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1. Cost-Utility Analysis of Transarterial Radioembolization With Yttrium-90 Resin Microspheres Compared With Sorafenib in Locally Advanced and Inoperable Hepatocellular Carcinoma

Author

Assenat, Eric, Delhom-Christol, Elisabeth, Guiu, Boris, Ilonca, Alina D., Lonjon, Julie, Pageaux, Georges-Philippe, Abdel-Rehim, Mohamed, Al-laham, Wassim, Bouattour, Mohamed, Castera, Laurent, Dieudonné, Arnaud, Lebtahi, Rachida, Ronot, Maxime, Sibert, Annie, Vilgrain, Valérie, Barraud, Hélène, Bazin, Christophe, Bronowicki, Jean-Pierre, Laurent, Valérie, Mathias, Elodie, Chagneau-Derrode, Carine, Perdrisot, Rémy, Silvain, Christine, Tasu, Jean-Pierre, RenéGerolami, Patrick Borentain, Mundler, Olivier, Seitz, Jean-Francois, Vidal, Vincent, Aubé, Christophe, Bouvier, Antoine, Couturier, Olivier, Oberti, Frédéric, Vervueren, Laurent, Brenot-Rossi, Isabelle, Raoul, Jean-Luc, Sar-ran, Anthony, Chalaye, Julia, Costentin, Charlotte, Itti, Emmanuel, Kobeiter, Hicham, Luciani, Alain, Adam, René, Lewin, Maïté, Samuel, Didier, Edeline, Julien, Garin, Etienne, Rolland, Yan, Archambeaud, Isabelle, Eugene, Thomas, Frampas, Eric, Cassinotto, Christophe, Guyot, Martine, Hiriart, Jean-Baptiste, Lapuyade, Bruno, Vergniol, Julien, Bachellier, Philippe, Detour, Julien, Duclos, Bernard, Greget, Michel, Habersetzer, Francois, Imperiale, Alessio, Merle, Philippe, Rode, Agnès, Morvan, Julie, Nguyen-Khac, Eric, Yzet, Thierry, Baudin, Guillaume, Chevallier, Patrick, Mahamat, Abakar, Piche, Thierry, Razzouk, Micheline, Hillon, Patrick, Loffroy, Romaric, Toubeau, Michel, Vincent, Julie, Barabino, Gabriele, Bouarioua, Nadia, Cuilleron, Muriel, Ecochard, Marie, Prevot-Bitot, Nathalie, Leroy, Vincent, Roux, Julie, Sengel, Christian, Bourcier, Valérie, Carrie, Nathalie Ganne, Seror, Olivier, Costo, Sylvie, Dao, Thông, Pelage, Jean-Pierre, Dumortier, Jérôme, Giammarile, Francesco, Valette, Pierre-Jean, Ghazzar, Nadia, Pellerin, Olivier, Taieb, Julien, Weinmann, Pierre, Berlot, Alexandra Heurgue, Marcus, Claude, Sommacale, Daniele, Castilla-Lièvre, Maria-Angéla, Maitre, Sophie, Marthey, Lysiane, Zarca, Kevin, Mimouni, Maroua, Pereira, Helena, Chatellier, Gilles, and Durand-Zaleski, Isabelle

Published
2021
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2. Tremelimumab plus Durvalumab in Unresectable Hepatocellular Carcinoma

Author

Ghassan K. Abou-Alfa, George Lau, Masatoshi Kudo, Stephen L. Chan, Robin Kate Kelley, Junji Furuse, Wattana Sukeepaisarnjaroen, Yoon-Koo Kang, Tu Van Dao, Enrico N. De Toni, Lorenza Rimassa, Valeriy Breder, Alexander Vasilyev, Alexandra Heurgué, Vincent C. Tam, Kabir Mody, Satheesh Chiradoni Thungappa, Yuriy Ostapenko, Thomas Yau, Sergio Azevedo, María Varela, Ann-Lii Cheng, Shukui Qin, Peter R. Galle, Sajid Ali, Michelle Marcovitz, Mallory Makowsky, Philip He, John F. Kurland, Alejandra Negro, and Bruno Sangro

Published
2022
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4. Sustained Remission After Treatment Withdrawal in Autoimmune Hepatitis: A Multicenter Retrospective Study

Author

Gérard Thiéfin, Pascal Renard, Anne Minello, Yasmina Ben Merabet, François Habersetzer, Solange Bresson-Hadni, Delphine Weil-Verhoeven, Thierry Thevenot, Brigitte Bernard-Chabert, Hélène Clot, Vincent Di Martino, Alexandra Heurgué-Berlot, Hervé Louvet, Didier Samuel, Coralie Barbe, Centre Hospitalier Universitaire de Reims (CHU Reims), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Institut de Recherche sur les Maladies Virales et Hépatiques (IVH), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Paul Brousse, and Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Physiology, Biopsy, Azathioprine, Autoimmune hepatitis, Sciences du Vivant [q-bio]/Médecine humaine et pathologie, Gastroenterology, Hepatitis, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Fibrosis, Recurrence, Internal medicine, medicine, Humans, Child, Aged, Retrospective Studies, medicine.diagnostic_test, business.industry, Remission Induction, Adrenal cortex hormones, Retrospective cohort study, Gamma globulin, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, [SDV.IMM.IMM]Life Sciences [q-bio]/Immunology/Immunotherapy, Middle Aged, Hepatology, medicine.disease, 3. Good health, Hepatitis, Autoimmune, Withholding Treatment, Liver, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, business, Immunosuppressive Agents, Follow-Up Studies, medicine.drug, Autoimmune
Abstract

BACKGROUND: In patients with autoimmune hepatitis (AIH), relapse rates between 25 and 100% after treatment withdrawal have been reported. The optimal strategy for immunosuppressive treatment withdrawal is controversial. AIM: To identify the predictive factors of histological remission and to assess the relapse rate after treatment withdrawal in AIH patients with prolonged biochemical response. METHODS: Patients with AIH and sustained biochemical remission on first-line treatment were retrospectively included. Histological response was defined as complete regression of interface hepatitis and lobular necrosis and no or minimal portal inflammation and relapse as any elevation of serum aminotransferase or gammaglobulin/IgG levels. RESULTS: Sixty-two patients were included. Forty-seven had a biopsy after a median biochemical response of 49.7 months. Twenty-five of them were histological responders. Independent predictors of histological remission were older age (OR = 1.1; CI 95%: 1.0; 1.2), mild-to-moderate fibrosis at diagnosis (OR = 8; CI: 1.4; 47.6) and aspartate aminotransferases

Published
2021
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5. Combination of fibrates with obeticholic acid is able to normalise biochemical liver tests in patients with difficult-to-treat primary biliary cholangitis

Author

Pietro Invernizzi, Dominique Larrey, Thomas Berg, Christine Silvain, Christina Weiler-Normann, Rodolphe Anty, Cervoni Jp, Albert Parés, Cynthia Levy, Olivier Chazouillères, Laurent Lam, Christophe Bureau, Isabelle Rosa-Hezode, Palak J. Trivedi, Christoph Schramm, Nora Cazzagon, Laurent Alric, Vincent Leroy, Alexandra Heurgué, Frederik Nevens, Jérôme Dumortier, Pierre Antoine Soret, Olivier Roux, Marco Carbone, Fabrice Carrat, Pascal Potier, Lena Smets, Christophe Corpechot, Gestionnaire, Hal Sorbonne Université, Centre de Référence des Maladies Rares - Maladies Inflammatoires des Voies Biliaires et Service d’Hépatologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de santé publique [CHU Saint-Antoine], University Hospitals Leuven [Leuven], Leipzig University, Università degli Studi di Milano-Bicocca = University of Milano-Bicocca (UNIMIB), Centre Hospitalier Universitaire [Grenoble] (CHU), University Hospitals Birmingham [Birmingham, Royaume-Uni], Azienda Ospedale Università di Padova = Hospital-University of Padua (AOUP), University Hospital Hamburg-Eppendorf, Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Centre Hospitalier Intercommunal de Créteil (CHIC), Centre Hospitalier Universitaire de Reims (CHU Reims), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Centre Hospitalier Régional d'Orléans (CHRO), Centre de référence des Maladies Vasculaires du Foie [Paris] (FILFOIE), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre Hospitalier Universitaire de Nice (CHU Nice), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), University of Miami Leonard M. Miller School of Medicine (UMMSM), Clinic Barcelona Hospital Universitari, Soret, P, Lam, L, Carrat, F, Smets, L, Berg, T, Carbone, M, Invernizzi, P, Leroy, V, Trivedi, P, Cazzagon, N, Weiler-Normann, C, Alric, L, Rosa-Hezode, I, Heurgue, A, Cervoni, J, Dumortier, J, Potier, P, Roux, O, Silvain, C, Bureau, C, Anty, R, Larrey, D, Levy, C, Pares, A, Schramm, C, Nevens, F, Chazouilleres, O, and Corpechot, C

Subjects
Liver Cirrhosis, medicine.medical_specialty, Cholagogues and Choleretics, Bilirubin, [SDV]Life Sciences [q-bio], Chenodeoxycholic Acid, Gastroenterology, chemistry.chemical_compound, Retrospective Studie, Internal medicine, Chenodeoxycholic acid, medicine, Humans, Pharmacology (medical), Cholagogues and Choleretic, ComputingMilieux_MISCELLANEOUS, Retrospective Studies, Bezafibrate, Fenofibrate, Hepatology, Liver Cirrhosis, Biliary, business.industry, Fibric Acids, Ursodeoxycholic Acid, Biliary, Obeticholic acid, Retrospective cohort study, Odds ratio, eye diseases, Ursodeoxycholic acid, Fibric Acid, [SDV] Life Sciences [q-bio], chemistry, business, Human, medicine.drug
Abstract

Background: Obeticholic acid (OCA) and fibrates are second-line therapies for patients with primary biliary cholangitis (PBC) with an inadequate response to ursodeoxycholic acid (UDCA). Aim: To know whether OCA and fibrates, administered together in combination with UDCA, have additive beneficial effects in patients with difficult-to-treat PBC. Methods: PBC patients treated for ≥3months with UDCA, OCA and fibrates (bezafibrate or fenofibrate) due to failure of either second-line therapy were included in a multicentre, uncontrolled retrospective cohort study. Changes in biochemical liver tests and pruritus were analysed using a generalised linear mixed-effect model. Results: Among 58 patients included, half received OCA as second-line and fibrates as third-line therapy (Group OCA-Fibrate), while the other half had the inverse therapeutic sequence (Group Fibrate-OCA). The mean duration of triple therapy was 11months (range 3-26). Compared to dual therapy, triple therapy was associated with a significant gain in alkaline phosphatase (ALP) reduction: 22% per first year (95% CI 12%-31%), an effect that was stronger in OCA-Fibrate than in Fibrate-OCA group. Triple therapy was associated with a 3.4 (95% CI 1.4-8.2) odds ratio (OR) of reaching normal ALP and with a significant decrease in gamma-glutamyl transpeptidase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin. The ORs of achieving the Paris-2 and Toronto criteria of adequate biochemical response were 6.8 (95% CI 2.8-16.7) and 9.2 (95% CI 3.4-25.1) respectively. Finally, triple therapy significantly improved pruritus in OCA-Fibrate but not in Fibrate-OCA group. Conclusions: Triple therapy with UDCA, OCA and fibrates is able to normalise biochemical liver tests and improve pruritus in patients with difficult-to-treat PBC.

