Academic journal of gastroenterology & hepatology最新文献

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Celiac Disease and Liver Abnormalities: What Relationships? 乳糜泻和肝脏异常:什么关系?

Academic journal of gastroenterology & hepatology

Pub Date : 2021-02-22 DOI: 10.33552/AJGH.2020.02.000543

D. Tagzout

Celiac disease (CD) may be associated with liver abnormalities (LA) and these abnormalities are often liver blood tests abnormalities corresponding to cryptogenic hypertransaminasemia or celiac hepatitis (CH) which is reversible after strict gluten free diet (GFD). CH may be the only manifestation of unrecognized CD. Other LA may be associated, especially those of dysimmune origin or overload. The mechanisms of these associations are unclear and the role of the GFD is uncertain.

腹腔疾病（CD）可能与肝脏异常（LA）有关，这些异常通常是与隐源性高氨化血症或腹腔肝炎（CH）相对应的肝血检查异常，在严格无麸质饮食（GFD）后是可逆的。CH可能是未识别CD的唯一表现。其他LA也可能相关，尤其是那些免疫失调或超负荷的LA。这些关联的机制尚不清楚，GFD的作用也不确定。

引用次数: 0

Severely Elevated Fecal Calprotectin in A Pediatric Patient with Persistent Giardiasis 持续性贾第虫患儿粪钙保护蛋白严重升高

Academic journal of gastroenterology & hepatology

Pub Date : 2021-01-28 DOI: 10.33552/AJGH.2020.02.000542

Sona Sehgal

Giardia, a protozoan pathogen, is a leading cause of acute gastroenteritis worldwide with higher prevalence in developing countries. It is a treatable diagnosis that should be considered in any patient presenting with clinical symptoms of abdominal pain, bloating, and diarrhea. It is diagnosed with stool microcopy, antigen testing, or immunologic assay. There are few studies on whether Giardia should be considered in the setting of elevated fecal calprotectin (FC), a stool biomarker of intestinal inflammation. We present the case of a patient with markedly elevated FC in the setting of persistent, severe giardiasis.

贾第鞭毛虫是一种原生动物病原体，是全球急性肠胃炎的主要病因，在发展中国家发病率较高。这是一种可治疗的诊断，任何出现腹痛、腹胀和腹泻临床症状的患者都应该考虑。可通过粪便显微镜检查、抗原检测或免疫测定进行诊断。很少有研究表明，在粪便钙卫蛋白（FC）升高的情况下是否应该考虑贾第鞭毛虫，这是肠道炎症的粪便生物标志物。我们报告了一例在持续性严重贾第鞭毛虫病中FC明显升高的患者。

引用次数: 3

Output Consistency Scale to Standardize Ostomate Output Description in Clinical Practice and Studies. 输出一致性量表在临床实践和研究中规范口腔输出描述。

Academic journal of gastroenterology & hepatology

Pub Date : 2021-01-01 DOI: 10.33552/ajgh.2021.03.000554

Lisa A Whisenhunt, Linda H Xu, Fan Yang, Jacques Izard

Stool descriptors have become popular due to the large diffusion of the Bristol Stool Form Scale (BSFS) via clinical studies, clinical trials, and social media. The applications have been numerous and centered around standardization of terminology that can be used by health care professionals and patients alike, as well as individuals interested in their wellness and the associated partners in the wellness industry. For a portion of the population, the digestive content is rerouted to an external manufactured pouch or bag, making the use of the BSFS visual descriptors of stool difficult. From day one post-resection surgery, ostomates are challenged with output management. The lack of standardized descriptors may hinder proper communication between the individual and the support team, as well as providing proper characterization in clinical studies and clinical trials. We propose the Lincoln Ostomy Output Consistency Scale for jejunostomy, ileostomy and colostomy (LOOCS) to overcome the limitations of the BSFS for qualifying ostomy outputs. The design was based on the need to describe perceived consistency from the ostomate point of view. We anticipate that the LOOCS scale can be effective in pediatric and adult clinical research settings, as well as self-monitoring to manage the quality of life.

由于布里斯托尔粪便形式量表(BSFS)通过临床研究、临床试验和社交媒体的广泛传播，粪便描述符已经变得流行起来。这些应用程序数量众多，并以术语标准化为中心，可供医疗保健专业人员和患者使用，以及对健康感兴趣的个人和健康行业的相关合作伙伴使用。对于一部分人群，消化内容物被转移到外部制造的小袋或袋子中，使得BSFS粪便视觉描述符的使用变得困难。从切除手术后的第一天起，造口者就面临着输出管理的挑战。缺乏标准化的描述可能会阻碍个人和支持团队之间的适当沟通，以及在临床研究和临床试验中提供适当的特征。我们提出了用于空肠造口、回肠造口和结肠造口(LOOCS)的林肯造口输出一致性量表，以克服BSFS在确定造口输出方面的局限性。该设计基于从口腔角度描述感知一致性的需要。我们期望LOOCS量表在儿科和成人临床研究环境以及自我监测中有效，以管理生活质量。

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引用次数: 1

Type 2 Autoimmune Hepatitis Due to Acute Epstein Barr Virus Infection or is it the Other Way Around? 2型自身免疫性肝炎是由急性eb病毒感染引起的，还是相反?

