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Archibugi L, Ciarfaglia G, Cárdenas-Jaén K, Poropat G, Korpela T, Maisonneuve P, Aparicio JR, Casellas JA, Arcidiacono PG, Mariani A, Stimac D, Hauser G, Udd M, Kylänpää L, Rainio M, Di Giulio E, Vanella G, Lohr JM, Valente R, Arnelo U, Fagerstrom N, De Pretis N, Gabbrielli A, Brozzi L, Capurso G, de-Madaria E. Machine learning for the prediction of post-ERCP pancreatitis risk: A proof-of-concept study. Dig Liver Dis 2023; 55:387-393. [PMID: 36344369 DOI: 10.1016/j.dld.2022.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Predicting Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis (PEP) risk can be determinant in reducing its incidence and managing patients appropriately, however studies conducted thus far have identified single-risk factors with standard statistical approaches and limited accuracy. AIM To build and evaluate performances of machine learning (ML) models to predict PEP probability and identify relevant features. METHODS A proof-of-concept study was performed on ML application on an international, multicenter, prospective cohort of ERCP patients. Data were split in training and test set, models used were gradient boosting (GB) and logistic regression (LR). A 10-split random cross-validation (CV) was applied on the training set to optimize parameters to obtain the best mean Area Under Curve (AUC). The model was re-trained on the whole training set with the best parameters and applied on test set. Shapley-Additive-exPlanation (SHAP) approach was applied to break down the model and clarify features impact. RESULTS One thousand one hundred and fifty patients were included, 6.1% developed PEP. GB model outperformed LR with AUC in CV of 0.7 vs 0.585 (p-value=0.012). GB AUC in test was 0.671. Most relevant features for PEP prediction were: bilirubin, age, body mass index, procedure time, previous sphincterotomy, alcohol units/day, cannulation attempts, gender, gallstones, use of Ringer's solution and periprocedural NSAIDs. CONCLUSION In PEP prediction, GB significantly outperformed LR model and identified new clinical features relevant for the risk, most being pre-procedural.
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Affiliation(s)
- Livia Archibugi
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy.
| | - Gianmarco Ciarfaglia
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Karina Cárdenas-Jaén
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Goran Poropat
- University Hospital of Rijeka, Department of Gastroenterology, Rijeka, Croatia
| | - Taija Korpela
- Helsinki University Hospital and University of Helsinki, Gastroenterological Surgery, Abdominal Center, Helsinki, Finland
| | - Patrick Maisonneuve
- Unit of Clinical Epidemiology, Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - José R Aparicio
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Juan Antonio Casellas
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Mariani
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Davor Stimac
- University Hospital of Rijeka, Department of Gastroenterology, Rijeka, Croatia
| | - Goran Hauser
- University Hospital of Rijeka, Department of Gastroenterology, Rijeka, Croatia
| | - Marianne Udd
- Helsinki University Hospital and University of Helsinki, Gastroenterological Surgery, Abdominal Center, Helsinki, Finland
| | - Leena Kylänpää
- Helsinki University Hospital and University of Helsinki, Gastroenterological Surgery, Abdominal Center, Helsinki, Finland
| | - Mia Rainio
- Helsinki University Hospital and University of Helsinki, Gastroenterological Surgery, Abdominal Center, Helsinki, Finland
| | - Emilio Di Giulio
- Department of Gastroenterology, Sant'Andrea Hospital, University Sapienza, Rome, Italy
| | - Giuseppe Vanella
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy; Department of Gastroenterology, Sant'Andrea Hospital, University Sapienza, Rome, Italy
| | - Johannes Matthias Lohr
- HPD Disease Unit, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Roberto Valente
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Surgical Oncology, Anschutz Medical Campus, University of Colorado, Denver, USA
| | - Urban Arnelo
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | | | - Nicolò De Pretis
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Armando Gabbrielli
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Lorenzo Brozzi
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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Papić E, Rački V, Hero M, Tomić Z, Starčević-Čižmarević N, Kovanda A, Kapović M, Hauser G, Peterlin B, Vuletić V. The effects of microbiota abundance on symptom severity in Parkinson's disease: A systematic review. Front Aging Neurosci 2022; 14:1020172. [PMID: 36570528 PMCID: PMC9772822 DOI: 10.3389/fnagi.2022.1020172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Parkinson's disease (PD) is neurodegenerative disease with a multifactorial etiopathogenesis with accumulating evidence identifying microbiota as a potential factor in the earliest, prodromal phases of the disease. Previous research has already shown a significant difference between gut microbiota composition in PD patients as opposed to healthy controls, with a growing number of studies correlating gut microbiota changes with the clinical presentation of the disease in later stages, through various motor and non-motor symptoms. Our aim in this systematic review is to compose and assess current knowledge in the field and determine if the findings could influence future clinical practice as well as therapy in PD. Methods We have conducted a systematic review according to PRISMA guidelines through MEDLINE and Embase databases, with studies being selected for inclusion via a set inclusion and exclusion criteria. Results 20 studies were included in this systematic review according to the selected inclusion and exclusion criteria. The search yielded 18 case control studies, 1 case study, and 1 prospective case study with no controls. The total number of PD patients encompassed in the studies cited in this review is 1,511. Conclusion The link between gut microbiota and neurodegeneration is a complex one and it depends on various factors. The relative abundance of various microbiota taxa in the gut has been consistently shown to have a correlation with motor and non-motor symptom severity. The answer could lie in the products of gut microbiota metabolism which have also been linked to PD. Further research is thus warranted in the field, with a focus on the metabolic function of gut microbiota in relation to motor and non-motor symptoms.
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Affiliation(s)
- Eliša Papić
- Department of Neurology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia,Clinic of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Valentino Rački
- Department of Neurology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia,Clinic of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Mario Hero
- Department of Neurology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia,Clinic of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Zoran Tomić
- Clinic of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Nada Starčević-Čižmarević
- Department of Medical Genetics and Biology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Anja Kovanda
- Clinical Institute of Genomic Medicine, Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Miljenko Kapović
- Department of Medical Genetics and Biology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Goran Hauser
- Department of Internal Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Borut Peterlin
- Clinical Institute of Genomic Medicine, Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Vladimira Vuletić
- Department of Neurology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia,Clinic of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia,*Correspondence: Vladimira Vuletić,
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3
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Mikolasevic I, Domislovic V, Ruzic A, Hauser G, Rahelic D, Klobucar-Majanovic S, Krznaric Z, Dobrila-Dintinjana R, Grgurevic I, Skenderevic N, Lukic A, Targher G. Elastographic parameters of liver steatosis and fibrosis predict independently the risk of incident chronic kidney disease and acute myocardial infarction in patients with type 2 diabetes mellitus. J Diabetes Complications 2022; 36:108226. [PMID: 35803839 DOI: 10.1016/j.jdiacomp.2022.108226] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/11/2022] [Accepted: 05/30/2022] [Indexed: 11/15/2022]
Abstract
AIMS The aim of this prospective study was to examine the relationship between controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) with the risk of developing a composite endpoint inclusive of incident acute myocardial infarction (AMI), cerebrovascular insult (CVI) or chronic kidney disease (CKD) in people with type 2 diabetes mellitus (T2DM). METHODS This study included 238 T2DM outpatients without chronic liver diseases. RESULTS The patient population was followed for a median period of 7.6 years. Kaplan-Meier survival analyses showed that there was a higher proportion of patients who developed the aforementioned composite outcome (P < 0.001 by the log-rank test), as well as CKD (P < 0.001) or AMI alone (P = 0.014) among those with elevated CAP values (≥238 dB/m) at baseline. Similarly, Kaplan-Meier survival analyses showed that there was a higher proportion of patients who developed the composite outcome (P < 0.001), as well as CKD (P < 0.001), or AMI alone (P < 0.001) among those with elevated LSM values (≥7.0/6.2 kPa). In multivariable regression analyses, the presence of elevated CAP (adjusted-hazard ratio 2.34, 95% CI 1.32-4.15) and elevated LSM (adjusted-hazard ratio 2.84, 95% CI 1.92-4.21), independently of each other, were associated with a higher risk of developing the composite outcome, as well as incident AMI or CKD alone after adjusting for traditional cardiovascular risk factors and diabetes-related variables. CONCLUSIONS Our study shows that the elastographic parameters of liver steatosis and fibrosis independently predict the long-term risk of developing chronic vascular complications in T2DM patients.
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Affiliation(s)
- I Mikolasevic
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia; Faculty of Medicine, Rijeka, Croatia.
| | - V Domislovic
- Department for Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - A Ruzic
- Faculty of Medicine, Rijeka, Croatia; Clinic for Cardiology, University Hospital Center Rijeka, Rijeka, Croatia
| | - G Hauser
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia; Faculty of Medicine, Rijeka, Croatia; Faculty of Health Studies, Rijeka, Croatia
| | - D Rahelic
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia; University of Zagreb Faculty of Medicine, Zagreb, Croatia; University of Osijek Faculty of Medicine, Osijek, Croatia
| | - S Klobucar-Majanovic
- Faculty of Medicine, Rijeka, Croatia; Department for Diabetes, Endocrinology and Metabolic Diseases, UHC Rijeka, Croatia
| | - Z Krznaric
- Department for Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia; University of Zagreb Faculty of Medicine, Zagreb, Croatia
| | - R Dobrila-Dintinjana
- Faculty of Medicine, Rijeka, Croatia; Department of Oncology, UHC Rijeka, Croatia
| | - I Grgurevic
- University of Zagreb Faculty of Medicine, Zagreb, Croatia; Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, Zagreb, Croatia
| | - N Skenderevic
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia
| | - A Lukic
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia
| | - G Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Italy
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Savarino E, Zingone F, Barberio B, Marasco G, Akyuz F, Akpinar H, Barboi O, Bodini G, Bor S, Chiarioni G, Cristian G, Corsetti M, Di Sabatino A, Dimitriu AM, Drug V, Dumitrascu DL, Ford AC, Hauser G, Nakov R, Patel N, Pohl D, Sfarti C, Serra J, Simrén M, Suciu A, Tack J, Toruner M, Walters J, Cremon C, Barbara G. Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility. United European Gastroenterol J 2022; 10:556-584. [PMID: 35695704 PMCID: PMC9278595 DOI: 10.1002/ueg2.12259] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
Irritable bowel syndrome with diarrhoea (IBS‐D) and functional diarrhoea (FDr) are the two major functional bowel disorders characterized by diarrhoea. In spite of their high prevalence, IBS‐D and FDr are associated with major uncertainties, especially regarding their optimal diagnostic work‐up and management. A Delphi consensus was performed with experts from 10 European countries who conducted a literature summary and voting process on 31 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation criteria. Consensus (defined as >80% agreement) was reached for all the statements. The panel agreed with the potential overlapping of IBS‐D and FDr. In terms of diagnosis, the consensus supports a symptom‐based approach also with the exclusion of alarm symptoms, recommending the evaluation of full blood count, C‐reactive protein, serology for coeliac disease, and faecal calprotectin, and consideration of diagnosing bile acid diarrhoea. Colonoscopy with random biopsies in both the right and left colon is recommended in patients older than 50 years and in presence of alarm features. Regarding treatment, a strong consensus was achieved for the use of a diet low fermentable oligo‐, di‐, monosaccharides and polyols, gut‐directed psychological therapies, rifaximin, loperamide, and eluxadoline. A weak or conditional recommendation was achieved for antispasmodics, probiotics, tryciclic antidepressants, bile acid sequestrants, 5‐hydroxytryptamine‐3 antagonists (i.e. alosetron, ondansetron, or ramosetron). A multinational group of European experts summarized the current state of consensus on the definition, diagnosis, and management of IBS‐D and FDr.
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Affiliation(s)
- Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Fabiana Zingone
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Brigida Barberio
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Giovanni Marasco
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Filiz Akyuz
- Department of Gastroenterology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Hale Akpinar
- Department of Internal Medicine, Dokuz Eylül University School of Medicine, Izmir, Turkey
| | - Oana Barboi
- Department of Gastroenterology, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi, Romania.,Institute of Gastroenterology and Hepatology, 'Saint Spiridon' Hospital, Iasi, Romania
| | - Giorgia Bodini
- Gastrointestinal Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Serhat Bor
- Division of Gastroenterology, Ege University School of Medicine, Izmir, Turkey
| | | | - Gheorghe Cristian
- Fundeni Clinical Institute Center of Gastroenterology and Hepatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Maura Corsetti
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Antonio Di Sabatino
- First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Anca Mirela Dimitriu
- Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, University of Medicine and Pharmacy, Bucharest, Romania
| | - Vasile Drug
- Department of Gastroenterology, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi, Romania.,Institute of Gastroenterology and Hepatology, 'Saint Spiridon' Hospital, Iasi, Romania
| | - Dan L Dumitrascu
- 2nd Department of Internal Medicine, 'Iuliu Hatieganu' University of Medicine and Farmacy, Cluj-Napoca, Romania
| | - Alexander C Ford
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Medical Research at St. James's Sciences, University of Leeds, Leeds, UK
| | - Goran Hauser
- Department of Gastroenterology, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Radislav Nakov
- Department of Gastroenterology, Tsaritsa Yoanna University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Nisha Patel
- Imperial College Healthcare NHS Trust, Institute of Global Health Innovation, St Mary's Hospital Campus, London, UK
| | - Daniel Pohl
- Department of Gastroenterology, University Hospital Zurich, Zurich, Switzerland
| | - Cătălin Sfarti
- Department of Gastroenterology, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi, Romania.,Institute of Gastroenterology and Hepatology, 'Saint Spiridon' Hospital, Iasi, Romania
| | - Jordi Serra
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain.,Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Badalona, Spain
| | - Magnus Simrén
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alina Suciu
- Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, University of Medicine and Pharmacy, Bucharest, Romania
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Murat Toruner
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Julian Walters
- Division of Digestive Diseases, Department of Metabolism, Digestion, and Reproduction, Faculty of Medicine, Imperial College London, London, UK.,Department of Gastroenterology, Division of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, UK
| | - Cesare Cremon
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Barbara
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Javor E, Hauser G, Skelin M. Therapeutic Drug Monitoring vs Standard Therapy During Maintenance Infliximab Therapy and Control of Immune-Mediated Inflammatory Diseases. JAMA 2022; 327:1505-1506. [PMID: 35438732 DOI: 10.1001/jama.2022.2935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Eugen Javor
- Department of Pharmacy, General Hospital Bjelovar, Bjelovar, Croatia
| | - Goran Hauser
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Marko Skelin
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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Mikolasevic I, Bozic D, Pavić T, Ruzic A, Hauser G, Radic M, Radic-Kristo D, Razov-Radas M, Puljiz Z, Milic S. Liver disease in the era of COVID-19: Is the worst yet to come? World J Gastroenterol 2021; 27:6039-6052. [PMID: 34629818 PMCID: PMC8476340 DOI: 10.3748/wjg.v27.i36.6039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/18/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023] Open
Abstract
The global social, economic and political crises related to coronavirus disease 2019 (COVID-19) presumably had more indirect than direct negative impacts on health systems. Drastic lifestyle changes, social isolation and distancing, and individual and global financial crises resulted in robust populations forfeiting healthy habits and seeking comfort in alcoholic beverages, drugs and unhealthy diets. The inevitable consequences are increases in the incidence of nonalcoholic fatty liver disease, viral hepatitis, acute alcoholic hepatitis, liver cirrhosis decompensation and ultimately liver-related mortality. The inaccessibility of regular clinical and sonographic monitoring systems has caused difficulties in the treatment of patients with chronic liver disease (CLD) and has prevented prompt hepatocellular carcinoma detection and treatment. A dramatic reduction in the number of liver donors and the transformation of numerous transplantation centers into COVID-19 units drastically decreased the rate of orthotopic liver transplantation. The indirect, unavoidable effects of the COVID-19 pandemic in the following years have yet to be determined. Substantial efforts in the management of patients with liver disease in order to overcome the inevitable COVID-19-related morbidity and mortality that will follow have yet to be initiated. Several questions regarding the impact of the COVID-19 pandemic on liver disease remain. The most important question for general CLD patients is: How will the modification of clinical practice during this pandemic affect the outcomes of CLD patients? This article reviews the influence of COVID-19 on patients with liver disease during the pandemic, with particular emphasis on the disease course associated with pandemic resolution.
