Abstract ID: W1699
K. Furuta,
T. Mishiro, T. Miyake, S. Sato, K. Adachi, Y.
Kinoshita
Introduction
Adiponectin,
an adipocyte-derived hormone, insulin-sensitizing,
and anti-atherosclerotic properties. Its serum concentration is regulated by
the balance between secretion from adipocytes and
excretion by the kidney and liver. Adiponectin is
also known to protect hepatocytes from injury directly via its receptors on
their surface, and administration of CCl4 to adiponectin-knockout
mice is reported to cause more severe liver damage than administration to
wild-type animals. In patients with liver cirrhosis, the serum adiponectin concentration is known to be elevated due to
decreased hepatic extraction of adiponectin from the
circulation, and this higher level of serum adiponectin
is believed to protect hepatocytes. In patients with chronic hepatitis, serum adiponectin may be influenced by body composition
parameters or by hepatic function.
Method
To clarify this, we have
measured the serum concentration of adiponectin in
patients with chronic hepatitis caused by
infection with type C hepatitis virus, and compared this with body composition
parameters. Fifty-two patients (mean age 56.3 +/- 9.6 yr, M/F = 29/23) with
chronic type C hepatitis who underwent hepatic histomorphological
study between January 2003 and October 2004 were included in the study. Before
performing ultrasound-guided biopsy of the liver, blood samples were collected
and the serum was separated. The serum concentration of adiponectin
and hepatitis C virus was determinated by specific
ELISA and quantitative RT-PCR assay, respectively. Histomorphological
data were graded according to the hepatitis activity index (HAI) score and Knodel's score, as reported previously. The serum adiponectin concentration in the patients with chronic type
C hepatitis was 9.1 +/- 5.5 mg/ml, which was not significantly different from
that reported in normal individuals measured using the same assay system.
Therefore, unlike the data already reported for patients with liver cirrhosis,
the serum adiponectin level was not elevated in
patients who retained their hepatic physiological function. In addition, there
was no correlation between hepatic histopathological
grade, hepatic function, and serum adiponectin level.
On the other hand, it has been reported that healthy individuals show a strong
correlation between body mass index(BMI) and serum adiponectin
concentration.
Conclusion
Our observations suggested
that the serum adiponectin concentration was affected
by BMI(p=0.001), even among patients with chronic hepatitis C.
Abstract ID: W935
J.K.
Lim, R.C. Cheung, M. Goldstein, R. Cronkite
BACKGROUND
Chronic hepatitis C virus
(HCV) infection has been shown to reduce health-related quality of life (HRQoL). Multiple
studies have demonstrated that
METHODS
We identified 29,750
RESULTS
Patients who were HCV+
scored lower in HRQoL on four of eight SF-36v
subscales (p<.01) and the mental component summary scale (p<.001)
compared to HCV- patients. These
patients were significantly more likely to have depression (p=.01),
post-traumatic stress disorder (PTSD) (p<0.004), and alcohol dependence
(p<.001). Multiple regression
analysis demonstrated that depression and PTSD independently predicted lower HRQoL scores for all eight HRQoL
subscales and both physical (p<.001) and mental component (P<.03) summary
scales.
CONCLUSION
Chronic HCV infection
results in a significantly decreased HRQoL in
Abstract ID: W1122
R. Koka,
G. Mehta, V. Araya, K.D. Rothstein
BACKGROUND
The prevalence of polyps on
screening colonoscopy has been well studied in patients with cirrhosis and as
part of pre-transplant evaluation. Recent studies have indicated that there
might be an increased prevalence in cirrhotics
especially in the age group<50 with prevalence rates of up to 40%. There
have been no studies examining the prevalence of polyps or colorectal cancer
specifically in patients with chronic hepatitis C.
AIM
Our goal was to examine the
prevalence of polyps in patients with chronic hepatitis C to determine if there
was an increase compared to the average risk population.
Methods
Retrospective database
review identified 181 screening colonoscopies performed in patients with
chronic hepatitis C between 1998 & 2004. Histological data on the polyps
removed were also examined.
RESULTS
181 screening colonoscopies
were performed, 42 were excluded for repeat colonoscopy, rectal bleeding, or
prior history of polyps. Of the 139 analyzed, 86 were men & 53 were women.
56/139 (40%) had polyps of which 24/139 (17%) had tubular adenomas. Other
pathologies noted at colonoscopy included diverticulosis,
AVMs and hemorrhoids. No cancers or dysplasia was
recorded in this group of patients.