Academic journal of gastroenterology & hepatology

Pub Date : 2020-12-09 DOI: 10.33552/AJGH.2020.02.000541

K. Busari

We present a case of a 19-year-old female who presented with abdominal pain and severe pruritus. Viral studies including complete hepatitis panel were negative for acute infection, however acute infectious mononucleosis heterophiles antibodies were positive along with liver kidney microsome (LKM-1) antibody. Patient’s liver on MRCP was markedly heterogenous and nodular with areas of confluent hepatic fibrosis consistent with cirrhosis. Subsequent liver biopsy confirmed findings of acute hepatitis with extensive parenchymal extinction and necrosis with moderate to severe mixed inflammation. The patient was initiated on cholestyramine 4 gm pack daily, prednisone and transferred to a tertiary center for liver transplant evaluation.

我们报告一个19岁女性的病例，她表现为腹痛和严重瘙痒。包括完全性肝炎在内的病毒研究对急性感染呈阴性，但急性感染性单核细胞增多症异亲抗体和肝肾微粒体（LKM-1）抗体呈阳性。MRCP上患者的肝脏明显不均匀且呈结节状，合并肝纤维化区域与肝硬化一致。随后的肝活检证实了急性肝炎的发现，伴有广泛的实质消退和坏死，伴有中度至重度混合炎症。患者开始服用每天4克的消胆胺和泼尼松，并转移到三级中心进行肝移植评估。

引用次数: 1

Severe Ischemic Colitis in A Patient with Melas Syndrome 梅拉斯综合征患者的严重缺血性结肠炎

Academic journal of gastroenterology & hepatology

Pub Date : 2020-10-29 DOI: 10.33552/AJGH.2020.02.000540

E. Lázaro

MELAS syndrome is a genetic mitochondrial myopathy affecting less than 0.05% of people, which occurs with encephalomyopathy, lactic acidosis and cerebral ischemia [1]. Although it has a variable phenotypic expression, the predominant digestive manifestations [2,3] are constipation and pseudo-obstruction which are infrequent and occasionally serious. We present a patient with MELAS syndrome and the digestive disorder chronic ischemic colitis following intestinal obstruction due to fecaloma.

MELAS综合征是一种遗传性线粒体肌病，影响不到0.05%的人，与脑肌病、乳酸酸中毒和脑缺血一起发生。虽然它具有可变的表型表达，但主要的消化表现[2,3]是便秘和假性梗阻，少见，偶尔严重。我们报告了一例伴有MELAS综合征和消化系统紊乱的慢性缺血性结肠炎，这是由粪瘤引起的肠梗阻引起的。

引用次数: 0

Secondary and Spontaneous Bacterial Peritonitis in Patients With Liver Cirrhosis and Ascites 肝硬化腹水患者继发性和自发性细菌性腹膜炎

Academic journal of gastroenterology & hepatology

Pub Date : 2020-10-02 DOI: 10.33552/AJGH.2020.02.000538

Kiprin G

in class B. Peritonitis in Child-Pugh class A cirrhosis is probably secondary. IAC (International Ascites Club) recommends the SBP diagnosis to be taken in polymorphonuclear leucocytes (PMNs) in ascitic fluid >250/mm3 regardless of the result of bacterial cultures. Leucocytes /and ascitic fluid total protein (AFTP)/ increase in ascitic fluid after diuretic treatment, but not the PMNs. In patients with AFTP<10g/L the risk of SBP increases tenfold /decreased opsonic activity of ascitic fluid/. The ascitic bacterial cultures in SBP are rarely positive. At present, half of the episodes of SBP are caused by gram-positive bacteria. Blood cultures should be performed in all patients with suspected SBP. Bacterioscites (5%) does not need treatment, but monitoring, if there are no clinical symptoms and signs of systemic inflammation or infection. SecBP should be suspected in patients who have localized abdominal symptoms or signs, presence of multiple microorganisms (aerobes and anaerobes) in ascitic culture, very high ascitic neutrophil count and high ascitic total protein concentration. A SecBP should be suspected when at least two of the following features are present in ascitic fluid: glucose levels <50mg/dL, protein concentration >10g/L, lactic dehydrogenase concentration > normal serum levels. Due to the low sensitivity and specificity of these criteria for SecBP, examination of alkaline phosphatase (>225U/L) and carcinoembryonic antigen (>5ng/ml) in ascites are recommended /Runyon’s criteria/. Patients with suspected SecBP should undergo CT. Conclusion: The medical and surgical treatment of peritonitis in liver cirrhosis may be almost equally dangerous in wrong diagnosis.

