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Screening for nonalcoholic fatty liver disease-when,who and how?

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World Journal of Gastroenterology 2021年第35期27卷 5803-5821页

作者： Christoph G Dietrich Monika Rau andreas geier Department of Internal Medicine Bethlehem Health CenterStolberg 52222Germany Department of Internal Medicine II University Hospital WürzburgWürzburg 97080Germany Department of Medicine II University Hospital WürzburgWürzburg 97080Germany

Nonalcoholic fatty liver disease(NAFLD)is becoming a frequent liver disease,especially in patients with metabolic syndrome and especially in Western *** of NAFLD comprise progressive fibrosis,cirrhosis and hepatocellular *** also represents an independent risk factor for cardiovascular disease,extrahepatic neoplasia and other organ damage,such as renal *** the epidemiological importance of the disease,new developments in specific treatment of the disease and the wide availability of noninvasive techniques in estimating steatosis and fibrosis,NAFLD should be subject to screening programs,at least in countries with a high prevalence of the *** review discusses prerequisites for screening,cost-effectiveness,current guideline recommendations,suitability of techniques for screening and propositions for the following questions:Who should be screened?Who should perform screening?How should screening be performed?It is time for a screening program in patients at risk for NAFLD.

关键词： Screening Nonalcoholic fatty liver disease Diabetes Liver fibrosis Cirrhosis

Molecular changes in hepatic metabolism and transport incirrhosis and their functional importance

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World Journal of Gastroenterology 2016年第1期22卷 72-88页

作者： Christoph G Dietrich Oliver Götze andreas geier Bethlehem Center of Health Department of Internal MedicineD-52222 Stolberg(Rhineland)Germany University of Würzburg Division of HepatologyDepartment of Internal Medicine IID-97080 WürzburgGermany

Liver cirrhosis is the common endpoint of many hepatic diseases and represents a relevant risk for liver failure and hepatocellular *** progress of liver fibrosis and cirrhosis is accompanied by deteriorating liver *** review summarizes the regulatory and functional changes in phase Ⅰ and phaseⅡmetabolic enzymes as well as transport proteins and provides an overview regarding lipid and glucose metabolism in cirrhotic ***,phase Ⅰ enzymes are generally down regulated transcriptionally,while phaseⅡenzymes are mostly preserved transcriptionally but are reduced in their *** proteins are regulated in a specific way that resembles the molecular changes observed in obstructive *** and glucose metabolism are characterized by insulin resistance and catabolism,leading to the disturbance of energy expenditure and *** non-invasive tests,especially breath tests,for components of liver metabolism are *** heterogeneity and complexity of changes in hepatic metabolism complicate the assessment of liver function in individual ***,studies in humans are rare,and species differences preclude the transferability of data from rodents to *** clinical practice,some established global scores or criteria form the basis for the functional evaluation of patients with liver cirrhosis,but difficult treatment decisions such as selection for transplantation or resection require further research regarding the application of existing non-invasive tests and the development of more specific tests.

关键词： liver cirrhosis drug metabolism transport breath tests lipid metabolism glucose metabolism

Side effects of budesonide in liver cirrhosis due to chronic autoimmune hepatitis: Influence of hepatic metabolism versus portosystemic shunts on a patient complicated with HCC

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World Journal of Gastroenterology 2003年第12期9卷 2681-2685页

作者： andreas geier Carsten Gartung Christoph G.Dietrich Hermann E.Wasmuth Patrick Reinartz Siegfried Matern Department of Intemal Medicine Ⅲ University of Technology (RWTH) AachenAachenGermany Nuclear Medicine University of Technology (RWTH) AachenAachenGermany Department of Internal Medicine Ⅲ University of Technology (RWTH) AachenAachenGermany

AIM: To investigate the systemic availability of budesonide in a patient with Child A drrhosis due to autoimmune hepatitis (AIH) and primary hepatocellular carcinoma, who developed serious side ***: Serum levels of budesonide, 6β-OH-budesonide and 16α-OH-prednisolon were measured by HPLC/MS/MS;portosysternic shunt-index (SI) was determined by 99mTc nuclear imaging. All values were compared with a matched control patient without side ***: Serum levels of budesonide were 13-fold increased in the index patient. The ratio between serum levels of the metabolites 6β-OH-budesonide and 16α-OH-prednisolone, respectively, and serum levels of budesonide was diminished (1.0 vs. 4.0 for 6β-OH-budesonide, 4.2 vs.10.7 for 16α-OH-prednisolone). Both patients had portosystemic SI (5.7% and 3.1%) within the range of healthy ***: Serum levels of budesonide vary up to 13-fold in AIH patients with Child A cirrhosis in the absence of relevant portosysternic shunting. Reduced hepatic metabolism, as indicated by reduced metabolite-to-drug ratio, rather than portosystemic shunting may explain systemic side effects of this drug in cirrhosis.

