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Papers by DrMohamed Bassiony

Research paper thumbnail of Prevalence and Risk Factors of Minimal Hepatic Encephalopathy in Patients with Compensated Liver Cirrhosis

The Egyptian Journal of Hospital Medicine, 2020

Background: Minimal hepatic encephalopathy (MHE) is the earliest phase of hepatic encephalopathy.... more Background: Minimal hepatic encephalopathy (MHE) is the earliest phase of hepatic encephalopathy. It is associated with increased risk of falls, impaired work and diminished quality of life. Subjects and methods: This study included 302 patients with liver cirrhosis, of which 130 patients had Child A (compensated) liver cirrhosis. All patients were assessed by history taking, clinical examination, routine investigations, serum ammonia level and abdominal ultrasound for porto-systemic shunt (PSS). MHE was diagnosed in 60 patients of compensated liver cirrhosis patients using mini-mental state examination (MMSE) and number connection test A (NCT-A). Results: Our stud showed that Child A patients were 43% of the study group and MHE was present in 46% of compensated liver cirrhosis patients. Our results showed a significant association between lower serum albumin, higher INR, high serum ammonia, presence of PSS in ultrasound examination and MMSE and NCT-A high scores with the developmen...

Research paper thumbnail of Prevalence and Risk Factors of Minimal Hepatic Encephalopathy in Patients with Compensated Liver Cirrhosis

The Egyptian Journal of Hospital Medicine, 2020

Background: Minimal hepatic encephalopathy (MHE) is the earliest phase of hepatic encephalopathy.... more Background: Minimal hepatic encephalopathy (MHE) is the earliest phase of hepatic encephalopathy. It is associated with increased risk of falls, impaired work and diminished quality of life. Subjects and methods: This study included 302 patients with liver cirrhosis, of which 130 patients had Child A (compensated) liver cirrhosis. All patients were assessed by history taking, clinical examination, routine investigations, serum ammonia level and abdominal ultrasound for porto-systemic shunt (PSS). MHE was diagnosed in 60 patients of compensated liver cirrhosis patients using mini-mental state examination (MMSE) and number connection test A (NCT-A). Results: Our stud showed that Child A patients were 43% of the study group and MHE was present in 46% of compensated liver cirrhosis patients. Our results showed a significant association between lower serum albumin, higher INR, high serum ammonia, presence of PSS in ultrasound examination and MMSE and NCT-A high scores with the developmen...

Research paper thumbnail of Recurrence of Helicobacter pylori Infection after Successful Eradication Therapy in Egyptian Patients

Acta scientific gastrointestinal disorders, 2020

Background: Helicobacter pylori (H. pylori), a highly prevalent gastrointestinal organism, infect... more Background: Helicobacter pylori (H. pylori), a highly prevalent gastrointestinal organism, infects more than 50% of the global population. It is the most common risk factor for peptic ulcer disease, cancer stomach and gastric lymphoma. Eradication therapy regimens for H. pylori are highly effective. However, bacterial resistance to antibiotics and patients nonadherence to the treatment regimens significantly increased the recurrence rates of H. pylori infection in the last few decades. Patients and Methods: We evaluated and followed up 157 patients for one year after confirmed successful eradication of H. pylori infection. We investigated the patients at 3, 6, 9 and 12 months for recurrence of H. pylori infection using urea breath and stool antigen tests. Study Aim: To assess the prevalence and possible risk factors of H. pylori recurrence in Egyptian patients after eradication therapy. Results and Conclusion: We found a one-year recurrence rate of 19% after successful eradication therapy of H. pylori. The education level of the patients and alcohol consumption were the most significant predictors of H. pylori recurrence. The one-year recurrence rate in our study is high but comparable to those reported in the developing countries most probably due to high rates of re-infection

Research paper thumbnail of Prevalence and Risk Factors of Minimal Hepatic Encephalopathy in Patients with Compensated Liver Cirrhosis

The Egyptian journal of hospital medicine , 2020

Background: Minimal hepatic encephalopathy (MHE) is the earliest phase of hepatic encephalopathy.... more Background: Minimal hepatic encephalopathy (MHE) is the earliest phase of hepatic encephalopathy. It is associated with increased risk of falls, impaired work and diminished quality of life. Subjects and methods: This study included 302 patients with liver cirrhosis, of which 130 patients had Child A (compensated) liver cirrhosis. All patients were assessed by history taking, clinical examination, routine investigations, serum ammonia level and abdominal ultrasound for porto-systemic shunt (PSS). MHE was diagnosed in 60 patients of compensated liver cirrhosis patients using mini-mental state examination (MMSE) and number connection test A (NCT-A). Results: Our stud showed that Child A patients were 43% of the study group and MHE was present in 46% of compensated liver cirrhosis patients. Our results showed a significant association between lower serum albumin, higher INR, high serum ammonia, presence of PSS in ultrasound examination and MMSE and NCT-A high scores with the development of MHE. MMSE and NCT A showed significantly good performance in diagnosis of MHE. Multiple regression analysis showed that high serum ammonia level (53-61) u/dl, large PSS (> 8 mm in diameter), MMSE score (22-26) and NCT A score (45-56) were the most significant risk factors for MHE. Conclusion: MHE is a major and prevalent manifestation in compensated liver cirrhosis patients. It is associated with significant decrease in work and driving abilities and quality of life. Its major risk factors are high serum ammonia, large PSS and high scores of MMSE and NCT A tests that have a good performance in MHE diagnosis.

Research paper thumbnail of Occurrence and Recurrence of Hepatocellular Carcinoma after Direct-Acting Antiviral Therapy: A Truth or a Myth

Research paper thumbnail of Bronchial Asthma and Eosinophilic Gastroenteritis: A Case Report

International Journal of Digestive Diseases

Research paper thumbnail of The role of mean platelet volume in predicting severity and prognosis of liver cirrhosis in Egyptian patients

The Egyptian Journal of Internal Medicine

Research paper thumbnail of Management of HCV-related decompensated cirrhosis with direct-acting antiviral agents: who should be treated?