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Affiliation(s)
- Ivana Mikolasevic
- Department of Gastroenterology, Clinical Hospital Center Rijeka, Rijeka 51000, Croatia
- Department of Gastroenterology, University Hospital Merkur, Zagreb 10000, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Dorotea Bozic
- Department for Gastroenterology and Hepatology, University Hospital Center Split, Split 21000, Croatia
| | - Tajana Pavić
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Sestre Milosrdnice University Hospital Center, Zagreb 10000, Croatia
| | - Alen Ruzic
- Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
- Clinic for Cardiology, University Hospital Center Rijeka, Rijeka 51000, Croatia
| | - Goran Hauser
- Department of Gastroenterology, Clinical Hospital Center Rijeka, Rijeka 51000, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
- Faculty of Health Studies, University of Rijeka, Rijeka 51000, Croatia
| | | | - Delfa Radic-Kristo
- Faculty of Medicine, Zagreb 10000, Croatia
- Department of Hematology, University Hospital Merkur, Zagreb 10000, Croatia
| | | | - Zeljko Puljiz
- Department for Gastroenterology and Hepatology, University Hospital Center Split, Split 21000, Croatia
- University of Split, School of Medicine, Split 21000, Croatia
| | - Sandra Milic
- Department of Gastroenterology, Clinical Hospital Center Rijeka, Rijeka 51000, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
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7
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Benjak Horvat I, Gobin I, Kresović A, Hauser G. How can probiotic improve irritable bowel syndrome symptoms? World J Gastrointest Surg 2021; 13:923-940. [PMID: 34621470 PMCID: PMC8462084 DOI: 10.4240/wjgs.v13.i9.923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/22/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
The onset and manifestations of irritable bowel syndrome (IBS) is associated with several factors, and the pathophysiology involves various central and peripheral mechanisms. Most studies indicate that the management of gut microbiota could significantly affect the improvement of subjective disorders in patients with IBS. Numerous clinical trials have assessed the efficacy of probiotics for IBS with controversial conclusions. Several clinical trials have suggested that probiotics can improve global IBS symptoms, while others only improve individual IBS symptoms, such as bloating scores and abdominal pain scores. Only a few clinical trials have found no apparent effect of probiotics on IBS symptoms. Generally, probiotics appear to be safe for patients with IBS. However, the question of which probiotics should be used for certain IBS subtypes remains unresolved. In everyday practice, the dose of the recommended probiotic remains questionable, as well as how long the probiotic should be used in therapy. The use of probiotics in the M subtype and non-classified IBS is particularly problematic, in which combination therapy should be recommended due to the change in symptoms. Therefore, new approaches are needed in the design of clinical studies that should address certain subtypes of IBS.
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Affiliation(s)
- Indira Benjak Horvat
- Department of Gastroenterology, Varaždin General Hospital, Varažin 42000, Croatia
| | - Ivana Gobin
- Department of Microbiology and Parasitology, Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Andrea Kresović
- Department of Gastroenterology, Clinical Hospital Center Rijeka, Rijeka 51000, Croatia
| | - Goran Hauser
- Department of Gastroenterology, Faculty of Medicine, Clinical Hospital Center Rijeka, University of Rijeka, Rijeka 51000, Croatia
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Papanikolaou IS, Tziatzios G, Chatzidakis A, Facciorusso A, Crinò SF, Gkolfakis P, Deriban G, Tadic M, Hauser G, Vezakis A, Jovanovic I, Muscatiello N, Meneghetti A, Miltiadou K, Stardelova K, Lacković A, Bourou MZ, Djuranovic S, Triantafyllou K. COVID-19 in the endoscopy unit: How likely is transmission of infection? Results from an international, multicenter study. World J Gastrointest Endosc 2021; 13:416-425. [PMID: 34630891 PMCID: PMC8474700 DOI: 10.4253/wjge.v13.i9.416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) significantly affected endoscopy practice, as gastrointestinal endoscopy is considered a risky procedure for transmission of infection to patients and personnel of endoscopy units (PEU).
AIM To assess the impact of COVID-19 on endoscopy during the first European lockdown (March-May 2020).
METHODS Patients undergoing endoscopy in nine endoscopy units across six European countries during the period of the first European lockdown for COVID-19 (March-May 2020) were included. Prior to the endoscopy procedure, participants were stratified as low- or high- risk for potential COVID-19 infection according to the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) joint statement, and contacted 7-14 d later to assess COVID-19 infection status. PEU were questioned regarding COVID-19 symptoms and/or infection via questionnaire, while information regarding hospitalizations, intensive care unit-admissions and COVID-19-related deaths were collected. The number of weekly endoscopies at each center during the lockdown period was also recorded.
RESULTS A total of 1267 endoscopies were performed in 1222 individuals across nine European endoscopy departments in six countries. Eighty-seven (7%) were excluded because of initial positive testing. Of the 1135 pre-endoscopy low risk or polymerase chain reaction negative for COVID-19, 254 (22.4%) were tested post endoscopy and 8 were eventually found positive, resulting in an infection rate of 0.7% [(95%CI: 0.2-0.12]. The majority (6 of the 8 patients, 75%) had undergone esophagogastroduodenoscopy. Of the 163 PEU, 5 [3%; (95%CI: 0.4-5.7)] tested positive during the study period. A decrease of 68.7% (95%CI: 64.8-72.7) in the number of weekly endoscopies was recorded in all centers after March 2020. All centers implemented appropriate personal protective measures (PPM) from the initial phases of the lockdown.
CONCLUSION COVID-19 transmission in endoscopy units is highly unlikely in a lockdown setting, provided endoscopies are restricted to emergency cases and PPM are implemented.
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Affiliation(s)
- Ioannis S Papanikolaou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Alexandros Chatzidakis
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia AOU, Foggia 1245, Italy
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, Verona 37138, Italy
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels 1070, Belgium
- Department of Medical Oncology, Institut Jules Bordet, Brussels 1000, Belgium
| | - Gjorgi Deriban
- University Clinic of Gastroenterohepatology, Medical Faculty, University "Ss. Cyril and Methodius" Skopje, Skopje 12345, Republic of North Macedonia
| | - Mario Tadic
- Department of Gastroenterology, Dubrava University Hospital Zagreb, Zagreb 10040, Croatia
| | - Goran Hauser
- Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Antonios Vezakis
- 2nd Department of Surgery, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Ivan Jovanovic
- Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, University of Belgrade Faculty of Medicine, Beograd 12345, Serbia
| | - Nicola Muscatiello
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia AOU, Foggia 1245, Italy
| | - Anna Meneghetti
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, Verona 37138, Italy
| | - Konstantinos Miltiadou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
| | - Kalina Stardelova
- University Clinic of Gastroenterohepatology, Medical Faculty, University "Ss. Cyril and Methodius" Skopje, Skopje 12345, Republic of North Macedonia
| | - Alojzije Lacković
- Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Maria-Zoi Bourou
- 2nd Department of Surgery, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Srdjan Djuranovic
- Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, University of Belgrade Faculty of Medicine, Beograd 12345, Serbia
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens 12462, Greece
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9
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Wauters L, Dickman R, Drug V, Mulak A, Serra J, Enck P, Tack J, Accarino A, Barbara G, Bor S, Coffin B, Corsetti M, De Schepper H, Dumitrascu D, Farmer A, Gourcerol G, Hauser G, Hausken T, Karamanolis G, Keszthelyi D, Malagelada C, Milosavljevic T, Muris J, O'Morain C, Papathanasopoulos A, Pohl D, Rumyantseva D, Sarnelli G, Savarino E, Schol J, Sheptulin A, Smet A, Stengel A, Storonova O, Storr M, Törnblom H, Vanuytsel T, Velosa M, Waluga M, Zarate N, Zerbib F. United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia. Neurogastroenterol Motil 2021; 33:e14238. [PMID: 34586707 DOI: 10.1111/nmo.14238] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Functional dyspepsia (FD) is one of the most common conditions in clinical practice. In spite of its prevalence, FD is associated with major uncertainties in terms of its definition, underlying pathophysiology, diagnosis, treatment, and prognosis. METHODS A Delphi consensus was initiated with 41 experts from 22 European countries who conducted a literature summary and voting process on 87 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus (defined as >80% agreement) was reached for 36 statements. RESULTS The panel agreed with the definition in terms of its cardinal symptoms (early satiation, postprandial fullness, epigastric pain, and epigastric burning), its subdivision into epigastric pain syndrome and postprandial distress syndrome, and the presence of accessory symptoms (upper abdominal bloating, nausea, belching), and overlapping conditions. Also, well accepted are the female predominance of FD, its impact on quality of life and health costs, and acute gastrointestinal infections, and anxiety as risk factors. In terms of pathophysiological mechanisms, the consensus supports a role for impaired gastric accommodation, delayed gastric emptying, hypersensitivity to gastric distention, Helicobacter pylori infection, and altered central processing of signals from the gastroduodenal region. There is consensus that endoscopy is mandatory for establishing a firm diagnosis of FD, but that in primary care, patients without alarm symptoms or risk factors can be managed without endoscopy. There is consensus that H. pylori status should be determined in every patient with dyspeptic symptoms and H. pylori positive patients should receive eradication therapy. Also, proton pump inhibitor therapy is considered an effective therapy for FD, but no other treatment approach reached a consensus. The long-term prognosis and life expectancy are favorable. CONCLUSIONS AND INFERENCES A multinational group of European experts summarized the current state of consensus on the definition, diagnosis and management of FD.
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Affiliation(s)
- Lucas Wauters
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Ram Dickman
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikwa, Israel
| | - Vasile Drug
- University of Medicine and Pharmacy Gr T Popa Iasi and University Hospital St Spiridon, Iasi, Romania
| | - Agata Mulak
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
| | - Jordi Serra
- University Hospital Germans Trias I Pujol and Centro de Investigación Biomédica en Red de enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain
| | - Paul Enck
- Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Jan Tack
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | | | - Anna Accarino
- CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Serhat Bor
- Division of Gastroenterology, School of Medicine, Ege University, Izmir, Turkey
| | - Benoit Coffin
- Université de Paris and AP-HP Hôpital Louis Mourier, Paris, France
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC), Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Heiko De Schepper
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium
| | - Dan Dumitrascu
- 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adam Farmer
- Wingate Institute of Neurogastroenterology, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Goran Hauser
- Medical Faculty Rijeka, University of Rijeka and Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Trygve Hausken
- Department of Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - George Karamanolis
- Gastroentrology Unit, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Daniel Keszthelyi
- Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Carolin Malagelada
- CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain
| | | | - Jean Muris
- Department of General Practice, Caphri Institute, Maastricht University, Maastricht, The Netherlands
| | - Colm O'Morain
- Department of Medicine, Trinity College Dublin and National Clinical Lead for Gastroenterology and Hepatology, Royal College Physicians Ireland, Dublin, Ireland
| | | | - Daniel Pohl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Diana Rumyantseva
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Departmento of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Jolien Schol
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Arkady Sheptulin
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Annemieke Smet
- Laboratory of Experimental Medicine and Pediatrics and InflA-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tübingen, and Charité Center for Internal Medicine and Dermatology, Tübingen, Germany
- Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Center of Endoscopy, Starnberg, Germany
- Ludwig-Maximilians-University, Munich, Germany
| | - Olga Storonova
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Martin Storr
- Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Hans Törnblom
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tim Vanuytsel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | | | - Marek Waluga
- Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland
| | - Natalia Zarate
- Gastrointestinal Physiology Unit, University College London Hospital, London, UK
| | - Frank Zerbib
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque and Gastroenterology Department, Université de Bordeaux, INSERM CIC, Bordeaux, France
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10
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Mikolasevic I, Rahelic D, Turk-Wensween T, Ruzic A, Domislovic V, Hauser G, Matic T, Radic-Kristo D, Krznaric Z, Radic M, Filipec Kanizaj T, Martinovic M, Jerkic H, Medjimurec M, Targher G. Significant liver fibrosis, as assessed by fibroscan, is independently associated with chronic vascular complications of type 2 diabetes: A multicenter study. Diabetes Res Clin Pract 2021; 177:108884. [PMID: 34082054 DOI: 10.1016/j.diabres.2021.108884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/10/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023]
Abstract
AIMS The aim of this study was to investigate whether controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), as assessed by vibration-controlled transient elastography (VCTE), are associated with chronic vascular complications of diabetes mellitus type 2 (T2DM). METHODS We studied 442 outpatients with established T2DM, and who underwent VCTE and extensive assessment of chronic vascular complications of diabetes. RESULTS A quarter of analyzed patients had a previous history of myocardial infarction and/or ischemic stroke, and about half of them had at least one microvascular complication (chronic kidney disease (CKD), retinopathy or polyneuropathy). The prevalence of liver steatosis (i.e., CAP ≥ 238 dB/m) and significant liver fibrosis (i.e., LSM ≥ 7.0/6.2 kPa) was 84.2% and 46.6%, respectively. Significant liver fibrosis was associated with an increased likelihood of having myocardial infarction (adjusted-odds ratio 6.61, 95%CI 1.66-37.4), peripheral polyneuropathy (adjusted-OR 4.55, 95%CI 1.25-16.6), CKD (adjusted-OR 4.54, 95%CI 1.24-16.6) or retinopathy (adjusted-OR 1.81, 95%CI 1.62-1.97), independently of cardiometabolic risk factors, diabetes-related variables, and other potential confounders. Liver steatosis was not independently associated with any macro-/microvascular diabetic complications. CONCLUSIONS Significant liver fibrosis is strongly associated with the presence of macro-/microvascular complications in patients with T2DM. These results offer a new perspective on the follow-up of people with T2DM.
