Endoscopic injection of fibrin glue into a bleeding peptic ulcer is an effective and safe treatment modality. The present report describes a patient who developed rectal bleeding from an arteriovenous malformation after endoscopic injection of fibrin glue containing human thrombin into a gastric ulcer. Additional laboratory investigations revealed the presence of an inhibitor against coagulation factor V, which resulted in severe coagulopathy, triggering the bleeding. Acquired factor V inhibitors have frequently been reported with the use of bovine thrombin, but to our knowledge, they have never been documented in patients exposed to human thrombin. Endoscopists should be aware of this rare, but potentially serious, complication.

Persistently normal alanine aminotransferase (PNALT) is present in 30 to 40% of chronic hepatitis patients and it is generally accepted that they have no liver damage. However, some studies suggest that there are some degrees of mild to moderate histological liver damage. We evaluated the fibrosis stage and the virological outcome in treated patients with PNALT. We collected HCV-positive patients with normal liver enzymes in a Belgian multicenter prospective randomized study between 2002 and 2006. They had fibrosis with at least F1 in Metavir score. Patients were followed for two years. They were divided in two groups. Group 1 (n=17) were patients treated by Pegylated Interferon alfa-2b (Pegintron) plus ribavirin (Rebetol). Group 2 (n=18) received no treatment and were used as a control group for 48 weeks. The sustained virological response (SVR) was 41% (7/17). The SVR in our study is equivalent for patients with elevated ALT levels. We also evaluated the evolution of the transaminases during treatment in group 1 patients. We observed a diminution of the already normal ALT and AST values, in patients who were treated. In our opinion there is no other publication that showed this evolution of the transaminases during treatment of HCV. With the knowledge that in our study, the patients showed a minimal degree of fibrosis even with normal liver enzymes, we agree with the findings of some authors who suggest to lower normal limit of the transaminases. Materials and Methods Study population Naïve adult patients with chronic hepatitis C and persistently normal ALT levels were selected for this study. The patients were randomized between treatment and observation (control group). PNALT was defined as the presence of 3 consecutive measurements within the normal range over a 6-month period [7].