关键词：布地缩松副作用肝硬化慢性自身免疫性肝炎门静脉吻合术丙型肝炎合并症

Origin of and therapeutic approach to cardiac syndrome X:Results of the proton pump inhibitor therapy for angina-like lingering pain trial (PITFALL trial)

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World Journal of Gastroenterology 2008年第42期14卷 6506-6512页

作者： Christoph G Dietrich Susanne Laupichler Sven Stanzel Ron Winograd Oliver Al-Taie Carsten Gartung andreas geier Department of Gastroenterology Aachen University Aachen 52074 Germany Department of Gastroenterology Klinikum Aschaffenburg Aschaffenburg 63739 Germany Department of Medical Statistics AachenUniversity Aachen 52074 Germany Department of Gastroenterology University Hospital Zurich Zurich 8091 Switzerland

AIM: To investigate the frequency of gastroen-terological diseases in the etiology and the efficacy of proton pump inhibitors (PPIs) in the treatment of cardiac syndrome X (CSX) as a subform of non-cardiac chest pain (NCCP). METHODS: We investigated 114 patients with CSX using symptom questionnaires. A subgroup of these patients were investigated regarding upper gastrointestinal disorders (GIs) and treated with PPI. Patients not willing to participate in investigation and treatment served as control group. RESULTS: Thirty-six patients denied any residual symptoms and were not further evaluated. After informed consent in 27 of the remaining 78 patients, we determined the prevalence of disorders of the upper GI tract and quantifi ed the effect of treatment with pantoprazole. We found a high prevalence of gastroenterological pathologies (26/27 patients, 97%)with gastritis, gastroesophageal reflux disease (GERD) and acid reflux as the most common associated disorders. If treated according to the study protocol, these patients showed a significant improvement in the symptom score. Patients treated by primary care physicians, not according to the study protocol had a minor response to treatment (n = 19, -43%), while patients not treated at all (n = 26) had no improvement of symptoms (-0%). CONCLUSION: Disorders of the upper GI tract are a frequent origin of CSX in a German population and can be treated with pantoprazole if given for a longer period.

关键词：非心脏胸痛食管回流疾病强心剂抑制剂

Occult celiac disease prevents penetrance of hemochromatosis

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World Journal of Gastroenterology 2005年第21期11卷 3323-3326页

作者： andreas geier Carsten Gartung Igor Theurl Guenter Weiss Frank Lammert Christoph G.Dietrich Ralf Weiskirchen Heinz Zoller Benita Hermanns Siegfried Matern Department of Internal Medicine Ⅲ Aachen University (RWTH) AachenGermany Department of Internal Medicine University of Innsbruck InnsbruckAustria Department of Clinical Chemistry and Pathobiochemistry Aachen University(RWTH) AachenGermany Department of Pathology Aachen University (RWTH) AachenGermany Department of Internal Medicine Ⅲ Aachen University(RWTH) Aachen Germany

AIM: To report a patient with C282Y homozygocity, depleted body iron and intestinal atrophy caused by celiac disease (CD) who experienced resolution of the enteropathy with subsequent normalization of iron metabolism upon glutenfree ***: To obtain information on the tissue distribution and quantitative expression of proteins involved in duodenal iron trafficking, we determined the expression of divalent-metal transporter 1 (DMT1), ferroportin 1 (FP1) and transferrin receptor (TfR1) by means of immunohistochemistry and real-time PCR in duodenal biopsies of this ***: Whereas in hereditary hemochromatosis patients without CD, DMT1 expression was up-regulated leading to excessive uptake of iron, we identified a significant reduction in protein and mRNA expression of DMT1 as acompensatory mechanism in this patient with HH and ***: Occult CD may compensate tot increased DMT1 expression in a specific subset of individuals withhomozygous C282Y mutations in the hemochromatosis(HFE) gene, thus contributing to the low penetrance of HH.

关键词：腹腔疾病血色沉着病外显率疾病预防 C282Y 肠萎缩