Pub Date : 2021-06-30DOI: 10.47363/jghr/2021(2)112
C. Knox, J. Almeida
Protein-losing gastroenteropathy is a rare syndrome of protein loss from the gastrointestinal system. It manifests with hypoproteinemic edema, which may be due to either lymphatic leakage due to increased interstitial pressure or leakage of protein-rich fluids due to intestinal disorders. Our case describes a 65-year-old female with life-threatening protein-losing enteropathy (PLE) requiring multiple transfers to intensive care unit for vasopressor support. In this rare instance, her extensive initial workup did not reveal any etiology for PLE, but she was later found to have underlying Crohn’s colitis. Protein-losing enteropathy is an underdiagnosed complication of inflammatory bowel disease and must be considered while treating patients with colitis.
{"title":"A Rare Case of Nsaid Induced Gastric Body Diaphragmatic-Like Stricture","authors":"C. Knox, J. Almeida","doi":"10.47363/jghr/2021(2)112","DOIUrl":"https://doi.org/10.47363/jghr/2021(2)112","url":null,"abstract":"Protein-losing gastroenteropathy is a rare syndrome of protein loss from the gastrointestinal system. It manifests with hypoproteinemic edema, which may be due to either lymphatic leakage due to increased interstitial pressure or leakage of protein-rich fluids due to intestinal disorders. Our case describes a 65-year-old female with life-threatening protein-losing enteropathy (PLE) requiring multiple transfers to intensive care unit for vasopressor support. In this rare instance, her extensive initial workup did not reveal any etiology for PLE, but she was later found to have underlying Crohn’s colitis. Protein-losing enteropathy is an underdiagnosed complication of inflammatory bowel disease and must be considered while treating patients with colitis.","PeriodicalId":363979,"journal":{"name":"Journal of Gastroenterology & Hepatology Reports","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131008456","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 : 2021-06-30DOI: 10.47363/jghr/2021(2)113
Maheep Sangha, C. Kelly
Protein-losing gastroenteropathy is a rare syndrome of protein loss from the gastrointestinal system. It manifests with hypoproteinemic edema, which may be due to either lymphatic leakage due to increased interstitial pressure or leakage of protein-rich fluids due to intestinal disorders. Our case describes a 65-year-old female with life-threatening protein-losing enteropathy (PLE) requiring multiple transfers to intensive care unit for vasopressor support. In this rare instance, her extensive initial workup did not reveal any etiology for PLE, but she was later found to have underlying Crohn’s colitis. Protein-losing enteropathy is an underdiagnosed complication of inflammatory bowel disease and must be considered while treating patients with colitis.
{"title":"A Rare Case Report of Life-Threatening Severe Protein-Losing Gastroenteropathy","authors":"Maheep Sangha, C. Kelly","doi":"10.47363/jghr/2021(2)113","DOIUrl":"https://doi.org/10.47363/jghr/2021(2)113","url":null,"abstract":"Protein-losing gastroenteropathy is a rare syndrome of protein loss from the gastrointestinal system. It manifests with hypoproteinemic edema, which may be due to either lymphatic leakage due to increased interstitial pressure or leakage of protein-rich fluids due to intestinal disorders. Our case describes a 65-year-old female with life-threatening protein-losing enteropathy (PLE) requiring multiple transfers to intensive care unit for vasopressor support. In this rare instance, her extensive initial workup did not reveal any etiology for PLE, but she was later found to have underlying Crohn’s colitis. Protein-losing enteropathy is an underdiagnosed complication of inflammatory bowel disease and must be considered while treating patients with colitis.","PeriodicalId":363979,"journal":{"name":"Journal of Gastroenterology & Hepatology Reports","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123723695","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 : 2021-06-30DOI: 10.47363/jghr/2021(2)118
Malek Michael Bouhairie, Racha Seblani
Background: COVID-19 has emerged as a global health pandemic emergency with a massive effect on public health globally. In addition to its effects on respiratory tract, COVID-19 disease had been linked to many gastrointestinal symptoms. Rarely, it has been associated with intestinal ischemia due to the resultant hypercoagulable state. Case Summary: We report a case of a young lady previously healthy, who presented with severe abdominal pain associated with tenesmus and mucoïdbloody diarrhea, diagnosed to have ischemic colitis post covid19 infection. One of the port of entry of coronavirus 2 (SARS-CoV-2), to cause infection, is via an angiotensin-converting enzyme2 (ACE2). View that these ACE 2 receptors are highly expressed at the level of