Gastroenterology and Hepatology

  • Place of therapeutic patient education in chronic hepatitis C treated with direct-acting antivirals

    Objective: Today, with the availability of direct-acting antivirals (DAAs), the value of therapeutic patient education (TPE) in chronic hepatitis C needs to be redefined, as these drugs have made treatment simple. The study presented here in sought to define what role TPE plays today in hepatitis C management along with what factors are associated with such programs being used. Methods: We included 786 patients mono-infected with hepatitis C virus (HCV) who underwent treatment with DAAs. 284 of whom benefited from a TPE program (36.1%). The characteristics of HCV and how it was treated were compared retrospectively between TPE+ and TPE- patients. The TPE program was overseen by a nurse. Results: The following factors were associated with TPE on multivariate analysis: migrant status (OR=3.63, 95%CI: 2.24-5.96, p

  • Digestive manifestations of SARS-COV2 infection in Togo

    Objective: to identify the main digestive manifestations related to SARS-CoV-2 in Togo and to determine their impact on the prognosis of the disease. Patients and method: This was a cross-sectional study with retrospective and prospective collection, with descriptive and analytical aims, conducted from May 1, 2020 to April 30, 2021 at the national center for the management of infectious diseases of Lome. Patients of both sexes and of any age, tested positive for SARS-CoV-2 by PCR on nasopharyngeal and oropharyngeal samples and hospitalized at the national center for infectious disease management of Lome were included in this study. Digestive manifestations were divided into gastrointestinal manifestations and hepatobiliary manifestations. The threshold of significance of the tests was retained for a p value less than or equal to 0.05. Results: out of 876 patients hospitalized during the study period, 215 presented with digestive manifestations, corresponding to a prevalence of 24.54%. the predominance was male, with a male/female sex ratio of 1.74. the mean age was 46.07+/-16.14 [02 months – 82 years]. gastrointestinal manifestations were found in 11.98% of cases. abdominal pain was the most frequent digestive symptom (15.35%). hepatobiliary manifestations were represented by cytolysis syndrome (44.19%) and cholestasis syndrome (36.28%). digestive manifestations were associated with renal failure (p=0.03) and thrombocytosis (p

  • Amyand’s Hernia: A Challenging Diagnosis

    Background: Hernia repair surgery is a procedure frequently performed today, both in elective or outpatient settings as in an emergency context. Hernia is defined as a condition in which part of an organ or its fascia protruded through the wall of the cavity containing it. Quite often in the emergency department incarcerated hernias are found, and in most cases, the content of the hernia sac is the omentum or small intestine. In very rare instances, the appendix can be found inside the hernia sac. When the appendix is found in the hernia sac it is called an “Amyand Hernia”, regardless if it is inflamed or not, with the incidence of appendicitis in an inguinal hernia being 0.07-0.13%. Preoperative diagnosis of an Amyand hernia is a clinical and often a Radiological challenge, being in many cases misdiagnosed as an incarcerated inguinal hernia. Usually, the diagnosis of Amyand’s hernia is an incidental finding during surgical repair of an inguinal hernia. There is still no real consensus on the ideal surgical treatment approach for this pathology. Clinical Case: A 72-year-old man, with a known reducible right inguinal hernia awaiting surgical repair presented to the Emergency Department with acute abdominal pain, nausea, vomiting and a painful right groin mass. He was diagnosed with an incarcerated right inguinal hernia and taken to the operating room for emergency surgery. An open approach was performed with a transverse right inguinal incision and the inflamed appendix was identified inside the inguinal sac. The patient was submitted to an appendectomy and subsequently, using the Bassini technique, had the incarcerated inguinal hernia corrected. Conclusion: Preoperative clinical and imaging diagnosis of amyand´s hernia is rare and difficult. More prospective studies should be carried out in order to standardize the treatment of this pathology. The diagnosis of Amyand´s hernia should be in…

  • Laparoscopic Ventral Rectopexy for the treatment for Solitary rectal ulcer- a good choice?

    Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease characterized by a combination of symptoms, clinical and histological findings, where men and women are affected equally, with a small predominance in women. Various treatment strategies have been advocated, ranging from conservative management to a variety of surgical procedures. Can laparoscopic ventral rectopexy be a good alternative for patients who do not respond to conservative treatment? Given the rarity of this pathology, we chose to present the case.

