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Gallach M, Vergara M, Pedro da Costa J, Miquel M, Casas M, Sanchez-Delgado J, Dalmau B, Rudi N, Parra I, Monllor T, Sanchez-Lloansí M, Dosal A, Valero O, Calvet X. Correction: Impact of treatment with direct-acting antivirals on anxiety and depression in chronic hepatitis C. PLoS One 2020; 15:e0241559. [PMID: 33104765 PMCID: PMC7588075 DOI: 10.1371/journal.pone.0241559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Miquel M, Pardo A, Forné M, Martínez-Alpin G, Rodríguez-Castellano A, Casas M, Rosinach M, Roget M, Dalmau B, Temiño R, Quer JC, Sanchez-Delgado J, Ortiz J, Vergara M. Current trends in access to treatment for hepatitis B in immigrants vs non-immigrants. Gastroenterol Rep (Oxf) 2020; 8:362-366. [PMID: 33163191 PMCID: PMC7603864 DOI: 10.1093/gastro/goaa010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/07/2019] [Revised: 09/27/2019] [Accepted: 10/20/2019] [Indexed: 12/20/2022] Open
Abstract
Background Universal vaccination for hepatitis B virus (HBV) and migratory movements have changed the demographic characteristics of this disease in Spain and in Europe. Therefore, we evaluated the characteristics of the disease and the possible differences according to origin (immigrants vs non-immigrants) and access to treatment. Methods This is a multicenter cross-sectional study (June 2014 to May 2015) in which outpatients with a positive HBsAg were seen and followed in four Hepatology units. Demographic and clinical data and indication and access to treatment were collected in two different regions of Catalonia (Spain) where there are no barriers to treatment due to a comprehensive coverage under the National Health System. Results A total of 951 patients were evaluated (48.1% men). Of these, 46.6% were immigrants (58.7% of them were born in Africa) and were significantly younger compared to non-immigrants. The proportions of patients with alcohol consumption, being overweight, and other indicators of metabolic co-morbidities were significantly higher in non-immigrants. Among the 937 patients receiving HBeAg examination, 91.7% were HBeAg-negative. Chronic HBeAg-positive infection was significantly higher in immigrants (3.9% vs 0.6%, P = 0.001) and chronic HBeAg-negative hepatitis was higher non-immigrants (31.7% vs 21.4%, P < 0.001). Not only was the proportion of patients who met treatment criteria significantly higher among non-immigrants (38.4% vs 29.2%, P = 0.003), but also the proportion of those with indication of effectively receiving therapy at the time of data collection (83.2% vs 57.8 %, P < 0.001). Conclusions The immigrant population with HBV is younger and has a lower prevalence of metabolic co-morbidities and a higher frequency of chronic HBeAg infection. Despite having access to care and an indication for treatment, some do not get adequately treated due to several factors including local adaptation that precludes access to treatment.
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Affiliation(s)
- Mireia Miquel
- Liver Unit, Gastroenterology Department, Parc Taulí University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
| | - Albert Pardo
- Gastroenterology Department, University Hospital Joan XXIII, Tarragona, Spain
| | - Montse Forné
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Gemma Martínez-Alpin
- Liver Unit, Gastroenterology Department, Consorci Sanitari de Terrassa, Terrassa, Spain
| | | | - Meritxell Casas
- Liver Unit, Gastroenterology Department, Parc Taulí University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
| | - Mercè Rosinach
- Liver Unit, Gastroenterology Department, University Hospital Mútua Terrassa, Barcelona, Spain
| | - Mercè Roget
- Liver Unit, Gastroenterology Department, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Blai Dalmau
- Liver Unit, Gastroenterology Department, Parc Taulí University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
| | - Rocío Temiño
- Liver Unit, Gastroenterology Department, University Hospital Mútua Terrassa, Barcelona, Spain
| | - Joan Carlos Quer
- Gastroenterology Department, University Hospital Joan XXIII, Tarragona, Spain
| | - Jordi Sanchez-Delgado
- Liver Unit, Gastroenterology Department, Parc Taulí University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
| | - Jordi Ortiz
- Liver Unit, Gastroenterology Department, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Mercedes Vergara
- Liver Unit, Gastroenterology Department, Parc Taulí University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
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Brunet E, Hernández L, Miquel M, Sánchez-Delgado J, Dalmau B, Valero O, Vergara M, Casas M. Análisis de los índices predictores de respuesta al tratamiento con ácido ursodeoxicólico en pacientes con colangitis biliar primaria. Med Clin (Barc) 2019; 152:377-383. [DOI: 10.1016/j.medcli.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 01/25/2023]
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Bella MR, Casas M, Vergara M, Brullet E, Junquera F, Martínez-Bauer E, Miquel M, Sánchez-Delgado J, Dalmau B, Campo R, Calvet X. Utility of histology for the diagnosis of portal hypertensive gastroenteropathy. Concordance between the endoscopic image and gastrointestinal biopsies. Role of the CD34 marker. Gastroenterol Hepatol 2019; 42:150-156. [PMID: 30459058 DOI: 10.1016/j.gastre.2019.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/17/2018] [Accepted: 09/21/2018] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Upper gastroscopy in patients with cirrhosis often reveals non-specific lesions, which are usually oriented as portal hypertensive gastropathy (PHG). However, the diagnosis of PHG can be difficult, both from an endoscopic and histological point of view. The study of CD34 expression, which enhances the endothelial cells of the microvasculature, could help the differential diagnosis. The objectives of this study were to evaluate the correlation between endoscopy and histology in the diagnosis of PHG and to assess the utility of CD34 in the diagnosis of PHG. MATERIAL AND METHODS The results of immunostaining with CD34 gastric fundus biopsies from 100 cirrhotic patients and 20 controls were compared with the endoscopic images. RESULTS The correlation between the histology and the endoscopic diagnosis of PHG was very low (kappa=0.15). In addition, the measurement of the diameter of the gastric vessels enhanced by the use of immunohistochemical staining (CD34) did not show good correlation with the endoscopic diagnosis (p=.26) and did not provide relevant information for the histological diagnosis of PHG either. DISCUSSION The correlation between histology and endoscopy is low for the diagnosis of PHG. The use of immunostaining for CD34 does not seem to improve the diagnostic yield of the histological study.
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Affiliation(s)
- Maria Rosa Bella
- Servicio de Anatomía Patológica, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Meritxell Casas
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Mercedes Vergara
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España.
| | - Enric Brullet
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Félix Junquera
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Eva Martínez-Bauer
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Mireia Miquel
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Jordi Sánchez-Delgado
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Blai Dalmau
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Rafael Campo
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Xavier Calvet
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
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Albert L, Profitós J, Sánchez-Delgado J, Capel I, González-Clemente JM, Subías D, Cano A, Berlanga E, Espinal A, Hurtado M, Pareja R, Rigla M, Dalmau B, Vergara M, Miquel M, Casas M, Giménez-Palop O. Salivary Cortisol Determination in ACTH Stimulation Test to Diagnose Adrenal Insufficiency in Patients with Liver Cirrhosis. Int J Endocrinol 2019; 2019:7251010. [PMID: 31320899 PMCID: PMC6609341 DOI: 10.1155/2019/7251010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/13/2019] [Accepted: 05/19/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The prevalence of adrenal insufficiency (AI) in patients with decompensated liver cirrhosis is unknown. Because these patients have lower levels of cortisol-binding carrier proteins, their total serum cortisol (TSC) correlates poorly with free serum cortisol (FC). Salivary cortisol (SaC) correlates better with FC. We aimed to establish SaC thresholds for AI for the 250 μg intravenous ACTH test and to estimate the prevalence of AI in noncritically ill cirrhotic patients. METHODS We included 39 patients with decompensated cirrhosis, 39 patients with known AI, and 45 healthy volunteers. After subjects fasted ≥8 hours, serum and saliva samples were collected for determinations of TSC and SaC at baseline 0'(T0) and at 30-minute intervals after intravenous administration of 250 μg ACTH [30'(T30), 60'(T60), and 90'(T90)]. RESULTS Based on the findings in healthy subjects and patients with known AI, we defined AI in cirrhotic patients as SaC-T0< 0.08 μg/dL (2.2 nmol/L), SaC-T60 < 1.43 μg/dl (39.5 nmol/L), or ΔSaC<1 μg/dl (27.6 nmol/L). We compared AI determination in cirrhotic patients with the ACTH test using these SaC thresholds versus established TSC thresholds (TSC-T0< 9 μg/dl [248 nmol/L], TSC-T60 < 18 μg/dl [497 nmol/L], or ΔTSC<9 μg/dl [248 nmol/L]). SaC correlated well with TSC. The prevalence of AI in cirrhotic patients was higher when determined by TSC (48.7%) than by SaC (30.8%); however, this difference did not reach statistical significance. AI was associated with sex, cirrhosis etiology, and Child-Pugh classification. CONCLUSIONS Measuring SaC was more accurate than TSC in the ACTH stimulation test. Measuring TSC overestimated the prevalence of AI in noncritically ill cirrhotic patients.
