ABSTRACT
Sarcopenia, frailty, and malnutrition in patients with liver cirrhosis are commonly observed and are associated with higher long-term mortality. Therefore, recognizing patients with increased nutritional risk and providing recommended interventions are essential in the long- and short-term management of cirrhosis, especially as alcoholic and non-alcoholic fatty liver disease continues to rise. Various assessment tools are available to gauge frailty and malnutrition but are infrequently used. Given the global burden of liver cirrhosis, periodic screening for malnutrition, sarcopenia, and frailty is desperately needed as it improves liver transplantation outcomes. Necessary steps include addressing knowledge gaps in professional healthcare workers and patients and using standardized assessment tools to counteract physical deconditioning as early as possible. One potential method for assessing sarcopenia involves using computed tomography to evaluate the skeletal muscle index. Regarding frailty, useful tools for longitudinal assessment include the liver frailty index and the Karnofsky performance status. Addressing educational requirements related to malnutrition involves seeking guidance from dieticians, who can provide counseling on achieving sufficient calorie and protein intake to combat the progression of malnutrition.
ABSTRACT
When evaluating biliary strictures, establishing a diagnosis can present challenges. The first-line approach of endoscopic retrograde cholangiopancreatography can often involve anatomic restrictions. Traditionally, percutaneous transhepatic cholangioscopy has been the answer for biopsies unable to be obtained with the modalities above but requires time for large tract dilation and days of sinus tract maturation to allow for a scope. We present a novel case of percutaneous digital cholangioscopy with SpyGlass DS, a small caliber scope traditionally used with endoscopic retrograde cholangiopancreatography, used for percutaneous transhepatic cholangioscopy after previous failed attempts by several different standard methods. Our case highlights a multidisciplinary approach in ultimately diagnosing malignancy.
ABSTRACT
BACKGROUND AND AIMS: The aim of this study was to assess the efficacy and safety of a novel, hydrophilic, bioenhanced curcumin (BEC) as add-on therapy in inducing clinical and endoscopic remission in mild to moderately active ulcerative colitis (UC). DESIGN: Mild to moderately active UC patients (partial Mayo score 2 to 6 with endoscopic Mayo score >1) on standard dose of mesalamine were randomized to either 50 mg twice daily BEC or an identical placebo. Clinical response (≥2 reduction of partial Mayo score), clinical remission (partial Mayo score ≤1), and endoscopic remission (endoscopic Mayo score of ≤1) were evaluated at 6 weeks and 3 months. Responders were followed-up at 6 and 12 months for assessing maintenance of remission. RESULTS: Sixty-nine patients were randomly assigned to BEC (n=34) and placebo (n=35). At 6 weeks, clinical and endoscopic remission occurred in 44.1% (15/34) and 35.3% (14/34) patients, respectively, compared with none in the placebo group (P<0.01). Clinical response was also significantly higher in the BEC group (18/34, 52.9%) compared with placebo (5/35, 14.3%) (P=0.001). The clinical remission, clinical response, and endoscopic remission rates at 3 months were 55.9% (19/34), 58.8% (20/34), 44% (16/34) and 5.7% (2/35), 28.6% (10/35), 5.7% (2/35) in BEC and placebo groups, respectively. At 6 and 12 months, 95% (18/19) and 84% (16/19) of the responders to BEC maintained clinical remission. None of the responders to placebo maintained clinical remission at 6 months. BEC appeared safe with no significant side effects. CONCLUSION: A low-dose BEC as add-on therapy was superior to placebo in inducing sustained clinical and endoscopic remission in patients with mild-to-moderately active UC on maximal dose of mesalamine (ClinicalTrials.gov: NCT02683733).
