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noninvasive scores for the prediction of esophageal varices and risk stratification in patients with cirrhosis

World Journal of Hepatology 2020年第11期12卷 908-918页

作者： Saroja Bangaru jihane n benhammou James H Tabibian Internal Medicine GastroenterologyUniversity of California at Los AngelesLos AngelesCA 90025United States The Vatche and Tamar Manoukian Division of Digestive Diseases University of California at Los AngelesLos AngelesCA 90095United States Department of Medicine Olive View-University of California at Los Angeles Medical CenterSylmarCA 91342United States David Geffen School of Medicine at UCLA Los AngelesCA 90095United States

The primary purpose of variceal screening in patients with cirrhosis is to detect gastroesophageal varices at high risk of hemorrhage and implement preventative intervention(s).It was previously recommended that all patients with cirrhosis undergo initial and periodic longitudinal variceal screening via upper endoscopy.However,there has been growing interest and methods to identify patients with cirrhosis who may not have clinically significant portal hypertension and therefore be unlikely to have varices requiring intervention or benefit from upper endoscopy.Because the population of patients with compensated advanced chronic liver disease continues to grow,it is neither beneficial nor cost-effective to perform endoscopic variceal screening in all patients.Therefore,there is ongoing research into the development of methods to non-invasively risk stratify patients with cirrhosis for the presence of high-risk esophageal varices and effectively limit the population that undergoes endoscopic variceal screening.This is particularly important and timely in light of increasing healthcare reform and barriers to healthcare.In this review,we discuss and compare,with respect to test characteristics and clinical applicability,the available methods used to noninvasively predict the presence of esophageal varices.

关键词： Gastroesophageal varices Variceal screening Advanced chronic liver disease Cirrhosis non-invasive screening Upper endoscopy

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Impact of sustained virologic response on chronic kidney disease progression in hepatitis C

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World Journal of Hepatology 2017年第36期9卷 1352-1360页

作者： Elizabeth S Aby Tien S Dong Jenna Kawamoto Joseph R Pisegna jihane n benhammou Division of Gastroenterology Hepatology and Parenteral Nutrition Department of Medicine VA Greater Los Angeles Healthcare System the Vatche and Tamar Manoukian Division of Digestive Diseases UCLA Los Angeles Department of Medicine University of California David Geffen School of Medicine

AIM To determine how sustained virological response at 12 wk(SVR12) with direct acting antivirals(DAAs) for the treatment of hepatitis C virus(HCV) infection affects chronic kidney disease(CKD) progression. METHODS A retrospective analysis was performed in patients aged ≥ 18 years treated for HCV with DAAs at the VA Greater Los Angeles Healthcare System from 2014-2016. The treatment group was compared to patients with HCV from 2011-2013 who did not undergo HCV treatment, prior to the introduction of DAAs; the control group was matched to the study group in terms of age, gender, and ethnicity. Analysis of variance and co-variance was performed to compare means between SVR12 subgroups adjusting for co-variates.RESULTS Five hundred and twenty-three patients were evaluated. When comparing the rate of change in estimated glomerular filtration rate(e GFR) one-year after HCV treatment to one-year before treatment, patients who achieved SVR12 had a decline in GFR of 3.1 m L/min ± 0.75 m L/min per 1.73 m^2 compared to a decline in e GFR of 11.0 m L/min ± 2.81 m L/min per 1.73 m^2 in patients who did not achieve SVR12(P = 0.002). There were no significant clinical differences between patients who achieved SVR12 compared to those who did not in terms of cirrhosis, treatment course, treatment experience, CKD stage prior to treatment, diuretic use or other co-morbidities. The decline in e GFR in those with untreated HCV over 2 years was 2.8 m L/min ± 1.0 m L/min per 1.73 m^2, which was not significantly different from the e GFR decline noted in HCV-treated patients who achieved SVR12(P = 0.43).COnCLUSIOn Patients who achieve SVR12 have a lesser decline in renal function, but viral eradication in itself may not be associated improvement in renal disease progression.

