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Update in lean metabolic dysfunction-associated steatotic liver disease

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World Journal of Hepatology 2024年第3期16卷 452-464页

作者： Karina Sato-Espinoza Perapa Chotiprasidhi Mariella R Huaman Javier Díaz-Ferrer Division of gastroenterology and Hepatology Department of MedicineMayo ClinicRochesterMN 55902United States Obesity and Metabolic Center for Obesity and Metabolic HealthLima 02002LimaPeru Hepatology service Department of Digestive DiseasesHospital Nacional Edgardo Rebagliati MartinsLima 02002LimaPeru Medicine Faculty Universidad San Martin de PorresLima 02002LimaPeru gastroenterology service Clinica InternacionalLima 02002LimaPeru

BACKGROUND A new nomenclature consensus has emerged for liver diseases that were previously known as non-alcoholic fatty liver disease(NAFLD)and metabolic dysfunction-associated fatty liver disease(MAFLD).They are now defined as metabolic dysfunction-associated steatotic liver disease(MASLD),which includes cardiometabolic criteria in adults.This condition,extensively studied in obese or overweight patients,constitutes around 30%of the population,with a steady increase worldwide.Lean patients account for approximately 10%-15%of the MASLD population.However,the pathogenesis is complex and is not well understood.AIM To systematically review the literature on the diagnosis,pathogenesis,characteristics,and prognosis in lean MASLD patients and provide an interpretation of these new criteria.METHODS We conducted a comprehensive database search on PubMed and Google Scholar between January 2012 and September 2023,specifically focusing on lean NAFLD,MAFLD,or MASLD patients.We include original articles with patients aged 18 years or older,with a lean body mass index categorized according to the World Health Organization criteria,using a cutoff of 25 kg/m2 for the general population and 23 kg/m2 for the Asian population.RESULTS We include 85 studies in our analysis.Our findings revealed that,for lean NAFLD patients,the prevalence rate varied widely,ranging from 3.8%to 34.1%.The precise pathogenesis mechanism remained elusive,with associations found in genetic variants,epigenetic modifications,and adaptative metabolic response.Common risk factors included metabolic syndrome,hypertension,and type 2 diabetes mellitus,but their prevalence varied based on the comparison group involving lean patients.Regarding non-invasive tools,Fibrosis-4 index outperformed the NAFLD fibrosis score in lean patients.Lifestyle modifications aided in reducing hepatic steatosis and improving cardiometabolic profiles,with some medications showing efficacy to a lesser extent.However,lean NAFLD patients exhibited a worse prognosis compared to the obese

关键词： Lean Non-obese Non-alcoholic fatty liver disease Metabolic dysfunction-associated fatty liver disease Metabolic dysfunction-associated steatotic liver disease Guidelines Diagnosis Management Pathogenesis Treatment

Anal Pathologies: What Management at the Reference Health Center of Bamako’s Commune V?

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Open Journal of gastroenterology 2024年第3期14卷 87-92页

作者： Sanra Déborah Sanogo Moussa Y. Dicko Ousmane Diarra Abou A. Diarra Drissa Katilé Abdoulaye Maiga Ouatou Mallé Sabine Drabo Makan S. Tounkara Hourouma Sow Kadiatou Doumbia Anselme Konaté Moussa T. Diarra Hepato-gastroenterology Department CHU Point G Bamako Mali service d’hépato-gastroentérologie CHU Gabriel Touré Bamako Mali Hepato-gastroenterology Unit CSREF Commune V Bamako Mali

Anal pathologies are conditions affecting the anal margin and the anal canal. The aim of our study was to update data on anal diseases. Non-specific, it can reveal an emergency, a serious illness, a chronic disease or a benign condition. It was a prospective, descriptive and analytical study from April 2022 to March 2023, carried out in the hepato-gastroenterology unit of the Centre de Santé de Référence de la commune V du District de Bamako in Mali. Out of seven hundred and forty-nine (749) patients seen in consultation, 98 had anal pathology, i.e. a prevalence of 13.08%. The mean age was 40 ± 15.15 years and the sex ratio was 1.5. Hemorrhoidal disease and anal fissure were the most frequent pathologies in 66.4% and 24.4% of cases respectively. Medical treatment was initiated in 91.9% of patients with hemorrhoidal disease and 91.7% with anal fissure. Anal pathologies are common in young male patients. In our context, they are dominated by benign conditions.

