[A cough in a patient with cholangitis in the course of caroli's disease. Case report]

Cough may be a manifestation of pulmonary and extra-pulmonary diseases. However, rarely liver disease is suspected as a cause of acute cough. A case of a 34-year-old patient with diagnosed Caroli's disease has been described, in which cough with fever was the main manifestation of cholangitis in the course of complications of the underlying disease. Caroli's disease is a congenital pathology of intrahepatic bile ducts, causing their cysts to widen. It usually has an asymptomatic course, however it promotes infectious complications such as liver abscesses and recurrent cholangitis. The patient was admitted to the ward because of high fever and cough, without any symptoms from the digestive system. On the basis of laboratory, microbiological and visual examinations, various causes of cough were excluded and a diagnosis of cholangitis was made. After appropriate antibiotic therapy, a rapid improvement in the clinical condition and resolution of symptoms was achieved.

[Study the role of lysosome-associated membrane protein type 2A for immune-mediated liver injury of primary biliary cholangitis]

Objective: To investigate the role of lysosome-associated membrane protein type 2A (LAMP-2A) for immune-mediated liver injury of primary biliary cholangitis (PBC). Methods: The association between LAMP-2A expression and PBC was examined by immunohistochemistry and electron microscopy in liver tissue samples from patients with PBC. Furthermore, the immunological damage of LAMP-2A overexpression on mouse liver was observed by adeno-associated virus (AAV) overexpression technique. The expression level of mRNA was analyzed by Student's t-test. The data were graphed and analyzed statistically using graphpad prism 5 (GraphPad Software).A value of p < 0.05 was considered statistically significant. Results: The expression of LAMP-2A in liver tissue of PBC patients was increased, and the autophagosome formation was observed in hepatocytes. C57BL/6 mice were injected into the caudal vein with LAMP-2A AAV for 6 weeks. The formation of autophagosomes in mouse hepatocytes was increased significantly. The expression of related molecules was abnormal; simultaneously, the degree of lymphocyte infiltration in the liver tissue of mice was significantly higher than the control group. Conclusion: An overexpression of LAMP-2A in the liver of patients with PBC may induce and/or promote the hepatic inflammatory response, especially the portal inflammatory infiltrate.

[Gut-liver axis: How intestinal bacteria affect the liver]

BACKGROUND

Liver and intestine are in close contact with each other. The risk of damage to the liver increases, when the intestinal barrier is damaged ("leaky gut") .

METHOD

The review article describes how intestinal bacteria influence the pathogenesis of chronic liver diseases and what treatment options are available.

RESULTS AND CONCLUSIONS

Intestinal dysbiosis plays an important role in the development of chronic liver diseases such as alcoholic liver disease, nonalcoholic fatty liver disease, primary biliary cholangitis, primary sclerosing cholangitis, and cirrhosis. Intestinal microbial modulating therapy with probiotics, prebiotics or synbiotics shows positive effects. The more precise meaning of this therapeutic approach needs to be clarified in further studies.

The Prognostic Value of CD8+ and CD45RO+ T Cells Infiltration and Beclin1 Expression Levels for Early Postoperative Cholangitis of Biliary Atresia Patients after Kasai Operation

BACKGROUND

Postoperative cholangitis is a common but severe complication after Kasai portoenterostomy for biliary atresia (BA). This study aimed to identify its prognostic factors.

METHODS

Two sets of liver paraffin-embedded tissue samples were collected from BA patients who received Kasai portoenterostomy (n = 25 and n = 31, respectively). Patients were divided into non-cholangitis and cholangitis groups. The infiltration of CD4⁺, CD8⁺, CD45RO⁺, CD68⁺ cells and expression of Beclin1 were quantitatively evaluated in immunohistochemical analysis.

