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Les derniers abstracts de la revue European Journal of Gastroenterology & Hepatology - Current Issue :


    Date de mise en ligne : Jeudi 01 janvier 1970
    Paris, Tonya; George, Elena S.; Roberts, Stuart K.; Tierney, Audrey C.
    The effects of diet and lifestyle interventions on insulin resistance in patients with nonalcoholic fatty liver disease: a systematic review
    imageNonalcoholic fatty liver disease (NAFLD) results from excessive fat accumulation in the liver in the absence of excessive alcohol consumption. Insulin resistance (IR) is proposed to be an underlying pathogenic factor in the development and progression of disease. There are currently no proven pharmacotherapies and weight loss is the only prescribed treatment despite a lack of evidence to support a specific diet or lifestyle therapy. The aim of this review is to evaluate the efficacy of dietary lifestyle interventions on IR measured by Homeostasis model assessment in patients with NAFLD. A systematic electronic search of Medline, Scopus, The Cochrane Library, CINAHL and PubMed databases (1999–2015) was performed by two independent reviewers. Randomized control trials evaluating the efficacy of diet and lifestyle interventions on IR in adults diagnosed with NAFLD were included. A total of 6441 articles were identified; eight randomized control trials fulfilled the inclusion criteria. Three studies involved dietary interventions and five incorporated diet and exercise. The majority of intervention groups resulted in significant reductions in IR, with no significant changes observed in the control groups. Lifestyle interventions compared with controls reduced IR measured by homeostasis model assessment. All diet and diet and lifestyle intervention trials were efficient in reducing IR in participants with NAFLD. A lack of literature and variation across interventions warrants the need for extensive research to establish firm dietary lifestyle recommendations.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Wardle, Richard A.; Wardle, Andrew J.; Charadva, Creana; Ghosh, Subrata; Moran, Gordon W.
    Literature review: impacts of socioeconomic status on the risk of inflammatory bowel disease and its outcomes
    imageThe relationship between socioeconomic status (SES) and inflammatory bowel disease (IBD) is controversial. To date, research has focused on effects on incidence and prevalence, disease management and clinical outcomes; however, conclusions remain uncertain. This review examines current evidence, identifies what remains to be understood and explores the practical implications this has for today. A structured literature search in Ovid, Medline, the Cochrane library, Google Scholar and clinicaltrials.gov was performed using defined key words, including all articles up until 5 October 2016 assessing SES as a primary or secondary outcome measure. Twenty-one studies were identified, investigating incidence and prevalence (n=13), disease outcomes (n=5) and mortality (n=3). Data linking SES with IBD incidence are conflicting, with studies citing both positive and negative trends. Patients with low SES, particularly those with Crohn’s disease, show higher rates of hospitalization, service usage and IBD-associated mortality. On the basis of the available study data, it is difficult to relate SES with the risk of IBD. For Crohn’s disease, in particular, the link between deprivation and increased hospitalization and mortality observed from world-wide studies is alarming. It seems most likely that the cause links to well-documented behavioural, materialistic, psychosocial and life-course models used to explain social class inequalities in other diseases.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Fric, Premysl; Šedo, Aleksi; Škrha, Jan; Bušek, Petr; Laclav, Martin; Škrha, Pavel; Zavoral, Miroslav
    Early detection of sporadic pancreatic cancer: time for change
    imageSporadic pancreatic cancer amounts to ∼90% of all pancreatic cancers. It is a gloomy depressive disease and the most recalcitrant malignancy, with a very low 5-year survival (3–6%). At present, diagnostic methods are commonly applied, as used half a century ago, after the appearance of local and systemic symptoms (abdominal and back pain, cholestasis, painless jaundice, fatigue, anorexia, weight loss, anemia, peripheral phlebitis, and cachexia). Unfortunately, these symptoms are harbingers of an advanced disease. The subsequent imaging methods may offer additional information on the location, size, and morphology of the lesion, but they do not influence the prognosis. Radical surgery may be offered to 15–20% of patients. The relapses after surgery are frequent and chemotherapy may be palliative. Preventive programs represent the only possibility of improvement. We propose the first multistep and multidisciplinary preventive program for early detection of sporadic pancreatic cancer for the differential identification of average-risk patients who probably have the disease from those who do not.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Fill Malfertheiner, Sara; Seelbach-Göbel, Birgit; Costa, Serban-Dan; Ernst, Wolfgang; Reuschel, Edith; Zeman, Florian; Malfertheiner, Peter; Malfertheiner, Maximilian V.
