Translational gastroenterology and hepatology最新文献

{"title":"The \"obese liver\" and gastrointestinal cancer risk.","authors":"Amedeo Lonardo, Luca Roncucci","doi":"10.21037/tgh.2019.12.07","DOIUrl":"https://doi.org/10.21037/tgh.2019.12.07","url":null,"abstract":"From an evolutionary point of view the accumulation of nutrients under the form of fatty substrates offers a protection during periods of famine (1). While the adipose tissue is the physiological reservoir of energetic fatty substrates, the liver is not (2). The normal liver is indeed virtually devoid of any fat content (3).","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"5 ","pages":"44"},"PeriodicalIF":3.0,"publicationDate":"2020-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/tgh.2019.12.07","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38126159","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 retrospective case-controlled cohort study of inpatient drug induced liver injury: the RIDDLE study.","authors":"Thomas Worland,&nbsp;Ken Lee Chin,&nbsp;Beverley Rodrigues,&nbsp;Amanda Nicoll","doi":"10.21037/tgh.2019.10.15","DOIUrl":"https://doi.org/10.21037/tgh.2019.10.15","url":null,"abstract":"<p><strong>Background: </strong>Identification of risk factors for drug-induced liver injury (DILI) has been hindered by the unpredictable incidence and idiosyncratic nature of DILI. The aim of this study was to identify characteristic host risk factors for DILI.</p><p><strong>Methods: </strong>A retrospective cohort study was performed examining all patients admitted with a diagnosis of DILI over a 5.5-year period. Cases were compared to a control group non-exposed to DILI using propensity score-derived inverse probability weights. Patients with DILI due to alcohol or paracetamol were excluded from analysis.</p><p><strong>Results: </strong>Seventy-two cases of DILI admitted to hospital were identified. Antimicrobials caused 56.9% of cases, with amoxicillin-clavulanate the single most common agent, responsible for 13.9% of cases. DILI cohort median age (50.2±36 years) was significantly younger than controls (65.0±38 years) (P<0.001). Pre-existing chronic liver disease (OR, 3.44; 95% CI, 1.38-8.59; P=0.008), length of stay (P<0.001) and in-hospital death (P=0.009) were more likely to be associated with DILI cases. There was no correlation with sex (OR male, 0.92; 95% CI, 0.50-1.67; P=0.78), presence of comorbid autoimmune disease (OR, 1.44; 95% CI, 0.68-3.05; P=0.35), past drug allergies (OR, 1.71; 95% CI, 0.92-3.16; P=0.09), or atopy (OR, 0.87; 95% CI, 0.42-1.82; P=0.72).</p><p><strong>Conclusions: </strong>Younger age and presence of chronic liver disease were associated with an admission with DILI; however, it remains difficult to predict the population at risk of DILI on clinical grounds and putative risk factors such as female gender, and history of other drug allergies and autoimmunity, were not demonstrated in this study.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"5 ","pages":"33"},"PeriodicalIF":3.0,"publicationDate":"2020-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/tgh.2019.10.15","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38124767","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":"EUS guided gallbladder drainage.","authors":"Hannah Posner,&nbsp;Jessica Widmer","doi":"10.21037/tgh.2019.12.20","DOIUrl":"https://doi.org/10.21037/tgh.2019.12.20","url":null,"abstract":"<p><p>Cholecystectomy is the gold standard treatment for acute cholecystitis, but it may not be appropriate for patients with significant comorbidities. Percutaneous gallbladder drainage (PT-GBD) and endoscopic transpapillary gallbladder drainage (ET-GBD) are alternatives with good technical and clinical success rates, but are limited by technical challenges and the need for definitive therapy. EUS-guided gallbladder drainage (EUS-GBD) is quickly becoming the preferred modality of treatment at expert centers in this cohort of patients due to increased efficacy and minimal adverse events. Technicalities of the procedure, including selection of access site, should be informed by the ultimate needs and anatomy of each patient. With the evolution of new stents and accessories, including a cautery-enhanced lumen apposing metal stent deployment system, success rates and adverse events are favorable. A review of published case series demonstrates an overall clinical success rate of approximately 97% for EUS-GBD. The most common complication is pneumoperitoneum, so the evolution of self-expanding LAMS is promising. EUS-GBD has been successfully described in cases where definitive therapy or a bridge to cholecystectomy is needed. As the procedure's applications continue to evolve, there should be greater discussion about specific details including access site and stent selection.