Pub Date : 2019-05-31DOI: 10.15226/2374-815x/7/1/001140
A. Al-Khazraji, J. Suri, A. Condella, S. Tewani, Ghazi A. Hussain, Z. Jiang, R. Malik
Background: Transient Elastography (TE) is a non-invasive method providing reliable measurements help staging liver fibrosis which is crucial for both prognosis and management. In this study, we assess the utility of TE in predicting clinical outcomes. Methods: Retrospective cohort 272 patients underwent serial TE measurements in a single liver center. TE scores at baseline and longitudinal change over time were correlated with the primary outcome of clinical decompensation (ascites, encephalopathy, variceal bleed, increase in CPC > 2, HCC, liver transplant, and death). Results: 162 patients (62%) had an initial TE score of < 12.5 kPa (non-cirrhotic) and 100 patients (38%) had a TE score of >12.5 kPa consistent with cirrhosis. In the cirrhosis group, mean TE score 26.4 kPa compared to 7.0 kPa non-cirrhosis (p < 0.0001). In the cirrhotic group, 85% had esophageal varices on upper endoscopy that had baseline TE score of ≥ 21.0 kPa in compare to 13% with baseline TE scores 12.5- 20.0kPa (p < 0.05). During a median follow-up period of 4.5 years, 14% of patients achieved a primary outcome of clinical decompensation [30% cirrhosis versus 4% non-cirrhosis (p < 0.01)]. Logistic regression analysis demonstrates that TE score of ≥35 kPa was the strongest predictor for primary endpoint OR 6.5 (95% CI 8.2 – 4.8, p < 0.01). An Annual increase in TE score of ≥8 kPa to the cirrhotic range ≥12.5 kPa was associated with a significant OR 2.8 (95% CI 2.1-3.9, p < 0.01) for developing clinical decompensation. Conclusion: Baseline TE scores ≥35kPa & annual increment TE score ≥8 kPa were associated with a significant risk of clinical decomposition. Key words: Transient elastography; liver fibrosis; Fibroscan; clinical decompensation;
背景:瞬时弹性成像(TE)是一种非侵入性方法，提供可靠的测量方法，有助于肝纤维化分期，这对预后和治疗都至关重要。在这项研究中，我们评估了TE在预测临床结果方面的应用。方法:回顾性队列272例患者在单个肝脏中心进行了一系列TE测量。基线时的TE评分和随时间的纵向变化与临床失代偿的主要结局(腹水、脑病、静脉曲张出血、CPC升高> 2、HCC、肝移植和死亡)相关。结果:162例(62%)患者的初始TE评分< 12.5 kPa(非肝硬化)，100例(38%)患者的TE评分>12.5 kPa(符合肝硬化)。肝硬化组TE平均评分26.4 kPa，而非肝硬化组TE平均评分为7.0 kPa (p < 0.0001)。在肝硬化组中，85%的患者在上内镜检查中发现基线TE评分≥21.0 kPa的食管静脉曲张，而基线TE评分12.5- 20.0kPa的患者为13% (p < 0.05)。在中位4.5年的随访期间，14%的患者实现了临床失代偿的主要结局[30%肝硬化对4%非肝硬化(p < 0.01)]。Logistic回归分析显示，TE评分≥35 kPa是主要终点OR 6.5的最强预测因子(95% CI 8.2 ~ 4.8, p < 0.01)。TE评分每年增加≥8kpa至肝硬化范围≥12.5 kPa与发生临床失代偿的显著OR为2.8 (95% CI 2.1-3.9, p < 0.01)相关。结论:基线TE评分≥35kPa和年增量TE评分≥8kpa与临床分解风险显著相关。关键词:瞬态弹性;肝纤维化;Fibroscan;临床呼吸困难;
{"title":"The Clinical Utility of Transient Elastography (TE) in Predicting Clinical Outcomes and Decompensation in Cirrhosis","authors":"A. Al-Khazraji, J. Suri, A. Condella, S. Tewani, Ghazi A. Hussain, Z. Jiang, R. Malik","doi":"10.15226/2374-815x/7/1/001140","DOIUrl":"https://doi.org/10.15226/2374-815x/7/1/001140","url":null,"abstract":"Background: Transient Elastography (TE) is a non-invasive method providing reliable measurements help staging liver fibrosis which is crucial for both prognosis and management. In this study, we assess the utility of TE in predicting clinical outcomes. Methods: Retrospective cohort 272 patients underwent serial TE measurements in a single liver center. TE scores at baseline and longitudinal change over time were correlated with the primary outcome of clinical decompensation (ascites, encephalopathy, variceal bleed, increase in CPC > 2, HCC, liver transplant, and death). Results: 162 patients (62%) had an initial TE score of < 12.5 kPa (non-cirrhotic) and 100 patients (38%) had a TE score of >12.5 kPa consistent with cirrhosis. In the cirrhosis group, mean TE score 26.4 kPa compared to 7.0 kPa non-cirrhosis (p < 0.0001). In the cirrhotic group, 85% had esophageal varices on upper endoscopy that had baseline TE score of ≥ 21.0 kPa in compare to 13% with baseline TE scores 12.5- 20.0kPa (p < 0.05). During a median follow-up period of 4.5 years, 14% of patients achieved a primary outcome of clinical decompensation [30% cirrhosis versus 4% non-cirrhosis (p < 0.01)]. Logistic regression analysis demonstrates that TE score of ≥35 kPa was the strongest predictor for primary endpoint OR 6.5 (95% CI 8.2 – 4.8, p < 0.01). An Annual