Implicaciones de la microbiota intestinal en las enfermedades crónicas del hígado / Implications of the intestinal microbiota in the chronic liver diseases

RESUMEN La microbiota se refiere al conjunto de todos los de microorganismos que se localizan de manera normal en distintos sitios de los cuerpos de los seres vivos pluricelulares, tales como el cuerpo humano. Las modificaciones del eje intestino-hígado se ha convertido en la actualidad en un grave problema científico al haberse encontrado en diversas investigaciones, que esta microbiota está relacionada con el daño hepático con independencia de la causa de la lesión hepática. Se realizó una revisión sistemática sobre las implicaciones demamicrobiota intestinal en las enfermedades hepáticas. Se realizó una revisión de artículos científicos publicados entre 2012 y 2018 en diversas bases de datos en línea. Se presenta el conocimiento existente hasta el momento sobre la microbiota intestinal en pacientes portadores de enfermedades hepáticas, con hincapié en las hepatitis C y la cirrosis hepática. La composición de microbiota de intestino estuvo asociada con el perfil inflamatorio y marcadores de fibrosis hepática, las que mejoraron con el tratamiento de antivirales de acción directa aunque las medidas de permeabilidad intestinal e inflamación permanecían inalteradas. Se reporta mejoría de los pacientes portadores de hepatitis viral tipo C, con antivirales de acción directa la cual estuvo asociada con modificaciones de la microbiota intestinal, que se correlacionó con mejoría en la fibrosis e inflamación hepática, los avances en este campo abren nuevas perspectivas en la biomedicina (AU).

SUMMARY Microbiota refers to the whole of microorganisms located in a normal way in different places of the bodies of pluricelular living beings, like the human body. The modifications of the axis intestine-liver have become a serious scientific problem, because in different researches researchers have found that this microbiota is related to hepatic damage depending on the cause of this hepatic lesion. To carry out a systematic review on the implication of intestinal macrobiota in liver diseases. The scientific articles published in the period 2012-2018 in different databases on line were reviewed. A total of 26 bibliographic sources were used, original articles and reviews. The authors present knowledge existent up to the moment on intestinal microbiota in patients who have liver diseases, making emphasis on hepatitis C and hepatic cirrhosis. The composition of the intestine microbiota was associated to an inflammatory and markers of hepatic fibrosis that improved with the treatment of direct action antivirals although the measures of intestinal permeability and inflammation remained inalterably. It is reported an improvement of patients carriers of viral hepatitis type C with the use direct action retrovirals, what was linked to modifications in the intestinal microbiota, and correlated to an improvement of fibrosis and liver inflammation; the advances obtained in this field open new perspectives in biomedicine (AU).

Intensive care management of patients with liver disease: proceedings of a single-topic conference sponsored by the Brazilian Society of Hepatology

ABSTRACT Survival rates of critically ill patients with liver disease has sharply increased in recent years due to several improvements in the management of decompensated cirrhosis and acute liver failure. This is ascribed to the incorporation of evidence-based strategies from clinical trials aiming to reduce mortality. In order to discuss the cutting-edge evidence regarding critical care of patients with liver disease, a joint single topic conference was recently sponsored by the Brazilian Society of Hepatology in cooperation with the Brazilian Society of Intensive Care Medicine and the Brazilian Association for Organ Transplantation. This paper summarizes the proceedings of the aforementioned meeting and it is intended to guide intensive care physicians, gastroenterologists and hepatologists in the care management of patients with liver disease.

RESUMO A sobrevida de pacientes cirróticos críticos aumentou significantemente nos últimos anos devido a inúmeros avanços obtidos no manejo do paciente com cirrose descompensada e com insuficiência hepática aguda grave, particularmente após a incorporação na prática clínica de uma série de estratégias baseadas em evidencias com impacto reconhecido na redução de mortalidade. Com o intuito de discutir as principais evidencias disponíveis na literatura médica sobre o assunto, a Sociedade Brasileira de Hepatologia, em conjunto com a Associação de Medicina Intensiva Brasileira e a Associação Brasileira de Transplantes de Órgãos promoveu uma reunião monotemática sobre o manejo do paciente hepatopata crítico, que ocorreu em 21 de maio de 2014 na cidade do Rio de Janeiro. O relatório da reunião foi resumido no presente manuscrito com o objetivo de nortear a prática clínica de intensivistas, gastroenterologistas e hepatologistas no manejo do paciente hepatopata em ambiente de terapia intensiva.