关键词： Anal Pathologies Hemorrhoidal Disease Anal Fissure

Snapshot of an integrated psychosocial gastroenterology service

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World Journal of gastroenterology 2015年第6期21卷 1893-1899页

作者： Sarah W Kinsinger Sarah Ballou Laurie Keefer Division of gastroenterology Northwestern University Feinberg School of Medicine Chicago

AIM:To characterize the patients utilizing a gastroenterology behavioral medicine service and examine the effect of treatment on health care utilization.METHODS:Patients were referred by their gastroenterologists for psychological treatment during a15 mo period.Patients seen for an intake with a psychologist completed the Brief Symptom Inventory(BSI)and a checklist of psychosocial concerns.A subset of patients with functional bowel disorders also completed a disease specific quality of life measure.Chart review was conducted to obtain information on type and frequency of sessions with the psychologist,the number of outpatient gastroenterology visits,and number of gastroenterology-related medical procedures during the 6 mo following psychological intake.RESULTS:Of 259 patients referred for treatment,118(46%)completed an intake with a psychologist.Diagnoses included:irritable bowel syndrome(42%),functional dyspepsia(20%),inflammatory bowel diseases(20%),esophageal symptoms(10%),and"other"(8%).Demographic variables and disease type did not differentiate between those who did and did not schedule an intake.Mean t-scores for the BSI global score index and the depression,anxiety,and somatization subscales fell below the cutoff for clinical significance(t=63).Treatments were predominantly gut-directed hypnosis(48%)and cognitive behavioral therapy(44%).Average length of treatment was 4 sessions.Among functional gastrointestinal(GI)patients,those patients who initiated treatment received significantly fewer GI-related medical procedures during the 6 mo following the referral than patients who did not schedule an intake[t(197)=2.69,P<0.01].CONCLUSION:Patients are receptive to psychological interventions for GI conditions and there is preliminary evidence that treatment can decrease health-care utilization among patients with functional GI conditions.

关键词： Psychological treatment Irritable bowel syndrome F

NAD+associated genes as potential biomarkers for predicting the prognosis of gastric cancer

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Oncology Research 2024年第2期32卷 283-296页

作者： XIANGDONG SUN HUIJUAN WEN FAZHAN LI IHTISHAM BUKHARI FEIFEI REN XIA XUE PENGYUAN ZHENG YANG MI Henan Key Laboratory for Helicobacter Pylori&Microbiota and GI Cancer Marshall Medical Research CenterThe Fifth Affiliated Hospital of Zhengzhou UniversityZhengzhouChina Department of gastroenterology The Fifth Affiliated Hospital of Zhengzhou UniversityZhengzhouChina

Nicotinamide adenine dinucleotide(NAD+)plays an essential role in cellular metabolism,mitochondrial homeostasis,inflammation,and senescence.However,the role of NAD+-regulated genes,including coding and long non-coding genes in cancer development is poorly understood.We constructed a prediction model based on the expression level of NAD+metabolism-related genes(NMRGs).Furthermore,we validated the expression of NMRGs in gastric cancer(GC)tissues and cell lines;additionally,β-nicotinamide mononucleotide(NMN),a precursor of NAD+,was used to treat the GC cell lines to analyze its effects on the expression level of NMRGs lncRNAs and cellular proliferation,cell cycle,apoptosis,and senescence-associated secretory phenotype(SASP).A total of 13 NMRGs-related lncRNAs were selected to construct prognostic risk signatures,and patients with high-risk scores had a poor prognosis.Some immune checkpoint genes were upregulated in the high-risk group.In addition,cell cycle,epigenetics,and senescence were significantly downregulated in the high-risk group.Notably,we found that the levels of immune cell infiltration,including CD8 T cells,CD4 naïve T cells,CD4 memory-activated T cells,B memory cells,and naïve B cells,were significantly associated with risk scores.Furthermore,the treatment of NMN showed increased proliferation of AGS and MKN45 cells.In addition,the expression of SASP factors(IL6,IL8,IL10,TGF-β,and TNF-α)was significantly decreased after NMN treatment.We conclude that the lncRNAs associated with NAD+metabolism can potentially be used as biomarkers for predicting clinical outcomes of GC patients.

