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World Journal of Gastroenterology 2014年第28期20卷 9439-9450页

作者： Carlos Sostres Carla Jerusalen Gargallo Angel Lanas service Department of digestive diseases University Hospital Lozano Blesa digestive diseases Department Aragon Health Sciences Institute CIBERehd University of Zaragoza (Zaragoza)

Previous reports clearly demonstrated that Helicobacter pylori(***)infection,nonsteroidal anti-inflammatory drugs(NSAID)or low dose aspirin(ASA)use significantly and independently increased the risk for the development of peptic ulcer ***,the presence of *** infection associated with low dose ASA and/or NSAID use in the same patient is becoming more frequent and therefore the potential interaction between these factors and the consequences of it has important *** NSAID intake in the presence of *** infection may further increase the risk of peptic ulcer carried by the presence of only one risk factor is still a matter of *** on the interaction between the two risk factors yielded conflicting data and no consensus has been reached in the last *** addition,the interaction between *** infection and low-dose ASA remains even more *** real clinical practice,we can find different clinical scenarios involving these three factors associated with the presence of different gastrointestinal and cardiovascular risk *** huge variety of possible combinations greatly hinder the decision making process of physicians.

关键词： Nonsteroidal anti-inflammatory drugs Low dose aspirin Helicobacter pylori infection Helicobacter pylori eradication Peptic ulcer disease

Anemia and digestive diseases: An update for the clinician

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World Journal of Gastroenterology 2009年第37期15卷 4615-4616页

作者： Fernando Gomollón Javier P Gisbert digestive diseases service Clinical University Hospital CIBEREHD IACS Avenida San Juan Bosco 15 Zaragoza 50009 Spain digestive diseases service University Hospital "La Princesa" CIBEREHD C/ Diego León 62 Madrid 28006 Spain

Anemia and iron deficiency are so common in digestive diseases that often are underestimated and undertreated. Our goal is to review from classif ication to treatment of the diverse types of anemias in different digestive diseases to update our knowledge on diagnosis and treatment. With the goal of improving the prognosis and quality of life of digestive diseases patients, we will review current transfusion, intravenous iron, and erythropoietin roles in the treatment of anemia.

关键词： Anemia Iron deficiency Inflammatory bowel disease Crohn's disease Ulcerative colitis

Inflammatory bowel diseases: A disease (s) of modern times? Is incidence still increasing?

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World Journal of Gastroenterology 2008年第36期14卷 5491-5498页

作者： Cristina Saro Gismera Beatriz Sicilia Aladrén service of digestive diseases Hospital de Cabuees Gijón Spain service of digestive diseases Alcaiz Hospital Spain

Inflammatory bowel diseases (IBD) are a heterogeneous group of diseases, not always easy to diagnose, even more difficult to classify, and diagnostic criteria are not always uniform. Well done population-based studies are not abundant, and so comparisons among different geographical areas or populations are not always very reliable. In this article, we have reviewed epidemiological studies available on the world’s population while making a critical review of published data.

关键词： Inflammatory bowel diseases Epidemiological Incidence Diagnostic criteria

Colorectal cancer population screening programs worldwide in 2016: An update

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World Journal of Gastroenterology 2017年第20期23卷 3632-3642页

作者： Mercedes Navarro Andrea Nicolas Angel Ferrandez Angel Lanas service of digestive diseases University Clinic Hospital Lozano Blesa University of Zaragoza Aragón Health Research Institute (IIS Aragón) CIBERehd

Colorectal cancer(CRC)is the third most commonly diagnosed cancer in the *** incidence and mortality show wide geographical *** is recommended to reduce both incidence and ***,there are significant differences among studies in implementation strategies and *** review aimed to present the results and strategies of different screening programs *** reviewed the literature on national and international screening programs published in Pub Med,on web pages,and in clinical *** Screening programs are currently underway in most European countries,Canada,specific regions in North and South America,Asia,and *** most extensive screening strategies were based on fecal occult blood testing,and more recently,the fecal immunochemical test(FIT).Participation in screening has varied greatly among different *** Netherlands showed the highest participation rate(68.2%)and some areas of Canada showed the lowest(16%).Participation rates were highest among women and in programs that used the FIT *** exhibited the greatest number of positive *** FIT test has been the most widely used screening program *** advent of this test has increased participation rates and the detection of positive results.

