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Effect of Aspergillus niger prolyl endopeptidase in patients with celiac disease on a long-term gluten-free diet

World Journal of gastroenterology 2024年第11期30卷 1545-1555页

作者： Juan Pablo Stefanolo Verónica Segura Martina Grizzuti Abel Heredia Isabel Comino Ana Florencia Costa Roberto Puebla María Paz Temprano Sonia Isabel Niveloni Gabriel de Diego María E Oregui Edgardo Gustavo Smecuol Mauricio C de Marzi Elena F Verdú Carolina Sousa Julio César Bai Small Bowel Section Department of MedicineGastroenterology Hospital of Buenos Aires“Dr.C.Bonorino Udaondo”Buenos Aires 1264Argentina department of Microbiology and Parasitology Faculty of PharmacyUniversity of SevilleSeville 41080Spain department of Medicine Dr.C.Bonorino Udaondo Gastroenterology HospitalBuenos Aires 1264Argentina Basic and Applied Research Group in Immunology and Bioactives(GIBAIB) Institute of Ecology and Sustainable Development(INEDES)National University of LujanLuján 6700Buenos AiresArgentina department of Medicine Farncombe Family Digestive Health Research InstituteMcMaster UniversityHamilton L8S 4L8OntarioCanada Facultad de Medicina Universidad del SalvadorBuenos Aires C1051ABBArgentina

BACKGROUND The gluten-free diet(GFD)has limitations,and there is intense research in the development of adjuvant *** To examine the effects of orally administered Aspergillus niger prolyl endopeptidase protease(AN-PEP)on inadvertent gluten exposure and symptom prevention in adult celiac disease(CeD)patients following their usual *** This was an exploratory,double-blind,randomized,placebo-controlled trial that enrolled CeD patients on a long-term *** a 4-wk run-in period,patients were randomized to 4 wk of two AN-PEP capsules(GliadinX;AVI Research,LLC,United States)at each of three meals per day or *** endpoints were:(1)Average weekly stool gluten immunogenic peptides(GIP)between the run-in and end of treatments and between AN-PEP and placebo;(2)celiac symptom index(CSI);(3)CeD-specific serology;and(4)quality of *** samples were collected for GIP testing by ELISA every Tuesday and Friday during run-ins and *** Forty patients were randomized for the intention-to-treat analysis,and three were excluded from the per-protocol ***,628/640(98.1%)stool samples were *** was undetectable(0.32μg/g)to potentially cause mucosal *** GIP concentration in the AN-PEP arm was 44.7%lower than in the run-in ***-third of patients exhibiting GIP>0.08μg/g during run-in had lower or undetectable GIP after AN-PEP *** with the run-in period,the proportion of symptomatic patients(CSI>38)in the AN-PEP arm was significantly lower(P<0.03).AN-PEP did not result in changes in specific *** This exploratory study conducted in a real-life setting revealed high adherence to the *** AN-PEP treatment did not significantly reduce the overall GIP stool ***,given the observation of a significantly lower prevale

关键词： Celiac disease Aspergillus niger prolyl endoprotease Gluten immunogenic peptides Trial Symptoms Real-life trial

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Addition of statins to the standard treatment in patients with cirrhosis:Safety and efficacy

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World Journal of gastroenterology 2021年第28期27卷 4639-4652页

作者： Alberto E Muñoz Florencia D Pollarsky Mónica Marino Mariano Cartier Horacio Vázquez Pablo Salgado Gustavo Romero Sección Hepatología Hospital de Gastroenterología Dr.Carlos Bonorino UdaondoFacultad de MedicinaUniversidad de Buenos AiresCiudad Autónoma de Buenos Aires 1264Argentina Instituto de Investigaciones en Salud Pública Facultad de OdontologíaUniversidad de Buenos AiresCiudad Autónoma de Buenos Aires 1122Argentina Unidad Clínica Hospital de Gastroenterología Dr.Carlos Bonorino UdaondoInvestigador Asociado del Gobierno de la Ciudad Autónoma de Buenos AiresCiudad Autónoma de Buenos Aires 1264Argentina

