Publications (59) View all
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Article: Pleural Effusion and Pseudocyst.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 08/2012; · 5.64 Impact Factor -
Article: Recurrent Intentional Foreign Body Ingestion: An Endoscopist's Dilemma.
Gastroenterology and Hepatology 07/2012; 8(7):482-4. -
Article: Pegylated Interferon α-2b, Ribavirin and Amantadine for Chronic Hepatitis C
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ABSTRACT: In an attempt to improve the efficacy of antiviral therapy for chronic hepatitis C, a three-drug combination of pegylated interferon -2b, ribavirin, and amantadine has been suggested. Despite the initial enthusiasm, the role of amantadine in the treatment of chronic hepatitis C remains controversial. In a multi-center, open-label clinical trial, the potential efficacy and safety of this triple combination regimen were assessed. In this open-label pilot study, two separate patient populations with chronic hepatitis C and viremia were enrolled: treatment-naive and those who had failed a previous course of treatment. Patients were started on pegylated interferon -2b at a dose of 1.5 g/kg weekly with ribavirin, 1000–1200 mg/day, and amantadine, 200 mg/day, for 4 weeks, followed by pegylated interferon -2b, 0.5 g/kg weekly, ribavirin, 1000–1200 mg/day, and amantadine, 200 mg/day, for another 20 weeks. Patients with undetectable HCV RNA at week 24 continued this regimen for a total of 48 weeks and were followed for another 24 weeks. Patients with undetectable virus (< 50 IU/mL) after 24 weeks of follow-up were considered to have SVR. Health-related quality of life and safety data were also collected. Sixty-nine treatment-naive and 99 nonresponder patients with chronic hepatitis C were enrolled in the study. Of all patients enrolled, 74% were male, aged 47.27 5.76 years; their body mass index (BMI) was 28.87 5.05 kg/m2, 79.4% were white, 85% had HCV genotypes 1 and 4, and 36% had cirrhosis. Their baseline HCV RNA was 689,242 698,030 IU/mL, with a baseline ALT of 107.25 79.08. Of the entire cohort, 35 (21%) discontinued early due to side effects or loss to follow-up. Significant anemia (hemoglobin, < 10 g/dL) occurred in 11% (19/168), while severe anemia (hemoglobin, < 8.5 g/dL) occurred in 0.6% (1/168). In the treatment-naive group, sustained virologic response (SVR) was 34.3%, versus 19.4% for the group who had previously failed to respond to a course of treatment (P = 0.01). For both groups combined, virologic response after 24 weeks of therapy was 40.5%, with an end-of-treatment virologic response of 35.7% and a SVR of 26.2%. Patients with genotypes 1 and 4 had lower response rates than those with genotypes 2 and 3 (SVR, 21 vs. 46%; P = 0.001). Patients with advanced fibrosis (Metavir stages 3 and 4) tended to have lower response rates than those with minimal or mild fibrosis (Metavir stages 0–2) (SVR, 10 vs. 30%; P = 0.08). African-American patients with HCV had lower response rates than Caucasians or other ethnic groups (SVR, 4 vs. 29 vs. 20%; P = 0.04). Age, gender, and BMI did not affect SVR. The addition of amantadine to pegylated interferon -2b and ribavirin does not seem to increase the efficacy of this antiviral regimen.Digestive Diseases and Sciences 04/2012; 50(5):970-975. · 2.12 Impact Factor -
Article: Hepatic encephalopathy
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ABSTRACT: – A characteristic feature of the neuropsychiatric changes in hepatic encephalopathy (HE) is the potential for a complete recovery in the majority of patients. In this review, we limit our discussion to HE in individuals with chronic liver disease. The optimal approach to the management of HE includes the following elements. – Provide standard supportive therapy for patients with an altered mental status. This is the mainstay of therapy in the majority of clinical situations and includes administration of parenteral fluids and nutrition, care of vascular and bladder catheters, control of self-injurious activities, and instituting aspiration precautions. – Rule out or control concomitant causes of encephalopathy. The diagnosis of HE has positive and negative criteria, and ruling out other causes of change in mental status is an essential component of the diagnosis. – Identify and correct the precipitating factors of HE. In the majority of patients with HE, a clearly defined precipitating factor usually is identified, and the reversal or control of these factors is a key step in management. – Institute gut-cleansing and ammonia-lowering measures. These measures are based on clinical and pathogenic characteristics of HE and are aimed at neutralizing the putative encephalogenic toxins (namely ammonia).Current Treatment Options in Gastroenterology 04/2012; 4(6):517-526. -
Article: New perspectives in hepatic encephalopathy.
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ABSTRACT: The terminology of hepatic encephalopathy (HE) remained poorly defined for decades. One major problem was the lack of definition of what constituted acute versus chronic HE. Chronic HE caused more confusion because it was proposed to signify any bout of HE in patients with chronic liver disease, whereas others thought it denoted a protracted period of loss of consciousness. Numerous other versions were rampant. This mass confusion was solved by the report of the Hepatic Encephalopathy Consensus Group at the World Congress of Gastroenterology in 1998. This new multi-axial definition led to standardization of diagnosis and explosion in the field of research in HE.Clinics in liver disease 02/2012; 16(1):1-5.
