BACKGROUND/AIM: Both nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis C virus (HCV) infection are common in Egypt, and their coexistence is expected. There is controversy regarding the influence of NAFLD on chronic HCV disease progression. This study evaluates the effect of NAFLD on the severity of chronic hepatitis C (CHC) (necroinflammation and fibrosis) and assesses the relative contribution of insulin resistance syndrome to the occurrence of NAFLD in patients with chronic HCV infection. PATIENTS AND METHODS: Untreated consecutive adults with chronic HCV infection admitted for liver biopsy were included in this study. Before liver biopsy, a questionnaire for risk factors was completed prospectively, and a blood sample was obtained for laboratory analysis. RESULTS: Our study included 92 male patients. Their mean ± SD age and aspartate aminotransferase (AST) level were 42 ± 7.7 years (range 20-56) and 68 ± 41.7 U/L (range 16-214), respectively. The mean insulin level and insulin resistance index were 15.6 ± 18.3 mIU/mL (range 5.1-137.4) and 5.9 ± 15.2 (range 0.9-136.2), respectively. Fifty four percent of patients had steatosis and 65% had fibrosis. In multivariate analyses, steatosis was associated with insulin resistance and fibrosis was associated with high AST level, age ≥40 years, and steatosis. CONCLUSIONS: Steatosis is a histopathologic feature in >50% of patients with chronic HCV infection. Insulin resistance has an important role in the pathogenesis of steatosis, which represents a significant determinant of fibrosis together with high serum AST level and older age.

BACKGROUND/AIM: Both nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis C virus (HCV) infection are common in Egypt, and their coexistence is expected. There is controversy regarding the influence of NAFLD on chronic HCV disease progression. This study evaluates the effect of NAFLD on the severity of chronic hepatitis C (CHC) (necroinflammation and fibrosis) and assesses the relative contribution of insulin resistance syndrome to the occurrence of NAFLD in patients with chronic HCV infection. PATIENTS AND METHODS: Untreated consecutive adults with chronic HCV infection admitted for liver biopsy were included in this study. Before liver biopsy, a questionnaire for risk factors was completed prospectively, and a blood sample was obtained for laboratory analysis. RESULTS: Our study included 92 male patients. Their mean ± SD age and aspartate aminotransferase (AST) level were 42 ± 7.7 years (range 20-56) and 68 ± 41.7 U/L (range 16-214), respectively. The mean insulin level and insulin resistance index were 15.6 ± 18.3 mIU/mL (range 5.1-137.4) and 5.9 ± 15.2 (range 0.9-136.2), respectively. Fifty four percent of patients had steatosis and 65% had fibrosis. In multivariate analyses, steatosis was associated with insulin resistance and fibrosis was associated with high AST level, age ≥40 years, and steatosis. CONCLUSIONS: Steatosis is a histopathologic feature in >50% of patients with chronic HCV infection. Insulin resistance has an important role in the pathogenesis of steatosis, which represents a significant determinant of fibrosis together with high serum AST level and older age.

Background and Aims: Chronic hepatitis C virus (HCV) infection is very common in Egypt. There is no available data about frequency of chronic HCV infection in patients with ulcerative colitis (UC) or effect of this infection on UC. We carried out this study to answer such questions. Methods: We prospectively analyzed 44 patients with UC from Tropical Medicine and Gastroenterology Department, Assiut University Hospital. For all participants, the following was conducted: clinical evaluation, abdominal ultrasonography (US) examination, and laboratory investigations. Differences in UC disease severity and distribution between patients with chronic HCV infection and those without were identified using univariate analysis. Results: Frequency of chronic HCV infection was 25% among study patients. Univariate analysis showed a significantly lower (p 0.05) severe UC activity index and higher moderate index in UC patients with chronic HCV infection than in those without. Conclusions: We found that frequency of chronic HCV infection among Egyptian patients with UC is similar to that among general population. Chronic HCV infection was associated with less severe activity index of UC suggesting an inhibitory role of HCV on UC activity.

