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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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Mikolasevic I, Kanizaj TF, Bozic D, Puz P, Shapeski SS, Puljiz Z, Radic-Kristo D, Lalovac M, Mijic M, Delija B, Juric T, Bogadi I, Virovic-Jukic L. Metabolism of Direct-acting Antiviral Agents (DAAs) in Hepatitis C Therapy: A Review of the Literature. Curr Drug Metab 2021; 22:89-98. [PMID: 33319667 DOI: 10.2174/1389200221999201214224126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/25/2020] [Accepted: 08/09/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is still one of the leading causes of chronic liver disease, with chronically infected making up approximately 1% of the global population. Of those infected, 70% (55-85%) will develop chronic HCV infection. Chronic HCV infection causes substantial morbidity and mortality, with complications including cirrhosis, end-stage liver disease, hepatocellular carcinoma, and eventually death. OBJECTIVE Therapeutic options for chronic HCV infection have evolved dramatically since 2014, with a translation from pegylated interferon and ribavirin (associated with suboptimal cure and high treatment-related toxicity) to oral direct-acting antiviral treatment. There are four classes of direct-acting antivirals which differ by their mechanism of action and therapeutic target. They are all pointed to proteins that form the cytoplasmic viral replication complex. Multiple studies have demonstrated that direct-acting antiviral therapy is extremely well tolerated, highly efficacious, with few side effects. METHODS We performed an indexed MEDLINE search with keywords regarding specific direct-acting antiviral regimes and their pharmacokinetics, drug-drug interactions, and metabolism in specific settings of pregnancy, lactation, liver cirrhosis, liver transplantation and HCC risk, kidney failure and kidney transplantation. RESULTS We present a comprehensive overview of specific direct-acting antiviral metabolism and drug-drug interaction issues in different settings. CONCLUSION Despite its complex pharmacokinetics and the possibility of drug-drug interactions, direct-acting antivirals are highly efficacious in providing viral clearance, which is an obvious advantage compared to possible interactions or side effects. They should be administered cautiously in patients with other comorbidities, and with tight control of immunosuppressive therapy.
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Affiliation(s)
- Ivana Mikolasevic
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
| | - Tajana F Kanizaj
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
| | - Dorotea Bozic
- Department for Gastroenterology and Hepatology, University Hospital Center, Split, Croatia
| | - Petra Puz
- Division of Internal Medicine, General Hospital Koprivnica, Croatia
| | | | - Zeljko Puljiz
- Department for Gastroenterology and Hepatology, University Hospital Center, Split, Croatia
| | | | - Milos Lalovac
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
| | - Maja Mijic
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
| | - Bozena Delija
- School of Medicine, University Center Hospital Rijeka, Rijeka, Croatia
| | - Toni Juric
- School of Medicine, University Center Hospital Rijeka, Rijeka, Croatia
| | - Ivan Bogadi
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
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Mikolasevic I, Domislovic V, Filipec Kanizaj T, Radic-Kristo D, Krznaric Z, Milovanovic T, Juric T, Klapan M, Skenderevic N, Delija B, Stevanovic T, Mijic A, Lukic A, Stimac D. Relationship between coffee consumption, sleep duration and smoking status with elastographic parameters of liver steatosis and fibrosis; controlled attenuation parameter and liver stiffness measurements. Int J Clin Pract 2021; 75:e13770. [PMID: 33070425 DOI: 10.1111/ijcp.13770] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022] Open
Abstract
AIM our aim was to explore the association between life habits and the controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) as the surrogate markers of liver steatosis and fibrosis in a large cohort of non-alcoholic fatty liver disease (NAFLD) patients. METHODS In this prospective, cross-sectional study we had analysed 1998 patients with diagnosed NAFLD. Sleeping duration was categorised in three groups: short (S) (<6 hours), moderate (M) (6-8 hours) and long (L) (>8 hours) sleep duration. Coffee drinking was categorized into no (0), moderate (1-2) and frequent (≥3) consumption (in cups/day). Smoking was categorised as yes versus no. RESULTS Frequent coffee consumers had the lowest prevalence of obesity, hypertension, dyslipidaemia and diabetes. Furthermore, coffee non-consumers had highest values of hepatic enzymes, CAP and LSM. Moderate sleep duration was associated with lower values of CAP and LSM. Coffee consumption was associated with lower CAP in all the multivariate models (CAP unadjusted and model 1, 2 and 3), with largest effect in most frequent coffee consumers (≥3, model 3). Also, most frequent coffee consumers were associated with lower LSM in unadjusted model, model 1 and 2, while this was not the case for model 3 and those who consumed 1-2 cups of coffee per day. Reduced sleeping was confirmed as risk factor for elevated CAP in most of the models (unadjusted and model 1 and 2). Also, negative association of LSM was also confirmed in unadjusted model and model 2. Patients which slept 6-8 hours per day were mostly associated with lower CAP and LSM. Smoking status was not associated with CAP or LSM values. CONCLUSION Coffee consumption has beneficial effect on CAP and LSM and this effect is dose dependent since and independent of a variety of relevant confounders. We have shown that moderate sleep duration has also beneficial effect on CAP and LSM.
