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Portal Vein Thrombosis in Non Cirrhotic Patients: Experience of Gastroenterology and Hepatology Department University Hospital Hassan II

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Open Journal of gastroenterology 2020年第12期10卷 349-356页

作者： Nada Lahmidani Mariam El Khayari Maria Lahlali Asmae Lamine Hakima Abid Mounia El Yousfi Dafr Allah Benajah Sidi Adil Ibrahimi Mohammed El Abkari department of gastroenterology and hepatology School of Medicine and Pharmacy of Fez University Hospital Hassan II University Sidi Mohammed Ben Abdallah Fez Morocco

Portal thrombosis (PT) is a rare condition of heterogeneous etiologies. The aim of our work is to study the epidemiological and etiological profile of portal thrombosis in non cirrhotic patients through the experience of our department. Patients and Methods: This is a retrospective study over a 9-year period (January 2009-July 2018), 54 cases of PT in non cirrhotic patients were collected in the department of Hepato-Gastro-Enterology of the HASSAN II Fez Hospital, 73 cases of PT were excluded among cirrhotic patients. Results: We collected 54 cases of PT cases;the average age was 45 years, with an F/M ratio of 1.42. PT was revealed by abdominal pain in 20 cases, complications of portal hypertension in 24 cases, and ultrasound discovery in 10 asymptomatic cases. Main underlying causes of PT were: A proteine S deficiency in 7 cases, Acute pancreatitis in 5 cases, colonic cancer in 4 cases, pancreatic cancer in 4 cases, Hydatic liver Echinococcoses (3 cases), anti phospholipid syndrom (3 cases), myeloproliferative syndrom (2 cases) and jak mutation 2 in 1 case, non identified etiology was reported in 20 cases (37%). Treatment was based on anticoagulation, treatment of portal hypertension complications, and etiological treatment in cases where etiological diagnosis was certainly posed. Conclusion: PT is a rare but serious condition, according to our study neoplastic causes are predominant followed by protein S deficiency. Etiological investigations have to be wide and early treatment is the best option to avoid extension and complication.

关键词： Portal Thrombosis Etiology Anticoagulant Non Cirrhotic

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Intestinal microecological transplantation for a patient with chronic radiation enteritis:A case report

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World Journal of gastroenterology 2024年第19期30卷 2603-2611页

作者： Lin Wang Yan Li Yu-Jing Zhang Li-Hua Peng department of gastroenterology and hepatology The First Medical CenterChinese PLA General HospitalBeijing 100853China department of gastroenterology and hepatology Chinese PLA Medical SchoolBeijing 100853China

BACKGROUND The gut microbiota is strongly associated with radiation-induced gut damage.This study aimed to assess the effectiveness and safety of intestinal microecological transplantation for treating patients with chronic radiation enteritis.CASE SUMMARY A 64-year-old female with cervical cancer developed abdominal pain,diarrhea,and blood in the stool 1 year after radiotherapy.An electronic colonoscopy was performed to diagnose chronic radiation enteritis.Two courses of intestinal microecological transplantation and full-length 16S rRNA microbiological analysis were performed.The patient experienced short-and long-term relief from symptoms without adverse effects.Whole 16S rRNA sequencing revealed significant differences in the intestinal flora’s composition between patient and healthy donors.Pathogenic bacteria,such as Escherichia fergusonii and Romboutsia timonensis,were more in the patient.Beneficial bacteria such as Faecalibacterium prausnitzii,Fusicatenibacter saccharivorans,Ruminococcus bromii,and Bifidobacterium longum were more in the healthy donors.Intestinal microbiota transplantation resulted in a significant change in the patient's intestinal flora composition.The composition converged with the donor's flora,with an increase in core beneficial intestinal bacteria,such as Eubacterium rectale,and a decrease in pathogenic bacteria.Changes in the intestinal flora corresponded with the patients'alleviating clinical symptoms.CONCLUSION Intestinal microecological transplantation is an effective treatment for relieving the clinical symptoms of chronic radiation enteritis by altering the composition of the intestinal flora.This study provides a new approach for treating patients with chronic radiation enteritis.

