Clinics and research in hepatology and gastroenterology最新文献

{"title":"Droplet digital PCR technique is ultrasensitive for the quantification of covalently closed circular DNA in the blood of chronic HBV-infected patients","authors":"Ravinder Singh ,&nbsp;Gayatri Ramakrishna ,&nbsp;Manoj Kumar Sharma ,&nbsp;Rahul Kumar ,&nbsp;Ekta Gupta ,&nbsp;Archana Rastogi ,&nbsp;Pranay Tanwar ,&nbsp;Shiv Kumar Sarin ,&nbsp;Nirupama Trehanpati","doi":"10.1016/j.clinre.2025.102531","DOIUrl":"10.1016/j.clinre.2025.102531","url":null,"abstract":"<div><h3>Background</h3><div>Covalently closed circular DNA (cccDNA) is a stable, episomal form of HBV DNA. cccDNA is a true marker for the intrahepatic events in controlled CHB infection. Quantifying cccDNA is critical for monitoring disease progression, and efficacy of anti-viral therapies.</div></div><div><h3>Methods</h3><div>To standardize the method, total HBV DNA was isolated from HepAD38 cells and digested with three exonuclease enzymes to remove linear and relaxed circular HBV DNA. Purified cccDNA quantification used ddPCR with specific primers. Treatment-naive chronic hepatitis B virus patients (nCHBV, n=36) with detectable HBV DNA and HBsAg were grouped by HBsAg levels: Group I (HBsAg^lo &lt; 2000 IU/ml, n=11) and Group II (HBsAg^hi &gt; 2000 IU/ml, n=25). cccDNA, HBV DNA and HBsAg were quantified in plasma and compared between groups. Correlation with clinical/histopathological features was done.</div></div><div><h3>Results</h3><div>Non-digested 3.6^{^}10⁶ tet^-ve HepAD38 cells showed 316 copies/µl of total viral DNA. After digesting the linear, integrated, and relaxed circular DNA with triple enzymes, 15 copies/µl of cccDNA were detected. Similarly, after DNA digestion, HBsAg^lo patients showed a median of 8.5 copies/µl (IQR 2.75-9.75 copies/µl), and HBsAg^hi gave a median of 11 copies/µl (IQR 4-16 copies/µl) but with no significant difference between groups (p=0.093). Further, HBsAg^lo patients with low cccDNA copy numbers showed significantly higher fibrosis grades than HBsAg^hi (p=0.036).</div></div><div><h3>Conclusions</h3><div>We conclude that employing a combined approach utilizing three exonucleases, cccDNA-specific primers, and ddPCR enables the detection of cccDNA copies even in patients exhibiting low levels of HBsAg and HBV DNA. This integrated method offers additional validation as a surrogate diagnostic tool.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 3","pages":"Article 102531"},"PeriodicalIF":2.6,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitochondrial dysfunction in drug-induced hepatic steatosis: Recent findings and current concept","authors":"Annie Borgne-Sanchez ,&nbsp;Bernard Fromenty","doi":"10.1016/j.clinre.2025.102529","DOIUrl":"10.1016/j.clinre.2025.102529","url":null,"abstract":"<div><div>Mitochondrial activity is necessary for the maintenance of many liver functions. In particular, mitochondrial fatty acid oxidation (FAO) is required for energy production and lipid homeostasis. This key metabolic pathway is finely tuned by the mitochondrial respiratory chain (MRC) activity and different transcription factors such as peroxisome proliferator-activated receptor α (PPARα). Many drugs have been shown to cause mitochondrial dysfunction, which can lead to acute and chronic liver lesions. While severe inhibition of mitochondrial FAO would eventually cause microvesicular steatosis, hypoglycemia, and liver failure, moderate impairment of this metabolic pathway can induce macrovacuolar steatosis, which can progress in the long term to steatohepatitis and cirrhosis. Drugs can impair mitochondrial FAO through several mechanisms including direct inhibition of FAO enzymes, sequestration of coenzyme A and <span>l</span>-carnitine, impairment of the activity of one or several MRC complexes and reduced PPARα expression. In drug-induced macrovacuolar steatosis, non-mitochondrial mechanisms can also be involved in lipid accumulation including increased <em>de novo</em> lipogenesis and reduced very-low-density lipoprotein secretion. Nonetheless, mitochondrial dysfunction and subsequent oxidative stress appear to be key events in the progression of steatosis to steatohepatitis. Patients suffering from metabolic dysfunction-associated steatotic liver disease (MASLD) and treated with mitochondriotoxic drugs should be closely monitored to reduce the risk of acute liver injury or a faster transition of steatosis to steatohepatitis. Therapies based on the mitochondrial cofactor <span>l</span>-carnitine, the antioxidant N-acetylcysteine, or thyromimetics might be useful to prevent or treat drug-induced mitochondrial dysfunction, steatosis, and steatohepatitis.