Search

AIM: To determine if proton pump inhibitor use in cirrhotic patients with endoscopic findings of portal hypertension is associated with a lower frequency of gastrointestinal bleeding. METHODS: Patients with cirrhosis and endoscopic findings related to portal hypertension, receiving or not receiving proton pump inhibitor (PPI) therapy, were included retrospectively. We assigned patients to two groups: group 1 patients underwent PPI therapy and group 2 patients did not undergo PPI therapy. RESULTS: One hundred and five patients with a me dian age of 58 (26-87) years were included, 57 (54.3%) of which were women. Esophageal varices were found in 82 (78%) patients, portal hypertensive gastropathy in 72 (68.6%) patients, and gastric varices in 15 (14.3%) patients. PPI therapy was used in 45.5% of patients (n = 48). Seventeen (16.1%) patients presented with upper gastrointestinal bleeding; in 14/17 (82.3%) patients, bleeding was secondary to esophageal varices, and in 3/17 patients bleeding was attributed to portal hypertensive gastropathy. Bleeding related to portal hypertension according to PPI therapy occurred in 18.7% (n = 9) of group 1 and in 14% (n = 8) of group 2 (odds ratio: 0.83, 95% confidence interval: 0.5-1.3, P = 0.51). CONCLUSION: Portal hypertension bleeding is not associated with PPI use. These findings do not support the prescription of PPIs in patients with chronic liver disease with no currently accepted indication.

Ampulla of Vater's tumors (AVT) are rare and account for 0.2% of neoplasia in necropsies. The stage, comorbidities and surgical experience are crucial for prognosis. The aim of this work is to report the clinical characteristics, treatment and complication of a group of patients with AVT.Patients with AVT were included in a retrospective manner. Descriptive statistics was used and data were shown as means and SD.One hundred and six patients were included with a mean age of 58.5 +/- 14 years and 58% were women. Jaundice was the most common clinical data and it was present in 90% of cases. Two-thirds of patients underwent a Whipple surgical procedure. Complications of surgery were present in 35% of cases and abdominal sepsis and pancreatic fistulae were the most common (32% and 29%, respectively). Adenocarcinoma was the most common histological type and 39% of cases were in stage IV at diagnosis. Age higher or equal to 65 years was associated with less surgical possibilities. Melena at presentation was associated with a higher probability of surgical resection.The probability of surgical resection is lower in patients older than 65 years and higher in those with melena at the diagnosis.

Aim To analyze the mortality risk factors in cirrhotic patients with bacterial meningitis (BM). Background Cirrhotic patients are susceptible to infections. Despite its high mortality rate, BM has not been extensively studied in this group of patients. Study BM patients diagnosed with cirrhosis, between 1987 and 2008, were studied. BM was defined as the presence of signs or symptoms of meningitis and a cerebrospinal fluid (CSF) leukocyte count >100/mm3 or the presence of bacteria in CSF. Results We identified 4955 infections among 7591 cirrhotic patients; 12 (0.2%) had BM. The mean age at diagnosis was 60±16 years. Abnormal mental status (83%), fever (67%), and neck stiffness (67%) were the most frequent clinical presentations. The sensitivity of CSF culture was 75% (Streptococcus pneumoniae, 2; Staphylococcus aureus, 2; Listeria monocytogenes, 1; Group B Streptococcus, 1; Streptococcus agalactiae, 1; Streptococcus bovis, 1; and Escherichia coli, 1), and its correlation with blood culture was 78%. Five patients died. On admission, the serum creatinine level was 1.63±0.93 mg/dL. A serum creatinine level ≥1.3 mg/dL was associated with increased mortality (P=0.028). The model for end-stage liver disease score, gastrointestinal bleeding, bilirubin level >3.5 mg/dL, hepatic encephalopathy, diabetes mellitus, and results of cytology and biochemistry tests of CSF were not associated with mortality. Conclusions BM in cirrhotic patients is associated with a high mortality rate. The clinical and microbiologic features of BM in cirrhotic patients differ from those in the general population. A serum creatinine level ≥1.3 mg/dL on admission is associated with a higher risk of mortality.