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Affiliation(s)
- I Mikolasevic
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia; Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia; Faculty of Medicine, Rijeka, Croatia.
| | - D Rahelic
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia; University of Zagreb Faculty of Medicine, Zagreb, Croatia; University of Osijek Faculty of Medicine, Osijek, Croatia
| | - T Turk-Wensween
- Faculty of Medicine, Rijeka, Croatia; Center for Diabetes, Endocrinology and Cardiometabolism, Thallassotherapia, Opatija, Croatia
| | - A Ruzic
- Faculty of Medicine, Rijeka, Croatia; Clinic for Cardiology, University Hospital Center Rijeka, Rijeka, Croatia
| | - V Domislovic
- Department for Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - G Hauser
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia; Faculty of Medicine, Rijeka, Croatia; Faculty of Health Studies, Rijeka, Croatia
| | - T Matic
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
| | - D Radic-Kristo
- University of Zagreb Faculty of Medicine, Zagreb, Croatia; Department of Hematology, University Hospital Merkur, Zagreb, Croatia
| | - Z Krznaric
- University of Zagreb Faculty of Medicine, Zagreb, Croatia; Department for Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - M Radic
- University of Zagreb Faculty of Medicine, Zagreb, Croatia
| | - T Filipec Kanizaj
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia; University of Zagreb Faculty of Medicine, Zagreb, Croatia
| | - M Martinovic
- Department of Hematology, University Hospital Merkur, Zagreb, Croatia
| | - H Jerkic
- Department of Cardiology, University Hospital Merkur, Zagreb, Croatia
| | | | - G Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Italy
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11
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Wauters L, Dickman R, Drug V, Mulak A, Serra J, Enck P, Tack J, Accarino A, Barbara G, Bor S, Coffin B, Corsetti M, De Schepper H, Dumitrascu D, Farmer A, Gourcerol G, Hauser G, Hausken T, Karamanolis G, Keszthelyi D, Malagelada C, Milosavljevic T, Muris J, O'Morain C, Papathanasopoulos A, Pohl D, Rumyantseva D, Sarnelli G, Savarino E, Schol J, Sheptulin A, Smet A, Stengel A, Storonova O, Storr M, Törnblom H, Vanuytsel T, Velosa M, Waluga M, Zarate N, Zerbib F. United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia. United European Gastroenterol J 2021; 9:307-331. [PMID: 33939891 PMCID: PMC8259261 DOI: 10.1002/ueg2.12061] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022] Open
Abstract
Background Functional dyspepsia (FD) is one of the most common conditions in clinical practice. In spite of its prevalence, FD is associated with major uncertainties in terms of its definition, underlying pathophysiology, diagnosis, treatment, and prognosis. Methods A Delphi consensus was initiated with 41 experts from 22 European countries who conducted a literature summary and voting process on 87 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus (defined as >80% agreement) was reached for 36 statements. Results The panel agreed with the definition in terms of its cardinal symptoms (early satiation, postprandial fullness, epigastric pain, and epigastric burning), its subdivision into epigastric pain syndrome and postprandial distress syndrome, and the presence of accessory symptoms (upper abdominal bloating, nausea, belching), and overlapping conditions. Also, well accepted are the female predominance of FD, its impact on quality of life and health costs, and acute gastrointestinal infections, and anxiety as risk factors. In terms of pathophysiological mechanisms, the consensus supports a role for impaired gastric accommodation, delayed gastric emptying, hypersensitivity to gastric distention, Helicobacter pylori infection, and altered central processing of signals from the gastroduodenal region. There is consensus that endoscopy is mandatory for establishing a firm diagnosis of FD, but that in primary care, patients without alarm symptoms or risk factors can be managed without endoscopy. There is consensus that H. pylori status should be determined in every patient with dyspeptic symptoms and H. pylori positive patients should receive eradication therapy. Also, proton pump inhibitor therapy is considered an effective therapy for FD, but no other treatment approach reached a consensus. The long‐term prognosis and life expectancy are favorable. Conclusions and Inferences A multinational group of European experts summarized the current state of consensus on the definition, diagnosis and management of FD.
Current knowledge
Functional dyspepsia is one of the most common conditions encountered in clinical practice. There is a lack of guidance for clinicians in guiding diagnosis and treatment of this prevalent condition. No treatments are currently approved for the treatment of functional dyspepsia in Europe.
What is new here
A Delphi panel consisting of 41 experts from 22 European countries established the level of consensus on 87 statements regarding functional dyspepsia. The statements reaching consensus serve to guide clinicians in recognizing, diagnosing and treating FD in clinical practice. Endoscopy is mandatory for establishing a firm diagnosis of functional dyspepsia D, but in primary care patients without alarm symptoms or risk factors can be managed without endoscopy. Helicobacter pylori status should be determined in every patient with dyspeptic symptoms and H. Pylori positive patients should receive eradication therapy. Proton pump inhibitor‐therapy is considered an effective therapy for FD, but no other treatment approach reached consensus support.
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Affiliation(s)
- Lucas Wauters
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Ram Dickman
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikwa, Israel
| | - Vasile Drug
- University of Medicine and Pharmacy Gr T Popa Iasi and University Hospital St Spiridon, Iasi, Romania
| | - Agata Mulak
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
| | - Jordi Serra
- University Hospital Germans Trias I Pujol and Centro de Investigación Biomédica en Red de enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain
| | - Paul Enck
- Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Jan Tack
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | | | - Anna Accarino
- CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Serhat Bor
- Division of Gastroenterology, School of Medicine, Ege University, Izmir, Turkey
| | - Benoit Coffin
- Université de Paris and AP-HP Hôpital Louis Mourier, Paris, France
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC), Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Heiko De Schepper
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium
| | - Dan Dumitrascu
- 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adam Farmer
- Wingate Institute of Neurogastroenterology, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Goran Hauser
- Medical Faculty Rijeka, University of Rijeka and Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Trygve Hausken
- Department of Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - George Karamanolis
- Gastroentrology Unit, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Daniel Keszthelyi
- Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Carolin Malagelada
- CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain
| | | | - Jean Muris
- Department of General Practice, Caphri Institute, Maastricht University, Maastricht, The Netherlands
| | - Colm O'Morain
- Department of Medicine, Trinity College Dublin and National Clinical Lead for Gastroenterology and Hepatology, Royal College Physicians Ireland, Dublin, Ireland
| | | | - Daniel Pohl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Diana Rumyantseva
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Departmento of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Jolien Schol
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Arkady Sheptulin
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Annemieke Smet
- Laboratory of Experimental Medicine and Pediatrics and InflA-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tübingen, and Charité Center for Internal Medicine and Dermatology, Tübingen, Germany.,Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Center of Endoscopy, Starnberg, Germany.,Ludwig-Maximilians-University, Munich, Germany
| | - Olga Storonova
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Martin Storr
- Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Hans Törnblom
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tim Vanuytsel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | | | - Marek Waluga
- Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland
| | - Natalia Zarate
- Gastrointestinal Physiology Unit, University College London Hospital, London, UK
| | - Frank Zerbib
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque and Gastroenterology Department, Université de Bordeaux, INSERM CIC, Bordeaux, France
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Cárdenas-Jaén K, Archibugi L, Poropat G, Korpela T, Maisonneuve P, Aparicio JR, Udd M, Stimac D, Arcidiacono PG, De Pretis N, Valente R, Di Giulio E, Casellas JA, Kylänpää L, Hauser G, Mariani A, Gabbrielli A, Löhr M, Vanella G, Rainio M, Brozzi L, Arnelo U, Fagerström N, Capurso G, de-Madaria E. Chronic use of statins and acetylsalicylic acid and incidence of post-endoscopic retrograde cholangiopancreatography acute pancreatitis: A multicenter, prospective, cohort study. Dig Endosc 2021; 33:639-647. [PMID: 32713065 DOI: 10.1111/den.13801] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Post-endoscopic retrograde cholangiopancreatography (ERCP) acute pancreatitis (PEP) is a frequent complication of this endoscopic procedure. Chronic statin intake has been linked to lower incidence and severity of acute pancreatitis (AP). Periprocedural rectal administration of non-steroidal anti-inflammatory drugs is protective against PEP, but the role of chronic acetylsalicylic acid (ASA) treatment is unclear. We aimed to investigate whether statins and chronic ASA intake are associated with lower risk of PEP. METHODS An international, multicenter, prospective cohort study. Consecutive patients undergoing ERCP in seven European centers were included. Patients were followed-up to detect those with PEP. Multivariate analysis by means of binary logistic regression was performed, and adjusted odds ratios (aORs) were calculated. RESULTS A total of 1150 patients were included, and 70 (6.1%) patients developed PEP. Among statins users, 8.1% developed PEP vs. 5.4% among non-users (P = 0.09). Multivariate analysis showed no association between statin use and PEP incidence (aOR 1.68 (95% CI 0.94-2.99, P = 0.08)). Statin use had no effect on severity of PEP, being mild in 92.0% of statin users vs. 82.2% in non-statin users (P = 0.31). Chronic ASA use was not associated with PEP either (aOR 1.02 (95% CI 0.49-2.13), P = 0.96). Abuse of alcohol and previous endoscopic biliary sphincterotomy were protective factors against PEP, while >1 pancreatic guidewire passage, normal bilirubin values, and duration of the procedure >20 minutes, were risk factors. CONCLUSIONS The use of statins or ASA is not associated with a lower risk or a milder course of PEP.
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Affiliation(s)
- Karina Cárdenas-Jaén
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Livia Archibugi
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Goran Poropat
- Department of Gastroenterology, Faculty of Medicine, Clinical Hospital Center of Rijeka, University of Rijeka, Rijeka, Croatia
| | - Taija Korpela
- Gastroenterological Surgery, Abdominal Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Jose R Aparicio
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Marianne Udd
- Gastroenterological Surgery, Abdominal Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Davor Stimac
- Department of Gastroenterology, Faculty of Medicine, Clinical Hospital Center of Rijeka, University of Rijeka, Rijeka, Croatia
| | - Paolo G Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Niccolò De Pretis
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Roberto Valente
- Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden
| | - Emilio Di Giulio
- Digestive and Liver Disease Unit, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Juan A Casellas
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Leena Kylänpää
- Gastroenterological Surgery, Abdominal Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Goran Hauser
- Department of Gastroenterology, Faculty of Medicine, Clinical Hospital Center of Rijeka, University of Rijeka, Rijeka, Croatia
| | - Alberto Mariani
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Armando Gabbrielli
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Matthias Löhr
- Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden
| | - Giuseppe Vanella
- Digestive and Liver Disease Unit, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Mia Rainio
- Gastroenterological Surgery, Abdominal Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Lorenzo Brozzi
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Urban Arnelo
- Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden
| | | | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy.,Digestive and Liver Disease Unit, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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Mikolasevic I, Delija B, Mijic A, Stevanovic T, Skenderevic N, Sosa I, Krznaric-Zrnic I, Abram M, Krznaric Z, Domislovic V, Filipec Kanizaj T, Radic-Kristo D, Cubranic A, Grubesic A, Nakov R, Skrobonja I, Stimac D, Hauser G. Small intestinal bacterial overgrowth and non-alcoholic fatty liver disease diagnosed by transient elastography and liver biopsy. Int J Clin Pract 2021; 75:e13947. [PMID: 33406286 DOI: 10.1111/ijcp.13947] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 12/14/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We aimed to determine if there was a higher incidence of small intestinal bacterial overgrowth (SIBO) in non-alcoholic fatty liver disease (NAFLD) than in patients without NAFLD. Moreover, we assessed whether patients with significant fibrosis (SF) had a higher incidence of SIBO compared with patients with non-significant or no liver fibrosis. METHODS NAFLD was diagnosed in 117 patients by using Fibroscan with a controlled attenuation parameter (CAP) as well as liver biopsy (LB). SIBO was defined by esophagogastroduodenoscopy with an aspiration of the descending duodenum. RESULTS Patients with non-alcoholic steatohepatitis (NASH) and those with SF on LB had a significantly higher incidence of SIBO than patients without NASH and those without SF, respectively (P < .05). According to histological characteristics, there was a higher proportion of patients in the SIBO group with higher steatosis and fibrosis grade, lobular and portal inflammation, and ballooning grade (P < .001). In multivariate analysis, significant predictors associated with SF and NASH were type 2 diabetes mellitus (T2DM) and SIBO. Moreover, in multivariate analysis, significant predictors that were independently associated with SIBO were T2DM, fibrosis stage and ballooning grade (OR 8.80 (2.07-37.37), 2.50 (1.16-5.37) and 27.6 (6.41-119), respectively). The most commonly isolated were gram-negative bacteria, predominantly Escherichia coli and Klebsiella pneumoniae. CONCLUSION In this relatively large population of patients, we used a gold standard for both SIBO (quantitative culture of duodenum's descending part aspirate) and NAFLD (LB), and we demonstrated that NASH patients and those with SF had a higher incidence of SIBO. Moreover, significant predictors independently associated with SIBO were T2DM, fibrosis stage and ballooning grade. Although TE is a well-investigated method for steatosis and fibrosis detection, in our study, independent predictors of SIBO were histological characteristics of NAFLD, while elastographic parameters did not reach statistical significance.
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Affiliation(s)
- Ivana Mikolasevic
- Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Department of Gastroenterology, UH Merkur, Zagreb, Croatia
| | - Bozena Delija
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Ana Mijic
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | | | | | - Ivan Sosa
- Department of Forensic Medicine and Criminalistics, University of Rijeka Faculty of Medicine, Rijeka, Croatia
| | | | - Maja Abram
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Department of Clinical Microbiology, UHC Rijeka, Rijeka, Croatia
| | - Zeljko Krznaric
- Department of Gastroenterology and Hepatology, UHC Zagreb, Zagreb, Croatia
- Faculty of Medicine, UHC Zagreb, Zagreb, Croatia
| | - Viktor Domislovic
- Department of Gastroenterology and Hepatology, UHC Zagreb, Zagreb, Croatia
| | - Tajana Filipec Kanizaj
- Department of Gastroenterology, UH Merkur, Zagreb, Croatia
- Faculty of Medicine, UHC Zagreb, Zagreb, Croatia
| | - Delfa Radic-Kristo
- Faculty of Medicine, UHC Zagreb, Zagreb, Croatia
- Department of Hematology, UH Merkur, Zagreb, Croatia
| | - Aleksandar Cubranic
- Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Aron Grubesic
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Department of Hematology, UHC Rijeka, Rijeka, Croatia
| | - Radislav Nakov
- Queen Yoanna University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Ivana Skrobonja
- Department of Clinical Microbiology, UHC Rijeka, Rijeka, Croatia
| | - Davor Stimac
- Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Goran Hauser
- Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Faculty of Health Studies, UHC Rijeka, Rijeka, Croatia
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Lukenda Zanko V, Domislovic V, Trkulja V, Krznaric-Zrnic I, Turk-Wensveen T, Krznaric Z, Filipec Kanizaj T, Radic-Kristo D, Bilic-Zulle L, Orlic L, Dinjar-Kujundzic P, Poropat G, Stimac D, Hauser G, Mikolasevic I. Vitamin D for treatment of non-alcoholic fatty liver disease detected by transient elastography: A randomized, double-blind, placebo-controlled trial. Diabetes Obes Metab 2020; 22:2097-2106. [PMID: 32613718 DOI: 10.1111/dom.14129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/20/2020] [Accepted: 06/27/2020] [Indexed: 02/06/2023]
Abstract
AIM To evaluate the effects of vitamin D on transient elastography (TE, FibroScan) indices of liver steatosis (controlled attenuation parameter [CAP]) and fibrosis (liver stiffness measurement [LSM]) in adults with non-alcoholic fatty liver disease (NAFLD). PATIENTS AND METHODS In this randomized (2:1), double-blind, single-centre, 12-month trial, patients with NAFLD were treated with vitamin D (1000 IU/day) (n = 201) or a matching placebo (n = 110). Two co-primary outcomes were changes in CAP and LSM after 360 days of treatment versus baseline. Two main secondary outcomes were CAP/LSM changes after 180 days of treatment. RESULTS Both CAP and LSM gradually decreased in vitamin D-treated patients and slightly increased in the placebo arm. Vitamin D was superior to placebo for both primary outcomes (mean differences in CAP and LSM changes (-49.5 dB/m [95% CI -59.5 to -39.4] and -0.72 kPa [95% CI -1.43 to 0.00], respectively) and both secondary outcomes (-22.1 dB/m [-32.1 to -12.1] and -0.89 kPa [-1.61 to -0.17], respectively). Of a number of exploratory outcomes (change at 12 months vs. baseline), vitamin D reduced serum uric acid (-17.9 μmol/L [-30.6 to -5.2]), gamma-glutamyltransferase (-8.9 IU/L [-15.5 to -2.3)] and fasting serum insulin levels (-5.1 pmol/L [-9.3 to -0.8]) as well as the homeostatic model assessment of insulin resistance index (-1.6 [-3.1 to -0.2]) (false discovery rate [5%]-adjusted P-values between .0572 and .0952). CONCLUSION Low-medium dose supplementation of vitamin D (1000 IU/day) over 12 months reduces TE indices of liver steatosis (CAP) and fibrosis (LSM) in NAFLD patients.