gastrointestinal tract, a variety of symptoms will occur. Recently, coagulopathy due to COVID-19 has emerged as a major component of the disease. The resultant ischemia has been reported to be associated with a hypercoagulable state. Lately, few cases were described worldwide of intestinal ischemia due to COVID-19 infection, mainly occuring in patients presenting with severe respiratory illness. Our patient did not complain of severe COVID-19 infection in the context of dyspnea or respiratory distress and did not have any features of shock requiring a vasopressor therapy. Treatment for ischemic colitis mainly involves supportive care with bowel rest. Conclusion: New datas concerning covid 19 infection are emerging. Ischemic colitis is a new aspect of manifestation of the infection, which can take place without necessarily being linked to a severe infection with covid 19 as in our case.
{"title":"Case Report of Ischemic Colitis Post Mild Covid 19 Infection","authors":"Malek Michael Bouhairie, Racha Seblani","doi":"10.47363/jghr/2021(2)118","DOIUrl":"https://doi.org/10.47363/jghr/2021(2)118","url":null,"abstract":"Background: COVID-19 has emerged as a global health pandemic emergency with a massive effect on public health globally. In addition to its effects on respiratory tract, COVID-19 disease had been linked to many gastrointestinal symptoms. Rarely, it has been associated with intestinal ischemia due to the resultant hypercoagulable state. Case Summary: We report a case of a young lady previously healthy, who presented with severe abdominal pain associated with tenesmus and mucoïdbloody diarrhea, diagnosed to have ischemic colitis post covid19 infection. One of the port of entry of coronavirus 2 (SARS-CoV-2), to cause infection, is via an angiotensin-converting enzyme2 (ACE2). View that these ACE 2 receptors are highly expressed at the level of gastrointestinal tract, a variety of symptoms will occur. Recently, coagulopathy due to COVID-19 has emerged as a major component of the disease. The resultant ischemia has been reported to be associated with a hypercoagulable state. Lately, few cases were described worldwide of intestinal ischemia due to COVID-19 infection, mainly occuring in patients presenting with severe respiratory illness. Our patient did not complain of severe COVID-19 infection in the context of dyspnea or respiratory distress and did not have any features of shock requiring a vasopressor therapy. Treatment for ischemic colitis mainly involves supportive care with bowel rest. Conclusion: New datas concerning covid 19 infection are emerging. Ischemic colitis is a new aspect of manifestation of the infection, which can take place without necessarily being linked to a severe infection with covid 19 as in our case.","PeriodicalId":363979,"journal":{"name":"Journal of Gastroenterology & Hepatology Reports","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130236491","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 : 2021-06-30DOI: 10.47363/jghr/2020(1)111
Malek Michael Bouhairie
Valproate induced hepatotoxicity is a well-known side effect, which frequently required periodic monitoring of serum drug level. Hepatotoxicity caused by valproate typically occurs at supratherapeutic drug levels. Once in a while, an idiosyncratic reaction is elicited, liver injury might occur despite normal serum valproate level mainly in chronic users. We hereby identify an unusual case of acute idiosyncratic valproate induced hepatotoxicity. We report a case of a 65 years old male with dyslipidemia and history of seizure, on valproic acid therapy, presented with altered mental status and drowsiness. The patient’s home medications include only zenil 10 mg daily and valproate which was started one month ago. At presentation, He was awake, oriented, but lethargic. Laboratory testing reveals hepatocellular injury with elevated transaminase levels, direct hyperbilirubinemia and coagulopathy. The ammonia level was normal and valproate level was within the therapeutic range. Abdomen computed tomography with IV contrast and MRCP results were irrelevant. Idiosyncratic valproate toxicity was diagnosed after exclusion of all other possible etiologies and after a rapid clinical and laboratory improvement once the drug was discontinued. Based on the patient’s clinical context the diagnosis of valproate induced hepatotoxicity was confirmed. This case emphasizes the importance of identifying, diagnosing, and managing valproate toxicity when no alternative clarification for their symptoms. We need further attempts and more researches to improve the detection of adverse hepatic reactions and to obtain reliable information about the discovery of new biomarkers or tools for early prediction of DILI, as well as to obtain accurate information on epidemiology, drug safety, and pathogenesis in order to improve management for better survival.