Background Nonalcoholic fatty liver disease (NAFLD) is increasingly recognised as a condition associated with overweight or obesity that may progress to end-stage liver disease. NAFLD histology resembles alcohol-induced liver injury, but occurs in patients with no history of alcohol abuse. NAFLD has a broad spectrum of clinical and histological manifestations, ranging from simple fatty liver to hepatic steatosis with inflammation, advanced fibrosis, and cirrhosis. The inflammatory stage is known as non-alcoholic steatohepatitis (NASH). Recent reports indicate that weight loss induced by bariatric procedures could be beneficial for NASH treatment. Objectives To assess the benefits and harms of bariatric surgery for NASH in obese patients. Search methods We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded to October 2009. Selection criteria All randomised clinical trials evaluating any bariatric procedure versus no intervention, placebo (sham procedure), or other interventions in patients with NASH regardless of publication status, number of patients randomised, language, or blinding. Quasi-randomised clinical studies were to be considered for the review if no randomised clinical trials were identified. If included, their bias towards positive findings was to be considered. Data collection and analysis We extracted data in duplicate, and we planned to analyse the data by intention-to-treat. Main results We could not find any randomised clinical trials or quasi-randomised clinical studies that fulfilled the inclusion criteria. Our search resulted in twenty-one prospective or retrospective cohort studies, in which improvement on steatosis or inflammation scores was reported. However, four studies also described some deterioration in the degree of fibrosis. Authors' conclusions The lack of randomised clinical trials and quasi-randomised clinical studies precludes us to assess the benefits and harms of bariatric surgery as a therapeutic approach for patients with NASH. Limitations of all other studies with inferior design did not allow us to draw any unbiased conclusion on bariatric surgery for treatment of NASH.

Background The cannabinoid-1 receptor blockers have been proposed in the management of obesity and obesity-related liver diseases (fatty liver as NAFLD or NASH). Due to increasing number of patients to be potentially treated and the need to assess the advantage of this treatment in terms of risk/benefit, we analyze the side events reported during the treatment with rimonabant by a systematic review and meta-analysis of all randomized controlled studies. Methods All published randomized controlled trials using rimonabant versus placebo in adult subjects were retrieved. Relative risks (RR) with 95% confidence interval for relevant adverse events and number needed to harm was calculated. Results Nine trials (n = 9635) were considered. Rimonabant 20 mg was associated with an increased risk of adverse event (RR 1.35; 95%CI 1.17-1.56), increased discontinuation rate (RR 1.79; 95%CI 1.35-2.38), psychiatric (RR 2.35; 95%CI 1.66-3.34), and nervous system adverse events (RR 2.35; 95%CI 1.49-3.70). The number needed to harm for psychiatric adverse events is 30. Conclusion Rimonabant is associated with an increased risk of adverse events. Despite of an increasing interest for its use on fatty liver, the security profile and efficacy it is needs to be carefully assessed before its recommendation. At present the use of rimonabant on fatty liver cannot be recommended.

Chronic liver disease has a high mortality among the Mexican population. However epidemiological data on hepatitis B (HBV) and hepatitis C (HCV) infection in the southeast areas of the country is limited. Our objective was to report the prevalence of blood markers of HBV and HCV among blood donors from the capital city of Veracruz, Mexico.Between January and December 2005 we analyzed the results of the screening tests used to detect serological markers of HBV and HCV infection (HBsAg and anti-HCV). We included demographic data of blood donors from the State Center for Blood Transfusion of the capital city of Veracruz.We reviewed 8,650 blood donor reports and found a prevalence of 0.057% and 1.1% for AgsHB and anti-HCV respectively. Only 2.97% of all individuals with a positive test had been previously screened for hepatic viruses.Results from our study indicate that the central and southeast regions of the state of Veracruz have a high anti-HCV prevalence among blood donors when compared with results from other states in Mexico. Further studies should evaluate risk factors in regions with high HCV seropositivity.

Background Spontaneous bacterial peritonitis is a complication of cirrhotic ascites that occurs in the absence of any intra-abdominal, surgically treatable source of infection. Antibiotic therapy is indicated and should be initiated as soon as possible to avoid severe complications that may lead to death. It has been proposed that empirical treatment should cover gram-negative enteric bacteria and gram-positive cocci, responsible for up to 90% of spontaneous bacterial peritonitis cases. Objectives This review aims to evaluate the beneficial and harmful effects of different types and modes of antibiotic therapy in the treatment of spontaneous bacterial peritonitis in cirrhotic patients. Search methods We performed electronic searches in The Cochrane Hepato-Biliary Group Controlled Trials Register (July 2008), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 3, 2008), MEDLINE (1950 to July 2008), EMBASE (1980 to July 2008), and Science Citation Index EXPANDED (1945 to July 2008). In addition, we handsearched the references of all identified studies and contacted the first author of each included trial. Selection criteria Randomised studies comparing different types of antibiotics for spontaneous bacterial peritonitis in cirrhotic patients. Data collection and analysis Data were independently extracted from the trials by at least two authors. Peto odds ratios or average differences, with their 95% confidence intervals, were estimated. Main results This systematic review attempted to summarise evidence from randomised clinical trials on the treatment of spontaneous bacterial peritonitis. Thirteen studies were included; each one of them compared different antibiotics in their experimental and control groups. No meta-analyses could be performed, though data on the main outcomes were collected and analysed separately for each included trial. Currently, the evidence showing that lower dosage or short-term treatment with third generation cephalosporins is as effective as higher dosage or long-term treatment is weak. Oral quinolones could be considered an option for those with less severe manifestations of the disease. Authors' conclusions This review provides no clear evidence for the treatment of cirrhotic patients with spontaneous bacterial peritonitis. In practice, third generation cephalosporins have already been established as the standard treatment of spontaneous bacterial peritonitis, and it is clear, that empirical antibiotic therapy should be provided in any case. However, until large, well-conducted trials provide more information, practice will remain based on impression, not evidence.