This review summarizes the safety and efficacy of statins in patients with *** to concerns about the safety of statins in patients with impaired liver function,they have recently been investigated as a potential treatment option in *** most clinically significant adverse event is statin-related myopathy,and this may be related to the high serum statin concentrations in the setting of severely impaired liver *** is the most serious and potentially life-threatening *** has recently been demonstrated that the recommended dose of simvastatin in patients with decompensated cirrhosis would be 20 mg/d because higher values,such as 40 mg/d,are associated with many adverse events,especially muscle ***,simvastatin should not be administered to patients with Model for End-stage Liver Disease score>12 and/or Child-Pugh class C because of the high risk of severe muscle *** to the pleiotropic effects,the focus on statins has shifted from being considered harmful to something *** these effects,statins could prevent liver-related morbidity and mortality in cirrhotic *** studies in large populations of patients with cirrhosis have shown that treatment with statins to decrease high cholesterol levels was associated with a reduced risk of hepatic decompensation,hepatocellular carcinoma development and *** few randomized controlled trials in patients with cirrhosis and portal hypertension showed that statins lower portal pressure,quite likely through a reduction in hepatic *** large randomized controlled trial in patients with variceal bleeding showed that simvastatin in addition to standard of care did not prevent rebleeding but improved survival *** these encouraging outcomes,the quality of the evidence regarding the use of statins is low or very low due to the observational characteristics of most of the studies ***,it is advisable to per

关键词： Cirrhosis Liver disease Statins Safety Efficiency

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Helicobacter pylori and corpus gastric pathology are associated with lower serum ghrelin

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World Journal of gastroenterology 2018年第3期24卷 397-407页

作者： Paula Mantero Gonzalo Sebastián Matus Rodolfo Ernesto Corti Ana María Cabanne Gerardo Gabriel Zerbetto de Palma Liliana Marchesi Olid María Marta Piskorz Marcela Beatriz Zubillaga Mariana Andrea Janjetic Cinthia Gabriela Goldman Universidad de Buenos Aires Facultad de Farmacia y BioquímicaCátedra de FísicaBuenos Aires C1113AADArgentina hospital de gastroenterología“dr.carlos bonorino udaondo” Sección Esófago-EstómagoBuenos Aires C1264AAAArgentina hospital de gastroenterología"dr.carlos bonorino udaondo” Unidad PatologíaBuenos Aires C1264AAAArgentina Universidad de Buenos Aires-CONICET Facultad de MedicinaInstituto de Microbiología y Parasitología Médica(IMPAM)Buenos Aires C1121ABGArgentina Universidad de Buenos Aires Facultad de MedicinaEscuela de NutriciónBuenos Aires C1121ABGArgentina hospital de Clínicas“Joséde San Martín” División GastroenterologíaBuenos Aires C1120AARArgentina National Scientific and Technical Research Council(CONICET) Buenos Aires C1425FQBArgentina

AIM To evaluate the association of Helicobacter pylori(H. pylori), cag A genotype, and type of gastric pathology with ghrelin, leptin and nutritional *** Fasted dyspeptic adults(18-70 years) referred for an upper digestive endoscopy were enrolled in this crosssectional study. Height and weight were assessed for body mass index(BMI) calculation. A sociodemographic survey was administered and nutrient intake was evaluated with 24 h dietary recalls. Serum total ghrelin and leptin levels were analyzed by enzymelinked immunosorbent assay. 13 C-Urea Breath Test was performed and four gastric biopsies were obtained during endoscopy for histopathology and H. pylori DNA amplification and genotyping. Data analysis was performed using χ2, Mann-Whitney U, Kruskal-Wallis tests, Spearman's correlation and linear *** One hundred and sixty-three patients(40.8 ± 14.0 years), 98/65 females/males, were included. Overall, persistent H. pylori prevalence was 53.4%(95%CI: 45.7%-65.8%). Neither nutrient intake nor BMI differed significantly between H. pylori positive and negative groups. Serum ghrelin was significantly lower in infected patients [median 311.0 pg/m L(IQR 230.0-385.5)] than in uninfected ones [median 355.0 pg/m L(IQR 253.8-547.8)](P = 0.025), even after adjusting for BMI and gender(P = 0.03). Ghrelin levels tended to be lower in patients carrying cag A positive strains both in the antrum and the corpus; however, differences with those carrying cag A negative strains did not reach statistical significance(P = 0.50 and P = 0.49, respectively). In addition, the type and severity of gastric pathology in the corpus was associated with lower serum ghrelin(P = 0.04), independently of *** status. Conversely, leptin levels did not differ significantly between infected and uninfected patients [median 1.84 ng/m L(0.80-4.85) vs 1.84 ng/m L(0.50-5.09),(P = 0.51)]. CONCLUSION H. pylori infection and severity of gastric corpus pathology are associated with l

关键词： Helicobacter pylori cagA Ghrelin Leptin Pathology

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Celiac disease serology in patients with different pretest probabilities: Is biopsy avoidable?

