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Fatty Liver Disease and Gut Microbiota:A Comprehensive Update

Journal of Clinical and Translational Hepatology 2019年第1期7卷 56-60页

作者： Lyna Campo Sara Eiseler tehilla apfel Nikolaos Pyrsopoulos Division of Gastroenterology and Hepatology University HospitalRutgers New Jersey Medical SchoolNewarkNJUSA

Nonalcoholic fatty liver disease(NAFLD)is the accumulation of fat in the liver in the absence of secondary *** is a multifactorial disease that results from the interaction of genetic predisposition and metabolic,inflammatory and environmental *** these factors,dysregulation of gut microbiome has been linked to the development of fatty liver *** microbiome composition can be modified by dietary habits leading to gut microbiome dysbiosis,especially when a diet is rich in saturated fats,animal products and fructose *** species of bacteria in the gut metabolize nutrients differently,triggering different pathways that contribute to the accumulation of fat within the liver and triggering inflammatory cascades that promote liver *** this review,we summarize the current understanding of the roles of gut microbiota in mediating NAFLD development and discuss possible gut microbiota-targeted therapies for *** summarize experimental and clinical evidence,and draw conclusions on the therapeutic potential of manipulating gut microbiota to decrease the incidence and prevalence of fatty liver disease.

关键词： Nonalcoholic fatty liver disease Gut microbiome Dysbiosis Endotoxins Choline metabolism

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Risk of progression of Barrett's esophagus in patients with cirrhosis

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World Journal of Gastroenterology 2017年第18期23卷 3287-3294页

作者： tehilla apfel Rocio Lopez Madhusudhan R Sanaka Prashanthi N Thota Department of General Internal Medicine Cleveland Clinic Foundation Department of Biostatistics Cleveland Clinic Foundation Department of Gastroenterology and Hepatology Digestive Disease and Surgery InstituteCleveland Clinic Foundation

AIM To study Barrett's esophagus(BE) in cirrhosis and assess progression to esophageal adenocarcinoma(EAC) compared to non-cirrhotic BE *** Cirrhotic patients who were found to have endoscopic evidence of BE confirmed by the presence of intestinal metaplasia on histology from 1/1/2000 to 12/1/2015 at Cleveland Clinic were included. Cirrhotic patients were matched 1:4 to BE controls without cirrhosis. Age, gender, race, BE length, hiatal hernia size, Child-Pugh(CP) class and histological findings were recorded. Cases and controls without high-grade dysplasia(HGD)/EAC and who had follow-up endoscopies were studied for incidence of dysplasia/EAC and to assess progression rates. Univariable conditional logistic regression was done to assess differences in baseline characteristics between the two groups. RESULTS A total of 57 patients with cirrhosis and BE were matched with 228 controls(BE without cirrhosis). The prevalence of dysplasia in cirrhosis and controls weresimilar with 8.8% vs 12% with low grade dysplasia(LGD) and 12.3 % vs 19.7% with HGD or EAC(P = 0.1). In the incidence cohort of 44 patients with median follow-up time of 2.7 years [interquartile range 1.0, 4.8], there were 7 cases of LGD, 2 cases of HGD, and 2 cases of EAC. There were no differences in incidence rates of HGD/EAC in nondysplastic BE between cirrhotic cases and noncirrhotic controls(1.4 vs 1.1 per 100 person-years, P = 0.8). In LGD, cirrhotic patients were found to have higher rates of progression to HGD/EAC compared to control group though this did not reach statistical significance(13.7 vs 8.1 per 100 personyears, P = 0.51). A significant association was found between a higher CP class and neoplastic progression of BE in cirrhotic patients(HR =7.9, 95%CI: 2.0-30.9, P = 0.003). CONCLUSION Cirrhotics with worsening liver function are at increased risk of progression of BE. More frequent endoscopic surveillance might be warranted in such patients.

关键词：肝肝硬化 Barretts 食管发育异常食道的瘤前进

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