Background Metronidazole is the standard of care for uncomplicated amoebic liver abscesses (considering that complicated liver abscesses are those localized in left lobe, multiple, and/or pyogenic abscesses). However, a subset of patients with amoebic liver abscesses remain symptomatic, with a significant risk of rupture of the abscess into the peritoneum. The role of image-guided percutaneous therapeutic aspiration in these patients remains controversial. Objectives To assess the beneficial and harmful effects of image-guided percutaneous procedure plus metronidazole versus metronidazole alone in patients with uncomplicated amoebic liver abscess. Search strategy We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library (Issue 2, 2007), MEDLINE (1966 to November 2007), EMBASE (1988 to September 2007), and Science Citation Index Expanded (1945 to September 2007). Selection criteria Randomised or quasi-randomised trials comparing an image-guided percutaneous procedure plus metronidazole versus metronidazole alone in patients with uncomplicated amoebic liver abscess. Data collection and analysis Inclusion criteria, trial quality assessment, and data extraction were done in duplicate. We calculated relative risks (RR) and mean differences, and checked for heterogeneity by visual inspection of forest plots and chi-squared and I(2) tests. Main results Seven low quality randomised trials were included. All studies included a total of 310 patients, but due to selective outcome reporting bias, less patients could be included in our analyses. Pooled analysis of three homogenous trials showed that needle aspiration did not significantly increase the proportion of patients with fever resolution (RR 0.60, 95% confidence interval (CI) 0.22 to 1.61). Sensitivity analysis according to trial quality preserved these findings. Trials that evaluated resolution of abdominal pain, days to resolution of fever, pain, resolution of abscess cavities, reduction in liver size, and duration of hospitalisation were heterogeneous. The benefits in the number of days to resolution of pain (MD -1.59, 95%CI -2.73 to -0.42), number of days to resolution of abdominal tenderness (MD -1.70, 95%CI -2.86 to -0.54), and duration of hospitalisation (MD -1.31, 95%CI -2.05 to -0.57) were observed in the needle aspiration group only. Authors' conclusions Therapeutic aspiration in addition to metronidazole to hasten clinical or radiologic resolution of uncomplicated amoebic liver abscesses cannot be supported or refuted by the present evidence. The trials lack methodological rigour and adequate sample size to conclude on the presence of effectiveness of adjunctive image-guided aspiration plus metronidazole versus metronidazole alone. Further randomised trials are necessary.

The aim was to evaluate the initial success, rebleeding rate, need for emergent surgery, and mortality rates of patients with Dieulafoy's lesion (DL) and endoscopic treatment (ET). Patients with DL from a tertiary center were included. We included 20 patients with follow-up of 90 (60-550) days. The lesser curvature was the most common localization. Initial success, rebleeding, and emergent surgery requirement were observed in 90%, 10%, and 15%, respectively. No objective variables were related with response to ET. In conclusion, ET is secure and useful in patients with DL and it must be considered as the first-line treatment modality.

AIM: To evaluate the prevalence of metabolic syndrome (MS), obesity and type 2 diabetes mellitus (T2DM) in a group of Mexican Mestizo patients with cryptogenic cirrhosis (CC) and to compare this group with patients with cirrhosis secondary to other causes (disease controls). METHODS: Patients with CC, diagnosed between January, 1990 and April, 2005, were included in a retrospective study. Patients with cirrhosis caused by chronic hepatitis C, alcohol abuse or autoimmune hepatitis (AIH) served as disease controls. RESULTS: A total of 134 patients with CC were analyzed. Disease controls consisted of 81 patients with chronic hepatitis C, 33 with alcohol abuse and 20 with AIH. The median age of patients with CC was 57 years (range, 16-87); 83 (61.9%) patients were female; 53 (39.6%) were Child A, 65 (48.5%) Child B, and 16 (11.9%) were Child C cirrhosis. The prevalence of MS (29.1% vs 6%; P < 0.001), obesity (16.4% vs 8.2%; P = 0.04) and T2DM (40% vs 22.4%; P = 0.013) was higher in CC patients than in disease controls. There were no differences in sex, age or liver function tests between the two groups. CONCLUSION: The prevalence of MS, obesity and T2DM were higher in patients with CC than in patients with cirrhosis secondary to others causes. Our findings support the hypothesis that non-alcoholic steatohepatitis (NASH) plays an under-recognized role in CC.

