GastroHep最新文献

Background. Haemochromatosis is a rare autosomal genetic disease that can cause multiple organ failure. In the past, this condition was not considered to affect pregnancy. The objectives of this study are to update the management of haemochromatosis in general as there are new treatments being investigated other than phlebotomy and to summarise the effects of the condition on pregnancy and vice versa. Methods. The initial search was in Ovid Medline® from 2002 to 2013. Review articles for haemochromatosis and case reports of its related complications in pregnancy were found. None of the reviews addressed pregnancy in detail. A second search in PubMed from 2014 to 2016 included studies regarding haemochromatosis and pregnancy and iron metabolism association with other metals and biomarkers, defining the mechanism of foetomaternal risks in maternal haemochromatosis. A third search at PubMed from 2017 to 2022 using key words haemochromatosis and pregnancy was done to look at the new data. Results. The results are qualitative indicating that even in the absence of abnormal iron parameters, haemochromatosis increases the risk of foetomaternal complications due to genetic predisposition, necessitating antenatal monitoring. Newer medications targeting the pathophysiology of the disease to eliminate it are being developed. The coabsorption of lead with iron causes increased risk of maternal preeclampsia, gestational hypertension, foetal congenital abnormalities, and growth problems. There is risk of neurodevelopmental delays, large for gestational age and childhood leukaemia in babies whose mothers and themselves have mutations for haemochromatosis. Conclusion. Previously, women with haemochromatosis were thought to have no higher risk of complications than the general population. However, there is evidence of foetomaternal complications. As a result, pregnancy with haemochromatosis necessitates additional monitoring for both mother and baby.

Background and Aims. Endoscopic variceal ligation (EVL) of esophageal varices alters the portal pressure. We observed the changes in 2D-shear wave elastography (2D-SWE) measurements of spleen and liver following EVL and tried to identify the predictors for rebleeding and mortality at 6 months. Methods. A prospective observational study of 202 patients who underwent EVL for bleeding esophageal varices was done. 2D-SWE measurements of liver stiffness (LS) and spleen stiffness (SS) and spleen volume (SV) were measured half an hour before, 1 hour, 2 weeks, and 6 weeks after EVL. All were followed up for 6 months for rebleeding and all-cause mortality. Results. 83 patients were in child C (41%). Difference in SV, SS, and LS at 2 and 6 weeks from baseline was noted as Delta 2 (2^nd week post-EVL - pre-EVL SV, LS, and SS) and Delta 3 (6^th week post EVL - pre - EVL SV, LS and SS), respectively. Mean Delta 2 VOL and Delta 3 VOL were lower in the bleeding and mortality groups. Delta 2 SS, Delta 3 SS, Delta 2 LS, and Delta 3 LS were higher in the rebleeding and mortality groups. These changes were statistically significant. AUROC in predicting rebleeding was the highest for Delta 2 VOL (0.773) and Delta 3 LS (0.764) amongst the USG parameters that performed better than MELD score (0.677). AUROC in predicting mortality was the highest for Delta 3 VOL and Delta 2 VOL-0.873 and 0.842, respectively, and higher than MELD’s (0.641). Statistically significant variables in binary logistic regression analysis for rebleeding were Delta 3 LS and Delta 3 SS and none for mortality. Conclusion. LS, SS, and SV change after EVL. Changes in liver and spleen stiffness at 6 weeks from baseline had good diagnostic accuracy for predicting rebleeding at 6 months.

Introduction. Upper gastrointestinal (UGI) video capsule endoscopy (VCE) provides a possible alternative to conventional oesophago-gastro-duodenoscopy (OGD). In Ireland, the COVID-19 pandemic led to unprecedented change in endoscopy services, accelerating the need for UGI VCE to help reduce patient exposure but allow the continuation of endoscopy services. We report on using UGI VCE as an alternative to OGD throughout all phases of COVID-related endoscopy adjustments. Aims/Background. Prospective observational study to assess identification of relevant UGI anatomical landmarks on UGI VCE as defined in the British Society of Gastroenterology. Method. Inclusion criteria were: patients with dyspepsia under 40 years of age with no alarm symptoms; known cirrhosis for variceal screening; UGI bleeds with the Blatchford score ≤ 2. A protocol for preparation and a series of positional movements were adapted for the procedure. Landmarks and pathology detection were evaluated by two independent endoscopists. Results. 127 UGI VCE was performed from June 2020 to December 2021, of which 22 required further evaluation with OGD. The most common indications were dyspepsia and abdominal pain, 71% and 19%, respectively. With the use of the dual-facing camera, clear views of the OGJ in 100% of cases, cardia 100%, fundus 97%, greater curve 99%, lesser curve 98%, incisura angularis 95%, antrum 95%, pylorus 94%, D1/bulb 83%, and D2 82% were obtained. The main findings at UGI VCE were reflux oesophagitis and gastritis, with normal mucosa observed in 48% of cases. Findings suggesting a neoplastic lesion at the OG junction were detected in 1 case. Conclusion. Since June 2020, 81% (N = 103) of a selected cohort of patients referred for UGI endoscopy avoided invasive traditional endoscopy and were successfully managed by VCE, thus reducing endoscopy waiting lists. UGI VCE may serve as a clinical diagnostic tool, used alongside OGD in appropriate cases, to help improve patient services and care delivery.

