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Biomedical subjects

Ewan H Forrest

Publications and source records attributed to Ewan H Forrest.

5 recordsLinked to original sources
PubMed2005

Bilirubin response to corticosteroids in severe alcoholic hepatitis.

INTRODUCTION: There is little consensus on the management of alcoholic hepatitis, particularly with regard to corticosteroid therapy. We aimed to identify those patients who respond to corticosteroid therapy for alcoholic hepatitis. METHODS: We identified 37 patients with alcoholic hepatitis with a modified Maddrey's discriminant function of 32 or greater. We assessed their outcomes at 28 and 56 days treatment after admission relative to their response to corticosteroid treatment. RESULTS: Corticosteroid treated patients experienced a change in the serum bilirubin concentration after 6-9 days of -23.0+/-4.7%. Overall, the mortality was 18.9 and 35.1% at 28 and 56 days. Response to corticosteroids was defined as a 25% fall in serum bilirubin after 6-9 days of treatment. The mortality of the non-responders was 36.8% and 57.9% at 28 and 56 days compared with 0% (P=0.0148) and 11.1% (P=0.0084) for corticosteroid responders. CONCLUSIONS: Patients with a 25% fall in bilirubin after 6-9 days of corticosteroid therapy have a significant and sustained improvement in outcome.

Administration, Oral↗
PubMed2002

Improvement in cholestasis associated with total parenteral nutrition after treatment with an antibody against tumour necrosis factor alpha.

BACKGROUND: Many patients receiving long-term total parenteral nutrition (TPN) develop liver disease; cholestasis is common and may be severe. Antitumour necrosis factor alpha (TNFalpha) antibodies have recently been used in order to treat Crohn's disease, but their effect on cholestasis in humans has not been previously described. CASE REPORT: A 45-year-old woman had complicated Crohn's disease with multiple fistulae and only 1 m of residual small bowel. She had been receiving TPN for 2.5 years when she developed cholestasis which worsened despite adjustments to her TPN regimen. Infliximab, an anti-TNFalpha antibody, was given with the aim of treating an enterocutaneous fistula, but it also produced a marked biochemical and histological improvement in the TPN-related cholestasis. CONCLUSIONS: Anti-TNFalpha antibodies appeared in this case to improve TPN-related cholestasis. This implies that TNFalpha may play an important role in the development of this condition.

Antibodies, Monoclonal↗
PubMed2002

Primary prophylaxis of variceal hemorrhage: a randomized controlled trial comparing band ligation, propranolol, and isosorbide mononitrate.

BACKGROUND & AIMS: This randomized controlled trial compared variceal band ligation (VBL), propranolol (PPL), and isosorbide-5-mononitrate (ISMN) in the prevention of first esophageal variceal bleed. METHODS: Over a 6-year period, 172 patients with cirrhosis, grade II or III esophageal varices that had never bled, were recruited; 44 into VBL, 66 into PPL, and 62 into ISMN. Baseline patient characteristics: age, 55 +/- 11 years; Child-Pugh score, 8 +/- 2; 65% alcohol-induced cirrhosis; follow-up period, 19.7 +/- 17.6 months (range, 0.13-72.1 months), were comparable in the 3 groups. RESULTS: On intention-to-treat analysis, variceal bleeding occurred in 7% of patients randomized to VBL, 14% to PPL, and 23% to ISMN. The 2-year actuarial risks for first variceal bleed were 6.2% (95% confidence interval [CI], 0.0%-15.0%) for VBL, 19.4% (95% CI, 0.1%-32.4%) for PPL, and 27.7% (95% CI, 14.2%-41.2%) for ISMN. A significant number of patients reported side effects with drug treatment (45% PPL and 42% ISMN vs. 2% VBL; P = 0.00), resulting in withdrawal from treatment in 30% of PPL and 21% of ISMN patients. There were no statistically significant differences in mortality rates in the 3 groups. In as-treated analysis, there was a statistically significant difference in actuarial risk for bleeding at 2 years between VBL and ISMN (7.5%, 95% CI, 2.5%-10.6% vs. 33.0%, 95% CI, 15%-49%, respectively, log rank test P = 0.03) but not between VBL and PPL. CONCLUSIONS: VBL was equivalent to PPL and superior to ISMN in preventing first variceal bleed. The side-effect profile for pharmacotherapy was considerable.

Antihypertensive Agents↗