  • Impact of age on the characteristics and medical care of chronic hepatitis C patients treated with direct-acting antivirals

    Aim: Chronic hepatitis C is more severe in elderly patients. In France, Direct Acting Antiviral therapy must be implemented via multidisciplinary team meetings in regional reference centers. This study aimed to define the impact of age on hepatitis C characteristics and medical care types across three groups: 70-yo. Methods: All patients with treated hepatitis C virus mono-infection during 8 to 24 weeks were included. Group comparison was based on 21 hepatitis C characteristic and medical care variables. Results: Male predominance decreased in >50-yo (59.7% vs. 72.5%, p 70-yo (36.2%, p 50-yo (27.8% vs. 51.9%, p=0.02) and increase in transfusion and nosocomial infection to 30% in >70-yo. Advanced fibrosis increased in >50-yo (57.5% vs. 41.5%, p 70-yo affected. Psychiatric comorbidity incidence was halved in >70-yo (7.1% vs. 14.8%, p

  • Psychiatric disorders and hepatitis C treated with direct-acting antivirals in a French reference center

    HCV can cause psychiatric disorders. It is crucial to re-evaluate them with direct-acting antiviral treatment (DDAs), since the interferon-based treatments of the past were capable of causing identical psychiatric adverse effects. A system of multidisciplinary team (MDT) meetings was implemented in France in December 2014 in regional reference centers with the aim of controlling the prescription and administration of these new treatments, along with optimizing how the patients undergoing these treatments are followed up. Our study sought to compare the characteristics and type of medical care received for chronic hepatitis C in patients with (PSY+ group) and without (PSY- group) psychiatric disorders using data from MDT meetings in the Alsace area of France collected from 2015 to 2019. All included patients were mono-infected and treated with DAAs in successive rounds between 2015 and 2019, as per recommendations from the French Hepatology Society. We compared the two groups (PSY+ and PSY-) based on 21 variables regarding the characteristics and medical care of hepatitis C. Psychiatric disorders were observed in 15% of patients. On multivariate analysis, a positive correlation was found between them and drug use (OR: 2.35; 95%CI: 1.40-3.98; p=0.001), excessive alcohol consumption (OR: 1.92; 95%CI: 0.98-3.69; p=0.05), smoking (OR: 1.81; 95%CI: 1.09-2.98; p=0.02), and incidence of drug interactions (OR: 3.94; 95%CI: 2.15-7.17; p

  • Isolated metastasis of hepatocellular carcinoma in the right atrium: a case observed in a university hospital in West Africa (Bouake, Ivory Coast)

    Intracardiac metastases from hepatocellular carcinoma (HCC) are rare and have a poor prognosis. We report an observation in a West African university hospital in a 39-year-old black patient admitted with upper gastrointestinal bleeding. Clinical examination noted signs of cirrhosis, namely hepatocellular failure, portal hypertension, melena and signs of right heart failure against a background of deterioration in general condition (WHO-3). The CT scan showed a focal hepatic lesion with arterial enhancement and portal lavage compatible with HCC and a right intracardiac mass taking contrast. Doppler echocardiography confirmed the presence of a large heterogeneous mass occupying almost the entire right atrium. Palliative and symptomatic treatment was instituted in the patient improving his clinical condition. His death occurred two months after his release. The intracardiac localization of HCC, although rare, is not exceptional and of appalling prognosis. It should be sought in the assessment of the extension of HCC, especially in the presence of signs of cardiac involvement.

  • Epidemiology and Risk Factors for Hepatitis C Infection in Malaysia: A Narrative Review

    Hepatitis C infection is a growing public health issue in Malaysia. A large number of people living with hepatitis C virus (HCV) are unaware of the infection. The treatment complexity warrants a comprehensive understanding of this infectious disease to support planning for strategies to reduce the burden of disease associated with hepatitis C. This study aimed to summarise the epidemiology and risk factors attributable to hepatitis C acquisition in Malaysia based on local published articles. Published articles related to epidemiology and risk factors for hepatitis C infection in Malaysia between 2005 and 2017 were searched through several online databases. Related information from the Ministry of Health official website was also compiled. An increasing trend in the incidence and mortality rate of hepatitis C infection is noted over the last decades. In 2009, the national prevalence of people infected with HCV was approximately 2.5%, with the prevalence rate varying according to different high-risk groups. The most common genotypes reported are genotypes 3 and 1. Frequently reported risk factor for HCV acquisition is injection drug use. Other identified risk factors are being a blood product recipient, haemodialysis patient or participant in high-risk sexual activity. Nevertheless, a considerable number of patients had no known risk factors. The prevalence and burden of HCV-related disease are substantial and can be attributed to many factors. High-quality design studies are needed to provide stronger evidence of the risk factors for hepatitis C infection in local populations for future public health planning.