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World Journal of gastroenterology 2010年第25期16卷 3144-3152页

作者： Emilia Sugai María L Moreno Hui J Hwang Ana Cabanne Adriana Crivelli Fabio Nach-man Horacio Vázquez Sonia Niveloni Julio Argonz Roberto Mazure Graciela La Motta María E Caniggia Edgardo Smecuol Néstor Chopita Juan C Gómez Eduardo Maurińo Julio C Bai Small Bowel Section department of Medicine Gastroenterology Hospital "Dr. C. Bonorino Udaondo" Caseros 2061 Ciudad de Buenos Aires Argentina Pathology Service hospital de Gastroenter-ología "dr. C. bonorino udaondo" Av. Caseros 2061 Ciudad de Buenos Aires Argentina USNMA HIGA "San Martín" La Plata B1900 Provincia de Buenos Aires Argentina Endoscopy Service Hospital de Gastroenter-ología "Dr. C. Bonorino Udaondo" Av. Caseros 2061 Ciudad de Buenos Aires Argentina Endoscopy Service HIGA "San Martín" La Plata

AIM: To establish the diagnostic performance of sev-eral serological tests, individually and in combination, for diagnosing celiac disease (CD) in patients with different pretest probabilities, and to explore potential se- rological algorithms to reduce the necessity for biopsy. METHODS: We prospectively performed duodenal biopsy and serology in 679 adults who had either high risk (n = 161) or low risk (n = 518) for CD. Blood samples were tested using six assays (enzyme-linked immunosorbent assay) that detected antibodies to tissue transglutaminase (tTG) and deamidated gliadin peptide (DGP). RESULTS: CD prevalence was 39.1% in the high-risk population and 3.3% in the low-risk group. In high-risk patients, all individual assays had a high diagnostic efficacy [area under receiving operator characteristic curves (AU ROC): 0.968 to 0.999]. In contrast, assays had a lower diagnostic efficacy (AU ROC: 0.835 to 0.972) in the low-risk group. Using assay combinations, it would be possible to reach or rule out diagnosis of CD without biopsy in 92% of cases in both pretest populations. We observed that the new DGP/tTG Screen assay resulted in a surplus compared to more conventional assays in any clinical situation. CONCLUSION: The DGP/tTG Screen assay could be considered as the best initial test for CD. Combinations of two tests, including a DGP/tTG Screen, might be able to diagnose CD accurately in different clinical scenarios making biopsy avoidable in a high proportion of subjects.

关键词： Celiac disease Serology Gliadin peptide antibodies Tissue transglutaminase Antigliadin antibodies Small bowel biopsy Diagnostic accuracy

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determination of gluten immunogenic peptides for the management of the treatment adherence of celiac disease: A systematic review

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World Journal of gastroenterology 2021年第37期27卷 6306-6321页

作者： Laura Coto Irati Mendia Carolina Sousa Julio César Bai Angel Cebolla Research and development BiomedalCamas 41900SevilleSpain Human Nutrition and Food Science Doctoral Program University of GranadaGranada 18011Spain Molecular Biology Biomedicine and Clinical Research Doctoral ProgramUniversity of SevilleSeville 41012Spain department of Microbiology and Parasitology University of SevilleSeville 41013Spain department of gastroenterology Dr.Carlos Bonorino Udaondo Gastroenterology HospitalBuenos Aires 1264Argentina Research Institutes Universidad del SalvadorBuenos Aires 1050Argentina

