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Leideck P, Nkontchou G, Elkrief L, Erard D, d'Alteroche L, Radenne S, Billioud C, Meszaros M, Regnault D, Pageaux GP, Hilleret MN, Tripon S, Guillaud O, Ollivier-Hourmand I, Ganne-Carrié N, Dumortier J. The role and evolution of partial splenic embolization over three decades: A multicentric retrospective single cohort study of 90 patients from French nationwide experience. Clin Res Hepatol Gastroenterol 2024; 48:102355. [PMID: 38679291 DOI: 10.1016/j.clinre.2024.102355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/10/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Partial splenic embolization (PSE) has been proposed to treat the consequences of hypersplenism in the context of portal hypertension, especially thrombocytopenia. However, a high morbidity/mortality rate has made this technique unpopular. We conducted a multicenter retrospective nationwide French study to reevaluate efficacy and tolerance. METHODS All consecutive patients who underwent PSE for hypersplenism and portal hypertension in 7 tertiary liver centers between 1998 and 2023 were included. RESULTS The study population consisted of 91 procedures in 90 patients, with a median age of 55.5 years [range 18-83]. The main cause of portal hypertension was cirrhosis (84.6 %). The main indications for PSE were (1) an indication of medical treatment or radiological/surgical procedure in the context a severe thrombocytopenia (59.3 %), (2) a chronic hemorrhagic disorder associated with a severe thrombocytopenia (18.7 %), and (3) a chronic pain associated with a major splenomegaly (9.9 %). PSE was associated with a transjugular intrahepatic portosystemic shunt in 20 cases. Median follow-up after PSE was 41.9 months [0.5-270.5]. Platelet count increased from a median of 48.0 G/L [IQR 37.0; 60.0] to 100.0 G/L [75.0; 148]. Forty-eight patients (52.7 %) had complications after PSE; 25 cases were considered severe (including 7 deaths). A Child-Pugh B-C score (p < 0.02) was significantly associated with all complications, a history of portal vein thrombosis (p < 0.01), and the absence of prophylactic antibiotherapy (p < 0.05) with severe complications. CONCLUSION Our results strongly confirm that PSE is very effective, for a long time, although a quarter of the patients experienced severe complications. Improved patient selection (exclusion of patients with portal vein thrombosis and decompensated cirrhosis) and systematic prophylactic antibiotherapy could reduce morbidity and early mortality in the future.
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Affiliation(s)
- Paul Leideck
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastroentérologie, 03, Lyon CEDEX 69437, France
| | - Gisèle Nkontchou
- Assistance Publique - Hôpitaux de Paris, Hôpital Avicenne, Service d'Hépato-Gastroentérologie, Bobigny, France
| | - Laure Elkrief
- CHU Tours, Hôpital Trousseau, Service d'Hépato-Gastroentérologie, Tours, France
| | - Domitille Erard
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'Hépato-Gastroentérologie, Lyon, France
| | - Louis d'Alteroche
- CHU Tours, Hôpital Trousseau, Service d'Hépato-Gastroentérologie, Tours, France
| | - Sylvie Radenne
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'Hépato-Gastroentérologie, Lyon, France
| | - Claire Billioud
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'Hépato-Gastroentérologie, Lyon, France
| | - Magdalena Meszaros
- CHU Saint Eloi, Département d'Hépatologie et Transplantation Hépatique, Montpellier, France
| | - David Regnault
- CHU Tours, Hôpital Trousseau, Service d'Hépato-Gastroentérologie, Tours, France
| | | | | | - Simona Tripon
- CHRU Hautepierre, Service d'Hépato-Gastroentérologie, Strasbourg, France
| | - Olivier Guillaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastroentérologie, 03, Lyon CEDEX 69437, France; Clinique de la Sauvegarde, Ramsay Générale de Santé, Lyon, France
| | | | - Nathalie Ganne-Carrié
- Assistance Publique - Hôpitaux de Paris, Hôpital Avicenne, Service d'Hépato-Gastroentérologie, Bobigny, France
| | - Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastroentérologie, 03, Lyon CEDEX 69437, France.
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2
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Louvet A, Bourcier V, Archambeaud I, d'Alteroche L, Chaffaut C, Oberti F, Moreno C, Roulot D, Dao T, Moirand R, Duclos-Vallée JC, Goria O, Nguyen-Khac E, Pol S, Carbonell N, Gournay J, Elkrief L, Fouchard-Hubert I, Chevret S, Ganne-Carrié N. Low alcohol consumption influences outcomes in individuals with alcohol-related compensated cirrhosis in a French multicenter cohort. J Hepatol 2023; 78:501-512. [PMID: 36423805 DOI: 10.1016/j.jhep.2022.11.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/24/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND & AIMS The harmful impact of heavy alcohol consumption and recurrence in patients with alcohol-related cirrhosis is long-established, although this is based on old studies. However, the drivers of long-term outcome still need to be clearly investigated. METHOD All patients with biopsy-proven compensated alcohol-related cirrhosis included in the CIRRAL cohort (22 centers) were prospectively studied. Prognostic variables of survival and liver event-free survival were assessed using multivariable Cox models with stepwise selection. The prognostic impact of alcohol recurrence during follow-up (computed in glass-years in the same way as pack-years for tobacco) was assessed using a time-dependent covariable. RESULTS From 2010 to 2016, 650 patients were included. The median age at baseline was 58.4 years, 67.4% were men and the median BMI was 27.8 kg/m2, 63.8% had a history of liver decompensation, and 70.2% had discontinued alcohol. At 5 years, recurrence occurred in 30.9% of abstinent patients and this risk was higher in patients with a history of drug abuse and in those with shorter alcohol discontinuation times. Median survival was 97 months. Age, alcohol consumption at baseline, platelet count and Child-Pugh score >5 were associated with overall and liver event-free survival on multivariate analysis. Alcohol consumption of more than 25 glass-years during follow-up was independently associated with lower survival and with a trend toward lower liver event-free survival, with the risk increasing from 1 glass-year, though not significantly. Simon & Makuch plots confirm the benefit of no alcohol consumption (<1 glass/week) on both outcomes and the dose-dependent impact of alcohol over time. CONCLUSION This prospective study in patients with compensated alcohol-related cirrhosis identifies factors predictive of alcohol recurrence during follow-up and shows that moderate alcohol consumption during follow-up negatively impacts outcomes. Patients with alcohol-related cirrhosis should be advised to completely stop drinking alcohol. REGISTRATION CIRRAL (NCT01213927) cohort was registered at ClinicalTrials.gov and the full protocol is available at the following link: https://clinicaltrials.gov/ct2/show/NCT01213927. IMPACT AND IMPLICATIONS In patients with alcohol-related cirrhosis, data are lacking about the impact of the amount of alcohol consumed on both survival and liver-related events. The present study based on the CIRRAL cohort demonstrates that alcohol recurrence occurs in more than 30% of patients with compensated cirrhosis and that even a moderate recurrence strongly influences outcomes. Patients with compensated alcohol-related cirrhosis should be advised to completely discontinue alcohol consumption, even in small amounts, as the present study shows that no alcohol consumption can be regarded as safe when cirrhosis has developed.
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Affiliation(s)
| | - Valérie Bourcier
- AP-HP, Hôpital Avicenne, Service d'Hépatologie, Bobigny, Université Sorbonne Paris Nord, Bobigny et INSERM U1138, Université de Paris, France
| | | | | | - Cendrine Chaffaut
- SBIM, APHP, Hôpital Saint-Louis, Paris, Inserm, UMR-1153, ECSTRRA Team, Paris, France
| | | | | | - Dominique Roulot
- AP-HP, Hôpital Avicenne, Service d'Hépatologie, Bobigny, Université Sorbonne Paris Nord, Bobigny et INSERM U1138, Université de Paris, France; Inserm U955 Université Paris Est, Créteil, France
| | - Thông Dao
- Liver Unit, University Hospital, Caen, France
| | | | | | - Odile Goria
- Liver Unit, University Hospital, Rouen, France
| | | | - Stanislas Pol
- Liver Unit, Hôpital Cochin, INSERM U1223, Institut Pasteur, Paris, France
| | | | | | | | | | - Sylvie Chevret
- SBIM, APHP, Hôpital Saint-Louis, Paris, Inserm, UMR-1153, ECSTRRA Team, Paris, France
| | - Nathalie Ganne-Carrié
- AP-HP, Hôpital Avicenne, Service d'Hépatologie, Bobigny, Université Sorbonne Paris Nord, Bobigny et INSERM U1138, Université de Paris, France.
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3
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Calame P, Rostam M, d'Alteroche L, Malakhia A, Cervoni JP, Weil D, Martino VD, Sutter O, Greget M, Risson JR, Vionnet M, Bouvier A, Mokrane FZ, Ghelfi J, Papadopoulos P, Sangel C, Rodes A, Goupil J, Delabrousse E, Douane F, Loffroy R, Hebert T, Boizet A, Guerrab A, Raynaud N, Carbillet PQ, Dumas V, Velasco S, Lapuyade B, Pey MA, Boatta E, De Marini P, Cœur J, Verdot P. Left gastric vein embolization during TIPS placement for acute variceal bleeding has no effect on bleeding recurrence: Results of a multicenter study. Diagn Interv Imaging 2023; 104:248-257. [PMID: 36740536 DOI: 10.1016/j.diii.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE The purpose of this study was to evaluate whether concomitant left gastric vein embolization (LGVE) during transjugular intrahepatic portosystemic shunt (TIPS) for acute variceal hemorrhage could reduce the risk of bleeding recurrence. MATERIAL AND METHOD A national multicenter observational study was conducted in 14 centers between January 2019 and December 2020. All cirrhotic patients who underwent TIPS placement for acute variceal bleeding were included. During TIPS procedure, size of left gastric vein (LGV), performance of LGVE, material used for LGVE and portosystemic pressure gradient (PPG) before and after TIPS placement were collected. A propensity score for the occurrence of LGVE was calculated to assess effect of LGVE on rebleeding recurrence at six weeks and one year. RESULTS A total of 356 patients were included (mean age 57.3 ± 10.8 [standard deviation] years; 283/356 [79%] men). Median follow-up was 11.2 months [interquartile range: 1.2, 13.3]. The main indication for TIPS was pre-emptive TIPS (162/356; 46%), rebleeding despite secondary prophylaxis (105/356; 29%), and salvage TIPS (89/356; 25%). Overall, 128/356 (36%) patients underwent LGVE during TIPS procedure. At six weeks and one year, rebleeding-free survival did not differ significantly between patients who underwent LGVE and those who did not (6/128 [5%] vs. 15/228 [7%] at six weeks, and 11/128 [5%] vs. 22/228 [7%] at one year, P = 0.622 and P = 0.889 respectively). A total of 55 pairs of patients were retained after propensity score matching. In patients without LGVE, the rebleeding rate was not different from those with LGVE (3/55 [5%] vs. 4/55 [7%], P > 0.99, and 5/55 [9%] vs. 6/55[11%], P > 0.99, at six weeks and one year respectively). Multivariable analysis identified PPG after TIPS placement as the only predictor of bleeding recurrence (hazard ratio = 1.09; 95% confidence interval: 1.02-1.18; P = 0.012). CONCLUSION In this multicenter national real-life study, we did not observe any benefit of concomitant LGVE during TIPS placement for acute variceal bleeding on bleeding recurrence rate.
