Journal of gastrointestinal and liver diseases : JGLD最新文献

Background and aims: Non-alcoholic fatty liver disease (NAFLD) is related to an increased atherosclerotic cardiovascular disease (ASCVD) risk. This study investigated a potential relationship between liver fibrosis scores (LFS) reflecting NAFLD and ascending aortic dilatation (AAD).

Methods: This is an observational and cross-sectional study. Patients were consecutively enrolled from a cardiology clinic. The NAFLD fibrosis score (NFS), fibrosis-4 (FIB-4) index, aspartate aminotransferase (AST) to platelet ratio (APRI), and BARD scores of each patient were calculated. The ascending aortic diameters were evaluated by transthoracic echocardiography according to current clinical guidelines. The patients were allocated into two groups with and without AAD.

Results: A total of 272 patients were included in the study. In AAD group, age, patients with hypertension (HT), coronary artery disease (CAD), FIB-4 index, BARD score and the NFS were significantly higher. As compared to the AAD group, body mass index (BMI), hemoglobin, and diuretic use were significantly higher in patients without aortic dilatation. The NFS with AAD, and NFS and FIB-4 index with indexed aortic diameter (AI) showed significant positive correlation (R=0.546, R=0.332, R=0.314 with p<0.001, respectively). In multivariate logistic regression analysis hemoglobin levels (OR=0.728, 95%CI: 0.553-0.958; p=0.023), BMI (OR=0.762, 95%CI: 0.668-0.869, p<0.001), HT (OR=3.269, 95%CI: 1.045-10.220; p=0.042), BARD score (OR=1.248, 95%CIL 0.815-1.955; p=0.044), and FIB-4 index (OR=2.432, 95%CI: 1.395-4.246; p=0.002) were found to be independently related to AAD.

Conclusions: Our study demonstrated a statistically significant relationship between NFS, FIB-4 index, BARD score and AAD. The presence of positive correlation among LFS and AAD in our study is remarkable. This may emphasize the increased risk of AAD in NAFLD.

Background and aims: Adipokines are among the biomarkers that have been studied in chronic pancreatitis (CP), as well as in pancreatic cancer (PC). So far, the existing findings are contradictory and inconclusive. Therefore, we assessed the levels of three major adipokines in CP in comparison to controls and PC, adiponectin, leptin, and resistin.

Methods: A systematic electronic search was carried out in November 2022 using PubMed, Embase, and Scopus, reviewing observational studies. By using the Newcastle-Ottawa Scale, the included studies' quality was evaluated (NOS). In the examination of the estimated overall effect size, we employed the random-effects model in conjunction with the mean difference (MD) analysis. The MD with 95% confidence interval (CI) served as the primary summary outcome.

Results: Our systematic review included a total of 14 studies, out of which nine were considered in our meta-analysis. A significant MD related to leptin levels in CP patients vs. controls (-1.299, 95%CI: -2.493 - -0.105), resistin levels in CP patients vs. controls (8.356, 95%CI: 3.700-13.012), and adiponectin levels in PC patients vs. controls (11.240, 95%CI: 5.872-16.60) was reported. However, no significant MD was reported in leptin levels between CP vs. PC patients (-0.936, 95%CI: -3.325-1.454), as well as adiponectin levels in CP patients vs. controls (0.422. 95%CI -5.651-6.535]) and in CP vs. PC patients (-6.252, 95%CI -13.269-0.766).

Conclusions: CP was significantly associated with decreased leptin levels and increased resistin levels. Furthermore, increased levels of adiponectin are associated with PC. Yet, no significant MD was seen for leptin and adiponectin levels between CP and PC patients, and likewise for adiponectin levels between CP patients and controls. Results should be interpreted with caution due to the high heterogeneity between the included studies.

The role of the liver in drug metabolism makes individuals with hepatic dysfunction more susceptible to adverse drug reactions, necessitating careful consideration in analgesic selection and dosing. Acetaminophen, despite being a common cause of liver failure, is considered safe within recommended dosages. Nonsteroidal anti-inflammatory drugs (NSAIDs), while effective, pose risks in cirrhosis due to complications like renal failure and gastrointestinal bleeding. Cyclooxygenase-2 inhibitors have limited data, and their use is discouraged due to cardiovascular concerns. Opiates, though potent, require cautious use in cirrhosis due to altered metabolism, potential adverse effects, and the risk of addiction. Tricyclic antidepressants like nortriptyline and desipramine can be utilized for neuropathic pain, while SSRIs and SNRIs are not recommended. Anticonvulsants such as gabapentin and pregabalin are preferred for neuropathic pain, with gabapentin being the first-line choice. Topical analgesics, including NSAIDs, lidocaine, and rubefacients, are deemed safe for use in cirrhosis, offering localized relief with minimal systemic effects. Nonpharmacological approaches addressing medical, psychological, and socio-economic factors are crucial adjuvants to analgesic therapy in advanced liver diseases. Physiotherapy, psychotherapy, behavioral therapy, relaxation techniques, acupuncture, and traditional practices like yoga and massage, as well as novel modalities, contribute to a holistic pain management strategy. This review provides healthcare professionals with valuable insights into the complex landscape of analgesic therapy in cirrhosis. Meticulous consideration of drug metabolism, hepatic safety, and individual patient factors is paramount in optimizing pain management strategies for this challenging patient population.