Endoscopic treatment of peptic ulcers with high-risk stigmata has been probed. The rates of recurrent bleeding, need for emergent surgery and death are related to Forrest Classification, Blatchford's modified risk score and the kind of endoscopic treatment used (monotherapy vs. dual). The aims of the present study were to report the success of endoscopic therapy in the reduction of the rate of initial success, recurrent bleeding, the need for surgery, and the mortality rate for patients with bleeding peptic ulcer and high-risk stigmata.From a retrospective view, patients seen from September 2004 to March 2007 who had peptic ulcers Forrest Ia, Ib, IIa and/or IIb were included.Fifty-six patients were included (mean [SD] age 57.3 +/-16.6 years). The success rate was 91%, whilst the rest of the patients required immediate surgery. Recurrent bleeding was presented in 14 (27%) patients and eight (14.2%) required emergency surgery. The mortality rate was 3.6%. No factors were associated with the risk of failure to initial treatment, recurrent bleeding or need for surgery. The use of monotherapy by endoscopy was associated with the mortality. The variable "performed by a fellow alone" was not associated with any kind of outcome.Complication rate is similar to previous reports of general hospitals, but is higher than those of referral centers. Endoscopic monotherapy is associated with a major mortality risk.

There is much clinical evidence of a relationship between infectious disease and chronic liver disease. The consequences of this adverse association have been described and advances in the treatment and prophylaxis of infectious disease have had an important effect on the management of patients with chronic liver disease. The association between infectious disease and chronic liver disease involves altered cytokine production, cellular immunity, and vascular response. However, there is little information on the mechanisms underlying these phenomena. In this report, we review the mechanistic basis of this common association.

The prevalence of non-alcoholic steatohepatitis has increased in the last years, paralleling the increasing incidence of overweight and obesity in the general population and related comorbidities. It is expected that in near future, non-alcoholic steatohepatitis will be responsible for a large number of subjects with chronic liver disease due to fatty liver Because of this, treatment options for fatty liver are necessary. To date, the cornerstone of treatment is based in weight reduction, with diet and increased physical activity, although reports indicating that insulin sensitizers and medications that reduce oxidative stress may hold promise for the treatment of this condition. This article reviews the most important aspects of treatment of non-alcoholic steatohepatitis.

Non Alcoholic Fatty Liver Disease (NAFLD) is a frequent entity to progress to liver fibrosis and cirrhosis, and it is associated with several metabolic disturbances. The insulin resistance is often considered the link between metabolic disturbances and NAFLD. The aim of this study was to determine the prevalence of NAFLD in healthy population and the prevalence of metabolic syndrome in this patients. The associated factors to develop liver cirrhosis were identified.2,503 records were reviewed and the presence of steatosis was determined by ultrasonography. A clinical and biochemical examination was carried out and the metabolic criteria were defined according to the ATP III.427 (17.05%) patients with NAFLD were detected. 359 (14.3%) with NAFLD were included, the mean age was 46.26 +/- 9.85 years. Overweight was present in 46.79% and obesity in 36.49% of patients. The association between DM, HAS, high levels of cholesterol and triglicerides was found in 3.6, 13.6, 63 and 43%, respectively. Steatohepatitis was found in in 34% of patients high levels of AST. AST/ALT ratio1 was detected in 76 patients (21.16%). According to the ATP III criteria, the prevalence of metabolic syndrome in patients with NAFLD was 22.8%.The frequency of NAFLD and metabolic syndrome in this study was 14.3% and 22.8%, respectively. Overweight, obesity and dyslipidemia were the main associated factors to NAFLD.