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Affiliation(s)
- Paul Calame
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France; EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, 25030, Besançon, France
| | - Mathieu Rostam
- Department of Radiology, CHU de Nantes, 44000, Nantes, France
| | | | - Alexandre Malakhia
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France; Department of Radiology, CHU Dijon-Bourgogne, 21079, Dijon, France
| | - Jean-Paul Cervoni
- Department of Hepatology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Delphine Weil
- Department of Hepatology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Vincent Di Martino
- Department of Hepatology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Olivier Sutter
- Interventional Radiology Unit, Avicenne Hospital, Paris-Seine-Saint-Denis University Hospitals, Assistance-Publique Hopitaux de Paris, 93000, Bobigny, France
| | - Michel Greget
- Department of Radiology, Strasbourg University Hospital, 67200, Strasbourg, France
| | | | - Mathilde Vionnet
- Department of Radiology, CHU de Poitiers, 86000, Poitiers, France
| | - Antoine Bouvier
- Department of Radiology, University Hospital, 49100, Angers, France
| | - Fatima-Zohra Mokrane
- Department of Radiology, University of Toulouse III Paul Sabatier, 31062, Toulouse, France
| | - Julien Ghelfi
- Department of Radiology, University of Grenoble-Alpes, 38700, Grenoble, France
| | | | - Christian Sangel
- Department of Radiology, University of Grenoble-Alpes, 38700, Grenoble, France
| | - Agnes Rodes
- Department of Radiology, Hôpital de la Croix Rousse, Centre Hospitalier Universitaire de Lyon, 69004, Lyon, France
| | - Jean Goupil
- Department of Radiology, CHU de Nîmes, 30900, Nîmes, France
| | - Eric Delabrousse
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France; EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, 25030, Besançon, France
| | - Frederic Douane
- Department of Radiology, CHU de Nantes, 44000, Nantes, France
| | - Romaric Loffroy
- Department of Radiology, CHU Dijon-Bourgogne, 21079, Dijon, France
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- Club Francophone pour l'Étude de l'Hypertension Portale (CFEHTP)
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Eymieux S, Hourioux C, Marlet J, Moreau A, Patient R, d'Alteroche L, Gaudy‐Graffin C, Blanchard E, Roingeard P. A morphometric analysis of hepatitis B subviral particles shows no correlation of filament proportion and length with clinical stage and genotype. J Viral Hepat 2022; 29:719-726. [PMID: 35633087 PMCID: PMC9541738 DOI: 10.1111/jvh.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/11/2022] [Accepted: 05/04/2022] [Indexed: 12/09/2022]
Abstract
It was recently suggested that the composition of circulating hepatitis B subviral particles (SVPs) could be used to differentiate the various stages in chronic hepatitis B virus (HBV) infection, with significantly lower proportions of L and M proteins in inactive carriers than in individuals with chronic hepatitis. L protein is abundant in virions and filamentous SVPs but almost absent from spherical SVPs. We, therefore, performed a morphometric analysis of SVPs in these two groups of patients, by conducting a retrospective analysis on sera from 15 inactive carriers and 11 patients with chronic hepatitis infected with various HBV genotypes. Subviral particles were concentrated by centrifugation on a sucrose cushion, with monitoring by transmission electron microscopy. The percentage of filamentous SVPs and filament length for 100 SVPs was determined with a digital camera. The L protein PreS1 promoter was sequenced from viral genomes by the Sanger method. No marked differences were found between patients, some of whom had only spherical SVPs, whereas others had variable percentages of filamentous SVPs (up to 28%), of highly variable length. High filament percentages were not associated with a particular sequence of the L protein promoter, HBV genotype or even disease stage. High levels of circulating filamentous SVPs are probably more strongly related to individual host factors than to viral strain characteristics or disease stage.
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Affiliation(s)
- Sébastien Eymieux
- INSERM U1259 MAVIVHUniversité de Tours and CHRU de ToursToursFrance,Plate‐Forme IBiSA de Microscopie ElectroniqueUniversité de Tours and CHRU de ToursToursFrance
| | - Christophe Hourioux
- INSERM U1259 MAVIVHUniversité de Tours and CHRU de ToursToursFrance,Plate‐Forme IBiSA de Microscopie ElectroniqueUniversité de Tours and CHRU de ToursToursFrance
| | - Julien Marlet
- INSERM U1259 MAVIVHUniversité de Tours and CHRU de ToursToursFrance,Service de Bactériologie‐Virologie‐HygièneCHRU de ToursToursFrance
| | - Alain Moreau
- INSERM U1259 MAVIVHUniversité de Tours and CHRU de ToursToursFrance
| | - Romuald Patient
- INSERM U1259 MAVIVHUniversité de Tours and CHRU de ToursToursFrance
| | - Louis d'Alteroche
- Unité d'Hépatologie, Service d'HépatogastroentérologieCHRU de ToursToursFrance
| | - Catherine Gaudy‐Graffin
- INSERM U1259 MAVIVHUniversité de Tours and CHRU de ToursToursFrance,Service de Bactériologie‐Virologie‐HygièneCHRU de ToursToursFrance
| | - Emmanuelle Blanchard
- INSERM U1259 MAVIVHUniversité de Tours and CHRU de ToursToursFrance,Plate‐Forme IBiSA de Microscopie ElectroniqueUniversité de Tours and CHRU de ToursToursFrance
| | - Philippe Roingeard
- INSERM U1259 MAVIVHUniversité de Tours and CHRU de ToursToursFrance,Plate‐Forme IBiSA de Microscopie ElectroniqueUniversité de Tours and CHRU de ToursToursFrance
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5
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Pearson A, Dujardin P, d'Alteroche L, Patat F, Scotto B, Dujardin F, Bastard C, Miette V, Sandrin L, Remenieras J. Vibration controlled transient elastography for non‐invasive evaluation of liver steatosis. Med Phys 2022; 49:1507-1521. [PMID: 35094409 PMCID: PMC9401907 DOI: 10.1002/mp.15484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Arthur Pearson
- Radiology department University Hospital of Tours Tours 37000 France
- CIC Inserm 1415 University Hospital of Tours Tours 37000 France
| | | | - Louis d'Alteroche
- Hepatology department University Hospital of Tours Tours 37000 France
| | - Frédéric Patat
- Radiology department University Hospital of Tours Tours 37000 France
- CIC Inserm 1415 University Hospital of Tours Tours 37000 France
- UMR Inserm 1253, iBrain François Rabelais University of Tours Tours 37000 France
| | - Béatrice Scotto
- Radiology department University Hospital of Tours Tours 37000 France
| | - Fanny Dujardin
- Pathology department University Hospital of Tours Tours 37000 France
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6
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Pageaux GP, Nzinga CL, Ganne N, Samuel D, Dorival C, Zoulim F, Cagnot C, Decaens T, Thabut D, Asselah T, Mathurin P, Habersetzer F, Bronowicki JP, Guyader D, Rosa I, Leroy V, Chazouilleres O, de Ledinghen V, Bourliere M, Causse X, Cales P, Metivier S, Loustaud-Ratti V, Riachi G, Alric L, Gelu-Simeon M, Minello A, Gournay J, Geist C, Tran A, Abergel A, Portal I, d'Alteroche L, Raffi F, Fontaine H, Carrat F, Pol S. Clinical outcomes after treatment with direct antiviral agents: beyond the virological response in patients with previous HCV-related decompensated cirrhosis. BMC Infect Dis 2022; 22:94. [PMID: 35086481 PMCID: PMC8796427 DOI: 10.1186/s12879-022-07076-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background In HCV-infected patients with advanced liver disease, the direct antiviral agents-associated clinical benefits remain debated. We compared the clinical outcome of patients with a previous history of decompensated cirrhosis following treatment or not with direct antiviral agents from the French ANRS CO22 HEPATHER cohort. Methods We identified HCV patients who had experienced an episode of decompensated cirrhosis. Study outcomes were all-cause mortality, liver-related or non-liver-related deaths, hepatocellular carcinoma, liver transplantation. Secondary study outcomes were sustained virological response and its clinical benefits. Results 559 patients met the identification criteria, of which 483 received direct antiviral agents and 76 remained untreated after inclusion in the cohort. The median follow-up time was 39.7 (IQR: 22.7–51) months. After adjustment for multivariate analysis, exposure to direct antiviral agents was associated with a decrease in all-cause mortality (HR 0.45, 95% CI 0.24–0.84, p = 0.01) and non-liver-related death (HR 0.26, 95% CI 0.08–0.82, p = 0.02), and was not associated with liver-related death, decrease in hepatocellular carcinoma and need for liver transplantation. The sustained virological response was 88%. According to adjusted multivariable analysis, sustained virological response achievement was associated with a decrease in all-cause mortality (HR 0.29, 95% CI 0.15–0.54, p < 0.0001), liver-related mortality (HR 0.40, 95% CI 0.17–0.96, p = 0.04), non-liver-related mortality (HR 0.17, 95% CI 0.06–0.49, p = 0.001), liver transplantation (HR 0.17, 95% CI 0.05–0.54, p = 0.003), and hepatocellular carcinoma (HR 0.52, 95% CI 0.29–0.93, p = 0.03). Conclusion Treatment with direct antiviral agents is associated with reduced risk for mortality. The sustained virological response was 88%. Thus, direct antiviral agents treatment should be considered for any patient with HCV-related decompensated cirrhosis. Trial registration: ClinicalTrials.gov registry number: NCT01953458. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07076-0.