关键词： NAD+ LncRNAs Cancer Cell infiltration Prognosis Tumor microenvironment

gastroenterology service in a teaching hospital in rural New Zealand, 1991-2003

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World Journal of gastroenterology 2009年第5期15卷 583-590页

作者： Michael Schultz Andrew Davidson Sarah Donald Bogna Targonska Angus Turnbull Susan Weggery Vicki Livingstone John D Dockerty Department of Medical and Surgical Sciences University of Otago PO Box 913 Dunedin New Zealand and Department of Gastroenterology Dunedin Public Hospital Otago District Health Board Dunedin New Zealand Dunedin School of Medicine University of Otago Dunedin New Zealand Department of Preventive and Social Medicine University of Otago Dunedin New Zealand

AIM: To retrospectively collect inpatient and outpatient data and to assess the use of endoscopic procedures during the years 1991, 1997 and 2003 to analyse for trends. METHODS: This retrospective survey was conducted in a University-associated gastroenterology Unit offering secondary and tertiary health care services for a population of approximately 182 000 people in Southern New Zealand. Data collected included patient contacts (inand outpatients), gastroscopic and colonoscopic investigations. RESULTS: We observed a significant increase in the absolute numbers of patient contacts over the years (1991: 2308 vs 1997: 2022 vs 2003: 2783, P services remained relatively stable but colonoscopic investigations for a positive family history of colorectal cancer increased significantly while more gastroscopies were performed for unexplained anaemia. CONCLUSION: The whole spectrum of gastroenterology contacts was studied. A substantial proportion of colonoscopies and outpatient consultations were undertaken to screen for colorectal cancer. This proportion is likely to grow further. Our fi ndings have implications for the recruitment and training of the next generation of gastroenterologists.

关键词：肠胃病学医院肝炎诊断

Population-based X-ray gastric cancer screening in Hiroshima prefecture, Japan

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World Journal of Clinical Oncology 2024年第2期15卷 271-281页

作者： Nhu Thi Hanh Vu Yuji Urabe Duc Trong Quach Shiro Oka Toru Hiyama Department of Internal Medicine University of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh 700000Viet Nam Department of Endoscopy Hiroshima University HospitalHiroshima 734-8551Japan Department of Gastrointestinal Endoscopy and Medicine Hiroshima University HospitalHiroshima 734-8551Japan Department of gastroenterology Hiroshima University HospitalHiroshima 734-8551Japan Health service Center Hiroshima UniversityHigashihiroshima 739-8514Japan

BACKGROUND X-ray gastric cancer(GC)screening has been shown to decrease mortality.Population-based X-ray GC screening has been performed in Hiroshima Prefe-cture,Japan,since 1983 but time trends and the efficacy of the method over 39 years have not been assessed.METHODS This was a population-based retrospective study.The data were derived from aggregated data of the Hiroshima Regional Health Medical Promotion Organization,including the number and rate of participants and those requiring esophagogastroduodenoscopies(EGDs),the number and rate of participants diagnosed as having GC,and the positive predictive value of the abnormal findings detected by X-ray and confirmed by EGDs.The number and rate of esophageal cancers were also collected.Further,the cost of detecting one GC was evaluated.RESULTS The number of participants has decreased during the last four decades,from 39925 in 1983 to 12923 in 2021.The rate of those requiring EGDs decreased significantly in recent years(P<0.001).The number of participants diagnosed as having GC has also declined,from 76 to 10 cases.However,the rate of cases diagnosed as GC among the participants remained around 0.1%.The positive predictive value increased significantly in recent years except during 1983-1991.The number and rate of accidentally detected esophageal cancers have risen recently,from 0%in 2008 to 0.02%in 2021,one-fifth of the diagnosis rate of GC.One GC diagnosis costs approximately 4200000 Japanese Yen(30000 United States Dollars)for the X-ray screenings and EGDs.CONCLUSION X-ray GC screening in Hiroshima has been efficient,but one challenge is the cost.Esophageal cancers may also need to be considered because they have gradually increased in recent years.