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Affiliation(s)
- Vesna Lukenda Zanko
- Department of Internal Medicine, General Hospital "Josip Benčević", Slavonski Brod, Croatia
| | - Viktor Domislovic
- Department for Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Vladimir Trkulja
- Department of Pharmacology, School of Medicine Zagreb, Zagreb, Croatia
| | - Irena Krznaric-Zrnic
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia
| | - Tamara Turk-Wensveen
- Department of Endocrinology, University Hospital Center Rijeka, Rijeka, Croatia
- School of Medicine, Rijeka, Croatia
| | - Zeljko Krznaric
- Department for Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, Zagreb, Croatia
| | - Tajana Filipec Kanizaj
- School of Medicine, Zagreb, Croatia
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
| | - Delfa Radic-Kristo
- School of Medicine, Zagreb, Croatia
- Department of Hematology, University Hospital Merkur, Zagreb, Croatia
- School of Medicine, Osijek, Croatia
| | - Lidija Bilic-Zulle
- Clinical Institute for Laboratory Diagnostics, Clinical Hospital Centre, Rijeka and Department of Medical Informatics, Rijeka University School of Medicine, Rijeka, Croatia
| | - Lidija Orlic
- School of Medicine, Rijeka, Croatia
- Department of Nephrology, University Hospital Center Rijeka, Rijeka, Croatia
| | | | - Goran Poropat
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia
- School of Medicine, Rijeka, Croatia
| | - Davor Stimac
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia
- School of Medicine, Rijeka, Croatia
| | - Goran Hauser
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia
- School of Medicine, Rijeka, Croatia
| | - Ivana Mikolasevic
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia
- School of Medicine, Rijeka, Croatia
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
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16
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Dumitrascu DL, Babin A, Bordin DS, Czimmer J, Dorofeyev A, Galica A, Hauser G, Lukic S, Mulak A, Nakov R, Rustamov M, Trajkovska M, Drug VL. Recent Data on Irritable Bowel Syndrome from some Central and East European Countries. J Gastrointestin Liver Dis 2020; 29:247-250. [PMID: 32531003 DOI: 10.15403/jgld-2407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/05/2020] [Indexed: 11/01/2022]
Affiliation(s)
- Dan L Dumitrascu
- 2nd Dept of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romnia.
| | - Alexandru Babin
- State Medical and Pharmaceutical University Nicolae Testemițanu, Kishinew, R. Moldova.
| | - Dmitry S Bordin
- A. S. Loginov Moscow clinical scientific center, Moscow, Russia; Tver State Medical University, Tver, Russia; A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow.
| | - Jozef Czimmer
- Division Gastroenterology, First Dept. Medicine, Medical School, Pecs University, Pecs, Hungary.
| | - Andryi Dorofeyev
- National Medical Academy of Postgraduate Education n.a.P.L.Shupik, Kyiv,Ukraine.
| | - Adelina Galica
- School of Medicine, University Fan S. Noli, Korce, Albania.
| | - Goran Hauser
- Department of Gastroenterology, Clinical Hospital Centre Rijeka, Medical faculty Rijeka ; Faculty of Health Studies, Rijeka, University of Rijeka, Rijeka, Croatia.
| | - Snezana Lukic
- Gastroenterol and Hepatol Clin., Clinical Centre of Serbia, Faculty of Medicine, Univ. of Belgrade, Serbia.
| | - Agata Mulak
- Department of Gastroenterol and Hepatol, Wroclaw Medical University, Wroclaw, Poland.
| | - Radislav Nakov
- Clinic of Gastroenterol, Tsaritsa Yoanna University Hospital, Medical University of Sofia, Sofia, Bulgaria.
| | - Mirzabey Rustamov
- Belarusian State Medical University, Department of Cardiology and Internal Medicine, Division of Gastroenterology Minsk Belarus.
| | - Meri Trajkovska
- Clinic of Gastroenterohepatology, Faculty of Medicine, Sts. Cyril and Methodius University, Skopje, RN Macedonia.
| | - Vasile L Drug
- Deptartment Gastroenterology, Grigore T Popa University of Medicine and Pharmacy Iasi, Romania.
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Poropat G, Radovan A, Peric M, Mikolasevic I, Giljaca V, Hauser G, Milic S, Stimac D. Prevention of Infectious Complications in Acute Pancreatitis: Results of a Single-Center, Randomized, Controlled Trial. Pancreas 2019. [PMID: 31404018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES This study aimed to investigate the efficiency of imipenem to prevent infectious complications in predicted severe acute pancreatitis (AP). METHODS Consecutive AP patients were randomized to imipenem 3 × 500 mg intravenously daily or an identical placebo. Exclusion criteria were prior AP, chronic pancreatitis, active malignancy, immune deficiency, active infection, concomitant antibiotic treatment, pregnancy, and patients younger than 18 years. Infectious complications including infected pancreatic necrosis, pneumonia, urinary tract infection, positive blood cultures, sepsis, and other infections were assessed as the primary outcome. Secondary outcomes included mortality, persistent organ failure, systemic inflammatory response syndrome, local complications, serious adverse events, and need for surgical intervention. RESULTS Forty-nine patients were randomized to each group. Infectious complications were present in 10 versus 12 of 49 patients (relative risk [RR], 0.833; 95% confidence interval [CI], 0.398-1.747). There were no significant differences in infected pancreatic necrosis (RR, 1.5; 95% CI, 0.262-8.588), pneumonia (RR, 1.5; 95% CI, 0.262-8.588), urinary tract infection (RR, 0.6; 95% CI, 0.152-2.374), positive blood cultures (RR, 0.5; 95% CI, 0.047-5.336), sepsis (RR, 0.333; 95% CI, 0.036-3.095), and other (RR, 1.333; 95% CI, 0.315-5.648). We found no significant differences in secondary outcomes. CONCLUSIONS Concordantly to available evidence, there is currently no ground to support prophylactic use of antibiotics in predicted severe AP.
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Affiliation(s)
- Goran Poropat
- From the Department of Gastroenterology, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka
| | - Anja Radovan
- From the Department of Gastroenterology, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka
| | - Marija Peric
- Faculty of Medicine, University of Medicine Rijeka, Rijeka, Croatia
| | - Ivana Mikolasevic
- From the Department of Gastroenterology, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka
| | - Vanja Giljaca
- Heart of England NHS Foundation Trust, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Goran Hauser
- From the Department of Gastroenterology, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka
| | - Sandra Milic
- From the Department of Gastroenterology, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka
| | - Davor Stimac
- From the Department of Gastroenterology, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka
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Abstract
A commentary [1] criticized our systematic review regarding the use of direct-acting agents (DAAs) in chronic hepatitis C [2]. The following represents our major disagreements. Sustained virological response (SVR) is a non-validated surrogate outcome. The principles of evidence-based medicine require that it be validated in randomized clinical trials (RCTs) by showing parallel benefits in clinical outcomes [3]. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Janus C Jakobsen
- The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark.,The Department of Cardiology, Holbaek Hospital, Holbaek, Denmark
| | - Goran Hauser
- The Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Dimitrinka Nikolova
- The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark
| | - Christian Gluud
- The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark
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Plavsic I, Zitinic I, Tulic V, Poropat G, Marusic M, Hauser G. Early immune response in post endoscopic retrograde cholangiopancreatography pancreatitis as a model for acute pancreatitis. World J Meta-Anal 2019; 7:96-100. [DOI: 10.13105/wjma.v7.i3.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 02/06/2023] Open
Abstract
This opinion review summarizes comparison of clinical presentation and immunology of post-endoscopic pancreatitis and acute pancreatitis (AP) of other etiology. The rationale for this topic was found in studies that mention differences in clinical presentation between these entities, stating that severe form of AP after endoscopic retrograde cholangiopancreatography was more severe than AP of other etiology. Found difference in clinical presentation may have a background in different immunology that needs to be further investigated.
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Affiliation(s)
- Ivana Plavsic
- Department of Anesthesiology and Critical care medicine, Clinical Hospital Centre, Medical Faculty, University of Rijeka, Rijeka 51000, Croatia
| | - Ivana Zitinic
- Department of Emergency Medicine, Clinical Hospital Centre, Rijeka 51000, Croatia
| | - Vera Tulic
- Department of Anesthesiology and Critical care medicine, Clinical Hospital Centre, Medical Faculty, University of Rijeka, Rijeka 51000, Croatia
| | - Goran Poropat
- Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre, Medical Faculty, Medical Faculty Rijeka, University of Rijeka, Rijeka 51000, Croatia
| | - Marinko Marusic
- Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Sv. Duh, Zagreb, Faculty of Health Studies, University of Rijeka, Rijeka 51000, Croatia
- Medical Faculty Osijek, University of J.J. Stossmayer, Osijek 31000, Croatia
| | - Goran Hauser
- Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre, Medical Faculty, Faculty of Health Studies, University of Rijeka, Rijeka 51000, Croatia
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Plavsic I, Žitinić I, Mikolasevic I, Poropat G, Hauser G. Endoscopic retrograde cholangiopancreatography-induced and non-endoscopic retrograde cholangiopancreatography-induced acute pancreatitis: Two distinct clinical and immunological entities? World J Gastrointest Endosc 2018; 10:259-266. [PMID: 30364685 PMCID: PMC6198307 DOI: 10.4253/wjge.v10.i10.259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/10/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis (AP) is common gastrointestinal disease of varied aetiology. The most common cause of AP is gallstones, followed by alcohol abuse as an independent risk factor. With the increased need for invasive techniques to treat pancreatic and bile duct pathologies such as endoscopic retrograde cholangiopancreatography (ERCP), AP has emerged as the most frequent complication. While severe AP following ERCP is rare (0.5%), if it does develop it has a greater severity index compared to non-ERCP AP. Development of a mild form of AP after ERCP is not considered a clinically relevant condition. Differences in the clinical presentation and prognosis of the mild and severe forms have been found between non-ERCP AP and post-endoscopic pancreatitis (PEP). It has been proposed that AP and PEP may also have different immunological responses to the initial injury. In this review, we summarise the literature on clinical and inflammatory processes in PEP vs non-ERCP AP.
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Affiliation(s)
- Ivana Plavsic
- Department of Anesthesiology and Critical care medicine, Clinical Hospital Centre, Medical Faculty, University of Rijeka, Rijeka 51000, Croatia
| | - Ivana Žitinić
- Department of Emergency Medicine, Clinical Hospital Centre, Rijeka 51000, Croatia
| | - Ivana Mikolasevic
- Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre, Medical Faculty, University of Rijeka, Rijeka 51000, Croatia
| | - Goran Poropat
- Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre, Medical Faculty, University of Rijeka, Rijeka 51000, Croatia
| | - Goran Hauser
- Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre, Medical Faculty, Faculty of health Studies, University of Rijeka, Rijeka 51000, Croatia
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21
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Koretz RL, Jakobsen JC, Djurisic S, Poropat G, Hauser G, Bjelakovic M, Bjelakovic G, Gluud C. Who is wrong? Responses to Kwo et al. Am J Gastroenterol 2018; 113:779-780. [PMID: 29487409 DOI: 10.1038/s41395-018-0029-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 01/05/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Ronald L Koretz
- Granada Hills, Los Angeles, CA, USA. The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Department of Cardiology, Holbaek Hospital, Holbaek, Denmark. Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia. Medical Faculty, University of Nis, Nis, Serbia. Department of Internal Medicine, Medical Faculty, University of Nis, Nis, Serbia
| | - Janus Christian Jakobsen
- Granada Hills, Los Angeles, CA, USA. The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Department of Cardiology, Holbaek Hospital, Holbaek, Denmark. Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia. Medical Faculty, University of Nis, Nis, Serbia. Department of Internal Medicine, Medical Faculty, University of Nis, Nis, Serbia.,Granada Hills, Los Angeles, CA, USA. The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Department of Cardiology, Holbaek Hospital, Holbaek, Denmark. Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia. Medical Faculty, University of Nis, Nis, Serbia. Department of Internal Medicine, Medical Faculty, University of Nis, Nis, Serbia
| | - Snezana Djurisic
- Granada Hills, Los Angeles, CA, USA. The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Department of Cardiology, Holbaek Hospital, Holbaek, Denmark. Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia. Medical Faculty, University of Nis, Nis, Serbia. Department of Internal Medicine, Medical Faculty, University of Nis, Nis, Serbia
| | - Goran Poropat
- Granada Hills, Los Angeles, CA, USA. The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Department of Cardiology, Holbaek Hospital, Holbaek, Denmark. Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia. Medical Faculty, University of Nis, Nis, Serbia. Department of Internal Medicine, Medical Faculty, University of Nis, Nis, Serbia
| | - Goran Hauser
- Granada Hills, Los Angeles, CA, USA. The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Department of Cardiology, Holbaek Hospital, Holbaek, Denmark. Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia. Medical Faculty, University of Nis, Nis, Serbia. Department of Internal Medicine, Medical Faculty, University of Nis, Nis, Serbia
| | - Milica Bjelakovic
- Granada Hills, Los Angeles, CA, USA. The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Department of Cardiology, Holbaek Hospital, Holbaek, Denmark. Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia. Medical Faculty, University of Nis, Nis, Serbia. Department of Internal Medicine, Medical Faculty, University of Nis, Nis, Serbia
| | - Goran Bjelakovic
- Granada Hills, Los Angeles, CA, USA. The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Department of Cardiology, Holbaek Hospital, Holbaek, Denmark. Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia. Medical Faculty, University of Nis, Nis, Serbia. Department of Internal Medicine, Medical Faculty, University of Nis, Nis, Serbia
| | - Christian Gluud
- Granada Hills, Los Angeles, CA, USA. The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Department of Cardiology, Holbaek Hospital, Holbaek, Denmark. Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia. Medical Faculty, University of Nis, Nis, Serbia. Department of Internal Medicine, Medical Faculty, University of Nis, Nis, Serbia
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22
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Marušić M, Klemenčić A, Troskot Perić R, Hauser G. Gastroesophageal variceal bleeding - An overview of current treatment options. Acta Gastroenterol Belg 2018; 81:305-317. [PMID: 30024703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Gastroesophageal variceal hemorrhage is the most important clinical event that results from portal hypertension. It is a lifethreatening condition that demands rapid and efficient treatment. The first step in bleeding control is hemodynamic stabilization and pharmacological treatment, which includes administration of vasoactive drugs and short-term antibiotic prophylaxis. After initial hemodynamic stabilization, endoscopic therapy should be performed. The first choice of endoscopic treatment for esophageal bleeding is endoscopic variceal ligation (EVL), or endoscopic injection sclerotherapy (EIS) if EVL cannot be performed. Several rescue therapies, such as application of balloon tamponade, a selfexpandable metal stent (SEMS), or a transjugular intrahepatic portosystemic shunt (TIPS), are available in cases of resistant variceal bleeding that cannot be controlled with endoscopic therapies. Gastric varices have a lower incidence than esophageal varices, but bleeding from gastric varices is associated with higher mortality and morbidity rates. The first-line treatment, as with esophageal variceal bleeding, is stabilization of the patient. After that, control of bleeding can be attempted. Optimal management of gastric variceal bleeding is not yet standardized due to diverse underlying pathologies and the lack of large, randomized controlled trials. Among endoscopic techniques, endoscopic variceal obturation (EVO) has been acknowledged as reliable. Among rescue therapies, balloon-occluded retrograde transvenous obliteration (B-RTO) of gastric varices and TIPS are the most common techniques.