Hepatology International

BackgroundMedical treatment of decompensated cirrhosis due to hepatitis C virus (HCV) remains a c... more BackgroundMedical treatment of decompensated cirrhosis due to hepatitis C virus (HCV) remains a clinical challenge even in the era of direct-acting antiviral drugs (DAAs). We evaluated the efficacy and safety of DAAs in the management of HCV genotype 4-related decompensated cirrhosis.MethodsThe study included a treatment group (n = 160) composed of HCV patients with decompensated cirrhosis who received DAAs for 3 months and a matched control group (n = 80) who preferred not to receive DAAs, follow-up was for 24–31 months.ResultsIn treatment group; there were improvements in platelet count, albumin, CTP (p = 0.001) and MELD scores (p = 0.03), a significant reduction in the frequency of hepatic encephalopathy (HE). SVR was achieved in 90%. Hepatocellular carcinoma (HCC) developed in 10% (n = 18) within 6.8 ± 2.5 months after DAAs, survival was higher in the treated vs. the control group (28.9 ± 0.95 vs. 11.4 ± 2.2 months, p = 0.001). Liver volume by ultrasound at a cutoff 495 ml was predictive of complications after DAAs therapy mainly HCC and reduced survival with sensitivity 93.2%, specificity 72%.ConclusionHCV with decompensated cirrhosis and adequate liver volume had a 90% SVR with improved CTP&MELD and survival. Clinical trial: (NCT03547895).

Research paper thumbnail of Combined Management Approach for Gastric & Extra-Gastric Dieulafoy’s Lesions

Advanced Research in Gastroenterology & Hepatology

Introduction: Dieulafoy's lesions are under-diagnosed and with considerable rate of re-bleeding. ... more Introduction: Dieulafoy's lesions are under-diagnosed and with considerable rate of re-bleeding. They are common causes of obscure gastrointestinal bleeding. These are 3 cases of Dieulafoy's lesion, one gastric & two are extra-gastric. The first case was an 11-year-old girl presented by recurrent hematemesis & melena. She was secured by endoscopic banding after adrenaline injection. The second case was a 19-year-old male who had multiple recurrent attacks of melena. Initial upper endoscopy was normal but angiography showed contrast extravasation at the first part of duodenum secured by coil embolization but another bleeding episode occurred 3 weeks later from an aberrant nearby vessel that was secured by endoscopic hemoclipping. The third patient was a 47-year-old man presented by hematochezia. Colonoscopy showed oozing from an aberrant vessel in the descending colon secured by endoscopic argon plasma coagulation and hemoclipping. Two days later, all three patients underwent endoscopic ultrasonography (EUS) which confirmed complete hemostasis. Conclusion: GI endoscopy plus angiography followed by EUS is an effective approach for a better management (diagnosis, treatment & follow up) of bleeding Dieulafoy's lesions with a markedly lower rate of recurrence & mortality.

Research paper thumbnail of Sofosbuvir and daclatasvir plus ribavirin treatment improve liver function parameters and clinical outcomes in Egyptian chronic hepatitis C patients

European Journal of Gastroenterology & Hepatology

Interferon-free direct-acting antivirals (DAA) combination therapies, including sofosbuvir (SOF) ... more Interferon-free direct-acting antivirals (DAA) combination therapies, including sofosbuvir (SOF) and daclatasvir (DCV) therapy, eradicate chronic hepatitis C virus (HCV) in a high percentage of patients, but its impact on improvements in liver function is unclear. The aim of this study was to investigate the changes in clinical and biochemical parameters reflecting liver function and general status in those who achieved HCV eradication by DAA. From March 2016 to October 2016, 374 chronic hepatitis C patients were enrolled for this prospective, observational study and received SOF, DCV with ribavirin, to evaluate the changes in liver function parameters, international normalized ratio, complete blood count, model for end-stage liver disease, and Child-Turcotte-Pugh scores after achieving a sustained virological response 12 weeks after treatment. In those who achieved HCV clearance, liver function parameters, serum albumin, bilirubin, platelet count, and international normalized ratio improved significantly in the majority of patients; the reduction in the model for end-stage liver disease score was (-2.36, SE 0.15, P<0.001). 44% of the patients showed an improved Child-Turcotte-Pugh score, 51% showed no change, and only 5% showed deterioration. Successful HCV eradication by DAAs including SOF, DCV with ribavirin therapy improved liver function parameters and clinical outcomes in chronic hepatitis C patients.

Research paper thumbnail of The Role of Endoscopic Retrograde Cholangiopancreatography in Acute Pancreatitis

The American Journal of Gastroenterology, 2014

Research paper thumbnail of Sofosbuvir and daclatasvir plus ribavirin treatment improve liver function parameters and clinical outcomes in Egyptian chronic hepatitis C patients

Background and aims Interferon-free direct-acting antivirals (DAA) combination therapies, includi... more Background and aims Interferon-free direct-acting antivirals (DAA) combination therapies, including sofosbuvir (SOF) and daclatasvir (DCV) therapy, eradicate chronic hepatitis C virus (HCV) in a high percentage of patients, but its impact on improvements in liver function is unclear. The aim of this study was to investigate the changes in clinical and biochemical parameters reflecting liver function and general status in those who achieved HCV eradication by DAA. Patients and methods From March 2016 to October 2016, 374 chronic hepatitis C patients were enrolled for this prospective, observational study and received SOF, DCV with ribavirin, to evaluate the changes in liver function parameters, international normalized ratio, complete blood count, model for end-stage liver disease, and Child-Turcotte-Pugh scores after achieving a sustained virological response 12 weeks after treatment. Results In those who achieved HCV clearance, liver function parameters, serum albumin, bilirubin, platelet count, and international normalized ratio improved significantly in the majority of patients; the reduction in the model for end-stage liver disease score was (− 2.36, SE 0.15, P < 0.001). 44% of the patients showed an improved Child-Turcotte-Pugh score, 51% showed no change, and only 5% showed deterioration. Conclusion Successful HCV eradication by DAAs including SOF, DCV with ribavirin therapy improved liver function parameters and clinical outcomes in chronic hepatitis C patients. Eur J Gastroenterol Hepatol 00:000-000

Research paper thumbnail of Occurrence and Recurrence of Hepatocellular Carcinoma after Direct-Acting Antiviral Therapy: A Truth or a Myth? OPEN ACCESS