Until recently the study of small bowel was limited to the radiographic approach. This paper describes experience with the first 86 procedures evaluated and treated with the new technique of double-balloon enteroscopy (DBE). Between August 2005 and September 2006, DBE was conducted in consecutive patients. The characteristics of the patients, indications for the procedures, procedural parameters, and diagnostic yield are described here. All conventional treatment options were available. All the patients had previously undergone esophagogastroduodenoscopy and colonoscopy. Eighty-six procedures in sixty-eight patients were carried out (41 women, 27 men; mean age 48.5 years, range 20–82). The most common indications were gastrointestinal bleeding (n = 40) and iron deficiency anemia (n = 7). The mean duration of the procedure was 63 (range 20–194) mins and 80 (range 20–150) minutes for the oral and anal routes, respectively. The mean depth of small-bowel insertion was 250 and 200 cm for the oral and anal routes, respectively. Impact in diagnosis and/or treatment was obtained in 50 patients (73.5%). The commonest findings in the 68 patients were angiodysplasia (n = 11), polyps (n = 8), nodular lymphoid hyperplasia (n = 5) and normal (n = 20). No major complications were observed. DBE is a useful tool for the diagnosis and treatment of patients with small-bowel pathology in whom traditional methods have not been effective. In almost two-thirds of patients DBE was clinically useful for diagnosis and treatment. The complication rate with the procedure was very low.

The aim of this study was to investigate adiponectin, leptin, and metabolic syndrome as predictors of the severity of obesity-related steatosis. By ultrasonography steatosis-positive (cases) subjects (n=141) were compared with controls (n=111). Demographic and anthropometric data and serum concentrations of adiponectin, leptin, and insulin were measured. The impact of several criteria of metabolic syndrome, serum adiponectin concentrations, and serum leptin concentrations were tested using a multivariate logistic regression analysis. The frequency of metabolic syndrome was higher in cases (44.0% versus 9.2%; P

The increasing prevalence of obesity is not only observed in adults. Children are affected by obesity and related diseases, such as chronic liver disease, more frequently than in the past. Nonalcoholic fatty-liver disease is an important cause of chronic liver disease and in the near future will become important worldwide. Considering this phenomenon, it is important for gastroenterologists and hepatologists to be aware of the presence of nonalcoholic fatty-liver disease in pediatric populations and to treat it adequately. This practice will have important benefits for future generations. This review discusses the most important aspects in epidemiology, diagnostics and treatment of nonalcoholic fatty-liver disease in children.

Colorectal cancer is an important neoplasm in general population, about 90% of the cases are sporadical, but near of 5% are due to hereditary non polyposis colorectal cancer. Early detection is imperative due to genetic linkage and association to other neoplasms diagnosed an early age. This case report is about a young man diagnosed with colorectal cancer that presented multiple recurrences and had at least two affected generations. The most important aspects of diagnosis, management and genetic counseling are discussed.

Objective: Investigate the association between polymorphisms in the leptin receptor gene associated with obesity and gallstone disease. Design: We conducted a cross-sectional study, carried out at a tertiary setting. Subjects: We enrolled 97 subjects, comprising 54 subjects with gallstones (cases) and 43 controls (without gallstones). Measurements: Diet was assessed using a validated questionnaire for the Mexican population. Body mass index, waist circumference, serum glucose, insulin, leptin, lipids and lipoproteins levels were measured. Insulin resistance was calculated by HOMA-IR. Genomic DNA was isolated from lymphoblastoid cells, and Q223R and K656N polymorphisms in the leptin receptor gene were typed using polymerase chain reaction. Unconditional univariate logistic regression analysis was conducted to estimate the probability of gallstone disease associated with the polymorphisms as main effect. Results: Cases were different in gender (40.74% males in cases vs 74.41% in controls; p < 0.001), older (49.74 vs 44.83 years; p < 0.05), and had more body fat (32.34% vs 28.14%; p = 0.01). Individuals carrying the polymorphism Q223R exhibited a higher BMI (28.44 ± 6.6 kg/m2 vs 25.94 ± 3.67 kg/m2, p < 0.05) and waist circumference (96.7 ± 16.39 cm vs 89.2 ± 11.05 cm, p < 0.05). In univariate analysis, we did not observe a relation between the presence of a R223 or N656 genotype and gallstone disease in our population (OR = 0.78, 95% CI 0.35-1.73). Conclusion: Obesity-related leptin receptor polymorphisms are not associated with gallstones disease.

Background There is a high prevalence of gallstone disease in Western countries as a consequence of genetic, biochemical, and environmental factors. Animal and clinical studies have explored the importance of dietary elements. Overwhelming but conflicting information has been reported about the relationship between specific dietary components and gallstone disease. Although the detailed biochemical pathways have been described in experimental models, human studies are mainly epidemiological. Methods We performed a Medline search with the terms “diet”, “gallstones”, “cholesterol”, “risk factors”, including results from 1965 to 2006 and the author's personal library to review the relationship between dietary factors and cholesterol gallstone disease. Results We identified over 150 references and present their results with respect to the author's criteria. Conclusions The best delineated relationship between cholesterol gallstones and diet was found in the studies that analyzed total calorie intake, refined sugars and fiber. The possible mechanisms are discussed in base of experimental studies.

