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Philips CA, Augustine P, Ahamed R, Rajesh S, George T, Kumbar S, Padsalgi G, Mahadevan P. Acute exacerbated severe form of nonalcoholic steatohepatitis leading to acute-on-chronic liver failure: A case series. Indian J Gastroenterol 2020; 39:97-101. [PMID: 32291579 DOI: 10.1007/s12664-020-01028-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/25/2020] [Indexed: 02/04/2023]
Abstract
We present three patients with uncontrolled metabolic syndrome and acute-on-chronic liver failure in whom, after meticulous evaluation, the acute event was found to be a severe and exacerbated form of nonalcoholic steatohepatitis (NASH), a novel entry in the natural history of non-alcoholic fatty liver disease. This novel disease entity was described partially, 17 years before by Caldwell et al. We discuss current literature, pertinent features, and outcomes associated with a severe form of NASH, which is associated with high mortality.
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Affiliation(s)
- Cyriac Abby Philips
- The Liver Unit, Monarch Liver Lab and Division of Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Centre, National Highway Bypass, Palarivattom, Kochi, 682 028, India. .,Philip Augustine Associates, 35/194 B, Symphony, Automobile Road, Palarivattom, Kochi, 682 025, India.
| | - Philip Augustine
- The Liver Unit, Monarch Liver Lab and Division of Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Centre, National Highway Bypass, Palarivattom, Kochi, 682 028, India.,Philip Augustine Associates, 35/194 B, Symphony, Automobile Road, Palarivattom, Kochi, 682 025, India
| | - Rizwan Ahamed
- The Liver Unit, Monarch Liver Lab and Division of Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Centre, National Highway Bypass, Palarivattom, Kochi, 682 028, India
| | - Sasidharan Rajesh
- The Liver Unit, Monarch Liver Lab and Division of Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Centre, National Highway Bypass, Palarivattom, Kochi, 682 028, India
| | - Tom George
- The Liver Unit, Monarch Liver Lab and Division of Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Centre, National Highway Bypass, Palarivattom, Kochi, 682 028, India
| | - Sandeep Kumbar
- The Liver Unit, Monarch Liver Lab and Division of Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Centre, National Highway Bypass, Palarivattom, Kochi, 682 028, India
| | - Guruprasad Padsalgi
- The Liver Unit, Monarch Liver Lab and Division of Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Centre, National Highway Bypass, Palarivattom, Kochi, 682 028, India
| | - Pushpa Mahadevan
- Pathology, VPS Lakeshore Hospital, Maradu, Nettoor, Kochi, 682 018, India
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Mackay TM, Genç CG, Takkenberg RB, Besselink MG, Somers I, Nieveen van Dijkum EJM. New onset non-alcoholic fatty liver disease after resection of pancreatic neuroendocrine tumors. J Surg Oncol 2018; 117:1548-1555. [PMID: 29572825 PMCID: PMC6055648 DOI: 10.1002/jso.25051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 02/26/2018] [Indexed: 12/11/2022]
Abstract
Background and Objectives Non‐alcoholic fatty liver disease (NAFLD) and non‐alcoholic steatohepatis (NASH) may occur after pancreatic resection due to exocrine pancreatic insufficiency (EPI). Patients with long‐term survival, such as after pancreatic neuroendocrine tumor (pNET) resection, are at risk of NAFLD/NASH. We aimed to determine the incidence and risk factors for new onset NAFLD/NASH and EPI after pNET resection. Methods Retrospective monocenter cohort study. Patients who underwent pNET resection (1992‐2016) were assessed for new onset NAFLD/NASH and EPI. Postoperative NAFLD/NASH was determined by a blinded abdominal radiologist, who compared pre‐ and postoperative imaging. Results Out of 235 patients with pNET, a total of 112 patients underwent resection and were included with a median follow‐up of 54 months. New onset NAFLD/NASH occurred in 20% and EPI in 49% of patients. Multivariate analysis showed that the only risk factor for new onset NAFLD/NASH was recurrent disease (OR 4.4, 95% CI 1.1‐16.8, P = 0.031), but not EPI (OR 0.94, 95% CI 0.3‐2.8, P = 0.911). The only risk factor for EPI was pancreatoduodenectomy (OR 4.3, 95% CI 1.4‐13.7, P = 0.012). Conclusions New onset NAFLD/NASH is occasionally found after pNET resection, especially in patients with recurrent disease, but is not related to EPI.
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Affiliation(s)
- Tara Michella Mackay
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Cansu Güney Genç
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Robert Bart Takkenberg
- Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Marc Gerard Besselink
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Inne Somers
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
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