Pub Date : 2021-01-01DOI: 10.47690/WJGHE.2021.3308
Zenon P, Michał S, Bozena K
It has been shown that the “smart surface” of cartilage is highly hydrophilic when wet and hydrophobic when air-dry. The minimum surface energy of the bilayer was found to spread over a wide range of pH (6.5 to 9.5). The decreased number of bilayers changed the wettability and lowered the PL lubricant properties. In conclusion, a cartilage smart material can significantly react to changes pH and moisture. The biological tissue of the articular cartilage (AC) is amphoteric in its natural condition transforming surface from the hydrophilic to hydrophobic in air-dry condition (Figure 1 a, b). The profiles of the interfacial surface energy (γ ) of spherical lipid bilayer model „bell-shaped curve” vs. pH change the surface charge from positive, neutral to negative, the articular cartilage can be named a “smart material” (Figure 1c). The understanding of AC amphoteric surface will be essential for understanding the joints lubrication mechanism, the effective repair and regeneration of the degraded knee joint. The isoelectric point, IEP, is at a pH of ~ 4 when a PL molecule carries no net electrical charge H2N (CH2)n PO4H-R1R2 H3N + (CH2)n PO4 -R1R2. Changes of the interfacial energy correspond to the amino (-NH3 +→ -NH2) transition with a low pH, after IEP the phosphate (-PO4H → -PO4 -) transition at a higher pH range of 4 to 6.5. The isoelectric point, IEP, with the pH at which a phospholipid molecule carries no net electrical charge. The wetted surfaces (pH~6.5 to 9.5) of the phospholipid membranes are negatively charged (–PO4 -). Biosurface wettability can be measured relative to the differences in the charge density of the functional phosphate (–PO4 -) group. In this regard, the wettability of a hydrated surface is characterized by the concentration of charged anionic phosphate (–PO4 -) groups that are deactivated when the surface is dehydrated. The dehydration of the phospholipid bilayer surface activates hydrophobic groups, R (CH2)n due to the formation World J Gastroenterol Hepatol Endosc Volume: 3.3 1/2 of a hydrophobic monolayer, Figure 1. The hydrophilic surface in the course of dehydration, for example, via air-drying, undergoes a slow increase in the wettability contact angle indicating conformational changes in the surface (flip-flop) phospholipid molecules. Poor lubrication in animal joints, particularly on the articular surface of cartilage, can be attributed to deterioration of the bilayer surface, where the wettability or contact angle (θ) changes from 104° to less than 70° (Wettability was measured in air-dry condition) (Figure 2). Figure 1 (a, b): The smart-surface constitution of superficial phospholipid bilayer of articular cartilage in (a) wet (hydrophilic) and (b) at air-dry condition (hydrophobic). Figuer 1(c): The profiles of the interfacial surface energy (γ ) of spherical lipid bilayer model “bell-shaped curve” vs. pH of buffer solution. (a) ( pH 0.2 to 4.0 (-NH3 +→ -NH2.). (b) (pH 4.0 to 6.5 ) (-PO4H → -PO4 -) IEP : H2N (C
{"title":"Articular Cartilage: Can Articular Cartilage be Considered a Smart Material?","authors":"Zenon P, Michał S, Bozena K","doi":"10.47690/WJGHE.2021.3308","DOIUrl":"https://doi.org/10.47690/WJGHE.2021.3308","url":null,"abstract":"It has been shown that the “smart surface” of cartilage is highly hydrophilic when wet and hydrophobic when air-dry. The minimum surface energy of the bilayer was found to spread over a wide range of pH (6.5 to 9.5). The decreased number of bilayers changed the wettability and lowered the PL lubricant properties. In conclusion, a cartilage smart material can significantly react to changes pH and moisture. The biological tissue of the articular cartilage (AC) is amphoteric in its natural condition transforming surface from the hydrophilic to hydrophobic in air-dry condition (Figure 1 a, b). The profiles of the interfacial surface energy (γ ) of spherical lipid bilayer model „bell-shaped curve” vs. pH change the surface charge from positive, neutral to negative, the articular cartilage can be named a “smart material” (Figure 1c). The understanding of AC amphoteric surface will be essential for understanding the joints lubrication mechanism, the effective repair and regeneration of the degraded knee joint. The isoelectric point, IEP, is at a pH of ~ 4 when a PL molecule carries no net electrical charge H2N (CH2)n PO4H-R1R2 H3N + (CH2)n PO4 -R1R2. Changes of the interfacial energy correspond to the amino (-NH3 +→ -NH2) transition with a low pH, after IEP the phosphate (-PO4H → -PO4 -) transition at a higher pH range of 4 to 6.5. The isoelectric