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Barcelona Clinic Liver Cancer Classification and Treatment of Hepatocellular Carcinoma in a C？te d’Ivoire University Hospital  [PDF]
Kissi Anzouan-Kacou Henriette Ya, Bangoura Aboubacar Demba, Kouame Dimitri, Doffou Stanislas Adjeka, Mahassadi Kouame Alassan, Yao Bathaix Fulgence Mamert, Attia Alain Koffi
Open Journal of Gastroenterology (OJGas) , 2023, DOI: 10.4236/ojgas.2023.1310029
Abstract: Context/Objectives: Hepatocellular carcinoma occurs mainly and increasingly in developing countries, where the prognosis is particularly poor. The Barcelona Clinic Liver Cancer classification is used to guide the treatment of hepatocellular carcinoma. The aim of this retrospective study was to describe the Barcelona Clinic Liver Cancer classification and the treatment of hepatocellular carcinoma in a University Hospital in Côte d’Ivoire. Methods: Patients with hepatocellular carcinoma hospitalized in the hepato-gastroenterology unit of the University Hospital of Yopougon from 01 January 2012 to 30 June 2017 were included. The diagnosis of hepatocellular carcinoma was based on the presence of hepatic nodules on the abdominal ultrasound scan, typical images with the helical scanner associated or not with an increase of the α-fetoprotein higher than 200 ng/ml or with histology. Demographic, clinical, biological and radiological data were determined at the time of diagnosis. Patients were classified according to the Barcelona Clinic Liver Cancer classification. Their treatment was specified. Results: There were 258 patients whose median age was 48.1 years. Viral hepatitis B virus was the primary cause of hepatocellular carcinoma in 64.7% of cases. The severity of the underlying cirrhosis was Child-Pugh A in 12.1%, B in 63.6% and C in 24.3% of cases. The median size of the tumor was 63 mm. The α-fetoprotein level was higher than 200 mg/ml in 56.03% of cases. The Eastern Cooperative Oncology Group (ECOG)/World Health Organization (WHO) system was ≥2 in 82.9%. The Barcelona Clinic Liver Cancer classification was A in 1.3%, B in 0%, C in 55.2% and D in 43.5% of patients. There was no transplantation or hepatic resection. Very few patients (1.9%) received radio-frequency curative therapy. The treatment was predominantly symptomatic in 97.8% of patients. During hospitalization 43.7% of patients died. Conclusion: Hepatocellular carcinoma occurs on a liver with severe cirrhosis at a late stage. This does not allow cure treatment and explains a high mortality rate during hospitalization. Hepatitis B virus is the main risk factor and immunization at birth will reduce the incidence of this cancer in Africa.
Factors Associated with Hepatic Steatosis in Black African Subjects with Chronic Viral Hepatitis B in C？te d’Ivoire  [PDF]
Kouamé Hatrydt Guillaume Dimitri, Kissi Anzouan-Kacou Henriette Ya, Gogan Patricia, Bangoura Aboubacar Demba, Doffou Stanislas Adjeka, Mahassadi Kouame Alassan, Yao Bathaix Fulgence Mamert, Attia Alain Koffi
Open Journal of Gastroenterology (OJGas) , 2023, DOI: 10.4236/ojgas.2023.1310030
Abstract: Context/Objectives: With the progression of the global epidemic of obesity and metabolic syndrome, the coexistence of hepatic steatosis in patients with chronic viral hepatitis B (VHB) is becoming significant. The aim of this work was to determine the factors associated with hepatic steatosis assessed by a Fibroscan with Controlled Attenuation Parameter (CAP) in patients with chronic viral hepatitis B in Côte d’Ivoire. Methods: This was a cross-sectional and analytical study. Data was collected from February 15 to July 31, 2020 in a private hospital structure in the city of Abidjan in Côte d’Ivoire. We included 83 patients with chronic viral hepatitis B. These were black patients, having performed a Fibroscan/CAP during the recruitment period and consenting to participate in the study. Patients with significant alcohol consumption, a secondary cause of hepatic steatosis, or other liver disease regardless of the etiology associated with hepatitis B were not included. Results: The frequency of hepatic steatosis in chronic VHB carriers assessed by the CAP in our study population was 48.19% including 24.10% severe steatosis. Obesity and high LDL cholesterol were statistically correlated with the presence of steatosis in our patients. Patients who had steatosis on ultrasound were 5 times more likely to have steatosis on CAP. Significant fibrosis was not significantly associated with steatosis. Conclusion: Obesity and LDL hypercholesterolemia are the main factors associated with hepatic steatosis detected by Fibroscan/CAP in patients with chronic viral hepatitis B.