Published
2021
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6. Extrahepatic autoimmune diseases in primary biliary cholangitis: Prevalence and significance for clinical presentation and disease outcome

Author

Fredrik Rorsman, Ellina Lytvyak, Mårten Werner, Aldo J. Montano-Loza, Fatema Alalkim, Benedetta Terziroli Beretta-Piccoli, Paolo Muratori, Thomas Berg, Thomas D. Schiano, Emma Nilsson, Tugrul Purnak, Ida Henriksson, David Semela, Staffan Wahlin, Eric M. Yoshida, Luigi Muratori, Alan Bonder, Murat Kiyici, Kristina Önnerhag, Janett Fischer, Ersan Ozaslan, Maneerat Chayanupatkul, Hanns-Ulrich Marschall, Murat Torgutalp, Claudia Coppo, Alexandra Heurgué-Berlot, Hirsh D. Trivedi, Nurhan Demir, Cumali Efe, Fatih Eren, Efe C., Torgutalp M., Henriksson I., Alalkim F., Lytvyak E., Trivedi H., Eren F., Fischer J., Chayanupatkul M., Coppo C., Purnak T., Muratori L., Werner M., Muratori P., Rorsman F., Onnerhag K., Nilsson E., Heurgue-Berlot A., Demir N., Semela D., Kiyici M., Schiano T.D., Montano-Loza A.J., Berg T., Ozaslan E., Yoshida E.M., Bonder A., Marschall H.-U., Beretta-Piccoli B.T., Wahlin S., Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı., CPU-6796-2022, and Eren, Fatih

Subjects
Male, Anti-nuclear antibody, PBC, Gastroenterology, Inflammatory bowel disease, 0302 clinical medicine, Lichen sclerosus et atrophicus, Antiphospholipid syndrome, Ascites, Undifferentiated connective tissue disease, Temporal arteritis, Myasthenia gravis, Hepatic encephalopathy, Hashimoto disease, Addison disease, Crohn disease, Pemphigus vulgaris, IgA nephropathy, Prognosis, Liver cell carcinoma, Management, Risk-factors, Retrospective study, Blood, Cirrhosis, Smooth muscle antibody, Biochemical response, Ursodeoxycholic acid, Primary biliary cirrhosis, 030220 oncology & carcinogenesis, Rheumatoid arthritis, Graves disease, Systemic sclerosis, 030211 gastroenterology & hepatology, Cohort analysis, Lichen planus, Anti-phospholipid syndrome, Human, Sex factor, medicine.medical_specialty, Cholangitis, Biliary Liver Cirrhosis, Obeticholic Acid, Sarcoidosis, Immunology, Major clinical study, Aspartate aminotransferase, Article, Dermatomyositis, Multiple sclerosis, 03 medical and health sciences, Humans, Clinical significance, Aspartate Aminotransferases, Autoimmune hemolytic anemia, Autoantibodies, Polymyositi, Ankylosing spondylitis, Bullous pemphigoid, Wegener granulomatosis, Medical record, Biliary cirrhosis, Follow up, medicine.disease, Event free survival, Ankylosing spondyliti, Ulcerative colitis, Pernicious anemia, Idiopathic thrombocytopenic purpura, Gastroenterology & hepatology, Complication, Biomarkers, Sarcoidosi, Autoantibody, Immunoglobulin A nephropathy, Autoimmune disease, Prevalence, Celiac disease, Middle aged, Variceal bleeding, Liver Cirrhosis, Biliary, Chronic urticaria, Mitochondria, Gastritis, Antibodies, Antinuclear, Female, medicine.symptom, Adult, Vitiligo, Autoimmune Diseases, Antinuclear antibody, Systemic lupus erythematosus, Sex Factors, Decompensated liver cirrhosis, Mitochondrion antibody, Internal medicine, Psoriasis, medicine, Multiple sclerosi, Collagenous colitis, Mitochondrion, Membranous glomerulonephritis, Hepatology, business.industry, Bleeding, Bilirubin, Polyarteritis nodosa, Alkaline Phosphatase, Polymyositis, Biological marker, business, Controlled study, Sjoegren syndrome
Abstract

Background and Aim: The prevalence and clinical significance of extrahepatic autoimmune diseases (EHAIDs) have not been evaluated in a large cohort of primary biliary cholangitis (PBC). Methods: The medical records of 1554 patients with PBC from 20 international centers were retrospectively reviewed. Development of decompensated cirrhosis (ascites, variceal bleeding, and/or hepatic encephalopathy) and hepatocellular carcinoma were considered clinical endpoints. Results: A total of 35 different EHAIDs were diagnosed in 440 (28.3%) patients with PBC. Patients with EHAIDs were more often female (92.5% vs 86.1%, P&nbsp

Published
2021

7. Absence de lien entre la densité de médecins généralistes et la survie des patients atteints de carcinome hépatocellulaire

Author

Daniele Sommacale, Moustapha Dramé, Gérard Thiéfin, Tullio Piardi, Brigitte Bernard-Chabert, Christine Hoeffel, Alexandra Heurgué, and Fabien Barrault

Subjects
Gynecology, medicine.medical_specialty, business.industry, Hepatocellular carcinoma, Public Health, Environmental and Occupational Health, medicine, In patient, medicine.disease, business
Abstract

Objectif : Determiner si la densite medicale (DM) de la zone de residence influencait la survie des patients atteints d’un carcinome hepatocellulaire (CHC) et le stade evolutif du CHC lors du diagnostic dans une region du Nord-Est de la France.Methodes : Cette etude retrospective a ete menee chez 246 patients atteints de CHC presentes consecutivement dans une reunion de concertation pluridisciplinaire (RCP) regionale dediee aux tumeurs hepatobiliaires du 27/03/2012 au 01/01/2016. Les informations suivantes etaient recueillies : donnees clinico-biologiques et radiologiques, densite des medecins generalistes (MG) de la zone de residence, stade evolutif du CHC, traitement. Les courbes de survie ont ete calculees par la methode de Kaplan-Meier et comparees par le test du log-rank.Resultats : Cinquante-et-un patients (20,7 %) residaient dans une zone de faible DM (2,2 a 6,8 MG/10 000 habitants) et 195 (79,3 %), dans une zone de haute DM (6,8 a 12,6 MG/10 000 habitants). La survie n’etait pas statistiquement differente entre les patients vivant en zones de basse et haute DM (survies medianes de 11,7 et 14,8 mois respectivement, p = 0,58). Le stade evolutif du CHC et le delai entre diagnostic et passage en RCP n’etaient pas significativement differents entre les deux zones etudiees.Conclusion : Dans cette etude menee chez des patients atteints de CHC et pris en charge dans un reseau pluridisciplinaire regional dedie aux tumeurs hepatobiliaires, la disparite de la DM de la zone de residence n’avait pas d’impact significatif sur la survie et le stade evolutif initial du CHC.

Published
2018
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8. Accuracy of calprotectin using the Quantum Blue Reader for the diagnosis of spontaneous bacterial peritonitis in liver cirrhosis

Author

Vincent Di Martino, Thomas Féron, Jean-Pierre Bronowicki, Karine Bardonnet, Céline Grandvallet, Sophie Chassagne, Elisabeth Monnet, Delphine Weil, Gérard Thiéfin, Alexandra Heurgué-Berlot, Jean-Paul Cervoni, Emilie Muel, and Thierry Thevenot

Subjects
medicine.medical_specialty, Cirrhosis, Hepatology, business.industry, medicine.disease, Gastroenterology, Asymptomatic, Bloody, 03 medical and health sciences, Liver disease, fluids and secretions, 0302 clinical medicine, Infectious Diseases, Spontaneous bacterial peritonitis, 030220 oncology & carcinogenesis, Positive predicative value, Internal medicine, Cytology, Medicine, 030211 gastroenterology & hepatology, Calprotectin, medicine.symptom, business
Abstract

AIM We aimed to evaluate the accuracy of the dosage of calprotectin in ascitic fluid (AF) using the Quantum Blue assay, for the prompt diagnosis of spontaneous bacterial peritonitis (SBP). METHODS We prospectively collected 236 AF samples from 119 cirrhotic patients hospitalized in two French centers between May 2016 and May 2017. Bloody and chylous/cloudy AF, and secondary peritonitis were excluded. SBP was diagnosed if neutrophils in AF were >250/mm3 using standard cytology. The Quantum Blue Reader selectively measured the calprotectin antigen (MRP8/14) in 12 min within the measurable range from 0.18 to 1.80 μg/mL; values outside this range were registered as 0.17 and 1.81 μg/mL. RESULTS A total of 36 AF were considered as SBP (15.2%). SBP had higher median levels of calprotectin than non-SBP (1.81 vs. 0.25 μg/mL, P

Published
2018
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9. Clinical implications of antimitochondrial antibody seropositivity in autoimmune hepatitis

Author

Alexandra Heurgué-Berlot, Ersan Ozaslan, Staffan Wahlin, Marco Lenzi, Thomas D. Schiano, Luigi Muratori, Claudine Lalanne, Cumali Efe, Paolo Muratori, Eric M. Yoshida, Muratori, Paolo, Efe, Cumali, Muratori, Luigi, Ozaslan, Ersan, Schiano, Thoma, Yoshida, Eric M., Heurgué-Berlot, Alexandra, Lalanne, Claudine, Lenzi, Marco, and Wahlin, Staffan

Subjects
Male, 0301 basic medicine, Cholangitis, medicine.medical_treatment, Autoimmune hepatitis, medicine.disease_cause, Gastroenterology, Serology, Autoimmunity, primary biliary cirrhosi, 0302 clinical medicine, immune system diseases, Child, autoimmune hepatiti, Aged, 80 and over, Univariate analysis, Immunosuppression, Middle Aged, autoantibodie, Mitochondria, Europe, Hepatitis, Autoimmune, Treatment Outcome, Child, Preschool, antimitochondrial antibodie, Antimitochondrial antibody, Female, 030211 gastroenterology & hepatology, Immunosuppressive Agents, Adult, medicine.medical_specialty, Adolescent, Young Adult, 03 medical and health sciences, Internal medicine, parasitic diseases, medicine, Humans, Serologic Tests, Clinical significance, Aged, Autoantibodies, Chi-Square Distribution, Hepatology, business.industry, Autoantibody, medicine.disease, digestive system diseases, Logistic Models, 030104 developmental biology, Case-Control Studies, North America, Immunology, business, Biomarkers
Abstract

Background/aim Antimitochondrial antibody (AMA) positivity is the serological marker of primary biliary cholangitis (PBC), but can also be sporadically detected in autoimmune hepatitis (AIH). Little is known about the clinical significance of AMA in AIH. Patients and methods We recruited 47 AMA-positive AIH cases from several centres and compared them with 264 well-characterized Italian AIH patients. Cases with any features of PBC were excluded. Results In univariate analysis, AMA-positive AIH patients were older (46 vs. 36, P=0.002) and more responsive to immunosuppression (74 vs. 59%, P=0.05), but no differences were observed between the two groups after logistic regression using AMA as a dependent variable. None of the AMA-positive AIH patients showed signs of evolving PBC features after a median follow-up of up 47 months. AMA was detected in combination with all serological AIH markers except antiliver kidney microsome type 1 and antiliver cytosol type 1. AMA was the only marker of autoimmunity in eight cases. Conclusion We found no differences between AIH with and without AMA. The groups had similar clinical, biochemical and histological features. AMA-positive AIH patients did not evolve towards PBC. In some cases, AMA was the only autoantibody.

