See also: Endocytoscopy can be used to assess histological healing in ulcerative colitisEndoscopy 2017; 49(06): 560-563DOI: 10.1055/s-0043-106556 See also: Reply to Gheorghe et al.Endoscopy 2017; 49(12): 1286-1286DOI: 10.1055/s-0043-120443
Background: Long-term morbidity and mortality following liver transplantation (LT) is influenced by HCV-related extrahepatic complications and effects of immunosuppressive therapy.Aim: To investigate if sustained virological response (SVR) after therapy with direct acting antivirals (DAA) in recipients with post-transplant recurrent hepatitis C can influence metabolic factors and renal function.Methods: Metabolic profile, cardiovascular risk scores, non-invasive evaluation of fibrosis, renal function was assessed in 89 HCV LT recipients at SVR and 24 months after cure.Results: Liver stiffness measurement evaluated by transient elastography, APRI, FIB-4 and NAFLD fibrosis scores decreased significantly between baseline, SVR and 24 months after SVR.In contrast, BARD score increased significantly (p=0.001).Steatosis grade 3 was significantly encountered in a higher percentage at 24 months after SVR compared to baseline (77.5% vs 22.5%, p<0.0001).The metabolic and cardiovascular risk profile (MetS and Framingham scores), respectively, remained stable during the timeline.All liver function tests such as alanine and aspartate aminotransferase, gamma glutamyl transferase, total bilirubin improved between initiation of antivirals, SVR and 24 months after SVR; platelets increased significantly (p<0.0001 for each variable).The renal function evaluated by creatinine serum level (p=0.03) and estimated glomerular filtration rate (p=0.02) was significantly deteriorated over time.Conclusions: Eradication of recurrent HCV infection has a clear benefit for liver-related complications, but has no impact on HCV extrahepatic manifestations.Prospective studies with non-HCV cohorts are required to compare the impact of immunosuppression on metabolic and renal complications.
Hepatitis C Virus (HCV) infection is a common condition with endemic prevalence in some areas of the world. In Romania the mean prevalence is about 3%. New treatments became available on the market in recent years and new drugs are in the pipeline. A re-evaluation of HCV therapy was considered mandatory. The Romanian Society of Gastroenterology and Hepatology undertook this task for the practitioners of this country.A group of recognized experts was created who screened the available literature and the major available guidelines. A list of items requiring attention has been created. These items were discussed and rated. Decisions were taken by consensus.We present here the first of the two parts of our Society's recommendations for chronic HCV infection treatment. An agreement was reached regarding the diagnostic tools, the assessment of severity and the up-dated therapy schedules.This Position Paper represents a guide for the assessment and the therapy of HCV infection. The recommendations are in concordance with other guidelines but are applied to the real-life conditions in this country.
The assessment of tissue healing has emerged as an important treatment goal in patients with inflammatory bowel disease. In patients with ulcerative colitis (UC), mucosal healing may represent the ultimate therapeutic goal due to the fact that the inflammation is limited to the mucosal layer. Mucosal and histological healing may indicate a subset of UC patients in long-term clinical, endoscopic and histological remission in whom immunomodulators, biologics, and even aminosalicylates may be withdrawn. Confocal laser endomicroscopy allows the assessment of residual cellular inflammation, crypt and vessel architecture distortion during ongoing endoscopy, and therefore permits a real-time evaluation of histological healing in patients with ulcerative proctitis. Images of conventional optical microscopy and confocal laser endomicroscopy in patients with ulcerative proctitis in remission are presented.
Background and Objectives: Inflammatory bowel diseases (IBD) are chronic conditions with an unpredictable course and a remitting–relapsing evolution. Fatigue is a frequent complaint in patients with IBD, affecting approximately half of the newly diagnosed patients with IBD. The aim of this study was to analyze fatigue in patients with IBD in remission. Materials and Methods: One hundred nineteen consecutive outpatients diagnosed with IBD for over 3 months that were in corticosteroid-free clinical and biochemical remission at the time of assessment were included in this cross-sectional study. Out of them, 72 (60.5%) were male; the median age was 39 years (IQR 30–47). Seventy-seven patients (64.7%) were diagnosed with Crohn’s disease and forty-two (35.3%) with ulcerative colitis, with a median disease duration of 6 years (IQR 2–10). Fatigue, health-related quality of life (HR-QoL), anxiety and depression were evaluated using the following self-administered questionnaires: FACIT Fatigue, IBDQ 32 and HADS. Results: The mean FACIT-Fatigue score was 41.6 (SD ± 8.62), and 38.7% of patients were revealed as experiencing fatigue when a cut-off value of 40 points was used. The mean IBDQ 32 score was 189.4 (SD ± 24.1). Symptoms of anxiety and depression were detected in 37% and 21% of the patients, respectively. In the multivariate analysis, fatigue was significantly associated with lower HR-QoL (OR 2.21, 95% CI: 1.42–3.44, p < 0.001), symptoms of anxiety (OR 5.04, 95% CI: 1.20–21.22, p = 0.008), female sex (OR 3.32, 95% CI: 1.02–10.76, p = 0.04) and longer disease duration (OR 1.13, 95% CI: 1.01–1.27, p = 0.04). Conclusions: Fatigue is highly prevalent even in patients with inactive IBD and is correlated with lower HR-QoL and anxiety, as well as with clinical factors such as longer disease duration and female sex.
, (p=0.007,Log Rank test).Analiza multivariată a identificat un factor de risc: existenţa metastazelor hepatice sincrone la momentul diagnosticului tumorii primare.Considerăm că rezecţia hepatică precedată de terapia cu inhibitori ai Tirozin Kinazei este strategia terapeutică actuală ce aduce şansele adecvate spre o posibilă vindecăre şi prelungirea supravieţuirii, la pacienţii selectaţi corespunzător, evaluaţi în cadrul unei comisii oncologice multidisciplinare.