child - puh腹膜炎可能继发于A级肝硬化。IAC(国际腹水俱乐部)建议，无论细菌培养结果如何，腹水中多形核白细胞(pmn)≥250/mm3均可诊断收缩压。利尿剂治疗后，腹水白细胞/和腹水总蛋白(AFTP)/增加，但pmn不增加。在AFTP10g/L的患者中，乳酸脱氢酶浓度>正常血清水平。由于这些标准对SecBP的敏感性和特异性较低，建议检查腹水中碱性磷酸酶(>225U/L)和癌胚抗原(>5ng/ml) /Runyon标准/。疑似SecBP患者应行CT检查。结论:肝硬化腹膜炎的内科和外科治疗误诊的危险性几乎相同。

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引用次数: 0

Complex Innovative Design for NASH Clinical Trials NASH临床试验的复杂创新设计

Academic journal of gastroenterology & hepatology

Pub Date : 2020-09-14 DOI: 10.33552/AJGH.2020.02.000537

S. Chow

The prevalence of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) is increasing world-wide. The development of drug product for treating NASH is considered unmet medical need. Due to the increasing prevalence and the health burden, there is a high need to develop therapeutic strategies for patients with NASH. The primary objective of the treatment for NASH is to prevent liver-related morbidity and mortality, which generally takes a long time (e.g., more than 10-20 years) to develop. In practice, it is not feasible to conduct such clinical studies. Thus, regulatory agencies such as United States Food and Drug Administration (FDA) encourage to look at surrogate endpoints for review and approval. Seamless adaptive clinical trial designs in NASH provide an opportunity to shorten the overall path to registration for a new drug and offer continuity for patients enrolled in the study. In this article, Characteristics for applying various seamless adaptive designs to clinical trials in NASH are reviewed. Statistical, clinical, and strategic issues related to drug development of NASH are also discussed.

非酒精性脂肪性肝病（NAFLD）和非酒精性脂性肝炎（NASH）的患病率在全球范围内呈上升趋势。用于治疗NASH的药物产品的开发被认为是未满足的医疗需求。由于流行率和健康负担的增加，非常需要制定NASH患者的治疗策略。NASH治疗的主要目的是预防肝脏相关的发病率和死亡率，这通常需要很长时间（例如，超过10-20年）才能发展。在实践中，进行此类临床研究是不可行的。因此，美国食品药品监督管理局（FDA）等监管机构鼓励寻找替代终点进行审查和批准。NASH的无缝适应性临床试验设计为缩短新药注册的总体路径提供了机会，并为参与研究的患者提供了连续性。本文综述了在NASH临床试验中应用各种无缝自适应设计的特点。还讨论了与NASH药物开发相关的统计、临床和战略问题。

引用次数: 1

Clinical Characteristics and Surgical Treatment of Presacral Cysts 骶前囊肿的临床特点及外科治疗

Academic journal of gastroenterology & hepatology

Pub Date : 2020-06-18 DOI: 10.33552/ajgh.2020.02.000534

B. Niu

Presacral cysts are cystic lesions occurring near the sacrorectal fossa, which can be clearly diagnosed by CT and MRI and anal digital examination before surgery. The characteristics of the tumor itself and the special location are not conducive to surgical resection. The introduction of laparoscopic techniques has brought hope for treatment, but attention should be paid to avoid damage to the rectal and presacral venous plexus. Presacral cysts with insidious onset should be checked regularly and discovered timely. Patients have good prognosis. Multi-disciplinary diagnosis was necessary. This review aims to summarize the clinical characteristics, diagnostic methods, surgical treatment, and prognosis of presacral cysts.

骶前囊肿是发生在骶直肠窝附近的囊性病变，术前通过CT、MRI及肛指检查可明确诊断。肿瘤本身的特点和特殊的位置不利于手术切除。腹腔镜技术的引入为治疗带来了希望，但应注意避免损伤直肠和骶前静脉丛。先兆性骶前囊肿应定期检查，及时发现。患者预后良好。多学科诊断是必要的。本文就骶前囊肿的临床特点、诊断方法、手术治疗及预后进行综述。

引用次数: 0

The Types and Indications of Cholecystectomy in Nigeria: Our Experience in Damaturu, North-Eastern Nigeria 尼日利亚胆囊切除术的类型和适应证：我们在尼日利亚东北部达马图鲁的经验

Academic journal of gastroenterology & hepatology

Pub Date : 2020-06-18 DOI: 10.33552/ajgh.2020.02.000535

Ningi Ab

引用次数: 0

A Large Gastroesophageal Junction Mass in an Elderly Caucasian Male 一例老年高加索男性胃食管交界处巨大肿块

Academic journal of gastroenterology & hepatology

Pub Date : 2020-06-11 DOI: 10.33552/ajgh.2020.02.000533

N. Parker

引用次数: 0

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