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Factors associated with early virological response to peginterferon-α-2a/ribavirin in chronic hepatitis C

World Journal of gastroenterology 2013年第12期19卷 1943-1952页

作者： Javier García-Samaniego Miriam Romero Rafael Granados Remedios Alemán Miguel Jorge Juan Dolores Suárez Ramón Pérez Gregorio Castellano Carlos González-Portela Liver Unit Hospital Carlos Ⅲ Centro de Investigación Biómedica en Red de Enfermedades Hepáticas y Digestivas Department of gastroenterology Hospital Universitario de Gran Canaria gastroenterology service Hospital Universitario de Canarias Department of gastroenterology Hospital Universitario Insular de Gran Canaria Internal Medicine service Hospital Arquitecto Marcide gastroenterology service Hospital Central de Asturias gastroenterology service Hospital 12 de Octubre gastroenterology service Hospital Policlínico de Vigo

AIM: To evaluate the impact of sociodemographic/clinical factors on early virological response (EVR) to pegin-terferon/ribavirin for chronic hepatitis C (CHC) in clinical practice. METHODS: We conducted a multicenter, cross-sectional, observational study in Hepatology Units of 91 Spanish hospitals. CHC patients treated with peginterferon α-2a plus ribavirin were included. EVR was defined as undetectable hepatitis C virus (HCV)-ribonucleic acid (RNA) or ≥ 2 log HCV-RNA decrease after 12 wk of treatment. A bivariate analysis of sociodemographic and clinical variables associated with EVR was carried out. Independent factors associated with an EVR were analyzed using a multiple regression analysis that included the following baseline demographic and clinical variables: age (≤ 40 years vs > 40 years), gender, race, educational level, marital status and family status, weight, alcohol and tobacco consumption, source of HCV infection, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, and gamma glutamyl transpeptidase (GGT) (≤ 85 IU/mL vs > 85 IU/mL), serum ferritin, serum HCV-RNA concentration ( 400 000 IU/mL in 74% of patients. The mean ALT and AST levels were 88.4 ± 69.7 IU/mL and 73.9 ± 64.4 IU/mL, respectively, and mean GGT level was 82 ± 91.6 IU/mL. The mean ferritin level was 266 ± 284.8 μg/L. Only 6.2% of patients presented with cirrhosis. All patients received 180 mg of peginterferon α-2a. The most frequently used ribavirin doses were 1000 mg/d (41%) and 1200 mg/d (41%).

关键词： Antiviral therapy Baseline factors Early virological response Peginterferon α-2a Ribavirin

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Patency and agile capsules

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World Journal of gastroenterology 2008年第34期14卷 5269-5273页

作者： ngel Caunedo-lvarez Javier Romero-Vazquez Juan M Herrerias-Gutierrez gastroenterology service "Virgen Macarena" University Hospital

Small bowel strictures can be missed by current diagnostic methods. The Patency capsule is a new non-endoscopic dissolvable capsule which has as an objective of checking the patency of digestive tract, in a non-invasive manner. The available clinical trials have demonstrated that the Patency capsule is a good tool for assessment of the functional patency of the small bowel, and it allows identification of those patients who can safely undergo a capsule endoscopy, despite clinical and radiographic evidence of small-bowel obstruction. Some cases of intestinal occlusion have been reported with the Patency capsule, four of them needed surgery. So, a new capsule with two timer plugs (Agile capsule) has been recently developed in order to minimize the risk of occlusion. This new device stars its dissolution process earlier (30 h after ingestion) and its two timer plugs have been designed to begin the disintegration even when the device is blocked in a tight stricture.

关键词： Capsule endoscopy Patency capsule Agile capsule Small bowel strictures

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High prevalence of cholestasis, with increased conjugated bile acids in inflammatory bowel diseases patients

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World Journal of Clinical Cases 2018年第4期6卷 44-53页

作者： Marc Girardin Antoine Hadengue Jean-Louis Frossard service of gastroenterology and Hepatology Geneva University Hospital