    Impact of gastroesophageal reflux disease symptoms on the quality of life in pregnant women: a prospective study
    imageObjective: Pregnant women often suffer from gastroesophageal reflux disease (GERD). GERD symptoms are known to influence the quality of life; however, there is a lack of data in pregnant women. The aim of this study was to establish the impact of GERD symptoms on health-related quality of life (HRQOL) during pregnancy. Participants and methods: A prospective longitudinal cohort study to investigate the impact of GERD symptoms on the HRQOL was carried out in 510 pregnant women and 330 nonpregnant women as controls. Two validated questionnaires, the Reflux Disease Questionnaire and the Quality of Life in Reflux and Dyspepsia Questionnaire, were used. Results: The study showed a significant negative impact on HRQOL in pregnant women with GERD symptoms. All five areas, emotional distress, sleep disturbance, vitality, food/drink problems, and physical/social functioning, were significantly reduced, but the most significant impact was on sleep (Quality of Life in Reflux and Dyspepsia Questionnaire score −35%). Overall, quality of life in women with GERD worsened throughout pregnancy. Conclusion: GERD is frequently seen in pregnant women and has a negative impact on HRQOL, especially in late pregnancy. Therefore, there is a need for adequate therapy of GERD in pregnant women and HRQOL could be an adequate monitoring tool in this population.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Posthumus, Lotte; Al-Toma, Abdul
    Duodenal histopathology and laboratory deficiencies related to bone metabolism in coeliac disease
    imageObjectives: Coeliac disease (CD) is a chronic immune-mediated small intestine enteropathy precipitated by gluten in genetically predisposed individuals. Adult presentation is often atypical and malabsorption of vitamins and minerals is common, with a consequent disturbance of bone metabolism. We aim to evaluate laboratory deficiencies related to bone metabolism and the relationship between severity of histological damage and degree of bone mass loss at diagnosis of CD. Materials and methods: A retrospective cross-sectional study of 176 adult coeliac patients was carried out. All patients fulfilled the histopathological criteria for CD. Biochemical data were analysed (calcium/phosphate/alkaline-phosphatase/vitamin D/parathormone). Duodenal histology was classified according to the Marsh classification. Bone mass density (BMD) at the lumbar and femoral regions measured by dual X-ray absorptiometry. A P-value of less than 0.05 was considered significant. Results: No correlation was found between the presence of gastrointestinal symptoms and the Marsh histopathological stage (P>0.05). Vitamin D deficiency was most common (44.5%), whereas only 5.7% had hypocalcaemia. Calcium was lower (P<0.05) and parathormone was higher (P=0.01) in patients with Marsh III. These patients had lower lumbar T-score (P<0.05). Although low BMD occurred in all age groups, most osteoporotic patients were aged 45–49 years (81.8%). A multiple regression analysis showed that the Marsh histopathological stage could be a predictor of lower lumbar BMD (r=0.322, B=−1.146, P<0.05). Conclusion: Laboratory deficiencies and decreased BMD could be severe and unrelated to the presence of gastrointestinal symptoms. At diagnosis, the Marsh histopathological stage could predict the occurrence of low BMD, which carries a risk of developing into osteoporosis. In coeliac patients older than 30 years, evaluation of bone biomarkers and dual X-ray absorptiometry examination should be considered.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Maire, Frédérique; Cibot, Jean-Olivier; Compagne, Catherine; Hentic, Olivia; Hammel, Pascal; Muller, Nelly; Ponsot, Philippe; Levy, Philippe; Ruszniewski, Philippe
    Epidemiology of pancreatic cancer in France: descriptive study from the French national hospital database