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Affiliation(s)
- Marinko Marušić
- University Hospital Sveti Duh, Department of Hepatology and Gastroenterology, 10000 Zagreb, Croatia; J.J. Strossmayer University of Osijek, Medical school, 31000 Osijek, Croatia; University of Rijeka, Faculty of Health Studies, 51000 Rijeka, Croatia
| | - Antonio Klemenčić
- Institute of Emergency Medicine The city of Zagreb, 10000 Zagreb, Croatia
| | - Rosana Troskot Perić
- University Hospital Sveti Duh, Department of Hepatology and Gastroenterology, 10000 Zagreb, Croatia; J.J. Strossmayer University of Osijek, Medical school, 31000 Osijek, Croatia; University of Rijeka, Faculty of Health Studies, 51000 Rijeka, Croatia
| | - Goran Hauser
- Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia, University of Rijeka, Faculty of Health Studies, 51000 Rijeka, Croatia
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23
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Jakobsen JC, Nielsen EE, Feinberg J, Katakam KK, Fobian K, Hauser G, Poropat G, Djurisic S, Weiss KH, Bjelakovic M, Bjelakovic G, Klingenberg SL, Liu JP, Nikolova D, Koretz RL, Gluud C. Direct-acting antivirals for chronic hepatitis C. Cochrane Database Syst Rev 2017; 9:CD012143. [PMID: 28922704 PMCID: PMC6484376 DOI: 10.1002/14651858.cd012143.pub3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Millions of people worldwide suffer from hepatitis C, which can lead to severe liver disease, liver cancer, and death. Direct-acting antivirals (DAAs), e.g. sofosbuvir, are relatively new and expensive interventions for chronic hepatitis C, and preliminary results suggest that DAAs may eradicate hepatitis C virus (HCV) from the blood (sustained virological response). Sustained virological response (SVR) is used by investigators and regulatory agencies as a surrogate outcome for morbidity and mortality, based solely on observational evidence. However, there have been no randomised trials that have validated that usage. OBJECTIVES To assess the benefits and harms of DAAs in people with chronic HCV. SEARCH METHODS We searched for all published and unpublished trials in The Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, Science Citation Index Expanded, LILACS, and BIOSIS; the Chinese Biomedical Literature Database (CBM), China Network Knowledge Information (CNKI), the Chinese Science Journal Database (VIP), Google Scholar, The Turning Research into Practice (TRIP) Database, ClinicalTrials.gov, European Medicines Agency (EMA) (www.ema.europa.eu/ema/), WHO International Clinical Trials Registry Platform (www.who.int/ictrp), the Food and Drug Administration (FDA) (www.fda.gov), and pharmaceutical company sources for ongoing or unpublished trials. Searches were last run in October 2016. SELECTION CRITERIA Randomised clinical trials comparing DAAs versus no intervention or placebo, alone or with co-interventions, in adults with chronic HCV. We included trials irrespective of publication type, publication status, and language. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcomes were hepatitis C-related morbidity, serious adverse events, and health-related quality of life. Our secondary outcomes were all-cause mortality, ascites, variceal bleeding, hepato-renal syndrome, hepatic encephalopathy, hepatocellular carcinoma, non-serious adverse events (each reported separately), and SVR. We systematically assessed risks of bias, performed Trial Sequential Analysis, and followed an eight-step procedure to assess thresholds for statistical and clinical significance. We evaluated the overall quality of the evidence, using GRADE. MAIN RESULTS We included a total of 138 trials randomising a total of 25,232 participants. The trials were generally short-term trials and designed primarily to assess the effect of treatment on SVR. The trials evaluated 51 different DAAs. Of these, 128 trials employed matching placebo in the control group. All included trials were at high risk of bias. Eighty-four trials involved DAAs on the market or under development (13,466 participants). Fifty-seven trials administered DAAs that were discontinued or withdrawn from the market. Study populations were treatment-naive in 95 trials, had been exposed to treatment in 17 trials, and comprised both treatment-naive and treatment-experienced individuals in 24 trials. The HCV genotypes were genotype 1 (119 trials), genotype 2 (eight trials), genotype 3 (six trials), genotype 4 (nine trials), and genotype 6 (one trial). We identified two ongoing trials.We could not reliably determine the effect of DAAs on the market or under development on our primary outcome of hepatitis C-related morbidity or all-cause mortality. There were no data on hepatitis C-related morbidity and only limited data on mortality from 11 trials (DAA 15/2377 (0.63%) versus control 1/617 (0.16%); OR 3.72, 95% CI 0.53 to 26.18, very low-quality evidence). We did not perform Trial Sequential Analysis on this outcome.There is very low quality evidence that DAAs on the market or under development do not influence serious adverse events (DAA 5.2% versus control 5.6%; OR 0.93, 95% CI 0.75 to 1.15 , 15,817 participants, 43 trials). The Trial Sequential Analysis showed that there was sufficient information to rule out that DAAs reduce the relative risk of a serious adverse event by 20% when compared with placebo. The only DAA that showed a lower risk of serious adverse events when meta-analysed separately was simeprevir (OR 0.62, 95% CI 0.45 to 0.86). However, Trial Sequential Analysis showed that there was not enough information to confirm or reject a relative risk reduction of 20%, and when one trial with an extreme result was excluded, the meta-analysis result showed no evidence of a difference.DAAs on the market or under development may reduce the risk of no SVR from 54.1% in untreated people to 23.8% in people treated with DAA (RR 0.44, 95% CI 0.37 to 0.52, 6886 participants, 32 trials, low quality evidence). Trial Sequential Analysis confirmed this meta-analysis result.Only 1/84 trials on the market or under development assessed the effects of DAAs on health-related quality of life (SF-36 mental score and SF-36 physical score).There was insufficient evidence from trials on withdrawn or discontinued DAAs to determine their effect on hepatitis C-related morbidity and all-cause mortality (OR 0.64, 95% CI 0.23 to 1.79; 5 trials, very low-quality evidence). However, these DAAs seemed to increase the risk of serious adverse events (OR 1.45, 95% CI 1.22 to 1.73; 29 trials, very low-quality evidence). Trial Sequential Analysis confirmed this meta-analysis result.None of the 138 trials provided useful data to assess the effects of DAAs on the remaining secondary outcomes (ascites, variceal bleeding, hepato-renal syndrome, hepatic encephalopathy, and hepatocellular carcinoma). AUTHORS' CONCLUSIONS The evidence for our main outcomes of interest come from short-term trials, and we are unable to determine the effect of long-term treatment with DAAs. The rates of hepatitis C morbidity and mortality observed in the trials are relatively low and we are uncertain as to how DAAs affect this outcome. Overall, there is very low quality evidence that DAAs on the market or under development do not influence serious adverse events. There is insufficient evidence to judge if DAAs have beneficial or harmful effects on other clinical outcomes for chronic HCV. Simeprevir may have beneficial effects on risk of serious adverse event. In all remaining analyses, we could neither confirm nor reject that DAAs had any clinical effects. DAAs may reduce the number of people with detectable virus in their blood, but we do not have sufficient evidence from randomised trials that enables us to understand how SVR affects long-term clinical outcomes. SVR is still an outcome that needs proper validation in randomised clinical trials.
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Affiliation(s)
| | - Emil Eik Nielsen
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Joshua Feinberg
- Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention Research, Department
7812Blegdamsvej 9CopenhagenDenmark2100
| | - Kiran Kumar Katakam
- Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention Research, Department
7812Blegdamsvej 9CopenhagenDenmark2100
| | - Kristina Fobian
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Goran Hauser
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51 000
| | - Goran Poropat
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51 000
| | - Snezana Djurisic
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department
7812, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Karl Heinz Weiss
- Heidelberg University HospitalInternal Medicine IV: Gastroenterology, Infectious Diseases, ToxicologyIm Neuenheimer Feld 410HeidelbergGermanyD‐69120
| | - Milica Bjelakovic
- University of NisMedical FacultyBoulevard Dr Zorana Djindjica 81NisSerbia18000
| | - Goran Bjelakovic
- Medical Faculty, University of NisDepartment of Internal MedicineZorana Djindjica 81NisSerbia18000
| | - Sarah Louise Klingenberg
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department
7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Jian Ping Liu
- Beijing University of Chinese MedicineCentre for Evidence‐Based Chinese Medicine11 Bei San Huan Dong Lu, Chaoyang DistrictBeijingChina100029
| | - Dimitrinka Nikolova
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department
7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | | | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department
7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
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24
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Jakobsen JC, Nielsen EE, Feinberg J, Katakam KK, Fobian K, Hauser G, Poropat G, Djurisic S, Weiss KH, Bjelakovic M, Bjelakovic G, Klingenberg SL, Liu JP, Nikolova D, Koretz RL, Gluud C. Direct-acting antivirals for chronic hepatitis C. Cochrane Database Syst Rev 2017; 6:CD012143. [PMID: 28585310 PMCID: PMC6484383 DOI: 10.1002/14651858.cd012143.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Millions of people worldwide suffer from hepatitis C, which can lead to severe liver disease, liver cancer, and death. Direct-acting antivirals (DAAs) are relatively new and expensive interventions for chronic hepatitis C, and preliminary results suggest that DAAs may eradicate hepatitis C virus (HCV) from the blood (sustained virological response). However, it is still questionable if eradication of hepatitis C virus in the blood eliminates hepatitis C in the body, and improves survival and leads to fewer complications. OBJECTIVES To assess the benefits and harms of DAAs in people with chronic HCV. SEARCH METHODS We searched for all published and unpublished trials in The Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, Science Citation Index Expanded, LILACS, and BIOSIS; the Chinese Biomedical Literature Database (CBM), China Network Knowledge Information (CNKI), the Chinese Science Journal Database (VIP), Google Scholar, The Turning Research into Practice (TRIP) Database, ClinicalTrials.gov, European Medicines Agency (EMA) (www.ema.europa.eu/ema/), WHO International Clinical Trials Registry Platform (www.who.int/ictrp), the Food and Drug Administration (FDA) (www.fda.gov), and pharmaceutical company sources for ongoing or unpublished trials. Searches were last run in October 2016. SELECTION CRITERIA Randomised clinical trials comparing DAAs versus no intervention or placebo, alone or with co-interventions, in adults with chronic HCV. We included trials irrespective of publication type, publication status, and language. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcomes were hepatitis C-related morbidity, serious adverse events, and quality of life. Our secondary outcomes were all-cause mortality, ascites, variceal bleeding, hepato-renal syndrome, hepatic encephalopathy, hepatocellular carcinoma, non-serious adverse events (each reported separately), and sustained virological response. We systematically assessed risks of bias, performed Trial Sequential Analysis, and followed an eight-step procedure to assess thresholds for statistical and clinical significance. The overall quality of the evidence was evaluated using GRADE. MAIN RESULTS We included a total of 138 trials randomising a total of 25,232 participants. The 138 trials assessed the effects of 51 different DAAs. Of these, 128 trials employed matching placebo in the control group. All included trials were at high risk of bias. Eighty-four trials involved DAAs on the market or under development (13,466 participants). Fifty-seven trials administered withdrawn or discontinued DAAs. Trial participants were treatment-naive (95 trials), treatment-experienced (17 trials), or both treatment-naive and treatment-experienced (24 trials). The HCV genotypes were genotype 1 (119 trials), genotype 2 (eight trials), genotype 3 (six trials), genotype 4 (nine trials), and genotype 6 (one trial). We identified two ongoing trials.Meta-analysis of the effects of all DAAs on the market or under development showed no evidence of a difference when assessing hepatitis C-related morbidity or all-cause mortality (OR 3.72, 95% CI 0.53 to 26.18, P = 0.19, I² = 0%, 2,996 participants, 11 trials, very low-quality evidence). As there were no data on hepatitis C-related morbidity and very few data on mortality (DAA 15/2377 (0.63%) versus control 1/617 (0.16%)), it was not possible to perform Trial Sequential Analysis on hepatitis C-related morbidity or all-cause mortality.Meta-analysis of all DAAs on the market or under development showed no evidence of a difference when assessing serious adverse events (OR 0.93, 95% CI 0.75 to 1.15, P = 0.52, I² = 0%, 15,817 participants, 43 trials, very low-quality evidence). The Trial Sequential Analysis showed that the cumulative Z-score crossed the trial sequential boundary for futility, showing that there was sufficient information to rule out that DAAs compared with placebo reduced the relative risk of a serious adverse event by 20%. The only DAA that showed a significant difference on risk of serious adverse events when meta-analysed separately was simeprevir (OR 0.62, 95% CI 0.45 to 0.86). However, Trial Sequential Analysis showed that there was not enough information to confirm or reject a relative risk reduction of 20%, and when one trial with an extreme result was excluded, then the meta-analysis result showed no evidence of a difference.DAAs on the market or under development seemed to reduce the risk of no sustained virological response (RR 0.44, 95% CI 0.37 to 0.52, P < 0.00001, I² = 77%, 6886 participants, 32 trials, very low-quality evidence) and Trial Sequential Analysis confirmed this meta-analysis result.Only 1/84 trials on the market or under development assessed the effects of DAAs on health-related quality of life (SF-36 mental score and SF-36 physical score).Withdrawn or discontinued DAAs had no evidence of a difference when assessing hepatitis C-related morbidity and all-cause mortality (OR 0.64, 95% CI 0.23 to 1.79, P = 0.40, I² = 0%; 5 trials, very low-quality evidence). However, withdrawn DAAs seemed to increase the risk of serious adverse events (OR 1.45, 95% CI 1.22 to 1.73, P = 0.001, I² = 0%, 29 trials, very low-quality evidence), and Trial Sequential Analysis confirmed this meta-analysis result.Most of all outcome results were short-term results; therefore, we could neither confirm nor reject any long-term effects of DAAs. None of the 138 trials provided useful data to assess the effects of DAAs on the remaining secondary outcomes (ascites, variceal bleeding, hepato-renal syndrome, hepatic encephalopathy, and hepatocellular carcinoma). AUTHORS' CONCLUSIONS Overall, DAAs on the market or under development do not seem to have any effects on risk of serious adverse events. Simeprevir may have beneficial effects on risk of serious adverse event. In all remaining analyses, we could neither confirm nor reject that DAAs had any clinical effects. DAAs seemed to reduce the risk of no sustained virological response. The clinical relevance of the effects of DAAs on no sustained virological response is questionable, as it is a non-validated surrogate outcome. All trials and outcome results were at high risk of bias, so our results presumably overestimate benefit and underestimate harm. The quality of the evidence was very low.
