Biliary Disease

Magnetic resonance cholangiography (MRC). MRC is a new application of MR imaging that can provide noninvasive yet complete visualization of the biliary tree. Paul Angulo and colleagues conducted a study in which MRC and invasive cholangiography (ERCP or PTC) were performed in 73 patients with cholestasis, found to have benign (n=42) or malignant (n=9) biliary disease or a normal biliary tree (n=22). MRC had an overall diagnostic accuracy of 90% compared to 97% for invasive cholangiography. While invasive cholangiography remains important and allows performance of therapeutic interventions, MRC is a safe procedure that has excellent diagnostic accuracy. (Angulo P, et al. J Hepatol 2000;33:520-527)

Spontaneous Bacterial Peritonitis (SBP)

Oral ciprofloxacin. Ruben Terg et al. randomized 80 hospitalized cirrhotic patients with uncomplicated SBP to receive intravenous ciprofloxacin 200 mg every 12 hours for 7 days (n=40) or intravenous ciprofloxacin 200 mg every 12 hours for 2 days followed by oral ciprofloxacin 500 mg every 12 hours for 5 days (n=40). The infection resolution rate was similar for both groups (76.3% vs. 78.4%), and hospital survival was also equivalent in both treatment groups (77.5%). These results show that oral ciprofloxacin for 5 days, following a short 2-day course of intravenous ciprofloxacin, is an effective therapy for SBP. (Terg R, et al. J Hepatol 2000;33:564-569)

Chronic Hepatitis

Mechanisms of interferon (IFN) resistance. Zhigang Tian and colleagues utilized preclinical hepatic cell models to investigate the effect of IL-1b, a proinflammatory cytokine, on the IFN-ab signal pathway. Pretreatment of human hepatocellular carcinoma HepG2 cells with IL-1b suppressed IFN-ab-induced antiviral activity and antiviral MxA mRNA expression. In addition, they found that the in vivo administration of IL-1b attenuated IFN-ab-induced STAT1 tyrosine phosphorylation in the liver. IL-1b did not affect the level of STAT1 protein and the inhibitory action of IL-1b was not affected by depleting Kuppfer cells. Thus, IL-1b may directly target signaling in hepatocytes. Pretreatment with proteasome inhibitors reversed these effects of IL-1b. These findings suggest that actions of proinflammatory cytokines such as IL-1b may cause resistance to IFN therapy in chronic hepatitis and are potential targets for improving the efficacy of IFN therapy. (Tian Z, et al. J Immunol 2000;165:3959-3965)

Chronic Hepatitis B Virus (HBV) INFECTION

Screening for hepatocellular carcinoma (HCC). Brian McMahon and associates conducted a prospective cohort study from October 1982 to December 1998 in which 1,487 hepatitis B surface antigen (HBsAg)-positive Alaskan natives were screened for HCC with serial alpha-fetoprotein determinations every 6 months. HCC was diagnosed in 32 patients, and 22 of these patients were treated with surgical resection. Survival after diagnosis for these HCC patients identified by screening was longer (p<.001) than that for 12 historical control Alaskan native patients with HBV-related HCC diagnosed from 1969 to October 1982. None of the historical control patients survived beyond 2 years after diagnosis, while the 5- and 10-year survival rates for the patients with HCC identified through the screening program were 42% and 30%, respectively. These results show that population-based screening has an important impact on survival for HBsAg-positive carriers who develop HCC. (McMahon B, et al. Hepatology 2000;32:842-846)

Relapse after lamivudine therapy. Prolonged therapy with lamivudine is limited by the development of viral resistance. Daryl Lau et al. studied 27 patients with chronic HBV infection who were treated with lamivudine for 2-4 years and found that viral resistance began to emerge after 8 months of therapy. Viral resistance developed in 14 patients, including 76% of HBeAg-positive patients and only 10% of HBeAg-negative patients. In a second study, Byung-Cheol Song et al. showed that lamivudine-induced HBeAg seroconversion was not durable (49% relapse rate at 2 years) in a population of Korean patients with chronic HBV infection. A high relapse rate, especially among HBeAg-positive patients, limits the effectiveness of lamivudine therapy. (Lau DT-Y, et al. Hepatology 2000;32:828-834 and Song B-C, et al. Hepatology 2000;32:803-806)

Nonalcoholic Steatohepatitis (NASH)

Case-control study. Asma Poonawala and colleagues studied 49 patients with cryptogenic cirrhosis (CC) identified from the Johns Hopkins Hospital liver transplantation registry. They compared the prevalence of obesity and diabetes in this cohort of patients with CC to age- and sex-matched controls (n=98) with a broad spectrum of known chronic liver diseases (except NASH). The prevalences of obesity (55% vs. 24%) and type II diabetes (47% vs. 22%) were greater in the CC patients, and 23% of patients with CC compared to 5% of controls had both obesity and diabetes (p=.002). These findings indicate that NASH may be an etiologic factor in some patients with CC. (Poonawala A, et al. Hepatology 2000;32:689-692)

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