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Affiliation(s)
- Georges-Philippe Pageaux
- Department of Hepatology and Gastroenterology, Centre Hospitalo-Universitaire Saint Eloi, Université de Montpellier, 34295, Montpellier, France.
| | - Clovis Lusivika Nzinga
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Nathalie Ganne
- Department of Hepatology, Hôpitaux Universitaires Paris Seine-Saint-Denis, Site Avicenne, AP-HP, Bobigny, France.,Université Paris 13, Sorbonne Paris Cité et INSERM UMR 1162, Paris, France
| | - Didier Samuel
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, 94800, Villejuif, France.,Université Paris-Saclay, Inserm, Physiopathogénèse et Traitement des Maladies du Foie, 94800, Villejuif, France.,Inserm, Unité 1193, Université Paris-Saclay, Hepatinov, 94800, Villejuif, France
| | - Céline Dorival
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Fabien Zoulim
- Department of Hepatology, Hospices Civils de Lyon, INSERM U1052, Université de Lyon, Lyon, France
| | - Carole Cagnot
- Unit for Basic and Clinical Research on Viral Hepatitis, ANRS (France REcherche Nord&Sud Sida-Vih Hépatites), Paris, France
| | - Thomas Decaens
- Université Grenoble Alpes, 38000, Grenoble, France.,Institute for Advanced Biosciences, Research Center Inserm U1209, CNRS UMR5309, 38700, La Tronche, France.,Service d'hépatogastroentérologie, Pôle Digidune, CHU Grenoble Alpes, 38700, La Tronche, France
| | - Dominique Thabut
- Department of Hepatology and Gastroenterology, Groupe Hospitalier Pitié-Salpétrière, AP-HP, INSERM UMR-S938, Sorbonne Université, Paris, France
| | - Tarik Asselah
- INSERM UMR 1149, Hepatology, Hospital Beaujon, Centre de Recherche sur l'Inflammation, (CRI), University Paris Diderot, Clichy, France
| | - Philippe Mathurin
- Service des Maladies de l'appareil Digestif, Université Lille 2 and Inserm U795, Lille, France
| | - François Habersetzer
- CIC, Inserm 1110 et Pôle Hépato-digestif des Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Jean-Pierre Bronowicki
- Inserm U1254 and Department of Hepato-Gastroenterology, University Hospital of Nancy Brabois, Université de Lorraine, Vandoeuvre-les-Nancy, France
| | - Dominique Guyader
- CHU de Rennes, Service d'hépatologie, 35033, Rennes, France.,Univ Rennes1, Inra, Inserm, Institut NUMECAN (Nutrition, Métabolismes et Cancer), UMR_A 1341, UMR_S 1241, 35033, Rennes, France
| | - Isabelle Rosa
- Department of Hepatology and Gastroenterology, Centre Hospitalier Intercommunal, Créteil, France
| | - Vincent Leroy
- Department of Hepatology and Gastroenterology, Hôpital Henri Mondor, AP-HP, Université Paris-Est, INSERM U955, Créteil, France
| | - Olivier Chazouilleres
- Department of Hepatology, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Victor de Ledinghen
- Hepatology Unit Hôpital Haut-Lévêque, Pessac, INSERM U1053, Université Bordeaux Segalen, Bordeaux, France
| | - Marc Bourliere
- Department of Hepatology and Gastroenterology, Hôpital Saint Joseph, Marseille, France
| | - Xavier Causse
- Department of Hepatology and Gastroenterology, CHR Orléans, Orléans, France
| | - Paul Cales
- Hepatology Department, University Hospital, Angers, France.,HIFIH Laboratory, Angers University, Angers, France
| | | | - Véronique Loustaud-Ratti
- Department of Hepatology and Gastroenterology, CHU Limoges, U1248 INSERM, Univ. Limoges, 87000, Limoges, France
| | - Ghassan Riachi
- Department of Hepatology and Gastroenterology, CHU Charles Nicolle, Rouen, France
| | - Laurent Alric
- Department of Internal Medicine and Digestive Diseases, CHU Purpan, UMR 152 Pharma Dev, IRD Toulouse 3 University, Toulouse, France
| | - Moana Gelu-Simeon
- Service d'Hépato-Gastroentérologie, CHU de la Guadeloupe-Faculté de Médecine, Université des Antilles, 97110, Pointe-à-Pitre Cedex, France.,INSERM, UMR-S1085/IRSET, 35043, Rennes, France
| | - Anne Minello
- Department of Hepatology and Gastroenterology, University Hospital Dijon, INSERM UMR 1231, Dijon, France
| | - Jérôme Gournay
- Gastroenterology and Hepatology Department, Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes, Nantes, France
| | - Claire Geist
- Department of Hepatology and Gastroenterology, Centre Hospitalier Régional, Metz, France
| | - Albert Tran
- Digestive Center, Centre Hospitalier Universitaire de Nice, INSERM U1065-8, Nice, France
| | - Armand Abergel
- Department of Digestive and Hepatobiliary Diseases, Estaing University Hospital, Clermont-Ferrand, France.,UMR 6602 CNRS-Sigma-Université Clermont Auvergne, Clermont-Ferrand, France
| | - Isabelle Portal
- Service d'Hépato-Gastroentérologie, Hôpital de la Timone, Aix-Marseille Université, AP-HM, Marseille, France
| | - Louis d'Alteroche
- Unit of Hepatology, Hépatogastroentérologie, CHU Trousseau, 37044, Tours, France
| | - François Raffi
- Department of Infectious Diseases, Hotel-Dieu Hospital-INSERM CIC 1413, Nantes University Hospital, Nantes, France
| | - Hélène Fontaine
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Unité d'Hépatologie, Paris, France
| | - Fabrice Carrat
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
| | - Stanislas Pol
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France.,Université Paris Descartes, Paris, France.,INSERM U-1223 et USM20, Institut Pasteur, Paris, France
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7
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Marlet J, Lier C, Roch E, Moreau A, Combe B, Handala L, Lefeuvre S, Maugey M, Elkrief L, d'Alteroche L, Potier P, Brand D, Gaudy-Graffin C. Evolution and phenotypic characterization of whole HBV genome in compliant patients experiencing unexplained entecavir treatment failure. Antiviral Res 2021; 192:105106. [PMID: 34214504 DOI: 10.1016/j.antiviral.2021.105106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/29/2021] [Accepted: 05/31/2021] [Indexed: 12/20/2022]
Abstract
Entecavir treatment failure can be observed in compliant patients despite an absence of detectable resistance mutations by Pol/RT Sanger sequencing. We hypothesized that these unexplained treatment failures could rely on other mechanisms of viral resistance, especially on mutations selected outside of the Pol/RT domain. Partial virological response to entecavir was observed in three patients treated with immunosuppressive drugs, without selection of Pol/RT resistance mutations. Mutations selected in the whole HBV genome during entecavir treatment and potentially associated with resistance were searched for using deep sequencing and characterized using a phenotypic resistance assay. Mutations Q206K (pre-core/core), Q120K (pre-S1/pre-S2, T-cell epitope) and A300E (spacer domain) were selected during entecavir treatment in patient #1 but were not associated with an increased level of resistance to entecavir or an increase in HBV replication capacity. Core promoter mutations T1753G, A1762T and G1764A were present as major mutations before and after treatment in patient #1. HBs Ag immune escape mutations were present as major mutations before and after treatment in patients #2 (sK122R, sT126I, sP127S and sG145R) and #3 (sM133I). We demonstrated that PVR to entecavir does not require selection of any resistance mutation in the whole HBV genome. Our results demonstrate that major mutations can be selected outside of the Pol/RT domain before or during entecavir treatment. These mutations could contribute to entecavir treatment failure by other mechanisms than an increased level of resistance.
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Affiliation(s)
- Julien Marlet
- INSERM U1259, Université de Tours et CHRU de Tours, France; Service de Bactériologie-Virologie-Hygiène, CHRU de Tours, France.
| | - Clément Lier
- INSERM U1259, Université de Tours et CHRU de Tours, France; Service de Bactériologie-Virologie-Hygiène, CHRU de Tours, France
| | | | - Alain Moreau
- INSERM U1259, Université de Tours et CHRU de Tours, France
| | - Benjamin Combe
- INSERM U1259, Université de Tours et CHRU de Tours, France
| | - Lynda Handala
- INSERM U1259, Université de Tours et CHRU de Tours, France
| | | | - Morgan Maugey
- INSERM U1259, Université de Tours et CHRU de Tours, France
| | - Laure Elkrief
- Service D'Hépato-gastroentérologie, CHRU de Tours, France
| | | | - Pascal Potier
- Service D'Hépato-gastroentérologie, CHR D'Orléans, France
| | - Denys Brand
- INSERM U1259, Université de Tours et CHRU de Tours, France; Service de Bactériologie-Virologie-Hygiène, CHRU de Tours, France
| | - Catherine Gaudy-Graffin
- INSERM U1259, Université de Tours et CHRU de Tours, France; Service de Bactériologie-Virologie-Hygiène, CHRU de Tours, France
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8
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Chalopin T, Vallet N, Morel M, Maguet R, d'Alteroche L, de Pinieux G, Hérault O, Gyan E, Sutton L, Villate A. Eosinophilic fasciitis (Shulman syndrome), a rare entity and diagnostic challenge, as a manifestation of severe chronic graft-versus-host disease: a case report. J Med Case Rep 2021; 15:135. [PMID: 33722291 PMCID: PMC7958384 DOI: 10.1186/s13256-021-02735-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 02/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background Shulman’s disease, or eosinophilic fasciitis (EF), is a rare autoimmune disease, characterized by sclerodermic skin lesions with progressive induration and thickening of the soft tissues. Chronic graft-versus-host-disease (GVHD) presenting as EF is a very rare manifestation of cutaneous GVHD. Case presentation We report an unusual case of EF in a 46-year-old Caucasian male patient who had received an allogenic hematopoietic stem cell transplantation in the context of relapsed/refractory multiple myeloma. The diagnosis was challenging, with the patient presenting hepatic dysfunction, normal eosinophils count, and incomplete clinical signs. Magnetic resonance imaging (MRI) and skin biopsy confirmed the diagnosis of EF. Early initiation of specific treatment with corticosteroids and prednisolone achieved complete response. Conclusion In practice, incomplete signs in this rare complication should lead to MRI as it is a major tool to guide decision-making based on the skin biopsy, allowing a rapid diagnosis and the initiation of treatment without delay.
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Affiliation(s)
- Thomas Chalopin
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France
| | - Nicolas Vallet
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France
| | - Marion Morel
- Department of Medical Imaging, University Hospital of Tours, Tours, France
| | - Raphael Maguet
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France
| | - Louis d'Alteroche
- Department of Hepatology, University Hospital of Tours, Tours, France
| | | | - Olivier Hérault
- Department of Biological Hematology, University Hospital of Tours, Tours, France.,Groupe Innovation et Ciblage Cellulaire EA 7501, ERL 7001 LNOx, CNRS-University of Tours, Tours, France
| | - Emmanuel Gyan
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France.,Groupe Innovation et Ciblage Cellulaire EA 7501, ERL 7001 LNOx, CNRS-University of Tours, Tours, France.,Clinical Investigation Center, University Hospital of Tours-INSERM U1415, Tours, France
| | - Laurent Sutton
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France
| | - Alban Villate
- Department of Hematology and Cell Therapy, University Hospital of Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France.
