Ascites remains a significant challenge in patients with cirrhosis, posing difficulties in management and affecting prognosis. This review examines the current understanding of ascites, including its underlying mechanisms, symptoms, and treatment options, with a specific focus on the innovative Alfa Pump device. The review begins by discussing traditional approaches to managing ascites while also addressing their limitations and potential complications. It then explores the emergence of the Alfa Pump system, a novel implantable device designed to tackle refractory ascites by continuously draining fluid from the abdomen while minimizing circulatory issues. Through a synthesis of current literature and clinical evidence, this narrative review underscores the importance of a multidisciplinary approach in the management of ascites, with a particular emphasis on the evolving role of the Alfa Pump in improving outcomes and quality of life for patients with refractory ascites.
{"title":"Advancements in ascites management: a comprehensive narrative review of the Alfa Pump system","authors":"Muhammad Asim, Nabiha Naqvi, Vikash Kumar Karmani, Aima Tahir, Umm E. Salma Shabbar Banatwala, Shahzeb Rehman, Minha Aslam, Aleena Majeed, Farhan Khan","doi":"10.1186/s43066-024-00373-0","DOIUrl":"https://doi.org/10.1186/s43066-024-00373-0","url":null,"abstract":"Ascites remains a significant challenge in patients with cirrhosis, posing difficulties in management and affecting prognosis. This review examines the current understanding of ascites, including its underlying mechanisms, symptoms, and treatment options, with a specific focus on the innovative Alfa Pump device. The review begins by discussing traditional approaches to managing ascites while also addressing their limitations and potential complications. It then explores the emergence of the Alfa Pump system, a novel implantable device designed to tackle refractory ascites by continuously draining fluid from the abdomen while minimizing circulatory issues. Through a synthesis of current literature and clinical evidence, this narrative review underscores the importance of a multidisciplinary approach in the management of ascites, with a particular emphasis on the evolving role of the Alfa Pump in improving outcomes and quality of life for patients with refractory ascites.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1186/s43066-024-00372-1
Rehan Rustam, Aqsa Qaisar
The importance of sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) remains crucial in managing chronic HCV infection among patients who have experienced treatment failure and relapse after prior use of direct-acting antivirals (DAAs), as evidenced by high SVR12. However, limited real-world data exists on safety and efficacy. Therefore, the study’s goal was to conduct a qualitative systematic review to assess SOF/VEL/VOX’s effectiveness and safety. Thorough searches spanned PubMed, Embase, and Scopus, from 2015 to August 1st, 2023. The outcomes assessed were SVR12 and treatment-related adverse events (AEs). We identified and analyzed 12 studies in which SVR12 of the per-protocol (PP) population was 96.7% and of the intention-to-treat (ITT) population was 92.6% showing excellent efficacy of SOF/VEL/VOX. SVR12 rates notably differed among patients: those without GT3 infection (94.20%) and without cirrhosis (97.60%) experienced higher rates compared to patients having GT3 infection (87.40%) and cirrhotic patients (94.20%). Treatment-related AEs were also recorded. To summarize, our study presents evidence that SOF/VEL/VOX serves as an extremely safe and efficacious therapy for HCV-infected patients, previously treated with DAAs.
{"title":"A systematic review of sofosbuvir/velpatasvir/voxilaprevir in HCV patients previously treated with direct-acting antivirals","authors":"Rehan Rustam, Aqsa Qaisar","doi":"10.1186/s43066-024-00372-1","DOIUrl":"https://doi.org/10.1186/s43066-024-00372-1","url":null,"abstract":"The importance of sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) remains crucial in managing chronic HCV infection among patients who have experienced treatment failure and relapse after prior use of direct-acting antivirals (DAAs), as evidenced by high SVR12. However, limited real-world data exists on safety and efficacy. Therefore, the study’s goal was to conduct a qualitative systematic review to assess SOF/VEL/VOX’s effectiveness and safety. Thorough searches spanned PubMed, Embase, and Scopus, from 2015 to August 1st, 2023. The outcomes assessed were SVR12 and treatment-related adverse events (AEs). We identified and analyzed 12 studies in which SVR12 of the per-protocol (PP) population was 96.7% and of the intention-to-treat (ITT) population was 92.6% showing excellent efficacy of SOF/VEL/VOX. SVR12 rates notably differed among patients: those without GT3 infection (94.20%) and without cirrhosis (97.60%) experienced higher rates compared to patients having GT3 infection (87.40%) and cirrhotic patients (94.20%). Treatment-related AEs were also recorded. To summarize, our study presents evidence that SOF/VEL/VOX serves as an extremely safe and efficacious therapy for HCV-infected patients, previously treated with DAAs.