    imageIntroduction: Although indirect evidence suggests that the incidence of pancreatic adenocarcinoma has increased in the last decade, few data are available in European countries. The aim of the present study was to update the epidemiology of pancreatic cancer in France in 2014 from the French national hospital database (Programme de Médicalisation des Systèmes d’Information). Patients and methods: All patients hospitalized for pancreatic cancer in France in 2014 in public or private institutions were included. Patient and stays (length, type of support, institutions) characteristics were studied. The results were compared with those observed in 2010. Results: A total of 13 346 (52% men, median age 71 years) new patients were treated for pancreatic cancer in 2014, accounting for a 12.5% increase compared with 2010. Overall, 22% of patients were operated on. Liver metastases were present in 60% of cases. The disease accounted for 146 680 hospital stays (+24.8% compared with 2010), 76% of which were related to chemotherapy (+32%). The average annual number and length of stay were 7 and 2.6 days, respectively. In 2014, 11 052 deaths were reported (+15.8%). Conclusion: Approximately 13 350 new cases of pancreatic cancer were observed in France in 2014. The increase in incidence was associated with a marked increase in hospital stays for chemotherapy.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Dragasevic, Sanja; Stankovic, Biljana; Milosavljevic, Tomica; Sokic-Milutinovic, Aleksandra; Lukic, Snezana; Alempijevic, Tamara; Zukic, Branka; Kotur, Nikola; Nikcevic, Gordana; Pavlovic, Sonja; Popovic, Dragan
    Genetic and environmental factors significant for the presentation and development of inflammatory bowel disease
    imageObjectives: The aim of the study was to evaluate associations between inflammatory bowel disease (IBD) presentation and variants in NOD2, TLR4, TNF-α, IL-6, IL-1β, and IL-RN genes in order to identify possible environmental factors that may affect IBD occurrence, investigate potential predictors for surgical treatment of IBD, and correlate the presence of granulomas in biopsy specimens with clinical characteristics of Crohn’s disease (CD) patients. Patients and methods: We genotyped 167 IBD patients using PCR-based methodology and tested for disease genotype–phenotype associations. Results: In CD patients ileal localization of disease was more frequent in NOD2 variant carriers. Ileal CD was associated with IL-6 GC+CC genotypes, identifying C allele as a possible marker of increased risk for ileal CD. In CD patients a positive family history for IBD was related to earlier onset of disease, higher risk for CD-related surgery, and appendectomy. CD patients who are TLR4 299Gly carriers are at higher risk for surgery at onset of the disease compared with TLR4 299Asp variant carriers. The presence of granuloma in biopsy specimens was more frequent in patients in whom a diagnosis of CD was made during emergency surgery. Multivariate analysis showed that CD carriers of the 299Gly allele had a 4.6-fold higher risk for emergency surgery before CD diagnosis is established compared with noncarriers, suggesting an aggressive disease course. Granuloma in endoscopic biopsies is detected 5.4-fold more frequently in patients treated surgically at the time of diagnosis. Conclusion: Genetic variants together with epidemiological and clinical data of IBD patients could potentially be used as predictors of the disease course.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Bähler, Caroline; Schoepfer, Alain M.; Vavricka, Stephan R.; Brüngger, Beat; Reich, Oliver
    Chronic comorbidities associated with inflammatory bowel disease: prevalence and impact on healthcare costs in Switzerland