Correlacionando icterícia, resultados de exames laboratoriais e diagnósticos de doenças / Correlating jaundice, laboratory test results and diagnosis of diseases

Para descobrir quais as doenças que mais comumente cursam com a icterícia em pacientes internados no Hospital Universitário Antônio Pedro (HUAP) e correlacioná-las com marcadores bioquímicos foram utilizados dados extraídos de prontuários de pacientes internados durante os anos de 2005 a 2007. 0s dados foram analisados usando métodos estatísticos como qui-quadrado e teste Z. Utilizamos a análise das dosagens de aspartato-aminotrans ferase (AST), alanina-aminotransferase (ALT), fosfatase alcalina (FA), gama-glutamiltransferase (gama-GT), bilirrubina (Bb) total e suas frações direta e indireta. Os sinais e sintomas mais comuns na amostra estudada foram: dor abdominal, vômitos e colúria, que estão presentes em cerca de 60% das queixas dos pacientes estudados. Na população entre nove e 85 anos de idade, a análise sugere que AST e ALT nos chamam atenção para uma possível lesão hepática associada aos casos de icterícia. Enquanto que FA e GGT são marcadores de colestase. A bilirrubina direta tem média mais elevada no grupo de pacientes entre nove e 85 anos e a bilirrubina indireta atinge níveis maiores no grupo com até dois meses de vida. As dosagens bioquímicas são armas muito importantes na pesquisa etiológica dos casos de icterícia.

To find out which diseases most commonly lead to jaundice in hospitalized patients in HUAP and correlate them with biochemical markers. We used data from medical records of patients hospitalized during the years 2005 to 2007. The data were analyzed using statistical methods to test and chi-square-Z. We used the analysis of the strengths of AST, ALI, FA, GGT, Bb and its fractions total direct and indirect. The most common signs and symptoms in the sample studied were abdominal pain, vomiting and choluria that are present in about 60% of complaints from patients. In the population between nine and 85 years of age, the analysis suggests that AST and ALT in calling attention to a possible liver damage linked to cases of jaundice. While FA and gamma-GT are markers of cholestasis. The direct bilirubin is highest average in the group of patients between nine and 85 years and indirect bilirubin levels higher in the group with up to two months of life. The biochemical doses are very important weapons in the etiological research of cases of jaundice.

Nutrición enteral en hepatopatías crónicas en niños y adolescentes / Enteral nutrition in chronic liver disease in children and adolescents

La desnutrición que se observa en enfermedades hepáticas crónicas en niños se asocia a un aumento de requerimientos por gasto calórico elevado. La historia clínica incluye un recordatorio de alimentación, evaluación clínica, antropometría. Los niños con colestasis deben recibir una dieta hipercalórica. Es fundamental garantizar el aporte calórico calculado completo y la alimentación enteral. Se debe garantizar un crecimiento adecuado en un niño en lista de espera para trasplante. Los niños con enfermedades metabólicas requieren el uso de fórmulas comerciales especiales.

Malnutrition seen in chronic liver disease in children is associated with increased requirements for high caloric expenditure. The medical history includes a reminder of food, clinical evaluation, anthropometry. Children with cholestasis should receive a high calorie diet. It is essential to ensure complete and estimated calorie enteral feeding. It must ensure adequate growth in a child on the waiting list for transplantation. Children with metabolic diseases require the use of special comercial formulations.