Treatment of Chronic Hepatitis B with Tenofovir Disoproxil Fumarate in Ivory Coast  [PDF]
Ya Henriette Kissi Anzouan-Kacou, Adjeka Stanislas Doffou, Djeinabou Diallo, Demba Aboubacar Bangoura, Yacouba Adéhouni, Hatrydt Dimitri Kouamé, Alassan Kouamé Mahassadi, Fulgence Yao Bathaix, Koffi Alain Attia, Aya Thérèse Ndri-Yoman
Open Journal of Gastroenterology (OJGas) , 2016, DOI: 10.4236/ojgas.2016.62006
Abstract: Little data exist on patients treated with tenofovir in Sub-Saharan Africa. Objective: To describe the clinical and laboratory characteristics of patients with viral hepatitis B treated with tenofovir. Material and methods: A descriptive single-center retrospective study, on chronic viral hepatitis B mono-infected, followed in the hepatogastroenterology department of the University Hospital of Yopougon and treated with tenofovir from February 2012 to February 2015. The studied parameters were demographic, clinical, biochemical, serological, virological, abdominal ultrasound. Liver fibrosis was assessed either by liver biopsy or non-invasive tests. Results: 110 patients were treated with tenofovir disoproxil fumarate with a mean age of 40.4 years and a male predominance. Clinical examination revealed jaundice in 9% of cases, hepatomegaly in 7.3% of cases, splenomegaly in 9.1% of cases and ascites in 15.5% of cases. The AST averaged 77.3 IU/l, the ALT 76.8 IU/l, prothrombin rate at 76.6% , albumin level at 32.3 g/l, total bilirubin at 29.9 g/l, alpha fetoprotein rate at 15.3 ng/ml. HBe antigen was negative in 76.2% of cases. The average rate of DNA at baseline was 7.4 log10 IU/l. 27.5% was cirrhotic. The average time of starting treatment was 23.7 months. Conclusion: TDF is the first-line treatment for chronic hepatitis B in our country, because it is a well-tolerated, potent therapy with a high threshold for resistance development. Our study population had an average age of 40.4 years. Virological profile was dominated by HBe antigen negative patients and high viral load of HVB DNA. One third of patients were at the stage of cirrhosis. This treatment must be delivered free of charge in all the country hospitals, which is going to improve significantly the natural evolution of the disease and to decrease the incidence of the HCC.
