Seit 2014 wurde die Behandlung der chronischen Hepatitis C durch die Einführung neuer direkt antiviral-wirkender Medikamente (DAA) revolutioniert. Bisher sind jedoch nur wenige Daten vorhanden, die Heilungsraten von Patienten unter Opiat-Substitutionstherapie (OST) im Behandlungsalltag zeigen, obwohl diese Gruppe eine der höchsten HCV Prävalenzen in Deutschland aufweist.

Einleitung/Ziele: Ledipasvir/Sofosbuvir (LDV/SOF) ist zur 8 bis 24-wöchigen Therapie einer chron. Hepatitis-C-Infektion (HCV) vom Genotyp 1 (GT1) zugelassen. In der ION-3 Studie war die 8-wöchige Behandlung einer 12-wöchigen Behandlung von therapienaiven Patienten ohne Zirrhose nicht unterlegen. Lt. Fachinformation kann eine 8-wöchige Behandlung bei therapienaiven Patienten ohne Zirrhose u. einer Baseline HCV-RNA Viruslast < 6 Mio IU/mL erwogen werden. Ziel dieser Analyse war es, das virologische Ansprechen nach 8-wöchiger Behandlung unter Real-World Bedingungen zu untersuchen.

Einleitung/Ziele: Direkt antivirale Substanzen (DAA) verbessern die Wirksamkeit der Behandlung einer chron. Hepatitis C-Virusinfektion (HCV). Phase 3-Studien deuteten auf geringere Ansprechraten bei Patienten mit Leberzirrhose hin. Informationen zur Wirksamkeit von DAA-Therapien bei Patienten mit fortgeschrittener Leberzirrhose sind nur begrenzt verfügbar. Nicht bekannt ist, in welchem Ausmaß interferonfreie Therapien die Leberfunktion dieser Patienten verbessern.

Einleitung/Ziele: In zulassungsrelevanten Studien zu direkt antiviralen Substanzen gegen Hepatitis C-Virusinfektionen vom Genotyp 1 (HCV GT1) wurde bei ca. 90% der Patienten ein dauerhaftes virolog. Ansprechen (SVR) erzielt. Bestätigungen dieser Ausheilungsraten in einem weniger gut kontrollierten Umfeld, d.h. im Real-World-Setting sowie bei Patienten, die schwieriger zu behandeln sind, liegen bisher nur zum Teil vor.

Einleitung/Ziele: Therapien mit neuartigen direkt antiviralen Substanzen (DAA) verbessern die Behandlung der chronischen Hepatitis C. Wenige Studien untersuchten DAA Therapien in älteren Patienten. Ziel dieser Analyse war daher die Untersuchung der Wirksamkeit und Sicherheit der DAA-Therapien bei Patienten > 70 Jahre vs. jüngere Patienten (≤70 Jahre), die in das Deutsche Hepatitis C-Register (DHC-R) eingeschlossen wurden.

Einleitung/Ziele: Eine Hepatitis C Virusinfektion mit Genotyp 1 (HCV GT1) kann bei > 90% der Patienten mit direkt antiviralen Substanzen (DAA) geheilt werden. Ein dauerhaftes virologisches Ansprechen (SVR) kann jedoch bei Patienten, die mit dem Genotyp 3 (GT3) infiziert sind, unter Therapie mit Sofosbuvir (SOF) u. Ribavirin (RBV) niedriger sein. Weitere Behandlungsregime umfassen 12 Wo. pegyliertes Interferon (PegIFN)+RBV+SOF u. 12 bis 24 Wochen SOF ± RBV plus Daclatasvir (DCV) oder Ledipasvir (LDV). Daten von Kohorten unter Real-World Bedingungen sind bisher nur begrenzt verfügbar.

Fallbericht: Eine 63-jährige Patientin stellte sich mit starken epigastrischen Beschwerden zur Gastroskopie vor.

