World journal of gastroenterology, hepatology and endoscopy最新文献

{"title":"Evaluation of spleen stiffness compared to liver stiffness as non-invasive predictors for esophageal varices in patient with liver cirrhosis (Egyptian study)","authors":"Amal Shawky, Ayman M. Abdel Aziz, Christina Alphonse, Zakaria Mahmoud","doi":"10.15761/ghe.1000192","DOIUrl":"https://doi.org/10.15761/ghe.1000192","url":null,"abstract":"Introduction: Patients with liver cirrhosis have high incidence of oesophageal varices with high morbidity and mortality due to bleeding; active surveillance via upper gastrointestinal endoscopic examination may be unnecessary for patients, therefore, the increasing number of non-invasive predictors of oesophageal varices has gained wide attention. Nevertheless, few Meta analyses have involved predicting oesophageal varices using Liver Stiffness measured using fibroscan. Aim of the work: To compare between predictive values of spleen stiffness and liver stiffness as non-invasive predictors of oesophageal varices in patients with liver cirrhosis. Patients and methods: After taking consent, 61 patients with liver cirrhosis attending outpatient clinic at Theodor Biharz Research Institute were assessed by history taking, clinical examination, Complete blood count, serum alanine aminotransferase, serum aspartate aminotransferase, bilirubin, serum albumin, prothrombin concentration, Alpha fetoprotein, abdominal ultrasound, upper gastrointestinal endoscopy and fibroscan. Data was collected and analysed. Results: This study included 61 patients with liver cirrhosis, 38 of them were males, with mean age 58.28 ± 1.18 years. All patients had post hepatitis C cirrhosis, and 6 of them had history of bilharziasis in addition. Using U/S there were 12 patients (19.67%) with mild ascites, 13 patients (21.31%) with moderate ascites and 7patients (11.48%) with marked ascites 53 patients (86.90%) had enlarged spleen, 8 patients (13.10%) showed average spleen with Splenic longitudinal diameter mean (16.08 ± 2.81) cm by U/S, 47 patients (77%) had shrunken liver, 12 patients (19.7 %) showed average liver, 2 patients (3.30%) had enlarged liver with portal vein diameter mean (13.70 ± 2.26) by U/S. Splenic stiffness mean was (59.66 ± 15.15) KPa & liver stiffness mean was (29.46 ± 12.11) KPa by fibroscan. Conclusion: Spleen stiffness is superior to Liver stiffness in predicting oesophageal varices in patients with liver cirrhosis and combination of spleen stiffness and liver stiffness is better than spleen stiffness and/or liver stiffness alone with sensitivity 95% and specificity 40%. *Correspondence to: Zakaria Mahmoud, Theodor Bilharz Research Institute, Mahad Al Abhas Al Bahari, Warraq Al Arab, El Warraq, Giza Governorate, Egypt, Tel: +20-235-401-019; E-mail: ibrahimshalash@yahoo.com key words: oesophageal varices, liver, fibroscan, ultrasound Received: December 05, 2019; Accepted: December 20, 2019; Published: December 23, 2019 Introduction Acute variceal bleeding is the major cause (70%) of upper gastrointestinal bleeding in cirrhotic patients with first episode mortality rate up to 15–20%, The main predictors of bleeding in clinical practice are: large versus small varices, red wale marks, Child Pugh C versus Child Pugh A-B [1]. The gold standard for the diagnosis of oesophageal varices is EGD which must be performed at the time of cirrhosis diagnosis, in absence of","PeriodicalId":93828,"journal":{"name":"World journal of gastroenterology, hepatology and endoscopy","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83783420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining syndrome and laboratory surveillance with genetic analysis to monitor for emergence of vaccine escape mutants after identification of a rapid rise in rotavirus acute gastroenteritis (RAGE) among children visiting HMOs, Israel, January 2014","authors":"Shulman Lm, Parizade M, K. Z., Anis E, Perry Markovich M, Bassal R, M. E, Grotto I, Kopel E","doi":"10.15761/ghe.1000177","DOIUrl":"https://doi.org/10.15761/ghe.1000177","url":null,"abstract":"","PeriodicalId":93828,"journal":{"name":"World journal of gastroenterology, hepatology and endoscopy","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74027626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early appearance of serum proteins in dog bile","authors":"K. Weigand","doi":"10.15761/ghe.1000188","DOIUrl":"https://doi.org/10.15761/ghe.1000188","url":null,"abstract":"Background and aim: The mechanism of secretion of plasma proteins into bile has been shown for rats but not for higher animals and for humans. Since dogs