Intensive enteral nutrition is ineffective for individuals with severe alcoholic hepatitis treated with corticosteroids.

peer reviewedBACKGROUND & AIMS: Severe alcoholic hepatitis (AH) is a lifethreatening disease for which adequate oral nutritional support is recommended. We performed a randomized controlled trial to determine whether the combination of corticosteroid and intensive enteral nutrition therapy is more effective than corticosteroid therapy alone in patients with severe AH. METHODS: We enrolled 136 heavy consumers of alcohol (age, 18–75 y) with recent onset of jaundice and biopsy-proven severe AH in our study, performed at 18 hospitals in Belgium and 2 in France, from February 2010 through February 2013. Subjects were assigned randomly (1:1) to groups that received either intensive enteral nutrition plus methylprednisolone or conventional nutrition plus methylprednisolone (controls). In the intensive enteral nutrition group, enteral nutrition was given via feeding tube for 14 days. The primary end point was patient survival for 6 months. RESULTS: In an intention-to-treat analysis, we found no significant difference between groups in 6-month cumulative mortality: 44.4% of patients died in the intensive enteral nutrition group (95% confidence interval [CI], 32.2%–55.9%) and 52.1% of controls died (95% CI, 39.4%– 63.4%) (P ¼ .406). The enteral feeding tube was withdrawn prematurely from 48.5% of patients, and serious adverse events considered to be related to enteral nutrition occurred in 5 patients. Regardless of group, a greater proportion of patients with a daily calorie intake less than 21.5 kcal/kg/day died (65.8%; 95% CI, 48.8–78.4) than patients with a higher intake of calories (33.1%; 95% CI, 23.1%–43.4%) (P < .001). CONCLUSIONS: In a randomized trial of patients with severe AH treated with corticosteroids, we found that intensive enteral nutrition was difficult to implement and did not increase survival. However, low daily energy intake was associated with greater mortality, so adequate nutritional intake should be a main goal for treatment

Relapse rates and clinical outcomes after nucleos(t)ide analogue therapy stop in a Belgian, predominantly caucasian cohort of chronic hepatitis B patients

status: publishe

Cessation of nucleos(t)ide analogue therapy after HBEAG seroconversion is associated with a decreased chance of HBSAG loss in a Belgian, predominantly caucasion cohort of chronic hepatitis B patients

status: publishe

Rapid, persistent hepatitis B viral DNA suppression predicts nucleos(t)ide, analogue induced HBeAG seroconversion in a belgian, predominantly caucasian cohort of chronic hepatitis B patients

status: publishe

Sofosbuvir in combination with simeprevir +/- ribavirin in genotype 4 hepatitis C patients with advanced fibrosis or cirrhosis: a real-life experience from Belgium

Background: All-oral, interferon-free regimens that combine direct-acting antiviral drugs have significantly advanced the treatment of hepatitis C (HCV), especially for genotype 1(G1) patients. However, efficacy and safety data of interferon-free regimens in HCV genotype 4 (G4) patients are scarce. In Belgium, Sofosbuvir (SOF) and Simeprevir (SMV) treatment is available since January 2015 for G4 patients with advanced fibrosis (F3-F4 METAVIR) for 12 weeks. Methods: analysis of HCV G4 patients receiving SOF and SMV treatment in Belgium. The aim of the study was to evaluate the safety and efficacy of the treatment. Results: 73 G4 patients were enrolled in this data collection including 32 (43.8%) patients with severe fibrosis F3 and 41(56.2%) cirrhotic patients. The study population comprised 58.9% male, 77.8% treatment experienced patients. Median age was 59 [51-66] years and 5 patients were HCV/HIV co-infected. 24 patients received the treatment associated with ribavirin, 11/32 (34.37%) of patients with advanced fibrosis and 13/41 (31.71%) of cirrhotic patients. In cirrhotic patients, median MELD and Child-Pugh score were 9 [7-12.5] and 5 [5-6], 46.2% had platelet below 100.000/mm and 28.6% had albumin below 35 g/L. W4 HCV RNA was undetectable in 31.25% (15/48). 9 of the 15 patients with undetectable W4 HCV RNA received RBV. At W12, 100% (23/23) had HCV RNA below the limit of quantification, with 6/23 still detectable. All SVR12 data will be available at the time of presentation. No patient experienced serious adverse event. Conclusions: these preliminary results in difficult-to-treat G4 HCV patients show that SOF/SIM +/- RBV treatment is safe and seems promising, in line with that was observed in G1 HCV patients