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9
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Audureau E, Carrat F, Layese R, Cagnot C, Asselah T, Guyader D, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Chazouillères O, Mallat A, Grangé JD, Attali P, d'Alteroche L, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Nguyen-Khac E, Bernard-Chabert B, Zucman D, Di Martino V, Sutton A, Pol S, Nahon P. Personalized surveillance for hepatocellular carcinoma in cirrhosis - using machine learning adapted to HCV status. J Hepatol 2020; 73:1434-1445. [PMID: 32615276 DOI: 10.1016/j.jhep.2020.05.052] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/21/2020] [Accepted: 05/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Refining hepatocellular carcinoma (HCC) surveillance programs requires improved individual risk prediction. Thus, we aimed to develop algorithms based on machine learning approaches to predict the risk of HCC more accurately in patients with HCV-related cirrhosis, according to their virological status. METHODS Patients with compensated biopsy-proven HCV-related cirrhosis from the French ANRS CO12 CirVir cohort were included in a semi-annual HCC surveillance program. Three prognostic models for HCC occurrence were built, using (i) Fine-Gray regression as a benchmark, (ii) single decision tree (DT), and (iii) random survival forest for competing risks survival (RSF). Model performance was evaluated from C-indexes validated externally in the ANRS CO22 Hepather cohort (n = 668 enrolled between 08/2012-01/2014). RESULTS Out of 836 patients analyzed, 156 (19%) developed HCC and 434 (52%) achieved sustained virological response (SVR) (median follow-up 63 months). Fine-Gray regression models identified 6 independent predictors of HCC occurrence in patients before SVR (past excessive alcohol intake, genotype 1, elevated AFP and GGT, low platelet count and albuminemia) and 3 in patients after SVR (elevated AST, low platelet count and shorter prothrombin time). DT analysis confirmed these associations but revealed more complex interactions, yielding 8 patient groups with varying cancer risks and predictors depending on SVR achievement. On RSF analysis, the most important predictors of HCC varied by SVR status (non-SVR: platelet count, GGT, AFP and albuminemia; SVR: prothrombin time, ALT, age and platelet count). Externally validated C-indexes before/after SVR were 0.64/0.64 [Fine-Gray], 0.60/62 [DT] and 0.71/0.70 [RSF]. CONCLUSIONS Risk factors for hepatocarcinogenesis differ according to SVR status. Machine learning algorithms can refine HCC risk assessment by revealing complex interactions between cancer predictors. Such approaches could be used to develop more cost-effective tailored surveillance programs. LAY SUMMARY Patients with HCV-related cirrhosis must be included in liver cancer surveillance programs, which rely on ultrasound examination every 6 months. Hepatocellular carcinoma (HCC) screening is hampered by sensitivity issues, leading to late cancer diagnoses in a substantial number of patients. Refining surveillance periodicity and modality using more sophisticated imaging techniques such as MRI may only be cost-effective in patients with the highest HCC incidence. Herein, we demonstrate how machine learning algorithms (i.e. data-driven mathematical models to make predictions or decisions), can refine individualized risk prediction.
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Affiliation(s)
- Etienne Audureau
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil, France
| | - Fabrice Carrat
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
| | - Richard Layese
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil, France
| | - Carole Cagnot
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENSH)
| | - Tarik Asselah
- AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy
| | | | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var
| | - Fabien Zoulim
- Hospices Civils de Lyon, Service d'Hépatologie; INSERM U1052 - CRCL; Université de Lyon, Lyon
| | | | - Albert Tran
- CHU de Nice, Service d'Hépatologie, F-06202, Cedex 3, Nice; Inserm U1065, C3M, Team 8, "Hepatic Complications in Obesity", F-06204, Cedex 3, Nice
| | | | | | | | - Paul Calès
- CHU d'Angers, Service d'Hépato-Gastroentérologie, Angers
| | | | - Laurent Alric
- CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse
| | | | | | - Jean-Frédéric Blanc
- Hôpital St André, Service d'Hépatologie, Bordeaux et Hôpital Haut-Lévêque, CHU Bordeaux, 33604 Pessac
| | - Armand Abergel
- Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand
| | - Olivier Chazouillères
- AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, and Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, Paris
| | - Ariane Mallat
- AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil
| | | | - Pierre Attali
- AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif
| | | | - Claire Wartelle
- Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen
| | - Dominique Thabut
- AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris
| | | | | | | | | | | | - David Zucman
- Hôpital Foch, Service de Médecine Interne, Suresnes
| | | | - Angela Sutton
- CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027; AP-HP, Hôpital Jean Verdier, Service de Biochimie, Bondy; Inserm U1148, Université Paris 13, Bobigny
| | - Stanislas Pol
- AP-HP, Hôpital Cochin, Département d'Hépatologie; Inserm UMS20 et U1223, Institut Pasteur, Université Paris Descartes, Paris
| | - Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy; Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", F-93206 Saint-Denis; Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides", F-75000, Paris, France.
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10
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Mouna L, Rossignol E, Tateo M, Coilly A, Duclos-Vallée JC, Duvoux C, Durand F, Tran A, Radenne S, Canva-Delcambre V, Houssel-Debry P, Dumortier J, Conti F, de Ledinghen V, Leroy V, Kamar N, Di Martino V, Moreno C, Botta Fridlund D, d'Alteroche L, Lebray P, Perre P, Besch C, Silvain C, Habersetzer F, Debette-Gratien M, Abergel A, Diallo A, Samuel D, Roque-Afonso AM, Pageaux GP. Hepatitis B virus reactivation in transplant patients treated for hepatitis C recurrence: Prophylaxis makes the difference. J Hepatol 2019; 70:1297-1300. [PMID: 30967293 DOI: 10.1016/j.jhep.2019.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/12/2019] [Accepted: 02/25/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Lina Mouna
- AP-HP Hôpital Paul Brousse, Virologie, Villejuif, France; INSERM, Unité 1193, Villejuif, France.
| | | | - Mariagrazia Tateo
- INSERM, Unité 1193, Villejuif, France; AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France; DHU Hepatinov, Villejuif F-94800, France
| | - Audrey Coilly
- INSERM, Unité 1193, Villejuif, France; AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France; DHU Hepatinov, Villejuif F-94800, France; Université Paris-Sud, Université Paris Sud-Saclay, UMR-S 1193, Villejuif, France
| | - Jean-Charles Duclos-Vallée
- INSERM, Unité 1193, Villejuif, France; AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France; DHU Hepatinov, Villejuif F-94800, France; Université Paris-Sud, Université Paris Sud-Saclay, UMR-S 1193, Villejuif, France
| | | | - François Durand
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Albert Tran
- Hôpital universitaire de Nice, Service d'Hépato-gastroentérologie, Nice, France
| | - Sylvie Radenne
- Service d'Hépatologie, HCL, Hôpital de la Croix-Rousse,Lyon, France
| | | | - Pauline Houssel-Debry
- Hôpital Universitaire de Pontchaillou, Service d'Hépatologie et Transplantation Hépatique, Rennes, France
| | - Jérôme Dumortier
- Unité de Transplantation Hépatique, Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon et Université Claude Bernard Lyon 1, Lyon, France
| | - Filomena Conti
- Service d'Hépatologie et de Transplantation Hépatique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Victor de Ledinghen
- Service d'Hépato-Gastroentérologie, Hôpital Haut-Lévêque, CHU Bordeaux, & INSERM U1053, Bordeaux, France
| | - Vincent Leroy
- Clinique Universitaire d'Hépato-Gastroentérologie, Pôle Digidune, CHU de Grenoble, France
| | - Nassim Kamar
- Département de Néphrologie et Transplantation d'Organes, CHU Rangueil, INSERM U1043, IFR-BMT, Université Paul Sabatier, Toulouse, France
| | - Vincent Di Martino
- Service d'Hépatologie, CHRU Jean Minjoz et Université de Franche-Comté, Besançon, France
| | - Christophe Moreno
- Département de Gastroenterologie, d'Hépatopancréatologie et Cancérologie Digestive, CUB Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | | | | | - Pascal Lebray
- Service d'Hépatologie et de Transplantation Hépatique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Philippe Perre
- Service de MPU Infectiologie CHD Vendée, 85925 La Roche sur Yon, France
| | - Camille Besch
- Centre de Chirurgie Digestive et Transplantation Hépatique, Université de Strasbourg, France
| | | | - François Habersetzer
- Hôpitaux Universitaires de Strasbourg, INSERM U 1110, LabEx HepSYS, Université de Strasbourg, Strasbourg, France
| | | | - Armando Abergel
- Service d'Hépato-gastroentérologie, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | - Alpha Diallo
- ANRS (France REcherche Nord&sud Sida-hiv Hépatites), Paris, France
| | - Didier Samuel
- INSERM, Unité 1193, Villejuif, France; AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France; DHU Hepatinov, Villejuif F-94800, France; Université Paris-Sud, Université Paris Sud-Saclay, UMR-S 1193, Villejuif, France
| | - Anne-Marie Roque-Afonso
- AP-HP Hôpital Paul Brousse, Virologie, Villejuif, France; INSERM, Unité 1193, Villejuif, France; DHU Hepatinov, Villejuif F-94800, France; Université Paris-Sud, Université Paris Sud-Saclay, UMR-S 1193, Villejuif, France
| | - Georges-Philippe Pageaux
- Département d'Hépato-gastroentérologie et de Transplantation Hépatique, CHU Saint-Eloi, Université de Montpellier, Montpellier, France
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11
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Moreau R, Elkrief L, Bureau C, Perarnau JM, Thévenot T, Saliba F, Louvet A, Nahon P, Lannes A, Anty R, Hillaire S, Pasquet B, Ozenne V, Rudler M, Ollivier-Hourmand I, Robic MA, d'Alteroche L, Di Martino V, Ripault MP, Pauwels A, Grangé JD, Carbonell N, Bronowicki JP, Payancé A, Rautou PE, Valla D, Gault N, Lebrec D. Effects of Long-term Norfloxacin Therapy in Patients With Advanced Cirrhosis. Gastroenterology 2018; 155:1816-1827.e9. [PMID: 30144431 DOI: 10.1053/j.gastro.2018.08.026] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS There is debate over the effects of long-term oral fluoroquinolone therapy in patients with advanced cirrhosis. We performed a randomized controlled trial to evaluate the effects of long-term treatment with the fluoroquinolone norfloxacin on survival of patients with cirrhosis. METHODS We performed a double-blind trial of 291 patients with Child-Pugh class C cirrhosis who had not received recent fluoroquinolone therapy. The study was performed at 18 clinical sites in France from April 2010 through November 2014. Patients were randomly assigned to groups given 400 mg norfloxacin (n = 144) or placebo (n = 147) once daily for 6 months. Patients were evaluated monthly for the first 6 months and at 9 months and 12 months thereafter. The primary outcome was 6-month mortality, estimated by the Kaplan-Meier method, censoring spontaneous bacterial peritonitis, liver transplantation, or loss during follow-up. RESULTS The Kaplan-Meier estimate for 6-month mortality was 14.8% for patients receiving norfloxacin and 19.7% for patients receiving placebo (P = .21). In competing risk analysis that took liver transplantation into account, the cumulative incidence of death at 6 months was significantly lower in the norfloxacin group than in the placebo group (subdistribution hazard ratio, 0.59; 95% confidence interval, 0.35-0.99). The subdistribution hazard ratio for death at 6 months with norfloxacin vs placebo was 0.35 (95% confidence interval, 0.13-0.93) in patients with ascites fluid protein concentrations <15 g/L and 1.39 (95% confidence interval, 0.42-4.57) in patients with ascites fluid protein concentrations ≥15 g/L. Norfloxacin significantly decreased the incidence of any and Gram-negative bacterial infections without increasing infections caused by Clostridium difficile or multiresistant bacteria. CONCLUSIONS In a randomized controlled trial of patients with advanced cirrhosis without recent fluoroquinolone therapy, norfloxacin did not reduce 6-month mortality, estimated by the Kaplan-Meier method. Norfloxacin, however, appears to increase survival of patients with low ascites fluid protein concentrations. ClinicalTrials.gov ID: NCT01037959.
