Pub Date : 2020-04-22DOI: 10.33552/ajgh.2020.02.000531
R. Mccullough
The superior performance of acid-controlling therapies, namely proton pump inhibitors (PPI) and histamine-2 receptor antagonists (H2RA), eroded the early but tenuous role of sucralfate in the treatment of gastroesophageal reflux disease (GERD), which role had resulted from clinical off-labeled use of sucralfate’s original regulatory indication, wihch was the management of duodenal ulcers. The clinical performance of standard sucralfate dosed at 14mg per kg (1 gram) four times daily was clinically inconsistent, substantially unimpressive and led to its exclusion from most clinical guidelines for GERD [1-4]. Clinical efficacy for standard sucralfate, whether tablet or suspension, had been largely mediocre for both erosive GERD and for NERD, non-erosive gastroesophageal reflux disease. There were two notable exceptions a trial conducted by Simon, et al. [5] in NERD patients using a mucoadherent gel formulation of sucralfate (twice as potent as sucralfate suspension in terms of retention on the mucosal lining of the gastrointestinal (GI) tract [6,7]) and a trial conducted by Vermieidien, et al. [8] using sucralfate suspension for eGERD. In the former study [5], a 14mg/ Abstract
{"title":"The Role for Pre-Polymerized Sucralfate in Management of Erosive and Non-Erosive Gastroesophageal Reflux Disease – High Potency Sucralfate-Mucin Barrier for Enteric Cytoprotection","authors":"R. Mccullough","doi":"10.33552/ajgh.2020.02.000531","DOIUrl":"https://doi.org/10.33552/ajgh.2020.02.000531","url":null,"abstract":"The superior performance of acid-controlling therapies, namely proton pump inhibitors (PPI) and histamine-2 receptor antagonists (H2RA), eroded the early but tenuous role of sucralfate in the treatment of gastroesophageal reflux disease (GERD), which role had resulted from clinical off-labeled use of sucralfate’s original regulatory indication, wihch was the management of duodenal ulcers. The clinical performance of standard sucralfate dosed at 14mg per kg (1 gram) four times daily was clinically inconsistent, substantially unimpressive and led to its exclusion from most clinical guidelines for GERD [1-4]. Clinical efficacy for standard sucralfate, whether tablet or suspension, had been largely mediocre for both erosive GERD and for NERD, non-erosive gastroesophageal reflux disease. There were two notable exceptions a trial conducted by Simon, et al. [5] in NERD patients using a mucoadherent gel formulation of sucralfate (twice as potent as sucralfate suspension in terms of retention on the mucosal lining of the gastrointestinal (GI) tract [6,7]) and a trial conducted by Vermieidien, et al. [8] using sucralfate suspension for eGERD. In the former study [5], a 14mg/ Abstract","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45489614","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 : 2020-04-22DOI: 10.33552/ajgh.2020.02.000530
Ningi Ab, S. Aliyu, Adewunmi Ol, Zarami Ab
Retroperitoneal tumours are an aggregate of multiple types of neoplastic lesions with a preponderance of tumours of mesenchymal origin. Other histological types such as Lymphoma, are reported to be commoner now. Retroperitoneal tumours are generally rare and clinical diagnosis is often difficult due its cryptic location. It is often diagnosed incidentally following abdominal radiological studies or following complications. The most common complication being an extrinsic compression, particularly, on the retroperitoneal structures; such as the ureters, duodenum or the major abdominal vessels. It may also present as a vague abdominal pain or chronic bowel obstruction like our index patient. Abdominal CT Scan is the most sensitive tool of diagnosis and complete surgical excision often, an enbloc excision with involved adjoining organs offers the best chance of cure. Adjuvant chemotherapy, radiotherapy or chemo-radiation improve disease free interval and overall survival. The mainstay of retroperitoneal lymphoma is however a cytotoxic chemotherapy or more recently Rituximab combination therapy. We present a case of a huge retroperitoneal large B-cell Lymphoma presenting as chronic small bowel obstruction.
