Aim. Our aim was to investigate the association among elastographic parameters of liver steatosis and fibrosis, controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), with ...gastroesophageal reflux disease (GERD). Methods. In this prospective, cross-sectional study, we have evaluated 937 patients with one or more components of the metabolic syndrome who had an esophagogastroduodenoscopy (EGD) due to GERD symptoms. In all patients, a laboratory analysis, an abdominal ultrasound, and FibroScan measurements were done. GERD was defined by EGD. Results. The mean body mass index (BMI) of the study population was 30.95 ± 5.45 kg/m2. The prevalence of increased CAP was 82.6% (774/937). Patients with increased CAP were younger, were more obese, had higher prevalence of hypertension, diabetes, and dyslipidemia, and had higher values of aminotransferases. Similar results of higher prevalence in patients with elevated CAP were observed with GERD, hiatal hernia, and insufficient cardia (defined as deficient or absent closure of the gastric inlet in relation to the esophagus). Additionally, patients with elevated CAP had a higher prevalence of GERD grades B and C in comparison to those without elevated CAP. Consequently, patients who did not have elevated CAP had a higher prevalence of GERD grade A. Even though we have found an upward trend in the prevalence of GERD, hiatal hernia, and insufficient cardia, there was no significant difference between subjects with fibrosis (F) 1-2 and F3-4 stage of fibrosis or F1 and F2-4. In a binary logistic regression, a significant positive association with GERD was obtained for CAP. Furthermore, a significant positive association with hiatal hernia was obtained for BMI and CAP. Finally, a significant positive association with hiatal hernia was obtained with CAP in multivariate analysis. Conclusion. To the best of our knowledge, our study is the first to reveal a positive association between CAP as a surrogate marker of liver steatosis and GERD after adjustments for other clinical variables.
Background
We aimed to determine if there was a higher incidence of small intestinal bacterial overgrowth (SIBO) in non‐alcoholic fatty liver disease (NAFLD) than in patients without NAFLD. Moreover, ...we assessed whether patients with significant fibrosis (SF) had a higher incidence of SIBO compared with patients with non‐significant or no liver fibrosis.
Methods
NAFLD was diagnosed in 117 patients by using Fibroscan with a controlled attenuation parameter (CAP) as well as liver biopsy (LB). SIBO was defined by esophagogastroduodenoscopy with an aspiration of the descending duodenum.
Results
Patients with non‐alcoholic steatohepatitis (NASH) and those with SF on LB had a significantly higher incidence of SIBO than patients without NASH and those without SF, respectively (P < .05). According to histological characteristics, there was a higher proportion of patients in the SIBO group with higher steatosis and fibrosis grade, lobular and portal inflammation, and ballooning grade (P < .001). In multivariate analysis, significant predictors associated with SF and NASH were type 2 diabetes mellitus (T2DM) and SIBO. Moreover, in multivariate analysis, significant predictors that were independently associated with SIBO were T2DM, fibrosis stage and ballooning grade (OR 8.80 (2.07‐37.37), 2.50 (1.16‐5.37) and 27.6 (6.41‐119), respectively). The most commonly isolated were gram‐negative bacteria, predominantly Escherichia coli and Klebsiella pneumoniae.
Conclusion
In this relatively large population of patients, we used a gold standard for both SIBO (quantitative culture of duodenum's descending part aspirate) and NAFLD (LB), and we demonstrated that NASH patients and those with SF had a higher incidence of SIBO. Moreover, significant predictors independently associated with SIBO were T2DM, fibrosis stage and ballooning grade. Although TE is a well‐investigated method for steatosis and fibrosis detection, in our study, independent predictors of SIBO were histological characteristics of NAFLD, while elastographic parameters did not reach statistical significance.
Nonalcoholic fatty liver disease (NAFLD) is a serious condition that can lead to fibrosis, cirrhosis, and hepatocellular carcinoma. NAFLD is associated with metabolic syndrome (MetS) and all of its ...components. According to data, around 25-30% of population has NAFLD. Giving the growing incidence of MetS, obesity and diabetes mellitus type 2, NAFLD related terminal-stage liver disease is becoming prevailing indication for liver transplantation. In order to prevent terminal stage of this disease, it is crucial to determine those that are in risk group, to modify their risk factors and monitor their potential progression. In the absence of other causes of chronic liver disease, the prime diagnosis of NAFLD in daily clinical practice includes anamnesis, laboratory results (increased levels of aminotransferases and gammaglutamil transferases) and imaging methods. The biggest challenge with NAFLD patients is to differentiate simple steatosis from nonalcoholic steatohepatitis, and detection of fibrosis, that is the main driver in NAFLD progression. The gold standard for NAFLD diagnosis still remains the liver biopsy (LB). However, in recent years many noninvasive methods were invented, such as transient elastography (TE). TE (FibroScan®, Echosens, Paris, France) is used for diagnosis of pathological differences of liver stiffness measurement (LSM) and controlled attenuation parameter (CAP). Investigations in the last years have confirmed that elastographic parameters of steatsis (CAP) and fibrosis (LSM) are reliable biomarkers to non-invasively assess liver steatosis and fibrosis respectively in NAFLD patients. A quick, straightforward and non-invasive method for NAFLD screening in patients with MetS components is TE-CAP. Once diagnosed, the next step is to determine the presence of fibrosis by LSM which should point out high risk patients. Those patients should be referred to hepatologists. LB may be avoided in a substantial number of patients if TE with CAP is used for screening.
