Efficacy and Safety of Glucagon-like Peptide-1 Receptor Agonists in the Treatment of Metabolic Associated Fatty Liver Disease: A Systematic Review and Meta-analysis.

BACKGROUND: Clinical trials examining the therapeutic benefits of glucagon-like peptide-1 receptor agonists (GLP-1RA) on patients with metabolic associated fatty liver disease (MAFLD) have reported inconsistent results. The aim of this meta-analysis was to verify the role of GLP-1RA in the treatment of MAFLD patients. MATERIALS AND METHODS: We searched PubMed, Embase, Medline, and the Cochrane Library for randomized controlled trials published that compared GLP-1RA with the control treatment in patients with MAFLD till to July 30, 2020. The effects of GLP-1RA on liver histology, body mass index, waist circumference (WC), aspartate aminotransferase, total cholesterol, triglycerides (TG), low-density lipoprotein and high-density lipoprotein were evaluated. RESULTS: Thirteen trials involving 704 patients were included in the meta-analysis. Compared with the control treatment, GLP-1RA treatment induced a greater resolution of steatohepatitis [RR=2.87; 95% confidence interval (CI): 0.89 to 9.23], delayed the progression of liver fibrosis (RR=3.83, 95% CI: 0.91 to 16.07) and reduced liver fat deposition (MD: -1.40; 95% CI: -2.75 to -0.05). In addition, it reduced the body mass index (MD: -1.15; 95% CI: -2.26 to -0.04), WC (MD: -3.33; 95% CI: -6.31 to -0.35) and improved serum aspartate aminotransferase (MD: -3.04; 95% CI: -5.93 to -0.16) and total cholesterol (MD: -0.20; 95% CI: -0.28 to -0.13). CONCLUSION: GLP-1RA improves liver steatosis and fibrosis. It is also beneficial to metabolic syndrome as it reduces BMI, WC, and hyperlipidemia.

Clinical characteristics and efficacy of endoscopic treatment of gastrointestinal ectopic varices: A single-center study.

BACKGROUND: Ectopic varices (EcVs) may cause massive bleeding, which can be difficult to control, with a high rate of mortality. The purpose of this study was to analyze the clinical characteristics of EcVs and the efficacy of endoscopic treatment. METHODS: From January 2008 to July 2017, the clinical data of 150 patients with EcVs in our center were retrospectively collected and analyzed. RESULTS: One hundred and fifty patients with EcVs (male 74.7%), with a mean age of: 54.1 ± 14.6 years were included. The prevalence of EcVs was 0.92% in gastrointestinal varices. Cirrhosis was the most common cause of EcVs (67.0%). The rates of bleeding were 57.14%, 4.34%, 30.0%, 33.3%, and 100% in the duodenal varices rectal varices, colonic varices, anastomotic varices, and small bowel varices, respectively. An age under 55 years, varices in the duodenum, and erythema were considered risk factors for EcV bleeding. Endoscopic treatments were performed in 15 patients with EcV bleeding. The follow-up period of the patients who underwent endoscopic treatment ranged from 0.5 to 24 months. The overall rate of treatment success was 73.33% for endoscopic treatment of EcV bleeding. The overall rates of rebleeding and mortality during 2 years were as high as 53.3% and 26.7%, respectively. CONCLUSION: Age, erythema, and the location of EcVs are considered risk factors for EcV bleeding, and the rate of bleeding is higher in patients with duodenal varices than in those with other EcVs. Endoscopic treatment is safe, effective, and feasible for controlling EcV bleeding.

Effectiveness and safety of endoscopic treatment for duodenal variceal bleeding: a systematic review.