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 3","pages":"Article 102529"},"PeriodicalIF":2.6,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expansion of interventional endoscopy and day-case procedures: A nationwide longitudinal study of gastrointestinal endoscopy in France","authors":"Hervé-Pierre Toudic ,&nbsp;Marie Morvan ,&nbsp;Noémi Reboux ,&nbsp;Stanislas Chaussade ,&nbsp;Olivier Gronier ,&nbsp;Stéphane Koch ,&nbsp;David Bernardini ,&nbsp;Emmanuel Coron ,&nbsp;Michel Robaszkiewicz ,&nbsp;Lucille Quénéhervé","doi":"10.1016/j.clinre.2024.102505","DOIUrl":"10.1016/j.clinre.2024.102505","url":null,"abstract":"<div><h3>Background</h3><div>An accurate assessment of the evolution of GI endoscopy volumes is warranted to identify long-term trends and to help anticipate training, infrastructure and human resource needs. The main objective of this longitudinal study was to evaluate the evolution of GI endoscopy in France.</div></div><div><h3>Methods</h3><div>This retrospective study consisted of a cross-sectional analysis repeated each year from 2008 to 2018 using data from a national health database related to hospital admissions. All day-case and hospital stays presenting at least one of the 119 GI endoscopy procedures were extracted.</div></div><div><h3>Results</h3><div>This study showed an increase in day-case and hospital stays including a GI endoscopy procedure of 18.4 %. In addition, day-case endoscopy increased from 67.8 % to 76.9 % of hospital admissions. There was a 19.6 % increase in lower GI endoscopy, with in particular a 247 % increase in endoscopic mucosal resection. EUS and pancreaticobiliary and duodenal endoscopy have seen the most significant increases, 63 % and 70.2 % respectively; notably, therapeutic EUS increased by 476 %.</div></div><div><h3>Conclusion</h3><div>This study shows the good dynamics of GI endoscopy in a European country with a sustained increase over 11 years in day-case and hospital stays of patients undergoing a GI endoscopy while day-case endoscopy is taking on an increasingly important role.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102505"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Induction triplet chemotherapy in patients with rectal adenocarcinoma and synchronous metastases, an AGEO-FFCD study","authors":"Victoire Dabout ,&nbsp;Laurent Mineur ,&nbsp;David Tougeron ,&nbsp;Karine Le Malicot ,&nbsp;Claire Gallois ,&nbsp;Jean Marc Phelip ,&nbsp;Anthony Turpin ,&nbsp;Romain Cohen ,&nbsp;Benedicte Demoustier ,&nbsp;Vincent Hautefeuille ,&nbsp;Christophe Locher ,&nbsp;Charles-Briac Levaché ,&nbsp;Emmanuel Mitry ,&nbsp;Thierry Lecomte ,&nbsp;Fabien Brocard ,&nbsp;Deborah Hassid ,&nbsp;Marie Porte ,&nbsp;Gilles Breysacher ,&nbsp;Jean-Paul Lagasse ,&nbsp;Côme Lepage ,&nbsp;Jean-Baptiste Bachet","doi":"10.1016/j.clinre.2024.102514","DOIUrl":"10.1016/j.clinre.2024.102514","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Aim of the study&lt;/h3&gt;&lt;div&gt;The management of synchronous metastatic rectal cancer (SMRC) is complex and multimodal, involving chemotherapy, surgery and/or radiotherapy. The aim of this study was firstly to confirm the efficacy of the induction FOLFIRINOX, and secondly to evaluate the different therapeutic strategies and outcomes of patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients and methods&lt;/h3&gt;&lt;div&gt;This French study combined data from a prospective FFCD trial and a multicenter cohort. Patients included had SMRC and had undergone induction triplet chemotherapy. Two groups of patients were defined according to the resectability of metastases at baseline: resectable (Res) and unresectable (URes). The primary endpoint was the objective response rate.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;146 patients were included in 16 French centers and 65 patients in the FFCD1102 trial. In overall population the median age of patients was 59 years, 86% of tumors were of the lower or middle rectum, 33% were well-differentiated, 53% were &lt;em&gt;RAS&lt;/em&gt; mutated and 7% &lt;em&gt;BRAF&lt;/em&gt; mutated. Triplet induction was associated with 80% of objective response and 92% of disease control. After the induction phase, 69% and 48% of patients of Res and URes groups underwent rectal surgery, and secondary metastases resection was done in 79% and 39% of patients, respectively. Median overall survival (OS) for Res was 56.3 months (95% CI: 22.54-NA). Median OS for URes who had or not secondary metastases resection were 45.1 months (95% CI: 39.89-NA) and 21.1 months (95% CI 17.31–27.1), respectively. Patients with &lt;em&gt;BRAF&lt;/em&gt; mutated tumors were more likely to have unresectable disease, and had worse survivals than the patients with &lt;em&gt;RAS&lt;/em&gt; mutated or &lt;em&gt;RAS/BRAF&lt;/em&gt; wild-type.