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Affiliation(s)
- Lara Albert
- Endocrinology Department, Parc Taulí University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
| | - Joaquím Profitós
- Liver and Gastrointestinal Diseases Department, Parc Tauli University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
| | - Jordi Sánchez-Delgado
- Liver and Gastrointestinal Diseases Department, Parc Tauli University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain
| | - Ismael Capel
- Endocrinology Department, Parc Taulí University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
| | - José Miguel González-Clemente
- Endocrinology Department, Parc Taulí University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
| | - David Subías
- Endocrinology Department, Parc Taulí University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
| | - Albert Cano
- Endocrinology Department, Parc Taulí University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
| | - Eugenio Berlanga
- Clinical Laboratory Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí University Hospital, Autonomous University of Barcelona, Sabadell, Spain
| | - Anna Espinal
- Servei d'Estadística Aplicada, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Marta Hurtado
- Endocrinology Department, Parc Taulí University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
| | - Rocío Pareja
- Endocrinology Department, Parc Taulí University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
| | - Mercedes Rigla
- Endocrinology Department, Parc Taulí University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
| | - Blai Dalmau
- Liver and Gastrointestinal Diseases Department, Parc Tauli University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
| | - Mercedes Vergara
- Liver and Gastrointestinal Diseases Department, Parc Tauli University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain
| | - Mireia Miquel
- Liver and Gastrointestinal Diseases Department, Parc Tauli University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain
| | - Meritxell Casas
- Liver and Gastrointestinal Diseases Department, Parc Tauli University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
| | - Olga Giménez-Palop
- Endocrinology Department, Parc Taulí University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain
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Gallach M, Vergara M, da Costa JP, Miquel M, Casas M, Sanchez-Delgado J, Dalmau B, Rudi N, Parra I, Monllor T, Sanchez-Lloansí M, Dosal A, Valero O, Calvet X. Impact of treatment with direct-acting antivirals on anxiety and depression in chronic hepatitis C. PLoS One 2018; 13:e0208112. [PMID: 30566421 PMCID: PMC6300319 DOI: 10.1371/journal.pone.0208112] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 03/27/2018] [Accepted: 11/12/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIM Treatment of hepatitis C with direct-acting antiviral agents (DAA) has few side effects. Although pivotal studies suggested that DAA were safe in patients with psychiatric diseases who could not be treated with previous antiviral therapies, their effects on anxiety and depression have not yet been analysed in clinical practice. The aim of our study was to analyse anxiety and depression in the setting of DAA treatment in a clinical practice series. METHODS All patients starting DAA treatment between November 1, 2014 and October 31, 2015 were eligible. Patients completed the Hospital Anxiety and Depression scale at different times during treatment. The results were plotted on line graphs and evaluated using a linear regression model with repeated measures. RESULTS One hundred and forty-five patients were included (11% with major psychiatric disorders; 32% on psychiatric treatment). Sustained virologic response (SVR) was achieved in 97.3% of cases. Anxiety and depression measures did not differ between time points. No differences between patients on psychiatric treatment or with advanced fibrosis or cirrhosis were found at any time point analysed. CONCLUSION DAA treatment had no impact on anxiety or depression during or after chronic hepatitis C infection treatment, even in high-risk patients with major psychiatric disorders.
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Affiliation(s)
- Marta Gallach
- Hepatology unit, Digestive Disease Department, Parc Taulí Hospital Universitari, Institutd’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona; Sabadell, Spain
| | - Mercedes Vergara
- Hepatology unit, Digestive Disease Department, Parc Taulí Hospital Universitari, Institutd’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona; Sabadell, Spain
- CIBERehd, Instituto Carlos III, Madrid, Spain
| | - Joao Pedro da Costa
- Hepatology unit, Digestive Disease Department, Parc Taulí Hospital Universitari, Institutd’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona; Sabadell, Spain
| | - Mireia Miquel
- Hepatology unit, Digestive Disease Department, Parc Taulí Hospital Universitari, Institutd’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona; Sabadell, Spain
- CIBERehd, Instituto Carlos III, Madrid, Spain
| | - Meritxell Casas
- Hepatology unit, Digestive Disease Department, Parc Taulí Hospital Universitari, Institutd’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona; Sabadell, Spain
| | - Jordi Sanchez-Delgado
- Hepatology unit, Digestive Disease Department, Parc Taulí Hospital Universitari, Institutd’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona; Sabadell, Spain
- CIBERehd, Instituto Carlos III, Madrid, Spain
| | - Blai Dalmau
- Hepatology unit, Digestive Disease Department, Parc Taulí Hospital Universitari, Institutd’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona; Sabadell, Spain
- CIBERehd, Instituto Carlos III, Madrid, Spain
| | - Núria Rudi
- Pharmacy Department, Parc Taulí Hospital Universitari, Institutd’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Isabel Parra
- Mental Health Department, Parc Taulí Hospital Universitari, Institutd’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Teresa Monllor
- Nursing, Hepatology Day Hospital, ParcTaulí Hospital Universitari, Institutd’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Meritxell Sanchez-Lloansí
- Nursing, Hepatology Day Hospital, ParcTaulí Hospital Universitari, Institutd’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Angelina Dosal
- Nursing, Hepatology Day Hospital, ParcTaulí Hospital Universitari, Institutd’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Oliver Valero
- Statistical services center, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Calvet
- Hepatology unit, Digestive Disease Department, Parc Taulí Hospital Universitari, Institutd’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona; Sabadell, Spain
- CIBERehd, Instituto Carlos III, Madrid, Spain
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Bella MR, Casas M, Vergara M, Brullet E, Junquera F, Martínez-Bauer E, Miquel M, Sánchez-Delgado J, Dalmau B, Campo R, Calvet X. Utility of histology for the diagnosis of portal hypertensive gastroenteropathy. Concordance between the endoscopic image and gastrointestinal biopsies. Role of the CD34 marker. Gastroenterol Hepatol 2018; 42:150-156. [PMID: 30459058 DOI: 10.1016/j.gastrohep.2018.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/17/2018] [Accepted: 09/21/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Upper gastroscopy in patients with cirrhosis often reveals non-specific lesions, which are usually oriented as portal hypertensive gastropathy (PHG). However, the diagnosis of PHG can be difficult, both from an endoscopic and histological point of view. The study of CD34 expression, which enhances the endothelial cells of the microvasculature, could help the differential diagnosis. The objectives of this study were to evaluate the correlation between endoscopy and histology in the diagnosis of PHG and to assess the utility of CD34 in the diagnosis of PHG. MATERIAL AND METHODS The results of immunostaining with CD34 gastric fundus biopsies from 100 cirrhotic patients and 20 controls were compared with the endoscopic images. RESULTS The correlation between the histology and the endoscopic diagnosis of PHG was very low (kappa=0.15). In addition, the measurement of the diameter of the gastric vessels enhanced by the use of immunohistochemical staining (CD34) did not show good correlation with the endoscopic diagnosis (p=.26) and did not provide relevant information for the histological diagnosis of PHG either. DISCUSSION The correlation between histology and endoscopy is low for the diagnosis of PHG. The use of immunostaining for CD34 does not seem to improve the diagnostic yield of the histological study.
