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Zhang Q, Li Y, Hu H, Tian M, Cao T, Wu H, Wu W, Zhang G. Serum arsenic augments gallstone risk in Henan rural cohort with multiple metal exposure. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 952:175991. [PMID: 39236814 DOI: 10.1016/j.scitotenv.2024.175991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 08/31/2024] [Accepted: 08/31/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND People are exposed to metals in various ways during their daily lives. However, the association between metal exposure and gallstones remains unclear. OBJECTIVES To investigate the relationship between serum elemental concentrations and the risk of gallstones. METHODS Participants (n = 4204) were drawn from the Henan Rural Cohort. Gallstone diagnosis was based on abdominal ultrasound reports during follow-up. Baseline serum elemental concentrations were measured using inductively coupled plasma mass spectrometry. The relationship between serum elemental levels and gallstones was evaluated using robust Poisson regression, restricted cubic spline (RCS), quantile g-computation (Qgcomp), grouped weighted quantile sum (GWQS) and Bayesian kernel machine regression (BKMR). RESULTS 121 individuals were diagnosed with gallstone (incidence rate of 2.88 %). In robust Poisson regression, after adjusting for confounding factors, the highest quartile of arsenic concentration compared to the lowest quartile had a 1.90 times higher relative risk (RR) [95 % confidence interval (CI): 1.05, 3.44]. Conversely, the highest quartile of zinc concentration compared to the lowest quartile had a 0.50 times lower RR (95 % CI: 0.28, 0.89). RCS showed an approximately "S"-shaped nonlinear relationship between serum arsenic levels and gallstones, with increasing arsenic concentration leading to a higher risk of gallstones; however, the risk plateaued when arsenic concentration exceeded 0.62 μg/L. Both the Qgcomp and GWQS indicated that arsenic plays a significant role in increasing the risk of gallstones, whereas zinc plays a significant role in reducing the risk of gallstones. BKMR showed that raising arsenic exposure from the 25th to the 75th percentile increased the risk of gallstones, while raising serum zinc concentration reduced it. CONCLUSIONS Higher serum arsenic concentration increases the risk of gallstones, whereas higher zinc concentration may reduce the risk. Effective prevention of gallstones may require further reduction of arsenic exposure and appropriate increases in zinc intake.
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Affiliation(s)
- Qian Zhang
- School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Yating Li
- School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Han Hu
- School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Meichen Tian
- School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Tingting Cao
- School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Hui Wu
- School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Weidong Wu
- School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan, China.
| | - Guofu Zhang
- School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan, China.
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Wang M, Guo J, Sun S. Dietary fatty acids and gallstone risk: insights from NHANES and Mendelian randomization analysis. Front Nutr 2024; 11:1454648. [PMID: 39211832 PMCID: PMC11358065 DOI: 10.3389/fnut.2024.1454648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Background Prior research suggests polyunsaturated fatty acids (PUFA) may prevent gallstones, but evidence on saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA) is limited. This study aims to explore the associations between fatty acids and gallstones using a large sample of American population and Mendelian randomization (MR) methods. Methods The cross-sectional study involved 6,629 participants from the National Health and Nutrition Examination Survey (NHANES) 2017-2020. Logistic regression and restricted cubic spline (RCS) analysis were conducted after stratifying by gender subgroups. Two-sample MR analysis was used to explore the causal relationship between fatty acids and gallstones without confounding factors. Results In females, higher SFA intake was positively associated with gallstone risk, while higher intake of n-3 and n-6 PUFA was negatively associated. No significant associations were found in males. No nonlinear correlations were found in any group by RCS analysis. MR analysis indicated that SFA, n-3, and n-6 PUFA could reduce gallstone risk. Conclusion The influence of dietary fatty acid composition on gallstone development differs by gender, providing insights into dietary prevention and treatment of gallstones.
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Affiliation(s)
| | | | - Siyu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
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Bhalla S, Mcquillen B, Cay E, Reau N. Preoperative risk evaluation and optimization for patients with liver disease. Gastroenterol Rep (Oxf) 2024; 12:goae071. [PMID: 38966126 PMCID: PMC11222301 DOI: 10.1093/gastro/goae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/24/2024] [Accepted: 06/14/2024] [Indexed: 07/06/2024] Open
Abstract
The prevalence of liver disease is rising and more patients with liver disease are considered for surgery each year. Liver disease poses many potential complications to surgery; therefore, assessing perioperative risk and optimizing a patient's liver health is necessary to decrease perioperative risk. Multiple scoring tools exist to help quantify perioperative risk and can be used in combination to best educate patients prior to surgery. In this review, we go over the various scoring tools and provide a guide for clinicians to best assess and optimize perioperative risk based on the etiology of liver disease.
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Affiliation(s)
- Sameer Bhalla
- Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | | | - Edward Cay
- Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Nancy Reau
- Internal Medicine, Division of Digestive Diseases, Section of Hepatology, Rush University Medical Center, Chicago, IL, USA
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Ding M, Yin Y, Wang X, Zhu M, Xu S, Wang L, Yi F, Abby Philips C, Gomes Romeiro F, Qi X. Associations of gallbladder and gallstone parameters with clinical outcomes in patients with cirrhosis. J Transl Int Med 2024; 12:308-316. [PMID: 39081278 PMCID: PMC11285020 DOI: 10.2478/jtim-2022-0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
Background Morphologic changes in the gallbladder and gallstones are common in cirrhotic patients, but their associations with outcomes of cirrhotic patients are unclear. Methods We retrospectively enrolled 206 cirrhotic patients and measured their gallbladder length and width, gallbladder wall thickness, presence of gallstones, and gallstones' length and width in axial contrast-enhanced computed tomography (CT) images. X-tile software was utilized to calculate the optimal cutoff values of these parameters for evaluating survival and hepatic decompensation events in the cirrhosis group. Their associations with survival were explored by Cox regression analyses and Kaplan-Meier curve analyses. Their associations with hepatic decompensation events were evaluated by competing risk analyses and Nelson-Aalen cumulative risk curve analyses where death was a competing event. Results Cirrhotic patients with gallbladder length < 72 mm had a significantly higher cumulative survival rate than those with a length of ≥ 72 mm (P = 0.049 by log-rank test), but gallbladder width, gallbladder wall thickness, presence of gallstones, and gallstones' length and width were not significantly associated with survival (P = 0.10, P = 0.14, P = 0.97, P = 0.73, and P = 0.73 by log-rank tests, respectively). Cirrhotic patients with gallbladder wall thickness < 3.4 mm had a significantly lower cumulative rate of hepatic decompensation events than those with a wall thickness of ≥ 3.4 mm (P = 0.02 by Gray's test), but gallbladder length and width, presence of gallstones, and gallstones' length and width were not significantly associated with hepatic decompensation events (P = 0.15, P = 0.15, P = 0.54, P = 0.76, and P = 0.54 by Gray's tests, respectively). Conclusion Changes in gallbladder length and gallbladder wall thickness, rather than gallstone parameters, may be in parallel with the long-term outcomes of cirrhotic patients.
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Affiliation(s)
- Min Ding
- Liver Cirrhosis Study Group, Department of Gastroenterology, the General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang 110840, Liaoning Province, China
| | - Yue Yin
- Liver Cirrhosis Study Group, Department of Gastroenterology, the General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang 110840, Liaoning Province, China
| | - Xueying Wang
- Liver Cirrhosis Study Group, Department of Gastroenterology, the General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, Liaoning Province, China
- Postgraduate College, Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China
| | - Menghua Zhu
- Liver Cirrhosis Study Group, Department of Gastroenterology, the General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, Liaoning Province, China
- Postgraduate College, Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China
| | - Shixue Xu
- Liver Cirrhosis Study Group, Department of Gastroenterology, the General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang 110840, Liaoning Province, China
| | - Le Wang
- Liver Cirrhosis Study Group, Department of Gastroenterology, the General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang 110840, Liaoning Province, China
| | - Fangfang Yi
- Liver Cirrhosis Study Group, Department of Gastroenterology, the General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, Liaoning Province, China
| | - Cyriac Abby Philips
- Clinical and Translational Hepatology & Monarch Liver Laboratory, the Liver Institute Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Kochi682028, India
| | - Fernando Gomes Romeiro
- Gastroenterology Division, Department of Internal Medicine, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu18608917, Brazil
| | - Xingshun Qi
- Liver Cirrhosis Study Group, Department of Gastroenterology, the General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang 110840, Liaoning Province, China
- Postgraduate College, Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China
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Liu D, Dong Y, Gao J, Wu Z, Zhang L, Wang B. Role of the circular RNA regulatory network in the pathogenesis of biliary atresia. Exp Ther Med 2024; 27:95. [PMID: 38313582 PMCID: PMC10831818 DOI: 10.3892/etm.2024.12383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/13/2023] [Indexed: 02/06/2024] Open
Abstract
Circular RNAs (circRNAs) serve an essential role in the occurrence and development of cholangiocarcinoma, but the expression and function of circRNA in biliary atresia (BA) is not clear. In the present study, circRNA expression profiles were investigated in the liver tissues of patients with BA as well as in the choledochal cyst (CC) tissues of control patients using RNA sequencing. A total of 78 differentially expressed circRNAs (DECs) were identified between the BA and CC tissues. The expression levels of eight circRNAs (hsa_circ_0006137, hsa_circ_0079422, hsa_circ_0007375, hsa_circ_0005597, hsa_circ_0006961, hsa_circ_0081171, hsa_circ_0084665 and hsa_circ_0075828) in the liver tissues of the BA group and control group were measured using reverse transcription-quantitative polymerase chain reaction. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis demonstrated that the identified DECs are involved in a variety of biological processes, including apoptosis and metabolism. In addition, based on the GO and KEGG pathway enrichment analyses, it was revealed that target genes that can be affected by circRNAs regulatory network were enriched in the TGF-β signaling pathway, EGFR tyrosine kinase inhibitor resistance pathway and transcription factor regulation pathway as well as other pathways that may be associated with the pathogenesis of BA. The present study revealed that circRNAs are potentially implicated in the pathogenesis of BA and could help to find promising targets and biomarkers for BA.
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Affiliation(s)
- Dong Liu
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, Guangdong 518000, P.R. China
| | - Yinghui Dong
- Department of Ultrasound, Shenzhen People's Hospital, Shenzhen, Guangdong 518000, P.R. China
| | - Jiahui Gao
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, Guangdong 518000, P.R. China
| | - Zhouguang Wu
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, Guangdong 518000, P.R. China
| | - Lihui Zhang
- Department of Traditional Chinese Medicine, Shenzhen Children's Hospital, Shenzhen, Guangdong 518000, P.R. China
| | - Bin Wang
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, Guangdong 518000, P.R. China
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Virk MS, Virk MA, He Y, Tufail T, Gul M, Qayum A, Rehman A, Rashid A, Ekumah JN, Han X, Wang J, Ren X. The Anti-Inflammatory and Curative Exponent of Probiotics: A Comprehensive and Authentic Ingredient for the Sustained Functioning of Major Human Organs. Nutrients 2024; 16:546. [PMID: 38398870 PMCID: PMC10893534 DOI: 10.3390/nu16040546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 02/10/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Several billion microorganisms reside in the gastrointestinal lumen, including viruses, bacteria, fungi, and yeast. Among them, probiotics were primarily used to cure digestive disorders such as intestinal infections and diarrhea; however, with a paradigm shift towards alleviating health through food, their importance is large. Moreover, recent studies have changed the perspective that probiotics prevent numerous ailments in the major organs. Probiotics primarily produce biologically active compounds targeting discommodious pathogens. This review demonstrates the implications of using probiotics from different genres to prevent and alleviate ailments in the primary human organs. The findings reveal that probiotics immediately activate anti-inflammatory mechanisms by producing anti-inflammatory cytokines such as interleukin (IL)-4, IL-10, IL-11, and IL-13, and hindering pro-inflammatory cytokines such as IL-1, IL-6, and TNF-α by involving regulatory T cells (Tregs) and T helper cells (Th cells). Several strains of Lactobacillus plantarum, Lactobacillus rhamnosus, Lactobacillus casei, Lactobacillus reuteri, Bifidobacterium longum, and Bifidobacterium breve have been listed among the probiotics that are excellent in alleviating various simple to complex ailments. Therefore, the importance of probiotics necessitates robust research to unveil the implications of probiotics, including the potency of strains, the optimal dosages, the combination of probiotics, their habitat in the host, the host response, and other pertinent factors.