关键词： Colorectal cancer Colorectal cancer screening Fecal occult blood test Fecal immunochemical test Colonoscopy

Local excision by transanal endoscopic surgery

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World Journal of Gastroenterology 2015年第31期21卷 9286-9296页

作者： Luis J García-Flórez Jorge L Otero-Díez General and digestive Surgery service Colorectal UnitHospital San Agustín

Transanal endoscopic surgery(TES) consists of a series of anorectal surgical procedures using different devices that are introduced into the anal canal. TES has been developed significantly since it was first used in the 1980 s. The key point for the success of these techniques is how accurately patients are selected. The main indication was the resection of endoscopically unresectable adenomas. In recent years,these techniques have become more widespread which has allowed them to be applied in conservative rectal procedures for both benign diseases and selected cases of rectal cancer. For more advanced rectal cancers it should be considered palliative or,in some controlled trials,experimental. The role of newer endoscopic techniques available has not yet been defined. TES may allow for new strategies in the treatment of rectal pathology,like transanal natural orifice transluminal endoscopic surgery or total mesorectal excision.

关键词： Transanal endoscopic surgery Rectal adenoma Early

Sphincter lesions observed on ultrasound after transanal endoscopic surgery

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World Journal of Gastroenterology 2015年第46期21卷 13160-13165页

作者： Laura Mora López Xavier Serra-Aracil Salvador Navarro Soto General and digestive Surgery service Parc Tauli University HospitalUniversidad Autonoma Barcelona

AIM: To assess the morphological impact of transanal endoscopic surgery on the sphincter apparatus using the modified Starck classification. METHODS: A prospective,observational study of 118 consecutive patients undergoing Transanal Endoscopic Operation/Transanal Endoscopic Microsurgery(TEO/TEM) from March 2013 to May 2014 was performed. All the patients underwent an endoanal ultrasound prior to surgery and one and four months postoperatively in order to measure sphincter width,identify sphincter defects and to quantify them in terms of the level,depth and size of the affected anal canal. To assess the lesions,we used the "modified" Starck classifi-cation,which incorporates the variable "sphincter fragmentation". The results were correlated with the Wexner incontinence ***: Of the 118 patients,twelve(sphincter lesions) were excluded. The results of the 106 patients were as follows after one month: 31(29.2%) lesions found on ultrasound after one month,median overall Starck score of 4(range 3-6); 10(9.4%) defects in the internal anal sphincter(IAS) and 3(2.8%) in the external anal sphincter(EAS); 17 patients(16%) had fragmentation of the sphincter apparatus with both sphincters affected in one case. At four months: 7(6.6%) defects,all in the IAS,overall median Starck score of 4(range 3-6). Mean IAS widths were 3.5 mm(SD 1.14) preoperatively,4.38 mm(SD 2.1) one month postoperatively and 4.03 mm(SD 1.46) four months postoperatively. The only statistically significant difference in sphincter width in the IAS measurements was between preoperatively and one month postoperatively. No incontinence was reported,even in cases of ultrasound ***: TEO/TEM may produce ultrasounda b n o r m a l i t i e s b u t t h i s i s n o t a c c o m p a n i e d b y clinical changes in continence. The modified Starck classification is useful for describing and managing these disorders.

关键词： Transanal endoscopic surgery Endoscopic ultrasound

Spectrum of anemia associated with chronic liver disease

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World Journal of Gastroenterology 2009年第37期15卷 4653-4658页

作者： Rosario Gonzalez-Casas E Anthony Jones Ricardo Moreno-Otero digestive Disease service and Center for Investigation of Hepatic and digestive diseases University Hospital La Princesa Autonomous University of Madrid Madrid 28006 Spain

Anemia of diverse etiology is a common complication of chronic liver diseases. The causes of anemia include acute or chronic gastrointestinal hemorrhage, and hypersplenism secondary to portal hypertension. Severe hepatocellular disease predisposes to hemorrhage because of impaired blood coagulation caused by deficiency of blood coagulation factors synthesized by hepatocytes, and/or thrombocytopenia. Aplastic anemia, which is characterized by pancytopenia and hypocellular bone marrow, may follow the development of hepatitis. Its presentation includes progressive anemia and hemorrhagic manifestations. Hematological complications of combination therapy for chronic viral hepatitis include clinically signif icant anemia, secondary to treatment with ribavirin and/or interferon. Ribavirininduced hemolysis can be reversed by reducing the dose of the drug or discontinuing it altogether. Interferons may contribute to anemia by inducing bone marrow suppression. Alcohol ingestion is implicated in the pathogenesis of chronic liver disease and may contribute to associated anemia. In patients with chronic liver disease, anemia may be exacerbated by defi ciency of folic acid and/or vitamin B12 that can occur secondary to inadequate dietary intake or malabsorption.