Journal of Gastroenterology, Hepatology and Endoscopy, 2019

Chronic Hepatitis C (CHC) is a global health epidemic affecting more than 70 million people world... more Chronic Hepatitis C (CHC) is a global health epidemic affecting more than 70 million people worldwide. More than 80% of CHC patients will progress to liver cirrhosis, of which about 20% will eventually develop Hepatocellular Carcinoma (HCC) [1]. During the previous decades, treatment of CHC depended on interferon-ribavirin combination with Sustained Virologic Response (SVR) less than 50% in most centers. Emergence of Direct Acting Antiviral (DAAs) drugs five years earlier provided a significant improvement in SVR achievement (more than 95%) in most centers and studies [2]. Reig et al. and other studies recently raised a global concern regarding increased de novo and recurrence of HCC following DAAs [3]. However, their studies had many points of criticism including inappropriate or not-fully elucidated criteria for selecting patients, their studies, timing of initiating DAAs treatment after HCC treatment, statistical bias, few numbers of patients in their studies etc [4]. Depending on the available meta-analysis studies, DAAs are not considered carcinogenic although they lack the anti-carcinogenic effect of INF. However, many authors still have reasonable concerns regarding the hepatic biochemical and immunological responses to CHC eradication after DAAs especially in patients with decompensated cirrhosis. Eradication of HCV after DAAs may change the types of immunological cells and cytokines in the liver, which in turn may pave the way for the abnormal proliferation of liver cells in those patients [5]. The timing for DAAs initiation after successful treatment of HCC, which must be at least 4-6 months, seems to be important in reducing HCC recurrence after DAAs therapy. Also, meticulous follow up is warranted in patients with cirrhosis who received DAAs because cirrhosis itself is the most common risk factor for HCC regardless of the underlying aetiology or DAAs use [6]. Improvement of the clinical, biochemical and histological features of chronic liver disease after DAAs therapy especially in cirrhotic patients provides higher success rates of the de-novo or recurrent HCC treatment with Radiofrequency Ablation (RFA), Trans-Arterial Chemoembolization (TACE) or surgical resection [7]. We conducted a multicenter study included 321 patients with CHC. One-hundred fifty patients were non-cirrhotic, 171 patients were cirrhotic of which 116 patients without previous history of HCC and 55 patients had a history of HCC and received DAAs after at least 6 months of successful HCC treatment. All patients received the same regimen of DAAs (Sofosbuvir and Daclatasvir +/-ribavirin) for 12 weeks. The SVR was 100% in non-cirrhotic patients and 91% in cirrhotic patients. After a median follow up period of 12 months for all patients whether achieved SVR or not, Only 6 patients had de-novo HCC, all were from the cirrhotic group, (1.9% of all patients & 5.2% of cirrhotic patients without previous HCC) and 9 patients had recurrent HCC (2.8% of all patients & 16.4% of cirrhotic patients with previous HCC). Univariate and multivariate analysis showed that cirrhosis, previous multifocal HCC and persistent ALT elevation after SVR achievement were the most important risk factors for HCC Occurrence and recurrence after DAAs. Our findings suggest no role for DAAs in occurrence or recurrence of HCC after CHC eradication.

Research paper thumbnail of The role of mean platelet volume in predicting severity and prognosis of liver cirrhosis in Egyptian patients

Egyptian Journal of Internal Medicine, 2019

Background and aims Liver cirrhosis is a major public health problem in Egypt due to widespread i... more Background and aims
Liver cirrhosis is a major public health problem in Egypt due to widespread infection
of hepatitis C virus. Mean platelet volume (MPV) is a noninvasive, inexpensive
parameter of complete blood count. In this study we aimed at evaluating the
association between MPV and clinical features, complications, and severity of
cirrhosis in Egyptian patients.
Patients and methods
One hundred and fourteen patients with cirrhosis of various grades of severity and
various presentations were enrolled in our study. The patients were evaluated to
assess the association between MPV values and cirrhosis parameters, model for
end-stage liver disease score, and fibrosis (FIB4) score.
Results
The study demonstrates the positive correlation between MPV values and
international normalized ratio, serum bilirubin, lower serum albumin in cirrhotic
patients. Also, the MPV values were significantly higher in patients with more
severe liver disease according to the model for end-stage liver disease (r=+0.424,
P=0.008) and FIB4 scores (r=+0.353, P=0.03).
Conclusion
MPV can be used as an important inexpensive biomarker in cirrhotic patients for the
degree of severity and prognosis of the disease.

Research paper thumbnail of Management of HCV‑related decompensated cirrhosis with direct‑acting antiviral agents: who should be treated?

Hepatology International, 2019

Abstract Background Medical treatment of decompensated cirrhosis due to hepatitis C virus (HCV) r... more Abstract
Background Medical treatment of decompensated cirrhosis due to hepatitis C virus (HCV) remains a clinical challenge even
in the era of direct-acting antiviral drugs (DAAs). We evaluated the efficacy and safety of DAAs in the management of HCV
genotype 4-related decompensated cirrhosis.
Methods The study included a treatment group (n = 160) composed of HCV patients with decompensated cirrhosis who
received DAAs for 3 months and a matched control group (n = 80) who preferred not to receive DAAs, follow-up was for
24–31 months.
Results In treatment group; there were improvements in platelet count, albumin, CTP (p = 0.001) and MELD scores
(p = 0.03), a significant reduction in the frequency of hepatic encephalopathy (HE). SVR was achieved in 90%. Hepatocellular
carcinoma (HCC) developed in 10% (n = 18) within 6.8 ± 2.5 months after DAAs, survival was higher in the treated vs.
the control group (28.9 ± 0.95 vs. 11.4 ± 2.2 months, p = 0.001). Liver volume by ultrasound at a cutoff 495 ml was predictive
of complications after DAAs therapy mainly HCC and reduced survival with sensitivity 93.2%, specificity 72%.
Conclusion HCV with decompensated cirrhosis and adequate liver volume had a 90% SVR with improved CTP&MELD
and survival. Clinical trial: (NCT03547895).
Keywords HCV · Decompensated cirrhosis · DAAs · Liver volume

Research paper thumbnail of Bronchial Asthma and Eosinophilic Gastroenteritis: A Case Report

Global Journal of Digestive Diseases, 2018

Abstract Eosinophilic gastroenteritis is a rare but highly recurrent condition of unknown aetiolo... more Abstract
Eosinophilic gastroenteritis is a rare but highly recurrent condition of unknown
aetiology. It is characterised by peripheral eosinophilia with extensive infiltration of
gastrointestinal (GI) wall layers by eosinophils causing a variety of clinical features
& complications. Corticosteroids & food restriction are the main treatment options
and are effective in inducing remission of most patients.
Keywords: Eosinophils; Bronchial asthma; Eosinophilic gastroenteritis; GIT;
Esophagus; Corticosteroids; Ascites; Peritonitis

