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Hepatolithiasis:Epidemiology,presentation,classification and management of a complex disease

World Journal of gastroenterology 2024年第13期30卷 1836-1850页

作者： Rodrigo V.Motta Francesca Saffioti Vasileios K Mavroeidis Translational gastroenterology and Liver unit Nuffield Department of MedicineUniversity of OxfordOxford OX39DUUnited Kingdom Department of gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustJohn Radcliffe HospitalOxford OX39DUUnited Kingdom UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver unit Royal Free Hospital and University College LondonLondon NW32QGUnited Kingdom Department of HPB Surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Transplant Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom Department of Gastrointestinal Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom

The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic ducts.The disease is more prevalent in Asia,mainly owing to socioeconomic and dietary factors,as well as the prevalence of biliary parasites.In the last century,owing to migration,its global incidence has increased.The main pathophysiological mechanisms involve cholangitis,bile infection and biliary strictures,creating a self-sustaining cycle that perpetuates the disease,frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of“recurrent pyogenic cholangitis”.Furthermore,long-standing hepatolithiasis is a known risk factor for development of intrahepatic cholangiocarcinoma.Various classifications have aimed at providing useful insight of clinically relevant aspects and guidance for treatment.The management of symptomatic patients and those with complications can be complex,and relies upon a multidisciplinary team of hepatologists,endoscopists,interventional radiologists and hepatobiliary surgeons,with the main goal being to offer relief from the clinical presentations and prevent the development of more serious complications.This comprehensive review provides insight on various aspects of hepatolithiasis,with a focus on epidemiology,new evidence on pathophysiology,most important clinical aspects,different classification systems and contemporary management.

关键词： Cholelithiasis Intrahepatic stones Cholangiocarcinoma Biliary parasites Recurrent pyogenic cholangitis Oriental cholangiohepatitis Hepatectomy Cholangioscopy Liver transplant paediatric

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Cytomegalovirus infection in liver-transplanted children

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World Journal of Hepatology 2022年第2期14卷 338-353页

作者： Norrapat Onpoaree Anapat Sanpavat Palittiya Sintusek Faculty of Medicine Chulalongkorn UniversityBangkok 10330Thailand Division of Pathology Faculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Thai paediatric gastroenterology Hepatology and Immunology Research UnitChulalongkorn UniversityBangkok 10330Thailand Division of gastroenterology Department of PediatricsFaculty of MedicineKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkok 10330Thailand

Cytomegalovirus (CMV) infection is a common complication of liver transplantationin children. The CMV serostatus of recipients and donors is theprimary risk factor, and prophylaxis or pre-emptive strategies are recommendedfor high-risk patients. Graft rejection, coinfection and Epstein-Bar virusreactivation, which can lead to post-transplant lymphoproliferative disease, areindirect effects of CMV infection. Assessment of CMV infection viral load shouldbe routinely performed upon clinical suspicion. However, tissue-invasive CMVdisease is not associated with CMV viraemia and requires confirmation by tissuepathology. Oral valganciclovir and intravenous ganciclovir are equivalenttreatments, and the duration of treatment depends on factors including CMV viralload, tissue pathology, and clinical response. Risk stratification by donor andrecipient status prior to transplantation and post-transplantation antiviralprophylaxis or pre-emptive therapy are recommended. Adult guidelines havebeen established but additional study of the effectiveness of the preventiveguidelines in children is needed. This review summarizes the burden, risk factors,clinical manifestations, laboratory evaluation, treatment, and prevention of CMVinfection in children after liver transplantation.