关键词： Chronic radiation enteritis Gut microbial transplantation Intestinal microecology Cancer Quality of life Case report

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Pregnancy and Crohn’s disease:concerns and assurance of medical therapy

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gastroenterology Report 2022年第1期10卷 171-177页

作者： Reezwana Chowdhury Sunanda V.Kane Division of gastroenterology and hepatology Department of MedicineJohns Hopkins UniversityBaltimoreMDUSA Division of gastroenterology and hepatology Department of MedicineMayo ClinicRochesterMNUSA

Approximately 50%of patients with inflammatory bowel disease including both Crohn’s disease and ulcerative colitis are female with many being diagnosed and treated during their reproductive years.It is important for women to be in remission prior to and during pregnancy.There have been many advances in the treatment of inflammatory bowel disease,including new therapies.In this review,we summarize the currently approved medications for Crohn’s disease and their safety in pregnancy and postpartum.The totality of evidence suggests that the majority of therapies are low-risk before and during pregnancy,and should be continued to control maternal disease.

关键词： Crohn’s disease pregnancy teratogenicity inflammatory bowel disease lactation biologics anti-TNF

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Autoimmune hepatitis and IgG4-related disease

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World Journal of gastroenterology 2019年第19期25卷 2308-2314页

作者： Kosuke Minaga Tomohiro Watanabe Hobyung Chung Masatoshi Kudo department of gastroenterology and hepatology Kindai University Faculty of Medicine department of gastroenterology and hepatology Kobe City General Hospital

IgG4-related disease(IgG4-RD) is a chronic-fibroinflammatory disorder affecting a wide range of organs. Elevation of serum IgG4 concentrations and abundant infiltration of IgG4-expressing plasma cells are key diagnostic features of this autoimmune disease. Although common organ involvement of IgG4-RD includes the salivary glands, pancreas, and bile duct, hepatic involvement is less well established. Recently, five studies identified a subtype of autoimmune hepatitis(AIH), called IgG4-associated AIH(IgG4-AIH). IgG4-AIH is diagnosed based on significant accumulation of IgG4-expressing plasmacytes in the liver in patients who met the diagnostic criteria for classical AIH. Although four of the five reports regarded IgG4-AIH based on hepatic accumulation of IgG4-positive cells alone, one report diagnosed IgG4-AIH based on both hepatic accumulation of IgG4-positive cells and elevated serum concentrations of IgG4. IgG4-AIH diagnosed based on the latter criteria may be a hepatic manifestation of IgG4-RD whereas IgG4-AIH diagnosed based on the former criteria may be a subtype of AIH. In this review article, we summarize and discuss clinicopathological features of IgG4-AIH.

关键词： Autoimmune hepatitis IgG4 IgG4-related disease IgG4-associated autoimmune hepatitis

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Novel non-invasive score to predict cirrhosis in the era of hepatitis C elimination: A population study of ex-substance users in Singapore

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Hepatobiliary & Pancreatic Diseases International 2019年第2期18卷 143-148页

作者： Yue Zhao Prem Harichander Thurairajah Rahul Kumar Jessica Tan Eng Kiong Teo John Chen Hsiang department of gastroenterology and hepatology Changi General Hospital

Background: Chronic hepatitis C infection is common among people with history of substance use. Liver fibrosis assessment is a barrier to linkage to care, particularly among those with history of substance users. The use of non-invasive scores can be helpful in predicting liver cirrhosis in the era of HCV elimination, especially in countries where transient elastography(TE) is not available. We compared the commonly used non-invasive scores with a novel non-invasive score in predicting liver cirrhosis in this population. Methods: HCV patients with history of substance use between 2011 and 2016 were analyzed. All patients had TE for liver fibrosis assessment. Clinical performance of established non-invasive scores for fibrosis assessment and novel score were compared. Youden's index was used to determine optimal cut-off of the novel score. Results: A total of 579 patients were included. In multivariate logistic regression, cirrhosis on TE was associated with age( P = 0.002), aspartate aminotransferase(AST)( P = 0.004), and platelet count( P < 0.001), but not alanine aminotransferase(ALT)( P = 0.896). These form the components of modified AST-toplatelet ratio index(APRI) score. Modified APRI was superior to APRI in predicting cirrhosis(AUROC, 0.796 vs. 0.770, P = 0.007), but not fibrosis-4 score(FIB-4)( P = 1.00). Modified APRI at cut-off of 4 has sensitivity, specificity and negative predictive value(NPV) of 94.4%, 26.9% and 92.6%, respectively, and at 19, has sensitivity, specificity and positive predictive value(PPV) of 33.3%, 96.2% and 77.1%, respectively. FIB-4 has a NPV and PPV of 88.6%, 41.8% and 78.5%, 77.6%, at cut-off of 1.45 and 3.25, respectively. Using the cut-off of 4 and 14 for modified APRI, 32.5% of patients can be correctly classified and misses out only 5.6% of cirrhosis patients. Conclusions: Modified APRI score is superior in predicting cirrhosis in HCV population, with 32.5% of the population being correctly classified using cut-off of 4 and 14. Further studies are required to validate the fin