{"title":"A Huge Retroperitoneal Large B-Cell Lymphoma Presenting as Chronic Small Bowel Obstruction: A Case Report","authors":"Ningi Ab, S. Aliyu, Adewunmi Ol, Zarami Ab","doi":"10.33552/ajgh.2020.02.000530","DOIUrl":"https://doi.org/10.33552/ajgh.2020.02.000530","url":null,"abstract":"Retroperitoneal tumours are an aggregate of multiple types of neoplastic lesions with a preponderance of tumours of mesenchymal origin. Other histological types such as Lymphoma, are reported to be commoner now. Retroperitoneal tumours are generally rare and clinical diagnosis is often difficult due its cryptic location. It is often diagnosed incidentally following abdominal radiological studies or following complications. The most common complication being an extrinsic compression, particularly, on the retroperitoneal structures; such as the ureters, duodenum or the major abdominal vessels. It may also present as a vague abdominal pain or chronic bowel obstruction like our index patient. Abdominal CT Scan is the most sensitive tool of diagnosis and complete surgical excision often, an enbloc excision with involved adjoining organs offers the best chance of cure. Adjuvant chemotherapy, radiotherapy or chemo-radiation improve disease free interval and overall survival. The mainstay of retroperitoneal lymphoma is however a cytotoxic chemotherapy or more recently Rituximab combination therapy. We present a case of a huge retroperitoneal large B-cell Lymphoma presenting as chronic small bowel obstruction.","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46045816","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 : 2020-04-22DOI: 10.33552/ajgh.2020.02.000532
R. Mccullough
Background: Unlike those with erosive reflux disease, patients with non-erosive reflux disease fail to adequately respond to proton pump inhibitors (PPI’s). Pre-polymerized sucralfate barrier therapy (PPSBT) recognized by US FDA as a medical device has significantly enhanced mucosal bioadherence compared to standard sucralfate drug. Aim: To evaluate whether enhanced mucosal protection by PPSBT can provide relevant symptom relief for NERD compared to placebo, even in undifferentiated population of NERD patients. Methods: In a multi-center randomized double-blind placebo controlled trial 42 patient with NERD were randomized to receive Esolgafate, a pre-polymerized cross-linked sucralfate barrier therapy or placebo. No pH monitoring was conducted to determine representative proportion of the 3 sub-types of NERD. Antacids were available to each group as rescue medication. Symptoms of heartburn, reflux sensation, retrosternal discomfort were evaluated before and after treatment. Adverse events were assessed. Results: At the end of the trial, for patients taking PPSBT primary endpoints were met in 90% for heartburn, 83.3% for reflux sensation and 88.2 % for retrosternal discomfort compared to 11.1%, 25% and 20% for those using placebo (p <0.01). Conclusion: The barrier effect of Esolgafate suggests that enhanced mucosal protection by PPSBT alone could improve symptom control in NERD patients undifferentiated by sub-type of non-erosive heartburn.