    imageObjective: Inflammatory bowel disease (IBD) was shown to be associated with a variety of chronic comorbidities. We aimed to evaluate the frequency of 21 chronic conditions and compared frequencies in IBD and non-IBD populations. Further, healthcare costs of those (additional) chronic conditions were calculated. Patients and methods: A total of 4791 IBD patients, who were insured at Helsana Insurance Group in 2014, were compared with 1 114 638 individuals without IBD. Entropy balancing was performed to create balanced samples. Chronic conditions were identified by means of the updated Pharmacy-based Cost Group model. Multivariate log-transformed linear regression modeling was performed to estimate the effect of the morbidity status (non-IBD +none, +1, +2, and +3 or more chronic conditions) on the healthcare costs. Results: Overall, 78% of IBD patients had at least one comorbidity, with a median of three comorbidities. Largest differences between individuals with and without IBD were found for rheumatologic conditions, acid-related disorders, pain, bone diseases, migraines, cancer, and iron-deficiency anemia, whereas no significant differences between the two groups were found for diabetes, dementia, hyperlipidemia, glaucoma, gout, HIV, psychoses, and Parkinson’s disease after adjustments for a variety of covariates. Each increase in the morbidity status led to increased healthcare costs; rheumatologic conditions, acid-related disorders, and pain as the most frequent comorbidities more than doubled total costs in IBD patients. Conclusion: We found a considerably high prevalence of concomitant chronic diseases in IBD patients. This was associated with considerably higher healthcare costs, especially in the outpatient setting.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Herzog, Denise; Fournier, Nicolas; Buehr, Patrick; Rueger, Vanessa; Koller, Rebekka; Heyland, Klaas; Nydegger, Andreas; Braegger, Christian P.; on behalf of the Swiss IBD Cohort Study Group
    Prevalence of intestinal complications in inflammatory bowel disease: a comparison between paediatric-onset and adult-onset patients
    imageIntroduction: Intestinal complications in inflammatory bowel disease indicate active inflammation and typically result in the intensification of therapy. Aim: To analyse whether the rates of intestinal complications were associated with age at disease onset. Patients and methods: Data from 1506 individuals with Crohn’s disease (CD) and 1201 individuals with ulcerative colitis (UC) were obtained from the Swiss inflammatory bowel disease cohort study database, classified into groups on the basis of age at diagnosis (<10, <17, <40 and >40 years of age), and retrospectively analysed. Results: In CD patients, the rates of stricturing (29.1–36.2%), abdominal penetrating disease (11.9–18.2%), resectional surgery (17.9–29.8%) and perianal disease (14.7–34.0%) were correlated with disease duration, but not age at diagnosis. However, paediatric-onset CD was associated with higher rates of multiple, rectal and anal strictures and earlier colon surgery. In addition, perianal disease occurred earlier, required earlier surgical intervention, and was more often combined with stricturing and penetrating disease. Finally, anal fissures were more prevalent among younger patients. In UC patients, the rates of progression or extension of disease (0–25.8%) and colectomy (3.0–8.7%) were dependent on disease duration, but not age at disease onset. Paediatric-onset disease was associated with a higher rate of extensive colitis at diagnosis and earlier progression or extension of disease, and nonsurgically treated patients with the youngest ages at onset more frequently required antitumour necrosis factor-α treatments. Conclusion: The higher rates of intestinal complications, including those of the small and large bowel and in the anal region, in paediatric-onset CD patients point towards a level of inflammation that is more difficult to control. Similar findings were also evident in UC patients.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Marques-Antunes, Joana; Libânio, Diogo; Gonçalves, Pedro; Dinis-Ribeiro, Mário; Pimentel-Nunes, Pedro