point, IEP, with the pH at which a phospholipid molecule carries no net electrical charge. The wetted surfaces (pH~6.5 to 9.5) of the phospholipid membranes are negatively charged (–PO4 -). Biosurface wettability can be measured relative to the differences in the charge density of the functional phosphate (–PO4 -) group. In this regard, the wettability of a hydrated surface is characterized by the concentration of charged anionic phosphate (–PO4 -) groups that are deactivated when the surface is dehydrated. The dehydration of the phospholipid bilayer surface activates hydrophobic groups, R (CH2)n due to the formation World J Gastroenterol Hepatol Endosc Volume: 3.3 1/2 of a hydrophobic monolayer, Figure 1. The hydrophilic surface in the course of dehydration, for example, via air-drying, undergoes a slow increase in the wettability contact angle indicating conformational changes in the surface (flip-flop) phospholipid molecules. Poor lubrication in animal joints, particularly on the articular surface of cartilage, can be attributed to deterioration of the bilayer surface, where the wettability or contact angle (θ) changes from 104° to less than 70° (Wettability was measured in air-dry condition) (Figure 2). Figure 1 (a, b): The smart-surface constitution of superficial phospholipid bilayer of articular cartilage in (a) wet (hydrophilic) and (b) at air-dry condition (hydrophobic). Figuer 1(c): The profiles of the interfacial surface energy (γ ) of spherical lipid bilayer model “bell-shaped curve” vs. pH of buffer solution. (a) ( pH 0.2 to 4.0 (-NH3 +→ -NH2.). (b) (pH 4.0 to 6.5 ) (-PO4H → -PO4 -) IEP : H2N (C","PeriodicalId":93828,"journal":{"name":"World journal of gastroenterology, hepatology and endoscopy","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76721723","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 : 2021-01-01DOI: 10.47690/WJGHE.2021.3307
Jamwal Kd
REVIEW Gastric Varices (GV) are present in 15-25% of cirrhotics with GOV1 and the primary gastric varices being the most common [1]. Gastric varices can also be present in patients with left sided portal hypertension. As compared to esophageal varices the incidence of gastric variceal bleeding is low (10-20%) and bleeding is not proportional to portal pressure as is noted in esophageal varices, with a re bleeding rate of 30% in GV [2,3]. The GV bleeding is difficult to control due to presence of a thick mucosal layer over the GV, which does not collapse after bleeding. With the advent of hemo dynamic studies in GV, there has been change in approach to management of GV. Recently there has been increased focus on individualised GV treatment based on hemo dynamics of the portal system, especially on the left sided venous diseases (GV, ectopic varices, lieno renal shunt) and not on traditionally based endoscopic appearance as is done in most of the cases worldwide. With a contrast CT scan of the portal venous system, it is easy to delineate the anatomy prior to planning a definitive treatment (either primary or secondary). At present the standard treatment for GV is endoscopic glue injection (EGI) by an endoscopist and BRTO (balloon retrograde trans venous obliteration) via intervention radiologist [4-8]. Technically BRTO seems more complete when compared to an EGI, because the whole shunt which drains the GV is taken care of by the BRTO procedure. Whereas in the EGI procedure, only the mucosal varices are treated and the remaining sub mucosal varices, the shunt and the draining pathways (both afferent and efferent) are left untreated. An endoscopic ultrasound (EUS) is a much superior modality of managing vascular disorders such as GV, a. it has col our doppler b. it can differentiate between an artery & a vein c. it can assess shunts & collaterals d. it can assess completion of therapy [9,10]. EUS has been used for treatment of GV from the last decade and it has shown to be technically superior, safe and also it decreases overall cost, number of sessions and morbidity related to re bleeding in GV. With the advent of better diagnostic imaging of the portal venous anatomy such as CT/ MR venography the venous drainage and collaterals can be delineated in patients with GV, this knowledge of the anatomy when combined treatment modalities such as EGI, BRTO or EUS guided vascular treatment helps in individualising the therapy for the patients with GV. In patients of GV with significant collaterals and shunts on the left side of mid line such as (afferent collateralsposterior gastric vein, short