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":"32 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In liver cirrhosis, events of spontaneous bacterial peritonitis (SBP) and hepatic encephalopathy (HE) portend a poor prognosis. Gut dysbiosis remains a common pathogenetic mechanism for both SBP and HE. Recent data suggests the role of rifaximin in gut modulation and improving intestinal dysbiosis. Due to emergence of multidrug-resistant organisms, gut-selective antibiotics with minimal systemic effects are warranted for secondary prophylaxis in patients of cirrhosis. We compared rifaximin alone vs combination with norfloxacin for secondary prophylaxis of patients of cirrhosis presenting with SBP and HE. This was a prospective, open-label, RCT which included all patients of cirrhosis with SBP and HE on admission. On discharge, in addition to standard medical treatment, patients were randomized to rifaximin 400 mg three times a day (group I) and rifaximin 400 mg three times a day with norfloxacin 400 mg once a day (group II) as a secondary prophylaxis of SBP. Primary outcomes were recurrent episodes of SBP and HE at 6 months and 28-day, 90-day, and 6-month mortalities. Secondary outcomes included number of rehospitalizations, episodes of upper gastrointestinal bleed, new acute kidney injury episodes, and change in Child–Turcotte–Pugh (CTP) and model for end-stage liver disease (MELD) scores over next 6 months. After screening 87 patients of cirrhosis with SBP and HE, 12 patients had in-hospital mortality and another 25 were excluded, one patient was lost to follow-up, and, finally, 49 patients were randomized into group I (n = 24) and group II (n = 25). The HE was grade 2 (18 vs 16) and grade 3 (6 vs 9) in groups I and II respectively. Primary outcomes as recurrent SBP (3 vs 2; P = 0.67); recurrent HE at 6 months (5 vs 2; P = 0.24); and 28-day (2 vs 2; P = 1.0) and 90-day mortality (4 vs 3; P = 0.72) and 6-month mortality (6 vs 8, P = 0.52) were comparable between two groups respectively. Secondary outcomes as number of rehospitalizations (3 vs 8, P = 0.07), new episodes of UGI bleed (2 vs 3, P = 0.1), new AKI episodes (4 vs 1, P = 0.06), ∆CTP (− 4 vs − 4), and ∆MELD (− 9 vs − 8) over the next 6 months were not significantly different between two groups respectively. Rifaximin was effective in secondary prevention of both SBP and HE in patients of cirrhosis. The randomized controlled trial was registered in CTRI/2021/09/036321 dated September 7, 2021.
在肝硬化患者中，自发性细菌性腹膜炎（SBP）和肝性脑病（HE）预示着不良的预后。肠道菌群失调仍是 SBP 和 HE 的常见致病机制。最近的数据表明，利福昔明在调节肠道和改善肠道菌群失调方面发挥了作用。由于多重耐药菌的出现，肝硬化患者需要使用对全身影响最小的肠道选择性抗生素进行二级预防。我们比较了利福昔明单独使用与诺氟沙星联合使用对出现 SBP 和 HE 的肝硬化患者进行二级预防的效果。这是一项前瞻性、开放标签的 RCT 研究，包括所有入院时出现 SBP 和 HE 的肝硬化患者。患者出院时，除接受标准药物治疗外，还随机接受利福昔明 400 毫克，每天三次（I 组）；利福昔明 400 毫克，每天三次，同时服用诺氟沙星 400 毫克，每天一次（II 组），作为 SBP 的二级预防药物。主要结果为 6 个月时 SBP 和 HE 的复发率，以及 28 天、90 天和 6 个月的死亡率。次要结果包括再次住院次数、上消化道出血发作次数、新的急性肾损伤发作次数以及未来 6 个月内 Child-Turcotte-Pugh (CTP) 和终末期肝病模型 (MELD) 评分的变化。在对87名患有SBP和HE的肝硬化患者进行筛选后，12名患者出现院内死亡，另有25名患者被排除在外，1名患者失去随访，最后，49名患者被随机分为I组（24人）和II组（25人）。I 组和 II 组的 HE 分别为 2 级（18 对 16）和 3 级（6 对 9）。两组的主要结果分别为：复发 SBP（3 对 2；P = 0.67）；6 个月时复发 HE（5 对 2；P = 0.24）；28 天（2 对 2；P = 1.0）和 90 天死亡率（4 对 3；P = 0.72）以及 6 个月死亡率（6 对 8，P = 0.52），两组结果相当。两组患者在接下来的 6 个月中再住院次数（3 vs 8，P = 0.07）、新的 UGI 出血发作（2 vs 3，P = 0.1）、新的 AKI 发作（4 vs 1，P = 0.06）、∆CTP（- 4 vs -4）和∆MLD（- 9 vs -8）等次要结果无显著差异。利福昔明对肝硬化患者的 SBP 和 HE 二级预防均有效。该随机对照试验已于2021年9月7日登记在CTRI/2021/09/036321号文件中。