Hintergrund und Ziele: TDF stellt in klinischen Studien eine sehr wirksame Therapie der CHB dar. Kenntnisse über Langzeitwirksamkeit und Verträglichkeit in der Praxis sind jedoch limitiert.

Aims: Many patients (pts) with chronic liver disease are asymptomatic or may have nonspecific symptoms such as fatigue in the absence of hepatic synthetic dysfunction. Information regarding the presentation of chronic liver disease in Germany is still scarce. We investigated the frequency of asymptomatic and symptomatic presentations of chronic liver disease according to HCV status, gender and age.

Hintergrund: Seit der Erstpublikation des IL28B-Wirtspolymorhismus und der Korrelation des Genotyps mit der SVR durch Ge et al. im August 2009 sind zahlreiche Untersuchungen und Auswertungen zu möglichen Einsatzformen des IL28B veröffentlicht worden. Obgleich in Deutschland die Messung des IL28B zurzeit keine kassenärztliche Leistung darstellt, wird der Test mittlerweile vielfach eingesetzt.

Die SVR-Raten von HCV-GT 1-Patienten, die mit den Subtypen 1a und 1b infiziert waren, führten teilweise zu gegensätzlichen Schlussfolgerungen, welcher Subtyp erfolgreicher zu therapieren ist. Subtyp-assoziierte Angaben zu Baselineparametern, die ebenfalls das Resultat beeinflussen, fehlten jedoch.

Little is known about the epidemiology of chronic hepatitis C (CHC) in Germany and especially about the importance of transmission, duration of infection, genotypes, symptoms and quality of life of the patients. The current study prospectively evaluates epidemiological and clinical data of patients infected with the hepatitis C virus (HCV). Using online data entry, various characteristics of 10,326 untreated patients with CHC were documented from March 2003 until May 2006 in 352 centres all over Germany. Mean age of patients was 43.4 years. Patients infected by i.v. drug abuse were considerably younger (36.5 years) than the remaining patients (49.2 years). As indicated by their native language, 64.4% of the patients came from Germany and 19.2% from Russia. 61.7% were infected with genotype 1 and 34.9% with genotype 2 or 3. 45.5% of the patients had been infected by i.v. drug abuse. In at least 5.4% of the patients liver cirrhosis had been proved by biopsy. 63.5% of the patients felt an impairment of quality of life caused by CHC. In many patients infected with hepatitis C socio-economic issues are existent. This is reflected, i.e., in very high rates of unemployment in special subpopulations. Coinfections with hepatitis B and HIV occurred in 1.5% and 4.7%, respectively. Nearly 80% of patients were managed near their homes. The data of the 10 326 patients represent about 2% of all German patients with CHC. This database is up to now the largest of its kind and gives a representative insight into the epidemiological situation of CHC in Germany.

Little is known about the epidemiology of chronic hepatitis C (CHQ in Germany and especially about the importance of transmission, duration of infection, genotypes, symptoms and quality of life of the patients. The current study prospectively evaluates epidemiological and clinical data of patients infected with the hepatitis C virus (HCV). Using online data entry, various characteristics of 10326 untreated patients with CHC were documented from March 2003 until May 2006 in 352 centres all over Germany. Mean age of patients was 43.4 years. Patients infected by i.v. drug abuse were considerably younger (36.5 years) than the remaining patients (49.2 years). As indicated by their native language, 64.4% of the patients came from Germany and 19.2% from Russia. 61.7% were infected with genotype 1 and 34.9% with genotype 2 or 3. 45.5% of the patients had been infected by i.v. drug abuse. In at least 5.4% of the patients liver cirrhosis had been proved by biopsy. 63.5% of the patients felt an impairment of quality of life caused by CHC. In many patients infected with hepatitis C socio-economic issues are existent. This is reflected, i.e., in very high rates of unemployment in special subpopulations. Coinfections with hepatitis B and HIV occurred in 1.5% and 4.7%, respectively. Nearly 80% of patients were managed near their homes. The data of the 10326 patients represent about 2% of all German patients with CHC. This database is up to now the largest of its kind and gives a representative insight into the epidemiological situation of CHC in Germany.

