Clinical value of acoustic radiation force impulse elastography in the prediction of hepatocellular carcinoma in chronic hepatitis C patients

Abstract Background and purpose of the study Acoustic radiation force impulse elastography (ARFI) represents an innovative non-invasive tool for the evaluation of liver fibrosis, cirrhosis, and early identification of neoplastic nodules during the follow-up of cirrhotic patients; however, its diagnostic accuracy in the prediction of hepatocellular carcinoma (HCC) is still controversial. Purpose of the study To assess the potential role of ARFI elastography as a non-invasive tool for the prediction of HCC development among chronic hepatitis C (CHC) patients with advanced hepatic fibrosis and liver cirrhosis. Methods The present study recruited 440 patients: 349 CHC patients with advanced hepatic fibrosis and cirrhosis and 91 patients with HCC-related hepatitis C virus (HCV). ARFI-imaging of the liver and transient elastography (TE) was carried out in all patients. ARFI imaging indices include the mean shear wave velocity of HCC, peritumoral parenchyma, and hepatic parenchyma in non-HCC patients. The area under the receiver operating characteristic curve (AUROC) and optimal cutoff values were obtained using a receiver operating characteristic curve analysis to assess the diagnostic performance of ARFI elastography in the predication of HCC. Results The mean hepatic shear wave velocities by ARFI elastography of peri-tumoral cirrhotic hepatic parenchyma were significantly higher than in hepatic parenchyma in non-HCC patients (3.09 vs. 2.26 m/s, p <0.001). The AUROC for the identification of HCC was 0.8, 0.76, 0.76, 0.66, 0.72, and 0.7 for hepatic ARFI elastography, TE, fibrosis-4 score (FIB-4), AST to Platelet Ratio Index (APRI), AST/ALT ratio (AAR), and Age platelets index (API), respectively. Moreover, univariate regression analysis revealed that hepatic ARFI has the highest odd ratio in the prediction of HCC. Conclusion ARFI elastography had a superior diagnostic performance in the prediction of HCC compared to TE and non-invasive markers in CHC patients with advanced fibrosis and cirrhosis, thus putting such patients on the top of the HCC screening list

Peginterferon alpha-2a versus peginterferon alpha-2b for chronic hepatitis C

Background A combination of weekly pegylated interferon (peginterferon) alpha and daily ribavirin still represents standard treatment of chronic hepatitis C infection in the majority of patients. However, it is not established which of the two licensed peginterferon products, peginterferon alpha‐2a or peginterferon alpha‐2b, is the most effective and has a better safety profile. Objectives To systematically evaluate the benefits and harms of peginterferon alpha‐2a versus peginterferon alpha‐2b in head‐to‐head randomised clinical trials in patients with chronic hepatitis C. Search methods We searched the Cochrane Hepato‐Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and LILACS until October 2013. We also searched conference abstracts, journals, and grey literature. Selection criteria We included randomised clinical trials comparing peginterferon alpha‐2a versus peginterferon alpha‐2b given with or without co‐intervention(s) (for example, ribavirin) for chronic hepatitis C. Quasi‐randomised studies and observational studies as identified by the searches were also considered for assessment of harms. Our primary outcomes were all‐cause mortality, liver‐related morbidity, serious adverse events, adverse events leading to treatment discontinuation, other adverse events, and quality of life. The secondary outcome was sustained virological response in the blood serum. Data collection and analysis Two authors independently used a standardised data collection form. We meta‐analysed data with both the fixed‐effect and the random‐effects models. For each outcome we calculated the relative risk (RR) with 95% confidence interval (CI) based on intention‐to‐treat analysis. We used domains of the trials to assess the risk of systematic errors (bias) and trial sequential analyses to assess the risks of random errors (play of chance). Intervention effects on the outcomes were assessed according to GRADE. Main results We included 17 randomised clinical trials which compared peginterferon alpha‐2a plus ribavirin versus peginterferon alpha‐2b plus ribavirin in 5847 patients. All trials had a high risk of bias. Very few trials reported data on very few patients for the patient‐relevant outcomes all‐cause mortality, liver‐related morbidity, serious adverse events, and quality of life. Accordingly, we were unable to conduct meta‐analyses on all‐cause mortality, liver‐related morbidity, and quality of life. Twelve trials reported on adverse events leading to discontinuation of treatment without clear evidence of a difference between the two peginterferons (197/2171 (9.1%) versus 311/3169 (9.9%); RR 0.84, 95% CI 0.57 to 1.22; I2 = 44%; low quality evidence). A trial sequential analysis showed that we could exclude a relative risk reduction of 20% or more on this outcome. Peginterferon alpha‐2a significantly increased the number of patients who achieved a sustained virological response in the blood serum compared with peginterferon alpha‐2b (1069/2099 (51%) versus 1327/3075 (43%); RR 1.12, 95% CI 1.06 to 1.18; I2= 0%, 12 trials; moderate quality evidence). Trial sequential analyses supported this result. Subgroup analyses based on risk of bias, viral genotype, and treatment history yielded similar results. Trial sequential analyses supported the results in patients with genotypes 1 and 4, but not in patients with genotypes 2 and 3

A study on eosinophilic and Lymphocytic esophagitis in patients with typical gastroesophageal reflux disease symptoms

Background: Eosinophilic esophagitis (EoE) has emerged as an important gastrointestinal (GI) disorder during the last 15 years, affecting approximately 15% of patients with dysphagia EoE presents a diagnostic challenge because eosinophils are also a feature of acid-induced esophagitis.The aim of this study was to evaluate prospectively the presence of eosinophilic and lymphocytic esophagitis in patients with typical gastroesophageal reflux disease symptoms. Patients and Methods: This was a prospective study which was conducted on 200 patients, to estimate the prevalence of eosinophilic and lymphocytic esophagitis in patients with typical gastroesophageal reflux disease symptoms.Results: Regarding serum IgE as laboratory investigation, all the cases 6 (100%) diagnosed to have EoE showed elevated level of serum IgE level ((normal range was used according to the laboratory was: 0 – 165 IU/ml). There was statistical significance for the presence of elevated serum IgE level and peripheral serum eosinophilia between positive and negative cases for EoE Conclusion: Eosinophilic esophagitis is not uncommon disease and presented in 6 cases out of 200 patients having typical symptoms of GERD. All the positive EoE cases having history of allergy and most of them are asthmatic