Pattern of Liver Diseases in Sudanese Children

We aimed at determining the pattern and the incidence of liver disease in the Sudanese children referred to the Gastroenterology unit as Gaafar Ibn Oaf Specialized Children Hospital; which has not been studied before. Materials and Methods: In a cross-sectional study conducted over 5 years; 450 liver needle biopsies were sent to the pathology laboratory of our center. Slides were prepared from paraffinembedded blocks; stained by routine H et E and special stains and were then reviewed. The frequency of each disorder; separately and in combination with the age group or gender of the patient were compared with other similar studies. Results: The male to female ratio was 1.5:1.The age range between 1 month and 15 years old and 42were less than 1 year old. The most common histological diagnosis was liver cirrhosis where no specific cause could be found (26) followed by neonatal hepatitis(20);fatty liver(12);Billary Atresia(10);chronic hepatitis(8); metabolic liver disease (6); Progressive Intrahepatic Cholestasis (5.5); non specific pathological changes (4.4) and Hepato Cellular Carcinoma in(4). Conclusion: A liver biopsy is a useful and practical tool for the appropriate diagnosis of pediatric liver diseases. We found that Idiopathic Liver Cirrhosis; Neonatal Hepatitis; Fatty Liver; Billary Atresia and Chronic Hepatitis in the stated order are the most prevalent histological diagnosis in Sudanese children. Hepatocellular Carcinoma is significantly high in our pediatrics population

Development of a Rating System for Digestive System Impairments: Korean Academy of Medical Sciences Guideline

A systematic and effective welfare system for people with digestive system impairments is required. In Korea, an objective and scientific rating guideline does not exist to judge the digestive system impairments. Whether the impairments exist or not and the degree of it need to be examined. Thus, with these considerations we need a scientific rating guideline for digestive system impairments to fit our cultural and social background. In 2007, a research team, for the development of rating impairment guidelines, was organized under the supervision of Korean Academy of Medical Sciences. The rating guidelines for digestive system impairments was classified into upper and lower gastrointestinal tracts impairments and liver impairment. We developed objective rating guidelines for the upper gastrointestinal tract, the impairment generated after surgery for the stomach, duodenum, esophagus, and for the lower gastrointestinal tract, the impairment generated after construction and surgery for colon, rectum, anus, and intestinal stomas. We tried to make the rating impairment guidelines to include science, objectivity, convenience, rationality, and actuality. We especially emphasized objectivity as the most important value. We worked to make it easy and convenient to use for both the subjects who received the impairment ratings and the doctors who will give the ratings.

Spectrum of liver disorders in children: a hospital based study

The aim of the study was to find out the existing pattern of liver diseases in hospitalized children. Observation descriptive study. Paediatric Unit-III Civil Hospital Karachi.affilliated with Dow University of Health Sciences Karachi. From January 2001 to December 2005. Children ages more than two months to 15 years. During the study period, 92 children were included who fulfilled the criteria. Amongst Acute hepatitis [31.5%], HBV was [41.4%], HAV [27.6%], HCV [10.3%], drug induced [6.9%] and idiopathic causes [13.8%]. Chronic liver diseases were 51%, which constitute cryptogenic [42.5%] and post-hepatitis [32.0%], among which HBV [23.4%], HCV [8.5%] while Wilson [17%], Gaucher's disease [4.3%], hemochromatosis [2%] and autoimmune hepatitis was 2%. In acute hepatitis, HBV is more common while HAV is less than anticipated, HCV is significantly present. In chronic liver disease, the majority of causes are cryptogenic, posthepatitis, metabolic and storage disorders

Pseudolesões hepáticas na tomografia computadorizada helicoidal: ensaio iconográfico / Helical computed tomography of hepatic pseudolesions: a pictorial essay

A tomografia computadorizada helicoidal é largamente empregada na avaliação do parênquima hepático e tem grande importância no planejamento clínico e cirúrgico. O fígado é o órgão que mais se beneficia de aquisições helicoidais, em fases diferentes da perfusão do parênquima, pela sua dupla vascularização e pela diferença de aporte sanguíneo entre tumores e parênquima sadio. Entretanto, várias armadilhas diagnósticas podem ser encontradas, dificultando a análise e prejudicando a diferenciação entre lesões verdadeiras e pseudolesões, principalmente aos olhos de radiologistas menos experientes. Essas pseudolesões têm forma, localização e características variadas, podendo simular lesões parenquimatosas. É de fundamental importância que estejamos aptos a reconhecê-las, no sentido de interpretar corretamente as imagens tomográficas. O objetivo deste ensaio é classificar e ilustrar as diversas pseudolesões hepáticas pela tomografia computadorizada helicoidal, com uma breve descrição dessas lesões e com alternativas para diferenciá-las das lesões do parênquima.

