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Fibrosis regression following hepatitis C antiviral therapy

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World Journal of Hepatology 2022年第6期14卷 1120-1130页

作者： Aisha Elsharkawy Reham Samir Mohamed El-Kassas department of Endemic medicine and hepatogastroenterology Faculty of MedicineCairo UniversityCairo 11566Egypt department of Endemic medicine Faculty of MedicineHelwan UniversityCairo 11795Egypt

Hepatitis C virus(HCV)infection is one of the most common causes of liver *** is a major etiological factor of continuous liver injury by triggering an uncontrolled inflammatory response,causing liver fibrosis and *** fibrosis is a dynamic process that can be reversible upon timely cessation of the injurious agent,which in cases of HCV is represented by the sustained virological response(SVR)following antiviral ***-acting antiviral therapy has recently revolutionized HCV therapy and minimized *** fibrosis can be assessed with variable invasive and non-invasive methods,with certain *** the broad validation of the diagnostic and prognostic value of non-invasive modalities of assessment of liver fibrosis in patients with HCV,the proper interpretation of liver stiffness measurement in patients after SVR remains *** is also still a debate whether this regression is caused by the resolution of liver injury following treatment of HCV,rather than true fibrosis *** of liver fibrosis can possess a positive impact on patient's quality of life reducing the incidence of ***,fibrosis regression does not abolish the risk of developing hepatocellular carcinoma,which mandates regular screening of patients with advanced fibrosis.

关键词： Fibrosis regression Hepatitis C virus Direct-acting antivirals Hepatocellular carcinoma Liver fibrosis Cirrhosis

Application of artificial intelligence in gastroenterology

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World Journal of Gastroenterology 2019年第14期25卷 1666-1683页

作者： Young Joo Yang Chang Seok Bang department of internal medicine Hallym University College of Medicine

Artificial intelligence(AI) using deep-learning(DL) has emerged as a breakthrough computer technology. By the era of big data, the accumulation of an enormous number of digital images and medical records drove the need for the utilization of AI to efficiently deal with these data, which have become fundamental resources for a machine to learn by itself. Among several DL models, the convolutional neural network showed outstanding performance in image analysis. In the field of gastroenterology, physicians handle large amounts of clinical data and various kinds of image devices such as endoscopy and ultrasound. AI has been applied in gastroenterology in terms of diagnosis,prognosis, and image analysis. However, potential inherent selection bias cannot be excluded in the form of retrospective study. Because overfitting and spectrum bias(class imbalance) have the possibility of overestimating the accuracy,external validation using unused datasets for model development, collected in a way that minimizes the spectrum bias, is mandatory. For robust verification,prospective studies with adequate inclusion/exclusion criteria, which represent the target populations, are needed. DL has its own lack of *** interpretability is important in that it can provide safety measures, help to detect bias, and create social acceptance, further investigations should be performed.

关键词： Artificial intelligence Convolutional neural network Deep-learning Computer-assisted Gastroenterology Endoscopy

Intestinal microbiota in pathophysiology and management of irritable bowel syndrome

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World Journal of Gastroenterology 2014年第27期20卷 8886-8897页

作者： Kang Nyeong Lee Oh Young Lee department of internal medicine Hanyang University College of Medicine

Irritable bowel syndrome (IBS) is a functional bowel disorder without any structural or metabolic abnormalities that sufficiently explain the symptoms, which include abdominal pain and discomfort, and bowel habit changes such as diarrhea and constipation. Its pathogenesis is multifactorial: visceral hypersensitivity, dysmotility, psychosocial factors, genetic or environmental factors, dysregulation of the brain-gut axis, and altered intestinal microbiota have all been proposed as possible causes. The human intestinal microbiota are composed of more than 1000 different bacterial species and 1014 cells, and are essential for the development, function, and homeostasis of the intestine, and for individual health. The putative mechanisms that explain the role of microbiota in the development of IBS include altered composition or metabolic activity of the microbiota, mucosal immune activation and inflammation, increased intestinal permeability and impaired mucosal barrier function, sensory-motor disturbances provoked by the microbiota, and a disturbed gut-microbiota-brain axis. Therefore, modulation of the intestinal microbiota through dietary changes, and use of antibiotics, probiotics, and anti-inflammatory agents has been suggested as strategies for managing IBS symptoms. This review summarizes and discusses the accumulating evidence that intestinal microbiota play a role in the pathophysiology and management of IBS.