Duodenal varix is a rare condition that involves massive bleeding, diagnostic difficulties, and a high rate of rebleeding and mortality. The purpose of this study was to systematically review endoscopic treatment for duodenal variceal bleeding to evaluate its effectiveness and safety. We searched PubMed, Embase, Web of Science, and the Cochrane Library up to 21 November 2019. Ninety-two studies containing 156 patients were finally included, and individual data from 101 patients (mean age: 52.67 ± 13.82 years, male: 64.4%) were collected and further analyzed. We used an analysis of variance and χ2 or Fisher's exact tests to analyze individual data from 101 patients. The cause of duodenal variceal bleeding was cirrhosis-related intrahepatic portal hypertension (IPH) in 76.2% of patients. The overall rates of initial hemostasis and treatment success of endoscopic treatment for duodenal variceal bleeding were 89.1 and 81.2%, respectively. The median duration of follow-up was 4.5 (1.0, 12.0) months. The overall rates of rebleeding and mortality were 8.9 and 13.9%, respectively. Among a variety of endoscopic treatments available, only the initial hemostasis rate was significantly different between the endoscopic injection sclerotherapy and endoscopic tissue adhesive (ETA) groups (72.7 vs. 94.7%, P = 0.023); differences in treatment success, rebleeding, mortality, and adverse events were not statistically significant among the four groups. Endoscopic intervention is a feasible, well tolerated, and effective modality for the treatment of duodenal variceal bleeding. Among the variety of endoscopic treatments available, ETA with cyanoacrylate may be preferable for duodenal variceal bleeding.

Endoscopic therapy for liver cirrhosis with esophageal variceal bleeding / 临床肝胆病杂志

Esophageal variceal bleeding is a serious complication of liver cirrhosis. Endoscopic therapy is a main method for the prevention and treatment of esophageal variceal bleeding, which includes endoscopic variceal ligation, sclerosing agent injection, endoscopic ultrasound-guided injection of sclerosing agent, tissue adhesive injection, self-expandable covered metallic stent, and combination treatment. This article reviews the indications, clinical effect, and complications of these endoscopic therapies.

Normal values for solid state high resolution anorectal manometry in healthy adult volunteers / 中华内科杂志

Objective To explore the normal values for two-dimension solid state high resolution anorectal manometry (HRAM) in healthy adult volunteers.Methods The healthy adult volunteers were recruited by advertisement and underwent solid state HRAM in the left lateral position.Anorectal pressures and rectal sensation were recorded and analyzed.Results (1) A total of 126 Chinese healthy adult volunteers (male:50 cases (39.7％);age:(37.5 ± 14.2) years old) were recruited in this study.(2)Mean anal resting pressure (MERP) was (71.8 ± 17.3) mmHg (1 mmHg =0.133 kPa).Maximum anal resting pressure (MARP) was (79.3 ± 17.8) mmHg,Maximum anal squeeze pressure (MSP) was (178.7 ± 52.8) mmHg.Anal high pressure zone (HPZ) length was (3.4 ± 0.6) cm.During simulated evacuation,residual anal pressure (RAP) was (63.8 ±20.5) mmHg,and anal relaxation rate (ARR) was (37.0 ± 11.5) ％.Rectal threshold volume for first sensation (FST),desire to defecate (DDT),urgency to defecate (UDT) and maximum discomfort (MDT) was (47.4 ±10.0) ml,(84.5 ±18.2) ml,(125.8 ± 28.5) ml,and (175.5 ±36.1) ml,respectively.(3) Compared with female subjects,male subjects had higher MSP [(211.0 ± 50.7) mmHg vs (157.5 ± 42.5) mmHg],RAP [(71.6 ± 18.1) mmHg vs (58.8 ± 20.5) mmHg]and rectal MDT[(187.0 ±36.4) mmHg vs (168.0 ±34.1)mmHg],but lower ARR [(32.1 ±8.0)％ vs (40.2 ±12.3)％],all P＜0.01.(4) MERP,MARP,MSP and rectal MDT were higher in young group (≤ 40 years old),all P ＜ 0.05.Conclusions These observations provide normal values for two-dimension solid state HRAM,which have significant difference between genders and different age groups.