{"title":"Case Report of A Rare Idiosyncratic Hepatotoxicity Induced by Valproic Acid","authors":"Malek Michael Bouhairie","doi":"10.47363/jghr/2020(1)111","DOIUrl":"https://doi.org/10.47363/jghr/2020(1)111","url":null,"abstract":"Valproate induced hepatotoxicity is a well-known side effect, which frequently required periodic monitoring of serum drug level. Hepatotoxicity caused by valproate typically occurs at supratherapeutic drug levels. Once in a while, an idiosyncratic reaction is elicited, liver injury might occur despite normal serum valproate level mainly in chronic users. We hereby identify an unusual case of acute idiosyncratic valproate induced hepatotoxicity. We report a case of a 65 years old male with dyslipidemia and history of seizure, on valproic acid therapy, presented with altered mental status and drowsiness. The patient’s home medications include only zenil 10 mg daily and valproate which was started one month ago. At presentation, He was awake, oriented, but lethargic. Laboratory testing reveals hepatocellular injury with elevated transaminase levels, direct hyperbilirubinemia and coagulopathy. The ammonia level was normal and valproate level was within the therapeutic range. Abdomen computed tomography with IV contrast and MRCP results were irrelevant. Idiosyncratic valproate toxicity was diagnosed after exclusion of all other possible etiologies and after a rapid clinical and laboratory improvement once the drug was discontinued. Based on the patient’s clinical context the diagnosis of valproate induced hepatotoxicity was confirmed. This case emphasizes the importance of identifying, diagnosing, and managing valproate toxicity when no alternative clarification for their symptoms. We need further attempts and more researches to improve the detection of adverse hepatic reactions and to obtain reliable information about the discovery of new biomarkers or tools for early prediction of DILI, as well as to obtain accurate information on epidemiology, drug safety, and pathogenesis in order to improve management for better survival.","PeriodicalId":363979,"journal":{"name":"Journal of Gastroenterology & Hepatology Reports","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126955606","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 : 2021-06-30DOI: 10.47363/jghr/2021(2)116
Chang Yong, Liver Solutions Clinic, R. Ang
Introduction: The laparoscopic approach in liver surgery has been preferred over the traditional approach in the resection of segments 2 and 3, as laparoscopic surgical technique can be standardized for easy adoption and is minimally invasive. This paper describes the laparoscopic surgical technique and recommends the patient selection criteria in the resection of segments 2, 3 and 4. Methods: This technique involves 2 key steps – early division of the left pedicle before the division of the liver parenchyma and the placement of an instrument beneath the transection plane to simulate a ‘hanging manoeuvre’ with reduced blood loss and allows the expeditious division of the liver parenchyma. Apart from the usual contraindications to liver resections, specific contraindications to this technique include patients with aberrant biliary drainage of right liver segments into the left hepatic duct, patients with tumours abutting the hilar plate and patients with tumours located near the junction of the left hepatic vein and the vena cava. Conclusion: The authors recommend these steps to serve as a standardized technique for laparoscopic hepatectomy of segments 2,3 and 4 in selected patients, allowing the learning curve for this technique to be markedly shortened
