Interferon plus amantadine versus interferon alone in the treatment of naïve patients with chronic hepatitis C: a UK multicentre study.

BACKGROUND/AIMS: The antiviral agent amantadine may have activity against the hepatitis C virus. To determine whether the combination of interferon-alpha plus amantadine was more effective than interferon monotherapy we conducted a multicentre clinical trial in untreated patients with chronic hepatitis C infection. METHODS: We performed a pilot study in two centres (36 patients) to determine the number needed for a statistically significant clinical trial and then conducted a multicentre, randomized controlled clinical trial involving 14 centres and 143 patients. RESULTS: There was no significant difference in sustained response rates in patients receiving interferon and amantadine compared to those receiving interferon alone. The on treatment response rate at 3 months was 65% on combination vs. 49% on interferon alone (P = 0.05) while the sustained response was 18 and 15%, respectively. CONCLUSIONS: Combination therapy with interferon plus amantadine does not lead to a significant increase in sustained response rates when compared to interferon monotherapy.

Gastritis and gastric campylobacter-like organisms in patients without peptic ulcer.

Gastric biopsy specimens were obtained from 83 patients without peptic ulcer disease and analysed histologically. Culture and serological studies were done on the last 64 patients. The patients were divided into two age groups (young and old groups.) In 34 patients with chronic superficial gastritis, gastric campylobacter-like organisms (GLCO) were identified histologically in 91% and grown on culture in 88%: antibody to GCLO was detected in 81%. No age-related difference in the prevalence of the organism was demonstrated. In the 23 patients with atrophic gastritis (all elderly), presence of the organisms appeared to be related to the presence of an inflammatory cell infiltrate into the gastric mucosa. These figures for the prevalence of the organism in this selected group of patients are similar to those reported in previous studies of unselected patients which included those with peptic ulcer. This suggests that GCLO is unlikely to be causally related to peptic ulcer.

Sensorineural deafness--a new complication of ulcerative colitis?

A case of sudden bilateral sensorineural deafness associated with active ulcerative colitis is reported. Evidence for an autoimmune basis for this condition is reviewed and the potential benefit of systemic corticosteroids emphasized. The condition may represent a recently recognized extra-intestinal complication of ulcerative colitis.

Twice daily tripotassium dicitrato bismuthate in the treatment of duodenal ulceration.

Fifty three patients with endoscopically proven duodenal ulceration have cooperated in a clinical trial to compare the ulcer healing effect of tripotassium dicitrato bismuthate (TDB) at standard dosage administered either twice or four times daily. No statistically significant difference has been found to exist between ulcer healing in the two groups at 4 weeks (72% and 67%, P = 0.944) or at 8 weeks (92% and 81%, P = 0.504) and it is concluded that twice daily TDB maintains the effectiveness of the drug and has advantages for patient compliance.

Likelihood of relapse of duodenal ulcer after initial treatment with cimetidine or colloidal bismuth subcitrate.

Colloidal bismuth subcitrate (CBS, DE-NOL) and cimetidine have been compared in a double-blind randomized trial in the management of 75 patients with duodenal ulcer. The drugs had similar potency with respect to ulcer healing. At one month the healing rates were 66% for CBS and 59% for cimetidine. At two months the rates were 89% and 85% respectively. When the drugs were withdrawn patients who had received CBS had significantly lower relapse rates than those who had received cimetidine. Relapse rates for CBS and cimetidine were 13% and 70% at six months and 39% and 85% at one year respectively.

Difference in relapse rates of duodenal ulcer after healing with cimetidine or tripotassium dicitrato bismuthate.

In a double-blind randomised trial in 75 patients with duodenal ulceration diagnosed endoscopically, 38 patients were given tripotassium dicitrato bismuthate and 37 cimetidine. There was no significant difference in the healing rates between the two drugs after 1 and 2 months, although relief of symptoms was marginally quicker with cimetidine. During follow-up for at least a year, relapse was significantly more common in patients whose ulcers had healed during treatment with cimetidine than in those whose ulcers had healed during treatment with tripotassium dicitrato bismuthate. This difference appears to be related to the medication rather than to any other difference between the two groups of patients. These results suggest that drug treatment given for a short period in duodenal-ulcer disease influences the progress of the disease.

Serial liver biopsies in blood donors with persistent HBs antigenaemia.

Initial liver biopsies from asymptomatic HBs antigen positive blood donors showed a range of histological abnormalities ranging from minor parenchymal lesions to cirrhosis. Twenty of these have now been followed up for periods of up to four years and during that time have had at least two liver biopsies. Throughout the period of study all the donors have remained carriers of HBs Ag, and there was no significant variation in the titers of antigen or the electron microscopic appearances of the serum in individual donors. The histological appearances of subsequent liver biopsies were not always the same as those seen initially, and while there appeared to be some improvement in three cases, there were nine in which the histological appearances were worse.