ABSTRACT
Non-alcoholic fatty liver disease (NAFLD) has a high prevalence and risk of progression to cirrhosis and other complications in patients with type 2 diabetes mellitus (T2DM). Likewise, the presence of NAFLD implies a high risk of developing T2DM, determining a bidirectional relationship between them. The diabetology and hepatology societies, developed a joint initiative aiming to unify criteria, reviewing the definitions, diagnostic criteria, risk stratification, treatment, and follow-up of patients with NAFLD and T2DM. The key questions to be discussed were defined by a panel of specialists in diabetology and hepatology. The Delphi methodology was used to reach consensus on the respective recommendations. Based on the discussion generated among the experts, diagnostic and treatment algorithms were proposed, as well as an indication for referral and the role of the different specialists involved in the management of these patients. Strengthening multidisciplinary work with patients with NAFLD and T2DM will allow the early recognition of the disease, the prevention of the progression to cirrhosis, and reducing the associated complications.
Subject(s)
Humans , Diabetes Mellitus, Type 2/complications , Non-alcoholic Fatty Liver Disease/complications , Gastroenterology , Chile/epidemiologyABSTRACT
Oxidative stress is implicated in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). In the present study, hepatic and plasma oxidative stress-related parameters were measured and correlated with clinical and histological findings in 31 NAFLD patients showing increased body mass index. Liver protein carbonyl content was enhanced by 403% in patients with steatosis (n=15) compared with control values (n=12), whereas glutathione content, superoxide dismutase (SOD) activity and the ferric reducing ability of plasma (FRAP) were decreased by 57%, 48% and 21% (P<0.05) respectively. No changes in microsomal p-nitrophenol hydroxylation and the total content of cytochrome P450 (CYP) or CYP2E1 were observed. Patients with steatohepatitis (n=16) exhibited protein carbonyl content comparable with that of controls, whereas glutathione content, SOD and catalase activities were decreased by 27%, 64% and 48% (P<0.05). In addition, FRAP values in patients with steatohepatitis were reduced by 33% and 15% (P<0.05) when compared with controls and patients with steatosis respectively, whereas p-nitrophenol hydroxylation (52%) and CYP2E1 content (142%) were significantly increased (P<0.05) compared with controls. It is concluded that oxidative stress is developed in the liver of NAFLD patients with steatosis and is exacerbated further in patients with steatohepatitis, which is associated with CYP2E1 induction. Substantial protein oxidation is followed by proteolysis of the modified proteins, which may explain the co-existence of a diminished antioxidant capacity and protein oxidation in the liver of patients with steatohepatitis.
Subject(s)
Fatty Liver/metabolism , Liver/metabolism , Oxidative Stress , Adolescent , Adult , Analysis of Variance , Biomarkers/analysis , Case-Control Studies , Catalase/analysis , Catalase/metabolism , Cytochrome P-450 CYP2E1/metabolism , Fatty Liver/pathology , Female , Glutathione/analysis , Glutathione/metabolism , Humans , Liver/pathology , Male , Middle Aged , Superoxide Dismutase/analysis , Superoxide Dismutase/metabolismABSTRACT
BACKGROUND: Drug induced liver disease (DILD) is common and of difficult diagnosis. AIM: To report the clinical, laboratory and pathological findings in 33 patients with DILD. PATIENTS AND METHODS: We revised 1,164 liver biopsies and 57 were selected as suspicious of DILD. In these, the scale proposed by Maria et al was applied to assess the possibility of hepatotoxicity reactions and 33 were selected. RESULTS: The 33 cases had a mean age of 48 +/- 18 years and 14 were male. Forty eight medications were involved, with an average of 1.4 drugs per patient. The main drugs were antimicrobials, antineoplastics-immunosuppressives and non-steroidal antiinflammatory drugs. The clinical presentations in order of frequency were cholestasis, hepatitis, asymptomatic, fulminant hepatitis and cirrhosis. The laboratory alterations observed in cases with hepatitis were 20 fold transaminase and bilirubin elevation. In cholestasis, moderate elevations of alkaline phosphatases and gamma glytamyl transferase were observed. Pathology showed hepatocellular damage, cholestasis and mixed damage, but also submassive necrosis and cirrhosis in one case. CONCLUSIONS: The present study confirms that DILD is frequently unpredictable and that it can cause a wide variety of clinical and pathological presentations, that can even evolve to chronicity.