AIM To investigate the prevalence and causes of cholestasis in patients with inflammatory bowel diseases in the Swiss Inflammatory Bowel Diseases Cohort. METHODS A retrospective cohort study was performed of all the patients in the Swiss Inflammatory bowel disease Cohort. Total bile acid was measured for all patients and cholestasis was defined as a concentration > 8 μmol/L. The characteristics of patients with or without cholestasis were compared. Bile acid profiles were then determined for 80 patients with high total bile acid and 80 matched patients with low total bile acid. Bile acid profiles were compared for smokers vs nonsmokers, ileal vs colonic disease, and inflammatory vs non inflammatory *** Ninety-six patients had more than 8 μmol/L total bile acid, giving a prevalence of 7.15%. Patients with an obvious cause of cholestasis, such as primary sclerosing cholangitis, were then excluded, leaving 1190 participants with total bile acid 8 μmol/L. In multivariate analysis, calcium supplementation was significantly associated with cholestasis(odds ratio, 2.36, 95%CI: 1.00-5.21, P = 0.040) whereas current smoking significantly reduced the risk of cholestasis(odds ratio, 0.42, 95%CI: 0.17-0.91, P = 0.041). Levels of all conjugated bile acids were higher in the cholestasis group than in the control group. When we compared patients with ileal vs colonic disease, the former had higher levels of primary, secondary, and tertiary bile acids whereas patients with colonic disease had higher levels of conjugated bile *** Prevalence of cholestasis is high. Smoking appears to reduce cholestasis. Conjugated bile acids are higher in cholestasis and in colonic disease whereas unconjugated in ileal disease.

关键词： Lipid Liver Crohn’s disease Ulcerative colitis Cholestasis

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Acute-on-chronic liver failure:Pathogenesis,prognostic factors and management

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World Journal of gastroenterology 2015年第42期21卷 12125-12140页

作者： Sara Blasco-Algora José Masegosa-Ataz María Luisa Gutiérrez-García Sonia Alonso-López Conrado M Fernández-Rodríguez service of gastroenterology Hospital Universitario Fundación

Acute-on-chronic liver failure(ACLF) is increasingly recognized as a complex syndrome that is reversiblein many cases. It is characterized by an acute deterioration of liver function in the background of a pre-existing chronic liver disease often associated with a high short-term mortality rate. Organ failure(OF) is always associated, and plays a key role in determining the course, and the outcome of the disease. The definition of ACLF remains controversial due to its overall ambiguity, with several disparate criteria among various associations dedicated to the study of liver diseases. Although the precise pathogenesis needs to be clarified, it appears that an altered host response to injury might be a contributing factor caused by immune dysfunction, ultimately leading to a pro-inflammatory status, and eventually to OF. The PIRO concept(Predisposition, Insult, Response and Organ Failure) has been proposed to better approach the underlying mechanisms. It is accepted that ACLF is a different and specific form of liver failure, where a precipitating event is always involved, even though it cannot always be ascertained. According to several studies, infections and active alcoholism often trigger ACLF. Viral hepatitis, gastrointestinal haemorrhage, or drug induced liver injury, which can also provoke the syndrome. This review mainly focuses on the physiopathology and prognostic aspects. We believe these features are essential to further understanding and providing the rationale for improveddisease management strategies.

关键词： Acute on-chronic liver failure Immune dysfunction

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Capsule endoscopy in patients refusing conventional endoscopy

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World Journal of gastroenterology 2014年第23期20卷 7424-7433页

作者： Javier Romero-Vázquez Federico Argüelles-Arias Josefa Maria García-Montes ángel Caunedo-álvarez Francisco Javier Pellicer-Bautista Juan Manuel Herrerías-Gutiérrez gastroenterology service Virgen Macarena University Hospital41071 SevilleSpain

Capsule endoscopy is nowadays the diagnostic technique of choice in the study of small bowel pathologies,allowing the non-invasive study of the entire *** has led,together with new technical advances,to the creation of two new models(PillCam ESO and PillCam Colon)for the study of esophageal and colonic *** two new capsules offer an interesting alternative to conventional endoscopy in the study of the upper and lower digestive tracts,because traditional endoscopy is often unpleasant and uncomfortable for the patient,can be painful,often requires moderate or deep sedation and is not without complications(hemorrhage,perforation,etc.).PillCam Colon is particularly important for its usefulness in the diagnosis of colonic polyps,and is a potentially useful tool in cases of incomplete colonoscopy or in colorectal cancer screening,even more when most patients are reluctant to undergo screening programs due to the said disadvantages of conventional *** article discusses the advantages of capsule endoscopy over conventional endoscopy,its current application possibilities and indications in routine clinical *** the various sections of the work,we assess the application of endoscopic capsule in different sections of the digestive tract(esophagus,stomach,and colon)and finally the potential role of panendoscopy with PillCam Colon.

