HEPATOLOGY WATCH®
OCTOBER 2002
HEPATITIS C VIRUS
(HCV) INFECTION
Psychiatric disorders. Hashem El-Serag et al. performed a
case-control study using databases from the Department of Veteran Affairs to
identify HCV-infected veterans hospitalized from 1992 to 1999. They identified
22,341 HCV-infected patients who were Vietnam War veterans and 43,267 patients
from the Vietnam War without HCV infection. A greater percentage of
HCV-infected veterans had depressive disorders, posttraumatic stress disorder,
psychosis, bipolar disorder, anxiety disorders, alcohol-related disorders, and
drug-use disorders compared to patients without HCV infection. Multivariate
regression analysis identified drug and alcohol use, depression, posttraumatic
stress disorder, and anxiety disorder to be associated with HCV infection.
These data show that HCV-infected veterans frequently have psychiatric
disorders. (El-Serag HB, et al. Gastroenterology
2002;123:476-482)
Prolongation of life
expectancy by interferon (IFN) therapy. Haruhiko Yoshida and coworkers conducted a retrospective
cohort study of 2,889 patients with chronic HCV identified from 8 hospitals in
Regression of splenic
lymphoma with interferon therapy. Olivier Hermine et al. report the results of IFN alfa-2b
(3 MIU tiw) treatment of 9 patients with HCV infection who had splenic lymphoma
with villous lymphocytes (a chronic B-cell lymphoproliferative disorder
characterized by a clonal expansion of B cells with villous projections and splenomegaly).
Seven of the 9 patients achieved a complete remission after loss of detectable
HCV RNA. One patient had a relapse of lymphoma after HCV RNA had become
detectable again in blood. These results support findings of epidemiologic
studies that have suggested a relationship between HCV infection and the
development of some B-cell non-Hodgkin's lymphomas. (Hermine O, at al. N Eng J Med 2002;347:89-94)
CHOLESTATIC LIVER
DISEASE
Ursodeoxycholic acid
(UDCA) therapy: A review. UDCA is a hydrophilic bile acid that is increasingly used for the
treatment of cholestatic disorders other than primary biliary cirrhosis (PBC).
Recently Gustav Paumgartner and Ulrich Beuers from the
Hyperlipidemia and
cardiovascular disease. M. Longo et al. determined serum lipid levels serially (mean of 6.2
yr; range, 4 mo to 24 yr) in 400 patients with PBC. Seventy-six percent of
patients had elevated serum cholesterol levels at diagnosis. Patients with
hyperbilirubinemia had higher serum cholesterol concentrations and lower serum
high density lipoprotein (HDL) levels (p<0.001). However, the incidence of
cardiovascular events was similar to that of the general population and serum
cholesterol and HDL levels were both found to decrease with disease
progression. These data show that despite findings of marked
hypercholesterolemia, patients with PBC do not have an increased risk for
cardiovascular events. (Longo M, et al. Gut
2002; 51:265-269)
COMPLICATIONS OF
CIRRHOSIS
Type I hepatorenal
syndrome (HRS).
Christophe Duvoux and colleagues treated 12 consecutive patients with type I
HRS with intravenous (IV) noradrenalin (0.5-3 mg/hr for 10 ± 3 d), albumin, and
furosemide. Reversal of HRS was observed in 10 patients (83%) and was
associated with a decrease in the serum creatinine level from 358 ± 161 to 145
± 78 umol/L and an increase in urinary sodium excretion from 8 ± 14 to 52 ± 72
mEq/d. In addition, noradrenalin therapy increased mean arterial pressure (65 ±
7 to 73 ± 9 mmHg) and reduced active renin and aldosterone plasma
concentrations. Noradrenalin was tolerated well with one episode of reversible
myocardial hypokinesis. These findings warrant further study. (Duvoux C, et al.
Hepatology 2002;36:374-380)
Variceal hemorrhage. Hock Lui et al. conducted a study
in which 172 patients with cirrhosis and grade II or III esophageal varices
that had never bled were randomized to prophylactic treatment with variceal
band ligation (VBL), propranolol (PPL), or isosorbide-5-mononitrate (ISMN).
Variceal bleeding occurred in 7%, 14%, and 23% of patients in the VBL, PPL, and
ISMN groups, respectively. There was a significant difference in the actuarial
risk for bleeding at 2 years between the VBL and ISMN treatment groups, but not
between the VBL and PPL groups. There were no differences in mortality rates. A
greater percentage of patients who underwent drug treatment reported adverse
events (45% of PPL and 42% of ISMN patients vs. 2% of VBL patients). VBL was
safe and well tolerated and was superior to ISMN to prevent variceal bleeding.
(Lui H, et al. Gastroenterology 2002;123:735-744)
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