{"title":"Efficacy and Safety of Esolgafate, A Pre-Polymerized Cross-Linked Sucralfate Medical Device for NERD. A Randomized Double-Blind Placebo-Controlled Trial","authors":"R. Mccullough","doi":"10.33552/ajgh.2020.02.000532","DOIUrl":"https://doi.org/10.33552/ajgh.2020.02.000532","url":null,"abstract":"Background: Unlike those with erosive reflux disease, patients with non-erosive reflux disease fail to adequately respond to proton pump inhibitors (PPI’s). Pre-polymerized sucralfate barrier therapy (PPSBT) recognized by US FDA as a medical device has significantly enhanced mucosal bioadherence compared to standard sucralfate drug. Aim: To evaluate whether enhanced mucosal protection by PPSBT can provide relevant symptom relief for NERD compared to placebo, even in undifferentiated population of NERD patients. Methods: In a multi-center randomized double-blind placebo controlled trial 42 patient with NERD were randomized to receive Esolgafate, a pre-polymerized cross-linked sucralfate barrier therapy or placebo. No pH monitoring was conducted to determine representative proportion of the 3 sub-types of NERD. Antacids were available to each group as rescue medication. Symptoms of heartburn, reflux sensation, retrosternal discomfort were evaluated before and after treatment. Adverse events were assessed. Results: At the end of the trial, for patients taking PPSBT primary endpoints were met in 90% for heartburn, 83.3% for reflux sensation and 88.2 % for retrosternal discomfort compared to 11.1%, 25% and 20% for those using placebo (p <0.01). Conclusion: The barrier effect of Esolgafate suggests that enhanced mucosal protection by PPSBT alone could improve symptom control in NERD patients undifferentiated by sub-type of non-erosive heartburn.","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69448617","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 : 2020-04-01DOI: 10.33552/ajgh.2020.02.000528
R. Mccullough
Background: Treatment of erosive gastroesophageal reflux disease (eGERD) centers on control of acid pH using proton pump inhibitors (PPI), histamine 2 receptor antagonists (H2RA) and antacids (AA). However, the presence of bile and serine proteases in gastric refluxate, not addressed by PPI, H2RA or AA, is suspected to be associated with onset of Barrett’s esophagus and rise of esophageal adenocarcinoma. Pre-polymerized sucralfate barrier therapy (PPSBT) recognized first by US FDA as a medical device has enhanced bio adherence and blocks access of acid and non-acid irritants to the mucosa. Aim: To evaluate the efficacy of mucosal protection by PPSBT for the treatment of erosive GERD. Methods: In a 28 day statistically powered, multi-center randomized double-blind placebo controlled trial, 19 patients with eGERD were randomized to receive PPSBT or placebo. Antacids were available to each group for breakthrough pain. Treatment effect on erosions and eGERD symptoms (heartburn & reflux sensation) were evaluated. Adverse events were assessed. Results: For patients taking PPSBT, 89% and 78% had relief of heartburn and reflux respectively compared to 25% and 12.5 % of those on placebo. Complete healing occurred in 89% taking PPSBT compared to 25% of those on placebo. No adverse events occurred. Conclusions: Enhanced mucosal protection by PPSBT demonstrates effective symptom control and erosion healing in patients with eGERD. Acid-indifferent cytoprotection from acid, bile and serine proteases by PPSBT may be a useful adjunct in management of eGERD, and a return to the past for the future.
{"title":"28 Day Randomized Double-Blind Placebo Controlled Trial using Pre-Polymerized Cross-Linked Sucralfate Barrier (Esolgafate) for Erosive GERD","authors":"R. Mccullough","doi":"10.33552/ajgh.2020.02.000528","DOIUrl":"https://doi.org/10.33552/ajgh.2020.02.000528","url":null,"abstract":"Background: Treatment of erosive gastroesophageal reflux disease (eGERD) centers on control of acid pH using proton pump inhibitors (PPI), histamine 2 receptor antagonists (H2RA) and antacids (AA). However, the presence of bile and serine proteases in gastric refluxate, not addressed by PPI, H2RA or AA, is suspected to be associated with onset of Barrett’s esophagus and rise of esophageal adenocarcinoma. Pre-polymerized sucralfate barrier therapy (PPSBT) recognized first by US FDA as a medical device has enhanced bio adherence and blocks access of acid and non-acid irritants to the mucosa. Aim: To evaluate the efficacy of mucosal protection by PPSBT for the treatment of erosive GERD. Methods: In a 28 