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Affiliation(s)
| | - Emil Eik Nielsen
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Joshua Feinberg
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Kiran Kumar Katakam
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalBlegdamsvej 9CopenhagenDenmark2100
| | - Kristina Fobian
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Goran Hauser
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51 000
| | - Goran Poropat
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51 000
| | - Snezana Djurisic
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalBlegdamsvej 9CopenhagenDenmark2100
| | - Karl Heinz Weiss
- Heidelberg University HospitalInternal Medicine IV: Gastroenterology, Infectious Diseases, ToxicologyIm Neuenheimer Feld 410HeidelbergGermanyD‐69120
| | - Milica Bjelakovic
- University of NisMedical FacultyBoulevard Dr Zorana Djindjica 81NisSerbia18000
| | - Goran Bjelakovic
- Medical Faculty, University of NisDepartment of Internal MedicineZorana Djindjica 81NisSerbia18000
| | - Sarah Louise Klingenberg
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Jian Ping Liu
- Beijing University of Chinese MedicineCentre for Evidence‐Based Chinese Medicine11 Bei San Huan Dong Lu, Chaoyang DistrictBeijingChina100029
| | - Dimitrinka Nikolova
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | | | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
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25
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Aralica M, Giljaca V, Poropat G, Hauser G, Štimac D. Serological tests for primary biliary cholangitis. Hippokratia 2017. [DOI: 10.1002/14651858.cd012560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Merica Aralica
- Clinical Hospital Centre Rijeka; Clinical Institute of Laboratory Diagnosis; Istarska 42 Rijeka Croatia 510000
| | - Vanja Giljaca
- Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital; Directorate of Surgery, Department of Gastroenterology; Bordesley Green East Birmingham UK B9 5SS
| | - Goran Poropat
- Clinical Hospital Centre Rijeka; Department of Gastroenterology; Kresimirova 42 Rijeka Croatia 51000
| | - Goran Hauser
- Clinical Hospital Centre Rijeka; Department of Gastroenterology; Kresimirova 42 Rijeka Croatia 51000
| | - Davor Štimac
- Clinical Hospital Centre Rijeka; Department of Gastroenterology; Kresimirova 42 Rijeka Croatia 51000
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26
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Hauser G, Blažević I, Salkić N, Poropat G, Giljača V, Bulić Z, Štimac D. Erratum to: Diclofenac sodium versus ceftazidime for preventing pancreatitis after endoscopic retrograde cholangiopancreatography: a prospective, randomized, controlled trial. Surg Endosc 2016; 31:611. [PMID: 27815741 DOI: 10.1007/s00464-016-5305-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Goran Hauser
- Department of Gastroenterology, Clinical Hospital Centre Rijeka, Krešimirova 42, Rijeka, 51000, Croatia. .,Faculty of Medicine Rijeka, University of Rijeka, Rijeka, Croatia. .,Faculty of Health Studies, University of Rijeka, Rijeka, Croatia.
| | - Ivana Blažević
- Department of Emergency Medicine, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Nermin Salkić
- Department of Gastroenterology and Hepatology, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
| | - Goran Poropat
- Department of Gastroenterology, Clinical Hospital Centre Rijeka, Krešimirova 42, Rijeka, 51000, Croatia.,Faculty of Medicine Rijeka, University of Rijeka, Rijeka, Croatia
| | - Vanja Giljača
- Department of Gastroenterology, Clinical Hospital Centre Rijeka, Krešimirova 42, Rijeka, 51000, Croatia.,Faculty of Medicine Rijeka, University of Rijeka, Rijeka, Croatia
| | - Zlatko Bulić
- Department of Gastroenterology, Clinical Hospital Centre Rijeka, Krešimirova 42, Rijeka, 51000, Croatia.,Faculty of Medicine Rijeka, University of Rijeka, Rijeka, Croatia
| | - Davor Štimac
- Department of Gastroenterology, Clinical Hospital Centre Rijeka, Krešimirova 42, Rijeka, 51000, Croatia.,Faculty of Medicine Rijeka, University of Rijeka, Rijeka, Croatia
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27
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Mikolasevic I, Orlic L, Franjic N, Hauser G, Stimac D, Milic S. Transient elastography (FibroScan ®) with controlled attenuation parameter in the assessment of liver steatosis and fibrosis in patients with nonalcoholic fatty liver disease - Where do we stand? World J Gastroenterol 2016; 22:7236-7251. [PMID: 27621571 PMCID: PMC4997649 DOI: 10.3748/wjg.v22.i32.7236] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/28/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. Currently, the routinely used modalities are unable to adequately determine the levels of steatosis and fibrosis (laboratory tests and ultrasonography) or cannot be applied as a screening procedure (liver biopsy). Among the non-invasive tests, transient elastography (FibroScan®, TE) with controlled attenuation parameter (CAP) has demonstrated good accuracy in quantifying the levels of liver steatosis and fibrosis in patients with NAFLD, the factors associated with the diagnosis and NAFLD progression. The method is fast, reliable and reproducible, with good intra- and interobserver levels of agreement, thus allowing for population-wide screening and disease follow-up. The initial inability of the procedure to accurately determine fibrosis and steatosis in obese patients has been addressed with the development of the obese-specific XL probe. TE with CAP is a viable alternative to ultrasonography, both as an initial assessment and during follow-up of patients with NAFLD. Its ability to exclude patients with advanced fibrosis may be used to identify low-risk NAFLD patients in whom liver biopsy is not needed, therefore reducing the risk of complications and the financial costs.
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Stimac D, Poropat G, Hauser G, Licul V, Franjic N, Valkovic Zujic P, Milic S. Early nasojejunal tube feeding versus nil-by-mouth in acute pancreatitis: A randomized clinical trial. Pancreatology 2016; 16:523-8. [PMID: 27107634 DOI: 10.1016/j.pan.2016.04.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 03/28/2016] [Accepted: 04/02/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES There is substantial evidence of superiority of enteral nutrition (EN) to parenteral nutrition in acute pancreatitis (AP) treatment, but few studies evaluated its effectiveness compared to no intervention. The objective of our trial was to compare the effects of EN to a nil-by-mouth (NBM) regimen in patients with AP. METHODS Patients with AP were randomized to receive either EN via a nasojejunal tube initiated within 24 h of admission or no nutritional support. Systemic inflammatory response syndrome (SIRS) was assessed as the primary outcome. Secondary outcomes included mortality, organ failure, local complications, infected pancreatic necrosis, surgical interventions, length of hospital stay, adverse events and inflammatory response intensity. Outcomes were compared using Student's t-test and Mann-Whitney U test as appropriate. RESULTS 214 patients were randomized in total, 107 to each group. SIRS occurrence was similar between groups, with 48 (45%) versus 51 (48%), respectively (RR 0.94; 95% CI 0.71-1.26). No significant reduction of persistent organ failure (RR 0.81; 95% CI 0.52-1.27) and mortality (RR 0.59; 95% CI 0.28-1.23) was present in the EN group. There were no significant differences in other outcomes between the groups. When analyzing the occurrence of SIRS and mortality in subgroup of patients with severe disease no significant differences were noted. CONCLUSION Our results showed no significant reduction of persistent organ failure and mortality in patients with AP receiving early EN compared to patients treated with no nutritional support (NCT01965873).
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Affiliation(s)
- D Stimac
- Department of Gastroenterology, Faculty of Medicine Rijeka, University Hospital Rijeka, Rijeka, Croatia
| | - G Poropat
- Department of Gastroenterology, Faculty of Medicine Rijeka, University Hospital Rijeka, Rijeka, Croatia.
| | - G Hauser
- Department of Gastroenterology, Faculty of Medicine Rijeka, University Hospital Rijeka, Rijeka, Croatia
| | - V Licul
- Department of Gastroenterology, Faculty of Medicine Rijeka, University Hospital Rijeka, Rijeka, Croatia
| | - N Franjic
- Department of Gastroenterology, Faculty of Medicine Rijeka, University Hospital Rijeka, Rijeka, Croatia
| | - P Valkovic Zujic
- Department of Radiology, Faculty of Medicine Rijeka, University Hospital Rijeka, Rijeka, Croatia
| | - S Milic
- Department of Gastroenterology, Faculty of Medicine Rijeka, University Hospital Rijeka, Rijeka, Croatia
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Jakobsen JC, Nielsen EE, Feinberg J, Fobian K, Katakam KK, Hauser G, Poropat G, Djurisic S, Weiss KH, Bjelakovic M, Bjelakovic G, Klingenberg SL, Liu JP, Nikolova D, Koretz RL, Gluud C. Direct-acting antivirals for chronic hepatitis C. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Pletikosic S, Plavsic I, Hauser G, Tkalcic M. Fecal Calprotectin and serum chromogranin A as potential biomarkers of irritable bowel syndrome symptom severity. Med Hypotheses 2015; 85:339-42. [PMID: 26112162 DOI: 10.1016/j.mehy.2015.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 06/13/2015] [Indexed: 01/06/2023]
Abstract
Irritable bowel syndrome (IBS) is a disorder of the lower gastrointestinal (GI) tract, which manifests as abdominal pain and/or discomfort accompanied by altered bowel function, in the absence of structural pathology. The onset and precipitation of IBS is the result of an interaction among several factors, including psychological distress, altered GI sensation and processing of sensory information as well as GI inflammation. These factors have varying contributions to disorder etiology in different patients, and in line with that, there is now emerging evidence about a low-grade inflammation in a subgroup of IBS patients. Because IBS diagnosis is based on the ROME III criteria, with the exclusion of structural pathology, patients are often exposed to numerous invasive and unpleasant tests. In order to decrease the cost of repeated testing, while simultaneously alleviating patients' anxiety, research should be aimed at detecting cost-effective biomarkers. We hypothesize chromogranin A (CgA) and fecal Calprotectin (FC) could be used to eliminate possible organic causes of IBS symptoms. Also, we hypothesize FC could be helpful in detecting IBS patients with low-grade inflammation. Forty-eight outpatients with IBS (76% females) completed a set of psychosocial measures (HRQoL, STAI, BDI, VSI, SF-36), and their FC and CgA levels were obtained. We found elevated CgA levels in 4 patients, but CgA levels were not related to any of the psychological measures used. Elevated FC levels were found in 12 patients. FC levels significantly correlated with the physical component of health related quality of life (HRQoL) (r48=-.42, p<.01). In addition, one-way ANOVA's were performed to test possible differences in psychosocial measures depending on the patient's FC status. The analysis showed only one significant difference. Patients with the highest levels of FC had significantly lower physical component of HRQoL compared to the other two groups of patients.
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Affiliation(s)
- Sanda Pletikosic
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Rijeka, Croatia
| | - Ivana Plavsic
- Centre for Emergency Medicine, Clinical Hospital Centre, Rijeka, Croatia
| | - Goran Hauser
- Centre for Emergency Medicine, Clinical Hospital Centre, Rijeka, Croatia; Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre, Rijeka, Croatia.
| | - Mladenka Tkalcic
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Rijeka, Croatia
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Zerem E, Hauser G, Loga-Zec S, Kunosić S, Jovanović P, Crnkić D. Minimally invasive treatment of pancreatic pseudocysts. World J Gastroenterol 2015; 21:6850-6860. [PMID: 26078561 PMCID: PMC4462725 DOI: 10.3748/wjg.v21.i22.6850] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/29/2015] [Accepted: 04/28/2015] [Indexed: 02/07/2023] Open
Abstract
A pancreatic pseudocyst (PPC) is typically a complication of acute and chronic pancreatitis, trauma or pancreatic duct obstruction. The diagnosis of PPC can be made if an acute fluid collection persists for 4 to 6 wk and is enveloped by a distinct wall. Most PPCs regress spontaneously and require no treatment, whereas some may persist and progress until complications occur. The decision whether to treat a patient who has a PPC, as well as when and with what treatment modalities, is a difficult one. PPCs can be treated with a variety of methods: percutaneous catheter drainage (PCD), endoscopic transpapillary or transmural drainage, laparoscopic surgery, or open pseudocystoenterostomy. The recent trend in the management of symptomatic PPC has moved toward less invasive approaches such as endoscopic- and image-guided PCD. The endoscopic approach is suitable because most PPCs lie adjacent to the stomach. The major advantage of the endoscopic approach is that it creates a permanent pseudocysto-gastric track with no spillage of pancreatic enzymes. However, given the drainage problems, the monitoring, catheter manipulation and the analysis of cystic content are very difficult or impossible to perform endoscopically, unlike in the PCD approach. Several conditions must be met to achieve the complete obliteration of the cyst cavity.
Pancreatic duct anatomy is an important factor in the prognosis of the treatment outcome, and the recovery of disrupted pancreatic ducts is the main prognostic factor for successful treatment of PPC, regardless of the treatment method used. In this article, we review and evaluate the minimally invasive approaches in the management of PPCs.
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Hauser G, Salkic N, Vukelic K, JajacKnez A, Stimac D. Probiotics for standard triple Helicobacter pylori eradication: a randomized, double-blind, placebo-controlled trial. Medicine (Baltimore) 2015; 94:e685. [PMID: 25929897 PMCID: PMC4603068 DOI: 10.1097/md.0000000000000685] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The primary objective in the study is determination of efficacy of probiotic preparation as a supportive therapy in eradication of Helicobacter pylori.The study was multicenter, prospective, randomized, placebo controlled, and double-blind. The subjects first filled out a specially designed questionnaire to assess the severity of the 10 symptoms, which can be related to eradication therapy to be monitored during the trial. Each subject then received 28 capsules of probiotic preparation or matching placebo capsules, which they were supposed to take over the following 14 days, twice a day, at least 2 hours prior to or after the antibiotic therapy administration.A total of 804 patients were enrolled in the trial, of which 650 (80.85%) were included in the analysis. The results show a significantly larger share of cured subjects in the probiotic arm versus the placebo arm (87.38% vs 72.55%; P < 0.001). Additionally, presence and intensity of epigastric pain, bloating, flatulence, taste disturbance, loss of appetite, nausea, vomiting, heartburn, rash, and diarrhea were monitored over the study period. At 15 days postinclusion, probiotic treatment was found superior to placebo in 7 of 10 mentioned symptoms. Average intensity for symptoms potentially related to antibiotic therapy was significantly higher in the placebo group, 0.76 vs 0.55 (P < 0.001).Adding probiotics to the standard triple therapy for H pylori eradication significantly contributes to treatment efficacy and distinctly decreases the adverse effects of therapy and the symptoms of the underlying disease.
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Affiliation(s)
- Goran Hauser
- From the Department of Gastroenterology, Clinical Hospital Centre, Rijeka, Rijeka, Croatia (GH, DS); Department of Gastroenterology and Hepatology, University Clinical Centre, Tuzla, Tuzla, Bosnia and Herzegovina (NS); and JGL d.d. Rijeka, Croatia (KV, AJ)
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Abstract
BACKGROUND Acute pancreatitis is a common and potentially lethal disease with increasing incidence. Severe cases are characterised by high mortality, and despite improvements in intensive care management, no specific treatment relevantly improves clinical outcomes of the disease. Meta-analyses suggest that enteral nutrition is more effective than conventional treatment consisting of discontinuation of oral intake with use of total parenteral nutrition. However, no systematic review has compared different enteral nutrition formulations for the treatment of patients with acute pancreatitis. OBJECTIVES To assess the beneficial and harmful effects of different enteral nutrition formulations in patients with acute pancreatitis. SEARCH METHODS We searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Specialised Register of Clinical Trials, the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 7), MEDLINE (from inception to 20 August 2013), EMBASE (from inception to 2013, week 33) and Science Citation Index-Expanded (from 1990 to August 2013); we conducted full-text searches and applied no restrictions by language or publication status. SELECTION CRITERIA We considered randomised clinical trials assessing enteral nutrition in patients with acute pancreatitis. We allowed concomitant interventions if they were received equally by all treatment groups within a trial. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and extracted data. We performed the analysis using Review Manager 5 (Review Manager 2013) and both fixed-effect and random-effects models. We expressed results as risk ratios (RRs) for dichotomous data, and as mean differences (MDs) for continuous data, both with 95% confidence intervals (CIs). Analysis was based on an intention-to-treat principle. MAIN RESULTS We included 15 trials (1376 participants) in this review. We downgraded the quality of evidence for many of our outcomes on the basis of high risk of bias. Low-quality evidence suggests that immunonutrition decreases all-cause mortality (RR 0.49, 95% CI 0.29 to 0.80). The effect of immunonutrition on other outcomes from a subset of the included trials was uncertain. Subgrouping trials by type of enteral nutrition did not explain any variation in effect. We found mainly very low-quality evidence for the effects of probiotics on the main outcomes. One eligible trial in this comparison reported a higher rate of serious adverse events leading to increased organ failure and mortality due to low numbers of events and low risk of bias. When we excluded this study as a post hoc sensitivity analysis, risks of mortality (RR 0.30, 95% CI 0.10 to 0.84), organ failure (RR 0.74, 95% CI 0.59 to 0.92) and local septic complications (RR 0.40, 95% CI 0.22 to 0.72) were lower with probiotics. In one trial assessing immunonutrition with probiotics and fibres, no deaths occurred, but hospital stay was shorter with immunonutrition (MD -5.20 days, 95% CI -8.73 to -1.67). No deaths were reported following semi-elemental enteral nutrition (EN), and the effect on length of hospital stay was small (MD 0.30 days, 95% CI -0.82 to 1.42). Fibre-enriched formulations reduced the number of other local complications (RR 0.52, 95% CI 0.32 to 0.87) and length of hospital stay (MD -9.28 days, 95% CI -13.21 to -5.35) but did not significantly affect all-cause mortality (RR 0.23, 95% CI 0.03 to 1.84) and other outcomes. Very low-quality evidence from the subgroup of trials comparing EN versus no intervention showed a decrease in all-cause mortality with EN (RR 0.50, 95% CI 0.29 to 0.86). AUTHORS' CONCLUSIONS We found evidence of low or very low quality for the effects of immunonutrition on efficacy and safety outcomes. The role of supplementation of enteral nutrition with potential immunomodulatory agents remains in question, and further research is required in this area. Studies assessing probiotics yielded inconsistent and almost contrary results, especially regarding safety and adverse events, and their findings do not support the routine use of EN enriched with probiotics in routine clinical practice. However, further research should be carried out to try to determine the potential efficacy or harms of probiotics. Lack of trials reporting on other types of EN assessed and lack of firm evidence regarding their effects suggest that additional randomised clinical trials are needed. The quality of evidence for the effects of any kind of EN on mortality was low, and further studies are likely to have an impact on the finding of improved survival with EN versus no nutritional support. Evidence remains insufficient to support the use of a specific EN formulation.
