Effects of late evening snack on diurnal plasma glucose profile in patients with chronic viral liver disease.

AIM: Glycemic control is important to improve the prognosis in cirrhotic patients with complications from diabetes. A late evening snack (LES) has been recommended for cirrhotic patients. We investigated the effects of LES on diurnal plasma glucose levels. METHODS: Subjects comprised 47 patients with chronic viral liver disease (chronic hepatitis, n = 11; cirrhosis, n = 36) treated in the Department of Gastroenterology & Hepatology, Dokkyo Medical University Koshigaya Hospital. Diurnal variations in plasma glucose were first investigated with three meals/day, in accordance with the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines. Starting the next day, patients were given four meals including a LES, without changing meal content. Diurnal variations in plasma glucose were examined on day 7, and urine C-peptide immunoreactivity (CPR), and homeostasis model assessment insulin resistance (HOMA-IR) were investigated. RESULTS: With a LES, plasma glucose levels in patients with chronic hepatitis were significantly lower 2 hours before and 2 hours after dinner. In cirrhotic patients, significant decreases in plasma glucose levels were seen 2 hours after breakfast, before lunch, and before dinner. Significant decreases were noted in average plasma glucose levels and highest plasma glucose levels with four meals including a LES in patients with liver cirrhosis. This decrease was greater when maximum plasma glucose levels were higher on the three-meal regimen. CONCLUSIONS: Improvements in plasma glucose levels were seen with four meals per day, including a LES, in viral chronic liver disease, particularly cirrhosis.

Measurement of serum branched-chain amino acids to tyrosine ratio level is useful in a prediction of a change of serum albumin level in chronic liver disease.

AIM: In patients with hepatitis C virus (HCV)-associated chronic liver diseases, especially in those with liver cirrhosis, accurate evaluation of their protein nutrition status is very important to improve their quality of life. Whereas the serum albumin level is commonly used to evaluate patients' protein nutrition status, in the present study, the serum amino acid levels were measured, as they also provide valuable information. METHODS: Serum albumin levels and branched-chain amino acids (BCAA) to tyrosine ratio (BTR) were determined in 447 patients with HCV-associated chronic liver diseases (313 with chronic hepatitis and 134 with liver cirrhosis). RESULTS: Chronic hepatitis progressed to liver cirrhosis, serum albumin and serum BTR levels decreased significantlyas chronic hepatitis progressed to liver cirrhosis. Hypoalbuminemia was significantly more common in patients with liver cirrhosis than in those with chronic hepatitis; however, the incidence of an amino acid imbalance was significantly higher than that of hypoalbuminemia in patients with liver cirrhosis. The presence of an amino acid imbalance was associated with a reduction in the serum albumin level 1 year later. CONCLUSIONS: It is important to evaluate serum albumin levels and the BTR in patients with HCV-associated chronic liver diseases.

Effect of symptomatic gastroesophageal reflux disease on quality of life of patients with chronic liver disease.

AIM: Reflux esophagitis is becoming increasingly more prevalent in Japan. It has been noted that symptomatic gastroesophageal reflux disease (GERD) and chronic liver disease may adversely affect patients' quality of life. METHODS: In the present study, 238 chronic liver disease patients (151 patients with chronic hepatitis and 87 patients with liver cirrhosis) were enrolled. The diagnosis of GERD was made based on the Quality-of-Life and Utility Evaluation Survey Technology questionnaire. Health-related quality of life was evaluated using the Short Forum 36 questionnaire. RESULTS: Symptomatic GERD was present in 31.8% (48/151) of patients with chronic hepatitis and 36.8% (32/87) of patients with liver cirrhosis. Among the chronic hepatitis group, compared to the GERD-negative group, the GERD-positive group had significantly lower scores in six domains, including "rolelimitation due to physical problem", "bodily pain", "general health perception", "vitality", "role limitation due to emotional problem", and "mental health". Among the cirrhotic group, compared to the GERD-negative group, the GERD-positive group had significantly lower scores in the "role limitation due to emotional problem" domain. Significant improvement in the "physical functioning", "bodily pain", and "general health perception" domain scores was noted in chronic hepatitis patients treated with rabeprazole. CONCLUSION: The QOL of chronic liver disease patients with symptomatic GERD was impaired.

Proton pump inhibitors and recurrent bleeding in peptic ulcer disease.

