Advances in Noninvasive Biomarkers for Nonalcoholic Fatty Liver Disease.

Nonalcoholic fatty liver disease (NAFLD) currently represents one of the most common liver diseases worldwide. Early diagnosis and disease staging is crucial, since it is mainly asymptomatic, but can progress to nonalcoholic steatohepatitis (NASH) or cirrhosis or even lead to the development of hepatocellular carcinoma. Over time, efforts have been put into developing noninvasive diagnostic and staging methods in order to replace the use of a liver biopsy. The noninvasive methods used include imaging techniques that measure liver stiffness and biological markers, with a focus on serum biomarkers. Due to the impressive complexity of the NAFLD's pathophysiology, biomarkers are able to assay different processes involved, such as apoptosis, fibrogenesis, and inflammation, or even address the genetic background and "omics" technologies. This article reviews not only the currently validated noninvasive methods to investigate NAFLD but also the promising results regarding recently discovered biomarkers, including biomarker panels and the combination of the currently validated evaluation methods and serum markers.

Interrelations between elevated alpha-fetoprotein levels and tumor morphology of patients with hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer related deaths worldwide, while at the same time having a constant growth in incidence. A commonly used biomarker in managing liver cancer cases, alpha-fetoprotein (AFP) is losing clinical ground in favor of imaging studies and emerging biomarkers. The study aims to reassess potential prognosis indicators and risk factors for an elevated level of this glycoprotein by analyzing its relationship with macroscopic morphology tumor-related features. PATIENTS, MATERIALS AND METHODS: One hundred and thirty-one newly diagnosed HCC patients had their clinical, tumor and liver disease features investigated in contrast to elevated AFP levels with 200 IU∕mL being used as preferred cut-off. RESULTS: Tumor size =5 cm [odds ratio (OR) 3.36, 95% confidence interval (CI): 1.29-8.74, p=0.013] is an independent tumor-related predictor of markedly elevated AFP values. Noteworthy connections with the type of tumor, multinodular appearance and portal vein thrombosis were also found through univariate analysis. CONCLUSIONS: AFP could still be a reliable tool in diagnosis and prognosis of HCC patients especially in developing countries due to its relevant association with aspects of advanced tumor and liver disease, gender and a poor functional status.

Efficacy of Helicobacter pylori eradication therapy in cirrhotic patients with peptic ulcer disease.

UNLABELLED: Few studies have been focused on the role of Helicobacter pylori eradication in cirrhotic patients with peptic ulcer and the reported results are conflicting. AIM: To evaluate the efficacy of proton pump inhibitor (PPI)-based triple therapy on peptic ulcer course in patients with liver cirrhosis. MATERIAL AND METHODS: This prospective study was carried out in a tertiary-care hospital. Of the 63 consecutive cirrhotic patients with peptic ulcer identified by endoscopy 39 (22 males, 14 females, aged 53 to 62 years) entered the study. The patients with peptic ulcer and H. pylori infection received eradication therapy, while H. pylori negative patients received PPI treatment. H. pylori eradication was confirmed by rapid urease test and histological examination. Follow-up endoscopies were performed at 6 and 12 months. The patients with peptic ulcer recurrence were treated with PPI. RESULTS: Of the 39 selected patients 22 (56.4%) were H. pylori positive, and 17 (43.6%) were H. pylori negative. H. pylori was eradicated in 63.6% (14/22) of the patients. During the follow-up period 2 H. pylori negative patients died from variceal bleeding and hepatic encephalopathy, respectively, and one H. pylori positive patient did not return for further assessment). Ulcers recurring within 1 year were found in 14 of 36 (38.8%) patients. Peptic ulcer recurred in 4 of 21 (19.0%) H. pylori positive patients and in 10 of 15 (47.6%) H. pylori negative patients at study entry. Patients' age (p = 0.018), Child-Pugh stage (p = 0.019), peptic ulcer site (p = 0.008), and H. pylori negative status (p = 0.004) were significantly related to ulcer recurrence. CONCLUSIONS: Eradication of H. pylori infection in patients with liver cirrhosis and peptic ulcer disease could be helpful, but does not protect all cirrhotic patients from peptic ulcer recurrence. Most relapsed ulcers were gastric ulcers in H. pylori negative patients.