day statistically powered, multi-center randomized double-blind placebo controlled trial, 19 patients with eGERD were randomized to receive PPSBT or placebo. Antacids were available to each group for breakthrough pain. Treatment effect on erosions and eGERD symptoms (heartburn & reflux sensation) were evaluated. Adverse events were assessed. Results: For patients taking PPSBT, 89% and 78% had relief of heartburn and reflux respectively compared to 25% and 12.5 % of those on placebo. Complete healing occurred in 89% taking PPSBT compared to 25% of those on placebo. No adverse events occurred. Conclusions: Enhanced mucosal protection by PPSBT demonstrates effective symptom control and erosion healing in patients with eGERD. Acid-indifferent cytoprotection from acid, bile and serine proteases by PPSBT may be a useful adjunct in management of eGERD, and a return to the past for the future.","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47404345","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 : 2020-03-12DOI: 10.33552/ajgh.2020.02.000527
A. Setya
A 3-year-old African female child with a noncontributory birth, past and family history presented with progressively increasing abdominal distension for 3 months associated with intermittent fever, abdominal pain and cough. On her initial evaluation, contrastenhanced computed tomography (CECT) abdomen revealed a mass in the right hepatic lobe with thrombus in the inferior vena cava (IVC) and right ventricle with enlarged aortocaval, para aortic and celiac lymph nodes with mild ascites. Liver biopsy was deferred, as the patient was sick upon presentation. Suspecting it to be hepatoblastoma, she was given 4 cycles of Doxorubicin and Carboplatin. Tumor markers carcinoembryonic antigen (CEA), Beta human chorionic gonadotropin (hCG) and Alpha-fetoprotein (AFP) were found to be negative. In view of poor response to chemotherapy and persistent symptoms, she was brought to our hospital in New Delhi, India. On presentation, she was hemodynamically stable and had firm hepatomegaly and pallor. Positron emission tomography–computed tomography (PET CT) abdomen revealed hypertrophied left lobe of the liver, 18F-fluorodeoxyglucose (FDG) avid large heterogenous arterial enhancing lesion in the right lobe liver involving segment VII, VIII, VI with extension into IVC, right atrium and ventricle. There was bilateral moderate pleural effusion with atelectasis. She underwent an ultrasound guided biopsy of the lesion which was suggestive of inflammatory Myofibroblastic tumor (bundles of oval to spindle shaped fibroblastic cells in a collagenized stroma with cells showing mild pleomorphism). Immunohistochemical stain for Anaplastic Lymphoma Kinase (ALK) was positive but stain for SMA, CD34 and CD31 were negative. Crizotinib (ALK inhibitor) was started for reduction of the tumor volume and patient improved. *Corresponding author: Aniruddh Setya, Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, USA. Received Date: March 02, 2020 Published Date: March 12, 2020
{"title":"Liver Transplant as Treatment Modality for Inflammatory Myofibroblastic Tumor of the Liver","authors":"A. Setya","doi":"10.33552/ajgh.2020.02.000527","DOIUrl":"https://doi.org/10.33552/ajgh.2020.02.000527","url":null,"abstract":"A 3-year-old African female child with a noncontributory birth, past and family history presented with progressively increasing abdominal distension for 3 months associated with intermittent fever, abdominal pain and cough. On her initial evaluation, contrastenhanced computed tomography (CECT) abdomen revealed a mass in the right hepatic lobe with thrombus in the inferior vena cava (IVC) and right ventricle with enlarged aortocaval, para aortic and celiac lymph nodes with mild ascites. Liver biopsy was deferred, as the patient was sick upon presentation. Suspecting it to be hepatoblastoma, she was given 4 cycles of Doxorubicin and Carboplatin. Tumor markers carcinoembryonic antigen (CEA), Beta human chorionic gonadotropin (hCG) and Alpha-fetoprotein (AFP) were found to be negative. In view of poor response to chemotherapy and persistent symptoms, she was brought to our hospital in New Delhi, India. On presentation, she was hemodynamically stable and had firm hepatomegaly and pallor. Positron emission tomography–computed tomography (PET CT) abdomen revealed hypertrophied left lobe of the liver, 18F-fluorodeoxyglucose (FDG) avid large heterogenous arterial enhancing lesion in the right lobe liver involving segment VII, VIII, VI with extension into IVC, right