{"title":"Gastric Varices Treatment: Is it Possible to Individualise Therapy for Bleeding Patients","authors":"Jamwal Kd","doi":"10.47690/WJGHE.2021.3307","DOIUrl":"https://doi.org/10.47690/WJGHE.2021.3307","url":null,"abstract":"REVIEW Gastric Varices (GV) are present in 15-25% of cirrhotics with GOV1 and the primary gastric varices being the most common [1]. Gastric varices can also be present in patients with left sided portal hypertension. As compared to esophageal varices the incidence of gastric variceal bleeding is low (10-20%) and bleeding is not proportional to portal pressure as is noted in esophageal varices, with a re bleeding rate of 30% in GV [2,3]. The GV bleeding is difficult to control due to presence of a thick mucosal layer over the GV, which does not collapse after bleeding. With the advent of hemo dynamic studies in GV, there has been change in approach to management of GV. Recently there has been increased focus on individualised GV treatment based on hemo dynamics of the portal system, especially on the left sided venous diseases (GV, ectopic varices, lieno renal shunt) and not on traditionally based endoscopic appearance as is done in most of the cases worldwide. With a contrast CT scan of the portal venous system, it is easy to delineate the anatomy prior to planning a definitive treatment (either primary or secondary). At present the standard treatment for GV is endoscopic glue injection (EGI) by an endoscopist and BRTO (balloon retrograde trans venous obliteration) via intervention radiologist [4-8]. Technically BRTO seems more complete when compared to an EGI, because the whole shunt which drains the GV is taken care of by the BRTO procedure. Whereas in the EGI procedure, only the mucosal varices are treated and the remaining sub mucosal varices, the shunt and the draining pathways (both afferent and efferent) are left untreated. An endoscopic ultrasound (EUS) is a much superior modality of managing vascular disorders such as GV, a. it has col our doppler b. it can differentiate between an artery & a vein c. it can assess shunts & collaterals d. it can assess completion of therapy [9,10]. EUS has been used for treatment of GV from the last decade and it has shown to be technically superior, safe and also it decreases overall cost, number of sessions and morbidity related to re bleeding in GV. With the advent of better diagnostic imaging of the portal venous anatomy such as CT/ MR venography the venous drainage and collaterals can be delineated in patients with GV, this knowledge of the anatomy when combined treatment modalities such as EGI, BRTO or EUS guided vascular treatment helps in individualising the therapy for the patients with GV. In patients of GV with significant collaterals and shunts on the left side of mid line such as (afferent collateralsposterior gastric vein, short","PeriodicalId":93828,"journal":{"name":"World journal of gastroenterology, hepatology and endoscopy","volume":"120 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87931253","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 : 2021-01-01DOI: 10.47690/WJGHE.2021.3403
M. Parveen, M. Vani, G. Usha, Paramjeet Sg, Pushkar, S. Yogesh, Akshay
INTRODUCTION: Chronic hepatitis C is one of the most common cause all over the world for causing cirrhosis of liver and thus requiring liver transplantation as the definitive treatment which is beyond reach in most of patients in developing countries. The availability of oral directly acting antiviral for treatment in India since 2015 has changed the scenario due to its good compliance among the patients. AIMS AND OBJECTIVES: To determine the compliance among patients who were treated with directly acting oral antiviral drugs for Hepatitis C (Sofosbuvir 400 mg, Daclastavir 60 mg, Velpatasvir 100 mg). MATERIALS AND METHODS: It was prospective study conducted at Department of Medical Gastroenterology, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, over a period of five years from 01.01.2016 to 31.12.2020. Out of four thousand patients of Chronic hepatitis C who reported in department in above five years duration, 570 patients pre therapy HCV RNA was not detected, hence they were not treated and were not part of the study. Out of the remaining 3430 patients, 130 patients went for alternative medications and hence were excluded from the study. The remaining 3300 confirmed patients of Chronic hepatitis C who were started on treatment with oral antiviral drugs were followed till they completed their treatment. Out of these 3300 patients,10 patients who were cirrhotic died during their course of treatment, hence in final analysis 3290 patients were included. RESULTS: Only ten patients out of total pool of 3290 left medicines due to side effects, thus high compliance rate of 99.69% was achieved.
