Introduction

Despite a lack of evidence, patients are often not fed for 48 to 96 hours after upper gastrointestinal bleeding (UGIB); however, many trials have demonstrated the benefits of early nutrition (EN). We conducted a meta-analysis of randomized controlled trials (RTCs) to evaluate the outcomes of EN compared to delayed nutrition (DN) after UGIB.

Aims & Methods

The protocol was registered on PROSPERO (CRD42022372306). PubMed, Embase, CENTRAL, Scopus, and Web of Science were searched on the 27^th of August 2023 to identify eligible RCTs. The primary outcomes were early (within 7 days) and late (within 30-42 days) mortality and rebleeding. Pooled risk ratios (RR), mean differences (MD), and corresponding 95% confidence intervals (CI) were calculated using a random-effects model.

Results

A total of 10 trials with 1,051 patients were included in the analysis. Early mortality was not significantly different between the two groups (RR: 1.20, CI: 0.85 – 1.71, I² = 0%), whereas late mortality was reduced to a clinically relevant extent in the EN group (RR: 0.61, CI: 0.35 – 1.06, I² = 0%). When comparing the two groups, we found no significant difference in terms of early and late rebleeding (RR: 1.04, CI: 0.66 – 1.63, I² = 0% and RR: 1.16, CI: 0.63 – 2.13, I² = 0%, respectively). Our analysis also showed that the length of hospital stay was reduced in the EN group compared to the DN group (MD: - 1.22 days, CI: - 2.43 to - 0.01, I² = 94%).

Conclusion

Compared with DN, EN (within 24 hours) appears to be a safe intervention and could reduce the length of hospital stay without increasing the risk of complications after UGIB.

Disclosure

None to declare.

Introduction

The threat of acute hepatitis A (AHA) to public health may be underestimated. We aimed to determine the frequency, clinical characteristics and outcomes of patients with AHA, and to compare them to those with acute hepatitis B (AHB).

Aims & Methods

This was a retrospective study of all patients diagnosed with AHA or AHB at a tertiary referral center between January 2013 and June 2024. Demographics, clinical presentation, laboratory findings, and outcomes were determined. AHA was defined by the presence of immunoglobulin M (IgM) antibodies to hepatitis A virus. AHB was defined by the presence of IgM antibodies to hepatitis B core antigen and positive hepatitis B surface antigen. Severe hepatitis was defined by serum bilirubin > 10 mg/dl, INR ≥ 1.5, serum creatinine > 2 mg/dl, and/or hepatic encephalopathy. Fulminant hepatitis (FH) was defined by the presence of hepatic encephalopathy.

Results

Over a period of 11 years, 398 patients were diagnosed with acute hepatitis, 367 (92%) with AHA and 31 (8%) with AHB. 336 patients (84.5%) were older than 18 years of age. Compared to patients with AHB, those with AHA were younger, were more likely to be females but were less likely to have an underlying immunocompromising illness (Table 1). There was no difference in the frequency of severe hepatitis, hospitalization rate, FH, and in hospital mortality between the two groups (Table 1). There were 115 patients (31%) with severe AHA, 89% of whom were older than 18 years of age. There was no difference in the mean age (33 ± 14 vs 31 ± 14 years, p=0.32), gender (37% vs 46% females, p=0.16), history of underlying liver disease (2.6% vs 0%, p=0.07) or having an underlying immunocompromising illness (4.2% vs 6.1%, p=0.47), between patients with severe AHA and patients with non-severe AHA. Furthermore, compared to patients with non-severe AHA, patients with severe AHA were more likely to require hospitalization (70% vs 43%, p=<0.001), ICU admission (8.7% vs 0.6%, p=<0.001), and to die during the index of hospitalization (4.3% vs 0%, p=0.01). Among patients with AHA who had a serum bilirubin > 10 mg/dl, INR ≥ 1.5, and/or serum creatinine > 2 mg/dl, 7% developed fulminant hepatitis while only 1% of patients with non-severe AHA developed fulminant hepatitis, p=0.003.

Table 1. Comparison of demographics, clinical characteristics, and outcomes between patients with acute hepatitis A (AHA) and patients with acute hepatitis B (AHB)

Conclusion

AHA is far more common than AHB, but is associated with similar rates of hospitalization, severe hepatitis, and fulminant hepatitis. The high frequency of AHA among adults in low-income countries calls for renewed attention to prevention and vaccination to reduce the burden of this often-overlooked disease. Furthermore, further research may be needed to develop pharmacological treatment for patients with severe AHA and those with fulminant hepatitis, in view of unavailability of liver transplantation in most developing countries.