BACKGROUND Sarcopenia, i.e., muscle loss is now a well-recognized complication of cirrhosis and in cases of non-alcoholic fatty liver disease can contribute to accelerate liver fibrosis leading to cirrhosis. Hence, it...BACKGROUND Sarcopenia, i.e., muscle loss is now a well-recognized complication of cirrhosis and in cases of non-alcoholic fatty liver disease can contribute to accelerate liver fibrosis leading to cirrhosis. Hence, it is imperative to study interventions which targets to improve sarcopenia in cirrhosis.AIM To examine the relationship between interventions such nutritional supplementation, exercise, combined life style intervention, testosterone replacement and trans jugular intrahepatic portosystemic shunt(TIPS) to improve muscle mass in cirrhosis.METHODS We search PubMed, EMBASE and Cochrane between June-August 2018, without a limiting period and the types of articles(RCTs, clinical trial, comparative study)in adult patients with sarcopenia and cirrhosis. The primary outcome of interest was improvement in muscle mass, strength and physical function interventions mentioned above. In the screening process, 154 full text articles were included in the review and 129 studies were excluded.RESULTS We identified 24 studies that met review inclusion criteria. The studies were diverse in terms of the design, setting, interventions, and outcome measurements.We performed only qualitative synthesis of evidence due to heterogeneity amongst studies. Risk of bias was medium in most of the included studies and low quality of evidence showed improvement in the muscle mass, strength and physical function following aerobic exercise. 60% of the included studies on the nutritional intervention, 100% of the studies on testosterone replacement in hypogonadal men and trans-jugular portosystemic shunt were proved to be effective in improving sarcopenia in cirrhosis.CONCLUSION Although the quality of evidence is low, the findings of our systematic review suggest improvement in the sarcopenia in cirrhosis with exercise, nutritional interventions, hormonal and TIPS interventions. High quality randomized controlled trials needed to further strengthen these findings.展开更多
Diseases of the liver and biliary tree have been described with significant frequency among patients with human immunodeficiency virus(HIV), and its advanced state, acquired immunodeficiency syndrome(AIDS). Through a ...Diseases of the liver and biliary tree have been described with significant frequency among patients with human immunodeficiency virus(HIV), and its advanced state, acquired immunodeficiency syndrome(AIDS). Through a variety of mechanisms, HIV/AIDS has been shown to affect the hepatic parenchyma and biliary tree, leading to liver inflammation and biliary strictures. One of the potential hepatobiliary complications of this viral infection is AIDS cholangiopathy, a syndrome of biliary obstruction and liver damage due to infection-related strictures of the biliary tract. AIDS cholangiopathy is highly associated with opportunistic infections and advanced immunosuppression in AIDS patients, and due to the increased availability of highly active antiretroviral therapy, is now primarily seen in instances of poor access to antiretroviral therapy and medication non-compliance. While current published literature describes well the clinical, biochemical, and endoscopic management of AIDS-related cholangiopathy, information on its epidemiology, natural history, and pathology are not as well defined. The objective of this review is to summarize the available literature on AIDS cholangiopathy, emphasizing its epidemiology, course of disease, and determinants, while also revealing an updated approach for its evaluation and management.展开更多
Upper gastrointestinal bleeding is defined as the bleeding originating from the esophagus to the ligament of Treitz and further classified into variceal and nonvariceal gastrointestinal bleeding.Non-variceal upper gas...Upper gastrointestinal bleeding is defined as the bleeding originating from the esophagus to the ligament of Treitz and further classified into variceal and nonvariceal gastrointestinal bleeding.Non-variceal upper gastrointestinal bleeding remains a common clinical problem globally.It is associated with high mortality,morbidity,and cost of the health care system.Despite the continuous improvement of therapeutic endoscopy,the 30-d readmission rate secondary to rebleeding and associated mortality is an ongoing issue.Available Food and Drug Administration approved traditional or conventional therapeutic endoscopic modalities includes epinephrine injection,argon plasma coagulation,heater probe,and placement of through the scope clip,which can be used alone or in combination to decrease the risk of rebleeding.Recently,more attention has been paid to the novel advanced endoscopic devices for primary treatment of the bleeding lesion and as a secondary measure when conventional therapies fail to achieve hemostasis.This review highlights emerging endoscopic modalities used in the management of non-variceal upper gastrointestinal related bleeding such as over-the-scope clip,Coagrasper,hemostatic sprays,radiofrequency ablation,cryotherapy,endoscopic suturing devices,and endoscopic ultrasound-guided angiotherapy.In this review article,we will also discuss the technical aspects of the common procedures,outcomes in terms of safety and efficacy,and their advantages and limitations in the setting of non-variceal upper gastrointestinal bleeding.展开更多