{"title":"Compliance on Directly Acting Oral Antiviral in Hcv Patients","authors":"M. Parveen, M. Vani, G. Usha, Paramjeet Sg, Pushkar, S. Yogesh, Akshay","doi":"10.47690/WJGHE.2021.3403","DOIUrl":"https://doi.org/10.47690/WJGHE.2021.3403","url":null,"abstract":"INTRODUCTION: Chronic hepatitis C is one of the most common cause all over the world for causing cirrhosis of liver and thus requiring liver transplantation as the definitive treatment which is beyond reach in most of patients in developing countries. The availability of oral directly acting antiviral for treatment in India since 2015 has changed the scenario due to its good compliance among the patients. AIMS AND OBJECTIVES: To determine the compliance among patients who were treated with directly acting oral antiviral drugs for Hepatitis C (Sofosbuvir 400 mg, Daclastavir 60 mg, Velpatasvir 100 mg). MATERIALS AND METHODS: It was prospective study conducted at Department of Medical Gastroenterology, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, over a period of five years from 01.01.2016 to 31.12.2020. Out of four thousand patients of Chronic hepatitis C who reported in department in above five years duration, 570 patients pre therapy HCV RNA was not detected, hence they were not treated and were not part of the study. Out of the remaining 3430 patients, 130 patients went for alternative medications and hence were excluded from the study. The remaining 3300 confirmed patients of Chronic hepatitis C who were started on treatment with oral antiviral drugs were followed till they completed their treatment. Out of these 3300 patients,10 patients who were cirrhotic died during their course of treatment, hence in final analysis 3290 patients were included. RESULTS: Only ten patients out of total pool of 3290 left medicines due to side effects, thus high compliance rate of 99.69% was achieved.","PeriodicalId":93828,"journal":{"name":"World journal of gastroenterology, hepatology and endoscopy","volume":"127 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80231887","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 : 2021-01-01DOI: 10.47690/wjghe.2021.3605
B. O., Meskini T, Berrani H, S. M, E. S, M. N
The term bezoar refers to foreign bodies found in the digestive tract. It results in a stagnation of ingested non-digestible substances. We report a case of an esophageal bezoar collected in the pediatric gastroenterology department of the children's hospital in RabatMOROCCO. This observation of an esophageal bezoar, the first in our institution, to our knowledge, confirms the rarity of the pathology. 7-year-old child, taken by his parents to the children's hospital of the university hospital in Rabat for total aphagia. His history shows: psychomotor retardation, followed for 2 years for peptic esophagitis complicated by peptic stenosis. The course was marked by total aphagia, early postprandial vomiting, and weight loss of 6 kg in 3 months. This symptomatology has been evolving for 2 months. Esophagogastroduodenal fibroscopy, using an 8.5mm pediatric fiberscope, revealed an esophageal bezoar made of tissues, fibers, hair, sponge, plastics and ropes. A multistage endoscopic extraction was performed, which extracted a 430g bezoar. After a complete cleansing of the esophagus, the esophagogastroduodenal exploration showed ascension of the gastric folds on retrovision, a gaping cardia, a hernial pouch, an esophageal caliber disparity of 25 cm to 20 cm of the dental arches with presence of mucous ulcerations and false membranes. After extraction, the child resumed his normal diet with no vomiting. a proton pump inhibitor and antibiotic therapy were prescribed. INTRODUCTION The term bezoar refers to foreign bodies found in the digestive tract. It results in a stagnation of ingested non-digestible substances, such as hair (trichobezoar), certain vegetable fibers (phytobezoar), concentrated dairy products (lactobezoar), more rarely certain drugs (pharmacobezoar). Its esophageal location is little reported in the literature, it is often secondary to a morphological and / or functional abnormality of the esophagus and is frequently involved. It usually concerns children or young adolescents with mental disorders [1]. We report a case of an esophageal bezoar collected in the pediatric gastroenterology department of the children's hospital in RabatMOROCCO. This observation of an esophageal bezoar, the first in our institution, to our knowledge, confirms the rarity of the pathology. PATIENT AND OBSERVATION 7-year-old child, taken by his parents to the children's hospital of the university hospital in Rabat for total aphagia. His history shows: psychomotor retardation, followed for 2 years for peptic esophagitis complicated by peptic stenosis. The course was marked by total aphagia, early postprandial vomiting, and weight loss of 6 kg in 3 months. This symptomatology has been evolving for 2 months. The admission exam noted: a pale patient. A weight of 12kg (3 DS), a height of 114cm (2DS). World J Gastroenterol Hepatol Endosc Volume: 3.6 1/3 Received Date: 10 Oct 2021 Accepted Date: 16 Oct 2021 Published Date: 22 Oct 2021 The biological assessment showed on the