    Incidence and predictors of adenoma after surgery for colorectal cancer
    imageObjective: Patients with colorectal cancer (CRC) are at increased risk for developing metachronous premalignant and malignant lesions. However, its real incidence and underlying risk factors are still unclear, and therefore quality measures for colonoscopy under this indication have not been completely established. The aim of this study was to assess the incidence of and risk factors for the development of adenomas after surgery for CRC. Patients and methods: A total of 535 patients submitted to curative surgery for CRC between January 2008 and December 2011 were selected and their clinical records and surveillance colonoscopies were reviewed. Results: During a median follow-up of 62 months, 39.4% of the patients developed adenomas, 17.6% advanced adenomas and 3.4% developed metachronous cancers. Male sex [adjusted odds ratio (AOR)=1.99; 95% confidence interval (CI): 1.29–3.07] was an independent risk factor for adenomas during follow-up and absence of a high-quality baseline colonoscopy was the only independent risk factor for advanced adenomas (AOR=1.78; 95% CI: 1.03–3.07) and metachronous cancer (AOR=7.05; 95% CI: 1.52–32.66). In patients who had undergone a high-quality colonoscopy at baseline and at the first follow-up, the presence of adenomas (odds ratio=12.30; 95% CI: 2.30–66.25) and advanced adenomas (odds ratio=10.50; 95% CI: 2.20–50.18) in the first follow-up colonoscopy was a risk factor for the development of metachronous advanced adenomas during the subsequent surveillance. Conclusion: Undergoing a high-quality baseline colonoscopy is the most important factor for reducing the incidence of advanced lesions after CRC surgery. All patients remain at high-risk for adenomas and advanced adenomas, but standardized follow-up should be adjusted after the first year of follow-up.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Jablonka, Alexandra; Solbach, Philipp; Wöbse, Michael; Manns, Michael P.; Schmidt, Reinhold E.; Wedemeyer, Heiner; Cornberg, Markus; Behrens, Georg M.N.; Hardtke, Svenja
    Seroprevalence of antibodies and antigens against hepatitis A–E viruses in refugees and asylum seekers in Germany in 2015
    imageBackground: Migration because of miscellaneous political crises in countries in the Middle East and Africa is a global challenge for whole Europe from an economic, social, and public health view. There is an urgent need to generate comprehensive, evidence-based data to expedite further screening and vaccination strategies. Methods: A total of 604 individuals ranging in age from 2 to 68 years who enrolled at a single reception center were tested for the prevalence of serologic markers for hepatitis virus types A, B, C, D, and E (HAV, HBV, HCV, HDV, HEV), respectively. Results: Anti-HAV antibody prevalence was 91.2 and 70.3% in children younger than 18 years of age. The prevalence of anti-HEV antibodies was 20.1% among the individuals. 3.0% were positive for hepatitis B surface antigen, whereas 15.2% tested positive for anti-hepatitis B core antigen. None of the refugees tested positive for anti-HDV. 14.1% of refugees were vaccinated against hepatitis B and had a protective anti-hepatitis B surface level of at least 10 mIU/ml. Significant differences in vaccination status were found between the regions (Eastern Mediterranean Region with 77/482 (16.0%; 95% confidence interval=12.7–19.3%) versus African Region with 1/55 (1.8%; 95% confidence interval=0–5.0%). The prevalence of anti-HCV antibodies was 1.2% (n=7), with 0.7% HCV RNA positivity; 16.7% of hepatitis B surface antigen-positive individuals were HCV coinfected (n=3). Conclusion: The prevalence of refugees with previous exposure to hepatitis viruses was higher than that in the general German population, but lower than in other migrant populations in Germany. The vaccination status against hepatitis B was poor.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Wang, Pin-Chao; Wei, Tao-Yang; Tseng, Tai-Chung; Lin, Hans Hsienhong; Wang, Chia-Chi