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Affiliation(s)
- Maria Rosa Bella
- Servicio de Anatomía Patológica, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Meritxell Casas
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Mercedes Vergara
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España.
| | - Enric Brullet
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Félix Junquera
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Eva Martínez-Bauer
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Mireia Miquel
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Jordi Sánchez-Delgado
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Blai Dalmau
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Rafael Campo
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Xavier Calvet
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
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Casas M, Vergara M, Brullet E, Junquera F, Martínez-Bauer E, Miquel M, Sánchez-Delgado J, Dalmau B, Campo R, Calvet X. Inter and intra-observer concordance for the diagnosis of portal hypertension gastropathy. Rev Esp Enferm Dig 2018; 110:166-171. [PMID: 29320862 DOI: 10.17235/reed.2018.5169/2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION At present there is no fully accepted endoscopic classification for the assessment of the severity of portal hypertensive gastropathy (PHG). Few studies have evaluated inter and intra-observer concordance or the degree of concordance between different endoscopic classifications. OBJECTIVES To evaluate inter and intra-observer agreement for the presence of portal hypertensive gastropathy and enteropathy using different endoscopic classifications. METHODS Patients with liver cirrhosis were included into the study. Enteroscopy was performed under sedation. The location of lesions and their severity was recorded. Images were videotaped and subsequently evaluated independently by three different endoscopists, one of whom was the initial endoscopist. The agreement between observations was assessed using the kappa index. RESULTS Seventy-four patients (mean age 63.2 years, 53 males and 21 females) were included. The agreement between the three endoscopists regarding the presence or absence of PHG using the Tanoue and McCormack classifications was very low (kappa scores = 0.16 and 0.27, respectively). CONCLUSIONS The current classifications of portal hypertensive gastropathy have a very low degree of intra and inter-observer agreement for the diagnosis and assessment of gastropathy severity.
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Affiliation(s)
- Meritxell Casas
- Servicio de Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona, españa
| | - Mercedes Vergara
- Servicio de Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona
| | - Enric Brullet
- Servicio de Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona, españa
| | - Félix Junquera
- Servicio de Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona, España
| | - Eva Martínez-Bauer
- Servicio de Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona, España
| | - Mireia Miquel
- Servicio de Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona
| | - Jordi Sánchez-Delgado
- Servicio Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona, España
| | - Blai Dalmau
- Servicio Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona
| | - Rafael Campo
- Servicio de Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona, España
| | - Xavier Calvet
- Servicio de Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona, España
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Pedrosa M, Nogales S, Vergara M, Miquel M, Casas M, Dalmau B, Font B, Sánchez-Delgado J. Reactivation of peritoneal and pleural tuberculosis during hepatitis C treatment with direct-acting antivirals. Gastroenterol Hepatol 2018; 42:174-175. [PMID: 29665974 DOI: 10.1016/j.gastrohep.2018.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/06/2018] [Accepted: 03/11/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Marc Pedrosa
- Servicio de Medicina Interna, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Sara Nogales
- Servicio de Medicina Intensiva, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Mercedes Vergara
- Unidad de Hepatología, Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación Biomédica y en Red enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Mireia Miquel
- Unidad de Hepatología, Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación Biomédica y en Red enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Meritxell Casas
- Unidad de Hepatología, Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Blai Dalmau
- Unidad de Hepatología, Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Bernat Font
- Servicio de Enfermedades Infecciosas, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Jordi Sánchez-Delgado
- Unidad de Hepatología, Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación Biomédica y en Red enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España.
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Melcarne L, Sopeña J, Martínez-Cerezo FJ, Vergara M, Miquel M, Sánchez-Delgado J, Dalmau B, Machlab S, Portilla D, González-Padrón Y, Real Álvarez M, Carpintero C, Casas M. Prognostic factors of liver cirrhosis mortality after a first episode of spontaneous bacterial peritonitis. A multicenter study. Rev Esp Enferm Dig 2018; 110:94-101. [PMID: 29313695 DOI: 10.17235/reed.2017.4517/2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Spontaneous bacterial peritonitis is an infectious complication with a negative impact on survival of patients with cirrhosis. OBJECTIVE To analyze the short- and long-term survival after a first episode of bacterial peritonitis and the associated prognostic factors. PATIENTS AND METHODS This was a retrospective, multicenter study of patients admitted to hospital for spontaneous bacterial peritonitis between 2008 and 2013. Independent variables related to mortality were analyzed by logistic regression. The prognostic power of the Child Pugh Score, the Model for End-Stage Liver Disease (MELD) and the Charlson index was analyzed by ROC curve. RESULTS A total of 159 patients were enrolled, 72% were males with a mean age of 63.5 years and a mean MELD score of 19 (SD ± 9.5). Mortality at 30 and 90 days and one and two years was 21%, 31%, 55% and 69%, respectively. Hepatic encephalopathy (p = 0.008, OR 3.5, 95% CI 1.4-8.8) and kidney function (p = 0.026, OR 2.7, 95% CI 1.13-16.7) were independent factors for short- and long-term mortality. MELD was a good marker of short- and long-term survival (area under the curve [AUC] 0.7: 95% CI 1.02-1.4). The Charlson index was related to long-term mortality (AUC 0.68: 95% CI 0.6-0.77). CONCLUSIONS Short- and long-term mortality of spontaneous bacterial peritonitis is still high. The main prognostic factors for mortality are impairment of liver and kidney function. MELD and the Charlson index are good markers of survival.
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Affiliation(s)
- Luigi Melcarne
- Unidad de Hepatología. Servicio Aparato Digestivo, Hospital Universitari Parc Taulí - Sabadell
| | - Julia Sopeña
- Servicio Aparato Digestivo, Hospital Universitari Joan XXIII - Tarragona
| | | | - Mercedes Vergara
- Unidad de Hepatología. Servicio Aparato Digestivo, Hospital Universitari Parc Taulí - Sabadell
| | - Mireia Miquel
- Unidad de Hepatología. Servicio Aparato Digestivo, Hospital Universitari Parc Taulí - Sabadell
| | - Jordi Sánchez-Delgado
- Unidad de Hepatología. Servicio Aparato Digestivo, Hospital Universitari Parc Taulí - Sabadell
| | - Blai Dalmau
- Unidad de Hepatología. Servicio Aparato Digestivo, Hospital Universitari Parc Taulí - Sabadell
| | - Salvador Machlab
- Unidad de Hepatología. Servicio Aparato Digestivo, Hospital Universitari Parc Taulí - Sabadell
| | - Dustin Portilla
- Servicio Aparato Digestivo, Hospital Universitari Joan XXIII - Tarragona
| | | | | | | | - Meritxell Casas
- Unidad de Hepatología. Servicio Aparato Digestivo, Hospital Universitari Parc Taulí - Sabadell
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11
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Gallach M, Vergara M, Miquel M, Casas M, Sánchez-Delgado J, Dalmau B, Gil M, Rudi N, Parra I, López M, Dosal A, Moreno L, Valero O, Calvet X. Effects of a multidisciplinary approach on the effectiveness of antiviral treatment for chronic hepatitis C. Ann Hepatol 2017; 15:524-31. [PMID: 27236151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
UNLABELLED Background. Despite the introduction of direct antiviral agents, pegylated interferon remains the mainstay of treatment for chronic hepatitis C. However, pegylated interferon is associated with a high rate of severe adverse events and decreased quality of life. Specific interventions can improve adherence and effectiveness. We aimed to determine whether implementing a multidisciplinary approach improved outcomes in the treatment of chronic hepatitis C. MATERIAL AND METHODS We analyzed consecutive patients treated with pegylated interferon plus ribavirin between August 2001 and December 2011. We compared patients treated before and after the implementation of a multidisciplinary approach in 2007. We compared the baseline demographic and clinical characteristics and laboratory findings between groups, and used bivariate logistic regression models to detect factors involved in attaining a sustained virological response, calculating the odds ratios with their respective 95% confidence intervals. To evaluate the effect of the multidisciplinary team, we fitted a multivariate logistic regression model to compare the sustained virological response after adjusting for unbalanced variables and predictive factors. RESULTS We included 514 patients [228 (44.4%) in the pre-intervention cohort]. Age, viral genotype, previous treatment, aspartate transaminase, ferritin, and triglyceride were prognostic factors of sustained virological response. After adjusting for prognostic factors, sustained virological response was higher in the multidisciplinary cohort (58 vs. 48%, p = 0.038). Despite higher psychiatric comorbidity and age in the multidisciplinary cohort, we observed a trend toward a lower rate of treatment abandonment in this group (2.2 vs. 4.9%, p = 0.107). CONCLUSION Multidisciplinary management of chronic hepatitis C improves outcomes.
