[Indicators of body composition as prognostic factors of efficiency of antiviral therapy for chronic hepatitis C]

Aim of the study was to assess prognostic value of body mass index (BMI), percent of body fat (PBF) and waist hip ratio (WHR) on to efficacy of therapy of chronic hepatitis C with pegylated interferon a2a plus ribavirin.

METHODS

Sixty-five chronic hepatitis C genotype 1 patients' BMI, WHR and PBF were evaluated before 48 weeks therapy with pegylated interferon a2a 180 mcg/week plus ribavirin 1000-1200 mg/day. PBF was assessed using bioelectrical impedance analysis. HCV viral load before and during the treatment was assessed by PCR. Sustained virologic response (SVR) was determined as PCR negative at week 24 after finishing the treatment course.

RESULTS

SVR was achieved in 49.2% (32/65) of patients. There was no difference in mean BMI (28.44 +/- 0.71 vs 29.46 +/- 0.61; p = 0.3) between patients achieved and non-achieved SVR. However, they had lower PBF (22.47 +/- 0.64 vs 25.55 +/- 0.80; p = 0.0003) and WHR (1,04 +/- 0,01 vs 1.10 +/- 0,01; p = 0.001). In conclusion, PBF and WHR demonstrate better prognostic value for pegylated interferon ribavirin combination therapy for chronic hepatitis C.

[Elastography efficiency in the liver fibrosis determination in patients with nonalcoholic fatty liver disease]

INTRODUCTION

Liver stiffness measurement (LSM) is a noninvasive and reliable method for the indirect evaluation of liver fibrosis, but it may be less effective in case of nonalcoholic fatty liver disease (NAFLD). AIM. To evaluate the relation between LSM and antropometric measurements - waist-hip ratio (WHR), proportion of excess of fat in body composition (%EFM), body mass index (BMI), insulin resistance index (HOMA IR), serum cholesterol an activity of ALT and AST.

METHODS

The antropometric sudies, bioimpedance analysis (ABC01-036, Medass, Russia), blood chemistry (Konelab 30i, Finland), and liver stiffness measurements using FibroScan (EchoSens, France) equipment were performed to 234 NAFLD patients. The availability of the LSM was estimated on the basis of calculation the proportion of patients with successive LSM (22 measurements, success rate no less then 30%). Correlation between LSM results and main studied parameters was evaluated by Spearman rank R correlation method.

RESULTS

Availability of LSM in NAFLD patients was 52.56%. We found strong correlation between the availability of LSM and BMI (R = -0.28, p = 0.00002). In patients with NAFLD were found direct correlations between LSM and HOMA (R = 0.33, p = 0.0002) and %EFM (R = 0.2, p = 0.034). In patients with simple steatosis there was no correlation between LSM and studied parameters. In NASH patients the results of LSM correlated with HOMA-IR (R = 0.41, p = 0.0004), % EFM (R = 0.3, p = 0.01), WHR (R= 0.3, p = 0.01), and BMI (R = 0.32, p = 0.01).

CONCLUSIONS

The diagnostic availability of liver stiffness measurement correlate with body mass index and goes up to 52.56%. In NAFLD patients there is strong correlation between LSM and results HOMA-IR (R = 0.33, p = 0.0002), and medium correlation with % EFM (R = 0,2, p = 0,034).

[Value of the high gastroesophageal reflux registration in the diagnosis of extraesophageal manifestations of GERD]

INTRODUCTION

The 24-hours pH-monitoring is the "gold standard" to verify the presence of pathologic reflux and confirmation of GERD. But there is lack of data whether it is helpful to verify the link between extraesophageal manifestations with GERD.

AIM

To evaluate the utility of proximal 24-hours pH monitoring for diagnosing ENR manifestations of GERD.

METHODS

Ninety one GERD patients were enrolled to the study. The allergic, infectious and toxic etiology of comorbid diseases were exclusion criteria. Dual-probe 24-hours pH studies were performed to all of the patients. Distal probe was placed 5 cm above esophago-gastric junction, the proximal one--at the upper 1/3 of esophagus over upper esophageal sphincter. The presence of high gastroesophageal reflux (HGR) was diagnosed when at least one episode of drop of pH < 4 for 20 sec at proximal probe during the study occurred. The evaluation of sensitivity and specificity of the method was calculated by the standard protocol.

