Summary
Background
De novo non‐alcoholic fatty liver disease (NAFLD) in liver‐transplanted patients for cirrhosis not due to non‐alcoholic steatohepatitis (NASH) is becoming a growing phenomenon.
...Aims
We performed a systematic review and evaluated the prevalence of this event and possible associated factors.
Methods
A literature search in medical databases (PubMed, MEDLINE/OVIDSP, Science Direct and EMBASE) was performed in March 2017. Relevant publications were identified in most important databases. We estimated the pooled prevalence of NAFLD and NASH in patients with liver transplant. The data have been expressed as proportions/percentages, and 95% confidence intervals (CI) were calculated, using the inverse variance method. Odd ratios (OR) and 95% confidence intervals (95% CI) were estimated.
Results
Twelve studies were selected, enrolling 2166 subjects overall undergoing post‐liver transplant biopsy. The pooled weighted prevalence of de novo NAFLD was 26% (95% CI 20%‐31%). The pooled weighted prevalence of NASH was 2% (95% CI 0%‐3%). The highest prevalences of de novo NAFLD were found for patients transplanted for alcoholic cirrhosis (37%) and cryptogenic cirrhosis (35%) and for patients taking tacrolimus (26%). Tacrolimus showed a risk of NAFLD similar to ciclosporin (OR = 1.02, 95% CI 0.3‐3.51).
Conclusions
Patients undergoing liver transplant are more prone to experience diabetes, hypertension or dyslipidaemia, and NAFLD may be an important element in this context. In this study, we show how the prevalence of NASH tends to remain significant and similar to the general population. Moreover, this study suggests a possible association with specific transplant indications. Further studies are required to confirm these findings.
Summary
Background
International guidelines rate class III (morbid) obesity (body mass index BMI≥40 kg/m2) as a relative contraindication for liver transplantation (LT) requiring further research. ...Moreover, data on the mortality risk in candidates with a BMI: 30‐34.9 and 35‐39.9 kg/m2 (class I and class II obesity, respectively) are weak.
Aim
To compare post‐operative complications and mortality risks in all obese candidates vs candidates with a BMI: 18.5‐29.9 (normal/overweight) assumed as controls.
Methods
We searched the Cochrane library, PubMed, Scopus, Web‐of‐Science and article reference lists, restricted to the English language, and selected cohort studies analysing the following outcomes: all‐causes mortality (at 30 days, 1‐2‐3‐5 years), post‐operative and cardiopulmonary complications, hospital and intensive care unit (ICU) length of stay. Two reviewers independently extracted the studies data and a third one resolved discrepancies.
Results
Twenty‐four studies comprising 132 162 patients met the inclusion criteria. As compared to controls, mortality risk was increased at all time‐periods (except at 3 years) for a BMI≥40, at 30 days for a BMI: 30‐34.9 and in none of the considered time‐periods for a BMI: 35‐39.9. Post‐operative complications were significantly higher for a BMI>30 and 30‐34.9. Due to the shortage/absence of data, we evaluated cardiopulmonary complications, hospital and ICU length of stay only in the BMI≥30 category. In these patients, only cardiopulmonary complications were increased as compared to controls.
Conclusions
Morbid obesity has an impact on patients’ survival after LT. However, since even a BMI>30 increases post‐transplant complications, new strategies should be included in the LT programme to favour weight loss in all obese candidates.
Linked ContentThis article is linked to Townsend and Newsome et al and Barone, Barone et al and Liu et al papers. To view these articles visit https://doi.org/10.1111/apt.14179, https://doi.org/10.1111/apt.14195, https://doi.org/10.1111/apt.14446 and https://doi.org/10.1111/apt.14425.
Background. The purpose of our study was to evaluate the incidence and clinical characteristics of febrile episodes during neutropenia following chemotherapy in children with cancer. Patients and ...methods. A prospective, 3-year single-center observational study of periods of neutropenia was performed. Epidemiology and clinical diagnoses of febrile episodes occurring during the neutropenic periods were evaluated, taking into consideration different categories of anticancer treatment based on the type of tumor and phase of therapy. Results. A total of 703 febrile episodes were observed during 614 (34%) of 1792 neutropenic periods (34%), for a total of 28,001 days at risk, accounting for a rate of 0.76 episodes per 30 days at risk. The highest proportions of neutropenic periods with primary febrile episodes were observed after autologous hemopoietic stem cell transplantation (58%), aggressive treatment for acute leukemia or non-Hodgkin lymphoma (48%), and allogeneic hemopoietic stem cell transplantation (44%); the lowest proportion (9%) was observed during maintenance chemotherapy for acute leukemia (P < .001). The most frequent clinical diagnosis was fever of unknown origin (in 79% of cases), followed by bacteremia (10%); invasive mycosis was diagnosed in only 2% of cases. Conclusions. The overall incidence of febrile neutropenia and severe infectious complications in children with cancer is low, with differences according to the aggressiveness of chemotherapy. This fact must be considered when designing clinical trials on the management of infectious complications in children with cancer.