Research paper thumbnail of Combined Management Approach for Gastric & Extra-Gastric Dieulafoy’s Lesions

Adv Res Gastroentero Hepatol, 2018

Introduction: Dieulafoy’s lesions are under-diagnosed and with considerable rate of re-bleeding. ... more Introduction: Dieulafoy’s lesions are under-diagnosed and with considerable rate of re-bleeding. They are common causes of obscure gastrointestinal bleeding. These are 3 cases of Dieulafoy’s lesion, one gastric & two are extra-gastric. The first case was an 11-year-old girl presented by recurrent hematemesis & melena. She was secured by endoscopic banding after adrenaline injection. The second case was a 19-year-old male who had multiple recurrent attacks of melena. Initial upper endoscopy was normal but angiography showed contrast extravasation at the first part of duodenum secured by coil embolization but another bleeding episode occurred 3 weeks later from an aberrant nearby vessel that was secured by endoscopic hemoclipping. The third patient was a 47- year-old man presented by hematochezia. Colonoscopy showed oozing from an aberrant vessel in the descending colon secured by endoscopic argon plasma coagulation and hemoclipping. Two days later, all three patients underwent endoscopic ultrasonography (EUS) which confirmed complete hemostasis.
Conclusion: GI endoscopy plus angiography followed by EUS is an effective approach for a better management (diagnosis, treatment & follow up) of bleeding Dieulafoy’s lesions with a markedly lower rate of recurrence & mortality.
Keywords: Dieulafoy’s lesion; Obscure; GI bleeding; Endoscopy; CT angiography; Hemoclips

Research paper thumbnail of Prevalence Of Metabolic Syndrome After Orthotopic Living-Donor Liver Transplantation

Liver transplantation (LT) is a life-saving procedure for patients with advanced liver diseases. ... more Liver transplantation (LT) is a life-saving procedure for patients with advanced liver diseases. Post-transplantation metabolic syndrome (PTMS), a consequence of LT, was associated with major vascular events; rapid progression of graft fibrosis and graft loss. The aim of this study was to assess the prevalence of metabolic syndrome (MS) following living-donor liver transplantation (LDLT) and the possible risk factors predisposing to it. Patients & Methods: A retrospective-prospective study was conducted on 85 Egyptian patients who underwent LDLT in the liver transplantation unit of the Military International Medical Center (IMC)-Cairo and completed one year of regular follow up. Results: Eighty five percent of our patients were males & mean age was 52 years. Pre-transplantation prevalence of MS, impaired fasting plasma glucose (FPG), DM, hypertension (HTN), Hypertriglyceridemia, Low serum High density lipoprotein (HDL) and Obesity was 14.1% , 12 % , 31 % , 11% , 2 % , 89 % and 22 % respectively. Post-transplantation prevalence of MS, impaired fasting plasma glucose (FPG), DM, hypertension (HTN), Hypertriglyceridemia, Low serum High density lipoprotein (HDL) and Obesity was 48% , 14 % , 77 % , 59% , 51% , 32 % and 35 % respectively. Conclusion: PTMS is an early and prevalent phenomenon after LDLT and its possible risk factors are pre-transplantation diabetes, pre-transplantation family history of diabetes and post-transplantation Obesity & Cyclosporine use.

Research paper thumbnail of Pancreas 2017 Pancreatic Disorders & Treatment Acute pancreatitis after short and long-term use of 5-amino-salicylic acid

Drug-induced pancreatitis (DIP) is a rare medical condition that needs a high index of suspicion ... more Drug-induced pancreatitis (DIP) is a rare medical condition that needs a high index of suspicion to be diagnosed. DIP is not accompanied by clinical or laboratory evidence of a drug reaction, such as rash, lymphadenopathy, and/or eosinophilia. Drug rechallenge is the best available evidence for diagnosis of DIP. Idiopathic pancreatitis or microlithiasis may induce recurrent attacks of acute pancreatitis increasing the challenge for diagnosis of DIP. Here, we present two cases of ulcerative colitis on 5-aminosalicylic acid (5-ASA) and developed DIP, one case developed acute pancreatitis 6 days and the other case developed acute pancreatitis 9 months after initiating the treatment with 5-ASA. DIP occurs with mesalamine suppositories in the first case while the second case ras secondary to oral mesalamine. Diagnosis was done by exclusion of other common causes, high amylase and lipase, dual-contrast abdominal CT and rechallenge test. Resolution of symptoms occurred 3 days and one week respectively after stopping mesalamine. We concluded that although DIP is a rare entity, it should be considered in patients taking mesalamine for both short and long periods.

Research paper thumbnail of Sofosbuvir and daclatasvir plus ribavirin treatment improve liver function parameters and clinical outcomes in Egyptian chronic hepatitis C patients

Interferon-free direct-acting antivirals (DAA) combination therapies, including sofosbuvir (SOF)... more Interferon-free direct-acting antivirals (DAA) combination therapies, including sofosbuvir (SOF) and daclatasvir (DCV) therapy, eradicate chronic hepatitis C virus (HCV) in a high percentage of patients, but its impact on improvements in liver function is unclear. The aim of this study was to investigate the changes in clinical and biochemical parameters reflecting liver function and general status in those who achieved HCV eradication by DAA. Patients and methods From March 2016 to October 2016, 374 chronic hepatitis C patients were enrolled for this prospective, observational study and received SOF, DCV with ribavirin, to evaluate the changes in liver function parameters, international normalized ratio, complete blood count, model for end-stage liver disease, and Child–Turcotte–Pugh scores after achieving a sustained virological response 12 weeks after treatment. Results In those who achieved HCV clearance, liver function parameters, serum albumin, bilirubin, platelet count, and international normalized ratio improved significantly in the majority of patients; the reduction in the model for end-stage liver disease score was (− 2.36, SE 0.15, P < 0.001). 44% of the patients showed an improved Child–Turcotte–Pugh score, 51% showed no change, and only 5% showed deterioration. Conclusion Successful HCV eradication by DAAs including SOF, DCV with ribavirin therapy improved liver function parameters and clinical outcomes in chronic hepatitis C patients. Eur J Gastroenterol Hepatol 00:000–000