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Triplet induction chemotherapy is a treatment of choice in selected patients with SMRC, allowing to adapt the therapeutic strategy to the response and invasiveness of the various sites.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Structured abstract&lt;/h3&gt;&lt;div&gt;The management of metastatic rectal cancer is essentially based on three main therapeutic approaches: surgery, radiotherapy/chemoradiotherapy and chemotherapy. Induction triplet chemotherapy appears as a good choice for fit and young patients. It allows to adapt the therapeutic strategy to the response and invasiveness of the various sites. In this study dedicated to patients undergoing treatment for rectal cancer with synchronous metastases, FOLFIRINOX-based induction chemotherapy was associated with objective response rate of 77% and disease control rate of 92%. These results are similar with those of the FFCD 1102 trial and confirm the efficacy of induction chemotherapy with FOLFIRINOX with or without targeted therapy in these patients in daily routine practice. Surgery for metastases is a key factor in determining patient's outcome and triplet induction chemotherapy, associated with high response rates, enables a significant perce","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102514"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current advances in nanoparticle-based approaches for the hepatocellular carcinoma treatment","authors":"Sathishbabu Paranthaman ,&nbsp;Umme Hani ,&nbsp;Riyaz Ali M. Osmani ,&nbsp;Rohit R. Bhosale ,&nbsp;Nazima Haider","doi":"10.1016/j.clinre.2024.102508","DOIUrl":"10.1016/j.clinre.2024.102508","url":null,"abstract":"<div><div>Hepatocellular carcinoma (HCC) is the most common form of liver (LC) with a high mortality rate, driven by risk factors including viral hepatitis, alcoholic liver disease, and nonalcoholic steatohepatitis. The incident of HCC increases 2–4% of the worldwide population each year which would most certainly exceed one million per year by 2025. Despite advances in our knowledge, 25% of HCC tumors have actionable mutations which demands for innovative treatments strategies. In this perspective, we are providing a comprehensive summary of nanoparticles (NPs) based therapeutic approaches for HCC. We begin with an overview of HCC, concentrating on its pathogenesis, current conventional therapies, and their limitations. Then we delve into the therapeutic application of various nanoparticles (NPs) platforms for HCC, including polymeric micelles, dendrimers, liposomes, solid-lipid nanoparticles, nanostructured lipid carriers, exosomes, niosomes, mesoporous silica nanoparticles, carbon nanotubes. Special attention is given to the application of NPs in photothermal and photodynamic treatment was also investigated, with a focus on their effectiveness in targeted cancer ablation. Additionally, the review discusses recent patents and clinical studies that demonstrate the promise of NPs-based therapies in improving HCC treatment outcomes. This article underscores the potential of NPs based technologies to address the challenges faced by traditional therapies and offers insights into future directions for HCC management.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102508"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward automated small bowel capsule endoscopy reporting using a summarizing machine learning algorithm: The SUM UP study","authors":"Charles Houdeville ,&nbsp;Marc Souchaud ,&nbsp;Romain Leenhardt ,&nbsp;Lia CMJ Goltstein ,&nbsp;Guillaume Velut ,&nbsp;Hanneke Beaumont ,&nbsp;Xavier Dray ,&nbsp;Aymeric Histace","doi":"10.1016/j.clinre.2024.102509","DOIUrl":"10.1016/j.clinre.2024.102509","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Deep learning (DL) algorithms demonstrate excellent diagnostic performance for the detection of vascular lesions via small bowel (SB) capsule endoscopy (CE), including vascular abnormalities with high (P2), intermediate (P1) or low (P0) bleeding potential, while dramatically decreasing the reading time. We aimed to improve the performance of a DL algorithm by characterizing vascular abnormalities using a machine learning (ML) classifier, and selecting the most relevant images for insertion into reports.