The Mexican consensus on nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) affects nearly one third of the population worldwide. Mexico is one of the countries whose population has several risk factors for the disease and its prevalence could surpass 50%. If immediate action is not taken to counteract what is now considered a national health problem, the medium-term panorama will be very bleak. This serious situation prompted the Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Hepatología to produce the Mexican Consensus on Fatty Liver Disease. It is an up-to-date and detailed review of the epidemiology, pathophysiology, clinical forms, diagnosis, and treatment of the disease, whose aim is to provide the Mexican physician with a useful tool for the prevention and management of nonalcoholic fatty liver disease.

The Mexican consensus on the treatment of hepatitis C

The aim of the Mexican Consensus on the Treatment of HepatitisC was to develop clinical practice guidelines applicable to Mexico. The expert opinion of specialists in the following areas was taken into account: gastroenterology, infectious diseases, and hepatology. A search of the medical literature was carried out on the MEDLINE, EMBASE, and CENTRAL databases through keywords related to hepatitisC treatment. The quality of evidence was subsequently evaluated using the GRADE system and the consensus statements were formulated. The statements were then voted upon, using the modified Delphi system, and reviewed and corrected by a panel of 34 voting participants. Finally, the level of agreement was classified for each statement. The present guidelines provide recommendations with an emphasis on the new direct-acting antivirals, to facilitate their use in clinical practice. Each case must be individualized according to the comorbidities involved and patient management must always be multidisciplinary.

Risk of non-alcoholic fatty liver disease in patients with psoriasis: a systematic review and meta-analysis

BACKGROUND

Psoriasis has been linked to an increased risk of metabolic syndrome (MetS). Non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of MetS, is now the commonest liver disease worldwide and can evolve into cirrhosis in a subgroup of patients. Psoriasis has been reported to be associated to NAFLD.

AIM

The aim of this study was to evaluate the strength of the association between psoriasis and NAFLD.

METHODS

A systematic review of the literature was conducted in six databases (Medline, CINAHL, Scopus, LILACS, Cochrane Library and EMBASE). Data from studies assessing frequency of NAFLD in psoriatic and non-psoriatic patients were extracted and meta-analysed using the Mantel-Haenszel method. Subgroups analysis of patients with psoriatic arthritis and moderate to severe psoriasis was also performed.

RESULTS

Seven case-control studies were included, all of them of low or moderate quality. Psoriatic patients exhibited an increased risk of NAFLD compared to non-psoriatic controls (six studies; n = 267,761 patients; odds ratio (OR): 2.15, 95% CI: 1.57-2.94). The association remained significant (OR: 2.07, 95% CI: 1.62-2.64) when only high/moderate quality studies were analysed (three studies; n = 3345 patients). The risk of NAFLD was significantly greater in patients with psoriatic arthritis (three studies; n = 505 patients; OR: 2.25, 95% IC: 1.37-3.71) and in patients with moderate to severe psoriasis compared to those with mild psoriasis (two studies; 51,930 patients, OR: 2.07, 95% CI: 1.59-2.71).

LIMITATIONS

Data quality and heterogeneity may restrict the interpretation of the pooled risk estimates.

CONCLUSION

Case-control studies support an association between psoriasis and NAFLD. Screening of NAFLD in this group of patients may be warranted.

[Usefulness of chewing gum for the resolution of postoperative ileus in left colon resections]

BACKGROUND AND AIM

Disturbances in intestinal motility have been described since XIX century, with a not very well understood pathogenesis and few therapeutic approaches. Considering chewing as an important stimulus to promote intestinal motility we designed this study to assess the efficacy of chewing gum to improve the postoperative ileus, and the clinical relevance of this intervention.

METHODS

Were included patients who underwent for elective left hemicolectomy during January 2007 to December 2008. The patients were randomly assigned to receive chewing gum or nothing during the post-surgery period. The main outcomes assessed were duration of postoperative ileus, and reduction in hospitalization days.

RESULTS

During the period of the study were included 32 patients, were included mainly men (11 and 9 in treated and control patients, respectively). The first defecation after surgery procedure occurs at (44.2 ± 17.6 h) in the treated group and (55.5 ± 14.8 h) in the control group (p = 0.05). In the same way oral tolerance was achieved faster in the treated group (p= 0.05). The hospital stay duration was not different among treated and not treated patients.

CONCLUSIONS

The use of chewing gum in patients after elective left hemicolectomy, reduce the duration of the postoperative ileus. However, this does not reduce the hospital stay duration.

[Comparative study of the clinical presentation and complications of acute colonic diverticulitis in patients older and younger than 65 years.]

BACKGROUND AND AIM

Colonic diverticular disease has an incidence from 66 to 85% in population older than 65 years. Most of them remain asymptomatic;20% will be symptomatic and about 35%will present an episode of Acute Colonic Diverticulitis(ACD). To date, there are not studies to compare its presentation in elderly patients. The aim of this study was to compare the clinical presentation, diagnostic procedures, treatment and complications of acute colonic diverticulitis (ACD)in patients older and younger than 65 years.

MATERIAL AND METHODS

A retrospective review of patients diagnosed with ACD from January 2003 to May 2006. Exclusion criteria included patients with incomplete medical records and those who didn't complete the in hospital treatment. Demographic,clinical, laboratory, and radiological,prognostic variables as well as chosen treatment,presence of complications were evaluated. Descriptive and comparative statistic analysis was performed by the Fisher Exact Test for categorical variables and Student t-Test for continual variables considering a statistically significant difference for p <0.05. The analysis was made with SPSS/PC v12.0 software.

RESULTS

Of 126 patients, 69 were men and 57 women; 93 younger than 65 years and 33 older than 65 years. 20 patients were excluded by previously defined criteria. Significant statistical differences were found for presence of pain in the left inferior quadrant (73.2% vs. 48.5% p <0.01); mean hemoglobin level (14.6 vs. 13.2 g/dL p<0.01), presence of anemia (10.8% vs. 27.3% p <0.05) use of ultrasonography (24.7% vs. 6.1%,p < 0.05) and presence of hemorrhage (3.3% vs.21.3% p < 0.01) respectively. There was not mortality in the series.

CONCLUSION

This series demonstrates that elderly patients with ACD have a greater rate of lower gastrointestinal bleeding and greater degree of anemia than younger patients.