关键词： Hepatitis C Direct-acting antivirals Chronic kidney disease End stage renal disease Sustained virological response

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Metabolic syndrome does not affect sustained virologic response of direct-acting antivirals while hepatitis C clearance improves hemoglobin A1c

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World Journal of Hepatology 2018年第9期10卷 612-621页

作者： Tien S Dong Elizabeth S Aby jihane n benhammou Jenna Kawamoto Steven-Huy Han Folasade P May Joseph R Pisegna the Vatche and Tamar Manoukian Division of Digestive Diseases University of California Los AngelesDepartment of MedicineUniversity of California David Geffen School of MedicineLos AngelesCA 90095United States Division of Gastroenterology Hepatology and Parenteral NutritionDepartment of MedicineVA Greater Los Angeles Healthcare SystemLos AngelesCA 90073United States the Pfleger Liver Institute Department of SurgeryUniversity of California David Geffen School of MedicineLos AngelesCA 90095United States VA Health Services Research and Development Center for the Study of Healthcare Innovation Center for the Study of Healthcare Innovation Implementation and Policy(CSHIIP)Los AngelesCA 90073United States Jonsson Comprehensive Cancer Center Los AngelesCA 90095United States

AIM To determine whether successful treatment with direc-tacting antivirals(DAA) is associated with improvements in hemoglobin A1 c(HbA1 c) and if type 2 diabetes mellitus(T2 DM) or metabolic syndrome affects sustained virologic response(SVR).METHODS We performed a retrospective analysis of all hepatitis C virus(HCV) patients at the VA Greater Los Angeles Healthcare System treated with varying DAA therapy between 2014-2016. Separate multivariable logistic regression was performed to determine predictors of HbA1 c decrease ≥ 0.5 after DAA treatment and predictors of SVR 12-wk post treatment(SVR12).RESULTS A total of 1068 patients were treated with DAA therapy between 2014-2016. The presence of T2 DM or metabolic syndrome did not adversely affect SVR12. 106 patients had both HCV and T2 DM. Within that cohort,patients who achieved SVR12 had lower mean HbA1 c pre treatment(7.35 vs 8.60,P = 0.02),and lower mean HbA1 c post-treatment compared to non-responders(6.55 vs 8.61,P = 0.01). The mean reduction in HbA1 c after treatment was greater for those who achieved SVR12 than for non-responders(0.79 vs 0.01,P = 0.03). In adjusted models,patients that achieved SVR12 were more likely to have a HbA1 c decrease of ≥ 0.5 than those that did not achieve SVR12(adjusted OR = 7.24,95%CI: 1.22-42.94). COnCLUSIOn In HCV patients with T2 DM,successful treatment with DAA was associated with a significant reduction in HbA1 c suggesting that DAA may have a role in improving insulin sensitivity. Furthermore,the presence of T2 DM or metabolic syndrome does not adversely affect SVR12 rates in patients treated with DAA.

关键词： Hepatitis C virus Hemoglobin A1c Diabetes mellitus Direct-acting antivirals Metabolic syndrome

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Hepatocellular carcinoma in nonalcoholic fatty liver disease:A growing challenge

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World Journal of Hepatology 2021年第9期13卷 1107-1121页

作者： Angelo Z Mattos Jose D Debes Renu Dhanasekaran jihane n benhammou Marco Arrese Andre Luiz V Patricio Amanda C Zilio Angelo A Mattos Graduate Program in Medicine:Hepatology Federal University of Health Sciences of Porto AlegrePorto Alegre 90020-090Rio Grande do SulBrazil Gastroenterology and Hepatology Unit Irmandade Santa Casa de Misericordia de Porto AlegrePorto Alegre 90020-090Rio Grande do SulBrazil Department of Medicine Division of Infectious Diseases and of GastroenterologyUniversity of MinnesotaMinneapolisMN 55455United States Department of Gastroenterology and Hepatology Erasmus Medical CenterRotterdam 3015 CNSouth HollandNetherlands Division of Gastroenterology and Hepatology Stanford UniversityStanfordCA 94305United States The Vatche and Tamar Manoukian Division of Digestive Diseases University of CaliforniaLos AngelesCA 90095United States Department of Gastroenterology Pontificia Universidad Catolica de ChileSantiago 3580000Chile

nonalcoholic fatty liver disease(nAFLD)is the most common cause of liver disease worldwide,and its prevalence increases continuously.As it predisposes to hepatocellular carcinoma both in the presence and in the absence of cirrhosis,it is not surprising that the incidence of nAFLD-related hepatocellular carcinoma would also rise.Some of the mechanisms involved in hepatocarcinogenesis are particular to individuals with fatty liver,and they help explain why liver cancer develops even in patients without cirrhosis.Genetic and immune-mediated mechanisms seem to play an important role in the development of hepatocellular carcinoma in this population.Currently,it is consensual that patients with nAFLD-related cirrhosis should be surveilled with ultrasonography every 6 mo(with or without alpha-fetoprotein),but it is known that they are less likely to follow this recommendation than individuals with other kinds of liver disease.Moreover,the performance of the methods of surveillance are lower in nAFLD than they are in other liver diseases.Furthermore,it is not clear which subgroups of patients without cirrhosis should undergo surveillance.Understanding the mechanisms of hepatocarcinogenesis in nAFLD could hopefully lead to the identification of biomarkers to be used in the surveillance for liver cancer in these individuals.By improving surveillance,tumors could be detected in earlier stages,amenable to curative treatments.