{"title":"Rifaximin alone vs combination with norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis with hepatic encephalopathy: randomized controlled trial","authors":"Tarana Gupta, Vaibhav Gaur, Anjali Saini, Nikhil Sai Jarpula, Sandeep Kumar Goyal","doi":"10.1186/s43066-024-00374-z","DOIUrl":"https://doi.org/10.1186/s43066-024-00374-z","url":null,"abstract":"In liver cirrhosis, events of spontaneous bacterial peritonitis (SBP) and hepatic encephalopathy (HE) portend a poor prognosis. Gut dysbiosis remains a common pathogenetic mechanism for both SBP and HE. Recent data suggests the role of rifaximin in gut modulation and improving intestinal dysbiosis. Due to emergence of multidrug-resistant organisms, gut-selective antibiotics with minimal systemic effects are warranted for secondary prophylaxis in patients of cirrhosis. We compared rifaximin alone vs combination with norfloxacin for secondary prophylaxis of patients of cirrhosis presenting with SBP and HE. This was a prospective, open-label, RCT which included all patients of cirrhosis with SBP and HE on admission. On discharge, in addition to standard medical treatment, patients were randomized to rifaximin 400 mg three times a day (group I) and rifaximin 400 mg three times a day with norfloxacin 400 mg once a day (group II) as a secondary prophylaxis of SBP. Primary outcomes were recurrent episodes of SBP and HE at 6 months and 28-day, 90-day, and 6-month mortalities. Secondary outcomes included number of rehospitalizations, episodes of upper gastrointestinal bleed, new acute kidney injury episodes, and change in Child–Turcotte–Pugh (CTP) and model for end-stage liver disease (MELD) scores over next 6 months. After screening 87 patients of cirrhosis with SBP and HE, 12 patients had in-hospital mortality and another 25 were excluded, one patient was lost to follow-up, and, finally, 49 patients were randomized into group I (n = 24) and group II (n = 25). The HE was grade 2 (18 vs 16) and grade 3 (6 vs 9) in groups I and II respectively. Primary outcomes as recurrent SBP (3 vs 2; P = 0.67); recurrent HE at 6 months (5 vs 2; P = 0.24); and 28-day (2 vs 2; P = 1.0) and 90-day mortality (4 vs 3; P = 0.72) and 6-month mortality (6 vs 8, P = 0.52) were comparable between two groups respectively. Secondary outcomes as number of rehospitalizations (3 vs 8, P = 0.07), new episodes of UGI bleed (2 vs 3, P = 0.1), new AKI episodes (4 vs 1, P = 0.06), ∆CTP (− 4 vs − 4), and ∆MELD (− 9 vs − 8) over the next 6 months were not significantly different between two groups respectively. Rifaximin was effective in secondary prevention of both SBP and HE in patients of cirrhosis. The randomized controlled trial was registered in CTRI/2021/09/036321 dated September 7, 2021.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":"1 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1186/s43066-024-00370-3
Ayfer Beyaz Coşkun, Semra Turkoglu, Adviye Gülçin Sağdıçoğlu Celep, İbrahim Hanifi Özercan, Engin Korkmaz
The rate of NAFLD in the general population is estimated to be 25.2%. NAFLD is affected by lifestyle, diet, and inflammation. In this study, the use of probiotics, prebiotics, and synbiotics was aimed to modulate the circadian clock in the liver and improve metabolic disorder through the gut–liver axis. Six-week-old, healthy, 43 Wistar albino rats were included in the study and their average weight was determined as 140.50 g (95.00–177.00) at the beginning of the study. Before the study, the rats were randomly divided into 5 groups, 8 animals were placed in the 1st, 3rd, 4th, and 5th groups and 11 animals were placed in the 2nd group. Rats in group 1 were fed standard food for 13 weeks. Rats in the 2nd, 3rd, 4th, and 5th groups were fed with 10% fructose water during the 1-week adaptation period and then 20% fructose water. After the 7th week, probiotic treatment (2 × 109 CFU/ml Lactobacillus rhamnosus GG) was administered to rats in group 3rd via gavage for 6 weeks, and prebiotic treatment was administered to rats in group 4th with feed containing 10% grape seed extract. Rats in the 5th group were given a feed consisting of 10% grape seed extract and 2 × 109 CFU/ml Lactobacillus rhamnosus GG via gavage. It was determined that the use of prebiotics as a treatment option in fatty liver had a more positive effect on glucose, ALT, melatonin, and ZO-1 values. In addition, it was observed that synbiotic use had more positive effects on histopathological findings, NAS score, and the expression level of circadian clock genes. While there was no significant difference between the mRNA levels of circadian clock genes, it was observed that gene expression levels increased with fructose consumption and decreased especially with synbiotic treatment. It has been observed that fructose modulates the circadian rhythm by affecting some biochemical and genomic pathways as a result of synbiotic use in order to prevent the negative effects of fructose on fatty liver.
