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Background Subjects with irritable bowel syndrome may undergo an excess of cholecystectomy. It is not known, however, whether the cholecystectomy rate parallels an increased risk of gallstones. Aim Aim was to assess the prevalence and the incidence of gallstones and cholecystectomy in subjects with irritable bowel syndrome symptoms. Subjects and methods In this population-based study, 29,139 subjects (63.2% of 46,139 randomly selected subjects, age 30–69 years) underwent a physical examination, an interview on gastrointestinal symptoms and an upper abdominal ultrasonography. An identical survey was carried out 7.8 ± 1.0 ( M ± S.D.) years later on 8460 gallstone-free subjects at the first survey. Prevalence and incidence of gallstones and cholecystectomy were assessed in subjects with (1) irritable bowel syndrome; (2) abdominal pain and normal bowel; (3) altered bowel and no abdominal pain and (4) asymptomatic controls; univariate and multivariate regression logistic models were used for statistical analysis. Results Prevalence odds of gallstones and cholecystectomy were significantly higher in irritable bowel syndrome and abdominal pain and normal bowel than in controls. Irritable bowel syndrome and abdominal pain and normal bowel subjects were more aware of gallstones than controls ( p Conclusions Irritable bowel syndrome subjects have an increased risk of cholecystectomy that is not due to an increased risk of gallstones, but rather to abdominal pain, awareness of having gallstones, and inappropriate surgical indications.

Background/aim Hepatic cirrhosis is a frequent reason for ordinary hospital admission (OA). The RING study collected hospital discharge files (HDF) from Italian hospital gastroenterology units (IGU). This caselist provides a broad picture of the patients admitted for this pathology. Material/methods More than 50,000 HDF for OA were collected between 2001 and 2004 from 26 IGU. Results Eight thousand four hundred and eighty-seven HDF (16%) had a diagnosis of hepatic cirrhosis; Child-Pugh classes were 20.2% A, 34.8% B and 45.0% C. Patients’ mean age was 63.7 ± 12.1 years and 62.5% were male. A 61.1% of the cirrhosis cases had ascites, 29.9% portal-systemic encephalopathy, 29.2% hepatocellular carcinoma (HCC), 10% bleeding varices, 3.0% hepatorenal syndrome (HRS). Mortality for OA for cirrhosis was 5.7% versus 2.6% for other diagnoses. The proportion varied with the severity of the cirrhosis: 0% for Child A, 1.1% B, 10.5% C. Mortality was significantly associated with: Child-Pugh at admission (odds ratio: OR 9.2), HRS (OR 11.7), bleeding varices (OR 2.2), HCC (OR 1.8). Conclusions Hepatic cirrhosis was found in 16% of the OA to IGU and mortality was double the rate for all the other pathologies in the same wards. Child-Pugh is a useful prognostic tool, higher classes implying a greater risk of death. HRS and bleeding varices were the complications with most influence on in-hospital mortality.

Background and aims : Little information are available on the relationship between energy balance and the alterations in nutritional status occurring in cirrhotic patients. The aim of the present study was to evaluate the daily energy balance in clinically stable cirrhotic patients with or without malnutrition. Patients : Seventy-four consecutive cirrhotic patients and nine healthy controls were studied. Methods : Basal energy expenditure was measured by indirect calorimetry and adjusted according to the patients' physical activity to estimate the daily energy expenditure. Food intake was evaluated based on a 3-day dietary diary. Nutritional status and body composition were assessed using skinfold anthropometry and dual energy X-ray absorptiometry, respectively. Results : Thirty-two patients in the cirrhotic group were classified as severely malnourished according to anthropometric parameters. Two different patterns of soft-tissue loss were observed in the malnourished cirrhotic group: a significant reduction in fat mass and in fat-free mass was observed in males, whereas, females showed a significant reduction in fat mass only. Basal energy expenditure was similar in all groups, while the non-protein respiratory quotient was lower in cirrhotics notwithstanding their nutritional status. This suggests that lipids were the preferred oxidized fuel in the post-absorptive state in these patients. No difference in the estimated daily energy expenditure and energy intake was observed among groups. Lipid content of the diet was significantly lower in malnourished cirrhotics than in controls (33.1±1% vs 37.8±1%, P =0.02). Conclusions : Cirrhotic patients in stable clinical condition with malnutrition show a normal energy balance.