are a much better model for human beings, the experiments were performed in dogs. Methods: The radioactive precursor amino acid leucine was injected into the dog vein and the increase of free radioactivity and of the protein bound radioactivity in serum and in bile was followed. Results: The secretion time for plasma proteins in the dog was 8-20 minutes. The secretion of radioactive proteins into bile showed a smaller peak after 20 minutes and a steep increase after 45 minutes. Conclusion: The biphasic appearance of radioactive proteins in bile indicates that the majority of bile proteins are derived from serum, a small amount, however, is secreted by hepatocytes directly into the bile. *Correspondence to: Kurt Weigand, Department of Medicine, Stauferklinik, Mutlangen, Teaching Hospital of the University of Ulm, Germany, Tel: 0049717163723; E-mail: k-weigand@t-online.de key words: dog bile, bile proteins, protein secretion Received: September 30, 2019; Accepted: October 14, 2019; Published: October 18, 2019 Introduction It has been demonstrated that the quantitatively most important proteins in bile, albumin and IgA [1], are transferred from plasma into bile [2]. However, it is unknown whether hepatocytes can secrete these proteins also directly into bile. If proteins are exclusively transferred from plasma into bile, radioactive proteins should not be detectible in bile earlier than in plasma after IV injection of a radioactive precursor amino acid. To determine if hepatocytes secrete newly synthesized proteins into bile directly, we studied the secretion of radioactively labeled proteins into bile and into plasma in the dog. The experiments were performed with dogs since it has been shown that for the study of the transport of IgA from plasma to bile dogs are a suitable model for humans in contrast to rats or rabbits [3]. Methods The experiments were performed in two not anesthetized female boxer dogs, weighing 20 (24) kg. Both dogs were equipped with a permanent Thomas cannula. A bile duct catheter was placed through the Thomas cannula and bile was collected at two minutes intervals. Bile flow was kept constant by infusion of 20 μmol taurocholate per minute. After i.v. injection of 250 μCi 1-14-C-leucine (59 mCi/mmol) plasma samples were drawn every 2 minutes. Protein radioactivity was measured according to Mans and Novelli [4]. Protein was measured by the method of Lowry [5]. Bile acids were measured enzymatically [6]. Dogs were kept and treated strictly according to the guidelines of the health department of the city of Berne, Switzerland. Results After injection of 250 μCi 1-14-C-leucine (59 mCi/mmol) it decreased rapidly in serum (Figure 1 and 2). Radioactively labeled proteins in serum were detectable after 10 to 14 minutes and increased exponentially. In bile non protein bound radioacti","PeriodicalId":93828,"journal":{"name":"World journal of gastroenterology, hepatology and endoscopy","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78859424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overexpression of TGF-α and EGFR, a key event in liver carcinogenesis, is induced by hypoxia specifically in hepatocytes","authors":"Ido Zambreg, Benjamin Assouline, C. Housset, E. Schiffer","doi":"10.15761/ghe.1000183","DOIUrl":"https://doi.org/10.15761/ghe.1000183","url":null,"abstract":"Transforming growth factor alpha (TGF-α) is a mitogenic factor for hepatocyte and a ligand of the epithelial growth factor receptor (EGFR). TGF-α promotes liver carcinogenesis. TGF-α is also overexpressed in regenerative nodules of the cirrhotic liver but the mechanism of this expression is poorly known. Because hypoxia is a feature of cirrhotic livers and hypoxia may induce TGF-α and EGFR expressions, the aim of this study was to determine whether the TGF-α/EGFR pathway is affected by hypoxia in liver cells. Cell isolates were prepared from normal Wistar rats. Liver myofibroblasts were obtained in culture by activation of hepatic stellate cells (HSC), and by outgrowth of portal myofibroblasts from bile duct segments. Hepatocytes, Kupffer cells and liver myofibroblasts in culture were submitted to hypoxia for 4-24 hours. Hypoxia was achieved using a catalytic system, which reduces oxygen concentration to less than 1% within 30 minutes. The absence of toxicity was verified by lactate dehydrogenase dosing in cell supernatant. Vascular endothelial growth factor (VEGF) served as a hypoxia-inducible control gene. Gene expression was assessed by real-time reverse transcription polymerase chain reaction (RT-PCR). Under normoxia, the expression of TGF-α was