Patients with fistulizing inflammatory bowel disease are traditionally difficult to treat. This patient population often experiences delayed or insufficient healing of fistulas using current standard regimens includin...Patients with fistulizing inflammatory bowel disease are traditionally difficult to treat. This patient population often experiences delayed or insufficient healing of fistulas using current standard regimens including anti-biotics, immunomodulators, anti-tumor necrosis factor--α drug, placement of setons, and surgical repair. Several studies over the last ten to fifteen years have been conducted using stem cell therapies with promising results in this patient population. These studies show stem cell therapy in fistulizing disease to be successful in healing between 60%--88% compared to currently 50% with infliximab. Moreover, remission was seen 24 wk to 52 wk in these studies. Further research with a multi--approach treatment using medications, stem cell therapy, and surgical interventions will likely be the future of this innovative treatment approach.展开更多
Those patients with perianal Crohn's disease or ul-cerative colitis experience a difficult to treat disease process with a delayed state and often inability to heal despite current therapies. The approaches curren...Those patients with perianal Crohn's disease or ul-cerative colitis experience a difficult to treat disease process with a delayed state and often inability to heal despite current therapies. The approaches currently used to treat these patients with corticosteroids,antibiotics,immunomodulators, anti-tumor necrosis factor-α drug, and surgical repair are limited in their healing ability. This review presents all current literature since emergence in the early 2000s of stem cell therapy for patients with perianal inflammatory bowel disease and analyzes the efficacy, outcomes and safety within these studies.展开更多
Since the beginning of the coronavirus disease 2019(COVID-19)pandemic various measures have been taken to mitigate the effects of the global health crisis in this unprecedented time.According to the World Health Organ...Since the beginning of the coronavirus disease 2019(COVID-19)pandemic various measures have been taken to mitigate the effects of the global health crisis in this unprecedented time.According to the World Health Organization,more than 5 million people have been infected with severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)and with more than 300000 deaths attributed to COVID-19 worldwide.There is emerging evidence that SARS-CoV-2 utilizes angiotensin-converting enzyme 2 receptors to enter human cells which are found in abundance in the alveoli and intestines.In addition,the infection is noted to be more severe in patients with co-morbid conditions,those who are malnourished,immunosuppressed and immunocompromised.Inflammatory bowel disease(IBD)which includes ulcerative colitis and Crohn’s disease is chronic remitting and relapsing disorders with intestinal and extraintestinal manifestation.IBD patients are often malnourished and on immunosuppressive medications and there is a hypothetical concern that IBD patients are at substantial risk of COVID-19 infection.The management of IBD patients is often complex and poses unique challenges for gastroenterologists during the pandemic.The purpose of this review article is to summarize the growing level of evidence and understanding of the management of IBD during the COVID-19 pandemic,in the light of international and national gastroenterology society guidelines.We performed a thorough literature search on IBD,SARS-CoV-2 and COVID-19 on PubMed,EMBASE,OVID Medline and Google Scholar and pertaining literature was critically examined and summarized.Per national and international society guidelines and recommendations,IBD is not a risk factor for SARS-CoV-2 infection.IBD patients should continue with their medications and they should follow universal precautions i.e.masks,hand and respiratory hygiene and avoidance of health care facilities and public toilets as general population.Among IBD patients older age,having active disease,and co-morbid conditions are risk factors for a severe SARS-CoV-2 infection.Furthermore,elective endoscopic and surgical procedures can be delayed or deferred until discussing the risks and benefits with patients.展开更多
Exosomes are small plasma membrane-bound multivesicular bodies ranging in size from 20-100 nm.Exosomes are degraded fragments of mRNA,microRNA,and enriched in proteins,lipids,and nucleic acid.They are produced in the ...Exosomes are small plasma membrane-bound multivesicular bodies ranging in size from 20-100 nm.Exosomes are degraded fragments of mRNA,microRNA,and enriched in proteins,lipids,and nucleic acid.They are produced in the endosomes of most eukaryotic cells and once secreted,exosomes are involved in cell to cell communication and remodeling of the matrix in the extracellular compartment.Exosome biogenesis plays a crucial role in cellular development,inflammation,immunity,hemostasis,carcinogenesis,and degeneration.Due to their unique biochemical and biophysical properties,exosomes serve a variety of functions including biomarkers of diagnostic and prognostic significance.Besides,there is an increasing level of evidence to expand our understanding of the exosomes as novel therapeutic agents.Inflammatory bowel disease(IBD)such as Crohn's disease and ulcerative colitis,hepatic fibrosis,and gastrointestinal malignancies such as colorectal cancer are the potential avenues where exosomes can be applied as cell therapy and immunotherapy and have shown promising results in several in-vitro and animal models.The purpose of this review article is to highlight the emerging role of exosomes as the diagnostic and therapeutic tool in various diseases involving the gastrointestinal tract like IBD,hepatocellular carcinoma,and colon cancer.A thorough literature search was performed on databases such as PubMed,Ovid Medline,and EMBASE to achieve the objectives of this review article.展开更多