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Affiliation(s)
- Muhammad Safiullah Virk
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
| | | | - Yufeng He
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
| | - Tabussam Tufail
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
- University Institute of Diet and Nutritional Sciences, The University of Lahore, Lahore 54000, Pakistan
| | - Mehak Gul
- Department of Internal Medicine, Sheikh Zayed Hospital, Lahore 54000, Pakistan
| | - Abdul Qayum
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
| | - Abdur Rehman
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
| | - Arif Rashid
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
| | - John-Nelson Ekumah
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
| | - Xu Han
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
| | - Junxia Wang
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
| | - Xiaofeng Ren
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
- Institute of Food Physical Processing, Jiangsu University, Zhenjiang 212013, China
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Manganas K, Delicou S, Xydaki A, Kourakli A, Evliati L, Vlachaki E, Klironomos E, Diamantidis M, Lafiatis I, Kattamis A, Koskinas J. Predisposing factors for advanced liver fibrosis in patients with sickle cell disease. Br J Haematol 2023; 202:1192-1198. [PMID: 37438880 DOI: 10.1111/bjh.18970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
Sickle cell disease (SCD) is one of the most common monogenic disorders worldwide and liver complications are common in this group of patients. Our study aims to highlight the prevalence of chronic liver complications and the main predisposing factors for advanced liver fibrosis in SCD patients. For this purpose, 219 patients from eight Thalassemia and Sickle Cell Units across Greece enrolled in our study and history of liver related disease complications was recorded, as well as a full laboratory and imaging analysis concerning their liver function. 13.6% of the patients had advanced liver fibrosis. The presence of liver fibrosis was significantly correlated with advanced age, male gender, cholelithiasis and higher LDH, γ-GT, INR, direct and indirect bilirubin levels. These patients had exhibited significantly more episodes of liver crises and acute intrahepatic cholestasis. No correlation was observed with right heart failure or previous viral hepatitis. Patients with advanced liver fibrosis were receiving a more intensive transfusion therapy for a longer period of time and had higher Liver Iron Concentration levels. Our study shows that liver complications and cirrhosis is a significant cause of morbidity in patients with SCD and it is primarily associated with intravascular hemolysis and vaso-occlusive phenomena and secondarily with iron overload.
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Affiliation(s)
| | - Sophia Delicou
- Thalassemia and Sickle Cell Unit, Hippokration General Hospital, Athens, Greece
| | - Aikaterini Xydaki
- Thalassemia and Sickle Cell Unit, Hippokration General Hospital, Athens, Greece
| | - Alexandra Kourakli
- Thalassemia & Hemoglobinopathies Unit, Hematology Division, Department of Internal Medicine, University of Patras Medical School, University Hospital, Patras, Greece
| | - Loukia Evliati
- Thalassemia and Sickle Cell Unit, General Hospital of Athens "Evaggelismos", Athens, Greece
| | - Efthymia Vlachaki
- Thalassemia and Sickle Cell Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelos Klironomos
- Thalassemia and Sickle Cell Unit, "Venizelion" General Hospital, Heraklion, Greece
| | - Michail Diamantidis
- Thalassemia and Sickle Cell Unit, General Hospital of Larissa, Larissa, Greece
| | - Ioannis Lafiatis
- Thalassemia and Sickle Cell Unit, "Vostanio" General Hospital of Mytilene, Mytilene, Greece
| | - Antonios Kattamis
- "Agia Sophia" Children Hospital, First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - John Koskinas
- Department of Internal Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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Chen S, Li MQ, Li BE, Lv TT, Li SX, Shan S, Li M, Kong YY, Zhang D, Ma H, Ou XJ, You H, Duan WJ, Jia JD. Concomitant gallstone disease was not associated with long-term outcomes in ursodeoxycholic acid-treated patients with primary biliary cholangitis. J Dig Dis 2023; 24:419-426. [PMID: 37464723 DOI: 10.1111/1751-2980.13207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/29/2023] [Accepted: 07/17/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES Primary biliary cholangitis (PBC) is a rare disease characterized by intrahepatic cholestasis, whereas gallstone disease (GD) is common. In this study, we aimed to investigate the prevalence and impact of GD on the prognosis of PBC in China. METHODS Medical records of the PBC patients were retrospectively reviewed and their follow-up data were obtained via regular structured, standardized telephone interviews. GD was defined as gallstones on ultrasonography or a history of cholecystectomy for gallstones. Propensity score matching (PSM) and Cox regression analysis were performed. The primary end-point was liver-related death and/or liver transplantation. RESULTS A total of 985 ursodeoxycholic acid (UDCA)-treated PBC patients were enrolled with a median follow-up duration of 5.3 years (range 1.0-20.9 years). Among them, 258 (26.2%) had GD, including 157 (22.9%) of non-cirrhotic and 101 (33.8%) of cirrhotic patients. Compared with PBC without GD, those with GD were older, more often had type 2 diabetes mellitus, and had a more severe liver disease at baseline. After PSM (1:2), 229 PBC patients with GD were matched with 458 PBC patients without GD based on age, sex, cirrhosis, and total bilirubin level. The transplant-free survival and incidence of hepatic events were similar between the two groups. Furthermore, multivariate Cox regression analysis showed that concomitant GD was not independently associated with a worse prognosis for PBC patients. CONCLUSION Concomitant GD was common but was not associated with long-term outcomes in patients with UDCA-treated PBC.
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Affiliation(s)
- Sha Chen
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Meng Qi Li
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Bu Er Li
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Ting Ting Lv
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Shu Xiang Li
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Shan Shan
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Min Li
- Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Yuan Yuan Kong
- Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Dong Zhang
- Experimental and Translational Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Clinical Research Institute; Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation, Beijing, China
| | - Hong Ma
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Xiao Juan Ou
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Hong You
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Wei Jia Duan
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Ji Dong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis; National Clinical Research Center for Digestive Diseases, Beijing, China
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Xiong J, Xia S, Peng G, Sun Y, Chen J, Cao K. Preoperative three-dimensional magnetic resonance cholangiopancreatography for choledocholithotomy. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2023. [DOI: 10.1016/j.jrras.2022.100499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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Adiamah A, Crooks CJ, Hammond JS, Jepsen P, West J, Humes DJ. Cholecystectomy in patients with cirrhosis: a population-based cohort study from England. HPB (Oxford) 2023; 25:189-197. [PMID: 36435712 DOI: 10.1016/j.hpb.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/15/2022] [Accepted: 08/15/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND This population-based cohort study aimed to determine postoperative outcomes after emergency and elective cholecystectomy in patients with cirrhosis. METHODS Linked electronic healthcare data from England were used to identify all patients undergoing cholecystectomy between January 2000 and December 2017. Length of stay (LOS), re-admission, case fatality and the odds ratio of 90-day mortality were calculated for patients with and without cirrhosis, adjusting for age, sex and co-morbidity using logistic regression. RESULTS Of the total 69,141 eligible patients who underwent a cholecystectomy, 511 (0.74%) had cirrhosis. In patients without cirrhosis 86.55% underwent a laparoscopic procedure compared with 57.53% in patients with cirrhosis (p < 0.0001). LOS was longer in those with cirrhosis (3 IQR 1-8 vs 1 IQR 1-3 days,p < 0.0001). 90-day re-admission was greater in patients with cirrhosis, 36.79% compared with 14.95% in those without cirrhosis. 90-day case fatality after elective cholecystectomy in patients with and without cirrhosis was 2.79% and 0.43%; and 12.82% and 2.39% following emergency cholecystectomy. This equated to a 3-fold (OR 3.22, IQR 1.72-6.02) and a 4-fold (OR 4.52, IQR 2.46-8.33) increased odds of death at 90-days following elective and emergency cholecystectomy after adjusting for confounders. CONCLUSION Patients with cirrhosis undergoing cholecystectomy have an increased 90-day risk of postoperative mortality, which is significantly worse after emergency procedures.
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Affiliation(s)
- Alfred Adiamah
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
| | - Colin J Crooks
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK; Division of Hepatobiliary and Transplant Surgery, Freeman Hospital. Freeman Rd, High Heaton, Newcastle Upon Tyne, NE7 7DN, UK
| | - John S Hammond
- Division of Hepatobiliary and Transplant Surgery, Freeman Hospital. Freeman Rd, High Heaton, Newcastle Upon Tyne, NE7 7DN, UK
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Joe West
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK
| | - David J Humes
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK; Population and Lifespan Sciences, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK
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Sarici KB, Akbulut S, Karabulut E, Sahin TT, Kucukakcali Z, Garzali IU, Aloun A, Yilmaz S. Histopathological Features of Gallbladder Specimens Obtained From Liver Recipients. Transplant Proc 2023:S0041-1345(22)00869-7. [PMID: 36604252 DOI: 10.1016/j.transproceed.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/19/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND To evaluate the histopathological features of gallbladder specimens obtained from liver transplantation (LT) recipients and to find the correlation between these findings with the clinical features of patients. METHODS The 1985 patients who underwent LT in our institute between March 2002 and January 2021 and whose data regarding pathologic analysis of gallbladder could retrospectively be obtained were included in the study. The data of the patients including age, gender, the reason for LT (fulminant or nonfulminant), presence of ascites, macroscopic characteristics of gallbladder (the length, diameter, and wall thickness), and microscopic findings were all obtained and analyzed in the present study. RESULTS A total of 1985 patients (men = 1300 and women = 685) with a median age of 39.4 years were included in this study. LT was performed in 249 patients because of fulminant liver failure, and abdominal ascites were detected in 933 patients during LT. There were statistical differences in terms of age (P < .001), gallbladder length (P < .001). and width (P < .001) among the both gender, but there was no difference in terms of histopathologic characteristics and presence of gallstones. On the other hand, there were significant differences in terms of age (P < .001), gallbladder length (P < .001), width (P < .001), wall thickness (P = .021), presence of gallstones (P < .001), and histopathologic characteristics (P < .001) between the patients with fulminant and nonfulminant liver failure etiologies. Similar results were obtained when characteristics of patients with and without ascites were compared. CONCLUSIONS This the first study analyzing the histopathological analysis of gallbladder specimens in LT recipients. Chronic liver disease, presence of ascites and gender are the factors affecting the macroscopic and microscopic features of the gallbladder.
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Affiliation(s)
- Kemal Baris Sarici
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sami Akbulut
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey; Department Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey.
| | - Ertuğrul Karabulut
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Tevfik Tolga Sahin
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Zeynep Kucukakcali
- Department Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ibrahim Umar Garzali
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey; Department of Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ali Aloun
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sezai Yilmaz
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
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Muacevic A, Adler JR, Diwaker A, Bhardwaj A, Sharma MK, Sarin S. Safety and Efficacy of Endoscopic Retrograde Cholangio-Pancreatography in Patients of Liver Cirrhosis: A Case-Control Study. Cureus 2023; 15:e34248. [PMID: 36855503 PMCID: PMC9968241 DOI: 10.7759/cureus.34248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 01/29/2023] Open
Abstract
Background With the improvement in noninvasive diagnostic imaging modalities, Endoscopic Retrograde Cholangio-Pancreatography (ERCP) has evolved into a primarily therapeutic procedure. Besides being efficacious and one of the most commonly done procedures, ERCP is also associated with a high risk of complications. However, there is a lack of studies analyzing the safety and success of ERCP in patients with liver cirrhosis. We retrospectively evaluated the outcome of ERCP in patients with cirrhosis of the liver compared to non-cirrhotic patients using the database from our institute. Methods Patients with liver cirrhosis who underwent ERCP from January 2010 to March 2020 were analyzed. This was a matched case-control study in which one cirrhotic patient undergoing ERCP was age and gender-matched randomly to one non-cirrhotic patient. We compared adverse events and the success rate of ERCP between cirrhotic patients and non-cirrhotic patients. The primary outcome of the study was analyzing the prevalence of procedure-related adverse events and their independent risk factors in patients of cirrhosis compared to the non-cirrhotic population. Results Two hundred patients were analyzed in both groups. Choledocholithiasis was the most common reason for ERCP in both groups. Mean Child-Turcotte-Pugh (CTP) score and Model for End-stage Liver Disease (MELD) score in the cirrhosis group were 9.16 ±1.78 and 19.09 ±7.06 respectively. Patients in the cirrhosis group had a significantly higher frequency of complications compared to the controls: 41 (20.5 %) versus 15 (7.5%), p < 0.01. Bleeding was the most common adverse event in both groups: 19 (9.5%) vs 6(3%). High International Normalised Ratio (INR), low platelets, and cholangitis at presentation were independently predictive of post-ERCP complications. Despite a similar technical success rate, the clinical success rate was lower in the cirrhotic than in the noncirrhotic group (83.9% versus 97.9%, p=0.006). Conclusion The prevalence of complications following ERCP was nearly three-fold higher in patients with cirrhosis than in non-cirrhotic patients. These events were related primarily to cholangitis, coagulopathy, and the advanced status of chronic liver disease.
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13
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Zhou J, Chen L, Zhang Z, Wu B. Analysis of risk factors for the increased incidence of gallstone caused by hepatectomy: A retrospective case-control study. Front Surg 2023; 10:1097327. [PMID: 36936662 PMCID: PMC10014528 DOI: 10.3389/fsurg.2023.1097327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/24/2023] [Indexed: 03/06/2023] Open
Abstract
Background An increased risk of gallstones has been observed in patients undergoing hepatectomy. This study attempted to analyze the risk factors for gallstones after hepatectomy. Methods From January 2013 to December 2016, clinical data of 1,452 eligible patients who underwent hepatectomy were consecutively reviewed. According to the imaging, including gallbladder ultrasound, computerized tomography, and magnetic resonance imaging, all patients were divided into the gallstone group and the nongallstone group. Univariate and multivariate logistic regression analyses were performed to select indicators associated with gallstone formation among patients after hepatectomy. Results In the total sample of included patients, there were 341 patients with gallstones and 1,147 patients without gallstones. The incidence of gallstones was 23.5% (341/1,452). The incidence of gallstones in the primary liver cancer group was higher than that in the benign liver tumor group (25.7% vs. 18.9%, P = 0.004). Univariate and multivariate logistic regression analyses showed that female gender, high body mass index, tumor located in S5, and severe postoperative complication were factors related to gallstones in patients with benign liver tumors after hepatectomy. In addition, Child-Pugh B, low albumin, liver cirrhosis, and transcatheter arterial chemoembolization (TACE) after recurrence were factors related to gallstones in patients with primary liver cancer after hepatectomy. Conclusions Hepatectomy increased the risk of gallstones in benign or malignant liver tumors, especially when the tumor was located in S5. TACE further increased the risk of gallstones in patients with postoperative recurrence.
