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See detailIntensive enteral nutrition is ineffective for individuals with severe alcoholic hepatitis treated with corticosteroids.
Moreno, C; Deltenre, P; Senterre, C et al

in Gastroenterology (2016), 150

BACKGROUND & AIMS: Severe alcoholic hepatitis (AH) is a lifethreatening disease for which adequate oral nutritional support is recommended. We performed a randomized controlled trial to determine whether ... [more ▼]

BACKGROUND & AIMS: Severe alcoholic hepatitis (AH) is a lifethreatening disease for which adequate oral nutritional support is recommended. We performed a randomized controlled trial to determine whether the combination of corticosteroid and intensive enteral nutrition therapy is more effective than corticosteroid therapy alone in patients with severe AH. METHODS: We enrolled 136 heavy consumers of alcohol (age, 18–75 y) with recent onset of jaundice and biopsy-proven severe AH in our study, performed at 18 hospitals in Belgium and 2 in France, from February 2010 through February 2013. Subjects were assigned randomly (1:1) to groups that received either intensive enteral nutrition plus methylprednisolone or conventional nutrition plus methylprednisolone (controls). In the intensive enteral nutrition group, enteral nutrition was given via feeding tube for 14 days. The primary end point was patient survival for 6 months. RESULTS: In an intention-to-treat analysis, we found no significant difference between groups in 6-month cumulative mortality: 44.4% of patients died in the intensive enteral nutrition group (95% confidence interval [CI], 32.2%–55.9%) and 52.1% of controls died (95% CI, 39.4%– 63.4%) (P ¼ .406). The enteral feeding tube was withdrawn prematurely from 48.5% of patients, and serious adverse events considered to be related to enteral nutrition occurred in 5 patients. Regardless of group, a greater proportion of patients with a daily calorie intake less than 21.5 kcal/kg/day died (65.8%; 95% CI, 48.8–78.4) than patients with a higher intake of calories (33.1%; 95% CI, 23.1%–43.4%) (P < .001). CONCLUSIONS: In a randomized trial of patients with severe AH treated with corticosteroids, we found that intensive enteral nutrition was difficult to implement and did not increase survival. However, low daily energy intake was associated with greater mortality, so adequate nutritional intake should be a main goal for treatment. [less ▲]

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See detailSofosbuvir in combination with simeprevir +/- ribavirin in genotype 4 hepatitis C patients with advanced fibrosis or cirrhosis: real-life experience from Belgium
Moreno, C; Lasser, L; DELWAIDE, Jean ULg et al

in Acta Gastro-Enterologica Belgica (2016, March), 79(1), 08

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See detailLight-to-moderate alcohol intake increases the risk of hepatocellular carcinoma in patients with HCV-related compensated cirrhosis: a prospective study.
Vandenbulcke, H; Moreno, C; Colle, I et al

in Acta Gastro-Enterologica Belgica (2016, March), 79(1), 01

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See detailAlcohol intake increases the risk of HCC in hepatitis C virus-related cirrhosis: a prospective study.
Vandenbulcke, H; Moreno, C; Colle, I et al

in Journal of Hepatology (2016), 65

Background & Aims:Whether alcohol intake increases the risk of complications in patients with HCV-related cirrhosis remains unclear. The aim of this study was to determine the impact of alcohol intake and ... [more ▼]