Aim
our aim was to explore the association between life habits and the controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) as the surrogate markers of liver steatosis and ...fibrosis in a large cohort of non‐alcoholic fatty liver disease (NAFLD) patients.
Methods
In this prospective, cross‐sectional study we had analysed 1998 patients with diagnosed NAFLD. Sleeping duration was categorised in three groups: short (S) (<6 hours), moderate (M) (6‐8 hours) and long (L) (>8 hours) sleep duration. Coffee drinking was categorized into no (0), moderate (1‐2) and frequent (≥3) consumption (in cups/day). Smoking was categorised as yes versus no.
Results
Frequent coffee consumers had the lowest prevalence of obesity, hypertension, dyslipidaemia and diabetes. Furthermore, coffee non‐consumers had highest values of hepatic enzymes, CAP and LSM. Moderate sleep duration was associated with lower values of CAP and LSM. Coffee consumption was associated with lower CAP in all the multivariate models (CAP unadjusted and model 1, 2 and 3), with largest effect in most frequent coffee consumers (≥3, model 3). Also, most frequent coffee consumers were associated with lower LSM in unadjusted model, model 1 and 2, while this was not the case for model 3 and those who consumed 1‐2 cups of coffee per day. Reduced sleeping was confirmed as risk factor for elevated CAP in most of the models (unadjusted and model 1 and 2). Also, negative association of LSM was also confirmed in unadjusted model and model 2. Patients which slept 6‐8 hours per day were mostly associated with lower CAP and LSM. Smoking status was not associated with CAP or LSM values.
Conclusion
Coffee consumption has beneficial effect on CAP and LSM and this effect is dose dependent since and independent of a variety of relevant confounders. We have shown that moderate sleep duration has also beneficial effect on CAP and LSM.
Primarna bilijarna ciroza (PBC), odnosno primarni bilijarni kolangitis, autoimuni je poremećaj koji spada u skupinu kolestatskih bolesti jetre. PBC je kronična upalna bolest jetre koja može dovesti ...do fibroze i ciroze jetre te razvoja hepatocelularnog karcinoma. Razumijevanje biologije PBC-a važno je kako bi se omogućila učinkovita skrb za bolesnike, povećale terapijske mogućnosti i kako bi liječenje bilo ciljano. Liječenje PBC-a je u pravilu doživotno. Cilj doživotne terapije je sprječavanje progresivne bolesti jetre i smanjenje, odnosno uklanjanje simptoma bolesti, koji smanjuju kvalitetu života pacijenata. U svakodnevnoj kliničkoj praksi nužno je kod svih bolesnika s povišenim parametrima kolestaze, osobito ako ona traje duže od 6 mjeseci, razmišljati o PBC-u. U radu je prikazan slučaj bolesnice s PBC-om čija je dijagnoza bila dugotrajna, a terapija zahtjevna.
Hepatocelularni karcinom i nealkoholna masna bolest jetre Stevanović Grahovac, Tajana; Skenderević, Nadija; Delija, Božena ...
Medicus (Zagreb, Croatia : 1992),
01/2020, Letnik:
29, Številka:
1 Hepatologija danas
Journal Article
Recenzirano
Odprti dostop
„Moderan” i „sjedeći” stil života doveli su do globalne epidemije pretilosti i metaboličkoga sindroma (MetS). Jetrena manifestacija MetS-a i pretilosti, odnosno nealkoholna masna bolest jetre (engl. ...non-alcoholic fatty liver disease, NAFLD) danas je najčešća kronična bolest jetre od koje boluje oko četvrtina populacije. NAFLD je klinički sindrom koji obuhvaća nekoliko stanja: jednostavnu steatozu, nealkoholni steatohepatitis, fibrozu i cirozu jetre te hepatocelularni karcinom (HCC). Posljednjih desetak godina bilježi se porast incidencije HCC-a, što se velikim dijelom pripisuje porastu incidencije MetS-a, a time i NAFLD-a. U narednim godinama NAFLD će postati vodeći etiološki čimbenik za razvoj HCC-a, a time i vodeća indikacija za liječenje transplantacijom jetre.
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