关键词： Conventional endoscopy Capsule endoscopy Esophageal capsule endoscopy Colon capsule endoscopy Panendoscopy

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Prevalence of HBs Antigen, and HCV and HIV Antibodies in a Young Male Population in Cameroon

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Open Journal of gastroenterology 2015年第12期5卷 185-190页

作者： Dominique Noah Noah Firmin Ankouane Andoulo Brice Valery Moussima Essoh Georges Nko’O Ayissi Servais Albert Fiacre Eloumou Bagnaka Magloire Biwole Sida Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon gastroenterology service of the yaounde central hospital Yaounde Cameroon Faculty of Medicine and Biomedical Sciences University of Yaounde 1 Yaounde Cameroon Hepatology and gastroenterology Department Yaounde University Teaching Hospital (CHU) Yaounde Cameroon Douala General hospital Douala Cameroon

Introduction: According to WHO estimates, 57% of cases of liver cirrhosis and 78% of primary liver carcinoma are caused by a hepatitis B or C virus. This study aimed to assess the prevalence of these diseases and HIV among a young male population, according to region. Methods: This was a descriptive cross-sectional study conducted from 17 February to 31 March 2014 in the ten administrative regions of Cameroon. The study included male subjects of Cameroonian nationality aged at least 18 and at most 23, and living in the regions concerned. It excluded subjects that did not match the age, gender, and nationality criteria. For each subject, 10 ml of blood was collected in a dry tube. After centrifugation at 3000 RPM for 5 minutes, the serum was collected for the detection of viral infections. For subjects that tested positive, a confirmatory test was conducted. Results: In total, 4367 subjects were selected, with an average age of 20.46 (+/- 1.17) years. The prevalence of hepatitis B virus stood at 13.01% (with 95% CI: 12.03% - 14.05%). That of viral hepatitis C was 0.30% (95% CI: 0.17% - 0.52%). Co-infection with hepatitis B and C viruses was 0.05% (95% CI: 0.01% - 0.18%). The prevalence of HIV infection was 1.01% (95% CI: 0.74% - 1.36%). Conclusion: The overall prevalence of HBsAg in the population of young males is high. It tallies with the early vertical and horizontal modes of transmission that prevail in our environment.

关键词： Hepatitis B Virus Hepatitis C Virus HIV Infection Young Male Population Cameroon

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Non-invasive methods for liver fi brosis prediction in hemochromatosis:One step beyond

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World Journal of Hepatology 2010年第7期2卷 251-255页

作者： Agustin Castiella Eva Zapata José M Alústiza gastroenterology service Mendaro Hospital Radiology service Osatek Donostia

Advances in recent years in the understanding of, and the genetic diagnosis of hereditary hemochromatosis (HH) have changed the approach to iron overload he-reditary diseases. The ability to use a radiologic tool (MRI) that accurately provides liver iron concentration determination, and the presence of non-invasive sero-logic markers for fibrosis prediction (ser um ferritin, platelet count, transaminases, etc), have diminished the need for liver biopsy for diagnosis and prognosis of this disease. Consequently, the role of liv er biopsy in iron metabolism disorders is changing. Furthermore, the irruption of transient elastography to assess liver stiffness, and, more recently, the ability to determine liver f ibrosis by means of MRI elastography will change this role even more, with a potential drastic decline in hepatic biopsies in years to come. This review will provide a brief summary of the different non-invasive methods available nowadays for diagnosis and prognosis in HH, and point out potential new techniques that could come about in the next years for fibrosis prediction, thus avoiding the need for liver biopsy in a greater number of patients. It is possible that liver biopsy will remain useful for the diagnosis of associated diseases, where other non-invasive means are not po-ssible, or for those rare cases displaying discrepancies between radiological and biochemical markers.