Published
2017
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10. Validation of risk scoring systems in ursodeoxycholic acid-treated patients with primary biliary Cholangitis

Author

Fatema Alalkim, Benedetta Terziroli Beretta-Piccoli, Thomas Berg, Cumali Efe, Fulya Gunsar, Ellina Lytvyak, Janett Fischer, Fredrik Rorsman, Ali Riza Caliskan, Hanns-Ulrich Marschall, Kristina Önnerhag, Tugrul Purnak, Ida Henriksson, Maneerat Chayanupatkul, Claudia Coppo, Can Gonen, David Semela, Staffan Wahlin, Murat Kiyici, Ersan Ozaslan, Alexandra Heurgué-Berlot, Emma Nilsson, Alan Bonder, Koray Tascilar, Luigi Muratori, Fatih Güzelbulut, Murat Aladağ, Aldo J. Montano-Loza, Fatih Eren, Mårten Werner, Nurhan Demir, Henriette Ytting, Paolo Muratori, Thomas D. Schiano, Hirsh D. Trivedi, Eric M. Yoshida, Johanna Eliasson, Bursa Uludağ Üniversitesi/Tıp Fakültesi/Dahili Tıp Bilimleri., Eren, Fatih, AAS-6286-2020, Ege Üniversitesi, Efe C., Tascilar K., Henriksson I., Lytvyak E., Alalkim F., Trivedi H., Eren F., Eliasson J., Beretta-Piccoli B.T., Fischer J., Caliskan A.R., Chayanupatkul M., Coppo C., Ytting H., Purnak T., Muratori L., Werner M., Muratori P., Rorsman F., Onnerhag K., Gunsar F., Nilsson E., Heurgue-Berlot A., Guzelbulut F., Demir N., Gonen C., Semela D., Aladag M., Kiyici M., Schiano T.D., Montano-Loza A.J., Berg T., Ozaslan E., Yoshida E.M., Bonder A., Marschall H.-U., and Wahlin S.

Subjects
Male, Scoring system, Survival rate, Kaplan Meier method, Cholagogues and choleretics, Gastroenterology, 0302 clinical medicine, Cholagogue, Pathology, Histological progression, Treatment outcome, Child, Hepatic encephalopathy, Prognosis, Ursodeoxycholic acid, Multicenter study, Clinical trial, Retrospective study, Cirrhosis, Biochemical response, Primary biliary cirrhosis, liver, autoimmune, human, 030220 oncology & carcinogenesis, Predictive value of tests, Risk stratification, Disease Progression, Dose-response relationship, drug, Cohort studies, 030211 gastroenterology & hepatology, Cohort analysis, Human, medicine.medical_specialty, Sex factor, Cholangitis, Biliary Liver Cirrhosis, Obeticholic Acid, Major clinical study, Article, Adverse outcome, 03 medical and health sciences, Age, Severity of illness, Dose response, Humans, Disease exacerbation, Survival analysis, Confidence interval, Biliary cirrhosis, Follow up, Globe, digestive system diseases, Event free survival, United States, Retrospective studies, International cooperation, Gastroenterology & hepatology, Internationality, Survival, Middle aged, Priority journal, Risk assessment, Liver Cirrhosis, Biliary, Ascites, Validation study, Europe, Female, France, Sex factors, Age factors, medicine.drug, Adult, Canada, Proportional hazards models, Adolescent, Kaplan-Meier estimate, Hazard ratio, Placebo-controlled trial, Predictive value, macromolecular substances, Outcomes, Proportional hazards model, Internal medicine, medicine, Mortality, Hepatology, business.industry, Drug administration, Bleeding, Drug administration schedule, Retrospective cohort study, Severity of illness index, Spain, Bezafibrate, business, Prediction, Controlled study
Abstract

EgeUn###, INTRODUCTION: Risk stratification based on biochemical variables is a useful tool for monitoring ursodeoxycholic acid (UDCA)-treated patients with primary biliary cholangitis (PBC). Several UDCA response criteria and scoring systems have been proposed for risk prediction in PBC, but these have not been validated in large external cohorts. METHODS: We performed a study on data of 1746 UDCA-treated patients with PBC from 25 centers in Europe, United States, and Canada. The prognostic performance of the risk scoring systems (GLOBE and UK-PBC) and the UDCA response criteria (Barcelona, Paris I, Paris II, Rotterdam, and Toronto) were evaluated. We regarded cirrhosis-related complications (ascites, variceal bleeding, and/or hepatic encephalopathy) as clinical end points. RESULTS: A total of 171 patients reached a clinical end point during a median 7 years (range 1-16 years) of follow-up. The 5-, 10- and 15-year adverse outcome-free survivals were 95%, 85%, and 77%. The GLOBE and UK-PBC scores predicted cirrhosis-related complications better than the UDCA response criteria. The hazard ratio (HR) for a 1 standard deviation increase was HR 5.05 (95% confidence interval (CI): 4.43-5.74, P < 0.001) for the GLOBE score and HR 3.39 (95% CI: 3.10-3.72, P < 0.001) for the UK-PBC score. Overall, the GLOBE and UK-PBC risk scores showed similar and excellent prognostic performance (C-statistic, 0.93; 95% CI: 0.91%-95% vs 0.94; 95% CI: 0.91%-0.96%). DISCUSSION: In our international, multicenter PBC cohort, the GLOBE and UK-PBC risk scoring systems were good predictors of future cirrhosis-related complications.

Published
2019

11. Signet Ring Cells and Efficacy of First-line Chemotherapy in Advanced Gastric or Oesogastric Junction Adenocarcinoma

Author

Olivier Bouché, Antoine Adenis, Alexandra Heurgué, Alain Duhamel, Eric Yaovi Amela, Nathalie Lemoine, Emmanuelle Leteurtre, Julia Salleron, and Mohamed Hebbar

Subjects
Adult, Male, 0301 basic medicine, Oncology, Cancer Research, medicine.medical_specialty, medicine.medical_treatment, Antineoplastic Agents, Adenocarcinoma, 03 medical and health sciences, 0302 clinical medicine, Stomach Neoplasms, Internal medicine, Overall survival, Humans, Medicine, Objective response, Aged, Chemotherapy, business.industry, Signet ring cell, Hazard ratio, General Medicine, Middle Aged, Prognosis, medicine.disease, Survival Rate, 030104 developmental biology, 030220 oncology & carcinogenesis, Female, Esophagogastric Junction, First line chemotherapy, business, Carcinoma, Signet Ring Cell, Proto-oncogene tyrosine-protein kinase Src
Abstract

AIM To evaluate the efficacy of first-line palliative chemotherapy, regarding the presence of signet ring cells (SRC). PATIENTS AND METHODS Retrospective analysis of consecutive patients with locally advanced or metastatic gastric or oesogastric junction adenocarcinoma who received first-line chemotherapy. Response to chemotherapy, progression-free survival (PFS) and overall survival (OS) were compared between SRC and non-SRC (NSRC) groups. RESULTS Two hundred and three patients were treated, with 57 (28%) having SRC adenocarcinoma. Objective response rate was significantly lower in SRC patients (5.3% vs. 28.1%, p=0.0004). PFS was not significantly different between SRC and NSRC patients (median=3.8 vs. 4.9 months, p=0.07). OS was significantly shorter in SRC patients (median=5.6 vs. 9.4 months, p

Published
2016
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12. Pharmacokinetics, safety and efficacy of a full dose sofosbuvir-based regimen given daily in hemodialysis patients with chronic hepatitis C

Author

Stanislas Harent, Brigitte Bernard Chabert, Dominique Salmon, Sophie Hillaire, Alexandra Heurgué-Berlot, Adriana Pinto, Minh Patrick Lê, Diane Descamps, Gilles Peytavin, David Zucman, Yazdan Yazdanpanah, Anne-Marie Simonpoli, Patrice Muret, Anne Gervais, Achour Laradi, Lucile Larrouy, Aude Desnoyer, Dan Pospai, and Hélène Fontaine

Subjects
Ledipasvir, Simeprevir, medicine.medical_specialty, Daclatasvir, Hepatology, Sofosbuvir, business.industry, medicine.medical_treatment, 030232 urology & nephrology, Hepatitis C, medicine.disease, End stage renal disease, 03 medical and health sciences, chemistry.chemical_compound, Regimen, 0302 clinical medicine, chemistry, Internal medicine, medicine, 030211 gastroenterology & hepatology, Hemodialysis, business, Intensive care medicine, medicine.drug
Abstract

Background & Aims Hepatitis C virus (HCV) infection is an independent risk factor for chronic kidney disease and leads to faster liver disease progression in patients requiring hemodialysis than in those with normal renal function. Little is known about the use of a sofosbuvir-containing regimen for infected patients on hemodialysis. We aimed to describe the pharmacokinetics, safety and efficacy of sofosbuvir in 2 dosing regimens and associated antiviral agents in HCV-infected patients requiring hemodialysis. Methods Multicenter, prospective and observational study of patients receiving sofosbuvir, 400mg once daily (n=7) or 3 times a week (n=5), after hemodialysis with simeprevir, daclatasvir, ledipasvir or ribavirin was conducted. Drug plasma concentrations were determined by liquid chromatography-tandem mass spectrometry before and after a 4h hemodialysis and 1.5h after last drug intake at the end of hemodialysis. Results Plasma concentrations of sofosbuvir or its inactive metabolite sofosbuvir-007 did not accumulate with either regimen between hemodialysis sessions or throughout the treatment course. Sofosbuvir-007 extraction ratio (52%) was consistent with historical data. In one patient receiving the once daily regimen, sofosbuvir-007 half-life was slightly higher (38h) than for patients with normal renal function receiving a full dose. Hemodialysis did not remove any other associated anti-HCV agents. Clinical and biological tolerance was good for all patients. Two relapses occurred with the 3 times a week regimen and none with the once daily. Conclusions A regimen including sofosbuvir, 400mg once daily, could be proposed for HCV-infected patients requiring hemodialysis and should be associated with close clinical, biological, cardiovascular, and therapeutic drug monitoring. Lay summary Hepatitis C Virus (HCV) infection in hemodialysis patients is prevalent and aggressive. Effective anti-HCV treatment in these patients may stabilize their renal disease. However, sofosbuvir, the cornerstone of most anti-HCV–containing regimens, should not be administered to these patients until more data is available. In this pharmacokinetic study, sofosbuvir full dose (400mg once daily) administered every day with another direct antiviral agent did not accumulate in hemodialysis patients and was safe and effective.