increase in TE score of ≥8 kPa to the cirrhotic range ≥12.5 kPa was associated with a significant OR 2.8 (95% CI 2.1-3.9, p < 0.01) for developing clinical decompensation. Conclusion: Baseline TE scores ≥35kPa & annual increment TE score ≥8 kPa were associated with a significant risk of clinical decomposition. Key words: Transient elastography; liver fibrosis; Fibroscan; clinical decompensation;","PeriodicalId":365218,"journal":{"name":"Journal of Gastroenterology, Pancreatology & Liver Disorders","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122742313","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 : 2019-05-15DOI: 10.15226/2374-815x/7/1/001139
R. Loffeld, B. Liberov, P. Dekkers
Introduction: The diagnostic yield of upper gastrointestinal endoscopy (UGE) is high. Aim: A study was done in order to relate the outcome of UGE to the speciality of the applicant and to study changes in yield in a long period of time. Material and Methods: A large dataset was used. The endoscopic diagnoses were noted as a percentage of the yearly procedures done on request of the specific applicant. The following endoscopic diagnoses were primarily scored: reflux oesophagitis, peptic ulcer disease, hiatal hernia or insufficient gastric cardia, and cancer. Results: A total of 36650 procedures were studied via the general practitioner (GP) in 14913 cases (40.6%), the gastroenterologist in 6993 (19%), surgeon or cardiologist in 496 (1.4%) and in 14248 cases (38.9%) via the internist. No abnormalities and reflux oesophagitis were significantly more often scored in cases done on request of the GP. Cancer was more often seen in cases with the gastroenterologist as the applicant. After an initial rise incidence of hiatal hernia, insufficient cardia, and reflux oesophagitis, both findings show a decrease since 2007. There is some yearly fluctuation in presence of reflux-oesophagitis and cancer, while peptic ulcer disease decreases. Conclusion: The general yield of UGE is relatively high. There are differences in outcome if the applicant is taken into account. It is also clear that gastro-oesophageal reflux disease is a condition mostly treated by general practitioners.
{"title":"Changes in Time in Yield of Upper Gastrointestinal Endoscopy in Relation to the Applicants Speciality","authors":"R. Loffeld, B. Liberov, P. Dekkers","doi":"10.15226/2374-815x/7/1/001139","DOIUrl":"https://doi.org/10.15226/2374-815x/7/1/001139","url":null,"abstract":"Introduction: The diagnostic yield of upper gastrointestinal endoscopy (UGE) is high. Aim: A study was done in order to relate the outcome of UGE to the speciality of the applicant and to study changes in yield in a long period of time. Material and Methods: A large dataset was used. The endoscopic diagnoses were noted as a percentage of the yearly procedures done on request of the specific applicant. The following endoscopic diagnoses were primarily scored: reflux oesophagitis, peptic ulcer disease, hiatal hernia or insufficient gastric cardia, and cancer. Results: A total of 36650 procedures were studied via the general practitioner (GP) in 14913 cases (40.6%), the gastroenterologist in 6993 (19%), surgeon or cardiologist in 496 (1.4%) and in 14248 cases (38.9%) via the internist. No abnormalities and reflux oesophagitis were significantly more often scored in cases done on request of the GP. Cancer was more often seen in cases with the gastroenterologist as the applicant. After an initial rise incidence of hiatal hernia, insufficient cardia, and reflux oesophagitis, both findings show a decrease since 2007. There is some yearly fluctuation in presence of reflux-oesophagitis and cancer, while peptic ulcer disease decreases. Conclusion: The general yield of UGE is relatively high. There are differences in outcome if the applicant is taken into account. It is also clear that gastro-oesophageal reflux disease is a condition mostly treated by general practitioners.","PeriodicalId":365218,"journal":{"name":"Journal of Gastroenterology, Pancreatology & Liver Disorders","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115671319","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 : 2019-04-24DOI: 10.15226/2374-815x/7/1/001138