Research paper thumbnail of Prevalence and Risk Factors of Minimal Hepatic Encephalopathy in Patients with Compensated Liver Cirrhosis

The Egyptian Journal of Hospital Medicine, 2020

Background: Minimal hepatic encephalopathy (MHE) is the earliest phase of hepatic encephalopathy.... more Background: Minimal hepatic encephalopathy (MHE) is the earliest phase of hepatic encephalopathy. It is associated with increased risk of falls, impaired work and diminished quality of life. Subjects and methods: This study included 302 patients with liver cirrhosis, of which 130 patients had Child A (compensated) liver cirrhosis. All patients were assessed by history taking, clinical examination, routine investigations, serum ammonia level and abdominal ultrasound for porto-systemic shunt (PSS). MHE was diagnosed in 60 patients of compensated liver cirrhosis patients using mini-mental state examination (MMSE) and number connection test A (NCT-A). Results: Our stud showed that Child A patients were 43% of the study group and MHE was present in 46% of compensated liver cirrhosis patients. Our results showed a significant association between lower serum albumin, higher INR, high serum ammonia, presence of PSS in ultrasound examination and MMSE and NCT-A high scores with the developmen...

Research paper thumbnail of Prevalence and Risk Factors of Minimal Hepatic Encephalopathy in Patients with Compensated Liver Cirrhosis

The Egyptian Journal of Hospital Medicine, 2020

Background: Minimal hepatic encephalopathy (MHE) is the earliest phase of hepatic encephalopathy.... more Background: Minimal hepatic encephalopathy (MHE) is the earliest phase of hepatic encephalopathy. It is associated with increased risk of falls, impaired work and diminished quality of life. Subjects and methods: This study included 302 patients with liver cirrhosis, of which 130 patients had Child A (compensated) liver cirrhosis. All patients were assessed by history taking, clinical examination, routine investigations, serum ammonia level and abdominal ultrasound for porto-systemic shunt (PSS). MHE was diagnosed in 60 patients of compensated liver cirrhosis patients using mini-mental state examination (MMSE) and number connection test A (NCT-A). Results: Our stud showed that Child A patients were 43% of the study group and MHE was present in 46% of compensated liver cirrhosis patients. Our results showed a significant association between lower serum albumin, higher INR, high serum ammonia, presence of PSS in ultrasound examination and MMSE and NCT-A high scores with the developmen...

Research paper thumbnail of Recurrence of Helicobacter pylori Infection after Successful Eradication Therapy in Egyptian Patients

Acta scientific gastrointestinal disorders, 2020

Background: Helicobacter pylori (H. pylori), a highly prevalent gastrointestinal organism, infect... more Background: Helicobacter pylori (H. pylori), a highly prevalent gastrointestinal organism, infects more than 50% of the global population. It is the most common risk factor for peptic ulcer disease, cancer stomach and gastric lymphoma. Eradication therapy regimens for H. pylori are highly effective. However, bacterial resistance to antibiotics and patients nonadherence to the treatment regimens significantly increased the recurrence rates of H. pylori infection in the last few decades. Patients and Methods: We evaluated and followed up 157 patients for one year after confirmed successful eradication of H. pylori infection. We investigated the patients at 3, 6, 9 and 12 months for recurrence of H. pylori infection using urea breath and stool antigen tests. Study Aim: To assess the prevalence and possible risk factors of H. pylori recurrence in Egyptian patients after eradication therapy. Results and Conclusion: We found a one-year recurrence rate of 19% after successful eradication therapy of H. pylori. The education level of the patients and alcohol consumption were the most significant predictors of H. pylori recurrence. The one-year recurrence rate in our study is high but comparable to those reported in the developing countries most probably due to high rates of re-infection

Research paper thumbnail of Prevalence and Risk Factors of Minimal Hepatic Encephalopathy in Patients with Compensated Liver Cirrhosis

The Egyptian journal of hospital medicine , 2020

Background: Minimal hepatic encephalopathy (MHE) is the earliest phase of hepatic encephalopathy.... more Background: Minimal hepatic encephalopathy (MHE) is the earliest phase of hepatic encephalopathy. It is associated with increased risk of falls, impaired work and diminished quality of life. Subjects and methods: This study included 302 patients with liver cirrhosis, of which 130 patients had Child A (compensated) liver cirrhosis. All patients were assessed by history taking, clinical examination, routine investigations, serum ammonia level and abdominal ultrasound for porto-systemic shunt (PSS). MHE was diagnosed in 60 patients of compensated liver cirrhosis patients using mini-mental state examination (MMSE) and number connection test A (NCT-A). Results: Our stud showed that Child A patients were 43% of the study group and MHE was present in 46% of compensated liver cirrhosis patients. Our results showed a significant association between lower serum albumin, higher INR, high serum ammonia, presence of PSS in ultrasound examination and MMSE and NCT-A high scores with the development of MHE. MMSE and NCT A showed significantly good performance in diagnosis of MHE. Multiple regression analysis showed that high serum ammonia level (53-61) u/dl, large PSS (> 8 mm in diameter), MMSE score (22-26) and NCT A score (45-56) were the most significant risk factors for MHE. Conclusion: MHE is a major and prevalent manifestation in compensated liver cirrhosis patients. It is associated with significant decrease in work and driving abilities and quality of life. Its major risk factors are high serum ammonia, large PSS and high scores of MMSE and NCT A tests that have a good performance in MHE diagnosis.

Research paper thumbnail of Occurrence and Recurrence of Hepatocellular Carcinoma after Direct-Acting Antiviral Therapy: A Truth or a Myth

Research paper thumbnail of Bronchial Asthma and Eosinophilic Gastroenteritis: A Case Report

International Journal of Digestive Diseases

Research paper thumbnail of The role of mean platelet volume in predicting severity and prognosis of liver cirrhosis in Egyptian patients

The Egyptian Journal of Internal Medicine

Research paper thumbnail of Management of HCV-related decompensated cirrhosis with direct-acting antiviral agents: who should be treated?