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Affiliation(s)
- Marta Gallach
- Emergency Department. † Hepatology Unit, Digestive Disease Department. ‡ Hospital Pharmacy
| | - Mercedes Vergara
- Hepatology Unit, Digestive Disease Department Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain; CIBERehd, Instituto Carlos III; Madrid, Spain
| | - Mireia Miquel
- Hepatology Unit, Digestive Disease Department Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain; CIBERehd, Instituto Carlos III; Madrid, Spain
| | - Meritxell Casas
- Hepatology Unit, Digestive Disease Department Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain
| | - Jordi Sánchez-Delgado
- Hepatology Unit, Digestive Disease Department Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain; CIBERehd, Instituto Carlos III; Madrid, Spain
| | - Blai Dalmau
- Hepatology Unit, Digestive Disease Department Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain
| | - Montserrat Gil
- Hepatology Unit, Digestive Disease Department Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain
| | - Núria Rudi
- Hospital Pharmacy Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain
| | - Isabel Parra
- Mental Health Department. Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain
| | - Maria López
- CIBERehd, Instituto Carlos III; Madrid, Spain; Nursing, Hepatology Day Hospital. Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain
| | - Angelina Dosal
- Nursing, Hepatology Day Hospital. Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain
| | - Laura Moreno
- Nursing, Hepatology Day Hospital. Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain
| | - Oliver Valero
- Department of Applied Statistics. Universitat Autónoma de Barcelona. Barcelona. Spain
| | - Xavier Calvet
- Hepatology Unit, Digestive Disease Department Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain; CIBERehd, Instituto Carlos III; Madrid, Spain
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12
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Moreno L, Sánchez-Delgado J, Vergara M, Casas M, Miquel M, Dalmau B. Recurrent drug-induced liver injury (DILI) with ciprofloxacin and amoxicillin/clavulanic. Rev Esp Enferm Dig 2017; 107:767-8. [PMID: 26671593 DOI: 10.17235/reed.2015.3810/2015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ciprofloxacin and amoxicillin/clavulanic are two widely used antibiotics due to their high efficacy and few side effects. While the percentage of hepatotoxicity of these antibiotics is low, their frequent use has led to a progressive increase in the number of cases. Both antibiotics have been associated with a wide variety of hepatotoxic reactions, from a slight rise of transaminases to fulminant hepatitis. Once hepatotoxicity secondary to a drug appears, the first step is to discontinue the drug. Physicians may opt to administer an alternative treatment with a different chemical structure. It should be borne in mind, however, that different chemical structures may also cause recurrent drug-induced liver injuries (DILI). We present the case of a patient who consecutively developed DILI due to ciprofloxacin and amoxicillin/clavulanic.
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Affiliation(s)
- Luís Moreno
- Medicina Interna, Corporació Sanitària i Universitària Parc Taulí, España
| | | | | | - Meritxell Casas
- Hepatología, Parc Tauli Sabadell. Hospital Universitari., españa
| | - Mireia Miquel
- Hepatología, Parc Tauli Sabadell. Hospital Universitari, España
| | - Blai Dalmau
- Hepatología, Parc Tauli Sabadell. Hospital Universitari., España
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13
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Urquijo JJ, Diago M, Boadas J, Planas R, Solá R, Del Olmo JA, Crespo J, Erdozaín JC, Antón MD, Arocena C, Suarez D, Giné J, Barrera JM, Gracia-Samaniego J, Perez R, Dalmau B, Montoro M. Safety and efficacy of treatment with pegylated interferon alpha-2a with ribavirin in chronic hepatitis C genotype 4. Ann Hepatol 2013; 12:30-5. [PMID: 23293191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The hepatitis C virus (HCV) genotype is an important predictive outcome parameter for pegylated interferon plus ribavirin therapy. Most published therapeutic trials to date have enrolled mainly patients with HCV genotypes 1, 2 and 3. Limited studies have focused on genotype 4 patients, who have had a poor representation in pivotal trials. Our aim was to evaluate the efficacy and safety of treatment with standard dose pegylated interferon alfa-2a in combination with weight-based ribavirin in patients with chronic hepatitis C genotype 4. In this prospective observational study, 198 patients with HCV-4 were included in this study from February 2004 to August 2005,188 patients who received at least 1 dose of drugs were included in the ITT analysis and they were treated with pegylated interferon alfa-2a and ribavirin for 48 weeks. Baseline and demographic characteristics, response to treatment at weeks 12, 48 and 72, and the nature and frequency of adverse effects were analyzed. Virological response at week 12 was achieved in 144 patients (76.6%). Virological response at the end of treatment was present in 110 patients (58.5%). At week 72, 99 patients presented SVR (52.7%). The reported adverse events were similar to those found in the literature for treatments of similar dose and duration. In conclusion, combined treatment with pegylated interferon alfa-2a and ribavirin was well tolerated and effective in chronic hepatitis C genotype 4, yielding response rates between those reported for genotype 1 and those of genotypes 2-3.
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14
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Fernandez-Atutxa A, Vergara M, Gil M, Dalmau B, Miquel M, Sanchez-Delgado J, Casas M. [Rizatriptan-induced liver toxicity. Report of a case]. Gastroenterol Hepatol 2012; 36:261-3. [PMID: 23084593 DOI: 10.1016/j.gastrohep.2012.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 07/11/2012] [Accepted: 07/24/2012] [Indexed: 11/19/2022]
Abstract
Triptans are a class of drugs with proven efficacy in the acute treatment of migraine headache. The first component of these drugs was sumatriptan, with various derivatives subsequently emerging. Until now, there has only been one reported case of liver toxicity with zolmitriptan. We now present a case of hepatotoxicity related to another drug in this group: rizatriptan.
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Affiliation(s)
- Alberto Fernandez-Atutxa
- Servicio de Digestivo, Corporación Sanitaria Parc Taulí, Universidad Autónoma de Barcelona, España.
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15
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Miquel M, Sopeña J, Vergara M, Gil M, Casas M, Sánchez-Delgado J, Puig J, Alguersuari A, Criado E, Dalmau B. Factors related to survival in hepatocellular carcinoma in the geographic area of Sabadell (Catalonia, Spain). Rev Esp Enferm Dig 2012; 104:242-7. [PMID: 22662776 DOI: 10.4321/s1130-01082012000500004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND hepatocellular carcinoma (HCC) is a very frequent tumor. Screening for the disease is effective, but the prognostic factors are difficult to evaluate. OBJECTIVES 1. To determine epidemiological data and the clinical course of HCC in our setting. 2. To compare patient survival according to whether screening is performed or not. 3. To evaluate survival prognostic factors. PATIENTS AND METHODS data on the epidemiology and clinical course of patients diagnosed with HCC were collected on a prospective basis (January 2004-December 2006). Two groups were considered according to whether screening had been performed (group A) or not (group B). RESULTS a total of 110 patients were diagnosed with HCC (70% males). The most common etiology of cirrhosis was hepatitis C (56.1%), and 69% presented mild liver failure (Child-Pugh grade A). The median follow-up was 1.8 years. Fifty-one percent had been subjected to screening. The diagnosis of HCC was established by imaging techniques in 48.2% of the cases, and by histological criteria in 51.8%. The median tumor size was 23 mm in group A and 28 mm in group B (p = 0.005). Treatment with curative intent was provided in 72% of the cases in group A and in 48% in group B (p = 0.011). The median overall survival was 1.99 years -2.67 years in group A and 1.75 years in group B (p = 0.05). The multivariate analysis of overall survival showed the type of treatment (OR = 2.82 95%CI: 1.3-6.12, p = 0.009) and liver function (OR = 1.71 95%CI: 1.1-2.68, p = 0.020) to be independent predictors of survival. CONCLUSIONS screening allows the diagnosis of smaller lesions and a higher percentage of curative treatments. The degree of liver function and the provision of curative treatment are independent predictors of survival.
