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Foredrag 1. Transcatheter Arterial Embolization after successful endoscopic hemostasis prevents rebleeding in peptic ulcer bleeding Stig Borbjerg Laursen, Jane Møller Hansen & Ove B Schaffalitzky de Muckadell Medicinsk Gastroenterologisk Afdeling S, Odense Universitetshospital Background & Aims One of the major challenges in peptic ulcer bleeding (PUB) is rebleeding which is associated with up to a five-fold increase in mortality. We examined if supplementary transcatheter arterial embolization (STAE) performed after achieved endoscopic hemostasis improves outcome in patients with high-risk ulcers. Methods The study was designed as a non-blinded, parallel group, randomized controlled trial and performed in a university hospital setting. Patients admitted with PUB from Forrest Ia-IIb ulcers controlled by endoscopic therapy were randomized (1:1 ratio) to receive STAE of the bleeding artery within 24 hours or continue standard treatment. Randomization was stratified according to stigmata of haemorrhage. Patients were followed for 30 days. Primary outcome was a composite endpoint. Among secondary outcomes were rebleeding, number of blood transfusions received, duration of admission, and mortality. Results A total of 105 patients were included. Of the 49 patients allocated to STAE 31 underwent successful STAE. Two versus eight patients re-bled in the STAE and control group respectively (Per-protocol analysis; P=.10). After adjustment for possible imbalances STAE was associated with a clear trend of reduced rate of rebleeding (P=.079). Only one of the patients undergoing successful STAE developed rebleeding, and this patient only had a minor rebleeding without need of hemostatic intervention. Conclusions With a 7.9% risk of performing a Type I error this study demonstrates that STAE is useful in prevention of rebleeding in patients with PUB from high-risk ulcers. STAE can safely be performed in selected cases with suspected high risk of rebleeding. 2. Soluble TNFa-receptor p55 as prognostic marker in liver cirrhosis with portal hypertension and TIPS Trebicka J*#, Krag A#, Gansweid S*, Sauerbruch T*, Spengler U* *Department of Internal Medicine I, University of Bonn, Germany # Department of Gastroenterology, Hvidovre Hospital, University of Kopenhagen, Denmark Background: TNFa levels are increased in liver cirrhosis even without obvious infection signs probably by continuous endotoxin influx in portal blood. Soluble TNFa receptors (p55, p75) are useful tools to investigate TNFa release, which itself has a short half-life. p75 levels correlate with mortality in liver cirrhosis (Clin Gastro Hep 2008;6:1255-1262). Here, we investigated p55- and p75-levels in patients receiving TIPS. Methods: 41 patients with liver cirrhosis and portal hypertension (12 viral, 29 alcoholic) received TIPS. Portal and central venous blood was withdrawn in these patients during the TIPS-procedure and in the invasive control two weeks later. In these samples levels of p55 and p75 were measured via ELISA. 4
Results: We found no significant difference of p55- and p75-levels in portal and central venous blood. Both p55- and p75-levels correlated directly with the MELD-score (p=0.001) and creatinine (p=0.0001), as well as inversely with albumin (p=0.02) and cholinesterase (p=0.01). The portal pressure measured during TIPS-procedure did not correlate with p55- and p75-levels. In contrast, portal pressure during the invasive control two weeks after TIPS correlated directly and systolic arterial pressure inversely with central venous p55-levels. Survival correlated inversely with central venous p55-levels (p=0.007). Discussion: This study shows that central venous p55 levels correlate with severity of hyperdynamic circulation as well as with increased mortality in patients receiving TIPS. This parameter could represent a prognostic marker for patients receiving TIPS. 3. Minimal hepatic encephalopathy and disease specific quality of life in outpatients with cirrhosis: Results from a prospective cohort Maja Thiele 1,4 , Gro Askgaard 2 , Hans Bording Timm 3 , Ole Hamberg 2 , Lise Lotte Gluud 4 1 Department of Medicine, Copenhagen University Hospital Køge, Denmark. 2 Department of Hepatology, Copenhagen University Hospital Rigshospitalet, Denmark. 3 Department of Medicine, Copenhagen University Hospital Glostrup, Denmark. 4 Department of Medicine, Copenhagen University Hospital Gentofte, Denmark. Objective We analysed predictors of health-related quality of life (HRQoL) among outpatients with cirrhosis. Methods A prospective cohort study on patients with cirrhosis was conducted in two Danish liver outpatient clinics. Patients with clinical or histological cirrhosis and no signs of clinically overt hepatic encephalopathy (assessed using the West Haven Criteria) were included. At inclusion patients were evaluated through screening of nutritional parameters (body mass index), blood tests and the continuous reaction time test, which is a computerized psychometric test validated for the diagnosis of minimal hepatic encephalopathy (MHE). MHE was defined as an Index Value for the reaction time variance below 1.900. The HRQoL was evaluated using the 6 point Chronic Liver Disease Questionnaire (CLDQ). Initially the questionnaire was backwards and forwards translated into Danish. The questionnaire was pilot tested among the eligible patient population. The CLDQ score was classed as low (
Page 1 and 2: Danish Society for Gastroenterology
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Page 11 and 12: Posters 1. Endoscopic, transmural d
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Page 17 and 18: 22- and IL-17A-producing T helper c
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Page 25 and 26: 20. Coloskopi - En sag for ligestil
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Page 33 and 34: in non-responders. Conclusion Our f
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