Treatment of Chronic Viral Hepatitis with Pegylated Interferon in Ivory Coast  [PDF]
Henriette Ya Kissi Anzouan-Kacou, Aboubacar Demba Bangoura, Djenabou Diallo, Yacouba Adéhouni, Adjeka Stanislas Doffou, Hartrydt Dimitri Kouamé, Alassan Kouamé Mahassadi, Mamert Fulgence Yao Bathaix, Alain Koffi Attia, Aya Thérèse Ndri-Yoman
Open Journal of Gastroenterology (OJGas) , 2016, DOI: 10.4236/ojgas.2016.63009
Abstract: Background: In the Ivory Coast, chronic infection by hepatitis B and C virus is the leading cause of cirrhosis and hepatocellular carcinoma. The absence of universal health coverage makes the treatment inaccessible to all. Objectives: To assess the efficacy of Pegylated Interferon in clinical practice in patients with chronic viral hepatitis B and C and determine the hematologic side effects. Patients and Methods: A descriptive retrospective study from January 2012 to November 2013 on a cohort of patients chronic carriers of hepatitis B virus (n = 11) treated with Pegylated Interferon to 180 mcg per week and hepatitis C virus (n = 30) treated with a combination therapy associating pegylated Interferon to 180 mcg per week and Ribavirin assayed according to the genotype. Results: Out of 1860 patients seen in hepatogastroenterology consultation 422 had viral hepatitis B or C that is a prevalence of 22.7% and 41 patients were treated (9.7%) by Pegylated Interferon. Among these 41 patients mentioned earlier, 30 had HCV (73.17%) with a case of HIV + HVC co-infection, 11 patients had HBV (26.83%) including 3 cases of HBV + HDV co-infection. Patients’ age ranged from 24 - 69 years with an average of 49.2 ± 12.2 years including 46.5 years for HBV and 51.9 years for HCV. The sex ratio was 1.56. The original transaminases were on average 93.37 IU/l for AST and 110.47 for ALT. The average RNA HCV was 1,685,331 IU/ml and the DNA HBV 33,312,767 IU/ml. Patients with HCV were of genotype 1 in 56.66%, genotype 2 in 40% and one case of genotype 4 (3.34%) from Central Africa. Fibrosis score at institution of treatment was significant (≥A2 and/or ≥F2) in 86.9% of cases of Fibrotest？, 100% of cases of Fibrometer？. We observed 48.8% of neutropenia < 750/mm3, 33.3% of anemia and 29.3% of thrombocytopenia < 100,000/mm3. There was no dose reduction of Pegylated Interferon and Ribavirin. For HBV there were 3 partial responses, 3 responders including 1 HBV + HDV co-infected non responder to HDV, 2 non responders including 1 HBV + HDV co-infected to Week 48. For HCV, there was 52.94% of cases of sustained viral response (SVR) including 44.44% of genotype 1, 83.33% of genotype 2 and 100% of genotype 4. Conclusion: The free antiviral treatment program helped treat 10% of chronic viral hepatitis B and C. Our results are not different from those of the literature. Difficulties remain in the performance of non supported diagnostic tests.
Risks of Viral Hepatitis B Transmission in Mother-to-Infant of Pregnant Women Carriers of Chronic Viral Hepatitis B in Cote d’Ivoire  [PDF]
Stanislas Adjéka Doffou, Fulgence Bathaix Yao, Aboubakar Demba Bangoura, Dimitri Kouamé, Henriette Kissi Anzouan-Kacou, Aristide Tchimou, Karidiatou Diallo, Mahassadi Kouamé Alassan, Alain Koffi Attia, Thérèse Ndri Yoman
Open Journal of Gastroenterology (OJGas) , 2017, DOI: 10.4236/ojgas.2017.77022
Abstract: The aim of this study was to identify the risk factors of mother-to-child transmission of HBV in positive Ag Hbs pregnant women in Cote d’Ivoire. Methods: This was a transversal prospective study that took place over a period of 7 months (from February 2016 to August 2016) in 2 university hospital and 2 private clinics. We consecutively recruited 91 pregnant women who were positive for HBs Ag in prenatal consultations. For each pregnant woman record included in the study, we provided Socio-demographic (Age, marital status, education level, social rank, gravidity, parity) and biological data (HBs Ag, Anti-HBc Total Ac, Hbe Ag, Ac anti-Hbe Ac, DNA-VHB, Ac anti-HCV Ac, retroviral serology, transaminases). All of these data were collected using a survey sheet developed for the study. Results: The age of our pregnant women HBs positive ranged from 18 years to 44 years with a mean age of 30.10 years. The age group from 20 to 39 years was the most represented with a frequency of 92.31%. Almost of all positive HBs Ag pregnant women was HBe Ag negative, only 3.3% was HBe Ag positive. The viral load above 2000 IU/ml was found in 21 (23.03%) patients. There were 4 co-infected patients, which 3 HBV-HIV and 1 HBV-HCV. Only 19 (20.88%) pregnant HBs Ag positive women were able to bring back the supplementary virological assessment within a period less than one month. Conclusion: According to our work the virologic profile of positive HBs Ag in pregnant women in Cote d’Ivoire is characterized by an important viral replication objectified by a high viral load in about 23% pregnant women, a negativity of HBe antigen in 96.6% of them.