atrium and ventricle. There was bilateral moderate pleural effusion with atelectasis. She underwent an ultrasound guided biopsy of the lesion which was suggestive of inflammatory Myofibroblastic tumor (bundles of oval to spindle shaped fibroblastic cells in a collagenized stroma with cells showing mild pleomorphism). Immunohistochemical stain for Anaplastic Lymphoma Kinase (ALK) was positive but stain for SMA, CD34 and CD31 were negative. Crizotinib (ALK inhibitor) was started for reduction of the tumor volume and patient improved. *Corresponding author: Aniruddh Setya, Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, USA. Received Date: March 02, 2020 Published Date: March 12, 2020","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47359462","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 : 2020-03-09DOI: 10.33552/ajgh.2020.02.000526
R. Mccullough
Chronic symptomatic Abstract Background: Barrier therapy has become an acceptable approach to manage heartburn in erosive gastro-esophageal reflux disease (eGERD). Following ingestion, pre-polymerized cross-linked formulation of standard sucralfate (PCLS, Esolgafate) self-anneals to achieve surface concentrations of sucralfate that is 2400% greater than otherwise possible using standard sucralfate. Main argument: By blocking access of refluxate (bile acid, proteases, hydrochloric acid) to esophageal mucosa, PCLS is as effective as acid controlling therapies within the first 7 days of use. Patients and methods: Multi-center randomized controlled trial in three university medical centers in Bangladesh used a protocol approved and registered with the Medical Research Council. Statistical power of this 4 arm trial required 9 participants per arm. Of 77 patients evaluated for severe dyspepsia, 42 had eGERD and were randomized into four treatment groups with 3 patients lost to follow up, thus leaving 39 for data analysis previously divided into 4 treatment arms that received either 1.5 gram bid sucralfate (PCLS), 20mg bid omeprazole, 150mg bid ranitidine or 30ml qid of aluminum/magnesium hydroxide antacid, 400mg/400mg per 10ml. Each group was assessed for (a) adverse events, (b) symptomatic relief, (c) endoscopic healing and (d) comparative association of relief as a function of healing. Results: Comparable symptomatic relief occurred among 4 groups from 66%-90%, but with divergent healing rates. There was 80% complete healing for PCLS compared to only 30% for omeprazole and 0% for ranitidine and antacids. Conclusions: Relief by healing from PCLS in contrast to relief without healing from acid-controlling therapies implies acid exposure is not the single most significant contributor to eGERD symptoms, but that bile acids and proteases may also be involved. The latter observation is noteworthy when considering causes of nocturnal breakthrough heartburn and refractory GERD.
{"title":"7 Day Comparative Effectiveness in Heartburn Relief and Endoscopic Healing. Randomized Controlled Trial using Omeprazole, Ranitidine, Antacids and Esolgafate, A Pre-Polymerized Cross-Linked Sucralfate (PCLS) Barrier Therapy","authors":"R. Mccullough","doi":"10.33552/ajgh.2020.02.000526","DOIUrl":"https://doi.org/10.33552/ajgh.2020.02.000526","url":null,"abstract":"Chronic symptomatic Abstract Background: Barrier therapy has become an acceptable approach to manage heartburn in erosive gastro-esophageal reflux disease (eGERD). Following ingestion, pre-polymerized cross-linked formulation of standard sucralfate (PCLS, Esolgafate) self-anneals to achieve surface concentrations of sucralfate that is 2400% greater than otherwise possible using standard sucralfate. Main argument: By blocking access of refluxate (bile acid, proteases, hydrochloric acid) to esophageal mucosa, PCLS is as effective as acid controlling therapies within the first 7 days of use. Patients and methods: Multi-center randomized controlled trial in three university medical centers in Bangladesh used a protocol approved and registered with the Medical Research Council. Statistical power of this 4 arm trial required 9 participants per arm. Of 77 patients evaluated for severe dyspepsia, 42 had eGERD and were randomized into four treatment groups with 3 patients lost to follow up, thus leaving 39 for data analysis previously divided into 4 treatment arms that received either 1.5 gram bid sucralfate (PCLS), 20mg bid omeprazole, 150mg bid ranitidine or 30ml qid of aluminum/magnesium hydroxide antacid, 400mg/400mg per 10ml. Each group was assessed for (a) adverse events, (b) symptomatic