{"title":"Esophageal bezoar on peptic stenosis in a 7-year-old child","authors":"B. O., Meskini T, Berrani H, S. M, E. S, M. N","doi":"10.47690/wjghe.2021.3605","DOIUrl":"https://doi.org/10.47690/wjghe.2021.3605","url":null,"abstract":"The term bezoar refers to foreign bodies found in the digestive tract. It results in a stagnation of ingested non-digestible substances. We report a case of an esophageal bezoar collected in the pediatric gastroenterology department of the children's hospital in RabatMOROCCO. This observation of an esophageal bezoar, the first in our institution, to our knowledge, confirms the rarity of the pathology. 7-year-old child, taken by his parents to the children's hospital of the university hospital in Rabat for total aphagia. His history shows: psychomotor retardation, followed for 2 years for peptic esophagitis complicated by peptic stenosis. The course was marked by total aphagia, early postprandial vomiting, and weight loss of 6 kg in 3 months. This symptomatology has been evolving for 2 months. Esophagogastroduodenal fibroscopy, using an 8.5mm pediatric fiberscope, revealed an esophageal bezoar made of tissues, fibers, hair, sponge, plastics and ropes. A multistage endoscopic extraction was performed, which extracted a 430g bezoar. After a complete cleansing of the esophagus, the esophagogastroduodenal exploration showed ascension of the gastric folds on retrovision, a gaping cardia, a hernial pouch, an esophageal caliber disparity of 25 cm to 20 cm of the dental arches with presence of mucous ulcerations and false membranes. After extraction, the child resumed his normal diet with no vomiting. a proton pump inhibitor and antibiotic therapy were prescribed. INTRODUCTION The term bezoar refers to foreign bodies found in the digestive tract. It results in a stagnation of ingested non-digestible substances, such as hair (trichobezoar), certain vegetable fibers (phytobezoar), concentrated dairy products (lactobezoar), more rarely certain drugs (pharmacobezoar). Its esophageal location is little reported in the literature, it is often secondary to a morphological and / or functional abnormality of the esophagus and is frequently involved. It usually concerns children or young adolescents with mental disorders [1]. We report a case of an esophageal bezoar collected in the pediatric gastroenterology department of the children's hospital in RabatMOROCCO. This observation of an esophageal bezoar, the first in our institution, to our knowledge, confirms the rarity of the pathology. PATIENT AND OBSERVATION 7-year-old child, taken by his parents to the children's hospital of the university hospital in Rabat for total aphagia. His history shows: psychomotor retardation, followed for 2 years for peptic esophagitis complicated by peptic stenosis. The course was marked by total aphagia, early postprandial vomiting, and weight loss of 6 kg in 3 months. This symptomatology has been evolving for 2 months. The admission exam noted: a pale patient. A weight of 12kg (3 DS), a height of 114cm (2DS). World J Gastroenterol Hepatol Endosc Volume: 3.6 1/3 Received Date: 10 Oct 2021 Accepted Date: 16 Oct 2021 Published Date: 22 Oct 2021 The biological assessment showed on the","PeriodicalId":93828,"journal":{"name":"World journal of gastroenterology, hepatology and endoscopy","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84554403","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}
C. Salvemini, Elena G. Bertozzi, E. Virgilio, M. Raichi
{"title":"Pilot experience of non-invasive delivery of radiofrequency energy in patients with pelvic hypertonia. A novel second-generation technology","authors":"C. Salvemini, Elena G. Bertozzi, E. Virgilio, M. Raichi","doi":"10.15761/ghe.1000216","DOIUrl":"https://doi.org/10.15761/ghe.1000216","url":null,"abstract":"","PeriodicalId":93828,"journal":{"name":"World journal of gastroenterology, hepatology and endoscopy","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83511772","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}
C. Salvemini, Elena G. Bertozzi, E. Virgilio, M. Raichi
{"title":"Non-invasive delivery of radiofrequency energy in women with faecal incontinence, the new era. The new-generation DQRF™ device","authors":"C. Salvemini, Elena G. Bertozzi, E. Virgilio, M. Raichi","doi":"10.15761/ghe.1000215","DOIUrl":"https://doi.org/10.15761/ghe.1000215","url":null,"abstract":"","PeriodicalId":93828,"journal":{"name":"World journal of gastroenterology, hepatology and endoscopy","volume":"114 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77704492","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 : 2021-01-01DOI: 10.47690/WJGHE.2021.3309