Obesity is currently considered one of the most important diseases worldwide due to its high morbidity and mortality rates. The mechanisms involved in the control of satiation, body weight and energy expenditure has led to the discovery of new hormones that participate in the gastrichypothalamic axis in charge of regulating satiation and other obesity-related processes. Ghrelin a novel hormone secreted mainly by gastric tissue, has shed some light on this mechanism. It is a hormone that regulates satiation and body weight by centrally mediated mechanisms, involving neuropeptide Y and Agouti associated proteins. The present review focuses on some important physiological aspects of this hormone.

Obesity increases significantly the risk of developing several common gastrointestinal diseases such as gallstone disease (GD) and hepatic steatosis (HS). Elsewhere we have shown a relationship between HDL cholesterol, cholesterol saturation index, and leptin in obese patients loosing weight. Furthermore, leptin plays an important role facilitating HS and possibly in the associated inflammatory process. The aim of this study was to investigate the relationship between GD and HS. The sample was comprised by patients attending the unit for check-up. Subjects with visible stones or HS by ultrasound (cases) were compared with healthy controls. Demographic and body mass index (BMI) were recorded. Plasma leptin, insulin and serum lipids and lipoproteins levels were measured by standard methods. A total of 317 subjects were included in this study. They were divided in four groups as follows: GD (n=100), HS (n=84), GD + HS (n=33) and controls (n=100). The control group was significantly older (GD, 52.6+/-11.6; HS, 49.8+/-11.1; GD +HS, 51.6+/-10.5; 57.1+/-7.4), p0.05. BMI was higher in the HS groups (28.7 +/- 2.8) and GD +EH (29.0 +/- 3.8) than in the GD (27.4 +/- 4.3) and control (27.0 +/- 3.1) group, p0.05. The GD group displayed the highest leptin levels (13.7 241 8.1), P0.05, whereas insulin levels were similar in all groups. Since GD and HS subjects have high plasma leptin levels compared with controls, our results suggest that leptin plays an important role in the pathophysiology of GD and HS.

AIM: To establish an association between the serum leptin levels and the development of gallstone disease (GD). METHODS: We carried out a non-matched case-controlled study in a university hospital in Mexico City. Two hundred and eighty-seven subjects were included: 97 cases with gallstones and 190 controls. Body mass index (BMI), fasting plasma leptin, insulin, serum lipid, and lipoprotein levels were measured. Insulin resistance was calculated by homeostasis model assessment (HOMA-IR). Unconditional logistic regression analysis (univariate and multivariate) stratified by BMI was used to calculate the risk of GD. RESULTS: The multivariate conditional regression analysis revealed a model for those patients with BMI

Over three decades of research in experimental animals and several clinical trials have brought us to the threshold of hepatocyte transplantation for the treatment of acute and chronic liver disease, and inherited metabolic disorders. However, more extensive clinical studies and routine clinical application are hampered by the shortage of good quality of donor cells. To overcome these hurdles, current research has focused on the search for alternatives, such as liver progenitors, fetal hepatoblasts, embryonic, bone marrow or umbilical cord blood stem cells and conditionally immortalized hepatocytes. Cross-species hepatocyte transplantation is also being explored. It is hoped that ongoing research will permit the application of hepatocyte transplantation to the treatment of a wide array of liver diseases.

Little information exists in the international scientific or medical literature about the hepatic manifestations and complications of Epstein-Barr virus (EBV). The aim of this study was to describe a series of patients with hepatic manifestations of EBV infection. Our sample population was a series of patients whose hepatic dysfunction was correlated with a documented EBV infection. Serum concentrations of IgG and IgM antibodies against the EBV viral capsid antigen (anti-EBV VCA IgG), EBV early antigen, and EBV nuclear antigen (EBV-EBNA), and heterophilic antibodies were determined. The expression of latent membrane protein (LMP 1) was also evaluated in each patient. RESULTS. The study included nine patients (six men, three women) with a mean age of 43.5 years. Five patients presented with recent clinical pictures suggestive of acute EBV infection. Five patients began with a cholestatic pattern. Two patients required liver biopsies. Those liver biopsies showed positive immunohistochemical staining for LPM 1. No fatalities were attributed to EBV infection. In conclusion, the bilirubin levels of patients with acute EBV infection differed from those reported in the medical literature. EBV infection should be considered in the differential diagnosis of patients with liver abnormalities or diverse hepatic manifestations, increased levels of aminotransferases, or a transitory cholestatic pattern with a favorable outcome.