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Affiliation(s)
- Jiangmin Zhou
- Department of Hepatobiliary Surgery, Wuhan No.1 Hospital (Wuhan Hospital of Traditional Chinese and Western Medicine), Wuhan, China
| | - Lin Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiwei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Zhiwei Zhang Biao Wu
| | - Biao Wu
- Department of Hepatobiliary Surgery, Wuhan No.1 Hospital (Wuhan Hospital of Traditional Chinese and Western Medicine), Wuhan, China
- Correspondence: Zhiwei Zhang Biao Wu
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14
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Li J, Hu J, Li P, Wu Y, Wang Y, Ji M, Hua H, Ran W, Pan Y, Zhang S. Analysis of risk factors associated with endoscopic retrograde cholangiopancreatography for patients with liver cirrhosis: a multicenter, retrospective, clinical study. Chin Med J (Engl) 2022; 135:2319-2325. [PMID: 36103988 PMCID: PMC9771285 DOI: 10.1097/cm9.0000000000002248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is the endoscopic modality of choice for the treatment of biliary and pancreatic diseases. However, patients with cirrhosis, particularly those with decompensated cirrhosis, are believed to be at increased risk for complications associated with ERCP. There is a paucity of literature describing the outcomes of ERCP for patients with cirrhosis. This study aimed to investigate the outcomes of ERCP for cirrhosis patients, especially adverse events, and evaluated its safety and efficacy. METHODS We performed a multicenter, retrospective study of all patients at Beijing Friendship Hospital affiliated to Capital Medical University, Xijing Hospital affiliated to Air Force Military Medical University, Beijing Youan Hospital affiliated to Capital Medical University, and the Fifth Medical Center of the People's Liberation Army General Hospital from June 2003 to August 2019. The adverse events of inpatient ERCP for patients with ( n = 182) and without liver cirrhosis (controls; n = 385) were compared. RESULTS A total of 567 patients underwent ERCP between January 2003 and December 2019 were enrolled in this study. Compared to patients without cirrhosis, patients with cirrhosis were at higher risk for postoperative complications (odds ratio [OR], 4.172; 95% confidence interval [CI], 1.232-7.031; P < 0.001) such as postoperative pancreatitis (OR, 2.026; 95% CI, 1.002-4.378; P = 0.001) and cholangitis (OR, 3.903; 95% CI, 1.001-10.038; P = 0.036). The main indications for ERCP for patients with cirrhosis in this study included choledocholithiasis (101 cases; 55.5%), benign bile duct strictures (46 cases; 25.3%), and malignant bile duct strictures (28 cases; 15.4%). Among them, 23 patients (12.6%) underwent balloon dilation and 79 patients (43.4%) underwent sphincterotomy. Of the patients with cirrhosis, delayed bleeding occurred in ten patients (5.5%), postoperative pancreatitis occurred in 80 patients (44.0%), and postoperative cholangitis occurred in 25 patients (13.7%). An additional multivariate analysis showed that the total bilirubin (TBIL) level (OR, 4.58; 95% CI, 2.37-6.70) and Child-Pugh score of C (OR, 3.11; 95% CI, 1.04-5.37) were risk factors for postoperative complications in patients with cirrhosis. CONCLUSIONS Compared with the general population of patients undergoing ERCP, patients with cirrhosis were more prone to postoperative pancreatitis and cholangitis. TBIL levels and Child-Pugh scores were risk factors for postoperative complications in patients with cirrhosis.
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Affiliation(s)
- Jielin Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing 100050, China
| | - Jiexuan Hu
- Department of Oncology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing 100050, China
| | - Yongdong Wu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing 100050, China
| | - Yongjun Wang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing 100050, China
| | - Ming Ji
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing 100050, China
| | - Haiyang Hua
- Department of Gastroenterology, Cheng De Central Hospital, Chengde, Hebei 067000, China
| | - Wenbin Ran
- Department of Gastroenterology, The Third People's Hospital of Chengdu, Chengdu, Sichuan 610031, China
| | - Yanglin Pan
- Xijing Hospital of Digestive Diseases, Air Force Medical University of People's Liberation Army, Xi’an, Shaanxi 710032, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing 100050, China
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15
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Patel AM, Yeola M, Mahakalkar C. Demographic and Risk Factor Profile in Patients of Gallstone Disease in Central India. Cureus 2022; 14:e24993. [PMID: 35719762 PMCID: PMC9190443 DOI: 10.7759/cureus.24993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2022] [Indexed: 11/20/2022] Open
Abstract
Background Gallbladder stones are more common in some regions of the world than others. Gallstones that are asymptomatic might be discovered as an afterthought during a regular ultrasound scan for another abdominal ailment. The changing incidence in India is mostly due to westernization and the availability of ultrasonography in both urban and rural areas, as well as increased affordability owing to changes in the socio-economic structure and the budget of investigations. This study aims to know the prevalence of gallstone disease as well as the risk factors that contribute to its development in central India. Method A single-center, cross-sectional observational study was conducted. Seventy-two radiologically diagnosed cases of gallstone disease irrespective of age, gender, and comorbid condition were included in the study. Result Seventy-two cases of gallstone were included in the research. The highest age-specific incidence of gallstone was in the fifth and sixth decades with the maximum incidence in the sixth decade. Females had a higher incidence of gallstone formation. The pain was the earliest symptom but we found that 41.67% patients had asymptomatic gallstones. A family history of gallstone disease is found positive in 69.44% of the patients who also had an increased risk of gallstone. 22.22% patient were only diabetic, 6.95% were only hypertensive and 20.83% were both diabetic + hypertensive. Comorbidity has a high prevalence of gallstone disease. Obesity has a significant link to gallstone disease, with BMI being one of the most important indicators of obesity. Conclusion The prevalence of asymptomatic gallstones is relatively high in central India. We strongly recommend ultrasonography as a screening modality in patients with older age group, female gender, high cholesterol level, family history of gallstones, sickle cell disease, increased BMI and co-morbidities like diabetes or hypertension for early detection of gallstones formation.
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Affiliation(s)
- Aditya M Patel
- Department of General Surgery, Datta Meghe Institute of Medical Science, Wardha, IND
| | - Meenakshi Yeola
- Department of General Surgery, All India Institute of Medical Sciences, Mangalagiri, Mangalagiri, IND
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16
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Environmental and Lifestyle Risk Factors in the Carcinogenesis of Gallbladder Cancer. J Pers Med 2022; 12:jpm12020234. [PMID: 35207722 PMCID: PMC8877116 DOI: 10.3390/jpm12020234] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/08/2021] [Accepted: 12/23/2021] [Indexed: 02/01/2023] Open
Abstract
Gallbladder cancer (GBC) is an aggressive neoplasm that in an early stage is generally asymptomatic and, in most cases, is diagnosed in advanced stages with a very low life expectancy because there is no curative treatment. Therefore, understanding the early carcinogenic mechanisms of this pathology is crucial to proposing preventive strategies for this cancer. The main risk factor is the presence of gallstones, which are associated with some environmental factors such as a sedentary lifestyle and a high-fat diet. Other risk factors such as autoimmune disorders and bacterial, parasitic and fungal infections have also been described. All these factors can generate a long-term inflammatory state characterized by the persistent activation of the immune system, the frequent release of pro-inflammatory cytokines, and the constant production of reactive oxygen species that result in a chronic damage/repair cycle, subsequently inducing the loss of the normal architecture of the gallbladder mucosa that leads to the development of GBC. This review addresses how the different risk factors could promote a chronic inflammatory state essential to the development of gallbladder carcinogenesis, which will make it possible to define some strategies such as anti-inflammatory drugs or public health proposals in the prevention of GBC.
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Vedachalam S, Jalil S, Krishna SG, Porter K, Li N, Kelly SG, Conteh L, Mumtaz K. Call for action: Increased healthcare utilization with growing use of percutaneous cholecystectomy tube over initial cholecystectomy in cirrhotics. Hepatobiliary Pancreat Dis Int 2022; 21:56-62. [PMID: 34420884 DOI: 10.1016/j.hbpd.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/30/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Acute calculous cholecystitis (ACC) is frequently seen in cirrhotics, with some being poor candidates for initial cholecystectomy. Instead, these patients may undergo percutaneous cholecystostomy tube (PCT) placement. We studied the healthcare utilization and predictors of cholecystectomy and PCT in patients with ACC. METHODS The National Database was queried to study all cirrhotics and non-cirrhotics with ACC between 2010-2014 who underwent initial PCT (with or without follow-up cholecystectomy) or cholecystectomy. Cirrhotic patients were divided into compensated and decompensated cirrhosis. Independent predictors and outcomes of initial PCT and failure to undergo subsequent cholecystectomy were studied. RESULTS Out of 919 189 patients with ACC, 13 283 (1.4%) had cirrhosis. Among cirrhotics, cholecystectomy was performed in 12 790 (96.3%) and PCT in the remaining 493 (3.7%). PCT was more frequent in cirrhotics (3.7%) than in non-cirrhotics (1.4%). Multivariate analyses showed increased early readmissions [odds ratio (OR) = 2.12, 95% confidence interval (CI): 1.43-3.13, P < 0.001], length of stay (effect ratio = 1.39, 95% CI: 1.20-1.61, P < 0.001), calendar-year hospital cost (effect ratio = 1.34, 95% CI: 1.28-1.39, P < 0.001) and calendar-year mortality (hazard ratio = 1.89, 95% CI: 1.07-3.29, P = 0.030) in cirrhotics undergoing initial PCT compared to cholecystectomy. Decompensated cirrhosis (OR = 2.25, 95% CI: 1.67-3.03, P < 0.001) had the highest odds of getting initial PCT. Cirrhosis, regardless of compensated (OR = 0.56, 95% CI: 0.34-0.90, P = 0.020) or decompensated (OR = 0.28, 95% CI: 0.14-0.59, P < 0.001), reduced the chances of getting a subsequent cholecystectomy. CONCLUSIONS Cirrhotic patients undergo fewer cholecystectomy incurring initial PCT instead. Moreover, the rates of follow-up cholecystectomy are lower in cirrhotics. Increased healthcare utilization is seen with initial PCT amongst cirrhotic patients. This situation reflects suboptimal management of ACC in cirrhotics and a call for action.
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Affiliation(s)
- Srikanth Vedachalam
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Sajid Jalil
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Somashaker G Krishna
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Kyle Porter
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Na Li
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Sean G Kelly
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Lanla Conteh
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Khalid Mumtaz
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
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Zuo S, Sawai T, Kanehiro H, Kuroda Y, Sho M. Gallstones in patients with severe motor and intellectual disability. Pediatr Int 2022; 64:e15220. [PMID: 35727861 DOI: 10.1111/ped.15220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Asymptomatic gallbladder stones may be detected with ultrasound; some gallstones produce symptomatic diseases, such as cholecystitis, cholangitis, or pancreatitis. Identifying the clinical features of symptomatic gallstones may help prevent severe complications by providing intervention for asymptomatic gallstones. We aimed to investigate risk factors associated with developing symptomatic disease in pediatric patients with severe motor and intellectual disabilities (SMID). METHODS This retrospective study enrolled 30 patients with SMID who were treated at the Nara Medical University between March 2016 and March 2019. We examined the prevalence of gallstones, and the rate at which associated symptoms of gallstones were observed in patients. Furthermore, we compared the clinical features of patients with and without gallstones. RESULTS Among 30 patients with SMID, 7 (23%) had gallstones, with 6 (86%) of them being symptomatic: 3 patients had acute pancreatitis and 3 had cholecystitis or cholangitis. Among 23 patients without gallstones, 2 had acute pancreatitis and 2 had biliary sludge. Patients with gallstones had significantly lower daily calorie intake than those without gallstones (P = 0.042). Furthermore, the incidence of gallstones was higher in patients who received total parenteral nutrition than in those who did not (P = 0.031). Comparative analysis between symptomatic and asymptomatic patients was not performed because almost all cases were symptomatic. CONCLUSION Gallstones were detected in 23% of patients with SMID. The gallstones were symptomatic at a very high rate. Considering this fact, patients with SMID should be surveyed for gallstones; careful management may be needed in such patients.