Assessment of the Efficacy of Rifaximin in the Management of Irritable Bowel Syndrome (IBS)  [PDF]
Stanislas A. Doffou, Kissi Henriette Anzouan-Kacou, Eugene K. Messou, Demba A. Bangoura, Dimitri H. Kouamé, Kouame M. Alassan, Constant Assi, Fulgence Mamert Y. Bathaix, Alain K. Attia, Marie-Jeanne K. Lohoues
Open Journal of Gastroenterology (OJGas) , 2017, DOI: 10.4236/ojgas.2017.710027
Abstract: The aim of our study was to assess in our context, the efficacy of Rifaxim in improving the symptoms of irritable bowel syndrome particularly in its diarrheal (IBS-D) or mixed (IBS-DC) component and therefore assess its impact on patients’ quality of life. Patients and methods: This was an uncontrolled, non-comparative prospective cohort study of a single group of patients. Patients recruitment was done in two University Hospitals for 6 months (September 2015-February 2016). Were included ambulatory patients, male or female, aged 18 - 75 years, with diarrheic IBS (IBS-D) or mixed IBS (IBS-DC) diagnosed according to Rome III criteria and who agreed to participate in the study. Each patient received 400mg Rifaximin × 2/d for 15 days. The overall assessment of the efficacy of treatment at D15 (end of treatment) and D30 (2 weeks post-treatment) was the primary criterion of judgment. The statistical tests used were the Chi-square test and Fisher’s exact test for the qualitative variables and Student’s test for the quantitative variables. Results: A total number of 30 patients (16 women) with an average age of 44.5 ± 13.9 years were included. The overall assessment of symptoms by the patient with the Likert scale found 28 (93.3%) patients, 12 (40%) patients and 10 patients (33.3%) for a scale ≥2 at D0, D15 and D30 respectively. The assessment of the intensity of pain or abdominal discomfort found at D0, D15 and D30 respectively: 27(90%), 13(43.4%) and 6(20.1%) patients who had an EVA score > 2. The mean score for Francis to assess the improved quality of life was 247.1 ± 97.4 at D0, 99.8 ± 63.1 at D15 and 128.8 ± 70.6 at D30. Conclusion: There is a good overall improvement of symptoms in our patients suffering from IBS-D or mixed (IBS-DC) on Rifaximin with improvement of the quality of life.
Predictors of Direct-Acting Antivirals Failure in Patients with Chronic Hepatitis C Virus in Ivory Coast: About 5 Cases  [PDF]
Dimitri Hatrydt Kouamé, Stanislas Adjéka Doffou, Henriette Kissi Anzouan-Kacou, Yannick Mfupa Tchana, Aboubakar Demba Bangoura, Mahassadi Kouamé Alassan, Fulgence Bathaix Yao, Alain Koffi Attia, Thérèse Ndri Yoman
Open Journal of Gastroenterology (OJGas) , 2019, DOI: 10.4236/ojgas.2019.910022
Abstract: Context and Aim: Direct-acting antivirals are the therapeutic revolution in the management of viral hepatitis C, but often with a few cases of failure. The aim of this study was to identify factors that may be implicated in the failure of direct-acting antiviral therapy in patients with hepatitis C virus in Ivory Coast. Methodology: This was a cross-sectional and descriptive study with a retrospective compendium of data from the year 2016 to the year 2018. This study included all patients with chronic viral hepatitis C, patients naive to antiviral treatment, or pre-treated patients in whom a failure to treatment with direct-acting antiviral has been diagnosed. Results: During the study period, 5 patients out of 14 cases of therapeutic failure were included, i.e. 35.71%. Most of the patients were over 50 years (4 out of 5) and predominantly female (3 out of 5). High blood pressure was the most common comorbidity (3 out of 5 patients). Genotype 1 was found in 4 patients versus 1 case of genotype 2. None of the patients had hepatitis B or HIV coinfection. A viral load > 6log was found in 4 patients at baseline. All our patients had hepatic cytolysis. Two of them were cirrhotic. All 4 cases of genotype 1 benefited from the combination sofosbuvir + ledipasvir for 12 weeks and the case of genotype 2 from the combination sofosbuvir + ribavirin for 24 weeks. The resistance mutations were observed mainly on the sequencing of NS5A at the Y93H, L31M, 28L, 30T, 31V, 58S and 93H genes and a case of mutation on the N3 gene sequencing. Conclusion: Age > 50 years, comorbidities (high blood pressure), polymedication, female gender, genotype 1b, viremia > 6log, and cytolysis were the profile of patients with treatment of HCV by direct-acting antiviral failure.