Hepatology International

BackgroundMedical treatment of decompensated cirrhosis due to hepatitis C virus (HCV) remains a c... more BackgroundMedical treatment of decompensated cirrhosis due to hepatitis C virus (HCV) remains a clinical challenge even in the era of direct-acting antiviral drugs (DAAs). We evaluated the efficacy and safety of DAAs in the management of HCV genotype 4-related decompensated cirrhosis.MethodsThe study included a treatment group (n = 160) composed of HCV patients with decompensated cirrhosis who received DAAs for 3 months and a matched control group (n = 80) who preferred not to receive DAAs, follow-up was for 24–31 months.ResultsIn treatment group; there were improvements in platelet count, albumin, CTP (p = 0.001) and MELD scores (p = 0.03), a significant reduction in the frequency of hepatic encephalopathy (HE). SVR was achieved in 90%. Hepatocellular carcinoma (HCC) developed in 10% (n = 18) within 6.8 ± 2.5 months after DAAs, survival was higher in the treated vs. the control group (28.9 ± 0.95 vs. 11.4 ± 2.2 months, p = 0.001). Liver volume by ultrasound at a cutoff 495 ml was predictive of complications after DAAs therapy mainly HCC and reduced survival with sensitivity 93.2%, specificity 72%.ConclusionHCV with decompensated cirrhosis and adequate liver volume had a 90% SVR with improved CTP&MELD and survival. Clinical trial: (NCT03547895).

Research paper thumbnail of Combined Management Approach for Gastric & Extra-Gastric Dieulafoy’s Lesions

Advanced Research in Gastroenterology & Hepatology

Introduction: Dieulafoy's lesions are under-diagnosed and with considerable rate of re-bleeding. ... more Introduction: Dieulafoy's lesions are under-diagnosed and with considerable rate of re-bleeding. They are common causes of obscure gastrointestinal bleeding. These are 3 cases of Dieulafoy's lesion, one gastric & two are extra-gastric. The first case was an 11-year-old girl presented by recurrent hematemesis & melena. She was secured by endoscopic banding after adrenaline injection. The second case was a 19-year-old male who had multiple recurrent attacks of melena. Initial upper endoscopy was normal but angiography showed contrast extravasation at the first part of duodenum secured by coil embolization but another bleeding episode occurred 3 weeks later from an aberrant nearby vessel that was secured by endoscopic hemoclipping. The third patient was a 47-year-old man presented by hematochezia. Colonoscopy showed oozing from an aberrant vessel in the descending colon secured by endoscopic argon plasma coagulation and hemoclipping. Two days later, all three patients underwent endoscopic ultrasonography (EUS) which confirmed complete hemostasis. Conclusion: GI endoscopy plus angiography followed by EUS is an effective approach for a better management (diagnosis, treatment & follow up) of bleeding Dieulafoy's lesions with a markedly lower rate of recurrence & mortality.

Research paper thumbnail of Sofosbuvir and daclatasvir plus ribavirin treatment improve liver function parameters and clinical outcomes in Egyptian chronic hepatitis C patients

European Journal of Gastroenterology & Hepatology

Interferon-free direct-acting antivirals (DAA) combination therapies, including sofosbuvir (SOF) ... more Interferon-free direct-acting antivirals (DAA) combination therapies, including sofosbuvir (SOF) and daclatasvir (DCV) therapy, eradicate chronic hepatitis C virus (HCV) in a high percentage of patients, but its impact on improvements in liver function is unclear. The aim of this study was to investigate the changes in clinical and biochemical parameters reflecting liver function and general status in those who achieved HCV eradication by DAA. From March 2016 to October 2016, 374 chronic hepatitis C patients were enrolled for this prospective, observational study and received SOF, DCV with ribavirin, to evaluate the changes in liver function parameters, international normalized ratio, complete blood count, model for end-stage liver disease, and Child-Turcotte-Pugh scores after achieving a sustained virological response 12 weeks after treatment. In those who achieved HCV clearance, liver function parameters, serum albumin, bilirubin, platelet count, and international normalized ratio improved significantly in the majority of patients; the reduction in the model for end-stage liver disease score was (-2.36, SE 0.15, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). 44% of the patients showed an improved Child-Turcotte-Pugh score, 51% showed no change, and only 5% showed deterioration. Successful HCV eradication by DAAs including SOF, DCV with ribavirin therapy improved liver function parameters and clinical outcomes in chronic hepatitis C patients.

Research paper thumbnail of The Role of Endoscopic Retrograde Cholangiopancreatography in Acute Pancreatitis

The American Journal of Gastroenterology, 2014

Research paper thumbnail of Sofosbuvir and daclatasvir plus ribavirin treatment improve liver function parameters and clinical outcomes in Egyptian chronic hepatitis C patients

Background and aims Interferon-free direct-acting antivirals (DAA) combination therapies, includi... more Background and aims Interferon-free direct-acting antivirals (DAA) combination therapies, including sofosbuvir (SOF) and daclatasvir (DCV) therapy, eradicate chronic hepatitis C virus (HCV) in a high percentage of patients, but its impact on improvements in liver function is unclear. The aim of this study was to investigate the changes in clinical and biochemical parameters reflecting liver function and general status in those who achieved HCV eradication by DAA. Patients and methods From March 2016 to October 2016, 374 chronic hepatitis C patients were enrolled for this prospective, observational study and received SOF, DCV with ribavirin, to evaluate the changes in liver function parameters, international normalized ratio, complete blood count, model for end-stage liver disease, and Child-Turcotte-Pugh scores after achieving a sustained virological response 12 weeks after treatment. Results In those who achieved HCV clearance, liver function parameters, serum albumin, bilirubin, platelet count, and international normalized ratio improved significantly in the majority of patients; the reduction in the model for end-stage liver disease score was (− 2.36, SE 0.15, P < 0.001). 44% of the patients showed an improved Child-Turcotte-Pugh score, 51% showed no change, and only 5% showed deterioration. Conclusion Successful HCV eradication by DAAs including SOF, DCV with ribavirin therapy improved liver function parameters and clinical outcomes in chronic hepatitis C patients. Eur J Gastroenterol Hepatol 00:000-000

Research paper thumbnail of Occurrence and Recurrence of Hepatocellular Carcinoma after Direct-Acting Antiviral Therapy: A Truth or a Myth? OPEN ACCESS