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Affiliation(s)
- Shogo Zuo
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Toshio Sawai
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | | | - Yasuhiro Kuroda
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
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Zhang Y, Fu T, Yuan XJ, Ye YC, Guo ZW, Liu K, Ji ZH, Shao ZJ. Analyzing the Spatiotemporal Distribution and Characteristics of Liver Cirrhosis in Hospitalized Patients in Wuwei, Gansu Province During 1995-2016: A Long-Term Retrospective Study. Front Physiol 2022; 13:845095. [PMID: 35392371 PMCID: PMC8980317 DOI: 10.3389/fphys.2022.845095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/07/2022] [Indexed: 12/09/2022] Open
Abstract
Objectives: This was a long-term retrospective study, aiming to understand the temporal and spatial trend of cirrhosis in Wuwei from 1995 to 2016, explore its spatio-temporal aggregation, and find out the high incidence areas. To provide theoretical basis for the formulation of comprehensive prevention and treatment strategy of cirrhosis in Wuwei. Methods: Herein, we extracted data of cirrhosis patients who were treated in 12 sentinel hospitals in Wuwei from their medical records. We used SAS and Joinpoint Regression Program for data analysis, SaTScan 9.4 software for clustering area detection, and ArcGIS 10.2 software for geographical distribution mapping. Results: Among 3308 patients with liver cirrhosis (average age, 55.34 years) included in this study, 15.9% were aged 50-54 years. The majority were men (2716, 65.8%), with a sex ratio of 1.92:1 and peasants by occupation (1369, 60.3%). The basic social medical insurance system covered the healthcare costs of 1271 patients (63%). A Joinpoint regression analysis done for 1995-2016 revealed an increase in the standardized cirrhosis rate [average annual percent change (AAPC) = 16.7% (95% CI, 10.2-23.5%)] with three joinpoints in 2010, 2013, and 2016. The annual percent change (APC) from 1995 to 2010 was 11.13% (95% CI: 6.5-16.0), and APC from 2010 to 2013 was 66.48% (95% CI:16.0-138.9); conversely, from 2013 to 2016, APC was 4.4% (95% CI, -7.5-17.8%). Hongshagang Town showed the highest average incidence. Each township showed a gradual increase in the incidence after 2010. The results revealed that in each township, liver cirrhosis incidence had some spatial aggregation and was nonrandom. Four liver cirrhosis clusters were noted in 75 townships in Wuwei. Data were gathered from 2011 to 2016. Conclusions: From 1995 to 2016, the incidence of cirrhosis in Wuwei still showed an increasing trend, but the growth rate slowed down since 2013. In Wuwei, the rate of standardization of cirrhosis in female patients increased steadily and faster than in male patients. It is necessary to strengthen the diagnosis, treatment, prevention, and control measures of cirrhosis-related diseases. The results of spatial scanning, basic spatial distribution, aggregation time, and time trend analysis were consistent.
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Affiliation(s)
- Yang Zhang
- Department of Epidemiology, School of Public Health, Air Force Medical University, Xi’an, China
- Shaanxi Energy Institute, College of Nursing, Xi’an, China
- Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Xi’an, China
- *Correspondence: Yang Zhang, ; Zhong-Jun Shao, ; Zhao-Hua Ji,
| | - Ting Fu
- Department of Epidemiology, School of Public Health, Air Force Medical University, Xi’an, China
- Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Xi’an, China
| | - Xiao-Jie Yuan
- Department of Epidemiology, School of Public Health, Air Force Medical University, Xi’an, China
- Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Xi’an, China
| | | | - Zhi-Wen Guo
- Department of Infection Disease Control and Prevention, Wu Wei Center for Disease Prevention and Control, Wuwei, China
| | - Kun Liu
- Department of Epidemiology, School of Public Health, Air Force Medical University, Xi’an, China
- Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Xi’an, China
| | - Zhao-Hua Ji
- Department of Epidemiology, School of Public Health, Air Force Medical University, Xi’an, China
- Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Xi’an, China
- *Correspondence: Yang Zhang, ; Zhong-Jun Shao, ; Zhao-Hua Ji,
| | - Zhong-Jun Shao
- Department of Epidemiology, School of Public Health, Air Force Medical University, Xi’an, China
- Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Xi’an, China
- *Correspondence: Yang Zhang, ; Zhong-Jun Shao, ; Zhao-Hua Ji,
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Lu Y, Hu L, Song J, Wan J, Chen H, Yin J. Gallstone disease and nonalcoholic fatty liver disease in patients with type 2 diabetes: a cross-sectional study. BMC Endocr Disord 2021; 21:231. [PMID: 34794397 PMCID: PMC8603504 DOI: 10.1186/s12902-021-00899-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) and gallstone disease (GSD) often coexist in the general population owing to shared risk factors. This study explored the relationship between NAFLD and GSD in patients with type 2 diabetes. METHODS We conducted a retrospective cross-sectional analysis of 4325 patients with type 2 diabetes. GSD and NAFLD were confirmed using ultrasonography. GSD was defined as either asymptomatic gallstones or previous cholecystectomy, and each was analyzed separately. RESULT There was no significant difference in the prevalence of GSD between patients with and without NAFLD (23.8% vs. 21.2%, P = 0.15). After case-control matching (1:1) of baseline data such as age, sex, duration of diabetes, and HbA1c between patients with and without NAFLD, there was still no significant difference in the prevalence of GSD (25.5% vs. 23.6%, P = 0.15). The prevalence of NAFLD in patients with asymptomatic gallstones was lower than that of patients without GSD (38.6% vs. 47.3%, P < 0.001), whereas the prevalence in those who had undergone cholecystectomy was much higher (61.2% vs. 47.3%, P < 0.001). The ratio of cholecystectomy to asymptomatic gallstone in patients with or without NAFLD was 1.97 and 0.79, respectively. The rate of cholecystectomy was higher in the patients with NAFLD than in those without NAFLD (15.8% vs. 9.3%, P < 0.001), consistent with the result after case-control matching (17.3% vs. 11.2%, P < 0.001). Multivariate logistic regression analysis, after adjusting for numerous potential confounding factors, revealed that GSD (OR = 1.241, 95%CI: 1.036-1.488, P = 0.002) and cholecystectomy (OR = 1.946, 95%CI: 1.546-2.445, P < 0.001) were both strongly associated with NAFLD. However, asymptomatic gallstone (OR = 0.663, 95%CI: 0.513-0.856, P = 0.002) seemed to be negatively correlated with NAFLD. CONCLUSIONS The prevalence of GSD was similar in patients with type 2 diabetes with and without NAFLD. The higher proportion of cholecystectomy and lower proportion of asymptomatic gallstones in patients with NAFLD suggests that NAFLD may increase the risk of complications of GSD.
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Affiliation(s)
- Ye Lu
- Department of Endocrinology and Metabolism, Shanghai Eighth People's Hospital, Shanghai, 200235, China
| | - Lili Hu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Diabetes Institute, Shanghai, 200233, China
| | - Jing Song
- Department of Endocrinology and Metabolism, Shanghai Eighth People's Hospital, Shanghai, 200235, China
| | - Jing Wan
- Department of Endocrinology and Metabolism, Shanghai Eighth People's Hospital, Shanghai, 200235, China
| | - Haibing Chen
- Department of Endocrinology and Metabolism, Shanghai 10th People's Hospital, Tongji University, Shanghai, 200072, China.
| | - Jun Yin
- Department of Endocrinology and Metabolism, Shanghai Eighth People's Hospital, Shanghai, 200235, China.
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Diabetes Institute, Shanghai, 200233, China.
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21
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Wang SY, Yeh CN, Jan YY, Chen MF. Management of Gallstones and Acute Cholecystitis in Patients with Liver Cirrhosis: What Should We Consider When Performing Surgery? Gut Liver 2021; 15:517-527. [PMID: 32921635 PMCID: PMC8283297 DOI: 10.5009/gnl20052] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/19/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023] Open
Abstract
Acute cholecystitis and several gallbladder stone-related conditions, such as impacted common bile duct stones, cholangitis, and biliary pancreatitis, are common medical conditions in daily practice. An early cholecystectomy or drainage procedure with delayed cholecystectomy is the current standard of treatment based on published clinical guidelines. Cirrhosis is not only a condition of chronically impaired hepatic function but also has systemic effects in patients. In cirrhotic individuals, several predisposing factors, including changes in the bile acid composition, increased nucleation of bile, and decreased motility of the gallbladder, contribute to the formation of biliary stones and the possibility of symptomatic cholelithiasis, which is an indication for surgical treatment. In addition to these predisposing factors for cholelithiasis, systemic effects and local anatomic consequences related to cirrhosis lead to anesthesiologic risks and perioperative complications in cirrhotic patients. Therefore, the treatment of the aforementioned biliary conditions in cirrhotic patients has become a challenging issue. In this review, we focus on cholecystectomy for cirrhotic patients and summarize the surgical indications, risk stratification, surgical procedures, and surgical outcomes specific to cirrhotic patients with symptomatic cholelithiasis.
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Affiliation(s)
- Shang Yu Wang
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chun Nan Yeh
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yi Yin Jan
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Miin Fu Chen
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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22
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Kannan A, Tara A, Quadir H, Hakobyan K, Gaddam M, Ojinnaka U, Ahmed Z, Dominic JL, Kantamaneni K, Went TR, Mostafa JA. The Outcomes of the Patients Undergoing Harmonic Scalpel Laparoscopic Cholecystectomy. Cureus 2021; 13:e15622. [PMID: 34277239 PMCID: PMC8275056 DOI: 10.7759/cureus.15622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/13/2021] [Indexed: 12/19/2022] Open
Abstract
Laparoscopic cholecystectomy has replaced conventional open cholecystectomy and has become the gold standard surgery for gall bladder pathologies. The harmonic scalpel is one of the instruments used to dissect and coagulate. Most surgeons accept the usage of the harmonic scalpel in laparoscopic cholecystectomy. The other standard method is electrocoagulation by electrocautery. The harmonic scalpel cholecystectomy has several advantages over other methods of laparoscopic cholecystectomy. Electrocoagulation by electrocautery produces smoke which can result in damage to lateral tissues, including the gall bladder. The clips are used along with electrocoagulation to seal cystic duct and cystic artery before dissection. There are various studies about bile leakage in the case of clip application. The harmonic scalpel uses ultrasonic energy to achieve hemostasis without bleeding, dissection, and gallbladder removal from the liver bed during laparoscopic surgery by causing coagulation of proteins. The patient outcome variables such as postoperative pain, duration of hospital stay, postoperative nausea and vomiting, surgical site infections, and other complications have not been compared in review articles. In this review, we collected the information from previously published studies and reviewed the outcomes of patients undergoing harmonic scalpel cholecystectomy. Harmonic scalpel cholecystectomy reduces the duration of hospital stay, duration of operation, intraoperative and postoperative complications, and postoperative pain. Thus the harmonic scalpel can be used instead of other instruments as it has better patient outcomes.
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Affiliation(s)
- Amudhan Kannan
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Anjli Tara
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,General Surgery, Stony Brook Medicine, Southampton Hospital, Southampton, USA
| | - Huma Quadir
- Internal Medicine/Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Knkush Hakobyan
- Diagnostic Radiology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mrunanjali Gaddam
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ugochi Ojinnaka
- Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Zubayer Ahmed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Jerry Lorren Dominic
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,General Surgery/Orthopedic Surgery, Cornerstone Regional Hospital, South Texas Health System, Edinburg, USA.,General Surgery, Stony Brook Medicine, Southampton Hospital, Southampton, USA
| | - Ketan Kantamaneni
- Vascular Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Terry R Went
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Jihan A Mostafa
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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23
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Adiamah A, Ban L, Hammond J, Jepsen P, West J, Humes DJ. Mortality After Extrahepatic Gastrointestinal and Abdominal Wall Surgery in Patients With Alcoholic Liver Disease: A Systematic Review and Meta-Analysis. Alcohol Alcohol 2021; 55:497-511. [PMID: 32558895 DOI: 10.1093/alcalc/agaa043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/26/2020] [Accepted: 04/28/2020] [Indexed: 12/16/2022] Open
Abstract
AIMS This meta-analysis aimed to define the perioperative risk of mortality in patients with alcoholic liver disease (ALD) undergoing extrahepatic gastrointestinal surgery. METHODS Systematic searches of Embase, Medline and CENTRAL were undertaken to identify studies reporting about patients with ALD undergoing extrahepatic gastrointestinal surgery published since database inception to January 2019. Studies were only considered if they reported on mortality as an outcome. Pooled analysis of mortality was stratified as benign and malignant surgery and specific operative procedures where feasible. RESULTS Of the 2899 studies identified, only five studies met inclusion criteria, representing cholecystectomy (one study), umbilical hernia repair surgery (one study) and oesophagectomy (three studies). The total number of patients with ALD in these studies was 172. Therefore, any study on liver disease patients undergoing extrahepatic surgery that crucially included a subset with alcohol aetiology was included as a secondary analysis even though they failed to stratify mortality by underlying aetiology. The total number of studies that met this expanded inclusion criteria was 62, reporting on 37,703 patients with liver disease of which 1735 (4.5%) had a definite diagnosis of ALD. Meta-analysis of proportions of in-hospital mortality in patients with ALD undergoing upper gastrointestinal cancer surgery (oesophagectomy) was 23% [95% confidence interval (CI) 14-35%, I2 = 0%]. In-hospital mortality following oesophagectomy in liver disease patients of all aetiologies was lower, 14% (95% CI 9-21%, I2 = 41.1%). CONCLUSION Postoperative in-hospital mortality is high in patients with liver disease and ALD in particular. However, the currently available evidence on ALD is limited and precludes definitive conclusions on postoperative mortality risk.
