16 research outputs found
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 The enteral feeding tube was withdrawn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
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