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Well-controlled autoimmune hepatitis treatment withdrawal may be safely accomplished without liver-biopsy guidance

Gastroenterology Report 2018年第4期6卷 284-290,I0002页

作者： john guirguis Yilien Alonso Rocio Lopez William Carey Department of Internal Medicine Blake Medical CenterBradentonFLUSA Department of Gastroenterology Ochsner Health SystemNew OrleansLAUSA Department of Quantitative Health Sciences Cleveland ClinicClevelandOHUSA Digestive Disease Institute Department of Gastroenterology and HepatologyCleveland ClinicClevelandOHUSA

Background:Autoimmune hepatitis may flare up after treatment withdrawal,especially in those who had not achieved histological remission but had normal liver *** European Association for the Study of the Liver(EASL)and the American Association for the Study of Liver Disease(AASLD)Guidelines recommend performing liver biopsy before treatment *** aim of the study is to define the outcome of treatment withdrawal in adults with wellcontrolled disease for 2 years with and without liver-biopsy ***:A retrospective observational study was conducted on biopsy-proven autoimmune hepatitis patients who were treated for 2 years and with persistently normal aspartate aminotransferase(AST)and alanine aminotransferase(ALT)or nearly so for 6 months prior to treatment *** were:juvenile onset autoimmune hepatitis and prior treatment or use of agents other than corticosteroids and *** primary endpoint was to define freedomfrom flare-ups for 1 year after treatment ***:Thirty-four consecutive subjectsmeeting study criteria were *** withdrawal was accomplished in 24 subjects without liver-biopsy guidance and 10 had pre-treatment withdrawal liver ***,immunosuppressive usage,pre-treatment cirrhosis and pre-treatment liver enzymes were similar between the two groups,and 25%had an enzyme flare-up within 12months after treatment withdrawal,which was similar in the two groups(20.8 vs 30.0%,P=0.57).Conclusions:Adults with autoimmune hepatitis and excellent response to therapy for 2 years are candidates for treatment withdrawal without the need for liver biopsy.

关键词： Autoimmune hepatitis liver biopsy treatment withdrawal liver enzyme

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Malnutrition:laboratory markers vs nutritional assessment

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Gastroenterology Report 2016年第4期4卷 272-280,I0001页

作者： Shishira Bharadwaj Shaiva Ginoya Parul Tandon Tushar D.Gohel john guirguis Hiren Vallabh Andrea Jevenn Ibrahim Hanouneh Department of Gastroenterology/Hepatology McMaster UniversityHamiltonOntarioCanada Department of Gastroenterology/Hepatology Cleveland ClinicClevelandOHUSA

Malnutrition is an independent risk factor for patient morbidity and mortality and is associated with increased healthcarerelated ***,a major dilemma exists due to lack of a unified definition for the ***,there are no standard methods for screening and diagnosing patients with malnutrition,leading to confusion and varying practices among physicians across the *** role of inflammation as a risk factor for malnutrition has also been recently ***,serum proteins such as albumin and prealbumin(PAB)have been widely used by physicians to determine patient nutritional ***,recent focus has been on an appropriate nutrition-focused physical examination(NFPE)for diagnosing *** current consensus is that laboratory markers are not reliable by themselves but could be used as a complement to a thorough physical *** studies are needed to identify serum biomarkers in order to diagnose malnutrition unaffected by inflammatory states and have the advantage of being noninvasive and relatively ***,a thorough NFPE has an unprecedented role in diagnosing malnutrition.

关键词： malnutrition physical examination serum markers

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