Spiral enteroscopy--a novel method for the management of small bowel diseases--case report and description of technique.

Small bowel diseases are associated with difficult management. Recently, new methods such as single or double balloon enteroscopy and capsule endoscopy have been implemented for the investigation of small bowel, but none is perfect. Spiral enteroscopy seems to be an alternative primising technique for the diagnosis and therapy of small bowel diseases. We report two cases in which spiral enetroscopy was useful both for diagnosis and therapy. One was the case of a man with repeated digestive bleeding of unknown cause and spiral enteroscopy helped for diagnosis and treatment with argon plasma coagulation of the vascular lesions. The later was a patient with Gartner Syndrome with multiple duodenal and intestinal polyps and spiral enteroscopy allowed small bowel evaluation. In conclusion, this novel method seems to allow a rapid and efficient diagnosis of small bowel diseases.

[Peptic ulcer disease in liver cirrhosis: role of Helicobacter pylori infection and therapeutic approach]. / Maladia peptica in ciroza hepatica: rolul infectiei cu Helicobacter pylori si conduita terapeutica.

Peptic ulcer has frequently been associated with liver cirrhosis. The death rate for peptic ulcer in cirrhotics has been reported to be five times higher than in general population. The underlying mechanisms are poorly understood. Different factors have been claimed to be involved, such as alterations in serum gastrin level, gastric acid secretions, mucosal blood flow and decreased prostaglandin production in gastric mucosa. Moreover, Helicobacter pylori infection, when accurately assessed, is detectable in most peptic ulcer cirrhotics. Since the H. pylori infection strongly correlates with peptic ulcer in general population, it is necessary to clarify the role of H. pylori in the pathogenesis of peptic ulcer in cirrhosis before eradication can be proposed as a preventive measure.

[Hemostatic disorders in liver disease]. / Anomaliile hemostazei in suferintele hepatice.

Hemorrhagic complications are common in patients with liver diseases and contribute to the morbidity and mortality associated to this condition. The liver plays a central role in the hemostatic process as here all clotting factors and their inhibitors are synthetized. Liver damage is commonly associated with variable impairment of hemostasis due to multiple causes: decreased synthesis of clotting and inhibitor factors, decreased clearance of activated factors, hyperfibrinolysis, accelerated intravascular coagulation, quantitative and qualitative platelet defects. Their clinical implications remain to be elucidated, so further studies addressing this issue are needed.

Extragastric manifestations of Helicobacter pylori infection.

The role of Helicobacter pylori (HP) in some digestive diseases (gastritis, ulcer, gastric cancer, MALT lymphoma) is well known. It has been suggested relatively recently that infection with HP can be involved in various extra-digestive conditions: respiratory disorders (chronic obstructive pulmonary disease, bronchiectasis, lung cancer, pulmonary tuberculosis, bronchial asthma); vascular disorders (ischaemic heart disease, stroke, primary Raynaud phenomena, primary headache); autoimmune disorders (Sjogren syndrome, Henoch-Schonlein purpura, autoimmune thrombocytopenia, autoimmune thyroiditis, Parkinson's disease, idiopathic chronic urticaria, rosacea, alopecia areata); other disorders (iron deficiency anaemia, growth retardations, liver cirrhosis). Case studies, small patient series and non-randomized trials that have shown a beneficial effect of HP eradication in different conditions are not convincing. According to Mastricht III the only conditions where HP eradication is indicated are immune thrombocytopenic purpura and iron deficiency anaemia.

[The changing spectrum of lower gastrointestinal haemorrhages]. / Evolutia spectrului etiologic al hemoragiilor digestive inferioare (HDI).