We investigated whether S-adenosyl-L-methionine (SAMe), dilinoleoylphosphatidylcholine (DLPC), or SAMe + DLPC influence liver lipid composition as well as acute ethanol hepatotoxicity in the isolated perfused rat liver (IPRL). SAMe (25 mg/kg intramuscularly three times a day) was administered for five consecutive days, while DLPC was administered intraperitoneally for five days. The liver was then isolated, perfused with taurocholate to stabilize bile secretion, and exposed to 0.5% ethanol for 70 min. SAMe, without changing total phospholipid (PL) content, induced an increase in the phosphatidylcholine/phosphatidylethanolamine (PC/PE) molar ratio in both liver homogenate and microsomes and a significant enrichment of 16:0-20:4 and 18:0-20:4 PC molecular species. DLPC induced a significant enrichment of PL in liver homogenate and microsomes due to a contemporary increase in PC and PE. The PC enrichment specifically involved 16:0-20:4 and 18:0-20:4 PC molecular species besides the HPLC peak containing the administered 18:2-18:2 PC species. DLPC + SAMe increased the concentration of PC in liver homogenate and microsomes due to a specific enrichment of 16:0-22:6, 16:0-20:4, and 18:0-20:4 PC molecular species, and the HPLC peak containing the administered 18:2-18:2 PC species. Ethanol acute exposure in the control IPRLs for 70 min induced a depletion of cholesterol in both liver homogenate and microsomes without significant changes in the composition of PL classes and PC molecular species. SAMe, DLPC, or SAMe + DLPC counteracted the cholesterol depletion induced by ethanol, indicating that phospholipid changes promoted by these treatments all induce a major resistance of liver membranes to the effect of ethanol. Ethanol administration in control IPRLs induced a fivefold increase of AST and LDH release in the perfusate, depletion of glutathione in homogenates and mitochondria, decreased oxygen liver consumption, and inhibition of bile flow. These effects of ethanol were significantly antagonized by SAMe. In contrast, DLPC alone only minimally attenuated enzyme release in the perfusate and the inhibitory effect of ethanol on bile flow, but it failed to influence the depletion of total and mitochondrial glutathione or the depressed oxygen consumption induced by ethanol. DLPC, administered together with SAMe, added nothing to the protective effect of SAMe against ethanol hepatotoxicity and cholestasis. In conclusion, this study demonstrates that both SAMe and DLPC induced marked modifications in the lipid composition of liver membranes with a similar enrichment of polyunsaturated PC molecular species. Only SAMe, however, significantly protected against the hepatotoxic and cholestatic effect of acute ethanol administration, an effect associated with maintained normal glutathione mitochondrial levels and oxygen liver consumption. This indicates that the protective effect of SAMe against ethanol toxicity is linked to multiple mechanisms, the maintenance of glutathione levels probably being one of the most important.

Background and aims. Hepatic expression of several proteins, includng albumin, is reduced during ischaemia and restored upon reperfusion n human liver transplantation (LT) [J Pathol 2005;207:111–8]. Compleent activation during ischaemia reperfusion (IR) injury has been reported n renal, liver, intestine and heart allografts. A link between proteolysis nd complement activation has been demonstrated in myocardial IR damge [Proteomics 2002;2:988–95]. To better elucidate the mechanism and rognostic significance of complement activation in hepatic IR injury we easured early changes of liver graft C4d expression and total protein ontent (TP) during LT. Methods. Liver graft samples were obtained from heartbeating donors efore the aorta was clamped (T1) and 2 h after reperfusion in the recipint (T2) during primary whole organ LT. TP was measured by the Bio-Rad rotein assay method in freeze-dried liver homogenates from 47 grafts. In a ubgroup of 29 grafts C4d immunohistochemistry was performed on paraffin ections and positive hepatocytes were scored on a semiquantitative scale. he data were evaluated comparing grafts which were lost (LG) or survivng (SG) at 1-year follow-up. Intergroup differences were assessed by the ann–Whitney U-test. Correlations were analysed by the Spearman rank est. Results. LG (n= 10) had a significantly (p< 0.05) higher difference etween TP in T1 and in T2 ( TP) than SG (n= 37) (31.55± 31.51 vs. .41± 33.16 g/mg dry liver, respectively). C4d hepatocyte immunohistohemistry was negative in both LG and SG T1 samples. LG (n= 9) showed significantly (p< 0.05) higher T2 C4d hepatocyte score than SG (n= 20) 4.44± 1.67 vs. 2.55± 2.28 C4d, respectively). A positive correlation was ound between T2 C4d hepatocyte score and TP (r= 0.547, p< 0.01). Conclusions. Early complement activation and impaired restoring of raft protein content after reperfusion are linked events in hepatic ischaemia eperfusion injury and are associated with graft loss within the first year after uman LT.

23 RECIPIENT MTHFR C677T POLYMORPHISM PREDICTS PRE-TRANSPLANT CIRRHOSIS PROGRESSION AND SURVIVAL AFTER LIVER TRANSPLANTATION S. Ginanni Corradini1, M.A. Burza1, F. Ferri1, A. Molinaro1, A. Cantafora1, I. Blotta1, M. Mordenti1, M.G. Mazzucconi2, G. Ferretti1, V. Giannelli1, M. Merli1, A.F. Attili1, P.B. Berloco1, M. Rossi1. Liver Transplant Unit and Dep of Cell. Biotechnology and Hematology, Sapienza Univ. of Rome, Italy