relief, (c) endoscopic healing and (d) comparative association of relief as a function of healing. Results: Comparable symptomatic relief occurred among 4 groups from 66%-90%, but with divergent healing rates. There was 80% complete healing for PCLS compared to only 30% for omeprazole and 0% for ranitidine and antacids. Conclusions: Relief by healing from PCLS in contrast to relief without healing from acid-controlling therapies implies acid exposure is not the single most significant contributor to eGERD symptoms, but that bile acids and proteases may also be involved. The latter observation is noteworthy when considering causes of nocturnal breakthrough heartburn and refractory GERD.","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41926120","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 : 2020-02-07DOI: 10.33552/ajgh.2020.01.000522
B. Sander
{"title":"Weight Regain after Bariatric Surgery - Argon Plasma Coagulation for Gastrojejunal Anastomosis Decrease","authors":"B. Sander","doi":"10.33552/ajgh.2020.01.000522","DOIUrl":"https://doi.org/10.33552/ajgh.2020.01.000522","url":null,"abstract":"","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44847862","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 : 2020-02-06DOI: 10.33552/ajgh.2020.01.000521
J. Mahadik
Introduction: Distinguishing hepatocellular carcinoma (HCC) from other primary liver tumors and metastatic carcinomas involving the liver can be problematic, especially in cases which do not exhibit classic hepatocellular morphology or immunohistochemistry (IHC). The clinical history including chronic viral infections, metabolic syndrome, alcohol, cirrhosis, and alpha-fetoprotein levels (AFP) can often help in this distinction. However, hepatoid adenocarcinoma (HAC), a rare but distinct entity, enters the list of differentials as it closely mimics HCC and may not be distinguished based on histology or immunohistochemistry. HAC is known to be aggressive and has limited therapeutic options; hence its distinction from HCC is crucial.
{"title":"Diffuse MOC-31 Expression in Hepatocellular Carcinoma: A Diagnostic Challenge","authors":"J. Mahadik","doi":"10.33552/ajgh.2020.01.000521","DOIUrl":"https://doi.org/10.33552/ajgh.2020.01.000521","url":null,"abstract":"Introduction: Distinguishing hepatocellular carcinoma (HCC) from other primary liver tumors and metastatic carcinomas involving the liver can be problematic, especially in cases which do not exhibit classic hepatocellular morphology or immunohistochemistry (IHC). The clinical history including chronic viral infections, metabolic syndrome, alcohol, cirrhosis, and alpha-fetoprotein levels (AFP) can often help in this distinction. However, hepatoid adenocarcinoma (HAC), a rare but distinct entity, enters the list of differentials as it closely mimics HCC and may not be distinguished based on histology or immunohistochemistry. HAC is known to be aggressive and has limited therapeutic options; hence its distinction from HCC is crucial.","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49320635","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 : 2020-01-03DOI: 10.33552/ajgh.2020.01.000520
M. Rogers
The majority of patients with chronic liver disease (CLD) experience malnutrition. There are multiple complex mechanism by which chronic liver disease leads to malnutrition, including anorexia and malabsorption. Assessing malnutrition in CLD is also difficult at this time as there are no standardized methods for quantifying nutritional status in this group of patients. However, newer methods are being developed to help ensure better diagnosis and thus start treatment earlier. These novel methods such as hang grip strength (HGS) and bioelectrical impedance analysis (BIA) are safe and inexpensive. However, further studies are needed to fully validate their reliability and testing in special groups, such as children. The goals of treatment are to provide adequate nutrition, support growth, preserve lean body mass, and prevent micronutrient and vitamin deficiencies. In addition to improving body mass, new studies are also focused on reducing sarcopenia (clinically relevant muscle wasting). Novel studies are revealing that improving muscle mass results in better long-term outcomes rather than just improving weight alone. This review will examine the scope of malnutrition in patients with CLD, its implications, the mechanisms by which malnutrition occurs, the methods to assess nutritional status, specific nutritional deficits, and current treatment approaches.