Background
A link between small intestinal bacterial overgrowth (SIBO) and celiac disease (CD) has been hypothesized.
Methods
Literature search was performed in main medical databases. Methods of ...analysis/inclusion criteria were based on Preferred Reporting Items for Systematic reviews and Meta‐Analyses recommendations. The end‐point was to estimate, by a pooled‐data analysis, SIBO prevalence in CD. Proportions/percentages and their 95% confidence intervals (CI) were calculated by inverse variance method, whereas odd ratios (OR) and their 95% CI were estimated, where available, based on the Mantel‐Haenszel method. Data were entered into the RevMan 5.3 software.
Key Results
Eleven articles fulfilled considered criteria. The pooled mean prevalence of SIBO in CD was 20% (95% CI of 10%‐30%). In comparison to asymptomatic controls, CD was associated to higher risk of SIBO, with an OR of 10.52 (95% CI 2.69‐41.21, P=.0007). Jejunal aspirate culture assessed SIBO prevalence of 11% (95% CI 3%‐19%) in CD, whereas breath tests detected a higher value (23%, 95% CI 10%‐37%). The pooled prevalence of SIBO in CD patients who were symptomatic despite a GFD was 28% (95% CI 10%‐47%), higher than in asymptomatic celiac patients (pooled prevalence of 10%, with a 95% CI of 3%‐16%), despite not statistically significant (P=.06). When GFD‐unresponsive CD was defined only by clinical persistence of symptoms, the prevalence of SIBO was higher than in the case of villous atrophy association (31% vs 16% P=.33).
Conclusions
The heterogeneity of available studies may not support a relationship SIBO‐CD. Nevertheless, SIBO could be more common in CD when symptoms do not improve after GFD.
A relationship between celiac disease (CD) and SIBO has been hypothesized. In particular, CD seemed to be a predisposing factor for SIBO. The prevalence of SIBO in CD is high, but the results are influenced by the test used to diagnose SIBO and by the response to gluten‐free diet. The high heterogeneity between studies is a limit to clarify the relationship between the two disorders. Nevertheless, our analysis suggests that SIBO could be more common in CD when symptoms do not improve after GFD, thus suggesting its detection and treatment in such cases before diagnosing a refractory CD.
Linked Content
This article is linked to Barone et al and Liu et al papers. To view these articles visit https://doi.org/10.1111/apt.14139 and https://doi.org/10.1111/apt.14425.
Linked ContentThis article is linked to Townsend and Newsome et al and Barone et al papers. To view these articles visit https://doi.org/10.1111/apt.14179 and https://doi.org/10.1111/apt.14195.
Summary
Background
Sequential therapy is a first‐line regimen obtaining satisfactory Helicobacter pylori eradication. Triple therapy prolongation improves the success rate even if a recent ...meta‐analysis showed satisfying results only for the 14‐day regimen. Studies from Africa and North America were unavailable in previous meta‐analyses.
Aim
To perform a meta‐analysis comparing sequential vs. prolonged 14‐day triple therapy with regard to ‘geographic weighting’ by considering subgroups analysis according to metronidazole/clarithromycin low and high resistance areas.
Methods
Based on PRISMA recommendations, we considered all first‐line clinical studies from 2003 to November 2014. Randomised clinical trials (RCTs) were included by a search on PubMed, MEDLINE, Science Direct, EMBASE. Data on eradication rates were expressed as ITT. Risk ratio (RR), pooled RR and 95% confidence intervals were calculated by the Mantel‐Haenszel method. Data were entered into RevMan 5.2 software (Nordic Cochrane Centre) using a random‐effects model.
Results
Databases identified 194 studies; seven met the inclusion criteria. Overall results showed a similar effectiveness of the two regimens considered (RR = 0.99; 95% CI = 0.94–1.05; p = 0.75). In areas with high resistance to clarithromycin, sequential was superior to 14‐day triple therapy (RR = 0.95; 95% CI = 0.90–1.00; p = 0.03). In areas with high metronidazole resistance, sequential and 14‐day triple therapy were equivalent (RR = 0.99; 95% CI = 0.91–1.08; p = 0.82).
Conclusions
‘Geographic weighting’ could be the main factor affecting the lack of differences between sequential and 14‐day triple therapy outcomes.
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