RESULTS

Cholangitis group had a significantly lower CD8⁺ T cell infiltration but a higher CD45RO⁺ cell infiltration, and a lower Beclin1 level than non-cholangitis group (all P < 0.01). Multivariate logistic regression analysis indicated that infiltration of CD8⁺ cells (odds ratio [OR], 0.112; 95% confidence interval [CI], 0.022-0.577) and CD45RO⁺ cells (OR, 3.88; 95% CI, 1.37-11.03), and Beclin1 level (OR, 0.088; 95% CI, 0.018-0.452) were independent influence factors for early postoperative cholangitis. Receiver operating characteristic (ROC) analysis showed that area under ROC curve (AUROC) values for CD8⁺ cells, CD45RO⁺ cells and Beclin1 were 0.857, 0.738 and 0.900, respectively.

CONCLUSION

Our findings demonstrated the CD8⁺ cells, CD45RO⁺ cells and Beclin1 level possessed the prognostic value for early postoperative cholangitis following Kasai operation, which may be helpful to develop new prevention and treatment strategies for postoperative cholangitis.

Editorial: scoring systems in primary biliary cholangitis - time to make a move

Linked Content

This article is linked to Yang et al papers. To view these articles visit https://doi.org/10.1111/apt.14010 and https://doi.org/10.1111/apt.13927.

Clinicopathological features of choledocholithiasis patients with high aminotransferase levels without cholangitis: Prospective comparative study

Common bile duct (CBD) stones are generally associated with greater elevations of alkaline phosphatase and gamma-glutamyl transpeptidase levels than aspartate aminotransferase and alanine aminotransferase levels. However, some patients with CBD stones show markedly increased aminotransferase levels, sometimes leading to the misdiagnosis of liver disease. Therefore, the aim of this study was to investigate the clinicopathologic features of patients with CBD stones and high aminotransferase levels.This prospective cohort study included 882 patients diagnosed with CBD stones using endoscopic retrograde cholangiopancreatography (ERCP). Among these patients, 38 (4.3%) exhibited aminotransferase levels above 400 IU/L without cholangitis (gallstone hepatitis [GSH] group), and 116 (13.2%) exhibited normal aminotransferase levels (control group). We compared groups in terms of clinical features, laboratory test results, radiologic images, and ERCP findings such as CBD diameter, CBD stone diameter and number, and periampullary diverticulum. Liver biopsy was performed for patients in the GSH group.GSH patients were younger and more likely to have gallbladder stones than control patients, implying a higher incidence of gallbladder stone migration. Also, GSH patients experienced more severe, short-lasting abdominal pain. ERCP showed narrower CBDs in GSH patients than in control patients. Histological analysis of liver tissue from GSH patients showed no abnormalities except for mild inflammation.Compared with control patients, GSH patients were younger and showed more severe, short-lasting abdominal pain, which could be due to a sudden increase of CBD pressure resulting from the migration of gallstones through narrower CBDs. These clinical features could be helpful not only for the differential diagnosis of liver disease but also for investigating the underlying mechanisms of liver damage in obstructive jaundice. Moreover, we propose a new definition of "gallstone hepatitis" based on the specific clinicopathologic characteristics observed in our patients.

IgG4-associated cholangitis

We report a young female patient with IgG4-associated cholangitis (IAC) who presented with common bile duct (CBD) stricture and review the features that distinguish IAC from both primary sclerosing cholangitis (PSC) and other types of secondary sclerosing cholangitis (SSC). IAC is a biliary manifestation of IgG4-related sclerosing disease, an autoimmune condition characterized by elevated serum IgG4 and infiltrates containing lymphocytes and IgG4-positive plasma cells, accompanied by sclerosis. On endoscopic retrograde cholangiopancreatography, IAC consists of segmental biliary strictures with a predilection for the distal CBD, whereas in PSC the strictures are more band-like; other types of SSC often demonstrate unifocal ductal obstructions, sometimes associated with choleliths. On histologic examination, the bile duct wall in IAC contains a denser lymphocytic infiltrate and sparser sclerosis than in PSC; other types of SSC can be distinguished histologically by the types of inflammatory cells present. Unlike those of PSC, IAC-related strictures are reversible with corticosteroids.