关键词： Cytomegalovirus Children Liver transplantation Pediatric Infection

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Double balloon enteroscopy in children:Diagnosis,treatment,and safety

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World Journal of gastroenterology 2010年第1期16卷 56-62页

作者： Mike Thomson Krishnappa Venkatesh Khalid Elmalik Willam van der Veer Maartan Jaacobs Centre for paediatric gastroenterology Sheffield Children's NHS Foundation Trust Department of gastroenterology VU University Medical Center

AIM:To assess the feasibility and utility of double balloon enteroscopy(DBE)in the management of small bowel diseases in children. METHODS:Fourteen patients(10 males)with a median age of 12.9 years(range 8.1-16.7)underwent DBE; 5 for Peutz-Jeghers syndrome(PJ syndrome),2 for chronic abdominal pain,4 for obscure gastrointestinal (GI)bleeding,2 with angiomatous malformations(1 blue rubber bleb nevus syndrome)having persistent GI bleeding,and 1 with Cowden's syndrome with multiple polyps and previous intussusception.Eleven procedures were performed under general anesthesia and 3 with deep sedation. RESULTS:The entire small bowel was examined in 6 patients,and a length between 200 cm and 320 cm distal to pylorus in the remaining 8.Seven patients had both antegrade(trans-oral)and retrograde(transanal and via ileostomy)examinations.One patient underwent DBE with planned laparoscopic assistance.The remaining 6 had trans-oral examination only.The median examination time was 118 min(range 95-195). No complications were encountered.Polyps were detected and successfully removed in all 5 patients with PJ syndrome,in a patient with tubulo-villous adenoma of the duodenum,in a patient with significant anemia and occult bleeding,and in a patient with Cowden's syndrome.A diagnosis was made in a patient with multiple angiomata not amenable to endotherapy,and in 1 with a discrete angioma which was treated with argon plasma coagulation.The source of bleeding was identified in a further patient with varices.DBE was normal or revealed minor mucosal friability in the remaining 3 patients.Hence a diagnostic yield of 11/14 with therapeutic success in 9/14 was achieved. CONCLUSION:Double balloon enteroscopy can be a useful diagnostic and therapeutic tool for small bowel disease in children,allowing endo-therapeutic intervention beyond the reach of the conventional endoscope.

关键词： Double balloon enteroscopy Gastrointestinal Peutz Jeghers syndrome Wireless video capsule endoscopy Children

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Fatigue in children and adolescents with inflammatory bowel disease

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World Journal of gastroenterology 2019年第5期25卷 632-643页

作者： Els Van de Vijver Ann Van Gils Laura Beckers Yannick Van Driessche Nicolette Dorien Moes Patrick Ferry van Rheenen Department of paediatric gastroenterology Hepatology and Nutrition Antwerp University Hospital Department of Anesthesiology Antwerp University Hospital Family Medicine Department of paediatric gastroenterology Hepatology and Nutrition University Medical Center Groningen

AIM To identify factors other than active disease and anemia that contribute to fatigue in pediatric inflammatory bowel disease(IBD).METHODS We performed an electronic search in Medline and EMBASE from their inception to May 2017 using the search term "fatigue" or the related keywords "physical impairment" and "inflammatory bowel disease" with the filter "child"(age 0-18 years). Cross-sectional and case-control studies were included. We restricted our search to studies published in English. We used the PRISMA checklist and flow diagram. Duplicate articles were manually deleted in End Note. To identify further relevant studies, we checked the reference lists of the selected articles.RESULTS We identified 149 papers, of which 19 were retrieved for full text review. Eleven studies were subsequently excluded because fatigue was not evaluated as an outcome measure. Eight papers focused on the desired topic and were discussed in the final analysis. A lack of uniformity of outcome measures made the pooling of data impossible. In all but one study, questionnaires were used to evaluate fatigue. In the remaining study, an accelerometer was used to measure daily activities, sleeping time and their relationships with fatigue in a more quantifiable manner. Adolescents with IBD are significantly more fatigued than healthy controls. In addition to active disease, increased anxiety or depression and disturbed family relationships were frequently reported predictors of fatigue. Quantitative measurement of physical activity in patients with Crohn's disease showed a reduction in the number of steps per day, and patients with ulcerative colitis had a shorter duration of physical activity during the day.CONCLUSION Fatigue in pediatric IBD is related to a combination of biological, functional and behavioral factors, which should all be taken into account when managing fatigue.