significantly higher in hepatocytes than in non-parenchymal liver cells (~1.7-fold). EGFR transcripts were also more abundant in Hepatocytes than in myofibroblasts (~3-fold) or in Kupffer cells (~22-fold). Hypoxia induced an increase in VEGF mRNA to a similar extent in all cell types. By contrast, hypoxia caused an increase in TGF-α transcripts mainly in Hepatocytes (112 ± 7 vs 32 ± 2 under normoxia), also but to a lesser extent in portal myofibroblasts (35 ± 5 vs 17 ± 4), but not in HSC-derived myofibroblasts nor in Kupffer cells. An increase in EGFR expression was induced by hypoxia also predominantly in Hepatocytes (125 ± 12 vs 44 ± 6), and to a much lesser extent in other cell types. These results demonstrate that hypoxia induces TGFand EGFR overexpression in hepatocytes and, thereby, might act as a promoting event in liver carcinogenesis upon cirrhotic liver. *Correspondence to: Eduardo Schiffer, Department of Anesthesiology, Geneva University Hospitals, Switzerland, Tel: (41) 79 55 32 069, Fax: (41) 22 372 76 90; E-mail: eduardo.schiffer@hcuge.ch key words: TGF-α, EGFR, hypoxia, carcinogenesis Received: July 02, 2019; Accepted: July 16, 2019; Published: July 19, 2019 Introduction TGF-α is a mitogenic factor for hepatocytes and a ligand of the EGF receptor (EGFR). TGF-α can promote liver carcinogenesis, as illustrated in TGF-α transgenic mice, which constantly develop hepatocellular carcinoma [1]. TGFis also overexpressed in regenerative nodules of the cirrhotic liver but the reason for this expression is unknown. Because local hypoxia is a constant feature of cirrhotic livers and hypoxia may induce TGF-α and EGFR expressions, the aim of this study was to determine whether the TGF-α/EGFR pathway ","PeriodicalId":93828,"journal":{"name":"World journal of gastroenterology, hepatology and endoscopy","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85411758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addition of simvastatin to the standard therapy increases survival and is safe in patients with decompensated cirrhosis","authors":"A. Muñoz, Walter Taddey, P. Salgado","doi":"10.15761/ghe.1000189","DOIUrl":"https://doi.org/10.15761/ghe.1000189","url":null,"abstract":"Background: Death by cardiovascular events has reduced by statins due to altering atherosclerosis development. As of 2007, no data on the use of statins in patients with decompensated cirrhosis were available. Aims: To evaluate the simvastatin efficacy and safety in patients with decompensated cirrhosis and cardiovascular factors. Methods: We performed a matched cases-series study. The case group included patients who agreed to add simvastatin to the standard therapy. The series group included patients who did not accept to add this drug to the standard of care. Each group had nine patients. Age, gender, cirrhosis etiology, Child-Pugh class, and Model for End-Stage Liver Disease (MELD) score matched case and series group in a ratio 1:1. Results: The intervals between cirrhosis complications in the case and series groups were 33.6 ± 19.9 months and 9.4 ± 8.2 months, respectively, P = 0.0065 . There was a significant deterioration of the liver function, which was evaluated through Child-Pugh and MELD scores in the series group while it was not affected in the case group. Median survival in the case group was 107 months, whereas it was 20 months in the series group (HR = 0.14; P < 0.0001 ). On the other hand, no patient in the case group experienced simvastatin-related adverse events. Furthermore, no patient in the case or series groups developed cardiovascular events. Conclusions: The addition of simvastatin to the standard therapy in patients with decompensated cirrhosis and cardiovascular risk factors was efficient as it decreased the patient’s mortality. Furthermore, the simvastatin was safe as patients showed good tolerance, considering that they did not develop adverse effects or serious adverse effects.","PeriodicalId":93828,"journal":{"name":"World journal of gastroenterology, hepatology and endoscopy","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85490799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periampullary cancer and cancer in head of pancreas: What is the difference?","authors":"E. Ray-Offor","doi":"10.15761/ghe.1000184","DOIUrl":"https://doi.org/10.15761/ghe.1000184","url":null,"abstract":"The pancreas, a fleshy retroperitoneal organ with mixed exocrine and endocrine function, is not spared of malignant disorders. Malignancies of the pancreas are generally of acinar, ductal or neuroendocrine origin. Majority of these are pancreatic