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World Journal of Gastroenterology 2006年第23期12卷 3625-3627页

作者： eric m yoshida mark Riley Laura T Arbour Department of medicine University of British ColumbiaVancouverBCCanada Department of Pediatrics University of British Columbia Vancouver BC Canada Department of medical Genetics the University of British Columbia. Vancouver BC Canada

Primary biliary cirrhosis (PBC) is a well-known but uncommon chronic liver disease that is presumed to be of autoimmune etiology. Recently, investigations in British Columbia (BC), a province of Canada situated along the Pacific North-West of North America, have suggested that PBC is not a rare disease amongst BC's Aboriginal (i.e. First Nations) communities. Geographically, BC is adjacent to South East Alaska, an American state that has also reported an increased prevalence of PBC amongst its Aboriginal communities. In this article, the medical evidence supporting a hypothesis of increased risk of PBC amongst BC's First Nations communities is reviewed. Evidence suggesting that autoimmune hepatitis is also more likely amongst BC's First Nations communities is also presented.

关键词： Primary biliary cirrhosis Aboriginal FirstNations British Columbia

Hepatoid adenocarcinoma of the colon in a patient with inflammatory bowel disease

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World Journal of Gastroenterology 2014年第35期20卷 12657-12661页

作者： Yuanyuan Chen David F Schaeffer eric m yoshida Division of Gastroenterology University of British Columbia Department of Pathology and Laboratory medicine University of British Columbia

A case is presented of a 36-year-old male with primary sclerosing cholangitis-associated inflammatory bowel disease(PSC-IBD) and two synchronous stage 1 adenocarcinomata of the colon,who was initially treated with a subtotal colectomy with *** year later,the patient presented with extensive intra-abdominal lymphadenopathy and peritoneal carcinomatosis,as well as a markedly elevated serum level of alpha-fetoprotein(AFP).Fine needle aspiration biopsy of a porta hepatis lymph node revealed a metastatic hepatoid *** review of the previous colectomy specimen showed that one of the previously identified adenocarcinomata had features suggestive of a hepatoid colonic *** patient was subsequently treated with a cytotoxic regimen of FOLFOX(oxaliplatin,leucovorin,5-fluorouracil) and bevacizumab,with stable results being achieved after six *** case presents the first known report of PSC-IBD associated with synchronous typical and hepatoid adenocarcinomata of the colon and highlights the importance of considering hepatoid adenocarcinoma as a differential diagnosis in patients with an increasing serum AFP level.

关键词： Hepatoid adenocarcinoma Inflammatory bowel disease Colon cancer Alpha-fetoprotein Ulcerative colitis Primary sclerosing cholangitis Recurrence metastasis

Acute lower gastrointestinal bleeding from a dieulafoy lesion proximal to the anorectal junction post-orthotopic liver transplant

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World Journal of Gastroenterology 2006年第46期12卷 7547-7548页

作者： Wichian Apiratpracha Jin Kee Ho James J Powell eric m yoshida British Columbia Transplant Society The University of British Columbia Vancouver BC Canada Division of Gastroenterology Department of Medicine The University of British Columbia Vancouver BC Canada Department of Surgery The University of British Columbia Vancouver BC Canada

A 67-year-old woman underwent an orthotopic liver transplantation for end stage liver disease secondary to chronic autoimmune hepatitis. She developed sudden massive hematochezia on post-operative day 23 with hemodynamic compromise. The source of hemorrhage was found at colonoscopy after careful irrigation and inspection to be a dieulafoy lesion situated just proximal to the anorectal junction. Hemostasis was achieved with epinephrine injection and thermal coagulation.