Background. Liver and spleen stiffness measured by shear-wave elastography have been demonstrated to correlate well with liver fibrosis and hepatic venous pressure gradient, respectively. Aim. To investigate the long-term effect of direct-acting antivirals (DAA) on liver and splenic stiffness in patients with chronic hepatitis C. Methods. We conducted a single-centre prospective observational study including 129 chronic hepatitis C patients who achieved a sustained virological response (SVR) with DAA treatment. Liver and spleen stiffness were measured by point shear-wave elastography at pretreatment, end of treatment (EOT), and 48 and 96 weeks after EOT (SVR48 and SVR96, respectively). Results. Liver stiffness measurements (LSM) continued to decline to SVR96, whereas there was no change in spleen stiffness measurements (SSM). Stratified analysis at the SSM 3.2 m/s, which was estimated as the cut-off value of clinically significant portal hypertension, showed that SSM did not change in the low SSM group (SSM <3.2 m/s, n =81), whereas in the high SSM group (SSM ≥3.2 m/s, n =48), the SSM decreased significantly between pretreatment and EOT but did not change thereafter. Moreover, multivariate analysis of risk factors for the SSM remaining in the range of SSM ≥3.2 m/s at SVR96 in the high SSM group revealed that LSM ≥1.93 m/s was a significant factor (p =0.019). Conclusion. These results suggest that DAA treatment of chronic hepatitis C patients may improve liver fibrosis in the long term and some patients with advanced liver fibrosis may not expect an improvement of portal hypertension even if an SVR is achieved.

Herbal medicines including teas and plant extracts have been in use for thousands of years. There are reports of the use of herbal preparations in Egypt, China, India, and Samaria. Many patients consider “natural” herbal teas to be completely free of unwanted side effects. Many herbal products, however, have biological activities that can result in severe hepatic cell toxicity or interact with other herbal products or prescription medications. Their use is increased dramatically. The most common herbal teas and nonmineral natural products are used as self-medication, principally for health improvement. However, these products are potentially dangerous to some individuals. Monitoring for liver injury is an important aspect of drug and herbal safety assessment. When present, herbal-induced liver injury (HILI) may limit the use or result in the discontinuation of these agents. HILI can exhibit with a wide spectrum of clinical and laboratory manifestations, ranging from asymptomatic elevations in aminotransferases to acute liver failure. Most cases of HILI resolve within several weeks after herbal remedy discontinuation. However, some cases can persist as low-level aminotransferase elevations. Our review aims to (1) describe the possible significant discrepancies between the ingredients listed on the label and the actual contents of the preparation; (2) evaluate teas containing multiple plants or herbs which may be adulterated by more toxic herbs, heavy metals, microbials, pharmaceuticals, and medicines; (3) describe pathophysiologic events in herbal tea-induced hepatotoxicity; and (4) discuss the key elements required for attributing the consumption of tea to the induction of liver injury. The widespread use of mixed heterogeneous remedies and the lack of randomized trials are an obstacle to providing safe use of plant-derived teas.

Background. Hepatic encephalopathy (HE) is a frequent and debilitating complication of liver disease. Treatments include lactulose and rifaximin-α. The objective of this literature review and meta-analysis was to assess the overall cost-effectiveness of rifaximin-α in HE treatment. Methods. Electronic database searches were conducted in November 2020 to identify cost-effectiveness studies comparing rifaximin-α with other interventions in HE, published in English. Incremental net benefit (INB) was calculated for each study using difference in effectiveness, difference in costs, and the willingness-to-pay threshold, or gross domestic product per capita for each country, and 95% confidence intervals (CI) were constructed. Costs were standardised to 2019 US$. An intervention was considered cost-effective if the INB was positive. Meta-analysis was used to pool calculated INB across studies, using a fixed-effects model if there was no heterogeneity or a random-effects model. Results. Eleven studies were included in the meta-analysis. For rifaximin-α plus lactulose in the second-line setting, the pooled INB was estimated at $20,156 (95% CI: $13,593-$29,887) versus lactulose monotherapy. For rifaximin-α monotherapy in the first-line setting, the pooled INB was $4834 (95% CI: $1601-$14,596) versus lactulose monotherapy. Due to lack of available data, meta-analyses were not possible for rifaximin-α added to lactulose therapy versus lactulose monotherapy in the first-line setting or for rifaximin-α as salvage therapy in the second-line setting. Conclusions. Rifaximin-α as an add-on treatment to lactulose in the second-line setting or as monotherapy in the first-line setting would be a cost-effective treatment for HE compared with lactulose monotherapy.

