Background/Aims: Whether primary biliary cirrhosis (PBC) autoimmune hepatitis (AIH) overlap syndrome requires immunosuppressive therapy in addition to ursodeoxycholic acid (UDCA) is a controversial issue. Methods: Sev...Background/Aims: Whether primary biliary cirrhosis (PBC) autoimmune hepatitis (AIH) overlap syndrome requires immunosuppressive therapy in addition to ursodeoxycholic acid (UDCA) is a controversial issue. Methods: Seventeen patients with simultaneous form of strictly defined overlap were followed for 7.5 years. First-line treatment was UDCA alone (UDCA) in 11 and combination of immunosuppressors and UDCA (UDCA+ IS) in 6. Results: Characteristics at presentation were not significantly different between the 2 groups. In the UDCA+ IS group (f-up 7.3 years), biochemical response in terms of AIH features (ALT< 2ULN and IgG< 16 g/L) was achieved in 4/6 and fibrosis did not progress. In the UDCA group, biochemical response was observed in three patients together with stable or decreased fibrosis (f-up 4.5 years) whereas the eight others were non-responders with increased fibrosis in four (f-up 1.6 years). Seven of these eight patients subsequently received combined therapy for 3 years. Biochemical response was obtained in 6/7 and no further increase of fibrosis was demonstrated. Overall, fibrosis progression in non-cirrhotic patients occurred more frequently under UDCA monotherapy (4/8) than under combined therapy (0/6) (P=0.04). Conclusions: Combination of UDCA and immunosuppressors appears to be the best therapeutic option for strictly defined PBC-AIH overlap syndrome.展开更多
Over the past two decades, new treatment modalities have been introduced for t he management of variceal bleeding. The aim of this retrospective study in a sin gle center was to assess whether these treatments have im...Over the past two decades, new treatment modalities have been introduced for t he management of variceal bleeding. The aim of this retrospective study in a sin gle center was to assess whether these treatments have improved the prognosis fo r cirrhotic patients with variceal bleeding. We reviewed the clinical records of all patients with cirrhosis admitted to our Liver Intensive Care Unit due to va riceal bleeding during the years 1980, 1985, 1990, 1995, and 2000. Whereas ballo on tamponade was still the first-line treatment in 1980, patients treated in 20 00 received a vasoactive agent, an endoscopic treatment, and an antibiotic proph ylaxis in, respectively, 90%, 100%, and 94%of cases. The in-hospital mortali ty rate steadily decreased over the study period: 42.6%, 29.9%, 25%, 16.2%, and 14.5%in 1980, 1985, 1990, 1995, and 2000, respectively (P < .05). Mortality decreased from 9%in 1980 to 0%in 2000 in Child-Turcotte-Pugh class A patien ts, from 46%to 0%in class B patients, and from 70%to 32%in class C patients. This improved survival was associated with a decrease of rebleeding (from 47%i n 1980 to 13%in 2000) and bacterial infection rates (from 38%to 14%).On multi variable analysis, endoscopic therapy and antibiotic prophylaxis were independen t predictors of survival. In conclusion, in-hospital mortality of patients with cirrhosis and variceal bleeding decreased three fold over the past two decades, in concurrence with an early and combined use of pharmacological and endoscopic therapies and short-term antibiotic prophylaxis.展开更多
文摘Background/Aims: Whether primary biliary cirrhosis (PBC) autoimmune hepatitis (AIH) overlap syndrome requires immunosuppressive therapy in addition to ursodeoxycholic acid (UDCA) is a controversial issue. Methods: Seventeen patients with simultaneous form of strictly defined overlap were followed for 7.5 years. First-line treatment was UDCA alone (UDCA) in 11 and combination of immunosuppressors and UDCA (UDCA+ IS) in 6. Results: Characteristics at presentation were not significantly different between the 2 groups. In the UDCA+ IS group (f-up 7.3 years), biochemical response in terms of AIH features (ALT< 2ULN and IgG< 16 g/L) was achieved in 4/6 and fibrosis did not progress. In the UDCA group, biochemical response was observed in three patients together with stable or decreased fibrosis (f-up 4.5 years) whereas the eight others were non-responders with increased fibrosis in four (f-up 1.6 years). Seven of these eight patients subsequently received combined therapy for 3 years. Biochemical response was obtained in 6/7 and no further increase of fibrosis was demonstrated. Overall, fibrosis progression in non-cirrhotic patients occurred more frequently under UDCA monotherapy (4/8) than under combined therapy (0/6) (P=0.04). Conclusions: Combination of UDCA and immunosuppressors appears to be the best therapeutic option for strictly defined PBC-AIH overlap syndrome.
文摘Over the past two decades, new treatment modalities have been introduced for t he management of variceal bleeding. The aim of this retrospective study in a sin gle center was to assess whether these treatments have improved the prognosis fo r cirrhotic patients with variceal bleeding. We reviewed the clinical records of all patients with cirrhosis admitted to our Liver Intensive Care Unit due to va riceal bleeding during the years 1980, 1985, 1990, 1995, and 2000. Whereas ballo on tamponade was still the first-line treatment in 1980, patients treated in 20 00 received a vasoactive agent, an endoscopic treatment, and an antibiotic proph ylaxis in, respectively, 90%, 100%, and 94%of cases. The in-hospital mortali ty rate steadily decreased over the study period: 42.6%, 29.9%, 25%, 16.2%, and 14.5%in 1980, 1985, 1990, 1995, and 2000, respectively (P < .05). Mortality decreased from 9%in 1980 to 0%in 2000 in Child-Turcotte-Pugh class A patien ts, from 46%to 0%in class B patients, and from 70%to 32%in class C patients. This improved survival was associated with a decrease of rebleeding (from 47%i n 1980 to 13%in 2000) and bacterial infection rates (from 38%to 14%).On multi variable analysis, endoscopic therapy and antibiotic prophylaxis were independen t predictors of survival. In conclusion, in-hospital mortality of patients with cirrhosis and variceal bleeding decreased three fold over the past two decades, in concurrence with an early and combined use of pharmacological and endoscopic therapies and short-term antibiotic prophylaxis.