    Cirrhosis has no impact on therapeutic responses of entecavir for chronic hepatitis B
    imageObjective: As the efficacy of a direct antiviral agent is reduced in cirrhotic chronic hepatitis C patients, prolonged duration of treatment or addition of ribavirin is recommended to improve the rates of sustained virological response. However, the impact of cirrhosis on the efficacy of antiviral treatment for chronic hepatitis B (CHB) remained unclear. Patients and methods: This retrospective cohort study screened entecavir (ETV)-treated CHB patients in Taipei Tzu Chi Hospital from January 2007 till October 2014. The diagnosis of cirrhosis was made on the basis of clinical/imaging or histologic findings. The primary endpoints were hepatitis B e antigen (HBeAg) loss in HBeAg-positive patients and undetectable hepatitis B virus (HBV) DNA in the overall study population. Initial virological response is defined as undetectable HBV DNA at 1-year ETV treatment. Results: A total of 381 (262 men; mean age: 49.6±12.9 years) CHB patients were recruited for the final analysis. Of these, 138 were cirrhotic. In 143 HBeAg-positive patients, there was no difference in the rates of 1- and 2-year HBeAg loss between cirrhotic and noncirrhotic patients (P=0.226 and 0.729, respectively). In the overall population, the rate of 1-year undetectable HBV DNA was higher in patients with cirrhosis than those without cirrhosis (76.1 vs. 64.2%, P=0.016). The rate of 2-year undetectable HBV DNA was not different between these two groups. Using multivariate logistic regression analysis, baseline HBV DNA levels (P=0.006) and HBeAg status (P=0.007), were associated with initial virological response, but not cirrhosis. Conclusion: Therapeutic responses of ETV are not decreased in cirrhotic CHB patients. Thus, cirrhotic CHB patients can be treated with ETV without the need for dose adjustment.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Kohla, Mohamed A.S.; Abbasy, Mohamed; Abozeid, Mai; El-Abd, Osama; Ezzat, Sameera; Kohla, Samah; Abdel-Rahman, Mohamed
    Assessment of liver fibrosis with acoustic radiation force impulse imaging versus liver histology in patients with chronic hepatitis C: a pilot study
    imageBackground: Acoustic radiation force impulse imaging (ARFI) involves the mechanical excitation of tissues using short-duration acoustic pulses to generate localized displacements in tissue. The displacements results in shear-wave propagation, tracked by ultrasonography (US) correlation-based methods and recorded in meters per seconds. Aim: To compare (ARFI) integrated into a conventional US with the standard histological examination of liver biopsy specimens for the assessment of liver fibrosis. Materials and methods: Histological fibrosis staging with standard liver biopsy using the Metavir scoring system as well as fibrosis assessment using ARFI were performed to 80 patients with chronic hepatitis C over a 3-month period. Results: ARFI findings were identical to the biopsy findings in 61 (76.25%) patients. Fifty-eight (67.5%) patients with an early fibrosis stage (F0, F1, and F2) by histology had identical fibrosis stages using ARFI. Only 20 out of 26 patients with an advanced fibrosis stage (F3 and F4) using ARFI had advanced fibrosis histologically. In the advanced fibrosis stages, the sensitivity of ARFI was 70% and specificity was 80%, with positive and negative predictive values of 53.8 and 88.9%, respectively. The accuracy of detection of advanced fibrosis by ARFI was 77.5%. Conclusion: ARFI imaging is a promising noninvasive US-based method for the assessment of liver fibrosis.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Singh, Akanksha; Kumar, Mavidi S.; Jaryal, Ashok K.; Ranjan, Piyush; Deepak, Kishore K.; Sharma, Sanjay; Lakshmy, Ramakrishnan; Pandey, Ravindra M.; Vikram, Naval K.