Published
2016
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13. FRI-002-Sustained remission after treatment withdrawal in autoimmune hepatitis: A multicenter retrospective study

Author

Delphine Weil-Verhoeven, Coralie Barbe, Anne Minello Franza, Solange Bresson hadni, Thierry Thevenot, Didier Samuel, Hélène Clot, Yasmina Ben Merabet, Gérard Thiéfin, François Habersetzer, Vincent Di Martino, Pascal Renard, Brigitte Bernard Chabert, Hervé Louvet, and Alexandra Heurgué-Berlot

Subjects
medicine.medical_specialty, Hepatology, business.industry, Internal medicine, medicine, Retrospective cohort study, Autoimmune hepatitis, Sustained remission, business, medicine.disease, After treatment
Published
2019
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14. A Placebo-Controlled Trial of Bezafibrate in Primary Biliary Cholangitis

Author

Jean-Pierre Zarski, Raoul Poupon, Christine Silvain, Victor de Ledinghen, Dominique Rainteau, Sylvie Chollet-Martin, Fabien Zoulim, Odile Goria, Armand Abergel, Gisèle N'Kontchou, Pascal Potier, François Habersetzer, Guillaume Lefèvre, Anne Minello, Farid Gaouar, Olivier Roux, Eric Nguyen-Khac, Olivier Chazouillères, Jérôme Boursier, Lydie Humbert, Jean-Pierre Bronowicki, Isabelle Ollivier-Hourmand, Sara Lemoinne, Maryline Debette-Gratien, Dominique Larrey, Christophe Corpechot, Luc de Chaisemartin, Philippe Mathurin, Alexandra Rousseau, Alexandra Heurgué-Berlot, Farid-Hakeem Admane, Tabassome Simon, Antonia Le Gruyer, Institut de Recherche sur les Maladies Virales et Hépatiques (IVH), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Référence des Maladies Rares - Maladies Inflammatoires des Voies Biliaires et Service d’Hépatologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche Clinique de l’Est Parisien [CHU Saint-Antoine] (URC-EST), Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts (CHNO)-CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Saint-Antoine [AP-HP], CHU Pontchaillou [Rennes], Centre Hospitalier Universitaire [Rennes], Hôpital Claude Huriez [Lille], CHU Lille, CHU Rouen, Normandie Université (NU), Service d'hépato-gastro-entérologie et oncologie digestive [CHR Orléans], Centre Hospitalier Régional d'Orléans (CHRO), Service d'Hépato-Gastro-Entérologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre hospitalier universitaire de Poitiers (CHU Poitiers), CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Service d'Hépato-Gastro-Entérologie et Nutrition [CHU Limoges], CHU Limoges, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service d’Hépatologie [Hôpital Beaujon], Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire de Nancy (CHU Nancy), Service d’Hépato-Gastroentérologie [CHU Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), Université d'Angers (UA), Service d'hépato-gastro-entérologie [CHU Haut-Lévêque], Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux], Hôpital Robert Debré, Service d'Hépato-gastroentérologie, 51092 Reims, France, affiliation inconnue, Service d'Hépato-gastroentérologie [CHU Amiens-Picardie], CHU Amiens-Picardie, Service d'Hépatologie [Hôpital de la Croix-Rousse - HCL], Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service d'Hépato-Gastro-Enterologie et Nutrition [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Service d'hépato-gastroentérologie [CHU Grenoble Alpes], Centre Hospitalier Universitaire Grenoble Alpes (CHU Grenoble Alpes), Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris-Sud - Paris 11 (UP11), Laboratoire des biomolécules (LBM UMR 7203), Centre National de la Recherche Scientifique (CNRS)-Sorbonne Université (SU)-Département de Chimie - ENS Paris, École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Chimie Moléculaire de Paris Centre (FR 2769), Institut de Chimie du CNRS (INC)-École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Ecole Superieure de Physique et de Chimie Industrielles de la Ville de Paris (ESPCI Paris), Université Paris sciences et lettres (PSL)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Laboratoire d'Immunologie 'Autoimmunité et Hypersensibilités' [AP-HP Hôpital Bichat, Paris], AP-HP - Hôpital Bichat - Claude Bernard [Paris], and Sorbonne Université (SU)

Subjects
Liver Cirrhosis, Male, Cirrhosis, Cholangitis, Biliary/complications/drug therapy, Obeticholic Acid, Placebo-controlled study, Gastroenterology, Placebos, chemistry.chemical_compound, Liver disease, 0302 clinical medicine, Treatment Failure, Bezafibrate/adverse effects/*therapeutic use, Multicenter, Hypolipidemic Agents/adverse effects/*therapeutic use, Hypolipidemic Agents, Combination Therapy, medicine.diagnostic_test, Liver Cirrhosis, Biliary, Ursodeoxycholic Acid, Obeticholic acid, General Medicine, Middle Aged, Prognosis, Ursodeoxycholic acid, 3. Good health, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, medicine.drug, Adult, medicine.medical_specialty, Outcomes, Placebo, Biochemical Response, Bile Acids and Salts, 03 medical and health sciences, Double-Blind Method, Internal medicine, medicine, Cholangitis/*drug therapy/etiology, Humans, Placebos/therapeutic use, Prothrombin time, Bezafibrate, business.industry, Ursodeoxycholic Acid/therapeutic use, medicine.disease, Renal-Function, Bile Acids and Salts/blood, chemistry, Fenofibrate Therapy, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

IF 79.258 (2017); International audience; Background : Patients with primary biliary cholangitis who have an inadequate response to therapy with ursodeoxycholic acid are at high risk for disease progression. Fibrates, which are agonists of peroxisome proliferator–activated receptors, in combination with ursodeoxycholic acid, have shown potential benefit in patients with this condition.Methods : In this 24-month, double-blind, placebo-controlled, phase 3 trial, we randomly assigned 100 patients who had had an inadequate response to ursodeoxycholic acid according to the Paris 2 criteria to receive bezafibrate at a daily dose of 400 mg (50 patients), or placebo (50 patients), in addition to continued treatment with ursodeoxycholic acid. The primary outcome was a complete biochemical response, which was defined as normal levels of total bilirubin, alkaline phosphatase, aminotransferases, and albumin, as well as a normal prothrombin index (a derived measure of prothrombin time), at 24 months.Results : The primary outcome occurred in 31% of the patients assigned to bezafibrate and in 0% assigned to placebo (difference, 31 percentage points; 95% confidence interval, 10 to 50; P

Published
2018
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15. Estimated risk reduction of mortality and transplantation with bezafibrate in patients with PBC and inadequate response to UDCA: application of the UK-PBC and Global PBC risk scores to the BEZURSO trial

Author

R. Olivier, Jérôme Boursier, Fabien Zoulim, Odile Goria, M.D. Gratien, Dominique Larrey, Armando Abergel, Tabassome Simon, P. Mathurin, Alexandra Heurgué-Berlot, Eric Nguyen-Khac, Olivier Chazouillères, L.G. Antonia, F.-H. Admane, N. Gisèle, Christophe Corpechot, Jean-Pierre Bronowicki, Alexandra Rousseau, Anne Minello Franza, C. Silvain, François Habersetzer, O.-H. Isabelle, P. Pascal, R.E. Poupon, V. de Ledinghen, Gaouar Farid, and Jean-Pierre Zarski

Subjects
Transplantation, Reduction (complexity), medicine.medical_specialty, Bezafibrate, Hepatology, business.industry, Internal medicine, medicine, In patient, business, Gastroenterology, medicine.drug
Published
2018
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16. Profiling serologic biomarkers in cirrhotic patients via high-throughput Fourier transform infrared spectroscopy: toward a new diagnostic tool of hepatocellular carcinoma

Author

Patrick Hillon, Gérard Thiéfin, Patrick Ducoroy, Ganesh D. Sockalingum, Valérie Untereiner, Caroline Truntzer, Cyril Gobinet, Imane Taleb, Alexandra Heurgué, Brigitte Bernard-Chabert, and Xiaoqing Zhang

Subjects
Male, medicine.medical_specialty, Pathology, Carcinoma, Hepatocellular, Disease detection, Protein Array Analysis, Pattern analysis, Pilot Projects, Sensitivity and Specificity, Gastroenterology, Serology, Serum biomarkers, Physiology (medical), Internal medicine, Spectroscopy, Fourier Transform Infrared, Biomarkers, Tumor, medicine, Humans, Fourier transform infrared spectroscopy, Aged, business.industry, Liver Neoplasms, Biochemistry (medical), Public Health, Environmental and Occupational Health, General Medicine, Middle Aged, medicine.disease, Serum samples, Fibrosis, Hepatocellular carcinoma, Female, Alpha-fetoprotein, business
Abstract

Identification of novel serum biomarkers of hepatocellular carcinoma (HCC) is needed for early-stage disease detection and to improve patients' survival. The aim of this study was to evaluate the potential of serum Fourier transform infrared (FTIR) spectroscopy for differentiating sera from cirrhotic patients with and without HCC. Serum samples were collected from 2 sets of patients: cirrhotic patients with HCC (n = 39) and without HCC (n = 40). The FTIR spectra (10 per sample) were acquired in the transmission mode, and data homogeneity was tested by cluster analysis to exclude outliers. After data preprocessing by extended multiplicative signal correction and principal component analysis, the Support Vector Machine (SVM) method was applied using a leave-one-out cross-validation algorithm to classify the spectra into 2 classes of cirrhotic patients with and without HCC. When SVM was applied to all spectra (n = 790), the sensitivity and the specificity for the diagnosis of HCC were, respectively, 82.02% and 82.5%. When applied to the subset of spectra excluding the outliers (n = 739), SVM classification led to a sensitivity and specificity of 87.18% and 85%, respectively. Using median spectra for each patient instead of all replicates, the sensitivity and specificity were 84.62% and 82.50%, respectively. The overall accuracy rate was 82%-86%. In conclusion, this study suggests that FTIR spectroscopy combined with advanced methods of pattern analysis shows potential for differentiating sera from cirrhotic patients with and without HCC.