Gallstone disease is exceptionally common, occurring especially in Western populations, with cholesterol gallstones predominating. Currently, it is believed that obesity is the most consistent and important risk factor for the development of cholesterol gallstones. Obesity has been shown to be associated with the supersaturation of bile with cholesterol because of increased hepatic secretion of the sterol. In accord with current information from experimental studies, leptin appears to be involved in biliary cholesterol secretion and cholesterol gallstone formation in humans. This review summarizes the current information on the role of obesity in biliary lipid secretion as well as the effect of leptin and its potential consequences for gallstone formation and therapy in the obese.

AIM: Obesity and insulin resistance (IR) are closely related to hepatic steatosis (HS), and adiponectin is a hepatic insulin sensitizer that has important effects in liver function. This study aims at investigating the relationship between serum adiponectin concentration and the presence of HS. METHODS: We carried out a cross-sectional study in a check-up unit of a University Hospital in Mexico City. We enrolled 196 subjects, comprising 98 subjects with HS (27 women, 71 men) and 98 controls (37 women and 61 men). Anthropometric, metabolic and biochemical variables were measured in the two groups. Serum adiponectin and leptin concentrations were determined, their association with grade of HS tested, and concentrations, according to quartiles, compared between cases and controls. χ2 analysis for linear trends was used to test for a dose-response relationship and logistic regression analysis was conducted to test for a protective effect of adiponectin. RESULTS: The HS subjects were older and more obese than controls, with a central obesity pattern. In the fourth quartile of adiponectin concentrations, HS was less common and severe. In a multivariate model of the fourth quartile of the adiponectin concentrations, we observed a protective effect (OR = 0.17, 95%CI: 0.04-0.67, P = 0.01). In subjects with more severe HS, we observed higher leptin concentrations, and caloric intakes, total fat and iron consumption were higher than in controls. CONCLUSION: The results of the present study suggest that a high serum concentration of adiponectin is associated with a protective effect against HS.

Gallbladder disease is a very common diagnosis and implies great economic cost. Gallbladder disease is a multifactorial process involved with host and environmental factors. Obesity is considered one of the most important risk factor associated with gallstone disease and is very important mainly due its increased prevalence worldwide. Several changes in cholesterol metabolism tend to increase gallbladder cholesterol secretion in conjunction with motility disturbances, which aids in gallstone growth. In this work, epidemiologic and pathophysiologic factors related with obesity and gallstone disease are discussed.

Obesity is the most important risk factor associated with non-alcoholic steatohepatitis, which is caused by to impaired insulin activity, overflow of portal triglycerides, and production of inflammatory cytokines; all of these are deleterious to hepatocytes. These phenomena facilitate disruptions in hepatic physiology, as observed in alcoholic hepatitis; however, consumption of this substance is absent. Non-alcoholic steatohepatitis has had a great impact due to the fact that previously, main cases of cryptogenic cirrhosis actually were attributed to this disease. Despite advances in understanding the pathophysiologic process of the disease, there is no better treatment than weight reduction (a combination of diet and exercise). In this issue, we describe the most important topics with regard to non-alcoholic steatohepatitis and the obesity-related process.

We determined the prevalence of hepatitis C virus (HCV) in hemodialysis patients by antibody testing and HCV RNA determination by PCR. A total of 149 patients with kidney failure with replacement therapy were tested. The prevalence of anti-HCV was 6.7% (10 of 149 patients), and viremia was detectable in 8 of 149 (5%) patients. Three of 149 patients (2%) were anti-HCV negative with detectable HCV RNA.

Non alcoholic fatty liver disease is a disease of emerging identity and importance. It is frequently associated with obesity, especially visceral fat, and is intimately related to fatty liver and markers of insulin resistance. Both the prevalence and the severity of liver steatosis are related to body mass index, waist circumference, hyperinsulinaemia, hypertriglyceridaemia and impaired glucose tolerance or type 2 diabetes. The identification fatty liver disease in obese patients, is very important in order to prevent complications such as steathohepatitis and cirrhosis. The pathogenesis of non alcoholic fatty liver disease is very complex, there are mitochondrial morphologic and functional alterations, as well as, high sensitivity to injurious stimulus, an increased inflammatory activity, and modifications in cellular metabolism at post-receptor level. Weight reduction is one of the first steps in the treatment of patients with non alcoholic fatty liver disease, as well as the management of associated conditions such as obesity, diabetes mellitus and hyperlipidaemia. Antioxidants, and others drugs such as ursodeoxycholic acid may be beneficial in the treatment of non alcoholic fatty liver disease. These medications, however, need first to be tested in well-controlled trials with clinically relevant end-points and extended follow-up. In this review, we analyze the new concepts in epidemiology, pathophysiology and treatment of this disease.