RESULTS

Comorbid ENR pathology (GERD + CP) was found in 59 patients. Presence of HGR was found in 76.27% of patients of GERD + CP group and in 43.75% of controls (p = 0.0026). Number of HGR was higher in GERD + CP group: M +/- s: 12.51 +/- 18.56 compared to 2.84 +/- 7.11 accordingly, p = 0.0003. Mean pH values were lower in the main group: 6.32 +/- 0.52 compared to 6.58 +/- 0.42 in controls, p = 0.011. Acid exposure time was greater in the main group: 3.19 +/- 6.76 min, compared to 2.42 +/- 10.02 min in controls, p = 0.003. The correlation was found between each of the studied pH-metric parameters and presence of ENR pathology in GERD patients. The results of calculated diagnostic efficacy of the 24-hrs pH monitoring for evaluating the link between GERD and comorbid pathology were as follows: Diagnostic sensitivity--76.27% (95% Confidence Interval's limits (CI): 0.6403-0.8531); Diagnostic specificity: 56.25% (95% CI [0.3933-0.7183]); likelihood ratio for a positive test result 1.743 (95% CI [1.148-2.648]); likelihood ratio for a negative test result 0.422 (95% CI [0.243-0.731]).

CONCLUSION

There is correlation between parameters of 24-hours pH-monitoring in the proximal esophagus and comorbid ENR pathology in GERD patients. High gastroesophageal reflux is more common in GERD patients with comorbid ENR pathology than in GERD patients without ENR diseases. Detection of high gastroesophageal reflux with placing the distal probe in the upper esophagus may be helpful for the diagnosing of extraesophageal manifestations of GERD.

[Clinical significance of food antigens blotting capacity by patients with irritable bowel syndrome]

53 patients suffered from IBS (according to Rome III criteria) were included to the study with solid-phase immune-enzyme detection of the ovalbumin blood level after consumption of egg whites. Patient complaints and quality of life were assessed. The same blood samples were tested for content of the total IgE and specific to food IgE (13 food allergens); specific to food IgG (24 food allergens). The abnormal intestinal permeability was found in 38% IBS patients, also the degree of abdominal pain was significantly higher and quality of life was lower in this patients. The abnormal intestinal permeability was found more frequently in IBS-C patients High levels of IgE and IgG were detected in a few IBS patients.

[The efficacy of transient liver elastography overweight patients with chronic liver diseases]

Transient elastography (TE) allows evaluating the liver fibrosis stage indirectly and noninvasively. High correlation between results with liver fibrosis stage was shown previously. It was suggested that availability and reproducibility of the method is low in patients with excessive.

AIM

To evaluate availability, reproducibility and diagnostic accuracy of transient elastography in patients with different body mass index (BMI) and liver fibrosis stage.

MATERIALS AND METHODS

Two hundred patients with chronic liver diseases (predominantly with chronic hepatitis C, n = 135) were enrolled. Among them 100 were included to the group with BMI > or = 25 kg/m2 (M +/- m 29,58 +/- 3,7 kg/m2) and 100 patients with BMI < 25 kg/m2 (M +/- m 22,07 +/- 2,1 kg/m2). Liver stiffness measurements were performed using FibroScan (EchoSens, France), M-type probe. Metavir grading score was used to estimate liver fibrosis stage. Availability of TE was assessed by counting the proportion of patients with successful examination (22 measurements, success rate > 30%) per group. The reproducibility of TE was studied by counting intra-observer agreement (correlation between results of two series by 11 measurements obtained during examination of the patient) and inter-observer agreement between the results of examinations of the patient by two independent skilled operators obtained on the same day. Diagnostic accuracy was estimated using concordance of the results of liver histology and TE with following cut-off values: 5.8 kPa for F0, 7.2 kPa for F2, 9.5 kPa for F3 and 12.5 kPa for F4.