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Affiliation(s)
- Richard Moreau
- Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Département Hospitalo-Universitaire UNITY, Service d'Hépatologie, Clichy, France; Institut National de la Santé et de la Recherche Médicale and Université Paris Diderot, Centre de Recherche sur l'Inflammation, Unité Mixte de Recherche 1149, Paris, France.
| | - Laure Elkrief
- Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Département Hospitalo-Universitaire UNITY, Service d'Hépatologie, Clichy, France
| | - Christophe Bureau
- Centre Hospitalier Universitaire, Université Paul Sabatier, Hôpital Purpan, Service d'Hépato-Gastroentérologie, Toulouse, France
| | - Jean-Marc Perarnau
- Centre Hospitalier Régional Universitaire de Tours, Unité d'Hépatologie, Hépato-Gastroentérologie, Tours, France
| | - Thierry Thévenot
- Centre Hospitalier Universitaire de Besançon, Hôpital Jean Minjoz, Service d'Hépatologie et de Soins Intensifs Digestifs, Besançon, France
| | - Faouzi Saliba
- Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - Alexandre Louvet
- Centre Hospitalier Régional Universitaire de Lille, Hôpital Huriez, Service des Maladies de l'Appareil Digestif, Lille, France
| | - Pierre Nahon
- Assistance Publique-Hôpitaux de Paris, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, and Université Paris 13, Sorbonne Paris Cité, Equipe Labellisée Ligue Contre le Cancer, Saint-Denis, and Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeur Solides, Paris, France
| | - Adrien Lannes
- Centre Hospitalier Universitaire d'Angers, Service d'Hépato-Gastroentérologie, Angers, France
| | - Rodolphe Anty
- Centre Hospitalier Universitaire de Nice, Pôle Digestif and Institut National de la Santé et de la Recherche Médicale U1065 and Université Côte d'Azur, Nice, France
| | - Sophie Hillaire
- Hôpital Foch, Service de Médecine Interne, Suresnes, France, France
| | - Blandine Pasquet
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Unité de Recherche Clinique Paris Nord, Paris and Institut National de la Santé et de la Recherche Médicale, Le Centre D'Investigation Clinique, Module Épidémiologie Clinique 1425, Hôpital Bichat, Paris, France
| | - Violaine Ozenne
- Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisère, Service d'Hépato-Gastroentérologie, Paris, France
| | - Marika Rudler
- Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, Service d'Hépatologie, Paris, France
| | - Isabelle Ollivier-Hourmand
- Centre Hospitalier Universitaire Côte de Nacre, Département d'Hépato-Gastroentérologie et de Nutrition, Caen, France
| | - Marie Angèle Robic
- Centre Hospitalier Universitaire, Université Paul Sabatier, Hôpital Purpan, Service d'Hépato-Gastroentérologie, Toulouse, France
| | - Louis d'Alteroche
- Centre Hospitalier Régional Universitaire de Tours, Unité d'Hépatologie, Hépato-Gastroentérologie, Tours, France
| | - Vincent Di Martino
- Centre Hospitalier Universitaire de Besançon, Hôpital Jean Minjoz, Service d'Hépatologie et de Soins Intensifs Digestifs, Besançon, France
| | - Marie-Pierre Ripault
- Centre Hospitalier Universitaire Montpellier, Hôpital Saint Eloi, Département d'Hépato-Gastroentérologie et Transplantation, Montpellier, France
| | - Arnaud Pauwels
- Centre Hospitalier de Gonesse, Service d'Hépato-Gastroentérologie, Gonesse, France
| | - Jean-Didier Grangé
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service d'Hépato-Gastroentérologie, Paris, France
| | - Nicolas Carbonell
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Département d'Hépatologie, Paris, France
| | - Jean-Pierre Bronowicki
- Centre Hospitalier Universitaire Nancy Brabois, Département d'Hépato-Gastroentérologie and Institut National de la Santé et de la Recherche Médicale U954 and Université Lorraine, Nancy, France
| | - Audrey Payancé
- Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Département Hospitalo-Universitaire UNITY, Service d'Hépatologie, Clichy, France
| | - Pierre-Emmanuel Rautou
- Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Département Hospitalo-Universitaire UNITY, Service d'Hépatologie, Clichy, France
| | - Dominique Valla
- Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Département Hospitalo-Universitaire UNITY, Service d'Hépatologie, Clichy, France; Institut National de la Santé et de la Recherche Médicale and Université Paris Diderot, Centre de Recherche sur l'Inflammation, Unité Mixte de Recherche 1149, Paris, France
| | - Nathalie Gault
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Unité de Recherche Clinique Paris Nord, Paris and Institut National de la Santé et de la Recherche Médicale, Le Centre D'Investigation Clinique, Module Épidémiologie Clinique 1425, Hôpital Bichat, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Département Epidémiologie Biostatistiques et Recherche Clinique, Clichy, France
| | - Didier Lebrec
- Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Département Hospitalo-Universitaire UNITY, Service d'Hépatologie, Clichy, France
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12
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Dumortier J, Leroy V, Duvoux C, de Ledinghen V, Francoz C, Houssel-Debry P, Radenne S, d'Alteroche L, Fougerou-Leurent C, Canva V, di Martino V, Conti F, Kamar N, Moreno C, Lebray P, Tran A, Besch C, Diallo A, Rohel A, Rossignol E, Abergel A, Botta-Fridlund D, Coilly A, Samuel D, Duclos-Vallée JC, Pageaux GP. Sofosbuvir-based treatment of hepatitis C with severe fibrosis (METAVIR F3/F4) after liver transplantation. Liver Transpl 2016; 22:1367-78. [PMID: 27348086 DOI: 10.1002/lt.24505] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/24/2016] [Accepted: 05/31/2016] [Indexed: 12/12/2022]
Abstract
Recurrence of hepatitis C virus (HCV) after liver transplantation (LT) can rapidly lead to liver graft cirrhosis and, therefore, graft failure and retransplantation or death. The aim of the present study was to assess efficacy and tolerance of sofosbuvir (SOF)-based regimens for the treatment of HCV recurrence in patients with severe fibrosis after LT. The Compassionate Use of Protease Inhibitors in Viral C Liver Transplantation (CULPIT) study is a prospective multicenter cohort including patients with HCV recurrence following LT treated with second generation direct antivirals. The present study focused on patients included between October 2013 and November 2014 and diagnosed with HCV recurrence and liver graft extensive fibrosis (METAVIR F3/F4). A SOF-based regimen was administered to 125 patients fulfilling inclusion criteria. The median delay from LT was 95.9 ± 69.6 months. The characteristics of patients were as follows: mean age, 59.4 ± 9.0 years; 78.4% male; infected by HCV genotype 1: 78.2%, mean HCV RNA: 6.1 ± 1.0 log10 IU/mL. Eighty patients had failed previous post-LT antiviral therapy (64.0%) including triple therapy with first generation protease inhibitors in 19 (15.2%) patients. The main combination regimen was SOF/daclatasvir (73.6%). Ribavirin was used in 60 patients. Sustained virological response 12 weeks after treatment was 92.8% (on an intention-to-treat basis); 7 patients with virological failure were observed. Serious adverse events occurred in 25.6% of the patients during antiviral treatment. During antiviral treatment and follow-up, 3 patients were retransplanted and 4 patients died. In conclusion, SOF-based antiviral treatment shows very promising results in patients with HCV recurrence and severe fibrosis after LT. Liver Transplantation 22 1367-1378 2016 AASLD.