Liver Transient Elastography Combined to Platelet Count (Baveno VI) Predict High Esophageal Varices in Black African Patient with Compensated Hepatitis B Related Cirrhosis  [PDF]
Doffou Adjeka Stanislas, Assi Constant, Ndjitoyap Ndam Antonin Wilson, Kouame Hardryt Dimitri, Bangoura Demba, Kissi Anzouan-Kacou, Ouattara Amadou, Lohoues-Kouacou Marie-Jeanne, Attia Koffi Alain
Open Journal of Gastroenterology (OJGas) , 2018, DOI: 10.4236/ojgas.2018.85021
Abstract: Aim: To assess the predictive value of the Baveno VI criteria for the diagnosis of large esophageal varices (EV) in Black African patient with compensated hepatitis B related cirrhosis. Methods: We carried out a cross-sectional study from January 2 to July 3 (2016), in Department of Gastroenterology at University Hospitals of Cocody (CHUC) and Yopougon (CHUY). All the black African patients included were more than 15 years old and their liver elasticity score (LES) was carried out at Yopougon University Hospital. Hepatitis B related cirrhosis was defined by LES ≥ 11 kPa (FibroScan？ (Echosens, France)) with positive HBs antigen (HBsAg) and anti HBc antibody. All the patients with hepatitis B related cirrhosis performed a gastroscopy at Cocody University Hospital and esophageal varices were ranked according to société fran？aise d’endoscopie digestive (SFED) classification. Data analysis was performed by SPSS model 20.0 statistics software (SPSS Inc., Chicago, IL, United States). Diagnostic performance of LES < 20 kPa and platelet count > 150,000/mmm3 (Baveno VI criteria) for the diagnosis of large EV by gastroscopy was studied (area under the ROC curve, specificity (Sp), sensitivity (Se), positive predictive value (PPV) and negative predictive value (NPV). Results: During the study period, 720 patients achieved liver FibroScan？ at CHUY. Of these, 60 respondents to our inclusion criteria were prospectively included in our study. Twelve (20%) of these 60 patients met the Baveno VI criteria. EV were present in 40% of cases (n = 24) with 6.7% (n = 4), 15% (n = 9) and 18.3% (n = 11) of grade 1, 2 and 3, respectively. (66.7% (n = 40) without EV or with small EV) and 33.3% (n = 20) with large EV. The Baveno VI criteria had a Se, Sp, PPV and NPV of 100%, 41.6%, 30% and 100% respectively for the diagnosis of large EV. The area under the ROC curve of a platelet count greater than 150,000/mm3, a liver elasticity score of less than 20 kPa and combination of both were respectively 0.763 [0.645 - 0.880; P = 0.272]; 0.588 [0.436 - 0.739; P = 0.01] and 0.650 [0.513 - 0.787 P = 0.005]. Conclusion: The combination of liver elasticity score < 20 kPa and a blood platelet count > 150,000/mm3, allowed the exclusion of large esophageal varices at gastroscopy with a 100 % NPV in Black African patients with compensated hepatitis B related cirrhosis.