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Affiliation(s)
- Ivana Mikolasevic
- Department of Gastroenterology, University Hospital Centre Rijeka, Rijeka, Croatia
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Viktor Domislovic
- Department for Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tajana Filipec Kanizaj
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Delfa Radic-Kristo
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Hematology, University Hospital Merkur, Zagreb, Croatia
| | - Zeljko Krznaric
- Department for Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tamara Milovanovic
- School of Medicine, University of Belgrade Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Toni Juric
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Mia Klapan
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Nadija Skenderevic
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
| | - Bozena Delija
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | | | - Ana Mijic
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Andjela Lukic
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Davor Stimac
- Department of Gastroenterology, University Hospital Centre Rijeka, Rijeka, Croatia
- School of Medicine, University of Rijeka, Rijeka, Croatia
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Mikolasevic I, Domislovic V, Turk Wensveen T, Delija B, Klapan M, Juric T, Lukic A, Mijic A, Skenderevic N, Puz P, Ostojic A, Krznaric Z, Radic-Kristo D, Filipec Kanizaj T, Stimac D. Screening for nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus using transient elastography - a prospective, cross sectional study. Eur J Intern Med 2020; 82:68-75. [PMID: 32839076 DOI: 10.1016/j.ejim.2020.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 03/17/2020] [Revised: 06/22/2020] [Accepted: 08/01/2020] [Indexed: 02/08/2023]
Abstract
AIM To investigate the prevalence and severity of nonalcoholic fatty liver disease (NAFLD) in patients with diabetes mellitus type 2 (T2DM), based on increased controlled attenuation parameter (CAP) and liver stiffness measurements obtained by transient elastography. In addition, we aimed to identify parameters that correlate with increased elastographic parameters of steatosis and fibrosis to provide a better indication when a patient with T2DM should be screened for NAFLD. METHODS We conducted prospective, cross-sectional study of 679 consecutive adult patients with diagnosed T2DM mean age 65.2±11.6. NAFLD was defined by transient elastography. In 105 patients a percutaneous liver biopsy (LB) was done. RESULTS The prevalence of NAFLD based on transient elastography was 83.6%. Independent factors associated with increased CAP were higher body mass index, longer T2DM duration, higher serum triglyceride, lower levels of vitamin D, higher C-reactive protein, and higher HOMA-IR. The prevalence of moderate liver fibrosis was 26.9% and advanced liver fibrosis 12.6%. Independent factors associated with moderated fibrosis based on elastography were higher body mass index and higher levels of alanine aminotransferase (ALT), while independent factors associated with advanced fibrosis were female gender, higher body mass index, higher levels of ALT, gama-glutamil transferase and C-reactive protein. Sixty-four (60.9%) of 105 patients with LB had NAFLD activity score ≥5. Regarding the presence and stages of fibrosis based on LB, moderate fibrosis was found in 29.5% of patients, while 29.5% had advanced fibrosis and 6.7% cirrhosis. CONCLUSION This study supports more aggressive screening for NAFLD and fibrosis in patients 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; School of Medicine, Rijeka, Croatia.
| | - V Domislovic
- Department for Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - T Turk Wensveen
- School of Medicine, Rijeka, Croatia; Department of Endocrinology, University Hospital Center Rijeka, Rijeka, Croatia
| | - B Delija
- School of Medicine, Rijeka, Croatia
| | - M Klapan
- School of Medicine, Rijeka, Croatia
| | - T Juric
- School of Medicine, Rijeka, Croatia
| | - A Lukic
- School of Medicine, Rijeka, Croatia
| | - A Mijic
- School of Medicine, Rijeka, Croatia
| | - N Skenderevic
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
| | - P Puz
- Internal Medicine, General Hospital Koprivnica, Koprivnica, Croatia
| | - A Ostojic
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
| | - Z Krznaric
- Department for Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia; School of Medicine, Zagreb, Croatia
| | - D Radic-Kristo
- Department of Hematology, University Hospital Merkur, Zagreb, Croatia; School of Medicine, Osijek, Croatia
| | - T Filipec Kanizaj
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia; School of Medicine, Zagreb, Croatia
| | - D Stimac
- Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia; School of Medicine, Rijeka, Croatia
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Mikolasevic I, Lukenda Zanko V, Jakopcic I, Domislovic V, Mijic A, Stevanovic T, Delija B, Bokun T, Dinjar Kujundzic P, Ostojic A, Filipec Kanizaj T, Grgurevic I, Krznaric Z, Stimac D, Targher G. Prospective evaluation of non-alcoholic fatty liver disease by elastographic methods of liver steatosis and fibrosis; controlled attenuation parameter and liver stiffness measurements. J Diabetes Complications 2020; 34:107512. [PMID: 31882273 DOI: 10.1016/j.jdiacomp.2019.107512] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/29/2019] [Accepted: 12/12/2019] [Indexed: 02/07/2023]