关键词： Population Retrospective studies X-ray Gastric cancer Screening

Eradication Treatment of Helicobacter pylori Infection: Evaluation of Therapeutic Strategies in N’Djamena

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Open Journal of gastroenterology 2024年第2期14卷 59-67页

作者： Mayanna Habkréo Ali Mahamat Moussa Tahir Mahamat Saleh Djerabet Franckly Fany Haby Mairé Dehainssala Adama Ngaré Mahamat Ali Hachim service de Medecine Interne et Gastroenterologie Centre Hospitalier Universitaire La Reference Nationale N’Djamena Tchad service de Medecine Interne Centre Hospitalier Universitaire La Renaissance N’Djamena Tchad service de Médecine Hopital de l’Amitié Tchad-Chine N’Djamena Tchad

Background: Helicobacter pylori (Hp) infection is the most widespread bacterial infection in the world. The infection is generally acquired in childhood, but can persist into adulthood. Eradication therapy has undergone several modifications. The aim of this study was to evaluate the different therapeutic strategies used in the eradication of Helicobacter pylori infection in the Centre Hospitalier Universitaire La Reference Nationale of N’Djaména. Patients and Methods: This was a prospective, descriptive analytical study spread over one year, from September 2021 to September 2022. Patients at least 15 years of age presenting with dyspeptic symptoms, seen consecutively in a hepato-gastroenterology consultation and with a positive stool test for H. pylori infection, were included in the study. Equally, 1/3 of patients were treated with dual or triple therapy. The remaining third received quadritherapy. Results: A total of 268 patients were included in the study (mean age 38.40 ± 14.66 with extremes of 16 and 80 years). Males predominated in 58% of cases. Overall therapeutic efficacy was 88.9%. According to different therapeutic strategies, efficacy was 90.75% for dual therapy with PPI (Rabeprazole) and Amoxicillin. On the other hand, efficacy was 87% and 88.88% for PPI-based triple therapy and dual antibiotic therapy, and for PPI-based quadruple therapy and triple antibiotic therapy. Conclusion: H. pylori infection is a common disease in Chad. Dual therapy with rabeprazole combined with a high dose of amoxicillin over a period of at least two weeks showed similar if not better efficacy than triple or quadruple therapy.

关键词： Helicobacter pylori Therapeutic Strategies Eradication Dyspepsia Chad

Endoscopic Treatment of Esophageal Achalasia: Experience of the Hepato-gastroenterology service of Fez

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Open Journal of gastroenterology 2019年第8期9卷 164-173页

作者： Houda Meyiz Asmae Lamine Mounia El Yousfi Nourdin Aqodad Mohammed El Abkari Adil Ibrahimi Dafr Allah Benajeh Ihssane Mellouki Department of Hepato-gastroenterology University Hospital Hassan II Fez Morocco Faculty of Medicine-Fez University Sidi Mohammed Ben Abdellah Fez Morocco