Background and Aims: Chronic hepatitis C virus (HCV) infection is very common in Egypt. There is no available data about frequency of chronic HCV infection in patients with ulcerative colitis (UC) or effect of this infection on UC. We carried out this study to answer such questions. Methods: We prospectively analyzed 44 patients with UC from Tropical Medicine and Gastroenterology Department, Assiut University Hospital. For all participants, the following was conducted: clinical evaluation, abdominal ultrasonography (US) examination, and laboratory investigations. Differences in UC disease severity and distribution between patients with chronic HCV infection and those without were identified using univariate analysis. Results: Frequency of chronic HCV infection was 25% among study patients. Univariate analysis showed a significantly lower (p 0.05) severe UC activity index and higher moderate index in UC patients with chronic HCV infection than in those without. Conclusions: We found that frequency of chronic HCV infection among Egyptian patients with UC is similar to that among general population. Chronic HCV infection was associated with less severe activity index of UC suggesting an inhibitory role of HCV on UC activity.

Background and Aims: Chronic hepatitis C virus (HCV) infection is very common in Egypt. There is no available data about frequency of chronic HCV infection in patients with ulcerative colitis (UC) or effect of this infection on UC. We carried out this study to answer such questions. Methods: We prospectively analyzed 44 patients with UC from Tropical Medicine and Gastroenterology Department, Assiut University Hospital. For all participants, the following was conducted: clinical evaluation, abdominal ultrasonography (US) examination, and laboratory investigations. Differences in UC disease severity and distribution between patients with chronic HCV infection and those without were identified using univariate analysis. Results: Frequency of chronic HCV infection was 25% among study patients. Univariate analysis showed a significantly lower (p 0.05) severe UC activity index and higher moderate index in UC patients with chronic HCV infection than in those without. Conclusions: We found that frequency of chronic HCV infection among Egyptian patients with UC is similar to that among general population. Chronic HCV infection was associated with less severe activity index of UC suggesting an inhibitory role of HCV on UC activity.

Association of ulcerative colitis (UC) with hepatobiliary disorders is well recognised. The most common hepatobiliary complications of inflammatory bowel disease (IBD) are fatty liver infiltration and cholelithiasis. The prevalence of liver dysfunction in IBD remains unclear. The aim of the study is to try to identify the frequency and risk factors of hepatobiliary disorders among patients with UC in Upper Egypt. PATIENTS AND METHODS: We prospectively analysed 33 patients with newly diagnosed UC of Tropical Medicine and Gastroenterology Department, Assiut University Hospital. For all participants, the following were conducted: clinical evaluation, abdominal ultrasonography (US) examination and laboratory investigations. Risk factors of hepatobiliary disorders were identified using univariate, then multivariate analysis. RESULTS: The frequency of hepatic disorders (fatty liver and elevated liver chemistry) was 75.8% in study patients while the frequency of biliary disorders (gallbladder stones and gallbladder wall thickening) was 54.5%. A higher risk of hepatic disorders was observed with older age (odds ratio (OR) 14, 95% confidence interval (CI) 2-124). A higher risk of biliary disorders was observed with UC severe activity index (OR 27, 95% CI 3-292). CONCLUSIONS: The frequency of hepatobiliary disorders in patients with UC exceeded what was previously reported. High frequency of hepatic disorders was related to older age, while that of biliary disorders was related to UC activity.

Association of ulcerative colitis (UC) with hepatobiliary disorders is well recognised. The most common hepatobiliary complications of inflammatory bowel disease (IBD) are fatty liver infiltration and cholelithiasis. The prevalence of liver dysfunction in IBD remains unclear. The aim of the study is to try to identify the frequency and risk factors of hepatobiliary disorders among patients with UC in Upper Egypt. PATIENTS AND METHODS: We prospectively analysed 33 patients with newly diagnosed UC of Tropical Medicine and Gastroenterology Department, Assiut University Hospital. For all participants, the following were conducted: clinical evaluation, abdominal ultrasonography (US) examination and laboratory investigations. Risk factors of hepatobiliary disorders were identified using univariate, then multivariate analysis. RESULTS: The frequency of hepatic disorders (fatty liver and elevated liver chemistry) was 75.8% in study patients while the frequency of biliary disorders (gallbladder stones and gallbladder wall thickening) was 54.5%. A higher risk of hepatic disorders was observed with older age (odds ratio (OR) 14, 95% confidence interval (CI) 2-124). A higher risk of biliary disorders was observed with UC severe activity index (OR 27, 95% CI 3-292). CONCLUSIONS: The frequency of hepatobiliary disorders in patients with UC exceeded what was previously reported. High frequency of hepatic disorders was related to older age, while that of biliary disorders was related to UC activity.