关键词： Anemia Liver disease Liver failure Aplastic anemia Pegylated interferon Ribavirin Alcohol

Using old liver grafts for liver transplantation: Where are the limits?

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World Journal of Gastroenterology 2014年第31期20卷 10691-10702页

作者： Carlos Jiménez-Romero Oscar Caso Maestro Félix Cambra Molero Iago Justo Alonso Cristina Alegre Torrado Alejandro Manrique Municio Jorge Calvo Pulido Carmelo Loinaz Segurola Enrique Moreno González service of General and digestive Surgery and Abdominal Organ Transplantation "Doce de Octubre" University Hospital

The scarcity of ideal liver grafts for orthotopic liver transplantation (OLT) has led transplant teams to investigate other sources of grafts in order to augment the donor liver pool. One way to get more liver grafts is to use marginal donors, a not well-defined group which includes mainly donors > 60 years, donors with hypernatremia or macrosteatosis > 30%, donors with hepatitis C virus or hepatitis B virus positive serologies, cold ischemia time > 12 h, non-heart-beating donors, and grafts from split-livers or living-related donations. Perhaps the most practical and frequent measure to increase the liver pool, and thus to reduce waiting list mortality, is to use older livers. In the past years the results of OLT with old livers have improved, mainly due to better selection and maintenance of donors, improvements in surgical techniques in donors and recipients, and intra- and post-OLT management. At the present time, sexagenarian livers are generally accepted, but there still exists some controversy regarding the use of septuagenarian and octogenarian liver grafts. The aim of this paper is to briefly review the aging process of the liver and reported experiences using old livers for OLT. Fundamentally, the series of septuagenarian and octogenarian livers will be addressed to see if there is a limit to using these aged grafts.

关键词： Old liver donors Liver transplantation Aging liver Liver graft Liver disease Aging Donor management Septuagenarian donors Octogenarian donors

Tenofovir vs lamivudine plus adefovir in chronic hepatitis B:TENOSIMP-B study

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World Journal of Gastroenterology 2017年第41期23卷 7459-7469页

作者： Manuel Rodríguez Juan Manuel Pascasio Enrique Fraga Javier Fuentes Martín Prieto Gloria Sánchez-Antolín Jose Luis Calleja Esther Molina María Luisa García-Buey María Angeles Blanco Javier Salmerón María Lucía Bonet Jose Antonio Pons Jose Manuel González Miguel Angel Casado Francisco Jorquera 无 Division of Gastroenterology and Hepatology.Hospital Universitario Central de Asturias Unit for the Clinical Management of digestive diseases IBISHospital Universitario Virgen del Rocío Liver Transplantation and Hepatology Unit Gastroenterology ServiceHospital Universitario Reina Sofía digestive Medicine service Hospital Universitario Miguel Servet Hepatology Unit Digestive Medicine ServiceHospital Universitari i Politècnic La Fe Hepatology Unit Hospital Universitario Rio Hortega Liver Unit Hospital Universitario Puerta de Hierro de MajadahondaUniversidad Autónoma de Madrid digestive Medicine service Hospital Clínico de Santiago de Compostela Liver Unit Hospital Universitario de La Princesa digestive Medicine service Hospital General Universitario Gregorio Maranon digestive Medicine Unit Complejo Hospitalario de Granada digestive Medicine service Hospital Universitario Son Espases Hepatology Unit IMIB Hospital Universitario Virgen de la Arrixaca digestive Medicine service Hospital Clínico Universitario de Valladolid Pharmacoeconomics and Outcomes Research Iberia Division of Gastroenterology and Hepatology Complejo Asistencial Universitario de León the TENOSIMP-B Research Group