关键词： Bleeding Anorectal Dieulafoy Rectum

Efficacy and safety of semaglutide in non-alcoholic fatty liver disease

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World Journal of Gastroenterology 2023年第37期29卷 5327-5338页

作者： Kai Zhu Rohan Kakkar Daljeet Chahal eric m yoshida Trana Hussaini Internal medicine University of British ColumbiaVancouver V5Z 1M9BCCanada Department of Gastroenterology University of British ColumbiaVancouver V5Z 1M9BCCanada BC Liver Transplant Program Vancouver General HospitalVancouver V5Z 1M9BCCanada Pharmaceutical Sciences University of British ColumbiaVancouver V5Z 1M9BCCanada

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the leading cause of chronic liver *** prevalence and disease burden of NAFLD are projected to exponentially increase resulting in significant healthcare expenditures and lower healthrelated quality of *** date,there are no approved pharmacotherapies for NAFLD or non-alcoholic steatohepatitis(NASH).Semaglutide has glycemic and weight loss benefits that may be advantageous for patients with *** To investigate the efficacy and safety of semaglutide in patients with *** mEDLINE,CENTRAL,and EmBASE were searched from inception to may 1,2023,to identify eligible randomized controlled trials(RCTs).meta-analysis was performed using random effects model expressing continuous outcomes as mean differences(mD)or standardized mDs(SmD),and dichotomous outcomes as odds ratios(OR)with 95%confidence intervals(CI).Statistical heterogeneity was assessed using the Cochran’s Q test and I2 *** Three RCTs involving 458 patients were *** increased the likelihood of NASH resolution(OR:3.18,95%CI:1.70,5.95;Pmprovement in steatosis(OR:2.83,95%CI:1.19,6.71;P=0.03),lobular inflammation(OR:1.81,95%CI:1.11,2.96;P=0.02),and hepatocellular ballooning(OR:2.92,95%CI:1.83,4.65;Pmaglutide reduced liver stiffness(SmD:-0.48,95%CI:-0.86,-0.11;P=0.01)and steatosis(mD:-4.96%,95%CI:-9.92,0.01;P=0.05).It also reduced alanine aminotransferase(mD:-14.06 U/L,95%CI:-22.06,-6.07;Pminotransferase(mD:-11.44 U/L,95%CI:-17.23,-5.65;Pmaglutide led to improved cardiometabolic outcomes,including decreased HgA1c(mD:-0.77%,95%CI:-1.18,-0.37;PmD:-6.53 kg,95%CI:-11.21,-1.85;P=0.006),but increased the occurrence of GIrelated side effects(OR:3.72,95%CI:1.68,8.23;P=0.001).Overall risk of serious adverse events was similar compared to placebo(OR:1.40,95%CI:0.75,2.62;P<0.29).CO

关键词： Non-alcoholic fatty liver disease Fatty liver metabolic-associated fatty liver Semaglutide

Acute sensorineural hearing loss associated with peginterferon and ribavirin combination therapy during hepatitis C treatment: Outcome after resumption of therapy

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World Journal of Gastroenterology 2005年第34期11卷 5392-5393页

作者： Victor K Wong Cindy Cheong-Lee Jo-Ann E Ford eric m yoshida Department of medicine Vancouver BC Canada University of British Columbia and the British Columbia Hepatitis Program Vancouver BC Canada Department of medicine Vancouver BC Canada University of British Columbia and the British Columbia Hepatitis Program Vancouver BC Canada

Peginterferon and ribavirin combination therapy for the treatment of hepatitis C virus （HCV） is well known to be associated with significant adverse effects. Sensorineural hearing loss, that in most cases is unilateral, has been reported as a consequence of therapy with both non-pegylabed and pegylated interferon （pegIFN） but is not a well-known adverse effect. We report a 45-year-old Caucasian woman who developed acute sensorineural hearing loss 2 mo after starting therapy with pegIFN-α 2b and ribavirin for the treatment of chronic HCV, genotype la. She did not report the hearing loss to the hepatitis clinic until 1 mo, later whereupon therapy was promptly discontinued. Although her serum alanine aminotransferase （ALT） normalized and her HCV-RNA became undetectable after 12 wk of pegIFN and dbavirin therapy, after discontinuation, her HCV-RNA became detectable with significant elevations of serum ALT. Four months after initial discontinuation, the patient re-commenced pegIFN and ribavirin combination therapy. After 44 of 48 wk of therapy, the patient＇s liver biochemistry has normalized and the HCV-RNA is undetectable. She has not developed worsening of her hearing loss and hearing on the left-side is unaffected. Both patients and physicians should be aware that sensorineural hearing loss may occur with pegIFN therapy. Our experience suggests that re-institution of therapy is not always associated with further hearing impairment.