{"title":"Laparoscopic Approach to Left Hepatectomy Using a Standardized Technique","authors":"Chang Yong, Liver Solutions Clinic, R. Ang","doi":"10.47363/jghr/2021(2)116","DOIUrl":"https://doi.org/10.47363/jghr/2021(2)116","url":null,"abstract":"Introduction: The laparoscopic approach in liver surgery has been preferred over the traditional approach in the resection of segments 2 and 3, as laparoscopic surgical technique can be standardized for easy adoption and is minimally invasive. This paper describes the laparoscopic surgical technique and recommends the patient selection criteria in the resection of segments 2, 3 and 4. Methods: This technique involves 2 key steps – early division of the left pedicle before the division of the liver parenchyma and the placement of an instrument beneath the transection plane to simulate a ‘hanging manoeuvre’ with reduced blood loss and allows the expeditious division of the liver parenchyma. Apart from the usual contraindications to liver resections, specific contraindications to this technique include patients with aberrant biliary drainage of right liver segments into the left hepatic duct, patients with tumours abutting the hilar plate and patients with tumours located near the junction of the left hepatic vein and the vena cava. Conclusion: The authors recommend these steps to serve as a standardized technique for laparoscopic hepatectomy of segments 2,3 and 4 in selected patients, allowing the learning curve for this technique to be markedly shortened","PeriodicalId":363979,"journal":{"name":"Journal of Gastroenterology & Hepatology Reports","volume":"140 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123292009","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 : 2021-06-30DOI: 10.47363/jghr/2021(2)117
R. Lim, Liver Solutions Clinic, Chang Sky
Cholecystectomy is a common surgical gold-standard treatment for cholelithiasis and its complications. Generally, gallbladder removal has no long-term ramifications, and most patients recover quickly without impairment on daily living activities. Nonetheless, some patients are found to develop postcholecystectomy syndrome (PCS) or diarrhoea (PCD), which can be uncomfortable, inconvenient and impair living quality. There is neither clear aetiology, nor clear solution for PCS/PCD. The significance of gut microbiome in maintaining a healthy gastrointestinal system is well-established. Dysbiosis, an imbalance between commensal and pathogenic bacteria, can lead to multiple GIT disorders like IBS or functional dyspepsia and has a strong association with change in stool consistency [1-3]. Alteration in gut microbiota can easily occur with physical or chemical changes. An invasive procedure like cholecystectomy exposes the intestinal lumen to exogenous bacteria and causes inflammatory changes, while secretory pattern changes of bacteriostatic bile acid disrupt the pH and microbial composition of the intestinal lumen. As such, it is worth understanding GIT microbiota changes post-cholecystectomy. While the concept of gut microbiome changes potentially causing PCS/PCD is not unknown, there is lack of literature reviewing research on what these microbial alterations are and establishing their association with PCS/PCD. In this review, we consolidate previous findings on post-cholecystectomy microbial alterations, effectiveness of diet on PCS/PCD based on gut microbiota and discuss the overall link between gut microbiome and PCS/PCD. This can deepen insight into aetiologies of idiopathic PCS/PCD, provide better management of PCS/PCD-associated comorbidities, and potentially offer a resolution for PCS/PCD through prescription of probiotics and prebiotics.