Men had 17/86 (19.7%) had
tubular adenomas compared to women 7/53(13%). When subdivided by race,
Caucasians (W) had higher rates of tubular adenomas 9/43(21%) compared to
African Americans (AA) 12/82 (14.6%)
|
|
MEDIAN AGE |
ADENOMAS N(%) |
|
MEN (86) |
57 |
17 (19.7%) |
|
WOMEN (53) |
57 |
7 (13%) |
|
AA (82) |
56 |
12 (14.6%) |
|
CAUCASIAN (43) |
52 |
9 (21%) |
CONCLUSIONS
The prevalence of polyps in
patients with chronic hepatitis C in our study is comparable to that of the asymptomatic
average risk population (24-47%) though the mean age was lower than in prior
studies (56 compared to 62.5). Since the incidence of polyps increases with
advancing age, this study suggests that patients with chronic hepatitis C may
have a higher prevalence of colonic polyps.
All patients with chronic
hepatitis C over the age of 50 should be screened with colonoscopy prior to
treatment given the significant prevalence of colon polyps, especially tubular
adenomas.
Abstract ID: W915
S. Chaudhari,
C.T. Tenner, E.H. Weinshel,
E.J. Bini
BACKGROUND
Although vaccination against
hepatitis A virus (HAV) and hepatitis B virus (HBV) is recommended for all
patients with chronic hepatitis C virus (HCV) infection, physician vaccination
practices are suboptimal. We evaluated physician knowledge and attitudes regarding
vaccination against HAV/HBV in patients with chronic HCV infection.
METHODS
A 2-page questionnaire was
mailed to 3000 primary care (PC), 1000 gastroenterology (GI), and 1000
infectious diseases (ID) physicians randomly selected from the AMA Physician Masterfile. The survey was pre-tested prior to mailing and
included questions about physician demographics, knowledge, and attitudes
regarding vaccination.
RESULTS
Among the 5000 physicians
surveyed, 115 were undeliverable, 89 were not in practice, and 2038 (42.5%) of
the 4796 eligible physicians returned completed surveys. There were no
differences between respondents and non-respondents with regard to age, sex,
geographic location, or specialty. Physicians knew that the following HCV+
persons should be vaccinated against HAV or HBV, respectively: normal ALT
(66.4%, 69.0%), elevated ALT (73.5%, 75.8%), HCV PCR+ (77.4%, 79.6%),
compensated cirrhosis (76.3%, 76.4%), decompensated cirrhosis (52.5%, 53.3%),
and HIV+ (71.9%, 72.3%). More PC than GI or ID physicians stated that none of
these HCV+ patients should be vaccinated against HAV (17.3% vs. 3.3% vs 5.1%, P <0.001) or HBV (15.8% vs. 3.0% vs. 4.6%, P
<0.001). Responders agreed/strongly agreed that HCV+ patients should be
tested for HAV antibodies (73.2%), susceptible patients should be vaccinated
against HAV (83.2%), HAV antibody testing should be done prior to HAV
vaccination (58.1%), and that the HAV vaccine is safe (79.6%) and effective
(72.0%). In addition, physicians agreed/strongly agreed that HCV+ patients
should be tested for HBV antibodies (84.2%), susceptible patients should be
vaccinated against HBV (87.2%), HBV antibody testing should be done prior to
HBV vaccination (74.1%), and that the HBV vaccine is safe (82.3%) and effective
(78.3%). The proportion of PC physicians who agreed with these statements
regarding HAV/HBV vaccination were all significantly lower (P <0.001) as
compared with GI or ID physicians.
CONCLUSIONS
Among physicians in the
Abstract ID: W922
J. Iturrino, C.J. Sanchez, V. Velazquez, D. Iturrino, A. Ortiz, P. Costas, E.A.
Torres
Background
One half of the population
of
Methods
Records were reviewed for
demographic characteristics, medical information, treatment decision, compliance
with therapy, side effects, completion of treatment and reasons for
discontinuation.
Results: Of 405 referred
patients, 308 were seen at least once; 153 (49.7%) did not receive treatment.
Reasons for not receiving treatment included: 99 (64.7%) were lost to follow up
after the initial evaluation; treatment was contraindicated in 32 (20.9%);
treatment was not indicated in 13 (8.5%); 5 (3.3%) patients refused treatment
and 4 (2.6%) never started due to social problems. The other 155 (50.3%) patients
started treatment. In 41 (26.5%), treatment was discontinued for the following
reasons: 22 (53.7%) were non responders; 13 (31.7%) had adverse effects; 4
(9.8%) developed co-morbidities during treatment; and 2 (4.9%) had unrelated
deaths. Another 36 patients (23.2%) were lost to follow up after having started
treatment. Fifty-four (34.8%) completed treatment and 24 (15.5%) are currently
in treatment. Of the original 308 patients, only 78 (25.3%) have the potential
of a full therapy and a response.
Conclusions
The pilot clinic for
uninsured HCV patients did not fulfill the aims of the program. Access to
treatment for hepatitis C is not enough for achieving success. Resources are
needed to improve identification of suitable candidates, compliance and management
of side effects. Investing in patient and primary physician education, clinic
coordinators, psychiatric consultants, and non-covered medications for side
effects should improve the success of therapy and result in a more efficient
and cost-effective use of limited government funds.