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Affiliation(s)
- Mireia Miquel
- Unit of Hepatology, Department of Digestive Diseases, Corporación Sanitària Parc Tauli, Universitat Autonòma de Barcelona, Sabadell, Barcelona, Spain.
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16
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Sánchez-Delgado J, Calzado S, de Haro C, Mas M, Miquel M, Casas M, Vergara M, Dalmau B, Gil M. [Long survival after resection of cranial metastases from hepatocellular carcinoma. Case report and review of the literature]. Gastroenterol Hepatol 2011; 35:12-6. [PMID: 22177938 DOI: 10.1016/j.gastrohep.2011.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 10/22/2011] [Accepted: 11/06/2011] [Indexed: 01/08/2023]
Abstract
The life expectancy of patients with hepatocellular carcinoma (HCC) has increased in the last few years due to recent treatment advances. However, extrahepatic metastases from tumors, previously described only occasionally, are becoming more frequent in clinical practice. The choice between an active or passive approach to these metastatic lesions can sometimes present clinicians with a difficult dilemma. We discuss the case of a male patient with multifocal HCC and cranial metastasis from a primary liver tumor and who, after surgery and radiotherapy over the metastatic lesion, has survived for more than 3 years.
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Affiliation(s)
- Jordi Sánchez-Delgado
- Unidad de Hepatología, Servicio de Aparato Digestivo, Universitat Autònoma de Barcelona, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España.
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17
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Gallach M, Pérez J, Vergara M, Olivé G, Miquel M, Casas M, Gil M, Dalmau B, Sánchez J, Dosal A, Moreno L, Alavedra E, Gené E. [Spontaneous visits to the emergency service and hepatology day hospital by patients with liver cirrhosis]. Gastroenterol Hepatol 2011; 34:599-604. [PMID: 22037093 DOI: 10.1016/j.gastrohep.2011.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/30/2011] [Accepted: 07/01/2011] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Because of the current overload of emergency services, new units, such as day units, have had to be created. Liver cirrhosis (LC) is a chronic disease with frequent decompensations requiring medical attention. The aim of this study was to compare differences between emergency consultations in a hepatology day hospital (HDH) and in an emergency service (ES) among patients with LC. METHODS AND MATERIAL We performed an observational prospective study. All patients with LC attending the HDH or ES from September 2007 to August 2008 were asked to complete a questionnaire. Demographic, clinical, and radiological variables were collected. RESULTS There were 743 consultations, of which 62% involved the HDH. The mean age was 65±12 years, and the male/female ratio was 2:3. The most frequent diagnosis in the ES was hepatic encephalopathy (26.2% ES versus 6% HDH, p<0.001) followed by upper gastrointestinal hemorrhage (17.7% ES versus 0.6% HDH, p<0.001), while the most frequent diagnosis in the HDH was ascites (66.2% HDH versus 22.7% ES, p<0.001). The tests performed were as follows: blood analysis: 95% ES versus 60% HDH (p<0.01); radiology: 71% ES versus 11% HDH (p<0.01) and paracentesis: 51% ES versus 74% HDH (p<0.01). The mean length of stay in the ES was 21.3±121.5 hours compared with 3.3±2.4 hours in the HDH (p<0.001). A total of 53% of patients attended in the ES were hospitalized compared with 12% of those attended in the HDH (p<0.05). CONCLUSION Patients with LC preferentially attend the HDH, where fewer tests are performed and the length of stay is shorter. The care provided in the HDH is appropriate and efficient.
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Affiliation(s)
- Marta Gallach
- Servicio de Aparato Digestivo, Hospital de Sabadell, Barcelona, España.
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Bejarano G, Vergara M, Dalmau B, Puig J, Bella MR, Suárez D, Calvet X. Prospective evaluation of liver fibrosis in chronic viral hepatitis C infection using the Sabadell NIHCED (Non-Invasive Hepatitis-C-Related Cirrhosis Early Detection) index. Rev Esp Enferm Dig 2009; 101:325-335. [PMID: 19527078] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION liver disease resulting from chronic hepatitis C virus (HCV) infection follows an asymptomatic course towards cirrhosis and its complications in 20-40% of cases. Earlier studies demonstrated that advanced fibrosis is a prognostic factor. The "gold standard" for the evaluation of fibrosis grade is liver biopsy. Our group validated a predictive index - NIHCED - based on demographic, laboratory parameters, and echographic data to determine the presence of cirrhosis. OBJECTIVE our objective is to evaluate whether the NIHCED score predicts the presence of advanced fibrosis in patients with chronic HCV infection. MATERIAL AND METHODS this prospective study included patients with chronic HCV infection who underwent liver biopsy and were administered the NIHCED score. Fibrosis grade correlated with the NIHCED score using the ROC curve analysis and Spearman s correlation coefficient. RESULTS in total 321 patients were included (male/female ratio 1.27) with a mean age of 48 +/- 14 years. Liver biopsy showed that 131 (30.5%) had no fibrosis or had portal expansion while 190 (69.5%) had advanced fibrosis or cirrhosis. At a cut-off point of 6, sensitivity was 72%, specificity was 76.3%, positive predictive value (PPV) was 81%, negative predictive value (NPV) was 63.7%, and diagnostic accuracy was 72.5%, with an area under the curve (AUC) of 0.787, and a Spearman s correlation coefficient of r = 0.65. CONCLUSIONS the NIHCED score predicts the presence of advanced fibrosis in an elevated percentage of patients with a need of liver biopsy.
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Affiliation(s)
- G Bejarano
- Service of Digestive Diseases, Universitat Autonoma de Barcelona, Barcelona, Spain.
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Bejarano G, Vergara M, Gil M, Dalmau B, Puig J, Bella MR, Suárez D, Calvet X. Evaluación de la fibrosis hepática en la hepatitis crónica por virus C mediante la aplicación prospectiva del Sabadell's NIHCED score: Sabadell's Non Invasive, Hepatitis C Related-Cirrhosis Early Detection Score. Rev esp enferm dig 2009. [DOI: 10.4321/s1130-01082009000500004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Vergara M, Gil M, Dalmau B, Ribot R, Navarro C, Martín A, Penafreta M, Puig J, Martín J, Perendreu J, Falcó J, Bella R. [Natural history of hepatocellular carcinoma in a cohort of pacients from a county hospital]. Rev Esp Enferm Dig 2008; 100:682-687. [PMID: 19159171 DOI: 10.4321/s1130-01082008001100003] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND hepatocellular carcinoma (HCC) is a cancer with high incidence and mortality. OBJECTIVE our aim was to describe the natural history of a patient cohort with HCC, and to identify the factors associated with survival. PATIENTS AND METHODS a retrospective and descriptive study of patients diagnosed with HCC between 1995 and 2002. Qualitative variables were expressed as frequencies and percentages. Quantitative variables were expressed as medians and standard deviations. Survival was calculated using the Kaplan-Meier method and log rank. RESULTS a total of 154 patients were analyzed. The men-to-women ratio was 2.9/1. Mean age was 68 +/- 9 years. 82% of patients died during a median follow-up of 28 months. Median survival was 21.5 months (95% CI: 16.98-26.04). Curative treatment was done in 40.3% of diagnosed patients, and 59.7% of patients received palliative treatment. Factors associated with survival were: ascites, number of lesions at diagnosis, and curative treatment. No statistical differences were found for the next factors: age, sex, etiology of cirrhosis, and Child-Pugh stage at diagnosis. CONCLUSIONS factors associated with low survival in patients with HCC were ascites and number of lesions. Curative treatment is associated with a higher survival when compared to palliative treatment.
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Affiliation(s)
- M Vergara
- Unidad de Enfermedades Digestivas, Barcelona, Spain.