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Affiliation(s)
- Alfred Adiamah
- Nottingham Digestive Diseases Biomedical Research Centre, National Institute for Health Research (NIHR), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, NG7 2UH, UK
| | - Lu Ban
- Nottingham Digestive Diseases Biomedical Research Centre, National Institute for Health Research (NIHR), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, NG7 2UH, UK
| | - John Hammond
- Division of Hepatobiliary and Transplant Surgery, Freeman Hospital, Freeman Rd, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology and Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark ,8200
| | - Joe West
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK
| | - David J Humes
- Nottingham Digestive Diseases Biomedical Research Centre, National Institute for Health Research (NIHR), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, NG7 2UH, UK.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK
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24
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Oh JK, Kim YR, Lee B, Choi YM, Kim SH. Prevention of Cholesterol Gallstone Formation by Lactobacillus acidophilus ATCC 43121 and Lactobacillus fermentum MF27 in Lithogenic Diet-Induced Mice. Food Sci Anim Resour 2021; 41:343-352. [PMID: 33987554 PMCID: PMC8115012 DOI: 10.5851/kosfa.2020.e93] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to evaluate the effects of Lactobacillus
acidophilus ATCC 43121 and L. fermentum MF27 on
biochemical indices in the serum, cholesterol metabolism in the liver and mucin
expression in the gallbladder in lithogenic diet (LD)-induced C57BL/6J mice to
determine the preventive effects of lactobacilli on gallstone formation. By the
end of 4 wk of the experimental period, mice fed on a LD with high-fat and
high-cholesterol exhibited higher levels of total and low-density lipoprotein
cholesterol in the serum compared to mice fed on control diet or LD with
L. acidophilus ATCC 43121 (LD+P1; p<0.05).
Cholesterol-lowering effects observed in the LD+P1 and LD with L.
fermentum MF27 (LD+P2) groups were associated with reduced
expression of 3-hydroxy-3-methylglutaryl coenzyme A reductase in the liver
compared to the LD group (p<0.05). Furthermore, expression of the
gel-forming mucin, including MUC5AB and MUC5B,
was suppressed in the LD+P1 and LD+P2 groups compared to the LD
group (p<0.05). Therefore, steady intake of both L.
acidophilus ATCC 43121 and L. fermentum MF27 may
have the ability to prevent the formation of cholesterol gallstones in
LD-induced C57BL/6J mice.
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Affiliation(s)
- Ju Kyoung Oh
- Department of Food Bioscience and Technology, Korea University, Seoul 02841, Korea
| | - You Ra Kim
- Department of Food Bioscience and Technology, Korea University, Seoul 02841, Korea
| | - Boin Lee
- Department of Animal Sciences and Biotechnology, Kyungpook National University, Sangju 37224, Korea
| | - Young Min Choi
- Department of Animal Sciences and Biotechnology, Kyungpook National University, Sangju 37224, Korea
| | - Sae Hun Kim
- Department of Food Bioscience and Technology, Korea University, Seoul 02841, Korea
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25
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Graham DS, Ito T, Lu M, Dinorcia J, Agopian VG, Farmer DG, Busuttil RW, Kaldas FM. Cholecystitis in Patients Undergoing Liver Transplantation: A Five-Year Analysis of Incidence, Causes, and Impact. Am Surg 2020; 86:1254-1259. [PMID: 33125269 DOI: 10.1177/0003134820964210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is a paucity of data on cholecystitis in liver transplant candidates (LTC), including the incidence of the cholecystitis and the associated outcomes in this patient population. As such, this study examines the incidence of and factors associated with cholecystitis in the high-acuity LTC population, as well as the association between cholecystitis and graft and patient survival. Liver transplant candidates undergoing orthotopic liver transplantation (OLT) at a large transplant center from January 1, 2012 to December 31, 2016 were included in the initial analysis. Surgical pathology reports were examined for the presence of cholecystitis. Univariate analyses were performed to determine the association between patient factors and cholecystitis. Kaplan-Meier analyses and multivariate Cox proportional hazard models were performed to examine the association between cholecystitis and graft and patient survival. Of the 405 patients in the final study population, 267 (65.9%) had no cholecystitis, 21 (5.2%) had acute cholecystitis, and 117 (28.9%) had chronic cholecystitis. The presence of cholecystitis was associated with preoperative WBC, sepsis within 10 days prior to transplant, location prior to transplant, and total length of stay. While this study revealed no association between cholecystitis and graft or patient survival, it also suggests that cholecystitis is under-recognized in high-model end-stage liver disease (MELD) OLT candidates. Therefore, a high index of suspicion for cholecystitis may be helpful in caring for this vulnerable patient population; however, further studies must be performed to determine the optimal management of cholecystitis in these patients.
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Affiliation(s)
- Danielle S Graham
- Department of Surgery, University of California Los Angeles, CA, USA
| | - Takahiro Ito
- Dumont-UCLA Liver Transplant Center, Department of Surgery, University of California Los Angeles, CA, USA
| | - Michelle Lu
- Dumont-UCLA Liver Transplant Center, Department of Surgery, University of California Los Angeles, CA, USA
| | - Joseph Dinorcia
- Dumont-UCLA Liver Transplant Center, Department of Surgery, University of California Los Angeles, CA, USA
| | - Vatche G Agopian
- Dumont-UCLA Liver Transplant Center, Department of Surgery, University of California Los Angeles, CA, USA
| | - Douglas G Farmer
- Dumont-UCLA Liver Transplant Center, Department of Surgery, University of California Los Angeles, CA, USA
| | - Ronald W Busuttil
- Dumont-UCLA Liver Transplant Center, Department of Surgery, University of California Los Angeles, CA, USA
| | - Fady M Kaldas
- Dumont-UCLA Liver Transplant Center, Department of Surgery, University of California Los Angeles, CA, USA
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26
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Follow-up study of the endoscopic retrograde cholangiopancreatography on cirrhotic patients with bile duct stones. Eur J Gastroenterol Hepatol 2020; 32:1264-1265. [PMID: 32740280 DOI: 10.1097/meg.0000000000001664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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27
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Michallet M, Sobh M, Deray G, Gangneux JP, Pigneux A, Larrey D, Ribaud P, Mira JP, Nivoix Y, Yakoub-Agha I, Timsit JF, Alfandari S, Herbrecht R. Antifungal Stewardship in Hematology: Reflection of a Multidisciplinary Group of Experts. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:35-45. [PMID: 32958431 DOI: 10.1016/j.clml.2020.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023]
Abstract
We have presented a practical guide developed by a working group of experts in infectious diseases and hematology to summarize the different recommendations issued by the different international groups on antifungal agents used for hematology patients. In addition, a working group of experts in the domains of nephrology, hepatology, and drug interactions have reported their different recommendations when administering antifungal agents, including dose adjustments, monitoring, and management of their side effects. This guide will enable prescribers to have a document available that will allow for better and optimal use of antifungal agents for hematology patients with consideration of the toxicity and interactions adjusted to each indication.
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Affiliation(s)
- Mauricette Michallet
- Hematology Department, Centre de lutte contre le cancer Léon Bérard, Lyon, France.
| | - Mohamad Sobh
- Hematology Department, Centre de lutte contre le cancer Léon Bérard, Lyon, France
| | - Gilbert Deray
- Nephrology Department, Pitié-Salpêtrière University Hospital, Paris, France
| | | | - Arnaud Pigneux
- Department of Hematology and Cellular Therapy, University Hospital of Bordeaux, Bordeaux, France
| | | | - Patricia Ribaud
- Quality Unit, Pôle Prébloc, Saint-Louis and Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Paul Mira
- Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yasmine Nivoix
- Pharmacy Department, Strasbourg University Hospitals, Strasbourg, France
| | | | - Jean-François Timsit
- Medical Intensive Care Unit, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Serge Alfandari
- Intensive Care and Infectious Disease Unit, Tourcoing Hospital, University of Lille, Tourcoing, France
| | - Raoul Herbrecht
- Department of Oncology and Hematology, Strasbourg University Hospitals and Strasbourg University, Strasbourg, France
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28
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Kiani Q, Farooqui F, Khan MS, Khan AZ, Nauman Tariq M, Akhtar A. Association of Body Mass Index and Diet with Symptomatic Gall Stone Disease: A Case-Control Study. Cureus 2020; 12:e7188. [PMID: 32269869 PMCID: PMC7135725 DOI: 10.7759/cureus.7188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/05/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Gall stone disease (GSD) is one of the commonest gastrointestinal disorders. Causative factors can be non-modifiable as genetics and modifiable like dietary habits. High-fat diet and high BMI are well known contributing factors world-over. Local and regional data is deficient about these factors. Moreover, Indo-Pakistani dietary patterns are very different from the western population. This study was conducted to see the association of high BMI and diet with GSD in our population. MATERIALS AND METHODS This case-control study was conducted in Shifa International Hospital, Islamabad, from 2012 to 2017. We included all female patients above 25 years of age with symptomatic gall stones on ultrasonography as cases and all females above 25 years of age with no gall stones on ultrasonography (done for any reason) as controls. The patients with gall stones having some other clear predisposing cause for gallstone formation, e.g., stoma, sudden weight loss, etc. were excluded. BMI, demographic details, dietary habits, and clinical profile of cases and controls were recorded. Data were analyzed by SPSS v 21. p-values were calculated. RESULTS A total of 396 patients were included in this study, with 103 cases and 293 controls. The mean BMI of GSD cases was 27.576±5.753, while controls had a mean BMI of 25.638±7.008 (p=0.08). About 26.4% of cases had an average fat consumption greater than 100g/day as compared to 11.9% controls (p=0.035). The average red meat intake per week was 222g among cases while 210g among controls (p=0.001). The average intake of fried food per week was 270g among controls and 250g among cases (p=0.012). The average intake of bakery items per week was 240g among cases and 210g among controls (p=0.038). CONCLUSION Gall stone disease is significantly related to high BMI and high dietary fat and meat intake in our population.
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Affiliation(s)
- Qamar Kiani
- General and Colorectal Surgery, Shifa Tameer-E-Millat University, Islamabad, PAK
| | | | | | - Aoun Z Khan
- Surgery, Rawalpindi Medical University, Islambad, PAK
| | | | - Aisha Akhtar
- Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
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29
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Cherkashchenko NA, Livzan MA, Krolevets TS. Features of the course of gallstone disease in patients with non-alcoholic fatty liver disease. TERAPEVT ARKH 2020; 92:48-54. [PMID: 32598718 DOI: 10.26442/00403660.2020.02.000550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 01/12/2023]
Abstract
Aim.To update information about comorbidity of non-alcoholic fatty liver disease (NAFLD) and gallstones disease (GD), evaluation of clinical and laboratory data, including insulin, leptin and adiponectin in individuals with NAFLD in combination with GD.
Materials and methods.According to the design, we conducted an open comparative study of 169 patients with NAFLD. The following comparison groups were formed: group 1 (n=95) patients with NAFLD without GD, group 2 (n=35) patients with NAFLD and GD and group 3 (n=39) patients with NAFLD, GD and previous cholecystectomy.
Results.A high prevalence of coronary heart disease was found in the group of patients with GD and cholecystectomy (2=6.198,p0.05); positive, statistically significant correlation relationships of cholelithiasis, cholecystectomy with ischemic heart disease (rs=0.172,p0.05 andrs=0.241,p0.05, respectively). There was a statistically significant decrease in total bilirubin and total protein in patients of group 3 (H=7.376,p0.03 and H=6.345,p0.04). The level of leptin is statistically significantly higher and positively interrelated with cholecystectomy (H=5.812,p0.05,rs=0.313,p0.05).
Conclusion.Patients with NAFLD, GD and previous cholecystectomy have a high prevalence of coronary heart disease; the phenomenon of insulin and leptin resistance, high level of adiponectin were revealed in patients with NAFLD and gallstones; hyperleptinemia was observed among patients with NAFLD, GD after cholecystectomy.
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30
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Patel KP, Mumtaz K, Li F, Luthra AK, Hinton A, Lara LF, Conwell DL, Krishna SG. Index admission cholecystectomy for acute biliary pancreatitis favorably impacts outcomes of hospitalization in cirrhosis. J Gastroenterol Hepatol 2020; 35:284-290. [PMID: 31264249 DOI: 10.1111/jgh.14775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/20/2019] [Accepted: 06/26/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Despite higher rates of gallstones in patients with cirrhosis, there are no population-based studies evaluating outcomes of acute biliary pancreatitis (ABP). Therefore, we sought to evaluate the predictors of early readmission and mortality in this high-risk population. METHODS We utilized the Nationwide Readmission Database (2011-2014) to evaluate all adults admitted with ABP. Multivariable logistic regression models were used to assess independent predictors for 30-day readmission, index admission mortality, and calendar year mortality. RESULTS Among 184 611 index admissions with ABP, 4344 (2.4%) subjects had cirrhosis (1649 with decompensation). Subjects with cirrhosis, when compared with those without, incurred higher rates of 30-day readmission (20.9% vs 11.2%; P < 0.001), index mortality (2.0% vs 1.0%; P < 0.001), and calendar year mortality (4.2% vs 0.9%; P < 0.001). Decompensation in cirrhosis was associated with significantly fewer cholecystectomies (26.7% vs 60.2%; P < 0.001) and endoscopic retrograde cholangiopancreatographies (23.3% vs 29.9%; P < 0.001). Multivariate analysis revealed that severe acute pancreatitis (odds ratio [OR]: 14.8; 95% confidence interval [CI]: 5.3, 41.2), sepsis (OR: 12.6; 95% CI: 5.8, 27.4), and decompensation (OR: 3.1; 96% CI: 1.4, 6.6) were associated with increased index admission mortality. Decompensated cirrhosis (OR: 1.8; 95% CI: 1.1, 3.0) and 30-day readmission (OR: 5.6; 95% CI: 3.3, 9.5) were predictors of calendar year mortality. However, index admission cholecystectomy was associated with decreased 30-day readmissions (OR: 0.6; 95% CI: 0.4, 0.7) and calendar year mortality (OR: 0.44; 95% CI: 0.25, 0.78). CONCLUSIONS The presence of cirrhosis adversely impacts hospital outcomes of patients with ABP. Among modifiable factors, index admission cholecystectomy portends favorable prognosis by reducing risk of early readmission and consequent calendar year mortality.