关键词： Hepatitis C Cirrhosis Fibrosis assessment AST-to-platelet ratio index Modified APRI Fibrosis-4 score

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Pathophysiology and Prevention of Paracentesis-induced Circulatory Dysfunction:A Concise Review

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Journal of Clinical and Translational hepatology 2020年第1期8卷 42-48页

作者： Anand V Kulkarni Pramod Kumar Mithun Sharma T R Sowmya Rupjyoti Talukdar Padaki Nagaraj Rao D Nageshwar Reddy department of hepatology Asian Institute of GastroenterologyHyderabadIndia department of gastroenterology Asian Institute of GastroenterologyHyderabadIndia

Annually,10%of cirrhotic patients with ascites develop refractory ascites for which large-volume paracentesis(LVP)is a frequently used therapeutic procedure.LVP,although a safe method,is associated with circulatory dysfunction in a significant percentage of patients,which is termed para-centesis-induced circulatory dysfunction(PICD).PICD results in faster reaccumulation of ascites,hyponatremia,renal impairment,and shorter survival.PICD is diagnosed through laboratory results,with increases of>50%of baseline plasma renin activity to a value≥4 ng/mL/h on the fifth to sixth day after paracentesis.In this review,we discuss the pathophysi-ology and prevention of PICD.

关键词： Refractory ascites Plasma renin activity Large-volume paracentesis Cirrhosis Portal hypertension

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Deep hyperammonemic hepatic encephalopathy precipitated by fecal microbiota transplantation for fulminant Clostridioides difficile infection

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gastroenterology Report 2022年第1期10卷 612-614页

作者： Lotte Lindgreen Eriksen Simon Mark Dahl Baunwall Peter Lykke Eriksen Kirstine Petrea Bak-Fredslund Jens Erik Nielsen Jens Frederik Dahlerup Karen Louise Thomsen Hendrik Vilstrup Christian Lodberg Hvas department of hepatology and gastroenterology Aarhus University HospitalAarhus NDenmark department of hepatology and gastroenterology Randers Regional HospitalRandersDenmark department of Radiology Aarhus University HospitalAarhus NDenmark

Introduction Fecal microbiota transplantation(FMT)is highly effective and potentially life-saving for recurrent Clostridioides difficile infection(CDI)[1].Recent pilot trials also reported the use of FMT to revert hepatic encephalopathy(HE)in patients with decompensated liver cirrhosis without infectious colitis[2,3].Intestinal microbiota-driven hyperammonemia is central to HE development and most treatments aim to reduce ammonia levels by modulating the intestinal microbiota.However,FMT might lead to increased intestinal ammonia production,as we describe here.

关键词： hepatic infection encephalopathy

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Prevalence of-and risk factors for work disability in Dutch patients with inflammatory bowel disease

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World Journal of gastroenterology 2017年第46期23卷 8182-8192页

作者： Lieke M Spekhorst Bas Oldenburg Ad A van Bodegraven Dirk J de Jong Floris Imhann Andrea E van der Meulen-de Jong Marieke J Pierik Janneke C van der Woude Gerard Dijkstra Geert D'Haens Mark Lowenberg Rinse K Weersma Eleonora AM Festen 无 department of gastroenterology and hepatology University of Groningen and University Medical Centre Groningen department of Genetics University of Groningen and University Medical Centre Groningen department of gastroenterology and hepatology University Medical Center Utrecht department of gastroenterology and hepatology VU University Medical Center department of gastroenterology and hepatology University Medical Center St. Radboud department of gastroenterology and hepatology Leiden University Medical Center department of gastroenterology and hepatology University Medical Center Maastricht department of gastroenterology and hepatology Erasmus Medical Center department of gastroenterology and hepatology Amsterdam Medical Center Parelsnoer Institute and the Dutch Initiative on Crohn and Colitis