Aim: To determine the frequency and risk factors of Gallbladder stone disease (GSD) among patients with chronic hepatitis C infection. Material and Methods: The study was conducted on patients with chronic HCV infection admitted to Tropical Medicine and Gastroenterology Department, Assiut University Hospital during the Period from November 2010 to December 2011 and patients without HCV infection attending Tropical Medicine and Gastroenterology Clinic, Assiut University Hospital. The study included 48 patients (29 males, 19 females) with chronic HCV infection and 192 patients (113 males, 79 females) without HCV infection. For all participants, the following was conducted: Clinical evaluation (Medical History and Physical Examination), abdominal ultrasonographic examination, and laboratory investigations including estimation of fasting serum level of glucose, lipid profile [fasting serum levels of cholesterol, low density lipoprotein (LDL)-cholesterol, high density lipoprotein (HDL)-cholesterol, and triglycerides], liver profile [serum levels of bilirubin, albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP)], prothrombin time, and complete blood count. Results: The frequency of GSD among patients with chronic HCV infection was 25% while it was 15.1% among the subjects without HCV infection. The metabolic syndrome (Odds ratio was 33 and 95% confidence interval was 3-424) and glucose intolerance (Odds ratio was 12 and 95% confi- dence interval was 1-133) were significantly, independently associated with GSD among patients with chronic HCV infection. Conclusion: The frequency of GSD is more among patients with chronic HCV infection than among HCV-negative sub- jects. Among patients with chronic HCV infection, risk factors for GSD are the metabolic syndrome and glucose intolerance.

Aim: To determine the frequency and risk factors of Gallbladder stone disease (GSD) among patients with chronic hepatitis C infection. Material and Methods: The study was conducted on patients with chronic HCV infection admitted to Tropical Medicine and Gastroenterology Department, Assiut University Hospital during the Period from November 2010 to December 2011 and patients without HCV infection attending Tropical Medicine and Gastroenterology Clinic, Assiut University Hospital. The study included 48 patients (29 males, 19 females) with chronic HCV infection and 192 patients (113 males, 79 females) without HCV infection. For all participants, the following was conducted: Clinical evaluation (Medical History and Physical Examination), abdominal ultrasonographic examination, and laboratory investigations including estimation of fasting serum level of glucose, lipid profile [fasting serum levels of cholesterol, low density lipoprotein (LDL)-cholesterol, high density lipoprotein (HDL)-cholesterol, and triglycerides], liver profile [serum levels of bilirubin, albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP)], prothrombin time, and complete blood count. Results: The frequency of GSD among patients with chronic HCV infection was 25% while it was 15.1% among the subjects without HCV infection. The metabolic syndrome (Odds ratio was 33 and 95% confidence interval was 3-424) and glucose intolerance (Odds ratio was 12 and 95% confi- dence interval was 1-133) were significantly, independently associated with GSD among patients with chronic HCV infection. Conclusion: The frequency of GSD is more among patients with chronic HCV infection than among HCV-negative sub- jects. Among patients with chronic HCV infection, risk factors for GSD are the metabolic syndrome and glucose intolerance.

OBJECTIVES: Patients with chronic hepatitis B virus (HBV) may exhibit significant liver pathology despite alanine aminotransferase (ALT) and HBV DNA levels below the cutoff values advised by treatment guidelines. We evaluated candidacy for HBV therapy when baseline histopathological changes are taken into consideration. METHODS: Clinical, biochemical, serological, virological, and histopathological (METAVIR score) data of 117 patients with HBeAg-negative chronic HBV genotype D were collected and analyzed. RESULTS: Significant pathology (≥F2 and/or ≥A2) and fibrosis (≥F2 ± ≥A2) were found in 73 (62.4%) and 59 (50.4%) patients, respectively. Based on HBV DNA (>2,000 IU/ml) and ALT levels >2 × 40 U/l (the standard cutoff value), only 31 (26.5%) patients were candidates for therapy. This increased to 58 (49.6%) patients when the new ALT cutoff values (30 U/l for males, and 19 U/l for females) were applied. Relying on either ≥F2 and/or A ≥2 or ≥F2 ± ≥A2 increases the treatment candidacy to 73 (62.4%) and 59 (50.4%) patients, respectively. Also, when compared with standard ALT cutoff values, applying both new ALT cutoff values with either significant pathology or fibrosis increases treatment candidacy to 28 (23.9%) and 42 (35.9%) patients, respectively. CONCLUSION: Liver pathology is more reliable than ALT and HBV DNA in the decision to treat patients with HBeAg-negative chronic HBV genotype D.