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Affiliation(s)
- Kishan P Patel
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Khalid Mumtaz
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Feng Li
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Anjuli K Luthra
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Luis F Lara
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Darwin L Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Somashekar G Krishna
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Cavallin F, Scarpa M, Cagol M, Alfieri R, Ruol A, Chiarion Sileni V, Rugge M, Ancona E, Castoro C. Cholecystectomy during esophagectomy is safe but unnecessary. Acta Chir Belg 2020; 120:35-41. [PMID: 30618322 DOI: 10.1080/00015458.2018.1554364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Prophylactic cholecystectomy has been proposed as a concomitant procedure during upper gastrointestinal surgery. This study evaluates the safety and the need of concurrent cholecystectomy during esophagectomy for cancer.Methods: All consecutive esophagectomies for esophageal cancer at the Center for Esophageal Diseases in Padova (Italy) between 1992 and 2011 were included. The safety of concurrent cholecystectomy was evaluated by surgical outcomes (length of stay, postoperative mortality and perioperative complications). The need for concurrent cholecystectomy was evaluated by occurrence of biliary duct stones and of cholelithiasis/cholecystitis after esophagectomy.Results: Cholecystectomy was performed during 67 out of 1087 esophagectomies (6.2%). Cirrhosis or chronic liver disease was associated with receiving cholecystectomy during esophagectomy (OR: 1.99, 95%C.I. 1.10-3.56). Patients receiving and those not receiving cholecystectomy showed similar length of stay (median 14 days, p = .87), postoperative mortality (3.0% vs. 2.5%, p = .68), intraoperative complication (4.5% vs. 7.1%, p = .62), early complications (52.2% vs. 44.6%, p = .25) and late complications (20.9% vs. 24.8%, p = .56). Cholelithiasis/cholecystitis after esophagectomy occurred in 61 (6.1%) patients, with only four requiring cholecystectomy during follow-up. The biliary stone occurrence was nil. Only pathologic stage III-IV (OR: 2.17, 95%C.I. 1.19-3.96) was associated with cholelithiasis/cholecystitis after esophagectomy.Conclusion: Routine prophylactic cholecystectomy during esophagectomy could be safe but unnecessary.
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Affiliation(s)
- Francesco Cavallin
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padova, Italy
| | - Marco Scarpa
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padova, Italy
| | - Matteo Cagol
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padova, Italy
| | - Rita Alfieri
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padova, Italy
| | - Alberto Ruol
- Clinica Chirurgica 3, Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche DiSCOG, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | | | - Massimo Rugge
- Department of Medicine (DIMED), Università di Padova, Padova, Italy
| | - Ermanno Ancona
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padova, Italy
| | - Carlo Castoro
- Department of upper GI surgery, Humanitas Research Hospital - Humanitas University, Rozzano (Milano), Italy
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Simons-Linares CR, Romero-Marrero C, Jang S, Bhatt A, Lopez R, Vargo J, Stevens T, Carey W, Chahal P. Clinical outcomes of acute pancreatitis in patients with cirrhosis. Pancreatology 2020; 20:44-50. [PMID: 31734110 DOI: 10.1016/j.pan.2019.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/02/2019] [Accepted: 11/06/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AP outcomes in cirrhotic patients have not yet been studied. We aim to investigate the outcomes of cirrhotics patients with acute pancreatitis. METHODS The National Inpatient Sample (NIS) database (2003-2013) was queried for patients with a discharge diagnosis of AP and liver cirrhosis. Cirrhosis was further classified as compensated and decompensated using the validated Baveno IV criteria. Primary outcome was inpatient mortality. The analysis was adjusted for age, gender, race, Charlson comorbidity index (CCI), median income quartile, and hospital characteristics. RESULTS Over 2.8 million patients with acute pancreatitis were analyzed. Cirrhosis prevalence was 2.8% (80,093). Both compensated and decompensated cirrhosis subjects had significantly higher mortality. Highest odds ratios (OR) were: inpatient mortality (OR 3.4, P < 0.001), Shock (OR 1.5, P = 0.02), Ileus (OR: 1.3, p = 0.02, ARDS (OR 1.2, p = 0.03), upper endoscopy performed (OR 2.0, p < 0.001), blood transfusions (OR 3.1, p < 0.001), gastrointestinal bleed (OR 5.5, p < 0.001), sepsis (OR 1.3, p = 0.005), portal vein thrombosis (PVT) (OR 7.2, p < 0.001), acute cholecystitis (OR 1.3, p < 0.001). Interestingly, cirrhosis patients had lower hospital length of stay, (OR 0.16, p < 0.001), AKI (OR 0.93, p = 0.06), myocardial infarction (OR 0.31, p < 0.001), SIRS (OR 0.62, p < 0.001), parenteral nutrition requirement (OR 0.84, p = 0.002). Decompensated cirrhosis had higher inflation-adjusted hospital charges (+$3896.60; p < 0.001). CONCLUSION AP patients with cirrhosis have higher inpatient mortality, but it is unlikely to be due to AP severity as patients had lower incidence of SIRS and AKI. Higher mortality is possibly related to complications of cirrhosis and portal hypertension itself such as GI bleed, shock, PVT, AC and sepsis.
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Affiliation(s)
- C Roberto Simons-Linares
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Carlos Romero-Marrero
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sunguk Jang
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Amit Bhatt
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rocio Lopez
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - John Vargo
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Tyler Stevens
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - William Carey
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Prabhleen Chahal
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
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Okamuro K, Cui B, Moazzez A, Park H, Putnam B, Virgilio CD, Neville A, Singer G, Deane M, Chong V, Kim DY. Laparoscopic Cholecystectomy is Safe in Emergency General Surgery Patients with Cirrhosis. Am Surg 2019. [DOI: 10.1177/000313481908501015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cirrhosis is associated with adverse outcomes after emergency general surgery (EGS). The objective of this study was to determine the safety of laparoscopic cholecystectomy (LC) in EGS patients with cirrhosis. We performed a two-year retrospective cohort analysis of adult patients who underwent LC for symptomatic gallstones. The primary outcome was the incidence of intraoperative complications. Of 796 patients, 59 (7.4%) were cirrhotic, with a median model for end-stage liver disease (MELD) score of 15 (IQR, 7). On unadjusted analysis, patients with cirrhosis were older, more likely to be male (both P < 0.01), diabetic ( P < 0.001), had a higher incidence of preadmission antithrombotic therapy use ( P < 0.02), and experienced a longer time to surgery (3.2 vs 1.8 days, P < 0.001). Coarsened exact matching revealed no difference in intra- or postoperative complications between groups ( P = 0.67). Operative duration was longer in patients with cirrhosis (162 vs 114 minutes, P = 0.001), who also had a nonsignificant increase in the rate of conversion to an open cholecystectomy (14% vs 4%, P = 0.07). The results of this study indicate that LC may be safely performed in EGS patients with cirrhosis.
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Affiliation(s)
- Kyle Okamuro
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Department of Surgery, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Brian Cui
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Department of Surgery, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Ashkan Moazzez
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Department of Surgery, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Hayoung Park
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Department of Surgery, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Brant Putnam
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Department of Surgery, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Chris De Virgilio
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Department of Surgery, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Angela Neville
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Department of Surgery, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - George Singer
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Department of Surgery, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Molly Deane
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Department of Surgery, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Vincent Chong
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Department of Surgery, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Dennis Y. Kim
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Department of Surgery, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
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Microstructural diversity of gallstones revealed by spectral microanalyses and their association with hepatic parameters. Indian J Gastroenterol 2019; 38:391-398. [PMID: 31808141 DOI: 10.1007/s12664-019-00972-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 07/03/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gallstones (GS) are formed as a result of impaired metabolic regulation and can be reflected in serum parameters. This study was focused on classifying GS based on spectral microanalysis and identifying the possible role of serum hepatic parameters on GS of different compositions. METHODS The study included a total of 126 GS from 80 consecutive patients who underwent cholecystectomy for GS diseases in a single center. The composition and microstructure of GS were analyzed using Fourier-transform infrared (FTIR) spectroscopy, field emission scanning electron microscopy (FESEM), and energy dispersive X-ray spectroscopy (EDS). The serum hepatic parameters were studied in order to establish a possible etiologic relationship with GS composition. RESULTS In the study group, the incidence of GS was higher in females 62 (77.5%) compared with males 18 (22.5%). The mean age was 42.81 ± 13.01 and 43.78 ± 14.4 years for female and male patients, respectively. Based on composition, the GS were assigned to four major groups: cholesterol, pigment, phosphate, and mixed stones. Mixed composition stones totally represented the majority 53 (66.3%), followed by pure cholesterol 23 (28.8%), pigment stones 2 (2.5%), and phosphate stones 2 (2.5%), respectively. Elemental composition revealed the presence of carbon (C), oxygen (O), calcium (Ca), and phosphorus (P) to be major elements along with traces of sodium (Na), magnesium (Mg), aluminum (Al), iron (Fe), copper (Cu), bromine (Br), manganese (Mn), and zinc (Zn). Among serum parameters, total bilirubin, direct bilirubin, indirect bilirubin, serum glutamic-oxaloacetic transaminase, and total protein were higher in patients with pigment GS than cholesterol GS. CONCLUSIONS Characterization of GS indicates that different types of stones have different characteristics in terms of microstructure, elemental composition, and distribution. Serum hepatic function test profiles showed an association with the compositions of GS.
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Kang Z, Lu M, Jiang M, Zhou D, Huang H. Proteobacteria Acts as a Pathogenic Risk-Factor for Chronic Abdominal Pain and Diarrhea in Post-Cholecystectomy Syndrome Patients: A Gut Microbiome Metabolomics Study. Med Sci Monit 2019; 25:7312-7320. [PMID: 31563920 PMCID: PMC6784683 DOI: 10.12659/msm.915984] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Laparoscopic cholecystectomy (LC) is regarded as the criterion standard for gallstone therapy, but post-cholecystectomy syndrome (PCS) is a common complication. This study aimed to analyze and identify differences in gut microbiome in PCS patients. Material/Methods This study involved 8 PCS patients (RS1), 8 asymptomatic PCS patients (RS2), and 8 healthy individuals (RS3). Genomic DNA of gut microbiome was extracted and amplified with CTAB method. PCR products were sequenced with Illumina High-Through Sequencing. Sequencing data were analyzed with QIIME software. Effective sequence of bacterial 16S-rRNA gene was clustered into OTUs using UPARSE software. Species annotations were evaluated using Mothur software. QIIME software was used to conduct complexity analysis and calculate UniFrac distances. R software was used to generate PCoA plots. Results Bacterial 16S-rDNA gene sequences showed that the effective species annotative data were more than 97%. According to Ternary plot, Firmicutes and Bacteroidetes had similar abundance and contents among the 3 groups. Contents of Proteobacteria in RS1 were higher compared to RS2 and RS3. Bacterial genomic DNAs samples were clustered together in the same group; however, distances were relative far between different groups. RS1 illustrated significantly higher abundance of Proteobacteria colonies compared to healthy people (p<0.05), and illustrated higher abundance of Verrucomicrobia and lower abundance of Bacteroidetes and Firmicutes, but without significant differences (p>0.05). Conclusions Gut microbiome of PCS patients was dominated by Proteobacteria in feces and contained little Firmicutes and Bacteroidetes. The enhanced abundance of Proteobacteria might be the highly pathogenic risk factor for chronic abdominal pain and diarrhea in PCS patients.
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Affiliation(s)
- Zuochang Kang
- Department of Gastroenterology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China (mainland).,Department of Gastroenterology, The People's Hospital of Tengchong, Tengchong, Yunnan, China (mainland)
| | - Mingliang Lu
- Department of Gastroenterology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Mingyuan Jiang
- Department of Gastroenterology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Di Zhou
- Department of Gastroenterology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Hua Huang
- Department of Gastroenterology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China (mainland)
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Zeaxanthin Dipalmitate in the Treatment of Liver Disease. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:1475163. [PMID: 31531108 PMCID: PMC6721266 DOI: 10.1155/2019/1475163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/16/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023]
Abstract
Goji berry, Lycium barbarum, has been widely used in traditional Chinese medicine (TCM), but its properties have not been studied until recently. The fruit is a major source of zeaxanthin dipalmitate (ZD), a xanthophyll carotenoid shown to benefit the liver. Liver disease is one of the most prevalent diseases in the world. Some conditions, such as chronic hepatitis B virus, liver cirrhosis, and hepatocellular carcinoma, remain incurable. Managing them can constitute an economic burden for patients and healthcare systems. Hence, development of more effective pharmacological drugs is warranted. Studies have shown the hepatoprotective, antifibrotic, antioxidant, anti-inflammatory, antiapoptotic, antitumor, and chemopreventive properties of ZD. These findings suggest that ZD-based drugs could hold promise for many liver disorders. In this paper, we reviewed the current literature regarding the therapeutic effects of ZD in the treatment of liver disease.