Published
2013
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17. A 2-year multicenter, double-blind, randomized, placebo-controlled study of bezafibrate for the treatment of primary biliary cholangitis in patients with inadequate biochemical response to ursodeoxycholic acid therapy (Bezurso)

Author

Eric Nguyen-Khac, Olivier Chazouillères, Dominique Larrey, Isabelle Ollivier-Hourmand, Armando Abergel, Alexandra Rousseau, Tabassome Simon, Anne Minello, François Habersetzer, Christophe Corpechot, Dominique Guyader, Fabien Zoulim, Odile Goria, Olivier Roux, Gisèle N'Kontchou, Jean-Pierre Bronowicki, C. Silvain, Farid Gaouar, Jean-Pierre Zarski, R.E. Poupon, V. de Ledhingen, Patrick Potier, Alexandra Heurgué-Berlot, Maryline Debette-Gratien, P. Mathurin, Jérôme Boursier, Maladies fibro-inflammatoires d’origine métabolique et biliaire du foie [CRSA], Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Unité de Technologies Chimiques et Biologiques pour la Santé (UTCBS - UM 4 (UMR 8258 / U1022)), Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service d'hépato-gastro-entérologie [Rennes] = Gastroenterology [Rennes], CHU Pontchaillou [Rennes], Interactions Virus-Hôte et Maladies Hépatiques, Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Virologie, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'Hépato-Gastroentérologie [CHU Rouen], Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Centre Hospitalier Régional d'Orléans (CHRO), Service d'Hépato-Gastro-Entérologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Laboratoire Inflammation, Tissus épithéliaux et Cytokines (LITEC), Université de Poitiers, Institut d'astrophysique spatiale (IAS), Université Paris-Sud - Paris 11 (UP11)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Centre National d’Études Spatiales [Paris] (CNES), Service d'Hépatologie Gastro-entérologie [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Service d'Hépato-Gastro-Entérologie et Nutrition [CHU Limoges], CHU Limoges, Cellules souches normales et cancéreuses, Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Département d'Hépato-Gastroentérologie et de Transplantation Hépatique [CHU Saint-Eloi], Hôpital Saint Eloi (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université de Montpellier (UM), Service d’Hépatologie [Hôpital Beaujon], Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service d'Hépato-gastro-entérologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), Université d'Angers (UA), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Bordeaux [Bordeaux], Centre Hospitalier Universitaire de Reims (CHU Reims), Groupe de Recherche sur l'alcool et les pharmacodépendances - UMR INSERM_S 1247 (GRAP), Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Hépato Gastroenterologie [CHU Amiens-Picardie], CHU Amiens-Picardie, Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CIC AP-HP (hegp Ex-Broussais)/inserm, Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Hépato-Gastro-Enterologie et Nutrition [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre Hospitalier Universitaire [Grenoble] (CHU), Hôpital Jean Verdier [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)

Subjects
medicine.medical_specialty, Bezafibrate, animal structures, Hepatology, business.industry, health care facilities, manpower, and services, [SDV]Life Sciences [q-bio], education, Placebo-controlled study, Gastroenterology, Ursodeoxycholic acid, Double blind, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Internal medicine, medicine, 030211 gastroenterology & hepatology, In patient, business, health care economics and organizations, medicine.drug
Abstract

International Liver Congress / 52nd Annual Meeting of the European-Association-for-the-Study-of-the-Liver-Disease, Amsterdam, NETHERLANDS, APR 19-23, 2017; International audience

Published
2017
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18. Efficacy and Safety of Mycophenolate Mofetil and Tacrolimus as Second-line Therapy for Patients With Autoimmune Hepatitis

Author

Rahima A. Bhanji, Daniel Klintman, Hanns-Ulrich Marschall, Eric M. Yoshida, Albert Parés, Thomas D. Schiano, Aldo J. Montano-Loza, Niklas F. Müller, Fin Stolze Larsen, Mustafa Cengiz, Cumali Efe, Mårten Werner, Xiong Ma, Fulya Gunsar, Tugrul Purnak, Hannes Hagström, Henriette Ytting, Michael A. Heneghan, Staffan Wahlin, Michele M. Tana, Qixia Wang, Sumita Verma, Ersan Ozaslan, Luigi Muratori, Paolo Muratori, Thomas Berg, Alexandra Heurgué-Berlot, Ege Üniversitesi, Efe, C, Hagström, H, Ytting, H, Bhanji, Ra, Müller, Nf, Wang, Q, Purnak, T, Muratori, Luigi, Werner, M, Marschall, Hu, Muratori, Paolo, Gunşar, F, Klintman, D, Parés, A, Heurgué-Berlot, A, Schiano, Td, Cengiz, M, May-Sien Tana, M, Ma, X, Montano-Loza, Aj, Berg, T, Verma, S, Larsen, F, Ozaslan, E, Heneghan, Ma, Yoshida, Em, and Wahlin, S.

Subjects
Male, medicine.medical_treatment, Azathioprine, Autoimmune hepatitis, Liver transplantation, Mycophenolate, Gastroenterology, 0302 clinical medicine, Medicine, Child, Autoimmune Liver Disease, Middle Aged, Europe, Hepatitis, Autoimmune, Treatment Outcome, surgical procedures, operative, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Immunosuppressive Agents, psychological phenomena and processes, medicine.drug, Adult, inorganic chemicals, Canada, China, medicine.medical_specialty, Standard of care, Adolescent, Drug-Related Side Effects and Adverse Reactions, behavioral disciplines and activities, Tacrolimus, Young Adult, 03 medical and health sciences, Internal medicine, otorhinolaryngologic diseases, Humans, Autoimmune liver disease, Aged, Retrospective Studies, Simplified Criteria, Second-line therapy, Hepatology, business.industry, Mycophenolic Acid, medicine.disease, United States, Liver Transplantation, Immunology, sense organs, business, Liver Failure, RC
Abstract

WOS: 000415165200027, PubMed ID: 28603052, BACKGROUND & AIMS: Predniso(lo) ne, alone or in combination with azathioprine, is the standard-of-care (SOC) therapy for autoimmune hepatitis (AIH). However, the SOC therapy is poorly tolerated or does not control disease activity in up to 20% of patients. We assessed the efficacy of mycophenolate mofetil (MMF) and tacrolimus as second-line therapy for patients with AIH. METHODS: We performed a retrospective study of data (from 19 centers in Europe, the United States, Canada, and China) from 201 patients with AIH who received second-line therapy (121 received MMF and 80 received tacrolimus), for a median of 62 months (range, 6-190 mo). Patients were categorized according to their response to SOC. Patients in group 1 (n = 108) had a complete response to the SOC, but were switched to second-line therapy as a result of side effects of predniso(lo) ne or azathioprine, whereas patients in group 2 (n = 93) had not responded to SOC. RESULTS: There was no significant difference in the proportion of patients with a complete response to MMF (69.4%) vs tacrolimus (72.5%) (P = .639). In group 1, MMF and tacrolimus maintained a biochemical remission in 91.9% and 94.1% of patients, respectively (P = .682). Significantly more group 2 patients given tacrolimus compared with MMF had a complete response (56.5% vs 34%, respectively; P = .029) There were similar proportions of liver-related deaths or liver transplantation among patients given MMF (13.2%) vs tacrolimus (10.3%) (log-rank, P = .472). Ten patients receiving MMF (8.3%) and 10 patients receiving tacrolimus (12.5%) developed side effects that required therapy withdrawal. CONCLUSIONS: Long-term therapy with MMF or tacrolimus generally was well tolerated by patients with AIH. The agents were equally effective in previous complete responders who did not tolerate SOC therapy. Tacrolimus led to a complete response in a greater proportion of previous nonresponder patients compared with MMF.

Published
2017
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19. The Periscreen Strip Is Highly Efficient for the Exclusion of Spontaneous Bacterial Peritonitis in Cirrhotic Outpatients

Author

Alexandre Louvet, Olivier Roux, Matthieu Schnee, Arnaud Pauwels, L. Elkrief, Marie Angèle Robic, Thong Dao, Eric Nguyen-Khac, Brigitte Bernard-Chabert, Jean-Baptiste Nousbaum, Si Ahmed Si Nafa, Vincent Macé, Delphine Weil, Vincent Di Martino, Valéry-Pierre Riche, Mourad Medmoun, Rodolphe Anty, Caroline Jezequel, Roger Faroux, Alexandra Heurgué-Berlot, Aurélie Le Thuaut, Nicolas Carbonell, Florence Tanné, Mehdi Kaassis, Edouard Bardou-Jacquet, Karim Aziz, Ghassan Riachi, Denis Grasset, Jean-Paul Cervoni, Thierry Thevenot, Sofia Hermann, Isabelle Ollivier-Hourmand, Christophe Bureau, Gérard Thiéfin, Hortensia Lison, Angh Cfehtp, Yasmina Belouchrani, Thomas Mouillot, Clémence M. Canivet, Charline Briot, H. Labadie, Jean-François Cadranel, Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Group Hospitalier public Sud Oise GHPSO (Creil), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital universitaire Robert Debré [Reims], CHU Toulouse [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Service des Maladies de l'Appareil Digestif, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Hépato-Gastroentérologie [CHU Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier de Gonesse, Service d’Hépato-Gastroentérologie [CHU Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Centre méditerranéen de médecine moléculaire (C3M), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA), Département Digestif, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital de l'Archet, Service d'Hépato-gastro-entérologie [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Bordeaux (UB), Groupe de Recherche sur l'alcool et les pharmacodépendances - UMR INSERM_S 1247 (GRAP), Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST ), Centre des Sciences du Goût et de l'Alimentation [Dijon] (CSGA), Institut National de la Recherche Agronomique (INRA)-Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Centre National de la Recherche Scientifique (CNRS), Méthodes Formelles pour la Bioinformatique (MéForBio), Laboratoire des Sciences du Numérique de Nantes (LS2N), IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Nantes - UFR des Sciences et des Techniques (UN UFR ST), Université de Nantes (UN)-Université de Nantes (UN)-École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Université de Nantes (UN)-Université de Nantes (UN)-École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS), Laboratoire d'Investigation Clinique (LIC), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Service d'hépato-gastroentérologie, Centre Hospitalier Laennec de Creil, Service de gastroentérologie (CHD Vendee - Hopital Les Oudairies, La Roche Sur Yon), CHD Vendee (La Roche Sur Yon), Service d'Hépatologie [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Robert Debré, Service d'Hépato-gastroentérologie, 51092 Reims, France, affiliation inconnue, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Toulouse (UT), Service des Maladies de l'Appareil Digestif [CHU Rennes], CHU Pontchaillou [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Université Nice Sophia Antipolis (1965 - 2019) (UNS), Centre Hospitalier de Saint-Denis [Ile-de-France], Service d'Hépato-Gastro-Entérologie (CHU de Dijon), and Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)

Subjects
Liver Cirrhosis, Male, medicine.medical_specialty, Neutrophils, [SDV]Life Sciences [q-bio], Peritonitis, Sensitivity and Specificity, Gastroenterology, Leukocyte Count, 03 medical and health sciences, 0302 clinical medicine, Spontaneous bacterial peritonitis, Predictive Value of Tests, Internal medicine, Ambulatory Care, medicine, Ascitic Fluid, Humans, Paracentesis, Prospective Studies, Aged, Hepatology, business.industry, Ascites, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Bacterial Infections, Middle Aged, medicine.disease, Logistic Models, 030220 oncology & carcinogenesis, Multivariate Analysis, Leukocytes, Mononuclear, Colorimetry, Female, 030211 gastroenterology & hepatology, business
Abstract

International audience; OBJECTIVES: We aimed to assess the performance of a new strip (Periscreen) for the rapid diagnosis of spontaneous bacterial peritonitis (SBP). METHODS: Ascitic fluid (AF) of cirrhotic patients hospitalized between March 2014 and August 2015 was independently tested by two readers using the new strip, which has four colorimetric graduations (negative, trace, small, and large). SBP was diagnosed on neutrophils in ascites>250/mm(3). Ascites not related to portal hypertension were excluded. RESULTS: Overall, 649 patients from 21 French centers were included and 1,402 AF (803 AF samples from 315 outpatients and 599 samples from 334 inpatients) were assessed. Eighty-four AF samples (17 AF in 9 outpatients and 67 AF in 31 inpatients) were diagnosed as SBP. The prevalence of SBP was 6% (2.1% in outpatients vs. 11.2% in inpatients; P