关键词： Peginterferon Hepatitis C Sensorineural hearing loss

Retinal vein thrombosis associated with pegylated-interferon and ribavirin combination therapy for chronic hepatitis C

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World Journal of Gastroenterology 2006年第30期12卷 4908-4910页

作者： Iman Zandieh mohamed Adenwalla Cindy Cheong-Lee Patrick E ma eric m yoshida Division of Gastroenterology Department of Medicine University of British Columbia Vancouver British Columbia Canada Department of Ophthal- mology University of British Columbia Vancouver British Columbia Canada Department of Ophthalmology University of British Columbia Vancouver British Columbia Canada

An estimated 300 million people worldwide suffer from chronic hepatitis C with a prevalence of 0.8%-1.0% of the general population in Canada. An increasing pool of evidence exists supporting the use of pegylated-interferon （pegIFN） and ribavirin combination therapy for hepatitis C. We report a 49-year old male of North American aboriginal descent with chronic hepatitis C （genotype 2b）. Biopsy confirmed that he had cirrhosis with a 2-wk history of left eye pain and decreased visual acuity. He developed retinal vein thrombosis after 16 of 24 wk of pegIFN-α 2a and ribavirin combination therapy. He was urgently referred to a retinal specialist and diagnosed with non-ischemic central retinal vein occlusion of the left eye. PegIFN and ribavirin combination therapy was discontinued and HCV RNA was undetectable after 16 wk of treatment. Hematologic investigations revealed that the patient was a factor V Leiden heterozygote with mildly decreased protein C activity. Our patient had a number of hypercoagulable risk factors, including factor V Leiden heterozygosity, cirrhosis, and hepatitis C that alone would have most likely remained clinically silent. We speculate that in the setting of pegIFN treatment, these risk factors may coalesce and cause the retinal vein thrombosis.

关键词： Interferon Pegylated-interferon Hepatitis C Cirrhosis Retinal vein thrombosis Thrombosis Central retinal vein occlusion

Review of Clinically Relevant Drug Interactions with Next Generation Hepatitis C Direct-acting Antiviral Agents

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Journal of Clinical and Translational Hepatology 2020年第3期8卷 322-335页

作者： Jenny Hong Robert C.Wright Nilu Partovi eric m.yoshida Trana Hussaini Pharmaceutical Sciences Vancouver General HospitalVancouverBCCanada Faculty of Pharmaceutical Sciences University of British ColumbiaVancouverBCCanada Liver Transplant Program Vancouver General HospitalVancouverBCCanada Division of Gastroenterology Faculty of MedicineUniversity of British ColumbiaVancouverBCCanada

In this review,we examine the pharmacokinetics and clinically relevant drug interactions of the newer generation direct-acting antivirals(DAAs)for the treatment of chronic hepatitis C,specifically sofosbuvir/velpatasvir(Epclusa®),sofosbuvir/velpatasvir/voxilaprevir(Vosevi®),glecaprevir/pibrentasvir(maviret®),and elbasvir/grazoprevir(Zepatier®).We searched mEDLINE(1948-January 2020),Embase(1964-January 2020),Google,and GoogleScholar using the terms pharmacokinetics,drug interaction,drug metabolism,sofosbuvir,velpatasvir,Epclusa,voxilaprevir,Vosevi,glecaprevir,pibrentasvir,maviret,elbasvir,grazoprevir,and Zepatier,from inception to January 13,*** search was limited to randomized controlled trials,in vitro studies,prospective and retrospective human studies,drug monographs,abstracts,and conference *** relevant published literature on pharmacokinetic and pharmacodynamic interactions involving DAAs were reviewed and the data *** clinically relevant drug-drug interactions(DDIs)were identified with the newer generation DAAs and commonly prescribed ***3/4A protease inhibitors are more likely to be involved in DDIs,followed by NS5A inhibitors and NS5B polymerase *** majority of clinically relevant DDIs are predictable,according to known pharmacokinetic,pharmacodynamics,and physicochemical properties of DAAs;however,in select cases,unpredictable DDIs do *** expected,many drug interactions exist between newer generation DAAs and commonly prescribed *** the majority of clinically relevant interactions are predictable,many require therapeutic dose adjustment or careful selection of non-interacting *** select cases,severe and unpredictable drug interactions can *** should consult hepatitis C virus pharmacotherapy experts and tertiary drug interaction resources when initiating DAA therapy in patients taking other medications.