Inhibiting effect of ursolic acid on hepatocyte apoptosis induced by TGF-β1 and its mechanism / 解放军医学杂志

Objective To study the effect of ursolic acid (UA) intervention on hepatocyte apoptosis induced by TGF-β1 and its potential mechanism.Methods Primary hepatocytes were extracted from healthy SD rats by in situ perfusion,cultured for 12-24h,then randomly divided into the following groups:blank control group,UA control group (UA 25μmol/L),TGF-β1 group (TGF-β1 2.5ng/ml),UA intervention group (UA 25μmol/L and TGF-β1 2.5ng/ml),DPI intervention group (DPI 0.5μmol/L and TGF-β1 2.5ng/ml).Each group was treated with drugs for corresponding time and their proliferation and apoptosis were detected by flow cytometry,the expression of CD95 (Fas) mRNA was analyzed by RT-qPCR,the expression of protein CD95 and membrane translocation of NADPH oxidase (NOX) subunit p47Phox were analyzed by Western blotting,and the reactive oxygen species (ROS) generation in primary hepatocytes was analyzed with reactive oxygen detection kit.Results UA intervention at 30min before TGF-β1 stimulating hepatocytes markedly reduced hepatocyte apoptosis (63.97 ± 3.19 vs 80.53 ± 1.56,P＜0.01) and promoted hepatocyte proliferation (18.67 ± 1.60 vs 10.83 ± 2.03,P＜0.01).UA intervention notably down-regulated the expressions of CD95 mRNA and protein (1.28 ± 0.15 vs 2.40 ± 0.25,P＜0.01;1.05 ± 0.15 vs 1.37 ± 0.18,P＜0.05),restrained membrane translocation of p47phox (1.13 ± 0.12 vs 1.76 ± 0.22,P＜0.01),and decreased ROS level in primary hepatocytes induced by TGF-β1 (2.12 ± 0.45 vs 3.23 ± 0.53,P＜0.01).Conclusion The mechanism of UA inhibiting hepatocyte apoptosis induced by TGF-β1 is likely to be that UA intervention reduced hepatocyte apoptosis by inhibiting NOX activation and decrease generation of ROS so as to down-regulate expression of CD95 in hepatocytes.

Clinical features analysis of 272 patients with gastric stump ulcer / 中华消化杂志

Objective To investigate the clinical features of gastric stump ulcer (GSU)after partial gastrectomy due to gastroduodenal ulcer.Methods From January 1st 2007 to October 31th 2013,272 patients with partial gastrectomy for gastroduodenal ulcer underwent gastroscopy due to upper gastrointestinal symptoms were collected.Among them,there were 237 male patients and 35 female patients with the average age (55 .4 ± 13.0 )years.The lesion location,symptoms and pathological changes of GSU were analyzed.Chi-square test and Fisher exact probability analysis were used for count data comparison.The t test was performed for measurement data comparison.Results There was no significant difference between patients with GSU after Billroth Ⅰ gastrectomy and Billroth Ⅱ gastrectomy in the incidence of dysphagia,nausea and vomiting,retrosternal pain,retrosternal buring sensation,upper abdominal pain, abdominal distention, acid regurgitation and (or) epigastric buring sensation, hematemesis and (or)melena (all P >0.05 ).The proportion of ulcer located in remnant stomach and anastomotic stoma of patients with Billroth Ⅰ gastrectomy (24.7%,18/73 and 72.6%,53/73 )was higher than those of patients with Billroth Ⅱ gastrectomy (10.1 %,20/199 and 58.3%,116/199 )and the difference was statistically significant (OR=2.929 and 1 .896,95 %CI :1 .448 to 5 .927 and 1 .055 to 3.409,χ2 =9.482 and 4.649,P =0.002 and 0.031 ).There was no significant difference between the proportion of afferent loop and efferent loop ulcer in patients with Billroth Ⅱ gastrectomy and the proportion of duodenal ulcer in patients with Billroth Ⅰ gastrectomy (P =0.619).The diameter of GSU of patients with BillrothⅠ((1.1±0.7)cm)was larger than that of ulcer of patients with BillrothⅡ((0.8±0.6)cm) and the difference was statistically significant (t = 3.591 ,P = 0.007 ).The incidence of intestinal metaplasia and atypic hyperplasia of GSU was 8.1 % (22/272),and there was no significant difference in gastric ulcer,stoma ulcer,nek ulcer,afferent loop and efferent loop ulcer (all P >0.05).The incidence of gastric stump cancer of GSU was 4.0% (11/272)and that of gastric ulcer,stoma ulcer,nek ulcer,afferent loop and efferent loop ulcer was 13.2% (5/38 ),2.4% (4/169 ),1.8% (1/55 )and 1/10,respectively.The incidence of gastric stump cancer of gastric ulcer was significantly higher than that of stoma ulcer and nek ulcer, the differences were statistically significant (OR =6.250 and 8.182,95%CI :1.593 to 24.519 and 0.915 to 73.126,χ2 =8.687 and 4.788,P =0.012 and 0.040).There was no statistically significant difference in the incidence of gastric stump cancer of GSU in other gastric parts (all P > 0.05 ).There was no statistically significant difference in the incidence of intestinal metaplasia,atypic hyperplasia and gastric stump cancer between case with BillrothⅠgastrectomy and case with Billroth Ⅱ gastrectomy (P =0.650 and 0.733).Among the 11 gastric stump cancers,the number of cases with the onset time with 20 years,20-30 years and beyond 30 years after gastrectomy were one,three,seven,respectively.Conclusion The incidence of intestinal metaplasia, atypic hyperplasia and gastric stump cancer of patients with GSU was high,and the predilection site of GSU was the remnant stomach.