Peptic ulcer disease (PUD) is one of the main lesions responsible for upper gastrointestinal (GI) bleeding, as well as esophageal varices and Mallory-Weiss tear. Helicobacter pylori and non-steroidal anti-inflammatory drugs (NSAIDs)/aspirin are the major responsible causes. In cases of upper GI bleeding, urgent endoscopy is performed after stabilization of vital signs. There are several modalities for controlling bleeding in PUD, such as ethanol injection or hypertonic saline with epinephrine. Recurrent bleeding occurs in 20% of patients after endoscopic therapy. The combination of endoscopic intervention and a proton pump inhibitor (PPI) is necessary to achieve hemostasis of active bleeding. It has been reported that high-dose omeprazole (80 mg bolus injection, then 8 mg/h continuous infusion for 72 h, then 40 mg/day orally for 1 week) can reduce recurrent bleeding, the need for surgery and mortality from hemorrhagic shock in patients with high-risk peptic ulcer bleeding, as compared with standard-dose omeprazole. The metabolism of PPIs is dependent upon P450 2C19 genotypes and the clinical usefulness of genotypic analysis remains to be determined.

[PPI-test].

GERD (gastro esophageal reflux disease) is defined as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Endoscopic-positive GERD can be easily diagnosed with endoscopy, while endoscopic-negative GERD cannot be. PPI test, which reveals the disorders by judging symptom-relief after PPI administration, is an effective tool for diagnosis of NERD, and extraesophageal GERD such as LPRD and bronchial asthma. Diagnostic power of PPI test is limited owing to the low PPI's cure rate against NERD, about 40%. PPI test-negative NERD is considered as non-acid associated NERD. Most of the NERD patients have the symptoms of functional dyspepsia(FD) for which the most effective medication is PPI administration, leading to the notion that subgroup of GERD and FD is considered as an acid associated disorder. This diagnostic entity is practical in a sense that anti-acid treatment is very effective for this disease. Besides, PPI test is a very useful tool to differentiate acid associated disorder from GERD and/or FD.

View-independent reconstruction algorithms for cone beam CT with general saddle trajectory.

In Yang et al (2006 Phys. Med. Biol. 51 1157-72), an exact filtered backprojection (FBP) reconstruction algorithm was proposed for cone beam tomography with saddle trajectory based on the seminal works of Pack and Noo (2005a Inverse Problems 21 1105-20; 2005b 8th Int. Meeting on Fully 3D Reconstruction in Radiology and Nuclear Medicine (Salt Lake City) ed F Noo, H Kudo and L G Zeng pp 287-90). However, the artefacts due to discretization and/or sampling errors in the reconstructed images by this method were still visible, especially when the pitch is large. In this paper, two view-independent (VI) algorithms, which are similar to the FDK-type algorithms (Feldkamp et al 1984 J. Opt. Soc. Am. A 1 612-19), are proposed for planar detector geometry. The first VI algorithm involves two filtered projections and a small additional term (two-dimensional (2D) Radon transform term). One of the filtered projections is obtained by ramp filtering (as in the FDK algorithm for circular trajectory) and the other one is obtained by Hilbert transform. The 2D Radon transform term is just like the term which was first derived by Hu (1996 Scanning 18 572-81) for a circular trajectory. The second VI algorithm involves only one filtered projection term, which is obtained by differentiation followed by Hilbert transform and the 2D Radon transform term. Both algorithms involve only one backprojection step with a weighting factor as in the FDK algorithm. The simulation studies show that the pixel values of the reconstructed images by the VI algorithms are more accurate than those by the original view differencing (VD) algorithm, the streak artefacts are also reduced, and their computational times are comparable to that of the original VD algorithm. We also generalize the concept of saddle trajectory and the corresponding reconstruction algorithm. The generalized algorithm is also theoretically exact, has a shift-invariant FBP structure, and does not depend on the concept of pi-line.

Exact cone beam reconstruction for a saddle trajectory.

We propose an exact shift-invariant filtered backprojection (FBP) algorithm for inversion of cone beam (CB) data in the case where the source trajectory is a saddle. The algorithm allows for axial truncation of the cone beam data. The algorithm involves only one family of filtering lines on the detector plane, and it does not depend on the existence of pi-lines. The algorithm is derived from a general formula in Pack and Noo (2005 Inverse Problems 21 1105-20). We also give the steps to implement the algorithm for planar detector geometry and discuss how to select the parameter of the saddle and the size of the detector when the trajectory is a standard saddle. The algorithm is tested by simulation studies.