BACKGROUND/AIMS: A long-term study and follow-up of an uniform treatment strategy for esophageal varices was evaluated to plan future strategies more effectively. MATERIAL AND METHODS: Morbidity and mortality in 101 patients with liver cirrhosis followed up for 5 years in a single center after the first detection of oesophageal varices were studied. RESULTS: Definitive hemostasis of the first variceal bleeding episode could not be obtained in 31.5%, despite emergency endoscopic sclerotherapy in combination with vasopressin and/or balloon tamponade. Mortality related to this bleeding was 26% in this cohort of patients. Overall mortality from variceal bleeding during the 5 year period was 38%. Death occurred predominantly in patients with advanced liver disease, since the Child-Pugh score of patients who bled and survived was 8 +/- 2 as compared to 11 +/- 2 (p<0.01) in those who bled and died. If fundic varices were the origin of the hemorrhage, the mortality reached 78% within 6 months. Eighty-five percent of the fatalities were related to the liver disease. Besides variceal bleeding, infection was the predominant trigger leading to liver failure; occurring in 25%. The cause of non-liver related death was malignancy of esophagus, lung and pancreas. Only 13% of the patients with liver failure had undergone an orthotopic liver transplantation. CONCLUSION: Since variceal hemorrhage still carries a high mortality rate, primary prophylaxis for patients at high risk is indicated. The systematic, concomitant use of vasoactive drugs to sclerotherapy and the early performance of TIPS in case of failure of sclerotherapy have to be evaluated. Finally patients with an advanced liver disease and increased risk factors for variceal bleeding should be considered earlier for liver transplantation.

Cohort Studies↗

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Damage to duct epithelium is necessary to develop progressing lesions of chronic pancreatitis in the cat.

BACKGROUND: The pathogenesis of chronic pancreatitis remains unclear. This investigation aimed to evaluate the relative importance of acinar or ductal lesions or of ductal subobstruction in the development of chronic pancreatitis in cats. MATERIALS AND METHODS: Ethanol was injected either interstitially in the parenchyma or in the main pancreatic duct, whereas in other animals the main duct was partially obstructed to 70% of its original diameter or totally obstructed. RESULTS: Total obstruction led to well known chronic obstructive pancreatitis and atrophy. Chronic progressive fibrosing pancreatitis developed only when the ductal epithelium was injured by intraductal injection of ethanol. It differed from the obstructive lesions, as demonstrated by biopsies taken over a one year period. Temporary, acute, or chronic-like lesions developed after intraparenchymal injection or in sub obstruction. Minor lesions were obtained in cats fed alcohol or submitted to ethanol feeding combined with partial duct obstruction. None of the laboratory tests used were very useful to detect mild chronic damage at an early stage but fecal fat and the plasma pancreolauryl test seemed the most sensitive. CONCLUSION: Damage of the ductal epithelium represents the most important pathogenetic factor to induce chronic pancreatitis. Further refinements, and investigations with more pathophysiologic agents are necessary to ultimately lead to a reproducible model resembling the human disease.

Animals↗

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Ascites: medical therapy and paracentesis.

An overview is given of diagnostic determinations to be carried out on ascites fluid, and on the medical therapy as based on our knowledge of the pathophysiology. Paracentesis has become more frequently used. It is slightly more effective than therapy with high doses of diuretics and carries less side effects. Longterm studies are needed to investigate whether albumin can be safely substituted by dextran-70 or haemaccel.

Ascites↗

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Liver transplantation: problems and perspectives.

Orthotopic liver transplantation (OLT) has made remarkable advances. However, results vary according to the etiology and the severity of the liver disease. Shortage of donors is becoming an increasing problem because results are improving, more centers are embarking on transplantation and because the indications become wider. Measures have to be taken to improve the number of good donor livers and the condition of the recipient.

Artificial Organs↗

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Early derivation operation can restore the pancreas histology and function in chronic obstructive pancreatitis in the cat.

BACKGROUND/AIMS: Obstruction of the main pancreatic duct leads to progressive obstructive and atrophying pancreatitis in the cat. The question remains whether "early" derivative procedures can halt the destructive process or not? METHODOLOGY: Twelve cats submitted to total obstruction of the main pancreatic duct developed chronic obstructive pancreatitis as documented by histopathology. After 5 weeks, five animals underwent a caudal pancreaticojejunostomy, the others served as controls. Pancreatic histopathology and ductography was conducted in both groups, as well as tests of endocrine and exocrine functioning. RESULTS: Three of the five cats that underwent a derivation operation died 3-5 weeks following the second operation mainly due to infection, but 2 cats could be followed-up for up to 52 weeks. The histological signs of inflammation and early fibrosis gradually disappeared and the pancreas returned to normal as assessed by histology, radiology and pancreatic function tests. In contrast, cats not submitted to the derivation procedure developed an atrophic chronic pancreatitis. CONCLUSIONS: A desobstructive operation, carried out 5 weeks after total obstruction of the main pancreatic duct in cats, can halt the progression of chronic obstructive pancreatitis and leads to restitution of the pancreas as assessed by histology, radiology and function tests.

Animals↗

PubMedDate not supplied

Is antiviral treatment (IFN alpha and/or ribavirin) justified in cirrhosis related to hepatitis C virus? Société Royale Belge de Gastro-entérologie.

AIM: To assess the benefit risk ratio of interferon and ribavirin in the treatment of patients with post hepatitis C cirrhosis we summarize the spontaneous over mortality of this disease, and made an overview of the randomized trials and of other controlled studies. RESULTS: In comparison to controls, patients with post hepatitis C cirrhosis have a 17 fold increase risk of dying from a liver disease that a control population, and a 6 fold increase from primary liver cancer. In France the hepatitis C epidemic which start in the sixties explains now the observed dramatic increase in mortality by primary liver cancer, both in men and women. Meta-analysis of randomized trials and controlled retrospective studies showed that interferon treatment is associated with a significant increase in ALT response at the end of the treatment, with a decrease in hepatocellular incidence as well as a decrease in mortality in comparison with controls. Very few data are published concerning ribavirin alone or in combination with interferon in patients with cirrhosis. Preliminary data suggest that this combination during 48 weeks permit to obtain in patients with compensated cirrhosis 20% of sustained virological response. The safety was acceptable but patients with low initial blood cells count must be carefully followed. In conclusion this overview clearly demonstrates a benefit-risk ratio in favor of treatment in patients with post hepatitis C cirrhosis by interferon.

Antiviral Agents↗