AIM To determine the prevalence of work disability in inflammatory bowel disease(IBD), and to assess risk factors associated with work disability.METHODS For this retrospective cohort study, we retrieved clinical data from the Dutch IBD Biobank on July 2014, containing electronic patient records of 3388 IBD patients treated in the eight University Medical Centers in the Netherlands. Prevalence of work disability was assessed in 2794 IBD patients and compared with the general Dutch population. Multivariate analyses were performed for work disability(sick leave, partial and full disability) and long-term full work disability(> 80% work disability for > 2 years).RESULTS Prevalence of work disability was higher in Crohn's disease(CD)(29%) and ulcerative colitis(UC)(19%) patients compared to the general Dutch population(7%). In all IBD patients, female sex, a lower education level, and extra-intestinal manifestations, were associated with work disability. In CD patients, an age > 40 years at diagnosis, disease duration > 15 years,smoking, surgical interventions, and anti-TNFα use were associated with work disability. In UC patients, an age > 55 years, and immunomodulator use were associated with work disability. In CD patients, a lower education level(OR = 1.62, 95%CI: 1.02-2.58), and in UC patients, disease complications(OR = 3.39, 95%CI: 1.09-10.58) were associated with long-term full work disability.CONCLUSION The prevalence of work disability in IBD patients is higher than in the general Dutch population. Early assessment of risk factors for work disability is necessary, as work disability is substantial among IBD patients.

关键词： Inflammatory bowel disease Crohn’s disease Ulcerative colitis Work disability Health care costs

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Epidemiology of inflammatory bowel disease in South America: A systematic review

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World Journal of gastroenterology 2019年第47期25卷 6866-6875页

作者： Sriharan Selvaratnam Santiago Gullino Lisa Shim Eric Lee Alice Lee Sudarshan Paramsothy Rupert W Leong department of gastroenterology and hepatology Macquarie University Hospital

BACKGROUND The worldwide epidemiology of inflammatory bowel disease(IBD)is rapidly changing.Increasing Crohn’s disease(CD)and ulcerative colitis(UC)incidence and prevalence have been recorded in developing regions such as Asia,Africa and Eastern Europe where it was previously thought to be uncommon.Whether this is also the case in South America is not well known.Demonstration that developing regions worldwide have increasing IBD incidence would indicate that environmental change plays a significant role in the development of IBD.AIM To report the incidence,prevalence and disease characteristics of CD and UC within the South American continent.METHODS A systematic review was conducted by searching published studies in major international and regional databases(MEDLINE,EMBASE and Scopus)between January 1990 and December 2018.Outcomes considered were incidence,prevalence,phenotype,environmental and genetic factors,ethnicity and gender.A pair of independent reviewers screened and reviewed all identified articles.RESULTS One hundred and sixty two citations were initially retrieved with 18 studies included in this systematic review.The majority of included studies were from Brazil(n=13,72%).The incidence of UC ranged from 4.3-5.3/100000 personyears whilst the incidence of CD ranged from 0.74-3.5/100000 person-years.Prevalence ranged from 15.0-24.1/100000 inhabitants for UC and from 2.4-14.1/100000 inhabitants for CD.The incidence and prevalence of both UC and CD has increased significantly in Brazil over the past 21 years.Pancolitis was the most common disease distribution in patients with UC whilst colonic involvement was the most common distribution in CD.People residing in urban areas were at higher risk of developing both CD and UC.CONCLUSION The IBD burden in South America is increasing at a rate possibly even greater than other developing regions around the world.There is a paucity of highquality epidemiological studies and further robust and representative data are required to further explore modifiable risk fac

关键词： Inflammatory bowel disease Crohn’s disease Ulcerative colitis South America Epidemiology

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Obesity and chronic diarrhea: a new syndrome?

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Chinese Medical Journal 2022年第15期135卷 1806-1807页

作者： Enqiang Linghu department of gastroenterology and hepatology Chinese PLA General HospitalBeijing 100853China

Obesity has become a global epidemic,and the prevalenceof obesity has increased to pandemic levels over the past 50 years.[1]fiAccording tothe statistics of the World Health Organization(WHO),there are>2.1 billion ove... 详细信息

关键词： Obesity diarrhea obesity

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