{"title":"The Association between Gut Microbiome and Post-Cholecystectomy Syndrome and Diarrhoea: A Review","authors":"R. Lim, Liver Solutions Clinic, Chang Sky","doi":"10.47363/jghr/2021(2)117","DOIUrl":"https://doi.org/10.47363/jghr/2021(2)117","url":null,"abstract":"Cholecystectomy is a common surgical gold-standard treatment for cholelithiasis and its complications. Generally, gallbladder removal has no long-term ramifications, and most patients recover quickly without impairment on daily living activities. Nonetheless, some patients are found to develop postcholecystectomy syndrome (PCS) or diarrhoea (PCD), which can be uncomfortable, inconvenient and impair living quality. There is neither clear aetiology, nor clear solution for PCS/PCD. The significance of gut microbiome in maintaining a healthy gastrointestinal system is well-established. Dysbiosis, an imbalance between commensal and pathogenic bacteria, can lead to multiple GIT disorders like IBS or functional dyspepsia and has a strong association with change in stool consistency [1-3]. Alteration in gut microbiota can easily occur with physical or chemical changes. An invasive procedure like cholecystectomy exposes the intestinal lumen to exogenous bacteria and causes inflammatory changes, while secretory pattern changes of bacteriostatic bile acid disrupt the pH and microbial composition of the intestinal lumen. As such, it is worth understanding GIT microbiota changes post-cholecystectomy. While the concept of gut microbiome changes potentially causing PCS/PCD is not unknown, there is lack of literature reviewing research on what these microbial alterations are and establishing their association with PCS/PCD. In this review, we consolidate previous findings on post-cholecystectomy microbial alterations, effectiveness of diet on PCS/PCD based on gut microbiota and discuss the overall link between gut microbiome and PCS/PCD. This can deepen insight into aetiologies of idiopathic PCS/PCD, provide better management of PCS/PCD-associated comorbidities, and potentially offer a resolution for PCS/PCD through prescription of probiotics and prebiotics.","PeriodicalId":363979,"journal":{"name":"Journal of Gastroenterology & Hepatology Reports","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115679044","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 : 2021-06-30DOI: 10.47363/jghr/2021(2)115
Tadao Tsuji, A. Sugiyama
We have treated 47 cases of incomplete pancreatic divisum (IPD) in theses 7 years. They were classified by the modified“Hirooka’s classification”— stenotic fusion type I / II, ansa pancreatica type, branch fusion type I / II / III, and one was unclassified. 36 cases were treated by ESWL and/or endoscopy. In difficult cases, we performed our new endoscopic procedures-rendezvous precut method and reverse balloon dilation method, with good results. The therapeutic success rate of IPD via major papilla was 100% (10/10) and via minor papilla 96% (24/25) without severe complications. After endoscopic treatment, the prognosis was good in 32, fair in 3 and one had an operation. In calcified IPD cases, endoscopic treatments were performed many times by stone and pain relapse, and EPS is still placed in 24 cases.
7年来，我们治疗了47例不完全性胰腺分裂(IPD)。采用改良的“Hirooka’s分类法”进行分类:狭窄型融合I / II型、胰旁型融合I / II / III型、分支融合I / II / III型，1例未分类。36例经体外冲击波碎石和/或内镜检查治疗。在困难的病例中，我们采用了新的内窥镜手术-交会预切法和反向球囊扩张法，效果良好。经大乳头治疗IPD成功率为100%(10/10)，经小乳头治疗成功率为96%(24/25)，无严重并发症。经内镜治疗后，32例预后良好，3例预后一般，1例手术。钙化IPD患者因结石和疼痛复发多次行内镜治疗，仍放置EPS 24例。