关键词： Hepatitis C Drug interactions Pharmacokinetics Direct-acting antiviral agents

Severe cholestasis due to adalimumab in a Crohn's disease patient

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World Journal of Hepatology 2013年第10期5卷 592-595页

作者： Edward Kim Brian Bressler David F Schaeffer eric m yoshida Division of Gastroenterology University of British Columbia Department of Pathology and Laboratory medicine University of British Columbia

Elevation of liver biochemistry has been reported with anti-tumor necrosis factor agents, but overt liver failure rarely reported. Autoimmune hepatitis has been more commonly reported with infliximab than adalimumab(ADA). Our case, however, describes the first reported case of ADA-associated severe cholestatic injury. A 39-year-old female with Crohn's disease developed severe jaundice after initiation of ADA. All serologic tests and imaging studies were normal. Liver biopsy showed prominent pericentral canalicular cholestasis,without features of steatosis or sclerosing cholangitis,consistent with drug-induced cholestasis. The serum total bilirubin peaked at 280 μmol/L, and improvement was seen after 5 wk with eventual normalization of liver enzymes at 10 wk. Our case describes the first reported case of ADA-associated severe cholestatic liver disease and the first histopathologic examination of this adverse drug effect. Clinicians need to be aware of this potential drug-induced liver injury when prescribing this commonly used biologic medication.

关键词： Crohn’s disease Cholestasis Adalimumab Anti-tumor necrosis factor agents Drug-induced liver injury

Unusual case of drug-induced cholestasis due to glucosamine and chondroitin sulfate

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World Journal of Hepatology 2015年第24期7卷 2559-2562页

作者： Stephen Ip Rachel Jeong David F Schaeffer eric m yoshida Division of Gastroenterology Vancouver General HospitalUniversity of British Columbia Faculty of medicine and Dentistry University of Alberta Department of Pathology and Laboratory medicine University of British Columbia

Glucosamine(GS) and chondroitin sulfate(CS) are common over-the-counter(OTC) supplements used in the treatment of osteoarthritis. These medications are seemingly safe, but there are increasing reports of hepatotoxicity with these supplements. We reported a unique case of drug-induced cholestasis caused by GS and CS in a combination tablet. The etiology of the jaundice was overlooked despite extensive investigations over a three-month period. Unlike drug-induced hepatocellular injury, drug-induced cholestatic jaundice with GS and CS has only been reported twice before. This case emphasizes the importance of a complete medication history, especially OTC supplements, in the assessment of cholestasis.

关键词： Glucosamine Chondroitin Hepatotoxicity Cholestasis

Chronic pancreatitis:a sequela of acute fatty liver of pregnancy

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Hepatobiliary & Pancreatic Diseases International 2008年第1期7卷 101-104页

作者： Wichian Apiratpracha eric m.yoshida Scudamore H.Charles Alan A.Weiss michael F.Byrne Division of Gastroenterology Department of medicine University of British ColumbiaVancouverBCCanada Division of Surgery Department of MedicineUniversity of British ColumbiaVancouverBCCanada

BACKGROUND: Chronic pancreatitis following acute fatty liver of pregnancy is rarely ***: We treated a 34-year-old woman who developed acute fatty liver of pregnancy (AFLP) after delivery by caesarean section at 32 weeks of gestation. AFLP was complicated by acute pancreatitis and multiple organ failure. The management of the disease was primarily supportive. She recovered from acute fulminant liver failure and multi-organ failure, apart from the development of symptomatic chronic pancreatitis thereafter. RESULTS: Investigations failed to identify any other causes of chronic pancreatitis. The patient responded very well to pancreatic enzyme supplement for the treatment of ***: To our knowledge, this is the first report of chronic pancreatitis as a consequence of multi-organ dysfunction caused by AFLP.

关键词： pancreatitis, chronic fatty liver acute pregnancy multiorgan dysfunction syndrome