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Affiliation(s)
- Goran Poropat
- Department of Gastroenterology, Clinical Hospital Centre Rijeka, Kresimirova 42, Rijeka, Croatia, 51000
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Hauser G, Milosevic M, Stimac D, Zerem E, Jovanović P, Blazevic I. Preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: What can be done? World J Gastroenterol 2015; 21:1069-1080. [PMID: 25632179 PMCID: PMC4306150 DOI: 10.3748/wjg.v21.i4.1069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/05/2014] [Accepted: 09/30/2014] [Indexed: 02/06/2023] Open
Abstract
Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography. The incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis varies substantially and is reported around 1%-10%, although there are some reports with an incidence of around 30%. Usually, PEP is a mild or moderate pancreatitis, but in some instances it can be severe and fatal. Generally, it is defined as the onset of new pancreatic-type abdominal pain severe enough to require hospital admission or prolonged hospital stay with levels of serum amylase two to three times greater than normal, occurring 24 h after ERCP. Several methods have been adopted for preventing pancreatitis, such as pharmacological or endoscopic approaches. Regarding medical prevention, only non-steroidal anti-inflammatory drugs, namely diclofenac sodium and indomethacin, are recommended, but there are some other drugs which have some potential benefits in reducing the incidence of post-ERCP pancreatitis. Endoscopic preventive measures include cannulation (wire guided) and pancreatic stenting, while the adoption of the early pre-cut technique is still arguable. This review will attempt to present and discuss different ways of preventing post-ERCP pancreatitis.
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Abstract
There are only a few cases found in literature regarding air embolism in endoscopic procedures, especially in connection to endoscopic retrograde cholangiopancreatography (ERCP). We are presenting a case of a 56-year-old female patient who suffered from non-Hodgkin lymphoma located in her right groin. She was also diagnosed with choledocholithiasis and underwent ERCP to remove the gallstones. Immediately after the procedure she went into sudden cardiac arrest and subsequently died, despite all of our efforts. We reviewed literature in order to identify possible causes of death because fatal outcome following an uneventful and successful procedure was not expected. It is important to bear in mind all possible complications of ERCP. Our focus during the literature search was on air embolism.
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Affiliation(s)
- Goran Hauser
- From the Department of Internal Medicine, Division of Gastroenterology (GH, DS); Department of Surgery, Division of Digestive Surgery (MZ); and Department of Anaesthesiology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia (MM)
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Tkalcic M, Domijan D, Pletikosic S, Setic M, Hauser G. Attentional biases in irritable bowel syndrome patients. Clin Res Hepatol Gastroenterol 2014; 38:621-8. [PMID: 24679665 DOI: 10.1016/j.clinre.2014.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/01/2014] [Accepted: 02/10/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE According to the cognitive behavioural model of irritable bowel syndrome (IBS) selective attention to visceral stimuli is one of the pathophysiological mechanisms in IBS. We aimed to investigate attentional biases in patients with IBS and to explore the relationship between neuroticism, trait anxiety, visceral anxiety and indices of attentional biases. METHODS Twenty-seven patients completed the global/local task and the modified Stroop task (using 4 word categories: neutral, symptom-related, emotionally and situationally relevant) while 28 healthy persons completed the Stroop task only. Both groups also filled out a set of psychological questionnaires. RESULTS The results show two distinct attentional biases in patients with irritable bowel syndrome. The index of global precedence was negatively correlated with neuroticism (r=-.41, P<.05) while there was no correlation of global precedence with trait and visceral anxiety. We found Stroop facilitation (F[3,81]=3.98, P<.02) specifically for situational threat words. Also, there were positive correlations between trait anxiety, visceral anxiety and the Stroop facilitation index for situational threat words (r=.43 and r=.47, P<.05). In the control group, we found neither Stroop facilitation nor interference. But, facilitation index of emotional words was positively correlated with neuroticism (r=.40, P<.05), which is in line with the "emotion congruent attentional bias" in the general population. CONCLUSIONS Neuroticism was associated with the reduction in global precedence observed in the global/local task. Trait anxiety and visceral anxiety were associated with Stroop facilitation elicited by situational threat words, which are of particular concern for patients with irritable bowel syndrome. These specific situations do not elicit an attentional bias in healthy participants, which might indicate that the observed facilitation to situational threat words is unique for IBS patients.
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Affiliation(s)
- Mladenka Tkalcic
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Rijeka, Sveucilisna avenija 4, 51000 Rijeka, Croatia
| | - Drazen Domijan
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Rijeka, Sveucilisna avenija 4, 51000 Rijeka, Croatia
| | - Sanda Pletikosic
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Rijeka, Sveucilisna avenija 4, 51000 Rijeka, Croatia
| | - Mia Setic
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Rijeka, Sveucilisna avenija 4, 51000 Rijeka, Croatia
| | - Goran Hauser
- Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre Rijeka, Kresimirova 42, 51000 Rijeka, Croatia.
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Salkic NN, Jovanovic P, Hauser G, Brcic M. Response to Munteanu et al. Am J Gastroenterol 2014; 109:1288-9. [PMID: 25091246 DOI: 10.1038/ajg.2014.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Nermin N Salkic
- Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Predrag Jovanovic
- Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Goran Hauser
- Department of Gastroenterology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Majda Brcic
- Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
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Hauser G, Pletikosic S, Tkalcic M. Cognitive behavioral approach to understanding irritable bowel syndrome. World J Gastroenterol 2014; 20:6744-58. [PMID: 24944466 PMCID: PMC4051915 DOI: 10.3748/wjg.v20.i22.6744] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/19/2013] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is considered a biopsychosocial disorder, whose onset and precipitation are a consequence of interaction among multiple factors which include motility disturbances, abnormalities of gastrointestinal sensation, gut inflammation and infection, altered processing of afferent sensory information, psychological distress, and affective disturbances. Several models have been proposed in order to describe and explain IBS, each of them focusing on specific aspects or mechanisms of the disorder. This review attempts to present and discuss different determinants of IBS and its symptoms, from a cognitive behavioral therapy framework, distinguishing between the developmental predispositions and precipitants of the disorder, and its perpetuating cognitive, behavioral, affective and physiological factors. The main focus in understanding IBS will be placed on the numerous psychosocial factors, such as personality traits, early experiences, affective disturbances, altered attention and cognitions, avoidance behavior, stress, coping and social support. In conclusion, a symptom perpetuation model is proposed.
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Salkic NN, Jovanovic P, Hauser G, Brcic M. FibroTest/Fibrosure for significant liver fibrosis and cirrhosis in chronic hepatitis B: a meta-analysis. Am J Gastroenterol 2014; 109:796-809. [PMID: 24535095 DOI: 10.1038/ajg.2014.21] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 12/30/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Extent of liver fibrosis is one of the most important factors in determining prognosis and the need for active treatment in chronic hepatitis B (CHB). Noninvasive alternatives such as FibroTest/Fibrosure (FT) have been developed in order to overcome the shortcomings of liver biopsy (LB). We aimed to systematically review studies describing the diagnostic accuracy of FT for predicting CHB-related fibrosis. METHODS MEDLINE and EMBASE searches and hand searching methods were performed to identify studies that assessed the diagnostic accuracy of FibroTest in HB patients using LB as a reference standard. We used a hierarchical summary receiver operating curves model and the bivariate model to produce summary receiver operating characteristic curves and pooled estimates of sensitivity and specificity. RESULTS We included 16 studies (N=2494) and 13 studies (N=1754) in the heterogenous meta-analysis for liver fibrosis and cirrhosis, respectively. The area under the hierarchical summary receiver operating curve for significant liver fibrosis and for all included studies was 0.84 (95% confidence interval (CI): 0.78-0.88). At the FT threshold of 0.48, the sensitivity, specificity, and diagnostic odds ratio (DOR) of FT for significant fibrosis were 61 (48-72%), 80 (72-86%), and 6.2% (3.3-11.9), respectively. The area under the hierarchical summary receiver operating curve for liver cirrhosis and for all included studies was 0.87 (95% CI: 0.85-0.90). At the FT threshold of 0.74, the sensitivity, specificity, and DOR of FT for cirrhosis were 62 (47-75%), 91 (88-93%), and 15.7% (8.6-28.8), respectively. CONCLUSIONS FibroTest is of value in exclusion of patients with CHB-related cirrhosis, but has suboptimal accuracy in the detection of significant fibrosis and cirrhosis. It is necessary to further improve the test or combine it with other noninvasive modalities in order to improve accuracy.
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Affiliation(s)
- Nermin N Salkic
- Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Predrag Jovanovic
- Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Goran Hauser
- Department of Gastroenterology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Majda Brcic
- Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
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Hauser G, Awad T, Brok J, Thorlund K, Štimac D, Mabrouk M, Gluud C, Gluud LL. Peginterferon plus ribavirin versus interferon plus ribavirin for chronic hepatitis C. Cochrane Database Syst Rev 2014; 2014:CD005441. [PMID: 24585509 PMCID: PMC11053364 DOI: 10.1002/14651858.cd005441.pub3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pegylated interferon (peginterferon) plus ribavirin is the recommended treatment for patients with chronic hepatitis C, but systematic assessment of the effect of this treatment compared with interferon plus ribavirin is needed. OBJECTIVES To systematically evaluate the benefits and harms of peginterferon plus ribavirin versus interferon plus ribavirin for patients with chronic hepatitis C. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Science Citation Index-Expanded, and LILACS. We also searched conference abstracts, journals, and grey literature. The last searches were conducted in September 2013. SELECTION CRITERIA We included randomised clinical trials comparing peginterferon plus ribavirin versus interferon plus ribavirin with or without co-intervention(s) (e.g., other antiviral drugs) for chronic hepatitis C. Quasi-randomised and observational studies retrieved through the searches for randomised clinical trials were also considered for reports of harms. Our primary outcomes were liver-related morbidity, all-cause mortality, serious adverse events, adverse events leading to treatment discontinuation, other adverse events, and quality of life. Our secondary outcome was sustained virological response in serum, that is, undetectable hepatitis C virus RNA in serum by sensitive tests six months after the end of treatment. DATA COLLECTION AND ANALYSIS Two review authors independently used a standardised data collection form. We meta-analysed data with both fixed-effect and random-effects models. For each outcome, we calculated the odds ratio (OR) (for liver-related morbidity or all-cause mortality) or the risk ratio (RR) along with 95% confidence interval (CI) based on intention-to-treat analysis. We used domains of the trials to assess the risk of systematic errors (bias) and trial sequential analyses to assess the risk of random errors (play of chance).For each outcome, we calculated the RR with 95% CI based on intention-to-treat analysis. Effects of interventions on outcomes were assessed according to GRADE. MAIN RESULTS We included 27 randomised trials with 5938 participants. All trials had high risk of bias. We considered that the risk of bias did not impact on the quality of evidence for liver-related mortality and adverse event outcomes, but it did for virological response. All trials compared peginterferon alpha-2a or peginterferon alpha-2b plus ribavirin versus interferon plus ribavirin for participants with chronic hepatitis C. Three trials administered co-interventions (amantadine hydrochloride 200 mg daily to both intervention groups), and 24 trials were conducted without co-interventions. The effect observed between the two intervention groups regarding liver-related morbidity plus all-cause mortality (5/907 (0.55%) versus 4/882 (0.45%) was imprecise: OR 1.14 ( 95% CI 0.38 to 3.42; five trials; low quality of evidence), as was the risk of adverse events leading to treatment discontinuation (332/2692 (12.3%) versus 409/2176 (18.8%); RR 0.86, 95% CI 0.68 to 1.09; 15 trials; low quality of evidence) or regarding adverse events leading to treatment discontinuation (332/2692 (12.3%) versus 409/2176 (18.8%); RR 0.86, 95% CI 0.66 to 1.12; 17 trials; low quality of evidence). However, peginterferon plus ribavirin versus interferon plus ribavirin significantly increased the risk of neutropenia (332/2202 (15.1%) versus 117/1653 (7.1%); RR 2.15, 95% CI 1.76 to 2.61; 13 trials), thrombocytopenia (65/1113 (5.8%) versus 23/1082 (2.1%); RR 2.63, 95% CI 1.68 to 4.11; 10 trials), arthralgia (517/1740 (29.7%) versus 282/1194 (23.6%); RR 1.19, 95% CI 1.05 to 1.35; four trials), injection site reaction (627/1168 (53.7%) versus 186/649 (28.7%); RR 1.71, 95% CI 1.50 to 1.93; four trials), and nausea (606/1784 (34.0%) versus 354/1239 (28.6%); RR 1.13, 95% CI 1.01 to 1.26; four trials). The most frequent adverse event was fatigue, which occurred in 57% of participants (2024/3608). No significant difference was noted between peginterferon plus ribavirin versus interferon plus ribavirin in terms of fatigue (1177/2062 (57.1%) versus 847/1546 (54.8%); RR 1.01, 95% CI 0.96 to 1.07; 12 trials). No significant differences were reported between the two treatment groups regarding anaemia, headache, rigours, myalgia, pyrexia, weight loss, asthenia, depression, insomnia, irritability, alopecia, pruritus, skin rash, thyroid malfunction, decreased appetite, or diarrhoea. We were unable to identify any data on quality of life. Peginterferon plus ribavirin versus interferon plus ribavirin seemed to significantly increase the number of participants achieving sustained virological response (1673/3300 participants (50.7%) versus 1081/2804 patients (36.7%); RR 1.39, 95% CI 1.25 to 1.56; I2 = 64%; 27 trials; very low quality of evidence). However, the risk of bias in the 13/27 (48.1%) trials reporting on this outcome was high and was considered only 'lower' in the remainder. Because the conventional meta-analysis did not reach its required information size (n = 14,486 participants), we used trial sequential analysis to control for risks of random errors. Again, in this analysis, the estimated effect was statistically significant in favour of peginterferon. Subgroup analyses according to risk of bias, viral genotype, baseline viral load, past treatment history, and type of intervention yielded similarly significant results favouring peginterferon over interferon on the outcome of sustained virological response. AUTHORS' CONCLUSIONS Peginterferon plus ribavirin versus interferon plus ribavirin seems to significantly increase the proportion of patients with sustained virological response, as well as the risk of certain adverse events. However, we have insufficient evidence to recommend or reject peginterferon plus ribavirin for liver-related morbidity plus all-cause mortality compared with interferon plus ribavirin. The clinical consequences of achieved sustained virological response are unknown, as sustained virological response is still an unvalidated surrogate outcome. We found no evidence of the potential benefits on quality of life in patients with achieved sustained virological response. Further high-quality research is likely to have an important impact on our confidence in the estimate of patient-relevant outcomes and is likely to change our estimates.There is very low quality evidence that peginterferon plus ribavirin increases the proportion of patients with sustained virological response in comparison with interferon plus ribavirin. There is evidence that it also increases the risk of certain adverse events.