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21
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Vergara M, Gallach M, Dalmau B, Gil M, Miquel M, Rudi N, Gavarro A, Cebollero A, Masip M, Real J. [Results of pegylated interferon and ribavirin for the treatment of chronic hepatitis C in clinical practice: a 5-year experience]. Gastroenterol Hepatol 2008; 31:274-9. [PMID: 18448055 DOI: 10.1157/13119878] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Numerous clinical trials have demonstrated the efficacy of treatment with pegylated interferon and ribavirin but little is known about the results obtained in clinical practice. OBJECTIVE To evaluate treatment response and factors influencing the treatment of chronic hepatitis C in clinical practice. MATERIAL AND METHODS Between August 2001 and December 2005, we treated 219 patients with pegylated interferon (alpha 2a -fixed dose, or alpha 2b, according to weight) and ribavirin. Patients with genotype 1 or 4 received treatment with pegylated interferon alpha 2a (180 microg/week) and ribavirin (1000 mg/day if body weight was <75 kg or 1200 mg/day if body weight was >75 kg) or interferon alpha 2b (1.5 microg/kg/week) and ribavirin (10.6 mg/kg/day) for 48 weeks. Patients with genotype 2 or 3 were treated for 24 weeks with the same regimen of pegylated interferon alpha-2a or alpha-2b, but with 800 mg of ribavirin divided in two daily doses. Sustained viral response was defined as absence of HCV-RNA 6 months after the end of treatment. RESULTS A total of 219 patients were included (69% men; mean age 44+/-10). As epidemiological antecedents, 22.4% of the treated patients had previously consumed drugs parenterally and 22.4% had received blood transfusions before 1992. Forty-seven percent of the patients with liver biopsy had fibrosis bridges or established liver cirrhosis. The genotype was distributed as follows: 69.8% genotype 1, 4.1% genotype 2, 17.8% genotype 3, and 8.2% genotype 4. Of the 219 patients, 76 (35%) were treated with pegylated interferon alpha 2a and 143 (65%) with interferon alpha 2b. Analysis of response by genotype revealed that sustained viral response was obtained in 46% genotype 1, 88.9% genotype 2, 78.9% genotype 3, and 33.3% genotype 4. Univariate analysis showed that the only variable influencing sustained viral response was genotype. CONCLUSION Treatment with pegylated interferon and ribavirin in clinical practice shows a similar pattern of sustained viral response to that obtained in clinical research. The main variable correlated with sustained viral response continues to be viral genotype.
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Affiliation(s)
- Mercedes Vergara
- Unidad de Enfermedades Digestivas, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España.
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22
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Pla X, Vergara M, Gil M, Dalmau B, Cisteró B, Bella RM, Real J. Incidence, prevalence and clinical course of primary biliary cirrhosis in a Spanish community. Eur J Gastroenterol Hepatol 2007; 19:859-64. [PMID: 17873609 DOI: 10.1097/meg.0b013e328277594a] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [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: 12/22/2022]
Abstract
BACKGROUND AND AIMS Primary biliary cirrhosis (PBC) is characterized by the autoimmune inflammatory response of small intrahepatic bile ducts. Prevalence in Spain is estimated as 61.9 cases per million inhabitants, whereas Northern Europe rates over 200 cases/million. Our objective was to determine the incidence and prevalence of PBC in our health area. MATERIAL AND METHODS PBC was defined by the presence of abnormal liver tests (dissociated cholestasis) with positive antimitochondrial antibodies and/or compatible liver histology. Medical records from patients diagnosed between 1990 and 2002 were reviewed retrospectively. The following data were collected: diagnostic data, demographic and analytic data, liver histology and stage and treatment and disease outcome. RESULTS In a population of 389 758 inhabitants, 87 patients were diagnosed with PBC. Mean age at diagnosis was 63.9+/-12.6 years. Eighty-four (96.6%) were women. Mean annual incidence was 17.2 per 10 inhabitants and the prevalence at the end of study was 195 per 10. Biopsy was performed in 71 (81.6%) patients, 61 of whom (86%) did not have fibrosis. Time of follow-up was 63.6+/-43.2 (2.28-153.9) months. CONCLUSION Incidence and prevalence in our reference area are higher than in some Spanish areas, as per the results previously published; however, they are comparable with those obtained in Northern Europe and the US.
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Affiliation(s)
- Xavier Pla
- Servei de Digestiu (Unitat d'Hepatologia), Corporació Parc Tauli, Parc Tauli s/n, 08208 Sabadell, Spain
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Diago M, Olveira A, Solá R, Romero-Gómez M, Moreno-Otero R, Pérez R, Salmerón J, Enríquez J, Planas R, Gavilán JC, Del Olmo J, Uribarrena R, Sillero C, Benítez A, Sánchez-Galdón S, Dalmau B, Eraña L, Montoro M, Portu J, Garijo JM, Barniol R, Domínguez A, Rota R, Olcoz JL, Antón M, Pamplona X, Casanovas T, Jiménez E, Huarte M, Díaz F, Sánchez-Ruano J, Orive M, Muñoz-Sánchez M, Roset M. Treatment of chronic he1patitis C genotype 1 with peginterferon-alpha2a (40 kDa) plus ribavirin under routine clinical practice in Spain: early prediction of sustained virological response rate. Aliment Pharmacol Ther 2007. [PMID: 17402993 DOI: 10.1111/j.1365-2036.2007.03270] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Sustained virological response rates of up to 52% have been obtained with peginterferon alpha2a (40 kDa) plus ribavirin in patients suffering from chronic hepatitis C genotype 1 in randomized-controlled trials. AIM To assess early virological response and its clinical utility in predicting an sustained virological response in patients suffering from chronic hepatitis C genotype 1 in routine clinical practice in Spain. METHODS Treatment-naïve patients received pegylated interferon alpha2a (40 kDa) 180 microg/week plus ribavirin 1000/1200 mg/day for 48 weeks, and were followed for a further 24 weeks. Overall, 475 patients received at least one dose of medication and were included in the efficacy population. RESULTS The overall sustained virological response rate was 48%. Of those with week 12 virological data, 83% had an early virological response. The negative predictive value of an early virological response was 93%. CONCLUSION If sustained virological response is the goal, a treatment-decision based on a 12-week evaluation during routine clinical practice is feasible.
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Affiliation(s)
- M Diago
- Hospital General de Valencia, Valencia, Spain.
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24
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Diago M, Olveira A, Solá R, Romero-Gómez M, Moreno-Otero R, Pérez R, Salmerón J, Enríquez J, Planas R, Gavilán JC, Del Olmo J, Uribarrena R, Sillero C, Benítez A, Sánchez-Galdón S, Dalmau B, Eraña L, Montoro M, Portu J, Garijo JM, Barniol R, Domínguez A, Rota R, Olcoz JL, Antón M, Pamplona X, Casanovas T, Jiménez E, Huarte M, Díaz F, Sánchez-Ruano J, Orive M, Muñoz-Sánchez M, Roset M. Treatment of chronic he1patitis C genotype 1 with peginterferon-alpha2a (40 kDa) plus ribavirin under routine clinical practice in Spain: early prediction of sustained virological response rate. Aliment Pharmacol Ther 2007; 25:899-906. [PMID: 17402993 DOI: 10.1111/j.1365-2036.2007.03270.x] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sustained virological response rates of up to 52% have been obtained with peginterferon alpha2a (40 kDa) plus ribavirin in patients suffering from chronic hepatitis C genotype 1 in randomized-controlled trials. AIM To assess early virological response and its clinical utility in predicting an sustained virological response in patients suffering from chronic hepatitis C genotype 1 in routine clinical practice in Spain. METHODS Treatment-naïve patients received pegylated interferon alpha2a (40 kDa) 180 microg/week plus ribavirin 1000/1200 mg/day for 48 weeks, and were followed for a further 24 weeks. Overall, 475 patients received at least one dose of medication and were included in the efficacy population. RESULTS The overall sustained virological response rate was 48%. Of those with week 12 virological data, 83% had an early virological response. The negative predictive value of an early virological response was 93%. CONCLUSION If sustained virological response is the goal, a treatment-decision based on a 12-week evaluation during routine clinical practice is feasible.
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Affiliation(s)
- M Diago
- Hospital General de Valencia, Valencia, Spain.