关键词： Hemochromatosis Iron overload Liver fibrosis Non-invasive Magnetic resonance imaging Ultrasound elastography

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Celiac disease

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World Journal of gastroenterology 2006年第41期12卷 6585-6593页

作者： Luis Rodrigo gastroenterology service University Hospital Central AsturiasOviedoSpain

Celiac disease （CD） is a common autoimmune disorder, induced by the intake of gluten proteins present in wheat, barley and rye. Contrary to common belief, this disorder is a protean systemic disease, rather than merely a pure digestive alteration. CD is closely associated with genes that code HLA-Ⅱ antigens, mainly of DQ2 and DQ8 classes. Previously, it was considered to be a rare childhood disorder, but is actually considered a frequent condition, present at any age, which may have multiple complications. Tissue transglutaminase-2 （tTG）, appears to be an important component of this disease, both, in its pathogenesis and diagnosis. Active CD is characterized by intestinal and/or extra-intestinal symptoms, villous atrophy and crypt hyperplasia, and strongly positive tTG auto-antibodies. The duodenal biopsy is considered to be the ＂gold standard＂ for diagnosis, but its practice has significant limitations in its interpretation, especially in adults. Occasionally, it results in a false-negative because of patchy mucosal changes and the presence of mucosal villous atrophy is often more severe in the proximal jejunum, usually not reached by endoscopic biopsies. CD is associated with increased rates of several diseases, such as iron deficiency anemia, osteoporosis, dermatitis herpetiformis, several neurologic and endocrine diseases, persistent chronic hypertransami-nasemia of unknown origin, various types of cancer and other autoimmune disorders. Treatment of CD dictates a strict, life-long gluten-free diet, which results in remission for most individuals, although its effect on some associated extraintestinal manifestations remains to be established.

关键词： Celiac disease Tissue transglutaminase antibodies Autoimmune disorders Gluten-free diet

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Endoscopic management of complications of chronic pancreatitis

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World Journal of gastroenterology 2013年第42期19卷 7308-7315页

作者： Jean-Marc Dumonceau Carlos Macias-Gomez Division of gastroenterology and Hepatology Geneva University Hospital1211 GenevaSwitzerland Gastrointestinal Endoscopy Unit Gastroenterology ServiceItalian Hospital1181 Buenos AiresArgentina

Pseudocysts and biliary obstructions will affect approximately one third of patients with chronic pancreatitis(CP).For CP-related,uncomplicated,pancreatic pseudocysts(PPC),endoscopy is the first-choice therapeutic *** advances have focused on endosonography-guided PPC transmural drainage,which tends to replace the conventional,duodenoscope-based coma immediately *** material is being tested to facilitate the endosonography-guided *** this review,the most adequate techniques depending on PPC characteristics are presented along with supporting *** CP-related biliary obstructions,endoscopy and surgery are valid therapeutic *** co-morbidities(e.g.,portal cavernoma)and expected patient compliance to repeat endoscopic procedures are important factors when selecting the most adapted *** should be reasonably ruled out before embarking on the endoscopic treatment of presumed CP-related biliary *** endoscopy,the gold standard technique consists of placing simultaneous,multiple,side-by-side,plastic stents for a oneyear *** covered self-expandable metal stents are challenging this method and have provided 50%mid-term success.

关键词： Biliary stricture Chronic pancreatitis Pseudocyst Endoscopic retrograde cholangio-pancreatography Endoscopic ultrasonography Stent

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Recurrent Clostridium difficile infections:The importance of the intestinal microbiota

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World Journal of gastroenterology 2014年第23期20卷 7416-7423页

作者： Marie Céline Zanella Terrier Martine Louis Simonet Philippe Bichard Jean Louis Frossard service of General Internal Medicine Geneva University Hospital1211 GenevaSwitzerland service of gastroenterology and Hepatology Geneva University Hospital1211 GenevaSwitzerland

Clostridium difficile infections(CDI)are a leading cause of antibiotic-associated and nosocomial *** effective antibiotic treatments,recurrent infections are *** the recent emergence of hypervirulent isolates of ***,CDI is a growing epidemic with higher rates of recurrence,increasing severity and *** microbiota transplantation(FMT)is an alternative treatment for recurrent CDI.A better understanding of intestinal microbiota and its role in CDI has opened the door to this promising therapeutic *** is thought to resolve dysbiosis by restoring gut microbiota diversity thereby breaking the cycle of recurrent *** the first reported use of FMT for recurrent CDI in 1958,systematic reviews of case series and case report have shown its effectiveness with high resolution rates compared to standard antibiotic *** article focuses on current guidelines for CDI treatment,the role of intestinal microbiota in CDI recurrence and current evidence about FMT efficacy,adverse effects and acceptability.

关键词： Clostridium difficile infection Clostridium difficile recurrence Fecal microbiota transplantation Stool transplantation Microbiota

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