D. P, Nair Sp, J. P., T. R, J. S., Jain Ss, Sonthalia N Rathi PM, U. S.
Introduction: Congenital common bile duct (CBD) webs are extremely rare abnormalities of the extra hepatic ducts with approximately 10 cases reported in the literature. The age at presentation and the clinical symptomatology of these anomalies depend on the grade of the biliary obstruction. These webs usually exhibit early in life as obstructive jaundice, dilation of the proximal biliary tree or even spontaneous perforation of the extra hepatic duct. Some of these congenital webs are partially developed and remain asymptomatic until adulthood. Case Report: 28 year female patient presented with cholestatic pattern jaundice for 2 months. On evaluation found to have dilated CBD with IHBRD on USG. On further imaging studies, CT revealed horizontal web like projection from distal CBD suggestive of web with similar findings on MRCP. ERCP showed horizontal filling defect on cholangiogram with dilated CBD. Endoscopic Ultrasound examination revealed horizontal hyper echoic structure at distal CBD with proximally dilated CBD and IHBRD. Dilatation was performed using Soehendra Biliary Dilation Catheter with significant improvement in her symptomatology. Conclusion: Our case remains the first of its kind in which EUS characterisation of CBD web is described. Though rare congenital anomalies remain an important cause of young patients presenting with obstructive jaundice. Treatment for such cases remains Endoscopic dilatation or surgical by-pass in which endoscopic treatment fails. Keywords: Common bile duct web; Obstructive jaundice; Soehendra Biliary Dilation Catheter; Endoscopic Ultrasound. Abbreviations: HB-Haemoglobin; TLC-Total Leucocyte Count; AST-Aspartate Transaminase; ALT-Alanine Transaminase; ALPAlkaline Phosphatase; USG- Ultrasonography; IHBRD- Intra-hepatic biliary radicle, CBD- Common bile duct; GB- Gall bladder; MRCPMagnetic Resonance Cholangio-Pancreatography
{"title":"Rare Cause of Obstructive Jaundice in a Young Female","authors":"D. P, Nair Sp, J. P., T. R, J. S., Jain Ss, Sonthalia N Rathi PM, U. S.","doi":"10.15226/2374-815x/7/1/001138","DOIUrl":"https://doi.org/10.15226/2374-815x/7/1/001138","url":null,"abstract":"Introduction: Congenital common bile duct (CBD) webs are extremely rare abnormalities of the extra hepatic ducts with approximately 10 cases reported in the literature. The age at presentation and the clinical symptomatology of these anomalies depend on the grade of the biliary obstruction. These webs usually exhibit early in life as obstructive jaundice, dilation of the proximal biliary tree or even spontaneous perforation of the extra hepatic duct. Some of these congenital webs are partially developed and remain asymptomatic until adulthood. Case Report: 28 year female patient presented with cholestatic pattern jaundice for 2 months. On evaluation found to have dilated CBD with IHBRD on USG. On further imaging studies, CT revealed horizontal web like projection from distal CBD suggestive of web with similar findings on MRCP. ERCP showed horizontal filling defect on cholangiogram with dilated CBD. Endoscopic Ultrasound examination revealed horizontal hyper echoic structure at distal CBD with proximally dilated CBD and IHBRD. Dilatation was performed using Soehendra Biliary Dilation Catheter with significant improvement in her symptomatology. Conclusion: Our case remains the first of its kind in which EUS characterisation of CBD web is described. Though rare congenital anomalies remain an important cause of young patients presenting with obstructive jaundice. Treatment for such cases remains Endoscopic dilatation or surgical by-pass in which endoscopic treatment fails. Keywords: Common bile duct web; Obstructive jaundice; Soehendra Biliary Dilation Catheter; Endoscopic Ultrasound. Abbreviations: HB-Haemoglobin; TLC-Total Leucocyte Count; AST-Aspartate Transaminase; ALT-Alanine Transaminase; ALPAlkaline Phosphatase; USG- Ultrasonography; IHBRD- Intra-hepatic biliary radicle, CBD- Common bile duct; GB- Gall bladder; MRCPMagnetic Resonance Cholangio-Pancreatography","PeriodicalId":365218,"journal":{"name":"Journal of Gastroenterology, Pancreatology & Liver Disorders","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130324660","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 : 2019-02-02DOI: 10.15226/2374-815x/7/1/001137
