Efficacy and tolerability of tegaserod in constipation dominant irritable bowel syndrome.

OBJECTIVE: To determine the efficacy and tolerability of tegaserod in the treatment of symptoms of irritable bowel syndrome (IBS) IBS-C patients. DESIGN: An open label (quasi interventional) study. PLACE AND DURATION OF STUDY: Patients were enrolled between October 2000 and August 2001 at 4 centres (AKUH, Karachi; Mayo Hospital, Lahore; PIMS, Islamabad; Hayatabad Teaching Complex, Peshawar). PATIENTS AND METHODS: Tegaserod was administered in a dose of 6 mg (twice-a-day) orally for a period of 6 weeks. Symptoms were assessed before and during treatment using a questionnaire. RESULTS: The mean age of patients was 37.5 years and 81(69.2%) were males. The study enrolled 117 patients and 101 patients completed the study. Number of bowel movements, symptoms of straining at defecation, stool consistency, bloating, urgency and abdominal pain improved significantly following treatment (p<0.05). Analysis of data in both genders separately showed statistically significant improvement in symptoms of urgency, straining at defecation, abdominal pain and number of bowel movements following treatment. Side effects of diarrhoea and vertigo (6 and 1 patients respectively) necessitating discontinuation of treatment were infrequent. CONCLUSION: Tegaserod given in a dose of 6 mg b.d. is effective and well tolerated in IBS-C patients. It is equally effective in males and females in relieving the symptoms of abdominal pain, bloating, straining at defecation as well as increased in the mean number of bowel movements per week.

Comparison of liver histology in chronic active hepatitis C and chronic active hepatitis B.

OBJECTIVE: To study the histological features of chronic active hepatitis C (CAH-C) and to compare these with those of chronic active hepatitis B (CAH-B). METHODS: Thirty-two liver biopsy specimens from patients with chronic active hepatitis and presence of antibodies to hepatitis C on second generation enzyme immunoassay were studied and compared with those in 34 patients with CAH-B. Seventeen of the 32 CAH-C patients had fully developed or developing cirrhosis of liver whereas the remainder had only chronic active hepatitis. RESULTS: Among 32 patients with CAH-C, fatty change (20), Kupffer cell hyperplasia (30), sinusoidal lymphocytosis (27) lymphoid follicles aggregates in portal tracts (26) and bridging necrosis (16) were regular features. Focal necrosis, bile duct necrosis, cholestasis and ground glass cells were however seen much less often. On the other hand, in patients with CAH-B, fatty change (no patient), sinusoidal lymphocytosis (one patient) and lymphoid follicles/aggregates in portal tracts (one patient) were rare. Also, Kupffer cell hyperplasia (22 patients) was seen less commonly in patients with CAH-B as compared to CAH-C. Focal necrosis (34 patients), bile ductular proliferation (9 patients), cholestasis (17 patients) and ground glass cells (15 patients) were more prominent in CAH-B. CONCLUSION: Presence of certain histological features can help in distinguishing between CAH-C and CAH-B.

Yet another cause of chronic viral hepatitis?

The clinical features, course and histology of liver in 20 patients; mostly middle aged to elderly females, closely resembling chronic Non A Non B hepatitis is presented. They presented quite late in their disease and therefore, complications such as variceal bleeds, ascites and encephalopathy were frequent. Our patients were negative for hepatitis B and C virus serology. Metabolic and immune causes of chronic liver disease were also ruled out. To the best of our knowledge, this is the first study of its kind elaborating the clinical features, course and histology of liver in chronic Non B Non C hepatitis and raises a number of questions as to the nature of the infecting virus and the epidemiology of disease.