Background HBeAg-negative chronic hepatitis B patients require long-term nucleos(t) ide analogues (NAs) because loss of surface antigen (HBsAg) is unusual. Low quantitative HBsAg (qHBsAg) levels can identify patients with higher probability of seroclearance. The aim of our study was to evaluate qHBsAg in HBeAg-negative patients receiving NAs to predict a reduction of HBsAg levels and seroclearance. Methods Retrospective analysis of qHBsAg in HBeAg-negative patients before and at years 1, 3, 5, 8 and over of NAs treatment. Results From 1999 to 2015, HBsAg was quantified in 358 serum samples from 95 HBeAg-negative patients. Low qHBsAg (< 120 IU/mL) was identified at baseline or during follow-up in 14% of patients and HBsAg loss in 4%. No baseline variables predicted seroclearance and only treatment duration predicted low qHBsAg. The annual decline of qHBsAg was -0.102 log IU/mL and the median time to HBsAg loss was 6.04 years. The decline was greater in patients achieving low HBsAg levels (-0.257) than in those who did not (-0.057)(p<0.001). The diagnostic accuracy (ROC curve, 95% CI) of qHBsAg delta at year 3 was 0.89 (0.81 +/- 0.97), with cut-off >0.3 log IU/mL showing a positive and negative predictive value of 42% and 100% to identify patients achieving low levels of HBsAg. Conclusions Reduction of qHBsAg is slow in HBeAg-negative patients receiving NAs, although low levels or faster qHBsAg decline may occur in 14%. A qHBsAg reduction >0.3 log IU/mL at year 3 can identify patients with a higher probability of achieving low levels and HBsAg seroclearance.

SummaryTransient elastography (TE) is the reference method to obtain liver stiffness measurements (LSM), but no results are obtained in 3.1% and unreliable in 15.8%. We assessed the applicability and diagnostic accuracy of TE re‐evaluation using M and XL probes. From March 2011 to April 2012 868 LSM were performed with the M probe by trained operators (50–500 studies) (LSM1). Measurements were categorized as inadequate (no values or ratio <60% and/or IQR/LSM >30%) or adequate. Inadequate LSM1 were re‐evaluated by experienced operators (>500 explorations) (LSM2) and inadequate LSM2 using XL probe (LSMXL). Inadequate LSM1 were obtained in 187 (21.5%) patients, IQR/LSM >30% in 97 (51%), ratio <60% in 24 (13%) and TE failed to obtain a measurement in 67 (36%). LSM2 achieved adequate registers in 123 (70%) of 175 registers previously considered as inadequate. Independent variables (OR, 95%CI) related to inadequate LSM1 were body mass index (1.11, 1.04–1.18), abdominal circumference (1.03, 1.01–1.06) and age (1.03, 1.01–1.04) and to inadequate LSM2 were skin‐capsule distance (1.21, 1.09–1.34) and abdominal circumference (1.05, 1.01–1.10). The diagnostic accuracy (AUROC) to identify significant fibrosis improved from 0.89 (LSM1) to 0.91 (LSM2) (P = 0.046) in 334 patients with liver biopsy or clinically significant portal hypertension. A third evaluation (LSMXL) obtained adequate registers in 41 (93%) of 44 patients with inadequate LSM2. Operator experience increases the applicability and diagnostic accuracy of TE. The XL probe may be recommended for patients with inadequate values obtained by experienced operators using the M probe. http://clinicaltrials.gov (NCT01900808).

La clínica obstructiva en el cáncer colorrectal (CCR) en estadio paliativo obliga a un tratamiento sintomático. La prótesis de colon (PC) es actualmente el tratamiento de elección si bien es un tema en discusión que la cirugía resectiva (CR) pueda aumentar la supervivencia en éstos pacientes.

Introducción: Estudios previos demuestran que los pacientes diabéticos responden peor a las preparaciones habituales. Un protocolo específico de preparación para pacientes diabéticos puede mejorar la limpieza y aceptabilidad.

Introducción: Las guías internacionales recomiendan la colonoscopia de rutina tras un episodio de diverticulitis aguda (DA) para descartar la presencia de neoplasia avanzada de colon (NAC). Sin embargo, tras la incorporación de la tomografía computarizada (TC) en el algoritmo diagnóstico, dicha recomendación está en entredicho.

Introducción: La diabetes mellitus se ha asociado con un riesgo superior de desarrollo de cáncer colorrectal (CCR) aunque los resultados son discordantes. Un estudio reciente con población asiática ha sugerido que los adenomas se desarrollan en edades más tempranas en pacientes diabéticos.

Table 1.Adverse events in 102 patientsIn the Intent to Treat analysis (ITT) the percentage of patients with HCV RNA <100 IU/ml (undetectable) at week 12 was 68% (58%), 79% (74%) for treatment naïve patients, 81% (77%) for relapsers, 77% (63%) for partial responders and 37% (22%) for null responders.In the Per-Protocol analysis (patients initiating boceprevir (n = 87)) the response was 79% (68%), 83% (78%) for treatment naïve patients, 84% (80%) for relapsers, 96% (79%) for partial responders and 50% (30%) for null responders. Conclusions:The triple therapy of boceprevir with PEG-IFN/RBV in patients with severe fibrosis is very effective in negativity HCV viremia at 12 weeks (68%), but is associated with serious adverse events in more than 33% of the patients.