Published
2016
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20. The Quick SOFA, a simple bedside score, identifies hospitalized cirrhotic patients with poor outcomes

Author

Frédéric Oberti, C. Bureau, J.-P. Cervoni, Claire Vanlemmens, Thong Dao, Violaine Ozenne, Marika Rudler, C. Richou, N. Talbodec, Philippe Saas, Vincent Di Martino, Aurélie Plessier, Gaël Piton, Delphine Weil, Isabelle Rosa, Thierry Thevenot, Emilie Muel, Rodolphe Anty, Alexandre Louvet, and Alexandra Heurgué-Berlot

Subjects
03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, Hepatology, business.industry, Medicine, 030208 emergency & critical care medicine, 030212 general & internal medicine, business, Intensive care medicine, Simple (philosophy)
Published
2017
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21. Effect of albumin in cirrhotic patients with infection other than spontaneous bacterial peritonitis. A randomized trial

Author

Alexandra Heurgué-Berlot, Elisabeth Monnet, Thong Dao, Xavier Causse, François Guillemot, Anne Minello, Aurélie Plessier, Odile Goria, Eric Nguyen-Khac, Naceur Abdelli, Danielle Botta-Fridlung, Roland Amathieu, Thierry Paupard, Frédéric Oberti, Christophe Bureau, Vincent Di Martino, Violaine Ozenne, Marika Rudler, Victor de Ledinghen, Hélène Barraud, Thierry Thevenot, Nicolas Carbonell, Alexandre Louvet, Isabelle Rosa, N. Talbodec, Rodolphe Anty, C. Becker, CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'hépatologie [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service Hépato-gastro-entérologie et oncologie digestive [CHR Orléans], Centre Hospitalier Régional d'Orléans (CHRO), CHU Rouen, Normandie Université (NU), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'investigation de la fibrose hépatique [CHU de Bordeaux] (Hôpital Haut-Lévêque ), Hôpital Haut-Lévêque [CHU de Bordeaux], Service d'Anesthésie et des Réanimations Chirurgicales, Centre Hospitalier Universitaire Henri Mondor-Université Paris Est Créteil Val de Marne (Paris 12) (UPEC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service d'Hépatogastroentérologie, CHU Amiens-Picardie, Service d’Hépato-Gastroentérologie, Centre Hospitalier de Lens, Centre Hospitalier de Dunkerque, Centre Hospitalier de Roubaix, Centre d'Investigation Clinique de Besançon (Inserm CIC 1431), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté]), Agents pathogènes et inflammation - UFC (EA 4266) (API), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service d'hépatologie, Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), CHU Toulouse [Toulouse], Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), Université d'Angers (UA), Centre méditerranéen de médecine moléculaire (C3M), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département Digestif, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital de l'Archet, Lille Inflammation Research International Center - U 995 (LIRIC), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Hôpital Beaujon, Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Robert Debré, Service d'Hépato-gastroentérologie, 51092 Reims, France, affiliation inconnue, CHI Créteil, Service d'Hépato-gastro-entérologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])-Université de Franche-Comté (UFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS BFC)-Université de Franche-Comté (UFC), and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)

Subjects
Adult, Male, Liver Cirrhosis, medicine.medical_specialty, Infusions, Survival rate, [SDV]Life Sciences [q-bio], Renal function, Kidney Function Tests, Gastroenterology, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Spontaneous bacterial peritonitis, Liver Function Tests, Internal medicine, Albumins, Sepsis, Clinical endpoint, Medicine, Humans, Renal Insufficiency, Infusions, Intravenous, Creatinine, Hepatology, medicine.diagnostic_test, business.industry, Acute kidney injury, Bacterial Infections, Middle Aged, medicine.disease, 3. Good health, Surgery, Anti-Bacterial Agents, Treatment Outcome, chemistry, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, business, Liver function tests, Hyponatremia, Intravenous
Abstract

International audience; BACKGROUND & AIMS: Albumin infusion improves renal function and survival in cirrhotic patients with spontaneous bacterial peritonitis (SBP) but its efficacy in other types of infections remains unknown. We investigated this issue through a multicenter randomized controlled trial.METHODS: A total of 193 cirrhotic patients with a Child-Pugh score greater than 8 and sepsis unrelated to SBP were randomly assigned to receive antibiotics plus albumin (1.5 g/kg on day 1 and 1g/kg on day 3; albumin group [ALB]: n=96) or antibiotics alone (control group [CG]: n=97). The primary endpoint was the 3-month renal failure rate (increase in creatinine ⩾50% to reach a final value ⩾133 μmol/L). The secondary endpoint was 3-month survival rate.RESULTS: Forty-seven (24.6%) patients died (ALB: n=27 vs. CG: n=20; 3-month survival: 70.2% vs. 78.3%; p=0.16). Albumin infusion delayed the occurrence of renal failure (mean time to onset, ALB: 29.0 ± 21.8 vs. 11.7 ± 9.1 days, p=0.018) but the 3-month renal failure rate was similar (ALB: 14.3% vs. CG: 13.5%; p=0.88). By multivariate analysis, MELD score (pCONCLUSIONS: In cirrhotic patients with infections other than SBP, albumin infusion delayed onset of renal failure but did not improve renal function or survival at 3 months. Infusion of large amounts of albumin should be cautiously administered in the sickest cirrhotic patients.

Published
2015
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22. Hépatite induite par l’infliximab : absence de toxicité croisée avec l’étanercept

Author

Jean-Paul Eschard, Alexandra Heurgué, Marie-Danièle Diebold, Gérard Thiéfin, and Aude Morelet

Subjects
Anti tumor necrosis factor alpha, Gynecology, medicine.medical_specialty, Rheumatology, Anticorps monoclonal, business.industry, Medicine, Anti tnf alpha, business, Tumor necrosis factor α, Co infection
Abstract

Resume Nous decrivons le cas d’un patient atteint de spondylarthrite ankylosante presentant une hepatite aigue sous traitement par infliximab. Une minime elevation des transaminases seriques etait observee apres quatre perfusions d’infliximab. Le traitement etait arrete apres la sixieme perfusion, devant une augmentation du taux serique des transaminases par un facteur 10. Une biopsie hepatique revelait une necrose en pont avec un infiltrat inflammatoire portal riche en macrophages, compatible avec le diagnostic d’hepatite toxique aigue. Apres arret du traitement par infliximab, les anomalies biologiques hepatiques regressaient et le patient etait traite par etanercept pendant plus de deux ans sans rechute de l’hepatite. Cette observation suggere l’absence de toxicite hepatique croisee entre l’infliximab et l’etanercept et permet d’envisager la reprise d’un traitement anti-TNF-alpha par etanercept chez les patients ayant presente une hepatite induite par l’infliximab.

Published
2008
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23. Proximal predominance of small bowel injury associated with uncoated low-dose aspirin therapy: a video capsule study in chronic users

Author

Alexandra Heurgué-Berlot, Pierre Nazeyrollas, Gérard Thiéfin, Hedia Brixi, and Florent Ehrhard

Subjects
Male, medicine.medical_specialty, Anemia, medicine.drug_class, Comorbidity, Gastroenterology, Capsule Endoscopy, Drug Administration Schedule, law.invention, Capsule endoscopy, law, Internal medicine, Antithrombotic, Intestine, Small, medicine, Humans, Intestinal Mucosa, Ulcer, Aged, Retrospective Studies, Aged, 80 and over, Aspirin, Hepatology, Anemia, Iron-Deficiency, Dose-Response Relationship, Drug, business.industry, Anticoagulant, Anti-Inflammatory Agents, Non-Steroidal, Anticoagulants, Retrospective cohort study, Middle Aged, medicine.disease, Dose–response relationship, Intestinal Diseases, Female, business, Gastrointestinal Hemorrhage, medicine.drug
Abstract

BACKGROUND AND AIM Only a limited number of studies have evaluated the small intestinal damage associated with chronic low-dose aspirin (LDA) therapy. We assessed, using capsule endoscopy, the prevalence and the characteristics of small bowel damage in chronic LDA users compared with patients taking an anticoagulant (AC) and those taking no antithrombotic drugs. PATIENTS AND METHODS We retrospectively reviewed 75 capsule endoscopy recordings from three groups of patients with unexplained iron-deficient anemia: 28 patients receiving LDA, 15 receiving an AC, and 32 not receiving any antithrombotic drug. The severity and location of small intestinal mucosal breaks were assessed in a blinded manner by two endoscopists. RESULTS All LDA users received uncoated aspirin. The number of small bowel mucosal breaks in patients receiving LDA (median 1, extremes 0-125) was significantly higher than that in those taking an AC (0, 0-1) (P=0.0005) or no antithrombotic drugs (0, 0-23) (P

Published
2013

24. Late autoimmune hepatitis after hepatitis C therapy

Author

Staffan Wahlin, Cumali Efe, Halis Simsek, Ersan Ozaslan, Tugrul Purnak, Alexandra Heurgué-Berlot, and Gérard Thiéfin

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, Autoimmune hepatitis, Gastroenterology, Antiviral Agents, immune system diseases, Interferon, Internal medicine, Medicine, Humans, In patient, Retrospective Studies, Hepatitis, Hepatology, business.industry, Medical record, Retrospective cohort study, Hepatitis C, Middle Aged, medicine.disease, digestive system diseases, Discontinuation, Hepatitis, Autoimmune, Female, Interferons, Chemical and Drug Induced Liver Injury, business, medicine.drug
Abstract

Background De-novo or reactivated autoimmune hepatitis (AIH) has been reported during or a short time after administration of interferon (IFN) in patients treated for hepatitis C (HCV). Reports on AIH during long-term follow-up after IFN treatment are scarce. Patients and methods Patients diagnosed with both HCV and AIH were identified in clinical databases of four gastroenterology departments. The medical records of patients diagnosed with AIH after IFN therapy were retrospectively assessed. Results Five patients (four female, one male) with a mean age of 50 years (range: 34-59) were identified. AIH developed at a mean duration of 4.8 years (range: 1-10) after HCV therapy. Three of five patients had a sustained viral response to antiviral therapy, whereas two were nonresponders. All patients were treated with immunosuppressive therapy after being diagnosed with AIH. Biochemical remission was achieved in four patients; however, one patient had an aggressive course and died despite immunosuppressive therapy. We could not identify any risk factors associated with the development of AIH. Conclusion AIH may develop in patients treated with IFN, not only during or after a short time from therapy but also after a long time from discontinuation of therapy.