</div></div><div><h3>Materials and methods</h3><div>A training dataset of 75 SB CE videos was created, containing 401 sequences of interest that encompassed 1,525 images of various vascular lesions. Several image classification algorithms were tested, to discriminate “typical angiodysplasia” (P2/P1) and “other vascular lesion” (P0) and to select the most relevant image within sequences with repetitive images. The performances of the best-fitting algorithms were subsequently assessed on an independent test dataset of 73 full-length SB CE video recordings.</div></div><div><h3>Results</h3><div>Following DL detection, a random forest (RF) method demonstrated a specificity of 91.1 %, an area under the receiving operating characteristic curve of 0.873, and an accuracy of 84.2 % for discriminating P2/P1 from P0 lesions while allowing an 83.2 % reduction in the number of reported images. In the independent testing database, after RF was applied, the output number decreased by 91.6 %, from 216 (IQR 108–432) to 12 (IQR 5–33). The RF algorithm achieved 98.0 % agreement with initial, conventional (human) reporting. Following DL detection, the RF method allowed better characterization and accurate selection of images of relevant (P2/P1) SB vascular abnormalities for CE reporting without impairing diagnostic accuracy. These findings pave the way for automated SB CE reporting.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102509"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Construction and validation of a machine learning-based prediction model for short-term mortality in critically ill patients with liver cirrhosis","authors":"ZhanJin Wang ,&nbsp;Fu Yuan Li ,&nbsp;JunJie Cai ,&nbsp;ZhangTuo Xue ,&nbsp;Ying Zhou ,&nbsp;Zhan Wang","doi":"10.1016/j.clinre.2024.102507","DOIUrl":"10.1016/j.clinre.2024.102507","url":null,"abstract":"<div><h3>Objective</h3><div>Critically ill patients with liver cirrhosis generally have a poor prognosis due to complications such as multiple organ failure. This study aims to develop a machine learning-based prediction model to forecast short-term mortality in critically ill cirrhotic patients in the intensive care unit (ICU), thereby assisting clinical decision-making for intervention and treatment.</div></div><div><h3>Methods</h3><div>Machine learning models were developed using clinical data from critically ill cirrhotic patients in the MIMIC database, with multicenter validation performed using data from the eICU database and Qinghai University Affiliated Hospital(QUAH). Various machine learning models, including a Stacking ensemble model, were employed, with the SHAP method used to enhance model interpretability.</div></div><div><h3>Results</h3><div>The Stacking ensemble model demonstrated superior predictive performance through internal and external validation, with AUC and AP values surpassing those of individual algorithms. The AUC values were 0.845 in the internal validation set, 0.819 in the eICU external validation, and 0.761 in the QUAH validation set. Additionally, the SHAP method highlighted key prognostic variables such as INR, bilirubin, and urine output. The model was ultimately deployed as a web-based calculator for bedside decision-making.</div></div><div><h3>Conclusion</h3><div>The machine learning model effectively predicts short-term mortality risk in critically ill cirrhotic patients in the ICU, showing strong predictive performance and generalizability. The model's robust interpretability and its deployment as a web-based calculator suggest its potential as a valuable tool for assessing the prognosis of cirrhotic patients.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102507"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A heterogeneous subtype of biliary epithelial senescence may be involved in the pathogenesis of primary biliary cholangitis","authors":"Motoko Sasaki ,&nbsp;Yasunori Sato ,&nbsp;Yasuni Nakanuma","doi":"10.1016/j.clinre.2024.102512","DOIUrl":"10.1016/j.clinre.2024.102512","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Biliary epithelial senescence is involved in the pathogenesis of primary biliary cholangitis (PBC). We hypothesized that a unique subtype of programmed death-ligand 1 (PD-L1)-positive senescent biliary epithelial cells (BECs) may be related to the pathogenesis of PBC in association with cyclic GMP-AMP synthase (cGAS)- stimulator of interferon genes (STING) pathway.