{"title":"Effect of probiotic, prebiotic, and synbiotic supplementation on circadian clock in rats with fructose-induced non-alcoholic fatty liver","authors":"Ayfer Beyaz Coşkun, Semra Turkoglu, Adviye Gülçin Sağdıçoğlu Celep, İbrahim Hanifi Özercan, Engin Korkmaz","doi":"10.1186/s43066-024-00370-3","DOIUrl":"https://doi.org/10.1186/s43066-024-00370-3","url":null,"abstract":"The rate of NAFLD in the general population is estimated to be 25.2%. NAFLD is affected by lifestyle, diet, and inflammation. In this study, the use of probiotics, prebiotics, and synbiotics was aimed to modulate the circadian clock in the liver and improve metabolic disorder through the gut–liver axis. Six-week-old, healthy, 43 Wistar albino rats were included in the study and their average weight was determined as 140.50 g (95.00–177.00) at the beginning of the study. Before the study, the rats were randomly divided into 5 groups, 8 animals were placed in the 1st, 3rd, 4th, and 5th groups and 11 animals were placed in the 2nd group. Rats in group 1 were fed standard food for 13 weeks. Rats in the 2nd, 3rd, 4th, and 5th groups were fed with 10% fructose water during the 1-week adaptation period and then 20% fructose water. After the 7th week, probiotic treatment (2 × 109 CFU/ml Lactobacillus rhamnosus GG) was administered to rats in group 3rd via gavage for 6 weeks, and prebiotic treatment was administered to rats in group 4th with feed containing 10% grape seed extract. Rats in the 5th group were given a feed consisting of 10% grape seed extract and 2 × 109 CFU/ml Lactobacillus rhamnosus GG via gavage. It was determined that the use of prebiotics as a treatment option in fatty liver had a more positive effect on glucose, ALT, melatonin, and ZO-1 values. In addition, it was observed that synbiotic use had more positive effects on histopathological findings, NAS score, and the expression level of circadian clock genes. While there was no significant difference between the mRNA levels of circadian clock genes, it was observed that gene expression levels increased with fructose consumption and decreased especially with synbiotic treatment. It has been observed that fructose modulates the circadian rhythm by affecting some biochemical and genomic pathways as a result of synbiotic use in order to prevent the negative effects of fructose on fatty liver.\u0000","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":"10 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142182485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-09DOI: 10.1186/s43066-024-00371-2
Ahmed Moustafa, Mohamed AbdAllah, Wafaa El Akel, Sherif Wahed, Shereen Abdel Alem, Gamal Esmat
Sickle cell disease (SCD) patients are at a high risk of chronic liver disease (CLD) due to chronic viral hepatitis infection such as hepatitis C virus (HCV) infection, iron overload, and sickle cell hepatopathy. Nowadays, several oral direct-acting antiviral drugs (DAAs) have been developed and approved by the FDA for hepatitis C treatment. However, the safety and efficacy of DAAs in SCD patients remain insufficiently explored. To evaluate the efficacy and safety of administration of generic sofosbuvir (SOF) and daclatasvir (DCV) for 12 weeks in SCD patients infected with HCV. A retrospective study included 38 SCD patients infected with HCV treated with generic SOF (400 mg) and DCV (60 mg) for 12 weeks without ribavirin. The effectiveness of the HCV treatment was assessed by the sustained virologic response (SVR) at 24 weeks after the end of the treatment (SVR24). The SVR24 rate was 100% (38/38).There were insignificant alterations in hemoglobin and total bilirubin levels during HCV treatment or at end of treatment (EOT). The number of anemic patients who needed blood transfusion two weeks before HCV treatment, at week 4 of treatment, and at EOT was 11 (28.9%), 3 (8%), and 1 (3%) respectively. Moreover, the reductions in serum transaminase levels from baseline were statistically significant compared to the EOT. Generic SOF and DCV regimens appear to be safe and effective in the treatment of chronic HCV in patients with SCD.
{"title":"Generic sofosbuvir and daclatasvir for treatment of hepatitis C virus infection in patients with sickle cell disease","authors":"Ahmed Moustafa, Mohamed AbdAllah, Wafaa El Akel, Sherif Wahed, Shereen Abdel Alem, Gamal Esmat","doi":"10.1186/s43066-024-00371-2","DOIUrl":"https://doi.org/10.1186/s43066-024-00371-2","url":null,"abstract":"Sickle cell disease (SCD) patients are at a high risk of chronic liver disease (CLD) due to chronic viral hepatitis infection such as hepatitis C virus (HCV) infection, iron overload, and sickle cell hepatopathy. Nowadays, several oral direct-acting antiviral drugs (DAAs) have been developed and approved by the FDA for hepatitis C treatment. However, the safety and efficacy of DAAs in SCD patients remain insufficiently explored. To evaluate the efficacy and safety of administration of generic sofosbuvir (SOF) and daclatasvir (DCV) for 12 weeks in SCD patients infected with HCV. A retrospective study included 38 SCD patients infected with HCV treated with generic SOF (400 mg) and DCV (60 mg) for 12 weeks without ribavirin. The effectiveness of the HCV treatment was assessed by the sustained virologic response (SVR) at 24 weeks after the end of the treatment (SVR24). The SVR24 rate was 100% (38/38).There were insignificant alterations in hemoglobin and total bilirubin levels during HCV treatment or at end of treatment (EOT). The number of anemic patients who needed blood transfusion two weeks before HCV treatment, at week 4 of treatment, and at EOT was 11 (28.9%), 3 (8%), and 1 (3%) respectively. Moreover, the reductions in serum transaminase levels from baseline were statistically significant compared to the EOT. Generic SOF and DCV regimens appear to be safe and effective in the treatment of chronic HCV in patients with SCD.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":"32 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142182499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-02DOI: 10.1186/s43066-024-00368-x
Qingxuan Deng, Ruyue Lv, Haoqi Zou, Tangbin Zou
Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases, and it is characterized by a series of fatty liver diseases that can lead to severe liver disease. Although no therapeutic drug has been approved as an effective therapy for NAFLD to date, dietary changes and physical activity are thought to be the cornerstone of NAFLD management. For this reason, some articles are available to analyze the studies done so far using various modifications of intermittent fasting (IF) among animals and patients with NAFLD. Data from preclinical and clinical trials suggested that IF positively impacts inflammatory and metabolic markers in both animals and humans. Inflammation and oxidative stress are the major risk factors involved in the pathogenesis of NAFLD. IF has been shown to have positive benefits in alleviating metabolic disorders, promoting the browning of white tissue, resetting circadian rhythm, and activating autophagy of cells. This review is intended to provide a detailed synopsis of the protocols, potential mechanisms of action, and supporting evidence for IF in NAFLD. We will highlight what is currently known about IF approaches in NAFLD treatments in clinical populations with mechanism insight from animal studies, and the safety concerns in certain patient groups. The protocols of intermittent fasting (IF) are various. Data from trials suggested that IF positively impacts both humans and animals. IF has been shown to have potential treatments for nonalcoholic fatty liver disease.