ductal cancer (PDAC) with head of pancreas as the most common site. In the developed world, PDAC is the fourth deadliest malignancy for men and the fifth for women and is predicted to become the second by 2030 [1]. Periampullary cancer is a complex disease of heterogenous origin. This is cancer arising within 2 cm of the papilla of Vater and include pancreatic, ampullary, biliary and duodenal cancers [2]. Duodenal cancer has the highest estimated 5-year survival (49%), followed by ampullary cancer (45%), distal bile duct cancer (27%), and pancreatic cancer (18%) [3]. There is some variance in the clinical presentation of periampullary cancer and cancer in the head of pancreas, but the main distinction lies in their cell biology and histology which affect prognosis and outcome. In all, surgical resection involving a pancreaticoduodenectomy is the main stay for curative treatment.","PeriodicalId":93828,"journal":{"name":"World journal of gastroenterology, hepatology and endoscopy","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76851463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should we always perform bulbar biopsies in celiac disease?","authors":"Aomari A, B. I, Firwana M, Ajana Fz","doi":"10.15761/ghe.1000176","DOIUrl":"https://doi.org/10.15761/ghe.1000176","url":null,"abstract":"","PeriodicalId":93828,"journal":{"name":"World journal of gastroenterology, hepatology and endoscopy","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83219416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantum microRNA network analysis in gastric and esophageal cancers: Xenotropic plant microRNAs cure from cancerous paradox via Helicobacter pylori infection","authors":"Yoichi R Fujii","doi":"10.15761/ghe.1000187","DOIUrl":"https://doi.org/10.15761/ghe.1000187","url":null,"abstract":"","PeriodicalId":93828,"journal":{"name":"World journal of gastroenterology, hepatology and endoscopy","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81838497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical data analysis of patients with drug and dietary supplement induced liver injury in Latvia","authors":"G. Schmidt, I. Tolmane","doi":"10.15761/ghe.1000186","DOIUrl":"https://doi.org/10.15761/ghe.1000186","url":null,"abstract":"Drug-induced liver injury (DILI) is a rare adverse reaction to medications or herbal and dietary supplements (HDS). Several studies have shown an increase in incidence over the last decades with a disproportionate higher increase in cases connected to HDS. Even though DILI is very rare, it is one of the leading causes of acute liver failure (ALF). The pathogenesis is not entirely understood, and specific diagnostic markers are not available yet. This together with the vast number of etiologic agents and variable presentations makes diagnosing DILI challenging. The aim of this study was to determine the demographic and clinical features, the most common causal agents in Latvia, the resulting liver injury patterns, and their relationships to its severity, to improve the understanding of the disease. This analysis was a retrospective study on patients diagnosed with DILI at the hepatology department of the Latvian Infectiology Center from 2014 to 2017. Among the 128 included patients 58.6% were women, and the mean age was 54 years. In 52 cases a single drug was implicated (40.6%), in 28 cases HDS (21.9%), and in 48 cases multiple agents were suspected (37.5%). Antimicrobials were the most frequently implicated class of drugs, and the most frequent HDS were multivitamin and herbal combinations. The proportion of HDS-induced injury increased from 17.9% in 2014 to 25% in 2017; these patients had fewer comorbidities ( p = 0.044), men were younger and had even fewer comorbidities than women. These findings call for more regulation and testing of freely available HDS. The main injury pattern was hepatocellular in 78 cases (66.7%), 19 cases showed a mixed pattern (16.25), and 20 cases were cholestatic (17.1%). The liver injury patterns of several etiologic agents differed from those described as their “signature” patterns found in the literature, questioning their validity. Risk factors for severe liver injury were a high number of comorbidities ( p = 0.041), underlying chronic liver disease ( p = 0.028), hypersensitivity reaction ( p = 0.017), male gender ( p = 0.050), and possibly diabetes mellitus ( p = 0.389).","PeriodicalId":93828,"journal":{"name":"World journal of gastroenterology, hepatology and endoscopy","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82219049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}