ABSTRACT
Currently, liver fibrosis and its complications are regarded as critical health problems. With the studies showing the reversible nature of liver fibrogenesis, scientists have focused on understanding the underlying mechanism of this condition in order to develop new therapeutic strategies. Although hepatic stellate cells are known as the primary cells responsible for liver fibrogenesis, studies have shown contributing roles for other cells, pathways, and molecules in the development of fibrosis depending on the etiology of liver fibrosis. Hence, interventions could be directed in the proper way for each type of liver diseases to better address this complication. There are two main approaches in clinical reversion of liver fibrosis; eliminating the underlying insult and targeting the fibrosis process, which have variable clinical importance in the treatment of this disease. In this review, we present recent concepts in molecular pathways of liver fibrosis reversibility and their clinical implications
ABSTRACT
BACKGROUND Only a few studies in Western countries have investigated the association between gastroesophageal reflux disease [GERD] and mortality at the general population level and they have shown mixed results
This study investigated the association between GERD symptoms and overall and cause-specific mortality in a large prospective population-based study in Golestan Province, Iran
METHODS: Baseline data on frequency, onset time, and patient-perceived severity of GERD symptoms were available for 50001 participants in the Golestan Cohort Study [GCS]
We identified 3107 deaths [including 1146 circulatory and 470 cancer-related] with an average follow-up of 6.4 years and calculated hazard ratios [HR] and 95% confidence intervals [CI] adjusted for multiple potential confounders
RESULTS: Severe daily symptoms [defined as symptoms interfering with daily work or causing nighttime awakenings on a daily bases, reported by 4.3% of participants] were associated with cancer mortality [HR 1.48, 95% CI: 1.04-2.05]
This increase was too small to noticeably affect overall mortality
Mortality was not associated with onset time or frequency of GERD and was not increased with mild to moderate symptoms
CONCLUSION: We have observed an association with GERD and increased cancer mortality in a small group of individuals that had severe symptoms. Most patients with mild to moderate GERD can be re-assured that their symptoms are not associated with increased mortality
ABSTRACT
Background: patients with inherited bleeding disorders who regularly receive clotting factors are frequently infected with hepatitis C virus [HCV]. Liver biopsy in these patients is high-risk and not always performed. There is no report on pegylated interferon [PEG-IFN] and ribavirin in patients with bleeding disorders in whom no histologic data is available
Aim: to assess the safety and efficacy of combined PEG-IFN alfa-2a and ribavirin in patients with inherited bleeding disorders and hepatitis C. Methods: We studied 37 patients with inherited bleeding disorders and HCV infection. Patients where planned to receive pegylated interferon alfa 2a [PEG-IFN alfa-2a] 180 micg weekly and ribavirin 800mg daily for 48 weeks. They were then followed for 24 weeks after the end of treatment
Results: early virologic response at week 12 of treatment was achieved in 3 1/34 patients [91%] and end-of-treatment response was achieved in 30/3 1 patients [97%]. Sustained virologic response was 26/32 [81%] and 26/35 [74%] on per-protocol and intention-to-treat analysis respectively. Dose reduction due to adverse effects was necessary in 11 patients
Conclusion: the combination of PEG-IFN alpha 2a and ribavirin is safe and highly effective in patients with inherited bleeding disorders and HCV infection, even when histologic data is absent