非酒精性脂肪肝（NAFLD）是最常见的慢性肝病之一，其特征是一系列可导致严重肝病的脂肪肝。尽管迄今为止还没有任何治疗药物被批准作为非酒精性脂肪肝的有效疗法，但饮食改变和体育锻炼被认为是治疗非酒精性脂肪肝的基石。为此，一些文章分析了迄今为止在动物和非酒精性脂肪肝患者中使用各种间歇性禁食（IF）方法所做的研究。来自临床前和临床试验的数据表明，间歇性禁食对动物和人类的炎症和代谢指标都有积极影响。炎症和氧化应激是导致非酒精性脂肪肝的主要危险因素。研究表明，IF 在缓解代谢紊乱、促进白色组织褐变、重置昼夜节律和激活细胞自噬方面具有积极的益处。本综述旨在详细概述 IF 治疗非酒精性脂肪肝的方案、潜在作用机制和支持证据。我们将重点介绍目前已知的非酒精性脂肪肝临床治疗中的间歇性禁食方法、动物实验中的作用机制，以及某些患者群体的安全性问题。间歇性禁食（IF）的方案多种多样。试验数据表明，间歇性禁食对人类和动物都有积极影响。间歇性禁食已被证明具有治疗非酒精性脂肪肝的潜力。
{"title":"Beneficial effects of intermittent fasting on nonalcoholic fatty liver disease: a narrative review","authors":"Qingxuan Deng, Ruyue Lv, Haoqi Zou, Tangbin Zou","doi":"10.1186/s43066-024-00368-x","DOIUrl":"https://doi.org/10.1186/s43066-024-00368-x","url":null,"abstract":"Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases, and it is characterized by a series of fatty liver diseases that can lead to severe liver disease. Although no therapeutic drug has been approved as an effective therapy for NAFLD to date, dietary changes and physical activity are thought to be the cornerstone of NAFLD management. For this reason, some articles are available to analyze the studies done so far using various modifications of intermittent fasting (IF) among animals and patients with NAFLD. Data from preclinical and clinical trials suggested that IF positively impacts inflammatory and metabolic markers in both animals and humans. Inflammation and oxidative stress are the major risk factors involved in the pathogenesis of NAFLD. IF has been shown to have positive benefits in alleviating metabolic disorders, promoting the browning of white tissue, resetting circadian rhythm, and activating autophagy of cells. This review is intended to provide a detailed synopsis of the protocols, potential mechanisms of action, and supporting evidence for IF in NAFLD. We will highlight what is currently known about IF approaches in NAFLD treatments in clinical populations with mechanism insight from animal studies, and the safety concerns in certain patient groups. The protocols of intermittent fasting (IF) are various. Data from trials suggested that IF positively impacts both humans and animals. IF has been shown to have potential treatments for nonalcoholic fatty liver disease. ","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":"94 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141883641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1186/s43066-024-00369-w
Hamza Bashir, Ali Abbas, Muhammad Arsalan Khan
Choledochal cysts are congenital conditions that affect the biliary tree, typically identified during childhood. These cysts present as dilations in the biliary system, occurring either in the extrahepatic or intrahepatic regions or in some cases, in both areas. Occasionally, it may have associated chronic pancreatitis posing a challenge to the management of both conditions. In the case reported, a female child was diagnosed with a choledochal cyst along with chronic pancreatitis. She had an excision of cyst and lateral pancreaticojejunostomy simultaneously for both conditions resulting in favorable outcomes. An 8-year-old child visited the clinic with a complaint of upper abdominal pain accompanied by intermittent vomiting. An ultrasound was performed which showed a dilated common bile duct. To confirm the diagnosis, an MRCP and baseline labs including liver function tests were ordered. The findings were suggestive of a type IA choledochal cyst with concomitant chronic pancreatitis. Subsequently, she had choledochal cyst excision with Roux-en-Y hepaticojejunostomy reconstruction plus lateral pancreaticojejunostomy using the classical Puestow’s technique. The patient’s recovery post-surgery was uneventful, resulting in discharge on the fifth post-operative day for routine outpatient follow-up. Patients afflicted with choledochal cysts are prone to recurrent pancreatitis, though the precise underlying mechanism is unknown. Certain studies propose an association between abnormal pancreatico-biliary junction and recurrent pancreatitis, often defined as a common channel surpassing 15 mm in length. However, this aberration could not be definitively established in the current case. Diagnosis of choledochal cysts can be confirmed through either ERCP or MRCP, with the latter preferred due to its non-invasive nature. The optimal management strategy for choledochal cysts necessitates cyst resection and Roux-en-Y hepaticojejunostomy reconstruction Moreover, in cases associated with chronic pancreatitis, longitudinal pancreatojejunostomy may be undertaken. Thus, it is concluded that although rare choledochal cysts may have associated chronic pancreatitis. Surgical excision of the cyst and lateral pancreaticojejunostomy can be performed simultaneously resulting in favorable post-operative outcomes.
