Hasil untuk "Diseases of the digestive system. Gastroenterology"

Thamer Abdulla Mohammed, Munaf H. Zalzala

Abstract Bile acids (BAs) synthesized from cholesterol in the liver play a crucial role in the absorption of fat-soluble vitamins and cholesterol in the small intestine. Hepatocytes possess basolateral uptake transporters, such as Na + /taurocholate cotransporting polypeptide (NTCP) and organic anion transporting polypeptide (OATPs), which facilitate the uptake of bile salts from portal blood. Efflux transporters, including bile salt export pump (BSEP) and multidrug resistance-associated protein 2 (MRP2), mediate the canalicular excretion of biliary constituents, a rate-limiting step in bile secretion. This review explores the roles of hepatobiliary transporters and their regulatory nuclear receptors in BA homeostasis, focusing on their clinical and therapeutic implications. Alternative basolateral efflux systems (MRP3, MRP1, MRP4, and OSTα-OSTβ) and hepatic canalicular export systems (BSEP, MRP2, MDR3, and MDR1) are discussed in the context of bile formation and drug transport. Gallstone pathogenesis is linked to canalicular transporters for phosphatidylcholine (MDR3), cholesterol (ABCG5/8), and BAs (BSEP), as well as their regulating nuclear receptors. Understanding the complex interplay between hepatobiliary transporters and nuclear receptors in BA homeostasis is essential for developing novel therapeutic strategies for cholestatic liver diseases and gallstone formation.

K. L. Raikhelson, A. O. Bueverov, E. A. Kondrashina et al.

Aim: to analyse the principles of diagnosis and treatment of intrahepatic cholestasis in chronic liver diseases, to present data on the effectiveness of ademetionine in the treatment of chronic liver diseases with intrahepatic cholestasis and the materials of the Expert Meeting held in 2023.   Key points. During the Expert Meeting, the problems of diagnostics and treatment of intrahepatic cholestasis in various chronic liver diseases were discussed, the effectiveness of ademetionine was clarified, and optimal regimens for its administration were determined. The relevance of the existing algorithm for diagnosing cholestasis in real clinical practice was assessed. The effectiveness of ademetionine in the treatment of various liver diseases occurring with intrahepatic cholestasis (cholestatic forms of drug-induced liver damage, alcoholic liver disease, non-alcoholic liver disease, primary biliary cholangitis) was demonstrated, manifested by a decrease in clinical and laboratory signs of cholestasis. The anticholestatic mechanisms of ademetionine action were clarified, which consist in normalizing the fluidity of hepatocyte membranes, regulating the activity of Nrf2, a key transcription factor, suppressing lipid peroxidation and the resulting damage to hepatocytes and cholangiocytes. Optimal regimens for prescribing ademetionine for various clinical situations were considered.   Conclusions. Ademetionine is an effective drug that, due to its pleiotropic action and favourable safety profile, can be used in various chronic liver diseases accompanied by cholestasis, including as a part of the complex therapy.

Sital Shah, Maria Fernanda Guerra Veloz, Kosh Agarwal et al.

Gabrielle Ritaccio, A. Sidney Barritt IV, Jamie L. Conklin et al.

Abstract Background Treatment choices in hepatocellular carcinoma (HCC) involve consideration of tradeoffs between the benefits, toxicities, inconvenience, and costs. Stated preference elicitation methods have been used in the medical field to help evaluate complex treatment decision-making. The aim of this study was to conduct a scoping review to assess the evidence base for the use of preference elicitation tools or willingness to pay/willingness to accept methods for HCC treatment decision-making from both the patient and provider perspective. Methods We performed a scoping review to identify abstracts or manuscripts focused on the role preference elicitation tools or willingness to pay/willingness to accept methods for HCC treatment options among patients, caregivers, and/or providers. Two researchers independently screened full-text references and resolved conflicts through discussion. We summarized key findings, including the type and setting of preference-elicitation tools used for HCC treatment decisions. Results Ten published abstracts or manuscripts evaluated the role of preference elicitation tools for HCC treatments. The studies revealed several attributes that are considered by patients and providers making HCC treatment decisions. Many of the studies reviewed suggested that while patients place the most value on extending their overall survival, they are willing to forgo overall survival to avoid risks of treatments and maintain quality of life. Studies of physicians and surgeons found that provider preferences are dependent on patient characteristics, provider specialty, and surgeon or hospital-related factors. Conclusion This scoping review explored both patient and physician preferences towards treatment modalities in all stages of HCC. The studies revealed a large scope of potential attributes that may be important to patients and that many patients are willing to forgo survival to maintain quality of life. Further research should explore both preference elicitation of currently available and emerging therapies for HCC as well as the use of this data to develop patient-facing tools to assist in navigating treatment options.