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Affiliation(s)
- Goran Hauser
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51 000
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupDepartment 7812, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Tahany Awad
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupDepartment 7812, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Jesper Brok
- RigshospitaletPaediatric Department 4072Blemdagsvej 9CopenhagenDenmark2100 Ø
| | - Kristian Thorlund
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamiltonOntarioCanada
| | - Davor Štimac
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51 000
| | - Mahasen Mabrouk
- Faculty of Medicine, Cairo UniversityEndemic Medicine and Liver DepartmentCairoEgypt
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupDepartment 7812, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Lise Lotte Gluud
- Copenhagen University Hospital HvidovreGastro Unit, Medical DivisionKettegaards AlleHvidovreDenmark2650
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Abstract
BACKGROUND A combination of weekly pegylated interferon (peginterferon) alpha and daily ribavirin still represents standard treatment of chronic hepatitis C infection in the majority of patients. However, it is not established which of the two licensed peginterferon products, peginterferon alpha-2a or peginterferon alpha-2b, is the most effective and has a better safety profile. OBJECTIVES To systematically evaluate the benefits and harms of peginterferon alpha-2a versus peginterferon alpha-2b in head-to-head randomised clinical trials in patients with chronic hepatitis C. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and LILACS until October 2013. We also searched conference abstracts, journals, and grey literature. SELECTION CRITERIA We included randomised clinical trials comparing peginterferon alpha-2a versus peginterferon alpha-2b given with or without co-intervention(s) (for example, ribavirin) for chronic hepatitis C. Quasi-randomised studies and observational studies as identified by the searches were also considered for assessment of harms. Our primary outcomes were all-cause mortality, liver-related morbidity, serious adverse events, adverse events leading to treatment discontinuation, other adverse events, and quality of life. The secondary outcome was sustained virological response in the blood serum. DATA COLLECTION AND ANALYSIS Two authors independently used a standardised data collection form. We meta-analysed data with both the fixed-effect and the random-effects models. For each outcome we calculated the relative risk (RR) with 95% confidence interval (CI) based on intention-to-treat analysis. We used domains of the trials to assess the risk of systematic errors (bias) and trial sequential analyses to assess the risks of random errors (play of chance). Intervention effects on the outcomes were assessed according to GRADE. MAIN RESULTS We included 17 randomised clinical trials which compared peginterferon alpha-2a plus ribavirin versus peginterferon alpha-2b plus ribavirin in 5847 patients. All trials had a high risk of bias. Very few trials reported data on very few patients for the patient-relevant outcomes all-cause mortality, liver-related morbidity, serious adverse events, and quality of life. Accordingly, we were unable to conduct meta-analyses on all-cause mortality, liver-related morbidity, and quality of life. Twelve trials reported on adverse events leading to discontinuation of treatment without clear evidence of a difference between the two peginterferons (197/2171 (9.1%) versus 311/3169 (9.9%); RR 0.84, 95% CI 0.57 to 1.22; I2 = 44%; low quality evidence). A trial sequential analysis showed that we could exclude a relative risk reduction of 20% or more on this outcome. Peginterferon alpha-2a significantly increased the number of patients who achieved a sustained virological response in the blood serum compared with peginterferon alpha-2b (1069/2099 (51%) versus 1327/3075 (43%); RR 1.12, 95% CI 1.06 to 1.18; I2= 0%, 12 trials; moderate quality evidence). Trial sequential analyses supported this result. Subgroup analyses based on risk of bias, viral genotype, and treatment history yielded similar results. Trial sequential analyses supported the results in patients with genotypes 1 and 4, but not in patients with genotypes 2 and 3. AUTHORS' CONCLUSIONS There is lack of evidence on patient-important outcomes and paucity of evidence on adverse events. Moderate quality evidence suggests that peginterferon alpha-2a is associated with a higher sustained virological response in serum than with peginterferon alpha-2b. This finding may be affected by the high risk of bias of the included studies . The clinical consequences of peginterferon alpha-2a versus peginterferon alpha-2b are unknown, and we cannot translate an effect on sustained virological response into comparable clinical effects because sustained virological response is still an unvalidated surrogate outcome for patient-important outcomes. The lack of evidence on patient-important outcomes and the paucity of evidence on adverse events means that we are unable to draw any conclusions about the effects of one peginterferon over the other.
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Affiliation(s)
- Goran Hauser
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51 000
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupDepartment 7812, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Tahany Awad
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupDepartment 7812, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Kristian Thorlund
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamiltonOntarioCanada
| | - Davor Štimac
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51 000
| | - Mahasen Mabrouk
- Faculty of Medicine, Cairo UniversityEndemic Medicine and Liver DepartmentCairoEgypt
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupDepartment 7812, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
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Abstract
This article provides an overview of the obstetric and gynecological manifestations of Crohn’s disease (CD). High incidence of the new onset of the disease in young women in their reproductive years demands special concern from physicians involved in their treatment. Pregnant women with CD are considered high-risk patients, regardless of disease activity index, due to associated complications. Predominately described complications are premature birth, low birth weight, and congenital anomalies. To minimize the risk for adverse pregnancy/birth outcomes, it is recommended that remission be achieved before conception. Treatment of CD in pregnant women is similar to that among the nonpregnant population, and there is no valid reason to terminate it, since most of the drugs are proven to be safe. Women with CD who wish to conceive or are already pregnant need to be properly advised according to the newest guidelines on the subject, given by the European Crohn’s and Colitis Organization. Gynecological manifestations are another special feature of CD. They are important in that they may facilitate early recognition of the underlying disease, which usually stays unrecognized for years before intestinal manifestation; in this way, the underlying manifestations are often mistreated.
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Affiliation(s)
- Ivana Plavšić
- Health Center, County of Primorje-Gorski Kotar, Rijeka, Croatia, Rijeka, Croatia
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Graves CE, Reid AH, Wang T, Wu B, de Jong S, Vahaplar K, Radu I, Bernstein DP, Messerschmidt M, Müller L, Coffee R, Bionta M, Epp SW, Hartmann R, Kimmel N, Hauser G, Hartmann A, Holl P, Gorke H, Mentink JH, Tsukamoto A, Fognini A, Turner JJ, Schlotter WF, Rolles D, Soltau H, Strüder L, Acremann Y, Kimel AV, Kirilyuk A, Rasing T, Stöhr J, Scherz AO, Dürr HA. Nanoscale spin reversal by non-local angular momentum transfer following ultrafast laser excitation in ferrimagnetic GdFeCo. Nat Mater 2013; 12:293-8. [PMID: 23503010 DOI: 10.1038/nmat3597] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 02/07/2012] [Indexed: 05/19/2023]
Abstract
Ultrafast laser techniques have revealed extraordinary spin dynamics in magnetic materials that equilibrium descriptions of magnetism cannot explain. Particularly important for future applications is understanding non-equilibrium spin dynamics following laser excitation on the nanoscale, yet the limited spatial resolution of optical laser techniques has impeded such nanoscale studies. Here we present ultrafast diffraction experiments with an X-ray laser that probes the nanoscale spin dynamics following optical laser excitation in the ferrimagnetic alloy GdFeCo, which exhibits macroscopic all-optical switching. Our study reveals that GdFeCo displays nanoscale chemical and magnetic inhomogeneities that affect the spin dynamics. In particular, we observe Gd spin reversal in Gd-rich nanoregions within the first picosecond driven by the non-local transfer of angular momentum from larger adjacent Fe-rich nanoregions. These results suggest that a magnetic material's microstructure can be engineered to control transient laser-excited spins, potentially allowing faster (~ 1 ps) spin reversal than in present technologies.
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Affiliation(s)
- C E Graves
- Stanford Institute for Materials and Energy Sciences, SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
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Hauser G, Bubic I, Vlahovic-Palcevski V, Spanjol J, Stimac D. Mycophenolate mofetil induced severe, life threatening lower gastrointestinal bleeding - case report. Nefrologia 2013; 33:146-147. [PMID: 23364647 DOI: 10.3265/nefrologia.pre2012.jun.11512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2012] [Indexed: 06/01/2023] Open
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Hauser G, Stimac D, Giljaca V, Mijandrusic Sincic B. Video capsule retention--endoscopic or surgical problem? Clin Res Hepatol Gastroenterol 2012; 36:e135-6. [PMID: 22921336 DOI: 10.1016/j.clinre.2012.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 06/13/2012] [Accepted: 06/20/2012] [Indexed: 02/04/2023]
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Loh ND, Hampton CY, Martin AV, Starodub D, Sierra RG, Barty A, Aquila A, Schulz J, Lomb L, Steinbrener J, Shoeman RL, Kassemeyer S, Bostedt C, Bozek J, Epp SW, Erk B, Hartmann R, Rolles D, Rudenko A, Rudek B, Foucar L, Kimmel N, Weidenspointner G, Hauser G, Holl P, Pedersoli E, Liang M, Hunter MS, Gumprecht L, Coppola N, Wunderer C, Graafsma H, Maia FRNC, Ekeberg T, Hantke M, Fleckenstein H, Hirsemann H, Nass K, White TA, Tobias HJ, Farquar GR, Benner WH, Hau-Riege SP, Reich C, Hartmann A, Soltau H, Marchesini S, Bajt S, Barthelmess M, Bucksbaum P, Hodgson KO, Strüder L, Ullrich J, Frank M, Schlichting I, Chapman HN, Bogan MJ. Erratum: Fractal morphology, imaging and mass spectrometry of single aerosol particles in flight. Nature 2012. [DOI: 10.1038/nature11426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Loh ND, Hampton CY, Martin AV, Starodub D, Sierra RG, Barty A, Aquila A, Schulz J, Lomb L, Steinbrener J, Shoeman RL, Kassemeyer S, Bostedt C, Bozek J, Epp SW, Erk B, Hartmann R, Rolles D, Rudenko A, Rudek B, Foucar L, Kimmel N, Weidenspointner G, Hauser G, Holl P, Pedersoli E, Liang M, Hunter MS, Hunter MM, Gumprecht L, Coppola N, Wunderer C, Graafsma H, Maia FRNC, Ekeberg T, Hantke M, Fleckenstein H, Hirsemann H, Nass K, White TA, Tobias HJ, Farquar GR, Benner WH, Hau-Riege SP, Reich C, Hartmann A, Soltau H, Marchesini S, Bajt S, Barthelmess M, Bucksbaum P, Hodgson KO, Strüder L, Ullrich J, Frank M, Schlichting I, Chapman HN, Bogan MJ. Fractal morphology, imaging and mass spectrometry of single aerosol particles in flight. Nature 2012; 486:513-7. [PMID: 22739316 DOI: 10.1038/nature11222] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 05/09/2012] [Indexed: 11/09/2022]
Abstract
The morphology of micrometre-size particulate matter is of critical importance in fields ranging from toxicology to climate science, yet these properties are surprisingly difficult to measure in the particles' native environment. Electron microscopy requires collection of particles on a substrate; visible light scattering provides insufficient resolution; and X-ray synchrotron studies have been limited to ensembles of particles. Here we demonstrate an in situ method for imaging individual sub-micrometre particles to nanometre resolution in their native environment, using intense, coherent X-ray pulses from the Linac Coherent Light Source free-electron laser. We introduced individual aerosol particles into the pulsed X-ray beam, which is sufficiently intense that diffraction from individual particles can be measured for morphological analysis. At the same time, ion fragments ejected from the beam were analysed using mass spectrometry, to determine the composition of single aerosol particles. Our results show the extent of internal dilation symmetry of individual soot particles subject to non-equilibrium aggregation, and the surprisingly large variability in their fractal dimensions. More broadly, our methods can be extended to resolve both static and dynamic morphology of general ensembles of disordered particles. Such general morphology has implications in topics such as solvent accessibilities in proteins, vibrational energy transfer by the hydrodynamic interaction of amino acids, and large-scale production of nanoscale structures by flame synthesis.
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Affiliation(s)
- N D Loh
- PULSE Institute, SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
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Gorkhover T, Adolph M, Rupp D, Schorb S, Epp SW, Erk B, Foucar L, Hartmann R, Kimmel N, Kühnel KU, Rolles D, Rudek B, Rudenko A, Andritschke R, Aquila A, Bozek JD, Coppola N, Erke T, Filsinger F, Gorke H, Graafsma H, Gumprecht L, Hauser G, Herrmann S, Hirsemann H, Hömke A, Holl P, Kaiser C, Krasniqi F, Meyer JH, Matysek M, Messerschmidt M, Miessner D, Nilsson B, Pietschner D, Potdevin G, Reich C, Schaller G, Schmidt C, Schopper F, Schröter CD, Schulz J, Soltau H, Weidenspointner G, Schlichting I, Strüder L, Ullrich J, Möller T, Bostedt C. Nanoplasma dynamics of single large xenon clusters irradiated with superintense x-ray pulses from the linac coherent light source free-electron laser. Phys Rev Lett 2012; 108:245005. [PMID: 23004284 DOI: 10.1103/physrevlett.108.245005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Indexed: 05/09/2023]
Abstract
The plasma dynamics of single mesoscopic Xe particles irradiated with intense femtosecond x-ray pulses exceeding 10(16) W/cm2 from the Linac Coherent Light Source free-electron laser are investigated. Simultaneous recording of diffraction patterns and ion spectra allows eliminating the influence of the laser focal volume intensity and particle size distribution. The data show that for clusters illuminated with intense x-ray pulses, highly charged ionization fragments in a narrow distribution are created and that the nanoplasma recombination is efficiently suppressed.
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Affiliation(s)
- T Gorkhover
- Institut für Optik und Atomare Physik, Technische Universität Berlin, Hardenbergstr. 36, 10623 Berlin, Germany
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Martin AV, Loh ND, Hampton CY, Sierra RG, Wang F, Aquila A, Bajt S, Barthelmess M, Bostedt C, Bozek JD, Coppola N, Epp SW, Erk B, Fleckenstein H, Foucar L, Frank M, Graafsma H, Gumprecht L, Hartmann A, Hartmann R, Hauser G, Hirsemann H, Holl P, Kassemeyer S, Kimmel N, Liang M, Lomb L, Maia FRNC, Marchesini S, Nass K, Pedersoli E, Reich C, Rolles D, Rudek B, Rudenko A, Schulz J, Shoeman RL, Soltau H, Starodub D, Steinbrener J, Stellato F, Strüder L, Ullrich J, Weidenspointner G, White TA, Wunderer CB, Barty A, Schlichting I, Bogan MJ, Chapman HN. Femtosecond dark-field imaging with an X-ray free electron laser. Opt Express 2012; 20:13501-12. [PMID: 22714377 DOI: 10.1364/oe.20.013501] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The emergence of femtosecond diffractive imaging with X-ray lasers has enabled pioneering structural studies of isolated particles, such as viruses, at nanometer length scales. However, the issue of missing low frequency data significantly limits the potential of X-ray lasers to reveal sub-nanometer details of micrometer-sized samples. We have developed a new technique of dark-field coherent diffractive imaging to simultaneously overcome the missing data issue and enable us to harness the unique contrast mechanisms available in dark-field microscopy. Images of airborne particulate matter (soot) up to two microns in length were obtained using single-shot diffraction patterns obtained at the Linac Coherent Light Source, four times the size of objects previously imaged in similar experiments. This technique opens the door to femtosecond diffractive imaging of a wide range of micrometer-sized materials that exhibit irreproducible complexity down to the nanoscale, including airborne particulate matter, small cells, bacteria and gold-labeled biological samples.
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Affiliation(s)
- A V Martin
- Center for Free-Electron Laser Science, DESY, Notkestrasse 85, 22607 Hamburg, Germany.
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