关键词： nonalcoholic fatty liver disease nonalcoholic steatohepatitis Hepatocellular carcinoma Hepatocarcinogenesis Surveillance

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Emerging risk factors for nonalcoholic fatty liver disease associated hepatocellular carcinoma

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Hepatoma Research 2020年第6期6卷 92-106页

作者： jihane nbenhammou Jonathan Lin Shehnaz KHussain Mohamed El-Kabany Pfleger Liver Institute University of California Los AngelesLos AngelesCA 90095USA Vatche and Tamar Manoukian Division of Digestive Diseases David Geffen School of Medicine at UCLALos AngelesCA 90095USA Department of Epidemiology Fielding School of Public HealthUniversity of CaliforniaCA 90095USA Department of Medicine Samuel Oschin Comprehensive Cancer InstituteCedars-Sinai Medical CenterLos AngelesCA 90048USA

Worldwide,nonalcoholic fatty liver disease(nAFLD)has reached epidemic proportions and in parallel,hepatocellular carcinoma(HCC)has become one of the fastest growing cancers.Epidemiological studies have not only shed light on the prevalence and incidence of the disease but have also unmasked important environmental risk factors,including the role of diabetes and dyslipidemia in disease pathogenesis.Genetic association studies have identified single nucleotide polymorphisms implicated in nAFLD-HCC,many of which are part of lipid metabolism pathways.Through these clinical studies and subsequently,translational and basic research,the role of statins as a chemoprotective agent has also emerged with ongoing clinical trials assessing their utility in HCC prevention and treatment.In this review,we summarize the recent epidemiological studies describing the burden of nAFLD-HCC in different patient populations and countries.We discuss the genetic and environmental risk factors for nAFLD-HCC and highlight the chemoprotective role of statins and aspirin.We also summarize what is known about nAFLD-HCC in the cirrhosis and non-cirrhosis populations and briefly address the role of surveillance in nAFLD-HCC patients.

关键词： nonalcoholic fatty liver disease nonalcoholic steatohepatitis hepatocellular carcinoma statins metabolic syndrome

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Allele and haplotype frequencies for HLA-DQ in Iranian celiac disease patients

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World Journal of Gastroenterology 2014年第20期20卷 6302-6308页

作者： Mohammad Rostami-nejad jihane Romanos Kamran Rostami Azita Ganji Mohammad Javad Ehsani-Ardakani Ali-Reza Bakhshipour Homayoun Zojaji Seyed Reza Mohebbi Mohammad-Reza Zali Cisca Wijmenga Department of Celiac Disease Gastroenterology and Liver Diseases Research Centers Shahid Beheshti University of Medical Sciences Tehran *** Iran Department of Genetics University of Groningen University Medical Centre of Groningen 9700 RB Groningen The Netherlands Department of Genetics Institute of Human Genetics Lebanese American University Byblos 36 Lebanon Department of Gastroenterology Worcestershire Royal Hospital Worcester WR5 1DD United Kingdom Department of Gastroenterology Imam Reza Hospital Mashhad University of Medical Sciences Mashhad 1351143 Iran Department of Gastroenterology Zahedan University of Medical Sciences Zahedan 2143453 Iran

AIM:To assess the distribution of human leukocyteantigen(HLA)-DQ2 and-DQ8 in Iranian celiac disease(CD)patients and compare them to healthy Iranian controls.METHODS:To predict the HLA-DQA1 and-DQB1genes,we used six previously reported HLA-tagging single nucleotide polymorphism to determine HLA genotypes in 59 Iranian patients with‘biopsy-confirmed’CD and in 151 healthy Iranian individuals.To test the transferability of the method,50 cases and controls were also typed using a commercial kit that identifies individual carriers of DQ2,DQ7 and DQ8 alleles.RESULTS:In this pilot study 97%of CD cases(n=57)and 58%of controls(n=87)were carriers of HLADQ2 and/or HLA-DQ8 heterodimers,either in the homozygous or heterozygous state.The HLA-DQ pattern of these 57 CD patients:heterozygous DQ2.2(n=14)and homozygous DQ2.2(n=1),heterozygous DQ2.5(n=33)and homozygous DQ2.5(n=8),heterozygous DQ8(n=13)and homozygous DQ8(n=2).Two CD patients were negative for both DQ2 and DQ8(3%).COnCLUSIOn:The prevalence of DQ8 in our CD population was higher than that reported in other populations(25.4%).As reported in other populations,our results underline the primary importance of HLA-DQ alleles in the Iranian population’s susceptibility to CD.

关键词： Human leukocyte antigen typing Validation Suscepti

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