BACKGROUND Gluten is a complex mixture of proteins with immunogenic peptide sequences triggering the autoimmune activity in patients with celiac disease(CeD).Gluten immunogenic peptides(GIP)are resistant to gastrointestinal digestion and are then excreted via the stool and *** common detection methods applied in the follow-up visits for CeD patients such as serology tests,dietetic interviews,questionnaires,and duodenal biopsy have been proved to be inefficient,invasive,or inaccurate for evaluating gluten-free diet(GFD)*** of excreted GIP in stool and urine has been developed as a non-invasive,direct,and specific test for GFD *** To summarize published literature about the clinical utility of GIP determination in comparison to the tools employed for GFD *** PubMed and Web of Science searches were performed using the keywords“gluten immunogenic peptides”or“gluten immunogenic peptide”and a combination of the previous terms with“feces”,“stools”,“urine”,“celiac disease”,“gluten-free diet”,and“adherence”to identify relevant clinical studies published in English and Spanish between 2012 to January *** lists from the articles were reviewed to identify additional pertinent *** articles and abstracts reporting the clinical use of GIP determination in stool and/or urine for the follow-up of patients with CeD in comparison with other tools in use were *** reports,commentaries,reviews,conference papers,letters,and publications that did not focus on the aims of this review were *** Total of 15 publications were found that involved the use of GIP determination in stool and/or urine to monitor the adherence to the GFD in comparison to other *** included both children and adults diagnosed with CeD and healthy ***,these preliminary studies indicated that this novel technique was highly sensitive for the detection of GFD transgressions and therefore could fac

关键词： Celiac disease Gluten-free diet Gluten immunogenic peptides Immunoassays Stool Urine

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Upper gastrointestinal endoscopic findings in celiac disease at diagnosis:A multicenter international retrospective study

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World Journal of gastroenterology 2022年第43期28卷 6157-6167页

作者： Juan Pablo Stefanolo Fabiana Zingone Carolina Gizzi Ilaria Marsilio María Luján Espinet Edgardo GustavoSmecuol Mark Khaouli María Laura Moreno María I Pinto-Sánchez Sonia Isabel Niveloni Elena F Verdú Carolina Ciacci Julio César Bai Small Bowel Section Dr.C.Bonorino Udaondo Gastroenterology HospitalBuenos Aires 1264Argentina department of Surgery Oncology and GastroenterologyUniversity of PaduaPadova 35124Italy gastroenterology Unit Azienda Ospedale UniversitàPadova 35128Italy department of Medicine SurgeryDentistryScuola Medica SalernitanaUniversity of SalernoSalerno 84081Italy department of Medicine Farncombe Family Digestive Health Research InstituteMcMaster UniversityHamilton L8S 4K1Canada Research Institutes Universidad del SalvadorBuenos Aires 1020Argentina

BACKGROUND Gastroduodenal endoscopy and biopsy following positive specific serology is considered the gold standard to diagnose celiac disease(CeD)in *** upper endoscopy helps detect comorbid conditions is *** To investigate the prevalence of non-celiac endoscopic findings in patients in whom endoscopy was performed to confirm CeD *** This is an observational,descriptive,multicenter,retrospective study that reports endoscopic findings obtained in adult patients enrolled in local registries from four tertiary *** collected data reported on first endoscopy,indicated for investigation of *** of CeD was performed by histology(≥Marsh 2type mucosal damage)and specific *** European and one North American center included biopsy-confirmed CeD following positive serology.A fourth center(South America)included symptomatic patients undergoing endoscopy,irrespective of CeD *** latter cohort included a non-CeD control *** A total of 1328 patients(80%female;35 years median age)were enrolled,of whom 95.6%had positive specific *** 135 patients,endoscopy revealed 163 abnormalities unrelated to CeD(prevalence:10.1%).Erosive reflux esophagitis(6.4%),gastric erosions(2.0%),and suspicion of esophageal metaplasia(1.2%)were the most common ***-confirmed Barrett’s esophagus was infrequent(0.2%).No endoscopic cancer was *** patients(≥51 years of age)had a higher prevalence of endoscopic findings than those≤50(P<0.01).Within the South American cohort,CeD was associated with a lower rate(8.2%)of comorbid endoscopic findings compared with controls(29.1%;P<0.001).In the adjusted multivariate analysis of this cohort,having CeD was associated with a 72%reduction in the risk of any endoscopic abnormality(P<0.0001),and having alarm symptoms was associated with a 37%reduction in the risk of finding at least one endoscopic lesion(P<0.02).CONCLUSION In this large multicenter study,young adults w

关键词： Celiac disease Upper gastrointestinal endoscopy Concomitant endoscopic lesions Malignancies Multicenter study

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Risk of fracture in celiac disease:Gender,dietary compliance,or both?