R. Thanage, S. Chandnani, Vinay G. Zanwar, Shubham Jain, Samit Jain, Q. Contractor, P. Rathi
The use of anabolic steroids is widespread, particularly among bodybuilders. Most athletes have only a crude pharmacological knowledge regarding these drugs and warnings of steroid misuse are neglected. The illicit use of Androgenic Anabolic Steroids (AAS) to obtain an athletic, healthy looking body can lead to serious and often irreversible organ damage [1]. Anabolic steroids with 17 alpha carbon substitutions have been associated with a cholestatic injury with little hepatocellular injury. In the case of hepatoxicity and severe cholestasis the prompt withdrawal of the steroid and the administration of ursodeoxycholic acid are recommended [2]. Steroid also is known to cause acute pancreatitis which would result in acute onset abdominal pain and vomiting. Possible mechanisms for drug-induced pancreatitis include immune-mediated inflammatory response, direct cellular toxicity, arteriolar thrombosis, and metabolic effects.
{"title":"Unusual Case of Simultaneous Acute Hepatitis and Acute Pancreatitis in a Bodybuilder","authors":"R. Thanage, S. Chandnani, Vinay G. Zanwar, Shubham Jain, Samit Jain, Q. Contractor, P. Rathi","doi":"10.15226/2374-815x/7/1/001137","DOIUrl":"https://doi.org/10.15226/2374-815x/7/1/001137","url":null,"abstract":"The use of anabolic steroids is widespread, particularly among bodybuilders. Most athletes have only a crude pharmacological knowledge regarding these drugs and warnings of steroid misuse are neglected. The illicit use of Androgenic Anabolic Steroids (AAS) to obtain an athletic, healthy looking body can lead to serious and often irreversible organ damage [1]. Anabolic steroids with 17 alpha carbon substitutions have been associated with a cholestatic injury with little hepatocellular injury. In the case of hepatoxicity and severe cholestasis the prompt withdrawal of the steroid and the administration of ursodeoxycholic acid are recommended [2]. Steroid also is known to cause acute pancreatitis which would result in acute onset abdominal pain and vomiting. Possible mechanisms for drug-induced pancreatitis include immune-mediated inflammatory response, direct cellular toxicity, arteriolar thrombosis, and metabolic effects.","PeriodicalId":365218,"journal":{"name":"Journal of Gastroenterology, Pancreatology & Liver Disorders","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123499951","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 : 2018-09-21DOI: 10.15226/2374-815x/7/1/001136
K. Marakhouski, S. Kletski, Margarita Devialtovskaya
Background and aims: Intestinal metaplasia(IM) of stomach mucosa in children is rare problem. Aim of the study is to apply the criteria used in adults for diagnostic and control of IM in pediatric cohort. Patients and methods: From 2011 to 2015 endoscopy with NBI was performed on 1860 children. Endoscopic studies were performed using high-definition (HD) resolution equipment with electronic magnification and/or standard-definition (SD) resolution with optical magnification using Exera II and III by Olympus (Tokyo, Japan) systems. Narrow band imaging (NBI) was used for illumination. Two groups were founded. The main group included 24 children with morphologically verify intestinal metaplasia (IM) and 65 children were included in the control group. Patients in the main group have precision biopsy from IM area. The main and the control group also underwent multiple non-targeted biopsies in accordance with OLGA criteria. H. pylori was defined in two ways - morphologically and С13 breath test. Evaluation of pepsinogens I and II, gastrin-17 levels in blood was performed in group with IM also. Results: The sensitivity and specificity of high-resolution endoscopy with NBI for the detection of intestinal metaplasia (IM) foci were 100% (85.18-100.00) and 98.59% (92.40-99.96), respectively. “Light blue crests” – was leading endoscopic symptom of IM. In 23 of 24 cases, the zone of IM was localised in the pre-pyloric zone, with trend to stomach angle. In the group with IM, H.pylori