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"5 ","pages":"41"},"PeriodicalIF":3.0,"publicationDate":"2020-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/tgh.2019.12.20","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38126156","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":"Trends and outcomes of fungal infections in hospitalized patients of inflammatory bowel disease: a nationwide analysis.","authors":"Kamran Mushtaq, Zubair Khan, Muhammad Aziz, Zakaria Abdullah Alyousif, Nauman Siddiqui, Muhammad Ali Khan, Ali Nawras","doi":"10.21037/tgh.2019.10.14","DOIUrl":"10.21037/tgh.2019.10.14","url":null,"abstract":"<p><strong>Background: </strong>Immunosuppressive therapy is being increasingly used in the management of inflammatory bowel disease (IBD) which comprises of ulcerative colitis (UC) and Crohn's disease (CD). Patients on immunosuppressive therapy are at increased risk of developing opportunistic fungal infections. We conducted this analysis to describe the epidemiology of opportunistic fungal infections in this cohort.</p><p><strong>Methods: </strong>We analyzed the National Inpatient Sample (NIS) database for all subjects with discharge diagnosis of IBD (UC and Crohn's disease) & Fungal infections (Histoplasmosis, Pneumocystosis, Cryptococcosis, Aspergillosis, Blastomycosis, candidiasis, Coccidioidomycosis) as primary or secondary diagnosis via ICD 9 codes during the period from 2002-2014.</p><p><strong>Results: </strong>In UC, the incidence of all fungal infections was more in age above 50 (except for pneumoconiosis) male gender (except Candidiasis) and in Caucasians. In CD, the incidence was more in age above 50 (except Pneumocystosis, Blastomycosis & Coccidioidomycosis), female gender (except Histoplasmosis, Pneumocystosis & Cryptococcosis) and in Caucasians. Histoplasmosis and Blastomycosis were more prevalent in Midwest, Cryptococcosis and Candidiasis in South, Coccidioidomycosis in west in both UC and CD. Age above 50, south region, HIV, Congestive heart failure, underlying malignancies, diabetes mellitus with complications, chronic pulmonary disease, anemia, rheumatoid arthritis, collagen vascular disease, pulmonary circulation disorders, weight loss were significant predictors of fungal infections in IBD. The yearly trend showed a consistent small rise in incidence, and the mortality dropped till 2006 to peak again in 2008 with a subsequent decline.</p><p><strong>Conclusions: </strong>Our study is the first one to describe the basic demographics features and characteristics of opportunistic fungal infections in hospitalized patients with IBD. The yearly incidence of fungal infections did not show a significant rise. The mortality increased between 2006-2008 and a significant difference remains between IBD patients with and without fungal infections. One explanation of rise in mortality but a consistent incidence could be due to the use of biologics that did not increase but compromised the ability of IBD patients to fight opportunistic fungal infections.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"5 ","pages":"35"},"PeriodicalIF":3.0,"publicationDate":"2020-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063509/pdf/tgh-05-2019.10.14.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38124769","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":"Prevalence of hepatitis B virus among children of HBsAg-positive mothers in Hebron district, Palestine.","authors":"Shefa Al-Amleh","doi":"10.21037/tgh.2019.11.06","DOIUrl":"https://doi.org/10.21037/tgh.2019.11.06","url":null,"abstract":"<p><strong>Background: </strong>Hepatitis B virus (HBV) is the major causative agent of chronic hepatitis causing liver cirrhosis and liver cancer. However, its transmission is likely to be minimized through vaccination. The study aims to determine the prevalence of hepatitis B among children born to hepatitis B surface antigen (HBsAg) positive women in Hebron district/Palestine.</p><p><strong>Methods: </strong>The overall number of women enrolled in this study was 125, all children of these mothers [386] were tested, out of which 42 were HBsAg-positive. The recruited participants were asked about their socio-demographic details including age, place of residence, occupation, level of education, as well as questions related to expected route of exposure to the virus and the type of vaccination they provided to their newborns. The results were explained based on the descriptive statistics that included frequencies and percentages.</p><p><strong>Results: </strong>The results showed that the prevalence of HBsAg among children born to HBsAg-positive mothers was 10.9% (42 positive children out of 386). Moreover, (33.6%) of the HBsAg-positive women had family history of hepatitis B infection. Transmission of hepatitis B among children of HBsAg-positive mothers was found in the low socio-economic class in the rural areas.