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World Journal of gastroenterology 2011年第25期17卷 3035-3042页

作者： María Inés Pinto Sánchez Adriana Mohaidle Andrea Baistrocchi Dolores Matoso Horacio Vázquez Andrea González Roberto Mazure Evangelina Maffei Guillermina Ferrari Edgardo Smecuol Adriana Crivelli Juan Andrés de Paula Juan C Gómez Silvia Pedreira Eduardo Maurio Julio César Bai Small Bowel Section Department of Medicine"Dr.C.Bonorino Udaondo" Gastroenterology Hospital department of gastroenterology German Hospital Nutritional Support Unit and Malabsortion "San Martin" HIGA1900 La PlataArgentina department of gastroenterology Italian Hospital

AIM:To determine the incidence of peripheral fractures in patients with celiac disease (CD) and the effect of treatment on fracture ***:We compared the incidence and risk of peripheral fractures before and after diagnosis between a cohort of 265 patients who had been diagnosed with CD at least 5 years before study entry and a cohort of 530 age-and sex-matched controls who had been diagnosed with functional gastrointestinal *** were collected through in-person interviews with an *** overall assessment window for patients was 9843 patient-years (2815 patient-years after diagnosis).RESULTS:Compared with the control group,the CD cohort showed significantly higher incidence rate and risk of first peripheral fracture before diagnosis [adjusted hazard ratio (HR):1.78,95% CI:1.23-2.56,P < 0.002] and in men (HR:2.67,95% CI:1.37-5.22,P < 0.004).Fracture risk was significantly associated with the classic CD presentation with gastrointestinal symptoms (P < 0.003).In the time period after diagnosis,the risk of fractures was comparable between the CD cohort and controls in both sexes (HR:1.08,95% CI:0.55-2.10 for women;HR:1.57,95% CI:0.57-4.26 for men).CONCLUSION:CD patients have higher prevalence of fractures in the peripheral skeleton before *** is associated with male sex and classic clinical *** fracture risk was reduced after the treatment.

关键词：骨折风险性别腹腔疾病饮食胃肠功能紊乱危险性

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Risk perception and knowledge of COVID-19 in patients with celiac disease

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World Journal of gastroenterology 2021年第12期27卷 1213-1225页

作者： Jamie Zhen Juan Pablo Stefanolo María de la Paz Temprano Caroline L Seiler Alberto Caminero Enrique de-Madaria Miguel Montoro Huguet Vivas Santiago Sonia Isabel Niveloni Edgardo Gustavo Smecuol Luis Uzcanga Dominguez Elena Trucco Virginia Lopez Carolina Olano Pasquale Mansueto Antonio Carroccio Peter H Green Donald Duerksen Andrew S Day Jason A Tye-Din Julio César Bai Carolina Ciacci Elena F Verdú Benjamin Lebwohl M Ines Pinto-Sanchez department of Medicine Farncombe Family Digestive Health Research InstituteMcMaster University Medical CenterHamilton Health SciencesHamilton L8S4K1ONCanada department of Medicine Dr.C.Bonorino Udaondo Gastroenterology HospitalBuenos Aires 1264Argentina department of Pancreatic Unit Hospital General Universitario de AlicanteAlicante 03010Spain department of Medicine Instituto Aragonés de Ciencias de la Salud(IACS)Zaragoza 50009Spain department of Medicine Hospital Universitario San Jorge.HuescaZaragoza 50004Spain department of gastroenterology Univ Hosp LeonGastroenterol UnitAltos de Nava S-NLeon 24071Spain department of Medicine Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico DF 14080Mexico department of Medicine Universidad de la RepublicMontevideo 11800Uruguay department of Internal Medicine PROMISE DepartmentUniversity of PalermoPalermo 90127Italy department of Internal Medicine V.Cervello HospitalPROMISE DepartmentUniversity of PalermoPalermo 90127Italy Celiac Disease Center Columbia University Medical CenterColumbia UnivCeliac Dis CtrDiv Digest and Liver DisNew YorkNY 10032United States department of Medicine St Boniface Gen HospUniversity of ManitobaWinnipeg R2H 2A6Canada department of Paediatrics University of Otago ChristchurchChristchurch 8041New Zealand department of gastroenterology Royal Melbourne HospitalImmunology DivisionWalter and Eliza Hall InstituteMelbourne 3052Australia department of Medicine Surgery and DentryScuola Medica SalernitanaUniversity of SalernoCeliac Center at the University Hospital San Giovanni di Dio e Ruggi di AragonaSalerno 84131Italy department of Medicine Farncombe Family Digestive Research InstituteMcMaster UniversityHamilton L8S4K1ONCanada The Celiac Disease Center Columbia UniversityNew YorkNY 10032United States