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Calvet X, Quesada M, Roselló M, Salceda F, Sanfeliu I, Dalmau B, Gil M. Stool antigen for the diagnosis of Helicobacter pylori infection in cirrhosis: comparative usefulness of three different methods. Aliment Pharmacol Ther 2003; 17:727-31. [PMID: 12641523 DOI: 10.1046/j.1365-2036.2003.01466.x] [Citation(s) in RCA: 12] [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: 12/12/2022]
Abstract
BACKGROUND Helicobacter pylori infection may lead to peptic ulcer disease, and causes significant morbidity in patients with cirrhosis. The measurement of H. pylori antigens in human stools has been proposed as a valuable, non-invasive, diagnostic tool. A number of tests have recently been commercialized. However, very few data are available on their reliability in patients with cirrhosis. AIM To evaluate the usefulness of three new tests--HpSA (Meridian Diagnostics Inc., Cincinnati, OH, USA), Simple H. pyl (OPERON S.A., Zaragoza, Spain) and FemtoLab H. pylori (Connex, Martinsried, Germany)--in the diagnosis of H. pylori infection in cirrhotic patients. METHODS H. pylori infection was determined in 79 cirrhotic patients (48 men, 31 women; age range, 29-82 years; mean, 62 +/- 11 years) by concordance of histology and urea breath test. The sensitivity, specificity and positive and negative predictive values of each stool test were calculated. RESULTS According to the reference method, the sensitivities of HpSA, Simple H. pyl and FemtoLab H. pylori immunoassays were 76%, 87% and 78%, respectively, and their specificities were 93%, 62% and 79%, respectively. CONCLUSIONS Faecal tests are non-invasive and easy-to-perform tools for the diagnosis of H. pylori infection. However, their sensitivity and specificity seem to be non-optimal in patients with cirrhosis.
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Affiliation(s)
- X Calvet
- Unitat de Malaties Digestives, Corporació Parc Taulí, Sabadell, Barcelona, Spain.
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Almirall J, Amengual MJ, López T, Andreu X, Oristrell J, Sala M, Luelmo J, Dalmau B. [Type II essential mixed cryoglobulinemia and renal disease. Hepatitis C virus association]. Nefrologia 2003; 22:531-9. [PMID: 12516286] [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] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
UNLABELLED Recently a number of studies have implicated C virus as a major cause of mixed cryoglobulinemia. Several authors described that up to 95% of "essential" mixed cryoglobulinemia could be attributed to this viral infection. Nevertheless, its prevalence and clinical significance are not well known. We review our experience in relation with the clinical, biological and evolutive characteristics of patients diagnosed of type II mixed cryoglobulinemia. METHODS Descriptive and protocolized study of all cases found to have type II mixed cryoglobulinemia over a period of 8 years. Secondary cryoglobulinemic nephropathy was defined in a restrictive way: a plasma creatinine > 1.5 mg/dl and/or proteinuria > 500 mg/24 h and/or hematuria (> 15 red blood cells) need to be present in the absence of any other pathological conditions that could justify these alterations. Furthermore, the information obtained from available kidney biopsies was considered. RESULTS 62 patients have been detected. C virus infection was demonstrated in 44 (72%). 52% had clinical symptoms related with cryoglobulinemia. 56% had alteration of renal tests, and 17 (27%) fulfil the conditions for the diagnosis of cryoglobulinemic nephropathy (nearly all with persistent microhematuria, median proteinuria 4.2 +/- 3.9 g/24 h; median plasma creatinine 2.8 +/- 1.8 mg/dl). Nine patients had been histologically examined, showing 6 cases a membranoproliferative glomerulonephritis pattern, one with associated extraglomerular vasculitis; two with mesangial proliferative pattern and one with membranous glomerulonephritis. The most striking differences between cryoglobulinemic nephropathy patients and the rest has been: higher amount of cryoglobulins (49 +/- 28 vs 20 +/- 22); more frequent hypocomplementemia, especially C4 (93% vs 59%) and recurrent purpura (75% vs 32%). No differences in the presence of C virus infection could be observed (75% vs 71%). IN CONCLUSION 72% of patients with type II mixed cryoglobulinemia are infected by C virus (so 28% in our serie are "essential"); 52% have symptoms related with the presence of cryoglobulins, half of them with cryoglobulinemic nephropathy.
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Affiliation(s)
- J Almirall
- Servicio de Nefrología, Corporació Parc Taulí Institut Universitari Parc Taulí (UAB) 08208 Sabadell, Barcelona.
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Calvet X, Sanfeliu I, Musulen E, Mas P, Dalmau B, Gil M, Bella MR, Campo R, Brullet E, Valero C, Puig J. Evaluation of Helicobacter pylori diagnostic methods in patients with liver cirrhosis. Aliment Pharmacol Ther 2002; 16:1283-9. [PMID: 12144578 DOI: 10.1046/j.1365-2036.2002.01293.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [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: 12/21/2022]
Abstract
BACKGROUND Helicobacter pylori-associated peptic ulcer is a frequent complication in cirrhotic patients and its morbidity rate is high. In spite of this, diagnostic methods for H. pylori infection have not been fully evaluated in these patients. AIM To evaluate H. pylori diagnostic methods in patients with liver cirrhosis. METHODS One hundred and one cirrhotic patients were included in the study. Three antral and two corpus biopsies were obtained for rapid urease test of the antral mucosa, and Giemsa stain and immunohistochemistry were performed for both the corpus and antrum. Serology, 13C-urea breath test and faecal H. pylori antigen determination were also carried out. RESULTS Sixty-two patients were positive and 35 were negative for H. pylori infection; four were indeterminate. The sensitivity and specificity were 90.4% and 100%, respectively, for antral histology, 100% and 100% for gastric body histology, 90.4% and 100% for antral immunohistochemistry, 96.2% and 96.7% for body immunochemistry, 85.7% and 97% for rapid urease test, 83.6% and 55.9% for serology, 96.4% and 97.1% for 13C-urea breath test and 75.4% and 94.1% for faecal antigen. CONCLUSION The most reliable tests for H. pylori infection in cirrhotic patients were the 13C-urea breath test and gastric body histology.
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Affiliation(s)
- X Calvet
- Digestive Diseases Unit, Corporació Parc Taulí, Sabadell, Barcelona, Spain.
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Planas R, Quer JC, Enríquez J, Barrera JM, Dalmau B, Casanovas T, Viver JM, Torres M, Boadas J, Solà R, Durández R, Richart C, Bruguera M. [Induction therapy with interferon alfa-2a in compensated hepatitis C virus-related cirrhosis. Randomized, multicenter study]. Med Clin (Barc) 2002; 118:641-4. [PMID: 12028899 DOI: 10.1016/s0025-7753(02)72483-4] [Citation(s) in RCA: 7] [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: 11/18/2022]
Abstract
BACKGROUND Although standard dose interferon (IFN) is successful in only 5% of patients with compensated hepatitis C virus (HCV)-related cirrhosis, it has been suggested that this therapy might decrease the risk of complications or the incidence of hepatocellular carcinoma. Based on HCV kinetics, daily IFN may improve response rates. PATIENTS AND METHOD Forty cirrhotic patients were randomised to receive (Group I: 19) or not (Group II: 21) treatment with IFN (4.5 MU/daily for 24 weeks, followed by 4.5 MU/48 hours for a further 24 weeks period, only if ALT was within normal values). RESULTS Dose reduction and discontinuation for adverse events was required in 11 (58%) and 6 (31.5%) cases, respectively. End-of-treatment response was not observed in any of the 21 controls but in 4 of the 19 (21%) treated patients (p = 0.04); a sustained response was achieved in only 2 treated patients (10.5%). The 3-year probability of developing any of the following: ascites, hepatocellular carcinoma, transplantation or death was lower in Group I than in Group II (6% vs 27%; p = 0.05). CONCLUSION Although induction IFN therapy is associated with common side effects and poor sustained response in compensated HCV-related cirrhosis, it might improve the outcome of patients at the medium-term.
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Affiliation(s)
- Ramon Planas
- Hospital Universitari Germans Trias i Pujol. Badalona. BArcelona. Spain.