</div></div><div><h3>Approach &amp; results</h3><div>The expression of PD-L1, STING and their association with senescent markers p16^INK4a and p21^WAF1/Cip1 were immunohistochemically determined in livers taken from the patients with PBC (<em>n</em> = 87) and 97 diseased and normal control livers. The expression of PD-L1 was significantly increased in a part of senescent BECs with p21^WAF1/Cip1 expression in BECs in the damaged small bile ducts in PBC, compared to control livers (<em>p</em> &lt; 0.01). In contrast, PD-L1 was not expressed in BECs in ductular reactions. The expression of STING was significantly increased in BECs in small bile ducts and ductular reactions in PBC, compared to control livers (<em>p</em> &lt; 0.01). The expression of PD-L1, STING and senescence associated secretory phenotypes (SASPs) including interferon (IFN)-beta was significantly increased in senescent BECs induced by a treatment with serum depletion or glycochenodeoxycholic acid (GCDC) for 4–7 days (<em>p</em> &lt; 0.01) and the increase was significantly suppressed by a knockdown of STING using <em>si</em>RNA (<em>p</em> &lt; 0.01). Induction of cellular senescence induced by a treatment with serum depletion or GCDC was significantly suppressed by a knockdown of STING in BECs. (<em>p</em> &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>A unique subtype of senescent BECs with PD-L1 expression associated with cGAS-STING pathway may be involved in the pathogenesis of PBC.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102512"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"α-L-Fucosidase: A potential biomarker for differential diagnosis of autoimmune hepatitis and drug-induced autoimmune hepatitis","authors":"Yingying Lin ,&nbsp;Xinyu Cui ,&nbsp;Yanyan Li ,&nbsp;Na Zhu ,&nbsp;Xin Li","doi":"10.1016/j.clinre.2024.102517","DOIUrl":"10.1016/j.clinre.2024.102517","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102517"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An ileo-anal pouch doing the twist (with video)","authors":"Flore de Castelbajac,&nbsp;Nicolas Billet,&nbsp;Laurence Monnier-Chollet,&nbsp;Aziz Zaanan,&nbsp;Philippe Seksik,&nbsp;Xavier Dray","doi":"10.1016/j.clinre.2024.102511","DOIUrl":"10.1016/j.clinre.2024.102511","url":null,"abstract":"<div><div>A 37-year-old female patient had a past history of proctocolectomy for Crohn's disease, with ileal J-pouch-anal anastomosis. She was admitted for acute obstructive symptoms. CT scan revealed a 180 twisted ileo-anal anastomosis without signs of severe ischemia (<span><span>Fig. 1</span></span> <strong>and video</strong>), prompting urgent endoscopic treatment. Lower endoscopy showed a complete spiral of the J-pouch which was easily untwisted and passed. Aspiration followed by placement of a multiperforated Faucher tube allowed immediate symptoms relief. The tube was withdrawn 2 days later and the patient was discharged on the same evening. Although the patient was warned for recurrences, no further episode had occurred at last (60 days) follow-up.</div><div>The term \"twisted syndrome\" refers to the twisting of the ileal pouch around its mesenteric axis, creating a volvulus, possibly leading to acute intestinal obstruction. It is often caused by insufficient adhesion of the ileum to the pelvis or to excessive length of the mesentery. If untreated, the twist can disrupt vascularization, leading to pouch ischemia and necrosis. The treatment typically involves emergency endoscopy to untwist the pouch whereas redo pouch-surgery should be discussed to prevent future episodes. Other mechanisms of pouch obstruction include prolapse (also known as “floppy pouch complex”) [2], inflammation, fibrosis, dysplasia or cancer related to inflammatory bowel disease, or rare extraluminal causes.</div><div>This case highlights the importance of combining emergency CT-scan and endoscopy to diagnose various pouch complications, to untwist the pouch in case of a volvulus, and to enhance the strategy for pouch salvage. Three-dimensional CT-based pouchography is also an advanced option to better guide decisions [3].</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102511"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}