</p><p><strong>Conclusions: </strong>The study concluded that the prevalence of HBsAg among children born to HBsAg-positive mothers was high among the families living in villages with low to moderate income.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"5 ","pages":"34"},"PeriodicalIF":3.0,"publicationDate":"2020-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/tgh.2019.11.06","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38124768","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":"Associated liver partition and portal vein ligation for staged hepatectomy: a review.","authors":"Kai Siang Chan, Jee Keem Low, Vishal G Shelat","doi":"10.21037/tgh.2019.12.01","DOIUrl":"10.21037/tgh.2019.12.01","url":null,"abstract":"<p><p>Outcomes of liver resection have improved with advances in surgical techniques, improvements in critical care and expansion of resectability criteria. However, morbidity and mortality following liver resection continue to plague surgeons. Post-hepatectomy liver failure (PHLF) due to inadequate future liver remnant (FLR) is an important cause of morbidity and mortality following liver resection. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel two-staged procedure described in 2012, which aims to induce rapid hypertrophy of the FLR unlike conventional two-stage hepatectomy, which require a longer time for FLR hypertrophy. Careful patient selection and modifications in surgical technique has improved morbidity and mortality rates in ALPPS. Colorectal liver metastases (CRLM) confers the best outcomes post-ALPPS. Patients <60 years old and low-grade fibrosis with underlying hepatocellular carcinoma (HCC) are also eligible for ALPPS. Evidence for other types of cancers is less promising. Current studies, though limited, demonstrate that ALPPS has comparable oncological outcomes with conventional two-stage hepatectomy. Modifications such as partial-ALPPS and mini-ALPPS have shown improved morbidity and mortality compared to classic ALPPS. ALPPS may be superior to conventional two-stage hepatectomy in carefully selected groups of patients and has a promising outlook in liver surgery.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"5 ","pages":"37"},"PeriodicalIF":3.0,"publicationDate":"2020-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063517/pdf/tgh-05-2019.12.01.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38125212","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":"Chromoendoscopy: role in modern endoscopic imaging.","authors":"Rajvinder Singh,&nbsp;Keng Hoong Chiam,&nbsp;Florencia Leiria,&nbsp;Leonardo Zorron Cheng Tao Pu,&nbsp;Kun Cheong Choi,&nbsp;Mariana Militz","doi":"10.21037/tgh.2019.12.06","DOIUrl":"https://doi.org/10.21037/tgh.2019.12.06","url":null,"abstract":"<p><p>Detection of early gastrointestinal tract malignancy can be challenging on white light endoscopy especially as lesions can be subtle and inconspicuous. With the advent of electronic chromoendoscopy technologies, lesions which have already been detected can be quickly and \"conveniently\" characterised. This review will discuss some of the indications and modern applications of chromoendoscopy in various conditions including Barrett's oesophagus, oesophageal squamous cell carcinoma, early gastric cancer, inflammatory bowel disease and neoplastic colonic lesions. In carefully selected situations, chromoendoscopy could still be a useful adjunct to white light endoscopy in day-to-day clinical practice.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"5 ","pages":"39"},"PeriodicalIF":3.0,"publicationDate":"2020-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/tgh.2019.12.06","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38126154","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":"New technologies for indeterminate biliary strictures.","authors":"R. Oleas, J. Alcívar-Vásquez, C. Robles-Medranda","doi":"10.21037/TGH.2020.03.05","DOIUrl":"https://doi.org/10.21037/TGH.2020.03.05","url":null,"abstract":"An early and accurate diagnosis of biliary strictures yields optimal patient outcomes; however, endoscopic retrograde cholangiopancreatography (ERCP) with cytobrush/biopsy forceps has low sensitivity with a high number of false negatives. Various attempts to improve the accuracy of diagnosing indeterminate biliary strictures though ERCP-guided specimen acquisition have been proposed, such as with the use of fluorescence in situ hybridization, an endoscopic scraper, and the wire-grasping method, with modest to large improvements in sensitivity. Direct visualization of the biliary tree during peroral cholangioscopy has shown high sensitivity and specificity for the differentiation of neoplastic and non-neoplastic biliary lesions; however, there is no consensus on the visual characteristics