关键词： Adolescents Children Fatigue Inflammatory bowel disease Physical impairment Sleep

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Helicobacter pylori,gastric microbiota and gastric cancer relationship:Unrolling the tangle

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World Journal of Gastrointestinal Oncology 2022年第5期14卷 959-972页

作者： Christos Liatsos Apostolis Papaefthymiou Nikolaos Kyriakos Michail Galanopoulos Michael Doulberis Marios Giakoumis Evangelia Petridou Christos Mavrogiannis Theodore Rokkas Jannis Kountouras Department of gastroenterology 401 General Military Hospital of AthensAthens 11525Greece gastroenterology University Hospital of LarissaLarissa 41336Greece Division of gastroenterology and Hepatology Medical University DepartmentKantonsspital AarauAarau 1234Switzerland Department of Microbiology “Agia Sofia”Paediatric HospitalGoudiAthens 11527Greece Gastrointestinal and Liver unit Faculty of NursingKifissia General and Oncology HospitalKaliftakiN.Kifisia 14564Greece Gastroenterological Clinic Henry Dunant HospitalAthens 11525Greece Department of Internal Medicine Second Medical ClinicIppokration HospitalAristotle University of ThessalonikiThessaloniki 41336MacedoniaGreece

Helicobacter pylori infection(Hp-I)represents a typical microbial agent intervening in the complex mechanisms of gastric homeostasis by disturbing the balance between the host gastric microbiota and mucosa-related factors,leading to inflammatory changes,dysbiosis and eventually gastric cancer.The normal gastric microbiota shows diversity,with Proteobacteria[Helicobacter pylori(H.pylori)belongs to this family],Firmicutes,Actinobacteria,Bacteroides and Fusobacteria being the most abundant phyla.Most studies indicate that H.pylori has inhibitory effects on the colonization of other bacteria,harboring a lower diversity of them in the stomach.When comparing the healthy with the diseased stomach,there is a change in the composition of the gastric microbiome with increasing abundance of H.pylori(where present)in the gastritis stage,while as the gastric carcinogenesis cascade progresses to gastric cancer,the oral and intestinal-type pathogenic microbial strains predominate.Hp-I creates a premalignant environment of atrophy and intestinal metaplasia and the subsequent alteration in gastric microbiota seems to play a crucial role in gastric tumorigenesis itself.Successful H.pylori eradication is suggested to restore gastric microbiota,at least in primary stages.It is more than clear that Hp-I,gastric microbiota and gastric cancer constitute a challenging tangle and the strong interaction between them makes it difficult to unroll.Future studies are considered of crucial importance to test the complex interaction on the modulation of the gastric microbiota by H.pylori as well as on the relationships between the gastric microbiota and gastric carcinogenesis.

关键词： Helicobacter pylori infection Gastric microbiota Gastric cancer Oncogenesis Dysbiosis Helicobacter pylori eradication

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Hepatic Histoplasmosis: An Update

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Journal of Clinical and Translational Hepatology 2022年第4期10卷 726-729页

作者： Maimuna Sayeed Md Benzamin Luthfun Nahar Masud Rana Aisharza Sultana Aishy Department of paediatric gastroenterology&Nutrition Bangabandhu Shiekh Mujib Medical University(BSMMU)DhakaBangladesh Hazi Asmot Ali Medical Centre BhairabKishoregonjDhakaBangladesh Jalalabad Ragib-Rabeya Medical College SylhetBangladesh

Histoplasma capsulatum is the most common cause of en-demic mycosis in developing countries. It is a self-limited and asymptomatic disease in immunocompetent individu-als but remains a frequent cause of opportunistic infection in patients with compromised immune status. Liver in-volvement as a part of disseminated histoplasmosis is well known. However, liver infection as a primary manifestation of histoplasmosis without evidence of primary lung involve-ment is rare. In conclusion, clinicians should be aware of isolated histoplasmosis affecting the hepatobiliary system, and careful evaluation is warranted to confirm the diagno-sis. Given the appropriate clinical context, histoplasmosis should be considered in both immunocompetent and immu-nocompromised patients, regardless of pulmonary symp-toms, in non endemic as well as endemic areas.