文摘BACKGROUND Sarcopenia, i.e., muscle loss is now a well-recognized complication of cirrhosis and in cases of non-alcoholic fatty liver disease can contribute to accelerate liver fibrosis leading to cirrhosis. Hence, it is imperative to study interventions which targets to improve sarcopenia in cirrhosis.AIM To examine the relationship between interventions such nutritional supplementation, exercise, combined life style intervention, testosterone replacement and trans jugular intrahepatic portosystemic shunt(TIPS) to improve muscle mass in cirrhosis.METHODS We search PubMed, EMBASE and Cochrane between June-August 2018, without a limiting period and the types of articles(RCTs, clinical trial, comparative study)in adult patients with sarcopenia and cirrhosis. The primary outcome of interest was improvement in muscle mass, strength and physical function interventions mentioned above. In the screening process, 154 full text articles were included in the review and 129 studies were excluded.RESULTS We identified 24 studies that met review inclusion criteria. The studies were diverse in terms of the design, setting, interventions, and outcome measurements.We performed only qualitative synthesis of evidence due to heterogeneity amongst studies. Risk of bias was medium in most of the included studies and low quality of evidence showed improvement in the muscle mass, strength and physical function following aerobic exercise. 60% of the included studies on the nutritional intervention, 100% of the studies on testosterone replacement in hypogonadal men and trans-jugular portosystemic shunt were proved to be effective in improving sarcopenia in cirrhosis.CONCLUSION Although the quality of evidence is low, the findings of our systematic review suggest improvement in the sarcopenia in cirrhosis with exercise, nutritional interventions, hormonal and TIPS interventions. High quality randomized controlled trials needed to further strengthen these findings.
文摘Diseases of the liver and biliary tree have been described with significant frequency among patients with human immunodeficiency virus(HIV), and its advanced state, acquired immunodeficiency syndrome(AIDS). Through a variety of mechanisms, HIV/AIDS has been shown to affect the hepatic parenchyma and biliary tree, leading to liver inflammation and biliary strictures. One of the potential hepatobiliary complications of this viral infection is AIDS cholangiopathy, a syndrome of biliary obstruction and liver damage due to infection-related strictures of the biliary tract. AIDS cholangiopathy is highly associated with opportunistic infections and advanced immunosuppression in AIDS patients, and due to the increased availability of highly active antiretroviral therapy, is now primarily seen in instances of poor access to antiretroviral therapy and medication non-compliance. While current published literature describes well the clinical, biochemical, and endoscopic management of AIDS-related cholangiopathy, information on its epidemiology, natural history, and pathology are not as well defined. The objective of this review is to summarize the available literature on AIDS cholangiopathy, emphasizing its epidemiology, course of disease, and determinants, while also revealing an updated approach for its evaluation and management.
文摘Upper gastrointestinal bleeding is defined as the bleeding originating from the esophagus to the ligament of Treitz and further classified into variceal and nonvariceal gastrointestinal bleeding.Non-variceal upper gastrointestinal bleeding remains a common clinical problem globally.It is associated with high mortality,morbidity,and cost of the health care system.Despite the continuous improvement of therapeutic endoscopy,the 30-d readmission rate secondary to rebleeding and associated mortality is an ongoing issue.Available Food and Drug Administration approved traditional or conventional therapeutic endoscopic modalities includes epinephrine injection,argon plasma coagulation,heater probe,and placement of through the scope clip,which can be used alone or in combination to decrease the risk of rebleeding.Recently,more attention has been paid to the novel advanced endoscopic devices for primary treatment of the bleeding lesion and as a secondary measure when conventional therapies fail to achieve hemostasis.This review highlights emerging endoscopic modalities used in the management of non-variceal upper gastrointestinal related bleeding such as over-the-scope clip,Coagrasper,hemostatic sprays,radiofrequency ablation,cryotherapy,endoscopic suturing devices,and endoscopic ultrasound-guided angiotherapy.In this review article,we will also discuss the technical aspects of the common procedures,outcomes in terms of safety and efficacy,and their advantages and limitations in the setting of non-variceal upper gastrointestinal bleeding.