were detected in 2 cases (8.3%), and in the control group, in 35 cases (53.8%). The relative risk of detection of H. pylori in the presence of IM was 0.0774 (0.0112-0.5341), and the Odds ratio was 0.0373 (0.0047-0.2926). The pepsinogen I and pepsinogen II levels were significantly higher in the control group (P< 0.01). The ratio of the pepsinogen I and pepsinogen II levels was reliably different in these groups. There were no reliable differences in the gastrin 17 levels. Conclusions: Endoscopy with NBI for detecting of intestinal metaplasia is a universal diagnosis tool for this type of pathology. The incidence of intestinal metaplasia in the main group was 1.29%. The visualised foci of intestinal metaplasia in children are mainly associated with the pylorus and have a vector of propagation towards the lesser gastric curvature. The probability of identifying the association of Helicobacter pylori in children with intestinal metaplasia is very low. Keywords: Intestinal Metaplasia; High-Resolution Endoscopy with NBI Illumination; Contamination of Gastric Mucosa With H. Pylori; Diagnostics; Children;
{"title":"Some Features of Intestinal Metaplasia in Children","authors":"K. Marakhouski, S. Kletski, Margarita Devialtovskaya","doi":"10.15226/2374-815x/7/1/001136","DOIUrl":"https://doi.org/10.15226/2374-815x/7/1/001136","url":null,"abstract":"Background and aims: Intestinal metaplasia(IM) of stomach mucosa in children is rare problem. Aim of the study is to apply the criteria used in adults for diagnostic and control of IM in pediatric cohort. Patients and methods: From 2011 to 2015 endoscopy with NBI was performed on 1860 children. Endoscopic studies were performed using high-definition (HD) resolution equipment with electronic magnification and/or standard-definition (SD) resolution with optical magnification using Exera II and III by Olympus (Tokyo, Japan) systems. Narrow band imaging (NBI) was used for illumination. Two groups were founded. The main group included 24 children with morphologically verify intestinal metaplasia (IM) and 65 children were included in the control group. Patients in the main group have precision biopsy from IM area. The main and the control group also underwent multiple non-targeted biopsies in accordance with OLGA criteria. H. pylori was defined in two ways - morphologically and С13 breath test. Evaluation of pepsinogens I and II, gastrin-17 levels in blood was performed in group with IM also. Results: The sensitivity and specificity of high-resolution endoscopy with NBI for the detection of intestinal metaplasia (IM) foci were 100% (85.18-100.00) and 98.59% (92.40-99.96), respectively. “Light blue crests” – was leading endoscopic symptom of IM. In 23 of 24 cases, the zone of IM was localised in the pre-pyloric zone, with trend to stomach angle. In the group with IM, H.pylori were detected in 2 cases (8.3%), and in the control group, in 35 cases (53.8%). The relative risk of detection of H. pylori in the presence of IM was 0.0774 (0.0112-0.5341), and the Odds ratio was 0.0373 (0.0047-0.2926). The pepsinogen I and pepsinogen II levels were significantly higher in the control group (P< 0.01). The ratio of the pepsinogen I and pepsinogen II levels was reliably different in these groups. There were no reliable differences in the gastrin 17 levels. Conclusions: Endoscopy with NBI for detecting of intestinal metaplasia is a universal diagnosis tool for this type of pathology. The incidence of intestinal metaplasia in the main group was 1.29%. The visualised foci of intestinal metaplasia in children are mainly associated with the pylorus and have a vector of propagation towards the lesser gastric curvature. The probability of identifying the association of Helicobacter pylori in children with intestinal metaplasia is very low. Keywords: Intestinal Metaplasia; High-Resolution Endoscopy with NBI Illumination; Contamination of Gastric Mucosa With H. Pylori; Diagnostics; Children;","PeriodicalId":365218,"journal":{"name":"Journal of Gastroenterology, Pancreatology & Liver Disorders","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124085502","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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