BACKGROUND We recently demonstrated that the odds of contracting coronavirus disease 2019(COVID-19)in patients with celiac disease(CeD)is similar to that of the general ***,how patients with CeD perceive their COVID-19 risk may differ from their actual *** To investigate risk perceptions of contracting COVID-19 in patients with CeD and determine the factors that may influence their *** We distributed a survey throughout 10 countries between March and June 2020 and collected data on demographics,diet,COVID-19 testing,and risk perceptions of COVID-19 in patients with *** were recruited through various celiac associations,clinic visits,and social *** perception was assessed by asking individuals whether they believe patients with CeD are at an increased risk of contracting COVID-19 when compared to the general *** regression was used to determine the influencing factors associated with COVID-19 risk perception,such as age,sex,adherence to a gluten-free diet(GFD),and comorbidities such as cardiac conditions,respiratory conditions,and *** was presented as adjusted odds ratios(aORs)RESULTS A total of 10737 participants with CeD completed the *** them,6019(56.1%)patients with CeD perceived they were at a higher risk or were unsure if they were at a higher risk of contracting COVID-19 compared to the non-CeD population.A greater proportion of patients with CeD perceived an increased risk of contracting COVID-19 when compared to infections in general due to their CeD(56.1%vs 26.7%,Pder age(aOR:0.99;95%CI:0.99 to 0.99,P<0.001),male sex(aOR:0.84;95%CI:0.76 to 0.93,P=0.001),and strict adherence to a GFD(aOR:0.89;95%CI:0.82 to 0.96,P=0.007)were associated

关键词： Celiac disease Gluten Risk Infection Knowledge Perception Coronavirus COVID-19

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Fatty liver disease,an emerging etiology of hepatocellular carcinoma in Argentina

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World Journal of Hepatology 2018年第1期10卷 41-50页

作者： Federico Pinero Josefina Pages Sebastián Marciano Nora Fernández Jorge Silva Margarita Anders Alina Zerega Ezequiel Ridruejo Beatriz Ameigeiras Claudia D’Amico Luis Gaite Carla Bermúdez Manuel Cobos carlos Rosales Gustavo Romero Lucas McCormack Virginia Reggiardo Luis Colombato Adrián Gadano Marcelo Silva Hepatology and Liver Transplantation Unit Hospital Universitario AustralBuenos Aires 1629Argentina Hepatology Section Liver Transplant ProgramDepartment of Academic ResearchHospital Italiano from Buenos AiresBuenos Aires 1424Argentina Sanatorio Trinidad San Isidro Buenos Aires 1642Argentina Clínica Privada San Fernando Buenos Aires 2013Argentina Hepatology and gastroenterology Hospital BritánicoBuenos Aires 1280Argentina Hepatobiliary Surgery Hospital G RawsonSan Juan 5400Argentina department of Hepatology and Liver Transplant Program Hospital AlemanBuenos Aires 1118Argentina department of Hepatology and Liver Transplantation Sanatorio AllendeCórdoba 5016Argentina Hepatology Section Department of MedicineCentro de Educación Médica e Investigaciones Clínicas Norberto department of Hepatology Hospital Ramos MejíaBuenos Aires 1221Argentina department of Hepatology Centro Especialidades Medicas Ambulatorias(CEMA)Mar del Plata 7600Argentina department of Hepatology and Liver Transplantation Clínica de Nefrología de Santa FeSanta Fe 3000Argentina department of Hepatology and gastroenterology Hospital C Bonorino UdaondoBuenos Aires 1264Argentina department of Hepatology and gastroenterology Hospital CentenarioSanta Fe 2002Argentina