Background & Aims:Whether alcohol intake increases the risk of complications in patients with HCV-related cirrhosis remains unclear. The aim of this study was to determine the impact of alcohol intake and viral eradication on the risk of hepatocellular carcinoma (HCC), decompensation of cirrhosis and death. Methods: Data on alcohol intake and viral eradication were prospectively collected in 192 patients with compensated HCVrelated cirrhosis. Results: 74 patients consumed alcohol (median alcohol intake: 15 g/day); 68 reached viral eradication. During a median followup of 58 months, 33 patients developed HCC, 53 experienced at least one decompensation event, and 39 died. The 5-year cumulative incidence rate of HCC was 10.6% (95% CI: 4.6–16.6) in abstainers vs. 23.8% (95% CI: 13.5–34.1) in consumers (p = 0.087), and 2.0% (95% CI: 0–5.8) vs. 21.7% (95% CI: 14.2–29.2) in patients with and without viral eradication (p = 0.002), respectively. The lowest risk of HCC was observed for patients without alcohol intake and with viral eradication (0%) followed by patients with alcohol intake and viral eradication (6.2% [95% CI: 0–18.4]), patients without alcohol intake and no viral eradication (15.9% [95% CI: 7.1– 24.7]), and patients with alcohol intake and no viral eradication (29.2% [95% CI: 16.5–41.9]) (p = 0.009). In multivariate analysis, lack of viral eradication and alcohol consumption were associated with the risk of HCC (hazard ratio for alcohol consumption: 3.43, 95% CI: 1.49–7.92, p = 0.004). Alcohol intake did not influence the risk of decompensation or death. Conclusions: Light-to-moderate alcohol intake increases the risk of HCC in patients with HCV-related cirrhosis. Patient care should include measures to ensure abstinence. Lay summary:Whether alcohol intake increases the risk of complications in patients with HCV-related cirrhosis remains unclear. In this prospective study, light-to-moderate alcohol intake was associated with the risk of hepatocellular carcinoma in multivariate analysis. No patients who did not use alcohol and who reached viral eradication developed hepatocellular carcinoma during follow-up. The risk of hepatocellular carcinoma increased with alcohol intake or in patients without viral eradication and was highest when alcohol intake was present in the absence of viral eradication. Patients with HCV-related cirrhosis should be strongly advised against any alcohol intake. Patient care should include measures to ensure abstinence. [less ▲]

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See detailSofosbuvir in combination with simeprevir +/- ribavirin in genotype 4 hepatitis C patients with advanced fibrosis or cirrhosis: a real-life experience from Belgium
Moreno, C; Lasser, L; DELWAIDE, Jean ULg et al

in Hepatology (Baltimore, Md.) (2015, October), 62(1), 746

Background: All-oral, interferon-free regimens that combine direct-acting antiviral drugs have significantly advanced the treatment of hepatitis C (HCV), especially for genotype 1(G1) patients. However ... [more ▼]

Background: All-oral, interferon-free regimens that combine direct-acting antiviral drugs have significantly advanced the treatment of hepatitis C (HCV), especially for genotype 1(G1) patients. However, efficacy and safety data of interferon-free regimens in HCV genotype 4 (G4) patients are scarce. In Belgium, Sofosbuvir (SOF) and Simeprevir (SMV) treatment is available since January 2015 for G4 patients with advanced fibrosis (F3-F4 METAVIR) for 12 weeks. Methods: analysis of HCV G4 patients receiving SOF and SMV treatment in Belgium. The aim of the study was to evaluate the safety and efficacy of the treatment. Results: 73 G4 patients were enrolled in this data collection including 32 (43.8%) patients with severe fibrosis F3 and 41(56.2%) cirrhotic patients. The study population comprised 58.9% male, 77.8% treatment experienced patients. Median age was 59 [51-66] years and 5 patients were HCV/HIV co-infected. 24 patients received the treatment associated with ribavirin, 11/32 (34.37%) of patients with advanced fibrosis and 13/41 (31.71%) of cirrhotic patients. In cirrhotic patients, median MELD and Child-Pugh score were 9 [7-12.5] and 5 [5-6], 46.2% had platelet below 100.000/mm and 28.6% had albumin below 35 g/L. W4 HCV RNA was undetectable in 31.25% (15/48). 9 of the 15 patients with undetectable W4 HCV RNA received RBV. At W12, 100% (23/23) had HCV RNA below the limit of quantification, with 6/23 still detectable. All SVR12 data will be available at the time of presentation. No patient experienced serious adverse event. Conclusions: these preliminary results in difficult-to-treat G4 HCV patients show that SOF/SIM +/- RBV treatment is safe and seems promising, in line with that was observed in G1 HCV patients. [less ▲]