关键词： Histoplasma capsulatum Histoplasmosis Hepatic manifestation Mycosis

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Treating children with inflammatory bowel disease: Current and new perspectives

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World Journal of gastroenterology 2017年第30期23卷 5469-5485页

作者： Graziella Guariso Marco Gasparetto University of Padova Department of paediatric gastroenterology Cambridge University Hospitals CUH-FT

Inflammatory bowel disease(IBD) is a chronic inflammatory condition of the gut characterised by alternating periods of remission and relapse. Whilst the mechanism underlying this disease is yet to be fully understood, old and newer generation treatments can only target selected pathways of this complex inflammatory process. This narrative review aims to provide an update on the most recent advances in treatment of paediatric IBD. A MEDLINE search was conducted using "paediatric inflammatory bowel disease", "paediatric Crohn's disease", "paediatric ulcerative colitis", "treatment", "therapy", "immunosuppressant", "biologic", "monitoring" and "biomarkers" as key words. Clinical trials, systematic reviews, and meta-analyses published between 2014 and 2016 were selected. Studies referring to earlier periods were also considered in case the data was relevant to our scope. Major advances have been achieved in monitoring the individual metabolism, toxicity and response to relevant medications in IBD including thiopurines and biologics. New biologics acting on novel mechanisms such as selective interference with lymphocyte trafficking are emerging treatment options. Current research is investing in the development of reliable prognostic biomarkers, aiming to move towards personalised treatments targeted to individual patients.

关键词：儿科学的煽动性的肠疾病 Crohns 疾病 Ulcerative 大肠炎治疗治疗抑制免疫力的药生物学监视 Biomarker

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Variability of anti-human transglutaminase testing in celiac disease across Mediterranean countries

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World Journal of gastroenterology 2017年第24期23卷 4437-4443页

作者： Andrea Smarrazzo Giuseppe Magazzù Mongi Ben-Hariz Maria Legarda Tamara Virtut Velmishi Elefhteria Roma Aydan Kansu Dusanka Micetic-Turk Enzo Bravi Pio Stellato Carmela Arcidiaco Luigi Greco Department of Translational Medical Sciences School of MedicineSection of PediatricsUniversity of Naples“Federico II” European Laboratory for Food Induced Diseases Celiac Regional Centre Pediatric Gastroenterology and Cystic Fibrosis UnitUniversity of Messina Pediatric unit Mongi SLIM’s Hospital of Tunis paediatric gastroenterology unit Cruces University Hospital Service of Pediatric gastroenterology"Mother Teresa"Hospital First Department of Pediatrics University of Athens Department of Pediatric gastroenterology School of MedicineAnkara University University Medical Centre Paediatric Department Eurospital SpA

AIM To verify the precision and accuracy of transglutaminase antibodies(TGA)assays across Mediterranean countries.METHODS This study involved 8 referral centres for celiac disease(CD)in 7 Mediterranean countries.A central laboratory prepared 8 kits of 7 blinded and randomized serum samples,with a titrated amount of Human TGA Ig A.Each sample was analysed three times on three different days,with each centre running a total of 21tests.The results were included in a blindly coded report form,which was sent to the coordinator centre.The coordinator estimated the mean coefficient of Variation(Co Var=σ/μ),the mean accuracy(Accur=Vobserved-Vreal)and the mean percent variation(Var%=[(Vobserved-Vreal)/Vreal]×100).RESULTS The analysis showed that 79.17%of the mean variation fell between-25%and+25%of the expected value,with the accuracy and precision progressively increasing with higher titres of TGA.From values 1.25 times greater than the normal cut-off,the measurements were highly reliable.CONCLUSION TGA estimation is a crucial step for the diagnosis of CD;given its accuracy and precision,clinicians could be confident in establishing a diagnosis.

