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Nonselective beta-blocker use is associated with increased hepatic encephalopathy-related readmissions in cirrhosis

World Journal of Clinical Cases 2022年第23期10卷 8097-8106页

作者： Mohammad Amin Fallahzadeh Sumeet K Asrani Elliot B Tapper giovanna saracino Robert S Rahimi Department of Internal Medicine Baylor University Medical CenterDallasTX 75246United States Division of Hepatology Baylor University Medical CenterDallasTX 75246United States Division of Hepatology University of MichiganAnn ArborMI 48109United States

BACKGROUND Hepatic encephalopathy(HE)is a neurocognitive condition in cirrhosis leading to frequent *** beta-blockers(NSBBs)are the mainstay of pharmacologic treatment in cirrhotic *** hypothesized that since NSBBs decrease cardiac output and portal flow,the decreased metabolic filtering process of liver parenchyma may lead to increased HE-related *** To evaluate the impact of NSBB administration on HE-related readmissions in cirrhotic *** In this retrospective cohort study,we included 393 patients admitted to Baylor University Medical Center for liver-related portal hypertension indications between January 2013 and July *** predictors of the first HErelated readmissions were identified using Cox proportional hazards *** cumulative incidence of the first HE-related readmissions between patients receiving NSBBs and not receiving NSBBs was examined using Fine-Gray modeling to account for the competing risk of death or liver *** The mean age was 58.1±10.2 years and most patients fell into Child class C(49.1%)or B(43.8%).The median Model for End-Stage Liver Disease-Sodium score was 22(IQR:11).The cumulative incidence of the first HE-related readmissions was significantly higher in patients taking NSBBs compared to patients not receiving NSBBs(71.8%vs 41.8%,P<0.0001).In multivariate analysis,after adjusting for demographics,markers of liver disease severity,selective beta-blocker,lactulose and rifaximin use,NSBB use[Hazard ratio:1.74(95%CI:1.29-2.34)]was independently associated with the first HE-related readmissions over a median follow-up of 3.8 *** NSBB use is independently associated with increased HE-related readmissions in patients with cirrhosis,regardless of liver disease severity.

关键词： Altered mental status Ascites Esophageal varices Liver disease Portal hypertension Hospitalization

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Therapy for <i>H.</i><i>pylori</i>: Current concepts

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Open Journal of Gastroenterology 2013年第1期3卷 38-41页

作者： Giulia Fiorini Angelo Zullo Valentina Castelli Chiara Ricci giovanna Lo Re Ilaria saracino Cristina Zaccaro Federico Maria Verardi Alessandra Reggi Dino Vaira Department of Clinical and Surgical Science S.Orsola-Malpighi Hospital University of Bologna Bologna Italy Department of Internal Medicine Aging and Kidney Disease Alma Mater Studiorum University of Bologna Bologna Italy Gastroenterology and Digestive Endoscopy “Nuovo Regina Margherita” Hospital Rome Italy Gastroenterology Unit University of Brescia Brescia Italy

Helicobacter pylori plays an important role in the pathogenesis of chronic active gastritis, peptic ulcer and gastric mucosa-associated lymphoid tissue-lymphoma, and is also involved in carcinogenesis of the stomach. Since now no current first-line therapy is able to cure the infection in all treated patients. We evaluated data on the most successful therapy regimens—sequential, concomitant and quadruple therapies—and on the standard therapy available for H. pylori eradication. When therapy fails several factors may be involved: we reviewed both bacterial and host factors that can affect the eradication and that can be involved in therapeutic management of the H. pylori infection.

关键词： Helicobacter pylori Sequential Therapy Eradication

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