HEPATOLOGY WATCH®
Timely Information for Practicing Physicians

Highlights from Digestive Disease Week®
May 16-19, 1999

CHRONIC HEPATITIS C VIRUS ( HCV)
Pegylated interferon alfa-2a (PEG). Mitchell Shiffman et al. conducted a phase II trial in 155 chronic HCV patients of PEG, a form of interferon which has a prolonged half-life (> 90 hours) that enables weekly dosing. This study indicates that PEG is more convenient and results in a greater sustained response rate than standard interferon therapy (3 MU TIW). (Shiffman M, et al. Abstract L0418)

Serum iron (Fe) indices. P Chokshi and colleagues studied the relationship of serum Fe indices with liver histology in patients with chronic HCV and found the percent Fe saturation and total iron binding capacity (TIBC) to correlate with the extent of hepatic fibrosis. (Chokshi P, et al. Abstract L0023)

TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS)
Shunt insufficiency. Martin Roessle and coworkers reviewed the clinical courses of 1,000 patients treated with TIPS over a 10 year period and found the need for shunt revision to be relatively low (39.4% of patients required at least one revision), thus resulting in cost effeciencies. (Roessle M, et al. Abstract L0382)

Body composition improvement. In a review of 18 patients with liver cirrhosis, Tatjama Schuetz and associates found TIPS to be associated with improvements in energy, protein, and carbohydrate intake resulting in gains (P<0.05) in muscle mass, weight, and body cell mass. (Scheutz T, et al. Abstract L0414)

PRIMARY BILIARY CIRRHOSIS (PBC) AND PRIMARY SCLEROSING CHOLANGITIS (PSC)
Ursodeoxycholic acid and serum cytokines. P. Angulo and colleagues assessed serum cytokine levels (TNF, IL-6, IL-8, IL-12) in 90 PBC patients prior to and after 2 years of ursodeoxycholic acid (UCDA) therapy. High serum cytokine levels were correlated with advanced PBC, and UCDA therapy was associated with decreased levels of TNF. (Angulo P, et al. Abstract L0259)

Cholestasis-induced osteoporosis. Keith Lindor utilized cyclical etidronate and supplemental calcium to treat 67 patients with osteoporosis associated with PBC. Etidronate was not observed to be effective as bone mass was not preserved after a year of therapy. (Lindor KD, et al. Abstract L0261)

Short-term stenting. Cyriel Ponsioen and coworkers reviewed their experience with short-term stenting in 32 PSC patients and found this procedure to effectively palliate cholestatic symptoms for several years in most patients. (Ponsioen CY, et al. Abstract L0365)

HEMOCHROMATOSIS
Screening for hereditary hemochromatosis (HHC). Hashim El-Serag and colleagues performed a cost analysis comparing serum iron studies with strategies incorporating gene testing to screen relatives of a proband for HHC. They found the least expensive strategies to be those utilizing gene testing of the proband as a first step. (El-Serag HB, et al. Abstract L0118)
July 1999

HEPATOCELLULAR CARCINOMA (HCC)
Percutaneous ethanol injection therapy (PEIT) and transcatheter arterial embolization (TAE). Masatoshi Akamatsu and associates reviewed the results of 569 HCC patients in Japan treated by PEIT (n=413) or by the combination of PEIT and TAE (n=156). After adjusting for prognostic factors, survival was similar between the two groups. (Akamatsu M, et al. Abstract L0007)

Prevalence of hemochromatosis gene mutations. Mark Aldersley and colleagues found 8 (25%) of 32 HCC patients to be heterozygous for the C282Y mutation. (compared to 5% of those in a control cholestatic liver disease group). Heterozygosity for this mutation may have a role in the pathogenesis of HCC. (Aldersley MA, et al. Abstract L0010)

Risk factors. Hashem EL-Serag and Andrew Mason conducted a case-control study utilizing the database of the U.S. Department of Veterans Affairs to investigate HCC risk factors (1,583 cases). Among U.S. veterans, alcoholic liver disease, chronic HCV, and chronic HBV were identified as risk factors in a logistic regression model. (El-Serag HB and Mason A. Abstract L0119)

CHRONIC LIVER DISEASE
Influenza A and hepatic decompensation. Andrea Duchini and coworkers analyzed 45 cirrhotic patients with positive influenza A viral cultures and found influenza A infection to be associated with a transient hepatic decompensation in 3 cases. (Duchini A, et al. Abstract L0111)

Living donor liver transplantation (LDLTx). Dr. Amadeo Marcos and colleagues reviewed a single center's experience using the right hepatic lobe for LDLTx in 10 adults. LDLTx was associated with minimal donor morbidity and excellent graft (100%) and patient (100%) survival. (Marcos A, et al. Abstract L0276)

Somatostatin (SST) administration. Alec Avegennos et al. conducted a pilot study to examine the optional duration of SST administration to control esophageal variceal bleeding. The failure rate was unacceptable when the infusion was halted after 48 hours, confirming pervious data showing that SST should be given for at least 120 hours. (Avegennos A. et al. Abstract L0029)

GENERAL
Impact of gastroenlerologists. E. J. Bini et al. presented data that a team approach to the care of patients with decompensated liver disease utilizing generalists and gastroenterologists decreased the length and cost of hospitalization for these patients. (Bini EJ, et al. Abstract G0203)