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Sobrino JF, Campo R, Brullet E, Montserrat A, Vergara M, Gil M, Dalmau B, Calvet X. [Paracetamol-codeine induced hepatic colic]. Gastroenterol Hepatol 2001; 24:365-6. [PMID: 11481075 DOI: 10.1016/s0210-5705(01)70196-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Calvet X, Navarro M, Gil M, Lafont A, Sanfeliu I, Brullet E, Campo R, Dalmau B, Rivero E, Mas P. Epidemiology of peptic ulcer disease in cirrhotic patients: role of Helicobacter pylori infection. Am J Gastroenterol 1998; 93:2501-7. [PMID: 9860415 DOI: 10.1111/j.1572-0241.1998.00711.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [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: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the clinical and epidemiological factors associated with the appearance of peptic ulcer in patients with cirrhosis and, in particular, the role of Helicobacter pylori infection. METHODS A total of 201 of 220 consecutive patients included in a prospective study that aimed to evaluate the effect of dietary intervention on cirrhotic complications and survival underwent upper gastrointestinal endoscopy. At entry, an epidemiological and clinical questionnaire was completed and the presence of peptic ulcer disease or esophageal varices at endoscopy was prospectively collected. Sera were obtained and stored at -70 degrees C until analyzed, being tested afterward for Helicobacter pylori antibodies using a commercial ELISA kit. RESULTS Eleven of 201 patients had borderline anti-Helicobacter pylori IgG titers and were excluded from further analysis. In the remaining 190 patients, point prevalence of peptic ulcer was 10.5% and lifetime prevalence 24.7%. Multivariate analysis selected male sex (OR 2.3; 95%CI 1.09-4.89) and Helicobacter pylori seropositivity (OR: 1.7, 95%CI 1.02-2.81) as the variables independently related to peptic ulcer disease. CONCLUSIONS Male sex and seropositivity for Helicobacter pylori are the major risk factors for peptic ulcer in cirrhosis.
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Affiliation(s)
- X Calvet
- Department of Internal Medicine, Consorci Hospitalari del Parc Taulí, Sabadell, Barcelona, Spain
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Calvet X, Navarro M, Gil M, Mas P, Rivero E, Sanfeliu I, Brullet E, Campo R, Dalmau B, Lafont A. Seroprevalence and epidemiology of Helicobacter pylori infection in patients with cirrhosis. J Hepatol 1997; 26:1249-54. [PMID: 9210611 DOI: 10.1016/s0168-8278(97)80459-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [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: 02/07/2023]
Abstract
BACKGROUND Helicobacter pylori infection is the major pathogenic factor for peptic ulcer disease. Its epidemiology is not fully known; few data are available in patients with chronic liver disease. AIMS To investigate the seroprevalence and factors associated with Helicobacter pylori infection in a series of liver cirrhosis patients. METHODS Two hundred and twenty consecutive patients were prospectively included in a study aimed to evaluate the effect of dietary intervention on cirrhosis complications and survival. At inclusion, an epidemiological and clinical questionnaire was completed. Sera were obtained and stored at -70 degrees C until analyzed. They were tested for Helicobacter pylori antibodies using a commercial ELISA kit. RESULTS Eleven out of 220 patients had borderline anti-Helicobacter pylori IgG titers. Of the remaining 209 patients, 105 (50.2%) showed positive titers of Helicobacter pylori IgG. Univariate analysis showed that Helicobacter pylori infection was more frequent in older patients, those born outside Catalonia, and in patients with a low educational level. Past ethanol consumption and current smoking correlated negatively with Helicobacter pylori infection. Multivariate analysis selected age (OR 3.1. 95% CI 1.46-6.45), educational level (OR 2.2. 95% CI 1.18-4.2) and alcohol consumption (OR 0.7. 95% CI 0.45-0.99) as the variables independently related to Helicobacter pylori infection. CONCLUSIONS Helicobacter pylori infection in cirrhosis has the same epidemiological pattern as in the general population. Suggestions that the etiology or the severity of the liver disease could be related to Helicobacter pylori infection were not confirmed by our study.
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Affiliation(s)
- X Calvet
- Internal Medicine, Consorci Hospitalari del Parc Taulí, Sabadell, Barcelona, Spain.
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Brullet E, Espinós J, Campo R, Viver JM, Calvet X, Forné M, Dalmau B, Fernández A, Gil M, Canet JJ, Mas YP. [Endoscopic ligation with elastic bands in the prevention of hemorrhage recurrence caused by esophageal varices. Study of 45 patients]. Gastroenterol Hepatol 1996; 19:339-43. [PMID: 8963901] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of the present study was to determine the usefulness of elastic band ligation in the prevention of hemorrhage recurrence by esophageal varices. Forty-five patients without known hepatocarcinoma who had survived a hemorrhagic variceal episode were included in the study. Seventeen patients (38%) were Child-Pugh A, 22 (49%) B, and 6 (13%) C, with the hepatitis C virus and alcohol being the etiology of cirrosis in 55 and 20% of the cases, respectively. The first ligation session was performed between the third and fifth days after the hemorrhagic episode and the posterior sessions were carried out at intervals of 2-4 weeks. The ligation sessions were performed without antibiotic prophylaxis and with placement of an overtube. A mean of 4 +/- 2 bands were placed per session (range, 1-8) and the mean number of sessions required per patient to achieve erradication of the varices was 3.5 +/- 1.5 (range, 2-8). The rate of bleeding recurrence was 17.7% (9 episodes, five by variceal rupture and four by ulcer secondary to ligation). All the episodes of bleeding recurrence occurred between the sessions, with the mortality being 11% (5/45 patients). In the 40 remaining patients the varices were erradicated although 19 (47.5%) required one or two additional sessions of sclerotherapy. The accumulated percentage of patients free of bleeding recurrence was 82% during a mean follow-up of 10.2 +/- 6.7 months. Ten lesions of dislaceration of the esophageal mucosa caused by placement of the were observed overtube. In conclusion, endoscopic elastic band ligation is a useful technique for the erradication of esophageal varices an in the prevention of bleeding recurrence.
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Affiliation(s)
- E Brullet
- Servicio de Endoscopia Digestiva, Consorci Hospitalari Parc Tauli, Sabadell, Barcelona
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Campo R, Brullet E, Montserrat A, Calvet X, Dalmau B, Gil M, Güell J, Mas P. [Prognostic factors of early mortality in the 1st episode of hemorrhage caused by esophageal varices]. Rev Esp Enferm Dig 1996; 88:395-9. [PMID: 8755319] [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] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM To assess the prognostic factors of early mortality in cirrhotic patients with the first variceal bleeding episode. PATIENTS AND METHODS Fifty-five cirrhotic patients with endoscopic evidence of variceal bleeding treated with sclerotherapy during emergent endoscopy were included. RESULTS Permanent hemostasis was obtained in 36 patients (65.5%). Fourteen (25.4%) patients died within six weeks of the bleeding episode. Twenty-four variables obtained at admission and in the following days were compared between patients who survived (n = 41), and died (n = 14). In the univariate analysis the following variables were related to early mortality: prothrombin ratio (p = 0.04), the presence of ascites (p = 0.004) and encephalopathy (p = 0.06), albumin (p = 0.01), Child-Pugh score (p = 0.0003), hemostasis during endoscopy (p = 0.002), absence of rebleeding at 24 hours (p = 0.01) and early rebleeding (within five days after the bleeding episode) (p = 0.006). Multiple logistic regression identified the Child-Pugh score (OR 11.86, CI 95% 2.54-55.48; p = 0.001) and early rebleeding (OR 6.27, CI 95% 1.29-30.44; p = 0.02) as prognostic independent factors of early mortality. CONCLUSIONS The degree of hepatic failure and early rebleeding are prognostic independent factors of early mortality in cirrhotic patients after the first variceal bleeding episode.
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Affiliation(s)
- R Campo
- Unidad de Endoscopia Digestiva (S.D.I), CH Parc Taulí, Sabadell, Barcelona
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Dalmau B, Nogueras A, Mas P, Segura F. Inoculation of blood culture bottles with ascitic fluid: improved detection of spontaneous bacterial peritonitis. Arch Intern Med 1987; 147:1849, 1852. [PMID: 3310944 DOI: 10.1001/archinte.147.10.1849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Marco M, Dalmau J, Aguilar M, Diestre G, Dalmau B, Segura F, Ripoll E. [Cerebral vascular pathology in the area of Sabadell. 1 year's experience (april 1984-march 1985) at its district hospitals. A prospective study]. Neurologia 1986; 1:194-7. [PMID: 3274216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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