Gallstone disease is exceptionally common, occurring especially in Western populations, with cholesterol gallstones predominating. Currently, it is believed that one of the essential factors in the pathogenesis of cholesterol gallstones is a physical-chemical event that results primarily from alterations in the lipid composition of gallbladder bile. Cholesterol supersaturation is due principally to excessive secretion of cholesterol into the bile. Several biochemical defects, as well as diet, might cause hypersecretion of cholesterol. The precise effects of diet on cholesterol supersaturation of bile have not been clearly established, although epidemiological, clinical, and animal studies indicate that diet plays an important role in cholesterol gallstone formation. This review summarizes current information on the role of dietary fat in the modulation of cholesterol gallstone formation.

Original abstract Background & Aims. Several outbreaks of hepatitis A affecting homosexual men have been reported in Europe. However, the prevalence of HIV infection in patients affected by hepatitis A has not been extensively studied and hepatitis A is not considered as an indicator disease for routine HIV testing. Methods. We retrospectively analyzed all adult cases of acute hepatitis A, reported by the National Institute of Infectious Disease “L. Spallanzani”, Rome-Italy, in 2002-2008. Data on HIV infection were obtained by chart review and cross-linkage with laboratory. Information on exposure to risk factors were collected from the standard questionnaire of the Local Health Unit. Results. We analyzed a total of 473 cases of hepatitis A, 368 (77.2%) males that accounted for 75% of all reported cases in Rome, aged 25-64 years (same gender distribution). During the study period, we diagnosed a high proportion of cases among male individuals (78%). Among the male patients, HIV serology was available for 203/368 (55.2%). The overall HIV prevalence was 15.2% (56/368); it was significantly associated with same gender sex and was significantly higher than that observed among patients with hepatitis B (4.0%). Conclusions. We found a high HIV prevalence, associated with same gender sex, among adult male patients diagnosed with hepatitis A in the period 2002-2008, except for 2006. Our data suggest that in a low incidence area for hepatitis A, with a constant high proportion of cases among male individuals, all individuals with acute hepatitis A should be routinely offered an HIV test.

Gastrointestinal bleeding can be a life-treating event that is managed with standard endoscopic therapy in the majority of cases. However, up to 5%-10% of patients may have persistent bleeding that does not respond to conventional measures. Several endoscopic treatment techniques have been proposed as strategies to control such cases, such as epinephrine injection, hemoclips or argon plasma coagulation, but there are certain clinical scenarios where it is difficult to achieve hemostasis even though adequate use of the available resources is made. Reasons for these failures can be associated with the lesion features, such as extent or location. The use of long-standing techniques in non-traditional scenarios, such as with cyanoacrylate for gastric varices sclerosis, has been reported with favorable results. Although new products such as TC-325 or Ankaferd Blood Stopper hemosprays may be useful, their formulations are not available worldwide. Here we present two clinical cases with very different scenarios of gastrointestinal bleeding, where the use of cyanoacrylate in spray had favorable results in uncommon indications. Cyanoacrylate used as a spray is a technique that can be used as an alternative method in emergent settings.

SIRS, We read with great interest the study of Cheng et al. In this compelling paper, the authors prospectively evaluated the modified Glasgow Blatchford Score (mGBS) to predict the need for clinical intervention: blood transfusion, endoscopic, radiological or surgical intervention and as secondaries outcomes, rebleeding or mortality rates. The Glasgow Blatchford Score (GBS) is a very useful tool in patients with upper gastrointestinal bleeding (UGIB) regarding to the prediction of the need for treatment to upper gastrointestinal haemorrhage and with some modifications has been proven that could be used to obviate urgent endoscopy in selected patients with nonvariceal upper gastrointestinal tract bleeding. In the present paper, the authors eliminated subjective variables from GBS to make it easier to use and therefore more easily implement into routine clinical practice. In a paper from our group, we made modifications to reach a simplified Glasgow Blatchford Score (sGBS), which is easy to remember and very easy to use in clinical practice (Table 1). Our primary outcome was prediction of rebleeding in patients with high-risk stigmata ulcers. The utility of this sGBS was very good and it offers some advantages over other scores: (i) it is easier to obtain; (ii) easier to use; and (iii) easier to remember. In that paper, we described a clear cut-off point for interpretation of the score. In the present study, we cannot find how to interpret a ‘high’ or ‘low’ risk score in a patient, in other words, how many points in the mGBS a particular patient needs for us to think that a clinical intervention is needed. We consider that the paper of Cheng et al. is a very useful study and adds new evidence that the current scoring systems for UGIB could be improved and that more prospective studies in this interesting topic are necessary.