关键词：腹的疾病面筋 Transglutaminase 非侵略的测试精确性精确

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Functional constipation in Bangladeshi school aged children:A hidden misty at community

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World Journal of Clinical Pediatrics 2022年第2期11卷 160-172页

作者： Md Benzamin ASM Bazlul Karim Md Rukunuzzaman Md Wahiduzzaman Mazumder Masud Rana Rubaiyat Alam Mohammad Majharul Islam Md Shafiul Alam Kamal Hossen Afsana Yasmin Kaniz Fathema Mukesh Khadga Aisharza Sultana Aishy Department of paediatric gastroenterology and Nutrition Bangabandhu Shiekh Mujib Medical UniversityDhaka 1000Bangladesh Department of Outpatient Hazi Asmot Medical CentreBhairab 2350Bangladesh Department of paediatric Nephrology Bangabandhu Shiekh Mujib Medical UniversityDhaka 1000Bangladesh Jalalabad Ragib Rabeya Medical College Sylhet 3100Bangladesh

BACKGROUND Constipation is a common problem in children and a frequent cause of hospital visit in both primary&specialized care,which needs proper evaluation&management.Presentation of constipation is variable among children.In Bangladesh there has been no published data regarding constipation in community among school aged children.AIM To determine the magnitude of functional constipation and its risk factors in community among Bangladeshi school children.METHODS This descriptive cross sectional study was conducted in different schools of Dhaka division,Bangladesh.All school aged children between 5-16 years of age who attended school were included in this study.Samples were collected randomly.Proper clinical history&physical examinations(without digital rectal examination)&available investigations(if done previously)were recorded.Diagnosis of functional constipation was done by Rome IV criteria and was compared with children without constipation.Children with any red flag sign,known chronic disease or any findings suggestive of organic disease and on treatment of constipation were excluded.Statistical analysis of the results was done by using Windows based software device with Statistical Packages for Social Science 20.For all statistical tests,P value of less than 0.05 was considered as statistically significant.RESULTS Total study populations were 707 and male was 443 and female 264.Among them,134(19%)children had constipation.In constipated children,78 children fulfilled the Rome IV criteria for functional constipation and it was 11%of total population.Mean age of children having functional constipation was 11.24±3.54 years and Male female ratio was 1:1.78.Anorexia,nausea,abdominal pain,hard stool,blood with hard stool,alternate hard and loose stool and fecal mass in left iliac fossa were analyzed between two group and all were significantly higher in children with functional constipation group.Children of school,where toilet numbers were inadequate had 2.5 times more constipation risk in comparison to childr

关键词： Bangladesh Children Functional constipation

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Hepatocyte cryopreservation:Is it time to change the strategy?

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World Journal of gastroenterology 2010年第1期16卷 1-14页

作者： Xavier Stéphenne Mustapha Najimi Etienne M Sokal Catholic University of Louvain and St Luc Clinics Paediatric Department(HPED)PEDI unitLaboratory of Paediatric Hepatology and Cell Therapy

Liver cell transplantation presents clinical benefit in patients with inborn errors of metabolism as an alternative,or at least as a bridge,to orthotopic liver transplantation.The success of such a therapeutic approach remains limited by the quality of the transplanted cells.Cryopreservation remains the best option for long-term storage of hepatocytes,providing a permanent and sufficient cell supply.However, isolated adult hepatocytes are poorly resistant to such a process,with a significant alteration both at the morphological and functional levels.Hence,the aim of the current review is to discuss the state of the art regarding widely-used hepatocyte cryopreservation protocols,as well as the assays performed to analyse the post-thawing cell quality both in vitro and in vivo. The majority of studies agree upon the poor quality and efficiency of cryopreserved/thawed hepatocytes as compared to freshly isolated hepatocytes.Intracellular ice formation or exposure to hyperosmotic solutionsremains the main phenomenon of cryopreservation process,and its effects on cell quality and cell death induction will be discussed.The increased knowledge and understanding of the cryopreservation process will lead to research strategies to improve the viability and the quality of the cell suspensions after thawing.Such strategies,such as vitrification,will be discussed with respect to their potential to significantly improve the quality of cell suspensions dedicated to liver cell-based therapies.

关键词： Hepatocyte Cryopreservation Quality Mitochondria Intracellular ice formation

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