The achalasia is a rare primary esophageal motor disorder characterized by relaxation disorders of the lower esophageal sphincter and absence of the esophageal body peristalsis. Several studies suggest that the response to the endoscopic treatment depends on several predictors. The aim of our study was to evaluate the endoscopic treatment of esophageal achalasia and identify the predictive factors of endoscopic treatment response. Patients and Methods: This is a retrospective analytical study of 78 patients with achalasia, managed in the gastroenterology department of the university medical center Hassan II-Fez, during a period of 5 years (January 2009 to December 2014). The diagnosis of achalasia was retained on a set of clinical, endoscopic, manometric and radiological arguments. A graded dilation protocol starting with a 35 mm balloon three times for 30 seconds in progressive pressure between 5 and 8 psi was performed. We used the Eckardt score to evaluate the clinical remission. Results: During the study period, 78 patients were included. The average age of our patients was 47 years old [18 - 81] with a sex-ratio M/F of 1.05. The average of Eckardt score before dilation was 5.9 [3 - 9]. An average of 1.41 dilation sessions was performed per patient with 85.9% of the initial success rate (n = 67). Initial success without further dilation sessions was achieved in 55.1% of our patients (n = 43). A clinical recurrence requiring further dilation sessions was observed in 30.8% of the cases (n = 24). The average relapse time after first dilation success was 2.7 years, 75% occurs within the first year. Dilation failure was retained in 14 patients (17.9%) requiring surgery. Only one post-dilation perforation was noted. In multivariate analysis, only odynophagia and the number of dilatation sessions were factors of failure of the endoscopic dilation. Conclusion: Pneumatic dilation is a minimally morbid and effective procedure. Our work showed that odynophagia, and the number of dilation sessions, are two predictive fac

关键词： Achalasia Pneumatic Dilatation Manometry Eckardt Score

Interest of Sclerosing Injections in Hemorrhoidal Pathology: Experience of the service of Hepato-gastroenterology of Fez

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Open Journal of gastroenterology 2019年第1期9卷 36-42页

作者： H. Abid R. Benjira M. Lahlali A. Lamine N. Lahmidani M. Elyousfi N. Aqodad D. Benajah A. Ibrahimi M. Elabkari Hepato-gastroenterology Department Hassan II University Medical Center Fez Morocco Faculty of Medicine Sidi Mohammed Ben Abdellah University Fez Morocco

Hemorrhoids are a clinical and anatomical subject that has not been completely investigated [1]. This benign condition is expressed by intermittent functional manifestations as rectorrhagies and prolapse. while the medical treatments seek to relieve symptoms, the instrumental ones are intended to reposition and hold the hemorrhoids in an anatomically correct position and to reduce their vascularity [1]. Indeed, sclerotherapy seems an effective and safe method in fact. Aim of the Study: To report the results of a moroccan series of patients treated with sclerosing injections, emphasizing short- and long-term efficacy as well as the rate of complications. Methods: This is a descriptive retrospective study of the 148 patients with symptomatic internal hemorrhoids who have been treated with sclerotherapy in the gastroenterology department of the university medical center of Fez over a period of 17 years [2001-2018]. Results: The average age of our patients is 47.1 years [19 - 86]. We notified a large male predominance with a sex ratio M/F 2.58. Rectorrhagies and prolapse were the most frequent reasons for consultation;they were respectively notified in 96% (n = 143) and 83% of patients (n = 123). Anemia was found in 45 cases (30.4%), of which 29 cases required transfusion. Proctologic examination found internal hemorrhoids grade 2 in 83% (n = 124) and grade 1 in 16.2% (n = 24) of patients. Initial success was found in 119 cases (80.4%) after an average of 2.25 sessions (1 - 4). Nine patients (8, 11%) had minor complications dominated by minimal rectorrhagies in 8 cases, resolved spontaneously. In 29 cases (19.5%), the sessions were interrupted following a failure of the technique in 12 cases (41.3%), in 11 cases after change of the stage of hemorrhoids of stage II to III, in 4 cases following the appearance of an anal fissure contraindicating the procedure, and in 2 cases due to severe pain post sclerosis. Among these 29 cases, 13 patients were referred for surgery, while in 16 patients we opted for an instrumental t

关键词： Internal Hemorrhoids Sclerosing Injection Evolution Complications