Disability weight of Clonorchis sinensis infection: captured from community study and model simulation

BACKGROUND

Clonorchiasis is among the most neglected tropical diseases. It is caused by ingesting raw or undercooked fish or shrimp containing the larval of Clonorchis sinensis and mainly endemic in Southeast Asia including China, Korea and Vietnam. The global estimations for population at risk and infected are 601 million and 35 million, respectively. However, it is still not listed among the Global Burden of Disease (GBD) and no disability weight is available for it. Disability weight reflects the average degree of loss of life value due to certain chronic disease condition and ranges between 0 (complete health) and 1 (death). It is crucial parameter for calculating the morbidity part of any disease burden in terms of disability-adjusted life years (DALYs).

METHODOLOGY/PRINCIPAL FINDINGS

According to the probability and disability weight of single sequelae caused by C. sinensis infection, the overall disability weight could be captured through Monte Carlo simulation. The probability of single sequelae was gained from one community investigation, while the corresponding disability weight was searched from the literatures in evidence-based approach. The overall disability weights of the male and female were 0.101 and 0.050, respectively. The overall disability weights of the age group of 5-14, 15-29, 30-44, 45-59 and 60+ were 0.022, 0.052, 0.072, 0.094 and 0.118, respectively. There was some evidence showing that the disability weight and geometric mean of eggs per gram of feces (GMEPG) fitted a logarithmic equation.

CONCLUSION/SIGNIFICANCE

The overall disability weights of C. sinensis infection are differential in different sex and age groups. The disability weight captured here may be referred for estimating the disease burden of C. sinensis infection.

Early ERCP in acute gallstone pancreatitis without cholangitis: a meta-analysis

CONTEXT

Early ERCP was reported to result in recovery from acute gallstone pancreatitis. To date, several RCTs comparing it to conservative treatment have yielded different results.

OBJECTIVE

We conducted a meta-analysis to determine the effect of early ERCP on the morbidity and mortality of acute gallstone pancreatitis without cholangitis.

METHODS

We searched the following databases up to January 11(th), 2008: the Cochrane Library, MEDLINE, EMBASE, the Australasian Medical Index, Latin American Caribbean Health Sciences Literature, and the Health Research and Development Information Network. References were scrutinized. Authors were contacted. There were no restrictions regarding language, publication date or publication status.

RESULTS

Seven RCTs were retrieved, but only two RCTs involving 177 treated patients and 163 control patients were included. A meta-analysis on morbidity was inconclusive (RR=0.95, 95% CI: 0.74-1.22). Meta-analysis on mortality only showed a trend in favor of conservative management (RR=1.92, 95% CI: 0.86-4.32) for both mild and severe pancreatitis.

CONCLUSIONS

There is a trend towards more mortality from early ERCP with or without sphincterotomy in the setting of acute gallstone pancreatitis without cholangitis. However, more studies are needed. In the meantime, early ERCP should not be carried out unless there is at least a slight suspicion of cholangitis or persistent ampullary obstruction.

Prise en charge de la lithiase de la voie biliaire principale

Choledocholithiasis is a not uncommon and potentially grave condition which requires a well-adapted approach. Echo endoscopy and biliary MRI have improved the ability to make the diagnosis non-invasively, but intraoperative cholangiography remains the most accurate study. A surgical approach permits simultaneous treatment of both choledocholithiasis and the associated cholecystolithiasis; laparoscopic common duct exploration has been more frequently performed through a laparoscopic approach in recent years, but this procedure requires specific equipment and surgical experience. In most circumstances, surgery should be preferred to endoscopic clearance of the common duct, but endoscopy may be preferred in the setting of severe cholangitis or pancreatitis. The importance of a systematic search for asymptomatic choledocholithiasis is once again emphasized.