Results: There was no significant difference between arterial and hepatic venous concentrations of TIMP-1 in either patients or controls.Hepatic venous concentrations of TIMP-1 was significantly increased in patients with liver cirrhosis 317 (193) ng/ml versus 153 (104) (median/IQ range) (p < 0.001) with a progressive increase throughout the Child classes with the highest levels in Child class C patients (p < 0.001).Circulating TIMP-1 correlated significantly with ICG-clearance (r = -0.62,p < 0.0001), GEC (r = -0.40,p < 0.0001), the hepatic venous pressure gradient: (r = 0.59, p < 0.0001), mean arterial pressure (r = -0.40,p < 0.0001), and systemic vascular resistance (r = -0.36,p < 0.0001).Conclusions: TIMP-1 is significantly increased in patients with liver cirrhosis.TIMP-1 correlates significantly with the severity of the liver disease, degree of portal hypertension, and the vasodilatory state.TIMP-1 may represent a promising non-invasive marker to predict development of haemodynamic-related complications in patients with cirrhosis.

OBJECTIVES:To evaluate the effect of Helicobacter pylori (H. pylori) eradication on ulcer bleeding recurrence in a prospective, long-term study including 1,000 patients. METHODS:Patients with peptic ulcer bleeding were prospectively included. Prior non-steroidal anti-inflammatory drug (NSAID) use was not considered exclusion criteria. H. pylori infection was confirmed by rapid urease test, histology, or (13)C-urea breath test. Several eradication therapies were used. Subsequently, ranitidine 150 mg o.d. was administered until eradication was confirmed by (13)C-urea breath test 8 weeks after completing therapy. Patients with therapy failure received a second, third, or fourth course of eradication therapy. Patients with eradication success did not receive maintenance anti-ulcer therapy and were controlled yearly with a repeat breath test. NSAID use was not permitted during follow-up. RESULTS:Thousand patients were followed up for at least 12 months, with a total of 3,253 patient-years of follow-up. Mean age 56 years, 75% males, 41% previous NSAID users. In all, 69% had duodenal ulcer, 27% gastric ulcer, and 4% pyloric ulcer. Recurrence of bleeding was demonstrated in three patients at 1 year (which occurred after NSAID use in two cases, and after H. pylori reinfection in another one), and in two more patients at 2 years (one after NSAID use and another after H. pylori reinfection). The cumulative incidence of rebleeding was 0.5% (95% confidence interval, 0.16-1.16%), and the incidence rate of rebleeding was 0.15% (0.05-0.36%) per patient-year of follow up. CONCLUSION:Peptic ulcer rebleeding virtually does not occur in patients with complicated ulcers after H. pylori eradication. Maintenance anti-ulcer (antisecretory) therapy is not necessary if eradication is achieved. However, NSAID intake or H. pylori reinfection may exceptionally cause rebleeding in H. pylori-eradicated patients.

Aims: We aimed to evaluate the effect of eradication of Helicobacter pylori on incidence of newly developed gastric carcinoma after endoscopic resection of gastric tumor.Methods: In this prospective, randomized, open-label trial, from Jan 2005 to Feb 2011, consecutive 664 patients with gastric tumor after endoscopic resection of early gastric cancer (n=408) or adenoma (n=256), were assigned to receive an H. pylori eradication treatment (n=346) or control (n=318).Eradication group received omeprazole, amoxicillin, clarithromycin for a week.Patients were examined by endoscopy and computed tomography at 3, 6, 12 months, and yearly after allocation.The primary end point was diagnosis of new carcinoma at another site in the stomach.Analyses were by intention to treat.Results: At 78-month follow-up (median 30 months), newly developed gastric carcinoma had developed in 10 patients in the eradication group and 15 in the control group (p=0.85).Cumulative incidence of gastric cancer was not significantly different between the treatment and control groups (p=0.32 by log-rank test).No significant difference in overall cumulative gastric cancer incidence was found between patients with positive and negative final H. pylori status (p=0.32).Conclusions: In this trial, prophylactic eradication of H. pylori after endoscopic resection of gastric tumor was found to be no significant impact on the development of metachronous gastric carcinoma.Further long-term studies to investigate the role of H. pylori eradication in patients with gastric tumor are warranted to solve this debating issue.

BACKGROUND:Strong acid inhibition using esomeprazole increases cure rates with triple therapy and 10-day treatments are more effective than 7-day ones. The combination of amoxicillin plus metronidazole at full doses, and using a physiologically-correct schedule three times a day, and has been shown to overcome metronidazole resistance and to achieve good eradication rates.AIMS:To assess the eradication rate of a new first-line treatment regimen associating strong acid inhibition, amoxicillin and metronidazole and to evaluate tolerance.METHODS:Patients from eight hospitals were included. Helicobacter pylori status was assessed by at least one of the following: histology, culture, rapid urease test or urea breath test (UBT). Ten-day treatment was prescribed comprising esomeprazole 40 mg twice a day plus amoxicillin 1 g and metronidazol 500 mg both three times a day. Helicobacter pylori cure was assessed by UBT.RESULTS:A hundred and thirty-six patients were enrolled. Mean age was 52.6 ± 16 years and 59.6% of patients were men. Main indications for treatment were: uninvestigated dyspepsia (13.6%); functional dyspepsia (18.2%); gastric ulcer (21.8%); and duodenal ulcer (39.8%). Helicobacter pylori eradication was achieved in 112 of the 127 patients who returned for follow-up. Eradication rates were 82.4% (95% CI: 74.7-88.1) by intention-to-treat analysis and 88.2% (95% CI: 81.2-92.8) by per protocol. Treatment was well tolerated and no major side effects were reported. Nine patients complained of mild side effects.CONCLUSIONS:Cure rates of the combination of esomeprazole, amoxicillin and metronidazole are high and the treatment was well tolerated. This pilot study warrants the comparison of this schedule with current standards.