Mauricio Sepulveda Copete, Nelson Enrique Rojas Rojas, Emiro Fernando Herrera Lara et al.

Objetivos: en Colombia se ha venido implementando la sedación por médicos no anestesiólogos para procedimientos endoscópicos fuera del quirófano. Se describió la experiencia en la unidad de gastroenterología de una clínica de alto nivel de atención en Cali, Colombia. Materiales y métodos: estudio observacional, de tipo cohorte analítica para describir la frecuencia y el tipo de eventos adversos asociados a los procedimientos de sedación por médicos generales, y evaluar los factores asociados a su ocurrencia en pacientes que acudieron a la unidad de endoscopia de la Fundación Valle del Lili para la realización de estudios endoscópicos bajo sedación intravenosa que, por ser de bajo riesgo, fue aplicada por un médico no anestesiólogo entre noviembre de 2018 y junio de 2019. Se realizó análisis descriptivo, se calcularon mediana y rango intercuartílico para las variables numéricas, y frecuencias para las variables cualitativas. Resultados: se incluyeron 1506 participantes, 59,4 % ASA I y 40,6 % ASA II. En promedio, la dosis inicial de propofol fue de 60 mg y la dosis total, de 140 mg. Se registraron eventos adversos no serios en 46 pacientes (3,05 %) y el más común fue la desaturación transitoria (80,4 %). Ningún paciente presentó eventos adversos serios. El puntaje inicial promedio de la escala de Aldrete fue 8, mientras que al alta el puntaje promedio fue de 10. Conclusiones: la sedación para procedimientos endoscópicos dada por médicos no anestesiólogos es segura, siempre y cuando sea realizado por personal entrenado que realice una adecuada valoración de los antecedentes (cardiovasculares, gastrointestinales y neurológicos) y factores de riesgo del paciente dentro del marco de los lineamientos institucionales vigentes.

Cori L. Ofstead, Krystina M. Hopkins, John E. Eiland

Hiroyuki Suzuki, Hideki Iwamoto, Ken Yamamoto et al.

Background and Aims: Hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) progresses with a highly multicentric occurrence (MO) even after radical hepatectomy. Despite several efforts to clarify the pathogenesis of MO, the underlying molecular mechanism remains elusive. The aim of this study was to evaluate alterations in DNA methylation in noncancerous liver tissues in the MO of HCC. Methods: A total of 203 patients with HCV-related HCC who underwent radical hepatectomy at our hospital between January 2008 and January 2012 were recruited. We defined a group of nonearly recurrence of HCC (NR) for ≥3 years after radical hepatectomy and a group of early recurrence of HCC (ER) with MO within 2 years after radical hepatectomy. Results: Three patients each were selected in the NR and ER groups in the first set, and 13 patients in the NR group and 17 patients in the ER group were selected in the second set. Genome-wide DNA methylation profiles were obtained from noncancerous liver tissues using a Human Methylation 450 BeadChip, and the differences between the groups were analyzed for each set. After excluding single nucleotide polymorphism-associated methylation sites and low-call sites, 401,282 sites were assessed using a generalized linear model without any adjustments. Nine gene regions, APBB1P, CLSTN3, DLG5, IRX5, OAS1, SOX12, SNX19, TENM2, and TRIM54, exhibiting a significant difference (P < .001) in DNA methylation levels were identified in the common direction between the 2 analysis sets. Conclusion: Alterations in DNA methylation of 9 genes in noncancerous liver tissues appear to be involved in MO after radical hepatectomy for HCV-related HCC.