关键词： Immunity Irritable bowel syndrome Microbiota Permeability Probiotics

Retreatment with peginterferon and ribavirin in chronic hepatitis C

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World Journal of Gastroenterology 2015年第6期21卷 1994-1999页

作者： Yong Min Jo Sung Wook Lee Sang Young Han Yang Hyun Baek Soo Young Kim Woo Jae Kim Ji Hye Ahn Ji Young Lee department of internal medicine Dong-A University School of Medicine

The development of boceprevir and telaprevir was a major step forward in the treatment of chronic hepatitis *** addition,the treatment of these infections has been recently revolutionized by the approval of sofosbuvir and ***,there are several challenges associated with the application of noveldrugs,such as new and more frequent adverse events,new drug interactions,and excessively high treatment *** additional concern is viral *** considerations highlight the fact that direct-acting antiviral agents are not a panacea and may not be the best option for all patients who are in need of *** retrospective study revealed that the sustained virologic response was not significantly reduced following peginterferon and ribavirin retreatment compared with the new *** suggest that patients who experience relapse shortly after completing treatment with peginterferon and ribavirin have a reasonable chance of achieving a sustained virologic response when retreated with these drugs alone.

关键词： Chronic hepatitis C Direct-acting antiviral agents

Current progress toward eradicating Helicobacter pylori in East Asian countries: Differences in the 2013 revised guidelines between China, Japan, and South Korea

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World Journal of Gastroenterology 2014年第6期20卷 1493-1502页

作者： Sun-Young Lee department of internal medicine Konkuk University School of Medicine

New 2013 guidelines on Helicobacter pylori(H. pylori) infection have been published in China, Japan, and South Korea. Like the previous ones, these new guidelines differ between the three countries with regard to the indications for H. pylori eradication, diagnostic methods, and treatment regimens. The most profound change among all of the guidelines is that the Japanese national health insurance system now covers the expenses for all infected subjects up to second-line treatment. This makes the Japanese indications for eradication much wider than those in China and South Korea. With regard to the diagnosis, a serum H. pylori antibody test is not recommended in China, whereas it is considered to be the most reliable method in Japan. A decrease relative to the initial antibody titer of more than 50% after 6-12 mo is considered to be the most accurate method for determining successful eradication in Japan. In contrast, only the urea breath test is recommended after eradication in China, while either noninvasive or invasive methods(except the bacterial culture) are recommended in South Korea. Due to the increased rate of antibiotics resistance, first-line treatment is omitted in China and South Korea in cases of clarithromycin resistance. Notably, the Japanese regimen consists of a lower dose of antibiotics for a shorter duration(7 d) than in the other countries. There is neither 14 d nor bismuth-based regimen in the first-line and second-line treatment in Japan. Such differences among countries might be due to differences in the approvals granted by the governments and national health insurance system in each country. Further studies are required to achieve the best results in the diagnosis and treatment of H. pylori infection based on cost-effectiveness in East Asian countries.

关键词： Helicobacter pylori Eradication Guideline Diagnosis Treatment

Peroxisome proliferator-activated receptor-delta agonist ameliorated inflammasome activation in nonalcoholic fatty liver disease

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World Journal of Gastroenterology 2015年第45期21卷 12787-12799页

作者： Hyun Jung Lee Jong Eun Yeon Eun Jung Ko Eileen L Yoon Sang Jun Suh Keunhee Kang Hae Rim Kim Seoung Hee Kang Yang Jae Yoo Jihye Je Beom Jae Lee Ji Hoon Kim Yeon Seok Seo Hyung Joon Yim Kwan Soo Byun department of internal medicine Korea University College of Medicine

AIM: To evaluate the inflammasome activation and the effect of peroxisome proliferator-activated receptors(PPAR)-δ agonist treatment in nonalcoholic fatty liver disease(NAFLD) ***: Male C57BL/6J mice were classified according to control or high fat diet(HFD) with or without PPAR-δ agonist(GW) over period of 12 wk [control, HFD, HFD + lipopolysaccharide(LPS), HFD + LPS + GW group]. Hep G2 cells were exposed to palmitic acid(PA) and/or LPS in the absence or presence of ***: HFD caused glucose intolerance and hepatic steatosis. In mice fed an HFD with LPS, caspase-1 and interleukin(IL)-1β in the liver were significantly increased. Treatment with GW ameliorated the steatosis and inhibited overexpression of pro-inflammatory cytokines. In Hep G2 cells, PA and LPS treatment markedly increased m RNA of several nucleotide-binding andoligomerization domain-like receptor family members(NLRP3, NLRP6, and NLRP10), caspase-1 and IL-1β. PA and LPS also exaggerated reactive oxygen species production. All of the above effects of PA and LPS were reduced by GW. GW also enhanced the phosphorylation of AMPK-α.CONCLUSION: PPAR-δ agonist reduces fatty acidinduced inflammation and steatosis by suppressing inflammasome activation. Targeting the inflammasome by the PPAR-δ agonist may have therapeutic implication for NAFLD.