文摘Patients with fistulizing inflammatory bowel disease are traditionally difficult to treat. This patient population often experiences delayed or insufficient healing of fistulas using current standard regimens including anti-biotics, immunomodulators, anti-tumor necrosis factor--α drug, placement of setons, and surgical repair. Several studies over the last ten to fifteen years have been conducted using stem cell therapies with promising results in this patient population. These studies show stem cell therapy in fistulizing disease to be successful in healing between 60%--88% compared to currently 50% with infliximab. Moreover, remission was seen 24 wk to 52 wk in these studies. Further research with a multi--approach treatment using medications, stem cell therapy, and surgical interventions will likely be the future of this innovative treatment approach.
文摘Those patients with perianal Crohn's disease or ul-cerative colitis experience a difficult to treat disease process with a delayed state and often inability to heal despite current therapies. The approaches currently used to treat these patients with corticosteroids,antibiotics,immunomodulators, anti-tumor necrosis factor-α drug, and surgical repair are limited in their healing ability. This review presents all current literature since emergence in the early 2000s of stem cell therapy for patients with perianal inflammatory bowel disease and analyzes the efficacy, outcomes and safety within these studies.
文摘Since the beginning of the coronavirus disease 2019(COVID-19)pandemic various measures have been taken to mitigate the effects of the global health crisis in this unprecedented time.According to the World Health Organization,more than 5 million people have been infected with severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)and with more than 300000 deaths attributed to COVID-19 worldwide.There is emerging evidence that SARS-CoV-2 utilizes angiotensin-converting enzyme 2 receptors to enter human cells which are found in abundance in the alveoli and intestines.In addition,the infection is noted to be more severe in patients with co-morbid conditions,those who are malnourished,immunosuppressed and immunocompromised.Inflammatory bowel disease(IBD)which includes ulcerative colitis and Crohn’s disease is chronic remitting and relapsing disorders with intestinal and extraintestinal manifestation.IBD patients are often malnourished and on immunosuppressive medications and there is a hypothetical concern that IBD patients are at substantial risk of COVID-19 infection.The management of IBD patients is often complex and poses unique challenges for gastroenterologists during the pandemic.The purpose of this review article is to summarize the growing level of evidence and understanding of the management of IBD during the COVID-19 pandemic,in the light of international and national gastroenterology society guidelines.We performed a thorough literature search on IBD,SARS-CoV-2 and COVID-19 on PubMed,EMBASE,OVID Medline and Google Scholar and pertaining literature was critically examined and summarized.Per national and international society guidelines and recommendations,IBD is not a risk factor for SARS-CoV-2 infection.IBD patients should continue with their medications and they should follow universal precautions i.e.masks,hand and respiratory hygiene and avoidance of health care facilities and public toilets as general population.Among IBD patients older age,having active disease,and co-morbid conditions are risk factors for a severe SARS-CoV-2 infection.Furthermore,elective endoscopic and surgical procedures can be delayed or deferred until discussing the risks and benefits with patients.
文摘Exosomes are small plasma membrane-bound multivesicular bodies ranging in size from 20-100 nm.Exosomes are degraded fragments of mRNA,microRNA,and enriched in proteins,lipids,and nucleic acid.They are produced in the endosomes of most eukaryotic cells and once secreted,exosomes are involved in cell to cell communication and remodeling of the matrix in the extracellular compartment.Exosome biogenesis plays a crucial role in cellular development,inflammation,immunity,hemostasis,carcinogenesis,and degeneration.Due to their unique biochemical and biophysical properties,exosomes serve a variety of functions including biomarkers of diagnostic and prognostic significance.Besides,there is an increasing level of evidence to expand our understanding of the exosomes as novel therapeutic agents.Inflammatory bowel disease(IBD)such as Crohn's disease and ulcerative colitis,hepatic fibrosis,and gastrointestinal malignancies such as colorectal cancer are the potential avenues where exosomes can be applied as cell therapy and immunotherapy and have shown promising results in several in-vitro and animal models.The purpose of this review article is to highlight the emerging role of exosomes as the diagnostic and therapeutic tool in various diseases involving the gastrointestinal tract like IBD,hepatocellular carcinoma,and colon cancer.A thorough literature search was performed on databases such as PubMed,Ovid Medline,and EMBASE to achieve the objectives of this review article.