{"title":"A Case Report-Endoscopic Treatments of 47 Incomplete Pancreatic Divisum (IPD) Cases in our Hospital – Special Emphasis on our New Procedures: Rendezvous Pre-Cut Method and Reverse Balloon Dilation Method","authors":"Tadao Tsuji, A. Sugiyama","doi":"10.47363/jghr/2021(2)115","DOIUrl":"https://doi.org/10.47363/jghr/2021(2)115","url":null,"abstract":"We have treated 47 cases of incomplete pancreatic divisum (IPD) in theses 7 years. They were classified by the modified“Hirooka’s classification”— stenotic fusion type I / II, ansa pancreatica type, branch fusion type I / II / III, and one was unclassified. 36 cases were treated by ESWL and/or endoscopy. In difficult cases, we performed our new endoscopic procedures-rendezvous precut method and reverse balloon dilation method, with good results. The therapeutic success rate of IPD via major papilla was 100% (10/10) and via minor papilla 96% (24/25) without severe complications. After endoscopic treatment, the prognosis was good in 32, fair in 3 and one had an operation. In calcified IPD cases, endoscopic treatments were performed many times by stone and pain relapse, and EPS is still placed in 24 cases.","PeriodicalId":363979,"journal":{"name":"Journal of Gastroenterology & Hepatology Reports","volume":"76 6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131244740","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 : 2021-06-30DOI: 10.47363/jghr/2021(2)114
K. Choi, C. Knox
{"title":"Case Studies of Acute Cholecystitis Complicating Biliary Metal Stent-in-Stent after ERCP","authors":"K. Choi, C. Knox","doi":"10.47363/jghr/2021(2)114","DOIUrl":"https://doi.org/10.47363/jghr/2021(2)114","url":null,"abstract":"","PeriodicalId":363979,"journal":{"name":"Journal of Gastroenterology & Hepatology Reports","volume":"237 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122156918","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 : 2021-03-31DOI: 10.47363/JGHR/2020(1)110
I. Elhidaoui, S. Oubaha, K. Benjouad
IBD is a common, serious and disabling chronic digestive disease, Their different manifestations, whether digestive and extra-digestive, require a multi-professional care adapted to each specific patient. Anti-TNFs are now an essential therapeutic weapon in the management of inflammatory bowel disease (IBD). Their effectiveness in both the short and long term has been demonstrated in various studies. However short and long term anti-tnf results vary from patient to patient which can be explained in many cases by the significant number of discontinued treatment in patients that experience side effects. The purpose of our work is to study the different side effects occurring in patients under biotherapy, the management of these side effects and their prevention. We prospectively analyzed since four years the medical records of 54 IBD patients who received anti-TNF treatment. An exhaustive pre-therapeutic assessment was performed systematically in all patients. A clinical and biological control was carried out systematically before each therapeutic administration to search for undesirable reactions. Side effects were classified into several categories including immediate hypersensitivity reactions, dermatological complications, infectious, neurological, haematological, neoplasic and cardiac complications. During this period, 54 patients were treated with biotherapies, representing 24.2% of all IBD patients. We observed 29 side effects, an incidence of 46% including two severe effects 3.5%, occurring on average after one month of treatment. The hematological undesirable effects were the most frequent appeared in 14 patients (26%), severe infection specifically tuberculosis appeared in 2 patients (3.6%), allergic effects were severe in only one case (anaphylactic shock), finally the secondary cutaneous lesions of Anti-TNF were observed in a single patient (extensive psoriasis). Severe adverse reactions led to permanent discontinuation of Anti-TNF in 24.1% of cases. The use of anti-TNF treatment is likely to generate numerous undesirable effects, hence the advantage of respecting the recommendations relating to the assessment before any treatment with biotherapy and of making regular clinical follow-up during treatment with a meticulous clinical examination as well as biological monitoring in order to prevent the occurrence of these complications, and to manage them correctly once they appear.