Published
2013

25. Diagnosis of hepatocellular carcinoma in cirrhotic patients: a proof-of-concept study using serum micro-Raman spectroscopy

Author

Caroline Truntzer, Patrick Hillon, Alexandra Heurgué, Gérard Thiéfin, Cyril Gobinet, I. Taleb, Patrick Ducoroy, Brigitte Bernard-Chabert, Michel Manfait, Valérie Untereiner, and Ganesh D. Sockalingum

Subjects
Liver Cirrhosis, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Support Vector Machine, Spectrum Analysis, Raman, Biochemistry, Gastroenterology, Sensitivity and Specificity, Analytical Chemistry, Text mining, Internal medicine, Electrochemistry, Carcinoma, medicine, Biomarkers, Tumor, Environmental Chemistry, Humans, Stage (cooking), Spectroscopy, Aged, Principal Component Analysis, business.industry, Liver Neoplasms, Case-control study, Cancer, Middle Aged, medicine.disease, Serum samples, Micro raman spectroscopy, Hepatocellular carcinoma, Case-Control Studies, Female, business
Abstract

Hepatocellular carcinoma (HCC) is the third most common cause of cancer death worldwide. The development of novel diagnostic methods is needed to detect tumours at an early stage when patients are eligible for curative treatments. The purpose of this proof-of-concept study was to determine if micro-Raman spectroscopy applied to the sera of cirrhotic patients may be an alternative method for rapidly discriminating patients with and without HCC. Serum samples were collected from 2 groups of patients: cirrhotic patients with HCC (n = 37) and without HCC (n = 34). Two different approaches were used, dried serum drops and freeze-dried serum, and micro-Raman spectra were acquired in the point-mode with a 785 nm laser excitation in the spectral range of 600-1800 cm(-1). Spectra were quality-tested and pre-processed (smoothing, baseline subtraction, vector normalization). Using principal component analysis, the 2 classes, corresponding to cirrhotic patients with and without HCC, could not be differentiated. In contrast, the support vector machine method using the leave-one-out cross validation procedure was able to correctly classify the two groups of patients with an overall rate of accuracy of 84.5% to 90.2% for dried serum drops and 86% to 91.5% for freeze-dried serum. These results are promising and support the concept that serum micro-Raman spectroscopy may become a useful diagnostic tool to detect biomarkers in the field of cancer, as described here for distinguishing between cirrhotic patients with and without HCC.

Published
2013

26. Treatment and prognosis of acute severe autoimmune hepatitis

Author

Anne Minello, Jean-Marc Perarnau, Nathalie Sturm, Christophe Duvoux, Florent Artru, Mylène Sebagh, Odile Goria, Hélène Agostini, V. de Ledinghen, Camille Besch, E. De Martin, Patrick Potier, Hélène Fontaine, Jean-Marie Péron, Jérôme Boursier, S. Radenne, Jérôme Dumortier, Georges Philippe Pageaux, Maryline Debette-Gratien, Isabelle Ollivier-Hourmand, Jean Charles Duclos-Vallée, Jean-Baptiste Nousbaum, François Durand, Laurent Alric, Rodolphe Anty, Alexandra Heurgué-Berlot, Marika Rudler, Christine Silvain, Pauline Houssel-Debry, Sandrine Barge, Audrey Coilly, Didier Samuel, M. Bourlière, P. Borrentain, Fabio Conti, Olivier Chazouillères, and Armando Abergel

Subjects
03 medical and health sciences, 0302 clinical medicine, Hepatology, business.industry, 030220 oncology & carcinogenesis, Immunology, Medicine, 030211 gastroenterology & hepatology, Autoimmune hepatitis, business, medicine.disease
Published
2017
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27. Chimioembolisation intra-artérielle puis embolisation portale avant hépatectomie pour CHC chez le patient cirrhotique améliore les résultats et augmente la nécrose tumorale: une étude cas-témoin

Author

Patrick Pessaux, Gérard Thiefin, Thomas F. Baumert, Reza Kianmanesh, Tullio Piardi, Yohann Renard, Jacques Marescaux, Alexandra Heurgué-Berlot, and Daniele Sommacale

Subjects
Surgery
Abstract

Introduction Une embolisation portale (EP) seule ou associee de maniere sequentielle avec une chimioembolisation intra-arterielle (CEIA) a ete proposee avant une resection hepatique pour carcinome hepato-cellulaire (CHC). Le but de cette etude etait de comparer les suites operatoires precoces de ces deux strategies. Methodes De janvier 2012 a juin 2013, 12 patients atteints de CHC recevaient un traitement sequentiel CEIA + EP (groupe 1, G1). Le groupe-controle (12 patients) etait traite par EP seule avant chirurgie (groupe 2, G2). Resultats Les caracteristiques des patients et des tumeurs etaient identiques dans les deux groupes. L’augmentation moyenne de VFR etait de 7,36 % dans le G1 et 4,6 % dans le G2 (p = ns). Dans le G1, 10 hepatectomies majeures ont ete realisees vs 12 dans le G2 (p = ns). L’incidence d’insuffisance hepato-cellulaire (IHC) post-ope-ratoire etait plus elevee dans le G2 (41,6 %, 5/12) que dans le G1 (8,3 %, 1/12). Parmi les 5 patients du G2, seul un est decede d’IHC post-operatoire. Les taux de complications et de mortalite post operatoire n’etaient pas differents dans les 2 groupes. La duree de sejour en reanimation etait plus elevee dans le G1 que dans le G2 (p = 0,03). L’incidence de necrose tumorale etait significativement plus elevee dans le G1 (11/12 vs 3/12 p = 0,002). Conclusion Le traitement sequentiel CEIA + EP avant hepa-tectomie pour CHC augmente le volume de foie restant, avec des suites operatoire plus simples, et augmente le taux de necrose tumorale.

Published
2014
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28. Efficacité du Mélange Equimolaire Protoxyde d'Azote-Oxygène (MEOPA) sur la tolérance de la fibroscopie oeso-gastro-duodénale: essai randomisé, en groupes parallèles, en double aveugle, versus placebo

Author

G Thiefin, B Papon, Brigitte Bernard-Chabert, Alexandra Heurgué, Stéphanie Lagarde, F. Vitry, H Brixi-Benmansour, Guillaume Cadiot, Fidy Ramaholimihaso, E Scaglia, and Olivier Bouché

Subjects
Gynecology, medicine.medical_specialty, business.industry, Gastroenterology, Medicine, business
Published
2008
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29. Infliximab-induced hepatitis: absence of cross-toxicity with etanercept

Author

Aude Morelet, Jean-Paul Eschard, Marie-Danièle Diebold, Alexandra Heurgué, and Gérard Thiéfin

Subjects
musculoskeletal diseases, Male, medicine.medical_specialty, Gastroenterology, Receptors, Tumor Necrosis Factor, Etanercept, Necrosis, Rheumatology, immune system diseases, Internal medicine, Medicine, Humans, Spondylitis, Ankylosing, Aspartate Aminotransferases, skin and connective tissue diseases, Adverse effect, Hepatitis, Ankylosing spondylitis, medicine.diagnostic_test, business.industry, Tumor Necrosis Factor-alpha, Antibodies, Monoclonal, Alanine Transaminase, gamma-Glutamyltransferase, Middle Aged, medicine.disease, Infliximab, Surgery, Discontinuation, stomatognathic diseases, Liver biopsy, Antirheumatic Agents, Immunoglobulin G, Toxicity, Chemical and Drug Induced Liver Injury, business, medicine.drug
Abstract

We describe a patient presenting with acute hepatitis while receiving infliximab for ankylosing spondylitis. A slight increase in serum aminotransferases was first observed in this patient after 4 infusions of infliximab. The treatment was stopped after the 6th infusion when laboratory work-up revealed a 10-fold increase in serum levels of aminotransferases. A liver biopsy showed interportovenular bridging necrosis with macrophage accumulation consistent with the diagnosis of acute toxic hepatitis. After infliximab discontinuation, hepatic abnormalities resolved and the patient was treated with etanercept for more than 2 years without recurrence of hepatitis. This case underlines the lack of hepatic cross-toxicity between infliximab and etanercept making possible the continuation of anti-TNF-α therapy with etanercept in patients who have presented infliximab-related hepatic dysfunction.

Published
2007

30. Drug-Induced Autoimmune-Like Hepatitis: A Case of Chronic Course After Drug Withdrawal

Author

Brigitte Bernard-Chabert, Gérard Thiéfin, Alexandra Heurgué-Berlot, and Marie-Danièle Diebold

Subjects
Hepatitis, medicine.medical_specialty, medicine.diagnostic_test, Physiology, business.industry, Gastroenterology, Hepatitis A, Gamma globulin, Azathioprine, Autoimmune hepatitis, medicine.disease, Liver disease, Prednisone, Liver biopsy, Internal medicine, medicine, business, medicine.drug
Abstract

Dear Editor, We read with interest the review by Albert J. Czaja on drug-induced autoimmune-like hepatitis [1]. As underlined by the author, the outcome is usually favourable after drug withdrawal, either spontaneously or after a few months of corticosteroid therapy. In contrast with classical autoimmune hepatitis, drug-induced disease does not require longterm immunosuppressive treatment [1, 2]. We report here a rare exception to this rule in a patient with minocyclineinduced autoimmune-like hepatitis which self-perpetuates after drug withdrawal. A 17-year-old male patient was treated for acne vulgaris with minocycline 100 mg/day for 2 months, then 50 mg/day for 1 month from August to October 2005. He had no previous history of liver disease, intravenous drug or alcohol abuse. His liver blood tests controlled 2 years before were in the normal range. At the end of minocycline treatment, a laboratory workup was performed and showed elevated serum levels of alanine aminotransferase (ALT 464 IU/l, normal \ 46), aspartate aminotransferase (AST 293 IU/l, normal \ 49), gamma-glutamyl transpeptidase (GGT 188 UI/l, normal \ 88), alkaline phosphatase (AP 343 UI/l, normal \ 290) and normal bilirubin level (11 lmol/l). His prothrombin index was 67% and gammaglobulins were elevated (31 g/l). The blood eosinophil count rose to 804/ll. Anti-nuclear and anti-smooth muscle antibodies were positive at a titre of 1/6,400 and 1/400, respectively, whereas anti-liver/kidney microsomal and anti-mitochondria antibodies were negative. Anti-native DNA antibodies were slightly positive using the Farr test (6 IU/ml, normal \ 4). Serologies for hepatitis A, B, C, Epstein-Barr virus and cytomegalovirus were negative. Abdominal ultrasound sonography was normal. A liver biopsy was performed and showed features of chronic hepatitis with portal and lobular lymphoplasmocytic infiltrate, rosette formation, peacemeal necrosis and centralportal bridging necrosis. In addition, bile duct damage with lymphocytic cholangitis and ductular proliferation were observed. The diagnosis of auto-immune hepatitis induced by minocycline was made. Treatment with prednisone 40 mg/day was initiated. Serum aminotransferases normalised within 1 month. Prednisone was gradually reduced and stopped after 4 months. Three months later, there was a relapse with serum ALT level of 105 IU/l, AST of 73 IU/l and GGT of 104 IU/l. Gamma globulins were elevated (25 g/l). Prednisone was reintroduced at 30 mg/day with azathioprine 125 mg/day. On the basis of histological bile duct damage, ursodeoxycholic acid 1,000 mg/day was added. His serum levels of aminotransferases and GGT returned to normal within 3 months. Prednisone was stopped after 6 months and the patient was maintained on azathioprine and ursodeoxycholic acid. From 2007 to 2009, periods of poor compliance translated into transient increased levels of aminotransferases. In October 2010, the liver tests were normal. The prothrombin index was 88% and serum albumin was 41 g/l. However, immunological abnormalities were still present. Serum immunoglobulin G was elevated (21.3 g/l). Anti-nuclear and anti-smooth muscle antibodies were positive at titres of 1/3,200 and 1/400, respectively. Anti-native DNA antibodies were positive (50 IU/ml, normal \ 4). During the following 2-month period, the compliance rate was very poor, i.e. less A. Heurgue-Berlot (&) B. Bernard-Chabert G. Thiefin Department of Hepato-Gastroenterology, CHU Reims, Reims, France e-mail: aheurgue@chu-reims.fr