{"title":"Simultaneous choledochal cyst excision and pancreaticojejunostomy (Puestow’s technique) for type IA cyst with associated chronic pancreatitis: a case report","authors":"Hamza Bashir, Ali Abbas, Muhammad Arsalan Khan","doi":"10.1186/s43066-024-00369-w","DOIUrl":"https://doi.org/10.1186/s43066-024-00369-w","url":null,"abstract":"Choledochal cysts are congenital conditions that affect the biliary tree, typically identified during childhood. These cysts present as dilations in the biliary system, occurring either in the extrahepatic or intrahepatic regions or in some cases, in both areas. Occasionally, it may have associated chronic pancreatitis posing a challenge to the management of both conditions. In the case reported, a female child was diagnosed with a choledochal cyst along with chronic pancreatitis. She had an excision of cyst and lateral pancreaticojejunostomy simultaneously for both conditions resulting in favorable outcomes. An 8-year-old child visited the clinic with a complaint of upper abdominal pain accompanied by intermittent vomiting. An ultrasound was performed which showed a dilated common bile duct. To confirm the diagnosis, an MRCP and baseline labs including liver function tests were ordered. The findings were suggestive of a type IA choledochal cyst with concomitant chronic pancreatitis. Subsequently, she had choledochal cyst excision with Roux-en-Y hepaticojejunostomy reconstruction plus lateral pancreaticojejunostomy using the classical Puestow’s technique. The patient’s recovery post-surgery was uneventful, resulting in discharge on the fifth post-operative day for routine outpatient follow-up. Patients afflicted with choledochal cysts are prone to recurrent pancreatitis, though the precise underlying mechanism is unknown. Certain studies propose an association between abnormal pancreatico-biliary junction and recurrent pancreatitis, often defined as a common channel surpassing 15 mm in length. However, this aberration could not be definitively established in the current case. Diagnosis of choledochal cysts can be confirmed through either ERCP or MRCP, with the latter preferred due to its non-invasive nature. The optimal management strategy for choledochal cysts necessitates cyst resection and Roux-en-Y hepaticojejunostomy reconstruction Moreover, in cases associated with chronic pancreatitis, longitudinal pancreatojejunostomy may be undertaken. Thus, it is concluded that although rare choledochal cysts may have associated chronic pancreatitis. Surgical excision of the cyst and lateral pancreaticojejunostomy can be performed simultaneously resulting in favorable post-operative outcomes.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":"52 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141870354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-20DOI: 10.1186/s43066-024-00361-4
Andrew Yesaya Swallow, Ali Hamisi Mwanga, Douglas Chamshama, Godfrey Mchele, Yona Ringo, Kibwana Kitembo, William Lutege, Azza Naif, Innocent Mosha
Ectopic liver tissue (ELT) is a developmental abnormality in which liver tissue develops at an extrahepatic site without connection to the true liver. It is a rare entity with an incidence of 0.24–0.56% according to data described in laparoscopic or autopsy studies. The detailed mechanism behind the development of ELT is poorly understood. ELT predominantly has an asymptomatic nature, even by means of radiological studies the diagnosis of ELT without surgery or autopsy is difficult. ELT has been reported mostly to be found frequently on the gallbladder and rarely on the gastrohepatic ligament. ELT has increased the potential risk of HCC which makes the resection crucial. Due to its variations anatomically, ELT recognition should gain clinical importance and surgeons need to be aware of these possible disparities. Case presentation. We present a 59-year-old female from Western Tanzania was presented to us with 2-month history of painless upper abdominal swelling. An abdominal CT scan was performed, and it revealed a large mass located at the gastrohepatic region with blood supply mainly from the left hepatic artery and omentum. Technically difficult excision of 17 × 12 cm tumor at gastrohepatic ligament was performed, with uneventful recovery. Post-operative histology results revealed capsulated hepatic parenchyma without the biliary components and limited sinusoids with tissue degeneration. To date, no complications happened during follow-up for one year. ELT is a rare entity with a predominantly asymptomatic nature. Preoperatively diagnosis is difficult even with images. It has anatomical variation and is hardly found along the gastrohepatic ligament. ELT has increased the potential risk of HCC which makes the resection crucial. Increased awareness of this congenital anomaly may result in increased detection rates.