We present the case of a 42-year-old female patient with the diagnoses of autoimmune hepatitis type I and autoimmune thyroiditis. Furthermore this patient had an unusual combination of coagulation disorders with homozygous Factor V Leiden mutation (APC resistance) and presence of antiphospholipid antibodies, leading to deep vein thromboses and miscarriages. Only few cases with the combination of autoimmune hepatitis and antiphospholipid antibodies have been described and almost all of them had become symptomatic with the antiphospholipid syndrome. As both autoimmune phenomenons furthermore share similar HLA-patterns, their coincidence is probably not as uncommon as the limited number of case reports suggests. Therefore attention in patients with autoimmune hepatitis should be focused on thrombophilia.

Hepatitis C virus (HCV) infection becomes chronic in more than 70% of patients, leading to endstage liver disease in about 20-30% of these patients. Apart from the virus itself,host factors that modulate the immune response are likely to be involved in determining the outcome of HCV infection. Studies on the association of human leucocyte antigens (HLAs) and HCV infection have shown inconsistent results. Selection of patient subgroups may be crucial. However, any association relevant to HCV disease progression will become evident, especially in those patients with end stage liver disease. Therefore, we analysed the phenotype frequencies of HLA antigens in two groups of 69 and 39 patients with HCV induced liver cirrhosis who had received a transplant or were awaiting liver transplantation, The first group was typed serologically and compared with 331 blood and Liver donors. The second; group, prospectively HLA typed by a polymerase chain reaction-sequence specific oligonucleotide (PCR-SSO) procedure for HLA-DRB and DQB alleles, was compared with another 170 PCR-SSO typed and randomly selected blood donors. Decreased frequencies for HLA-DR5 and HLA-DQ3 were found in one group of patients with HCV induced liver cirrhosis compared with the control groups. In the second analysis comparing 39 patients with end stage liver cirrhosis with blood donors, we confirmed the significant decrease in HLA-DRB1*11 and HLA-DQB1*03, which corresponded to serological HLA-DR5 and HLA-DQ3 antigens, respectively. Our results show that the presence of HLA-DRB1*11 and HLA-DQB1*03 alleles is associated with a reduced risk for the development of HCV induced end stage liver disease.

In order to obtain novel mutations in the recently discovered Wilson disease gene, we screened 5 unrelated German individuals for mutations in the 21 exons and their flanking intronic sequences. We detected 9 mutations affecting the Wilson disease gene. Four of those, designated 802-808delTGTAAGT, 2008-2013delTATATG, Cys985Thr, and Ile1148Thr have not yet been reported. One patient had a homozygous mutation whereas the remaining four subjects were compound heterozygous. Therefore these data confirm, that mutations causing Wilson disease are frequently found in affected subjects and they are very heterogenous.

We describe a 52-year-old woman who presented with severe diarrhea, nausea, intermittent abdominal pain and weight loss of 18 kg within ten months. Jejunal and duodenal ulcers were detected by endoscopy and multiple biopsies revealed villous atrophy of the jejunum. However, neither gliadin nor endomysium antibodies were detected and no clinical and histological improvement was achieved after gluten withdrawal. Despite strong clinical suspicion for intestinal lymphoma many unrevealing biopsies were done. The patient developed intermittent septic fever and diagnostic laparotomy revealed jejunal perforation. Partial jejunal resection was performed and histology confirmed the diagnosis of an intestinal T-cell lymphoma without celiac disease. Malabsorption and all intestinal ulcers disappeared during the course of chemotherapy (six cycles CHOP) and the patient recovered remarkably.

therapy 175 Bile lipids 515 -secretion 515 Binary complexes 305 Bionormalizer 538 Bisacodyl 69 Bosentan 484 Bullfrog duodenum 324 Caco-2 cells 238 Caerulein 56 Calcitonin gene-related peptide 338 cAMP 324 Cancer 216 -, gastrointestinal tract