Upper Gastrointestinal Endoscopy and Children Digestive Pathology in Abidjan  [PDF]
Aboubacar Demba Bangoura, Henriette Ya Anzouan Kissi-Kacou, Stanislas Doffou, Constant A ssi, Mamert Fulgence Yao Bathaix, Alain Koffi Attia, Aya Thérèse Ndri-Yoman
Open Journal of Gastroenterology (OJGas) , 2016, DOI: 10.4236/ojgas.2016.610031
Abstract:

The aim of our study is to determine the demographic data, indications, performance, and security of gastroscopy in children in Ivory Coast. Patients and Methods: This is a retrospective analytical study based on reports of upper digestive endoscopy per-formed in children (from 1 day to 15 years included) in 2 university hospitals in Abid-jan from March 2009 to March 2016. Results: 276 upper gastrointestinal endoscopies (UGIE) were performed in children during the study period. UGIE was performed with a diagnostic purpose in most cases (99%). The indications of UGIE were abdominal pains (38.95%), ingestion of caustic substances (29.82%), upper gastrointestinal bleeding (10.87%) and vomiting (10.17%). UGIE was normal in 39.49% of cases for all ages. The main anomalies observed in upper gastrointestinal (GI) endoscopy for all ages were gastropathies (29%); caustic lesions (13.02%) and bile reflux (10.45%). Ul-cers were rarely found (2.54%). Histological examination of biopsies revealed chronic H. pylori gastritis in 67% of gastric samples examined. All endoscopic examinations were performed without incident. Conclusion: Gastroscopy is a harmless examination with a great diagnostic and therapeutic utility in digestive pathology of children in Ivory Coast.

Epidemiologic Transition and Heart Failure in Black African Adults  [PDF]
Djinguin Ben Justin Koffi, Loa Ambroise Gnaba, Iklo Coulibaly, Bamba Kamagaté, Jean Baptiste Anzouan-Kacou
World Journal of Cardiovascular Diseases (WJCD) , 2017, DOI: 10.4236/wjcd.2017.710033
Abstract: The objective of this study is to report clinical, electrocardiographic, and echocardiographic data on heart failure for the evaluation of its cardiovascular risk factors and causes at the Institute of Cardiology of Abidjan and the National Police Hospital. Patients and Methods: The 12-month prospective study included 989 patients who were diagnosed with heart failure at the Institute of Cardiology of Abidjan and the Heart Department of the National Police Hospital in Cote d’Ivoire. Results: The mean age of the patients was 55 ± 12 years. Patients ≤ 50 years, aged 50 and 70 years, and ≥ 70 years were 42%, 60%, and 18%, respectively. The major cardiovascular risk factors were high blood pression (60%), smoking (19%), type 2 diabetes (11%), and hypercholesterolemia (8%). The status of 11% of HIV positive patients were ignored upon admission to the Heart Hospitals. Severe kidney failure (25%) was found in all hypertensive patients. Atrial fibrillation patients and sinus rhythm subjects were 20% and 80%, respectively. The average duration of QRS was 102 ± 24 ms. 20% of patients had a complete left bundle branch block. The mean of the left ventricular ejection fraction (LVEF) was 35.8% ± 13%. The LVEF was？ ≤ 45% in 57% of cases and ≤ 30% in 30% of cases. The identified causes of heart failure were ischemic heart disease (60%), hypertensive heart disease (20%), and rheumatic valvulopathy (12%). Among the patients with ischemic heart disease, 80% were infarction. The coronarography and the myocardial revascularization were performed in 50% of cases. The primitive cardiomyopathy was diagnosed in 15% of cases. The average follow-up was 12.6 ± 8 months. 18% of patients died, 14% of whom deceased within 1 year after the initial diagnosis and 5% of death occurred in 19 months following the first symptoms of heart failure. The end stage of heart failure (13%) was the most frequent cause of death followed by the sudden death (5%) and the terminal kidney failure (2%). The patients were
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