BACKGROUND/OBJECTIVE: Alcoholic liver disease (ALD) is a controversial yet established indication for liver transplantation (LT), and there is emerging evidence supporting a survival benefit in selected patients with severe acute alcoholic hepatitis. The aim of the present survey was to describe policies among Canadian transplant centres for patients with ALD.METHODS: A survey was distributed to the medical directors of all seven liver transplant centres in Canada.RESULTS: All seven liver transplant programs in Canada participated in the survey. Every centre requires patients to have a minimum of six months of abstinence from alcohol before listing for LT. Completion of a rehabilitation program is only mandatory in one program; the remaining programs do not mandate this if patients have demonstrated prolonged abstinence, and sufficient insight and social supports. No program considers LT for patients with severe acute alcoholic hepatitis, although six of the seven programs are interested in exploring a national policy. Random alcohol checks for waitlisted patients are performed routinely on patients listed for ALD at only one centre; the remaining centres only perform checks if there is clinical suspicion. In the past five years, the mean (&#xb1; SD) number of patients per centre with graft dysfunction from recidivism was 10&#xb1;4.36; a mean of 2.5&#xb1;4.36 patients per centre developed graft failure.CONCLUSIONS: With minor exceptions, LT policies for subjects with ALD are uniform across Canadian transplant programs. Presently, no centres perform LT for acute alcoholic hepatitis, although there is broad interest in exploring a national policy. Recidivism resulting in graft loss is a rare phenomenon.

Natasha Chandok

Mohammed Aljawad

Angela White

Roberto Hernandez-Alejandro

Paul Marotta

Eric M Yoshida

Liver Transplantation for Alcoholic Liver Disease among Canadian Transplant Centres: A National Study

OBJECTIVE: A nationwide analysis of alcoholic hepatitis (AH) admissions was conducted to determine the impact of hepatitis C virus (HCV) infection on short-term survival and hospital resource utilization.METHODS: Using the Nationwide Inpatient Sample, noncirrhotic patients admitted with AH throughout the United States between 1998 and 2006 were identified with diagnostic codes from the International Classification of Diseases, Ninth Revision. The in-hospital mortality rate (primary end point) of AH patients with and without co-existent HCV infection was determined. Hospital resource utilization was assessed as a secondary end point through linear regression analysis.RESULTS: From 1998 to 2006, there were 112,351 admissions for AH. In-hospital mortality was higher among patients with coexistent HCV infection (41.1&#x25; versus 3.2&#x25;; P=0.07). The adjusted odds of in-hospital mortality in the presence of HCV was 1.48 (95&#x25; CI 1.10 to 1.98). Noncirrhotic patients with AH and HCV also had longer length of stay (5.8 days versus 5.3 days; P&#x3c;0.007) as well as greater hospital charges (US$25,990 versus US$21,030; P=0.0002).CONCLUSIONS: Among noncirrhotic patients admitted with AH, HCV infection was associated with higher in-hospital mortality and resource utilization.

Paul J Thuluvath

Eric Ahn

Geoffrey C Nguyen

Hepatitis C as a Prognostic Indicator among Noncirrhotic Patients Hospitalized with Alcoholic Hepatitis

BACKGROUND: Helicobacter pylori infection is the most common chronic infection in humans. It is a major contributor to the cause of duodenal and gastric ulcers worldwide. Its eradication has been shown to reduce rates of H pylori-related ulcers as well as other complications such as gastric cancer.OBJECTIVE: To determine the rate of appropriate treatment in patients following a diagnosis of H pylori infection on biopsy during esophagoduodenoscopy for upper gastrointestinal bleeding over a four-year period at a tertiary centre in Vancouver, British Columbia. Also evaluated was the rate of eradication confirmation using the urea breath test.METHODS: A retrospective review of 1501 inpatients who underwent esophagoduodenoscopy for upper gastrointestinal bleeding (January 2006 to December 2010) was undertaken. Patients who were biopsy stain positive for H pylori were selected for drug review either via a provincial database (PharmaNet) or via records from patients&#x2019; family practitioners. Data were also obtained via two provincial laboratories that perform the urea breath test to determine the rates of confirmation of eradication.RESULTS: Ninety-eight patients had biopsy-proven H pylori. The mean (&#xb1; SD) age was 56.13&#xb1;17.9 years and 65 were male. Data were not available for 22 patients; the treatment rate was 52.6&#x25; (40 of 76). Of those treated, 12 patients underwent a post-treatment urea breath test for eradication confirmation.CONCLUSION: There was substantial discrepancy between the number of diagnosed H pylori infections and the rate of treatment as well as confirmation of eradication. Numerous approaches could be taken to improve treatment and eradication confirmation.

Frank Wong

George Ou

Sigrid Svarta

Ricky Kwok

Kieran Donaldson

Joe Frenette

Robert Enns

Do We Eradicate Helicobacter pylori in Hospitalized Patients with Peptic Ulcer Disease?

BACKGROUND: Celiac disease (CD) is a common autoimmune disorder of the small intestine that occurs in genetically predisposed individuals. Animal studies have suggested that the hedgehog (Hh) signalling pathway is involved in gut inflammation, injury and repair.OBJECTIVE: To examine the expression of components of the Hh signalling pathway in CD.METHODS: Children undergoing gastroscopy investigation for CD at Monash University (Victoria, Australia), and other children undergoing gastroscopy in whom small bowel pathology was not expected (ie, controls), were included in the present study. One histopathologist, who was blinded to the biopsy data, analyzed the biopsies and a diagnosis of CD was made according to standard Marsh criteria. From these samples, RNA was extracted and complementary DNA was synthesized using reverse transcription polymerase chain reaction. The levels of Hh ligand Sonic hh, Indian hh, protein patched homologue 1 (PTCH 1) and bone morphogenetic protein 4 (BMP4) messenger RNA were quantified by real-time polymerase chain reaction. Relative expression quantification was performed using the &#x394;&#x394;Ct method.RESULTS: Duodenal biopsies were collected from 37 children. There were 20 CD specimens and 17 normal controls. The relative expression of Sonic hh from CD patients was 58&#x25; lower than that of the controls; similarly, Indian hh expression was decreased in children with CD by 44&#x25;. Compared with controls, the expression of Hh receptor PTCH 1 decreased by 71&#x25; and the expression of the Hh target gene BMP4 by 42&#x25;.CONCLUSIONS: The expression of the Hh signalling pathway genes was consistently downregulated in untreated CD children. These results suggest that the Hh signalling pathway plays a role in the mucosal lesions encountered in CD.

Rui Liang

Rupert Hinds

Helen E Abud

Wei Cheng

Hedgehog Signalling is Downregulated in Celiac Disease

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Canadian Journal of Gastroenterology and Hepatology publishes studies of areas related to medical, surgical, pathological, biochemical and physiological aspects of gastroenterology and hepatology.

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Canadian Journal of Gastroenterology and Hepatology - Table of contents 2013

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Canadian Journal of Gastroenterology and Hepatology publishes studies of areas related to medical, surgical, pathological, biochemical and physiological aspects of gastroenterology and hepatology.

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Canadian Journal of Gastroenterology and Hepatology

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Canadian Journal of Gastroenterology and Hepatology