{"title":"Enormous ectopic liver tissue at the gastrohepatic ligament: a rare entity at Muhimbili National Hospital, Tanzania","authors":"Andrew Yesaya Swallow, Ali Hamisi Mwanga, Douglas Chamshama, Godfrey Mchele, Yona Ringo, Kibwana Kitembo, William Lutege, Azza Naif, Innocent Mosha","doi":"10.1186/s43066-024-00361-4","DOIUrl":"https://doi.org/10.1186/s43066-024-00361-4","url":null,"abstract":"Ectopic liver tissue (ELT) is a developmental abnormality in which liver tissue develops at an extrahepatic site without connection to the true liver. It is a rare entity with an incidence of 0.24–0.56% according to data described in laparoscopic or autopsy studies. The detailed mechanism behind the development of ELT is poorly understood. ELT predominantly has an asymptomatic nature, even by means of radiological studies the diagnosis of ELT without surgery or autopsy is difficult. ELT has been reported mostly to be found frequently on the gallbladder and rarely on the gastrohepatic ligament. ELT has increased the potential risk of HCC which makes the resection crucial. Due to its variations anatomically, ELT recognition should gain clinical importance and surgeons need to be aware of these possible disparities. Case presentation. We present a 59-year-old female from Western Tanzania was presented to us with 2-month history of painless upper abdominal swelling. An abdominal CT scan was performed, and it revealed a large mass located at the gastrohepatic region with blood supply mainly from the left hepatic artery and omentum. Technically difficult excision of 17 × 12 cm tumor at gastrohepatic ligament was performed, with uneventful recovery. Post-operative histology results revealed capsulated hepatic parenchyma without the biliary components and limited sinusoids with tissue degeneration. To date, no complications happened during follow-up for one year. ELT is a rare entity with a predominantly asymptomatic nature. Preoperatively diagnosis is difficult even with images. It has anatomical variation and is hardly found along the gastrohepatic ligament. ELT has increased the potential risk of HCC which makes the resection crucial. Increased awareness of this congenital anomaly may result in increased detection rates.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":"69 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141741733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-19DOI: 10.1186/s43066-024-00367-y
Hala Mansoor, Mahnam Khizer, Aneela Afreen, Noor Masood Sadiq, Aamir Habib, Shafqat Ali, Asim Raza, Tayyaba Hafeez
Cirrhotic cardiomyopathy, an intricate and multifaceted complication of end-stage liver disease, manifests as systolic and diastolic dysfunction in patients without previously diagnosed cardiac disease. Our study aims to investigate the prevalence of systolic and diastolic function in patients with cirrhotic cardiomyopathy in our region. We conducted a cross-sectional study on 68 patients with established cirrhosis, and no overt cardiac manifestations, who consequently underwent 2D echocardiography to quantify systolic and diastolic dysfunction, as defined by the 2019 Cirrhotic Cardiomyopathy Consortium. The severity of cirrhosis was determined using various validated scoring systems. A total of 19 out of 68 (28%) had systolic dysfunction, while 6/68 (9%) had evidence of diastolic dysfunction. Overall prevalence of cirrhotic cardiomyopathy was 23/68 (34%), and the presence of hepatitis C was strongly associated with systolic dysfunction with p-value of 0.007. However, it was not significantly associated with diastolic dysfunction, p-value = 0.59. Logistic regression analysis did not show any significant association between cardiac dysfunction and the severity of liver cirrhosis, as assessed by Child–Pugh, MELD, ALBI, PALBI, portal hypertension, and FIB-4 score (R2 = 3.66, F (13, 39) = 1.33, p = 0.234). Our study reveals a remarkable prevalence of cirrhotic cardiomyopathy, which despite being a frequently occurring phenomenon often goes unrecognized. Lack of correlation with the severity of liver cirrhosis, based on currently available scoring system, suggests either a still poorly understood pathological mechanism or requires the development of a new validated reliable scoring system through multi-center longitudinal studies.
