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Insulin sensitizers for the treatment of non-alcoholic fatty liver disease

World Journal of Hepatology 2014年第4期6卷 199-206页

作者： Zeynel Abidin Ozturk abdurrahman kadayifci Department of Internal Medicine Faculty of MedicineUniversity of Gaziantep Division of Gastroenterology Faculty of MedicineUniversity of Gaziantep Division of Gastroenterology Massachusetts General Hospital

Non-alcoholic fatty liver disease(NAFLD) is the leading cause of liver disease in the Western world and is closely associated with metabolic syndrome,which includes hypertension,central obesity,dyslipidemia and insulin *** includes a wide spectrum of liver alterations,ranging from simple hepatic steatosis to variable degrees of fibrosis,cirrhosis and even hepatocellular *** the etiology and progression of the disorder remain poorly understood,insulin resistance is considered to play a pivotal role in the *** sensitizers such as biguanides,thiazolidinediones(TZDs),glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase 4 inhibitors have been studied as therapeutic approaches for NAFLD in recent *** improves insulin sensitivity and serum alanine transaminase and aspartate transaminase(ALT/AST) levels in the majority of subjects; however,it has no significant effect on liver *** improve insulin sensitivity,serum ALT/ AST levels and histology in some cases,but there are some concerns about the safety of long-term *** of appropriate patients for avoiding side effects and the treatment of underlying disease are themain *** drugs are the best choice for the treatment of NAFLD in patients with type 2 DM who are also candidates for treatment with an insulin *** present review provides an overview of insulin sensitizers in the treatment of NAFLD.

关键词： Insulin sensitizers Metformin Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis Thiazolidinediones

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Transnasal endoscopy: Technical considerations, advantages and limitations

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World Journal of Gastrointestinal Endoscopy 2014年第2期6卷 41-48页

作者： Mustafa Atar abdurrahman kadayifci Division of Gastroenterology Department of Medicine Massachusetts General Hospital Division of Gastroenterology Faculty of Medicine University of Gaziantep

Transnasal endoscopy(TNE) is an upper endoscopy method which is performed by the nasal route using a thin endoscope less than 6 mm in diameter. The primary goal of this method is to improve patient tolerance and convenience of the procedure. TNE can be performed without sedation and thus eliminates the risks associated with general anesthesia. In this way,TNE decreases the cost and total duration of endoscopic procedures, while maintaining the image quality of standard caliber endoscopes, providing good results for diagnostic purposes. However, the small working channel of the ultra-thin endoscope used for TNE makes it difficult to use for therapeutic procedures except in certain conditions which require a thinner *** is possible with special forceps less than 2 mm in diameter. Recently, TNE has been used for screening endoscopy in Far East Asia, including Japan. In most controlled studies, TNE was found to have better patient tolerance when compared to unsedated endoscopy. Nasal pain is the most significant symptom associated with endoscopic procedures but can be reduced with nasal pretreatment. Despite the potential advantage of TNE, it is not common in Western countries, usually due to a lack of training in the technique and a lack of awareness of its potential advantages. This paper briefly reviews the technical considerations as well as the potential advantages and limitations of TNE with ultra-thin scopes.

关键词： Transnasal endoscopy Transoral endoscopy Ultra-thin endoscopy Sedated endoscopy Unsedated endoscopy

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Approach to Helicobacter pylori infection in geriatric population

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2014年第3期5卷 139-147页

作者： Sevdenur Cizginer Zehra Ordulu abdurrahman kadayifci Division of Geriatrics and Palliative Medicine Department of MedicineAlpert Medical School of Brown UniversityProvidenceRI 02903United States Department of Obstetrics and Gynecology Brigham and Women’s HospitalHarvard Medical SchoolBostonMA 02115United States Division of Gastroenterology Department of MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMA 02115United States Division of Gastroenterology Faculty of MedicineUniversity of Gaziantep27310 GaziantepTurkey

The prevalence of Helicobacter pylori(H. pylori) infection and its complications increase with age. The majority of infected individuals remain asymptomatic throughout the life but 10%-20% develops peptic ulcer disease and 1% gastric malignancies. The incidence of ulcers and their complications are more common in the older population resulting in higher hospitalization and mortality rates. The increased use of medications causing gastric mucosal damage and the decreased secretion of protective prostaglandins in elderly are major factors increasing gastric mucosal sensitivity to the destructive effects of H. pylori. Due to higher prevalence of gastrointestinal(GI) malignancies,upper GI endoscopy is mostly preferred in elderly for the diagnosis of infection. Therefore,"endoscopy and treat" strategy may be more appropriate instead of "test and treat" strategy for dyspeptic patients in older age. Urea breath test and stool antigen test can be used for control of eradication,except for special cases requiring follow-up with endoscopy. The indications for treatment and suggested eradication regimens are similar with other age groups; however,the eradication failure may be a more significant problem due to high antibiotic resistance and low compliance rate in elderly. Multidrug usage and drug interactions should always be consid-ered before starting the treatment. This paper reviews briefly the epidemiology,diagnosis,disease manifesta-tions,and treatment options of H. pylori in the geriatric population.

关键词： Helicobacter pylori Epidemiology Diagnosis Treatment Eradication Elderly Geriatrics Geriatric population

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