  • Two-year Single-Center Real-Life Data of Tenofovir Disoproxil Fumarate Treatment for Chronic Hepatitis B Patients in Togo

    Objective: to evaluate the treatment efficacy of Tenofovir disoproxil fumarate (TDF) in patients with chronic hepatitis B (CHB) in the Teaching hospital campus of Lome. Patients and method: retrospective cross-sectional study, conducted in the outpatient department of the Hepato-Gastro-Enterology department of the Teaching hospital campus of Lome from January 2018 and December 2020. Patients with HBsAg were included. Outpatient patients having achieved at least HBeAg, anti-HBe antibody, anti-HCV antibody, anti-HBc IgG; viral load hepatic assessment; retroviral serology. Some patients had achieved actitest-fibrotest. Patients with abdominal pain, clinical signs of portal hypertension or hepatocellular insufficiency had achieved alphafetoprotein, protidogram, and abdominal ultrasound. These explorations made it possible to classify patients into different virological profiles. Results: More than sixty-four percent of the patients were male. The patients were asymptomatic at 97.37%. HBeAg was positive in 15.19% of patients. The viral load was detectable in 80.43% of cases with a value of 52000000 IU / ml +/- 280000000UI / ml. Ninety-five point twenty-four patients had an inflammatory activity less than 2 and 52.38% a fibrosis greater than 2 on the Metavir grid. The APRI and Fib-4 scores found a strong predictive value for fibrosis in 16.22% and 11.01% of cases, respectively. HBeAg negative chronic hepatitis was the most common virologic profile (58%). Cirrhosis was the most common complication (9.97%). Tenofovir was the therapeutic molecule used. At 12 months of treatment, HBe seroconversion was noted in 100% of cases, an undetectable viral load in 50% of cases and normalization of the hepatic balance in 84% of cases. No side effects of the treatment were reported Conclusion: TDF treatment shows high rate of complete virologic response in CHB patients. TDF is tolerable and safe during the 96 weeks of treatment period. Monitoring of HBV DNA level and drug adherence is important for achieving complete suppression…

  • Carnitine status before and after paracentesis in patients with ascites and liver cirrhosis and improvement of subjective symptoms by intravenous administration of carnitine ― Initial study

    Introduction: Recently, carnitine has been reported to be useful for improving blood ammonia and cognitive function in cirrhotic patients with subclinical hepatic encephalopathy In Japan, levocarnitine has become available, and there have been several reports in which the carnitine concentration was first measured and whether symptomatic patients improved or not . And, the examination of symptomatic state around the ascites centesis was also carried out. Method: Total carnitine concentration was measured in 5 cirrhotic patients undergoing ascites drainage during our hospital ambulatory, and after ascites drainage, intravenous administration of ercarnitine was conducted to examine whether or not the symptoms improved. Carnitine concentrations were measured before and after dialysis in four non-dialysis patients and one dialysis patient. Oral carnitine was administered in 3 patients (1 dialysis patient) because symptoms of cramps were noted, but in 2 cases. It was administered only after ascites drainage. Case presentation: The case was in a 55 year-old male. The chief complaint was persistent ascites, cramps and general malaise. The patient had a medical history of treatment with radiofrequency ablation (Radiofrequency: RFA) for hepatocellular carcinoma. The patient had been followed up at another hospital for chronic liver cirrhosis type C. Interferon therapy was performed for liver cirrhosis, resulting in a virological complete response (sustained virological response: SVR). The ascites storage was obvious, but the round was repeated from 2 to 3 times a week of golf. Because of frequent leg cramps during and at the end of golf, patients were given branched-chain amino acid preparations and liver protection drugs as oral medications. In a patient with liver cirrhosis, improvement of hepatic encephalopathy associated with decreased carnitine level and decreased ammonia were reported, and deterioration of muscle symptoms associated with carnitine deficiency in a dialysis patient was also reported [1-3]. Therefore, [4] Carnitine concentration and acylcarnitine/free carnitine…