158 RESPONSE PREDICTION IN CHRONIC HEPATITIS C AFTER LIVER TRANSPLANT BY ASSESSMENT ENT-1-RELATED SINGLE NUCLEOTIDE POLYMORPHISMS V. Giannelli, U. Visco Comandini, M. Simmaco, M. Giusto, G. Gentile, L. Lionetto, S. Ginanni Corradini, A. Molinaro, E. Biliotti, A.F. Attili, G. Taliani, M. Merli. Clinical Medicine Div. Gastroenterology, Sapienza University of Rome, Infectious Diseases, National Institue for Infectious Disease, NESMOS Department, Advanced Molecular Diagnostic Unit, Sant’Andrea Hospital, Clinical Medicine Div. Infectious and Tropical Disease, Sapienza University of Rome, Rome, Italy E-mail: mr_valegiann84@hotmail.it

Background and Aim: Malnutrition and infections are frequent burdens in patients with end-stage liver disease and both have been demonstrated to impair prognosis. Moreover, a poor nutritional status has been associated with an increased susceptibility to infections in cirrhotic patients. The aim of the present study was to investigate the role of malnutrition on the outcome of cirrhotic patients with infections. Patients and Methods: Cirrhotic patients consecutively admitted at our university hospital in the last 24 months were enrolled. Protein malnutrition was defined as Mid-Arm Muscle Circumference below 5th percentile. Bacterial infections were actively searched. The onset of portal hypertension related complications (hepatic encephalopathy, variceal bleeding, hepato-renal-syndrome and hyponatremia) and the modification in liver function (MELD and CHILD) were analyzed during the infection. In-hospital and short term (6 weeks) follow up was considered. Results: One-hundred-two cirrhotic patients with infection (70% males; median age 64 yrs; median Child score 9 and MELD score 14) were evaluated. Malnutrition was diagnosed in 40% of patients. Malnourished patients were more frequently males (90% vs 56%) with similar age and degree of liver function vs not malnourished patients. Episodes of sepsis (61% vs 57%) and multi-drug-resistant infections (27% vs 43%) were not different between malnourished and not malnourished patients. Moreover, sites and epidemiology (community acquired, nosocomial, healthcare associated) of infections were also similar. The occurrence of portal hypertension related complications and the deterioration of liver function (MELD and CHILD) caused by the infection were similar in malnourished and not malnourished patients. In-hospital and short term (6 weeks) mortality rates were comparable in patients with and without malnutrition [(24% vs 25%, (p = 0.9) and 14% vs 17% (p = 0.5)]. Conclusions: While malnutrition increases the susceptibility for infections, the present data suggest that the impact of malnutrition on the outcomes and short term survival of cirrhotic patients with a concomitant infection is less relevant.

Background and Aim: Nosocomial infections represent a frequent and severe complication in cirrhotic patients. Predisposing factors for nosocomial infections in this patients have not been clearly identified. The aim of the present study was to assess the risk factors for nosocomial infections in cirrhotic patients. Material and Methods: Consecutive cirrhotic patients admitted at our University Hospital in the last 24 months were enrolled. Diagnosis of infection in the first 48 hours, concomitant HIV infection, immunosuppressive or steroid therapy were considered as exclusion criteria. All possible risk factors for the development of infections (severity of liver disease, variceal bleeding, hyponatremia, presence of TIPS, hospitalization in a room with additional bed, days of hospitalization, invasive procedures) were considered. Results: 238 patients were enrolled (66% males; median age 63 years; median Child score 8, MELD score 14). During the hospitalization, 43 nosocomial infectious episodes were recorded. The main infections were: urinary tract infection (40%), pneumonia (20%), spontaneous bacterial peritonitis (17%). Multidrug resistant bacteria were isolated in 45% of the cases. Patients who developed an infection during the hospitalization were more likely to present a worse liver function (MELD 15±8 vs 12±4; p< 0.01), to bear a TIPS (20% vs 7%; p = 0.05), to be hospitalized in a room with addictive bed (53% vs 19%; p< 0.01) and to undergone a major number of invasive procedures (2.7±2 vs 1.7±1.1; p = 0.01). Moreover, these patients were hospitalized for a longer time (25±17 vs 11±10). At the multivariate analysis, MELD score (p = 0.03; OR 1.1; IC 1.01-1.2), hospitalization in a room with an additional bed (p = 0.004; OR 2.9; IC 1.5-8) and a longer hospital stay (p = 0.001; OR 1.06; IC 1.021.1) were selected as independent factors for the development of nosocomial infections. Conclusions: Severity of liver disease and factors more strictly related to hospitalization, like duration and conditions of hospital stay, are significantly related to the development of nosocomial infections in cirrhotic patients. O9 BACTERIAL INFECTIONS INDUCE BOTH OVERT AND MINIMAL HEPATIC ENCEPHALOPATHY: RESULTS OF A PROSPECTIVE STUDY C. Lucidi, V. Di Gregorio, V. Giannelli, M. Giusto, I. Pentassuglio, C. Pasquale, S. Nardelli, A.F. Attili, O. Riggio, M. Merli. Gastroenterology, Department of Clinical Medicine, “Sapienza” University of Rome, Italy