Helical computed tomography has been widely used in the evaluation of the liver parenchyma for clinical and surgical management. The liver is probably the organ for which helical computed tomography examination is best indicated due to hepatic dual blood perfusion and the difference in blood supply between liver tumors and normal parenchyma. However, there are pitfalls in the interpretation of the images that may impair differentiation of true lesions from pseudolesions, particularly for the inexperienced radiologist. These pseudolesions present different shapes, location and characteristics that may mimic parenchymal lesions and their recognition and understanding are essential to avoid misdiagnoses. The aim of this study is to propose a systematic classification of the pseudolesions of the liver using illustrative cases and thus offer alternative means to differentiate these lesions from true parenchymal lesions.

Opportunistic infections in the liver of HIV-infected patients in Thailand: a necropsy study.

Liver necropsy from patients infected with human immunodeficiency virus was analyzed in 117 cases. Wide ranges of opportunistic infections were recorded in 47%. Cryptococcosis (21.4%) was the most outstanding infection, followed by tuberculosis (16.2%), cytomegalovirus (5.1%) and penicillosis (3.4%). Non-specific alterations of the liver tissues included fatty steatosis (49.6%), fibrosis (55.6%), portal inflammation and reactive hepatitis. Cases of chronic active and chronic passive hepatitis and one case of hepatocellular carcinoma were reported. In the infected liver, predominant pathological changes included granuloma and spotty necrosis, which were attributed to tuberculous hepatitis. Infection with Cryptococcus usually showed no associated pathological change. The sensitivity for the clinical diagnosis of Cryptococcus was 88.8% and specificity was 91.7%. For tuberculosis, sensitivity was 20% and specificity was 67.9%.

Need for liver transplantation in Indian children.

BACKGROUND: Liver transplantation (LT) is the most successful and accepted mode of therapy for failing liver in children. Pediatric LT has neither been widely attempted nor its need objectively assessed in our country. OBJECTIVE: To assess requirement of LT in children at a tertiary care hospital. METHODS: Data of children admitted to pediatric GE services (January 1992 to June 1997) were retrospectively analyzed. Subgroups of children with acute liver disease (ALD), chronic liver disease (CLD), neonatal cholestasis syndrome (NCS) and other etiology were evaluated for need for LT according to established criteria. RESULTS: Of the total 301 inpatients with liver diseases assessed at our center, ALD constituted 26% (n=79), CLD 35% (n=106), NCS 27% (n=82) and miscellaneous 11% (n=34). Among ALD, 19% (n=15) had FHF and 67% (n=10) qualified for LT (INR>4.0). Of CLD, LT was warranted in 13% (2/15) cases of Wilson's disease (Wilson's score > 6) and 60% of cirrhotics (n=40/66) with decompensation. NCS comprised extrahepatic biliary atresia (EHBA) in 43, choledochal cyst in 2, paucity of intralobular bile duct (PILBD) in 2, neonatal hepatitis in 23, and was of indeterminate etiology in 12 cases. Of NCS groups, LT was the only therapeutic option in 45% (n=36) of cases (EHBA 34, choledochal cyst 2). Of 34 cases of EHBA requiring LT, 32 presented after 4 months of age and other 2 children had decompensation before four months of age. Both children with choledochal cysts had decompensated liver disease. One patient of Crigler Najjar syndrome type I had kernicterus and qualified for LT. CONCLUSION: Our data shows need for LT in 30% of children with liver diseases constituted by cirrhosis (45%), biliary atresia (38%) and FHF (11%).