Short Review Acute variceal bleeding (AVB) is seen in 50-70% of patients with cirrhosis & portal hypertension (PHT) [1]. Over the time the severity of the bleeding and complications related to bleeding have significantly reduced due to improvement in clinical management, better availability of vasopressor drugs, improved endoscopic therapies as well as due to availability of definitive treatment options such as TIPS and liver transplantation. About 10-20% patients do not respond to initial management (failure to control bleeding within 48 hrs) and develop re bleeding within 5 days of starting the therapy (initial control of bleeding), these patients can be defined to have refractory variceal bleeding. The causes for refractory variceal bleeding are a. severe liver disease (high MELD-Na and CTP score) b. coagulopathy (increased PT, INR and low platelets) c. post EVL band ulcers (PEBU’s) or slippage of bands [2-4]. Failure to control bleeding leads to poorer outcome due to a. worsening liver failure b. development of organ dysfunction due to hypovolemia and progressive shock c. systemic sepsis and increased gut translocation of bacteria. The management in this group of patients depends upon the general condition of the patient and the liver disease status. There was a recent study which showed that endoscopic appearance of the varices after banding can determine the outcomes in addition to MELDNa score [4]. I. Generalized treatment for stabilization of the patient: a. This includes blood transfusion (packed red blood cell) to maintain a hemoglobin level of 7-8 gram / dl. The restrictive vs liberal treatment has shown that the restrictive strategy was better in terms of rebleeding and mortality [5]. b. The patients with coagulopathy can be treated either with blood products based on lab parameters (INR, platelet count, aPTT) or blood products based on TEG (thromboelastography). The conventional approach in coagulopathy with variceal bleeding is blood component based correction but the data does not support use of blood products in AVB. A recent RCT was done in cirrhotics with GI bleeding and cogulopathy, the patients had a non variceal bleeding source and were managed with TEG guided corrections in comparison to standard INR guided corrections. The study concluded that TEG based correction showed significant reduction in number of blood products
{"title":"Refractory Variceal Bleeding: Approach To Management (Mini Review)","authors":"","doi":"10.47690/WJGHE.2021.3309","DOIUrl":"https://doi.org/10.47690/WJGHE.2021.3309","url":null,"abstract":"Short Review Acute variceal bleeding (AVB) is seen in 50-70% of patients with cirrhosis & portal hypertension (PHT) [1]. Over the time the severity of the bleeding and complications related to bleeding have significantly reduced due to improvement in clinical management, better availability of vasopressor drugs, improved endoscopic therapies as well as due to availability of definitive treatment options such as TIPS and liver transplantation. About 10-20% patients do not respond to initial management (failure to control bleeding within 48 hrs) and develop re bleeding within 5 days of starting the therapy (initial control of bleeding), these patients can be defined to have refractory variceal bleeding. The causes for refractory variceal bleeding are a. severe liver disease (high MELD-Na and CTP score) b. coagulopathy (increased PT, INR and low platelets) c. post EVL band ulcers (PEBU’s) or slippage of bands [2-4]. Failure to control bleeding leads to poorer outcome due to a. worsening liver failure b. development of organ dysfunction due to hypovolemia and progressive shock c. systemic sepsis and increased gut translocation of bacteria. The management in this group of patients depends upon the general condition of the patient and the liver disease status. There was a recent study which showed that endoscopic appearance of the varices after banding can determine the outcomes in addition to MELDNa score [4]. I. Generalized treatment for stabilization of the patient: a. This includes blood transfusion (packed red blood cell) to maintain a hemoglobin level of 7-8 gram / dl. The restrictive vs liberal treatment has shown that the restrictive strategy was better in terms of rebleeding and mortality [5]. b. The patients with coagulopathy can be treated either with blood products based on lab parameters (INR, platelet count, aPTT) or blood products based on TEG (thromboelastography). The conventional approach in coagulopathy with variceal bleeding is blood component based correction but the data does not support use of blood products in AVB. A recent RCT was done in cirrhotics with GI bleeding and cogulopathy, the patients had a non variceal bleeding source and were managed with TEG guided corrections in comparison to standard INR guided corrections. The study concluded that TEG based correction showed significant reduction in number of blood products","PeriodicalId":93828,"journal":{"name":"World journal of gastroenterology, hepatology and endoscopy","volume":"107 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77450341","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 : 2021-01-01DOI: 10.47690/WJGHE.2021.3401