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See detailImpact of intensive enteral nutrition in association with corticosteroïds in the treatment of severe alcoholic hepatitis: a multicenter randomized controlled trial
Moreno, C; Trepo, E; Louvet, A et al

in Acta Gastro-Enterologica Belgica (2015, March), 78(1), 01

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See detailEthnic epidemiological profiles and antiviral therapy among patients infected with hepatitis C virus genotype 4: a multicenter study from Belgium.
Nkuize, M; Mulkay, JP; Moreno, C et al

in Acta Gastro-Enterologica Belgica (2015), 78(4), 365-372

Background: Hepatitis C virus genotype 4 (HCV-4) is the most prevalent genotype in Central Africa. A large population of Black African individuals, among whom HCV-4 infection is widespread, resides in ... [more ▼]

Background: Hepatitis C virus genotype 4 (HCV-4) is the most prevalent genotype in Central Africa. A large population of Black African individuals, among whom HCV-4 infection is widespread, resides in Belgium. Aim: To compare epidemiology, clinical characteristics and any differences in receipt of HCV therapy in two populations of HCV-4 patients residing in Belgium. Methods: This retrospective multicenter study selected 473 patients from seven hospital databases and compared them according to ethnic origin, i.e., Black African (n=331) or not (n=142), for epidemiological, clinical, biological and histological characteristics. Interleukin 28B polymorphism (CC-genotype) was evaluated in a second cohort of 69 Black African and 30 non-Black African patients. Results: Compared to other patients, the Black African patients were more likely to be female and were older, more commonly overweight, more frequently had abnormal glucose metabolism and arterial hypertension; they were less likely to have dyslipidemia, a history of alcohol consumption or ALT elevation. The route of infection was more frequently unknown in Black African than in other patients. Black African patients had more HCV-4 subtypes, were less frequently of IL28B CC-genotype and had less severe liver fibrosis. The proportion of patients who received antiviral treatment was similar in the two groups. Conclusion: In this Belgian cohort, patients with HCV-4 infection were more frequently of Black African origin than of other origin. Infected Black African patients were more commonly female, older at diagnosis, and had more co-morbidities than other patients; they also had less advanced liver fibrosis than infected non-Black African patients and fewer had a CC genotype. The number of patients treated with antiviral therapy was similar in the two groups. [less ▲]

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See detailImpact of intensive enteral nutrition in association with corticosteroïds in the treatment of severe alcoholic hepatitis: a multicenter randomized controlled trial
Moreno, C; Trepo, E; Louvet, A et al

in Hepatology (Baltimore, Md.) (2014, October), 60(S1),

Intensive enteral nutrition by feeding tube does not improve 6-month survival in patients with severe alcoholic hepatitis. However, adequate nutritional support is associated with a better short-term ... [more ▼]

Intensive enteral nutrition by feeding tube does not improve 6-month survival in patients with severe alcoholic hepatitis. However, adequate nutritional support is associated with a better short-term prognosis. Adequate nutritional intake should be targeted in alcoholic hepatitis patients treated with corticosteroids. [less ▲]

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See detailResponse of Black African patients with hepatitis C virus genotype 4 to treatment with peg-interferon and ribavirin
Nkuize, M; Mulkay, JP; Adler, M et al

in Acta Gastro-Enterologica Belgica (2013), 76

Aim : To compare responses to therapy of Black African (BA) and non-Black African (non- BA) patients with hepatitis C virus genotype 4 (HCV-4) residing in Belgium. Methods : In this retrospective ... [more ▼]

Aim : To compare responses to therapy of Black African (BA) and non-Black African (non- BA) patients with hepatitis C virus genotype 4 (HCV-4) residing in Belgium. Methods : In this retrospective multicenter study, 473 patients with HCV-4 were selected from databases at 7 Belgian centers ; 209 treatment-naïve patients (154 BA) had received treatment with peg-interferon (peg-IFN) plus ribavirin (RBV) and were included in the study. Results : There was a greater percentage of female patients in the BA group than in the non- BA group ; BA patients were also older, had a greater body mass index, and more frequently had abnormal glucose metabolism. The route of contamination was more frequently unknown in BA than in non-BA patients and BA patients had more HCV-4 subtypes. There were no differences in other demographic factors between the groups. Sustained viral response (SVR) and complete early viral response rates were significantly lower and relapse rates significantly higher in BA than in non-BA patients. There were no differences between groups in rates of dose modification or in drug tolerance. Conclusion : In our cohort, treatment-naïve BA patients with HCV-4 who were treated with peg-IFN and ribavirin had a much lower SVR rate than treatment-naïve non-BA patients with HCV- 4 who were treated with peg-IFN and ribavirin, and a higher relapse rate, possibly related to a weaker response to interferonbased therapy. Treatment may need to be adapted in this population. [less ▲]