of neoplastic lesions and moderate agreement between observers. Peroral cholangioscopy system (POCS)-guided specimen acquisition using forceps has shown inferior sensitivity compared to the visual characteristics; however, the specificity remains high. Optimal specimen processing with onsite evaluations and touch imprint cytology have been shown to improve the sensitivity and accurately diagnose nearly 90% of patients. In vivo evaluations of biliary strictures with probe-based confocal laser endomicroscopy have demonstrated high sensitivity with modest specificity for malignant biliary strictures. Optical computed tomography described reproductible criteria for malignancy detection in biliary strictures, increasing the sensitivity during ERCP evaluations. Differentiating benign causes from malignant causes of biliary strictures is a challenging task in clinical practice, with various concerns that still need to be addressed. Efforts should be made to define each diagnostic method's role in the evaluation of indeterminate biliary strictures.","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"14 1","pages":"22"},"PeriodicalIF":3.0,"publicationDate":"2020-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76698347","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":"Management of severe acute pancreatitis in 2019.","authors":"Eddie L. Copelin, J. Widmer","doi":"10.21037/TGH-2019-IE-03","DOIUrl":"https://doi.org/10.21037/TGH-2019-IE-03","url":null,"abstract":"Pancreatic fluid collections (PFCs) are frequent complications in severe acute pancreatitis that are the result of damage to the pancreas to include but not limited to trauma, surgery, autoimmune diseases, alcohol abuse, infections, medications, gallstones, metabolic disorders, and premalignant or malignant conditions. The majority of these collections resolve spontaneously; however, if the collection is infected or causes symptoms to include abdominal pain, nausea, vomiting, diarrhea, fevers, and tachycardia, drainage is indicated. Drainage of PFCs can be accomplished surgically, percutaneously, or endoscopically and should be approached in a multidisciplinary fashion for best overall patient care and outcomes. Before the introduction of endoscopic procedures, surgical and percutaneous drainage was the preferred modality. Today a minimally-invasive \"step-up\" approach is generally accepted depending upon the specific characteristics of the PFC and clinical presentation. Endoscopic ultrasound-guided PFC drainage is favored due to high success rates, shorter hospital stays, and lower cost. Direct debridement of walled-off pancreatitis can now be performed endoscopically with higher success rates with larger caliber fully covered metal stents. At large, the field of endoscopic techniques has evolved, and more specifically, the management of PFCs continues to evolve with increasing experience and with the advent of new stents and accessories, leading to increased efficacy with less adverse events.","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"32 1","pages":"16"},"PeriodicalIF":3.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88418787","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":"Electronic chromo-endoscopy: technical details and a clinical perspective.","authors":"P. Pal, A. Singh, N. Kanuri, R. Banerjee","doi":"10.21037/TGH-19-373","DOIUrl":"https://doi.org/10.21037/TGH-19-373","url":null,"abstract":"Precise endoscopic assessment is necessary to detect neoplastic changes in an early stage. Electronic or virtual chromo-endoscopy (ECE) is an alternative to conventional dye-based chromo-endoscopy which markedly improves capillary pattern and hence can detect micro-vessel morphological changes of early neoplasia to target biopsies and aid in diagnosis. The clinical significance increased after the advent of endoscopic treatment modalities like ESD/EMR which requires precise delineation of extent and depth of lesion. Most of the studies have used narrow-band imaging (NBI) (Olympus Medical Systems Tokyo, Japan), although data from i-SCAN (PENTAX Endoscopy, Tokyo, Japan) and flexible spectral imaging color enhancement (FICE) (Fujinon, Fujifilm Medical Co, Saitama, Japan) are emerging. Electronic chromo-endoscopy is convenient compared to dye-based chromo-endoscopy in the sense that it is available at the push of a button in endoscope and reduces procedure time substantially with comparable efficacy. Scope of this review is to discuss available electronic chromo-endoscopy modalities and their role in the diagnosis, surveillance, and management of early GI neoplasia.","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"27 1","pages":"6"},"PeriodicalIF":3.0,"publicationDate":"2020-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72889641","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}