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Affiliation(s)
- Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, Lyon, France.
| | - Vincent Leroy
- Pôle Digidune, Clinique Universitaire d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Grenoble, INSERM/Université Grenoble Alpes U823, Institut Albert Bonniot, Grenoble, France
| | | | - Victor de Ledinghen
- Service d'Hépatologie, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, INSERM U1053, Université Bordeaux, Bordeaux, France
| | - Claire Francoz
- Service d'Hépatologie, Hôpital Beaujon, AP-HP, Université Paris Diderot et INSERM U1149, Centre de Recherche sur l'Inflammation, Clichy, France
| | - Pauline Houssel-Debry
- Service des Maladies du Foie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Sylvie Radenne
- Service d'Hépatologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Louis d'Alteroche
- Service d'hépato-gastroentérologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Claire Fougerou-Leurent
- Unité de Pharmacologie Clinique, Centre Hospitalier Universitaire de Rennes, Centre d'Investigation Clinique INSERM 1414, Rennes, France
| | - Valérie Canva
- Services Maladies de l'Appareil Digestif, Hôpital Claude Huriez, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Vincent di Martino
- Service d'Hépatologie, Hôpital Jean Minjoz, Centre Hospitalier Universitaire de Besançon, Université de Franche Comté, Besançon, France
| | - Filomena Conti
- Service d'hépato-gastroentérologie, Groupe Hospitalier Pitié-Salpétrière, AP-HP, Université Pierre et Marie Curie Paris 6, INSERM Unités Mixtes de Recherche S938, Paris, France
| | - Nassim Kamar
- Département de Néphrologie et de Transplantation d'Organes, Centre Hospitalier Universitaire Rangueil, Université de Toulouse, Toulouse, France
| | - Christophe Moreno
- Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Pascal Lebray
- Service d'hépato-gastroentérologie, Groupe Hospitalier Pitié-Salpétrière, AP-HP, Université Pierre et Marie Curie Paris 6, INSERM Unités Mixtes de Recherche S938, Paris, France
| | - Albert Tran
- Service d'Hépatologie, Hôpital de l'Archet 2, Centre Hospitalier Universitaire de Nice, INSERM U1065, Université de Nice-Sophia-Antipolis, Nice, France
| | - Camille Besch
- Service de Transplantation, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Alpha Diallo
- Unit for Basic and Clinical Research on Viral Hepatitis, France Recherche Nord&Sud Sida-HIV Hépatites, Agence Nationale de Recherche sur le Sida, Paris, France
| | - Alexandra Rohel
- Unit for Basic and Clinical Research on Viral Hepatitis, France Recherche Nord&Sud Sida-HIV Hépatites, Agence Nationale de Recherche sur le Sida, Paris, France
| | - Emilie Rossignol
- Unité de Pharmacologie Clinique, Centre Hospitalier Universitaire de Rennes, Centre d'Investigation Clinique INSERM 1414, Rennes, France
| | - Armand Abergel
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire Estaing, Université d'Auvergne, Unités Mixtes de Recherche CNRS 6284, Clermont-Ferrand, France
| | | | - Audrey Coilly
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Université Paris-Sud, Université Paris-Saclay, UMR-S 1193, INSERM Unité 1193, Département Hospitalo-Universitaire Hepatinov, Villejuif, France
| | - Didier Samuel
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Université Paris-Sud, Université Paris-Saclay, UMR-S 1193, INSERM Unité 1193, Département Hospitalo-Universitaire Hepatinov, Villejuif, France
| | - Jean-Charles Duclos-Vallée
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Université Paris-Sud, Université Paris-Saclay, UMR-S 1193, INSERM Unité 1193, Département Hospitalo-Universitaire Hepatinov, Villejuif, France
| | - Georges-Philippe Pageaux
- Département d'Hépato-Gastroentérologie et de Transplantation Hépatique, Centre Hospitalier Universitaire Saint-Eloi, Université de Montpellier, Montpellier, France
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Perrin HB, Cintas P, Abravanel F, Gérolami R, d'Alteroche L, Raynal JN, Alric L, Dupuis E, Prudhomme L, Vaucher E, Couzigou P, Liversain JM, Bureau C, Vinel JP, Kamar N, Izopet J, Peron JM. Neurologic Disorders in Immunocompetent Patients with Autochthonous Acute Hepatitis E. Emerg Infect Dis 2016; 21:1928-34. [PMID: 26490255 PMCID: PMC4622229 DOI: 10.3201/eid2111.141789] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Neurologic disorders, mainly Guillain-Barré syndrome and Parsonage–Turner syndrome (PTS), have been described in patients with hepatitis E virus (HEV) infection in industrialized and developing countries. We report a wider range of neurologic disorders in nonimmunocompromised patients with acute HEV infection. Data from 15 French immunocompetent patients with acute HEV infection and neurologic disorders were retrospectively recorded from January 2006 through June 2013. The disorders could be divided into 4 main entities: mononeuritis multiplex, PTS, meningoradiculitis, and acute demyelinating neuropathy. HEV infection was treated with ribavirin in 3 patients (for PTS or mononeuritis multiplex). One patient was treated with corticosteroids (for mononeuropathy multiplex), and 5 others received intravenous immunoglobulin (for PTS, meningoradiculitis, Guillain-Barré syndrome, or Miller Fisher syndrome). We conclude that pleiotropic neurologic disorders are seen in HEV-infected immunocompetent patients. Patients with acute neurologic manifestations and aminotransferase abnormalities should be screened for HEV infection.
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Nicolas C, d'Alteroche L, Perarnau JM. Reply to: "Shunt dysfunction: is it suitable as the primary end point in transjugular intrahepatic portosystemic shunt trials?". J Hepatol 2015; 62:247-8. [PMID: 25245894 DOI: 10.1016/j.jhep.2014.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 09/14/2014] [Indexed: 12/04/2022]
Affiliation(s)
- Charlotte Nicolas
- Unit of Hepatology, Hépatogastroenterologie, CHU Trousseau, 37044 Tours, France
| | - Louis d'Alteroche
- Unit of Hepatology, Hépatogastroenterologie, CHU Trousseau, 37044 Tours, France
| | - Jean-Marc Perarnau
- Unit of Hepatology, Hépatogastroenterologie, CHU Trousseau, 37044 Tours, France.
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15
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Perarnau JM, Le Gouge A, Nicolas C, d'Alteroche L, Borentain P, Saliba F, Minello A, Anty R, Chagneau-Derrode C, Bernard PH, Abergel A, Ollivier-Hourmand I, Gournay J, Ayoub J, Gaborit C, Rusch E, Giraudeau B. Covered vs. uncovered stents for transjugular intrahepatic portosystemic shunt: a randomized controlled trial. J Hepatol 2014; 60:962-8. [PMID: 24480619 DOI: 10.1016/j.jhep.2014.01.015] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 01/14/2014] [Accepted: 01/14/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS The first studies comparing covered stents (CS) and bare stents (BS) to achieve Transjugular Intrahepatic Portosystemic Shunt (TIPS) were in favor of CS, but only one randomized study has been performed. Our aim was to compare the primary patency of TIPS performed with CS and BS. METHODS The study was planned as a multicenter, pragmatic (with centers different in size and experience), randomized, single-blinded (with blinding of patients only), parallel group trial. The primary endpoint was TIPS dysfunction defined as either a portocaval gradient ⩾12mmHg, or a stent lumen stenosis ⩾50%. A transjugular angiography with portosystemic pressure gradient measurement was scheduled every 6months after TIPS insertion. RESULTS 137 patients were randomized: 66 to receive CS, and 71 BS. Patients who were found to have a hepato-cellular carcinoma, or whose procedure was cancelled were excluded, giving a sample of 129 patients (62 vs. 67). Median follow-up for CS and BS were 23.6 and 21.8months, respectively. Compared to BS, the risk of TIPS dysfunction with CS was 0.60 95% CI [0.38-0.96], (p=0.032). The 2-year rate of shunt dysfunction was 44.0% for CS vs. 63.6% for BS. Early post TIPS complications (22.4% vs. 34.9%), risk of hepatic encephalopathy (0.89 [0.53-1.49]) and 2-year survival (70% vs. 67.5%) did not differ in the two groups. The 2-year cost/patient was 20k€ [15.9-27.5] for CS vs. 23.4k€ [18-37] for BS (p=0.52). CONCLUSIONS CS provided a significant 39% reduction in dysfunction compared to BS. We did not observe any significant difference with regard to hepatic encephalopathy or death.
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Affiliation(s)
- Jean Marc Perarnau
- Service d'Hépato-Gastroentérologie, Hôpital Trousseau, CHRU Tours, France.
| | - Amélie Le Gouge
- INSERM, CIC 202, Tours, France; CHRU de Tours, Tours, France
| | - Charlotte Nicolas
- Service d'Hépato-Gastroentérologie, Hôpital Trousseau, CHRU Tours, France; Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
| | - Louis d'Alteroche
- Service d'Hépato-Gastroentérologie, Hôpital Trousseau, CHRU Tours, France
| | - Patrick Borentain
- Service d'Hépato-Gastroentérologie, Hôpital de la Conception, Marseille, France
| | - Faouzi Saliba
- Service d'Hépato-Gastroentérologie, Hôpital Paul Brousse, Paris, France
| | - Anne Minello
- Service d'Hépato-Gastroentérologie, CHRU Dijon, France
| | - Rodolphe Anty
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, "Hepatic Complications in Obesity", Nice F-06204, Cedex 3, France; Centre Hospitalier Universitaire of Nice, Digestive Center, Nice F-06202, Cedex 3, France; University of Nice-Sophia-Antipolis, Faculty of Medecine, Nice F-06107, Cedex 2, France
| | | | | | - Armand Abergel
- Service d'Hépato-Gastroentérologie, CHRU Clermont-Ferrand, France
| | | | | | - Jean Ayoub
- Service d'Echographie Hôpital Trousseau, CHRU Tours, France
| | - Christophe Gaborit
- Service d'information médicale, épidémiologie et économie de la santé, CHRU Bretonneau, Tours, France
| | - Emmanuel Rusch
- Service d'information médicale, épidémiologie et économie de la santé, CHRU Bretonneau, Tours, France
| | - Bruno Giraudeau
- INSERM, CIC 202, Tours, France; CHRU de Tours, Tours, France; Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
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16
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Depla M, d'Alteroche L, Le Gouge A, Moreau A, Hourioux C, Meunier JC, Gaillard J, de Muret A, Bacq Y, Kazemi F, Avargues A, Roch E, Piver E, Gaudy-Graffin C, Giraudeau B, Roingeard P. Viral sequence variation in chronic carriers of hepatitis C virus has a low impact on liver steatosis. PLoS One 2012; 7:e33749. [PMID: 22479436 PMCID: PMC3315576 DOI: 10.1371/journal.pone.0033749] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 02/16/2012] [Indexed: 12/14/2022] Open
Abstract
Most clinical studies suggest that the prevalence and severity of liver steatosis are higher in patients infected with hepatitis C virus (HCV) genotype 3 than in patients infected with other genotypes. This may reflect the diversity and specific intrinsic properties of genotype 3 virus proteins. We analyzed the possible association of particular residues of the HCV core and NS5A proteins known to dysregulate lipid metabolism with steatosis severity in the livers of patients chronically infected with HCV. We used transmission electron microscopy to quantify liver steatosis precisely in a group of 27 patients, 12 of whom were infected with a genotype 3 virus, the other 15 being infected with viruses of other genotypes. We determined the area covered by lipid droplets in liver tissues and analyzed the diversity of the core and NS5A regions encoded by the viral variants circulating in these patients. The area covered by lipid droplets did not differ significantly between patients infected with genotype 3 viruses and those infected with other genotypes. The core and NS5A protein sequences of the viral variants circulating in patients with mild or severe steatosis were evenly distributed throughout the phylogenic trees established from all the collected sequences. Thus, individual host factors seem to play a much greater role than viral factors in the development of severe steatosis in patients chronically infected with HCV, including those infected with genotype 3 viruses.