F. Cosentino, A. Rigante, R. Barbera, R. Giuberti, R. Tinelli, S. Zanardi
BACKGROUND: Colonoscopy is the standard method for CCR prevention, diagnosis, and treatment, but it is painful and highly dependent on quality of bowel preparation. This study describes the experience of the first 150 colonoscopies performed using the Endotics System at S. Giuseppe Hospital in Milan (Italy), demonstrating the effectiveness, diagnostic quality, and lack of pain even without sedation. Moreover, at the patient's request, robotic system was combined with Colon Wash technology, able to prepare the bowel in a comfortable and effective way without use of purgatives. METHODS: The study is observational, retrospective, comparative, on a group of 150 patients, enrolled consecutively over a year. Quality of the intestinal preparation is evaluated and then reported based on BBPS for both patients who underwent Colon Wash and those who opted for the traditional preparation. In addition, the total percentage of cecal intubation and the average time needed to achieve it, in patients who have also undergone Colon Wash, are reported. RESULTS: 87 out of the 150 patients enrolled, (58%) chose intestinal preparation with Colon Wash technology. In this group, optimal preparation was obtained in 71.3% of cases. The percentage of optimal preparation among patients who chose the traditional method decreased 66.7%. Failure rates of procedure due to poor bowel preparation were 4.6% and 3.2% respectively. Cecum was achieved in 99.2% of cases with an average time of 22.5 minutes. In addition, in patients with a previous failed conventional colonoscopy, cecum was achieved in 92.3% of cases. 58 patients out of the 150 were eligible for the ADR calculation according to the ASGE guidelines, resulting in an overall ADR of 39.7% (ADR M of 60% and ADR F of 24.2%). CONCLUSIONS: Endotics system confirms its ability to perform painless procedures as effectively as conventional colonoscopy (and Journal Home: https://scienceworldpublishing.org/journals/world-journal-of-gastroenterology-hepatology-and-endoscopy/WJGHE World J Gastroenterol Hepatol Endosc Volume: 3.4 2/9 more effectively in difficult cases). Colon Wash technology allows intestinal preparation comparable to the standard one. The combination of these two technologies can increase acceptance of colonoscopy procedure and adherence to CCR screening programs.
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{"title":"Impact of Ramadan on crohn's disease","authors":"E. M, Benelbarhdadi I, Borahma M, Ajana Fz","doi":"10.15761/ghe.1000217","DOIUrl":"https://doi.org/10.15761/ghe.1000217","url":null,"abstract":"","PeriodicalId":93828,"journal":{"name":"World journal of gastroenterology, hepatology and endoscopy","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73125666","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 : 2020-09-01DOI: 10.47690/wjghe.2020.3301
E. Gadour, Zeinab E. Hassan, Khalid Shrwani
Background Covid-19 Induced Hepatitis (CIH), is a novel terminology which is used in this article for the first time in the medical literature. Objective To study the pattern of liver impairment in patients with Covid-19 as well as to find acceptable and practical diagnostic criteria of Covid-19 Induced Hepatitis (CIH). This review article gives new insight and guidance about the diagnosis of Covid-19 Induced Hepatitis (CIH), possible causes of liver damage and review of recently published data about the impairment of liver function in Covid-19 patients. Methodology Extensive literature review of newly published data and study in PubMed cited journals and other international publisher journals. Research of all studies that reviewed liver derangement in COVID-19 were mainly reviewed. Statistical analysis of submitted data were checked using SPSS. PubMed Chinese language versions were also used. Results 60% of patients with SARS can have abnormal liver functions. Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) have noticeably been abnormal in around 14–53% of patients with Covid-19 (7/114, 6.14%) (P>0.05). Impairment in liver enzymes, mainly ALT/AST, in severe Covid-19 pneumonia was significantly higher than patients with mild disease, with mean average (37.87±32.17 vs 21.22± 12.67;38.87 ± 22.55 vs 24.39± 9.79, P Conclusion Covid-19 Induced Hepatitis (CIH) is a new clinical syndrome, which can be defined as a ‘benign new transient hepatitis in a SARS-CoV-2 patients which icharacterized by the following; Gradual onset, elevated AST and ALT, Dilated sinusoids with lymphocytic infiltration of liver parenchyma, non-Obstructive jaundice, stable Underlying liver disease and no Radiological new hepatobiliary changes.’ Using GADOUR criteria may support the diagnosis, however, sensitivity and specificity are yet to be established. Meticulous statistical studies need to be done before establishing overly sensitive scoring system can be reach.