V. T. Ivashkin, I. V. Maev, Yu. A. Shelygin et al.

Aim. Current clinical recommendations accentuate current methods for the diagnosis and treatment of irritable bowel syndrome (IBS).Key points. IBS is a functional bowel disorder manifested with recurrent, at least weekly, abdominal pain with the following attributes (any two leastwise): link to defecation, its frequency or stool shape. The symptoms are expected to persist for at minimum three months in a total six-month follow-up. Similar to other functional gastrointestinal (GI) disorders, IBS can be diagnosed basing on the patient symptoms compliance with Rome IV criteria, provided the absence of potentially symptom-causative organic GI diseases. Due to challenging differential diagnosis, IBS can be appropriately established per exclusionem, with pre-examination as follows: general and biochemical blood tests; tissue transglutaminase IgA/IgG antibody tests; thyroid hormones test; faecal occult blood test; hydrogen glucose/ lactulose breath test for bacterial overgrowth; stool test for enteric bacterial pathogens and Clostridium difficile A/B toxins; stool calprotectin test; abdominal ultrasound; OGDS, with biopsy as appropriate; colonoscopy with biopsy. The IBS sequence is typically wavelike, with alternating remissions and exacerbations often triggered by psychoemotional stress. Treatment of IBS patients includes dietary and lifestyle adjustments, various-class drug agents prescription and psychotherapeutic measures.Conclusion. Adherence to clinical recommendations can facilitate timely diagnosis and improve medical aid quality in patients with different clinical IBS variants.

Tiffany Nguyen-Vu, BA, Carmel Malvar, BA, Yung Ka Chin, MD et al.

José María Remes-Troche, Enrique Coss-Adame, Miguel Ángel Valdovinos-Díaz et al.

Dysbiosis, a loss of balance between resident bacterial communities and their host, is associated with multiple diseases, including inflammatory bowel diseases (nonspecific chronic ulcerative colitis and Crohn’s disease), and digestive functional disorders. Probiotics, prebiotics, synbiotic organisms and, more recently, pharmabiotics, have been shown to modulate the human microbiota. In this review, we provide an overview of the key concepts relating to probiotics, prebiotics, synbiotic organisms, and pharmabiotics, with a focus on available clinical evidence regarding the specific use of a unique pharmabiotic, the strain Lactobacillus acidophilus LB ( Lactobacillus boucardii ), for the management of gastrointestinal disorders. Since it does not contain living organisms, the administration of L. acidophilus LB is effective and safe as an adjuvant in the treatment of acute diarrhea, chronic diarrhea, and antibiotic-associated diarrhea, even in the presence of immunosuppression.

Hao Chi Zhang, Monica Tamil, Keshav Kukreja et al.

Concomitant malignant gastric outlet obstruction and biliary obstruction may occur in patients with advanced cancers affecting these anatomical regions. This scenario presents a unique challenge to the endoscopist in selecting an optimal management approach. We sought to determine the efficacy and safety of endoscopic techniques for treating simultaneous gastric outlet and biliary obstruction (GOBO) with endoscopic ultrasound (EUS) guidance for biliary drainage. An extensive literature search for peer-reviewed published cases yielded 6 unique case series that either focused on or included the use of EUS-guided biliary drainage (EUS-BD) with simultaneous gastroduodenal stenting. In our composite analysis, a total of 51 patients underwent simultaneous biliary drainage through EUS, with an overall reported technical success rate of 100% for both duodenal stenting and biliary drainage. EUS-guided choledochoduodenostomy or EUS-guided hepaticogastrostomy was employed as the initial technique. In 34 cases in which clinical success was ascribed, 100% derived clinical benefit. The common adverse effects of double stenting included cholangitis, stent migration, bleeding, food impaction, and pancreatitis. We conclude that simultaneous double stenting with EUS-BD and gastroduodenal stenting for GOBO is associated with high success rates. It is a feasible and practical alternative to percutaneous biliary drainage or surgery for palliation in patients with associated advanced malignancies.