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See detailHepatitis B virus and hepatitis C virus infection in Belgium: similarities and differences in epidemic and initial management
De Vroey, B; Moreno, C; Laleman, W et al

in European Journal of Gastroenterology & Hepatology (2013), 25(5), 613-619

Introduction Nationwide studies comparing patients with hepatitis B and C virus (HBV and HCV) infections are mandatory for assessing changes in epidemiology. Aim The aim of this study was to compare ... [more ▼]

Introduction Nationwide studies comparing patients with hepatitis B and C virus (HBV and HCV) infections are mandatory for assessing changes in epidemiology. Aim The aim of this study was to compare epidemiological data and initial management of newly diagnosed patients with persistent HBV (HBsAg positive) or HCV (detectable HCV RNA) infection in Belgium. Patients and methods Data were extracted from two Belgian observational databases. Results A total of 655 patients (387 HBV and 268 HCV) were included. Compared with HCV patients, HBV patients were younger, more frequently men, more often of Asian or African origin (43 vs. 10%, P < 0.0001), and less frequently contaminated by transfusion or intravenous drug use (9 and 6% vs. 34 and 44%, P< 0.0001). Viral replication was assessed in 89% of HBV patients. Compared with HCV patients, HBV patients more frequently had normal alanine aminotransferase (ALT) levels (65 vs. 29%, P < 0.0001), less frequently underwent liver biopsy (29 vs. 67%, P < 0.0001), and were less often considered for antiviral therapy (25 vs. 54%, P < 0.0001). When taking only HBV patients with detectable viral replication into consideration, results remained unchanged. During the multivariate analysis, ALT was a major factor for performing liver biopsy or considering antiviral therapy in both groups. Conclusion HBV and HCV screening policies should be targeted toward immigrants and intravenous drug users, respectively. Guidelines recommending systematic search for viral replication should be reinforced in HBV patients. HBV patients less frequently underwent liver biopsy and were less often considered for antiviral therapy compared with HCV patients. Despite the lack of sensitivity and specificity, ALT remains a pivotal decision-making tool for liver biopsy and antiviral therapy in both infections. [less ▲]

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See detailHBV infection in Belgium: results of the BASL observatory of 1456 HBsAg carriers.
Deltenre, P.; Laleman, W.; Van Gossum, M. et al

in Acta Gastro-Enterologica Belgica (2012), 75(1), 35-41

Introduction : Nationwide studies are mandatory to assess changes in the epidemiology of HBV infection in Europe. Aim : To describe epidemiological characteristics of HBsAgpositive patients, especially ... [more ▼]

Introduction : Nationwide studies are mandatory to assess changes in the epidemiology of HBV infection in Europe. Aim : To describe epidemiological characteristics of HBsAgpositive patients, especially inactive carriers, and to evaluate how practitioners manage HBV patients in real life. Methods : Belgian physicians were asked to report all chronically infected HBV patients during a one-year period. Results : Among 1,456 patients included, 1,035 (71%) were classified into one of four phases of chronic infection : immune tolerance (n = 10), HBeAg-positive hepatitis (n = 248), HBeAgnegative hepatitis (n = 420) and inactive carrier state (n = 357 HBeAg-negative patients with ALT < upper limit of normal (ULN) and HBV DNA < 2,000 IU/mL). Using less restrictive criteria for ALT (1-2 ULN) or HBV DNA (2,000-20,000 IU/mL), 93 unclassified patients were added to the group of inactive carriers. These 93 additional inactive carriers were younger, more frequently males, with similar risk factors for HBV infection and histological features compared to inactive carriers according to recent guidelines. Recent guidelines on management of HBV patients were generally followed, but systematic HBV DNA measurements and HDV coinfection screening should be reinforced. Conclusion : In Belgium, an inactive carrier state was a common form of chronic HBV infection. Using less restrictive criteria for classification of inactive carriers did not modify their main characteristics and seemed better adapted to clinical practice. Recent guidelines on management of HBV patients should be reinforced. [less ▲]