{"title":"Anti-Tnf Side Effects in the Treatment of Chronic Inflammatory Bowel Disease","authors":"I. Elhidaoui, S. Oubaha, K. Benjouad","doi":"10.47363/JGHR/2020(1)110","DOIUrl":"https://doi.org/10.47363/JGHR/2020(1)110","url":null,"abstract":"IBD is a common, serious and disabling chronic digestive disease, Their different manifestations, whether digestive and extra-digestive, require a multi-professional care adapted to each specific patient. Anti-TNFs are now an essential therapeutic weapon in the management of inflammatory bowel disease (IBD). Their effectiveness in both the short and long term has been demonstrated in various studies. However short and long term anti-tnf results vary from patient to patient which can be explained in many cases by the significant number of discontinued treatment in patients that experience side effects. The purpose of our work is to study the different side effects occurring in patients under biotherapy, the management of these side effects and their prevention. We prospectively analyzed since four years the medical records of 54 IBD patients who received anti-TNF treatment. An exhaustive pre-therapeutic assessment was performed systematically in all patients. A clinical and biological control was carried out systematically before each therapeutic administration to search for undesirable reactions. Side effects were classified into several categories including immediate hypersensitivity reactions, dermatological complications, infectious, neurological, haematological, neoplasic and cardiac complications. During this period, 54 patients were treated with biotherapies, representing 24.2% of all IBD patients. We observed 29 side effects, an incidence of 46% including two severe effects 3.5%, occurring on average after one month of treatment. The hematological undesirable effects were the most frequent appeared in 14 patients (26%), severe infection specifically tuberculosis appeared in 2 patients (3.6%), allergic effects were severe in only one case (anaphylactic shock), finally the secondary cutaneous lesions of Anti-TNF were observed in a single patient (extensive psoriasis). Severe adverse reactions led to permanent discontinuation of Anti-TNF in 24.1% of cases. The use of anti-TNF treatment is likely to generate numerous undesirable effects, hence the advantage of respecting the recommendations relating to the assessment before any treatment with biotherapy and of making regular clinical follow-up during treatment with a meticulous clinical examination as well as biological monitoring in order to prevent the occurrence of these complications, and to manage them correctly once they appear.","PeriodicalId":363979,"journal":{"name":"Journal of Gastroenterology & Hepatology Reports","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130661171","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 : 2021-03-31DOI: 10.47363/JGHR/2020(1)109
Hassan Akouch, Malek Michael Bouhairie, Sabrina Nasreddine
Introduction: Drug induced liver injury or DILI is any injury to the liver by a medication, herb, or dietary supplement. Ranking as the first cause of acute liver failure in the USA and Europe, spectrum of clinical presentation may range from asymptomatic elevated liver function test to ALF. Approximately 20 new cases of DILI per 100,000 persons occur each year worldwide. Classified as intrinsic (with the most common cause being acetaminophen), and idiosyncratic adverse drug reaction (including mostly those related to antibiotics, NSAID drugs, and isoniazid). Isotretinoin is indicated to treat severe inflammatory acne that is refractory to antibiotics or topical agents; Although it has a high margin of safety, adverse effects include transaminasitis, like many retinoids, but unlike acitretin and etretinate, isotretinoin has not been clearly implicated in cases of clinically apparent acute liver failure. We report a case of 31 year old lady on isotretinoin therapy for her acnea since 8 month with poor follow up, presenting with acute liver failure to our emergency department. Case Presentation: 31 year old lady , NKDFA, on isotretinoin for her acne, started 8 month ago at a dose 40mg daily, is brought by her family for decrease level of consciousness and increasing jaundice since around 5 days associated with mild abdominal disconfort. Intubated for GCS of 3, laboratory tests showed prolonged INR and elevated total bilirubin, mainly direct, with elevated transaminase levels, all work up for other etiologies turned negative, and patient was diagnosed with isotretinoin inducing acute liver failure. Discussion: Hepatotoxicity manifesting by liver test abnormalities, occur in up to 15% of patients on isotretinoin. These liver test abnormalities are usually asymptomatic and resolve spontaneously even without discontinuation of therapy in most cases. Severe liver injury due to isotretinoin is exceedingly rare: The acute liver failure was only been described with etretinate and acitretin and not with isotretinoin therapy. Risk factors for DILI include older age, female sex, African American, pharmacological risk (including daily dosage, degree of lipophilicity and extent of hepatic metabolism), preexisting liver disease and Host Genetic Factors. An important association was found between the dose of oral medication and hepatotoxicity in the United States and Sweden, in addition to a positive association between higher drug lipophilicity and DILI in condition to be coupled with high dose ingestion. Our patient meets the criteria for sex and for the pharmacological characteristic of isotretinoin (which is a highly lipophilic drug and was ingested at 40mg daily). DILI may cause cholestatic or hepatocellular liver injury or mixed on the basis of the R value, In addition, studies have showed that DILI in females is more often hepatocellular and may be associated with a more severe course, which can result in the need for liver transplant, or death and all tha
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