L.G. Nelissen, I.J.N. Koppen, F.R. Follett et al.

Introduction and aims: The prevalence of functional gastrointestinal disorders (FGIDs) in Argentinean children and adolescents has not yet been studied. Our aim was to determine the prevalence of FGIDs among children and adolescents in Argentina using the Rome III diagnostic criteria. Materials and methods: A total of 483 children, 12-18 years of age, from 3 private schools and 3 public schools, were included in the study. Each child completed the Spanish version of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III), which is an age-appropriate and previously validated instrument for diagnosing FGIDs according to the Rome III criteria. Sociodemographic data (age, sex, type of school, family structure and size, family history of gastrointestinal disorders) and data on stressful life events were also obtained. Results: The mean age of the population studied was 15 years (standard deviation 1.74, range 12-18, 52.8% boys). Of the respondents, 229 children (47.4%) attended private school and 254 children (52.6%) attended public school. In total, 82 children (17.0%) were diagnosed with an FGID, according to the Rome III criteria. Abdominal migraine (16.4%) was the most common diagnosis, followed by irritable bowel syndrome (7.0%), functional constipation (6.4%), and aerophagia (5.6%). Girls suffered significantly more from FGIDs than boys (22.4 vs. 12.2%, P = .0032). Children attending private school had significantly more FGIDs than children in public schools (20.5 vs. 13.8%, P = .0499). Conclusion: FGIDs are common among Argentinean children and adolescents. Resumen: Introducción y objetivos: La prevalencia de los trastornos funcionales digestivos (TFD) en niños y adolescentes argentinos no ha sido estudiada aun. El objetivo fue determinar la prevalencia de los TFD entre niños y adolescentes argentinos utilizando los criterios de diagnóstico de Roma III. Materiales y métodos: Se incluyó a un total de 483 niños de entre 12 y 18 años de edad, reclutados de 3 escuelas privadas y 3 escuelas públicas. Cada niño completó el Cuestionario Pediátrico de Síntomas Gastrointestinales-Roma III en su versión en español, el cual es un instrumento adecuado para esa edad y que ha sido previamente validado para diagnosticar los TFD de acuerdo a los criterios de Roma III. También se obtuvieron datos sociodemográficos (edad, sexo, tipo de escuela, estructura y tamaño de la familia, historia familiar de enfermedades gastrointestinales) y datos sobre eventos estresantes de la vida. Resultados: La edad promedio de la población estudiada fue de 15 años de edad (desviación estándar de 1.74, rango de 12-18, el 52.8% varones). Doscientos veintinueve de los 483 niños (47.4%) fueron estudiantes de escuelas privadas y 254 (52.6%) de escuelas públicas. En total, 82 niños fueron diagnosticados con un TFD de acuerdo a los criterios de Roma III. La migraña abdominal fue el diagnóstico más común (16.4%), seguido del síndrome de intestino irritable (7%), estreñimiento funcional (6.4%), y aerofagia (5.6%). Los TFD fueron significativamente más frecuentes en niñas que en niños (22.4 vs. 12.2%, p = 0.0032). Con relación al tipo de escuela, el porcentaje de los TFD fue mayor en los niños de escuelas privadas que en los de escuelas públicas (20.5 vs. 13.8%, p = 0.0499), con diferencia estadísticamente significativa. Conclusión: Los TFD son comunes entre los niños y adolescentes argentinos. Keywords: Adolescents, Argentina, Children, FGIDs, Prevalence, Palabras clave: Adolescentes, Argentina, Niños, TFD, Prevalencia

Ji Yong Ahn

Hideyuki Tamai, Yoshiyuki Ida, Akira Kawashima et al.