Objective. The Japanese guideline for the treatment of chronic constipation recommends that nonpharmacological treatment be applied. However, only a small proportion of patients with constipation seek medical care, and even when they do visit a hospital for constipation in Japan, most are only prescribed medication. This is because the effectiveness of exercise therapy for constipation is still unclear. The purpose of this study was to evaluate the prevalence of constipation in Japanese subjects and the relationship between constipation and exercise. Methods. We conducted a questionnaire survey over a period of four months to determine the prevalence of chronic constipation in nonexercise and exercise groups, as well as the effectiveness of exercise on chronic constipation. Subjective constipation was defined by the constipation scoring system. Multiple regression analysis was performed on risk factors for high constipation scoring system scores, and factors related to constipation symptoms were extracted. Result. We analysed responses regarding 556 participants ranging in mean age 35.6 ± 17.2 years. The constipation scoring system score was significantly higher in the nonexercise group than in the exercise group. Independent predictors for the constipation scoring system score were sex, implementation of exercise, and presence of disease under treatment. Conclusion. The result showed that independent predictors for the constipation scoring system score were sex, implementation of exercise, and presence of disease under treatment. Thus, the present study demonstrated that exercise affects constipation symptom.

Background. COVID-19 is rapidly spreading as a global pandemic disease that affects mortality, morbidity, and economic recession worldwide including Myanmar. This study is aimed at investigating the prevalence and temporal nature of gastrointestinal and hepatic manifestations as well as their association with composite clinical endpoints in patients with COVID-19. Method. This was a retrospective hospital-based cohort study conducted on confirmed COVID-19 patients who were admitted to two designated COVID-19 hospitals: DSLH and No. (22/100) MH, Yangon, Myanmar, from June 1, 2021, to August 31, 2021. Data related to patients’ demographics, clinical characteristics, and clinical outcomes were abstracted manually through individual hospital records. Results. Out of the 241 patients recruited, 68 (28.2%) of the patients had GI symptoms. Ageusia/hypogeusia and diarrhea are the most common symptoms at 41.3% and 28.3%, respectively. Abnormal liver chemistries at admission are found in 52.7% of total patients. Mortality is 12.9% (31/241). Patients with abnormal liver chemistry are older (p < 0.001), unvaccinated or incompletely vaccinated (p = 0.04), associated comorbidities (p = 0.019), leukocytosis (p < 0.001), lymphopenia (p = 0.033), hypoalbuminemia (p < 0.001), higher INR (p < 0.001), and longer HDU stay (p < 0.001) and higher mortality (p < 0.001). Conclusion. COVID-19-infected patients with abnormal liver chemistry are found to have worse clinical outcomes, although no significant association is found in patients with digestive symptoms. More attention should be given to this group of patients in the next coming wave.

Irritable bowel syndrome (IBS) is a common functional disorder. The syndrome’s multifactorial pathophysiology makes it challenging to design effective therapies. The present paper reviews several therapeutic approaches to treating IBS, highlighting the challenges of losing response over time to therapies. Here, we present the relevance of chronobiology in biological systems focusing on the potential of chronotherapy for IBS. Artificial intelligence- (AI-) based approaches have been developed over the last few years to improve the diagnosis, therapeutic approaches, and monitoring of patients with various diseases. We discuss the use of first-generation AI platforms and their limitations in clinical practice and present the establishment of a second-generation system designed to overcome obstacles in managing these patients. The system identifies costly patients and those who do not respond to therapies and may benefit from algorithm-based therapies. We present a patient-tailored approach for improving the response to therapy in IBS using an AI-based algorithm. This system provides a tool for a patient-tailored monitoring system. The second-generation AI system can provide a comprehensive tool for improving the diagnosis and therapy and monitoring of patients with IBS.

Aims. A widespread complication of inflammatory bowel disease (IBD) is iron deficiency anaemia (IDA), which affects quality of life (QoL) and is associated with frequent hospitalizations. The intravenous iron therapies, ferric carboxymaltose (FCM), ferric derisomaltose (FD), and iron sucrose (IS), have previously been shown to replenish haemoglobin (Hb) levels more effectively than oral iron. However, they differ in both costs and efficacy (response to treatment), leading to differences in acquisition by health-care payers. We investigated the cost-effectiveness of FCM versus FD and IS, in terms of additional cost per additional responder, for the treatment of IBD-associated IDA in multiple Swedish regional settings, using current tender prices. Methods and Materials. A microsimulation model estimated the additional cost per patient achieving a response, based on Hb normalization or an increase of ≥2 g/dL in Hb levels. Efficacy estimates were taken from a previously published network meta-analysis. Treatment costs (2021 SEK) included current tender prices in Swedish health-care regions. Resource use depended partly on dosing, which was based on patient characteristics simulated in the model. Results. The analysis showed that FCM was associated with the highest number of responders (81%) compared to FD (74%) and IS (75%), while costing less per responder than its comparators, in included regions. Conclusions. These results suggest that regional health-care budget holders should consider more than drug prices when choosing which IV formulations to acquire and that they should use all available tools when deciding how to fulfil the needs of their patients.