RESULTS

Availability of TE was lower for patients with BMI > or = 25 kg/m2: 87,13% vs 99% (BMI < 25 kg/m2), p < 0,05. Intra-observer agreement was excellent and did not differ between both studied groups: 0.986595% CI [0.9794-0.9911] for the group with BMI > or = 25 kg/m2, and 0.990095% [0.9851 -0.9931] for patients with BMI < 25 kg/m2, p = 0.3122. Inter-observer agreement was higher for group with BMI > or = 25 kg/m2 (0.987, 95% CI [0.981 -0.990]) then in group with BMI < 25 kg/m2, p = 0.037. The diagnostic accuracy did not differ between groups with excessive weight compared to the BMI < 25 kg/m2 group related to liver fibrosis stage: 65.4% vs. 72.2%, p = 0.59 for F0, 68.1% vs. 70.5%, p = 0.84 for F1, 75.2% vs. 82.1%, p = 0.65 for F2, 84.1% vs. 88.8%, p = 0.76 for F3, 92.2 vs. 94.4, p = 0.85 for F4, accordingly.

CONCLUSION

The availability of TE is lower for patients with an excessive weight. TE is highly reproducible method. The diagnostic accuracy of TE with taken cut-off values was fair and did not differ between both weight groups.

[The prevalence of heartburn in the elderly patients in urban outpatient clinics in Russia]

INTRODUCTION

Heartburn is the most common symptom of GERD. It's prevalence among different age groups of Russian population has not been studied yet.

AIM

To study the prevalence of heartburn and its influence on the quality of life patterns in Russian urban primary care patients.

METHODS

The data presented in the article is a part of ARIADNE study on epidemiology of heartburn in Russian urban population. A cross-sectional survey, using a reliable and validated self-filled questionnaire was performed on randomly selected 18706 primary care patients in the 11 largest cities of Russia.

RESULTS

The data of 14,521 respondents were available to the final analysis. Among the respondents 8,643 (59.5%) reported heartburn, among them elderly (> or = 60 y. o.) 2,017. Heartburn was more prevalent in elderly (61.87%) compared to younger people (59.29%), p = 0.028. Frequent (> or = 2 times a week) heartburn was found in 3,295 respondents. The prevalence of frequent symptom was also higher in elderly then in people less than 60 y. o.: 30.59% compared to 21.42%, p < 0.001. The deeper influence of heartburn on the quality of life of the elderly respondents was found compared to younger patients, especially in regard to necessity to avoid favorite dishes and beverages (40.95% vs 37.52% in younger, p = 0.021), sleep disturbance (29.41% vs 19.22% respectively, p = 0.00001), need to limit physical activity (16.99% vs 13.61%, p = 0.0015). CONCLUSIONS; Heartburn is the prevalent symptom among Russian urban primary care patients. The prevalence of heartburn in patients 60 y. o. and older is higher than in younger people. Frequent heartburn is more prevalent in elderly people compared to younger. The quality of life is significantly decreased in patients experiencing heartburn. The impact of heartburn on the quality of life changes is stronger in elderly people.

[The role of gastroesophageal reflux in malignization of post-burn and peptic esophageal strictures]

The subjects of the study were 221 patients with cicatrical esophageal strictures. 62 (28.5%) patients had peptic strictures, and 159 (71.9%)--post-burn strictures. 67 (30.3%) patients underwent esophageal resection with one-stage intrapleural esophagoplasty with the stomach, 152 (68.8%) patients--gullet bougienage in combination with surgical intervention or as an only treatment. The study revealed 8 cases of squamous cell carcinoma in patients with post-burn strictures, and 3 cases of squamous cell carcinoma in patients with peptic strictures. In 2 cases the researchers found early stage of esophageal cancer (verrucose carcinoma)--in 1 patient with post-burn stricture and 1 patient with peptic stricture. The results suggest an important role of chronic gastroesophageal reflux in the oncogenesis of esophageal squamous cell carcinoma in patients with post-burn and peptic strictures.