    Diabetic status and grade of nonalcoholic fatty liver disease are associated with lower baroreceptor sensitivity in patients with nonalcoholic fatty liver disease
    imageObjectives: Baroreceptor sensitivity (BRS), a functional consequence of vascular stiffness, may be affected by the presence of diabetes mellitus (DM) and nonalcoholic fatty liver disease (NAFLD). The present study was designed to assess the effect of diabetic status and NAFLD grade on the BRS in patients with NAFLD. Methods: Seventy-five individuals (25 NAFLD without DM, 25 NAFLD with DM and 25 controls) were recruited for the study who underwent anthropometric and body composition analysis along with estimation of plasma glucose, serum insulin and serum lipids. BRS and blood pressure variability (BPV) analysis was carried out in both time and frequency domains. Carotid–radial and carotid–dorsalis pedis artery pulse wave velocity, and radial artery augmentation index were computed as measures of arterial stiffness. Results: BRS was found to be lower in the NAFLD with DM group as well those with grade II NAFLD compared with the controls. Correlation analysis showed a negative correlation of BRS with postprandial blood glucose level (r=−0.39) and BMI (r=−0.467). The diabetic status and grade of NAFLD were associated independently with a decrease in BRS as well as the low-frequency component of diastolic BPV. The augmentation index and carotid–distal pulse wave velocity were higher in the NAFLD with DM group compared with controls. Conclusion: Both the diabetic status and grade of NAFLD were shown to have an independent effect on the decrease in the BRS with a consequent effect on BPV, with a greater influence of diabetic status rather than NAFLD grade on arterial stiffness.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Romero-Ibarguengoitia, Maria E.; Herrera-Rosas, Arturo; Domínguez-Mota, Alfredo A.; Camas-Benitez, Jinny T.; Serratos-Canales, María F.; León-Hernández, Mireya; González-Chávez, Antonio; López-Ortiz, Eduardo; Mummidi, Srinivas; Duggirala, Ranvidranth; López-Alvarenga, Juan C.
    Nonalcoholic fatty liver disease can be predicted by retinal vascular changes in patients with obesity without hypertension or diabetes
    imageObjective: To evaluate the utility of predicting nonalcoholic fatty liver disease (NAFLD) and obesity by retinal vascular changes (RVC) found in fundoscopy and to determine whether this is related to a low-grade inflammatory process. Methods: We carried out a cross-sectional analysis that included 152 (ages 18–45 years) patients divided into four groups: NAFLD and BMI less than 25, absence of NAFLD and BMI less than 25, NAFLD and BMI more than 30, and absence of NAFLD and BMI more than 30. Retinal fundoscopy, hepatic ultrasound, metabolic profile, and cytokine measurement were performed. We calculated odds ratio [95% confidence interval (CI)], performed diagnostic utility tests, and carried out a 2k factorial analysis. Results: Obesity was associated with RVC (odds ratio: 21.25; 95% CI: 8.79–51.4) and NAFLD [25 (9.07–72.6)]. NAFLD was associated with RVC [11.24 (4.98–26.48)], and the prediction of NAFLD showed a sensitivity of 75% (95% CI: 68–82) and a specificity of 81% (75–86); when RVC-obesity were combined, sensitivity increased to 90% (88–91.7), with a specificity of 85% (84–85.8). C-reactive protein was associated with the three factors, suggesting an independent contribution. Thin patients with RVC and NAFLD had higher concentrations of interleukin-2, interleukin-6, tumor necrosis factor-α, and interferon-γ. Conclusion: NAFLD in patients with obesity without diabetes or hypertension can be predicted by RVC, a noninvasive technique carried out by eye fundoscopy. NAFLD alone can drive inflammatory conditions in the absence of obesity that manifests as RVC.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Seleem, Waseem M.; Hanafy, Amr S.