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Affiliation(s)
- Marion Depla
- INSERM U966, Université François Rabelais and CHRU de Tours, Tours, France
| | - Louis d'Alteroche
- INSERM U966, Université François Rabelais and CHRU de Tours, Tours, France
- Service d'Hépatogastroentérologie, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Amélie Le Gouge
- INSERM CIC 0202, Université François Rabelais and CHRU de Tours, Tours, France
| | - Alain Moreau
- INSERM U966, Université François Rabelais and CHRU de Tours, Tours, France
| | - Christophe Hourioux
- INSERM U966, Université François Rabelais and CHRU de Tours, Tours, France
- Unité de Biologie Cellulaire, Hôpital Bretonneau, CHRU de Tours, Tours, France
- Plate-Forme RIO des Microscopies, PPF ASB, Université François Rabelais, Tours, France
| | | | - Julien Gaillard
- Plate-Forme RIO des Microscopies, PPF ASB, Université François Rabelais, Tours, France
| | - Anne de Muret
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Yannick Bacq
- Service d'Hépatogastroentérologie, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Farhad Kazemi
- Service d'Hépatogastroentérologie, Centre Hospitalier de Blois, Blois, France
| | - Aurélie Avargues
- INSERM CIC 0202, Université François Rabelais and CHRU de Tours, Tours, France
| | - Emmanuelle Roch
- INSERM U966, Université François Rabelais and CHRU de Tours, Tours, France
| | - Eric Piver
- INSERM U966, Université François Rabelais and CHRU de Tours, Tours, France
- Service de Biochmie, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Catherine Gaudy-Graffin
- INSERM U966, Université François Rabelais and CHRU de Tours, Tours, France
- Service de Bactériologie-Virologie, Hôpital Bretonneau, CHRU de Tours, Tours, France
| | - Bruno Giraudeau
- INSERM CIC 0202, Université François Rabelais and CHRU de Tours, Tours, France
| | - Philippe Roingeard
- INSERM U966, Université François Rabelais and CHRU de Tours, Tours, France
- Unité de Biologie Cellulaire, Hôpital Bretonneau, CHRU de Tours, Tours, France
- Plate-Forme RIO des Microscopies, PPF ASB, Université François Rabelais, Tours, France
- * E-mail:
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17
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Chaillon A, Sirinelli A, De Muret A, Nicand E, d'Alteroche L, Goudeau A. Sustained virologic response with ribavirin in chronic hepatitis E virus infection in heart transplantation. J Heart Lung Transplant 2011; 30:841-3. [PMID: 21515077 DOI: 10.1016/j.healun.2011.03.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Revised: 03/09/2011] [Accepted: 03/09/2011] [Indexed: 10/18/2022] Open
Abstract
Hepatitis E virus (HEV) is an emerging problem amongst transplant recipients. We report a patient with chronic HEV hepatitis after a heart transplant. The patient received a 3-month course of oral ribavirin (17 mg/kg/day). HEV RNA became undetectable in the serum after 1 month of treatment and remained undetectable in serum and stool samples until the last follow-up, 2 months after completion of ribavirin therapy. The values of liver function indicators returned to normal reference ranges. The main ribavirin-induced side effect was a significant but well-tolerated anemia. We confirmed that ribavirin may induce a sustained virologic response (4 months after ribavirin cessation) in heart transplant patients with chronic HEV infection. Liver cytolysis is rather common in patients after heart transplantation. Rapid evolution to liver fibrosis lesions and available anti-viral therapy highlight the need to look for HEV infection in heart transplant recipients with unexplained hepatitis.
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Affiliation(s)
- Antoine Chaillon
- Service de Bactériologie-Virologie, CHRU Bretonneau, Tours, France; INSERM U966 Université François-Rabelais de Tours, UFR Médecine, Tours, France.
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18
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Delahousse B, Labat-Debelleix V, Decalonne L, d'Alteroche L, Perarnau JM, Gruel Y. Comparative study of coagulation and thrombin generation in the portal and jugular plasma of patients with cirrhosis. Thromb Haemost 2010. [PMID: 20806106 DOI: 10.1160/th10-01-0040]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Portal vein thromboses are frequent in cirrhotic patients and may be favoured by hypercoagulability in the splanchnic venous system. The coagulation balance and thrombin generation (TG) were evaluated in platelet-free plasma obtained from portal and systemic blood samples in 28 cirrhotic patients while undergoing transjugular intrahepatic porto-systemic shunt. TG assay (TGA) was performed with all samples from cirrhotic patients and with plasma samples from 14 healthy controls, with varying concentrations of tissue factor and phospholipids, with or without thrombomodulin. Screening tests and specific assays were also performed and activated partial thromboplastin time was shorter in portal plasma samples with higher FVIII and lower protein C levels, well correlated with Child-Pugh scores, and higher D-dimers and F1+2 levels However, all TGA parameters were similar in portal and jugular samples, possibly due in part to similar concentrations of factor II and antithrombin in these two sites of plasma sampling. TGA showed lower thrombin peaks and endogenous thrombin potential values in cirrhotic plasma compared to those of healthy controls. Importantly, a resistance to thrombomodulin that well correlated with factor VIII and PC levels, was evidenced in all samples from patients with cirrhosis, and was more significant in those from severely affected cases. This study therefore supports the existence of a relative hypercoagulability in the portal vein of cirrhotic patients that is likely due to protein C/S deficiency and to high FVIII levels.
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Calès P, Halfon P, Batisse D, Carrat F, Perré P, Penaranda G, Guyader D, d'Alteroche L, Fouchard-Hubert I, Michelet C, Veillon P, Lambert J, Weiss L, Salmon D, Cacoub P. Comparison of liver fibrosis blood tests developed for HCV with new specific tests in HIV/HCV co-infection. J Hepatol 2010; 53:238-44. [PMID: 20493576 DOI: 10.1016/j.jhep.2010.03.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 03/13/2010] [Accepted: 03/17/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS We compared 5 non-specific and 2 specific blood tests for liver fibrosis in HCV/HIV co-infection. METHODS Four hundred and sixty-seven patients were included into derivation (n=183) or validation (n=284) populations. Within these populations, the diagnostic target, significant fibrosis (Metavir F > or = 2), was found in 66% and 72% of the patients, respectively. Two new fibrosis tests, FibroMeter HICV and HICV test, were constructed in the derivation population. RESULTS Unadjusted AUROCs in the derivation population were: APRI: 0.716, Fib-4: 0.722, Fibrotest: 0.778, Hepascore: 0.779, FibroMeter: 0.783, HICV test: 0.822, FibroMeter HICV: 0.828. AUROCs adjusted on classification and distribution of fibrosis stages in a reference population showed similar values in both populations. FibroMeter, FibroMeter HICV and HICV test had the highest correct classification rates in F0/1 and F3/4 (which account for high predictive values): 77-79% vs. 70-72% in the other tests (p=0.002). Reliable individual diagnosis based on predictive values > or = 90% distinguished three test categories: poorly reliable: Fib-4 (2.4% of patients), APRI (8.9%); moderately reliable: Fibrotest (25.4%), FibroMeter (26.6%), Hepascore (30.2%); acceptably reliable: HICV test (40.2%), FibroMeter HICV (45.6%) (p<10(-3) between tests). FibroMeter HICV classified all patients into four reliable diagnosis intervals (< or =F1, F1+/-1, > or =F1, > or =F2) with an overall accuracy of 93% vs. 79% (p<10(-3)) for a binary diagnosis of significant fibrosis. CONCLUSIONS Tests designed for HCV infections are less effective in HIV/HCV infections. A specific test, like FibroMeter HICV, was the most interesting test for diagnostic accuracy, correct classification profile, and a reliable diagnosis. With reliable diagnosis intervals, liver biopsy can therefore be avoided in all patients.
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Affiliation(s)
- Paul Calès
- Hepatology Department, University Hospital, Angers, France.
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Labat-Debelleix V, d'Alteroche L, Abidine Benchellal Z, Duboeuf T, Guyétant S, Henry Metman E. [Pancreatic adenocarcinoma complicating a cystic dystrophy on an ectopic pancreas in the ampullar region]. ACTA ACUST UNITED AC 2008; 32:653-5. [PMID: 18486383 DOI: 10.1016/j.gcb.2008.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 02/19/2008] [Accepted: 02/20/2008] [Indexed: 11/30/2022]
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d'Alteroche L, Perarnau JM, Perrotin F, Bacq Y. [Portal hypertension and pregnancy]. ACTA ACUST UNITED AC 2008; 32:541-6. [PMID: 18472375 DOI: 10.1016/j.gcb.2008.02.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2007] [Revised: 02/14/2008] [Accepted: 02/28/2008] [Indexed: 02/08/2023]
Abstract
Pregnancy in patients with portal hypertension is rare but worrying for the clinician. Although the effects of portal hypertension during pregnancy have not been fully elucidated, there is an evident increase in morbidity, especially associated with cirrhosis, which justifies the idea of at-risk pregnancy and requires management by a multidisciplinary team. The prevention and treatment of gastrointestinal haemorrhage is quite similar to that in nonpregnant patients. Investigation and management of portal hypertension before and at the beginning of pregnancy can reduce the risks of foetal loss, restricted intra-uterine growth, premature birth and maternal mortality, which are closely related to gastrointestinal haemorrhage. The risks related to the underlying disease, such as liver failure with cirrhosis and thromboembolic risk with vascular diseases associated with thrombophilia must be taken into consideration. Generally, vaginal delivery with early analgesics for the mother assisted by an extraction device should be preferred to caesarean section, which must be reserved for obstetrical indications.
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Affiliation(s)
- L d'Alteroche
- Service d'hépatogastroentérologie, hôpital Trousseau, CHU de Tours, 37044 Tours cedex 9, France.
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Lefrou L, d'Alteroche L, Harchaoui Y, Franco D, Metman EH. Peritoneovenous shunt after failure of octreotide treatment for chylous ascites in lymphangioleiomyomatosis. Dig Dis Sci 2007; 52:3188-90. [PMID: 17638079 DOI: 10.1007/s10620-006-9353-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 03/25/2006] [Indexed: 12/09/2022]
Affiliation(s)
- Laurent Lefrou
- Department of Gastroenterology, Trousseau Hospital, 37044, Tours, France.
