: In the 187 consecutive patients we studied, in addition to regular upper endoscopy, H. pylori status and blood group. Exposure to H. pylori was diagnosed when the results of two or more of three methods were found to be positive. RESULTS: Exposure was found in 123 patients and 64 negative. The groups were similar in average age and origin, and no significant difference was demonstrated for blood group. Blood group distribution between any given origin was not significantly different in our patients and in a sample of 182,701 blood donors. CONCLUSIONS: Positivity for H. pylori was not associated with blood group O. Our observation does not support the conclusion that the receptor for H. pylori in the gastric mucosa is the blood group antigen Lewis b.

Clinical, serological and molecular characteristics of 471 hepatitis B virus carriers.

A total of 471 Israel Defense Forces (IDF) blood donors identified as hepatitis B virus (HBV) carriers were examined a few months after blood donation. When compared to the general population of IDF blood donors the HBV carriers were older, belonged to certain ethnic groups and were predominantly males. Physical examination revealed minimal findings: 1 (0.3%) had splenomegaly and 5 (1.6%) had hepatomegaly. Fifty-two individuals (11.1%) had elevated liver enzymes. E antigen was present in 3.2% of HBV carriers, 94% had anti-e antibodies and 1.9% had anti-delta antibodies. Of 258 carriers tested for HBV DNA, 29 (11.2%) were positive. Abnormal liver enzymes were significantly associated with the presence of e antigen as well as with the presence of HBV DNA.

Ethnic differences in the prevalence of hepatitis B surface antigen among Israeli blood donors: changes between 1972 and 1988.

The prevalence of hepatitis B surface antigen (HBsAg) carriers among blood donors in Israel during 1988 was compared with that in a similar survey carried out on donors during 1972. The overall age- and sex-standardized prevalence of HBsAg declined from 1.22% to 1.01%. The ethnic differences previously observed were much diminished in native Israelis. The age of highest prevalence shifted from 18-21 to 31-40 years of age, probably due to a cohort effect. The higher prevalence among males has persisted. These findings indicate that the strong ethnic differences in the prevalence of HBsAg previously observed in Israel probably reflect the high rate of infections in the country of birth, and although intra-family spread may have persisted, the overall infection rate in Israel is much lower.

Perforating folliculitis in association with primary sclerosing cholangitis.

Two patients with primary sclerosing cholangitis developed perforating lesions in the skin of the extremities. Clinically and histologically, the cutaneous condition showed the features of perforating folliculitis with superimposed lesions of prurigo nodularis. The course of the eruption paralleled the severity of the biliary disease. A theory of pathogenesis for the development of the perforating folliculitis in these patients is suggested. To the best of our knowledge, this is the first report of the coexistence of both conditions.

Sclerotherapy for the treatment of fissure in ano.

Sclerotherapy has a useful part in the conservative management of anal fissure. When compared with results obtained with routine forms of local treatment, it leads to a higher incidence of successful outcome and reduced number of patients coming to operation. The complication rate was almost nonexistent and in no instance led to any permanent effects. It is an outpatient procedure and can be done with a minimum amount of equipment, technical skill and expertise, resulting in immediate relief. It does not lead to accelerated healing; this is of no consequence since the patient is asymptomatic. We recommend this procedure for acute anal fissures which cause moderate to marked symptoms, particularly when other conservative methods have failed.

Colitis.

The disability caused by proctitis or colitis has been assessed among patients attending a hospital outpatient clinic. Although bowel frequency was a common and troublesome symptom, urgency of defaecation with a tendency to precipitate incontinence was a major factor limiting working life and leisure and social activities. Abdominal or rectal pain and lassitude were the other main symptoms. In every aspect of life studied the disability was as great for patients with proctitis or distal colitis as for those with more extensive inflammation of the colon. As a result of symptoms about a fifth of the patients had a reduced earning capacity and quarter were restricted in their social or leisure activities even when symptoms were at their least bad. The social disability of proctitis or colitis may be underestimated because patients do not mention their fear of incontinence and because their complaint of lassitude does not always correlate with the apparent activity or extent of the disease.

Protracted diarrhea of unknown etiology in Israeli soldiers.

Twenty-five Israeli soldiers, seen over a period of five years, suffered from diarrhea lasting from one month to three years. This was accompanied by weight loss and, in some cases, by evidence of malabsorption and/or mild abnormalities in small bowel and rectal biopsies. The etiology of the diarrhea is unknown, since a routine search for parasites or pathogenic bacteria was unrewarding. An infectious etiology is, however, most likely.