Abstract
AIMS To examine the temporal changes of both controlled attenuation parameter (CAP) and liver stiffness measurements (LSM), assessed by Fibroscan, in a large sample of patients with non-alcoholic fatty liver disease (NAFLD). METHODS In this prospective, observational study, we consecutively enrolled 507 adult individuals with Fibroscan-defined NAFLD who were followed for a mean period of 21.2 ± 11.7 months. RESULTS During the follow-up period, 84 patients (16.5%) had a progression of CAP of at least 20% with a median time of 39.93 months, while 201 (39.6%) patients had a progression of LSM of at least 20% with median time of 30.46 months. There were significant differences in the proportion of LSM progression across body mass index (BMI) categories, with obese patients having the highest risk of progression over the follow-up (hazard ratio 1.66; 95%CI 1.23-2.25). Multivariable regression analysis showed that BMI and serum creatinine levels were the strongest predictors for CAP progression in the whole population, while HOMA-estimated insulin resistance was an independent predictor of LSM progression over time in the subgroup of obese patients. CONCLUSION This prospective study shows for the first time that the progression risk of both liver steatosis and fibrosis, detected non-invasively by Fibroscan, is relevant and shares essentially the same metabolic risk factors that are associated with NAFLD progression detected by other invasive methods.
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Affiliation(s)
- I Mikolasevic
- Department of gastroenterology, UHC Rijeka, Rijeka, Croatia; School of medicine, Rijeka, Croatia; Department of gastroenterology, UH Merkur, Zagreb, Croatia.
| | - V Lukenda Zanko
- Department of Internal medicine, General hospital "Josip Benčević", Slavonski Brod, Croatia
| | | | - V Domislovic
- Department of gastroenterology and hepatology, UHC Zagreb, Zagreb, Croatia
| | - A Mijic
- School of medicine, Rijeka, Croatia
| | | | - B Delija
- School of medicine, Rijeka, Croatia
| | - T Bokun
- Department of gastroenterology and hepatology, UH Dubrava, Zagreb, Croatia
| | | | - A Ostojic
- Department of gastroenterology, UH Merkur, Zagreb, Croatia
| | - T Filipec Kanizaj
- Department of gastroenterology, UH Merkur, Zagreb, Croatia; School of medicine, Zagreb, Croatia
| | - I Grgurevic
- Department of gastroenterology and hepatology, UH Dubrava, Zagreb, Croatia; School of medicine, Zagreb, Croatia
| | - Z Krznaric
- Department of gastroenterology and hepatology, UHC Zagreb, Zagreb, Croatia; School of medicine, Zagreb, Croatia
| | - D Stimac
- Department of gastroenterology, UHC Rijeka, Rijeka, Croatia; School of medicine, Rijeka, Croatia
| | - G Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Abstract
SUMMARY
The aim of this in vitro study was to evaluate the radiopacity of 19 current dental flowable composite materials by a digital technique. Digital radiographs were obtained with a CCD sensor using an aluminum step wedge, a 1-mm-thick tooth slice, and a 1-mm-thick flowable composite specimen using five different combinations of exposure and voltage. The radiopacity in pixels was determined using Digora 2.6. software. The equivalent thickness of aluminum for each material was then calculated based on the calibration curve. All of the tested flowable composite materials had higher radiopacities than that of dentin, but in almost every combination of exposure and voltage, there were some composite materials that exhibited radiopacities equal to or slightly greater than enamel p>α; α=0.01). Of the flowable composite materials tested, 37% showed lower radiopacities than enamel, and 21% of the tested materials had higher radiopacities than the 3-mm aluminum equivalent. The highest radiopacity at all exposure values was produced by the Majesty Flow and Charisma Opal Flow materials, which had radiopacities almost twice that of enamel. Flowable composite materials should have radiopacities greater than that of enamel (ISO 4049), an important consideration for the introduction of new materials to the market. The digital radiopacity analysis techniques used in this study provide an easy, reliable, rapid, and precise method to characterize radiopacity of dental flowable composite materials.
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Affiliation(s)
- W Dukić
- Walter Dukić, assistant professor, PhD, DMD, School of Dental Medicine University of Zagreb, Pediatric Dentistry, Zagreb, Croatia
| | - B Delija
- Barbara Delija, DDM, Private Dental Practice Omega, Zagreb, Croatia
| | - S Lešić
- Stjepanka Lešić, DDS, Public Health Centre Stitar, Stitar, Zupanja, Croatia
| | - I Dubravica
- Ivica Dubravica, DDS, Private Dental Centar Dubravica, Vodice, Croatia
| | - D Derossi
- Doria Derossi, student, School of Dental Medicine University of Zagreb, Zagreb, Croatia
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