Journal of Gastroenterology, Hepatology and Endoscopy, 2019

Chronic Hepatitis C (CHC) is a global health epidemic affecting more than 70 million people world... more Chronic Hepatitis C (CHC) is a global health epidemic affecting more than 70 million people worldwide. More than 80% of CHC patients will progress to liver cirrhosis, of which about 20% will eventually develop Hepatocellular Carcinoma (HCC) [1]. During the previous decades, treatment of CHC depended on interferon-ribavirin combination with Sustained Virologic Response (SVR) less than 50% in most centers. Emergence of Direct Acting Antiviral (DAAs) drugs five years earlier provided a significant improvement in SVR achievement (more than 95%) in most centers and studies [2]. Reig et al. and other studies recently raised a global concern regarding increased de novo and recurrence of HCC following DAAs [3]. However, their studies had many points of criticism including inappropriate or not-fully elucidated criteria for selecting patients, their studies, timing of initiating DAAs treatment after HCC treatment, statistical bias, few numbers of patients in their studies etc [4]. Depending on the available meta-analysis studies, DAAs are not considered carcinogenic although they lack the anti-carcinogenic effect of INF. However, many authors still have reasonable concerns regarding the hepatic biochemical and immunological responses to CHC eradication after DAAs especially in patients with decompensated cirrhosis. Eradication of HCV after DAAs may change the types of immunological cells and cytokines in the liver, which in turn may pave the way for the abnormal proliferation of liver cells in those patients [5]. The timing for DAAs initiation after successful treatment of HCC, which must be at least 4-6 months, seems to be important in reducing HCC recurrence after DAAs therapy. Also, meticulous follow up is warranted in patients with cirrhosis who received DAAs because cirrhosis itself is the most common risk factor for HCC regardless of the underlying aetiology or DAAs use [6]. Improvement of the clinical, biochemical and histological features of chronic liver disease after DAAs therapy especially in cirrhotic patients provides higher success rates of the de-novo or recurrent HCC treatment with Radiofrequency Ablation (RFA), Trans-Arterial Chemoembolization (TACE) or surgical resection [7]. We conducted a multicenter study included 321 patients with CHC. One-hundred fifty patients were non-cirrhotic, 171 patients were cirrhotic of which 116 patients without previous history of HCC and 55 patients had a history of HCC and received DAAs after at least 6 months of successful HCC treatment. All patients received the same regimen of DAAs (Sofosbuvir and Daclatasvir +/-ribavirin) for 12 weeks. The SVR was 100% in non-cirrhotic patients and 91% in cirrhotic patients. After a median follow up period of 12 months for all patients whether achieved SVR or not, Only 6 patients had de-novo HCC, all were from the cirrhotic group, (1.9% of all patients & 5.2% of cirrhotic patients without previous HCC) and 9 patients had recurrent HCC (2.8% of all patients & 16.4% of cirrhotic patients with previous HCC). Univariate and multivariate analysis showed that cirrhosis, previous multifocal HCC and persistent ALT elevation after SVR achievement were the most important risk factors for HCC Occurrence and recurrence after DAAs. Our findings suggest no role for DAAs in occurrence or recurrence of HCC after CHC eradication.

Research paper thumbnail of The role of mean platelet volume in predicting severity and prognosis of liver cirrhosis in Egyptian patients

Egyptian Journal of Internal Medicine, 2019

Background and aims Liver cirrhosis is a major public health problem in Egypt due to widespread i... more Background and aims
Liver cirrhosis is a major public health problem in Egypt due to widespread infection
of hepatitis C virus. Mean platelet volume (MPV) is a noninvasive, inexpensive
parameter of complete blood count. In this study we aimed at evaluating the
association between MPV and clinical features, complications, and severity of
cirrhosis in Egyptian patients.
Patients and methods
One hundred and fourteen patients with cirrhosis of various grades of severity and
various presentations were enrolled in our study. The patients were evaluated to
assess the association between MPV values and cirrhosis parameters, model for
end-stage liver disease score, and fibrosis (FIB4) score.
Results
The study demonstrates the positive correlation between MPV values and
international normalized ratio, serum bilirubin, lower serum albumin in cirrhotic
patients. Also, the MPV values were significantly higher in patients with more
severe liver disease according to the model for end-stage liver disease (r=+0.424,
P=0.008) and FIB4 scores (r=+0.353, P=0.03).
Conclusion
MPV can be used as an important inexpensive biomarker in cirrhotic patients for the
degree of severity and prognosis of the disease.

Research paper thumbnail of Management of HCV‑related decompensated cirrhosis with direct‑acting antiviral agents: who should be treated?

Hepatology International, 2019

Abstract Background Medical treatment of decompensated cirrhosis due to hepatitis C virus (HCV) r... more Abstract
Background Medical treatment of decompensated cirrhosis due to hepatitis C virus (HCV) remains a clinical challenge even
in the era of direct-acting antiviral drugs (DAAs). We evaluated the efficacy and safety of DAAs in the management of HCV
genotype 4-related decompensated cirrhosis.
Methods The study included a treatment group (n = 160) composed of HCV patients with decompensated cirrhosis who
received DAAs for 3 months and a matched control group (n = 80) who preferred not to receive DAAs, follow-up was for
24–31 months.
Results In treatment group; there were improvements in platelet count, albumin, CTP (p = 0.001) and MELD scores
(p = 0.03), a significant reduction in the frequency of hepatic encephalopathy (HE). SVR was achieved in 90%. Hepatocellular
carcinoma (HCC) developed in 10% (n = 18) within 6.8 ± 2.5 months after DAAs, survival was higher in the treated vs.
the control group (28.9 ± 0.95 vs. 11.4 ± 2.2 months, p = 0.001). Liver volume by ultrasound at a cutoff 495 ml was predictive
of complications after DAAs therapy mainly HCC and reduced survival with sensitivity 93.2%, specificity 72%.
Conclusion HCV with decompensated cirrhosis and adequate liver volume had a 90% SVR with improved CTP&MELD
and survival. Clinical trial: (NCT03547895).
Keywords HCV · Decompensated cirrhosis · DAAs · Liver volume

Research paper thumbnail of Bronchial Asthma and Eosinophilic Gastroenteritis: A Case Report

Global Journal of Digestive Diseases, 2018

Abstract Eosinophilic gastroenteritis is a rare but highly recurrent condition of unknown aetiolo... more Abstract
Eosinophilic gastroenteritis is a rare but highly recurrent condition of unknown
aetiology. It is characterised by peripheral eosinophilia with extensive infiltration of
gastrointestinal (GI) wall layers by eosinophils causing a variety of clinical features
& complications. Corticosteroids & food restriction are the main treatment options
and are effective in inducing remission of most patients.
Keywords: Eosinophils; Bronchial asthma; Eosinophilic gastroenteritis; GIT;
Esophagus; Corticosteroids; Ascites; Peritonitis