Published
2011
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31. O69 ALBUMIN INFUSION FOR BACTERIAL INFECTIONS OTHER THAN SPONTANEOUS BACTERIAL PERITONITIS IN CIRRHOTIC PATIENTS: A MULTICENTER RANDOMIZED CONTROLLED STUDY (ALB-CIRINF STUDY)

Author

Isabelle Rosa, Aurélie Plessier, V. Di Martino, C. Bureau, Eric Nguyen-Khac, Marika Rudler, Alexandre Louvet, Rodolphe Anty, V. de Ledinghen, Thierry Paupard, Thierry Thevenot, Odile Goria, Alexandra Heurgué-Berlot, Roland Amathieu, N. Abdelli, Elisabeth Monnet, N. Talbodec, Anne Minello, Violaine Ozenne, Frédéric Oberti, Hélène Barraud, Nicolas Carbonell, Thong Dao, D. Botta-Fridlung, F. Guillemot, Xavier Causse, and C. Becker

Subjects
medicine.medical_specialty, Hepatology, business.industry, Albumin, medicine.disease, Gastroenterology, law.invention, Surgery, Spontaneous bacterial peritonitis, Randomized controlled trial, law, Internal medicine, Medicine, business
Published
2014
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32. Overlap Syndrome and Connective Tissue Diseases

Author

Alexandra Heurgué-Berlot, Gérard Thiéfin, Solange Bresson-Hadni, and Brigitte Bernard-Chabert

Subjects
medicine.medical_specialty, Pathology, Physiology, business.industry, Gastroenterology, Connective tissue, Overlap syndrome, Hepatology, medicine.disease, medicine.anatomical_structure, Transplant surgery, Internal medicine, medicine, business
Published
2010
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33. Overlap syndrome triggered by acute viral hepatitis A

Author

Alexandra Heurgué, Brigitte Bernard-Chabert, Rémi Picot, Gérard Thiéfin, and Guillaume Cadiot

Subjects
Autoimmune disease, Hepatology, Liver Cirrhosis, Biliary, business.industry, Gastroenterology, Overlap syndrome, Syndrome, Autoimmune hepatitis, Hepatitis A, medicine.disease, Virology, Virus, Hepatitis, Autoimmune, Young Adult, Primary biliary cirrhosis, Acute Disease, Immunology, Genetic predisposition, Humans, Medicine, Female, Viral disease, business, Viral hepatitis
Abstract

We report the case of a 24-year-old woman with an autoimmune hepatitis/primary biliary cirrhosis overlap syndrome triggered by an acute hepatitis A. A number of viruses have been proposed as potential triggers of autoimmune hepatitis in patients with genetic predisposition. To date, approximately 10 cases of type 1 autoimmune hepatitis following hepatitis A virus infection have been published in the medical literature. To our knowledge, this is the first case of overlap syndrome triggered by an acute hepatitis A.

Published
2009
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38. M1018a The Efficacy of Prefixed Equimolar Nitrous Oxyde and Oxygen Mixture (N2o) for Gastroduodenal Endoscopy Tolerance: A Randomized, Double-Blind Trial, Versus Placebo

Author

Olivier Bouché, Gérard Thiéfin, Alexandra Heurgué, Stéphanie Lagarde, Guillaume Cadiot, Hedia Brixi-Benmansour, Fabien Vitry, Benjamin Papon, Brigitte Bernard-Chabert, Fidy Ramaholimihaso, and Elodie Scaglia

Subjects
Double blind, medicine.medical_specialty, Hepatology, medicine.diagnostic_test, business.industry, Anesthesia, Gastroenterology, medicine, business, Placebo, Oxygen mixture, Surgery, Endoscopy
Published
2008
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39. Pregnancy in idiopathic non-cirrhotic portal hypertension: A multicentric study on maternal and fetal management and outcome

Author

Aurélie Plessier, Juan Carlos García-Pagán, Olivier Roux, Frédéric Oberti, Dhiraj Tripathi, Christophe Bureau, Louis d’Alteroche, Pierre-François Ceccaldi, Filipe Andrade, Fanny Turon, Emmanuelle de Raucourt, Valdig investigators, Alexandra Heurgué, Marco Senzolo, Audrey Payancé, Akash Shukla, Dominique Valla, and Pierre-Emmanuel Rautou

Subjects
Adult, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Pregnancy, High-Risk, Gestational Age, 030204 cardiovascular system & hematology, Miscarriage, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Pregnancy, Ascites, Hypertension, Portal, medicine, Humans, Retrospective Studies, Venous Thrombosis, Hepatology, Ectopic pregnancy, Obstetrics, business.industry, Portal Vein, Infant, Newborn, Pregnancy Outcome, medicine.disease, Portal vein thrombosis, Abortion, Spontaneous, Portal hypertension, Gestation, Premature Birth, 030211 gastroenterology & hepatology, Female, Uterine Hemorrhage, medicine.symptom, business, Gastrointestinal Hemorrhage, Transjugular intrahepatic portosystemic shunt, Follow-Up Studies
Abstract

Background & Aims A total of 15% of patients with idiopathic non-cirrhotic portal hypertension (INCPH) are women of childbearing age. We aimed to determine maternal and fetal outcome of pregnancies occurring in women with INCPH. Methods We retrospectively analyzed the charts of women with INCPH followed in the centers of the VALDIG network, having had ≥1 pregnancy during the follow-up of their liver disease. Data are represented as median (interquartile range). Results A total of 24 pregnancies occurred in 16 women within 24 (5–66) months after INCPH diagnosis. Four women had associated partial portal vein thrombosis before pregnancy. At conception, 2 out of the 16 women had detectable ascites and others were asymptomatic. Out of these 24 pregnancies, there were four miscarriages, one ectopic pregnancy, and one medical termination of pregnancy at 20 weeks of gestation. Out of the 18 other pregnancies reaching 20 weeks of gestation (in 14 patients), there were nine preterm and nine term deliveries. All infants were healthy at delivery, but one died at day 1 of unknown cause and one at day 22 of infectious meningitis; both were preterm. Concerning mothers, two had worsening of ascites, two had variceal bleeding despite non-selective betablockers during pregnancy and one developed a main portal vein thrombosis in early postpartum. Genital bleeding occurred in three patients, including two receiving anticoagulation. All 16 women were alive and asymptomatic after a median follow-up of 27 (9–93) months after last delivery. Conclusion The overall outcome of women with INCPH who become pregnant is favorable despite a significant incidence of complications related to portal hypertension. Fetal outcome is favorable in most pregnancies reaching 20 weeks of gestation. Lay summary About 15% of patients with idiopathic non-cirrhotic portal hypertension are women of childbearing age, who can become pregnant. As available reports on pregnancy in these women are scarce and heterogeneous, it is unclear whether or not pregnancy should be contraindicated in this setting. We provide detailed data showing that, regardless of the associated conditions, the overall outcome of women with idiopathic non-cirrhotic portal hypertension becoming pregnant is good despite a significant incidence of complications related to portal hypertension, and that fetal outcome is favorable in most pregnancies reaching 20 weeks of gestation.

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40. Sequential presentation of primary biliary cirrhosis and autoimmune hepatitis

Author

Alexandra Heurgué-Berlot, Taylan Kav, Cumali Efe, Solange Bresson-Hadni, Paolo Muratori, Chiara Masi, Staffan Wahlin, Ersan Ozaslan, Murat Torgutalp, Tugrul Purnak, Luigi Muratori, Gérard Thiéfin, Thomas D. Schiano, C. Efe, E. Ozaslan, A. Heurgué-Berlot, T. Kav, C. Masi, T. Purnak, M. Torgutalp, L. Muratori, S. Bresson-Hadni, G. Thiéfin, T. D. Schiano, P. Muratori, and S. Wahlin

Subjects
Male, Time Factors, medicine.medical_treatment, Autoimmune hepatitis, Liver transplantation, PBC, Gastroenterology, Primary biliary cirrhosis, AIH, Risk Factors, immune system diseases, skin and connective tissue diseases, Liver Cirrhosis, Biliary, Remission Induction, Ursodeoxycholic Acid, Overlap syndrome, Immunosuppression, Syndrome, Middle Aged, Ursodeoxycholic acid, Europe, Hepatitis, Autoimmune, Treatment Outcome, Liver, Disease Progression, Drug Therapy, Combination, Female, Immunosuppressive Agents, medicine.drug, Adult, medicine.medical_specialty, Adolescent, digestive system, Young Adult, Gastrointestinal Agents, Internal medicine, medicine, Humans, Aged, Retrospective Studies, Hepatitis, Hepatology, business.industry, Retrospective cohort study, medicine.disease, United States, digestive system diseases, Liver Transplantation, business, Biomarkers
Abstract

Background Primary biliary cirrhosis (PBC)-autoimmune hepatitis (AIH) overlap syndrome is used to describe the coexistence of both diseases, with either a sequential or a simultaneous presentation in the same patient. Available studies have focused on the simultaneous form, whereas there is limited information on sequential PBC-AIH. We carried out a retrospective study of patients who sequentially developed PBC-AIH overlap syndrome. Methods The medical data of 1065 patients diagnosed with PBC (n=483) and AIH (n=582) were retrospectively analyzed. Results A sequential development of PBC-AIH was observed in 19 (1.8%) patients after a mean of 6.5 (1-14) years of follow-up. AIH developed in 12 (2.5%) PBC patients, whereas PBC occurred in seven (1.2%) patients with AIH. The baseline serologic and histological findings of patients who developed PBC-AIH were similar to those of patients with typical PBC or AIH. Eighteen patients were treated with a combination of ursodeoxycholic acid (UDCA) and immunosuppression after the diagnosis of PBC-AIH was established. One patient showed a spontaneous resolution of hepatitic flare under UDCA therapy. Biochemical remission was achieved in 16 patients, whereas three progressed to decompensated cirrhosis and required liver transplantation. Conclusion The sequential overlap of PBC-AIH can occur during the follow-up of patients with pure PBC or AIH. In our cohort, we could not identify any factors that predicted the development of this rare condition. The combination of UDCA and immunosuppression seems to be an appropriate therapy in the setting of PBC-AIH.

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