The prevalence of non-acidic reflux and its relation with heartburn symptoms in patients with gastroesophageal reflux disease / 中华消化杂志

Objective To investigate the prevalence of non-acidic reflux in patients with gastroesophageal reflux disease and its correlation extent with heartburn symptom by 24-hour combined multichannel intraluminal impedance-pH (MII-pH) monitoring. Methods Consecutive patients with chief complain of heartburn in gastrointestinal specialty clinic were enrolled. Patients were divided into erosive esophagitis (EE) group, non-erosive reflux disease (NERD) group after upper gastrointestinal endoscope, further diagnosed with 24-hour combined MII-pH monitoring and rabeprazole test. The MII-pH parameters were compared in these two groups. Results 36 cases of EE and 62 of NERD were enrolled. There was significant difference in acidic reflux frequency and acidic reflux time percentage between these two groups (P=0. 001 and 0. 002). The frequency of non-acidic reflux in EE and NERD groups was 37.3% (663/1777) and 44.3% (1220/2754) respectively (x2 =21. 723,P = 0. 000). The percentage of heartburn symptom positive index in patients with acidic reflux, non-acidic reflux , and total reflux in EE group was 36.1 % (13/36), 19.4 % (7/36) and 55.6%(20/36) respectively, while in NERD group was 27. 4% (17/62), 6.4 % (4/62) and 33.8% (21/62).Conclusion The percentage of non-acidic reflux in EE and NERD groups was 37.3% and 44.3%respectively, and the non-acidic reflux was highly related to heartburn symptom.

Value of combined multichannel intralumminal impedance-pH monitoring in the diagnosis of gastroesophageal reflux disease / 中华消化杂志

Objective To investigate the role of combined multichannel intralumminal impedanee-pH (MII-pH) monitoring in the diagnosis of gastroesophageal reflux disease (GERD). Methods Forty-four consecutive patients, who had heartburn symptom and without esophageal mucosal lesion, underwent combined MII-pH monitoring. Then rabeprazole test was performed for 14 days with 10 mg twice daily. Rabeprazole test was defined as positive if patients were totally heartburn symptom free in the second week. The normal values from 70 healthy volunteers who underwent MII-pH monitoring were served as controls. Results Conventional esophageal pH monitoring showed that 20 patients (45.5%) had pathologic esophageal acid exposure or positive acid reflux associated symptom index. MII-pH monitoring revealed that 2 patients were positive for weakly acidic reflux related to symptom index, thus increased the diagnostic yield to 50% (22/44). Furthermore, rabeprazole test demonstrated that 4 patients were positive which increased the diagnostic yield to 54.5%(24/44). Conclusion The detective rate of GERD will be elevated if combined with MII-pH monitoring in diagnosis.