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Hepatocellular carcinoma in Latin America: Diagnosis and treatment challenges

World Journal of Gastroenterology 2018年第37期24卷 4224-4229页

作者： Federico Pinro jaime poniachik Ezequiel Ridruejo Marcelo Silva Hospital Universitario Austral Facultad de Ciencias BiomédicasUniversidad AustralPilarBuenos Aires B1629HJArgentina American Liver Research Educational and Awareness Network Buenos Aires B1629HJArgentina Hepatology Hospital Clínico Universidad de ChileSantiago de ChileRegión Metropolitana Santiago 46010Chile Santa María Santiago de ChileRegión Metropolitana Santiago 834-0518Chile Médica e Investigaciones Clínicas Norberto Quirno Ciudad de Buenos Aires C1425ASGArgentina

Latin America, a region with a population greater than 600000000 individuals, is well known due to its wide geographic, socio-cultural and economic heterogeneity. Access to health care remains as the main barrier that challenges routine screening, early diagnosis and proper treatment of hepatocellular carcinoma(HCC). Therefore, identification of population at risk, implementation of surveillance programs and access to curative treatments has been poorly obtained in the region. Different retrospective cohort studies from the region have shown flaws in the implementation process of routine surveillance and early HCC diagnosis. Furthermore, adherence to clinical practice guidelines recommendations assessed in two studies from Brazil and Argentina demonstrated that there is also room for improvement in this field, similarly than the one observed in Europe and the United States. In summary, Latin America shares difficulties in HCC decision-making processes similar to those from developed countries. However, a transversal limitation in the region is the poor access to health care with the consequent limitation to standard treatments for overall population. Specifically, universal health care access to the different World Health Organization levels is crucial, including improvement in research, education and continuous medical training in order to expand knowledge and generation of data promoting a continuous improvement in the care of HCC patients.

关键词： Latin America Liver cancer Limitations Challenge

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Management of nonalcoholic fatty liver disease:An evidence-based clinical practice review

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World Journal of Gastroenterology 2014年第34期20卷 12182-12201页

作者： Juan P Arab Roberto Candia Rodrigo Zapata Cristián Mu?oz Juan P Arancibia jaime poniachik Alejandro Soza Francisco Fuster Javier Brahm Edgar Sanhueza Jorge Contreras M Carolina Cuellar Marco Arrese Arnoldo Riquelme Departamento de Gastroenterología Escuela de MedicinaPontificia Universidad Católica de Chile8330024 SantiagoChile Sección de Gastroenterología Hospital del SalvadorEscuela de MedicinaUniversidad de Chile7500922 SantiagoChile Unidad de Gastroenterología Universidad del DesarrolloClínica Alemana7650568 SantiagoChile Unidad de Trasplante Hepático Hospital del SalvadorUnidad de GastroenterologíaClínica Las Lilas7510524 SantiagoChile Sección de Gastroenterología Departamento de MedicinaHospital Clínico Universidad de ChileChile8380456 SantiagoChile Sección de Gastroenterología Hospital Clínico Universidad de ChileEscuela de MedicinaUniversidad de Chile8380456 SantiagoChile Digestive Diseases Unit Clínica Re?aca2540364 Vi?a del MarChile Gastroenterology Department Clínica Las Condes6770128 SantiagoChile Centre for Medical Education Escuela de MedicinaPontificia Universidad Católica de Chile8330024 SantiagoChile

AIM:To build a consensus among Chilean specialists on the appropriate management of patients with nonalcoholic fatty liver disease(NAFLD)in clinical ***:NAFLD has now reached epidemic proportions *** optimal treatment for NAFLD has not been established due to a lack of evidence-based *** expert panel of members of the Chilean Gastroenterological Society and the Chilean Hepatology Association conducted a structured analysis of the current literature on NAFLD *** quality of the evidence and the level of recommendations supporting each statement were assessed according to the recommendations of the United States Preventive Services Task Force.A modified three-round Delphi technique was used to reach a consensus among the ***:A group of thirteen experts was *** survey included 17 open-ended questions that were distributed among the experts,who assessed the articles associated with each *** levels of agreement achieved by the panel were 93.8%in the first round and 100%in the second and third *** final recommendations support the indication of lifestyle changes,including diet and exercise,for all patients with *** pharmacological therapies include only vitamin E and pioglitazone,which can be used in nondiabetic patients with biopsy-proven nonalcoholic steatohepatitis(the progressive form of NAFLD),although the long-term safety and efficacy of these therapies have not yet been ***:Current NAFLD management is rapidly evolving,and new pathophysiology-based therapies are expected to be introduced in the near *** NAFLD patients should be evaluated using a three-focused approach that considers the risks of liver disease,diabetes and cardiovascular events.

关键词： Nonalcoholic fatty liver disease Steatosis Consens

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