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Abstract
Liver cirrhosis is a major risk factor for increased mortality and morbidity in patients undergoing non-hepatic surgery with overall mortality rates as high as 45–50%. However, cirrhotic patients are often in need of surgical procedures including urological surgeries like cystectomies for muscle invasive bladder cancer. Data on the prognosis of these patients undergoing cystectomy for bladder cancer are scarce in the literature. In the present case-study, we describe the outcomes of 3 patients with liver cirrhosis who underwent radical cystectomy for muscle invasive bladder cancer. To the best of our knowledge, this is the first study reporting on this kind of urological surgery in patients with liver cirrhosis. Accordingly, we provide a review in the literature on prognosis and factors influencing the survival of cirrhotic patients who undergo surgical procedures.
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Abstract
Bile is composed of multiple macromolecules, including bile acids, free cholesterol, phospholipids, bilirubin, and inorganic ions that aid in digestion, nutrient absorption, and disposal of the insoluble products of heme catabolism. The synthesis and release of bile acids is tightly controlled and dependent on feedback mechanisms that regulate enterohepatic circulation. Alterations in bile composition, impaired gallbladder relaxation, and accelerated nucleation are the principal mechanisms leading to biliary stone formation. Various physiologic conditions and disease states alter bile composition and metabolism, thus increasing the risk of developing gallstones.
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Affiliation(s)
| | | | - Zeljka Jutric
- Department of Surgery, University of California Irvine; Hepatobiliary and Pancreas Surgery, Department of Surgery, University of California Irvine, Orange, CA, USA.
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Zhang W, Wang BY, Du XY, Fang WW, Wu H, Wang L, Zhuge YZ, Zou XP. Big-data analysis: A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones. World J Gastroenterol 2019; 25:1002-1011. [PMID: 30833805 PMCID: PMC6397721 DOI: 10.3748/wjg.v25.i8.1002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A clinical pathway (CP) is a standardized approach for disease management. However, big data-based evidence is rarely involved in CP for related common bile duct (CBD) stones, let alone outcome comparisons before and after CP implementation. AIM To investigate the value of CP implementation in patients with CBD stones undergoing endoscopic retrograde cholangiopancreatography (ERCP). METHODS This retrospective study was conducted at Nanjing Drum Tower Hospital in patients with CBD stones undergoing ERCP from January 2007 to December 2017. The data and outcomes were compared by using univariate and multivariable regression/linear models between the patients who received conventional care (non-pathway group, n = 467) and CP care (pathway group, n = 2196). RESULTS At baseline, the main differences observed between the two groups were the percentage of patients with multiple stones (P < 0.001) and incidence of cholangitis complication (P < 0.05). The percentage of antibiotic use and complications in the CP group were significantly less than those in the non-pathway group [adjusted odds ratio (OR) = 0.72, 95% confidence interval (CI): 0.55-0.93, P = 0.012, adjusted OR = 0.44, 95%CI: 0.33-0.59, P < 0.001, respectively]. Patients spent lower costs on hospitalization, operation, nursing, medication, and medical consumable materials (P < 0.001 for all), and even experienced shorter length of hospital stay (LOHS) (P < 0.001) after the CP implementation. No significant differences in clinical outcomes, readmission rate, or secondary surgery rate were presented between the patients in the non-pathway and CP groups. CONCLUSION Implementing a CP for patients with CBD stones is a safe mode to reduce the LOHS, hospital costs, antibiotic use, and complication rate.
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Affiliation(s)
- Wei Zhang
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Bing-Yi Wang
- Medical Division, Yidu Cloud (Beijing) Technology Co., Ltd. Beijing 100101, China
| | - Xiao-Yan Du
- Medical Division, Yidu Cloud (Beijing) Technology Co., Ltd. Beijing 100101, China
| | - Wei-Wei Fang
- Medical Division, Yidu Cloud (Beijing) Technology Co., Ltd. Beijing 100101, China
| | - Han Wu
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Lei Wang
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Yu-Zheng Zhuge
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Xiao-Ping Zou
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
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Leal C, Prado V, Colan J, Chavez-Rivera K, Sendino O, Blasi A, Roura P, Juanola A, Rodriguez de Miguel C, Pavesi M, Gomez C, Guarner C, Guarner-Argente C, Fernández J, Cardenas A. Adverse Events and Acute Chronic Liver Failure in Patients With Cirrhosis Undergoing Endoscopic Retrograde Cholangiopancreatography: A Multicenter Matched-Cohort Study. Am J Gastroenterol 2019; 114:89-97. [PMID: 30177786 DOI: 10.1038/s41395-018-0218-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data on the outcome of adverse events (AEs) and the risk of developing acute-on-chronic liver failure (ACLF) after ERCP in patients with cirrhosis are unknown. We examined the incidence and risk factors of post-ERCP AEs in patients with cirrhosis and the appearance of ACLF after ERCP. METHODS In this multicenter, retrospective, matched-cohort study, we evaluated ERCPs performed from January 2002 to 2015. A group of patients with cirrhosis with non-ERCP interventions and one without interventions was also analyzed for the development of ACLF. RESULTS A total of 441 ERCPs were analyzed; 158 in patients with cirrhosis (cases) and 283 in patients without cirrhosis (controls). The overall rate of AEs after all ERCPs was significantly higher in cases compared to controls (17% vs 9.5, p = 0.02). Cholangitis developed more in cases compared to controls (6.3% vs 1.8%; p = 0.01). In a subanalysis of those with sphincterotomy, the rate of bleeding was higher in those with cirrhosis (9.4% vs 3.4%; p = 0.03). Logistic regression identified cirrhosis (OR, 2.48; 95% CI, 1.36-4.53; p = 0.003) and sphincterotomy (OR, 2.66; 95% CI, 1.23-5.72; p = 0.01) as risk factors of AEs. A total of 18/158 (11.4%) cases developed ACLF after ERCP. ACLF occurred in 7/27 cases with post-ERCP AEs and in 11/131 without post-ERCP AEs (25.9% vs 8.3%; p = 0.01). A total of 3.2% (13/406) patients without interventions developed ACLF compared to 17.5% (102/580) who developed ACLF after non-ERCP interventions. Patients with decompensated cirrhosis at ERCP had a higher risk of developing ACLF (17% vs 6.8%; p = 0.04). Patients with a MELD score ≥ 15 were 3.1 times more likely (95% CI: 1.14-8.6; p = 0.027) to develop ACLF after ERCP. CONCLUSIONS The rate of AEs after ERCP is higher in patients with cirrhosis compared to the non-cirrhotic population. The incidence of ACLF is higher in those with AEs after ERCP compared to those without AEs, especially cholangitis. The development of ACLF is common after ERCP and other invasive procedures. ACLF can be precipitated by numerous factors which include preceding events before the procedure, including manipulation of the bile duct, and AEs after an ERCP.
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Affiliation(s)
- Carles Leal
- GI/Endoscopy Unit. Institut de Malalties Digestives i Metabòliques, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Gastroenterology Department, Hospital Universitari de Vic, Barcelona, Spain
| | - Veronica Prado
- Liver Unit. Institut de Malalties Digestives i Metabòliques, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Juan Colan
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Institut de Reçerca - IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Karina Chavez-Rivera
- GI/Endoscopy Unit. Institut de Malalties Digestives i Metabòliques, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Oriol Sendino
- GI/Endoscopy Unit. Institut de Malalties Digestives i Metabòliques, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS) y Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Anabel Blasi
- Anesthesiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pere Roura
- Gastroenterology Department, Hospital Universitari de Vic, Barcelona, Spain
| | - Adria Juanola
- Liver Unit. Institut de Malalties Digestives i Metabòliques, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS) y Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Cristina Rodriguez de Miguel
- GI/Endoscopy Unit. Institut de Malalties Digestives i Metabòliques, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Marco Pavesi
- European Foundation for the Study of Chronic Liver Failure (EF-CLIF), Barcelona, Spain
| | - Cristina Gomez
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Institut de Reçerca - IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Guarner
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Institut de Reçerca - IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Guarner-Argente
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Institut de Reçerca - IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Fernández
- Liver Unit. Institut de Malalties Digestives i Metabòliques, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS) y Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,European Foundation for the Study of Chronic Liver Failure (EF-CLIF), Barcelona, Spain
| | - Andres Cardenas
- GI/Endoscopy Unit. Institut de Malalties Digestives i Metabòliques, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Liver Unit. Institut de Malalties Digestives i Metabòliques, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS) y Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
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Abstract
Acute-on-chronic-liver-failure (ACLF) describes acute deterioration of liver function in patients with decompensated cirrhosis resulting in organ failure, and can occur as a procedural complication. In the current issue, Leal et al found that, compared to in-patients with cirrhosis who did not undergo interventions, ACLF was significantly more common among undergoing ERCP, but not more so than other non-ERCP interventions. ACLF risk increased significantly, however, if an ERCP-related AE occurred. ACLF can be a consequence of both the indication for and a complication of ERCP. When the indication is strong, the benefit of ERCP still outweighs risk among patients with cirrhosis.
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Affiliation(s)
- Tilak Shah
- Division of Gastroenterology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA.,Division of Gastroenterology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Elliot B Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.,Gastroenterology Section, VA Ann Arbor Health System, Ann Arbor, MI, USA
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Mashiana HS, Dhaliwal AS, Sayles H, Dhindsa B, Yoo JW, Wu Q, Singh S, Siddiqui AA, Ohning G, Girotra M, Adler DG. Endoscopic retrograde cholangiopancreatography in cirrhosis - a systematic review and meta-analysis focused on adverse events. World J Gastrointest Endosc 2018; 10:354-366. [PMID: 30487946 PMCID: PMC6247096 DOI: 10.4253/wjge.v10.i11.354] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/17/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate indications and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhotics, especially adverse events. Patients with cirrhosis undergoing ERCP are believed to have increased risk. However, there is a paucity of literature describing the indications and outcomes of ERCP procedures in patients with cirrhosis, especially focusing on adverse events. METHODS We performed a systematic appraisal of major literature databases, including PubMed and EMBASE, with a manual search of literature from their inception until April 2017. RESULTS A total of 6,505 patients from 15 studies were analyzed (male ratio 59%, mean age 59 years), 11% with alcoholic and 89% with non-alcoholic cirrhosis, with 56.2% Child-Pugh class A, and 43.8% class B or C. Indications for ERCP included choledocholithiasis 60.9%, biliary strictures 26.2%, gallstone pancreatitis 21.1% and cholangitis 15.5%. Types of interventions included endoscopic sphincterotomy 52.7%, biliary stenting 16.7% and biliary dilation 4.6%. Individual adverse events included hemorrhage in 4.58% (95%CI: 2.77-6.75%, I 2 = 85.9%), post-ERCP pancreatitis (PEP) in 3.68% (95%CI: 1.83-6.00%, I 2 = 89.5%), cholangitis in 1.93% (95%CI: 0.63-3.71%, I 2 = 87.1%) and perforation in 0.00% (95%CI: 0.00-0.23%, I 2 = 37.8%). Six studies were used for comparison of ERCP-related complications in cirrhosis vs non-cirrhosis, which showed higher overall rates of complications in cirrhosis patients with pooled OR of 1.63 (95%CI: 1.27-2.09, I 2 = 65%): higher rates of hemorrhage with OR of 2.05 (95%CI: 1.62-2.58, I 2 = 2.1%) and PEP with OR of 1.33 (95%CI: 1.04-1.70, I 2=65%), but similar cholangitis rates with OR of 1.23 (95%CI: 0.67-2.26, I 2 = 44.3%). CONCLUSION There is an overall higher rate of adverse events related to ERCP in patients with cirrhosis, especially hemorrhage and PEP. A thorough risk/benefit assessment should be performed prior to undertaking ERCP in patients with cirrhosis.