{"title":"Evaluation and Management of Nutrition in Chronic Liver Disease","authors":"M. Rogers","doi":"10.33552/ajgh.2020.01.000520","DOIUrl":"https://doi.org/10.33552/ajgh.2020.01.000520","url":null,"abstract":"The majority of patients with chronic liver disease (CLD) experience malnutrition. There are multiple complex mechanism by which chronic liver disease leads to malnutrition, including anorexia and malabsorption. Assessing malnutrition in CLD is also difficult at this time as there are no standardized methods for quantifying nutritional status in this group of patients. However, newer methods are being developed to help ensure better diagnosis and thus start treatment earlier. These novel methods such as hang grip strength (HGS) and bioelectrical impedance analysis (BIA) are safe and inexpensive. However, further studies are needed to fully validate their reliability and testing in special groups, such as children. The goals of treatment are to provide adequate nutrition, support growth, preserve lean body mass, and prevent micronutrient and vitamin deficiencies. In addition to improving body mass, new studies are also focused on reducing sarcopenia (clinically relevant muscle wasting). Novel studies are revealing that improving muscle mass results in better long-term outcomes rather than just improving weight alone. This review will examine the scope of malnutrition in patients with CLD, its implications, the mechanisms by which malnutrition occurs, the methods to assess nutritional status, specific nutritional deficits, and current treatment approaches.","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44492129","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 : 2019-11-12DOI: 10.33552/ajgh.2019.01.000517
Xiangyan Liu
Cell death plays a significant role in the survival and development of individual. It includes necrosis and apoptosis, which are the two most common forms of cell death. As more and more researches progress, some findings can’t be explained by apoptosis. Nowadays, some researchers have found that some antitumor drugs developed against apoptosis exist apoptosis escape and chemotherapy tolerance. So, is there any other form of cell death to overcome the resistance of tumor cells? Camptothecin (CPT) can induce apoptotic cell death, which is characterized by nuclear pyknosis and karyorhexis. Dolma et al. [1] found no similar morphological changes in erastin-treated cells. Therefore, erastininduced cell death is considered a nonapoptotic cell death. Soon afterwards, Yang et al. [2] and Yagoda et al. [3] found that this form of cell death can be suppressed by iron chelators, accompanied by an increase in intracellular reactive oxygen species. In 2012, Dixion et al. [4] named this new form of cell death as ferroptosis, which is characterized by ferric ion involved and is different from apoptosis, necrosis and autophagy. The discovery of ferroptosis provides an imaginative space for the treatment of tumors and overcoming drug resistance, opens new avenues for the development of new drugs. This review summarizes the research progress of ferroptosis in digestive system tumors.
{"title":"Research Progress in Ferroptosis for Digestive Carcinoma","authors":"Xiangyan Liu","doi":"10.33552/ajgh.2019.01.000517","DOIUrl":"https://doi.org/10.33552/ajgh.2019.01.000517","url":null,"abstract":"Cell death plays a significant role in the survival and development of individual. It includes necrosis and apoptosis, which are the two most common forms of cell death. As more and more researches progress, some findings can’t be explained by apoptosis. Nowadays, some researchers have found that some antitumor drugs developed against apoptosis exist apoptosis escape and chemotherapy tolerance. So, is there any other form of cell death to overcome the resistance of tumor cells? Camptothecin (CPT) can induce apoptotic cell death, which is characterized by nuclear pyknosis and karyorhexis. Dolma et al. [1] found no similar morphological changes in erastin-treated cells. Therefore, erastininduced cell death is considered a nonapoptotic cell death. Soon afterwards, Yang et al. [2] and Yagoda et al. [3] found that this form of cell death can be suppressed by iron chelators, accompanied by an increase in intracellular reactive oxygen species. In 2012, Dixion et al. [4] named this new form of cell death as ferroptosis, which is characterized by ferric ion involved and is different from apoptosis, necrosis and autophagy. The discovery of ferroptosis provides an imaginative space for the treatment of tumors and overcoming drug resistance, opens new avenues for the development of new drugs. This review summarizes the research progress of ferroptosis in digestive system tumors.","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44558595","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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