Background/AimsThe present study aimed to evaluate the safety and efficacy of simeprevir-based triple therapy with reduced doses of pegylated interferon (PEG-IFN) and ribavirin for interferon (IFN) ineligible patients, such as elderly and/or cirrhotic patients, and to elucidate the factors contributing to a sustained virologic response (SVR).Methods : One hundred IFN ineligible patients infected with genotype 1b hepatitis C virus (HCV) were treated. Simeprevir (100 mg) was given orally together with reduced doses of PEG-IFN-α 2a (90 μg), and ribavirin (200 mg less than the recommended dose).Results : The patients’ median age was 70 years, and 70 patients were cirrhotic. Three patients (3%) discontinued treatment due to adverse events. The SVR rate was 64%. Factors that significantly contributed to the SVR included the γ-glutamyl transferase and α-fetoprotein levels, interleukin-28B (IL28B) polymorphism status, and the level and reduction of HCV RNA at weeks 2 and 4. The multivariate analysis showed that the IL28B polymorphism status was the only independent factor that predicted the SVR, with a positive predictive value of 77%.Conclusion : sSimeprevir-based triple therapy with reduced doses of PEG-IFN and ribavirin was safe and effective for IFN ineligible patients infected with genotype 1b HCV. IL28B polymorphism status was a useful predictor of the SVR.

Vi Nguyen, Jiawei Li, Jaslyn Gan et al.

Background. The incidence of nonalcoholic fatty liver disease (NAFLD) continues to parallel the rise in obesity rates. Endobariatric devices such as the intragastric balloon (IGB) may provide an alternative treatment option. Methods. Outcomes following IGB treatment in 135 patients with obesity and NAFLD (mean baseline weight 117.9 kg; BMI 41.7 kg/m2; HOMA-IR 3.6) were retrospectively examined. Clinical, anthropometric, and biochemical changes were analysed at six months and after consecutive treatment with two and three serial IGBs. Results. After six months, significant changes were seen with weight and BMI (mean reductions of 11.3 kg and 4.1 kg/m2, resp., p<0.01 for both). Significant improvements were also seen with ALT, GGT, and HOMA-IR, with all changes corresponding with weight loss. Forty-eight patients received two IGBs, and 20 were treated with three serial IGBs. The greatest amount of total weight loss was observed after the first 6 months (mean weight lost 7.4 kg, versus 3.6 kg and 1.9 kg with two and three IGBs, resp.). Conclusions. IGB therapy is an effective, alternative nonsurgical means for weight loss in the management of obesity and NAFLD over the short term, with greatest outcomes observed after six months. Improvements in insulin resistance and hepatic transaminases correlated with weight change.

Tiara Teders

Yi-Qun Zhang, Li-Qing Yao, Mei-Dong Xu et al.

Abstract Background/Aims: To improve the understanding of esophageal leakage after peroral endoscopic myotomy (POEM). Materials and Methods: From August 2010 to April 2013, patients with postoperative esophageal leakage were identified from the database of cases with achalasia who had undergone POEM and their medical records were reviewed. Results: Three patients (0.4%, 3/679) developed esophageal leakage after POEM. All three patients had non-severe chest or upper abdominal pain within 3 days after the procedure. Infections were observed, and computed tomography scans showed pleural effusion in all three patients. Pneumonia occurred in two of the three patients. Esophageal leakage was confirmed by gastroscopy. Incision rupture due to an early breaking-off of the clips at the tunnel entry was revealed in two cases. When detected, the entry was immediately closed using metal clips. A thoracic drain was placed in all cases. An enteric feeding tube was also placed to help correct nutrition deficiencies. Successful leakage closure was achieved in all three cases and no surgical intervention was needed. Conclusion: Early diagnosis and treatment can improve the status of patients with esophageal leakage after POEM and can shorten the recovery time.

F. Bossali, C. Ahoui-Apendi, G. Ndziessi et al.

G. Targher, C. Byrne