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See detailAre patients with HBV and HCV infection different? Comparison between 2 cohorts of newly diagnosed cases included in prospective registries of the Belgian Association for the Study of the Liver
De Vroey, B.; Moreno, C.; Laleman, W. et al

in Acta Gastro-Enterologica Belgica (2011, March), 74(1), 21

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See detailHepatitis C genotype 4 response rate to pegylated interferon and ribavirin treatment in Belgium is similar to genotype 1
de Galocsy, C.; Kaufman, L.; Tomasovic, S. et al

in Acta Gastro-Enterologica Belgica (2010), 73

Background and aims : Patients with genotype 4 (G4) chronic hepatitis C from the Middle East respond better to treatment than genotype 1 (G1) patients. There are few data on the response rates to ... [more ▼]

Background and aims : Patients with genotype 4 (G4) chronic hepatitis C from the Middle East respond better to treatment than genotype 1 (G1) patients. There are few data on the response rates to treatment of G4 patients living in Western Europe. Many G4 patients in Belgium originate from Central Africa, and their response to treatment seems lower. Methods : We analysed the data from 2 randomized phase III studies conducted in Belgium, BerNar-1 and BerNar-2, comparing the sustained virological response (SVR) to pegylated interferon and ribavirin of 78 G4 patients (34 Caucasians, 44 Blacks) and 477 G1 patients (455 Caucasians, 12 Blacks), and assessing the predictors of SVR. Results : Baseline characteristics of G4 and G1 patients were similar except mainly for race. Complete early virological response (cEVR) was similar in G4 (73.2%) and G1 (68.1%). cEVR was also similar between Black and Caucasian G4 and between Black and Caucasian G1 patients. Partial early virological response was similar for G4 and G1. SVR was similar for G4 (51.3%) and G1 (51.8%). There was a trend for a higher SVR in Caucasians than in Blacks. In multivariate analysis, the only predictors for SVR were the presence of cirrhosis, HCV viral load, age < 40 vs 40 yrs, and treatment status (relapsers vs naïve). Conclusions : G4 patients in Belgium have the same SVR as G1 patients. It is lower than the SVR described in Arab countries, especially for Black G4 patients. (Acta gastro enterol. belg., 2010, 73, 229-234). [less ▲]

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See detailDaily induction combination treatment with alpha 2b interferon and ribavirin or standard combination treatment in naive chronic hepatitis C patients. A multicentre randomized controlled trial
Van Vlierberghe, H.; Leroux-Roels, G.; Adler, M. et al

in Journal of Viral Hepatitis (2003), 10(6), 460-466

The standard treatment for patients with chronic hepatitis C is a 6-12-month combination therapy with interferon alpha and ribavirin. Induction treatment could result in a faster early decline of the ... [more ▼]

The standard treatment for patients with chronic hepatitis C is a 6-12-month combination therapy with interferon alpha and ribavirin. Induction treatment could result in a faster early decline of the hepatitis C virus (HCV) load and a better response rate. Naive chronically infected HCV patients (n = 454) were randomized into two arms to receive either induction treatment with interferon alpha 2b 5 million units (MU) subcutaneously (s.c.) daily during a period of 8 weeks (arm A); or treatment with interferon alpha 2b 5 MU s.c. three times a week (TIW) for a period of 8 weeks (arm B). After week 8, interferon treatment in both arms was 3 MU s.c. TIW for a total period of 12 months. In both arms, ribavirin (1000-1200 mg orally per day) was added at week 4. Induction treatment resulted in a higher virological response at week 8 of treatment (66%vs 47%; P < 0.01). However, response at the end of treatment and at 6 months follow-up was not different (53%vs 50%, 41%vs 33%). The occurrence of adverse events and the drop-out rate were similar in both arms. Although an early virological response is observed more frequently in the induction treatment, end of treatment response and sustained responses did not differ. [less ▲]

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