{"title":"Systolic and diastolic impairment in cirrhotic cardiomyopathy: insights from a cross-sectional study","authors":"Hala Mansoor, Mahnam Khizer, Aneela Afreen, Noor Masood Sadiq, Aamir Habib, Shafqat Ali, Asim Raza, Tayyaba Hafeez","doi":"10.1186/s43066-024-00367-y","DOIUrl":"https://doi.org/10.1186/s43066-024-00367-y","url":null,"abstract":"Cirrhotic cardiomyopathy, an intricate and multifaceted complication of end-stage liver disease, manifests as systolic and diastolic dysfunction in patients without previously diagnosed cardiac disease. Our study aims to investigate the prevalence of systolic and diastolic function in patients with cirrhotic cardiomyopathy in our region. We conducted a cross-sectional study on 68 patients with established cirrhosis, and no overt cardiac manifestations, who consequently underwent 2D echocardiography to quantify systolic and diastolic dysfunction, as defined by the 2019 Cirrhotic Cardiomyopathy Consortium. The severity of cirrhosis was determined using various validated scoring systems. A total of 19 out of 68 (28%) had systolic dysfunction, while 6/68 (9%) had evidence of diastolic dysfunction. Overall prevalence of cirrhotic cardiomyopathy was 23/68 (34%), and the presence of hepatitis C was strongly associated with systolic dysfunction with p-value of 0.007. However, it was not significantly associated with diastolic dysfunction, p-value = 0.59. Logistic regression analysis did not show any significant association between cardiac dysfunction and the severity of liver cirrhosis, as assessed by Child–Pugh, MELD, ALBI, PALBI, portal hypertension, and FIB-4 score (R2 = 3.66, F (13, 39) = 1.33, p = 0.234). Our study reveals a remarkable prevalence of cirrhotic cardiomyopathy, which despite being a frequently occurring phenomenon often goes unrecognized. Lack of correlation with the severity of liver cirrhosis, based on currently available scoring system, suggests either a still poorly understood pathological mechanism or requires the development of a new validated reliable scoring system through multi-center longitudinal studies.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":"30 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141741727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-18DOI: 10.1186/s43066-024-00364-1
Mohamed Elbadry, Amin Abdel Baki, Asmaa bakr, Eman A. Elhamrawy, Hayam Abdel-Tawab, Abdelghany Aish, Israa Nooh, Abdulmoneim Adel, Moataz Y. Soliman, Nessren Mohammed, Samy Zaky
Covert hepatic encephalopathy (CHE) is a form of cerebral dysfunction that affects 30–40% of patients with liver cirrhosis as a grave sequel of disease progression. Although being a silent condition, yet; CHE has been reported as seriously predictive for the development of overt hepatic encephalopathy. Covert hepatic encephalopathy is said to conclude grades (0 and 1) hepatic encephalopathy in West Heaven grading of hepatic encephalopathy, hence; inferring to discrete deficits in attention, cognition, and motor control, strongly associated with poorer quality of private and social aspects of the patients’ life. Clinical recognition of cases of CHE is such a tedious task that unluckily devoid of discernment. Worthwhile; the battery of neuropsychometric tests widely known as the only tool to identify CHE can give abnormal results without specifying the cause of brain dysfunction Therefore, dedicated history-taking and clinical evaluation of liver cirrhosis patients are still the cornerstones that should unify other diagnostic tools to identify those patients at risk of developing overt hepatic encephalopathy. Diagnosis of CHE is challenging and often neglected in clinical practice, so the aim of this review is to improve our approach to CHE and begin a unified effort for the advancement of CHE through studying easy, fast, and reliable psychometric diagnostic tests to meet our clinical needs.
隐匿性肝性脑病（CHE）是一种脑功能障碍，30%-40% 的肝硬化患者会出现这种症状，这是疾病发展的严重后遗症。虽然隐匿性肝性脑病是一种无声的病症，但据报道，隐匿性肝性脑病对显性肝性脑病的发展有严重的预示作用。在西天堂肝性脑病分级中，隐性肝性脑病被认为是肝性脑病分级（0 级和 1 级）的结论，因此可推断出患者在注意力、认知和运动控制方面存在离散性缺陷，这与患者私人生活和社会生活质量较差密切相关。临床识别 CHE 病例是一项繁琐的工作，但不幸的是却缺乏辨别能力。因此，对肝硬化患者进行专门的病史采集和临床评估仍然是统一其他诊断工具的基石，以识别那些有可能发展为明显肝性脑病的患者。肝性脑病的诊断具有挑战性，在临床实践中常常被忽视，因此本综述旨在通过研究简便、快速、可靠的心理测量诊断测试来满足临床需求，从而改进我们对肝性脑病的诊断方法，并开始为促进肝性脑病的发展做出统一的努力。
{"title":"Covert hepatic encephalopathy: a neglected topic—a narrative review","authors":"Mohamed Elbadry, Amin Abdel Baki, Asmaa bakr, Eman A. Elhamrawy, Hayam Abdel-Tawab, Abdelghany Aish, Israa Nooh, Abdulmoneim Adel, Moataz Y. Soliman, Nessren Mohammed, Samy Zaky","doi":"10.1186/s43066-024-00364-1","DOIUrl":"https://doi.org/10.1186/s43066-024-00364-1","url":null,"abstract":"Covert hepatic encephalopathy (CHE) is a form of cerebral dysfunction that affects 30–40% of patients with liver cirrhosis as a grave sequel of disease progression. Although being a silent condition, yet; CHE has been reported as seriously predictive for the development of overt hepatic encephalopathy. Covert hepatic encephalopathy is said to conclude grades (0 and 1) hepatic encephalopathy in West Heaven grading of hepatic encephalopathy, hence; inferring to discrete deficits in attention, cognition, and motor control, strongly associated with poorer quality of private and social aspects of the patients’ life. Clinical recognition of cases of CHE is such a tedious task that unluckily devoid of discernment. Worthwhile; the battery of neuropsychometric tests widely known as the only tool to identify CHE can give abnormal results without specifying the cause of brain dysfunction Therefore, dedicated history-taking and clinical evaluation of liver cirrhosis patients are still the cornerstones that should unify other diagnostic tools to identify those patients at risk of developing overt hepatic encephalopathy. Diagnosis of CHE is challenging and often neglected in clinical practice, so the aim of this review is to improve our approach to CHE and begin a unified effort for the advancement of CHE through studying easy, fast, and reliable psychometric diagnostic tests to meet our clinical needs.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":"100 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141741728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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