Ultraestructura del hepatocito en diversas hepatopatías / Hepatocyte ultrastructure in liver diseases

Se estudiaron 14 biopsias hepáticas obtenidas de ocho pacientes con hepatitis viral aguda y series con hepatopatías crónicas, y se halló buena correlación de los datos clínicos con las alteraciones morfológicas por lo que parece recomendable hacer una clasificación etiológica para evitar que los pacientes progresen a cirrosis y desarrollen carcinoma hepatocelular. El estudio de la hepatitis viral mediante los microscopios de luz y electrónico de transmisión, correlacionado con la clínica y completado con estudios de histoquímica y virología, sirven para aclarar interrogantes en relación a la identificación del virus

Imagen en las masas focales hepáticas / Imaging of the focal masses of the liver

El objetivo de esta revisión es examinar los signos característicos de los estudios de imagen en las lesiones focales hepáticas benignas, quistes, abscesos, hemangiomas, adenomas e hiperplasia nodular focal y malignas, carcinoma hepatocelular y metástasis, ya que en la mayoría de estos pacientes presentan imágenes específicas en un porcentaje alto (85-98 por ciento) que permiten un diagnóstico certero de la lesión, con lo cual podemos evitar la necesidad de su comprobación mediante biopsia percutánea o de estudios de seguimiento por imagen

Traumatismo hepático / Hepatic trauma

Se analizó los resultados obtenidos en el tratamiento de 35 pacientes con traumatismos hepático (1984-1991). La mayoría de sexo masculino, edad promedio 27,5 años. El 94% fue debido contusión y el 80% tenía lesiones asociadas. Catorce eran menores (Grado I ó II) y los 21 restantes eran traumatismos hepáticos complejos. (Grado III, IV ó V). Tres se trataron en forma conservadora. La indicación quirúrgica inicial fue clínica en 17 ó mediante un lavado peritoneal en 11. El 66% pudo ser tratado con medidas simples (electrocoagulación o hepatorrafia simple). En las restantes se utilizó hepatotomía (8,6%) o resección (20%). Como medidas adicionales se utilizó packing (4), toracotomía y clampeo aórtico (4), shunt cavo (2) y Balón de Morimoto (1). Doce pacientes presentaron complicaciones, siendo reintervenidos siete (21,9%). Fallecen por el traumatismo hepático seis pacientes (17,1%), cinco de ellos por hemorragia

Utilidad de los ácidos biliares séricos en el diagnóstico de las enfermedades hepatobiliares

Con el fin de establecer el valor diagnóstico de los ácidos biliares séricos se estudiaron 81 pacientes, atendidos por el Instituto de Enfermedades Hepatobiliares de la Fundación Santa Fe de Bogotá (IEHB). Encontramos que la sensibilidad de la coliglicina (CG) RIA (un ácido biliar) para detectar enfermedad hepatobiliar fue similar a la de la AST y la fosfatasa alcalina (78.5 por ciento, 81.5 por ciento y 78.5 por ciento, respectivamente), y superior a la de las otras pruebas (ALT y bilirrubina total). La especificidad (100 por ciento) y los valores predictivos (prueba positiva 100 por ciento, prueba negativa 54.3 por ciento) fueron mejores que los de las pruebas convencionales (p<0.05). El perfil hepático (AST, ALT, fosfatasa alcalina y bilirrubina total) tuvo alta sensibilidad (95.4 por ciento), pero muy baja especificidad (43.8 por ciento). La CG RIA fue positiva en cirróticos un máyor número de veces que las otras pruebas (95.2 por ciento), pero no encontramos que los niveles de CG RIA se correlacionaran con el estudio clínico de la cirrosis según la clasificación de Child-Turcotte. Los niveles de CG RIA fueron normales en siete pacientes con síndrome de Gilbert. Concluímos que la CG RIA es una prueba de alto valor diagnóstico y que es útil como complemento del perfil hepático convencional; en segundo lugar, que no hay correlación entre los niveles de CG RIA y el estado clínico de la cirrosis, finalmente, que la CG RIA es normal en el síndrome de Gilbert, lo cual ayuda a descartar enfermedad hepatobiliar estructural o funcional en estos casos.