Research paper thumbnail of Combined Management Approach for Gastric & Extra-Gastric Dieulafoy’s Lesions

Adv Res Gastroentero Hepatol, 2018

Introduction: Dieulafoy’s lesions are under-diagnosed and with considerable rate of re-bleeding. ... more Introduction: Dieulafoy’s lesions are under-diagnosed and with considerable rate of re-bleeding. They are common causes of obscure gastrointestinal bleeding. These are 3 cases of Dieulafoy’s lesion, one gastric & two are extra-gastric. The first case was an 11-year-old girl presented by recurrent hematemesis & melena. She was secured by endoscopic banding after adrenaline injection. The second case was a 19-year-old male who had multiple recurrent attacks of melena. Initial upper endoscopy was normal but angiography showed contrast extravasation at the first part of duodenum secured by coil embolization but another bleeding episode occurred 3 weeks later from an aberrant nearby vessel that was secured by endoscopic hemoclipping. The third patient was a 47- year-old man presented by hematochezia. Colonoscopy showed oozing from an aberrant vessel in the descending colon secured by endoscopic argon plasma coagulation and hemoclipping. Two days later, all three patients underwent endoscopic ultrasonography (EUS) which confirmed complete hemostasis.
Conclusion: GI endoscopy plus angiography followed by EUS is an effective approach for a better management (diagnosis, treatment & follow up) of bleeding Dieulafoy’s lesions with a markedly lower rate of recurrence & mortality.
Keywords: Dieulafoy’s lesion; Obscure; GI bleeding; Endoscopy; CT angiography; Hemoclips

Research paper thumbnail of Prevalence Of Metabolic Syndrome After Orthotopic Living-Donor Liver Transplantation

Liver transplantation (LT) is a life-saving procedure for patients with advanced liver diseases. ... more Liver transplantation (LT) is a life-saving procedure for patients with advanced liver diseases. Post-transplantation metabolic syndrome (PTMS), a consequence of LT, was associated with major vascular events; rapid progression of graft fibrosis and graft loss. The aim of this study was to assess the prevalence of metabolic syndrome (MS) following living-donor liver transplantation (LDLT) and the possible risk factors predisposing to it. Patients & Methods: A retrospective-prospective study was conducted on 85 Egyptian patients who underwent LDLT in the liver transplantation unit of the Military International Medical Center (IMC)-Cairo and completed one year of regular follow up. Results: Eighty five percent of our patients were males & mean age was 52 years. Pre-transplantation prevalence of MS, impaired fasting plasma glucose (FPG), DM, hypertension (HTN), Hypertriglyceridemia, Low serum High density lipoprotein (HDL) and Obesity was 14.1% , 12 % , 31 % , 11% , 2 % , 89 % and 22 % respectively. Post-transplantation prevalence of MS, impaired fasting plasma glucose (FPG), DM, hypertension (HTN), Hypertriglyceridemia, Low serum High density lipoprotein (HDL) and Obesity was 48% , 14 % , 77 % , 59% , 51% , 32 % and 35 % respectively. Conclusion: PTMS is an early and prevalent phenomenon after LDLT and its possible risk factors are pre-transplantation diabetes, pre-transplantation family history of diabetes and post-transplantation Obesity & Cyclosporine use.

Research paper thumbnail of Pancreas 2017 Pancreatic Disorders & Treatment Acute pancreatitis after short and long-term use of 5-amino-salicylic acid

Drug-induced pancreatitis (DIP) is a rare medical condition that needs a high index of suspicion ... more Drug-induced pancreatitis (DIP) is a rare medical condition that needs a high index of suspicion to be diagnosed. DIP is not accompanied by clinical or laboratory evidence of a drug reaction, such as rash, lymphadenopathy, and/or eosinophilia. Drug rechallenge is the best available evidence for diagnosis of DIP. Idiopathic pancreatitis or microlithiasis may induce recurrent attacks of acute pancreatitis increasing the challenge for diagnosis of DIP. Here, we present two cases of ulcerative colitis on 5-aminosalicylic acid (5-ASA) and developed DIP, one case developed acute pancreatitis 6 days and the other case developed acute pancreatitis 9 months after initiating the treatment with 5-ASA. DIP occurs with mesalamine suppositories in the first case while the second case ras secondary to oral mesalamine. Diagnosis was done by exclusion of other common causes, high amylase and lipase, dual-contrast abdominal CT and rechallenge test. Resolution of symptoms occurred 3 days and one week respectively after stopping mesalamine. We concluded that although DIP is a rare entity, it should be considered in patients taking mesalamine for both short and long periods.

Research paper thumbnail of Sofosbuvir and daclatasvir plus ribavirin treatment improve liver function parameters and clinical outcomes in Egyptian chronic hepatitis C patients

Interferon-free direct-acting antivirals (DAA) combination therapies, including sofosbuvir (SOF)... more Interferon-free direct-acting antivirals (DAA) combination therapies, including sofosbuvir (SOF) and daclatasvir (DCV) therapy, eradicate chronic hepatitis C virus (HCV) in a high percentage of patients, but its impact on improvements in liver function is unclear. The aim of this study was to investigate the changes in clinical and biochemical parameters reflecting liver function and general status in those who achieved HCV eradication by DAA. Patients and methods From March 2016 to October 2016, 374 chronic hepatitis C patients were enrolled for this prospective, observational study and received SOF, DCV with ribavirin, to evaluate the changes in liver function parameters, international normalized ratio, complete blood count, model for end-stage liver disease, and Child–Turcotte–Pugh scores after achieving a sustained virological response 12 weeks after treatment. Results In those who achieved HCV clearance, liver function parameters, serum albumin, bilirubin, platelet count, and international normalized ratio improved significantly in the majority of patients; the reduction in the model for end-stage liver disease score was (− 2.36, SE 0.15, P < 0.001). 44% of the patients showed an improved Child–Turcotte–Pugh score, 51% showed no change, and only 5% showed deterioration. Conclusion Successful HCV eradication by DAAs including SOF, DCV with ribavirin therapy improved liver function parameters and clinical outcomes in chronic hepatitis C patients. Eur J Gastroenterol Hepatol 00:000–000