AIM To demonstrate the non-inferiority(15% non-inferiority limit) of monotherapy with tenofovir disoproxil fumarate(TDF) vs the combination of lamivudine(LAM) plus adefovir dipivoxil(ADV) in the maintenance of virologic response in patients with chronic hepatitis B(CHB) and prior failure with *** This study was a Phase IV prospective, randomized, open, controlled study with 2 parallel groups(TDF and LAM+ADV) of adult patients with hepatitis B e antigen(HBe Ag)-negative CHB, prior failure with LAM, on treatment with LAM+ADV for at least 6 mo, without prior resistance to ADV and with an undetectable viral load at the start of the study, in 14 Spanish hospitals. The follow-up time for each patient was 48 wk after randomization, with quarterly visits in which the viral load, biochemical and serological parameters, adverse effects, adherence to treatment and consumption of hospital resources were *** Forty-six patients were evaluated [median age: 55.4 years(30.2-75.2); 84.8% male], including 22 patients with TDF and 24 with LAM+ADV. During study development, hepatitis B virus DNA(HBV-DNA) remained undetectable, all patients remained HBe Ag negative, and hepatitis B surface antigen(HBs Ag) positive. Alanine aminotransferase(ALT) values at the end of the study were similar in the 2 groups(25.1± 7.65, TDF vs 24.22 ± 8.38, LAM+ADV, P = 0.646). No significant changes were observed in creatinine or serum phosphorus values in either group. No significant differences between the 2 groups were noted in the identification of adverse effects(AEs)(53.8%, TDF vs 37.5%, LAM+ADV, P = 0.170), and none of the AEs which occurred were serious. Treatment adherence was 95.5% and 83.3% in the TDF and the LAM+ADV groups, respectively(P = 0.488). The costs associated with hospital resource consumption were significantly lower with the TDF treatment than the LAM+ADV treatment(€4943 ± 1059 vs €5811 ± 1538, respectively, P < 0.001).CONCLUSION TDF monotherapy proved to be safe

关键词： Tenofovir Lamivudine+Adefovir Efficacy Safety Adherence Costs Hepatitis B

Rethinking de novo immune hepatitis,an old concept for liver allograft rejection:relevance of glutathione S-transferase T1 mismatch

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World Journal of Gastroenterology 2018年第29期24卷 3239-3249页

作者： Isabel Aguilera Elena Aguado-Dominguez Jose Manuel Sousa Antonio Nunez-Roldan Department of Immunology Instituto de Biomedicina de Sevilla(IBIS)Hospital Universitario Virgen del RocíoSevilla 41013Spain digestive and Liver diseases service Hospital Universitario Virgen del RocíoSevilla 41013Spain

Antibody-mediated rejection(AMR) in liver transplantation has long been underestimated. The concept of the liver as an organ susceptible to AMR has emerged in recent years, not only in the context of the major histocompatibility complex with the presence of HLA donor-specific antibodies, but also with antigens regarded as "minor", whose role in AMR has been demonstrated. Among them, antibodies against glutathione S-transferase T1 have been found in 100% of patients with de novo autoimmune hepatitis(dn AIH) when studied. In its latest update, the Banff Working Group for liver allograft pathology proposed replacing the term dn AIH with plasma cell(PC)-rich rejection. Antibodies to glutathione S-transferase T1(GSTT1) in null recipients of GSTT1 positive donors have been included as a contributory but nonessential feature of the diagnosis of PC-rich rejection. Also in this update, non-organ-specific anti-nuclear or smooth muscle autoantibodies are no longer included as diagnostic criteria. Although initially found in a proportion of patients with PC-rich rejection, the presence of autoantibodies is misleading since they are not diseasespecific and appear in many different contexts as bystanders. The cellular types and proportions of the inflammatory infiltrates in diagnostic biopsies have been studied in detail very recently. PC-rich rejection biopsies present a characteristic cellular profile with a predominance of T lymphocytes and a high proportion of PCs, close to 30%, of which 16.48% are Ig G4+. New data on the relevance of GSTT1-specific T lymphocytes to PC-rich rejection will be discussed in this review.

关键词： glutathione S-transferase T1 mismatch liver allograft rejection plasma cell-rich rejection de novo autoimmune hepatitis donor-specific antibodies newCAST cell quantification IgG4+plasma cell T lymphocytes