    Management of different types of gastric varices with band ligation: a 3-year experience
    imageBackground and aim: Gastric varices (GVs) occur with an incidence of 20% in patients with portal hypertension. The aim of this study was to evaluate the efficacy of endoscopic band ligation (BL) as an option in the management of small-to-moderate nonbleeding GVs in cirrhotic patients. Patients and methods: A total of 50 patients (GOV2; n=6, IGV1; n=34, IGV2; n=10) with nonbleeding small-to-moderate-sized GVs without local risk signs of bleeding, such as large size, red-colored elevated areas or red wales, and systemic factors of bleeding risk such as an international normalized ratio of at least 2 and a platelet count of 80 000/µl or less were subjected to endoscopic BL. The patients were followed up every 2 weeks for 1 month and then every 1.5 months for 6 months. The primary outcome was GV eradication, detection of complications such as postprocedural bleeding ulceration and mortality. Results: The mean number of BL sessions was 2.2±0.8; post-BL ulceration occurred in two (4%) patients (n=2 in IGV1, P=0.61), bleeding occurred in one (2%) patient (n=1 in IGV1, P=0.79), and epigastric pain occurred in six (12%, n=4 in GOV2, n=2 in IGV1) patients. There was no mortality reported among patients treated with BL. Conclusion: Endoscopic BL resulted in better outcome and a lower incidence of complications when used to treat small-to-medium-sized nonbleeding GVs. Further, early eradication can save effort and cost, thus avoiding the future risk of treatment of large or risky GVs with sclerotherapy.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Allamneni, Chaitanya; Alkurdi, Basem; Naseemuddin, Rehan; McGuire, Brendan M.; Shoreibah, Mohamed G.; Eckhoff, Devin E.; Peter, Shajan
    Orthotopic liver transplantation changes the course of gastric antral vascular ectasia: a case series from a transplant center
    imageBackground and aim: Gastric antral vascular ectasia (GAVE) is an important cause of upper gastrointestinal bleeding and anemia in patients with cirrhosis. The aim of our study was to evaluate the effect of orthotopic liver transplantation (OLT) on GAVE and associated anemia. Patients and methods: We performed a chart review and identified all cirrhotic patients with GAVE who underwent OLT at the University Of Alabama at Birmingham between 2005 and 2013. Population’s demographics, etiology of cirrhosis, comorbidities, presentation and treatment modalities of GAVE, endoscopic and histopathologic reports, hemoglobin values before and after transplant, and immunosuppressive regimens were collected. Results: Twelve patients were identified, mean age 52.4±4.4 years; seven were men (58.3%); 11 (91.7%) were White; and 6 of 12 patients had biopsy-proven GAVE. The most common etiology of cirrhosis in the cohort was chronic hepatitis C and obesity was the most common chronic condition in 50 and 83.3%, respectively. Anemia resolution was observed in 9/12 (75%) patients who underwent OLT with an increase in hemoglobin from 8.1±2.4 (5.7–13.1) before transplant to 12.0±1.4 (10–15) after transplant (P<0.0001). Esophagogastroduodenoscopy after transplant was performed in all 12 (100%) patients. The mean time between transplant and post-OLT esophagogastroduodenoscopy was 13.8±18.28 (2–57) months; complete resolution of GAVE was observed in 10 (83.3%) patients, with resolving GAVE in one (8.3%) patient. Conclusion: GAVE is an important cause of anemia and upper gastrointestinal bleeding in patients with liver cirrhosis. Our findings show that liver transplantation can resolve GAVE and related anemia.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Agarwal, Jaya
    It’s time to ponder
    imageNo abstract available


    Date de mise en ligne : Jeudi 01 janvier 1970
    Ji, Fanpu; Tian, Changyin; Li, Zongfang; Deng, Hong; Nguyen, Mindie H.
    Ledipasvir and sofosbuvir combination for hepatitis C virus infection in three patients aged 85 years and older
    imageNo abstract available


    Date de mise en ligne : Jeudi 01 janvier 1970
    Wahid, Braira; Saleem, Komal; Ali, Amjad; Rafique, Shazia; Idrees, Muhammad
    Rising relapse rate in hepatitis C virus type 3a-infected patients against sofosbuvir and ribavirin combination therapy: a Pakistani experience
    imageNo abstract available


    Date de mise en ligne : Jeudi 01 janvier 1970
    Huang, Rui; Xia, Juan; Liu, Yong; Zhang, Zhaoping; Wu, Chao
    Acoustic radiation force impulse in the diagnosis of liver fibrosis in patients with chronic hepatitis B
    No abstract available


    Date de mise en ligne : Jeudi 01 janvier 1970
    Paper alert
    No abstract available


    Date de mise en ligne : Jeudi 01 janvier 1970
    Comparative effectiveness of antiviral treatment for hepatitis B: a systematic review and Bayesian network meta-analysis: Erratum
    No abstract available