[Esomeprasol and rabeprasol effects on esophageal acidification in patients with gastroesophageal reflux disease, intensively metabolizing inhibitors of proton pump]

AIM

To compare action of different esomeprasol and rabeprasol doses on esophageal acidification in patients with gastroesophageal reflux disease (GERD).

MATERIAL AND METHODS

A cross-over study was made in 27 GERD patients (12 males and 15 females). It included esophagoduodenoscopy with biopsy for detection of H-pylori and 24-h pH-metry of esophageal content. Rabeprasol and esomeprasol efficacy was compared for daily doses 20 mg of each (stage I) and rabeprasol 20 mg and esomeprasol 40 mg (stage II).

RESULTS

All the patients proved H-pylori positive. Before the treatment mean daily time of marked esophageal acidification was 29-36%. At stage I significant differences between the drugs were absent. At stage If esomeprasol was more effective from the first day of therapy both in relation to time to effect and its intensity.

CONCLUSION

Esomeprasol provided a fast and noticeable correction of esophageal acidification. This relieves symptoms of GERD and accelerates esophageal mucosa epithelization.

[Comparative effectiveness of the antisecretory action of rabeprazole and esomeprazole in people with rapid metabolism of proton pump inhibitors]

AIM

To compare antisecretory effects of Rabeprazole and Esomeprazole in proton pump inhibitors extensive metabolizers in an open, randomized, two-way crossover study.

METHODS

Sixteen GERD H. pylori-positive patients (8 men, mean age 49.6 and 8 women, mean age 49.3) with the homozygous extensive metabolizer genotype of CYP2C19 determined by polymerase chain reaction-restriction fragment length polymorphism analysis received Rabeprazole 20 mg or Esomeprazole 20 mg daily on days 1-6, with a 14-day wash-out period. Intragastric pH was recorded continuously on days 0, 1, 5 and 7.

RESULTS

On days 1 and 5 no differences were found between Rabeprazole 20 mg and Esomeprazole 20 mg in 24-hours median pH (day 1: 5.9 versus 5.0; day 5: 6.45 versus 6.3) or in percent of time with pH 4 (day 1: 57.8% versus 50.5%; day 5: 81.4% versus 81.2%). On day 1, mean percent of time pH 4 were significantly greater after Esomeprazole 20 mg 52.6% (95% CI: 23.6-68.2) than Rabeprazole 20 mg 33.0% (95% CI: 15.3-48.2) during 0-6 h (p = 0.02). On day 7 (24 later the last dose), 24-hours median pH was higher after Esomeprazole 20 mg than Rabeprazole 20 mg (2.7 versus 5.05; p = 0.02).

CONCLUSIONS

Rabeprazole 20 mg and Esomeprazole 20 mg are equally effective in increasing gastric pH in H. pylori-positive PPI extensive metabolizers on days 1 and 5. Esomeprazole 20 mg is more effective than Rabeprazole 20 mg in maintaining pH 4 during the first 6 hours on the first day and increasing of intragastric pH on the day 24 hours later the last dose.

[Antisecretory therapy for prevention of stenoses of bougienage after-burn of esophageal strictures]

The purpose of the research was to study the efficacy of the bougienage of after-burn esophageal strictures against the background of long-term treatment with proton pump inhibitors of H2-blockers. 100 patients with after-burn esophageal strictures were divided into 3 groups in a random way: 1) only bougienage--53 patients; 2) bougienage and omeprazole, 20 mg per day during 12 months--20 patients; 3) bougienage and ranitidine, 300 mg per day during 12 months--27 patients. Bougienage was efficient in 83 patients (83%). 17 patients underwent esophagoplasty due to inefficiency of bougienage. Repeated bougienage was necessary for 35% of patients who were taking omeprazole (p = 0.04), 48.1%--ranitidine (p = 0.2), and 60.4% of patients who underwent only bougienage. Bougienage of the esophagus is efficient in treatment of after-burn strictures. Twelve-month treatment of these patients with omeprazole reduces the number of repeated bougienage courses significantly.