关键词： Nonalcoholic fatty liver disease Nonalcoholic stea

Acetylsalicylic acid for metal stent in malignant distal common bile duct obstruction:A randomized controlled trial

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Hepatobiliary & Pancreatic Diseases International 2022年第5期21卷 493-499页

作者： Jin Ho Choi Kyong Joo Lee Woo Hyun Paik Namyoung Park Jung Won Chun Sang Hyub Lee Ji Kon Ryu Yong-Tae Kim department of internal medicine Liver Research InstituteSeoul National University College of MedicineSeoulKorea department of internal medicine Yonsei University Wonju College of MedicineWonjuKorea

Background:Endoscopic biliary drainage is the treatment of choice for patients with malignant distal common bile duct ***-expandable metal stents have clinical advantages including an increased duration of patency that may be prolonged by acetylsalicylic acid(ASA)*** aim of this study was to investigate whether ASA had a positive effect on the patency of self-expandable metal stents compared with ***:This prospective,multicenter,double-blinded,and randomized placebo-controlled trial was conducted from October 2017 to May 2020 in *** who underwent palliative endoscopic biliary drainage with self-expandable metal stents for malignant distal bile duct obstruction were enrolled,and allocated to ASA treatment or *** study outcomes were the rate of stent dysfunction at 6 months,duration of stent patency,risk factors for stent dysfunction,and any adverse ***:Interim analysis included 24 and 28 patients in the ASA and placebo groups,*** was no significant difference between the ASA and placebo groups in stent dysfunction(25.0%vs.20.7%,P=0.761)or the duration of stent patency(150.97±10.55 vs.158.07±8.70 days,P=0.497).Six patients experienced suspected ASA-related adverse events,and there was one lethal ***:ASA did not prolong stent *** study was terminated early because of the possibility of serious adverse events related to ASA treatment of these patients receiving palliative care.

关键词： Endoscopic retrograde cholangiopancreatography Self expandable metallic stents Randomized controlled trial Acetylsalicylic acid

Association between Helicobacter pylori status and metachronous gastric cancer after endoscopic resection

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World Journal of Gastroenterology 2016年第44期22卷 9794-9802页

作者： Sung Bum Kim Si Hyung Lee Seung Il Bae Yo Han Jeong Se Hoon Sohn Kyeong Ok Kim Byung Ik Jang Tae Nyeun Kim department of internal medicine Yeungnam University College of Medicine

AIM To investigate the effect of Helicobacter pylori(H. pylori) status test and H. pylori eradication on the occurrence of metachronous gastric cancer(MGC) after endoscopic submucosal dissection(ESD) of early gastric cancer(EGC) and risk factors of MGC. METHODS The authors retrospectively reviewed the medical records of 433 patients(441 lesions) who underwent ESD for EGC from January 2005 to January 2015 in Yeungnam University Hospital. Patients were categorized into two groups; the H. pylori tested group(n = 257) and the H. pylori non-tested group(n = 176) based on performance of H. pylori status test after ESD of EGC. The H. pylori tested group was further categorized into three subgroups based on H. pylori status; the H. pylori-eradicated subgroup(n = 120), the H. pylori-persistent subgroup(n = 42), and the H. pylori-negative subgroup(n = 95). Incidences of MGC and risk factors of MGC were *** Median follow-up duration after ESD was 30.00 mo(range, 6-107 mo). Total 15 patients developed MGC during follow-up. MGC developed in 11 patients of the H. pylori tested group(7 in the H. pylori-negative subgroup, 3 in the H. pylori-eradicated subgroup, and 1 in the H. pylori-persistent subgroup) and 4 patients of the H. pylori non-tested group(P > 0.05). The risk factors of MGC were endoscopic mucosal atrophy in the H. pylori tested group and intestinal metaplasia in all patients. CONCLUSION H. pylori eradication and H. pylori status test seems to have no preventive effect on the development of MGC after ESD for EGC. The risk factors of MGC development were endoscopic mucosal atrophy in the H. pylori tested group alone and intestinal metaplasia in all patients.

关键词： Metachronous gastric cancer Endoscopic submucosal dissection Helicobacter pylori

Epidemiological and clinical characteristics of inflammatory bowel diseases in Cairo,Egypt

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World Journal of Gastroenterology 2014年第3期20卷 814-821页

作者： Serag Esmat Mohamed El Nady Mohamed Elfekki Yehia Elsherif Mazen Naga Division of Gastroenterology Department of Internal MedicineFaculty of MedicineCairo University department of internal medicine Faculty of MedicineBeni Suef University department of Tropical medicine Faculty of MedicineCairo University

AIM: To study the natural history, patterns and clinical characteristics of inflammatory bowel diseases (IBD) in Egypt.

关键词： Natural history of Inflammatory bowel diseases, Epidemiology of Ulcerative colitis, Epidemiology of Crohn’ s disease, Epidemiology of inflammatory bowel diseases in Egypt, inflammatory bowel diseases Prevalence, Incidence of ulcerative colitis, Incidence of Crohn’ s disease