Subject(s)
Chemical and Drug Induced Liver Injury , Adult , Aged , Chemical and Drug Induced Liver Injury/diagnosis , Female , Humans , Liver Diseases/diagnosis , Male , Middle AgedABSTRACT
BACKGROUND: Gastric neuroendocrine tumors correspond to less than 1% of all gastric tumors. These tumors can be of three types. Seventy five percent are type I and are associated to chronic atrophic gastritis type A (CAG-A). Half of them are associated with pernicious anemia. Type II tumors are associated with Zollinger Ellison syndrome and type I multiple endocrine neoplasia. Type III are sporadic tumors. AIM: To report the clinical, endoscopical features and response to the treatment of gastric neuroendocrine tumors. PATIENTS AND METHODS: A retrospective study of eleven patients (seven male, aged 38 to 72 years old) with a pathological diagnosis of gastric neuroendocrine tumor. Their clinical presentation, associated diseases, treatment and follow up were reviewed. RESULTS: Epigastric pain was present in eight patients, weight loss in three, epigastric pain and weight loss in one and post prandial abdominal pain in two. At endoscopy, multiple polyps in the fundus were observed in six, verrucose gastritis in one, polyps in the antrum in one, two subcardial polyps in 1, a fundus ulcer in one and a Bormann III type lesion in one. Chronic atrophic gastritis was diagnosed in seven patients and pernicious anemia in five. Serum gastrin levels were determined in 4 patients and were high in all. Four subjects were treated with endoscopic polipectomy only. A partial or total gastrectomy was done in seven patients. No complications or mortality occurred during the follow up. CONCLUSIONS: Abdominal pain is a common presentation of patients with gastric neuroendocrine neoplasia. Polyps predominantly in the fundus are the most common endoscopic finding. Surgical treatment or endoscopical polypectomy, depending of the extension of the disease, yield satisfactory results.
Subject(s)
Neuroendocrine Tumors/pathology , Stomach Neoplasms/pathology , Adult , Aged , Female , Follow-Up Studies , Gastrectomy , Gastrinoma/pathology , Gastrinoma/surgery , Gastroscopy , Humans , Male , Middle Aged , Neuroendocrine Tumors/surgery , Retrospective Studies , Stomach Neoplasms/surgeryABSTRACT
Esta revisión actualiza los conocimientos más recientes sobre los Probióticos, como hidratos de carbono, proteínas, fibras y otros sustratos de la flora intestinal y los Probióticos, microrganismos vivos que ejercen un efecto beneficioso en la salud al poblar el instestino. Estos últimos son objetos del estudio. Los más estudiados han sido a base de Lactobacillus, Enterococcus faecium, Bifidobacterium, Streptococcus, y Saccharomyces boulardii (un hongo). Se estima que los resultados mejor demostrado son: sobrevivencia en el instestino, adhesión a epitelio y colonización intestinal en el largo plazo, mejor tolerancia a yogurt, prevención y acortamiento de la diarrea postantibióticos (Saccharomyces boulardii y Enterococcus faecium), prevención de recurrencias de cuadros intestinales por Clostridium difficile (con Saccharomyces boulardii) y acortamiento de la diarrea por Rotavirus (con leches fermentadas conteniendo Lactobacillus rhamnosus GG). Se mencionan otras posibles circuntancias de su utilidad, como transtornos funcionales, enfermedades intestinales inflamatorias y neoplásicas