背景Covid-19诱导肝炎(CIH)是医学文献中首次使用的一个新术语。目的探讨新型冠状病毒感染(Covid-19)患者的肝损害规律，寻求可接受的、实用的新型冠状病毒性肝炎(CIH)诊断标准。这篇综述文章对Covid-19诱导肝炎(CIH)的诊断、肝损伤的可能原因以及最近发表的关于Covid-19患者肝功能损害的数据进行了综述，提供了新的见解和指导。对PubMed引用期刊和其他国际出版商期刊上新发表的数据和研究进行广泛的文献综述。主要综述了所有涉及新冠肺炎肝损害的研究。对提交的数据进行SPSS统计分析。PubMed中文版也被使用。结果60%的SARS患者可出现肝功能异常。约14 ~ 53%的新冠肺炎患者存在谷草转氨酶(AST)和丙氨酸转氨酶(ALT)异常(7/114,6.14%)(P < 0.05)。重症肺炎患者以ALT/AST为主的肝酶损害显著高于轻症患者，平均(37.87±32.17 vs 21.22±12.67;38.87±22.55 vs 24.39±9.79)P结论CIH是一种新的临床综合征，可定义为SARS-CoV-2患者的“良性新一过性肝炎”，具有以下特点;逐渐发病，AST和ALT升高，窦状窦扩张伴肝实质淋巴细胞浸润，非梗阻性黄疸，稳定的潜在肝脏疾病，无影像学上新的肝胆改变。“使用GADOUR标准可能支持诊断，然而，敏感性和特异性尚未建立。”在建立过于敏感的评分系统之前，需要进行细致的统计研究。
{"title":"COVID-19 Induced Hepatitis (CIH), Definition and Diagnostic Criteria of a Poorly Understood New Clinical Syndrome","authors":"E. Gadour, Zeinab E. Hassan, Khalid Shrwani","doi":"10.47690/wjghe.2020.3301","DOIUrl":"https://doi.org/10.47690/wjghe.2020.3301","url":null,"abstract":"Background Covid-19 Induced Hepatitis (CIH), is a novel terminology which is used in this article for the first time in the medical literature. Objective To study the pattern of liver impairment in patients with Covid-19 as well as to find acceptable and practical diagnostic criteria of Covid-19 Induced Hepatitis (CIH). This review article gives new insight and guidance about the diagnosis of Covid-19 Induced Hepatitis (CIH), possible causes of liver damage and review of recently published data about the impairment of liver function in Covid-19 patients. Methodology Extensive literature review of newly published data and study in PubMed cited journals and other international publisher journals. Research of all studies that reviewed liver derangement in COVID-19 were mainly reviewed. Statistical analysis of submitted data were checked using SPSS. PubMed Chinese language versions were also used. Results 60% of patients with SARS can have abnormal liver functions. Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) have noticeably been abnormal in around 14–53% of patients with Covid-19 (7/114, 6.14%) (P>0.05). Impairment in liver enzymes, mainly ALT/AST, in severe Covid-19 pneumonia was significantly higher than patients with mild disease, with mean average (37.87±32.17 vs 21.22± 12.67;38.87 ± 22.55 vs 24.39± 9.79, P Conclusion Covid-19 Induced Hepatitis (CIH) is a new clinical syndrome, which can be defined as a ‘benign new transient hepatitis in a SARS-CoV-2 patients which icharacterized by the following; Gradual onset, elevated AST and ALT, Dilated sinusoids with lymphocytic infiltration of liver parenchyma, non-Obstructive jaundice, stable Underlying liver disease and no Radiological new hepatobiliary changes.’ Using GADOUR criteria may support the diagnosis, however, sensitivity and specificity are yet to be established. Meticulous statistical studies need to be done before establishing overly sensitive scoring system can be reach.","PeriodicalId":93828,"journal":{"name":"World journal of gastroenterology, hepatology and endoscopy","volume":"128 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74577473","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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