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Affiliation(s)
- Harmeet Singh Mashiana
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV 89102, United States
| | - Amaninder Singh Dhaliwal
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE 68198-2000, United States
| | - Harlan Sayles
- Department of Biostatistics, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE 68198-2000, United States
| | - Banreet Dhindsa
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV 89102, United States
| | - Ji Won Yoo
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV 89102, United States
| | - Qing Wu
- Nevada Institute of Personalized Medicine, Department of Environmental and Occupational Health, School of Community Health Sciences, University of Nevada, Las Vegas, NV 89154-4009, United States
| | - Shailender Singh
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE 68198-2000, United States
| | - Ali A Siddiqui
- Division of Gastroenterology, Jefferson Medical College, Philadelphia, PA 19107, United States
| | - Gordon Ohning
- Division of Gastroenterology, University of Nevada Las Vegas School of Medicine, Las Vegas, NV 89102, United States
| | - Mohit Girotra
- Division of Gastroenterology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, UT 84132, United States
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Rai AA, Nazeer A, Luck NH. Frequency of gallstones and mean BMI in decompensated cirrhosis. Pan Afr Med J 2018; 30:123. [PMID: 30374369 PMCID: PMC6201626 DOI: 10.11604/pamj.2018.30.123.12742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 05/25/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction The aim of the study was to determine the frequency of gallstones in patients with decompensated cirrhosis and to know about mean Body mass index (BMI) in patients of decompensated cirrhosis i.e End stage liver disease (ESLD) with and without gallstones. Methods it is a cross sectional descriptive study, conducted at the department of Hepato-gastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi from 1st August 2014 to 28 February 2015. Two hundred patients were enrolled from outpatient clinics of Hepato-gastroenterology that fulfilled the defined selection criteria. Questionnaire was filled for data collection. SPSS version 20.0 was used to analyze data. Mean value of age and BMI was calculated by mean ± S.D. values. Mean ± SD was also calculated for BMI in patients with and without gallstones. Stratification of the age, gender, and liver disease severity were done and chi-Square test was applied. p-values less than 0.05 considered statistically significant. Results Two hundred consecutive patients were enrolled among them 112(56%) were male. Mean age was 46.89 ± 11.9, BMI 23.59 ± 4.7 and CTP score was 9.7 ± 1.9. Most of the patient had Child class 'B' cirrhosis 102(51%), most common etiology was found to be Hepatitis C 133 (66.5%), cholelithiasis was found in 59(29.5%), sludge in 36 (18%) and both stone and sludge in 24(12%) of the cases. Advanced liver disease that is, more CTP score and child class 'C' was associated with increased frequency of gall stone formation (p-value = 0.012), and advancing age on age stratification (p-value = 0.024) however no relation was observed with increase BMI, gender, ethnicity, cause or duration of disease in this population. Conclusion Gallstone formation is associated with advanced stage of cirrhosis and hepatitis C Virus related CLD, contrary to the established risk factors, no relation of gender or BMI was found in decompensated liver disease.
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Affiliation(s)
- Ayesha Aslam Rai
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistani
| | - Aisha Nazeer
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistani
| | - Nasir Hassan Luck
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistani
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Li X, Gao P. Hepatitis C Virus Infection Increases Risk of Gallstone Disease in Elderly Chinese Patients with Chronic Liver Disease. Sci Rep 2018; 8:4636. [PMID: 29545607 PMCID: PMC5854625 DOI: 10.1038/s41598-018-22896-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 02/28/2018] [Indexed: 12/11/2022] Open
Abstract
We investigated possible links between the etiology of liver disease and gallstone risk in Chinese patients with chronic liver disease (CLD). We compared the outcomes of 267 Chinese CLD patients with gallstones and those of a control group of 1,015 CLD patients without gallstones. Logistic regression analyses adjusting for demographic features and other gallstone risk factors revealed that liver cirrhosis increased the risk of gallstone development twofold [adjusted odds ratio (AOR); 95% confidence interval (95% CI): 2.343 (1.710–3.211)]. HCV infection increased gallstone risk 1–2-fold [AOR; 95% CI: 1.582 (1.066–2.347)] higher than did HBV infection. Multivariate analyses of the risk of developing gallstones in patients with liver cirrhosis after an HCV or HBV infection yielded an estimated AOR (95% CI) of 1.601 (1.063–2.413) in patients with an HCV infection. In elderly patients with CLD (≥60 years of age), gallstone risk also increased significantly after an HCV infection [AOR (95% CI): 2.394 (1.066–5.375)]. HCV infection, older age, and liver cirrhosis significantly correlate with an increased risk of gallstone development in Chinese patients with CLD. HCV infection further increases this risk in both patients with liver cirrhosis and in elderly CLD patients (≥60 years of age).
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Affiliation(s)
- Xu Li
- Department of Hepatology, The First Hospital of Jilin University, Jilin University, No. 71 Xinmin Street, Changchun, 130021, China
| | - Pujun Gao
- Department of Hepatology, The First Hospital of Jilin University, Jilin University, No. 71 Xinmin Street, Changchun, 130021, China.
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Wijarnpreecha K, Thongprayoon C, Panjawatanan P, Lekuthai N, Ungprasert P. Hepatitis C virus infection and risk of gallstones: A meta-analysis. J Evid Based Med 2017; 10:263-270. [PMID: 29193901 DOI: 10.1111/jebm.12277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 11/06/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND/OBJECTIVES Gallstones and its complications are one of the most common hepatobiliary tract diseases. Several epidemiologic studies have suggested that patients with hepatitis C virus (HCV) infection might be at an increased risk of gallstones. However, the data on this relationship remain inconclusive. This meta-analysis was conducted with the aims to summarize all available evidence. METHODS A literature search was performed using MEDLINE and EMBASE databases from inception to May 2016. Studies that reported relative risks, odd ratios, or hazard ratios comparing the risk of gallstones among HCV-infected patients versus subjects without HCV infection were included. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS Eleven studies met our eligibility criteria and were included in the analysis. The pooled OR of gallstones in HCV-infected patients versus subjects without HCV infection was 1.83 (95% CI, 1.35 to 2.48, I2 = 89%). Subgroup analysis showed that significant risk was increased for both male (pooled OR of 2.07, 95% CI, 1.14 to 3.76) and female (pooled OR of 3.00, 95% CI, 2.16 to 4.17). CONCLUSIONS Our study demonstrated a significantly increased risk of gallstones among HCV-infected patients. Further studies are required to clarify how this risk should be addressed in the clinical picture.
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Affiliation(s)
- Karn Wijarnpreecha
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - Charat Thongprayoon
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | | | - Natasorn Lekuthai
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patompong Ungprasert
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Li X, Gao Y, Xu H, Hou J, Gao P. Diabetes mellitus is a significant risk factor for the development of liver cirrhosis in chronic hepatitis C patients. Sci Rep 2017; 7:9087. [PMID: 28831144 PMCID: PMC5567219 DOI: 10.1038/s41598-017-09825-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/31/2017] [Indexed: 12/21/2022] Open
Abstract
We explored the association between diabetes mellitus (DM) and the risk of hepatitis C virus (HCV)-related liver cirrhosis in Chinese patients with chronic hepatitis C (CHC). To examine the link between DM and liver cirrhosis, we conducted a case-control study of 210 Chinese CHC patients diagnosed with liver cirrhosis, comparing them to an age- and sex-matched control group of 431 CHC patients without liver cirrhosis. We conducted logistic regression analyses adjusting for demographic features and liver cirrhosis risk factors, and found that DM increased the risk of developing liver cirrhosis 2-fold [adjusted odds ratio (AOR), 2.132; 95% confidence interval (CI), 1.344–3.382]. Furthermore, the proportion of liver cirrhosis patients and CHC-only patients with elevated serum triglycerides (>1.8 mmol/L) were 5.2% and 17.4%, respectively, yielding an AOR of 0.264 (95% CI, 0.135–0.517). Multivariate analyses that stratified the risk of developing HCV-related liver cirrhosis in DM patients by gender revealed that the estimated AOR (95% CI) for males was 0.415 (0.178–0.969). In conclusion, DM was associated with an increased risk of developing liver cirrhosis in CHC patients in China. Furthermore, among patients diagnosed with both CHC and DM, females had an increased risk of liver cirrhosis development.
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Affiliation(s)
- Xu Li
- Department of Hepatology, The First Hospital of Jilin University, Jilin University, No. 71 Xinmin Street, Changchun, 130021, China
| | - Yang Gao
- Department of Neurology, The First Hospital of Jilin University, Jilin University, No. 71 Xinmin Street, Changchun, 130021, China
| | - Hongqin Xu
- Department of Hepatology, The First Hospital of Jilin University, Jilin University, No. 71 Xinmin Street, Changchun, 130021, China.,Jilin Province Key Laboratory of Infectious Disease, Laboratory of Molecular Virology, Changchun, 130021, China
| | - Jie Hou
- Department of Nephrology, The First Hospital of Jilin University, Jilin University, No. 71 Xinmin Street, Changchun, 130021, China
| | - Pujun Gao
- Department of Hepatology, The First Hospital of Jilin University, Jilin University, No. 71 Xinmin Street, Changchun, 130021, China.
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Aghdassi AA, Schneider A, Kahl M, Schütte K, Kuliaviene I, Salacone P, Lutz J, Tukiainen E, Simon P, Schauer B, Uomo G, Hauge T, Ceyhan GO. Analysis of lifestyle factors in patients with concomitant chronic pancreatitis and liver cirrhosis. Pancreatology 2017; 17:698-705. [PMID: 28784575 DOI: 10.1016/j.pan.2017.07.194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 07/26/2017] [Accepted: 07/30/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND & OBJECTIVES Chronic pancreatitis (CP) and liver cirrhosis (LC) are common gastroenterological disorders but their co-incidence is considered to be rare. This study was designed to identify lifestyle factors that are associated with the development of concomitant LC in patients with CP. METHODS In a retrospective case-control study between 2000 and 2005 122 patients with both CP and LC and 223 matched control patients with CP and no known liver disease were identified in 11 European university medical centers. Another 24 patients and 48 CP controls were identified in the period between 2006 and 2012. RESULTS Alcoholism was most commonly regarded as aetiology for both CP (82.2%; 95% confidence interval (CI): 75.0-88.0%) and LC (79.5%; 95% CI: 72.0-85.7%) as compared to controls with CP only (68.6%; 95% CI: 62.7-74.1%). The preferred type of alcoholic beverage and pattern of alcohol intake were the only significant lifestyle factors in multivariate analysis. Frequency of alcohol intake (p = 0.105) and smoking status (p = 0.099) were not significant in bivariate analysis and dropped out of the multivariate model. Recurrent and chronic pancreatic pain was observed more often in patients with only CP, whereas gallstones were more common in individuals with both chronic disorders. CONCLUSIONS These findings indicate that certain lifestyle factors might be important for the development of concomitant CP and LC. More studies will be needed to identify additional genetic and environmental factors underlying this association.
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Affiliation(s)
- Ali A Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany.
| | - Alexander Schneider
- Department of Medicine II, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Matthias Kahl
- Israelitisches Krankenhaus Hamburg, Hamburg, Germany
| | - Kerstin Schütte
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Irma Kuliaviene
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Jon Lutz
- Department of Surgery, Inselspital Bern, Bern, Switzerland
| | - Eija Tukiainen
- Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Peter Simon
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Birgit Schauer
- Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Generoso Uomo
- Department of Internal Medicine, Cardarelli Hospital, Naples, Italy
| | - Truls Hauge
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Güralp O Ceyhan
- Department of Surgery, Technical University of Munich, Munich, Germany
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Li X, Wang Z, Wang L, Pan M, Gao P. Liver cirrhosis: a risk factor for gallstone disease in chronic hepatitis C patients in China. Medicine (Baltimore) 2017; 96:e7427. [PMID: 28658178 PMCID: PMC5500101 DOI: 10.1097/md.0000000000007427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We investigated the possible link between liver cirrhosis and gallstone risk in chronic hepatitis C (CHC) patients in China.To analyze the association between liver cirrhosis and gallstone development, we compared outcomes of 133 Chinese CHC patients with gallstones and an age-, sex-, and hepatitis C virus RNA level-matched control group of 431 CHC patients without gallstones.We found that liver cirrhosis was more prevalent in gallstone patients (40.6%) than in the control group (24.4%). Logistic regression analyses adjusting for demographic features and other gallstone risk factors revealed that liver cirrhosis increased the risk of gallstone development 2-fold (adjusted odds ratio [AOR]: 2.122; 95% confidence interval [CI]: 1.408-3.198). Moreover, multivariate analyses comparing the risk of gallstone development in liver cirrhosis patients with decompensated or compensated liver cirrhosis yielded an estimated AOR (95% CI) of 2.869 (1.277-6.450) in patients with decompensated liver cirrhosis. Gallstone risk also increased significantly with older age (>60 years) (AOR: 2.019; 95% CI: 1.017-4.009).Liver cirrhosis significantly correlates with increased risk of gallstone development in CHC patients in China. Decompensated liver cirrhosis and older age further heighten this risk in patients diagnosed with hepatitis C-related cirrhosis.
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Dolejs SC, Beane JD, Kays JK, Ceppa EP, Zarzaur BL. The model for end-stage liver disease predicts outcomes in patients undergoing cholecystectomy. Surg Endosc 2017; 31:5192-5200. [DOI: 10.1007/s00464-017-5587-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/02/2017] [Indexed: 02/07/2023]
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Banu P, Constantin VD, Popa F, Motofei I, Bălălău C. Cholecystectomy in cirrhotic patients – how safe is it? JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2017. [DOI: 10.25083/2559.5555.21.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Liver cirrhosis is a major health problem worldwide with a prevalence that varies greatly from one geographical area to another. Besides the risk factors common to the general population to develop gallstone disease such as advanced age, female sex or positive family history of gallstones, in patients with liver cirrhosis there are additional risk factors that contribute to the occurrence of gallstones. They are more frequent in patients with a longer duration of the disease and in Child B and C stages. Gallstones disease occurs three times more frequently in patients with liver cirrhosis than in non-cirrhotic patients. Surgery is required if symptoms or complications related to the presence of gallstones occur and a thorough preoperative evaluation and optimization of patient’s condition is necessary prior to surgery. The procedure of choice in these situations is laparoscopic cholecystectomy. The technique has some particularities resulting from local anatomical changes and conversion to open technique remains low and morbidity and mortality rates are within acceptable limits.
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