UNLABELLED: Lower gastrointestinal haemorrhage (LGH) is a frequent reason for medical referral. It has an annual incidence ranging between 17 and 20.5 cases per 100,000 adults and represents 20-30% of all gastrointestinal haemorrhages. OBJECTIVE: To evaluate the evolution of the etiologic spectrum of lower gastrointestinal bleeding. METHODS: All the files of patients with lower gastrointestinal bleeding admitted in our unit between 1990 and 2001 were reviewed retrospectively. The annual admission and annual admission rates for each disease (disease/total LGH in a specific year) were analysed using linear regression. RESULTS: We identified 2565 patients with LGH (mean age 50.8+/-8.7 years, 1338 (52%) men and 1227 (48%) women). The annual number of patients had a linear increase (p<0.05) from 103 in 1990 to 399 in 2001. The mean age of the patients increased linearly from 48.5 to 53 years (p<0.05). The annual rate for some specific diseases has changed over time. There was a trend of increase for the colorectal cancer and polyps, which reach statistical significance for diverticular disease and haemorrhoids (p<0.05). While the annual incidence for ulcerative colitis remained constant the annual rates decrease. For Crohn disease, angiodysplasia and radiation colitis no changes was found.

[Abdominal pain in liver cirrhosis patient--an unusual case]. / Durerea abdominala la pacientul cirotic--un caz neobisnuit.

We present the case of a 62 years male subjects, known with liver cirrhosis diagnosed in 2000 during a laparoscopy. The subject presented with important atypical abdominal pain, leucocytosis, thrombocytosis, small ascites; pneumatosis and hydro-aeric images of small intestine at abdominal X Ray, thickened bowel wall at CT-scan. Laparoscopy revealed mesenteric venous thrombosis, intestinal infarction and the standard surgical treatment was enterectomy. Mesenteric thrombosis may rarely occur in liver cirrhosis due to portal hypertension. This rare but severe complication is usually difficult to diagnose..

[Liver metastases with unknown primary site]. / Metastazele hepatice cu punct de plecare necunoscut.

Patients with unknown primary site cancer represents 5% to 10% of all neoplasia patients. Liver is a favourite site for gastrointestinal tumors, but not only. The adenocarcinomas represents 60% of patients from this group. A detailed physical examination, extensive laboratory and imaging procedures are necessary to locate the primary tumor. However, liver biopsy could be essential for histological diagnosis and important to identify the tumors who may benefit from specific and effective therapy (breast cancer, prostate cancer, ovarian cancer and small-cell carcinoma of the lung). Systemic chemotherapy represents the most frequently treatment, but only patients with good performance status and without co-morbidities may benefit. "Best supporting care" may be the optimal treatment for most patients, majority with poor performance status at the time of diagnosis.

[Functional digestive disorders and the relationship with psychiatric diseases]. / Afectiunile digestive functionale si relatia lor cu antecedentele psihiatrice.

UNLABELLED: Functional gastrointestinal disorders are frequent causes for medical consultations. Features related to disease, patient or the environment could influence the medical referral. The aim of the study was to estimate the importance of psychiatric disorders in patients with functional gastrointestinal disorders. MATERIAL AND METHOD: The study was designed to have two phases. Phase I consisted in studying the prevalence of Irritable Bowel Syndrome (IBS) and psychiatric past history in a random sample of 338 from an urban community of 18000 people. Phase II consisted in studying the presence of psychiatric history in patients referred for IBS symptoms. RESULTS: The prevalence of IBS symptoms in the general population was: 14.4% (8.4% in males and 17.7% in females). Psychiatric positive history was present in 6.2% of the general population and in 6.1% of IBS subjects (p > 0.05). Psychiatric disorders were more common in the IBS subjects who were seeking medical assistance (18%) than in subjects with same symptoms from the general population (6.2%) (p < 0.05). CONCLUSIONS: Psychiatric disorders may influence the medial referral for patients with IBS.