AIM To investigate any changing trends in the etiologies of hepatocellular carcinoma(HCC) in Argentina during the last years. METHODS A longitudinal cohort study was conducted by 14 regional hospitals starting in 2009 through 2016. All adult patients with newly diagnosed HCC either with pathology or imaging criteria were included. Patients were classified as presenting non-alcoholic fatty liver disease(NAFLD) either by histology or clinically, provided that all other etiologies of liver disease were ruled out, fatty liver was present on abdominal ultrasound and alcohol consumption was excluded. Complete follow-up was assessed in all included subjects since the date of HCC diagnosis until death or last medical *** A total of 708 consecutive adults with HCC were included. Six out of 14 hospitals were liver transplant centers(n = 484). The prevalence of diabetes mellitus was 27.7%. Overall, HCV was the main cause of liver disease related with HCC(37%) including cirrhotic and non-cirrhotic patients, followed by alcoholic liver disease 20.8%, NAFLD 11.4%, cryptogenic 9.6%, HBV 5.4% infection, cholestatic disease and autoimmune hepatitis 2.2%, and other causes 9.9%. A 6-fold increase in the percentage corresponding to NAFLDHCC was detected when the starting year, i.e., 2009 was compared to the last one, i.e., 2015(4.3% vs 25.6%; P dence of NAFLD-HCC documented in the United States and Europe is also observed in Argentina, a confirmation with important Public Health implications.

关键词： Hepatocellular carcinoma Etiology Fatty liver South America

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Gluten immunogenic peptide excretion detects dietary transgressions in treated celiac disease patients

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World Journal of gastroenterology 2019年第11期25卷 1409-1420页

作者： Ana Florencia Costa Emilia Sugai María de la Paz Temprano Sonia Isabel Niveloni Horacio Vázquez María Laura Moreno M.Remedios Domínguez-Flores Alba Mu?oz-Suano Edgardo Smecuol Juan Pablo Stefanolo Andrea F González Angel Cebolla-Ramirez Eduardo Mauri?o Elena F Verdú Julio César Bai Small Bowel Section Department of MedicineDr.C.Bonorino Udaondo Gastroenterology HospitalBuenos Aires 1263Argentina department of Immunology Biomedal S.L.Sevilla 41092Spain Farncombe Family Digestive Health Research Institute McMaster UniversityHamiltonON L8S4L8Canada Research Institutes Universidad del SalvadorBuenos Aires 1050Argentina

BACKGROUND Life-long removal of gluten from the diet is currently the only way to manage celiac disease(CeD). Until now, no objective test has proven useful to objectively detect ingested gluten in clinical practice. Recently, tests that determine consumption of gluten by assessing excretion of gluten immunogenic peptides(GIP) in stool and urine have been developed. Their utility, in comparison with conventional dietary and analytical follow-up strategies, has not been fully *** To assess the performance of enzyme-linked immunosorbent assay(ELISA) and point-of-care tests(PoCTs) for GIP excretion in CeD patients on gluten-free diet(GFD).METHODS We conducted an observational, prospective, cross-sectional study in patients following a GFD for at least two years. Using the Gastrointestinal Symptom Rating Scale questionnaire, patients were classified at enrollment as asymptomatic or symptomatic. Gluten consumption was assessed twice by 3-d dietary recall and GIP excretion(by ELISA in stool and PoCTs(commercial kits for stool and urine) in two consecutive samples. These samples and dietary reports were obtained 10 day apart one from the other. Patients were encouraged to follow their usual GFD during the study *** Forty-four patients were enrolled, of which 19(43.2%) were symptomatic despite being on a GFD. Overall, 83 sets of stool and/or urine samples were *** out of 44 patients(25.0%) had at least one positive GIP test. The occurrence of at least one positive test was 32% in asymptomatic patients compared with 15.8% in symptomatic patients. GIP was concordant with dietary reports in 65.9% of cases(Cohen′s kappa: 0.317). PoCT detected dietary indiscretions. Both ELISA and PoCT in stool were concordant(concomitantly positive or negative) in 67 out of 74(90.5%) samples. Excretion of GIP was detected in 7(8.4%) stool and/or urine samples from patients considered to be strictly compliant with the GFD by dietary *** GIP dete

关键词： Celiac disease Follow-up Gluten-free diet Gluten immunogenic peptide excretion Rapid tests

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