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Aubourg A, d'Alteroche L, Senecal D, Gaudy C, Bacq Y. [Autoimmune thrombopenia associated with hepatitis B reactivation (reverse seroconversion) after autologous hematopoietic stem cell transplantation]. ACTA ACUST UNITED AC 2007; 31:97-9. [PMID: 17273140 DOI: 10.1016/s0399-8320(07)89335-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We report a case of autoimmune thrombocytopenia associated with acute reverse seroconversion of hepatitis B in a patient who was initially hepatitis B virus surface antigen negative and hepatitis B virus surface antibody positive. Reactivation occurred 9 months after chemotherapy with anti-CD 20 monoclonal antibodies and autologous hematopoietic stem cell transplantation for lymphoma had been performed. After non specific polyglobulin injections and treatment with adefovir dipivoxil, thrombocytopenia and viral replication were controlled. Seroconversion for both HBe and HBs occurred at 5 months. Adefovir was stopped 4 months later with no relapse during fifteen months of follow-up. This case shows that patients who have had previous contact with hepatitis B virus should be monitored if they become immunosuppressed, even if anti-HBs were initially present.
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d'Alteroche L, Majzoub S, Lecuyer AI, Delplace MP, Bacq Y. Ophthalmologic side effects during alpha-interferon therapy for viral hepatitis. J Hepatol 2006; 44:56-61. [PMID: 16223542 DOI: 10.1016/j.jhep.2005.07.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Revised: 07/13/2005] [Accepted: 07/15/2005] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIMS Ophthalmologic side effects have been reported during interferon therapy, particularly retinal lesions and neurovisual impairment. The aim of this prospective study was to assess the nature and the frequency of such lesions during alpha-interferon therapy for viral hepatitis. METHODS Between 1995 and 2003, 156 patients treated with standard or pegylated alpha-interferon, with or without ribavirin, had a regular ophthalmologic examination before and during treatment. No patient had signs of retinopathy before treatment. Cotton-wool spots were found in 31 patients and retinal hemorrhage in nine patients during treatment (24% of patients). These lesions remained asymptomatic and disappeared in all patients. A previous history of arterial hypertension (RR 4.60, 95% CI 1.95-10.85), age above 45 years (RR 2.80, 95% CI 1.36-5.85), and use of pegylated alpha-interferon (RR 2.75, 95% CI 1.41-5.38) were significantly associated with retinopathy. Neurovisual impairment was present in 31 patients (20%) before treatment and in 74 patients (47%) during treatment. CONCLUSIONS In conclusion, this study showed that signs of retinopathy and neurovisual impairment were common in patients receiving alpha-interferon therapy but were rarely symptomatic. It suggests that alpha-interferon may usually be continued in asymptomatic patients as long as there is careful fundoscopic examination.
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Affiliation(s)
- Louis d'Alteroche
- Service d'Hépato-Gastroentérologie, Hôpital Trousseau, 37044 Tours cedex, France.
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d'Alteroche L, Assor P, Lefrou L, Senecal D, Gaudy C, Bacq Y. Neutropénie et thrombopénie auto-immunes sévères associées à une hépatite chronique C : effet du traitement antiviral. ACTA ACUST UNITED AC 2005; 29:297-9. [PMID: 15864183 DOI: 10.1016/s0399-8320(05)80766-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We report the case of a 45-year-old man admitted for severe autoimmune thrombopenia and neutropenia associated with chronic viral C hepatitis. After failed, intravenous gammaglobulin and corticosteroid therapy antiviral treatment with interferon and ribavirin was given for one year. Thrombopenia improved progressively during antiviral therapy and worsened after the end of treatment. Neutropenia improved during antiviral therapy. Two years after the end of treatment, serum RNA-HCV was positive, white cell count was normal and platelet count was 77 G/L. In conclusion, these results suggest that antiviral therapy may be useful in patients with auto-immune cytopenia associated with viral hepatitis C infection.
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d'Alteroche L, Bacq Y, Barbereau D, de Muret A, Dubois F. [Sustained virologic response after two months antiviral treatment in two patients suffering from chronic hepatitis C]. Gastroenterol Clin Biol 2003; 27:946-7. [PMID: 14631313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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de Widerspach-Thor A, d'Alteroche L, Rault A, Thuan JF, Masseron T, Hovette P. [Predictive factors of mortality in severe shigellosis]. Med Trop (Mars) 2003; 62:101. [PMID: 12038166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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d'Alteroche L, Oung C, Fourquet F, Picon L, Lagasse JP, Metman EH. Evolution of clinical and radiological features at diagnosis of achalasia during a 19-year period in central France. Eur J Gastroenterol Hepatol 2001; 13:121-6. [PMID: 11246610 DOI: 10.1097/00042737-200102000-00006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Symptoms of achalasia are often misinterpreted, resulting in delayed diagnosis. The aims of our study were (1) to estimate the evolution of clinical and radiological features of a large population of achalasic patients between two successive periods; and (2) to determine the influence of symptoms on diagnostic delay. METHODS Between 1980 and 1998, all achalasia patients treated in our unit were assessed at the time of manometric diagnosis for clinical and radiological features. These data were compared between two successive periods (1980-1994 and 1994-1998). Then, a correlation between the diagnostic delay, clinical and radiological data and symptoms was investigated. RESULTS Three hundred and forty-five consecutive achalasia patients were assessed (mean age at diagnosis, 56 years; mean diagnostic delay, 5.7 years). The duration of the disease was correlated with the oesophageal diameter (P = 0.0001). Dysphagia, chest pain and heartburn were more frequent in young patients (respectively, P = 0.003, 0.0001 and 0.001). Women had 1.7 times the risk of men for suffering of chest pain (95% CI, 1.1 -2.6) and 2.2 times the risk for heartburn (95% CI, 1.2-4.0). Pulmonary involvement was more frequent when the oesophagus was dilated (P = 0.0002), and 3.4 times more frequent when associated with regurgitations (95% CI, 1.3-8.9). The oesophageal diameter was significantly smaller (38 vs 48 mm) in the last period, but we have not observed any significant shortening of the diagnostic delay. No symptoms influenced the diagnostic delay. CONCLUSIONS Despite a smaller oesophageal diameter at the time of diagnosis, during the period 1994-1998, diagnostic delay was not reduced. No clinical features associated with late diagnoses could be identified.
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Affiliation(s)
- L d'Alteroche
- Department of Gastroenterology, Trousseau University Hospital, Tours, France.
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Hurreesing C, Babuty D, Fauchier L, d'Alteroche L, Montout M, Poret P, Cosnay P. [Pericardial extravasation as an indicator of congestive heart failure due to thiamine deficiency in a young adult]. Rev Med Interne 2000; 21:993-7. [PMID: 11109597 DOI: 10.1016/s0248-8663(00)00256-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Thiamine (B1) deficiency is one of the classical causes of congestive heart failure. Although in the western world and in other developed regions this disorder is generally associated with chronic alcoholism, it may also only occur as a result of a deficient diet. EXEGESIS A young patient was admitted for electrocardiographic examination, and pericardial extravasation was recorded. The etiological assessment showed a case of congestive heart failure due to thiamine (B1) deficiency. A hemodynamic examination and investigation of thiamine blood levels confirmed this diagnosis. The patient's health status improved following thiamine administration, with complete and rapid regression of symptoms of congestive heart failure. CONCLUSION Although cardiomyopathic beriberi is infrequent, it should systematically be taken into account in the etiology of congestive heart failure. The present study also notes that a dietary thiamine deficiency is uncommon, but should nevertheless be considered when other symptoms of denutrition are present.
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Affiliation(s)
- C Hurreesing
- Service de cardiologie B, hôpital Trousseau, Tours, France
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Joseph-Reinette C, d'Alteroche L, Viguier J, Guimard Y, Codjovi P, Metman EH. [Hepatic abscess in Rendu-Osler disease]. Gastroenterol Clin Biol 2000; 24:230-2. [PMID: 12687967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Abstract
OBJECTIVE The aim of this retrospective study was to determine the risk factors of early complications after progressive pneumatic dilation for achalasia. METHODS Five hundred four dilations were performed in 237 consecutive achalasic patients between 1980 and 1994 with the same technique: low-pressure pneumatic dilation every other day with balloons of increasing diameter until success criteria were obtained (depending on manometric examination and esophageal x-ray transit performed 24 h after each dilation). Clinical, radiographical, endoscopical, and manometrical data as technical procedure characteristics for patients with perforations or other early complications were compared with those without complications. RESULTS We observed 15 complications (6% of patients): 7 perforations (3%), 3 asymptomatic esophageal mucosal tears, 4 esophageal hematomas, and 1 fever. Perforations occurred in 6 of 7 patients during the first dilation. The mean age was 68.5 yr in the group with complications versus 56.4 yr for the remainder (p < 0.05). Two deaths occurred in patients older than 90 yr. Instability of the balloon during dilations was noted in 8 of 15 cases of complications versus 57 of 222 patients (p < 0.05). No other data differed significantly. CONCLUSIONS This study showed a low prevalence of early complications using this progressive technique. Patients with hiatal hernia, esophageal diverticulum, or vigorous achalasia may safely undergo progressive pneumatic dilation. Only patients older than 90 yr should be referred for progressive pneumatic dilation with caution. Most of perforations arose during the first dilation, but there was no predictive pretherapeutic factor of perforation.
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Affiliation(s)
- E H Metman
- Service d'Hépato-gastroentérologie, Hôpital Trousseau, Tours, France
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Viguier J, d'Alteroche L, Picon L, Karsenti D, Guerin M, Bacq Y, Metman EH. [Acute hepatitis caused by tisopurine. A case]. Gastroenterol Clin Biol 1997; 21:342. [PMID: 9208004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Gargot D, Chaussade S, d'Alteroche L, Desbazeille F, Grandjouan S, Louvel A, Douvin J, Causse X, Festin D, Chapuis Y. Nonsteroidal anti-inflammatory drug-induced colonic strictures: two cases and literature review. Am J Gastroenterol 1995; 90:2035-8. [PMID: 7485018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report two patients with large bowel submucosal diaphragm disease associated with nonsteroidal anti-inflammatory drugs (slow release form of diclofenac and phenylbutazone) who were admitted in 1990 and 1991 because of iron deficiency. At colonoscopy, the lumen of the ascending colon was divided into compartments by multiple thin circumferential mucosal membranes. Barium enema showed two short strictures in one patient. Right hemicolectomy was carried out on one patient. The other patient was simply advised to discontinue taking diclofenac and remains well. Such lesions are rare (10 cases have been reported) and resemble those previously described in the small bowel.
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Affiliation(s)
- D Gargot
- Service d'Hépato-Gastroentérologie, Hôpital de Blois, France
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